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；这是典型发育中青年的三倍。这种“双重诊断”(智力残疾和精神障碍)使他们面临一系列不利的长期生活结果的风险大大增加。此外，这些青年给他们的家庭带来了重大的应对和健康挑战，也给服务提供系统带来了经济挑战。虽然肯定有一些与症状相关的因素导致双重诊断，但大多数患有轻度或临界性智力残疾的儿童并没有确定的遗传综合征。发展精神病理学在解决儿童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重大进展。不幸的是，智障青年经常被排除在大多数研究之外，因此我们对双重诊断预防的理解进展甚微。这是一项继续合作家庭研究的建议，这是一项独特的纵向前瞻性研究，重点是智障青年的精神病理学和社会能力的发展；还有一组典型的发育中的青年。主要目的是确定精神病理学从儿童早期到青春期的出现和延续，并了解早期和正在进行的家庭过程以及学校经历对智障儿童和非智障儿童的调节能力和结果的动态影响。CFS每年评估190名儿童及其家庭，从3岁到9岁，获得深入的儿童发展评估，对亲子互动和儿童情绪和行为调节的自然和结构化观察，父母和孩子功能的综合报告，以及儿童学校的评估。到目前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，这反过来又增加了儿童家庭的压力，损害了儿童的心理和身体健康。我们建议将CFS持续到青春期早期(12岁、13岁、15岁)，那时许多精神障碍的风险都会增加。我们将招募一个至少60%为西班牙裔的额外样本(n=90)，并在两个著名的文化群体(西班牙裔和非西班牙裔白人)内研究家庭过程与年轻人的精神病理和社会能力之间的关系。鉴于智力残疾中精神障碍问题的严重性，这项研究具有直接的公共卫生意义。关于这些青少年的精神病理过程和原因的研究结果可以为预防和早期干预计划以及通过青春期、学校课程和青少年本身的治疗计划提供父母教育计划提供信息。公共卫生相关性：智力残疾(智力低下)儿童患精神障碍或严重行为问题的可能性大约是正常发育儿童的三倍，但对原因知之甚少。这项前瞻性的纵向研究，从3岁到15岁，评估了儿童、家庭、学校和文化对智力残疾儿童和青少年以及典型发育中的对照组的精神病理学和社会能力发展的影响。它具有直接的公共卫生相关性，因为关于这些青少年的精神病理过程和原因的调查结果可以为预防和早期干预计划的内容以及青少年本身的父母教育计划、学校课程和治疗计划提供信息。

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 public health relevance, given the enormity of the problem of mental disorder in intellectual disability. Findings about the course and causes of psychopathology in these youth could inform prevention and early intervention programs, as well as parent education programs through adolescence, school curricula, and therapeutic programs for the youth themselves. PUBLIC HEALTH RELEVANCE: Children with intellectual disability (mental retardation) are about three times as likely to have mental disorders or serious behavior problems as are typically developing children, but little is known about causes. This prospective longitudinal study, from child age 3 to 15 years, is assessing child, family, school, and cultural influences on the development of psychopathology and social competence in children and adolescents with intellectual disability and a typically developing comparison group. It has direct public health relevance, as findings about the course and causes of psychopathology in these youth could inform the content of prevention and early intervention programs, as well as parent education programs, school curricula, and therapeutic programs for the youth themselves.