2005 Joint Annual Meeting of the American Academy of Child & Adolescent Psychiatry and the Canadian Academy of Child & Adolescent Psychiatry Toronto, Canada. October 18-23, 2005

Symposia 1 Anxiety Disorders from Preschool to Early Adulthood

1 A Anxiety Disorders from Preschool to Early Adulthood Adrian Angold Objective  changes in rates of common anxiety disorders from pre-adolescence to young adulthood  components of puberty most strongly associated with specific anxiety disorders

1 A Anxiety Disorders from Preschool to Early Adulthood Methods  Great Smoky Mountains study  1,420 community-representative sample  children aged 9, 11 or 13 at study entry  received multiple intensive parent-and child-reported psychiatric assessment (Child and Adolescent Psychiatric Assessment-CAPA) from 9 to 19

1 A Anxiety Disorders from Preschool to Early Adulthood Results  very different patterns of development change for different anxiety disorders  in social phobia in adolescent girls was associated with testosterone and estradiol while  in GAD was associated with LH and FSH  The dramatic age-dependent fall off in rates separation anxiety was not associated with any pubertal factors  No significant effect of age on the rates of specific phobia

1 A Anxiety Disorders from Preschool to Early Adulthood Conclusion :Sex differences in “ adjustment ” at puberty depend on sex – differentiated, behaviour type-specific patterns of interaction between specific components of puberty, genetic effects and environmental components

1 BSpecific Childhood Anxiety Disorders as predictors of Adolescent Psychopathology Antje Bittner Objective  implications of specific childhood disorders (before age 13 years) for adolescent disorders (age 13-19) Methods  Great Smoky Mountains study

1 BSpecific Childhood Anxiety Disorders as predictors of Adolescent Psychopathology Results  In girls Childhood SAD was associated with subsequentspecific phobia. OAD was related to adolescent OAD, panic attacks and CD. GAD in childhood was significant associated with subsequent SAD, depression,CD and SUD.

1 BSpecific Childhood Anxiety Disorders as predictors of Adolescent Psychopathology Results  In boys Homotypic continuity was seen for SAD and social phobia. Childhood OAD was associated with adolescent depression. Social phobia predicted later SAD, panic attacks and ADHD.

1 BSpecific Childhood Anxiety Disorders as predictors of Adolescent Psychopathology Conclusion  Anxiety disorders in childhood- especially OAD and social phobia – seem to be strong predictors of psychiatric disorders in adolescence  Deletion of OAD and revision of GAD for children may lead to underestimation of the impact of childhood anxiety disorders

1 CAnxiety Disorders in Preschool children Helen L. Egger Objective  To describe the prevalence of specific DSM-IV anxiety disorders and the associations with age, gender,other psychiatric disorders, impairment, and mental health service use in preschool children

1 CAnxiety Disorders in Preschool children Methods  1,073 parents of children age 2-5 attending a large paediatric clinic were screened  193 parents of high scorers age (top 30%) and 114 randomly selected parents of non-high scorers were interviewed with the Preschool Age Psychiatric Assessment (PAPA), a structured parent psychiatric interview for assessing psychiatric symptoms and disorders in preschool children  Data is weighted back to the screening population

1 CAnxiety Disorders in Preschool children Results  The overall prevalence of anxiety disorders was 9.5%, with no significant gender differences.  Older children were more likely to meet criteria for any anxiety disorder and PTSD.  Preschoolers with an anxiety disorder were more likely to have another anxiety disorder, other psychiatric disorders and be impaired.

1 CAnxiety Disorders in Preschool children Conclusion  Anxiety disorders are common in preschool children, exhibit substantial homotypic and heterotypic comorbidity, and show differences in the rates of homotypic and heterotypic comorbidity among the specific anxiety disorders.  Preschoolers with anxiety disorders are impaired but few are referred for mental health evaluations.

1 DPediatric Anxiety and Neural Circuitry Dysfunction : A Neuroscience Perspective Daniel S. Pine Objective  To review four studies that examine the associations among attention, developmental psychopathology and emotion, focusing on the amygdala and its role in threat processing

1 DPediatric Anxiety and Neural Circuitry Dysfunction : A Neuroscience Perspective Daniel S. Pine Methods  Two studies examine relationships in children and adolescents among anxiety disorders, major depression, and performance on attention bias tasks.  Two studies use fMRI to examine the relationships among attention, amygdala activation and development.

1 DPediatric Anxiety and Neural Circuitry Dysfunction : A Neuroscience Perspective Results  The two behavioural studies document abnormal attention bias in paediatric anxiety disorders.

1 DPediatric Anxiety and Neural Circuitry Dysfunction : A Neuroscience Perspective Results  In the fMRI study, greater amygdala and ventral PFC activation is found in adolescents with anxiety disorders, relative to psychiatrically healthy adolescents. endogenous attention control during face - emotion viewing, greater activation in patients is found both in the amygdala and ventral PFC. exogenous attention control during face-emotion viewing greater amygdala activation is found in patients for the subliminal presentation of angry faces.

1 DPediatric Anxiety and Neural Circuitry Dysfunction : A Neuroscience Perspective Conclusion  Attention abnormalities occur in paediatric anxiety disorders and may relate to perturbed functioning in the amygdala and ventral PFC

14Tracking Trauma and its effects from Infancy to Adolescence

14A Psychiatric Sequelae of Institutional Care : A randomized controlled Trial in Romania Charles H. Zeanah Objective  to evaluate foster care as an alternative to institutionalized care for orphaned children Methods  136 institutionalized Romanian children ages 5-31 months randomly assigned either to continued institionalized care or foster care  An additional group of 72 children that had never been institutionalized were recruited for comparison

14 A Psychiatric Sequelae of Institutional Care : A randomized controlled Trial in Romania Results  Both institutionalized and foster care groups displayed higher levels of psychopathology than children never institutionalized.  Preliminary results supported lower of emotional disorders for children in the foster care group as compared to the institutionalized groups.  No difference were observed between foster care and institutionalized groups on behavioural disorders.

14 A Psychiatric Sequelae of Institutional Care : A randomized controlled Trial in Romania Conclusion  Preliminary data support foster care as an effective alternative to institutionalized care.

14 BThe epidemiology of Trauma and Post-Traumatic Stress in children William E. Copeland Objective  to examine the prevalence of potentially traumatic life events and post-traumatic stress in an epidemiologic sample of rural children and adolescents

14 BThe epidemiology of Trauma and Post-Traumatic Stress in children Mehtods  1,420 children assessed at multiple time points from 9 to 16  CAPA used to collect information about potentially traumatic events, PTSD symptomatology and other psychiatric disorders

14 BThe epidemiology of Trauma and Post-Traumatic Stress in children Results  70% of children reported exposure to a potentially traumatic event by Age 16  Although few children met full DSM-IV criteria for PTSD, up to 25% of children exposed to an event displayed some post-traumatic stress symptomatology

14 BThe epidemiology of Trauma and Post-Traumatic Stress in children Results  Symptoms were highest for children exposed directly to violence, or indirectly through witnessing or learning about violence perpetrated to a peer or loved one  Children exposed to trauma were two to three times as likely to display other DSM-IV disorders as children without trauma

14 BThe epidemiology of Trauma and Post-Traumatic Stress in children Conclusion  Exposure to trauma in childhood is both common and deleterious.  While some children display PTSD symptomotology, many more display other behavioural and emotional problems.

14 CThe epidemiology of stressful life events and preschool mental health Helen L. Egger Objective  to estimate the prevalence of potentially stressful life events in preschool children  to determine risk factors associated with trauma exposure

14 CThe epidemiology of stressful life events and preschool mental health Methods  A cohort of 307 parents of preschool children (Age 2-5) were interviewed with PAPA to assess psychiatric functioning  The PAPA includes a life event module assessing how low magnitude stressful events such as birth of a sibling and high magnitude eventssuch as physical or sexual abuse

14 CThe epidemiology of stressful life events And preschool mental health Results  Over half of the children were exposed to some potentially stressful event in the past three months  Poverty and frequent relocation were strongly related to stress exposure  High magnilude events were significantly related to the meeting the criteria for an anxiety disorder

14 CThe epidemiology of stressful life events and preschool mental health Conclusion  Potentially traumatic life events are relatively common in the lives of preschool children and are associated with greater risk for psychiatric disorders and impairment.

14 D Maltreatment and Resilience : Evidence from A longitudinal study Elizabeth Jane Costello Objective  to answer 2 questions 1) Does childhood maltreatment predict adolescent problems in the general population ? 2) What predicts adolescent resilience to childhood maltreatment ? Methods  Great Smoky Mountains study  CAPA was used to assess maltreatment (i.e physical abuse, sexual abuse or neglect) psychiatric functioning and relevant risk factors

14 D Maltreatment and Resilience : Evidence from A longitudinal study Results  Maltreated children displayed higher rates of both psychiatric disorder and other signs of doing poorly.  Resilience to physical or sexual abuse was predicted by adequate supervision by parents and low level of exposure to traumatic events.

14 D Maltreatment and Resilience : Evidence from A longitudinal study Results  For neglect, decreased exposure to common stressors predicted better functioning  Family structure, gender and race were not related to resilience

14 D Maltreatment and Resilience : Evidence from A longitudinal study Conclusion  Many children are resilient to maltreatment  A relatively small group of factors predict resilience to maltreatment and most are amendable to change