This is an application for a Mentored Clinical Scientist Development Award with a focus on developing expertise in designing and evaluating early interventions for childhood anxiety disorders. The candidate proposes to build upon her experience studying behavioral inhibition as a risk factor for anxiety disorders by learning to apply this knowledge to benefit children at risk. Anxiety disorders represent the most prevalent category of childhood mental disorder. They have been shown to run in families, with children of parents with anxiety disorders at high risk to develop these disorders themselves. Studies by the candidate and her sponsors have identified behavioral inhibition as a temperamental risk factor for the development of childhood anxiety disorders. Children whose behavioral inhibition remains stable throughout early childhood and whose parents have multiple anxiety disorders appear at greatest risk. The ability to identify young children at high risk affords the opportunity for early intervention. Research Plan: The candidate proposes to refine and test an intervention for behaviorally-inhibited 4.0-5.9-year-old children of parents with panic disorder with agoraphobia to facilitate the children's learning strategies for reducing inhibition and managing anxiety. The twelve- week intervention includes parent-skills training and child anxiety management. It will be tested in a randomized controlled trial with proximal (three-month) and long-term (two-year) follow-up assessment for child behavioral inhibition and psychopathology. Environment: The proposed study will be based at the Massachusetts General Hospital and will complement a program of training and supervised research under the mentorship of Joseph Biederman, MD and co-sponsored by Jerrold F. Rosenbaum, MD, with consultation from experts in the areas of behavioral inhibition, childhood anxiety disorders and intervention research. Career development plan: Training will emphasize skills necessary for designing and evaluating interventions for anxious children and assessing psychological and familial vulnerability factors including child temperament, psychopathology, cognitive risk factors and family interactions. Coursework at the Harvard School of Public Health and tutorials in intervention research design, statistical methods, and methodology for longitudinal follow-up will complement supervision by the consultants. In this manner, the candidate will develop a critical fund of knowledge in childhood anxiety disorders, developmental psychopathology, intervention research, and statistical methodology which will lay the foundation for future independent investigation of intervention strategies for high risk children.
