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）是儿童时期最常见的心理健康状况之一，可预测成年早期的物质使用障碍（SUD）。然而，这些结果是高度可变的，往往来自没有发展信息的研究。最重要的是，通过关注SUD风险的介导者和调节者来解释这种变异性的研究，超越了行为障碍合并症和兴奋剂治疗，需要扩展以告知治疗和预防。MTA（ADHD的多模式治疗）中儿童的前瞻性纵向随访，一项多中心研究，开始作为药物管理，行为疗法及其组合的随机临床试验，用于儿童ADHD组合亚型，为解决这些问题提供了独特的机会。MTA样本很大（579名ADHD儿童; 289名同学比较儿童），在成年早期的16年内保持良好，它为关于ADHD相关SUD风险的中介和调节者的理论驱动假设的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岁）结合纵向跟踪提高了检验年龄特异性关联和影响干预时机的促成变量的发展展开的能力。多站点设计和招募策略提高了调查结果的普遍性。从儿童期（前物质使用）到成年早期的前瞻性数据包括全面的物质使用措施和多名报告者对SUD风险相关变量的评估。MTA样本的16年随访数据收集，当参与者在20多岁时，在NIDA的合同支持下于2013年完成。为数据收集提供了资金，但为数据分析提供了有限的支持，这种支持在成人数据可用之前就结束了。因此，本申请寻求资金至关重要，以支持合作分析工作所需的测试机制的发展假设，超越简单的双变量协会测试到目前为止，有关ADHD相关的发病，升级，课程，以及物质使用和SUD的原因到成年早期的MTA。我们强调从我们最近发表的综述中对理论知情的假设进行检验，该综述将典型和高危儿童药物滥用风险病因学的文献与青春期和成年期ADHD相关障碍的最新文献相结合。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。从研究结果中获得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.