Early detection and prevention of childhood anxiety

平均而言，在英国的每个小学教室里，大约有6名儿童会经历临床上显著的焦虑水平。该博士学位旨在提高我们检测有患焦虑症风险的儿童的能力，并帮助为他们开发新的更有针对性的早期干预措施。我们专注于唤醒（压力）失调，焦虑的核心组成部分。在婴儿早期，父母在帮助孩子调节唤醒状态方面具有影响力。亲子共同调节被认为有助于焦虑的代际传递，是一个易于干预的目标。主要的研究问题是如何在幼儿期发现和预防焦虑。我们假设：（a）婴儿唤醒失调和父母的反应性相互作用，以预测儿童焦虑在童年中期，（B）父母与没有心理健康问题的调节他们的婴儿的唤醒状态的差异，（c）一个简短的父母介导的干预，提高父母的婴儿唤醒的调节。 博士学位的第一部分将涉及临床高危儿童（N = 150）纵向数据集的再分析。这是为了检查7岁时的精神病诊断评估，5，10，14，24和36个月时的婴儿唤醒措施以及父母-婴儿互动之间的关系。博士论文的第二部分使用自然主义方法和家访电池，比较母亲和婴儿对环境视听刺激和生理协变的反应（N = 80）。博士学位的第三部分涉及可行性案例研究访谈，以调查患者对为临床诊断风险的婴儿制定压力调节干预措施的观点。这个博士学位的贡献是（1）确定明确的儿童焦虑的早期标志，包括作为调节剂的关键周围环境因素（2）通过在家庭环境中进行研究，产生对焦虑如何在社会伙伴之间起作用的代表性理解;（3）纵向和跨精细时间框架检查焦虑传递，例如简短的互动，（4）纳入有关压力识别和调节的新信息，以帮助制定一项专注于降低儿童焦虑风险的干预措施。

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.