Behavior Modification and Young ADHD Children

描述(由申请人提供)：十年来，接受精神刺激药物治疗ADHD的儿童数量一直在急剧增加。虽然也是一种循证治疗，但行为矫正并没有得到广泛的推荐。主要问题是，是否所有服用药物的儿童都需要药物治疗，如果首先采用行为治疗，这种需要是否可以减少，以及所需剂量是否随着行为治疗的存在和强度而变化。在一项正在进行的由NIMH资助的研究中，我们正在研究不同剂量的行为(无、低和高)和药物(pl、.15、.3和.6 mg/kg mph tii.d)的相对影响和相互作用。通过在受控暑期计划(STP)中评估ADHD儿童的单独和联合效果来治疗ADHD儿童。我们的初步结果(1/3的SS)表明，根据同时进行的行为治疗，平均每天的MPH总剂量可以从60毫克减少到10-20毫克。随后学年的跟踪调查表明，如果首先提供行为干预，许多儿童在学校和家庭环境中都不需要药物治疗。鉴于最近社会对药物使用的关注，特别是在幼儿中，以及对长期副作用和缺乏有益的长期影响的日益关注，这些发现可能对公共卫生具有重大意义。目前的申请旨在将我们功效研究的结果推广到常规学校环境。我们选择将注意力集中在早期学习阶段，对尚未接受ADHD药物治疗的儿童进行抽样，检查正在进行的行为治疗是否可以减少这些儿童对药物的需求。孩子们将在正常的家庭和学校环境中开始这项研究，这些研究被分配到没有、低或高行为修正条件下。每周将对儿童的功能进行评估，当功能恶化到预定水平时，将在治疗方案中添加药物。由于ADHD的治疗必须是慢性的，治疗将继续在指定的水平上进行3年，并在治疗结束时进行1年的随访。除了目前的功能，主要的依赖指标将是在没有药物治疗的情况下存活的时间长度，药物剂量作为行为治疗水平的函数，以及治疗费用。包括儿童、家庭和教师特征在内的个体差异将被考察。

DESCRIPTION (provided by applicant): The number of children being treated with psychostimulant medication for ADHD has been increasing dramatically for a decade. Although also an evidence-based treatment, behavior modification is not as widely recommended. Primary questions are whether medication is needed by all of the children who take it, whether this need could be reduced if behavioral treatments were employed first, and whether the required dosage varies as a function of the presence of and intensity of behavioral treatments. In an ongoing funded NIMH study, we are examining the relative effects of and interactions between different doses of behavioral (none, low, and high) and pharmacological (pl, .15, .3, and .6 mg/kg MPH t.i.d.) treatments for ADHD children by evaluating their separate and combined effects in a controlled summer program (STP). Our preliminary results (1/3 of the Ss) suggest that average total daily dose of MPH can be reduced from 60 mg to 10-20 mg, depending on the concurrent behavioral treatment. Follow-up in the subsequent school year has shown that the need for medication in both the school and home settings is eliminated for many children if behavioral intervention is provided first. Given recent societal concerns about medication use especially in young children and growing concerns about long-term side effects and the absence of beneficial long-term effects, these findings may have great public health importance. The current application seeks to extend the results from our efficacy study to a regular school setting. We have chosen to concentrate on early school years, in a sample of children who are not yet medicated for ADHD, examining whether ongoing behavioral treatment can reduce the need for medication in those children. Children will begin the study assigned to no, low, or high behavior modification conditions in their regular home and school settings. Children's functioning will be assessed weekly, and medication will be added to their treatment regimen when functioning deteriorates to a predefined level. Because treatment for ADHD must be chronic, treatment will continue at the assigned level for a period of 3 years, with a 1-year follow up at the conclusion of treatment. Beyond current functioning, primary dependent measures will be the length of time survived without medication, medication dose as a function of behavioral treatment level, and costs of treatments. Individual differences including child, family, and teacher characteristics will be examined.