Methods

The study was called the Great Smoky Mountains Study (GSMS). It was a long-term investigation on the development of psychiatric disorders and the need for related
services. From a pool of 20,000 children, 1,420 subjects were chosen. From this
group, three cohorts of children aged 9, 11, 13 were created. Study participants were assessed annually for DSM-IV disorders until age 16. All subjects were recruited from communities within western North Carolina. Eight percent of the subjects were black, 1% Hispanic, and 25% Native American. Native Americans were over sampled in this study.

Authors used the Child and Adolescent Psychiatric Assessment (CAPA)—an interview based evaluation. Both parent and child were interviewed to determine the existence and/or severity of disorder. Researchers interviewed parents only, during review of ADHD symptoms.

Results

36.7% of the subjects had at least one psychiatric disorder (31% of girls and 42% of boys). The most prevalent disorder was social anxiety, panic, depression, and substance abuse. Separation anxiety disorder and attention-deficit/hyperactivity disorder (ADHD) occurred less frequently. Children (especially girls) who were previously diagnosed with a disorder were more likely to be diagnosed again with the same disorder in subsequent visits with researchers.

At ages 9 to 10, the occurrence of any disorder was greatest. By age 12 the likelihood of disorders occurring was lowest. In addition during this period, signs of ADHD, separation anxiety disorder [SAD], enuresis and encopresis, as well as motor and verbal tic disorders) vanished--especially in boys. Age twelve was characterized by the disappearance of childhood disorders and the yet-to-be-developed disorders of adolescence and adulthood.

Results indicated that entry into adolescence was characterized by an increase in depression and social phobia in girls but not in boys. By mid-adolescence their was a significant increase in the number of substance use disorders among all subjects as well as a small increase in the numbers of panic and generalized anxiety disorder (GAD). Continuity of disorder was prevalent in most of the subjects.


Conclusions

Authors of the study concluded that the chance of developing a psychiatric disorder by age 16 is very high. They also asserted that comordibity (the occurrence of more than one disorder), homotypic and heterotypic continuity is more prevalent in girls than boys during childhood.


Terms

Enuresis - the uncontrolled or involuntary discharge of urine.

Encopresis – the uncontrolled or involuntary leakage of stool



Complete findings of the study appear in the Archives of General Psychiatry. 2003;60:837-844.

Author and inquiry information

E. Jane Costello, PhD, Center for Developmental Epidemiology, Department of
Psychiatry and Behavioral Sciences, Duke University Medical School, DUMC Box 3454, Durham, NC 27710 (e-mail: jcostell@psych.mc.duke.edu).

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