Suniya Luthar - US grants

Little is currently known about risks confronting children, of opioid and cocaine abusers, since previous studies involving addicts and their families have generally focused on probands' parents and siblings, rather than their offspring. In studying risks faced by addicts' children, the author proposes a unique approach that combines strategies used in family-genetic studies, and those used in clinical research. Family-genetic studies indicate merely the aggregation of psychiatric disorders in families, without specifying any mechanisms of influence. It would be useful to ascertain the extent to which effects of a parent's psychopathology might be mediated by different patterns of dysfunctional family relations. The simultaneous study of major familial risks is particularly vital from the perspective of designing interventions, since the relative importance of different paths of influence must be ascertained to determine which of then might be most beneficially targeted, while intervening with families of cocaine/opioid addicts. The candidate will pursue research germane to her long-term research goals, by (1.) conducting a longitudinal study of 125 children of treatment- seeking cocaine/opioid addicted parents; (2.) examining psychiatric disorders and resilience among these addicts' children in terms of various risk/protective factors (using cross-sectional data), and (3.) examining factors associated with adolescent substance use, using data from six-month, multi-method, multi-trait prospective study, on inner-city high school students.

DESCRIPTION: (Applicant's Abstract) Despite ongoing concern about the impact of parental substance abuse on child development, there are a number of unresolved questions about ways in which parental drug use and comorbid psychopathology affect the psychosocial adjustment of children. Building upon theory and methodology from the field of developmental psychopathology, we will use a conceptual model of causal Influence, a comprehensive approach to measurement, and both individual- and variable-based approaches to data analysis to address four specific issues concerning the impact of maternal drug dependence and comorbid psychopathology on developmental outcomes for school-age children and adolescents living with an opioid-dependent mother. Using a stratified sample of 525 mothers caring for children 8 to 17 years of age under conditions representing varying degrees of risk for poor developmental outcomes, we will: 1) distinguish risks associated with maternal drug use from those associated with comorbid psychopathology common among opioid-dependent women; 2) examine patterns of social competence in the children and clarify the relationships present among competence, early substance use, and emerging psychopathology; 3) explore ways in which in utero exposure to drugs of abuse, perinatal complications, psychological trauma, and exposure to high risk family environments mediate relationships between maternal drug use, comorbid psychopathology and developmental outcomes; and 4) explore ways in which attributes of the chid, positive aspects of the family environment. social support, and utilization of community services attenuate risk and promote positive child development despite the presence of adversity. By clarifying developmental processes promoting both positive and negative child development within this specific population, we expect the findings will offer direction for future research done with children living with a drug, dependent parent and inform the ongoing development of intervention for this disenfranchised population of drug-dependent women and their children, particularly intervention designed to move beyond remediation of deficits toward promotion of child resilience.

DESCRIPTION (provided by applicant): This application requests continuation of funding to support research on the role of maternal drug abuse, as opposed to other commonly co-occurring psychiatric disorders, in relation to children's adjustment outcomes. Our group is currently in the process of obtaining comprehensive data on maladjustment, competence, and vulnerability and protective factors in a sample of 8-17 year old children and their mothers. We anticipate a total baseline sample of about 350 child-mother dyads, and almost half of the mothers will have diagnoses of cocaine/opioid dependence or abuse. In the proposed project, we seek to re-assess this cohort approximately four years after the initial assessments. Specific aims are to examine: (1) the degree to which maternal drug abuse/dependence, as opposed to affective and anxiety diagnoses which are commonly comorbid problems, are linked with escalations in children's maladjustment over time; (2) the degree to which proximal indicators of disturbed family functioning are linked with increases in children's psychopathology over time, and mediate effects of lifetime maternal diagnoses; (3) the role of protective forces at the level of the child, the family, and the community; (4) the degree to which child psychopathology might presages increases in mothers' distress over time. The baseline study entailed measurement of diverse influences at the individual, family and community levels, with the use of a multi-method, multi-informant assessment strategy. Child outcomes were assessed in terms of both diagnostic and dimensional indicators of maladjustment, as well as aspects of everyday competence. To our knowledge, this will be among the first studies to obtain this breadth of prospective assessments on a large cohort of older children of addicted mothers, with a matched comparison sample. Given the developmental periods encompassed with half the youth in mid-adolescence at follow-up, and half approaching adulthood- we will be able to examine factors implicated both in the onset, and the crystallization, of serious adjustment problems such as substance abuse and conduct disturbances. Findings are also expected to be highly informative for treatments and policies affecting addicted mothers and their children, underscoring, for example, the critical need for attention to these mother's psychological and parenting problems in addition to issues of abstinence, and countering myths that these women are inevitably more inimical for minor children in their care than are any other highly stressed mothers, living in urban poverty.

DESCRIPTION (provided by applicant): The proposed investigation is focused on a group of youngsters rarely studied by developmental scientists in the past, those in relatively affluent, suburban families. The few studies that do exist indicate surprisingly high maladjustment among these youth across various domains, particularly substance use and subjective distress. The central objective of this research is to illuminate the ontogenesis of substance use and related problems among suburban teens, with special attention to forces likely to be especially salient in this contextual setting and at this developmental stage. Specifically, based on annual assessments of a cohort of suburban youth from the 6th through 12th grades, we will pursue the following aims: (1.) To examine developmental trajectories across the pre- through late adolescent years;(2.) To examine the antecedents of substance useamong suburban adolescents, including individual factors (subjective distress and behavioral competence); context-relevant pathways (including achievement pressures and disconnection from parents); and influences of the peer community (peers? endorsement of substance use); (3.) To examine the consequences of substance usethrough the high school years, including those pertaining to self-reported inner distress problems in everyday social competence (academic difficulties and behavioral non-conformity), and alienation from parents. Each of these objectives will be pursued separately for boys and girls. Assessments involve multiple respondents and multiple instruments with good psychometric properties, and substance use is measured in terms of both annual and monthly use of different substances, as well as problem severity. The sample will consist of a cohort of sixth grade students (n=338) in an affluent town in the North East. Baseline 6th grade), as well as one- and two-year prospective data have already been obtained, and funding is being requested to follow this cohort for four more annual assessments. Tracking these youth through a seven-year period spanning pre-adolescence (prior to the onset of substance use and related problems) through late adolescence (by which time many problems have become crystallized) will be invaluable in documenting the pathways to, and consequences of, substance use by a group of youngsters at apparently high risk -- yet little studied in the past.

[unreadable] 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. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): This proposal is a request for funds to support continuing collaborative research efforts of the highly successful Family Research Consortium (FRC), in the Transdisciplinary Consortium on Mental Health, Co- occurring disorders, and Families (FRC V). As the fifth generation of a collaborative initiative that began 20 years ago, FRC V will draw upon the accomplishments of its predecessor, the Consortium on Transitions, Families, and Mental Health in Diverse Populations (FRC IV). However, the proposed new consortium has a distinctive function, a reconstructed faculty, and a new set of activities to continue the advancement of science on mental health and families. The focus of FRC V will be on the effects of co-occurring psychiatric disorders (e.g., affective/anxiety diagnoses or personality disorders co-occurring with drug/alcohol abuse), conceptualized within a transdisciplinary framework and with emphasis on translational interventions. This Consortium will continue the FRC tradition of deliberate, careful attention to ethnic, racial, cultural, and economic diversity and in this new iteration, will bring concerted attention, in particular, to the role of mothers (who are generally primary caregivers of children and other adults, and whose own adjustment can have major spillover effects on others). The Family Research Consortium was initially established in order to promote intellectual exchange and collaboration among scholars across the nation on issues related to families and mental health. The activities of this consortium will focus specifically on the implications and consequences of comorbidity in five broad areas: 1) Comorbidity and human productivity: Costs to society;2) Comorbid problems in childhood and adolescence;3) Gender differences in comorbidity: Pathways and Implications;4) Comorbidity in racial, ethnic, and other minorities;5) Mental health and substance use: Prevention, treatments, and policies The specific aims of the proposed FRC-V consortium are (1) to promote intellectual exchange and collaborative research and training in the study of comorbid psychiatric disorders among diverse groups of families, as they influence the well-being and resilience of family members;(2) to advance innovative, substantive, theoretical and methodological knowledge on the ramifications of comorbidity for parenting and family relations;and (3) to consider evidence across multiple levels of influence, using a translational approach a) to prioritize salient risk and protective processes for diverse families in multiple contexts and across multiple levels of inquiry;b) to design appropriate and culturally relevant interventions;and c) to inform policies at state and national levels through dissemination of research advancements. to public health A significant number of people today suffer from serious mental illnesses (such as depression or anxiety) simultaneously with substance abuse. These individuals tend to fall through the gaps between treatment systems, often at high costs to society. This proposal will bring together leading scientists who study risk and protective factors implicated in co-occurring disorders, with the aims of (a) synthesizing cutting-edge knowledge and (b) translating this knowledge into effective prevention and treatment strategies for diverse groups of families.

DESCRIPTION (provided by applicant): Based in developmental psychopathology paradigms of risk, resilience and prevention, this study seeks to extend 9 annual assessments of a cohort of about 300 affluent students (New England Study of Suburban Youth, NESSY;DA014385). Students have been followed from the 6th-12th grades at school and post freshman year at college, and we are now conducting assessments post sophomore year of college. The NESSY study has involved multiple measures, constructs, and respondents, with retention of 85-90% over time. Results thus far have shown substantial elevations in many adjustment problems especially substance use and rule-breaking among both girls and boys, and elevated depression and anxiety among the girls. PUBLIC HEALTH RELEVANCE PARAGRAPH: In the proposed study, we seek to follow this cohort for 4 additional annual assessments post Years 3 and 4 of college, and the first 2 years after college graduation, toward pursuing the following Specific Aims: (1) To examine developmental trajectories of substance use through early adulthood;(2) To examine antecedents of early adult substance use, considering a) prior parent and peer socializing dimensions, b) mediators of links between socializing dimensions and substance use (i.e., youths'overemphasis on achievements, internalizing and externalizing problems), and c) potential moderators involving youths'personal characteristics;(3) To examine the consequence of substance use for early adulthood including a) psychological problems, b) academic performance, and c) quality of close relationships as rated by others. Recent studies of other affluent teen samples corroborate our findings with NESSY youth, showing high substance use and related problems relative to norms. The long-term ramifications of these adolescent disturbances, however, are presently unknown. This study would be the first to yield multi-wave data on a cohort of affluent youth, illuminating trajectories (and/or potential "maturing out") of substance use and associated problems across adolescence and early adulthood (spanning the high-risk college years as well as the transition out of college, potentially into jobs and committed long-term relationships). With multi- informant data gathered from middle childhood onwards and high retention, prospective analyses of risk and protective processes could be invaluable in informing interventions for youth such as these -- a non-trivial proportion of whom have consistently reported high levels of substance use over several years.