Early detection and prevention of childhood anxiety

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On average, in every primary school classroom in the UK about 6 children will experience clinically significant levels of anxiety. This PhD aims to improve our ability to detect children at risk of developing an anxiety disorder, and to help develop new and better targeted early interventions for them. We focus on arousal (stress) dysregulation, a core component of anxiety. In early infancy, parents are influential in helping their child to regulate arousal states. Parent-infant co-regulation is thought to contribute to the intergenerational transmission of anxiety, and be a tractable target for intervention. The primary research question examines how anxiety can be detected and prevented in early childhood. We hypothesise that (a) infant arousal dysregulation and parent responsivity interact to predict child anxiety in middle childhood, (b) parents with and without mental health difficulties regulate their infant's arousal states differentially, and (c) a brief parent-mediated intervention improves parent regulation of infant arousal. The first part of the PhD will involve a reanalysis of longitudinal dataset of clinically at-risk children (N = 150). This is in order to examine the relationship between psychiatric diagnostic assessments at seven years, infant arousal measures at 5, 10, 14, 24 and 36 months, and parent-infant interaction. The second part of the PhD uses naturalistic methods and a home visit battery, comparing mother and infants' reactivity to ambient audio-visual stimuli and physiological covariation (N = 80). The third part of the PhD involves feasibility case study interviews to investigate patient perspectives on developing a stress regulation intervention for infants at-risk of clinical diagnosis. The contribution of this PhD is to (1) identify clear early markers of childhood anxiety, including key ambient environmental factors that act as moderators (e.g. noise, clutter, time spent outdoors); (2) generate a representative understanding of how anxiety functions between social partners by undertaking studies in the home setting; (3) examine anxiety transmission longitudinally and across fine grain time frames, e.g. brief interactions, and (4) incorporate new information on the identification and regulation of stress to help develop an intervention focused on reducing risk for childhood anxiety.