Neural Markers of the Transition from ADHD risk before age 7 to stable diagnosis

7 岁之前 ADHD 风险到稳定诊断转变的神经标志物

• 批准号: 8028569
• 负责人: Margaret Ann Sheridan
• 金额: $ 18.03万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-24 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8028569
• 关键词: Neural; Markers; Transition; ADHD; risk

DESCRIPTION (provided by applicant): Current estimates place the prevalence of attention-deficit/hyperactivity disorder (ADHD) in the US at 3-5%. The usual age of first diagnosis is between 6-7 years of age when students are first entering school; however, many parents will argue that they observed signs/symptoms of ADHD much earlier. Intriguingly, of all 3-4 year old children diagnosed with ADHD (using traditional parent/teacher interview methods), only about 50% continue to meet diagnostic criteria at age 7. Previous attempts at achieving better diagnostic stability before the age of seven have expanded the number and kinds of behavior that are measured. Although these attempts have slightly improved predictability, no new gold standard for this age range has been achieved. The primary goal of this K01 research plan is to examine the development of the neural systems that mark the transition from signs and symptoms of ADHD to stable ADHD diagnosis. By using neuroimaging to better infer the underlying biology, better prediction of which children who exhibit elevated inattention and hyperactivity at age 3 will continue to exhibit these behaviors at age 7 and beyond may be achieved. Children who continue to meet diagnostic criteria for ADHD after the age of 7 are very likely to continue to meet diagnostic criteria across childhood, and in 40-70% of cases into adulthood. Even if they do not meet criteria for the disorder in adulthood they will, based on their childhood diagnosis, have increased risk for academic failure, social problems, substance use disorder, car accidents, and incarceration. Neuroimaging studies have associated deficits of cognitive control with differential activation of the prefrontal cortex in children and adolescents with and without ADHD ages 8 through adulthood. Less is known, however, about the neural basis of the development of cognitive control in younger children ages 3-7 and how this contributes to the development of ADHD. This is a major gap in knowledge, considering how crucial this time period may be to the continued expression of ADHD symptomology. Researchers have found it challenging to investigate the neuro-developmental roots of executive function because of limitations in our ability to image the brain in children this young. However, techniques allowing EEG data collection in 3-4 year olds and fMRI data collection in 5-7 year olds have recently been perfected and are proposed here. PUBLIC HEALTH RELEVANCE: The usual age of first diagnosis for attention-deficit/hyperactivity disorder (ADHD) is between 6-7 years of age when students are first entering school. However, parents and children can experience the negative effects of high ADHD symptomology long before they enter school, increasing the child's risk of social isolation, learning problems, and parental abuse. However current diagnostic techniques for children younger than 7 are inadequate; of all preschool children diagnosed with ADHD (using traditional methods), only about 50% continue to meet diagnostic criteria at age 7. At the moment, some physicians prescribe stimulant medications to children younger than 7 regardless of the diagnostic complications, other physicians do not. The current study would have the potential to reduce conflict around this issue by providing better diagnostic methods earlier.

描述（由申请人提供）：目前估计美国注意力缺陷/多动障碍 (ADHD) 的患病率为 3-5%。通常初诊年龄为学生入学时的6-7岁；然而，许多家长会争辩说，他们很早就观察到了多动症的体征/症状。有趣的是，在所有被诊断为 ADHD 的 3-4 岁儿童中（使用传统的家长/老师访谈方法），只有约 50% 在 7 岁时继续符合诊断标准。之前在 7 岁之前实现更好的诊断稳定性的尝试已经扩大测量的行为的数量和种类。尽管这些尝试稍微提高了可预测性，但尚未实现该年龄段的新黄金标准。 K01 研究计划的主要目标是检查标志着 ADHD 体征和症状向稳定 ADHD 诊断转变的神经系统的发育。通过使用神经影像学更好地推断潜在的生物学，可以更好地预测哪些在 3 岁时表现出注意力不集中和多动的儿童将在 7 岁及以后继续表现出这些行为。 7 岁后继续符合 ADHD 诊断标准的儿童很可能在整个童年时期都继续符合诊断标准，并且 40-70% 的病例到成年后仍然符合诊断标准。即使他们在成年后不符合该疾病的标准，根据他们童年的诊断，他们也会增加学业失败、社会问题、药物滥用障碍、车祸和监禁的风险。神经影像学研究发现，8 岁至成年期间患有或不患有 ADHD 的儿童和青少年的认知控制缺陷与前额皮质的差异激活有关。然而，对于 3-7 岁幼儿认知控制发展的神经基础以及这如何促进 ADHD 的发展，人们知之甚少。考虑到这一时期对于 ADHD 症状的持续表现可能至关重要，这是一个重大的知识空白。研究人员发现，由于我们对如此年幼的儿童的大脑进行成像的能力有限，因此研究执行功能的神经发育根源具有挑战性。然而，允许 3-4 岁儿童收集 EEG 数据和 5-7 岁儿童 fMRI 数据收集的技术最近已得到完善，并在此提出。 公共卫生相关性：首次诊断注意力缺陷/多动障碍 (ADHD) 的通常年龄为学生首次入学时的 6 至 7 岁。然而，父母和孩子早在进入学校之前就可能经历高度多动症症状的负面影响，增加孩子社会孤立、学习问题和父母虐待的风险。然而，目前针对 7 岁以下儿童的诊断技术还不够充分；在所有诊断为 ADHD（使用传统方法）的学龄前儿童中，只有约 50% 在 7 岁时继续符合诊断标准。目前，一些医生无论诊断并发症如何，都会给 7 岁以下的儿童开兴奋剂药物，而其他医生则不会。目前的研究有可能通过更早地提供更好的诊断方法来减少围绕这个问题的冲突。