ADHD Treatment:Comparative and Combined Dosage Effects

描述(由申请者提供)：大量研究已经检验了 精神刺激剂药物和行为矫正的近期疗效 (两种循证治疗)治疗ADHD，但 已经注意到这两种治疗方法在急性效果方面的不足，导致 这两种方法的结合的广泛使用。然而， 联合治疗方法在这两个国家还没有得到广泛的研究 短期或长期评估。关于ADHD的许多关键问题 治疗仍未解决。一个主要的悬而未决的问题是，强度或 行为疗法和药物疗法的剂量及其组合 影响比较疗效研究的结果。其中一个主要的 支持联合治疗的支持者提出的论点是 联合治疗能够使用更低剂量的药物和更少的 强化行为治疗相对于单峰治疗；然而，这 这一概念还没有在良好对照的试验中进行经验研究。这个 这项拟议研究的目的是考察和 不同剂量的行为(无、低和高)和 ADHD的药物治疗(PL、0.3 mg/kg和0.6 mg/kg)通过评估 在受控的夏季节目设置中，它们的单独和综合影响。这个 具体目标如下：1)综合治疗是否有 超越其组成部分的递增功效，并解决了这一问题 问题因行为治疗的剂量/强度和剂量而异 2)问题1的答案取决于功能领域吗 (例如，同伴关系、学习功能、破坏性行为、 与成年人的互动)；3)问题的答案我依赖于 评估效果的环境(即，与同伴的娱乐环境， 课堂环境、家庭环境)；4)个体差异如何 变量(例如，年龄。性别，损伤的严重程度，共病的儿童诊断， 家庭和父母特征)影响对所述问题的回答 5)不同强度的行为有何影响？ 对家长、教师和辅导员的药理学和联合治疗 情绪、压力、努力和对治疗的满意度？这些问题将 在一项对144名ADHD儿童进行的内部调查中得到回答 5岁和12岁，每个孩子在这个年龄接受所有的条件。我们会 采用各种生态上有效的措施在夏季发挥作用 治疗程序设置已经被很好地研究了 行为和药物治疗，并允许精确的治疗 保真度和客观结果。治疗效果将在两个地点进行分析 组和子级。

DESCRIPTION (provided by applicant): Numerous studies have examined the short-term efficacy of psychostimulant medication and behavior modification (the two evidence-based treatments) in the treatment of ADHD, but insufficiencies in acute effects of both treatments have been noted, leading to the widespread use of the combination of the two approaches. However, the combined approach to treatment has not yet been extensively studied in either short- or long-term evaluations. Numerous critical issues regarding ADHD treatment remain unresolved. A primary unresolved issue is how the intensity or dose of behavioral and pharmacological treatments and their combination influence the results of comparative efficacy studies. One of the major supporting arguments that proponents of combined treatments have made is that combining treatments enables the use of lower doses of medication and less intensive behavioral treatment relative to unimodal treatments; however, this concept has not been empirically studied in a well-controlled trial. The purpose of the proposed study is to examine the relative effects of and interactions between different doses of behavioral (none, low, and high) and pharmacological treatments (pl, .3mg/kg, and .6mg/kg) for ADHD by evaluating their separate and combined effects in a controlled summer program setting. The following specific aims are addressed: 1) Do combined treatments have incremental efficacy beyond their components, and does the answer to this question vary with the dose/intensity of the behavioral treatment and the dose of medication; 2) Do the answers to question 1 depend on domain of functioning (e.g., peer relationships, academic functioning, disruptive behavior, interactions with adults); 3) Do the answers to question I depend on the setting in which effects are assessed (i.e., recreational settings with peers, classroom settings, home/family settings); 4) How do individual difference variables (i.e., age. gender, severity of impairment, comorbid child diagnoses, family and parent characteristics) influence the answers to questions addressed above and; 5) What are the impacts of different intensities of behavioral, pharmacological, and combined treatments on parent, teacher, and counselor affect, stress, effort, and satisfaction with treatment? These questions will be answered in a within-subject investigation with 144 ADHD children between the ages of 5 and 12 in which each child receives all conditions. We will employ a variety of ecologically valid measures of functioning in a summer treatment program setting that has been well studied with respect to both behavioral and pharmacological treatments and allows precise of treatment fidelity and objective outcomes. Treatment effects will be analyzed at both the group and child level.