Dougherty Lea R, Smith Victoria C, Bufferd Sara J, Kessel Ellen, Carlson Gabrielle A, Klein Daniel N
Department of Psychology, University of Maryland, College Park, MD, USA.
Department of Psychology, California State University San Marcos, San Marcos, CA, USA.
J Child Psychol Psychiatry. 2015 Sep;56(9):999-1007. doi: 10.1111/jcpp.12403. Epub 2015 Feb 27.
Little is known about the predictive validity and clinical significance of chronic irritability during early childhood. This prospective, longitudinal study examined associations of preschool chronic irritability with psychiatric disorders, functional impairment, and service use at age nine in a large community sample.
Four hundred and forty-six children were assessed at age three and again at age nine. Child psychopathology and functional impairment were assessed at age three with the Preschool Age Psychiatric Assessment (PAPA) with parents and at age nine with the Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS) with parents and children. Items from the PAPA were used to create a dimensional measure of chronic irritability at age three. At age nine, mothers, fathers, and youth completed the Child Depression Inventory (CDI) and the Screen for Anxiety Related Disorders (SCARED).
Chronic irritability at age three predicted any current and lifetime anxiety disorders at age nine, current and lifetime generalized anxiety disorder, and current separation anxiety, after controlling for baseline anxiety disorders. In addition, preschool irritability predicted increases in anxiety and disruptive behavior disorder symptoms on the K-SADS, and maternal and paternal reports of depressive and anxiety symptoms on the CDI and SCARED. Lastly, preschool irritability predicted greater functional impairment and outpatient treatment use, even after controlling for all psychiatric disorders at baseline.
Findings underscore the central role of irritability in developmental psychopathology and support the importance of early detection and interventions targeting preschool irritability.
关于幼儿期慢性易激惹的预测效度和临床意义，人们所知甚少。这项前瞻性纵向研究在一个大型社区样本中，考察了学龄前慢性易激惹与9岁时精神障碍、功能损害及服务利用之间的关联。
对446名儿童在3岁时进行了评估，并在9岁时再次评估。在3岁时，通过家长参与的学龄前儿童精神病学评估（PAPA）对儿童精神病理学和功能损害进行评估；在9岁时，通过家长和儿童参与的儿童情感障碍和精神分裂症量表（K-SADS）进行评估。利用PAPA中的项目创建了一个3岁时慢性易激惹的维度测量指标。在9岁时，母亲、父亲和青少年完成了儿童抑郁量表（CDI）和焦虑相关障碍筛查量表（SCARED）。
在控制了基线焦虑障碍后，3岁时的慢性易激惹可预测9岁时的任何当前和终生焦虑障碍、当前和终生广泛性焦虑障碍以及当前的分离焦虑。此外，学龄前易激惹可预测K-SADS上焦虑和破坏性行为障碍症状的增加，以及母亲和父亲在CDI和SCARED上报告的抑郁和焦虑症状。最后，即使在控制了基线时的所有精神障碍后，学龄前易激惹仍可预测更大的功能损害和门诊治疗的使用。
研究结果强调了易激惹在发展性精神病理学中的核心作用，并支持早期发现和针对学龄前易激惹进行干预的重要性。
