Children with MR: Family Processes and Dual Diagnosis

描述（由申请人提供）：大约50%的智力残疾儿童和青少年有精神障碍或严重的行为问题;这是正常发育青年的三倍。这种“双重诊断”（智力残疾和精神障碍）使他们面临更高的风险，导致一系列不利的长期生活结果。同样，这些青年对其家庭提出了重大的应对和健康挑战，也对服务提供系统提出了经济挑战。虽然肯定有一些综合征相关的双重诊断的贡献，大多数轻度或边缘智力残疾的儿童没有确定的遗传综合征。发展精神病理学在解决儿童期精神障碍的连续性以及风险和保护因素产生影响的机制等基本问题方面取得了巨大进展。不幸的是，智力残疾的青年通常被排除在大多数研究之外，因此我们对预防双重诊断的理解几乎没有进展。这是一项继续开展协作家庭研究的建议，这是一项独特的纵向前瞻性研究，重点关注智力残疾青年的精神病理学和社会能力的发展;还有一组对照组的典型发展青年。主要目的是确定从幼儿期到青春期的精神病理学的出现和连续性，并了解早期和持续的家庭过程以及学校经历对有智力残疾和无智力残疾儿童的监管能力和结果的动态影响。中心每年评估190名3至9岁的儿童及其家庭，获得深入的儿童发展评估、对父母与子女互动和儿童情绪及行为调节的自然主义和结构化观察、父母与子女功能的全面报告以及儿童学校的评估。迄今为止的研究结果表明，早期的家庭过程确实与儿童的自我调节能力和儿童随后的挑战性行为有关，这反过来又会增加压力，损害儿童家庭的身心健康。我们建议继续CFS通过青春期早期（12 - 13岁，15岁），当许多精神疾病的风险增加。我们将招募一个额外的样本（n=90），将至少60%的西班牙裔，并研究家庭过程和青年的精神病理学和社会能力之间的关系，在两个突出的文化群体（西班牙裔和非西班牙裔白人）。这项研究直接

DESCRIPTION (provided by applicant): About 50% of children and adolescents with intellectual disability have a mental disorder or serious behavior problems; this is three times as high as is found in typically developing youth. This "dual diagnosis" (intellectual disability and mental disorder) puts them at much heightened risk for a host of unfavorable long- term life outcomes. Too, these youth present major coping and health challenges to their families and also economic challenges to the service delivery system. While there are certainly some syndrome-related contributions to dual diagnosis, most children with mild or borderline intellectual disability do not have identified genetic syndromes. There have been dramatic advances in developmental psychopathology in addressing the basic questions of continuity of mental disorder across childhood, and the mechanisms by which risk and protective factors have an influence. Unfortunately, youth with intellectual disability are routinely excluded from most studies, so there has been little advance in our understanding of prevention of dual diagnosis. This is a proposal to continue the Collaborative Family Study, a unique longitudinal prospective study that focuses on the development of psychopathology and social competence in youth with intellectual disability; there is also a contrasting group of typically developing youth. The primary aim is to determine the emergence and continuity of psychopathology from early childhood through adolescence, and to understand the dynamic influences of early and ongoing family processes, as well as school experiences, on regulatory capacities and outcomes for children with and without intellectual disability. The CFS has assessed 190 children and their families annually from child age 3 to 9 years, obtaining in- depth child developmental assessments, naturalistic and structured observations of parent-child interactions and children's emotional and behavioral regulation, comprehensive reports of parent and child functioning, and assessments from the children's schools. Findings to date indicate that early family processes do relate to the child's self-regulatory abilities and child subsequent challenging behaviors, which, in turn, increase stress and impair mental and physical health in the child's family. We propose continuing the CFS through early adolescence (ages 12 13, 15), when risk for many mental disorders increases. We will recruit an additional sample (n=90) that will be at least 60% Hispanic, and study the relationships between family processes and youths' psychopathology and social competence within two prominent cultural groups (Hispanics and non- Hispanic Whites). This study has direct