Development of a Multifaceted Cognitive Training Program for Children with ADHD

为多动症儿童制定多方面的认知训练计划

• 批准号: 8233507
• 负责人: JEFF N. EPSTEIN
• 金额: $ 31.64万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-10 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8233507
• 关键词: Academic achievement; Address; Applications Grants; Area; Attention; Attention deficit hyperactivity disorder; Behavior; Behavior Therapy; Behavioral; CD-ROM; Child; Clinical; Clinical Trials; Cognitive; Cognitive deficits; Collection; Complement; Computer software; Consensus; Data; Development; Educational Intervention; Effectiveness; Ensure; Family; Feedback; Focus Groups; Future; Goals; Grant; Home environment; Impaired cognition; Individual; Intervention; Intervention Studies; Investigation; Lead; Manuals; Measurable; Measures; Modification; Outcome; Outcome Measure; Parents; Patients; Pattern; Perception; Performance; Phase; Protocols documentation; Psychopharmacology; Randomized Clinical Trials; Reaction Time; Reporting; Research; Running; Sample Size; Short-Term Memory; Testing; Time; Training; Training Programs; Treatment Efficacy; United States National Institutes of Health; Visuospatial; Work; cognitive function; cognitive training; computerized; effective therapy; efficacy testing; efficacy trial; evidence base; follow-up; improved; interest; intervention effect; intervention program; method development; neuropsychological; novel; programs; response; skills; success; teacher; treatment effect

DESCRIPTION (provided by applicant): After decades of ADHD intervention research, only two intervention approaches (i.e., psychopharmacology, behavioral treatment) have a "well-established" evidence-base supporting their efficacy for children with ADHD. Both of these interventions have inherent limitations. Recently multiple studies have demonstrated that cognitive training may improve neuropsychological and behavioral functioning in children with ADHD. The magnitude of treatment effects for cognitive training has been comparable to treatment effects for behavioral treatment for ADHD (i.e., small to moderate effect sizes). A limitation of existing cognitive training programs that may limit their efficacy is that each has employed a unifaceted approach. Each intervention program has targeted a single cognitive domain (e.g., working memory). This is problematic since as a group, children with ADHD have multiple areas of cognitive deficit (i.e., working memory, attention, response inhibition, delay aversion, intra-individual variability) and thus a unifaceted intervention does not address the multifaceted array of cognitive dysfunction in children with ADHD. Also, because individuals with ADHD each have unique patterns of cognitive deficits, a unifaceted cognitive training approach may target areas which are non-deficient and miss areas of significant deficit in individual patients depending on their ideographic cognitive profile. The primary goal of the proposed research is to develop and test a multifaceted cognitive training intervention that addresses a comprehensive array of ADHD- related cognitive deficits thereby ensuring that children's unique areas of cognitive deficit are targeted. During Phase I (R21 grant), software and a manual will be developed consisting of four training tasks targeting response inhibition, verbal working memory, attention, and delay aversion. Each task will possess advancing levels of difficulty. On each task, children will receive feedback on performance accuracy as well as on intra-individual variability in reaction times. The software will be pilot tested in Phase I to determine performance thresholds and intervention duration. Also, focus groups will be conducted to obtain patient perceptions of each task's difficulty and interest level. In Phase II (R33 grant), a preliminary randomized clinical trial will be conducted in order to obtain initial estimates of treatment efficacy. Pre-, post-, and follow up outcomes will be collected on a wide range of neuropsychological, behavioral, and academic measures. Effect size estimates across outcomes will be used to guide sample size determinations for future clinical trials of multifaceted cognitive training.

描述（由申请人提供）：经过数十年的多动症干预研究，只有两种干预方法（即心理药理学，行为治疗）具有“良好的”证据库，可以支持其对ADHD儿童的功效。这两种干预措施都有固有的局限性。最近，多项研究表明，认知训练可以改善ADHD儿童的神经心理学和行为功能。认知训练的治疗效果的幅度与ADHD行为治疗的治疗效果相当（即小到中度效应大小）。现有的认知培训计划可能限制其疗效的局限性是每个人都采用了统一的方法。每个干预程序都针对一个单个认知领域（例如，工作记忆）。这是有问题的，因为作为一个小组，患有多动症的儿童具有多个认知缺陷的领域（即工作记忆，注意力，反应抑制，延迟厌恶，个体内变异性），因此无截面的干预措施不能解决ADHD儿童的多方面认知功能障碍。同样，由于患有多动症的个体每个人都有独特的认知缺陷模式，因此，一种独立的认知训练方法可能针对无缺陷的区域，这些领域因其意识形态认知素材而定位，而单个患者的区域却没有明显的赤字。拟议研究的主要目标是开发和测试多方面的认知训练干预措施，该干预措施涉及一系列与ADHD相关的认知缺陷，从而确保针对儿童的独特认知缺陷领域。在第一阶段（R21赠款）期间，将制定软件和手册，包括针对响应抑制，口头工作记忆，注意力和延迟厌恶的四个培训任务。每个任务都将具有进步的困难水平。在每个任务上，儿童都会收到有关性能准确性以及反应时间内个体变异性的反馈。该软件将在I期中进行试验，以确定性能阈值和干预持续时间。此外，将进行焦点小组以获取对每个任务难度和兴趣水平的患者看法。在第二阶段（R33 Grant）中，将进行初步的随机临床试验，以获得治疗疗效的初步估计。将在各种神经心理学，行为和学术措施上收集前，后和后续结果。跨结果的效应尺寸估计值将用于指导样本量确定，以确定多方面认知训练的未来临床试验。