Integrated Multi-Setting Psychosocial Treatment for ADHD-Inattentive Type

描述(申请人提供)：注意力缺陷多动障碍-主要是注意力不集中类型(ADHD-I)是一种非常普遍和严重的儿童精神障碍[有证据表明损害是严重和持久的]。患有ADHD-I的儿童具有不同于ADHD混合型(ADHD-C)的注意力缺陷、共病障碍、社交障碍和神经认知障碍的特征。这些差异的程度排除了直接的假设，即ADHD-C的治疗结果可以推广到ADHD-I。通过R21治疗发展基金的资助，我们为ADHD-I开发了一种新的心理社会治疗(综合多背景心理社会治疗--IPT)。IPT结合了针对ADHD-I的标准行为治疗(家长培训)，与儿童生活技能培训(来自康复医学的支持性策略)和教师咨询相结合。作为R21的一部分，我们进行了一项小规模随机对照试验，将IPT与未经治疗的对照组进行比较，结果表明：(A)对注意力不集中、学业和社交障碍的治疗效果显著，以及(B)该模型的可行性和可接受性。这些积极的结果证明了目前的应用是合理的，该应用的目标是提供一项IPT的双部位随机临床试验。我们将[210]名患有ADHD-I的7-11岁(2-5年级)的儿童随机分为IPT([N=78])、以家长为中心的训练(PFT，[N=78])或照常治疗的TAU([N=54])。随机对照试验的目的是测试与标准的社区治疗TAU相比，IPT是否能更好地减少家长和教师(主要终点)评定的DSM-IV注意力缺陷症状；以及[PFT]，这是一种有效减轻ADHD症状的积极治疗方法。我们将包括服药和未服药的儿童，并将从广泛的诊所和学校招募人员，这与我们增加普适性的目标一致。二次分析将评估干预对包括学习和社会功能在内的多个损害领域的影响，以及对标准临床任务期间观察得出的注意力和养育方式的客观衡量，以及对基于课程的学业成就衡量的影响。我们预测，与TAU相比，IPT的ADHD-I症状将显著降低，其次，学术和社会功能将显著提高]。我们假设，与[PFT]相比，IPT组的ADHD-I症状将显著降低，其次，学习和社会功能将显著提高。我们还将在[5-7]个月的随访中检查治疗成果的持久性。我们预测，与其他组相比，IPT组的ADHD-I症状将保持最低水平，而学习/社会功能将保持最高水平。公共卫生相关陈述注意力缺陷/多动障碍，主要是注意力不集中类型，是一种普遍和严重的儿童精神障碍，严重和持续地影响儿童在学校、家庭和与同龄人相处的功能。本研究旨在评估整合学校、家庭和儿童技能成分的行为干预对改善这些儿童的注意力症状和学习和社会功能的有效性。

DESCRIPTION (provided by applicant): Attention Deficit Hyperactivity Disorder-Predominantly Inattentive Type (ADHD-I) is a highly prevalent and serious childhood psychiatric disorder [with evidence that impairment is severe and persistent]. Children with ADHD-I have a profile of attention deficits, comorbid disorders, social impairments, and neurocognitive dysfunction that differs from that associated with ADHD-Combined Type (ADHD-C). The extent of these differences precludes straightforward assumptions that treatment outcome findings for ADHD-C can be generalized to ADHD-I. Through funding from an R21 Treatment Development grant, we have developed a novel psychosocial treatment (Integrated Multi-Setting Psychosocial Treatment--IPT) for ADHD-I. IPT combines a standard behavioral treatment for ADHD (parent training) that has been adapted for ADHD-I, with child life skills training (supportive strategies drawn from rehabilitation medicine) and with teacher consultation. As part of the R21, we conducted a small-scale randomized controlled trial comparing IPT to an untreated control group and demonstrated (a) significant treatment effects on inattention, and academic and social impairment, and (b) feasibility and acceptability of the model. These positive outcomes justify the current application, which aims to provide a dual-site, randomized clinical trial of IPT. We will randomize [210] children with ADHD-I ages 7-11 (2nd-5th grades) to IPT ([N=78]), Parent-Focused Training (PFT, [N=78]), or Treatment as Usual, TAU ([N=54]). The goal of the RCT is to test whether IPT provides superior reduction of DSM-IV inattention symptoms as rated by parents and teachers (the primary endpoint), in comparison to standard community treatment, TAU; and to [PFT], which constitutes an active treatment that is effective at reducing symptoms of ADHD. We will include medicated and unmedicated children and will recruit from a broad array of clinics and schools, consistent with our goal of increasing generalizability. Secondary analyses will evaluate the effects of the intervention across multiple domains of impairment including academic and social functioning and on objective measures of attention and parenting derived from observations during standard clinic-based tasks, and on curriculum-based measures of academic achievement. We predict that ADHD-I symptoms will be significantly lower and, secondarily, that academic and social functioning will be significantly higher, in IPT relative to TAU]. We hypothesize that ADHD-I symptoms will be significantly lower and, secondarily, that academic and social functioning will be significantly higher, in the IPT group relative to [PFT]. We will also examine the durability of treatment gains at [5-7] month follow-up. We predict that ADHD-I symptoms will remain lowest and academic/social functioning will remain highest in the IPT group relative to the other groups at follow-up. PUBLIC HEALTH RELEVANCE STATEMENT Attention-deficit\Hyperactivity Disorder, Predominantly Inattentive type is a prevalent and serious childhood psychiatric disorder which severely and persistently impacts a child's functioning at school, at home, and with peers. This study aims to evaluate the effectiveness of a behavioral intervention, integrating school, home and child skills components, for improving attentional symptoms and academic and social functioning in these children.