Pathways to adult substance use and abuse from childhood ADHD in the MTA

 描述（由申请人提供）：注意力缺陷/多动障碍 (ADHD) 是起源于儿童期的最常见心理健康状况之一，预示着成年早期物质使用障碍 (SUD)。然而，这些结果变化很大，并且往往源于没有发展信息的研究。最重要的是，除了行为障碍合并症和兴奋剂治疗之外，旨在通过关注 SUD 风险的中介因素和调节因素来解释这种变异性的研究需要扩展，以便为治疗和预防提供信息。 MTA（ADHD 多模式治疗）是一项多中心研究，最初是针对儿童 ADHD 联合亚型的药物管理、行为疗法及其组合的随机临床试验，对儿童进行前瞻性纵向随访，为解决这些问题提供了独特的机会。 MTA 样本量很大（579 名 ADHD；289 名同学对照儿童），在 16 年内到成年早期都有良好的记忆力，并且它为对有关 ADHD 相关 SUD 风险的中介因素和调节因素的理论驱动假设进行新的和创新的测试提供了充足的动力。招募时的狭窄年龄范围（7-9.9）与纵向跟踪相结合，提高了测试年龄特异性关联和影响干预时间的影响变量的发育展开的能力。多站点设计和招募策略提高了研究结果的普遍性。从童年（物质使用前）到成年早期的前瞻性数据包括全面的物质使用措施和与 SUD 风险相关变量的多位报告者评估。 MTA 样本的 16 年随访数据收集工作于 2013 年在 NIDA 合同支持下完成，当时参与者为 20 多岁。为数据收集提供了资金，但为数据分析提供了有限的支持——而且这种支持在成人数据可用之前就结束了。因此，本申请寻求至关重要的资金来支持测试机械发展假设所需的协作分析工作，超越迄今为止测试的简单双变量关联，涉及 MTA 中 ADHD 相关的发病、升级、病程以及物质使用和 SUD 的原因到成年早期。我们强调对我们最近发表的评论中基于理论的假设进行检验，该评论将典型和高风险儿童药物滥用风险病因学的文献与最近关于青春期和成年期 ADHD 相关障碍的文献结合起来。这些假设的创新测试将对理解风险过程的发展特异性产生影响，特别是在向成年过渡的过程中。研究结果的见解可能会为这一通往成年的发育桥梁确定新的治疗目标。

 DESCRIPTION (provided by applicant): Attention-Deficit/Hyperactivity Disorder (ADHD), one of the most common mental health conditions with origins in childhood, predicts early adulthood substance use disorders (SUDs). However, these outcomes are highly variable and often emanate from research that was not developmentally informed. Most importantly, research that seeks to explain this variability by focusing on mediators and moderators of SUD risk, beyond Conduct Disorder comorbidity and stimulant treatment, needs expansion to inform treatment and prevention. The prospective longitudinal follow-up of the children in the MTA (Multimodal Treatment of ADHD), a multi-site study that began as a randomized clinical trial of medication management, behavior therapy, and their combination for childhood ADHD Combined Subtype, provides a unique opportunity to address these concerns. The MTA sample is large (579 ADHD; 289 classmate comparison children), with good retention over 16 years into early adulthood, and it provides ample power for new and innovative tests of theory-driven hypotheses about mediators and moderators of ADHD-related risk of SUD. The narrow age range at recruitment (7-9.9) combined with longitudinal tracking improves power to test age-specific associations and developmental unfolding of contributing variables with implications for timing of interventions. The multi-site design and recruitment strategies improve generalizability of findings. Prospective data from childhood (pre- substance use) to early adulthood include comprehensive substance use measures and multiple-reporter assessments of variables pertinent to SUD risk. Data collection for the 16-year follow-up of the MTA sample, when participants were in their mid-20s, was completed in 2013 with NIDA contractual support. Funds were provided for data collection but limited support was provided for data analysis-and this support ended before adult data were available. Thus, this application seeks funding crucial to support the collaborative analytic work needed to test mechanistic developmental hypotheses, beyond simple bivariate associations tested to date, about ADHD-related onset, escalation, course, and causes of substance use and SUD into early adulthood in the MTA. We emphasize tests of theory-informed hypotheses from our recent published review that integrated literature on the etiology of drug abuse risk in typical and high risk children with the recent literature on ADHD- related impairments in adolescence and adulthood. Innovative tests of these hypotheses will have implications for understanding developmental specificity of risk processes, particularly in the transition to adulthood. Insights from the findings may identify novel treatment targets for this developmental bridge into adulthood.