A Novel Multimodal Intervention for Children with ADHD and Impaired Mood

描述（由申请人提供）：越来越多的人认识到，许多患有ADHD的儿童表现出抑郁和躁狂样症状，这些症状会在几个功能领域产生实质性的损害。ADHD儿童的这些情绪症状的诊断和预后意义已经成为一个主要的临床争议，一些人认为它们是早发性双相情感障碍（BP）的证据。我们的初步工作发现，这些儿童比那些没有并发症的多动症的儿童更容易受损，患抑郁症和BP的风险更高，家族性情绪障碍的发生率更高，对传统的多动症治疗有积极的反应，但需要额外的治疗来达到最佳功能。ADHD合并情绪障碍（AIM）儿童的药物管理是一个临床难题，因为对有躁狂症状的儿童使用兴奋剂的安全性知之甚少，而且很难证明在没有明显躁狂发作的儿童中使用情绪稳定剂或抗精神病药物是合理的。心理社会干预对患有AIM的儿童尤其有希望，因为它们得到了充分的研究，儿科治疗几乎没有情绪症状恶化的风险。一种针对多动症和情绪症状的心理治疗，同时同时解决父母的情感症状，可以与药物结合使用，并且易于对儿童和家庭实施，这将是AIM的理想治疗方法。我们建议开发一种综合的社会心理治疗方法，将ADHD的行为矫正方案与儿童和成人情绪障碍的认知行为和心理教育技术相结合。这种新疗法结合兴奋剂药物将与标准ADHD治疗（兴奋剂）在控制环境下对ADHD和情绪受损（AIM）的儿童进行比较。本研究还将评估兴奋剂对情绪不稳定青年的疗效和耐受性。这种新疗法具有巨大的公共卫生效益，因为它将是第一个系统地针对多动症儿童的内化和外化症状的疗法，也是为数不多的针对可能患有双相情感障碍的儿童的多模式干预研究之一。该结果旨在为ADHD和BP儿童多模式干预的发展以及ADHD青少年早发性情绪症状的长期结果提供初步调查。

DESCRIPTION (provided by applicant): There has been increasing recognition that many children with ADHD exhibit depressive and manic-like symptoms that produce substantial impairment across several functional domains. The diagnostic and prognostic implications of these mood symptoms in ADHD children have become a major clinical controversy, with some considering them to be evidence of early onset Bipolar Disorder (BP). Our preliminary work has found that these children are more impaired than those with uncomplicated ADHD, at increased risk for developing depression and BP, have elevated rates of familial mood disorders and respond positively to traditional ADHD treatments but need additional treatments to achieve optimal functioning. The pharmacological management of children with ADHD plus impairments in mood (AIM) is a clinical dilemma as little is known about the safety of stimulants in children with manic symptoms, and it is difficult to justify the use of mood stabilizers or antipsychotics in children without clear manic episodes. Psychosocial interventions hold particular promise for children with AIM as they are well studied, pediatric treatments with little risk of worsening mood symptoms. A psychosocial treatment that targets ADHD and mood symptoms, while conjointly addressing affective symptoms in the parents, can be combined with medications and easily administered to children and families would be an ideal treatment for AIM. We propose to develop an integrative psychosocial treatment that combines aspects of behavior modification programs for ADHD with cognitive-behavioral and psychoeducation techniques for pediatric and adult mood disorders. This novel therapy combined with stimulant medication will be compared to standard ADHD treatment (stimulants) under controlled settings in children with ADHD and impaired mood (AIM). This study will also assess the efficacy and tolerability of stimulants in mood labile youth. The novel therapy holds substantial public health benefit as it will be the one the first to systematically target both internalizing and externalizing symptoms in children with ADHD and represents one of the few multimodal intervention studies for children with possible bipolar spectrum illness. The results are intended to serve as preliminary investigations into the development of multimodal interventions for children with ADHD and BP and the long term outcomes of ADHD youth with early onset mood symptoms.