Youth screen use in the ABCD® study.

Adolescent screen usage is ubiquitous and influences development and behavior. Longitudinal screen usage data coupled with psychometrically valid constructs of problematic behaviors can provide insights into these relationships. We describe methods by which the screen usage questionnaire was developed in the Adolescent Brain Cognitive Development (ABCD) Study, demonstrate longitudinal changes in screen usage via child report and describe data harmonization baseline-year 2. We further include psychometric analyses of adapted social media and video game addiction scales completed by youth. Nearly 12,000 children ages 9-10 years at baseline and their parents were included in the analyses. The social media addiction questionnaire (SMAQ) showed similar factor structure and item loadings across sex and race/ethnicities, but that item intercepts varied across both sex and race/ethnicity. The videogame addiction questionnaire (VGAQ) demonstrated the same configural, metric and scalar invariance across racial and ethnic groups, however differed across sex. Video gaming and online social activity increased over ages 9/10-11/12 (p's < 0.001). Compared with boys, girls engaged in greater social media use (p < .001) and demonstrated higher ratings on the SMAQ (p < .001). Compared with girls, boys played more video games (p < .001) and demonstrated higher ratings on the VGAQ (p < .001). Time spent playing video games increased more steeply for boys than girls from age 9/10-11/12 years (p < .001). Black youth demonstrated significantly higher SMAQ and VGAQ scores compared to all other racial/ethnic groups. These data show the importance of considering different screen modalities beyond total screen use and point towards clear demographic differences in use patterns. With these comprehensive data, ABCD is poised to address critical questions about screen usage changes across adolescence.

Adolescent Binge Drinking Is Associated With Accelerated Decline of Gray Matter Volume.

The age- and time-dependent effects of binge drinking on adolescent brain development have not been well characterized even though binge drinking is a health crisis among adolescents. The impact of binge drinking on gray matter volume (GMV) development was examined using 5 waves of longitudinal data from the National Consortium on Alcohol and NeuroDevelopment in Adolescence study. Binge drinkers (n = 166) were compared with non-binge drinkers (n = 82 after matching on potential confounders). Number of binge drinking episodes in the past year was linked to decreased GMVs in bilateral Desikan-Killiany cortical parcellations (26 of 34 with P < 0.05/34) with the strongest effects observed in frontal regions. Interactions of binge drinking episodes and baseline age demonstrated stronger effects in younger participants. Statistical models sensitive to number of binge episodes and their temporal proximity to brain volumes provided the best fits. Consistent with prior research, results of this study highlight the negative effects of binge drinking on the developing brain. Our results present novel findings that cortical GMV decreases were greater in closer proximity to binge drinking episodes in a dose-response manner. This relation suggests a causal effect and raises the possibility that normal growth trajectories may be reinstated with alcohol abstinence.

Cannabis and alcohol use, and the developing brain.

Sex hormones and white (and grey) matter in the limbic system, cortex and other brain regions undergo changes during adolescence. Some of these changes include ongoing white matter myelination and sexually dimorphic features in grey and white matter. Adolescence is also a period of vulnerability when many are first exposed to alcohol and cannabis, which appear to influence the developing brain. Neuropsychological studies have provided considerable understanding of the effects of alcohol and cannabis on the brain. Advances in neuroimaging have allowed examination of neuroanatomic changes, metabolic and neurotransmitter activity, and neuronal activation during adolescent brain development and substance use. In this review, we examine major differences in brain development between users and non-users, and recent findings on the influence of cannabis and alcohol on the adolescent brain. We also discuss associations that appear to resolve following short-term abstinence, and attentional deficits that appear to persist. These findings can be useful in guiding earlier educational interventions for adolescents, and clarifying the neural sequelae of early alcohol and cannabis use to the general public.

White matter integrity in alcohol-naive youth with a family history of alcohol use disorders.

BACKGROUND: Understanding pre-existing neural vulnerabilities found in youth who are family history positive (FHP) for alcohol use disorders could help inform preventative interventions created to delay initiation age and escalation of heavy drinking. The goal of this study was to compare indices of white matter integrity using diffusion tensor imaging (DTI) between FHP and family history negative (FHN) youth using a sample of 94 alcohol-naive adolescents and to examine if differences were associated with global and domain-specific cognitive functioning. METHOD: Participants were 48 FHP and 46 FHN demographically matched, healthy, substance-naive 12- to 14-year-olds (54% female) recruited from local middle schools. Participants completed a neuropsychological test battery and magnetic resonance imaging session, including DTI. RESULTS: FHP youth had higher fractional anisotropy and axial diffusivity, and lower radial and mean diffusivity, than FHN youth in 19 clusters spanning projection, association and interhemispheric white matter tracts. Findings were replicated after controlling for age, gender, socio-economic status, grade and pubertal development. Groups did not differ significantly on global or domain-specific neuropsychological test scores. CONCLUSIONS: FHP teens showed higher white matter integrity, but similar cognitive functioning, to FHN youth. More mature neural features could be related to more precocious behaviors, such as substance use initiation, in FHP youth. Future research exploring white matter maturation before and after substance use initiation will help elucidate the neurodevelopmental trajectories in youth at risk for substance use disorders, to inform preventive efforts and better understand the sequelae of adolescent alcohol and drug use.

Adolescents' fMRI activation to a response inhibition task predicts future substance use.

BACKGROUND: Deficient behavioral regulation may be a risk factor for substance use disorders in adolescents. Abnormalities in brain regions critical to cognitive control have been linked to more intense and problematic future substance use (e.g., Durazzo, Gazdzinski, Mon, & Meyerhoff, 2010; Falk, Berkman, Whalen, & Lieberman, 2011; Paulus, Tapert, & Schuckit, 2005). The goal of this study was to examine the degree to which brain response to an inhibition task measured in mid-adolescence can predict substance use 18 months later. METHOD: Adolescents aged 16-19 (N=80) performed a go/no-go response inhibition task during fMRI at project baseline, and were followed 18 months later with a detailed interview on substance use and dependence symptoms. Participants were 39 high frequency users and 41 demographically similar low frequency users (458 versus 2 average lifetime drug use occasions at baseline, respectively). RESULTS: Across all subjects, no-go trials produced significant increases in neural response in the ventromedial prefrontal cortex and a region including the left angular and supramarginal gyri (p(FWE)<.01, cluster threshold ≥ 30 voxels). Less ventromedial prefrontal activation but more left angular gyrus activation predicted higher levels of substance use and dependence symptoms in the following 18 months, particularly for those who were high frequency users in mid-adolescence (p<.05). CONCLUSIONS: These findings are consistent with studies showing that impairments in cognitive control have strong associations with substance use. We found a predictive relationship between atypical activation patterns at baseline and substance use behavior 18 months later, particularly among adolescents with histories of previous heavy use.

White matter integrity in adolescents with histories of marijuana use and binge drinking.

Structural brain abnormalities have been observed in adolescents with alcohol use disorders but less is known about neuropathological brain characteristics of teens with sub-diagnostic binge drinking or the common pattern of binge drinking combined with marijuana use. The goal of this study was to examine white matter integrity in adolescents with histories of binge drinking and marijuana use. Diffusion tensor imaging (DTI) was conducted with 42 adolescents (ages 16-19) classified as controls, binge drinkers, or binge drinkers who are also heavy marijuana users. Tract based spatial analysis identified shared fiber structure across individuals and facilitated voxelwise comparisons of fractional anisotropy (FA) and mean diffusivity (MD) between groups. Significant between group differences were found in FA in eight white matter regions (ps < or = .016) between the binge drink-only group and controls, including superior corona radiata, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and superior longitudinal fasciculus. Interestingly, in 4 of these same regions, binge drinkers who are also heavy marijuana users had higher FA than binge drinkers who did not use marijuana (ps<.05). MD did not differ between groups. Findings are largely consistent with research suggesting less neuropathology in adolescents without histories of substance use. However, binge drinkers who also use marijuana did not show as consistent a divergence from non-users as did the binge drink-only group. Detection of white matter alterations may have implications in identifying early cognitive dysfunction in substance using adolescents.

Functional consequences of marijuana use in adolescents.

Nearly half of 12th graders have tried marijuana, and 6% use daily. This paper reviews studies on neuropsychological functioning, brain structure, brain function, and subjective and objective measures of sleep in relation to adolescent marijuana use. Adolescents who use marijuana heavily tend to show disadvantaged attention, learning, and processing speed; subtle abnormalities in brain structure; increased activation during cognitive tasks despite intact performance; and compromised objective indicators of sleep quality. Some abnormalities appear to persist beyond a month of abstinence, but may resolve within three months if cessation is maintained. Recommendations for future studies include characterizing these indices in youth prior to the onset of marijuana use then examining change after chronic use has started, and using large samples of youth with varying degrees of involvement with marijuana as well as alcohol, nicotine, and other drugs to characterize the interactive influences on neurocognition and neural health.

The influence of substance use on adolescent brain development.

Adolescence is a unique period in neurodevelopment. Alcohol and marijuana use are common. Recent research has indicated that adolescent substance users show abnormalities on measures of brain functioning, which is linked to changes in neurocognition over time. Abnormalities have been seen in brain structure volume, white matter quality, and activation to cognitive tasks, even in youth with as little as 1-2 years of heavy drinking and consumption levels of 20 drinks per month, especially if > 4-5 drinks are consumed on a single occasion. Heavy marijuana users show some subtle anomalies too, but generally not the same degree of divergence from demographically similar non-using adolescents. This article reviews the extant literature on neurocognition, brain structure, and brain function in adolescent substance users with an emphasis on the most commonly used substances, and in the context of ongoing neuromaturational processes. Methodological and treatment implications are provided.

Four-year outcomes from adolescent alcohol and drug treatment.

OBJECTIVE: Knowledge of treatment response for alcohol and drug problems among adults is mounting; less is known about long-term outcome for adolescents who receive treatment for alcohol and drug problems. The current study examined youth substance involvement over 4 years (using five waves of data collection) following treatment for alcohol and drug abuse. METHOD: A cohort of youth (N = 162, 60% male) treated during adolescence (mean age = 16 years) was followed into young adulthood, a period associated with stabilization of alcohol use patterns and elevated risk for life problems secondary to both alcohol and drug use. Participants (14-18 years old) were consecutive admissions to inpatient adolescent alcohol and drug treatment centers in San Diego that were abstinence focused and based on the 12-step approach. RESULTS: Alcohol and other drug use were reduced during the 4 years posttreatment, with the exception of nicotine. The greatest prevalence reduction occurred for stimulants; modest changes were evident in alcohol and marijuana use. Nicotine was the most commonly used substance throughout the 4 years after treatment. Several distinct substance involvement trajectories were evident during the 4 years following treatment. CONCLUSIONS: Alcohol and drug use patterns during the 4 years following treatment highlight both changes and diversity in substance involvement as youth make the transitions from middle to late adolescence and into young adulthood. Findings demonstrate the importance of identifying transitional periods and the need for alternative intervention strategies that may help the progression of this population into young adulthood.

fMRI measurement of brain dysfunction in alcohol-dependent young women.

BACKGROUND: Studies of brain functioning in alcohol-dependent adults have produced varied results but generally suggest that alcohol affects brain functioning and that relatively short durations of heavy drinking may adversely affect women. It remains unclear when in the course of alcohol dependency and at which developmental stage these brain changes emerge. Our neuropsychological studies have indicated that drinking-related neurocognitive effects occur as early as adolescence (Brown et al., 2000; Tapert & Brown, 1999). This study seeks to characterize brain regions that subserve the affected neurocognitive functions. METHODS: Alcohol-dependent young women (n = 10) were recruited from a longitudinal study of alcohol- and drug-abusing youth, all of whom met criteria for alcohol dependence. Control participants (n = 10) had no history of alcohol or drug problems and were comparable with alcohol-dependent participants on age (18-25 years), family history of alcohol use disorders, and education. After a minimum of 72 hr of abstinence, functional magnetic resonance imaging, neuropsychological, alcohol/drug involvement, and mood data were collected. Participants performed spatial working memory and vigilance tasks during functional magnetic resonance imaging acquisition to probe brain response. RESULTS: Alcohol-dependent women demonstrated significantly less blood oxygen level-dependent response than controls during the spatial working memory task in the right superior and inferior parietal, right middle frontal, right postcentral, and left superior frontal cortex, after controlling for the baseline vigilance response. CONCLUSIONS: Working memory produces a larger neuronal response in some cortical regions than vigilance. Alcohol-dependent women showed less differential response to working memory than controls in frontal and parietal regions, especially in the right hemisphere. Heavy, chronic drinking appears to produce adverse neural effects that are detectable by functional magnetic resonance imaging.

Adolescent substance use and sexual risk-taking behavior.

PURPOSE: To examine the relationship of adolescent substance use and dependence to sexual risk-taking behavior in late adolescence and young adulthood. METHODS: We prospectively examined self-reported sexual behaviors and substance involvement questionnaires in a sample of youth in substance abuse treatment programs and a comparison sample of sociodemographically similar community youths without histories of substance use disorders recruited from media ads. Assessments of sexual behaviors and substance involvement (78% white, 51% female) were collected at 2, 4, and 6 years after initial assessments, as they transitioned from middle adolescence to young adulthood (from age 15.5 to age 21.5 years, on average). The two samples were compared using Chi-square, analysis of variance, and multivariate analysis of variance approaches. Continuous indicators of high-risk sexual behaviors and substance involvement were analyzed with multiple regression. RESULTS: Earlier age of onset to sexual activity, more sexual partners, less consistent use of condoms, more sexually transmitted diseases (STDs), and greater prevalence of human immunodeficiency virus testing were reported by youth in the clinical treatment sample relative to sociodemographically comparable nonabusing community youth. High rates of STDs were found among females, and more substance-abusing females reported pregnancies than community females. Substance involvement continued to be associated with high-risk sexual behavior throughout the transition into young adulthood. CONCLUSIONS: Youth identified with substance problems are more likely to engage in risky sexual behaviors during adolescence and to continue risky sexual behaviors to the extent that substance problems persist. Risk reduction education should be included with adolescent substance abuse treatment.

Substance dependence, family history of alcohol dependence and neuropsychological functioning in adolescence.

AIMS: It was hypothesized that adolescent substance dependence moderates the relationship between family history of alcohol dependence and neuropsychological functioning. DESIGN: This study compared the neuropsychological functioning of non-abusing and alcohol and drug-dependent adolescents with and without a family history of alcohol dependence using hierarchical multiple regressions and general factorial analyses. SETTING: Substance-dependent adolescents were recruited and tested in inpatient alcohol and drug abuse treatment programs after 3 weeks of abstinence. A matched sample of non-abusing adolescents was recruited from the same San Diego-area communities. PARTICIPANTS: Substance-dependent adolescents (n = 101) met DSM-III-R criteria for dependence on alcohol and at least one other substance. Non-abusing adolescents (n = 50) had no substance use disorders. Groups were comparable on socio-economic status. Participants were 44% female, ages 13-18, and had no serious head injuries or neurological disorders. MEASUREMENTS: Information was gathered on demographics, family history, substance involvement, and conduct disorder behaviors and adolescents were administered neuropsychological tests covering language, visuospatial, verbal memory, attention and executive functioning domains. FINDINGS: The hypothesis was supported for language and attention tests. Substance involvement interacted with family history of alcohol dependence to predict language and attention functioning. Family history negative non-abusers performed better than the other adolescents. CONCLUSIONS: The pattern of results suggests that family history of alcohol dependence and adolescent substance use are separate risk factors for poorer neuropsychological performance in youth.

The role of alcohol in adolescent relapse and outcome.

Although adolescents entering treatment for substance abuse typically use several substances, alcohol is seldom the drug of choice. Given alcohol's role as a gateway substance in the initiation of substance misuse, the authors hypothesize that alcohol is substantially involved in adolescent relapse following substance abuse treatment. One hundred fifty-seven youths (39.5% female, mean age 15.91 years) were recruited from adolescent inpatient alcohol and drug treatment centers and assessed at six and 12 months after discharge. Of the youths studied, 79% had used one or more substances by 12-month follow-up. Although only 1% reported alcohol as their substance of choice while hospitalized, alcohol was involved in 46% of initial posttreatment use episodes. Almost a quarter (23%) of initial posttreatment substance use events involved multiple substances. Initial posttreatment use episodes involving multiple substances and preferred substances were associated with poorer outcomes during the year following treatment both in terms of rate of return to and severity of substance involvement. Youths who initially used only alcohol were also likely to resume harmful levels of substance involvement by one year after treatment. Results suggest two routes, gateway and preferred substance, for adolescents in the resumption of harmful substance use following treatment. This gateway role merits consideration by adolescent substance abuse treatment providers and families of treated youths.

Neurocognitive functioning of adolescents: effects of protracted alcohol use.

BACKGROUND: The present study examined associations between alcohol involvement in early to middle adolescence and neuropsychological (NP) functioning. METHODS: Alcohol-dependent adolescents (n = 33) with over 100 lifetime alcohol episodes and without dependence on other substances were recruited from alcohol/drug abuse treatment facilities. Comparison (n = 24) adolescents had no histories of alcohol or drug problems and were matched to alcohol-dependent participants on age (15 to 16 years), gender, socioeconomic status, education, and family history of alcohol dependence. NP tests and psychosocial measures were administered to alcohol-dependent participants following 3 weeks of detoxification. RESULTS: Alcohol-dependent and comparison adolescents demonstrated significant differences on several NP scores. Protracted alcohol use was associated with poorer performance on verbal and nonverbal retention in the context of intact learning and recognition discriminability. Recent alcohol withdrawal among adolescents was associated with poor visuospatial functioning, whereas lifetime alcohol withdrawal was associated with poorer retrieval of verbal and nonverbal information. CONCLUSIONS: Deficits in retrieval of verbal and nonverbal information and in visuospatial functioning were evident in youths with histories of heavy drinking during early and middle adolescence.

Neuropsychological correlates of adolescent substance abuse: four-year outcomes.

Alcohol and other drug use are common in youth, but neurocognitive sequelae are unclear. This study examines the relationship between neuropsychological functioning and protracted substance use in adolescence. One hundred fifteen adolescents, ages 13 to 19 years, were recruited from inpatient substance abuse treatment programs and followed for 4 years. Adolescents were administered a comprehensive battery of neuropsychological tests and evaluated on substance use involvement during treatment, and at 6-month, 1-year, 2-year, and 4-year follow-up time points. Protracted substance abuse over the 4 years of follow-up was associated with significantly poorer subsequent functioning on tests of attention. In addition, alcohol and drug withdrawal accounted for significant variance in visuospatial functioning, above and beyond demographic, educational, and health variables in detoxified late adolescents and young adults. Results suggest that alcohol and drug withdrawal may be a more powerful marker of protracted neuropsychological impairments than other indices of youthful alcohol and drug involvement.

The role of neurocognitive abilities in coping with adolescent relapse to alcohol and drug use.

OBJECTIVE: Neurocognitive abilities are hypothesized to influence coping with temptations to relapse to alcohol and drug use. In particular, a moderator model was proposed whereby neurocognitive abilities moderate the influence of coping strategies on treatment outcome. METHOD: Participants (N = 79) were consecutive admissions to inpatient alcohol and drug treatment centers in the San Diego, California. area, (age range = 14 to 18 years; 41% female). Treatment programs were abstinence focused, with an average inpatient stay of 5 weeks. Participants met DSM-III-R lifetime criteria for alcohol abuse or dependence and abuse or dependence of at least one other substance. Follow-up assessments were conducted 1 and 2 years following discharge, including a battery of neuropsychological tests, coping questionnaire, and detailed assessment of alcohol and other drug involvement. RESULTS: The interaction between general intelligence and coping diversity significantly predicted alcohol and drug use 1 year later (F = 10.71, 1/72 df, p <.005, R2 change =.08), even when controlling for current use. Attention-coping and problem solving-coping interactions also significantly predicted outcome, but not above the intelligence-coping interaction. CONCLUSIONS: Teens with poor neurocognitive abilities used little or no alcohol and drugs if good coping skills were evidenced, but used more alcohol and drugs if their coping skills were poor. This association between coping skills and outcome did not exist for teens with better neurocognitive abilities. Clinically, teens with poorer neurocognitive skills may maximally benefit from coping skills training programs, and neuropsychological evaluations may be particularly helpful in addressing these individual needs in treatment.

Psychometric evaluation of the Customary Drinking and Drug Use Record (CDDR): a measure of adolescent alcohol and drug involvement.

OBJECTIVE: The present study was undertaken to assess the psychometric characteristics of the Customary Drinking and Drug Use Record (CDDR), an interviewer-administered questionnaire. The CDDR provides current (past 3 months) and lifetime measures of four alcohol- and other drug-related domains: level of involvement, withdrawal characteristics, psychological/behavioral dependence symptoms, and negative consequences. The present report describes the evaluation of the psychometric properties of the instrument with youth between the ages of 13 and 22 years who had markedly variable histories of involvement with alcohol and other psychoactive substances. METHOD: The sample assessed was composed of 166 adolescents recruited from two inpatient substance abuse treatment programs and 115 adolescents recruited from the community. Of the 281 subjects, 150 were male. Follow-up interviews with each adolescent and a resource person were conducted 6, 12, 24 and 48 months after the initial assessment. RESULTS: Reliability of the CDDR was assessed by examination of internal consistency, test-retest reliability and interrater reliability. Convergent, discriminant and construct validity were evaluated for each of the CDDR domains, and gender and ethnic differences on substance involvement were examined. The CDDR was found to be internally consistent and reliable over time and across interviewers for each major domain assessed. The findings supported the validity of the four domains of alcohol and other drug involvement assessed on the CDDR. CONCLUSIONS: The present results demonstrated convergent validity of the CDDR, ability to differentiate abusing from nonabusing youth and strong diagnostic specificity when compared to other standard instruments. The solid psychometric characteristics of the CDDR support its use for both research and clinical purposes.