Understanding early causal pathways in ADHD: can early-emerging atypicalities in activity and affect cause later-emerging difficulties in attention?

注意力缺陷多动障碍（ADHD）是一种临床疾病，影响多达5%的英国儿童的注意力和注意力。ADHD可能与成年后的心理健康困难和生活质量差有关，因此确定新的支持策略非常重要。虽然这种情况往往只在学龄儿童中被诊断出来，但大多数增加儿童患多动症可能性的因素都是从出生时就存在的。我们研究的目的是研究导致ADHD出现的发展过程。我们的目标是研究如何早期出现的行为变化，检测早在婴儿期，可以扰乱其他领域的后续发展。我们认为这可能导致发展级联反应，其中症状模式随着时间的推移变得越来越复杂。我们的长期目标是通过针对关键级联发展机制的早期干预，提高我们在ADHD发展早期识别和干预的能力。为了做到这一点，我们研究了有ADHD家族史的婴儿，我们从出生到童年后期纵向跟踪他们。在我们早期的工作中，我们和其他人已经表明，后来被诊断患有ADHD的婴儿表现出两种特征。首先，他们通常有更高水平的身体活动。第二，他们可能更被动，有更多的消极情绪。重要的是，我们的研究还表明，影响学校成绩的注意力和专注力的变化直到发育后期才出现。在这项研究中，我们问这些早期出现的活动和消极情绪的差异是否有助于通过影响孩子可以练习他们的注意力集中技能的程度来影响后期出现的注意力差异。为了验证这一点，我们将使用最先进的方法来测量儿童日常互动中的细粒度行为和大脑活动。我们将看看孩子们如何通过与周围的物体和人的互动来创造专注于事物的机会。我们还将研究这些互动是如何被多动症儿童的活动和负面情绪所破坏的。首先（目标1），我们将使用可穿戴式大脑成像和运动跟踪来研究我们的ToddlerLab中的150名幼儿，ToddlerLab是一个针对自然主义幼儿成像进行优化的新设施。我们将测量活动和消极情绪如何“中断”现实世界的注意力事件和注意力集中的大脑状态。通过在10个月、14个月和24个月重复这些评估，我们将测试这是否会随着时间的推移削弱关键注意力网络。另外，我们现有的300名有ASD/ADHD家族史的婴儿队列，我们将测试6到10岁时相同的注意力集中的大脑状态与ADHD症状的关系。第二（目标2），我们将使用儿童及其父母佩戴的摄像机、麦克风和自主监测器收集一整天的家庭录音。我们将测量幼儿活动增加和消极情绪如何阻止亲子共同注意力状态的发展;以及破坏亲子共同注意力状态如何影响长期发展。同样，通过在三个时间点重复这些评估，我们将测试这些影响如何随着时间的推移而出现;在我们先前存在的队列中，我们将测试婴儿期相同的共同注意力状态如何与6至10岁的ADHD结果相关。最后（目标3），我们将进行一项实验性干预，以测试向父母提供“实时”、对时间敏感的实时反馈是否可以打破儿童活动/消极情绪增加与儿童注意力下降之间的循环。特别是，我们将调查是否有可能帮助父母支持他们的孩子的新兴的注意力集中在父母给他们的孩子提示的时间。总之，我们的工作旨在测试一种新的机制模型，以了解ADHD症状如何出现。

Attention Deficit Hyperactivity Disorder (ADHD) is a clinical disorder that affects attention and concentration in up to 5% of UK children. ADHD can be associated with mental health difficulties and poor quality of life in adulthood, making it important to identify new support strategies. Although the condition tends only to be diagnosed in school-aged children, most of the factors that increase the likelihood of a child developing ADHD are present from birth. The aim of our research is to study the developmental processes that cause ADHD to emerge. We aim to study how early-emerging behavioural changes, detectable as early as infancy, can disrupt subsequent development in other areas. We think this can lead to developmental cascades in which patterns of symptoms become progressively more complex over time. Our long-term aim is to improve our ability to identify and intervene early in the development of ADHD, via early interventions targeted at key cascading developmental mechanisms. To do this we study infants with a family history of ADHD, and we track them longitudinally from birth through to later childhood. In our earlier work we and others have shown that infants later diagnosed with ADHD show two profiles. First, they often have a higher level of physical activity. Second, they can be more reactive and have more negative moods. Importantly, our research also suggested that the changes in attention and concentration that impact school attainment do not emerge until later in development. In this study we ask whether these early-emerging differences in activity and negative mood contribute to later-emerging differences in attention through affecting how much a child can practice their concentration skills. To test this, we will use state-of-the-art methods to measure fine-grained behaviours and brain activity during children's everyday interactions. We will look at how children generate opportunities to concentrate on things through how they interact with objects and people around them. We will also look at how these interactions are disrupted by activity and negative mood in children developing ADHD. First (Aim 1), we will use wearable brain imaging and motion tracking to study 150 toddlers in our ToddlerLab, a new facility optimised for naturalistic toddler imaging. We will measure how activity and negative moods 'interrupt' real-world attention episodes and attentive brain states. By repeating these assessments at 10, 14 and 24 months we will test whether this weakens key attention networks over time. Separately, with our pre-existing cohort of 300 infants with a family history of ASD/ADHD, we will test how the same attentive brain states relate to ADHD symptoms at 6 to 10 years. Second (Aim 2), we will collect day-long home recordings using cameras, microphones and autonomic monitors worn by children and their parents. We will measure how toddlers' increased activity and negative mood can prevent shared parent-child attention states from developing; and how disrupted shared parent-child attention states affect long-term development. Again, by repeating these assessments at three timepoints we will test how these effects emerge over time; and in our pre-existing cohort, we shall test how the same shared attention states during infancy relate to ADHD outcomes at 6 to 10 years. Finally (Aim 3), we shall run an experimental intervention to test whether giving 'live', time-sensitive real-time feedback to parents can break the loop between increased child activity/negative moods and decreased child attention. In particular, we will investigate whether it is possible to help parents to support their child's emerging attention by focusing on timing of when parents give prompts to their child. Taken together our work is designed to test a new mechanistic model for understanding how ADHD symptoms emerge.