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ADHD儿童表现出抑郁和躁狂样症状，在几个功能领域产生实质性损害。这些情绪症状在ADHD儿童中的诊断和预后意义已成为一个主要的临床争议，有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，这些儿童比那些患有简单ADHD的儿童受损更严重，患抑郁症和BP的风险增加，家族性情绪障碍的发病率升高，对传统ADHD治疗反应积极，但需要额外的治疗才能实现最佳功能。ADHD伴心境障碍（AIM）儿童的药物管理是一个临床难题，因为对躁狂症状儿童使用兴奋剂的安全性知之甚少，并且难以证明在没有明确躁狂发作的儿童中使用心境稳定剂或抗精神病药的合理性。心理社会干预对AIM儿童特别有希望，因为它们已经得到了很好的研究，儿科治疗几乎没有情绪症状恶化的风险。一种针对ADHD和情绪症状的心理社会治疗，同时结合解决父母的情感症状，可以与药物结合，很容易给儿童和家庭使用，这将是AIM的理想治疗方法。我们建议开发一种综合性的心理社会治疗方法，将ADHD的行为矫正计划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。这种新的疗法与兴奋剂药物相结合，将在ADHD和情绪受损（AIM）儿童的受控环境下与标准ADHD治疗（兴奋剂）进行比较。这项研究还将评估兴奋剂在情绪不稳定青年中的疗效和耐受性。这种新型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ADHD儿童的内化和外化症状的疗法，并且是针对可能患有双相谱系疾病的儿童的少数多模式干预研究之一。这些结果旨在作为对ADHD和BP儿童多模式干预措施的发展以及ADHD青年早发情绪症状的长期结果的初步调查。

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.