The Development of Alcohol Use and Abuse in ADHD Adolescents and Young Adults

描述(由申请人提供)：这项竞争性续签申请要求为11-15年提供资金，以继续研究匹兹堡ADHD纵向研究(PALS)中酒精使用和酒精使用障碍的发病、过程、原因和后果。在PAL中，364名患有ADHD(先证者)的儿童在他们参加了匹兹堡大学WPIC的ADHD夏季治疗计划后，在他们的小学年龄被确定。这是此类研究中规模最大的一次：儿童时期被严格诊断为ADHD，详细的儿童时期数据(包括标准化和客观数据)，以及对理论上与酒精滥用和酒精依赖发展相关的领域(例如，酗酒家族史；酒精期望值)的详细年度后续评估。受试者年龄在11岁至25岁之间，在第1至第5年对先证者进行第一次随访期间，招募了一组在人口统计学上相似的非ADHD参与者(n=240)。采用队列顺序设计，所有参与者自被招募到PALS以来每年都被跟踪；保留率超过90%，并始终采用多名记者的方法。研究结果样本包括：1)先证者青少年大量饮酒和AUD的风险更高；2)当对照组也大量饮酒时，18-25岁AUD的先天对照差异不存在；3)终生兴奋剂治疗持续时间与成年早期酗酒呈正相关；4)儿童行为问题与后来的饮酒结果之间存在微弱关联，但同时存在很强的相关性，支持ADHD？行为？AUD途径；以及5)父母监测对ADHD风险的影响对青少年饮酒频率纵向增长的影响。要求进行持续的随访(每年至25岁，此后以年龄为目标的定期评估)，以确定在戒酒成为美国标准的情况下，早期大量饮酒的模式是否持续到20多岁，确定AUD的新病例是否在25岁中后期发展，并研究这些AUD发展的假定因果机制和成年早期的后果。公共卫生相关性：这是一项关于儿童时期被诊断为注意力缺陷多动障碍(ADHD)的人中酗酒的大型长期研究。这项研究将有助于解释ADHD儿童面临酗酒风险的原因，包括哪些因素会导致这种风险，哪些因素会降低这种风险。ADHD是美国最常见的儿童心理健康问题之一；这些人酗酒的风险给社会带来了巨大的直接和间接成本。这项研究将为改善美国这一大群高危儿童的酒精问题的预防和治疗提供信息。

DESCRIPTION (provided by applicant): This competing renewal application requests funding for Years 11-15 to continue study of the onset, course, causes, and consequences of alcohol use and alcohol use disorders in The Pittsburgh ADHD Longitudinal Study (PALS). In the PALS, 364 children with ADHD (probands) were ascertained in their elementary school-aged years following their participation in the ADHD Summer Treatment Program at WPIC, University of Pittsburgh. This is the largest study of its kind: rigorously diagnosed ADHD in childhood, detailed comprehensive childhood data (including standardized and objective data), and detailed annual follow-up assessments of domains theoretically related to the development of alcohol abuse and alcohol dependence (e.g., family history of alcoholism; alcohol expectancies). A nonADHD demographically similar group of participants (n=240) was recruited during the first follow-up of the probands between grant years 1 and 5 when participant ages ranged from 11 to 25. Using a cohort sequential design, all participants have been followed annually since recruitment into the PALS; retention is over 90% and a multiple reporter approach has been adopted throughout. A sampling of findings includes: 1) a higher risk for heavy drinking and AUD in proband adolescents; 2) absence of proband-control differences for AUD at 18-25 yrs when controls are also drinking heavily; 3) positive association between duration of lifetime stimulant treatment and early adulthood binge drinking, 4) weak associations between childhood conduct problems and later drinking outcomes but strong concurrent associations, supporting an ADHD?conduct?AUD pathway, and 5) moderating influence of parental monitoring on ADHD risk for longitudinal growth in adolescent drinking frequency. Continued follow-up (annual to age 25, age-targeted periodic assessments thereafter) is requested to determine whether early heavy drinking patterns persist through the twenties when desistance is the U.S. norm, to determine whether new cases of AUD develop in the mid-to-late 20s, and to study the putative causal mechanisms underlying these AUD developments and consequences in early adulthood. PUBLIC HEALTH RELEVANCE: This is a large long-term study of alcoholism in people who were diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD) in childhood. This study will help explain why children with ADHD are at risk of alcoholism, including what factors contribute to the risk and what factors decrease the risk. ADHD is one of the most frequently diagnosed mental health problems of children in the United States; alcoholism risk in these individuals carries large direct and indirect costs to society. This study will provide information to improve prevention as well as treatments for alcohol problems in this large group of high risk children in the U.S.