Integrated Multi-Setting Psychosocial Treatment for ADHD-Inattentive Type

ADHD-注意力不集中型的综合多环境心理社会治疗

• 批准号: 8071503
• 负责人: STEPHEN HINSHAW
• 金额: $ 64.59万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-01 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8071503
• 关键词: Academic achievement; Age; Attention; Attention deficit hyperactivity disorder; Behavior Therapy; Child; Childhood; Clinic; Communities; Complement; Consultations; Control Groups; DSM-IV; Data; Decision Making; Disease; Educational Curriculum; Effectiveness; Evaluation; Family; Functional disorder; Funding; Goals; Grant; Home environment; Hyperactive behavior; Impairment; Impulsivity; Intervention; Language; Life; Literature; Measures; Medicine; Mental disorders; Modeling; Modification; Neurocognitive; Outcome; Parent-Child Relations; Parenting behavior; Parents; Pharmaceutical Preparations; Protocols documentation; Publishing; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Rehabilitation therapy; Relative (related person); Research; Schools; Site; Social Functioning; Structure; Symptoms; Testing; Training; Treatment outcome; Work; active method; base; behavior change; blind; design; evidence base; follow-up; improved; inattention; intervention effect; novel; peer; programs; psychosocial; public health relevance; skills; skills training; social; teacher; therapy development; treatment as usual; treatment effect; trial comparing

DESCRIPTION (provided by applicant): Attention Deficit Hyperactivity Disorder-Predominantly Inattentive Type (ADHD-I) is a highly prevalent and serious childhood psychiatric disorder [with evidence that impairment is severe and persistent]. Children with ADHD-I have a profile of attention deficits, comorbid disorders, social impairments, and neurocognitive dysfunction that differs from that associated with ADHD-Combined Type (ADHD-C). The extent of these differences precludes straightforward assumptions that treatment outcome findings for ADHD-C can be generalized to ADHD-I. Through funding from an R21 Treatment Development grant, we have developed a novel psychosocial treatment (Integrated Multi-Setting Psychosocial Treatment--IPT) for ADHD-I. IPT combines a standard behavioral treatment for ADHD (parent training) that has been adapted for ADHD-I, with child life skills training (supportive strategies drawn from rehabilitation medicine) and with teacher consultation. As part of the R21, we conducted a small-scale randomized controlled trial comparing IPT to an untreated control group and demonstrated (a) significant treatment effects on inattention, and academic and social impairment, and (b) feasibility and acceptability of the model. These positive outcomes justify the current application, which aims to provide a dual-site, randomized clinical trial of IPT. We will randomize [210] children with ADHD-I ages 7-11 (2nd-5th grades) to IPT ([N=78]), Parent-Focused Training (PFT, [N=78]), or Treatment as Usual, TAU ([N=54]). The goal of the RCT is to test whether IPT provides superior reduction of DSM-IV inattention symptoms as rated by parents and teachers (the primary endpoint), in comparison to standard community treatment, TAU; and to [PFT], which constitutes an active treatment that is effective at reducing symptoms of ADHD. We will include medicated and unmedicated children and will recruit from a broad array of clinics and schools, consistent with our goal of increasing generalizability. Secondary analyses will evaluate the effects of the intervention across multiple domains of impairment including academic and social functioning and on objective measures of attention and parenting derived from observations during standard clinic-based tasks, and on curriculum-based measures of academic achievement. We predict that ADHD-I symptoms will be significantly lower and, secondarily, that academic and social functioning will be significantly higher, in IPT relative to TAU]. We hypothesize that ADHD-I symptoms will be significantly lower and, secondarily, that academic and social functioning will be significantly higher, in the IPT group relative to [PFT]. We will also examine the durability of treatment gains at [5-7] month follow-up. We predict that ADHD-I symptoms will remain lowest and academic/social functioning will remain highest in the IPT group relative to the other groups at follow-up. PUBLIC HEALTH RELEVANCE STATEMENT Attention-deficit\Hyperactivity Disorder, Predominantly Inattentive type is a prevalent and serious childhood psychiatric disorder which severely and persistently impacts a child's functioning at school, at home, and with peers. This study aims to evaluate the effectiveness of a behavioral intervention, integrating school, home and child skills components, for improving attentional symptoms and academic and social functioning in these children.

描述（由申请人提供）：注意力缺陷多动障碍主导地位不集中型（ADHD-I）是一种高度普遍且严重的儿童精神障碍[有证据表明损害是严重且持续存在的]。 ADHD-I的儿童具有注意力缺陷，合并症，社会障碍和神经认知功能障碍与与ADHD混合类型（ADHD-C）的不同之处。这些差异的程度无法直接假设ADHD-C的治疗结果结果可以推广到ADHD-I。通过R21治疗开发资助的资金，我们为ADHD-I开发了一种新颖的社会心理治疗（综合的多设定心理心理治疗 - IPT）。 IPT结合了已适用于ADHD-I的ADHD（父母培训）的标准行为治疗，以及儿童生活技能培训（根据康复医学的支持策略）和教师咨询。作为R21的一部分，我们进行了一项小规模的随机对照试验，将IPT与未经处理的对照组进行了比较，并证明了（a）对不集中以及学术和社会障碍的显着治疗效果，以及（b）模型的可行性和可接受性。这些积极的结果证明了当前的应用程序，该应用程序旨在提供IPT的双站点随机临床试验。我们将对IPT（[[N = 78]），以父母为重点的训练（PFT，[N = 78]）或tau（[n = 54]）的IPT（[N = 78]）的IPT（[n = 78]），以父母为重点的培训（[n = 78]）随机将[210]年龄7-11岁（2-5年级）的儿童随机分配给IPT（[N = 78]）。 RCT的目的是测试IPT是否提供了与父母和老师（主要终点）评级的DSM-IV症状症状的较高减少，与标准社区治疗相比，TAU；以及[PFT]构成有效治疗的积极治疗，可有效减少多动症的症状。我们将包括药物和未药物的儿童，并将从广泛的诊所和学校中招募，这符合我们提高普遍性的目标。次要分析将评估跨多个损害领域的干预措施的影响，包括学术和社会功能，以及在基于标准诊所任务期间观察到的观察以及基于课程的学术成就衡量的观察结果的客观量度。我们预测，ADHD-I症状将显着降低，其次，IPT在IPT中，学术和社会功能将显着更高。我们假设ADHD-I症状将显着降低，其次，相对于[PFT]，IPT组中的学术和社会功能将明显更高。我们还将在[5-7]月随访中检查治疗增长的耐用性。我们预测，ADHD-I症状将保持最低，并且在IPT组中，相对于其他小组，学术/社会功能将保持最高。公共卫生相关性陈述注意力缺陷\多动症，主要是不专心的类型是一种普遍且严重的儿童精神疾病，严重而持久地影响了儿童在学校，在家中和同伴的功能。这项研究旨在评估行为干预，整合学校，家庭和儿童技能组成部分的有效性，以改善这些儿童的注意力症状以及学术和社会功能。