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

从早期发育阶段到成年中期的酒精中毒个体发生的纵向研究明显缺乏。青春期和成年初期酗酒在多大程度上会持续到晚年，以及在就业和家庭责任接近“上升”的中年阶段时，其发展到中年的原因，人们对此研究得很少。考虑到高风险饮酒在30-44岁人群中增加了37%和47%，这一点尤其成问题。NIAAA优先采用发展性方法来确定酒精滥用和问题的潜在机制，以及在整个生命周期内共同出现的精神健康问题(目标1-2，目标1a)。横断面研究表明，脆弱的机制随着年龄的增长而变化，从积极的强化过程到消极的强化过程。匹兹堡ADHD纵向研究(PALS)非常适合于为高危人群解决这些重要问题：患有注意力缺陷多动障碍(ADHD)的成年人。PALS旨在前瞻性地研究大量ADHD儿童的AUD的发病、病程和原因--ADHD是青少年和年轻成人AUD的既定危险因素。样本目前的年龄超过30岁，90%的保留率(360个ADHD，224个非ADHD)，并提供了一个独特的机会来测试假说，在一个大的年龄跨度变化的风险和恢复机制，直到30多岁，没有经验先例。我们建议利用PALS样本的当前年龄来利用这个机会，新的重点是理解冲动和情绪的交集，因为它与ADHD风险有关。除了在PALS中纵向收集的大量前瞻性评估的自我和告密者报告变量外，拟议的新的、扩展到成年中期的评估将包括生态瞬时评估协议(EMA)和冲动行为任务指数。拟议的20天EMA突发嵌入前瞻性纵向设计，将表征传统评估中未包括的酒精风险过程的动态性质和时间顺序(例如，冲动的变化)，并将整合ADHD患者可能对其更敏感的环境因素(例如，人际压力)和个人因素(例如，负面情绪、睡眠障碍)。结合对重要发育窗口(青春期、青春期、中年)的病因过程的综合检查，前瞻性的扩展评估(在35岁、37岁和39岁，在35岁或37岁进行为期20天的EMA)将加强对成年期期间酗酒和酗酒问题恶化和改善过程的理解，当生活改变后果变得特别昂贵时。结果为开发个性化药物治疗目标提供了希望，这可能对降低有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.