Emergence of Adolescent Substance Use Problems from the Externalizing Spectrum

描述（由申请人提供）：本申请涉及广泛的挑战领域（04）临床研究和特定挑战主题，04-DA-102：纵向数据的新视角。先前的研究一直表明，有发生物质使用障碍风险的青少年表现出外化行为问题，包括更高水平的行为问题（例如，对立行为、攻击性、犯罪）和注意力缺陷/多动（ADHD）症状（即，注意力不集中、多动、冲动）。最近的研究已经确定了一种对去抑制精神病理学的表型脆弱性，称为外化谱，这被认为是青春期和成年期物质使用，问题和障碍的发展的基础，以及在整个生命周期中发生的外化行为问题（ADHD，对立违抗性障碍，行为障碍和反社会人格障碍）。然而，发展模式的外化频谱尚未得到测试，也没有出现的物质使用和问题的外化频谱进行了检查。考虑到与物质使用相关的公共卫生成本，必须研究物质使用障碍出现的过程，以及在何处、何时或与谁进行干预，以防止物质使用问题和障碍的发展。拟议的研究将利用一个广泛的纵向数据集，快速跟踪项目，以检查从童年到青春期后期的外化频谱的不同指标之间的关系。Fast Track是一项多中心纵向研究，从幼儿园到20岁，每年对社区样本中严重行为问题高风险儿童（n = 754）进行评估，这些儿童是从9，454名儿童的筛选样本中确定的。本研究的第一个目标是利用筛选样本和纵向样本建立一个外化频谱的发展敏感模型（包括物质使用）（童年，青春期早期和青春期后期），特别关注测试外化谱的心理测量结构是否在时间，性别，种族，和邻里环境（城市与农村）。第二个目标是测试外部化谱是否可以由跨发育时期的单个高阶因子表示，并确定潜在的外部化谱是否最好表征为分类的（即，性质上不同的发展途径）或连续的（即，在整个青春期的外部化问题的连续体）。最终，这些二级数据分析的结果将为预防和治疗物质使用，问题和障碍提供潜在目标。这个项目将增加对从童年到青春期后期行为的“外化谱”是如何表达的理解。它还将研究如何物质使用，问题和障碍出现作为整个发展时期的外化频谱的一部分。这对设计更有效的预防和治疗药物使用及相关问题的干预措施具有重要意义。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (04) Clinical Research and Specific Challenge Topic, 04-DA-102: A New Look at Longitudinal Data. Prior research has consistently indicated that adolescents who are at risk for developing substance use disorders exhibit externalizing behavior problems, including higher levels of conduct problems (e.g., oppositional behavior, aggression, delinquency) and attention-deficit/hyperactivity (ADHD) symptoms (i.e., inattention, hyperactivity, impulsivity). Recent research has identified a phenotypic vulnerability to disinhibitory psychopathology, called the externalizing spectrum, which is believed to underlie the development of substance use, problems, and disorder during adolescence and adulthood, and externalizing behavior problems that occur across the lifespan (ADHD, oppositional defiant disorder, conduct disorder, and antisocial personality disorder). Yet developmental models of the externalizing spectrum have not been tested, nor has the emergence of substance use and problems within the externalizing spectrum been examined. Given the public health costs associated with substance use, it is imperative to study the process by which substance use disorders emerge and where, when, or with whom it is possible to intervene in order to prevent the development of substance use problems and disorder. The proposed study will capitalize on an extensive longitudinal data set, the Fast Track project, to examine the relationships between different indicators of the externalizing spectrum from childhood to late adolescence. Fast Track was a multisite, longitudinal study that conducted annual evaluations from kindergarten to age 20 in a community sample of children (n = 754) at high risk for serious conduct problems, who were identified from a screening sample of 9,454 children. The first goal of the proposed research is to use the screening and longitudinal samples to develop a developmentally sensitive model of the externalizing spectrum (including substance use) within three developmental periods (childhood, early adolescence, and late adolescence), with a specific focus on testing whether the psychometric structure of the externalizing spectrum is consistent across time, sex, race, and neighborhood setting (urban vs. rural). The second goal is to test whether the externalizing spectrum can be represented by a single higher-order factor across developmental periods, and to determine whether the underlying externalizing spectrum is best characterized as categorical (i.e., qualitatively distinct pathways of development) or continuous (i.e., continuum of externalizing problems throughout adolescence). Ultimately, the results from these secondary data analyses will provide insight into potential targets for the prevention and treatment of substance use, problems, and disorders. This project will increase understanding of how the "externalizing spectrum" of behaviors is expressed from childhood through late adolescence. It will also examine how substance use, problems, and disorder emerge as part of the externalizing spectrum across this developmental period. This has important implications for designing more effective preventive and treatment interventions for substance use and related problems.