Online Family Based Problem Solving after Pediatric Traumatic Brain Injury: The Moderating Effect of Attention Problems

 描述（由申请人提供）：候选人梅根·纳拉德博士目前是辛辛那提儿童医院医学中心物理医学和康复科的博士后研究员。Narad博士获得了博士学位。2014年，在辛辛那提大学的临床心理学上。她的职业目标是成为一名独立的临床研究人员，在学术医疗中心进行以患者为导向的研究。她在ADHD领域接受过重要的培训，并希望重新专注于儿科事业 创伤性脑损伤（TBI）。拟议的培训计划包括以下领域的目标：1）发展儿科TBI的神经认知后果和损伤的长期影响的先进知识和2）提高实验设计和统计分析技能，包括干预开发和研究的培训。她组建了一个指导团队和一套独特的培训经验，这将有助于她实现这些目标。Wade博士是一位成熟的研究人员，在儿科创伤性脑损伤以及干预开发和试验方面具有专业知识。Yeates博士是一位儿科神经心理学家，擅长儿科脑损伤后的长期行为，认知和社会后果。 最后，辛辛那提儿童医院医学中心的生物统计学家张南华博士同意担任该项目的统计学顾问。Zhang博士曾与Wade博士和Yeates博士合作过许多项目，包括当前申请中的试验。因此，他对数据集有深入的了解，并同意为申请人提供额外的统计培训和支持。拟议研究：遭受创伤性脑损伤的儿童在受伤后经常会遇到执行功能和注意力不集中的困难。此外，患有注意缺陷多动障碍（ADHD）的儿童 更严重的行为症状和功能障碍。以家庭为基础的问题解决（FBPS）已显示出在改善儿童TBI后的执行功能，外化行为和照顾者效能方面的有效性;然而，ADHD（无论是损伤前还是继发性）对治疗反应的影响尚未明确研究。除了父母行为训练外，很少有心理治疗可以改善ADHD儿童的症状或功能障碍。拟议的研究将检查ADHD，包括损伤前和二级注意力问题）作为治疗反应的调节剂。该项目将联合收割机来自Wade博士基于网络的FBPS干预的两项随机对照试验（研究1 n =132，研究2 n= 153）的数据集，并提供足以满足研究目标的样本量。首先，假设有注意力问题（无论是损伤前ADHD或继发性注意力问题）和TBI的儿童将表现出更大的功能障碍比那些单独的TBI。此外，假设注意力问题（包括损伤前ADHD和继发性注意力问题）将缓和治疗反应。根据文献，ADHD是一种表现缺陷，而不是技能缺陷，结合CBT在治疗儿童和青少年方面的有限有效性， 对于ADHD，假设有ADHD损伤前病史的青少年比TBI的青少年表现出较小的治疗效果。虽然以前的研究强调了CBT/问题解决干预在ADHD治疗中的局限性，但本研究中的FBPS干预解决了许多这些局限性;因此，损伤前ADHD患者可能表现出与单独TBI患者相同的改善。如果假设1是正确的，也有可能损伤前ADHD患者在治疗后表现出更大的改善，并且该亚组有更大的改善空间。此外，由于TBI后学习新技能与受伤害影响的康复技能有着根本的不同，而且可能更加困难，因此假设有次级注意力问题的儿童在治疗后会比那些有损伤前ADHD的儿童表现出更大的改善。

 DESCRIPTION (provided by applicant): The candidate, Dr. Megan Narad, is currently a post-doctoral fellow in the Division of Physical Medicine and Rehabilitation at Cincinnati Children's Hospital Medical Center. Dr. Narad received her Ph.D. in Clinical Psychology from the University of Cincinnati in 2014. Her career goal is to become an independent clinical researcher conducting patient-oriented research in an academic medical center. She has significant training in the area of ADHD, and is looking to re-specialize for a career in pediatric traumatic brain injury (TBI). The proposed training plan includes goals in the following domains: 1) Develop an advanced knowledge of the neurocognitive consequences of pediatric TBI and the long term impact of injury and 2) Improve experimental design and statistical analysis skills, including training in intervention development and research. She has put together a mentoring team and unique set of training experiences that will facilitate her achievement of these goals. Dr. Wade is a well-established researcher with expertise in pediatric traumatic brain injury as well as intervention development and trials. Dr. Yeates is a pediatric neuropsychologist with expertise in long term behavioral, cognitive, and social outcomes following pediatric brain injury. Finally, Dr. Nanhua Zhang is a biostatistician at Cincinnati Children's Hospital Medical Center and agreed to be a statistical consultant on the project. Dr. Zhang has worked with Drs. Wade and Yeates on a number of projects including the trials in the current application. Therefore he has advanced knowledge of the datasets, and has agreed to provide additional statistical training and support to the applicant. Proposed research: Children who sustain traumatic brain injuries often experience difficulties with executive functioning and inattention following their injury. Additionally, children with pre-injury Attention Deficit Hyperactivity Disorder (ADHD) have greater behavioral symptoms and functional impairments following their injury. Family-based problem solving (FBPS) has shown effectiveness in improving executive functioning, externalizing behaviors, and caregiver efficacy following childhood TBI; however the impact of ADHD, either pre-injury or secondary, on treatment response has not been explicitly studied. Few psychosocial treatments, aside from behavioral parent training, have been shown to improve symptoms or functional impairments for children with ADHD. The proposed research study will examine ADHD, both pre-injury and secondary attention problems) as a moderator of treatment response. The project will combine the datasets from two randomized controlled trials of Dr. Wade's web-based FBPS intervention (study 1 n =132, study 2 n= 153) and provides a sample size sufficient to address study aims. First, it is hypothesized that children with attentio problems (either pre-injury ADHD or secondary attention problems) and TBI will demonstrate greater functional impairments than those with TBI alone. Additionally, it is hypothesized that attention problems (both pre-injury ADHD and secondary attention problems) will moderate treatment response. Based on the literature that ADHD is a performance deficit rather than a skills deficit, combined with the limited effectiveness of CBT in treating children and adolescents with ADHD, it is hypothesized that teens with a pre-injury history of ADHD will demonstrate smaller treatment effects than those with TBI. While previous studies have highlighted the limitations of CBT/problem solving interventions in ADHD treatment, the FBPS intervention in the present study addresses many of these limitations; therefore it is possible that patients with pre-injury ADHD may demonstrate equivalent improvements to patients with TBI alone. It is also possible that patients with pre-injury ADHD may demonstrated greater improvement with treatment should hypothesis 1 be correct, and this sub-group has greater room for improvement. Further, because learning new skills after TBI is fundamental different, and possibly more difficult, than rehabilitating skills affected by injury, it is hypothesized that chidren with secondary attention problems will demonstrate greater improvements with treatment than those with pre-injury ADHD.