Assessing Functional Impairment in Youth: Development of the Adolescent Life Interference Scale for Internalizing Symptoms (ALIS-I)

A Hierarchical Model of the Symptom-Level Structure of Psychopathology in Youth

More comprehensive modelling of psychopathology in youth is needed to facilitate a developmentally informed expansion of the Hierarchical Taxonomy of Psychopathology (HiTOP) model. This study examined a symptom-level model of the structure of psychopathology in youth-most aged 11-17 years-bringing together data from large clinical, community, and representative samples (N = 18,290) and with coverage of nearly all major forms of mental disorders and related content domains (e.g., aggression). The resulting hierarchical and dimensional model was based on the points of convergence among three statistical approaches and included fifteen narrow dimensions nested under four broad dimensions of Internalizing; Externalizing; Eating Pathology; and Uncontrollable Worry, Obsessions, and Compulsions. We position these findings within the context of the existing literature, and articulate implications for future research. Ultimately, these findings add to the rapidly growing literature on the structure of psychopathology in youth and take us a step closer towards understanding (dis-)continuities in psychopathology's structure across the lifespan.

The psychometric properties of the child anxiety and depression life interference scale (CADLIS)

OBJECTIVE

Life interference is a key diagnostic feature for anxiety and depressive disorders. Measures focusing on life interference caused by anxiety and depressive disorders in children and adolescents have received minimal attention. This study evaluated the psychometric properties of the Child Anxiety and Depression Life Interference Scale (CADLIS), a brief child (CADLIS-C) and parent-report (CADLIS-P) measure designed to assess life interference from anxiety and depressive disorders in both the child and parent's life.

METHOD

A total of 672 parents of children aged 4-18 years completed the CADLIS-P, and 627 children aged 7-18 years completed the CADLIS-C.

RESULTS

The proposed two-factor CADLIS-C model was not supported, instead, due to high inter-factor covariance a one-factor model of life interference was proposed. The one-factor model demonstrated better model fit. The proposed three-factor model for the CADLIS-P was not supported, instead, an exploratory factor analysis found a two-factor model differentiating life interference into child and parent life interference a better model fit. The CADLIS demonstrated excellent internal consistency, good convergent and divergent validity, interrater correlations and was able to differentiate between children with and without clinical levels of anxiety and depressive symptoms.

LIMITATIONS

Limitations of the study included the sample population which consisted of a small clinical sample, an over-representation of high-income families and the use of a panel provider.

CONCLUSIONS

Overall, the CADLIS demonstrated sound psychometric properties. The CADLIS is a reliable measure that demonstrates evidence of convergent validity for the assessment of life interference associated with anxiety and depressive symptoms in children.

A Systematic Review and Meta-Analysis of Impairment and Quality of Life in Children and Adolescents with Anxiety Disorders

Anxiety disorders are common, emerge during childhood, and pose a significant burden to society and individuals. Research evaluating the impact of anxiety on functional impairment and quality of life (QoL) is increasing; however, there is yet to be a systematic review and meta-analysis of these relationships in pediatric samples. This systematic review and meta-analysis were conducted to determine the extent of impairments in functioning and QoL that young people with anxiety disorders experience relative to their healthy peers, as well as sociodemographic and clinical moderators of these relationships. Studies were included when they compared young people (mean age range within studies 7-17 years) with a primary clinical anxiety disorder to a healthy comparison group and measured impairment and/or QoL via a validated instrument. A total of 12 studies met criteria for this review (N = 3,129 participants). A majority of studies (K = 9) assessed impairment as an outcome measure, and three assessed QoL outcomes. Meta-analysis of nine studies (N = 1,457 children) showed large relationships between clinical anxiety and life impairment (g = 3.23) with the strongest effects seen for clinician report (g = 5.00), followed by caregiver (g = 2.15) and child (g = 1.58) report. The small number of studies and diversity in methodology prevented quantitative investigation of moderating factors. In the systematic review of QoL outcomes, all three studies reported significantly poorer QoL for youth with anxiety disorders relative to unaffected peers. Findings support the importance of measuring functioning and QoL as outcomes in clinical research and practice among anxious young people.This study is registered with PROSPERO under the identification number CRD42023439040.

Assessing Anxiety-Related Impairment in Children and Adolescents

Anxiety disorders (ADs) frequently lead to significant impairment across important domains of youth functioning. Yet until recently, clinical research and assessment have largely neglected the measurement of anxiety-related impairment. In this article, we review the evidence for five extant rating scales of youth anxiety-related impairment, guided by widely used evaluative criteria. Emerging psychometric data show the potential utility of these rating scales for achieving different assessment functions. Of the five scales, the Child Anxiety Impact Scale, particularly the parent-report version, has been the most researched one. Promising psychometric data support its use for assessing anxiety-related impairment in school, social, and family/home domains of functioning. We conclude with recommendations for growing this research base and for incorporating these rating scales into the youth AD clinical and research assessment process.

Online treatment of adolescents with comorbid anxiety and depression: A randomized controlled trial

OBJECTIVE

Adolescents experiencing both anxiety and mood disorders show greater life impairment than those with either disorder alone. The aim of this study was to evaluate the efficacy of an online cognitive behavior therapy (CBT) program for these comorbid youth.

METHODS

Ninety-one adolescents aged 12 to 17 years (M = 14.29, S.D. = 1.62; 66% female) participated if they met DSM-5 criteria for both an anxiety and depressive disorder. Diagnoses were assessed by structured interview and participants also completed measures of symptoms, negative thoughts, and life interference. Participants were randomly allocated to either active treatment (n = 45) or wait (n = 46). Treatment comprised access to an 8-module, online program and was supported by 8, 30-minute telephone sessions with a therapist and the youth, of which the caregiver participated in four.

RESULTS

Treated participants showed significantly greater reduction than waiting participants on the primary outcome: total number of disorders and were more likely to remit from all anxiety and mood disorders (43.8% vs 20.9%). Secondary outcomes covering symptoms of anxiety and depression showed similar group by time differences, but there was no significant group by time interaction on life interference.

CONCLUSIONS

This brief, easily accessible, online intervention that requires relatively low levels of therapist time showed promising impact for a very impaired population.

REGISTRATION

This trial was registered on the ANZ clinical trials registry-ACTRN12616000139471.