Movement-Based Training for Children with ADHD: A Feasibility Study

描述(申请人提供)：注意缺陷多动障碍(ADHD)是儿童时期最常见的行为诊断。它会产生高昂的医疗费用，并可能导致学习成绩不佳、成人精神疾病、药物滥用和犯罪行为。标准治疗，如主要针对症状的刺激性药物，以及对接受ADHD治疗的儿童的长期跟踪研究表明，与典型的发育中(TD)同龄人相比，他们的结果仍然明显更差。因此，行为训练计划有巨大的潜在公共健康益处，可以补救ADHD的核心特征。为此，值得考虑的是，长期的观察表明，ADHD儿童经常表现出运动控制困难，包括运动不持久和抑制运动溢出失败，这与更高级别的行为控制措施平行(并与之相关)。此外，最近的功能成像和经颅磁刺激(TMS)结果显示，ADHD儿童表现出皮质抑制机制的异常招募，并且这些运动去抑制的生理学措施与儿童ADHD症状的父母评分密切相关。鉴于这些发现，基于运动的干预旨在通过运动系统的参与来实现更好的行为控制，为ADHD的特定生物底物提供了一种有前景的方法。在认知和行为控制方面的进步已经被观察到使用正念运动训练，包括这一应用的重点：太极。尽管与老年人相比，儿童的大脑可塑性明显更强，但正念运动训练在儿科的应用一直没有得到充分利用和研究。为了解决这一差距，我们建议检查以运动为基础的太极训练对ADHD儿童的效果。考虑到在正念和运动训练研究中对生理生物标记物的公认需求，除了评估核心的ADHD症状外，我们还将跟踪特定的运动行为和生理标记物(来自TMS)的变化。我们提出的设计采用了“快速失败模式”，为太极疗效的临床试验建立了可行性，并可能为患有ADHD的儿童进行其他形式的正念运动训练。在R21阶段，ADHD儿童将进行为期8周的太极训练，训练前和训练后通过TMS和行为测试测量运动系统功能。还将收集学生和家长体验的定性衡量标准，以补充核心运动系统目标的数据。在项目里程碑完成后，R33阶段将包括ADHD症状严重程度的测量，以及认知控制的研究领域标准(RDoC)测量。此外，R33阶段将包括中期训练(除了训练前和训练后)评估，我们将调查运动系统测量的变化将先于ADHD症状严重程度变化的假设。这项拟议的研究为开发ADHD的新治疗方法提供了巨大的潜力，而不良反应的风险很小。

DESCRIPTION (provided by applicant): Attention Deficit Hyperactivity Disorder (ADHD) is the most common behavioral diagnosis in childhood. It incurs high medical costs, and can contribute to poor academic achievement, adult mental illness, substance abuse, and criminal behavior. Standard treatments, such as stimulant medications, primarily target symptoms, and long-term follow-up studies of children treated for ADHD reveal that their outcomes remain significantly worse as compared to typically developing (TD) peers. Thus, there are tremendous potential public health benefits for behavioral training programs that could remediate core features of ADHD. To this end, it is worth considering the long-standing observation that children with ADHD often demonstrate difficulties with motor control, including motor impersistence and failure to inhibit motor overflow, that parallel (and correlate with) difficultie with measures of higher-order behavioral control. Further, recent functional imaging and transcranial magnetic stimulation (TMS) findings reveal children with ADHD show abnormal recruitment of cortical inhibitory mechanisms, and that these physiologic measures of motor disinhibition robustly correlate with parent ratings of children's ADHD symptoms. Given these findings, it follows that movement-based interventions that aim to achieve improved behavioral control through engagement of the motor system offer a promising approach for targeting specific biological substrates of ADHD. Gains in cognitive and behavioral control have been observed using mindful movement training, including the focus of this application: Tai Chi. Despite the markedly greater brain plasticity observed in children as compared to older adults, pediatric applications of mindful movement training has been under utilized and under investigated. Addressing this gap, we propose to examine the efficacy of a movement-based Tai Chi training for children with ADHD. Given the recognized need for physiologic biomarkers in mindfulness and movement training studies, we will track changes in specific motor behavioral and physiologic (from TMS) markers, in addition to assessment of core ADHD symptoms. Our proposed design employs a "Fast Fail Model" to establish feasibility for progression to a clinical trial of efficacy for Tai Chi, and potentially other forms of mindful movement training, for childrn with ADHD. In the R21 phase, children with ADHD will engage in an 8-week Tai Chi training, with pre- and post-training measurement of motor system function via TMS and behavioral testing. Qualitative measures of student and parent experience will also be collected to complement data on core motor system targets. Upon completion of project milestones, the R33 phase will incorporate measures of ADHD symptom severity, as well as Research Domain Criteria (RDoC) measures of cognitive control. Further, the R33 phase will include a mid-training (in addition to pre- and post-training) assessment and we will investigate the hypothesis that changes in motor system measures will precede changes in ADHD symptom severity. The proposed study offers immense potential for the development of novel therapeutic approaches for ADHD with little risk of adverse reaction.