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Children at risk for anxiety disorders
THURSDAY, MAY 18
BIOL PSYCHIATRY 593 1995;37
ABSTRACTS n
Society of Biological Psychiatry 1995 Annual Meeting
THURSDAY, MAY 18
1. DEVELOPMENT OF HUMAN ANXIETY J.F. Rosenbaum l, J. Biederman l, E. BolducMurphy 1, S. Faraone l, & J. Chaloff 1, J. Kagan 2 1Massachusetts General Hospital; 2Harvard University, Boston, M A 021 14 Childhood antecedents of anxiety disorders in adulthood remain poorly understood. We have examined from longitudinal and familial perspectives the relationship between behavioral inhibition in children and anxiety disorders. In a series of studies we have found an association between behavioral inhibition and anxiety disorders in two independently ascertained and previously described samples of children. One sample was cross-sectional and clinically derived; the other was epidemiologically derived and longitudinal. Our studies have found that: 1) children of parents with panic disorder with agoraphobia are at increased risk for behavioral inhibition; 2) children identified as having behavioral inhibition have high rates of childhood-onset anxiety disorders themselves; 3) behavioral inhibition is associated with familial risk for anxiety disorder; 4) children with behavioral inhibition and anxiety disorders have greater familial loading of anxiety disorders; 5) children who remain inhibited over time are at highest risk for anxiety disorders in themselves and their families; and 6) differences between inhibited and noninhibited children become more robust at 3-year follow-up. These findings indicate that behavioral inhibition is an early predictor of later anxiety disorders. Implications of these findings to neurobiological approaches to human anxiety and the development of new treatments will be discussed.
2. CHILDREN AT RISK FOR ANXIETY DISORDERS D.C. Beidel & S.M. Turner Department o f Psychiatry and Behavioral Sciences, Medical University o f South Carolina There is considerable evidence for the existence of familial factors in the anxiety disorders, and offspring of anxiety disorder patients must be considered a group at high risk. This study uses a cross-sectional and longitu© 1995 Society of Biological Psychiatry
dinal design to examine the contribution of psychosocial adjustment, autonomic response patterns to challenging tasks, and parent-child interactions to the development of anxiety and anxiety disorders in young children (ages 7-12). Children of parents with anxiety disorders were compared with those whose parents had depression, anxiety and depression, and normal controls. The preliminary results indicate that 40% of children of anxious parents have an anxiety disorder, compared to 11% of the children of normal controls, 25% of the children of depressed parents, and 20% of children of parents with anxiety and depression. Furthermore, compared to the other groups, offspring of parents with anxiety disorders or anxiety disorders and depression manifested a distinct psychophysiological response consisting of heightened reactivity and minimal habituation when presented with "frightening" auditory or visual stimuli, and this pattern remained even when children who were diagnosed with anxiety disorders were removed from the analysis. Finally, parents with anxiety disorders are more likely than normal control parents to use cautionary statements during their child's play (e.g., "Be Careful," "Watch Out") and inhibit their child's play. The results are discussed in terms of their implications for early detection and prevention of anxiety disorders in young children.
3. TREATMENT AND FOLLOW-UP OF CHILDREN WITH ANXIETY DISORDERS R.G. Klein Columbia University, College o f Physicians & Surgeons, N e w York, NY 10032 Longitudinal studies of children enable clarification of the ultimate significance of disorders and their relationship to other conditions, and document developmental aspects of adult psychopathology. In turn, they may lay the groundwork for early case identification and prevention. Longitudinal studies of anxiety in population samples have found that fears and shyness are relatively stable in "normal" children, providing support for examining the consequences of childhood anxiety. Nine studies that have reported on the outcome of outpatient anxious children and adolescents are limited by the fact that diagnostic evaluations were not performed. We have completed an 18-year follow-up of 54 children who were diagnosed by us as having separation anxiety between ages 6 and 15. The findings indicate that, in adulthood, compared to controls, cases were significantly more likely to have panic disorder. A trend was also found for an excess of major depression in the former anxious children. The women, but not the men, had significantly higher rates of social phobia. Of public health import is the finding that 15% of the formerly anxious children had been hospitalized at least once in a psychiatric facility. 0006-3223/95/$09.50 SS DI 0006-3223(95)00120-6
BIOL PSYCHIATRY 593 1995;37
ABSTRACTS n
Society of Biological Psychiatry 1995 Annual Meeting
THURSDAY, MAY 18
1. DEVELOPMENT OF HUMAN ANXIETY J.F. Rosenbaum l, J. Biederman l, E. BolducMurphy 1, S. Faraone l, & J. Chaloff 1, J. Kagan 2 1Massachusetts General Hospital; 2Harvard University, Boston, M A 021 14 Childhood antecedents of anxiety disorders in adulthood remain poorly understood. We have examined from longitudinal and familial perspectives the relationship between behavioral inhibition in children and anxiety disorders. In a series of studies we have found an association between behavioral inhibition and anxiety disorders in two independently ascertained and previously described samples of children. One sample was cross-sectional and clinically derived; the other was epidemiologically derived and longitudinal. Our studies have found that: 1) children of parents with panic disorder with agoraphobia are at increased risk for behavioral inhibition; 2) children identified as having behavioral inhibition have high rates of childhood-onset anxiety disorders themselves; 3) behavioral inhibition is associated with familial risk for anxiety disorder; 4) children with behavioral inhibition and anxiety disorders have greater familial loading of anxiety disorders; 5) children who remain inhibited over time are at highest risk for anxiety disorders in themselves and their families; and 6) differences between inhibited and noninhibited children become more robust at 3-year follow-up. These findings indicate that behavioral inhibition is an early predictor of later anxiety disorders. Implications of these findings to neurobiological approaches to human anxiety and the development of new treatments will be discussed.
2. CHILDREN AT RISK FOR ANXIETY DISORDERS D.C. Beidel & S.M. Turner Department o f Psychiatry and Behavioral Sciences, Medical University o f South Carolina There is considerable evidence for the existence of familial factors in the anxiety disorders, and offspring of anxiety disorder patients must be considered a group at high risk. This study uses a cross-sectional and longitu© 1995 Society of Biological Psychiatry
dinal design to examine the contribution of psychosocial adjustment, autonomic response patterns to challenging tasks, and parent-child interactions to the development of anxiety and anxiety disorders in young children (ages 7-12). Children of parents with anxiety disorders were compared with those whose parents had depression, anxiety and depression, and normal controls. The preliminary results indicate that 40% of children of anxious parents have an anxiety disorder, compared to 11% of the children of normal controls, 25% of the children of depressed parents, and 20% of children of parents with anxiety and depression. Furthermore, compared to the other groups, offspring of parents with anxiety disorders or anxiety disorders and depression manifested a distinct psychophysiological response consisting of heightened reactivity and minimal habituation when presented with "frightening" auditory or visual stimuli, and this pattern remained even when children who were diagnosed with anxiety disorders were removed from the analysis. Finally, parents with anxiety disorders are more likely than normal control parents to use cautionary statements during their child's play (e.g., "Be Careful," "Watch Out") and inhibit their child's play. The results are discussed in terms of their implications for early detection and prevention of anxiety disorders in young children.
3. TREATMENT AND FOLLOW-UP OF CHILDREN WITH ANXIETY DISORDERS R.G. Klein Columbia University, College o f Physicians & Surgeons, N e w York, NY 10032 Longitudinal studies of children enable clarification of the ultimate significance of disorders and their relationship to other conditions, and document developmental aspects of adult psychopathology. In turn, they may lay the groundwork for early case identification and prevention. Longitudinal studies of anxiety in population samples have found that fears and shyness are relatively stable in "normal" children, providing support for examining the consequences of childhood anxiety. Nine studies that have reported on the outcome of outpatient anxious children and adolescents are limited by the fact that diagnostic evaluations were not performed. We have completed an 18-year follow-up of 54 children who were diagnosed by us as having separation anxiety between ages 6 and 15. The findings indicate that, in adulthood, compared to controls, cases were significantly more likely to have panic disorder. A trend was also found for an excess of major depression in the former anxious children. The women, but not the men, had significantly higher rates of social phobia. Of public health import is the finding that 15% of the formerly anxious children had been hospitalized at least once in a psychiatric facility. 0006-3223/95/$09.50 SS DI 0006-3223(95)00120-6