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) 的儿童会经历深刻、持续和 学术功能和长期进步严重受损，使得识别和评估 有效方法至关重要。因此，令人惊讶的是，很少有实证工作探索有效的方法。 与学习相关的干预方法。 该提案将调查常见学术住宿（加时、频繁 为注意力集中的儿童提供休息、低干扰环境和适应性家具） 缺陷/多动障碍（ADHD）以及课堂行为管理积极支持和 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 在标准教育环境中，针对患有多动症的儿童，将其相互结合起来。因此，在这个提议中 研究、常用学术住宿的有效性、行为支持干预措施，以及 药物治疗将在课堂环境中通过受试者内设计进行严格评估，并在良好的环境下进行。 夏季治疗计划环境中的受控条件。 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 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 名被诊断患有以下疾病的儿童（K-5 年级；四年中每年 72 名；每个地点 36 名） 多动症。在基线时，有关合并症的信息（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 注意力）将作为调节者进行测量和评估。然后，在主题内设计中，所有孩子都会 接受各个级别的行为改变调整（即没有积极的行为支持、积极的行为支持） 行为支持）、每个药物水平（即安慰剂、0.3 mg/kg 哌醋甲酯）以及每个水平 学术住宿（即延长时间、适应性家具、频繁休息、优先/低分心 座位与标准教室环境）。 关键成果的衡量将包括行为和学术功能的客观衡量。 其中包括对课堂行为（即任务行为）和学术生产力的观察 （即工作完成）在独立座位作业和小组指导环境中。

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.