Adrian Angold’s research while affiliated with Duke University Medical Center and other places

This chapter describes the Preschool Age Psychiatric Assessment (PAPA), a structured diagnostic parent-administered psychiatric interview about children ages 2–5 (24 months through 72 months) that assesses parent-reported psychiatric symptoms, disorders, and impairment in preschool children. The PAPA also assesses school or day-care functioning, family structure and functioning, parenting behaviors, adverse life events, and a host of demographic variables including socioeconomic status (Egger, Ascher, & Angold, 1999). Also described is the ePAPA, a web-based tool for administering the PAPA electronically. The PAPA is derived from the Child and Adolescent Psychiatric Assessment, an interview for children ages 9–18 years old. The PAPA, the Child and Adolescent Psychiatric Assessment, and now the Young Adult Psychiatric Assessment comprise a suite of interviews that employ a consistent approach to the assessment of psychopathology in childhood, adolescence, and young adulthood. The chapter reviews the history of the PAPA’s development and describes the structure, content, reliability, and uses of the PAPA in research. Implications for clinical practice are also discussed.

Objective: The prevalence of depression increases dramatically during puberty in girls. Earlier work in this sample reported that the sex steroids estradiol and testosterone were associated with increased depression in girls. Using three additional data waves (983 new observations), we retest the relative contributions of pubertal timing, pubertal status, and sex hormones on the increases in female depression. Method: Eight waves of data from the prospective, representative Great Smoky Mountains Study were used covering female participants in the community who were 9 to 16 years of age (3,005 assessments of 630 girls; 1993-2000). Structured interviews assessed depressive disorders. Youth rated their pubertal status using Tanner stage drawings, and sex steroids were assayed from dried blood spots. Results: Risk for depression during puberty was associated with both age and Tanner stage in univariate models. In adjusted models accounting for pubertal timing and sex steroids, the apparent effects of age and Tanner stage were attenuated both in terms of statistical significance and effect size. The only significant predictors of change in depression status during puberty were early pubertal timing (odds ratio = 5.8, 95% CI = 1.9-17.9, p = .002 after age 12 years) and higher testosterone levels (odds ratio = 2.0, 95% CI = 1.1-3.8, p = .03 for quartile-split variable). Conclusion: The added observations have modified the original conclusions, implicating the following: testosterone only, but not estradiol; and early pubertal timing, but not age or pubertal status per se. These findings argue for multiple pubertal determinants of depression risk, including factors that are socially and biologically mediated.

Aims: To describe the Great Smoky Mountains Study (GSMS). Methods: GSMS is a longitudinal study of child psychiatric disorders that began in 1992 to look at need for mental health services in a rural area of the USA. Over 20 years it has expanded its range to include developmental epidemiology more generally, not only the development of psychiatric and substance abuse problems but also their correlates and predictors: family and environmental risk, physical development including puberty, stress and stress-related hormones, trauma, the impact of poverty, genetic markers, and epigenetics. Now that participants are in their 30s the focus has shifted to adult outcomes of childhood psychopathology and risk, and early physical, cognitive, and psychological markers of aging. Results: This paper describes the results from over 11,000 interviews, examples of the study's contributions to science and policy, and plans for the future. Conclusions: Longitudinal studies can provide insights that aid in policy planning.

Introducing epidemiology as the study of health and illness in human populations, we discuss what questions modern epidemiology addresses, the key methods it uses, and how these methods can be applied to developmental psychopathology. A short history of how child psychiatric epidemiology has grown into developmental epidemiology illustrates society's changing concerns about child mental health. We describe some of the ways in which developmental epidemiology is branching out into related areas: life course and intergenerational epidemiology; global epidemiology; genetic epidemiology; the study of burden of disease, including cost-benefit analysis; and the use of epidemiologic designs to test hypotheses about causation. Finally, we note that developmental epidemiology extends the range of translational epidemiology. We make the case that (1) the goal of epidemiological research is disease prevention; (2) understanding the development of a disease and intervening to prevent and control it are equally important aspects of epidemiological research; (3) understanding the development of a disease may point to different kinds of intervention at different stages in the developmental process; and (4) understanding individual development is a critical part of understanding and intervening in the disease process because both risk for and expression of disorder change over the life course. Keywords: development; epidemiology; psychiatry; risk; public health; mechanisms

We examined the clinical significance of moderate and severe selective eating (SE). Two levels of SE were examined in relation to concurrent psychiatric symptoms and as a risk factor for the emergence of later psychiatric symptoms. Findings are intended to guide health care providers to recognize when SE is a problem worthy of intervention. A population cohort sample of 917 children aged 24 to 71 months and designated caregivers were recruited via primary care practices at a major medical center in the Southeast as part of an epidemiologic study of preschool anxiety. Caregivers were administered structured diagnostic interviews (the Preschool Age Psychiatric Assessment) regarding the child's eating and related self-regulatory capacities, psychiatric symptoms, functioning, and home environment variables. A subset of 188 dyads were assessed a second time ∼24.7 months from the initial assessment. Both moderate and severe levels of SE were associated with psychopathological symptoms (anxiety, depression, attention-deficit/hyperactivity disorder) both concurrently and prospectively. However, the severity of psychopathological symptoms worsened as SE became more severe. Impairment in family functioning was reported at both levels of SE, as was sensory sensitivity in domains outside of food and the experience of food aversion. Findings suggest that health care providers should intervene at even moderate levels of SE. SE associated with impairment in function should now be diagnosed as avoidant/restrictive food intake disorder, an eating disorder that encapsulates maladaptive food restriction, which is new to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Copyright © 2015 by the American Academy of Pediatrics.

The public health burden of alcohol is unevenly distributed across the life course, with levels of use, abuse, and dependence increasing across adolescence and peaking in early adulthood. Here, we leverage this temporal patterning to search for common genetic variants predicting developmental trajectories of alcohol consumption. Comparable psychiatric evaluations measuring alcohol consumption were collected in three longitudinal community samples ( N = 2,126, obs = 12,166). Consumption-repeated measurements spanning adolescence and early adulthood were analyzed using linear mixed models, estimating individual consumption trajectories, which were then tested for association with Illumina 660W-Quad genotype data (866,099 SNPs after imputation and QC). Association results were combined across samples using standard meta-analysis methods. Four meta-analysis associations satisfied our pre-determined genome-wide significance criterion (FDR < 0.1) and six others met our ‘suggestive’ criterion (FDR <0.2). Genome-wide significant associations were highly biological plausible, including associations within GABA transporter 1, SLC6A1 (solute carrier family 6, member 1), and exonic hits in LOC100129340 (mitofusin-1-like). Pathway analyses elaborated single marker results, indicating significant enriched associations to intuitive biological mechanisms, including neurotransmission, xenobiotic pharmacodynamics, and nuclear hormone receptors (NHR). These findings underscore the value of combining longitudinal behavioral data and genome-wide genotype information in order to study developmental patterns and improve statistical power in genomic studies.