Online Family Based Problem Solving after Pediatric Traumatic Brain Injury: The Moderating Effect of Attention Problems

 描述(由申请人提供)：候选人Megan Narad博士目前是辛辛那提儿童医院医学中心物理医学和康复科的博士后研究员。纳拉德博士于2014年在辛辛那提大学获得临床心理学博士学位。她的职业目标是成为一名独立的临床研究员，在学术医学中心进行以患者为中心的研究。她在ADHD领域接受了大量的培训，并希望重新专攻儿科 创伤性脑损伤(TBI)。拟议的培训计划包括以下领域的目标：1)发展关于儿童脑外伤的神经认知后果和损伤的长期影响的高级知识，以及2)改进实验设计和统计分析技能，包括干预开发和研究方面的培训。她组建了一支指导团队和一套独特的培训经验，这将有助于她实现这些目标。韦德博士是一位在儿童创伤性脑损伤以及干预开发和试验方面拥有专业知识的知名研究员。叶茨医生是一位儿科神经心理学家，在儿科脑损伤后的长期行为、认知和社会后果方面拥有专业知识。 最后，张南华博士是辛辛那提儿童医院医学中心的生物统计学家，并同意担任该项目的统计顾问。张博士与韦德博士和叶芝博士在多个项目上进行了合作，包括目前申请中的试验。因此，他掌握了数据集的高级知识，并同意向申请者提供额外的统计培训和支持。建议的研究：遭受创伤性脑损伤的儿童通常在受伤后经历执行功能困难和注意力不集中。此外，受伤前患有注意力缺陷多动障碍(ADHD)的儿童 受伤后出现更严重的行为症状和功能障碍。基于家庭的问题解决(FBPS)在改善儿童脑损伤后的执行功能、外化行为和照顾者效能方面显示出有效性；然而，无论是伤前还是继发性ADHD对治疗反应的影响还没有明确的研究。除了父母行为训练之外，很少有心理社会治疗被证明能改善ADHD儿童的症状或功能障碍。这项拟议的研究将考察ADHD(包括伤害前和继发性注意问题)作为治疗反应的调节因素。该项目将结合韦德博士基于网络的FBPS干预的两个随机对照试验的数据集(研究1 n=132，研究2 n=153)，并提供足以满足研究目标的样本大小。首先，假设有注意力问题的儿童(无论是受伤前的ADHD或继发性注意力问题)和脑外伤儿童将表现出比单纯脑外伤儿童更大的功能障碍。此外，还假设注意力问题(伤害前的注意缺陷多动症和继发性注意力问题)会影响治疗反应。根据文献，ADHD是一种表现缺陷，而不是技能缺陷，再加上CBT治疗儿童和青少年的效果有限 对于ADHD，假设受伤前有ADHD病史的青少年表现出的治疗效果比那些患有脑损伤的青少年要小。虽然以前的研究强调了CBT/问题解决干预在ADHD治疗中的局限性，但本研究中的FBPS干预解决了许多这些限制；因此，损伤前ADHD患者可能表现出与单纯脑外伤患者相同的改善。也有可能，如果假设1是正确的，损伤前ADHD患者的治疗可能会显示出更大的改善，这一亚组有更大的改善空间。此外，由于脑外伤后学习新技能与恢复受损伤影响的技能是根本不同的，而且可能更困难，因此假设有继发性注意力问题的儿童在治疗后将比受伤前的ADHD儿童表现出更大的改善。

 DESCRIPTION (provided by applicant): The candidate, Dr. Megan Narad, is currently a post-doctoral fellow in the Division of Physical Medicine and Rehabilitation at Cincinnati Children's Hospital Medical Center. Dr. Narad received her Ph.D. in Clinical Psychology from the University of Cincinnati in 2014. Her career goal is to become an independent clinical researcher conducting patient-oriented research in an academic medical center. She has significant training in the area of ADHD, and is looking to re-specialize for a career in pediatric traumatic brain injury (TBI). The proposed training plan includes goals in the following domains: 1) Develop an advanced knowledge of the neurocognitive consequences of pediatric TBI and the long term impact of injury and 2) Improve experimental design and statistical analysis skills, including training in intervention development and research. She has put together a mentoring team and unique set of training experiences that will facilitate her achievement of these goals. Dr. Wade is a well-established researcher with expertise in pediatric traumatic brain injury as well as intervention development and trials. Dr. Yeates is a pediatric neuropsychologist with expertise in long term behavioral, cognitive, and social outcomes following pediatric brain injury. Finally, Dr. Nanhua Zhang is a biostatistician at Cincinnati Children's Hospital Medical Center and agreed to be a statistical consultant on the project. Dr. Zhang has worked with Drs. Wade and Yeates on a number of projects including the trials in the current application. Therefore he has advanced knowledge of the datasets, and has agreed to provide additional statistical training and support to the applicant. Proposed research: Children who sustain traumatic brain injuries often experience difficulties with executive functioning and inattention following their injury. Additionally, children with pre-injury Attention Deficit Hyperactivity Disorder (ADHD) have greater behavioral symptoms and functional impairments following their injury. Family-based problem solving (FBPS) has shown effectiveness in improving executive functioning, externalizing behaviors, and caregiver efficacy following childhood TBI; however the impact of ADHD, either pre-injury or secondary, on treatment response has not been explicitly studied. Few psychosocial treatments, aside from behavioral parent training, have been shown to improve symptoms or functional impairments for children with ADHD. The proposed research study will examine ADHD, both pre-injury and secondary attention problems) as a moderator of treatment response. The project will combine the datasets from two randomized controlled trials of Dr. Wade's web-based FBPS intervention (study 1 n =132, study 2 n= 153) and provides a sample size sufficient to address study aims. First, it is hypothesized that children with attentio problems (either pre-injury ADHD or secondary attention problems) and TBI will demonstrate greater functional impairments than those with TBI alone. Additionally, it is hypothesized that attention problems (both pre-injury ADHD and secondary attention problems) will moderate treatment response. Based on the literature that ADHD is a performance deficit rather than a skills deficit, combined with the limited effectiveness of CBT in treating children and adolescents with ADHD, it is hypothesized that teens with a pre-injury history of ADHD will demonstrate smaller treatment effects than those with TBI. While previous studies have highlighted the limitations of CBT/problem solving interventions in ADHD treatment, the FBPS intervention in the present study addresses many of these limitations; therefore it is possible that patients with pre-injury ADHD may demonstrate equivalent improvements to patients with TBI alone. It is also possible that patients with pre-injury ADHD may demonstrated greater improvement with treatment should hypothesis 1 be correct, and this sub-group has greater room for improvement. Further, because learning new skills after TBI is fundamental different, and possibly more difficult, than rehabilitating skills affected by injury, it is hypothesized that chidren with secondary attention problems will demonstrate greater improvements with treatment than those with pre-injury ADHD.