From Child Maltreatment to Adolescent Substance Abuse: Risks, Protective Factors

虐待和忽视儿童是影响美国数百万婴儿、儿童和青少年的巨大社会问题。几十年的研究表明，经历滥用或忽视与药物滥用和各种其他问题有关，包括焦虑和抑郁；攻击性和犯罪；认知延迟和学业成就问题；人际关系问题；以及健康问题。我们对虐待在增加药物使用风险方面的作用知之甚少，尤其是对可能导致这种联系的机制有很多需要了解的地方。建议的是第一项前瞻性的纵向研究，旨在仔细衡量不同的儿童虐待经历与青少年药物滥用的关系，并强调心理生物失调和青春期时机在这种关系中可能发挥的作用。这项研究的第二个焦点是青少年的高危性行为，这通常与药物滥用有关。这项研究的另一个独特之处是分析从青春期早期、青春期过渡到青春期中期/晚期的心理社会功能轨迹，以检查不同的复原力和适应不良模式。这项拟议的研究是对16岁和17岁的受虐青少年(N=303)和对照青少年(N=151)(47%女性)的随访，首次评估是在大约11岁。这些样本构成了居住在洛杉矶市中心的拉美裔、非裔美国人和高加索裔虐待儿童和对照儿童的平衡子集。受虐儿童是通过洛杉矶县儿童和家庭服务部(LACDCFS)招募的。我们招募了来自LACDCFS样本相同社区的对照儿童。在交叉序贯研究设计中，每隔一年到一年半，对儿童样本进行三次测量(称为时间1、2和3)。每次针对药物滥用的一系列测量指标都与药物滥用相关和预测，包括药物使用指标；青少年犯罪；社交和同伴关系能力指标；心理健康和行为问题(抑郁、焦虑、创伤后应激障碍、攻击性)；应激反应的心理生物学指标(唾液皮质醇和唾液α淀粉酶)和自主神经系统唤醒指标(皮肤电导率、心率)；认知能力和学习表现指标；以及青春期发育。这些同样的措施将在后续行动中获得，同时还将获得表征青春期后期发展的措施，包括使用和滥用药物和酒精的措施以及危险性行为的措施。

Child abuse and neglect are huge social problems affecting millions of infants, children, and adolescents in America. Several decades of research indicate that experiencing abuse or neglect is associated with substance abuse and a variety of other problems, including anxiety and depression; aggression and delinquency; cognitive delays and school achievement problems; problems with interpersonal relationships; and health problems. We know little about the role of maltreatment in increasing the risk for substance use, and in particular have much to learn about the mechanisms that may be responsible for this association. What is proposed is the first prospective, longitudinal study to examine the relationship of different child maltreatment experiences, carefully measured, to adolescent substance abuse with an emphasis on the role that psychobiological dysregulation and timing of puberty may play in this relationship. A second focal adolescent outcome of this study is high-risk sexual behavior, which is commonly associated with substance abuse. Also unique to this study will be analyses that examine trajectories of psychosocial functioning from early adolescence, during the pubertal transition, to mid/late adolescence in order to examine different patterns of resilience and maladaptation. This proposed study is a follow-up of maltreated (N=303) and comparison (N=151) adolescents (47% female) at ages 16 and 17, first assessed at approximately 11 years of age. The samples form balanced subsets of Latino, African-American, and Caucasian maltreated and comparison children residing in the inner-city of Los Angeles. Maltreated children were recruited through the Los Angeles County Department of Children and Family Services (LACDCFS). We recruited comparison children from the same neighborhoods as the LACDCFS sample. The sample of children has been measured on 3 occasions (known as Time 1, 2, and 3) at 1 to 1.5 year intervals in a cross sequential research design. A battery of measures on each occasion targets correlates and predictors of substance abuse and includes indicators of substance use; delinquency; competence in social and peer relationships; mental health and behavior problems (depression, anxiety, PTSD, aggression); psychobiological indictors of stress reactivity (salivary cortisol and salivary alpha amylase) and autonomic nervous system arousal (skin conductance, heart rate); indicators of cognitive abilities and school performance; and pubertal development. These same measures will be obtained at follow up, along with measures characterizing development in later phases of adolescence, including measures of the use and abuse of drugs and alcohol and measures of risky sexual behavior.