Risk Factors For Attention Deficit/hyperactivity Disorde

注意力缺陷/多动症的危险因素

• 批准号: 7007399
• 负责人: Dale P Sandler
• 金额: --
• 依托单位: NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7007399
• 关键词: age difference; alcoholic beverage consumption; attention deficit disorder; behavioral /social science research tag; clinical research; disease /disorder etiology; disease /disorder proneness /risk; environmental exposure; gender difference; human subject; interview; maternal behavior; mental disorder diagnosis; mental health epidemiology; middle childhood (6-11); occupations; pregnancy disorder; premature infant human; psychometrics; questionnaires; racial /ethnic difference; socioeconomics; tobacco abuse

The prevalence of and risk factors for Atention Deficit Hyperactivity Disorder are being investigated in a population-based study carried out in Johnston County, North Carolina. Through the cooperation of the Johnston County schools, all elementary school age children in the county were studied. With parental permission, teachers completed behavior rating evaluations for children in their classroom. All children classified as potentially having ADHD according to teacher responses or reported by parents to be taking medications were eligible for further study, along with a random sample of all other children. Parent interviews obtained information on child behavior, prenatal and childhood exposures, parental occupational exposures and other factors potentially related to risk for ADHD. The pilot study combined parent and teacher information to estimate the prevalence of ADHD among elementary school children. Two-stage screening used DSM-IV criteria. Teachers completed behavior-rating scales on all children and then parents of potential cases were administered a structured telephone interview. 362 of 424 (85%) children in grades 1-5 in four schools were screened. We estimated the prevalence of medication treatment for attention deficit-hyperactivity disorder (ADHD) among elementary school children in a North Carolina county. We asked parents of 7333 children in grades 1 through 5 attending 17 public elementary schools whether their child had ever been given a diagnosis of ADHD by a psychologist or physician and whether their child was currently taking medication to treat ADHD. The primary aims of the project are 1) to describe the prevalence of ADHD and how it varies by age, race, gender, and SES, 2) to test the hypothesis that preterm and post-term births are at higher risk for ADHD and 3) to evaluate the role of maternal smoking, maternal occupation, maternal alcohol consumption and pregnancy complications as risk factors for ADHD. In the results for the first year of the study, according to parental reports, 43 children (12%) previously had been diagnosed with ADHD by a health professional. Thirty-four children (9%) were taking ADHD medication. Forty-six children met study case criteria for ADHD based on combined teacher and parent reports. After adjusting for non-response, the estimated prevalence of treated or untreated ADHD combined was 16% The prevalence estimate based on the full sample is lower, but still greater than published reports based on DSMIV criteria. In the overall study, parents of 6099 children (83%) provided information on medication use. Of these, 607 children (10%) had been given an ADHD diagnosis, and 434 (7%) were receiving ADHD medication treatment (71% of the diagnosed children were receiving medication). Treatment rates varied by sex, race/ethnicity, and grade. If treatment patterns observed in this study are representative, the public health impact of ADHD may be underestimated. The lead investigator for this project left NIEHS for a position at the University of New Mexico. Work on this project is continuing. In the past year, Two papers on the psychometric properties of the diagnostic scales used in this population-based effort has been drafted. The ability of these scales to identify children with ADHD is being contrasted with results from a more individualized physician-based approach. In addition, an overall prevalence estimate is being determined using information from all study participants, and attention will now shift to identifying prgnancy-related factors as well as environmental exposures (e.g. lead) that may contribute to risk of ADHD. Dr. Rowland (former NIEHS lead investigator) is developing a proposal to follow the children who were studied to evaluate persistence of symptoms and outcomes among children with various subtypes of ADHD, and will be seeking grant support for such an effort.

在北卡罗来纳州约翰斯顿县进行的一项基于人群的研究中，正在研究出现缺陷多动障碍的流行和危险因素。通过约翰斯顿县学校的合作，研究了该县所有小学时代的儿童。在父母的许可下，教师完成了教室中儿童的行为评级评估。所有被归类为根据老师的反应或父母报告服用药物的儿童有资格进行进一步研究，以及所有其他儿童的随机样本。家长访谈获得了有关儿童行为，产前和儿童暴露，父母职业暴露以及其他可能与多动症风险有关的因素的信息。试点研究结合了父母和教师信息，以估计小学儿童多动症的流行。两阶段筛选使用DSM-IV标准。教师对所有儿童完成了行为评估量表，然后对潜在案件的父母进行了结构化的电话采访。在四所学校的1 - 5年级中，有424名（85％）的儿童中有362名。我们估计了北卡罗来纳州县的小学儿童中注意力缺陷 - 经历性障碍（ADHD）的药物治疗率。我们询问了1至5年级的7333名儿童的父母，上17所公立小学是否曾经被心理学家或医生诊断为ADHD，以及他们的孩子目前是否正在服用药物治疗多动症。该项目的主要目的是1）描述多动症的流行率及其随着年龄，种族，性别和SES的变化，2）测试以下假设：早产和后期出生的ADHD风险较高，3）评估产妇吸烟，母性吸烟，产妇占用，母体饮酒和怀孕的风险因素作为ADHD的风险。根据父母的报告，在研究的第一年的结果中，卫生专业人员以前有43名儿童（12％）被诊断为ADHD。 34名儿童（9％）服用了多动症药物。 46个儿童根据教师和家长报告符合ADHD的研究案例标准。调整了无响应后，经过处理或未经处理的ADHD合并的估计患病率为16％，基于完整样本的患病率估计值较低，但仍大于基于DSMIV标准的已发布报告。在整个研究中，有6099名儿童（83％）的父母提供了有关药物使用的信息。其中有607名儿童（10％）接受了多动症诊断，434名（7％）接受了ADHD药物治疗（诊断儿童的71％接受药物治疗）。性别，种族/种族和等级因治疗率而异。如果本研究中观察到的治疗模式是代表性的，则可能低估了多动症的公共卫生影响。 该项目的首席调查员离开了NIEHS担任新墨西哥大学的职位。该项目的工作仍在继续。在过去的一年中，已经起草了两篇关于这项基于人群努力的诊断量表的心理计量学特性的论文。这些量表鉴定多动症儿童的能力与基于医师的个性化方法的结果形成对比。此外，正在使用所有研究参与者的信息确定总体患病率估计，现在注意力将转移到确定可能导致ADHD风险的诊断相关因素以及环境暴露（例如铅）。 Rowland博士（前NIEHS首席研究员）正在制定一项建议，以跟随接受研究的儿童，以评估ADHD各种亚型的儿童的症状和结果的持久性，并将为此寻求授予支持。