Neurodevelopmental Perspectives on ADHD

ADHD 的神经发育观点

• 批准号: 7729631
• 负责人: JEFFREY M HALPERIN
• 金额: $ 63.52万
• 依托单位: QUEENS COLLEGE
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-02-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7729631
• 关键词: 12 year old; 4 year old; Address; Adult; Affect; Age; Age-Years; Arousal; Attention deficit hyperactivity disorder; Base of the Brain; Behavioral; Behavioral Symptoms; Brain Stem; Brain region; Characteristics; Child; Childhood; Clinical; Cognitive; Comorbidity; Corpus striatum structure; Data Analyses; Data Set; Defect; Development; Disease; Effectiveness; Environmental Risk Factor; Etiology; Extroversion; Frequencies; Functional Magnetic Resonance Imaging; Goals; Growth; Heart; Heterogeneity; High Prevalence; Home environment; Impairment; Impulsivity; Individual; Intervention; Lead; Link; Literature; Longitudinal Studies; Matched Group; Measures; Mediating; Mental disorders; Modeling; Neurocognitive; Neurocognitive Deficit; Nursery Schools; Outcome; Parents; Patients; Pattern; Performance; Personality; Positioning Attribute; Prefrontal Cortex; Preschool Child; Process; Progress Reports; Psychopathology; Recruitment Activity; Reporting; Research; Risk; Sampling; School-Age Population; Schools; Secondary to; Severities; Sex Characteristics; Short-Term Memory; Staging; Symptoms; System; Temperament; Testing; Thick; Time; Variant; Work; Youth; alertness; base; boys; cognitive control; cost; design; early childhood; emerging adult; executive function; functional disability; functional outcomes; girls; high risk; improved; inattention; insight; interest; introvert; neuropsychological; novel; prognostic indicator; prospective; public health relevance; relating to nervous system; teacher; theories

DESCRIPTION (provided by applicant): This competitive renewal application is based on a novel model which posits that partially distinct neural and cognitive mechanisms are involved in the etiology and developmental trajectory of attention-deficit/hyperactivity disorder (ADHD). We hypothesize that ADHD is due to a primary deficit in regulatory functions, most probably of subcortical origin, that is present early in ontogeny, remains relatively static throughout the lifetime, and is unrelated to the commonly-present, although highly variable, diminution of symptoms and impairment often seem over development. We hypothesize that the variation in diminution of symptoms and impairment frequently seen throughout development is in part related to the degree to which cortically-mediated neural systems can compensate for these early deficits through the use of "top-down" executive control. Using a large sample of "hyperactive/inattentive" and typically-developing control children who were recruited when they were 3-4 years-old and evaluated annually since then, this study will examine trajectories of ADHD symptoms over the school-age years to determine the relationship between changes in ADHD severity and the development of regulatory and executive functions over time. Children will be comprehensively reevaluated annually using clinical and neuropsychological measures between the ages of 8 and 12 years. In addition, these annual assessments will be supplemented by semi-annual parent and teacher ratings of ADHD symptom severity and impairment in the home and school settings, which will greatly facilitate our ability to conduct analyses of individualized trajectories for ADHD severity. The primary aim of the proposed project is to test the hypothesis that the diminution of ADHD symptoms typically seen over development is associated with the development of "top-down" executive processes, but that "bottom-up" regulatory functions will remain impaired irrespective of clinical improvement. If this hypothesis is confirmed, it could have a significant impact on the development of novel treatment interventions. PUBLIC HEALTH RELEVANCE: This project is designed to test a model that posits specific mechanisms that are linked to the improvement of ADHD severity over development as distinct from those that cause the disorder. If our hypothesis is confirmed, it could have a significant impact on the development of novel, long-lasting, treatment interventions for this highly impaired group of patients.

描述（由申请人提供）：该竞争性更新申请基于一种新颖的模型，该模型假设部分不同的神经和认知机制涉及注意力缺陷/多动障碍（ADHD）的病因和发展轨迹。我们假设 ADHD 是由于调节功能的主要缺陷引起的，很可能是皮质下起源的，这种缺陷出现在个体发育早期，在整个一生中保持相对静态，并且与普遍存在的症状和损伤的减轻无关，尽管变化很大，但症状和损伤往往似乎是过度发育的。我们假设，在整个发育过程中常见的症状和损伤减轻的变化部分与皮质介导的神经系统通过使用“自上而下”的执行控制来补偿这些早期缺陷的程度有关。这项研究将使用大量“多动/注意力不集中”和典型发育的对照儿童样本，这些儿童在 3-4 岁时被招募，并从那时起每年进行一次评估，该研究将检查学龄期间 ADHD 症状的轨迹，以确定 ADHD 严重程度的变化与随着时间的推移调节和执行功能的发展之间的关系。每年将使用临床和神经心理学措施对 8 至 12 岁的儿童进行全面重新评估。此外，这些年度评估将辅以每半年一次的家长和教师对多动症症状严重程度和家庭和学校环境损害的评级，这将极大地促进我们对多动症严重程度进行个性化轨迹分析的能力。该项目的主要目的是检验这样的假设：ADHD 症状在发育过程中通常出现的减轻与“自上而下”的执行过程的发展有关，但无论临床如何改善，“自下而上”的调节功能仍然会受到损害。如果这一假设得到证实，可能会对新型治疗干预措施的开发产生重大影响。公共健康相关性：该项目旨在测试一个模型，该模型提出了与 ADHD 严重程度在发展过程中的改善相关的特定机制，与导致该疾病的机制不同。如果我们的假设得到证实，可能会对针对这一高度受损的患者群体开发新颖、持久的治疗干预措施产生重大影响。