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.