Integrative Data Analysis of Psychosocial Treatment Studies for Adolescent ADHD

青少年多动症心理社会治疗研究的综合数据分析

• 批准号: 9982543
• 负责人: Stefany Jean Coxe
• 金额: $ 7.73万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9982543
• 关键词: Academic Detailing; Adolescence; Adolescent; Adult; Aftercare; Age; Attention deficit hyperactivity disorder; Caring; Characteristics; Child; Child Rearing; Childhood; Clinic; Clinical; Code; Cognitive deficits; Communities; Community Mental Health Centers; Complex; Conflict (Psychology); Corpus striatum structure; County; Data; Data Analyses; Data Collection; Data Set; Databases; Development; Education; Enrollment; Equation; Family; Foundations; Funding; Generations; Goals; Guidelines; Heterogeneity; Individual; Institutes; Intervention; Life; Link; Maintenance; Mediator of activation protein; Mental Health; Methodology; Modeling; National Institute of Mental Health; Neuronal Plasticity; Outcome; Outcome Measure; Parents; Participant; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Phenotype; Population; Population Heterogeneity; Prediction of Response to Therapy; Preparation; Randomized Clinical Trials; Recommendation; Records; Research; Risk; Sample Size; Sampling; Schools; Science; Selection for Treatments; Series; Structure; Students; Subgroup; Symptoms; Teenagers; Time; Training; Treatment outcome; Universities; Work; Youth; base; contingency management; critical period; design; ethnic minority population; executive function; experience; falls; follow-up; improved; individualized medicine; personalized medicine; precision medicine; primary outcome; psychosocial; racial minority; response; reward processing; school district; secondary outcome; skills; teacher; treatment as usual; treatment guidelines; treatment program; treatment response

Project Summary. During the last six years, our team conducted four randomized clinical trials of psychosocial treatments for adolescents with ADHD with a cumulative sample size of 876 youth (ages of 11- 17; Sibley et al., 2016, under review, in preparation, in progress) with funding from the NIMH (R34 MH092466, R01 MH106587), Institute of Education Sciences (R305A150433), and the Klingenstein Third Generation Foundation. In the current proposal, we outline a plan to conduct an Integrative Data Analysis (IDA; Curran & Hussong, 2009) that will pursue a linked series of person-level treatment outcome analyses. We will combine multimethod (i.e., observational, parent-rated, self-rated, teacher-rated, official records) data from the four recent RCTs (cumulative N=876) that evaluate brief psychosocial treatments for adolescents with ADHD across a range of settings, interventions, and referral characteristics. Common across studies is a Baseline (BL)-Post Treatment (POST)-Follow up (FU) design and a standard battery was delivered across studies that includes core primary and secondary outcome measures (see Table 3). In the first months of Y01, Drs. Sibley & Coxe will work with Dr. Curran to create a harmonized data set. Following completion of the final database, the team will conduct a series of Latent Class Analyses, Mixture Models, and Structural Equation Models as outlined in the study aims. These analyses will identify treatment-related phenotypes and family-risk profiles using latent class analysis that organize the heterogeneous population into clinically meaningful subgroups. We will then examine questions of treatment moderation, such as whether latent classes predict treatment engagement (% of prescribed treatment course attended), and whether latent classes and adjunctive supports (i.e., medication, parent involvement style, school accommodations) predict treatment response trajectories on two primary outcomes (parent-rated ADHD symptoms and GPA). We will also examine whether there are treatment-level variables (time of year, setting of treatment, content of treatment) that moderate the relationship between phenotype and response. Finally, we will use structural equation modeling to identify key treatment mediators (i.e., teen organization skills, parent contingency management, parent-teen conflict, parental well-being) and to examine whether significance of mediators varies by phenotype, treatment-level variables, and parenting profile. We believe that pursuing personalized medicine questions for adolescents with ADHD could provide useful information that promotes improved treatment engagement and response— leading to meaningful changes in long-term outcome for individuals with ADHD, whose adult trajectory is highly related to experiences in adolescence (Barkley et al., 2008; Molina et al., 2012; Sibley et al., 2014). Treatment research for adolescents with ADHD lags behind research on treatments for children with ADHD. As a result, complex person-level and mediator x moderator analyses have not been conducted with this population— namely due to sample size limitations in extant studies.

项目摘要。在过去六年中，我们的团队进行了四项随机临床试验 对患有 ADHD 的青少年进行心理社会治疗，累计样本量为 876 名青少年（11 岁至 17； Sibley 等人，2016 年，正在审查、准备中、进行中），由 NIMH 资助（R34 MH092466， R01 MH106587), Institute of Education Sciences (R305A150433), and the Klingenstein Third Generation 基础。在当前提案中，我们概述了进行综合数据分析的计划（IDA；Curran & Hussong，2009）将进行一系列相互关联的个人层面的治疗结果分析。我们将结合 多方法（即观察、家长评分、自评、教师评分、官方记录）数据来自四个 最近的随机对照试验（累计 N=876）评估了患有 ADHD 的青少年的短期心理社会治疗 涵盖一系列环境、干预措施和转诊特征。跨研究的共同点是基线 (BL)-后处理 (POST)-后续 (FU) 设计和标准电池在研究中提供 包括核心主要和次要结果指标（见表 3）。在 Y01 的前几个月，博士。西布利 & Coxe 将与 Curran 博士合作创建一个统一的数据集。最终数据库完成后， 该团队将进行一系列潜在类别分析、混合模型和结构方程模型： 概述了研究目标。这些分析将确定与治疗相关的表型和家庭风险状况 使用潜在类别分析将异质人群组织成有临床意义的亚组。 然后我们将研究治疗适度的问题，例如潜在类别是否预测治疗 参与度（参加规定治疗课程的百分比），以及是否有潜在课程和辅助支持 （即药物、家长参与方式、学校住宿）预测治疗反应轨迹 两个主要结果（家长评价的 ADHD 症状和 GPA）。我们还将检查是否有 调节治疗水平变量（一年中的时间、治疗环境、治疗内容） 表型和反应之间的关系。最后，我们将使用结构方程模型来识别关键 治疗调解因素（即青少年组织技能、家长应急管理、家长与青少年冲突、 父母的福祉）并检查中介的重要性是否因表型、治疗水平而异 变量和育儿档案。我们相信，追求青少年的个性化医学问题 患有多动症的患者可以提供有用的信息，促进改善治疗参与和反应—— 导致多动症患者的长期结果发生有意义的变化，他们的成年轨迹高度变化 与青春期经历有关（Barkley et al., 2008; Molina et al., 2012; Sibley et al., 2014）。治疗 对患有多动症的青少年的研究落后于对患有多动症的儿童的治疗研究。因此， 尚未对这一人群进行复杂的个人层面和调解者 x 调解者分析—— 即由于现有研究中样本量的限制。