Co-occurring ADHD in young children with ASD: Precursors, detection, neural signatures, and early treatment

患有 ASD 的幼儿同时发生 ADHD：先兆、检测、神经特征和早期治疗

基本信息

批准号：
9385863
负责人：
Geraldine Dawson
金额：
$ 238.05万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-07 至 2022-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9385863
关键词：
Acceleration Address Affect Age Age-Months Attention Attention deficit hyperactivity disorder Attentional deficit Autistic Disorder Behavior Behavior Therapy Behavioral Biological Biological Markers Brain Caring Characteristics Child Childhood Clinic Clinical Clinical Trials Comorbidity Computer Vision Systems Computers Data Data Analyses Detection Development Diagnosis Disease Early Diagnosis Early Intervention Early treatment Education Engineering Epidemiology Ethnic Origin Etiology Eye Genetic Goals Health Health Services Research Heterogeneity High Prevalence Hyperactive behavior Impulsivity Individual Intervention Knowledge Life Link Measures Medical History Methods Modeling Monitor Movement Neurobiology Neurocognitive Neurosciences Outcome Parent-Child Relations Parents Patients Pattern Pharmacology Phenotype Population Primary Health Care Process Quality of life Race Recruitment Activity Research Research Infrastructure Research Personnel Risk Risk Factors Sampling Social Interaction Socioeconomic Status Source Subgroup Symptoms Technology Temperament Testing Toddler Work autism spectrum disorder base clinical practice cohort cost data management developmental psychology early childhood effective therapy high risk improved improved outcome inattention infancy model development neuromechanism neurophysiology novel outreach personalized medicine prospective relating to nervous system response routine care screening social social attention social engagement social learning statistics treatment response treatment strategy

项目摘要

ABSTRACT – Co-occurring ADHD in young children with ASD: Precursors, detection, neural signatures, and early treatment Attention deficit hyperactivity disorder (ADHD) occurs in ~40-60% of individuals with autism spectrum disorder (ASD) and substantially contributes to poorer clinical outcomes. Yet, very little research has focused on the overlap of ASD and ADHD during early childhood. Thus, little is known about how these two conditions co- emerge early in life. Given the high prevalence and clinical impact of the comorbidity of ASD and ADHD, the overall goal of the Duke Autism Center of Excellence is to characterize how co-occurring ADHD influences early screening, neural signatures, developmental trajectories, and response to early treatment of young children with ASD. Project 1 will characterize risk factors for and emergence of co-occurring ADHD symptoms in young children at risk for ASD and examine how these symptoms influence early detection and progression of ASD. This project will clarify why children who have co-occurring ADHD are diagnosed at a much later age and inform more effective early detection strategies. Following a large sample of toddlers receiving routine care in Duke pediatric primary clinics (N = ~ 2800 patients/year), Project 1 will prospectively identify children at risk for ASD and collect data on risk factors, ADHD, and developmental outcomes. Project 2 will elucidate shared and distinct neural signatures and attention-related biomarkers related to ASD and ADHD, examine the functional impact of co-occurring ADHD in young children with ASD, and identify precursor characteristics during infancy that are predictive of later emergence of comorbid ASD and ADHD. This project will characterize children with ASD alone, ASD+ADHD, ADHD alone, and typically-developing children, using state-of-the-art methods, including neurophysiology, eye-tracking, movement-tracking, and computer vision analysis. Project 3 will evaluate a novel early intervention model personalized for young children with ASD+ADHD that pharmacologically addresses ADHD symptoms prior to initiating early behavioral intervention, and identify changes in behavioral and neurophysiological activity that may underlie response to treatment. This project will accomplish these goals by evaluating whether stimulant treatment (Adzenys-XR-ODT) augments the efficacy of a parent-delivered behavioral intervention based on the Early Start Denver Model. This project will examine whether changes in outcome are correlated with improvements in social attention, measured via eye-tracking biomarkers, and social engagement during parent-child interaction. This project will also examine neurophysiological changes underlying improvements in behavior. These projects will be supported by four cores: Administrative Core, Recruitment and Assessment Core, Data Management and Analysis Core, and Dissemination and Outreach Core. Functioning as a whole, the Duke Autism Center of Excellence will offer the most comprehensive understanding to date of the impact of ADHD on young children with ASD, providing important information that will allow for biologically informed and personalized methods for early detection and treatment that could mitigate the negative impact of co-occurring ADHD on individuals with ASD.

摘要 – 患有 ASD 的幼儿同时发生 ADHD：前兆、检测、神经特征和早期治疗约 40-60% 的自闭症谱系障碍患者患有注意力缺陷多动障碍 (ADHD) （自闭症谱系障碍）并导致较差的临床结果，然而，很少有研究关注这一点。自闭症谱系障碍 (ASD) 和多动症 (ADHD) 在儿童早期有重叠，因此，我们对这两种疾病如何共同作用知之甚少。鉴于 ASD 和 ADHD 合并症的高患病率和临床影响，杜克大学自闭症卓越中心的总体目标是描述同时发生的多动症如何影响早期筛查、神经特征、发育轨迹以及对年轻人早期治疗的反应项目 1 将描述同时发生的 ADHD 症状的危险因素和出现情况。对有 ASD 风险的幼儿进行研究，并研究这些症状如何影响早期发现和进展该项目将阐明为什么患有多动症的儿童在很晚的年龄才被诊断出来。并通过大量接受常规护理的幼儿样本，提供更有效的早期检测策略。在杜克大学儿科初级诊所（N = ~ 2800 名患者/年），项目 1 将前瞻性地识别处于危险中的儿童项目 2 将阐明 ASD 的风险因素、ADHD 和发展结果的数据。以及与 ASD 和 ADHD 相关的独特神经特征和注意力相关生物标志物，检查患有 ASD 的幼儿同时发生 ADHD 的功能影响，并确定先兆特征该项目将描述婴儿期出现自闭症谱系障碍 (ASD) 和多动症 (ADHD) 共病的预测。单独患有自闭症谱系障碍 (ASD) 的儿童、自闭症谱系障碍 (ASD) + 注意力缺陷多动症 (ADHD)、单独的注意力缺陷多动症 (ADHD) 以及正常发育的儿童，使用最先进的技术方法，包括神经生理学、眼球追踪、运动追踪和计算机视觉分析项目。 3 将评估针对 ASD+ADHD 幼儿的个性化新型早期干预模型在开始早期行为干预之前，从药物上解决 ADHD 症状，并确定该项目将导致行为和神经生理活动的变化，这可能是治疗反应的基础。通过评估刺激治疗 (Adzenys-XR-ODT) 是否增强疗效来实现这些目标该项目将研究基于“早期开始丹佛模型”的家长提供的行为干预。结果的变化是否与通过眼动追踪测量的社会注意力的改善相关该项目还将研究生物标志物以及亲子互动期间的社会参与。这些项目将得到四个项目的支持。核心：行政核心、招聘与考核核心、数据管理与分析核心、杜克大学自闭症卓越中心将作为一个整体发挥作用。提供迄今为止最全面的关于注意力缺陷多动症（ADHD）对患有自闭症谱系障碍（ASD）幼儿的影响的了解，提供重要信息，以便为早期诊断提供生物学信息和个性化方法检测和治疗可以减轻同时发生的多动症对自闭症患者的负面影响。