Integrated Multi-Setting Psychosocial Treatment for ADHD-Inattentive Type

描述（由申请人提供）：注意缺陷多动障碍-主要注意力不集中型（ADHD-I）是一种高度普遍和严重的儿童精神障碍[有证据表明损害是严重和持续的]。ADHD-I型儿童有注意力缺陷、共病障碍、社交障碍和神经认知功能障碍，与ADHD-C型儿童不同。这些差异的程度排除了简单的假设，即ADHD-C的治疗结果可以推广到ADHD-I。通过R21治疗发展基金的资助，我们开发了一种新的ADHD-I心理社会治疗方法（综合多环境心理社会治疗-IPT）。IPT结合了ADHD的标准行为治疗（家长培训），该方法已被应用于ADHD- i，儿童生活技能培训（来自康复医学的支持性策略）和教师咨询。作为R21的一部分，我们进行了一项小规模的随机对照试验，将IPT与未治疗的对照组进行比较，并证明了(a) IPT对注意力不集中、学业和社交障碍的显著治疗效果，以及(b)该模型的可行性和可接受性。这些积极的结果证明了目前的应用，其目的是提供一个双站点，IPT的随机临床试验。我们将把[210]名7-11岁（2 -5年级）的ADHD-I儿童随机分配到IPT （[N=78]）、以家长为中心的训练（PFT, [N=78]）或照常治疗TAU （[N=54]）。RCT的目的是测试IPT与标准社区治疗（TAU）相比，是否能更好地减轻家长和老师评定的DSM-IV注意力不集中症状（主要终点）；以及[PFT]，这是一种积极的治疗方法，可以有效地减轻多动症的症状。我们将包括接受药物治疗和未接受药物治疗的儿童，并将从广泛的诊所和学校招募人员，以符合我们提高普遍性的目标。二级分析将评估干预在多个障碍领域的影响，包括学业和社会功能，以及在标准临床任务中观察到的注意力和育儿的客观测量，以及基于课程的学业成就测量。我们预测，与TAU相比，IPT的ADHD-I症状会显著降低，其次，学术和社会功能会显著提高。我们假设，相对于[PFT]， IPT组的ADHD-I症状会显著降低，其次，学术和社会功能会显著提高。我们还将在随访[5-7]个月时检查治疗效果的持久性。我们预测，在随访中，相对于其他组，IPT组的ADHD-I症状将保持最低，学术/社会功能将保持最高。注意缺陷/多动障碍，主要是注意力不集中型，是一种普遍和严重的儿童精神障碍，严重和持续地影响儿童在学校、家庭和与同龄人的功能。本研究旨在评估行为干预的有效性，整合学校，家庭和儿童技能组成部分，改善这些儿童的注意力症状和学业和社会功能。

DESCRIPTION (provided by applicant): Attention Deficit Hyperactivity Disorder-Predominantly Inattentive Type (ADHD-I) is a highly prevalent and serious childhood psychiatric disorder [with evidence that impairment is severe and persistent]. Children with ADHD-I have a profile of attention deficits, comorbid disorders, social impairments, and neurocognitive dysfunction that differs from that associated with ADHD-Combined Type (ADHD-C). The extent of these differences precludes straightforward assumptions that treatment outcome findings for ADHD-C can be generalized to ADHD-I. Through funding from an R21 Treatment Development grant, we have developed a novel psychosocial treatment (Integrated Multi-Setting Psychosocial Treatment--IPT) for ADHD-I. IPT combines a standard behavioral treatment for ADHD (parent training) that has been adapted for ADHD-I, with child life skills training (supportive strategies drawn from rehabilitation medicine) and with teacher consultation. As part of the R21, we conducted a small-scale randomized controlled trial comparing IPT to an untreated control group and demonstrated (a) significant treatment effects on inattention, and academic and social impairment, and (b) feasibility and acceptability of the model. These positive outcomes justify the current application, which aims to provide a dual-site, randomized clinical trial of IPT. We will randomize [210] children with ADHD-I ages 7-11 (2nd-5th grades) to IPT ([N=78]), Parent-Focused Training (PFT, [N=78]), or Treatment as Usual, TAU ([N=54]). The goal of the RCT is to test whether IPT provides superior reduction of DSM-IV inattention symptoms as rated by parents and teachers (the primary endpoint), in comparison to standard community treatment, TAU; and to [PFT], which constitutes an active treatment that is effective at reducing symptoms of ADHD. We will include medicated and unmedicated children and will recruit from a broad array of clinics and schools, consistent with our goal of increasing generalizability. Secondary analyses will evaluate the effects of the intervention across multiple domains of impairment including academic and social functioning and on objective measures of attention and parenting derived from observations during standard clinic-based tasks, and on curriculum-based measures of academic achievement. We predict that ADHD-I symptoms will be significantly lower and, secondarily, that academic and social functioning will be significantly higher, in IPT relative to TAU]. We hypothesize that ADHD-I symptoms will be significantly lower and, secondarily, that academic and social functioning will be significantly higher, in the IPT group relative to [PFT]. We will also examine the durability of treatment gains at [5-7] month follow-up. We predict that ADHD-I symptoms will remain lowest and academic/social functioning will remain highest in the IPT group relative to the other groups at follow-up. PUBLIC HEALTH RELEVANCE STATEMENT Attention-deficit\Hyperactivity Disorder, Predominantly Inattentive type is a prevalent and serious childhood psychiatric disorder which severely and persistently impacts a child's functioning at school, at home, and with peers. This study aims to evaluate the effectiveness of a behavioral intervention, integrating school, home and child skills components, for improving attentional symptoms and academic and social functioning in these children.