ODD/Depression in young children: Developmental aspects

描述（由申请人提供）：这是针对儿童和青少年中抑郁症与破坏性行为障碍（对立违抗性障碍；ODD）共病研究的RFA而开发的申请的重新提交，这种情况被认为特别难以治疗，是青少年药物滥用的前兆。对应用程序的第一个批评导致了数据分析程序的修订，以允许SEM分析更仔细地检查整个模型。在重新提交的报告中纳入了审稿人的建议，扩展了模型，纳入了一个新的变量（注意力问题），改进了某些措施，纳入了教师的观察，并重新引入了原始应用的某些元素，以检查具有临床显著程度的ODD和抑郁症的儿童亚组。对立违抗性障碍（ODD）是幼儿中最常见的精神疾病。符合DSM诊断标准的抑郁症在学龄前儿童中并不常见，但抑郁症状却并非如此。在对整个儿童和青少年年龄段的抑郁症和ODD的研究中，一些家庭、母亲和孩子的特征，以及母亲和孩子的互动模式已经被确定为风险因素/相关因素，大多数特征似乎是ODD和抑郁症的风险因素。虽然有关于ODD的早期起源的研究，但相对较少的研究涉及幼儿抑郁症状的发病，更少的研究涉及ODD/抑郁合并症的发展。本研究将检验一个模型，该模型包括家庭（冲突、压力源）、母亲（抑郁）、孩子（气质、学校学术能力、社交技能问题、注意力问题）和互动（母婴互动、气质）变量，这些变量已得到实证支持，作为研究开始时4-5岁儿童群体中ODD和抑郁发展的前兆。参与者将从公立学校和初级保健儿科实践中招募，并进行每年三次的数据收集。主要使用结构化方程建模技术，整体模型拟合和特定变量在ODD、抑郁及其共病发展中的作用将在家长和教师评估结果中进行检验；其他分析将检查临床亚组。

DESCRIPTION (provided by applicant): This is a resubmission of a application developed in response to an RFA concerning studies of the comorbidity of depression with a disruptive behavior disorder (oppositional defiant disorder; ODD) in children and adolescents, a condition that is believed to be particularly resistant to treatment and a precursor to adolescent drug abuse. The first critique of the application led to revisions in data analytic procedures to allow for SEM analysis to examine the overall model more carefully. Incorporating recommendations from reviewers for this resubmission expands the model to incorporate a new variable (attention problems), improves certain measures, incorporates teacher observations, and reintroduces certain elements of the original application to examine subgroups of children with clinically significant levels of ODD and depression. Oppositional defiant disorder (ODD) is the most common psychiatric problem among young children; depression meeting DSM diagnostic criteria is uncommon in preschoolers, but depressive symptoms are not. In studies of depression and ODD among the entire age spectrum of childhood and adolescents, several family, maternal, and child characteristics, along with the mother-child interactional patterns have been identified as risk factors/correlates, with most characteristics seeming to be risk factors for both ODD and depression. While studies of the early origins of ODD exist, relatively few have examined onset of depressive symptoms in young children, and even fewer have examined the development of ODD/depression comorbidity. This proposed study will examine a model included family (conflict, stressors), maternal (depression), child (temperament, school academic competence, social skills problems, attentional problems), and interactional (mother-child interaction, temperament) variables that have received empirical support as precursors to the development of ODD and depression in a large (N=1615) group of children age 4-5 at study onset. Participants will be recruited from public schools and primary care pediatric practices and followed across 3 annual waves of data collection. Primarily using structured equation modeling techniques, overall model fit and the role of specific variables in he development of ODD, depression, and their comorbidity will be examined for both parent and teacher-rated outcomes; additional analyses will examine clinical subgroups.