Children at Risk for Anxiety Disorders: A Follow up Stu*

有焦虑症风险的儿童：后续研究*

• 批准号: 7046093
• 负责人: JERROLD F ROSENBAUM
• 金额: $ 64.37万
• 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 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7046093
• 关键词: academic achievement; adolescence (12-20); behavioral /social science research tag; case history; child behavior; clinical research; comorbidity; conflict; disease /disorder proneness /risk; family structure /dynamics; human subject; interview; longitudinal human study; major depression; mental health epidemiology; panic disorder; personality; psychopathology; self concept; social psychology; socioeconomics; substance abuse related disorder

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.

描述（由申请人提供）：拟议的研究是对有恐慌症风险（PD）风险的大型队列（n = 446）的长达12年随访，以及对重度抑郁症（MD）风险的比较后代，或者没有情绪或焦虑症的脆弱性。这些孩子最初是在蹒跚学步的胡德（Toddler Hood）招募的，幼儿时期是在童年时期重新评估的（在第六年），并将在下一波浪潮中进入青春期。该样本是独一无二的，因为a）儿童在基线时使用了行为抑制（BI）的实验室测量和新生症状的评估，在他们进入儿童焦虑症的风险期之前，他们对新生症状的评估进行了广泛的特征； b）父母对成人和儿童心理病理学进行了全面评估，并仔细地关注了可能已经暴露的后代的划定情节； c）据我们所知，它代表了迄今为止纵向遵循焦虑症风险的最大样本。我们的研究也是独特的，因为它已经在多个有前途的方向上产生了分支，包括研究BI的遗传基础和针对有焦虑症风险的幼儿的早期干预。 我们持续的目标是研究是否有可能预测父母父母儿童中焦虑症的发展和顺序，以及确定儿童精神病理学的危险因素，包括气质（行为抑制或抑制[BD]），父母的合并症和心理社会逆境因素可能影响或中度风险。我们已经确定了PD，恐惧症的中期风险增加，以及PD父母后代的多种焦虑症，在MD父母的后代，BI少年的社交焦虑以及BD儿童的颠覆性行为障碍方面的一系列焦虑，情绪和破坏性行为障碍。我们还指出了焦虑症风险与围产期和社会心理风险因素之间的关联。现在，随着孩子们进入青春期，社交恐惧症，PD和MD的风险增加，以及滥用酒精和毒品，同伴困难以及其他心理社会问题，我们处于令人兴奋和独特的位置，可以回答有关由父母PD，PD，BID，BI或BD，BID或PRE-BD和PRE-PRECESSISS的特定脆弱性的问题，以及其他弱点。我们还可以开始询问为什么我们在儿童早期发现的危险因素以及如何影响心理病理学或青春期的韧性，以及它们以哪些方式与预测结果的保护因素相结合。 这些研究问题很简单，但它们具有广泛的影响。对高危儿童和青少年的研究是最大的主要公共卫生相关性，因为鉴定精神病理学和药物使用障碍的预测因素可以为有针对性的初级或二级预防计划奠定基础。如果我们要理解为什么有些患有生物或社会心理风险因素的儿童在青春期保持健康并成功地谈判此时期的发展任务时，而其他人在功能中发展了精神病理学或脱轨，则必须识别这种预测因素，无论是宪法还是环境。仔细阐明此类因素运作的机制将使特定，高效和具有成本效益的干预措施设计以防止青春期的不良情况，并允许针对最有可能受益于此类计划的人口的稀缺社会资源。