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，注意力缺陷/多动障碍(ADHD)在美国的患病率为3-5%。第一次确诊的年龄通常在学生第一次入学的6-7岁之间；然而，许多家长会争辩说，他们很早就观察到了ADHD的迹象/症状。有趣的是，在所有被诊断为ADHD的3-4岁儿童中(使用传统的家长/教师访谈方法)，只有大约50%的儿童在7岁时继续符合诊断标准。以前试图在7岁之前实现更好的诊断稳定性的尝试扩大了可测量的行为的数量和种类。尽管这些尝试略微提高了可预测性，但还没有为这一年龄段实现新的黄金标准。这项K01研究计划的主要目标是检查神经系统的发展，这些神经系统标志着ADHD从体征和症状到稳定的ADHD诊断的转变。通过使用神经成像更好地推断潜在的生物学，可以更好地预测哪些儿童在3岁时注意力不集中和多动程度增加，在7岁及以后继续表现出这些行为。在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继续符合诊断标准，在40%-70%的病例中成年后也很可能继续符合诊断标准。即使他们在成年后不符合这种障碍的标准，根据他们童年的诊断，他们也会增加学习失败、社交问题、药物使用障碍、车祸和监禁的风险。神经成像研究已经将认知控制缺陷与8岁至成年期间患有和不患有ADHD的儿童和青少年的前额叶皮质的不同激活联系在一起。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有助于ADHD的发展，人们知之甚少。考虑到这段时间对ADHD症状的持续表达可能是多么关键，这是知识上的一个重大差距。研究人员发现，由于我们对这么小的儿童的大脑成像能力有限，研究执行功能的神经发育根源是具有挑战性的。然而，允许在3-4岁儿童收集脑电数据和在5-7岁儿童收集功能磁共振数据的技术最近已经得到完善，并在此提出。 与公共卫生相关：注意力缺陷/多动障碍(ADHD)的首次诊断年龄通常在学生第一次入学时的6-7岁之间。然而，父母和孩子在上学前很久就会体验到高度ADHD症状的负面影响，增加了孩子社交孤立、学习问题和父母虐待的风险。然而，目前针对7岁以下儿童的诊断技术是不够的；在所有被诊断为ADHD的学龄前儿童中(使用传统方法)，只有大约50%的儿童在7岁时继续符合诊断标准。目前，一些医生给7岁以下的儿童开兴奋剂药物，而不考虑诊断并发症，其他医生不这样做。目前的研究将有可能通过更早地提供更好的诊断方法来减少围绕这一问题的冲突。

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.