Adult Outcome of Attention Deficit Hyperactivity Disorder

描述（由申请人提供）：我们提议对患有注意缺陷多动障碍（ADHD）的男孩进行为期15年的随访研究。在基线评估中，我们从精神科和非精神科环境中确定了140名ADHD儿童和120名正常对照儿童。这两组分别有454和368个一级亲缘关系。我们对先证者和他们的兄弟姐妹进行了1年、4年和10年的随访。超过90%在基线时确定的受试者在每次随访评估时重新检查。我们现在提议进行一项为期五年的研究，在基线评估15年后，重新检查先证者和兄弟姐妹到成年。我们有五个主要目的：1)评估ADHD儿童及其兄弟姐妹的持续性、功能正常化和缓解；2)评估精神障碍、神经心理和社会功能障碍共病的预测效度；3)评价DSM-IV ADHD亚型的有效性；4)评估成人ADHD诊断的心理测量特征；5)评估基因变异如何预测成人结局。在我们的初步工作中，我们已开始处理作为拟议工作重点的每一项具体目标。出于几个原因，我们认为提议延长我们的工作是一个必要的步骤。首先，虽然有七项ADHD儿童的随访研究，但只有两项（包括我们在内）使用了DSM-III-R标准。此外，与大多数先前的随访研究不同，我们提出的工作可以全面解决ADHD的精神共病，因为我们没有在基线时使用共病条件来排除病例，而且我们在每次评估时都评估了广泛的共病条件。只有少数先前的研究评估了智力、成就和学校功能，没有一个研究彻底检查了注意力-执行神经心理功能，只有一个研究了社会心理和家庭功能。相比之下，我们的研究采用了多维度的测量方法；我们在基线和每次后续评估时评估了这些功能领域。因为在我们的样本中使用的治疗干预措施没有被控制，我们将能够记录到自然的治疗过程。此外，我们是唯一一项收集所有一级亲属的临床和分子遗传数据的长期研究，并跟踪ADHD患者和对照组的兄弟姐妹直到成年。由于这些原因，我们期望提出的工作能够澄清ADHD的过程和结果。

DESCRIPTION (provided by applicant): We are proposing a fifteen year follow-up study of boys with attention deficit hyperactivity disorder (ADHD). At a baseline assessment, we ascertained 140 ADHD and 120 normal control children from psychiatric and non-psychiatric settings. These groups had 454 and 368 first degree biological relatives, respectively. We have followed the probands and their siblings at one, four and ten year follow-ups. Over 90% of the subjects ascertained at baseline were re-examined at each follow-up assessment. We now propose a five-year study that will re-examine the probands and siblings into adulthood, fifteen years after the baseline assessment. We have five main Aims: 1) To assess the persistence, normalization of functioning and remission in ADHD children and their siblings; 2) To assess the predictive validity of comorbidity with psychiatric disorders and neuropsychological and social dysfunction; 3) To evaluate the validity of DSM-IV subtypes of ADHD; 4) To assess the Psychometric Features of the Adult ADHD diagnosis; and 5) To assess how gene variants will predict adult outcome. In our preliminary work, we have begun to address each of the Specific Aims that are the focus of the proposed work. We view the proposed extension of our work as an essential step for several reasons. First, although there have been seven follow-up studies of ADHD children and only two (our included) used DSM-III-R criteria. Moreover, unlike most prior follow-up studies, the proposed work can comprehensively address psychiatric comobidity in ADHD because we did not use comorbid conditions to exclude cases at baseline and we assessed for a wide range of comorbid conditions at each assessment. Only a few prior studies assessed intelligence, achievement and school functioning, none have thoroughly examined attentional-executive neuropsychological functions and only one examined psychosocial and family functioning. In contrast, our study has taken a multidimensional approach to measurement; we have assessed these domains of functioning at baseline and each follow-up assessment. Because the treatment interventions used in our sample are not being controlled, we will be able to document to naturalistic course of treatment use. Also, we are the only long-term study to collect clinical and molecular genetic data on all first degree relatives and to follow the siblings of ADHD and control subjects into adulthood. For these reasons, we expect the proposed work to clarify the course and outcome of ADHD.