A Novel Multimodal Intervention for Children with ADHD and Impaired Mood

描述(由申请人提供)：越来越多的人认识到，许多ADHD儿童表现出抑郁和躁狂样症状，这些症状会在几个功能领域造成实质性损害。这些情绪症状在ADHD儿童中的诊断和预后意义已成为一个主要的临床争议，一些人认为它们是早发性双相情感障碍(BP)的证据。我们的初步工作发现，这些儿童比那些不复杂的ADHD儿童更容易受损，患抑郁症和BP的风险更高，家族性情绪障碍的发生率更高，对传统的ADHD治疗反应积极，但需要额外的治疗才能实现最佳功能。ADHD合并情绪障碍(AIM)儿童的药物治疗是一个临床难题，因为人们对兴奋剂在有躁狂症状的儿童中的安全性知之甚少，而且很难证明在没有明显躁狂发作的儿童中使用情绪稳定剂或抗精神病药物是合理的。心理社会干预为AIM儿童带来了特别的希望，因为他们已经得到了充分的研究，儿科治疗几乎没有恶化情绪症状的风险。针对ADHD和情绪症状的心理社会治疗，同时联合解决父母的情感症状，可以与药物相结合，方便儿童和家庭使用，将是AIM的理想治疗方法。我们建议开发一种综合的心理社会治疗方法，将ADHD的行为矫正计划与儿童和成人情绪障碍的认知行为和心理教育技术相结合。这种结合刺激性药物的新疗法将与ADHD和情绪受损(AIM)儿童在受控环境下的标准ADHD治疗(兴奋剂)进行比较。这项研究还将评估兴奋剂在情绪不稳定青年中的有效性和耐受性。这种新的疗法对公众健康有很大的好处，因为它将是第一个系统地针对ADHD儿童的内化和外化症状的疗法，并且是为数不多的针对可能患有躁郁症的儿童的多模式干预研究之一。这些结果旨在作为对患有ADHD和BP的儿童进行多模式干预的发展以及具有早期情绪症状的ADHD青少年的长期结果的初步调查。

DESCRIPTION (provided by applicant): There has been increasing recognition that many children with ADHD exhibit depressive and manic-like symptoms that produce substantial impairment across several functional domains. The diagnostic and prognostic implications of these mood symptoms in ADHD children have become a major clinical controversy, with some considering them to be evidence of early onset Bipolar Disorder (BP). Our preliminary work has found that these children are more impaired than those with uncomplicated ADHD, at increased risk for developing depression and BP, have elevated rates of familial mood disorders and respond positively to traditional ADHD treatments but need additional treatments to achieve optimal functioning. The pharmacological management of children with ADHD plus impairments in mood (AIM) is a clinical dilemma as little is known about the safety of stimulants in children with manic symptoms, and it is difficult to justify the use of mood stabilizers or antipsychotics in children without clear manic episodes. Psychosocial interventions hold particular promise for children with AIM as they are well studied, pediatric treatments with little risk of worsening mood symptoms. A psychosocial treatment that targets ADHD and mood symptoms, while conjointly addressing affective symptoms in the parents, can be combined with medications and easily administered to children and families would be an ideal treatment for AIM. We propose to develop an integrative psychosocial treatment that combines aspects of behavior modification programs for ADHD with cognitive-behavioral and psychoeducation techniques for pediatric and adult mood disorders. This novel therapy combined with stimulant medication will be compared to standard ADHD treatment (stimulants) under controlled settings in children with ADHD and impaired mood (AIM). This study will also assess the efficacy and tolerability of stimulants in mood labile youth. The novel therapy holds substantial public health benefit as it will be the one the first to systematically target both internalizing and externalizing symptoms in children with ADHD and represents one of the few multimodal intervention studies for children with possible bipolar spectrum illness. The results are intended to serve as preliminary investigations into the development of multimodal interventions for children with ADHD and BP and the long term outcomes of ADHD youth with early onset mood symptoms.