Neural Markers of the Transition from ADHD risk before age 7 to stable diagnosis

描述（由申请人提供）：目前估计美国注意力缺陷/多动障碍（ADHD）的患病率为3-5%。通常第一次诊断的年龄在学生刚入学的6-7岁之间；然而，许多家长会争辩说，他们更早地观察到多动症的迹象/症状。有趣的是，在所有被诊断为多动症的3-4岁儿童中（使用传统的家长/老师访谈方法），只有大约50%的儿童在7岁时仍然符合诊断标准。之前在7岁前获得更好的诊断稳定性的尝试已经扩大了被测量行为的数量和种类。尽管这些尝试略微提高了可预见性，但对于这个年龄范围还没有达成新的黄金标准。这个K01研究计划的主要目标是检查神经系统的发展，标志着从ADHD的体征和症状到稳定的ADHD诊断的转变。通过使用神经成像来更好地推断潜在的生物学，可以更好地预测哪些在3岁时表现出注意力不集中和多动的儿童在7岁及以后会继续表现出这些行为。7岁以后继续符合ADHD诊断标准的儿童很可能在整个童年时期都继续符合诊断标准，并且有40-70%的病例进入成年期。即使他们在成年后没有达到障碍的标准，根据他们童年的诊断，他们在学业失败、社会问题、物质使用障碍、车祸和监禁方面的风险也会增加。神经影像学研究表明认知控制缺陷与8岁至成年期间患有或未患有ADHD的儿童和青少年前额叶皮层的不同激活有关。然而，关于3-7岁儿童认知控制发展的神经基础，以及这如何导致ADHD的发展，我们所知甚少。考虑到这段时间对ADHD症状的持续表现是多么重要，这是一个重大的知识缺口。研究人员发现，调查执行功能的神经发育根源是一项挑战，因为我们对这么小的孩子的大脑成像能力有限。然而，允许3-4岁儿童的EEG数据收集和5-7岁儿童的fMRI数据收集的技术最近已经完善并在此提出。

DESCRIPTION (provided by applicant): Current estimates place the prevalence of attention-deficit/hyperactivity disorder (ADHD) in the US at 3-5%. The usual age of first diagnosis is between 6-7 years of age when students are first entering school; however, many parents will argue that they observed signs/symptoms of ADHD much earlier. Intriguingly, of all 3-4 year old children diagnosed with ADHD (using traditional parent/teacher interview methods), only about 50% continue to meet diagnostic criteria at age 7. Previous attempts at achieving better diagnostic stability before the age of seven have expanded the number and kinds of behavior that are measured. Although these attempts have slightly improved predictability, no new gold standard for this age range has been achieved. The primary goal of this K01 research plan is to examine the development of the neural systems that mark the transition from signs and symptoms of ADHD to stable ADHD diagnosis. By using neuroimaging to better infer the underlying biology, better prediction of which children who exhibit elevated inattention and hyperactivity at age 3 will continue to exhibit these behaviors at age 7 and beyond may be achieved. Children who continue to meet diagnostic criteria for ADHD after the age of 7 are very likely to continue to meet diagnostic criteria across childhood, and in 40-70% of cases into adulthood. Even if they do not meet criteria for the disorder in adulthood they will, based on their childhood diagnosis, have increased risk for academic failure, social problems, substance use disorder, car accidents, and incarceration. Neuroimaging studies have associated deficits of cognitive control with differential activation of the prefrontal cortex in children and adolescents with and without ADHD ages 8 through adulthood. Less is known, however, about the neural basis of the development of cognitive control in younger children ages 3-7 and how this contributes to the development of ADHD. This is a major gap in knowledge, considering how crucial this time period may be to the continued expression of ADHD symptomology. Researchers have found it challenging to investigate the neuro-developmental roots of executive function because of limitations in our ability to image the brain in children this young. However, techniques allowing EEG data collection in 3-4 year olds and fMRI data collection in 5-7 year olds have recently been perfected and are proposed here. PUBLIC HEALTH RELEVANCE: The usual age of first diagnosis for attention-deficit/hyperactivity disorder (ADHD) is between 6-7 years of age when students are first entering school. However, parents and children can experience the negative effects of high ADHD symptomology long before they enter school, increasing the child's risk of social isolation, learning problems, and parental abuse. However current diagnostic techniques for children younger than 7 are inadequate; of all preschool children diagnosed with ADHD (using traditional methods), only about 50% continue to meet diagnostic criteria at age 7. At the moment, some physicians prescribe stimulant medications to children younger than 7 regardless of the diagnostic complications, other physicians do not. The current study would have the potential to reduce conflict around this issue by providing better diagnostic methods earlier.