Integrated Brain, Body and Social Intervention for Attention Deficit Hyperactivity Disorder (ADHD)

NCT01542528 | Completed Results DMC

• 2 other identifiers: 11100009142R01HD070821
• Study Type: interventional
• Target: 117
• Locations: 2 countries
• Sites: 5

Brief Summary

The investigators are conducting this randomized trial to determine if IBBS (Integrated Brain, Body, and Social)intervention is an effective treatment for ADHD (attention Deficit Hyperactivity Disorder) in two culturally distinct settings; Hamden and New Haven, Connecticut and Beijing, China. A subgroup of the children in the US will also participate in an EEG study before and after IBBS and will be compared to a group of typically developing children. IBBS combines computer-presented brain exercises with a physical education curriculum, all of which is designed to be fun, as well as to enhance sustained attention, inhibitory control and other executive capacities. IBBS is a school-based program in which groups children (composed of children with ADHD, children at risk for ADHD, and typically developing children) alternate between a classroom setting and the gymnasium four days a week for 15 weeks. These mixed age groups will be composed of children with ADHD, children at-risk for ADHD, and typically developing children. Although IBBS takes place in a group setting, the computer game component individualizes instruction to maximize benefit for each child. During the last year of the grant, we will be introducing a pilot study of an organizational skills training (OST) that will provide individualized parent and child training for improved executive functioning in children randomized to the OST plus home-based program.

Conditions

Attention Deficit Hyperactivity Disorder (ADHD)

Keywords

ADHD; Executive function; Inhibitory control; Computer games; Sports activities; Good Behavior Game

Outcome Measures

Primary Outcomes (1)

• Improvement in ADHD Severity From Baseline to End of Intervention

  ADHD severity was measured by the Swanson, Nolan, and Pelham Rating Scale (SNAP)-IV-ADHD consists of 18 items that closely parallel in wording the diagnostic symptoms for ADHD as they appear in the DSM-IV. The range of scores are from 0 to 54. Higher scores indicate greater ADHD severity . The blinded assessors (Clinicians) used clinical judgement to provide an overall rating, based on all available information from the parents, teachers, and the assessors' own direct interactions with the child on the day of the assessment.

  End of intervention is at a maximum of 15 weeks from baseline.

Secondary Outcomes (1)

• Overall Improvement

  15 weeks for a total of 60 IBBS sessions vs. treatment as usual (TAU)

Study Arms (2)

IBBS

EXPERIMENTAL

Combination of computer-presented brain exercises with a physical education curriculum designed to enhance sustained attention, inhibitory control and other executive capacities. Groups of 10 students incorporating the Good Behavior Game. Two-hour sessions four days a week: classroom with computers (45-60 mins) plus sports activities in the gymnasium (45-60 mins) extending over a total 15 weeks (60 sessions).

Behavioral: IBBS

Treatment as Usual (TAU)

NO INTERVENTION

Whatever care arrangement the parents have arranged for their child during the same two hour period over the same 15 week period.

Interventions

IBBS BEHAVIORAL

Combination of computer-presented brain exercises with a physical education curriculum designed to enhance sustained attention, inhibitory control and other executive capacities. Groups of 10 students incorporating the Good Behavior Game. Two-hour sessions four days a week: classroom with computers (45-60 mins) plus sports activities in the gymnasium (45-60 mins) extending over a total 15 weeks (60 sessions).

IBBS

Eligibility Criteria

• Age: 5 Years - 10 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

You may qualify if:

• Boys and girls between 5 and 10 years of age, inclusive.
• Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV Diagnosis of ADHD (definite, probable, possible) based on a best estimate diagnosis using all available information.
• IQ of greater or equal to 80 on the Abbreviated IQ Test
• Currently not receiving any psychotropic medication or on a stable dose of medication prescribed for ADHD (psychostimulants, alpha agonists, atomoxetine, modafinil) for \> 4 weeks.

You may not qualify if:

• English is a secondary language
• Current DSM-IV diagnosis requiring alternative treatment, e.g., Major Depression, Bipolar Disorder, Autism Spectrum Disorder, or a psychotic disorder.
• Presence of serious behavioral problems (tantrums, aggression, self-injury) for which another treatment is warranted or which could be too disruptive of the group treatment settings.
• Significant medical condition or injury identified by school personnel (that would normally identify these issues such as the school nurse, physical education teacher, or child's primary pediatrician) that would prohibit or limit the child's ability to perform the physical activity component of the IBBS (e.g. uncontrolled asthma or a musculoskeletal injury or condition.)
• Any restrictions that have been previously identified by the child's pediatrician to school personnel will, of course, be followed.
• Children with conditions normally prohibiting exercise will be excluded.

Sponsors & Collaborators

• Yale University: lead
• Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): collaborator
• Hamden Public Schools, Connecticut: collaborator
• C8Sciences: collaborator
• BeCaid China: collaborator
• Peking University: collaborator
• Capital Medical University: collaborator
• Beijing Sport University: collaborator

Study Sites (5)

Hamden Public Schools

Hamden, Connecticut, 06517, United States

Location

Department of Psychiatry, Yale University

New Haven, Connecticut, 06520, United States

Location

Yale Child Study Center

New Haven, Connecticut, 06520, United States

Location

Capital Medical University

Beijing, Beijing Municipality, China

Location

Peking University

Beijing, Beijing Municipality, China

Location

Related Publications (22)

• Dovis S, Van der Oord S, Wiers RW, Prins PJ. Can motivation normalize working memory and task persistence in children with attention-deficit/hyperactivity disorder? The effects of money and computer-gaming. J Abnorm Child Psychol. 2012 Jul;40(5):669-81. doi: 10.1007/s10802-011-9601-8.

  PMID: 22187093 BACKGROUND

• Embry DD. The Good Behavior Game: a best practice candidate as a universal behavioral vaccine. Clin Child Fam Psychol Rev. 2002 Dec;5(4):273-97. doi: 10.1023/a:1020977107086.

  PMID: 12495270 BACKGROUND

• Fernandez A, Quintero J, Hornero R, Zuluaga P, Navas M, Gomez C, Escudero J, Garcia-Campos N, Biederman J, Ortiz T. Complexity analysis of spontaneous brain activity in attention-deficit/hyperactivity disorder: diagnostic implications. Biol Psychiatry. 2009 Apr 1;65(7):571-7. doi: 10.1016/j.biopsych.2008.10.046. Epub 2008 Dec 21.

  PMID: 19103438 BACKGROUND

• Gaub M, Carlson CL. Behavioral characteristics of DSM-IV ADHD subtypes in a school-based population. J Abnorm Child Psychol. 1997 Apr;25(2):103-11. doi: 10.1023/a:1025775311259.

  PMID: 9109027 BACKGROUND

• Ialongo NS, Werthamer L, Kellam SG, Brown CH, Wang S, Lin Y. Proximal impact of two first-grade preventive interventions on the early risk behaviors for later substance abuse, depression, and antisocial behavior. Am J Community Psychol. 1999 Oct;27(5):599-641. doi: 10.1023/A:1022137920532.

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• Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997 Jul;36(7):980-8. doi: 10.1097/00004583-199707000-00021.

  PMID: 9204677 BACKGROUND

• Klingberg T, Fernell E, Olesen PJ, Johnson M, Gustafsson P, Dahlstrom K, Gillberg CG, Forssberg H, Westerberg H. Computerized training of working memory in children with ADHD--a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry. 2005 Feb;44(2):177-86. doi: 10.1097/00004583-200502000-00010.

  PMID: 15689731 BACKGROUND

• Leckman JF, Sholomskas D, Thompson WD, Belanger A, Weissman MM. Best estimate of lifetime psychiatric diagnosis: a methodological study. Arch Gen Psychiatry. 1982 Aug;39(8):879-83. doi: 10.1001/archpsyc.1982.04290080001001.

  PMID: 7103676 BACKGROUND

• MTA Cooperative Group. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: changes in effectiveness and growth after the end of treatment. Pediatrics. 2004 Apr;113(4):762-9. doi: 10.1542/peds.113.4.762.

  PMID: 15060225 BACKGROUND

• MTA Cooperative Group. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Pediatrics. 2004 Apr;113(4):754-61. doi: 10.1542/peds.113.4.754.

  PMID: 15060224 BACKGROUND

• Northup J, Broussard C, Jones K, George T, Vollmer TR, Herring M. The differential effects of teacher and peer attention on the disruptive classroom behavior of three children with a diagnosis of attention deficit hyperactivity disorder. J Appl Behav Anal. 1995 Summer;28(2):227-8. doi: 10.1901/jaba.1995.28-227.

  PMID: 7601806 BACKGROUND

• Raggio DJ, Scattone D, May W. Relationship of the Kaufman Brief Intelligence Test-Second Edition and the Wechsler Abbreviated Scale of Intelligence in children referred for ADHD. Psychol Rep. 2010 Apr;106(2):513-8. doi: 10.2466/pr0.106.2.513-518.

  PMID: 20524553 BACKGROUND

• Robbins TW. Shifting and stopping: fronto-striatal substrates, neurochemical modulation and clinical implications. Philos Trans R Soc Lond B Biol Sci. 2007 May 29;362(1481):917-32. doi: 10.1098/rstb.2007.2097.

  PMID: 17412678 BACKGROUND

• Shalev L, Tsal Y, Mevorach C. Computerized progressive attentional training (CPAT) program: effective direct intervention for children with ADHD. Child Neuropsychol. 2007 Jul;13(4):382-8. doi: 10.1080/09297040600770787.

  PMID: 17564853 BACKGROUND

• Shaw P, Sharp WS, Morrison M, Eckstrand K, Greenstein DK, Clasen LS, Evans AC, Rapoport JL. Psychostimulant treatment and the developing cortex in attention deficit hyperactivity disorder. Am J Psychiatry. 2009 Jan;166(1):58-63. doi: 10.1176/appi.ajp.2008.08050781. Epub 2008 Sep 15.

  PMID: 18794206 BACKGROUND

• Swanson J, Lerner M, March J, Gresham FM. Assessment and intervention for attention-deficit/hyperactivity disorder in the schools. Lessons from the MTA study. Pediatr Clin North Am. 1999 Oct;46(5):993-1009. doi: 10.1016/s0031-3955(05)70168-1.

  PMID: 10570701 BACKGROUND

• van Lier PA, Muthen BO, van der Sar RM, Crijnen AA. Preventing disruptive behavior in elementary schoolchildren: impact of a universal classroom-based intervention. J Consult Clin Psychol. 2004 Jun;72(3):467-78. doi: 10.1037/0022-006X.72.3.467.

  PMID: 15279530 BACKGROUND

• Wexler BE, Anderson M, Fulbright RK, Gore JC. Preliminary evidence of improved verbal working memory performance and normalization of task-related frontal lobe activation in schizophrenia following cognitive exercises. Am J Psychiatry. 2000 Oct;157(10):1694-7. doi: 10.1176/appi.ajp.157.10.1694.

  PMID: 11007730 BACKGROUND

• Bikic A, Christensen TO, Leckman JF, Bilenberg N, Dalsgaard S. A double-blind randomized pilot trial comparing computerized cognitive exercises to Tetris in adolescents with attention-deficit/hyperactivity disorder. Nord J Psychiatry. 2017 Aug;71(6):455-464. doi: 10.1080/08039488.2017.1328070. Epub 2017 Jun 9.

  PMID: 28598701 BACKGROUND

• Li F, Zheng Y, Smith SD, Shic F, Moore CC, Zheng X, Qi Y, Liu Z, Leckman JF. A preliminary study of movement intensity during a Go/No-Go task and its association with ADHD outcomes and symptom severity. Child Adolesc Psychiatry Ment Health. 2016 Dec 12;10:47. doi: 10.1186/s13034-016-0135-2. eCollection 2016.

  PMID: 27999615 BACKGROUND

• Kennedy D. Performance on a computerized cognitive remediation of students with attention deficit hyperactivity disorder. A thesis submitted to Yale School of Medicine in partial fulfillment of the requirements for the degree of doctor of medicine. January, 2013.

  BACKGROUND

• Smith SD, Vitulano LA, Katsovich L, Li S, Moore C, Li F, Grantz H, Zheng X, Eicher V, Aktan Guloksuz S, Zheng Y, Dong J, Sukhodolsky DG, Leckman JF. A Randomized Controlled Trial of an Integrated Brain, Body, and Social Intervention for Children With ADHD. J Atten Disord. 2020 Mar;24(5):780-794. doi: 10.1177/1087054716647490. Epub 2016 May 13.

  PMID: 27178060 RESULT

Related Links

• website for company developing the computer programs to enhance cognitive development

MeSH Terms

Conditions

Attention Deficit Disorder with Hyperactivity

Condition Hierarchy (Ancestors)

Attention Deficit and Disruptive Behavior Disorders; Neurodevelopmental Disorders; Mental Disorders

Results Point of Contact

• Title: Dr. James Leckman
• Organization: Yale University

james.leckman@yale.edu

203-785-5880

Study Officials

• James Leckman, MD

  Yale University

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 23, 2012
• First Posted: March 2, 2012
• Study Start: March 1, 2012
• Primary Completion: July 1, 2016
• Study Completion: July 1, 2016
• Last Updated: January 17, 2018
• Results First Posted: September 25, 2017

Record last verified: 2018-01

Locations

US (3); CN (2)