Notice Number: NOT-MH-18-026
Release Date: March 5, 2018
National Institute of Mental Health (NIMH)
NIMH is issuing this Notice to highlight its interest in supporting projects that evaluate the preliminary effectiveness of augmented or modified interventions designed to promote sustained improvement in attention-deficit/hyperactivity disorder (ADHD) symptoms and functional impairments across settings and transitions. Specifically, NIMH is interested in supporting research that takes an empirically-informed, deployment-focused approach to the refinement and testing of interventions and intervention augmentations for ADHD in children, adolescents, and young adults. An emphasis is placed on trials that go beyond seeking incremental gains in intervention effects, and instead take a theory-driven, empirical approach to applying modifications that will have a significant and enduring impact on functioning.
The focus of this Notice stems from longitudinal research demonstrating that across the lifespan, individuals with ADHD remain significantly impaired relative to individuals without ADHD, regardless of interventions received during childhood or adolescence. While evidence-based treatments (EBTs) for ADHD exist, the majority are focused exclusively on elementary school-aged children, and existing evidence suggests intervention effects typically dissipate dramatically over time. The sustained use of interventions, and the maintenance of treatment gains, is hampered, in part, by a lack of interventions optimized for delivery across settings (e.g., home, academic, childcare, extracurricular, occupational) and key developmental transitions (e.g., elementary school to middle school, middle school to high school, high school to post-secondary education or employment). Modifiable factors associated with the sustained impact of ADHD interventions (i.e., intervention dose, duration, modality, sequence) and the long-term trajectory of ADHD symptoms and impairments (i.e., level of parental monitoring, academic performance, peer relationships, comorbid conditions) have been identified in the literature. However, few evidence-supported strategies exist for tailoring interventions across development based on these targets.
NIMH is interested in deployment-focused, investigator-initiated studies aimed at sustaining improvements in ADHD symptoms and impairments by targeting: 1) mediators and moderators of sustained treatment effects, 2) strategies that promote sustained adherence to interventions across settings and transitions, 3) empirically-informed adaptations of existing interventions that are matched to developmental stage, environmental demands, and the capabilities of the intervention agent (i.e., parent, teacher, individual with ADHD), 4) theoretically and empirically informed intervention enhancements that promote skill generalization, and 5) the treatment of residual symptoms, impairments, and comorbidities following the initial intervention phase. Novel applications of technology may be particularly useful in promoting sustained effects across each of these three areas.
The focus of this Notice is on the testing of intervention adaptations and refinements, and not on the development of novel interventions. However, the expectation is that all project data will be collected in a manner consistent with the mechanism-based, NIMH experimental therapeutics approach, whereby all effectiveness trials, including those that propose adaptations or augmentations, are designed to explicitly address whether the intervention engages the putative, proximal target(s)/mechanism(s) presumed to underlie intervention effects. Data from these trials will be shared via the NMH Data Archive and will be used to facilitate future novel intervention development efforts though the identification of new intervention targets. It is also expected that studies will be deployment-focused, with attention given to end-user perspectives and the characteristics of the settings in which the interventions will be provided, to ensure that the proposed approaches are acceptable, feasible, and scalable.
Investigators interested in the research specified by this Notice should apply to the NIMH R34 Funding Opportunity Announcement (FOA) entitled, “Pilot Effectiveness Trials for Post-Acute Interventions and Services to Optimize Longer-Term Outcomes” (PAR-18-431).
Please direct all inquiries to:
Mary Rooney, Ph.D., ABPP
National Institute of Mental Health (NIMH)