A LONGITUDINAL FOLLOW UP OF CHILDREN AT RISK FOR ANXIETY

在这项拟议的研究中，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恐慌症(PD)的幼儿中焦虑症的发展？这个问题很简单，但答案却具有广泛的含义。虽然众所周知，父母患有帕金森氏症的孩子患焦虑症的风险很高，但这些孩子中只有一些会发展成精神病态。确定预测因素将有助于初级预防，方法是在父母患有帕金森病的儿童中确定一组患焦虑症的高风险儿童。在之前的资助期间，我们已经完成了一项横断面研究，对象是200多名有帕金森病风险的儿童，并与正常对照父母的子女进行比较。我们的样本是独一无二的，因为在儿童进入儿童焦虑症的风险年龄之前，他们已经被广泛识别和表征。这些年轻人已经接受了行为抑制、心理生理标记和焦虑的早期迹象以及心理社会逆境的标记的评估。已经长大到可以可靠地评估DSM-IV诊断的亚样本，已经使用结构化的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一个独特的机会来跟踪预期跟踪的有精神病理风险的儿童的功能障碍和精神病理的发展。据我们所知，这将是纵向跟踪的最大规模的此类样本。正如我们在《进展报告》中所描述的，我们的工作表明，多个测量领域将是高危儿童精神病理学的有用预测指标。这些领域是：父母障碍、儿童气质(通过对不熟悉的人的行为抑制[BI]来索引)、心理生理异常和心理社会逆境。这项拟议的工作试图通过在基线评估后五年对样本进行跟踪，验证这些措施作为后续精神病理学和功能障碍的预测因子。这个项目的主要目标是由我们过去12年来研究BI和幼儿焦虑症的工作确定的。我们的三个主要目标是：L)描述恐慌症高危儿童的心理病理和功能结果；2)确定焦虑症高危儿童不良结局的预测因素；以及3)描述这些儿童焦虑症的发展顺序。此外，在单独的资助下，我们正在从这群家庭中收集DNA样本。因此，通过确保DNA样本将在未来可用，我们保留了我们的样本将用于前瞻性地预测来自假定的焦虑基因的精神障碍和残疾的可能性。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.