Early detection and prevention of childhood anxiety

平均而言，在英国的每个小学教室里，大约有6名儿童会经历临床上显著的焦虑水平。这一博士学位旨在提高我们发现有患焦虑症风险的儿童的能力，并帮助为他们开发新的、更有针对性的早期干预措施。我们的重点是唤醒(压力)失调，这是焦虑的核心组成部分。在早期婴儿期，父母在帮助他们的孩子调节唤醒状态方面具有影响力。父母和婴儿的共同调节被认为有助于焦虑的代际传播，并且是一个容易处理的干预目标。主要的研究问题是如何在儿童早期检测和预防焦虑。我们的假设是：(A)婴幼儿唤醒调节失调和父母责任感交互作用预测儿童中期的焦虑，(B)有心理健康问题的父母和没有心理健康问题的父母对婴儿的唤醒状态进行不同的调节，以及(C)父母的短暂干预改善了父母对婴幼儿唤醒的调节。PHD的第一部分将涉及对临床高危儿童(N=150)的纵向数据集的重新分析。这是为了检查七岁时的精神诊断评估，5、10、14、24和36个月的婴儿唤醒测量，以及父母-婴儿互动之间的关系。PHD的第二部分使用自然主义方法和家访组合，比较母亲和婴儿对周围视听刺激和生理协变的反应(N=80)。PHD的第三部分包括可行性案例研究访谈，以调查患者对为有临床诊断风险的婴儿开发压力调节干预措施的观点。这一博士学位的贡献是：(1)确定儿童焦虑的明确早期标志，包括作为调节因素的关键环境因素(如噪音、杂乱、户外时间)；(2)通过在家庭环境中进行研究，对焦虑如何在社交伙伴之间发挥作用产生具有代表性的理解；(3)纵向和跨细粒度时间框架检查焦虑的传播，例如短暂的互动；以及(4)纳入关于压力识别和调节的新信息，以帮助制定侧重于降低儿童焦虑风险的干预措施。

On average, in every primary school classroom in the UK about 6 children will experience clinically significant levels of anxiety. This PhD aims to improve our ability to detect children at risk of developing an anxiety disorder, and to help develop new and better targeted early interventions for them. We focus on arousal (stress) dysregulation, a core component of anxiety. In early infancy, parents are influential in helping their child to regulate arousal states. Parent-infant co-regulation is thought to contribute to the intergenerational transmission of anxiety, and be a tractable target for intervention. The primary research question examines how anxiety can be detected and prevented in early childhood. We hypothesise that (a) infant arousal dysregulation and parent responsivity interact to predict child anxiety in middle childhood, (b) parents with and without mental health difficulties regulate their infant's arousal states differentially, and (c) a brief parent-mediated intervention improves parent regulation of infant arousal. The first part of the PhD will involve a reanalysis of longitudinal dataset of clinically at-risk children (N = 150). This is in order to examine the relationship between psychiatric diagnostic assessments at seven years, infant arousal measures at 5, 10, 14, 24 and 36 months, and parent-infant interaction. The second part of the PhD uses naturalistic methods and a home visit battery, comparing mother and infants' reactivity to ambient audio-visual stimuli and physiological covariation (N = 80). The third part of the PhD involves feasibility case study interviews to investigate patient perspectives on developing a stress regulation intervention for infants at-risk of clinical diagnosis. The contribution of this PhD is to (1) identify clear early markers of childhood anxiety, including key ambient environmental factors that act as moderators (e.g. noise, clutter, time spent outdoors); (2) generate a representative understanding of how anxiety functions between social partners by undertaking studies in the home setting; (3) examine anxiety transmission longitudinally and across fine grain time frames, e.g. brief interactions, and (4) incorporate new information on the identification and regulation of stress to help develop an intervention focused on reducing risk for childhood anxiety.