Identifying patterns of anxiety and depression in children with chromosome 22q11.2 deletion syndrome: Comorbidity predicts behavioral difficulties and impaired functional communications.

[22q11.2 deletion syndrome]

Chromosome 22 q 11 .2 deletion syndrome (22 q 11 .2 DS ) is a complex genetic disorder with a variable clinical presentation that can include cardiac , neural , immunological , and psychological issues . Previous studies have measured elevated anxiety and depression in children with 22 q 11 .2 DS . Comorbity of anxiety and depression is well established in the pediatric literature but the nature of comorbidity patterns has not been empirically established in children with 22 q 11 .2 DS . Comorbidity of anxiety and depression has important implications for treatment and prognosis , and may be a marker of risk in this population of children at high -risk for developing schizophrenia .Participants were 131 boys and girls ages 8 -14 with (n =76 ) and without (n =55 ) 22 q 11 .2 DS and their mothers . Children and mothers independently completed self- and parent-report measures of anxiety and depression . Mothers also completed measures of behavioral functioning including the Behavioral Assessment for Children , 2nd ed . (BASC-2 ). Cluster analyses were conducted to test if theoretically based groupings of anxiety and depression could be identified . We hypothesized four psychological profiles based on child- and mother-reports : low /no anxiety and low /no depression , higher depression and low /no anxiety , higher anxiety and no /low depression , and a comorbid profile of higher anxiety and higher depression . BASC-2 subscale scores were then compared across subgroups of children to determine if a comorbid profile would predict greater behavioral difficulties .In the full sample of children both with and without 22 q 11 .2 DS , cluster analyses of self and maternal reported anxiety and depression revealed the expected subgroups : (1 ) a group of children with higher anxiety /lower depression (anxious ); (2 ) a group with primary depression (lower anxiety /higher depression (depressed )); (3 ) a comorbid group with higher anxiety /higher depression (comorbid ); and , (4 ) a lowest anxiety /lowest depression group (NP ). Mothers ' reports produced highly similar groupings . Furthermore , the 22 q 11 .2 DS youth were more likely to be in anxiety , depressed or comorbid clusters than the typically developing (TD ) youth . Children with 22 q 11 .2 DS comorbid for anxiety and depression exhibited the worst functional outcomes (e .g ., poor poorer functional communication , and reduced daily life activities ).Anxiety , comorbid with depression may be of particular concern in children with 22 q 11 .2 DS who arguably carry a greater burden on their stress coping resources than children without a complex genetic disorder . Furthermore , the manifestation of negative mood , anxiety and difficult behavior is likely to reverberate between the child and her or his environment . This can lead to negative interactions with family , peers , and teachers , which in turn further taxes coping resources . Comorbidity of anxiety and depression within a vulnerable population highlights the need for the development of tailored interventions .