The Pittsburgh ADHD Longitudinal Study: Predicting alcohol misuse, problems and disorder in mid-adulthood

匹兹堡多动症纵向研究：预测中年时期的酒精滥用、问题和障碍

基本信息

批准号：
10470217
负责人：
BROOKE S.G. MOLINA
金额：
$ 57.8万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-25 至 2025-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10470217
关键词：
Address Adolescence Adolescent and Young Adult Adult Age Aging Alcohol abuse Alcohol consumption Alcoholism Alcohols Attention deficit hyperactivity disorder Behavioral Buffers Categories Child Childhood Chronic Coupled Data Depressed mood Development Developmental Process Diagnosis Dimensions Disease Ecological momentary assessment Elderly Employment Environmental Risk Factor Etiology Family Goals Growth Health Heavy Drinking Impulsivity Individual Life Literature Longevity Longitudinal Studies Measurement Measures Mental Health Mental disorders Methods Moods National Institute on Alcohol Abuse and Alcoholism Nature Negative Reinforcements Outcome Pathway interactions Persons Phase Predictive Factor Process Prospective Studies Protocols documentation Psychiatric Diagnosis Recording of previous events Recovery Reporting Research Risk Risk Factors Sampling Sampling Studies Severities Sleep Sleep disturbances Social Environment Social support Stress Stretching Symptoms Testing Time Vulnerable Populations Work alcohol misuse alcohol risk alcohol use disorder cohort coping cost design disorder risk drinking emerging adult high risk drinking high risk population improved indexing informant longitudinal design middle age negative mood novel personalized medicine prospective stressor young adult

项目摘要

There is a striking dearth of longitudinal studies of alcoholism ontogeny to mid-adulthood from earlier developmental periods. The extent to which heavy drinking in adolescence and early adulthood persists into later life, and the reasons for its progression to mid-adulthood when employment and family responsibilities are approaching the “ascendant” midlife phase, is vastly under-studied. This is particularly problematic considering that high-risk drinking has increased 37% and AUD 47% among 30-44 year olds. NIAAA has prioritized a developmental approach to the identification of mechanisms underlying alcohol misuse and problems and co- occurring mental health conditions across the lifespan (Goals 1-2, Objective 1a). Cross-sectional research suggests shifting mechanisms of vulnerability with age, from positive to negative reinforcement processes. The Pittsburgh ADHD Longitudinal Study (PALS) is uniquely suited to address these important questions for a high-risk population: adults with a childhood diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). The PALS was designed to prospectively study the onset, course, and causes of AUD in a large cohort of children with ADHD -- an established risk factor for adolescent and young adult AUD. The sample is currently aging through their 30s with > 90% retention (360 ADHD, 224 nonADHD) and provides a unique opportunity to test hypotheses about changing mechanisms of AUD risk and recovery over a large age span, into the late 30s, without empirical precedent. We propose to capitalize on the current age of the PALS sample to take advantage of this opportunity, with a novel emphasis on understanding the intersection of impulsivity and mood as it relates to ADHD risk for AUD. In addition to a wealth of prospectively assessed self- and informant-reported variables collected longitudinally in the PALS, the proposed new, expanded assessments stretching into mid-adulthood will include an ecological momentary assessment protocol (EMA) and behavioral task indices of impulsivity. The proposed 20-day EMA burst embedded in the prospective longitudinal design will characterize the dynamic nature and temporal ordering of alcohol risk processes (e.g., shift in impulsivity) not captured in traditional assessments and will integrate environmental (e.g., interpersonal stress) and individual factors (e.g., negative mood, sleep disturbances) to which individuals with ADHD may be more sensitive. Coupled with integrated examination of etiological processes across important developmental windows (adolescence, young adulthood, mid-adulthood), the prospective, expanded assessments (at ages 35, 37, and 39, with a 20-day EMA at age 35 or 37) will enhance understanding of developmental processes in relation to worsening and improving course of heavy drinking and alcohol problems through mid-adulthood when life altering consequences become especially costly. Results hold promise for developing personalized medicine treatment targets that may be particularly efficacious for reducing AUD risk among adults with a history of ADHD.

对从早期发育阶段到成年中期的酗酒个体发育进行了惊人深入的纵向研究，研究了青春期和成年早期的大量饮酒持续到晚年的程度，以及在就业和家庭时发展到成年中期的原因。考虑到 30-44 岁人群中高风险饮酒人数增加了 37%，澳元增加了 47%，这一问题的研究还远远不够。 NIAAA 优先考虑采用发展方法来识别酒精滥用和问题以及整个生命周期中同时发生的心理健康状况的机制（目标 1-2，目标 1a）。匹兹堡 ADHD 纵向研究 (PALS) 特别适合解决高危人群的这些重要问题：儿童时期被诊断患有注意力缺陷多动障碍 (ADHD) 的成年人。旨在前瞻性地研究一大群患有 ADHD 的儿童 AUD 的发病、病程和原因——这是青少年和年轻人 AUD 的既定危险因素。该样本目前已超过 30 岁，保留率 > 90%（360 ADHD）。 , 224 nonADHD），并提供了一个独特的机会来检验有关 AUD 风险和恢复在一个大年龄跨度（到 30 多岁）的变化机制的假设，我们建议利用 PALS 样本的当前年龄。利用这个机会，特别强调理解冲动和情绪的交叉点，因为它与 AUD 的 ADHD 风险相关。除了在 PALS 中纵向收集的大量前瞻性评估的自我报告变量和知情者报告变量之外，拟议的新的、扩展至成年中期的计划将包括生态瞬时评估协议（EMA）和冲动行为任务指数。嵌入前瞻性纵向设计中的拟议 20 天 EMA 爆发评估将描述动态性质和时间顺序。传统评估中未捕获的酒精风险过程（例如冲动的转变）将整合环境（例如人际压力）和个人因素（例如负面情绪、睡眠障碍），ADHD 患者可能对此更加敏感。对重要发育窗口（青春期、青年期、成年中期）的病因学过程进行综合检查，前瞻性、扩展评估（在 35、37 和 39 岁，以35 岁或 37 岁的 20 天 EMA 将增强对与延长和改善成年中期酗酒和酒精问题相关的发育过程的理解，此时改变生活的后果变得特别昂贵，结果有望为个性化药物治疗目标的发展带来希望。这对于降低有 ADHD 病史的成年人的 AUD 风险可能特别有效。