PRIMARY CARE--LAB FOR CLINICAL & BASIC RESEARCH ON ADHD

虽然我们对导致儿童注意力和学习问题的遗传和神经生物学因素的理解已经急剧增长，但多动症仍然是一个重要的公共卫生问题。它的高患病率，相关的和可变的发病率，以及频繁的慢性性，使得ADHD很难被单一的健康或精神健康提供者诊断和治疗。然而，多式联运和多学科护理费用昂贵，许多儿童可能无法获得这种护理，尽管实践标准要求这种护理。随着管理式护理的发展和特殊教育政策的变化，兴奋剂治疗多动症在北美的流行率急剧上升，同时从亚专科治疗转向主要由初级保健医生治疗。虽然经常提供心理测试、家长培训和学校咨询等社会心理服务，但尚不清楚兴奋剂治疗与这些社会心理服务相辅相成的频率。此外，尽管大多数ADHD治疗是在初级保健中提供的，但在初级保健机构中进行的关于ADHD的研究却很少。本提案的主要重点是实现以下目标：1)描述初级卫生保健机构提供的ADHD治疗的服务利用模式和有效性；2)开发和试点药物治疗和社会心理治疗，以改善初级保健机构的ADHD管理；3)建立初级保健的临床研究环境，为ADHD的临床试验和基因研究提供有代表性的样本。帮助将神经生物学和遗传学的进步与临床实践联系起来，最终目标是在通常的实践环境中提高ADHD治疗的有效性。Mark A. Stein在ADHD方面有着丰富的临床和研究经验。这项提议将使Mark Stein能够进一步发展他在初级保健环境中进行成本效益研究的技能，并保持他正在进行的关于ADHD病因、鉴别诊断和药物治疗的研究项目。在CNMC的支持下，候选人将指导来自心理学，精神病学，儿科和神经病学对ADHD研究感兴趣的初级教师。

While our understanding of the genetic and neurobiological factors that contribute to attention and learning problems in children has grown sharply, ADHD remains a significant public health concern. Its high prevalence, associated and variable morbidity, and frequent chronicity make ADHD difficult for a single health or mental health provider to diagnose and treat. However, multimodal and multidisciplinary care is expensive and may be unavailable for many children, despite standards of practice calling for such care. Coincident with the growth of managed care and changes in special education policies, the prevalence of stimulant treatment for ADHD in North America has increased dramatically, accompanied by a shift from subspecialist care to predominantly care by primary care physicians. Although psychosocial services such as psychological testing, parent training and school consultation are often available, it is unclear how often stimulant treatment is augmented or coordinated with these psychosocial services. Moreover, despite the fact that the majority of ADHD treatment is provided in primary care, very little research on ADHD is conducted in primary care settings. The primary focus of this proposal is to address the following goals: 1) describe the service utilization patterns and effectiveness of ADHD treatment provided in primary health-care settings; 2) develop and pilot pharmacotherapy and psychosocial treatments to improve ADHD management in primary care settings; and 3) develop clinical research settings in primary care to provide representative samples for clinical trials and genetic research on ADHD. Helping link advances in neurobiology and genetics with clinical practice, the ultimate goal is to increase the effectiveness of ADHD treatment in usual practice settings. Mark A. Stein has considerable clinical and research experience with ADHD. This proposal would enable Mark Stein to develop further his skills to conduct cost-effectiveness studies in primary care settings, and maintain his ongoing research program on the etiology, differential diagnosis, and pharmacological treatment of ADHD. With the support of CNMC, the candidate will mentor junior faculty from psychology, psychiatry, pediatrics, and neurology interested in ADHD research.