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

描述（由申请人提供）：注意缺陷多动障碍（ADHD）是儿童时期最常见的行为诊断。它会导致高昂的医疗费用，并可能导致学习成绩差、成人精神疾病、药物滥用和犯罪行为。标准的治疗方法，如兴奋剂药物，主要针对的是症状，对患有多动症的儿童的长期随访研究表明，与正常发育（TD）的同龄人相比，他们的结果仍然明显更差。因此，行为训练项目有巨大的潜在公共健康效益，可以纠正多动症的核心特征。为此，值得考虑的是，长期以来的观察表明，患有ADHD的儿童通常表现出运动控制方面的困难，包括运动不持续性和抑制运动溢出的失败，这些困难与高阶行为控制的测量平行（并与之相关）。此外，最近的功能成像和经颅磁刺激（TMS）研究结果显示，多动症儿童表现出皮层抑制机制的异常补充，这些运动去抑制的生理指标与父母对儿童多动症症状的评分密切相关。鉴于这些发现，基于运动的干预措施旨在通过运动系统的参与来改善行为控制，这为针对ADHD的特定生物基质提供了一种有希望的方法。在认知和行为控制方面的收益已经被观察到使用正念运动训练，包括这个应用的重点：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童中的应用尚未得到充分利用和研究。为了解决这一差距，我们建议研究以运动为基础的太极拳训练对多动症儿童的疗效。考虑到在正念和运动训练研究中对生理生物标志物的公认需求，除了评估核心ADHD症状外，我们还将跟踪特定运动行为和生理（来自经颅磁刺激）标志物的变化。我们提出的设计采用了一个“快速失败模型”，以确定太极拳和其他形式的正念运动训练对多动症儿童疗效的临床试验进展的可行性。在R21阶段，ADHD儿童将进行为期8周的太极训练，通过TMS和行为测试测量训练前和训练后的运动系统功能。还将收集学生和家长经验的定性测量，以补充核心运动系统目标的数据。在完成项目里程碑后，R33阶段将纳入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阶段将包括训练中期（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。这项研究为开发新的治疗ADHD的方法提供了巨大的潜力，而且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.