Behavior Modification and Young ADHD Children

描述（由申请人提供）：十年来，接受精神兴奋剂药物治疗ADHD的儿童人数急剧增加。虽然也是一种循证治疗，但行为矫正并不被广泛推荐。主要的问题是，是否所有服用药物的儿童都需要药物，如果首先采用行为治疗，是否可以减少这种需求，以及所需剂量是否随行为治疗的存在和强度而变化。在一项正在进行的NIMH研究中，我们正在检查不同剂量的行为（无，低和高）和药理学（pl，.15，.3和.6 mg/kg MPH t.i.d.）通过在受控夏季计划（STP）中评估ADHD儿童的单独和联合治疗效果。我们的初步结果（1/3的Ss）表明，根据同时进行的行为治疗，MPH的平均每日总剂量可从60 mg降至10-20 mg。随后学年的随访表明，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，特别是在幼儿和日益关注的长期副作用和缺乏有益的长期影响，这些发现可能具有很大的公共卫生重要性。目前的应用程序旨在将我们的功效研究结果扩展到常规学校环境。我们选择专注于早期的学校，在尚未接受ADHD药物治疗的儿童样本中，检查持续的行为治疗是否可以减少这些儿童对药物的需求。儿童将开始研究，在他们的常规家庭和学校环境中分配无、低或高行为矫正条件。儿童的功能将每周进行评估，当功能恶化到预定义的水平时，药物将被添加到他们的治疗方案中。由于ADHD的治疗必须是慢性的，治疗将在指定的水平上持续3年，治疗结束时随访1年。除了目前的功能，主要的依赖措施将是生存时间的长度没有药物，药物剂量作为行为治疗水平的函数，和治疗费用。个别差异，包括儿童，家庭和教师的特点将被检查。

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.