A LONGITUDINAL FOLLOW UP OF CHILDREN AT RISK FOR ANXIETY

对有焦虑风险的儿童进行纵向追踪

• 批准号: 6351684
• 负责人: JERROLD F ROSENBAUM
• 金额: $ 61.12万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 1993
• 资助国家: 美国
• 起止时间: 1993-05-01 至 2004-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6351684
• 关键词: DNA; agoraphobia; anxiety disorders; behavior prediction; behavioral /social science research tag; biomarker; child (0-11); child psychology; clinical research; disease /disorder proneness /risk; family genetics; human genetic material tag; human subject; interview; longitudinal human study; molecular genetics; outcomes research; panic disorder; phobias; psychophysiology; social psychology; socioeconomics

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.

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恐慌症（PD）的幼儿焦虑症的发展？ 这个问题很简单，但答案却具有广泛的含义。尽管众所周知，父母患有帕金森病的孩子患焦虑症的风险很高，但其中只有部分孩子会出现精神病理学。预测因子的识别将通过在那些因父母患有PD而已经处于焦虑症风险的儿童中划定一组处于焦虑症极高风险的幼儿，从而促进一级预防。在之前的资助期间，我们完成了一项横断面研究，对象为 200 多名有 PD 风险的儿童以及正常对照父母的后代。我们的样本的独特之处在于，这些儿童在进入儿童焦虑症高危年龄之前就已被广泛识别和表征。这些年轻人已经接受了行为抑制、心理生理标志、焦虑的早期迹象以及社会心理逆境标志的评估。年龄足够大、可以可靠评估 DSM-IV 诊断的子样本已经通过结构化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独特的机会来追踪有精神病理学风险的前瞻性儿童的功能障碍和精神病理学的发展。据我们所知，这将代表纵向跟踪的最大此类样本。正如我们在进展报告中所述，我们的工作表明，多个测量领域将成为高危儿童精神病理学的有用预测因子。这些领域是：父母疾病、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。拟议的工作旨在通过在基线评估五年后对样本进行跟踪来验证这些措施作为后续精神病理学和功能障碍的预测因素。该项目的主要目标是根据我们过去 12 年研究 BI 和幼儿焦虑症的工作而确定的。我们的三个主要目标是： l) 描述有惊恐障碍风险的儿童的心理病理和功能结果； 2）确定有焦虑症风险的儿童不良后果的预测因素； 3) 描述这些儿童焦虑症的发展顺序。此外，在单独的资助下，我们正在从这群家庭中收集 DNA 样本。因此，通过确保 DNA 样本将来可用，我们的样本将有可能用于前瞻性预测由假定的焦虑基因引起的精神疾病和残疾。鉴于我们也在评估环境的不利特征，我们还将能够确定基因与环境的相互作用是否在焦虑症的发生中发挥作用。