Inhibitory control and clinical response in ADHD

ADHD 的抑制控制和临床反应

• 批准号: 6922195
• 负责人: LARRY W HAWK
• 金额: $ 39.35万
• 依托单位: STATE UNIVERSITY OF NEW YORK AT BUFFALO
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-01 至 2010-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6922195
• 关键词: attention; attention deficit disorder; behavioral /social science research tag; child behavior; clinical research; human subject; impulsive behavior; methylphenidate; middle childhood (6-11); motivation; neuropsychological tests; neuropsychology; patient oriented research; performance; pharmacokinetics; psychopharmacology; reinforcer; short term memory

DESCRIPTION (provided by applicant): Although there is a long history of research on basic cognitive and motivational processes in ADHD and a long history of research on effective treatments for ADHD, there is almost a total absence of research relating basic processes to the impact of clinical interventions. Contemporary theories of ADHD emphasize a range of basic cognitive processes, including inhibitory control, working memory, and sustained attention, and basic motivational processes such as delay-related impulsivity (a tendency to choose small, immediate rewards over larger, delayed rewards). An important, yet untested, corollary of these models is that the primary treatments for ADHD - stimulants such as methylphenidate (MPH), behavioral treatment, and their combination - exert their effects by improving these basic processes. Thus, there are important gaps in our understanding of the extent to which the basic processes are sensitive to each of these treatments, and there are almost no data to address whether changes in basic cognitive and motivational processes actually account for treatment effects in clinical settings. The proposed research fills these gaps. First, it is the first study to concurrently examine the effects of both MPH and performance-based motivational incentives (i.e., monetary rewards, an analogue of behavioral treatment) on laboratory measures of inhibitory control, working memory, sustained attention, and delay-related impulsivity in children with ADHD (n=108). A group of age- and gender-matched controls (n=108) is included for comparison but not given MPH. We hypothesize that children with ADHD will exhibit impaired performance in the absence of motivational incentives, but that this pattern will be ameliorated in the presence of incentives for good performance. Second, among the children with ADHD, incentive will be crossed with doses of extended-release MPH (placebo, O.3., and 0.6 mg/kg) on a within-subjects basis to provide an initial examination of the separate and interactive effects of these analogue treatments on neurocognitive processing. Third, the proposed research will be the first to test the extent to which MPH effects on basic processes assessed in the lab actually mediate, or account for, individual differences in clinical response to MPH. To accomplish this aim, the participants with ADHD will undergo a 3-week, double blind school-based medication assessment to examine MPH effects on ADHD children's functioning in a natural setting. Thus, the proposed research will bridge basic and clinical research in ADHD and will provide critical initial tests of the hypothesis that changes in basic cognitive and motivational processes are the mechanisms by which treatments for ADHD work. This work will pave the way for a new generation of translational research and theory in ADHD.

描述（由申请人提供）：尽管对ADHD的基本认知和动机过程的研究历史悠久，对ADHD的有效治疗方法的研究历史悠久，但几乎完全缺乏将基本过程与临床干预影响相关的研究。ADHD的当代理论强调一系列基本认知过程，包括抑制控制，工作记忆和持续注意力，以及基本动机过程，如延迟相关的冲动（倾向于选择小的，立即的奖励而不是更大的，延迟的奖励）。这些模型的一个重要但未经检验的推论是，ADHD的主要治疗方法--哌甲酯（MPH）等兴奋剂、行为治疗及其组合--通过改善这些基本过程来发挥作用。因此，我们对基本过程对每种治疗敏感程度的理解存在重大差距，并且几乎没有数据来解决基本认知和动机过程的变化是否实际上解释了临床环境中的治疗效果。这项研究填补了这些空白。首先，这是第一项同时研究MPH和基于绩效的激励性激励（即，金钱奖励，行为治疗的类似物）对ADHD儿童（n=108）的抑制控制，工作记忆，持续注意力和延迟相关冲动的实验室测量。包括一组年龄和性别匹配的对照组（n=108）进行比较，但不给予MPH。我们假设ADHD儿童在缺乏动机性激励的情况下表现出受损的表现，但在存在良好表现的激励时，这种模式将得到改善。第二，在患有ADHD的儿童中，激励将与延长释放的MPH（安慰剂，0.3.，和0.6mg/kg），以提供这些类似物治疗对神经认知处理的单独和交互作用的初步检查。第三，拟议的研究将是第一个测试MPH对实验室评估的基本过程的影响实际上介导或解释MPH临床反应的个体差异的程度。为了实现这一目标，患有ADHD的参与者将接受为期3周的双盲校本药物评估，以检查MPH对ADHD儿童在自然环境中的功能的影响。因此，拟议的研究将弥合ADHD的基础和临床研究，并将提供基本认知和动机过程的变化是ADHD治疗工作机制的假设的关键初步测试。这项工作将为ADHD的新一代转化研究和理论铺平道路。