ADHD Treatment:Comparative and Combined Dosage Effects

描述（由申请人提供）：许多研究已经检查了 精神兴奋剂药物和行为矫正短期疗效 (the两种循证疗法）治疗ADHD，但 已经注意到两种治疗的急性效应的不一致性，导致 这两种方法结合起来的广泛使用。但 联合治疗方法尚未得到广泛研究， 短期或长期评估。关于ADHD的许多关键问题 治疗尚未解决。一个尚未解决的主要问题是， 行为和药物治疗剂量及其组合 影响比较疗效研究的结果。的一个主要 联合治疗的支持者提出的支持论点是， 联合治疗能够使用较低剂量的药物， 相对于单一模式治疗的强化行为治疗;然而， 这一概念尚未在一项对照良好的试验中进行实证研究。的 拟议研究的目的是审查的相对影响， 不同剂量的行为（无，低，高）和 通过评估药物治疗（pl，.3mg/kg和.6mg/kg）对ADHD的影响， 在一个受控的夏季项目设置中，它们的单独和综合影响。的 以下具体目标是解决：1）联合治疗是否有 超越其组成部分的增量功效，并回答这个问题 问题随行为治疗的剂量/强度和剂量而变化 2）问题1的答案是否取决于功能领域 (e.g.,同伴关系，学术功能，破坏性行为， 与成人的互动）; 3）问题I的答案是否取决于 评估效果的设置（即，娱乐场所， 教室设置，家庭/家庭设置）; 4）个体差异如何 变量（即，年龄性别、损伤严重程度、共病儿童诊断， 家庭和父母特征）影响对问题的回答 5）不同强度的行为， 药物治疗和家长、教师和辅导员的联合治疗 影响，压力，努力和对治疗的满意度？这些问题将 在对144名ADHD儿童进行的一项受试者内调查中， 5岁和12岁，每个孩子都接受所有条件。我们将 在夏季采用各种有效的生态措施 治疗方案设置已得到充分研究， 行为和药物治疗，并允许精确的治疗 忠诚和客观的结果。治疗效果将在以下两个时间点进行分析： 组和儿童水平。

DESCRIPTION (provided by applicant): Numerous studies have examined the short-term efficacy of psychostimulant medication and behavior modification (the two evidence-based treatments) in the treatment of ADHD, but insufficiencies in acute effects of both treatments have been noted, leading to the widespread use of the combination of the two approaches. However, the combined approach to treatment has not yet been extensively studied in either short- or long-term evaluations. Numerous critical issues regarding ADHD treatment remain unresolved. A primary unresolved issue is how the intensity or dose of behavioral and pharmacological treatments and their combination influence the results of comparative efficacy studies. One of the major supporting arguments that proponents of combined treatments have made is that combining treatments enables the use of lower doses of medication and less intensive behavioral treatment relative to unimodal treatments; however, this concept has not been empirically studied in a well-controlled trial. The purpose of the proposed study is to examine the relative effects of and interactions between different doses of behavioral (none, low, and high) and pharmacological treatments (pl, .3mg/kg, and .6mg/kg) for ADHD by evaluating their separate and combined effects in a controlled summer program setting. The following specific aims are addressed: 1) Do combined treatments have incremental efficacy beyond their components, and does the answer to this question vary with the dose/intensity of the behavioral treatment and the dose of medication; 2) Do the answers to question 1 depend on domain of functioning (e.g., peer relationships, academic functioning, disruptive behavior, interactions with adults); 3) Do the answers to question I depend on the setting in which effects are assessed (i.e., recreational settings with peers, classroom settings, home/family settings); 4) How do individual difference variables (i.e., age. gender, severity of impairment, comorbid child diagnoses, family and parent characteristics) influence the answers to questions addressed above and; 5) What are the impacts of different intensities of behavioral, pharmacological, and combined treatments on parent, teacher, and counselor affect, stress, effort, and satisfaction with treatment? These questions will be answered in a within-subject investigation with 144 ADHD children between the ages of 5 and 12 in which each child receives all conditions. We will employ a variety of ecologically valid measures of functioning in a summer treatment program setting that has been well studied with respect to both behavioral and pharmacological treatments and allows precise of treatment fidelity and objective outcomes. Treatment effects will be analyzed at both the group and child level.