A LONGITUDINAL FOLLOW UP OF CHILDREN AT RISK FOR ANXIETY

在拟议的研究中，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惊恐障碍（PD）的幼儿的焦虑障碍的发展？这个问题很直接，但答案却有着广泛的含义。虽然已经确定父母患有PD的孩子患焦虑症的风险很高，但这些孩子中只有一部分会发展为精神病理。确定一个预测因子将有助于一级预防，通过在那些已经有PD父母的儿童中描绘出一组非常高的焦虑障碍风险。在之前的资助期内，我们已经完成了一项对200多名有PD风险的儿童和正常对照父母的后代的横断面研究。我们的样本是独一无二的，因为这些儿童在进入患儿童焦虑症的风险年龄之前就被广泛地识别和表征了。这些青少年已经被评估为行为抑制、心理生理标记、焦虑的早期迹象以及社会心理逆境的标记。一个已经长大到可以可靠地评估DSM-IV诊断的子样本，已经通过结构化的临床访谈进行了精神病理学评估。因此，这个有价值的样本为我们提供了一个独特的机会来追踪功能障碍和精神病理的发展，这些儿童有患精神病理的风险。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那样，我们的工作表明，多种测量领域将是高风险儿童精神病理的有用预测因素。这些领域是：父母障碍、儿童气质（以“对不熟悉的行为抑制”[BI]为索引）、心理生理异常和社会心理逆境。建议的工作旨在验证这些措施作为随后的精神病理和功能障碍的预测因素，通过在基线评估后对样本进行随访五年。这个项目的主要目的是由我们过去12年研究幼儿BI和焦虑症的工作决定的。我们的三个主要目的是：1)表征有惊恐障碍风险的儿童的精神病理和功能结果；2)确定焦虑障碍高危儿童不良结局的预测因素；3)分析儿童焦虑障碍的发展顺序。此外，在单独的资助下，我们正在从这组家庭收集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有助于从假定的焦虑基因中预测精神疾病和残疾的可能性。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起源中发挥作用。

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.