Integrating Behavioral Sleep Medicine with Behavioral Parent Training for Preschool ADHD: Stakeholder Insights for an Early Childhood Intervention.

Objectives

Behavioral Parenting Training (BPT), the gold-standard treatment for preschool attention-deficit/hyperactivity disorder (ADHD), does not consistently improve core symptoms of inattention and hyperactivity/impulsivity. Pairing BPT with complementary preventative therapies targeting biological mechanisms, such as sleep dysregulation, may improve treatment outcomes. This qualitative study with key stakeholders aims to inform the development of parent-based interventions that incorporate behavioral sleep medicine (BSM) strategies to improve ADHD-related outcomes in preschoolers.

Method

Three stakeholder groups participated in two rounds of semi-structured focus group sessions: parents/caregivers of preschoolers with elevated ADHD symptoms (n = 8), pediatricians (n = 9), and pediatric behavioral health providers (n = 6). Each session included a review of a potential integrated BPT-BSM treatment. Participants provided iterative feedback on its helpfulness, appeal, and accessibility and recommended changes. Group session transcripts were coded and thematically analyzed using inductive and deductive approaches.

Results

Dominant themes across stakeholders concerned treatment content, structure, process, materials, and individualization. Stakeholders highlighted the importance of a 24-hr approach for improving preschool ADHD symptoms and emphasized needs for specific, practical, and developmentally-appropriate strategies; appropriate session pacing/time for troubleshooting skill use; sufficient support for caregiver skill implementation; validation of caregivers' experiences; easy-to-use handouts; digital materials; and treatment tailored to family culture, structure, and household environment.

Conclusions

Stakeholder input is essential for developing acceptable, feasible, and effective preschool ADHD interventions that incorporate BSM strategies and are adapted for real-world settings. Future research should evaluate whether the identified themes contribute to increased feasibility, scalability, and effectiveness of parent-based sleep treatments for improving sleep, ADHD, and functional outcomes among preschoolers at-risk for ADHD.