Single and Combined Effects of Positive Behavior Support, Medication and Academic Accommodation for Children with ADHD

患有注意力缺陷/多动障碍(ADHD)的儿童经历深刻、持续和 严重的学术功能障碍和长期进步，做出识别和评估 有效的方法至关重要。因此，令人惊讶的是，如此少的实证工作探索出了有效的 与学习相关的干预方法。 这项提案将调查普通学习住宿(额外时间，频繁 休息时间、低分心环境和适应性家具)为儿童提供注意力- 缺陷/多动障碍(ADHD)以及课堂行为管理的积极支持和 药物治疗。目前还没有一项严格的试验单独调查这些干预措施 在标准的教育环境中，为ADHD儿童相互结合。因此，在这项提议中， 研究，常用的学术住宿，行为支持干预的有效性，以及 药物治疗将在受试者内部设计的课堂环境下进行严格的评估- 夏季治疗程序设置中的受控条件。 该项目的具体目标包括对行为的单一和综合影响的评估 支持、用药和学术住宿。此外，儿童特征的调节作用 将探索使用标准诊断程序以及基线神经认知功能。 参与者将是288名儿童(K-5年级；四年内每年72名；每个站点36名)，被诊断为 多动症。在基线上，关于共病的信息(具体的学习障碍、破坏性行为障碍)和 神经认知障碍(加工速度、工作记忆、反应时变异性、抑制控制和 注意力)将作为主持人进行衡量和评估。然后，在主体内的设计中，所有的孩子都将 接收每个级别的行为改变调节(即，没有积极的行为支持、积极的 行为支持)，每一水平的药物(即，安慰剂，0.3毫克/公斤的哌醋甲酯)和每一水平的 学术住宿(例如，延长的时间、适应性家具、频繁的休息、优先/低分心 座位与标准教室环境的对比)。 对关键结果的衡量将包括对行为和学习功能的客观衡量。 这包括对课堂行为的观察(即任务中的行为)和学习效率 (即工作完成)在独立座椅和小组指示设置中。

Children with attention-deficit/hyperactivity disorder (ADHD) experience profound, sustained, and severe impairments in academic functioning and long-term progress, making the identification and evaluation of effective approaches critical. Therefore, it is surprising that such little empirical work has explored effective intervention approaches related to learning. This proposal will investigate the efficacy of common academic accommodations (extra time, frequent breaks, low-distraction environment, and adaptive furniture) provided for children with attention- deficit/hyperactivity disorder (ADHD) as well as classroom behavior management positive supports and medication. There has not yet been a rigorous trial that investigates these interventions alone and in combination with one another for children with ADHD in standard educational settings. Thus, in this proposed study, the efficacy of commonly employed academic accommodations, behavioral support interventions, and medication will be rigorously evaluated in a within-subject design in a classroom setting conducted under well- controlled conditions in a summer treatment program setting. Specific aims for the project include an evaluation of the single and combined effects of behavioral supports, medication, and academic accommodations. Further, the moderating effect of child characteristics using standard diagnostic procedures as well as baseline neurocognitive functioning will be explored. Participants will be 288 children (grades K-5; 72 per year for four years; 36 per site), diagnosed with ADHD. At baseline, information on comorbidities (specific learning disability, disruptive behavior disorder) and neurocognitive impairments (processing speed, working memory, reaction time variability, inhibitory control and attention) will be measured and evaluated as moderators. Then, in a within-subject design, all children will receive each level of the behavior modification accommodations (i.e., no positive behavioral supports, positive behavioral supports), each level of medication (i.e., placebo, .3 mg/kg methylphenidate) and each level of the academic accommodations (i.e., extended time, adaptive furniture, frequent breaks, preferential/low distraction seating vs. a standard classroom environment). Measures of key outcome will include objective measures of behavioral and academic functioning. These include observations of behavior in the classroom (i.e., on-task behavior) and academic productivity (i.e., work completion) in independent seatwork and group instruction settings.