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

有一个惊人的缺乏纵向研究酒精中毒的个体发育到成年中期从早期的发展阶段。青少年和成年早期酗酒持续到晚年的程度，以及当就业和家庭责任接近中年“上升”阶段时酗酒发展到中年的原因，都没有得到充分的研究。考虑到30-44奥尔兹的高危饮酒增加了37%，澳元增加了47%，这一点尤其成问题。NIAAA优先采用发展性方法来识别酒精滥用和问题的潜在机制以及整个生命周期中同时发生的心理健康状况（目标1-2，目标1a）。跨部门研究表明，随着年龄的增长，脆弱性机制从积极的强化过程转变为消极的强化过程。匹兹堡ADHD纵向研究（帕尔斯）是唯一适合解决这些重要问题的高风险人群：成人与儿童诊断为注意缺陷多动障碍（ADHD）。帕尔斯旨在前瞻性研究ADHD儿童的发病、病程和病因，ADHD是青少年和年轻成人AUD的一个既定危险因素。该样本目前正在老化到30多岁，保持率> 90%（360名ADHD，224名非ADHD），并提供了一个独特的机会来测试关于在30多岁后期的大年龄跨度中AUD风险和恢复机制变化的假设，没有经验先例。我们建议利用帕尔斯样本的当前年龄来利用这个机会，重点关注冲动和情绪的交叉点，因为它与AUD的ADHD风险有关。除了在帕尔斯中纵向收集的大量前瞻性评估的自我和线人报告的变量外，拟议的新的扩展评估延伸到成年中期，将包括生态瞬时评估协议（EMA）和冲动行为任务指数。在前瞻性纵向设计中嵌入的拟议20天EMA突发将表征酒精风险过程的动态性质和时间顺序（例如，冲动性的变化），并将纳入环境（例如，人际压力）和个体因素（例如，负面情绪，睡眠障碍），ADHD患者可能更敏感。再加上对重要发育窗口的病因学过程的综合检查（青春期、青年期、中年期）、前瞻性、扩展评估（在35岁、37岁和39岁时，在35岁或37岁时有20天的EMA）将增强对发展过程的理解，这些发展过程与重度饮酒和酒精问题的恶化和改善有关，成年后，改变生活的后果变得特别昂贵。研究结果有望开发个性化的药物治疗靶点，这些靶点可能对降低有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.