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）：注意力缺陷多动障碍（ADHD）是儿童期最常见的行为诊断。它会带来高昂的医疗费用，并可能导致学业成绩不佳、成人精神疾病、药物滥用和犯罪行为。标准治疗（例如兴奋剂药物）主要针对症状，对接受多动症治疗的儿童进行的长期随访研究表明，与典型发育（TD）同龄人相比，他们的结果仍然明显较差。因此，可以纠正多动症核心特征的行为训练计划具有巨大的潜在公共健康益处。为此，值得考虑的长期观察是，患有多动症的儿童经常表现出运动控制方面的困难，包括运动不持久和无法抑制运动溢出，这与高阶行为控制措施的困难平行（并相关） 。此外，最近的功能成像和经颅磁刺激（TMS）研究结果表明，患有 ADHD 的儿童表现出皮质抑制机制的异常募集，并且这些运动去抑制的生理测量与家长对儿童 ADHD 症状的评分密切相关。鉴于这些发现，基于运动的干预措施旨在通过运动系统的参与来改善行为控制，为针对 ADHD 的特定生物基质提供了一种有前途的方法。使用正念运动训练可以观察到认知和行为控制方面的进步，包括本应用的重点：太极拳。尽管与老年人相比，儿童的大脑可塑性明显更高，但正念运动训练的儿科应用尚未得到充分利用和研究。为了解决这一差距，我们建议检查基于运动的太极拳训练对多动症儿童的功效。考虑到正念和运动训练研究中对生理生物标志物的需求已得到认可，除了评估核心 ADHD 症状外，我们还将跟踪特定运动行为和生理（来自 TMS）标志物的变化。我们提出的设计采用“快速失败模型”来建立太极拳功效临床试验的可行性，以及针对多动症儿童的潜在其他形式的正念运动训练。在R21阶段，患有ADHD的儿童将接受为期8周的太极拳训练，并通过TMS和行为测试在训练前和训练后测量运动系统功能。还将收集学生和家长体验的定性测量，以补充核心运动系统目标的数据。项目里程碑完成后，R33 阶段将纳入 ADHD 症状严重程度的测量以及认知控制的研究领域标准 (RDoC) 测量。此外，R33 阶段将包括训练中期（除了训练前和训练后）评估，我们将研究以下假设：运动系统测量的变化将先于 ADHD 症状严重程度的变化。这项拟议的研究为开发多动症的新型治疗方法提供了巨大的潜力，而且不良反应的风险很小。