The Pittsburgh ADHD Longitudinal Study: Predicting alcohol misuse, problems and disorder in mid-adulthood

从早期发育阶段到中年酗酒个体发生的纵向研究非常缺乏。青春期和成年早期的酗酒会在多大程度上持续到晚年，以及当就业和家庭责任接近“上升”的中年阶段时，酗酒会发展到中年的原因，这些都还没有得到充分的研究。考虑到高风险饮酒在30-44岁人群中增加了37%，AUD增加了47%，这尤其成问题。NIAAA优先采用发展性方法来确定整个生命周期中酒精滥用和酒精问题以及共同发生的精神健康状况的机制（目标1-2，目标1a）。横断面研究表明，随着年龄的增长，脆弱性的机制从正强化过程转变为负强化过程。匹兹堡ADHD纵向研究（PALS）是唯一适合解决这些重要问题的高危人群：成人与儿童诊断为注意缺陷多动障碍（ADHD）。PALS旨在前瞻性地研究大量患有ADHD的儿童中AUD的发病、病程和病因——ADHD是青少年和年轻人AUD的既定危险因素。该样本目前年龄增长到30多岁，保留率为90%(360例ADHD， 224例非ADHD)，并提供了一个独特的机会，可以在没有经验先例的情况下，在大年龄范围内检验AUD风险和恢复机制的变化假设。我们建议利用PALS样本的当前年龄来利用这个机会，并强调理解冲动和情绪的交集，因为它与AUD的ADHD风险有关。除了在PALS纵向收集的大量前瞻性评估的自我和举报人报告变量外，拟议的新的扩展评估延伸到成年中期，将包括生态瞬时评估协议（EMA）和冲动的行为任务指数。在前瞻性纵向设计中嵌入的拟议的20天EMA爆发将表征传统评估中未捕获的酒精风险过程的动态性质和时间顺序（例如，冲动的转变），并将整合环境（例如，人际压力）和个人因素（例如，负面情绪，睡眠障碍），ADHD患者可能对这些因素更敏感。结合重要发育窗口（青春期、青年期、中年期）的病因学过程的综合检查，前瞻性的、扩展的评估（35岁、37岁和39岁，35岁或37岁时的20天EMA）将加强对重度饮酒和酒精问题恶化和改善过程相关的发育过程的理解，直到成年中期，当生活改变的后果变得特别昂贵时。研究结果为开发个性化的药物治疗目标提供了希望，这些治疗目标可能对降低有ADHD病史的成年人的AUD风险特别有效。

There is a striking dearth of longitudinal studies of alcoholism ontogeny to mid-adulthood from earlier developmental periods. The extent to which heavy drinking in adolescence and early adulthood persists into later life, and the reasons for its progression to mid-adulthood when employment and family responsibilities are approaching the “ascendant” midlife phase, is vastly under-studied. This is particularly problematic considering that high-risk drinking has increased 37% and AUD 47% among 30-44 year olds. NIAAA has prioritized a developmental approach to the identification of mechanisms underlying alcohol misuse and problems and co- occurring mental health conditions across the lifespan (Goals 1-2, Objective 1a). Cross-sectional research suggests shifting mechanisms of vulnerability with age, from positive to negative reinforcement processes. The Pittsburgh ADHD Longitudinal Study (PALS) is uniquely suited to address these important questions for a high-risk population: adults with a childhood diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). The PALS was designed to prospectively study the onset, course, and causes of AUD in a large cohort of children with ADHD -- an established risk factor for adolescent and young adult AUD. The sample is currently aging through their 30s with > 90% retention (360 ADHD, 224 nonADHD) and provides a unique opportunity to test hypotheses about changing mechanisms of AUD risk and recovery over a large age span, into the late 30s, without empirical precedent. We propose to capitalize on the current age of the PALS sample to take advantage of this opportunity, with a novel emphasis on understanding the intersection of impulsivity and mood as it relates to ADHD risk for AUD. In addition to a wealth of prospectively assessed self- and informant-reported variables collected longitudinally in the PALS, the proposed new, expanded assessments stretching into mid-adulthood will include an ecological momentary assessment protocol (EMA) and behavioral task indices of impulsivity. The proposed 20-day EMA burst embedded in the prospective longitudinal design will characterize the dynamic nature and temporal ordering of alcohol risk processes (e.g., shift in impulsivity) not captured in traditional assessments and will integrate environmental (e.g., interpersonal stress) and individual factors (e.g., negative mood, sleep disturbances) to which individuals with ADHD may be more sensitive. Coupled with integrated examination of etiological processes across important developmental windows (adolescence, young adulthood, mid-adulthood), the prospective, expanded assessments (at ages 35, 37, and 39, with a 20-day EMA at age 35 or 37) will enhance understanding of developmental processes in relation to worsening and improving course of heavy drinking and alcohol problems through mid-adulthood when life altering consequences become especially costly. Results hold promise for developing personalized medicine treatment targets that may be particularly efficacious for reducing AUD risk among adults with a history of ADHD.