Does referral bias impact findings in high-risk offspring for anxiety disorders? A controlled study of high-risk children of non-referred parents with panic disorder/agoraphobia and major depression

Background: Previous findings in referred samples documented significant diagnostic specificity in patterns of transmission between parents with panic disorder (PD) and parents with major depression (MD) and their offspring. This study evaluated whether these patterns of transmission between parents and high-risk offspring are moderated by referral bias. Methods: Parental PD/agoraphobia (AG) and parental MD were used to predict rates of offspring psychiatric disorders and functional outcomes using data from an opportunistic sample of parents (n=991) and offspring (n=734) ascertained from case–control family genetic studies of youth with and without attention-deficit hyperactivity disorder. Subjects were comprehensively assessed with structured diagnostic interview methodology to evaluate psychiatric disorders in parents and offspring. Results: Parental PD/AG increased the risk for anxiety disorders in offspring, independently of parental MD while parental MD increased the risk for mood and disruptive behavior disorders in offspring, independently of parental PD/AG. Parental psychopathology was also associated with functional impairment in offspring. Limitations: The use of a sample ascertained by ADHD and control probands, and parent psychiatric diagnostic reports for children under 12. Conclusions: These results extend to non-referred samples previous findings from referred samples documenting diagnostic specificity in the familial transmission of PD/AG and MD from parents to offspring, suggesting that these patterns of transmission are not due to referral bias. These results could inform and enhance community programs aimed at screening for and treating pediatric psychopathology.