Children at Risk for Anxiety Disorders: A Follow up Study

描述(由申请人提供)：这项拟议的研究是对患有恐慌症(PD)风险的子女(N=446)进行为期12年的跟踪调查，并比较患有严重抑郁症(MD)风险的子女和没有情绪或焦虑症易感性的子女。这些孩子最初是在蹒跚学步的童年和童年早期被招募的，在童年中期(6岁)被重新评估，并将在下一波浪潮中进入青春期。这个样本的独特之处在于，a)在儿童进入儿童焦虑症的风险期之前，就广泛地使用了实验室的行为抑制(BI)测量和新生症状学评估来表征儿童的特征；b)先天父母对他们的成人和儿童的精神病理学进行了全面的评估，并仔细注意描绘出子女可能接触到的情节；以及c)据我们所知，这是迄今为止纵向上跟踪的最大的焦虑症风险儿童样本。我们的研究也是独一无二的，因为它在几个有希望的方向上产生了分支，包括对BI的遗传基础的研究，以及对有焦虑风险的幼儿的早期干预的研究。 我们目前的目标是研究是否有可能预测父母患有帕金森病的儿童的焦虑症的发展和序列，以及确定儿童精神病理的风险因素，包括气质(行为抑制或去抑制[BD])、父母共病以及可能影响或中等风险的心理社会逆境因素。我们已经发现，帕金森病父母的子女在童年中期患帕金森病、广场恐怖症和多发性焦虑症的风险增加，MD父母的子女出现一系列焦虑、情绪和破坏性行为障碍的风险增加，BI青少年的社交焦虑风险增加，BD儿童的破坏性行为障碍风险增加。我们还注意到焦虑症的风险与围产期和心理社会风险因素之间的关联。现在，随着孩子们进入青春期，这是一个社交恐惧症、PD和MD的高危时期，以及酒精和药物滥用、同伴困难和其他心理社会问题，我们处于令人兴奋和独特的位置来回答有关父母PD、父母MD、BI或BD以及先前存在的儿童障碍的具体脆弱性的问题。我们还能够开始问，我们在童年早期确定的风险因素为什么以及如何影响青春期的精神病理学或复原力，以及它们在预测结果时如何与保护性因素相结合。 这些研究问题直截了当，但它们蕴含着广泛的含义。对高危儿童和青少年的研究具有最重大的公共卫生意义，因为确定精神病理学和物质使用障碍的预测因素可以为有针对性的一级或二级预防计划奠定基础。如果我们要了解为什么一些有生物或心理社会风险因素的儿童在青春期保持健康，并成功地完成这一时期的发展任务，而另一些儿童则出现精神病态或功能脱轨，识别这些预测因素至关重要，无论是身体因素还是环境因素。仔细阐述这些因素的作用机制将能够设计出具体、有效和成本效益高的干预措施，以防止青春期不良结果，并允许将稀缺的社会资源用于最有可能从此类计划中受益的人群。

DESCRIPTION (provided by applicant): The proposed study is a 12-year follow-up of a large cohort (N=446) of offspring at risk for panic disorder (PD), and comparison offspring at risk for major depression (MD) or without vulnerability for mood or anxiety disorders. The children were originally recruited in toddler hood and early childhood, were reassessed in middle childhood (at Year 6), and will enter adolescence during the next wave. This sample is unique in that a) children were characterized extensively at Baseline, using laboratory measures of behavioral inhibition (BI) and assessments of nascent symptomatology well before they entered the period of risk for childhood anxiety disorders; b) proband parents underwent comprehensive assessments of their adult and childhood psychopathology, with careful attention to delineating episodes to which offspring might have been exposed; and c) to our knowledge, it represents the largest sample of children at risk for anxiety followed longitudinally to date. Our study is also unique in that it has spawned offshoots in several promising directions, including studies of the genetic bases of BI and of an early intervention for young children at risk for anxiety. Our ongoing goals have been to study whether it is possible to predict the development and sequence of anxiety disorders among children of parents with PD, as well as to identify risk factors for childhood psychopathology, including temperamental (behavioral inhibition or disinhibition [BD]), parental comorbidity, and psychosocial adversity factors which might influence or moderate risk. We have already identified increased risks in middle childhood for PD, agoraphobia, and multiple anxiety disorders in offspring of PD parents, for a range of anxiety, mood and disruptive behavior disorders in offspring of MD parents, for social anxiety in BI youngsters, and for disruptive behavior disorders in children with BD. We have also noted associations between risk for anxiety disorders and perinatal and psychosocial risk factors. Now, as the children enter adolescence, a period of heightened risk for onset of social phobia, PD, and MD, as well as alcohol and substance abuse, peer difficulties, and other psychosocial problems, we are in the exciting and unique position to answer questions about the specific vulnerabilities conferred by parental PD, parental MD, BI or BD, and pre-existing childhood disorders. We are also able to begin to ask why and how the risk factors we have identified early in childhood influence psychopathology or resiliency in adolescence, and in what ways they combine with protective factors in predicting outcome. These research questions are straightforward, yet they carry broad implications. Studies of high-risk children and adolescents are of the utmost major public health relevance, since the identification of predictors of psychopathology and substance use disorders can set the stage for targeted primary or secondary prevention programs. The identification of such predictors, whether constitutional or environmental, is essential if we are to understand why some children with biological or psychosocial risk factors remain healthy during adolescence and successfully negotiate developmental tasks of this period while others develop psychopathology or derailments in functioning. Careful articulation of the mechanisms by which such factors operate would enable the design of specific, efficient, and cost-effective interventions to prevent poor outcomes in adolescence, and would permit the targeting of scarce societal resources for populations most likely to benefit from such programs.