The aim of this application, """"""""Outcomes of Preschool Mental Health Problems,"""""""" is to examine the predictive validity of preschool anxiety and depressive symptoms, syndromes, and disorders that present in the preschool period at follow-up 3 1/2 to 6 1/2 years after the initial psychiatric assessment. We propose to build upon a study of 307 children aged 2 to 5 involved in a successful test-retest study of a psychiatric diagnostic interview for parents of preschoolers (the Preschool Age Psychiatric Assessment- PAPA). In the original study, we screened 1,073 parents of preschool children attending a general pediatric clinic with the parent report Child Behavior Checklist 11/2-5 (CBCL). Parents of children screening at or above the 30th percentile (N=193) and a random selection of the rest (N=114) were administered the PAPA twice separated by a week. The sample was stratified by age (2-5), gender, and race (African-American versus non-African-American). Data can be weighted back to the screening population. Here we propose to add 3 waves of follow-ups to this study, the first a 3 1/2 year follow-up, with 2 subsequent 18 month follow-ups. Across these 3 waves, the children's ages will range from 5 1/2 to 11 1/2 years old. We will use multi-modal, multi-informant assessments of psychiatric symptoms and disorders, as well as measures of developmental status, parent-child interactions, and risk factors known to be associated with psychiatric symptoms in older children.} Predictive validity will be examined through (1) temporal stability of psychiatric symptoms, syndromes, and disorders and (2) prediction of preschool symptoms to later psychiatric symptoms, disorders, and impairment and (3) association of early childhood anxiety and depressive symptoms and disorders with psychosocial impairment, neurocognitive deficits, particularly language problems, and risk factors including adverse life events, problems in the parent-child relationship, parental stress, and parental psychopathology. In the absence of any gold-standard for the identification of preschool psychiatric syndromes we adopt a construct-validation approach based on reasonable expectations for (1) stability over time of (a) syndrome scale scores (e.g., count of depressive symptoms) and (b) categorical syndromes (e.g., major depressive disorder) (homotypic continuity); (2) continuity of syndrome scale score and categorical syndrome problems even when those problems change in form over time (e.g., from depressive to conduct symptoms - heterotypie continuity).
