Integrated Multi-Setting Psychosocial Treatment for ADHD-Inattentive Type

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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.