Preschool Anxiety Disorders in Primary Care

初级保健中的学前焦虑症

• 批准号: 7143373
• 负责人: ADRIAN C ANGOLD
• 金额: $ 73.76万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-01 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7143373
• 关键词: African American; anxiety; anxiety disorders; attention; behavioral /social science research tag; caregivers; caucasian American; child psychology; clinical research; comorbidity; developmental psychology; diagnosis quality /standard; disease /disorder classification; human subject; interview; mental disorder diagnosis; mental health epidemiology; parent offspring interaction; pediatrics; preschool child (1-5); primary care physician; statistics /biometry; teacher

DESCRIPTION (provided by applicant): Recent advances in the technology of structured psychiatric evaluation have proved that reliable psychiatric diagnoses can be made in preschool age (2-5 years) children using the DSM-IV diagnostic criteria. In a relatively small earlier study of psychopathology in general, we found that the prevalence of anxiety disorders in unselected pediatric clinic attendees was 9%. We now propose to conduct the first specific study of DSM-IV anxiety disorders in a preschool pediatric population. We plan to examine the validity of such disorders in terms of their relationships with (1) disability (psychosocial impairment), (2) associations with previously validated scale measures of psychopathology, (3) teacher/caregiver reports of problems, (4) temperamental extremes, (5) measures of attention and inhibitory control, and (6) parental history of psychopathology. We will also determine whether the DSM-IV nosology provides an adequate description of the patterns of association among anxiety symptoms in this age group. We plan to screen an initial sample of 4,900 unselected attendees at several Duke University Medical Center affiliated non-specialty pediatric clinics, using a parent-report anxiety disorders screening measure we have developed. We will then conduct parent-reported interviews about the child for those scoring in the top 20% on this screen, plus a 7.9% random sample of the rest (for a total of 929 completed interviews). From these interviews we will identify nested groups of 250 anxious disorder cases and 250 non-anxious controls for more intensive study, including teacher/caregiver assessments and intensive laboratory assessment with the parent and child. If, as we expect, these diagnoses turn out to be valid, the study will have enormous implications for pediatric clinical practice, because we know that they are not currently being identified, referred for specialist evaluation, or treated by pediatricians. It will also indicate that "prevention" efforts for anxiety disorders will need to be started much earlier than is usually supposed.

描述（申请人提供）：结构化精神病学评估技术的最新进展已经证明，使用 DSM-IV 诊断标准可以对学龄前儿童（2-5 岁）做出可靠的精神病学诊断。在一项相对较小的早期精神病理学研究中，我们发现未经选择的儿科诊所就诊者的焦虑症患病率为 9%。我们现在提议在学龄前儿科人群中开展第一项 DSM-IV 焦虑症具体研究。我们计划检查此类疾病与以下关系的有效性：(1) 残疾（社会心理障碍）；(2) 与先前验证的精神病理学量表测量的关联；(3) 教师/看护者的问题报告；(4) 气质极端情况，（5）注意力和抑制控制的测量，以及（6）父母的精神病理学史。我们还将确定 DSM-IV 疾病分类学是否对该年龄组焦虑症状之间的关联模式提供了充分的描述。我们计划使用我们开发的家长报告焦虑症筛查措施，在杜克大学医学中心附属的几家非专业儿科诊所对 4,900 名未经选择的参与者进行初步样本筛查。然后，我们将对屏幕上得分排名前 20% 的儿童进行家长报告的有关孩子的访谈，再加上其余 7.9% 的随机样本（总共 929 次已完成的访谈）。从这些访谈中，我们将确定由 250 个焦虑症病例和 250 个非焦虑对照组成的嵌套组，以进行更深入的研究，包括教师/看护者评估以及与家长和孩子一起进行的强化实验室评估。如果正如我们预期的那样，这些诊断被证明是有效的，这项研究将对儿科临床实践产生巨大影响，因为我们知道这些诊断目前尚未被识别、转介专家评估或由儿科医生治疗。它还表明，焦虑症的“预防”工作需要比通常认为的更早开始。