A LONGITUDINAL FOLLOW UP OF CHILDREN AT RISK FOR ANXIETY

在这项拟议中的研究中，我们试图解决一个基本的科学问题：是否有可能预测父母患有惊恐障碍（PD）的幼儿焦虑障碍的发展？ 这个问题很简单，但答案却有着广泛的含义。虽然已经确定父母患有PD的儿童患焦虑症的风险很高，但这些儿童中只有一部分会发展为精神病理学。确定一个预测因子将有助于一级预防划定一组幼儿在非常高的风险，焦虑症的那些已经在风险中有PD的父母。在之前的资助期间，我们已经完成了一项横断面研究，研究对象是200多名有PD风险的儿童，并对正常对照父母的后代进行了比较。我们的样本是独一无二的，因为这些儿童在进入儿童焦虑症风险年龄之前就已经被广泛识别和表征。这些青少年已经被评估了行为抑制，心理生理学标记，焦虑的早期迹象以及心理社会逆境的标记。一个年龄足够大的子样本已经被可靠地评估为DSM-IV诊断，已经使用结构化临床访谈进行了精神病理学评估。因此，这一有价值的样本为我们提供了独特的机会，以跟踪功能障碍和精神病理学的发展，在前瞻性随访的儿童在精神病理学的风险。据我们所知，这将是纵向跟踪的最大样本。正如我们在进展报告中所描述的，我们的工作表明，多个领域的测量将是有用的预测高危儿童的精神病理学。这些域是：父母精神障碍、儿童气质（以“对陌生事物的行为抑制”[BI]为指标）、心理生理异常和心理社会逆境。拟议的工作旨在验证这些措施作为随后的精神病理学和功能障碍的预测因素，通过跟踪样本五年后，他们的基线评估。这个项目的主要目标是由我们过去12年研究BI和幼儿焦虑症的工作确定的。我们的三个主要目标是：1）描述惊恐障碍高危儿童的精神病理学和功能结果; 2）确定焦虑障碍高危儿童不良结果的预测因子; 3）描述这些儿童焦虑障碍的发展顺序。此外，我们正在另拨经费，从这批家庭收集DNA样本。因此，通过确保将来可以获得DNA样本，我们保留了这样一种可能性，即我们的样本将有助于从假定的焦虑基因中前瞻性地预测精神疾病和残疾。鉴于我们也在评估环境的不利特征，我们也将能够确定基因-环境相互作用是否在焦虑症的发生中发挥作用。

In the proposed study, we seek to address a basic scientific question: Is it possible to predict the development of anxiety disorders among young children whose parents have panic disorder (PD)? This question is straightforward, yet the answer has broad implications. Although it is well established that children of parents with PD are at high risk for anxiety disorders, only some of these children will develop psychopathology. The identification of a predictor would facilitate primary prevention by delineating a group of young children at very high risk for anxiety disorders among those already at risk by having a PD parent. During the prior funding period we have completed a cross-sectional study of over 200 children at risk for PD and comparison offspring of normal control parents. Our sample is unique in that the children have been identified and characterized extensively before they entered the age of risk for childhood anxiety disorders. These youngsters have already been assessed for behavioral inhibition, psychophysiological markers, and early signs of anxiety as well as for markers of psychosocial adversity. A subsample who have grown old enough to be reliably assessed for DSM-IV diagnoses, have already been assessed for psychopathology using structured clinical interviews. Therefore this valuable sample affords us the unique opportunity to track the development of dysfunction and psychopathology in prospectively followed children at risk for psychopathology. To our knowledge, this would represent the largest such sample followed longitudinally. As we describe in the Progress Report, our work suggests that multiple domains of measurement will be useful predictors of psychopathology in high risk children. These domains are: parental disorders, child temperament (as indexed by "behavioral inhibition to the unfamiliar" [BI]), psychophysiologic abnormalities, and psychosocial adversity. The proposed work seeks to validate these measures as predictors of subsequent psychopathology and dysfunction by following up the sample five years after their baseline evaluation. The main aims of this project were determined by our past 12 years of work studying BI and anxiety disorders among young children. Our three main aims are: l) to characterize the psychopathologic and functional outcomes of children at risk for panic disorder; 2) to determine predictors of adverse outcomes among children at risk for anxiety disorders; and 3) to characterize the developmental sequence of anxiety disorders in these children. Moreover, under separate funding, we are collecting DNA samples from this cohort of families. Thus, by assuring that DNA samples will be available in the future, we leave open the possibility that our sample will be useful for prospectively predicting psychiatric disorders and disability from putative anxiety genes. Given that we are also assessing adverse features of the environment, we will also be able to determine if gene-environment interactions play a role in the genesis of anxiety disorders.