Movement-Based Training for Children with ADHD: A Feasibility Study

多动症儿童的运动训练：可行性研究

• 批准号: 8770999
• 负责人: Stewart H Mostofsky
• 金额: $ 26.22万
• 依托单位: HUGO W. MOSER RES INST KENNEDY KRIEGER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-05 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8770999
• 关键词: Academic achievement; Address; Adult; Adverse reactions; Attention deficit hyperactivity disorder; Attitude; Behavior; Behavior Control; Behavioral; Biological; Biological Markers; Blinded; Brain; Child; Childhood; Clinical Trials; Cognitive; Complement; Dancing; Data; Development; Diagnosis; Disinhibition; Elderly; Evaluation; Failure; Feasibility Studies; Feedback; Frustration; Functional Imaging; Happiness; Health Benefit; Hyperactive behavior; Impulsivity; Individual; Intervention; Learning; Measurement; Measures; Medical; Meditation; Mental disorders; Modeling; Motor; Movement; Outcome; Parents; Participant; Patients; Pharmaceutical Preparations; Phase; Physiological; Population; Population Study; Protocols documentation; Public Health; Randomized; Randomized Controlled Trials; Recruitment Activity; Research Domain Criteria; Risk; Severities; Students; Substance abuse problem; Surveys; Symptoms; System; Tai Ji; Testing; Therapeutic; Training; Training Programs; Transcranial magnetic stimulation; Validation; base; behavior test; cognitive control; cost; criminal behavior; design; experience; follow-up; improved; interest; meetings; mindfulness; motor control; motor deficit; novel; novel therapeutic intervention; peer; programs; public health relevance; response; standard care

DESCRIPTION (provided by applicant): Attention Deficit Hyperactivity Disorder (ADHD) is the most common behavioral diagnosis in childhood. It incurs high medical costs, and can contribute to poor academic achievement, adult mental illness, substance abuse, and criminal behavior. Standard treatments, such as stimulant medications, primarily target symptoms, and long-term follow-up studies of children treated for ADHD reveal that their outcomes remain significantly worse as compared to typically developing (TD) peers. Thus, there are tremendous potential public health benefits for behavioral training programs that could remediate core features of ADHD. To this end, it is worth considering the long-standing observation that children with ADHD often demonstrate difficulties with motor control, including motor impersistence and failure to inhibit motor overflow, that parallel (and correlate with) difficultie with measures of higher-order behavioral control. Further, recent functional imaging and transcranial magnetic stimulation (TMS) findings reveal children with ADHD show abnormal recruitment of cortical inhibitory mechanisms, and that these physiologic measures of motor disinhibition robustly correlate with parent ratings of children's ADHD symptoms. Given these findings, it follows that movement-based interventions that aim to achieve improved behavioral control through engagement of the motor system offer a promising approach for targeting specific biological substrates of ADHD. Gains in cognitive and behavioral control have been observed using mindful movement training, including the focus of this application: Tai Chi. Despite the markedly greater brain plasticity observed in children as compared to older adults, pediatric applications of mindful movement training has been under utilized and under investigated. Addressing this gap, we propose to examine the efficacy of a movement-based Tai Chi training for children with ADHD. Given the recognized need for physiologic biomarkers in mindfulness and movement training studies, we will track changes in specific motor behavioral and physiologic (from TMS) markers, in addition to assessment of core ADHD symptoms. Our proposed design employs a "Fast Fail Model" to establish feasibility for progression to a clinical trial of efficacy for Tai Chi, and potentially other forms of mindful movement training, for childrn with ADHD. In the R21 phase, children with ADHD will engage in an 8-week Tai Chi training, with pre- and post-training measurement of motor system function via TMS and behavioral testing. Qualitative measures of student and parent experience will also be collected to complement data on core motor system targets. Upon completion of project milestones, the R33 phase will incorporate measures of ADHD symptom severity, as well as Research Domain Criteria (RDoC) measures of cognitive control. Further, the R33 phase will include a mid-training (in addition to pre- and post-training) assessment and we will investigate the hypothesis that changes in motor system measures will precede changes in ADHD symptom severity. The proposed study offers immense potential for the development of novel therapeutic approaches for ADHD with little risk of adverse reaction.

描述（由申请人提供）：注意缺陷多动障碍（ADHD）是儿童期最常见的行为诊断。它会造成高昂的医疗费用，并可能导致学业成就不佳，成人精神疾病，药物滥用和犯罪行为。标准治疗方法，例如刺激药物，主要针对症状以及对经多动症治疗的儿童的长期随访研究表明，与典型发展（TD）同龄人相比，他们的结果仍然明显差。因此，行为培训计划具有巨大的潜在公共卫生益处，可以补救多动症的核心特征。为此，值得考虑的是，长期以来，多动症的儿童经常表现出运动控制的困难，包括运动障碍和无法抑制运动溢流的难度，这与高阶行为控制的措施相似（并与之相关）。此外，最近的功能成像和经颅磁刺激（TMS）的发现表明，患有ADHD的儿童表现出异常的皮质抑制机制募集，并且这些运动抑制的这些生理性测量与儿童ADHD症状的父母评分息息相关。鉴于这些发现，因此得出的基于运动的干预措施旨在通过参与运动系统来改善行为控制，这为靶向ADHD的特定生物底物提供了有希望的方法。使用正念运动训练（包括本应用的重点：TAI CHI），已经观察到了认知和行为控制的收益。尽管与老年人相比，在儿童中观察到的大脑可塑性明显更高，但人们的小儿应用仍在使用和研究中。在解决这一差距的情况下，我们建议研究基于运动的ADHD儿童的TAI CHI培训的功效。鉴于人们对正念和运动训练研究的生理生物标志物的认可，我们还将跟踪特定运动行为和生理学（来自TMS）标记的变化，除了评估核心ADHD症状。我们提出的设计采用“快速失败模型”来确立可行性，以促进Tai Chi的临床疗效试验，以及其他可能是其他形式的正念运动训练，该培训对儿童的ADHD进行了可行性。在R21阶段，患有多动症的儿童将进行为期8周的TAI CHI训练，并通过TMS和行为测试对运动系统功能进行训练前和训练后的测量。还将收集学生和父母经验的定性衡量标准，以补充有关核心运动系统目标的数据。在完成项目里程碑后，R33阶段将结合ADHD症状严重程度的度量，以及研究领域的标准（RDOC）认知控制的度量。此外，R33阶段还将包括中期训练（除训练前和培训后）评估，我们将调查以下假设：运动系统测量的变化将在ADHD症状严重程度的变化之前进行。拟议的研究为开发新型多动症治疗方法的发展提供了巨大的潜力，而不良反应的风险很小。