Theory-of-mind, cognitive development, and children's interpretation of anxiety-related physical symptoms

Interoception in preschoolers: New insights into its assessment and relations to emotion regulation and stress

Interoception may play an important role for emotion regulation and stress, thereby affecting mental health in children and adults. Yet, little is known on interoception in preschool children. Therefore, we investigated interoceptive accuracy using the adapted Jumping Jack Paradigm (JJP) and its relationship with emotion regulation and stress. In Study I, 40 preschoolers completed the JJP and an emotion regulation task, demonstrating a positive relationship between interoceptive accuracy and emotion regulation at trend level (R² = 0.231, p = .023; β = .278, p = .073). In Study II, 31 preschoolers completed the adapted JJP before and after an acute laboratory stress test. Higher total cortisol output following acute stress induction was associated with reduced interoceptive accuracy (r = -0.670, p = .017). Extending earlier findings in adults and school-children, the relationship of interoceptive accuracy with emotion regulation and stress highlights the importance to investigate interoception in early childhood.

Theory of Mind as a Mechanism That Accounts for the Continuity or Discontinuity of Behavioral Inhibition: A Developmentally Informed Model of Risk for Social Anxiety

Research has established that children with high levels of early behavioral inhibition (BI) - a subdued, timid, fearful response to novel or mildly challenging stimuli or events - are at an elevated risk for social anxiety in later childhood and adolescence. Yet, substantial heterogeneity has been documented in those developmental trajectories; consequently, understanding factors that moderate children's paths from early BI to social anxiety is an important goal. We proposed that the association between children's BI at toddler age and social anxiety at early school age is (a) mediated by their BI at preschool age, and (b) moderated by the level of social understanding, or Theory of Mind (ToM). In 102 typically developing community children, we observed BI in the laboratory at age 2 and 4.5 in "Risk Room" paradigms and assessed ToM at age 4.5 and 5.5 using false belief tasks. Mothers and fathers rated children's social anxiety symptoms at age 6.5. We supported the proposed moderated mediation model, with the path from BI at age 2 to BI at age 4.5 to social anxiety at age 6.5 unfolding only for children whose ToM abilities were relatively low, but not for those whose ToM abilities were relatively high. Results also supported a curvilinear relation between ToM and social anxiety, which highlights the risk of elevated social anxiety for children with extremely low ToM abilities. Taken together, proficiency in mindreading may help inhibited children navigate social environments and thus reduce risks for social anxiety.

Mediators of youth anxiety outcomes 3 to 12 years after treatment

OBJECTIVE

Test changes in perceived coping efficacy, negative self-statements, and interpretive biases to threat during treatment as potential mediators of the relationship between randomly assigned treatment conditions and long-term anxiety follow-ups. Age at randomization was also tested as a moderator of mediational relationships.

METHOD

Participants included 319 youth (ages 7-17) from the Child/Adolescent Multimodal Study (CAMS) who participated in a naturalistic follow-up beginning an average of 6.5 years after the end of the CAMS intervention. The intervention conditions included cognitive behavioral therapy (CBT; Coping Cat), pharmacotherapy (sertraline), combined CBT and sertraline, and pill placebo. Putative mediators were measured four times during the intervention phase. Follow-up consisted of four annual assessments of current anxiety.

RESULTS

Reductions on a measure of interpretive bias to threat over the course of the combined condition intervention, as compared to the placebo condition, mediated anxiety outcomes at the first follow-up visit. This mediated effect was not significant for the CBT-only or sertraline-only conditions when compared to the placebo condition. No other significant mediated effects were found for putative mediators. Age did not significantly moderate any mediated effects.

CONCLUSION

Changes in youth-reported interpretive biases to threat over the course of combined youth anxiety interventions, as compared to a placebo intervention, may be associated with lower anxiety an average of 6.5 years following treatment.

Psychophysiological arousal and biased perception of bodily anxiety symptoms in socially anxious children and adolescents: a systematic review

Cognitive models of social anxiety [Clark and Wells, Social phobia: Diagnosis, assessment, and treatment, Guilford Press, New York, 1995], diagnostic criteria and studies on adult samples suggest that both an overestimation of bodily anxiety symptoms and psychophysiological abnormalities play an important role in social anxiety. To date, less is known about such a perception bias and physiological characteristics in children and adolescents with social anxiety. We performed a systematic review of the literature in the electronic databases Medline, PsycINFO, and PSYNDEX. Additional studies were identified by hand search using the ancestry approach. We identified 1,461 studies, screened their titles and abstracts, viewed 94 papers, and included 28 of these. Study samples were heterogeneous and consisted of socially phobic, high socially anxious, shy and test anxious children and adolescents. Regarding a biased perception, most studies in the review suggest that bodily symptoms of anxiety were overestimated by children and adolescents across the social anxiety spectrum when compared with control groups. An elevated psychophysiological reactivity to social stress was present in samples of high social anxiety, shyness, and test anxiety. In clinical samples with social phobia, by contrast, no differences or an even lower physiological responding compared with healthy control groups were reported. In addition, some evidence for a chronic psychophysiological hyperarousal was found across all sample types. The results are discussed with regard to current models of social anxiety, psychophysiological theories, and treatment implications.

Early evidence for factorial structure of the separation anxiety symptom inventory in Italian children

The aim of this study was to explore the internal consistency and confirm the factor structure of the separation anxiety symptom inventory for children (SASI-C) in a community sample of 329 Italian children, ages 6 to 10 years. A confirmatory factor analysis yielded two interpretable factors. Correlations between scores for the SASI-C and the Italian Fear Survey Schedule for Children were calculated to estimate convergent validity; medium effect sizes are hypothesized. Implications regarding the clinical utility of the SASI-C are discussed.

Is there room for 'development' in developmental models of information processing biases to threat in children and adolescents?

Clinical and experimental theories assume that processing biases in attention and interpretation are a causal mechanism through which anxiety develops. Despite growing evidence that these processing biases are present in children and, therefore, develop long before adulthood, these theories ignore the potential role of child development. This review attempts to place information processing biases within a theoretical developmental framework. We consider whether child development has no impact on information processing biases to threat (integral bias model), or whether child development influences information processing biases and if so whether it does so by moderating the expression of an existing bias (moderation model) or by affecting the acquisition of a bias (acquisition model). We examine the extent to which these models fit with existing theory and research evidence and outline some methodological issues that need to be considered when drawing conclusions about the potential role of child development in the information processing of threat stimuli. Finally, we speculate about the developmental processes that might be important to consider in future research.

Is there room for 'development' in developmental models of information processing biases to threat in children and adolescents?

Clinical and experimental theories assume that processing biases in attention and interpretation are a causal mechanism through which anxiety develops. Despite growing evidence that these processing biases are present in children and, therefore, develop long before adulthood, these theories ignore the potential role of child development. This review attempts to place information processing biases within a theoretical developmental framework. We consider whether child development has no impact on information processing biases to threat (integral bias model), or whether child development influences information processing biases and if so whether it does so by moderating the expression of an existing bias (moderation model) or by affecting the acquisition of a bias (acquisition model). We examine the extent to which these models fit with existing theory and research evidence and outline some methodological issues that need to be considered when drawing conclusions about the potential role of child development in the information processing of threat stimuli. Finally, we speculate about the developmental processes that might be important to consider in future research.

Listen to your heart beat and shiver! An experimental study of anxiety-related emotional reasoning in children

The present study investigated anxiety-related emotional reasoning in 9-13-year-old children using an experimental approach. Eighty-one children completed a computerized ambiguous situations test for assessing their perception of threat under two conditions. In the experimental condition, children were attached to an apparatus that allegedly recorded their heart beat, the sound of which was presented to them via headphones. In the control condition, children listened to the sound of an African djembe drum while completing the ambiguous situations test. It was found that children in the experimental condition generally provided higher threat ratings than children in the control condition, and this difference remained significant when controlling for levels of anxiety sensitivity, panic and other anxiety symptoms. These results are in keeping with the idea that children may partially rely on internal physical sensations when evaluating the dangerousness of ambiguous events.

Cognitive coping and childhood anxiety disorders

To investigate differences in cognitive coping strategies between anxiety-disordered and non-anxious 9-11-year-old children. Additionally, differences in cognitive coping between specific anxiety disorders were examined. A clinical sample of 131 anxiety-disordered children and a general population sample of 452 non-anxious children were gathered. All children filled out the child version of the Cognitive Emotion Regulation Questionnaire (CERQ-k). Structured clinical interviews were used to assess childhood anxiety disorders. Results showed that anxiety-disordered children experience significantly more 'lifetime' negative life events than non-anxious children. Adjusted for the 'lifetime' experience of negative life events, anxiety-disordered children scored significantly higher on the strategies catastrophizing and rumination, and significantly lower on the strategies positive reappraisal and refocus on planning than non-anxious children. No significant differences in cognitive coping were found between children with specific anxiety disorders. Anxiety-disordered children employ significantly more maladaptive and less adaptive cognitive coping strategies in response to negative life events than non-anxious children. The results suggest that cognitive coping is a valuable target for prevention and treatment of childhood anxiety problems.

Children's internal attributions of anxiety-related physical symptoms: age-related patterns and the role of cognitive development and anxiety sensitivity

The present study examined age-related patterns in children's anxiety-related interpretations and internal attributions of physical symptoms. A large sample of 388 children aged between 4 and 13 years completed a vignette paradigm during which they had to explain the emotional response of the main character who experienced anxiety-related physical symptoms in a variety of daily situations. In addition, children completed measures of cognitive development and anxiety sensitivity. Results demonstrated that age, cognitive development, and anxiety sensitivity were all positively related to children's ability to perceive physical symptoms as a signal of anxiety and making internal attributions. Further, while a substantial proportion of the younger children (i.e., <7 years) were able to make a valid anxiety-related interpretation of a physical symptom, very few were capable of making an internal attribution, which means that children of this age lack the developmental prerequisites for applying physical symptoms-based theories of childhood anxiety.

The Relation Between Cognitive Development and Anxiety Phenomena in Children

We examined the relation between cognitive development and fear, anxiety, and behavioral inhibition in a non-clinical sample of 226 Dutch children aged 4-9 years. To assess cognitive development, children were tested with Piagetian conservation tasks and a Theory-of-Mind (TOM) test. Fears were measured by means of a self-report scale completed by the children, while anxiety symptoms and behavioral inhibition were indexed by rating scales that were filled out by parents. Significant age trends were observed for some anxiety phenomena. For example, younger children displayed higher fear scores, whereas older children exhibited higher levels of generalized anxiety. Most importantly, results of regression analyses (in which we controlled for age) indicated that cognitive development, and in particular TOM ability, made a unique and significant contribution to various domains of behavioral inhibition. In all cases, higher levels of TOM were associated with lower levels of behavioral inhibition. In general, percentages of explained variance were rather small (i.e., <6%), indicating that the role of cognitive development in various anxiety phenomena is limited.

Gibt es die Panikstörung im Kindes- und Jugendalter?

Seit dem DSM-IV gelten für das Kindes- und Jugendalter weitestgehend die gleichen diagnostischen Kriterien für Angststörungen wie für Erwachsene. Das Vorkommen der Panikstörung im Kindesalter ist jedoch umstritten. Im vorliegenden Beitrag werden epidemiologische, klinisch-psychologische sowie experimentelle Untersuchungen zur Panikstörung im Kindesalter kritisch diskutiert. Die untersuchten Studien zeigen, dass bereits präpubertäre Kinder Panikattacken erleben, die phänomenologisch vergleichbar mit denen des Erwachsenenalters sind. Diagnostisch sind diese Panikattacken jedoch nicht unter das Label der Panikstörung einzuordnen, da die für die Diagnose der Panikstörung erforderlichen katastrophisierenden Bewertungen der Attacken fehlen. Panikattacken in Kindheit und Jugend stellen dabei unspezifische Marker einer erhöhten Vulnerabilität für folgende psychopathologische Auffälligkeiten dar.

Emotional reasoning and parent-based reasoning in non-clinical children, and their prospective relationships with anxiety symptoms

Emotional and parent-based reasoning refer to the tendency to rely on personal or parental anxiety response information rather than on objective danger information when estimating the dangerousness of a situation. This study investigated the prospective relationships of emotional and parent-based reasoning with anxiety symptoms in a sample of non-clinical children aged 8-14 years (n = 122). Children completed the anxiety subscales of the Revised Children's Anxiety and Depression Scale (Muris et al. Clin Psychol Psychother 9:430-442, 2002) and provided danger ratings of scenarios that systematically combined objective danger and objective safety information with anxiety-response and positive-response information. These measurements were repeated 10 months later (range 8-11 months). Emotional and parent-based reasoning effects emerged on both occasions. In addition, both effects were modestly stable, but only in case of objective safety. Evidence was found that initial anxiety levels were positively related to emotional reasoning 10 months later. In addition, initial levels of emotional reasoning were positively related to anxiety at a later time, but only when age was taken into account. That is, this relationship changed with increasing age from positive to negative. No significant prospective relationships emerged between anxiety and parent-based reasoning. As yet the clinical implications of these findings are limited, although preliminary evidence indicates that interpretation bias can be modified to decrease anxiety.