Psychiatric Disorders in Young Children-Part 2. Trajectories of Disorders from age 4 to 12: Differential Susceptibility to the Environment

Effective treatment and preventive efforts targeting children's mental health problems should be rooted in knowledge on the prevalence and course of psychiatric disorders as well their risk and protective factors. Most research has addressed factors at one point in time that might predict mental health problems at a specific later point in time. However, research is generally silent as to the predictors of the longer term course of disorders. To fill this gap in knowledge we follow two birth cohorts of children with biennial assessments of psychiatric disorders by means of structured psychiatric interviews form the age of 4 to 12 years (5 waves). Among the 995 participants interviewed at age 4, 670 completed the 5th wave. Selected findings: Wichstrøm et al. (2013). DSM-IV defined symptoms of common disorders also fit 4-years olds well. Wichstrøm et al. (2013). ADHD, victimization and temperamental shyness prospective predict anxiety disorders in young children. Steinsbekk et al. (2013). For the first time we document the prevalence of sleep disorders in preschool children and their comorbidity with psychiatric disorders. Gresseth et al. (2014). A coding system for parent-child interaction (the DPICS) has very good efficiency in identifying behavioral disorders in young children. Sveen et al. (2013; 2016). A much used tool (SDQ) is efficient for screening at the population level albeit with a substantial amount of false positives. SDQ also predicts persistent cases. Stenseng et al. (2014). Social exclusion and bullying may reduce such self-regulation in children. Stenseng et al. (2015). Social exclusion also increase the risk of future indications of behavioral disorders, but not emotional disorders. Wichstrøm et al. (2014). What is the rate of service use for mental health problems, and what are predictors of service use? Here we document that only 10% of children with a disorder receive help at age 4; a rate that increases to 25% at age 6. Behavioral disorders predict future service use, but not emotional disorders, as do parents' perceived burden. Hygen et al. (2015). Traumatic life-events predict increased aggression in children, but only among children with a particular version of the COMT gene. Skalicka et al. (2015a og 2015b). A favorable teacher-student relationship may protect against further development of behavioral problems. Children who have attended day care facilities with less structure evidence greater continuity in behavioral problems than children who have attended day care with traditional and more stable structure. Similar negative effects were also seen with respect to problems in the teacher-student relationship and in behavioral problems among children attending day care organized in large (as opposed to smaller) groups. Skalicka et al. (2015c). Even though a good relationship between teacher and student may protect against behavioral problems, we provide evidence here that this is a two-way street; children?s behavior problems also predict a worsened relationship to teacher, and vice versa, especially among girls. Steinsbekk & Wichstrøm (2015). The s insomnia and sleep walking are moderately stable from 4 to 6 years, and that insomnia increase the risk of future behavioral disorders, depression and social phobia. Husby, S.M. & Wichstrøm, L. (2016). Although long believed to be the case, the empirical support for ODD as a precursor for conduct disorders is meagre. Here we show that symptoms of ODD predict more symptoms of conduct disorders at all ages from 4 to 10 years of age. Reinfjell et al. (2016). Depressive symptoms increase from 4 to 6 years of age, and this increase is predicted by low social competence and inaccuracy in parents' perception of the child's ability to understand emotions. Zahl et al. (2017). Moderate and vigorous physically activity, measured by accelerometers, predict a reduction in symptoms of major depression in middle childhood. Steinsbekk et al. (2017). Previous studies indicate that emotional eating in childhood may increase the risk of eating disorders in adolescence. We find that child emotional eating and parental emotional feeding reinforce each other during middle childhood. Wichstrøm et al. (2017a). Why are mental health problems stable over time? Two options are viable: 1) mental health problems starts off vicious circles or leave scars and thereby increase the risk of future problems or 2) the same factors cause mental health problems at different ages, making them stable over time. We show that explanation 2) is the case. Wichstrøm et al. (2017b). Is difficult temperament a cause of future mental health problems, or are such problems just an extreme version of temperament? Here we show that temperamental negative affectivity and effortful control do indeed predict psychiatric symptoms in children, over and beyond any communality between temperament and mental health problems.

Most research on the etiology and course of psychiatric disorders in children seeks to identify predictors of a specific future disorder at a specific point in time. However, treatment and management efforts also need to be informed by research on predict ors of long-term course of disorders. Previous research using questionnaires and rating scales translate only modestly into diagnosable disorders. Thus, there is no research describing the longer-term trajectories in children, and predictors thereof. We w ill therefore identify typical trajectories of disorders from age 4 to 12, and to determine their predictors. Research on predictors has applied a vulnerability-stress model, implying that some children are particularly vulnerable/resilient to negative environmental factors. Evidence suggests that conceptualizing these children as vulnerable or resilient does not fully capture the dynamics of pathological development. Thus, we test the proposition that some children may be more malleable to both negativ e and positive parent and peer relations, focusing on temperamental, emotional, cognitive and physiological factors as not just as vulnerability/resilience factors but as plasticity factors, making some children more susceptible to environmental influence s - for better and for worse- than others. Two birth cohorts meeting at the health check-up for 4-year olds in Trondheim have been screened with the SDQ (N=3,800) and a stratified sample of 1,250 families (82% consent) have been drawn to participate in a more intensive study. The families have been followed up bi-annually with similar protocols. Parents and children (from age 8 onwards) complete a structured diagnostic interview. Child emotion regulation, executive functioning, temperament and ANS react ivity are measured; video recording of parent-child interaction (e.g. sensitivity, limit setting) are made; and children, parents and teachers provide information on peer relations (e.g. rejection, inclusion).