Maternal Drug Abuse, Psychopathology, and Child Adaptation

描述（由申请人提供）：本申请要求继续提供资金，以支持对药物滥用和其他常见并发症母亲的子女进行第二次随访。在基线（或时间1），我们评估了360名8至17岁儿童及其母亲的适应不良、能力、风险和保护因素;大约一半的母亲被诊断为可卡因/阿片类药物依赖或滥用。在第一次随访（时间2）时，孩子们的年龄在12-21岁之间;在提交本申请时，我们已经完成了720次时间2评估中的579次，预计留存率至少为90%。在拟议的项目（时间3）中，我们寻求在他们最后一次评估后约4年重新评估这一队列，此时后代将为18-25岁，这是药物滥用和行为问题的高风险时期。具体目标是：（1）确定母亲药物滥用与情感/焦虑诊断是否与成年期严重的后代病理学有关;（2）检查母亲和后代障碍与脆弱性/保护因素之间联系的潜在机制，包括（i）母亲功能的持久方面（人格障碍，自我发展和消极的父母行为）;（ii）遗传脆弱性因素（CNS多巴胺能通路的多态性）;（iii）后代应激反应性（通过皮质醇水平和迷走神经张力）、执行控制缺陷和人格障碍;（iv）子女亲密人际关系中的忠诚与越轨。(3)研究后代的精神病理学可能预示着母亲的压力和痛苦随着时间的推移而增加的程度。先前的浪潮需要通过多种方法和信息提供者测量不同的风险和保护指数，并根据诊断和尺寸失调以及跨阶段突出发展任务的能力评估后代结果。在这次新的随访中，我们将继续进行全面的精神和行为评估，并补充生物和遗传评估。这将是第一批对大量成瘾母亲的后代进行如此广泛的前瞻性评估的研究之一，其中匹配的样本是（a）患有情感/焦虑障碍的母亲和（B）没有这些诊断的母亲的孩子。我们前两次评估的数据显示，吸毒母亲的孩子在青春期的表现并不比SES匹配的其他人差。与此同时，有迹象表明存在重大问题（例如，反社会问题）可能在成年后出现。建立在深入的前瞻性数据，在这个高风险群体随后从童年后期/青春期到成年早期，从这项研究的见解可能是非常重要的，有助于发展心理病理学理论和研究，并在通知翻译的努力，涉及权宜干预和社会政策，以造福于今天的儿童和家庭的极其脆弱的人口。滥用可卡因/海洛因的母亲被广泛认为对其未成年子女具有高度破坏性，但这项正在进行的研究表明，在青春期，他们的孩子并不比抑郁/焦虑妇女的孩子更容易出现适应问题。然而，在成年早期，成瘾母亲的孩子确实开始表现出一些反社会的问题。在过去8年数据的基础上，对这些青年的持续评估将澄清与不同孕产妇精神疾病有关的风险，以及使一些儿童即使在成年后也能表现良好而另一些儿童则步履蹒跚的保护因素。在这些数据的指导下进行预防性干预可以为当代社会的法律的、教育和医疗保健系统节省大量资金。

DESCRIPTION (provided by applicant): This application requests continued funding to support a second follow-up of children of mothers with drug abuse and other commonly co-occurring disorders. At baseline (or Time1), we assessed maladjustment, competence, and risk and protective factors in a sample of 360 eight to seventeen year old children and their mothers; about half of the mothers had diagnoses of cocaine/opioid dependence or abuse. At the first follow-up (Time 2), the children were 12-21 years old; at the time of submitting this application, we have completed 579 of 720 Time 2 assessments with a projected retention rate of at least 90 percent. In the proposed project (Time 3), we seek to re- assess this cohort about 4 years after their last assessment, when the offspring will be 18-25 years old, a time of high risk for substance abuse and conduct problems. Specific aims are (1) to determine whether maternal drug abuse, versus affective/anxiety diagnoses, is linked with significant offspring pathology during adulthood; (2) To examine mechanisms underlying links between maternal and offspring disorder and vulnerability/protective factors, involving (i) enduring aspects of maternal functioning (personality disturbances, ego development, and negative parenting behaviors); (ii) genetic vulnerability factors (polymorphisms of the CNS dopaminergic pathway); (iii) offspring stress-reactivity (via cortisol levels and vagal tone),deficits in executive control, and personality disturbances; (iv) supportiveness versus deviance in offsprings' close personal relationships. (3) To examine the degree to which offsprings' psychopathology might presage increases in mothers' stress and distress over time. Prior waves entailed measurement of diverse risk and protective indices via multiple methods and informants, with offspring outcomes assessed in terms of diagnostic and dimensional maladjustment as well as competence across stage-salient developmental tasks. In this new follow-up, we will continue comprehensive psychiatric and behavioral assessments and supplement these with biological and genetic ones. This will be among the first studies to obtain this breadth of prospective assessments on a large cohort of offspring of addicted mothers, with matched samples of children of (a) mothers with affective/ anxiety disorders and (b) none of these diagnoses. Data from our first 2 assessments show that children of drug abusing mothers did not fare more poorly than SES matched others through adolescence. At the same time, there are signs of significant problems (e.g., antisocial problems) potentially emerging around adulthood. Building on in-depth prospective data in this high-risk group followed from late childhood/ adolescence through early adulthood, insights from this study could be highly significant in contributing to developmental psychopathology theory and research, and in informing translational efforts involving expedient interventions and social policies to benefit an extremely vulnerable population of today's children and families. Cocaine/heroin abusing mothers are widely viewed as highly destructive for their minor children, but this ongoing study has shown that up through adolescence, their children are at no greater risk for adjustment problems than are children of depressed/anxious women. By early adulthood, however, addicted mothers' children do begin to show some antisocial problems. Building on data from 8 years in the past, continued assessments of these youth will clarify risks linked with different maternal mental illnesses as well as protective factors that allow some children to do well, even through adulthood, while others falter. Preventive interventions guided by these data could result in great savings to the legal, educational, and health care systems in contemporary society.