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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

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slide1

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

slide2

Symposia

1 Anxiety Disorders

from

Preschool

to

Early Adulthood

1 a 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 adulthood4
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 adulthood5
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 adulthood6
1 A Anxiety Disorders from Preschool to Early Adulthood

Conclusion : Sexdifferences 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 b specific childhood anxiety disorders as predictors of adolescent psychopathology
1 B Specific 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 b specific childhood anxiety disorders as predictors of adolescent psychopathology8
1 B Specific Childhood Anxiety Disorders as predictors of Adolescent Psychopathology

Results In girls

Childhood SAD was associated with subsequent specific 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 b specific childhood anxiety disorders as predictors of adolescent psychopathology9
1 B Specific 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 b specific childhood anxiety disorders as predictors of adolescent psychopathology10
1 B Specific 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 c anxiety disorders in preschool children
1 C Anxiety 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 c anxiety disorders in preschool children12
1 C Anxiety 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 c anxiety disorders in preschool children13
1 C Anxiety 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 c anxiety disorders in preschool children14
1 C Anxiety 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 heterotypiccomorbidity

among the specific anxiety disorders.

 Preschoolers with anxiety disorders

are impaired but few are referred

for mental health evaluations.

1 d pediatric anxiety and neural circuitry dysfunction a neuroscience perspective
1 D Pediatric 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 d pediatric anxiety and neural circuitry dysfunction a neuroscience perspective16
1 D Pediatric 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 d pediatric anxiety and neural circuitry dysfunction a neuroscience perspective17
1 D Pediatric Anxiety and Neural Circuitry Dysfunction : A Neuroscience Perspective

Results The two behavioural studies document abnormal attention bias in paediatric anxiety disorders.

1 d pediatric anxiety and neural circuitry dysfunction a neuroscience perspective18
1 D Pediatric Anxiety and Neural Circuitry Dysfunction : A Neuroscience Perspective

Results In the fMRI study, greater amygdala

and ventral PFCactivation 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 d pediatric anxiety and neural circuitry dysfunction a neuroscience perspective19
1 D Pediatric 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

slide20

14 Tracking Trauma and its

effects from Infancy to

Adolescence

a psychiatric sequelae of institutional care a randomized controlled trial in romania
A 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
14 A Psychiatric Sequelae of Institutional Care : A randomized controlled Trial in Romania

Results Both institutionalized and foster care

groups displayedhigher 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 romania23
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 b the epidemiology of trauma and post traumatic stress in children
14 B The 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 b the epidemiology of trauma and post traumatic stress in children25
14 B The 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 b the epidemiology of trauma and post traumatic stress in children26
14 B The 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 b the epidemiology of trauma and post traumatic stress in children27
14 B The 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 b the epidemiology of trauma and post traumatic stress in children28
14 B The 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 c the epidemiology of stressful life events and preschool mental health
14 C The 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 c the epidemiology of stressful life events and preschool mental health30
14 C The 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 events such as physical or sexual abuse

14 c the epidemiology of stressful life events and preschool mental health31
14 C The 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 c the epidemiology of stressful life events and preschool mental health32
14 C The 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
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 study34
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 study35
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 study36
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