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

注意力缺陷/多动障碍（ADHD）儿童经历深刻的，持续的， 严重损害的学术功能和长期的进步，使识别和评估 有效的方法至关重要。因此，令人惊讶的是，如此少的实证工作已经探索了有效的 与学习有关的干预措施。 本提案将调查常见的学术住宿（额外时间，频繁 休息，低分心的环境，和自适应家具）提供的儿童与注意- 缺陷/多动障碍（ADHD）以及课堂行为管理的积极支持， 药目前还没有一个严格的试验，调查这些干预措施单独和 在标准的教育环境中，对患有ADHD的儿童进行相互结合。因此，在本提议中， 研究，常用的学术住宿，行为支持干预措施， 药物治疗将在一个良好的课堂环境下进行的主题内设计进行严格评估， 在夏季治疗方案设置中的受控条件。 该项目的具体目标包括评估行为的单一和综合影响， 支持、药物和学术住宿。此外，儿童特征的调节作用 使用标准诊断程序以及基线神经认知功能将被探索。 参与者将是288名儿童（K-5级;每年72名，持续4年;每个研究中心36名），诊断为 多动症。基线时，共病信息（特定学习障碍、破坏性行为障碍）和 神经认知障碍（处理速度、工作记忆、反应时间变异性、抑制控制和 注意）将作为主持人进行测量和评估。然后，在受试者内设计中，所有儿童都将 接收行为修正调节的每个级别（即，没有积极的行为支持，积极的 行为支持），每种药物水平（即，3 mg/kg哌醋甲酯）和每种水平的 学术住宿（即，延长时间，适应性家具，频繁休息，优先/低分心 标准教室环境）。 关键结果的测量将包括行为和学术功能的客观测量。 这些包括对课堂行为的观察（即，任务行为）和学术生产力 (i.e.,工作完成）在独立的座位和小组指令设置。

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.