# Preschool Attention and Sleep Support (PASS): A Telehealth Intervention for Children at Risk for ADHD

> **NIH NIH R34** · DUKE UNIVERSITY · 2024 · $241,500

## Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD) is a chronic condition associated with substantial functional
deficits as well as risk for poorer mental and physical health over the lifespan. Although ADHD symptoms often
emerge during preschool, most children are not identified or treated during this developmental stage, missing
the critical window in which early intervention may have the greatest impact on ADHD symptom trajectories.
Additionally, even when evidence-based preschool behavioral interventions (behavioral parent training [BPT])
are delivered, treatment effects on core ADHD symptoms are inconsistent. One explanation is BPT's primary
focus on ameliorating daytime impairment, whereas ADHD may be best understood as a 24-hour disorder with
deficits in both daytime function and nighttime sleep. Indeed, sleep is frequently dysregulated in school-aged
children with ADHD, is associated with increased ADHD morbidity (i.e., increased core ADHD symptom
severity and comorbidity, poorer cognition and functioning), and when enhanced via behavioral sleep medicine
(BSM), results in improved core ADHD symptoms. Our recent work has shown similar associations between
sleep and ADHD symptoms in a primary-care based sample of preschoolers, suggesting that regulating sleep
may represent a critical mechanism for early interventions seeking to alter ADHD symptom trajectories among
preschoolers at risk. Recognizing the powerful connection between sleep and ADHD early in life, there is a
critical need to adapt BPT to target behaviors across the 24-hour period in a single, efficient intervention via
integration with BSM, the first-line intervention for sleep regulation in this age group. In addition, it is essential
to optimize the delivery system to reach preschoolers at-risk for ADHD in real-world clinical care settings. For
the proposed project, we will develop and evaluate the feasibility and acceptability of an 8-week telehealth
intervention (Preschool Attention and Sleep Support; PASS) for preschoolers identified in primary care as at
risk for ADHD (i.e., with elevated symptoms). PASS combines proven behavioral interventions to tackle
daytime (via BPT) and nighttime (via BSM) ADHD impairments in a single, streamlined treatment. PASS will be
delivered by behavioral health care providers and will guide caregivers in applying the antecedent-behavior-
consequence (ABC) framework of BPT to reduce daytime behavior concerns and support sleep regulation. We
will also evaluate the short-term effectiveness of PASS on core ADHD symptoms, functional outcomes, and
comorbidity compared to BPT. Finally, we will examine whether PASS impacts the hypothesized target
mechanism, sleep regulation via both actigraphy and caregiver report, and assess if improved sleep regulation
is associated with reduced core ADHD symptoms. Findings from this study will provide the foundation for an
adequately-powered RCT to evaluate the effectiveness of PASS to improve ADHD symptoms and sleep...

## Key facts

- **NIH application ID:** 10783796
- **Project number:** 5R34MH131994-02
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Jessica Ruth Lunsford-Avery
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $241,500
- **Award type:** 5
- **Project period:** 2023-02-10 → 2026-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10783796

## Citation

> US National Institutes of Health, RePORTER application 10783796, Preschool Attention and Sleep Support (PASS): A Telehealth Intervention for Children at Risk for ADHD (5R34MH131994-02). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10783796. Licensed CC0.

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