Integrated Multi-Setting Psychosocial Treatment for ADHD-Inattentive Type

描述（由申请人提供）：注意缺陷多动障碍-主要是注意力不集中型（ADHD-I）是一种高度流行和严重的儿童精神疾病[有证据表明损害严重且持续]。ADHD-I型儿童的注意力缺陷、共病障碍、社交障碍和神经认知功能障碍与ADHD-C型儿童不同。这些差异的程度排除了ADHD-C的治疗结果可以推广到ADHD-I的直接假设。通过R21治疗开发赠款的资助，我们为ADHD-I开发了一种新的心理治疗（综合多设置心理治疗-IPT）。IPT结合了ADHD的标准行为治疗（父母培训），已适用于ADHD-I，儿童生活技能培训（从康复医学中提取的支持策略）和教师咨询。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了比较，并证明了（a）对注意力不集中以及学业和社会障碍的显著治疗效果，以及（B）模型的可行性和可接受性。这些积极的结果证明了当前申请的合理性，该申请旨在提供IPT的双中心随机临床试验。我们将[210]名7-11岁（2 - 5年级）的ADHD-I儿童随机分配至IPT（[N=78]）、家长集中训练（PFT，[N=78]）或治疗组TAU（[N=54]）。RCT的目的是测试与标准社区治疗TAU和[PFT]相比，IPT是否能有效减少家长和教师评定的DSM-IV注意力不集中症状（主要终点）的上级减少，[PFT]是一种有效减少ADHD症状的积极治疗。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，这与我们提高普遍性的目标一致。二次分析将评估干预对多个损伤领域的影响，包括学业和社会功能，以及对标准临床任务期间观察得出的注意力和养育子女的客观措施，以及对基于学习成绩的措施的影响。我们预测，ADHD-I症状将显着降低，其次，学术和社会功能将显着提高，在IPT相对于TAU]。我们假设，与PFT相比，IPT组的ADHD-I症状将显著降低，其次，学业和社会功能将显著提高。我们还将在[5-7]个月随访时检查治疗收益的持久性。我们预测，在随访时，与其他组相比，IPT组的ADHD-I症状将保持最低，学术/社会功能将保持最高。注意力缺陷\多动障碍，主要是注意力不集中型是一种流行的严重儿童精神障碍，严重和持续地影响儿童在学校、家中和与同龄人的功能。本研究旨在评估行为干预的有效性，整合学校，家庭和儿童技能的组成部分，改善这些儿童的注意力症状和学业和社会功能。

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.