(PS6-81) Increasing Access to Care for Preschool Children with ADHD in Rural Areas: A Pilot RCT of the Preschool ROAR Program

Attention Deficit/Hyperactivity Disorder (ADHD) is a chronic and impairing neurodevelopmental disorder diagnosed in approximately 2-4% of preschool-age children and 9% of all children in the U.S. The American Academy of Pediatrics “strongly recommends” that preschool children (ages 3-6) receive evidence-based behavioral parent training (BPT) as the first line treatment, before starting stimulant medication. Research also shows that high-quality parent education on ADHD and its treatments can increase parent empowerment, leading to better outcomes for children. Unfortunately, less than half of families recommended BPTs engage in these treatments due to workforce shortages and systemic barriers in the healthcare system. Needed are flexible delivery models, such as brief clinician-led telehealth programs, capable of reaching rural and low resource communities. Brief telehealth programs have documented benefits for children ages 6-12 with ADHD; however, it is unclear if these benefits extend to younger children. In this study, we tested the newly developed Preschool ROAR, a clinician-led 7-session education and parent training program designed for telehealth with interactive digital content. Method. We conducted a pilot RCT examining the feasibility, acceptability, and preliminary effectiveness of Preschool ROAR. Forty-four children from a rural area with ADHD (ages 3-7; M_age = 4.8; 62% male) were randomized into either Preschool ROAR or a waitlist control and followed for 24 weeks. We collected standard metrics of feasibility (e.g., recruitment, retention) and acceptability (Treatment Experiences Inventory; TEI) and compared obtained values to a priori benchmark values, based on estimates needed to conduct a fully powered RCT. Proximal target outcomes were parenting practices (Parenting Scale) and family empowerment (Family Empowerment Scale). Distal outcomes were ADHD symptoms (ADHD-5), disruptive behaviors (ECBI), and impairment (ECBI). Results. Obtained values met or exceeded all a priori benchmarks for feasibility and acceptability. We retained 17/22 treatment families 19/22 waitlist families through post-test. All treatment families (17/17) found the treatment to be at least moderately acceptable (TEI > 27) and 75% reported that participation led to likely permanent improvement. Repeated measures ANOVAs controlling for child gender and age revealed significant group*time interaction effects in favor of the treatment group compared to the waitlist control on family empowerment scores, F(1, 31) = 15.33, p < .001, η² = .33; ADHD total scores, F(2, 54) = 3.76, p = .03, η²= .12; ratings of ADHD inattention, F(1.63, 44.05) = 3.96, p = .03, η² = .13; ECBI total behavior problems, F(2, 56) = 6.78, p < .01, η² = .19; and EBCI impairment ratings, F(2, 20) = 4.06, p = .03, η² = .29. Discussion. Advances in assessment have made it more common for ADHD symptoms to be identified in preschool children. Needed are scalable, transportable, and effective interventions capable of reaching families in rural communities during this developmental period. This study demonstrated that this brief telehealth program was feasible, acceptable, and likely beneficial to families that face barriers to traditional care.