The following project is a supplement to the funded application """"""""ADHD Treatment: Comparative and Combined Dosage Effects (1 RO1 MH62946 01A1)."""""""" The parent grant funds an investigation of behavioral, stimulant, and combined treatment for ADHD. This supplement allows for the collection of normative information. Normalization of functioning has become an important yardstick in evaluating clinically meaningful and socially valid treatment results. By contrasting ADHD and comparison children we will be able to evaluate normalization effects of the three interventions in the parent grant-behavioral, stimulant, and combined treatments. We will also validate two measures of impairment within the context of the treatment study. No scale has been developed that is clinically useful and cost-effective for the regular repetitions required in measuring target outcomes in impairment and its reciprocal-adaptive functioning, We propose to evaluate in the context of the parent treatment study two measures of impairment for assessing treatment outcome: (1) the Impairment Rating Scale measures problems in daily life functioning and need for treatment as rated by parents, teachers, and clinicians across functional domains; and (2) the Functional Improvement Ratings (FIR) are domain specific clinical global impressionof improvement (CGI-I) in the child's functional impairments, competencies, and skills. The validity of these two ratings as indices of treatment effects will be investigated within the parent grant in which treatments will be manipulated and measured across multiple settings, domains, and sources. The following specific aims will be addressed: Do behavioral interventions, stimulant medication, and combinations of the two normalize functioning of ADHD children? Are cost effective measures of impairment sensitive to treatment effects (i.e., varying intensities and combinations of behavior modification and stimulant medication), and does sensitivity depend on the domain of impairment or the setting in which symptoms/ impairment is measured (e.g., recreational, classroom, and home settings) or individual differences (e.g., age)? Do measures of impairment offer unique variance in measuring treatment outcome above measures of DSM symptoms when normalized functioning is the gold standard?
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