2/2-Multisite Study of School Based Treatment Approaches for ADHD Adolescents

描述（由申请人提供）：本研究的长期目标是确定将像挑战视野计划（CHP）这样的治疗项目添加到社区中患有ADHD的青少年服务中的价值。对于患有多动症的青少年，仍然缺乏有效的心理治疗数据。这是有问题的，因为对于大多数青少年来说，药物作为唯一的治疗形式是不够的，而青春期是ADHD相关损害变得越来越危险、改变生活和严重的时期。具体而言，本研究旨在：1)评估CHP的课后项目模式和咨询模式与社区护理相比的效果；2)估计两种服务水平的成本效益比；3)确定两种CHP干预模式治疗反应的调节因子和中介因子。此外，研究结果应该为治疗决策提供信息，以确定哪些儿童需要哪种级别的护理。治疗服务可以通过课后计划（CHP- as）或由学校雇用的教师提供，这些教师接受过培训，并就卫生防护方法提供持续咨询。在5年多的时间里，将在两个地点的7所中学招募315名符合ADHD标准的参与者，并随机分配接受CHP-AS、CHP-C或社区护理。将衡量为所有三种情况提供服务的成本以及症状和损害结果。数据收集将在儿童参与项目的学年期间持续进行。此外，将在基线、治疗后立即和治疗后6个月进行正式评估。与初步研究的结果一致，预计对两种积极治疗条件的反应将因参与者而异。将收集评估，确定治疗反应的潜在调节因素和中介因素，这些将被纳入分析，以确定可能预测治疗反应的儿童和家长特征，以及预测治疗反应的与治疗过程相关的变量（例如，出勤率）。

DESCRIPTION (provided by applicant): The long term objective of this study is to determine the value of adding treatment programs like the Challenging Horizons Program (CHP) to the services available to youth with ADHD in a community. There continues to be a lack of data on effective psychosocial treatments for adolescents with ADHD. This is problematic, as medication is inadequate for most youth as a sole form of treatment and adolescence is a time where the impairment associated with ADHD becomes increasingly dangerous, life-altering, and serious. Specifically, this study aims to: 1) Evaluate the efficacy of the after-school program model and the consultation model of CHP as compared to each other and as compared to community care, 2) Estimate cost-effectiveness ratios for each of the two levels of services, and 3) Identify moderators and mediators of treatment response for the two CHP intervention models. In addition, the findings should inform treatment decisions about which children need which level of care. Treatment services are delivered either through an after-school program (CHP-AS) or through teachers employed by the school who are trained and provided with ongoing consultation on the CHP methods (CHP-C). Over five years 315 participants who meet criteria for ADHD will be recruited at seven middle schools across two sites and randomly assigned to receive either the CHP-AS, CHP-C or community care. Costs of providing the services for all three conditions will be measured as well as symptom and impairment outcomes. Data collection will occur on an ongoing basis over the academic year of a child's participation in the project. In addition, formal evaluations will occur at baseline, immediately post-treatment, and 6 months post-treatment. Consistent with findings from preliminary studies it is expected that response to both active treatment conditions will vary across participants. Assessments will be collected that identify potential moderators and mediators of treatment response and these will be included in the analyses in order to identify child and parent characteristics that may predict response to treatment as well as variables related to the treatment process (e.g., attendance) that predicts response. PUBLIC HEALTH RELEVANCE: The lack of adequate treatments for youth with problems related to substance use, automobile accidents, school failure and other difficulties associated with adolescents with ADHD presents a serious public health problem. This study evaluates the effectiveness and cost associated with two emerging comprehensive treatment options for youth and identifies characteristics of the teens (moderators) and the treatment (mediators) that predict positive outcomes. The development of a cost-effective treatment for young adolescents with ADHD that can be integrated into schools and the community will provide invaluable assistance to the public health field and address problems across multiple sectors of public well being.