Development Of Disruptive Behavior Disorders From Early

破坏性行为障碍的特征是反社会、攻击性行为。外化问题是儿童心理健康问题中最常见的诊断问题。随着时间的推移，它们往往是稳定的，对治疗耐药，并与青春期和成年期的精神障碍有关。早发性攻击是生命过程中持续的反社会行为的先兆。然而，人们对促成不同发展结果的宪法和环境因素及其相互作用知之甚少。在随后的三个时间点，即6-7岁、8-10岁和12-13岁，对82名低、中或高风险的4-5岁儿童(基于外化问题的初始水平)进行了再次研究。结合社会化经验，研究儿童功能的社会、情感、认知和生理领域。目标是找出导致幼儿行为问题随时间延续和变化的关键因素。由于反社会、破坏性行为往往与焦虑和抑郁并存，因此也对这些内在化问题的发展轨迹进行了调查。一些儿童和父母的风险和保护因素有助于儿童中期问题的延续而不是改善，此前已有报道。 下面总结三个新项目的发现。前两种研究侧重于儿童早期特征和父母环境因素对情绪和行为问题发展的影响。第三项研究考察了生理反应在青春期早期问题和精神症状表达中的作用。(1)父母观察和自我报告的社会化实践往往准确地反映在儿童的游戏和象征性游戏中。到了小学早期，无论是捣乱的女孩还是男孩，都比没有攻击性的孩子更容易感受到父母的惩罚性。反社会的女孩(但不是反社会的男孩)也感觉到更多的父母拒绝和爱退缩，这表明他们更担心与家庭成员的关系。这些反社会的女孩也更有可能在青春期早期经历焦虑和情绪症状，这表明社会化经历和精神结果之间存在重要联系。(2)女孩在学龄前和学龄期都比男孩表现出更多的顺从情绪(悲伤和焦虑)(在家庭游戏互动中观察到的)和情绪唤醒。父母对女孩的这些情绪的反应比男孩更快。因此，除了孩子的贡献外，父母的反应方式将鼓励性别角色一致的情感表达。这些早期观察到的情绪预测了两年后抑郁的精神症状。这表明，早期详细观察儿童在家庭互动和父母情绪社会化过程中表达的情绪，对于理解后来出现的精神症状非常重要。(3)对青少年进行两种社会挑战、评价性操作前后的自我报告情绪状态、心率和血压进行了检测。内在性问题与更多的焦虑和心血管唤醒有关，而外在性问题预示着更多的敌意，但更少的心血管唤醒。这些发现反映了将共病特征和多种反应系统纳入对压力的生理反应与情绪和行为问题之间联系的研究中的必要性。

Disruptive behavior disorders are characterized by antisocial, aggressive behaviors. Externalizing problems are the most commonly diagnosed mental health problems of childhood. They tend to be stable over time, resistant to treatment, and linked to psychiatric disorders in adolescence and adulthood. Early onset aggression is a precursor of life-course persistent antisocial behavior. Little is known, however, about constitutional and environmental factors, and their interactions, that contribute to different developmental outcomes. Eighty-two 4-5 year-old children at low, moderate or high risk for later disruptive behavior disorders (based on initial levels of externalizing problems), have been studied again at three subsequent time points; 6-7, 8-10, and 12-13 years. Social, emotional, cognitive, and physiological areas of child functioning are examined, in conjunction with socialization experiences. The goal is to identify key factors that contribute to continuity and change over time in young children's behavioral problems. Because antisocial, disruptive behaviors often are comorbid with anxiety and depression, the developmental trajectories for these internalizing problems also are investigated. Several child and parent risk and protective factors that contribute to continuity versus amelioration of problems during middle childhood were previously reported. The findings from three new projects are summarized next. The first two focus on the role of early child characteristics and parental environmental factors that influence the development of emotional and behavioral problems. The third examines the role of physiological reactivity in the expression of problems and psychiatric symptoms in early adolescence. (1) Parents' observed and self-reported socialization practices often are accurately reflected in children's and symbolic play. By early grade school, both disruptive girls and boys perceived parents as punitive more often than non-aggressive children. Antisocial girls (but not antisocial boys) also perceived more parental rejection and love withdrawal, indicating greater concerns about relationships with family members. These antisocial girls also were more likely to experience anxiety and mood symptoms by early adolescence, suggesting important links between socialization experiences and psychiatric outcomes.(2) Girls both at preschool and school age, expressed more submissive emotions (sadness and anxiety) than boys (as observed during and emotionally arousing family game interaction. Parents were more responsive to these emotions in girls than boys. Thus, in addition to the child's contribution, parents responsed in a way that would encourage gender-role consistent emotion expressions. These early observed emotions predicted psychiatric symptoms of depression two years later. This indicates the importance of early detailed observations of children's emotions expressed during family interactions and parental socialization of emotion for understanding the emergence of later psychiatric symptoms. (3) Self-reported emotional states, heart rate and blood pressure were examined before and after adolescents engaged in two socially challenging, evaluative manipulations. Internalizing problems were associated with greater anxiety and cardiovascular arousal, whereas externalizing problems predicted greater hostility but less cardiovascular arousal. These findings reflect the need to incorporate comorbid characteristics and multiple response systems into studies of the links between physiological reactivity to stress and emotional and behavioral problems.