Social and Academic Problems in ADHD: The Role of Implicit and Explicit Learning

描述(由申请者提供)：计划中的研究是为了提高该领域对认知和学习过程的理解，这些过程形成了ADHD儿童最慢性的两种现实世界障碍：社会表现缺陷和学业成绩低下。先前的研究已经证实，与ADHD相关的工作记忆缺陷(WM)直接影响ADHD儿童明确获得一项认知技能的能力，学习成绩只是其中的一个例子。这项工作与ADHD干预的一个很有前途的新方向有关，即采用认知补救方法进行治疗。这些尖端项目的初步发现是令人鼓舞的；然而，大多数项目的目标是“执行功能”(EF)，这些功能既没有明确规定，也不是作为单个结构和作为一个集体的过程组。目前的应用结果有可能响应日益增长的将神经科学整合到教育和干预项目中的呼声，通过确定更具体/有效的认知目标(S)来指导这些项目的发展。因此，本研究的第一个目的是询问加工速度慢是否会导致工作记忆中与ADHD相关的缺陷，以及外显认知技能的获得不佳，这反过来又会预测慢性学习成绩低下。如果事实证明是这样，那么心理治疗和药物干预应该以处理速度为目标(而不是更摩尔的EF过程)，这将对许多更高级别的执行过程产生积极的下游影响，包括但不限于WM。另一个潜在的限制创新治疗发展的步骤是，EFS的检查在很大程度上主导了儿童ADHD的认知神经科学研究，排除了其他有希望的认知机制。因此，第二和第三个目标考察了内隐学习系统是否(A)在ADHD儿童中是完整的，以及(B)是否可以预测ADHD的社会表现缺陷。内隐学习系统在很大程度上独立于EF，但依赖于ADHD所涉及的神经解剖结构(即基底节和纹状体)，并负责学习用于指导社会行为的复杂的非语言规则。尽管有许多经验支持的治疗ADHD的心理社会疗法，但没有一种在同伴地位或学习成绩正常化方面显示出长期的好处。为了实现这些目标，我们采用扫描电子显微镜的方法，系统地考察了8-12岁儿童在使用和不使用DSM-IV ADHD的情况下，EFS、快速表现和外显/内隐学习过程对社会和学习成绩的潜在联合贡献。我们对ADHD技能获得过程的基本理解空白，加上需要改进我们现有的心理社会和学术补救计划，主张对ADHD的外显和内隐学习以及有助于技能获得的认知过程进行全面研究。 公共卫生相关性：这项研究的目标是更好地了解认知和学习过程，这些过程导致ADHD儿童最常见的两种共生和慢性障碍：社交适应不良和学业成绩低下。这两者都是导致许多负面后果的重要风险因素，包括青少年犯罪、药物滥用以及较低的职业和社会经济地位。我们对ADHD的技能获得过程的基本理解存在空白，再加上需要改进我们现有的心理社会和学术补救计划，因此有必要对ADHD的学习以及有助于获得技能的认知过程进行全面研究。

DESCRIPTION (provided by applicant): The planned study is to improve the field's understanding of the cognitive and learning processes that shape two of the most chronic real world impairments seen in children with ADHD: social performance deficits and academic underachievement. Prior work has established that ADHD-related weaknesses in working memory (WM) directly impacts the ability of children with ADHD to explicitly acquire a cognitive skill, of which academic achievement would be but one example. Such work is relevant to a promising new direction in ADHD intervention which adopts a cognitive remediation approach to treatment. Initial findings from these cutting edge programs are encouraging; however, most target "executive functions" (EF) which are both poorly specified and non-unitary as individual constructs and as a collective group of processes. Results from the current application have the potential to answer the growing call to integrate neuroscience into educational and intervention programs by guiding the development of these programs through the identification of more specific/efficient cognitive target(s) for remediation. The first aim of the present study therefore asks whether slow speed of processing accounts for ADHD-related deficits in WM as well as the poor acquisition of explicit cognitive skills, which in turn would predict chronic academic underachievement. If this proves to be the case, then psychotherapeutic and pharmacologic interventions should target processing speed (as opposed to the more molar EF process), which would have positive downstream implications for a number of higher order executive processes, including but not limited to WM. Another potential rate limiting step to the development of innovative treatments, is that the examination of EFs has largely dominated research in the cognitive neuroscience of childhood ADHD, to the exclusion of other promising cognitive mechanisms. The second and third aims thus examine whether the implicit learning system, a learning system largely independent of EF, but dependent upon neuroanatomical structures implicated in ADHD (i.e. basal ganglia and striatum) and responsible for learning complex nonverbal rules used in directing social behavior, is (a) intact in children with ADHD, and (b) can predict social performance deficits in ADHD. Despite the availability of a number of empirically supported psychosocial treatments for ADHD, none have demonstrated long term benefits in the normalization of peer status or academic achievement. To meet these goals, we have adopted an SEM approach to systematically examine the potential conjoint contributions of EFs, speeded performance, and explicit/implicit learning processes on social and academic performance in children aged 8-12 with and without DSM-IV ADHD.The void in our basic understanding of skill acquisition processes in ADHD, combined with a need to improve our existing psychosocial and academic remediation programs, argues for a comprehensive study of explicit and implicit learning in ADHD, and of the cognitive processes that contribute to the acquisition of skill. PUBLIC HEALTH RELEVANCE: The goal of this study is to better understand the cognitive and learning processes that contribute to two of the most common, co-occurring, and chronic impairments seen in children with ADHD: social maladjustment and academic underachievement. Both are significant risk factors for a host of negative outcomes including delinquency, substance abuse, as well as lower occupational and socioeconomic status. The void in our basic understanding of skill acquisition processes in ADHD, combined with a need to improve our existing psychosocial and academic remediation programs, argues for a comprehensive study of learning in ADHD, and of the cognitive processes that contribute to the acquisition of skill.