Development of a Multifaceted Cognitive Training Program for Children with ADHD

描述(申请人提供)：经过数十年的ADHD干预研究，只有两种干预方法(即精神药理学、行为治疗)具有支持其对ADHD儿童疗效的“完善的”证据基础。这两种干预措施都有内在的局限性。最近的多项研究表明，认知训练可以改善ADHD儿童的神经心理和行为功能。认知训练的治疗效果与ADHD行为治疗的治疗效果相当(即，小到中等的效果大小)。现有认知训练计划可能会限制其有效性的一个限制是，每个计划都采用了单一的方法。每个干预计划都针对单个认知域(例如，工作记忆)。这是有问题的，因为作为一个群体，ADHD儿童有多个领域的认知缺陷(即工作记忆、注意力、反应抑制、延迟厌恶、个体内变异性)，因此单面干预无法解决ADHD儿童多方面的认知功能障碍。此外，由于ADHD患者每个人都有独特的认知缺陷模式，单面认知训练方法可能针对非缺陷区域，并根据他们的表意认知特征而遗漏个体患者显著缺陷的区域。拟议研究的主要目标是开发和测试一种多方面的认知训练干预措施，以解决与ADHD相关的一系列全面的认知缺陷，从而确保针对儿童独特的认知缺陷领域。在第一阶段(R21授权)，将开发软件和手册，包括针对反应抑制、言语工作记忆、注意力和延迟厌恶的四个培训任务。每项任务都会有不断提升的难度。在每一项任务中，孩子们将收到关于表现准确性以及反应时间的个体内变异性的反馈。该软件将在第一阶段进行试点测试，以确定性能阈值和干预持续时间。此外，还将进行焦点小组，以了解患者对每项任务的难度和兴趣水平的看法。在第二阶段(R33赠款)，将进行初步随机临床试验，以获得治疗效果的初步估计。将收集各种神经心理、行为和学术测量的前、后和后续结果。对结果的效应大小估计将用于指导未来多方面认知训练临床试验的样本量确定。

DESCRIPTION (provided by applicant): After decades of ADHD intervention research, only two intervention approaches (i.e., psychopharmacology, behavioral treatment) have a "well-established" evidence-base supporting their efficacy for children with ADHD. Both of these interventions have inherent limitations. Recently multiple studies have demonstrated that cognitive training may improve neuropsychological and behavioral functioning in children with ADHD. The magnitude of treatment effects for cognitive training has been comparable to treatment effects for behavioral treatment for ADHD (i.e., small to moderate effect sizes). A limitation of existing cognitive training programs that may limit their efficacy is that each has employed a unifaceted approach. Each intervention program has targeted a single cognitive domain (e.g., working memory). This is problematic since as a group, children with ADHD have multiple areas of cognitive deficit (i.e., working memory, attention, response inhibition, delay aversion, intra-individual variability) and thus a unifaceted intervention does not address the multifaceted array of cognitive dysfunction in children with ADHD. Also, because individuals with ADHD each have unique patterns of cognitive deficits, a unifaceted cognitive training approach may target areas which are non-deficient and miss areas of significant deficit in individual patients depending on their ideographic cognitive profile. The primary goal of the proposed research is to develop and test a multifaceted cognitive training intervention that addresses a comprehensive array of ADHD- related cognitive deficits thereby ensuring that children's unique areas of cognitive deficit are targeted. During Phase I (R21 grant), software and a manual will be developed consisting of four training tasks targeting response inhibition, verbal working memory, attention, and delay aversion. Each task will possess advancing levels of difficulty. On each task, children will receive feedback on performance accuracy as well as on intra-individual variability in reaction times. The software will be pilot tested in Phase I to determine performance thresholds and intervention duration. Also, focus groups will be conducted to obtain patient perceptions of each task's difficulty and interest level. In Phase II (R33 grant), a preliminary randomized clinical trial will be conducted in order to obtain initial estimates of treatment efficacy. Pre-, post-, and follow up outcomes will be collected on a wide range of neuropsychological, behavioral, and academic measures. Effect size estimates across outcomes will be used to guide sample size determinations for future clinical trials of multifaceted cognitive training.