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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
Preschool
to
Early Adulthood
1A
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
1A
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
1A
Results
Anxiety Disorders from Preschool to Early
Adulthood




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
1A
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
1B
Specific Childhood Anxiety Disorders as
predictors of Adolescent Psychopathology
Antje Bittner
Objective 
Methods 
implications of specific
childhood disorders (before
age 13 years) for adolescent
disorders (age 13-19)
Great Smoky Mountains
study
1B
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.
1B
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.
1B
Specific Childhood Anxiety Disorders as
predictors of Adolescent Psychopathology
Conclusion  Anxiety disorders in childhoodespecially 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
1C
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
1C
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
1C
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.
1C
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 heterotypic comorbidity
among the specific anxiety disorders.
Preschoolers with anxiety disorders
are impaired but few are referred
for mental health evaluations.
1D
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
1D
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.
1D
Pediatric Anxiety and Neural Circuitry
Dysfunction : A Neuroscience Perspective
Results

The two behavioural studies
document abnormal attention
bias in paediatric anxiety
disorders.
1D
Results
Pediatric Anxiety and Neural Circuitry
Dysfunction : A Neuroscience Perspective

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.
1D
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
14 Tracking Trauma and its
effects from Infancy to
Adolescence
14
A
Psychiatric Sequelae of Institutional
Care : A randomized controlled Trial
in Romania
Charles H. Zeanah
Objective

Methods


to evaluate foster care as an
alternative to institutionalized care
for orphaned children
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 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 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 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 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 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
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 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 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 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
Results
Maltreatment and Resilience : Evidence from
A longitudinal study

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