Preschool Psychopathology: Continuity and Outcomes at Age 6

描述(由申请人提供)：对学龄前儿童的精神病理学知之甚少，特别是关于这一人群的内化问题的研究更是少之又少。此外，很少有纵向研究考察儿童早期障碍和症状的连续性。需要进行纵向研究来阐明幼儿精神病理学的临床意义和未来影响。现有的研究倾向于将问题外部化，并包括症状清单措施，几乎没有提供关于症状的性质和临床意义的细节。此外，学龄前儿童的精神病理学研究通常使用临床样本，这些样本容易受到各种偏见的影响。这项拟议的研究项目是一项前瞻性的纵向研究，旨在通过在大的社区样本中进行全面的诊断性访谈来检查幼儿精神病理学的稳定性。具体的情绪和行为障碍和症状将在3岁和6岁时进行评估，以比较障碍的发生率、症状水平和并发合并症。将分析疾病和症状的同型和异型连续性。此外，还将检查3个领域中症状变化的预测因子：儿童(功能障碍、气质)、家庭(母亲精神病理、育儿行为)和生活压力。将测试一个初步模型，该模型假设3岁儿童和家庭变量对3至6岁儿童症状的变化有直接影响，以及在6岁评估之前通过生活压力对症状的间接影响。最后，样本的一个子集将在3个月后重新访谈，以探索延长诊断性访谈主要阶段的长度的价值。从3岁到6岁的症状和诊断的稳定性将支持学龄前儿童精神病理学的有效性，并鼓励针对情绪和行为问题及其发育后遗症的预防和早期干预努力的发展。公共卫生相关性：这项研究有可能提高我们对学龄前儿童精神病理学的过程和意义的理解，并确定精神症状变化的预测因子，可用于指导有关早期干预和服务需求的决策。此外，这项研究还有助于完善对幼儿的精神病理学评估。

DESCRIPTION (provided by applicant): Little is known about psychopathology in preschoolers, and there are particularly few studies on internalizing problems in this population. In addition, there are few longitudinal studies that examine the continuity of early childhood disorders and symptoms. Longitudinal studies are needed to elucidate the clinical significance and future implications of psychopathology in young children. Existing studies tend to focus on externalizing problems and include symptom checklist measures that provide few details about the nature and clinical significance of symptoms. Further, studies of psychopathology in preschoolers have typically used clinical samples, which are subject to a variety of biases. The proposed research project is a prospective longitudinal study designed to examine the stability of psychopathology in young children using a comprehensive diagnostic interview in a large community sample. Specific emotional and behavioral disorders and symptoms will be assessed at ages 3 and 6 to compare rates of disorders, levels of symptoms, and concurrent comorbidity. Homotypic and heterotypic continuity of disorders and symptoms will be analyzed. In addition, predictors of change in symptoms in 3 domains will be examined: child (functional impairment, temperament), family (maternal psychopathology, parenting behavior), and life stress. A preliminary model positing that age 3 child and family variables have direct effects on change in children's symptoms between ages 3 and 6, as well as indirect effects on symptoms as mediated by life stress prior to the age 6 assessment will be tested. Finally, a subset of the sample will be re-interviewed 3 months later to explore the value of extending the length of the primary period of the diagnostic interview. The stability of symptoms and diagnoses from ages 3 to 6 would support the validity of psychopathology in preschoolers and encourage the development of prevention and early intervention effort targeting both emotional and behavioral problems and their developmental sequelae. Public Health Relevance: is study has the potential to improve our understanding of the course and significance of psychopathology in preschoolers, and to identify predictors of change in psychiatric symptoms that can be used to guide decision-making regarding early intervention and need for services. In addition, this study can help to refine the assessment of psychopathology in young children.