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）：当前估计将美国注意力缺陷/多动症（ADHD）的患病率定为3-5％。首次诊断的通常年龄是学生首次进入学校的6-7岁。但是，许多父母会争辩说，他们更早地观察到多动症的体征/症状。有趣的是，在诊断为多动症的所有3-4岁儿童中（使用传统的父母/教师访谈方法），只有大约50％的孩子继续满足7岁时的诊断标准。先前尝试在七岁之前实现更好的诊断稳定性的尝试扩大了衡量的行为数量和类型。尽管这些尝试的可预测性略有提高，但没有实现此年龄范围的新金标准。该K01研究计划的主要目的是检查神经系统的发展，这些神经系统标志着从多动症的体征和症状到稳定的ADHD诊断的过渡。通过使用神经影像来更好地推断潜在的生物学，可以更好地预测在3岁时表现出较高注意力和多动症的儿童将继续在7岁及以后表现出这些行为。 7岁以后继续满足ADHD诊断标准的儿童很可能会继续满足整个童年时期的诊断标准，而在40-70％的病例到成年后。即使他们在成年后不符合这种疾病的标准，他们将根据童年的诊断，具有学术失败，社会问题，药物使用障碍，汽车事故和监禁的风险增加。神经影像学研究与认知对照的缺陷有关，在有或没有多动症8年龄至成年的儿童和青少年中，前额叶皮层的差异激活。然而，关于3-7岁儿童认知控制发展的神经基础的知之甚少，以及这如何有助于多动症的发展。考虑到这段时间对ADHD症状的持续表达可能至关重要，这是知识的主要差距。研究人员发现，研究执行功能的神经发展根源是我们的挑战，这是因为我们对这个年轻儿童的大脑形象的限制。但是，最近已经完善了5-7岁儿童的3-4岁儿童和fMRI数据收集的脑电图数据收集的技术，并在此处提出。 公共卫生相关性：注意力缺陷/多动症障碍（ADHD）的通常年龄在学生首次进入学校时的年龄在6-7岁之间。但是，父母和孩子在进入学校之前很久就会经历高多动症症状的负面影响，从而增加了孩子的社会隔离，学习问题和父母虐待的风险。但是，当前针对7岁以下儿童的诊断技术不足；在所有被诊断患有多动症的学龄前儿童（使用传统方法）中，只有大约50％的儿童在7岁时继续符合诊断标准。目前，一些医生为7岁以下儿童开出了刺激药物，而不管诊断性的并发症如何，其他医生都没有。当前的研究将有可能通过提前提供更好的诊断方法来减少围绕此问题的冲突。