We have continued over the past year with the second wave of follow-up assessments, and remain slightly ahead of our projected recruitment numbers.

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1 Progress Report A. Specific Aims The specific aims of the study remain as they were presented in the proposal. B. Studies and Results The study protocol remains unchanged from the original proposal. During the last year we have continued to recruit families for follow-up assessments, as described in the original protocol. At the time of writing, we have completed the first wave of follow-ups. We stopped attempting to trace and interview further members of the sample at the end of March,, at which point we had assessed of the original. Our assessment rate for this first wave of follow-up was, therefore,.%. This means that we have slightly improved upon the % participation rate projected in the original proposal. We have continued over the past year with the second wave of follow-up assessments, and remain slightly ahead of our projected recruitment numbers. Results Preliminary results from the first follow-up wave were presented by Angold & Egger at the annual meeting of the Epidemiology and Services branch of the World Psychiatric Association in Saskatoon, Saskatchewan on May th,. A summary of these results is presented below. The primary aim of the study was to determine whether DSM-IV preschool disorders showed continuity over time ( years at outcome wave ), as do disorders later in life. The demonstration of longitudinal continuity (whether homotypic or heterotypic) has long been regarded as an important validator of diagnostic categories. Parents of children under eight completed the Preschool Age Psychiatric Assessment, those of eight-yearolds completed the Child and Adolescent Psychiatric Assessment (CAPA), whereas nine-year-old completed a self-report CAPA in addition to their parents CAPA interviews. The results of all these assessment procedures were combined on the grounds that for each age the best available informant(s) and instrument(s) had been used. Table. shows the bivariate associations between baseline and first-wave follow-up diagnoses. Diagnosis at age - Odds ratios for diagnosis at age - ADHD CD ODD Anx Dep ADHD CD ODD Anx Dep. - It can be seen that the typical pattern is for most disorders to be predictive in both homotypic and heterotypic patterns.

2 However, it is possible that some of these predictive paths are actually mediated by comorbid disorders a either baseline or follow-up. To adjust for this possibility the following figures show the ORs for prediction from the disorder shown in the heading to each of the disorders at follow-up. Solid bars were statistically significant at at least the. level. Figure. School-age outcomes of preschool ADHD ADHD ODD CD Anxiety Depression Figure. School-age outcomes of preschool ODD Figure. School-age outcomes of preschool CD

3 Figure. School-age outcomes of preschool anxiety disorders Figure. School-age outcomes of preschool depressive disorders Every preschool disorder, except ODD, was significantly predictive of some later disorder, even when other disorders were adjusted for. The bivariate effects of ODD were accounted for by its comorbidity with other disorders. Both ADHD and depression showed strong homotypic continuity, and depression was also predated by anxiety disorders. Both of these patterns are typical of later ages. It was also to be expected that disruptive disorders would predict later emotional disorders (in this case CD predicting anxiety). However, in later life it is unusual to see significant prediction from earlier emotional disorders to later disruptive disorders, as seen here with anxiety and ODD. We would also not have predicted from the literature on older children that depressive disorders would be protective against later ADHD (arrow in figure ), or that preschool CD would be protective against depression (arrow in figure ). No adverse events have resulted from this study. Since data collection is not yet complete, no publications have yet been submitted from the study.

4 C. Significance The preliminary results presented above already point to two important conclusions: () DSM-IV preschool diagnoses are associated with both homotypic and heterotypic disorder continuity. The do not merely represent evanescent developmental variations in behavior. The vast majority of these children with problems have never received any services for them. These results suggest that there is a great deal of unmet need for preschool psychiatric services both preventive and therapeutic. () The unusual pattern of prediction of later disruptive disorders by earlier emotional disorders, and the two protective effects noted suggest that there may be previously undescribed developmental differences in patterns of disorder continuity and discontinuity. Our second wave of follow-up data should cast further light on this issue. D. Plans During the next budget period we will complete the second wave of assessments, conduct final analyses of the two waves of follow-up data, and prepare manuscripts for submission. The protocol for the remaining assessments will be as described in the original proposal. This application does not include a trial which requires registration in ClinicalTrials.gov. E. Publications None F. Project-Generated Resources None

5 ESNAP Report FINAL Inclusion Enrollment Report Table This report format should NOT be used for data collection from study participants. Study Title: Outcomes of Preschool Mental Health Problems-PROTOCOL- Total Enrollment: Protocol Number: MH Grant Number: RMH- PART A. TOTAL ENROLLMENT REPORT : Number of Subjects Enrolled to Date (Cumulative) by Ethnicity and Race Ethnic Category Sex/Gender Females Males Unknown or Not Reported Hispanic or Latino Not Hispanic or Latino Unknown (Individuals not reporting ethnicity) Ethnic Category:Total of All Subjects Racial Categories American Indian or Alaska Native Asian Native Hawaiian Or Other Pacific Islander Black Or African American White More than one race Unknown or Not Reported Racial Categories: Total of All Subjects PART B. HISPANIC ENROLLMENT REPORT: Number of Hispanics or Latinos Enrolled to Date (Cumulative) Total Racial Categories Sex/Gender Females Males Unknown or Not Reported American Indian or Alaska Native Asian Native Hawaiian Or Other Pacific Islander Black Or African American White More than one race Unknown or Not Reported Racial Categories: Total of Hispanics Or Latinos Total PHS Page