Maternal Drug Abuse, Psychopathology, and Child Adaptation

说明(由申请人提供)：本申请要求继续提供资金，以支持对患有药物滥用和其他常见共生疾病的母亲的子女进行第二次后续行动。在基线(或时间1)时，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出对可卡因/阿片类药物依赖或滥用。在第一次跟进时(时间2)，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，预计保留率至少为90%。在拟议的项目(时间3)中，我们试图在上次评估后大约4年重新评估这一群体，届时子女将达到18-25岁，这是药物滥用和行为问题的高危时期。具体目标是(1)确定母亲滥用药物与诊断为情感/焦虑是否与成年后子女的重大病理有关；(2)研究母子障碍与脆弱/保护因素之间潜在联系的机制，涉及(I)母亲功能的持久方面(人格障碍、自我发展和负面养育行为)；(Ii)遗传脆弱因素(中枢神经系统多巴胺能通路的多态性)；(Iii)子女应激反应(通过皮质醇水平和迷走神经紧张)、执行控制缺陷和人格障碍；(Iv)子女密切人际关系中的支持与偏差。(3)检查子女的心理病理可能在多大程度上预示着母亲的压力和痛苦会随着时间的推移而增加。以前的波需要通过多种方法和告密者测量不同的风险和保护指数，并根据诊断和维度适应不良以及跨越阶段突出的发展任务的能力来评估后代的结果。在这一新的后续行动中，我们将继续进行全面的精神和行为评估，并用生物学和遗传学的评估加以补充。这将是第一批对大量上瘾母亲的子女进行前瞻性评估的研究之一，其中包括(A)患有情感/焦虑症的母亲和(B)没有这些诊断的母亲的子女的匹配样本。我们前两次评估的数据显示，吸毒母亲的孩子在青春期期间的表现并不比SES匹配的其他孩子差。与此同时，有迹象表明，成年前后可能会出现重大问题(例如，反社会问题)。基于对这一高危人群从儿童期后期/青春期到成年期早期的深入前瞻性数据，这项研究的见解可能对促进发展精神病理学理论和研究，以及为涉及权宜之计的干预和社会政策的转化努力造福当今儿童和家庭中的极端脆弱群体具有非常重要的意义。人们普遍认为，滥用可卡因/海洛因的母亲对她们未成年的孩子具有极大的破坏性，但这项正在进行的研究表明，在整个青春期，她们的孩子患适应问题的风险并不比抑郁/焦虑女性的孩子更大。然而，到了成年初期，上瘾母亲的孩子确实开始出现一些反社会的问题。基于过去8年的数据，对这些青少年的持续评估将澄清与不同母亲精神疾病有关的风险，以及保护因素，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。根据这些数据指导的预防性干预可以为当代社会的法律、教育和医疗保健系统带来巨大的节省。

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.