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Phillips KE, Buinewicz SAP, Kagan E, Frank HE, Dunning E, Benito KG, Kendall PC. The Pediatric Accommodation Scale: Psychometric Evaluation of a Therapist-Report Format. Child Psychiatry Hum Dev 2024; 55:667-679. [PMID: 36149550 DOI: 10.1007/s10578-022-01447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/03/2022]
Abstract
Anxiety disorders are the most common mental health problem in youth, and accommodation is prevalent among youth with anxiety disorders. The Pediatric Accommodation Scale (PAS) is an interview administered by trained evaluators and a parent-report form (PAS-PR) to assess accommodation and its impact. Both have strong psychometric properties including internal consistency, inter-rater reliability, and data supporting construct validity. The present study evaluates the Pediatric Accommodation Scale - Therapist Report (PAS-TR), a therapist-reported version of the PAS-PR. Participants were 90 youth enrolled in cognitive behavioral therapy for anxiety. Therapists completed the PAS-TR over 16 therapy sessions. Internal consistency at baseline, convergent validity, divergent validity, and parent-therapist agreement were evaluated. Results suggest that the PAS-TR has mixed psychometric qualities suggesting that while not strong prior to the initiation of treatment, the PAS-TR may be a useful measure for therapists to rate accommodation as treatment progresses. Implications for assessment, treatment, and research are discussed.
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Affiliation(s)
- Katherine E Phillips
- Department of Psychology, Temple University, Temple University, 1701 North 13th St, 19122, Philadelphia, PA, USA.
| | | | - Elana Kagan
- Massachusetts General Hospital, Boston, MA, USA
| | - Hannah E Frank
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Erin Dunning
- Department of Psychology, Temple University, Temple University, 1701 North 13th St, 19122, Philadelphia, PA, USA
| | - Kristen G Benito
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Temple University, 1701 North 13th St, 19122, Philadelphia, PA, USA
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2
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Haug IM, Neumer SP, Handegård BH, Lisøy C, Rasmussen LMP, Bania EV, Adolfsen F, Patras J. Dose-Response Effects of MittEcho, a Measurement Feedback System, in an Indicated Mental Health Intervention for Children in Municipal and School Services in Norway. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01389-9. [PMID: 38809322 DOI: 10.1007/s10488-024-01389-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 05/30/2024]
Abstract
Including routine client feedback can increase the effectiveness of mental health interventions for children, especially when implemented as intended. Rate of implementation, or dose, of such feedback interventions has been shown to moderate results in some studies. Variation in implementation and use of client feedback may also contribute to the mixed results observed within the feedback literature. This study evaluates dose-response associations of client feedback using a novel Measurement Feedback System (MFS) within an indicated group intervention. The primary aim was to determine whether the rate of MFS implementation predicts symptom reduction in anxiety and depression among school-aged children. The secondary aim was to assess whether the rate of MFS implementation influences children's satisfaction with the group intervention or their dropout rates. Data were collected via a randomized factorial study (clinicaltrials.gov NCT04263558) across 58 primary schools in Norway. Children aged 8 to 12 years (N = 701) participated in a group-based, transdiagnostic intervention targeting elevated symptoms of anxiety or depression. Half of the child groups also received the feedback intervention using the MittEcho MFS. Group leaders (N = 83), recruited locally, facilitated the interventions. The MFS dose was measured using the Implementation Index, which combines the use of MFS by both children and providers (group leaders) into a single dose variable. Results showed no significant additional effect of dose of MFS on change in depression or anxiety scores, on user satisfaction with the intervention or on intervention dropout. The discussion addresses potential reasons for these non-significant findings and implications for MFS implementation in preventive, group-based interventions in school settings.
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Affiliation(s)
- Ida Mari Haug
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway.
| | - Simon-Peter Neumer
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Bjørn Helge Handegård
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
| | - Carina Lisøy
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Lene-Mari P Rasmussen
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
| | - Elisabeth Valmyr Bania
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frode Adolfsen
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
| | - Joshua Patras
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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3
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Lisøy C, Neumer SP, Adolfsen F, Ingul JM, Potulski Rasmussen LM, Wentzel-Larsen T, Patras J, Sund AM, Ytreland K, Waaktaar T, Holen S, Askeland AL, Haug IM, Bania EV, Martinsen K. Optimizing indicated cognitive behavioral therapy to prevent child anxiety and depression: A cluster-randomized factorial trial. Behav Res Ther 2024; 176:104520. [PMID: 38522127 DOI: 10.1016/j.brat.2024.104520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 12/12/2023] [Accepted: 03/13/2024] [Indexed: 03/26/2024]
Abstract
Identifying effective components can lead to interventions that are less resource-intensive and better suited for real-world needs. In this 2×2×2 cluster-randomized factorial trial (clinicaltrials.gov NCT04263558), we investigated the effects of three components of an indicated, transdiagnostic CBT intervention for children: 1) Intervention Delivery Format (child group format versus a blended format with group sessions and automated web-based sessions), 2) Parental Involvement in the intervention (group-based versus psychoeducational brochure), and 3) a Measurement Feedback System (MFS; on versus off). The intervention was delivered at schools in a group-based format. The participants (N = 701 children) were school children (age 8-12 years) with elevated symptoms of anxiety or depression, and their parents. The main outcomes were self-reported (N = 633) and parent-reported (N = 725) symptoms of child anxiety and depression post-intervention. The secondary outcome was children's user satisfaction with the intervention. We did not find significant main or interaction effects of Delivery Format, Parental Involvement, or MFS on children's symptom levels. There were no significant effects on children's user satisfaction. Results were compatible with retaining the least resource intensive combination (i.e., blended format, parental brochure, no MFS) in an optimized intervention.
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Affiliation(s)
- Carina Lisøy
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP Øst og Sør, Postboks 4623 Nydalen, 0405, Oslo, Norway; Department of Psychology, University of Oslo, Harald Schjelderups hus Forskningsveien 3A, 0373, Oslo, Norway.
| | - Simon-Peter Neumer
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP Øst og Sør, Postboks 4623 Nydalen, 0405, Oslo, Norway.
| | - Frode Adolfsen
- Regional Centre for Child and Youth Mental Health and Child Welfare - Northern Norway, UiT - The Arctic University of Norway (UiT Norges Arktiske Universitet, Det helsevitenskapelige Fakultet, RKBU Nord, Varemottak-MH, Plan 6, Sykehusv. 44 9019 Tromsø, Norway.
| | - Jo Magne Ingul
- Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, Department of Mental Health, Norwegian University of Science and Technology (NTNU, RKBU Midt-Norge, 7491, Trondheim, Norway.
| | - Lene-Mari Potulski Rasmussen
- Regional Centre for Child and Youth Mental Health and Child Welfare - Northern Norway, UiT - The Arctic University of Norway (UiT Norges Arktiske Universitet, Det helsevitenskapelige Fakultet, RKBU Nord, Varemottak-MH, Plan 6, Sykehusv. 44 9019 Tromsø, Norway.
| | - Tore Wentzel-Larsen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP Øst og Sør, Postboks 4623 Nydalen, 0405, Oslo, Norway.
| | - Joshua Patras
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP Øst og Sør, Postboks 4623 Nydalen, 0405, Oslo, Norway.
| | - Anne Mari Sund
- Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, Department of Mental Health, Norwegian University of Science and Technology (NTNU, RKBU Midt-Norge, 7491, Trondheim, Norway.
| | - Kristin Ytreland
- Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, Department of Mental Health, Norwegian University of Science and Technology (NTNU, RKBU Midt-Norge, 7491, Trondheim, Norway.
| | - Trine Waaktaar
- Department of Psychology, University of Oslo, Harald Schjelderups hus Forskningsveien 3A, 0373, Oslo, Norway.
| | - Solveig Holen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP Øst og Sør, Postboks 4623 Nydalen, 0405, Oslo, Norway.
| | - Anne Liv Askeland
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP Øst og Sør, Postboks 4623 Nydalen, 0405, Oslo, Norway.
| | - Ida Mari Haug
- Regional Centre for Child and Youth Mental Health and Child Welfare - Northern Norway, UiT - The Arctic University of Norway (UiT Norges Arktiske Universitet, Det helsevitenskapelige Fakultet, RKBU Nord, Varemottak-MH, Plan 6, Sykehusv. 44 9019 Tromsø, Norway.
| | - Elisabeth Valmyr Bania
- Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, Department of Mental Health, Norwegian University of Science and Technology (NTNU, RKBU Midt-Norge, 7491, Trondheim, Norway.
| | - Kristin Martinsen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP Øst og Sør, Postboks 4623 Nydalen, 0405, Oslo, Norway; Department of Psychology, University of Oslo, Harald Schjelderups hus Forskningsveien 3A, 0373, Oslo, Norway.
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4
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Martinsen K, Lisøy C, Wentzel-Larsen T, Neumer SP, Rasmussen LMP, Adolfsen F, Sund AM, Ingul JM. School children's mental health during the COVID-19 pandemic. Front Psychol 2024; 14:1290358. [PMID: 38327509 PMCID: PMC10848797 DOI: 10.3389/fpsyg.2023.1290358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/13/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction The COVID-19 pandemic significantly impacted the daily routines of children, with social distancing and quarantine leading to reduced social interactions and potential increased conflicts within families. These factors can increase the risk for anxiety and depression while reducing overall quality of life. Methods Our study included 1843 school children aged 8 to 12 from 56 schools over a 2.5-year period before and during the pandemic. This multi-wave cross-sectional study utilized baseline data from an optimization trial of an indicated preventive intervention. The main outcomes were self-reported symptoms of anxiety and depression, and quality of life was the secondary outcome measure. Furthermore, responses to COVID-relevant questions were measured using a self-composed scale. Our objectives were to compare anxiety and depression symptom levels between cohorts of children who participated in the study before and during the pandemic, to examine if anxiety or depression predicted the COVID response, and whether anxiety and depression and subtypes of anxiety had an impact on quality of life during the pandemic. Linear regression and interaction models were used to examine relevant associations. Results Levels of anxiety and depression were higher in all waves compared to pre-pandemic levels. Quality of life was lower during the pandemic than before the pandemic, particularly among children with generalized anxiety symptoms. Quality of life was negatively associated with loneliness. Discussion Our study revealed that children reported higher anxious and depressive symptoms during the pandemic compared to pre-pandemic levels, as well as reduced quality of life. Lockdowns and restrictions may have contributed to this burden. Additionally, self-reported loneliness was a significant possible consequence of the restrictive measures imposed on children during the pandemic. Additional research is needed to investigate the long-term effects of the pandemic on children, particularly regarding the stability of elevated levels of anxiety and depression. Such studies could examine whether these conditions are indicative of a trajectory toward more severe internalizing disorders.Clinical trial registration: NCT04263558.
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Affiliation(s)
- Kristin Martinsen
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Carina Lisøy
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Tore Wentzel-Larsen
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Simon-Peter Neumer
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare - North, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Lene-Mari Potulski Rasmussen
- Regional Centre for Child and Youth Mental Health and Child Welfare - North, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Frode Adolfsen
- Regional Centre for Child and Youth Mental Health and Child Welfare - North, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Anne Mari Sund
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Jo Magne Ingul
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
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Rabner J, Norris LA, Crane ME, Klugman J, Kendall PC. Impact of youth and caregiver worries about treatment on therapeutic process factors and posttreatment outcomes. J Anxiety Disord 2023; 98:102741. [PMID: 37348261 PMCID: PMC10527968 DOI: 10.1016/j.janxdis.2023.102741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To examine the impact of youth- and caregiver-reported pretreatment worries about treatment (i.e., concerns about the effect of, perceptions of, or aspects involved in treatment) before cognitive behavioral therapy for anxiety on (1) clinician-rated therapeutic process factors (i.e., client engagement, client-therapist alliance, content mastery, and homework completion) and symptom change (i.e., improvement, anxiety severity) assessed throughout treatment and (2) independent evaluator-rated posttreatment outcomes (i.e., response, remission, and functional impairment). METHODS Participants were 128 youth, aged 7-17 years, who sought treatment for a principal anxiety disorder, and their primary caregiver. Multilevel models were estimated to examine the relationship between worries about treatment and the set of therapeutic factors. Regression models examined the relationship between worries about treatment and posttreatment outcomes. RESULTS Results indicated that greater youth-reported worries about treatment flattened/lessened improvement trajectories throughout treatment and had a positive association with higher anxiety severity and lower content mastery. Greater caregiver-reported worries about treatment were associated with greater homework completion, client engagement, and content mastery throughout treatment. Youth- and caregiver-reports of worries about treatment did not impact independent evaluator-rated posttreatment outcomes. CONCLUSIONS Findings support the notion that worries about treatment do not prevent youth from achieving favorable posttreatment outcomes, but do impact various therapeutic factors differentially across youth and caregiver report (e.g., content mastery, client engagement, and homework completion). The value of addressing worries about treatment at the start of therapy is discussed.
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Affiliation(s)
- Jonathan Rabner
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA.
| | - Lesley A Norris
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA; Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Margaret E Crane
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA; Department of Psychiatry, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Joshua Klugman
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA; Department of Sociology, Temple University, Philadelphia, PA, USA
| | - Philip C Kendall
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
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6
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Rabner JC, Olino TM, Albano AM, Ginsburg GS, Compton SN, Piacentini J, Sakolsky D, Birmaher B, Gosch E, Kendall PC. Do youth anxiety measures assess the same construct consistently throughout treatment? Results are...complicated. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01515-y. [PMID: 36856912 DOI: 10.1007/s10578-023-01515-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
Interventionists interpret changes in symptoms as reflecting response to treatment. However, changes in symptom functioning and the measurement of the underlying constructs may be reflected in reported change. Longitudinal measurement invariance (LMI) is a statistical approach that assesses the degree to which measures consistently capture the same construct over time. We examined LMI in measures of anxiety severity/symptoms [i.e., Pediatric Anxiety Rating Scale (PARS), Multidimensional Anxiety Scale for Children (MASC), Screen for Child Anxiety and Related Disorders (SCARED)] in anxious youth at baseline and posttreatment. Initial fit was inadequate for 27 of 38 baseline and posttreatment models, but model modifications resulted in acceptable fit. Tests of LMI supported scalar invariance for the PARS and many, but not all, MASC and SCARED subscales. Findings suggest that the PARS, and many MASC and SCARED subscales can accurately be used to measure change over time, however, others may reflect changes in measurement properties.
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Affiliation(s)
- Jonathan C Rabner
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA.
| | - Thomas M Olino
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Anne Marie Albano
- Department of Psychiatry, Columbia University, New York City, NY, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, West Hartford, CT, USA
| | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elizabeth Gosch
- Department of Clinical Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Philip C Kendall
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
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7
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Freitag GF, Salem H, Conroy K, Busto C, Adrian M, Borba CPC, Brandt A, Chu PV, Dantowitz A, Farley AM, Fortuna L, Furr JM, Lejeune J, Miller L, Platt R, Porche M, Read KL, Rivero-Conil S, Hernandez RDS, Shumway P, Sikov J, Spencer A, Syeda H, McLellan LF, Rapee RM, McMakin D, Pincus DB, Comer JS. The Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric and parent-proxy short forms for anxiety: Psychometric properties in the Kids FACE FEARS sample. J Anxiety Disord 2023; 94:102677. [PMID: 36773484 DOI: 10.1016/j.janxdis.2023.102677] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023]
Abstract
There is tremendous need for brief and supported, non-commercial youth- and caregiver-report questionnaires of youth anxiety. The pediatric and parent proxy short forms of the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety scale (8a v2.0) are free, brief, publicly accessible measures of youth- and caregiver-reported anxiety in children and adolescents. Despite increased use of the PROMIS, no study has evaluated performance of its anxiety scales in a sample of treatment-engaged anxious youth. Analyses were conducted on baseline data from the first 265 families (child MAge=11.14 years, 70% racial/ethnic minoritized youth) to enroll in the Kids FACE FEARS trial, a multisite comparative effectiveness trial of therapist-led vs. self-administered treatment for elevated youth anxiety. Confirmatory factor analysis (CFA) examined factor structure; omega coefficients and regression models examined internal consistency, convergent validity, and cross-informant reliability. CFA supported adjusted single-factor solutions across youth and caregiver reports, and internal consistency was high. Convergent validity was supported by medium-to-large associations with anxiety-related impairment and severity. Moderate cross-informant reliability between reports was found. Results showcase the first psychometric study of the PROMIS Anxiety scale short forms among treatment-engaged youth with elevated anxiety. Findings highlight the PROMIS Anxiety scale's utility in typical care settings for youth anxiety.
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Affiliation(s)
- Gabrielle F Freitag
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, USA.
| | - Hanan Salem
- University of California Santa Barbara, Santa Barbara, CA, USA
| | - Kristina Conroy
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, USA
| | - Carolina Busto
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, USA
| | - Molly Adrian
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA
| | - Christina P C Borba
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Amelia Brandt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Annie Dantowitz
- Department of Psychological and Brain Sciences, Center for Anxiety and Related Disorders (CARD), Boston University, Boston, MA, USA
| | - Alyssa M Farley
- Department of Psychological and Brain Sciences, Center for Anxiety and Related Disorders (CARD), Boston University, Boston, MA, USA
| | - Lisa Fortuna
- University of California San Francisco, San Francisco, CA, USA
| | - Jami M Furr
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, USA
| | - Julia Lejeune
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Leslie Miller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Rheanna Platt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michelle Porche
- University of California San Francisco, San Francisco, CA, USA
| | - Kendra L Read
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA
| | | | | | | | - Jennifer Sikov
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Andrea Spencer
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Haniya Syeda
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Lauren F McLellan
- School of Psychological Sciences, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Ronald M Rapee
- School of Psychological Sciences, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Dana McMakin
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, USA; Nicklaus Children's Hospital, Miami, FL, USA
| | - Donna B Pincus
- Department of Psychological and Brain Sciences, Center for Anxiety and Related Disorders (CARD), Boston University, Boston, MA, USA
| | - Jonathan S Comer
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, USA
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8
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Helland SS, Baardstu S, Kjøbli J, Aalberg M, Neumer SP. Exploring the Mechanisms in Cognitive Behavioural Therapy for Anxious Children: Does Change in Emotion Regulation Explain Treatment Effect? PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:214-225. [PMID: 35089507 DOI: 10.1007/s11121-022-01341-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 12/14/2022]
Abstract
Cognitive behavioural therapy (CBT) for childhood anxiety has shown moderate effects. However, inconsistency in findings during the last decades of treatment research and lack of measurable treatment gains over time has led to a call for optimizing interventions by identifying the active mechanisms involved and for whom such interventions are effective. It has been suggested that the moderate effects may be explained by the fact that emotion regulation rarely is directly targeted in CBT-interventions and that interventions may be more effective for children with a certain level of problems with emotion regulation. Using data from a randomized controlled trial with 160 children and their mothers at baseline (t1) and posttreatment (t2), we examined whether being randomized to CBT predicted change in anxiety symptoms from t1 to t2 and whether this change was mediated by change in emotion regulation from t1 to t2. We also investigated whether the strength of this indirect pathway depended on the level of emotion regulation problems at baseline. Latent baseline target moderated mediation analyses within a structural equation modelling framework were conducted. Results showed a significant indirect pathway between receiving CBT to improved emotion regulation, which again was significantly associated with reductions in anxiety symptoms. The findings suggest that the effect of CBT is similar for children irrespective of initial levels of emotion regulation measured broadly, whereas there was some evidence of a baseline moderation effect of the subdomain emotional control. Emotion regulation, and especially emotional control, seems to be an underlying mechanism for positive effects of CBT for anxiety disorders in children, possibly indicating that a greater emphasis on emotion regulation may optimize the intervention.
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Affiliation(s)
- S S Helland
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Gullhaugveien 1-3, 0484, Oslo, Norway.
| | - S Baardstu
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Gullhaugveien 1-3, 0484, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - J Kjøbli
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Gullhaugveien 1-3, 0484, Oslo, Norway.,Institute of Education, University of Oslo, Oslo, Norway
| | - M Aalberg
- Akershus University Hospital, Lorenskog, Norway
| | - S P Neumer
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Gullhaugveien 1-3, 0484, Oslo, Norway.,The Regional Centre for Child and Youth Mental Health and Child Welfare - Northern Norway, RKBU Nord, The Arctic University of Norway, Tromso, Norway
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9
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Townsend AN, Guzick AG, Hertz AG, Kerns CM, Goodman WK, Berry LN, Kendall PC, Wood JJ, Storch EA. Anger Outbursts in Youth with ASD and Anxiety: Phenomenology and Relationship with Family Accommodation. Child Psychiatry Hum Dev 2022:10.1007/s10578-022-01489-3. [PMID: 36576640 PMCID: PMC10300226 DOI: 10.1007/s10578-022-01489-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/30/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
Anger outbursts (AO) are associated with severe symptoms, impairment and poorer treatment outcomes for anxious children, though limited research has examined AO in youth with co-occurring autism and anxiety disorders. This study examined AO in children with autism and anxiety by evaluating clinical characteristics, family accommodation, and changes in AO following anxiety-focused treatment. The sample comprised 167 youth with autism and anxiety enrolled in a multi-site randomized clinical trial comparing standard care CBT for anxiety, CBT adapted for youth with autism, and usual care. Most participants (60%) had AO, which contributed to impairment above and beyond anxiety and autism. AO impacted functional impairment indirectly through a pathway of parental accommodation. AO reduced with anxiety-focused treatment. Findings highlight that AO are common in this population and uniquely contribute to functional impairment, indicating a need for direct targeting in treatment.
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Affiliation(s)
- Allie N Townsend
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, USA
| | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, USA
| | - Alyssa G Hertz
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, USA
| | - Connor M Kerns
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, USA
| | - Leandra N Berry
- Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Jeffrey J Wood
- Department of Education, University of California, Los Angeles, CA, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, USA.
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10
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Lisøy C, Neumer SP, Waaktaar T, Ingul JM, Holen S, Martinsen K. Making high-quality measures available in diverse contexts-The psychometric properties of the Revised Child Anxiety and Depression Scale in a Norwegian sample. Int J Methods Psychiatr Res 2022; 31:e1935. [PMID: 35947730 PMCID: PMC9720212 DOI: 10.1002/mpr.1935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/27/2022] [Accepted: 07/22/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Recent initiatives have recommended the Revised Child Anxiety and Depression Scale (RCADS) for use in research and as patient-reported outcome in health care globally. We aimed to investigate, for the first time, whether the psychometric properties of the anxiety and depression youth self-report measures, RCADS-47 and RCADS-25, generalize to a Norwegian setting. METHODS We examined gender and age differences in symptomatology among 592 children (mean age 10.7 years), and conducted a psychometric investigation of the internal reliability, structural validity, measurement invariance and convergent validity of the RCADS-47 and RCADS-25 youth versions. RESULTS Girls reported higher levels of anxious and depressive symptoms than boys, but no age differences were observed. Reliability coefficients for the RCADS-47 and RCADS-25 scales indicated good internal consistency. Structural validity for RCADS-47 and RCADS-25 was supported by confirmatory factor analyses results. For both measures, strong gender-based measurement invariance was present. Convergent validity of the RCADS-47 and RCADS-25 with other well-established self-report measures for anxiety (Multidimensional Anxiety Scale for Children) and depression (The Short Mood and Feelings Questionnaire) was supported. CONCLUSION The RCADS-47 and RCADS-25 youth versions are valid and reliable instruments for measuring symptoms of anxiety and depression in a Norwegian setting. The results add to the evidence supporting RCADS's cross-cultural validity.
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Affiliation(s)
- Carina Lisøy
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Simon-Peter Neumer
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Trine Waaktaar
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Jo Magne Ingul
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Solveig Holen
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Kristin Martinsen
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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11
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Phillips KE, Conroy K, Pinney EL, Comer JS, Kendall PC. School-based supports and accommodations among anxious youth in treatment. J Anxiety Disord 2022; 90:102603. [PMID: 35944449 DOI: 10.1016/j.janxdis.2022.102603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
Within pediatric anxiety, accommodation describes ways caregivers modify their behavior in an effort to alleviate distress shown by anxious youth. In schools, accommodation refers to school-based supports (SBS) placed to increase academic success for students with disabilities. The present study, using school documents provided at treatment, examined the types of SBS provided to youth (N = 76; ages 7-17; mean age 11.07; 47.4 % female) diagnosed with an anxiety disorder. SBS were rated by a panel of youth anxiety experts on the degree to which each SBS promoted (a) approach or (b) avoidance. School documents were coded for the presence of SBS and each SBS received a (a) total approach and (b) total avoidance score. Analyses revealed (a) approach and (b) avoidance promoting SBS were differentially associated with diagnostic status: youth with social anxiety disorder were more likely to be recommended SBS promoting avoidance and youth with a specific phobia were more likely to be recommended SBS promoting approach. Overall, the present study characterizes types of SBS being received by anxious youth and finds that SBS recommended to anxious youth vary in type and quality. Discussion considers the need for observations in schools to further address the merits/demerits of anxiety-related SBS.
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12
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Psychometric Properties of the Obsessive Compulsive Inventory-Child Version in Iranian Clinical and Community Samples. Child Psychiatry Hum Dev 2022; 53:156-164. [PMID: 33409771 DOI: 10.1007/s10578-020-01108-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
This study evaluated the psychometric properties of the Persian version of the Obsessive-Compulsive Inventory-Child Version (OCI-CV) in clinical and community samples. Factor structure (confirmatory factor analysis), validity (convergent/discriminant, and predictive), and reliability (internal consistency, and 4-week retest) of the Persian version of the OCI-CV were investigated in a sample of 391 children and adolescents 7-17 years comprised of two groups: a clinical sample of youth with OCD (n = 62), and a community sample (n = 329). Participants completed the OCI-CV, Multidimensional Anxiety Scale for Children (MASC), Children's Depression Inventory (CDI), and Child Behavior Checklist (CBCL). Similar to the English version of the OCI-CV, the Persian version of the scale demonstrated a stable six-factor structure, good convergent and discriminant validity through its correlations with other specific measures of pediatric psychopathology, acceptable sensitivity and specificity for the detection of OCD, and good reliability in terms of internal consistency and temporal stability. These findings suggest that the OCI-CV is a valid and reliable measure to assess obsessive-compulsive symptom dimensions in Iranian youth. Findings provide cross cultural support on the utility of OCI-CV as a self-report measure of obsessive-compulsive symptomology.
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13
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Park Y, Guzick AG, Schneider SC, Fuselier M, Wood JJ, Kerns CM, Kendall PC, Storch EA. Dental Anxiety in Children With Autism Spectrum Disorder: Understanding Frequency and Associated Variables. Front Psychiatry 2022; 13:838557. [PMID: 35463526 PMCID: PMC9021783 DOI: 10.3389/fpsyt.2022.838557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Dental anxiety seems to be elevated in children with autism spectrum disorder (ASD), and may be associated with feelings of helplessness, loss of control, and sensory overload. Dental anxiety, a primary contributor to dental avoidance, can lead to unwanted long-term oral hygiene consequences. This manuscript characterizes the frequency and correlates of dental anxiety in children with ASD. Specifically, this study examined associations between child-reported dental anxiety and parent-reported autism symptom severity, anxiety symptom severity, sensory sensitivity, and internalizing/externalizing symptom severity. Participants included 76 children without cognitive impairment (age in years M = 9.9, SD = 1.8) who took part in a cognitive behavioral therapy study for children with ASD and co-occurring anxiety disorders. Elevated dental anxiety was found in 68% of participants based on a cut-off score from a dental anxiety measure, with fears related to pain being the most commonly endorsed concern; over half of youth endorsed feeling scared about pinching feelings or having a tooth pulled out at the dentist. No significant correlations between dental anxiety and other variables of interest were found, including overall anxiety severity, ASD symptoms, internalizing and externalizing symptoms, and sensory sensitivities. The findings contextualize the frequency of dental anxiety and its relationship to various variables, which may be useful in tailoring existing treatments to reduce dental anxiety in children with ASD.
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Affiliation(s)
- Ye Park
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Sophie C Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Madeleine Fuselier
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Jeffrey J Wood
- Department of Education, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States
| | - Connor M Kerns
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, United States
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
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14
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Frank HE, Kagan ER, Storch EA, Wood JJ, Kerns C, Lewin AB, Small BJ, Kendall PC. Accommodation of Anxiety in Youth with Autism Spectrum Disorder: Results from the TAASD Study. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:219-229. [PMID: 32511015 PMCID: PMC7722072 DOI: 10.1080/15374416.2020.1759075] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: Accommodation, or the ways in which families modify their routines and expectations in response to a child's anxiety, is common and interferes with anxiety treatment outcomes. However, little research has examined family accommodation among youth with autism spectrum disorder and anxiety. The current study aimed to (a) identify pre-treatment correlates of accommodation, (b) examine changes in accommodation after treatment, and (c) assess relationships between accommodation and post-treatment anxiety severity.Method: The sample consisted of 167 youth (mean age = 9.90 years; 79.6% male; 18% Latinx) with clinically significant anxiety and a diagnosis of autism spectrum disorder who were enrolled in a randomized clinical trial comparing two cognitive behavioral therapy interventions for anxiety and treatment-as-usual. Participants were evaluated for symptom severity and family accommodation at pre- and post-treatment.Results: Results indicated that clinician-rated anxiety severity and parent-rated externalizing behaviors and autism spectrum disorder severity significantly predicted pre-treatment accommodation. Accommodation significantly decreased from pre- to post-treatment and non-responders showed significantly higher accommodation at post-treatment compared to responders. Finally, youth with higher pre-treatment accommodation had higher post-treatment anxiety.Conclusions: Findings indicate that accommodation for anxiety is common among youth with autism spectrum disorder and anxiety. Furthermore, accommodation is implicated in treatment outcomes and should be targeted in treatment for youth with autism spectrum disorder and anxiety.
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Affiliation(s)
- Hannah E. Frank
- Temple University, Philadelphia, PA,Corresponding author: Hannah Frank, M.A., 1701 N 13th St., Philadelphia, PA 19122,
| | | | | | | | - Connor Kerns
- University of British Columbia, Vancouver, BC, Canada
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15
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Cremaschi A, De Iorio M, Seng Chong Y, Broekman B, Meaney MJ, Kee MZL. A Bayesian nonparametric approach to dynamic item-response modeling: An application to the GUSTO cohort study. Stat Med 2021; 40:6021-6037. [PMID: 34412151 PMCID: PMC9546363 DOI: 10.1002/sim.9167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/08/2022]
Abstract
Statistical analysis of questionnaire data is often performed employing techniques from item-response theory. In this framework, it is possible to differentiate respondent profiles and characterize the questions (items) included in the questionnaire via interpretable parameters. These models are often crosssectional and aim at evaluating the performance of the respondents. The motivating application of this work is the analysis of psychometric questionnaires taken by a group of mothers at different time points and by their children at one later time point. The data are available through the GUSTO cohort study. To this end, we propose a Bayesian semiparametric model and extend the current literature by: (i) introducing temporal dependence among questionnaires taken at different time points; (ii) jointly modeling the responses to questionnaires taken from different, but related, groups of subjects (in our case mothers and children), introducing a further dependency structure and therefore sharing of information; (iii) allowing clustering of subjects based on their latent response profile. The proposed model is able to identify three main groups of mother/child pairs characterized by their response profiles. Furthermore, we report an interesting maternal reporting bias effect strongly affecting the clustering structure of the mother/child dyads.
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Affiliation(s)
- Andrea Cremaschi
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore
| | - Maria De Iorio
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Science, Yale-NUS College, Singapore, Singapore.,Department of Statistical Science, University College London, London, UK
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Birit Broekman
- Department of Psychiatry, VU Medical Centre, Amsterdam, the Netherlands
| | - Michael J Meaney
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore.,Department of Psychiatry, Douglas Mental Health University Research Institute, McGill University, Montreal, Quebec, Canada
| | - Michelle Z L Kee
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore
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16
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Pedersen ML, Jozefiak T, Sund AM, Holen S, Neumer SP, Martinsen KD, Rasmussen LMP, Patras J, Lydersen S. Psychometric properties of the Brief Problem Monitor (BPM) in children with internalizing symptoms: examining baseline data from a national randomized controlled intervention study. BMC Psychol 2021; 9:185. [PMID: 34838153 PMCID: PMC8626919 DOI: 10.1186/s40359-021-00689-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 11/16/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Prevention is essential to reduce the development of symptomology among children and adolescents into disorders, thereby improving public health and reducing costs. Therefore, easily administered screening and early assessment methods with good reliability and validity are necessary to effectively identify children's functioning and how these develop. The Brief Problem Monitor (BPM) is an instrument designed for this purpose. This study examined the psychometric properties of the Norwegian version of the BPM parent (BPM-P) and teacher (BPM-T) versions, including internal reliability and construct validity at assessing children with internalizing problems. METHODS Baseline data were collected from a national randomized controlled intervention study. Children aged 8-12 years with self-reported symptoms of anxiety and/or depression with one standard deviation above a chosen population's mean were included in this study. Teachers (n = 750) and parents (n = 596) rated children using the BPM-T and BPM-P, respectively. Internal consistency was measured using Cronbach's alpha, and multi-informant agreement between the BPM-P and BPM-T was measured using Spearman's correlations. Construct validity was assessed via confirmatory factor analysis. RESULTS Internal consistency was good throughout all domains for both the BPM-P and BPM-T, with a Cronbach's alpha ranging from .763 to .878. Multi-informant agreement between the parents and the teacher was moderate on the externalizing, attention, and total scales and low on the internalizing scale. The model fit for the three-factor structure of the BPM was excellent for the BPM-P and good for the BPM-T. CONCLUSIONS Internal consistency was good, and the original three-factor solution of the BPM-P and BPM-T was confirmed based on our sample of school children at-risk for emotional problems. These promising results indicate that the BPM may be a valid short assessment tool for measuring attentional, behavioral, and internalizing problems in children. Trial registration in Clinical Trials: NCT02340637; June 12, 2014.
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Affiliation(s)
- Marit Løtveit Pedersen
- Regional Center for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Thomas Jozefiak
- Regional Center for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Mari Sund
- Regional Center for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olavs University Hospital, Trondheim, Norway
| | - Solveig Holen
- Centre for Child and Adolescent Mental Health, RBUP East and South, Oslo, Norway
| | - Simon-Peter Neumer
- Centre for Child and Adolescent Mental Health, RBUP East and South, Oslo, Norway
| | - Kristin D. Martinsen
- Centre for Child and Adolescent Mental Health, RBUP East and South, Oslo, Norway
| | - Lene Mari P. Rasmussen
- RKBU – North, Health Sciences Faculty, UiT The Arctic University of Norway, Tromsø, Norway
| | - Joshua Patras
- RKBU – North, Health Sciences Faculty, UiT The Arctic University of Norway, Tromsø, Norway
| | - Stian Lydersen
- Regional Center for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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17
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Zemestani M, Valiei Z, Isanejad O, Storch EA. Factor Structure, Reliability, and Validity of a Persian Version of the Children’s Florida Obsessive Compulsive Inventory (C-FOCI). JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-021-09896-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Neumer SP, Patras J, Holen S, Lisøy C, Askeland AL, Haug IM, Jeneson A, Wentzel-Larsen T, Adolfsen F, Rasmussen LMP, Ingul JM, Ytreland K, Bania EV, Sund AM, Martinsen K. Study protocol of a factorial trial ECHO: optimizing a group-based school intervention for children with emotional problems. BMC Psychol 2021; 9:97. [PMID: 34154666 PMCID: PMC8215478 DOI: 10.1186/s40359-021-00581-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/04/2021] [Indexed: 12/19/2022] Open
Abstract
Background Youth mental health problems are a major public health concern. Anxiety and depression are among the most common psychological difficulties. The aim of this study is to evaluate an optimized version of a promising indicated group intervention for emotional problems. The program (EMOTION Coping Kids Managing Anxiety and Depression) targets school children 8–12 years with anxious and depressive symptoms and examines three factors. Factor 1 compares the standard EMOTION intervention delivered in 16 group-based sessions (Group), versus a partially-digital EMOTION intervention (DIGGI) delivered as eight group sessions and eight digital sessions. Both versions use virtual reality technology (VR) to improve behavioral experiments. Factor 2 compares parent participation in a 5-session parent group (high involvement) versus sharing information with parents via a brochure (low involvement). Factor 3 compares the use of a measurement and feedback system (MFS) designed to help group leaders tailor the intervention using feedback from children with no MFS. Methods Using a cluster-randomized factorial design, 40 schools across Norway will be randomized to eight different experimental conditions based on three, two-level factors. To assess internalizing symptoms in children, children and their parents will be given self-report questionnaires pre-, post-, and one year after intervention. Parents also report on demographics, user satisfaction, personal symptoms and perception of family related factors. Teachers report on child symptoms and school functioning. Group leaders and the head of the municipal services report on implementation issues. The primary outcomes are changes in depressive and anxious symptoms. Some secondary outcomes are changes in self-esteem, quality of life, and user satisfaction. Questions regarding the consequences of the COVID-19 pandemic are included. Treatment fidelity is based on checklists from group leaders, and on user data from the participating children. Discussion This study is a collaboration between three regional centers for child and adolescent mental health in Norway. It will provide knowledge about: (1) the effect of school-based preventive interventions on anxiety and depression in children; (2) the effect of feedback informed health systems, (3) the effect and cost of digital health interventions for children, and (4) the effect of parental involvement. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00581-y.
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Affiliation(s)
- Simon-Peter Neumer
- The Center for Child and Adolescent Mental Health - Eastern and Southern Norway, Postboks 4623, 0405, Nydalen, Oslo, Norway. .,The Regional Centre for Child and Youth Mental Health and Child Welfare - Northern Norway, RKBU Nord UiT Norges Arktiske Universitet, 9037, Tromsø, Norway.
| | - Joshua Patras
- The Regional Centre for Child and Youth Mental Health and Child Welfare - Northern Norway, RKBU Nord UiT Norges Arktiske Universitet, 9037, Tromsø, Norway
| | - Solveig Holen
- The Center for Child and Adolescent Mental Health - Eastern and Southern Norway, Postboks 4623, 0405, Nydalen, Oslo, Norway
| | - Carina Lisøy
- The Center for Child and Adolescent Mental Health - Eastern and Southern Norway, Postboks 4623, 0405, Nydalen, Oslo, Norway
| | - Anne Liv Askeland
- The Center for Child and Adolescent Mental Health - Eastern and Southern Norway, Postboks 4623, 0405, Nydalen, Oslo, Norway
| | - Ida Mari Haug
- The Regional Centre for Child and Youth Mental Health and Child Welfare - Northern Norway, RKBU Nord UiT Norges Arktiske Universitet, 9037, Tromsø, Norway
| | - Annette Jeneson
- The Center for Child and Adolescent Mental Health - Eastern and Southern Norway, Postboks 4623, 0405, Nydalen, Oslo, Norway
| | - Tore Wentzel-Larsen
- The Center for Child and Adolescent Mental Health - Eastern and Southern Norway, Postboks 4623, 0405, Nydalen, Oslo, Norway.,Norwegian Centre for Violence and Traumatic Stress Studies, 0484, Oslo, Norway
| | - Frode Adolfsen
- The Regional Centre for Child and Youth Mental Health and Child Welfare - Northern Norway, RKBU Nord UiT Norges Arktiske Universitet, 9037, Tromsø, Norway
| | - Lene-Mari Potulski Rasmussen
- The Regional Centre for Child and Youth Mental Health and Child Welfare - Northern Norway, RKBU Nord UiT Norges Arktiske Universitet, 9037, Tromsø, Norway
| | - Jo Magne Ingul
- The Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, MTFS, Pb 8905, 7491, Trondheim, Norway
| | - Kristin Ytreland
- The Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, MTFS, Pb 8905, 7491, Trondheim, Norway
| | - Elisabeth Valmyr Bania
- The Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, MTFS, Pb 8905, 7491, Trondheim, Norway
| | - Anne Mari Sund
- The Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, MTFS, Pb 8905, 7491, Trondheim, Norway.,St.Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7030, Trondheim, Norway
| | - Kristin Martinsen
- The Center for Child and Adolescent Mental Health - Eastern and Southern Norway, Postboks 4623, 0405, Nydalen, Oslo, Norway.,Department of Psychology, University of Oslo, Forskningsveien 3A, 0373, Oslo, Norway
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19
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Norris LA, Rabner JC, Mennies RJ, Olino TM, Kendall PC. Increased self-reported reward responsiveness predicts better response to cognitive behavioral therapy for youth with anxiety. J Anxiety Disord 2021; 80:102402. [PMID: 33894552 PMCID: PMC8141042 DOI: 10.1016/j.janxdis.2021.102402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/15/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022]
Abstract
Few consistent predictors of differential cognitive behavioral therapy (CBT) outcome for anxious youth have been identified, although emerging literature points to youth reward responsiveness as a potential predictor. In a sample of youth ages 7-17 with a primary anxiety disorder (N = 136; Mage = 12.18 years, SDage = 3.12; 70 females; Caucasian n = 108, Black n = 12, Asian n = 4, Hispanic n = 5, other n = 7), the current study examined whether youth reward responsiveness assessed via the Behavioral Inhibition and Behavioral Activation System Scales for children, reward responsiveness subscale, predicted post-treatment (a) anxiety symptom severity, (b) depressive symptom severity, (c) functioning, (d) responder status and (e) number of homework/exposure tasks completed following 16-weeks of CBT, controlling for pre-treatment age, sex, anxiety/depressive symptom severity, and functioning. Moderation analyses examined whether relationships differed by age. Increased reward responsiveness was associated with lower anxiety and depressive symptom severity, higher functioning, and increased likelihood of being a responder, but not homework or exposure completion. Moderation analyses showed that younger, but not older, youth who were more reward responsive completed more exposures. Findings indicate that increased reward responsiveness is a predictor of better CBT outcomes for anxious youth, particularly functional outcomes, and that reward responsiveness may play a different role in exposure completion across development.
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Affiliation(s)
- Lesley A Norris
- Department of Psychology, Temple University, Philadelphia, USA.
| | | | | | - Thomas M Olino
- Department of Psychology, Temple University, Philadelphia, USA
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20
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Radez J, Waite P, Chorpita B, Creswell C, Orchard F, Percy R, Spence SH, Reardon T. Using the 11-item Version of the RCADS to Identify Anxiety and Depressive Disorders in Adolescents. Res Child Adolesc Psychopathol 2021; 49:1241-1257. [PMID: 33792821 PMCID: PMC8321965 DOI: 10.1007/s10802-021-00817-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to identify items from the Revised Children's Anxiety and Depression Scale - RCADS-C/P that provided a brief, reliable and valid screen for anxiety and/or depressive disorders in adolescents. In addition, we examined whether adding items assessing suicidal ideation (Moods and Feelings Questionnaire - MFQ- C/P) and symptom impact and duration (items adapted from the Strengths and Difficulties Questionnaire - SDQ) improved the identification of adolescents with anxiety and/or depressive disorders. We compared two samples of adolescents and their parents - a community sample, recruited through secondary schools in England (n = 214) and a clinic-referred sample, who met diagnostic criteria for anxiety and/or depressive disorder and were recruited through a university-based research clinic (n = 246). Participants completed the RCADS-C/P with additional symptom impact and duration items, and the MFQ-C/P. Using ROC curve analyses, we identified a set of 11 RCADS-C/P items (6 addressing anxiety and 5 depression symptoms) for adolescent- and parent-report. This set of 11 symptom items achieved sensitivity/specificity values > .75, which were comparable to corresponding values for the RCADS-47-C/P. Combining adolescent and parent-report improved the identification of anxiety/depression in adolescents compared to using adolescent-report alone. Finally, adding two symptom impact items further improved the sensitivity/specificity of the 11 symptom items, whereas adding suicidal ideation items did not. The 11 RCADS items accurately discriminated between the community and clinic-referred sample with anxiety and/or depressive disorders and have the potential to quickly and accurately identify adolescents with these disorders in community settings.
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Affiliation(s)
- Jerica Radez
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK.,The Oxford Institute of Clinical Psychology Training and Research, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK
| | - Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK. .,Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, OX2 6GG, UK.
| | - Bruce Chorpita
- Department of Psychology, University of California, Box 951563, Los Angeles, CA, 90095, USA
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, OX2 6GG, UK
| | - Faith Orchard
- School of Psychology, University of Sussex, Brighton, BN1 9RH, UK
| | - Ray Percy
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK
| | - Susan H Spence
- School of Applied Psychology and Australian Institute of Suicide Research and Prevention, Griffith University, Brisbane, QLD 4121, Australia
| | - Tessa Reardon
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, OX2 6GG, UK
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21
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Vermilion J, Pedraza C, Augustine EF, Adams HR, Vierhile A, Lewin AB, Collins AT, McDermott MP, O'Connor T, Kurlan R, van Wijngaarden E, Murphy TK, Mink JW. Anxiety Symptoms Differ in Youth With and Without Tic Disorders. Child Psychiatry Hum Dev 2021; 52:301-310. [PMID: 32519083 DOI: 10.1007/s10578-020-01012-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We compared anxiety symptoms in youth with and without tic disorders by comparing scores on the Multidimensional Anxiety Scale for Children (MASC) in youth with tic disorders to those in a concurrent community control group and in a group of treatment-seeking anxious youth from the Child/Adolescent Anxiety Multimodal Study (CAMS). Data from 176 youth with tic disorders, 93 control subjects, and 488 CAMS participants were included. Compared to youth with tic disorders, controls had lower total MASC scores (p < 0.0001) and CAMS participants had similar total MASC scores (p = 0.13). Separation Anxiety (p = 0.0003) and Physical Symptom (p < 0.0001) subscale scores were higher in youth with tic disorders than in CAMS participants. We conclude that the anxiety symptom profile differs in youth with and without tic disorders, which may have important implications for targeting treatment of anxiety in youth with tic disorders.
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Affiliation(s)
- Jennifer Vermilion
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA. .,Division of Child Neurology, Department of Neurology, Box 631, 601 Elmwood Ave, Rochester, NY, 14642, USA.
| | | | - Erika F Augustine
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Heather R Adams
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Amy Vierhile
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Alyssa T Collins
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Thomas O'Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Roger Kurlan
- Center for Neurological and Neurodevelopmental Health, Voorhees, NJ, USA
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Jonathan W Mink
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
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22
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Creswell C, Nauta MH, Hudson JL, March S, Reardon T, Arendt K, Bodden D, Cobham VE, Donovan C, Halldorsson B, In-Albon T, Ishikawa SI, Johnsen DB, Jolstedt M, de Jong R, Kreuze L, Mobach L, Rapee RM, Spence SH, Thastum M, Utens E, Vigerland S, Wergeland GJ, Essau CA, Albano AM, Chu B, Khanna M, Silverman WK, Kendall PC. Research Review: Recommendations for reporting on treatment trials for child and adolescent anxiety disorders - an international consensus statement. J Child Psychol Psychiatry 2021; 62:255-269. [PMID: 32683742 DOI: 10.1111/jcpp.13283] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/03/2020] [Accepted: 05/12/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anxiety disorders in children and young people are common and bring significant personal and societal costs. Over the last two decades, there has been a substantial increase in research evaluating psychological and pharmacological treatments for anxiety disorders in children and young people and exciting and novel research has continued as the field strives to improve efficacy and effectiveness, and accessibility of interventions. This increase in research brings potential to draw together data across studies to compare treatment approaches and advance understanding of what works, how, and for whom. There are challenges to these efforts due largely to variation in studies' outcome measures and variation in the way study characteristics are reported, making it difficult to compare and/or combine studies, and this is likely to lead to faulty conclusions. Studies particularly vary in their reliance on child, parent, and/or assessor-based ratings across a range of outcomes, including remission of anxiety diagnosis, symptom reduction, and other domains of functioning (e.g., family relationships, peer relationships). METHODS To address these challenges, we convened a series of international activities that brought together the views of key stakeholders (i.e., researchers, mental health professionals, young people, parents/caregivers) to develop recommendations for outcome measurement to be used in treatment trials for anxiety disorders in children and young people. RESULTS AND CONCLUSIONS This article reports the results of these activities and offers recommendations for selection and reporting of outcome measures to (a) guide future research and (b) improve communication of what has been measured and reported. We offer these recommendations to promote international consistency in trial reporting and to enable the field to take full advantage of the great opportunities that come from data sharing going forward.
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Affiliation(s)
- Cathy Creswell
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Jennifer L Hudson
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Sonja March
- School of Psychology and Counselling, University of Southern Queensland, Springfield, QLD, Australia
| | - Tessa Reardon
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Denise Bodden
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Vanessa E Cobham
- Children's Health QLD Child and Youth Mental Health Service, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Caroline Donovan
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Brynjar Halldorsson
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK.,Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy Unit, University of Koblenz and Landau, Landau, Germany
| | | | | | - Maral Jolstedt
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Rachel de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Leonie Kreuze
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Lynn Mobach
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Ronald M Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Susan H Spence
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia.,Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD, Australia
| | | | - Elisabeth Utens
- Research Institute of Child Development and Education, University of Amsterdam / The Bascule / Amsterdam UMC, Amsterdam, The Netherlands.,Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sarah Vigerland
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Gro Janne Wergeland
- Division of Psychiatry, Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Cecilia A Essau
- Department of Psychology, University of Roehampton, London, UK
| | - Anne Marie Albano
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
| | - Brian Chu
- Department of Clinical Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Muniya Khanna
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Wendy K Silverman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
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23
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Abstract
The Coping Questionnaire (CQ)-child and parent version-is an idiographic measure of youth's perceived ability to cope in anxiety provoking situations. Participants (N = 442; aged 7-17) met DSM-IV criteria for separation anxiety disorder, generalized anxiety disorder, or social anxiety disorder. The internal consistency of the CQ was supported, and retest reliability and parent/child agreement were, as expected, modest. The CQ scores were significantly correlated in the expected direction with measures of anxiety symptoms and functioning, providing evidence of convergent and divergent validity. The criterion validity of the CQ also was supported: the CQ scores were significantly correlated with the clinical severity rating of the youth's principal diagnosis on ADIS. There was a significant correlation between change in CQ scores and in anxiety severity and symptoms following treatment. Results support the CQ as a measure to assess coping efficacy in anxious youths as part of evidence-based assessment.
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24
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Phillips KE, Norris LA, Kendall PC. Separation Anxiety Symptom Profiles and Parental Accommodation Across Pediatric Anxiety Disorders. Child Psychiatry Hum Dev 2020; 51:377-389. [PMID: 31907734 PMCID: PMC8109254 DOI: 10.1007/s10578-019-00949-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Parental accommodation refers to ways in which caregivers modify their behavior to decrease child distress in the short-term. Accommodation is prevalent among anxious youth and related to decreased treatment and functional outcomes. Although separation anxiety disorder (SAD) is associated with increased accommodation, SAD is not a predictor of treatment response, suggesting that a diagnosis of SAD alone may not be enough to clarify the relationship between accommodation and separation anxiety symptoms within a clinical context. Participants were youth with a primary anxiety disorder (N = 186; aged 7-17) enrolled in an outpatient anxiety clinic. Latent class analysis was used to extract profiles from parent-reported SAD symptoms using the Anxiety Disorders Interview Schedule for DSM-IV/5. Profiles were compared on pre-treatment accommodation. Low, moderate, and interfering SAD classes emerged. Interfering SAD was associated with high accommodation. Results help to clarify the association between SAD and accommodation and has implications for personalized intervention.
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Affiliation(s)
- Katherine E Phillips
- Department of Psychology, Temple University, 1701 North 13th St, Philadelphia, PA, 19122, USA.
| | - Lesley A Norris
- Department of Psychology, Temple University, 1701 North 13th St, Philadelphia, PA, 19122, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, 1701 North 13th St, Philadelphia, PA, 19122, USA.
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25
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Intolerance of uncertainty in youth: Psychometrics of the Intolerance of Uncertainty Index-A for Children. J Anxiety Disord 2020; 71:102197. [PMID: 32126335 DOI: 10.1016/j.janxdis.2020.102197] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/26/2020] [Accepted: 02/10/2020] [Indexed: 01/04/2023]
Abstract
Intolerance of uncertainty (IU) is a cognitive vulnerability for pathological anxiety. The current study adapted the Intolerance of Uncertainty Index-A for Children (IUI-A-C), and created a single-item Intolerance of Uncertainty Clinician-Rated Index (IUCR), both of which assess a youth's general inability to endure uncertainty. Psychometric properties of these two measures were evaluated. Participants were 146 youth aged 7-17 years seeking treatment for anxiety. The IUI-A-C evidenced individual item performance (i.e., correlations between each item and the total remainder score > .40, ps <.001), internal consistency, convergent validity with the IUCR and self-report measures of anxiety and functional impairment, divergent validity with ADHD severity, and retest reliability with a mean interval of over four weeks. The IUCR also evidenced convergent validity with the IUI-A-C and self-report measures of anxiety and functional impairment and divergent validity with ADHD severity. The IUI-A-C predicted composite principal diagnosis severity but did not predict composite GAD diagnosis severity. The IUI-A-C and IUCR have utility as measures of IU in youth. The role of IU in specific anxiety disorders and future research are discussed.
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26
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Zhang Y, Li KY, Lo ECM, Wong MCM. Structural equation model for parental influence on children's oral health practice and status. BMC Oral Health 2020; 20:56. [PMID: 32066428 PMCID: PMC7027297 DOI: 10.1186/s12903-020-1048-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/12/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Children's oral health status (OHS) can be influenced by their oral health practices and many parental factors. This study aimed to investigate pathways from parental factors to oral health practices and status of children in Hong Kong. METHODS Using a combination of random and purposive sampling of Hong Kong households, 432 families with children aged 5-7 participated in a cross-sectional survey. Data on socioeconomic status, smoking, and oral health knowledge, attitudes, and practices, as well as OHS of parents and parents' knowledge of and attitudes towards their children's oral health, were collected through a questionnaire. Tooth status, periodontal status, and oral hygiene data were also collected through clinical examination. Correlations of oral health behaviors (OHB) and OHS within families were assessed by confirmatory factor analysis. A conceptual model of the parental influences on children's oral health practices and status was tested by a structural equation model (SEM). Chi-square test, chi-square/df, nonnormed fit index, comparative fit index, and root mean square error of approximation were used to assess the model fit. RESULTS Fit indexes for confirmatory factor analysis and SEM showed good fit. Positive correlations of OHB and OHS were found within the families that ranged from 0.74 to 0.98 for OHB and 0.30 to 0.43 for OHS. SEM showed better socioeconomic status of mothers led to better oral health knowledge and attitude (γ = 0.75, P < 0.001) and also towards their children's better oral health knowledge and attitude (γ = 0.44, P < 0.01). Parents' attitudes towards their children's oral health (β = 0.40, P = 0.04) and mothers' OHB (β = 0.60, P < 0.001) were positively associated with OHB of children. Positive OHB of children (β = - 0.48, P < 0.01) in turn led to better oral health. CONCLUSIONS Correlations of OHB and OHS between mothers and children were stronger than those of fathers. Children's OHS was directly affected by their mothers' OHB, which in turn were affected by parents' oral health knowledge, attitudes, and practices.
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Affiliation(s)
- Yan Zhang
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Pofulam, Hong Kong, SAR China
| | - Kar Yan Li
- Faculty of Dentistry, The University of Hong Kong, Pofulam, Hong Kong, SAR China
| | - Edward Chin Man Lo
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Pofulam, Hong Kong, SAR China
| | - May Chun Mei Wong
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Pofulam, Hong Kong, SAR China
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27
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Pedersen ML, Holen S, Lydersen S, Martinsen K, Neumer SP, Adolfsen F, Sund AM. School functioning and internalizing problems in young schoolchildren. BMC Psychol 2019; 7:88. [PMID: 31870462 PMCID: PMC6929288 DOI: 10.1186/s40359-019-0365-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 12/08/2019] [Indexed: 12/20/2022] Open
Abstract
Background Symptoms of anxiety and depression are common mental health problems in children and are often referred to as internalizing symptoms. Youth with such symptoms are at greater risk for poor academic achievement, school non-completion, and future mental health problems, all of which, lead to public health consequences and costs to society. The aim of the current study was to investigate associations between young school children’s internalizing symptoms and school functioning, as assessed separately by the teachers and the children. Methods This study is a cross-sectional study including children (N = 750. 58% girls) from the ages of 8–12 years with elevated levels of self-reported symptoms of anxiety (MASC-C) and/or depression (SMFQ). Teachers reported the academic achievement, school adaptation (TRF) and internalizing symptoms (BPM-T) of the children. Associations were analyzed using linear regression analyses. Results Both teacher-reported internalizing symptoms and children’s self-reported depressive symptoms were associated with poor academic achievement and school adaptation, while self-reported symptoms of anxiety were not. Symptoms of depression as assessed by the children were associated with teacher-rated internalizing symptoms, while self-reported symptoms of anxiety were not. Conclusion We found negative associations between school functioning and internalizing symptoms, as assessed by both the teachers and the children. The dual findings strengthen the validity of these relationships. Thus, prevention of depressive and anxiety symptoms in children may lead to positive changes in school domains such as academic achievement and school adaptation. We also identified a negative association between teacher-rated internalizing symptoms and children’s self-report of depressive symptoms, indicating that teachers may have difficulties recognizing children with these symptoms. Trial registration Clinical Trials NCT02340637, Registered on June 12, 2014, Retrospectively registered.
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Affiliation(s)
- Marit Løtveit Pedersen
- Regional Center for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Solveig Holen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
| | - Stian Lydersen
- Regional Center for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kristin Martinsen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
| | - Simon-Peter Neumer
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
| | - Frode Adolfsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT Arctic University of Norway, Tromsø, Norway
| | - Anne Mari Sund
- Regional Center for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Child and Adolescent Psychiatry, St. Olavs University Hospital, Trondheim, Norway
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28
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But what will the results be?: Learning to tolerate uncertainty is associated with treatment-produced gains. J Anxiety Disord 2019; 68:102146. [PMID: 31669785 DOI: 10.1016/j.janxdis.2019.102146] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 08/20/2019] [Accepted: 09/18/2019] [Indexed: 12/25/2022]
Abstract
The current study examined the association between changes in intolerance of uncertainty (IU) and treatment outcomes for anxious youth. Participants were youth ages 7 to 17 who received cognitive behavioral therapy for anxiety (N = 73). Youth and their primary caregivers completed a diagnostic interview and self- and parent-report measures at pre- and post-treatment, including the Intolerance of Uncertainty Scale for Children (IUS-C/P; Przeworski, 2006), the Coping Questionnaire (CQ-C/P; Kendall, 1994) and the Multidimensional Anxiety Scale for Children (MASC-C/P; March et al., 1997). Hierarchical regression analyses evaluated the role of change in IU (the IUS-C/P) in predicting changes in functional impairment, coping efficacy, and anxiety severity post-treatment, controlling for demographic variables (age and gender), and baseline levels of IU, anxiety severity, functional impairment, and coping efficacy. Results demonstrated that treatment was associated with improvements across child-, parent- and clinician-report, and decreased IU from pre- to post-treatment was associated with (a) decreased functional impairment, (b) increased coping efficacy and (c) decreased anxiety severity. The findings indicate that a greater reduction in IU over treatment is associated with better outcomes in children and adolescents with anxiety across informants, suggesting the possibility that an increased focus on IU during treatment for youth anxiety may improve treatment outcomes. Future research should assess the causality of this relationship.
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29
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Abstract
The current study examined emotional awareness as a predictor of differential outcomes for youth treated for an anxiety disorder. 37 youth ages 7-15 received either individual cognitive-behavioral therapy or family cognitive-behavioral therapy to treat generalized anxiety disorder, separation anxiety disorder, and/or social phobia. Diagnoses were determined by independent evaluators, following semi-structured interviews (ADIS-IV-C/P) with youth and their parents. Self-report questionnaires, including the multidimensional anxiety scale for children and the emotion expressivity scale for children, were completed at pre- and posttreatment. Youth with higher levels of pretreatment emotional awareness had better treatment outcomes than youth with lower levels of emotional awareness, with specific regard to improved ability to cope with worry. Findings suggest that higher levels of emotional awareness facilitate better specific outcomes for anxious youth. Findings highlight the importance of understanding the emotions associated with worry during the treatment process.
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30
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McGuire JF, Caporino NE, Palitz SA, Kendall PC, Albano AM, Ginsburg G, Birmaher B, Walkup JT, Piacentini J. Integrating evidence-based assessment into clinical practice for pediatric anxiety disorders. Depress Anxiety 2019; 36:744-752. [PMID: 31231969 PMCID: PMC6679780 DOI: 10.1002/da.22900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/11/2019] [Accepted: 04/05/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although evidence-based assessments are the cornerstone of evidence-based treatments, it remains unknown whether incorporating evidence-based assessments into clinical practice enhances therapists' judgment of therapeutic improvement. This study examined whether the inclusion of youth- and parent-reported anxiety rating scales improved therapists' judgment of treatment response and remission compared to the judgment of treatment-masked independent evaluators (IEs) after (a) weekly/biweekly acute treatment and (b) monthly follow-up care. METHODS Four hundred thirty six youth received cognitive-behavioral therapy (CBT), medication, CBT with medication, or pill placebo through the Child/Adolescent Anxiety Multimodal Study. Participants and parents completed the following anxiety scales at pretreatment, posttreatment, and follow-up: Screen for Childhood Anxiety and Related Disorders (SCARED) and Multidimensional Anxiety Scale for Children (MASC). IEs rated anxiety on the Clinical Global Impression of Severity (CGI-S) and Improvement (CGI-I) at posttreatment and follow-up. Therapists rated anxiety severity and improvement using scales that paralleled IE measures. RESULTS Fair-to-moderate agreement was found between therapists and IEs after acute treatment (κ = 0.38-0.48), with only slight-to-fair agreement found after follow-up care (κ = 0.07-0.33). Optimal algorithms for determining treatment response and remission included the combination of therapists' ratings and the parent-reported SCARED after acute (κ = 0.52-0.54) and follow-up care (κ = 0.43-0.48), with significant improvement in the precision of judgments after follow-up care (p < .02-.001). CONCLUSION Therapists are good at detecting treatment response and remission, but the inclusion of the parent-report SCARED optimized agreement with IE rating-especially when contact was less frequent. Findings suggest that utilizing parent-report measures of anxiety in clinical practice improves the precision of therapists' judgment.
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Affiliation(s)
- Joseph F. McGuire
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | | | | | | | - Anne Marie Albano
- New York State Psychiatric Institute and Columbia University Medical Center
| | | | | | - John T. Walkup
- Lurie Children’s Hospital and Northwestern University Feinberg School of Medicine
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
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31
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Reardon T, Creswell C, Lester KJ, Arendt K, Blatter-Meunier J, Bögels SM, Coleman JRI, Cooper PJ, Heiervang ER, Herren C, Hogendoorn SM, Hudson JL, Keers R, Lyneham HJ, Marin CE, Nauta M, Rapee RM, Roberts S, Schneider S, Silverman WK, Thastum M, Thirlwall K, Wergeland GJ, Eley TC. The utility of the SCAS-C/P to detect specific anxiety disorders among clinically anxious children. Psychol Assess 2019; 31:1006-1018. [PMID: 31070449 PMCID: PMC6671872 DOI: 10.1037/pas0000700] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/17/2018] [Accepted: 12/31/2018] [Indexed: 12/14/2022]
Abstract
Questionnaire measures offer a time and cost-effective alternative to full diagnostic assessments for identifying and differentiating between potential anxiety disorders and are commonly used in clinical practice. Little is known, however, about the capacity of questionnaire measures to detect specific anxiety disorders in clinically anxious preadolescent children. This study aimed to establish the ability of the Spence Children's Anxiety Scale (SCAS) subscales to identify children with specific anxiety disorders in a large clinic-referred sample (N = 1,438) of children aged 7 to 12 years. We examined the capacity of the Separation Anxiety, Social Phobia, Generalized Anxiety, and Physical Injury Fears (phobias) subscales to discriminate between children with and without the target disorder. We also identified optimal cutoff scores on subscales for accurate identification of children with the corresponding disorder, and examined the contribution of child, mother, and father reports. The Separation Anxiety subscale was able to accurately identify children with separation anxiety disorder, and this was replicated across all 3 reporters. Mother- and father-reported Social Phobia subscales also accurately identified children with social anxiety disorder, although child report was only able to accurately detect social anxiety disorder in girls. Using 2 or more reporters improved the sensitivity of the Separation Anxiety and Social Phobia subscales but reduced specificity. The Generalized Anxiety and Physical Injury Fears subscales failed to accurately identify children with the corresponding disorders. These findings have implications for the potential use of mother-, father-, and child-report SCAS subscales to detect specific disorders in preadolescent children in clinical settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Kristian Arendt
- Department of Psychology and Behavioural Sciences, Aarhus University
| | | | - Susan M Bögels
- Research Institute Child Development and Education, University of Amsterdam
| | - Jonathan R I Coleman
- Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry Centre, King's College London
| | - Peter J Cooper
- School of Psychology and Clinical Language Sciences, University of Reading
| | | | - Chantal Herren
- Department of Forensic Psychiatry, University of Basel Psychiatric Clinics
| | - Sanne M Hogendoorn
- Department of Child and Adolescent Psychiatry/De Bascule, Academic Medical Centre
| | - Jennifer L Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University
| | - Robert Keers
- Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry (SGDP) Centre, King's College London
| | - Heidi J Lyneham
- Centre for Emotional Health, Department of Psychology, Macquarie University
| | - Carla E Marin
- Child Study Center, Yale University School of Medicine
| | - Maaike Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University
| | - Susanna Roberts
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London
| | - Silvia Schneider
- Mental Health Research and Treatment Center (MHRTC), Ruhr University Bochum
| | | | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University
| | - Kerstin Thirlwall
- School of Psychology and Clinical Language Sciences, University of Reading
| | - Gro Janne Wergeland
- Anxiety Disorders Research Network and Division of Psychiatry, Department of Child and Adolescent Psychiatry, Haukeland University Hospital
| | - Thalia C Eley
- Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry (SGDP) Centre, King's College London
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Crawford EA, Burke TA, Siegel D, Jager-Hyman S, Alloy LB, Kendall PC. Somatic Symptoms of Anxiety and Suicide Ideation Among Treatment-Seeking Youth With Anxiety Disorders. Suicide Life Threat Behav 2019; 49:811-825. [PMID: 29900567 DOI: 10.1111/sltb.12479] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/27/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The severity of anxiety, in general, has been associated with suicide ideation (SI) among youth, but research has yet to examine the specific anxiety symptoms that may contribute to SI among youth. This study examined the severity of specific anxiety symptom clusters (i.e., tense/restless, somatic/autonomic symptoms, humiliation/rejection, performing in public, separation anxiety, perfectionism, and anxious coping) and SI in youth who met diagnostic criteria for an anxiety disorder. METHOD Participants (N = 87) were treatment-seeking children and adolescents ages 6-17 (M = 11.1 years, SD = 3.06; 52.9% male) diagnosed with a principal anxiety disorder. Youth and their parents completed measures of youth anxiety symptom severity, depression, and SI. RESULTS Hierarchical linear regressions revealed that when anxiety symptom clusters were entered simultaneously, only youth self-reported (and not parent-reported) somatic/autonomic symptoms of anxiety significantly predicted SI, after controlling for depression and sex. Importantly, the relationship between somatic/autonomic symptoms of anxiety and SI was stronger than that between depression and SI. CONCLUSIONS These results suggest that assessing somatic symptoms of anxiety is especially important when quantifying suicide risk among anxiety-disordered youth.
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Affiliation(s)
| | | | - David Siegel
- Psychology, Temple University, Philadelphia, PA, USA
| | - Shari Jager-Hyman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Norris LA, Olino TM, Gosch EA, Compton SN, Piacentini J, Ginsburg GS, Albano AM, Walkup JT, Birmaher B, Kendall PC. Person-Centered Profiles Among Treatment-Seeking Children and Adolescents with Anxiety Disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:626-638. [PMID: 31039048 DOI: 10.1080/15374416.2019.1602839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Latent profile analysis (LPA) was used to derive homogeneous subgroups within the Child/Adolescent Anxiety Multimodal Study sample (N = 488; 7-17 years, M = 10.69, SD = 2.80) and examine whether class membership predicted or moderated treatment response. Subgroups were identified on baseline multi-informant measures of variables most consistently associated with outcome (youth anxiety/diagnosis, impairment, family psychopathology/functioning). Subgroup membership was examined as a predictor/moderator of outcome across the four treatment conditions (CBT, Sertraline, CBT+Sertraline, pill placebo) at posttreatment (12 weeks) and open-extension follow-up (24 weeks). Four subgroups emerged: mild symptoms/impairment, moderate symptoms/impairment, moderate symptoms/impairment with family dysfunction/parental psychopathology, and severe symptoms/impairment. There were significant between-class differences on socioeconomic status (SES; lower reported SES in the moderate with family dysfunction/parental psychopathology class compared to the mild and moderate class) and age (older age in the severe symptoms class compared to the other three classes). Youth in the mild symptoms/impairment class showed lower posttreatment anxiety across conditions but reported significantly lower symptom severity at baseline. Controlling for demographic differences, response to treatment type did not differ across classes. Analyses indicate that elevated family dysfunction/parental psychopathology clusters primarily within one subgroup of anxious youth rather than mapping onto symptom severity, highlighting the utility of LPA for clarifying within-person combinations of predictor/moderator variables. Implications for development of interventions targeting class-relevant variables are discussed.
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Affiliation(s)
| | | | - Elizabeth A Gosch
- Department of Psychology, Philadelphia College of Osteopathic Medicine
| | - Scott N Compton
- Department of Psychiatry and Behavioral Psychology, Duke University Medical Center
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles School of Medicine
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut Health Center
| | - Anne Marie Albano
- Department of Psychiatry, New York State Psychiatric Institute-Columbia University Medical Center
| | - John T Walkup
- Department of Psychiatry, Weill Cornell Medicine, New York-Presbyterian
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine
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Villabø MA, Narayanan M, Compton SN, Kendall PC, Neumer SP. Cognitive-behavioral therapy for youth anxiety: An effectiveness evaluation in community practice. J Consult Clin Psychol 2018; 86:751-764. [PMID: 30138014 DOI: 10.1037/ccp0000326] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare the effectiveness of individual cognitive-behavioral therapy (ICBT) and group CBT (GCBT) for referred children with anxiety disorders within community mental health clinics. METHOD Children (N = 165; ages 7-13 years) referred to 5 clinics in Norway because of primary separation anxiety disorder (SAD), social anxiety disorder (SOC), or generalized anxiety disorder (GAD) based on Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) criteria participated in a randomized clinical trial. Participants were randomized to ICBT, GCBT, or wait list (WL). WL participants were randomized to 1 of the 2 active treatment conditions following the wait period. Primary outcome was loss of principal anxiety disorder over 12 weeks and 2-year follow-up. RESULTS Both ICBT and GCBT were superior to WL on all outcomes. In the intent-to-treat analysis, 52% in ICBT, 65% in GCBT, and 14% in WL were treatment responders. Planned pairwise comparisons found no significant differences between ICBT and GCBT. GCBT was superior to ICBT for children diagnosed with SOC. Improvement continued during 2-year follow-up with no significant between-groups differences. CONCLUSIONS Among anxiety disordered children, both individual and group CBT can be effectively delivered in community clinics. Response rates were similar to those reported in efficacy trials. Although GCBT was more effective than ICBT for children with SOC following treatment, both treatments were comparable at 2-year follow-up. Dropout rates were lower in GCBT than in ICBT, suggesting that GCBT may be better tolerated. Response rates continued to improve over the follow-up period, with low rates of relapse. (PsycINFO Database Record
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Affiliation(s)
| | | | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
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Spence SH. Assessing anxiety disorders in children and adolescents. Child Adolesc Ment Health 2018; 23:266-282. [PMID: 32677290 DOI: 10.1111/camh.12251] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Given the relatively high prevalence of anxiety problems among young people and their adverse consequences if left untreated, it is important that clinicians and researchers have access to reliable and valid assessment tools to facilitate early detection, case formulation, treatment design and evaluation of outcomes. METHOD This paper presents the findings of a pragmatic review of the literature regarding the assessment of anxiety in young people in multiple contexts, including mental health services, school-based screening and research trials. RESULTS Commonly used diagnostic interviews, questionnaire measures and alternative assessment methods are described, along with psychometric properties and practical issues. The review indicates the complexities of assessing anxiety problems given the high level of comorbidity between anxiety disorders and with depression. It also highlights the different approaches required for assessment across different age groups, the need for multiple informants and issues relating to the lack of agreement between reporters. There is a strong evidence-base for several diagnostic instruments and anxiety scales, although the accuracy of youth and parent report scales in forming clinical diagnoses is not sufficiently strong to justify their use in isolation for diagnostic purposes. CONCLUSIONS The assessment of youth anxiety should ideally include a multiinformant, multimethod approach, with measures tailored to the age of the child, and the purpose of the evaluation. There is now a sufficiently strong research base to enable clinicians and researchers to ensure that they select evidence-based instruments.
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Affiliation(s)
- Susan H Spence
- Australian Institute for Suicide Research and Prevention and School of Applied Psychology, Griffith University, Mt Gravatt, Australia
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Reardon T, Spence SH, Hesse J, Shakir A, Creswell C. Identifying children with anxiety disorders using brief versions of the Spence Children's Anxiety Scale for children, parents, and teachers. Psychol Assess 2018; 30:1342-1355. [PMID: 29902050 PMCID: PMC6179143 DOI: 10.1037/pas0000570] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Anxiety disorders are among the most prevalent mental health disorders experienced by children and are associated with significant negative outcomes. Only a minority of affected children, however, access professional help, and a failure to identify children with anxiety disorders presents a key barrier to treatment access. Existing child anxiety questionnaire measures are long and time consuming to complete, limiting their potential for widespread use as identification tools in community settings. We developed a brief questionnaire for parents, children, and teachers using items from the Spence Children’s Anxiety Scale (SCAS) and evaluated the new measure’s psychometric properties, capacity to discriminate between a community (n = 361) and clinic-referred sample (n = 338) of children aged 7–11, and identified optimal cut-off scores for accurate identification of preadolescent children experiencing clinically significant levels of anxiety. The findings provided support for the reliability and validity of 8-item versions of the SCAS, with the brief questionnaire scores displaying comparable internal consistency, agreement among reporters, and convergent/divergent validity to the full-length SCAS scores. The brief SCAS scores also discriminated between the community and clinic-referred samples and identified children in the clinic-referred sample with a moderate-to-good level of accuracy and acceptable sensitivity and specificity. Combining reporters improved sensitivity, but at the expense of specificity, and findings suggested parent report should be prioritized. This new brief questionnaire has potential for use in community settings as a tool to improve identification of children who are experiencing clinically significant levels of anxiety and warrant further assessment and potential support. We developed and evaluated brief versions of the Spence Children’s Anxiety Scale for parents, children, and teachers. Results provide support for the potential application of this new brief questionnaire in community settings to improve identification of children with anxiety disorders.
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Affiliation(s)
| | - Susan H Spence
- School of Applied Psychology and Australian Institute of Suicide Research and Prevention, Griffith University
| | - Jordan Hesse
- School of Psychology and Clinical Language Sciences, University of Reading
| | - Alia Shakir
- School of Psychology and Clinical Language Sciences, University of Reading
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading
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37
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Palitz SA, Caporino NE, McGuire JF, Piacentini J, Albano AM, Birmaher B, Walkup JT, Compton SN, Ginsburg GS, Kendall PC. Defining Treatment Response and Remission in Youth Anxiety: A Signal Detection Analysis With the Multidimensional Anxiety Scale for Children. J Am Acad Child Adolesc Psychiatry 2018; 57:418-427. [PMID: 29859557 PMCID: PMC5988233 DOI: 10.1016/j.jaac.2018.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/16/2017] [Accepted: 04/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the percent reduction cutoffs on the Multidimensional Anxiety Scale for Children (MASC) that optimally predict treatment response and remission in youth with anxiety disorders. METHOD Youths and their parents completed the MASC-C/P before and after treatment, and the Anxiety Disorders Interview Schedule for DSM-IV-Child and Parent Versions (ADIS-IV-C/P) and the Clinical Global Impression-Improvement Scale (CGI-I) were administered by independent evaluators. Treatment response and remission were defined by post-treatment ratings on the CGI-I and the ADIS-IV-C/P, respectively. Quality receiver operating characteristic methods determined the optimal cutoff on the MASC-P for predicting overall remission (loss of all study entry diagnoses) and optimal percent reductions on the MASC-P for predicting treatment response and remission of separation anxiety, social anxiety, and generalized anxiety. RESULTS A post-treatment raw score of 42 optimally predicted remission. A reduction of 35% on the total MASC-P predicted treatment response. A reduction of 30% on the Separation Anxiety/Panic subscale of the MASC-P predicted separation anxiety remission. A reduction of 35% on the Social Anxiety subscale of the MASC-P predicted social anxiety remission. The MASC did not evidence a cutoff for remission of generalized anxiety disorder. CONCLUSION MASC cutoffs can facilitate comparison across studies and guide practice, aiding clinicians in assessing progress and informing treatment plans.
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Affiliation(s)
| | | | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Johns Hopkins University, Baltimore, MD
| | | | - Anne Marie Albano
- New York State Psychiatric Institute and Columbia University Medical Center, NY
| | - Boris Birmaher
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - John T Walkup
- Weill Cornell Medicine and New York-Presbyterian Hospital, NY
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38
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Gambin M, Sharp C. Relations between empathy and anxiety dimensions in inpatient adolescents. ANXIETY STRESS AND COPING 2018; 31:447-458. [DOI: 10.1080/10615806.2018.1475868] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
- Menninger Clinic, Houston, TX, USA
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Ratcliff MB, Catlin PA, Peugh JL, Siegel RM, Kirk S, Tamm L. Psychosocial Screening Among Youth Seeking Weight Management Treatment. Clin Pediatr (Phila) 2018; 57:277-284. [PMID: 28695753 DOI: 10.1177/0009922817715936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The objectives of this study were to identify rates of, and factors associated with, "at-risk" scores on a brief psychosocial screener among overweight/obese youth seeking weight management treatment, as well as concordance between youth and caregiver reports. A retrospective chart review of 1443 consecutive patients ages 4 to 18 years and their caregivers was conducted. Almost 1 in 4 youth with overweight/obesity presented with psychosocial symptoms in the at-risk range for significant mental health issues based on caregiver report on the Pediatric Symptom Checklist (PSC) and 1 in 6 based on youth self-report on the Youth Pediatric Symptom Checklist (Y-PSC). Concordance between caregiver and youth was fair (agreement 24% to 40%). Higher scores were associated with male sex and older age on the PSC and with indication of depressive disorder in the electronic medical record on the Y-PSC. Conducting a brief psychosocial screen in comprehensive weight management programs is feasible and clinically indicated.
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Affiliation(s)
- Megan B Ratcliff
- 1 Center for Weight Management at Gwinnett Medical Center, Duluth, GA, USA
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - James L Peugh
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert M Siegel
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shelley Kirk
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Leanne Tamm
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Hale AE, Ginsburg GS, Chan G, Kendall PC, McCracken J, Sakolsky D, Birmaher B, Compton S, Marie Albano A, Walkup J. Mediators of Treatment Outcomes for Anxious Children and Adolescents: The Role of Somatic Symptoms. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2018; 47:94-104. [PMID: 28278599 PMCID: PMC6129169 DOI: 10.1080/15374416.2017.1280804] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors are effective treatments for pediatric anxiety disorders. However, the mechanisms of these treatments are unknown. Previous research indicated that somatic symptoms are reduced following treatment, but it is unclear if their reductions are merely a consequence of treatment gains. This study examined reductions in somatic symptoms as a potential mediator of the relationship between treatment and anxiety outcomes. Participants were 488 anxious youth ages 7-17 (M = 10.7), 50.4% male, 78.9% Caucasian, enrolled in Child/Adolescent Anxiety Multimodal Study, a large randomized control trial comparing 12-week treatments of CBT, sertraline, a combination of CBT and sertraline, and a pill placebo. Causal mediation models were tested in R using data from baseline, 8-, and 12-week evaluations. Somatic symptoms were assessed using the Panic/Somatic subscale from the Screen for Child Anxiety Related Emotional Disorders. Youth outcomes were assessed using the Pediatric Anxiety Rating Scale and Children's Global Assessment Scale. Reductions in somatic symptoms mediated improvement in anxiety symptoms and global functioning for those in the sertraline-only condition based on parent report. Conditions involving CBT and data based on child reported somatic symptoms did not show a mediation effect. Findings indicate that reductions in somatic symptoms may be a mediator of improvements for treatments including pharmacotherapy and not CBT. Although the overall efficacy of sertraline and CBT for anxiety may be similar, the treatments appear to function via different mechanisms.
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Affiliation(s)
- Amy E. Hale
- University of Connecticut Health Center, 65 Kane St, West Hartford, CT 06119
| | - Golda S. Ginsburg
- University of Connecticut Health Center, 65 Kane St, West Hartford, CT 06119
| | - Grace Chan
- University of Connecticut Health Center, 65 Kane St, West Hartford, CT 06119
| | | | - James McCracken
- UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, CA
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Yalın Sapmaz Ş, Özek Erkuran H, Öztürk M, Ergin D, Şen Celasin N, Karaarslan D, Köroğlu E, Aydemir Ö. Validity and reliability of the Turkish version of the DSM-5 Separation Anxiety Disorder Severity Scale–child form. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1412606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Şermin Yalın Sapmaz
- Department of Child and Adolescent Psychiatry, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Handan Özek Erkuran
- Department of Child and Adolescent Psychiatry, Dr. Behcet Uz Children’s Hospital, Izmir, Turkey
| | - Masum Öztürk
- Department of Child and Adolescent Psychiatry, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Dilek Ergin
- Department of Pediatric Nursing, School of Health, Celal Bayar University, Manisa, Turkey
| | - Nesrin Şen Celasin
- Department of Pediatric Nursing, School of Health, Celal Bayar University, Manisa, Turkey
| | - Duygu Karaarslan
- Department of Pediatric Nursing, School of Health, Celal Bayar University, Manisa, Turkey
| | | | - Ömer Aydemir
- Department of Psychiatry, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
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Wei C, Swan AJ, Makover HB, Kendall PC. A Multi-Informant Examination of Maternal Symptoms and Autonomy Granting in Youth Anxiety. Child Psychiatry Hum Dev 2017; 48:1001-1009. [PMID: 28389842 DOI: 10.1007/s10578-017-0722-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Evidence suggests the important role of (a) parenting behaviors and (b) parental psychopathology in the development and maintenance of youth anxiety. Using a multi-informant approach, the current study examined the association of maternal autonomy granting and maternal symptoms (i.e., anxiety and depression) with youth anxiety among mothers and 88 youth (ages of 6-17) diagnosed with a principal anxiety disorder. Results from the generalized estimating equations (GEE) analyses indicated that mothers reported higher youth anxiety symptoms compared to youth self-reports. Youth-perceived maternal autonomy granting was inversely associated with youth anxiety, and maternal self-reported anxiety and depressive symptoms significantly moderated this relationship: As mothers reported higher anxiety and depressive symptoms, the inverse association between parental autonomy granting and youth anxiety weakened. The interaction between parenting behavior and parental psychopathology significantly influenced youth anxiety symptoms, which presents important clinical implications to integrate into parenting work in the treatment of youth anxiety disorders.
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Affiliation(s)
- Chiaying Wei
- Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Anna J Swan
- Department of Psychology, Weiss Hall, Temple University, 1701 North 13th Street, Philadelphia, PA, 19087, USA
| | - Heather B Makover
- Department of Psychology, Weiss Hall, Temple University, 1701 North 13th Street, Philadelphia, PA, 19087, USA
| | - Philip C Kendall
- Department of Psychology, Weiss Hall, Temple University, 1701 North 13th Street, Philadelphia, PA, 19087, USA.
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Walsh LM, Wolk CB, Haimes EMB, Jensen-Doss A, Beidas RS. The Relationship Between Anger and Anxiety Symptoms in Youth with Anxiety Disorders. JOURNAL OF CHILD AND ADOLESCENT COUNSELING 2017; 4:117-133. [PMID: 30828611 PMCID: PMC6392190 DOI: 10.1080/23727810.2017.1381930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examined the relationship between anger and anxiety in youth in an outpatient anxiety treatment clinic. Participants included 40 primarily female and Caucasian youth, all diagnosed with a primary anxiety disorder. Youth provided ratings of anger, anxiety, and depressive symptoms. We also obtained parent and clinician ratings of anxiety severity. Analyses supported a significant relationship between trait anger and anxiety severity. When rated by youth, trait anger was significantly related to physical symptoms of anxiety and harm avoidance. Youth report of anger symptoms was not related to parent or clinician report of youth anxiety severity. Assessing symptoms of anger in youth with anxiety disorders may be important, as it may be related to higher anxiety symptom severity for some youth. Future research in larger samples is needed to understand the co-occurrence of different components of anger and anxiety disorders and its impact on prognosis and treatment process.
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Affiliation(s)
- Lucia M Walsh
- Department of Psychology, University of Miami, USA; Center for Mental Health Policy and Services Research, University of Pennsylvania, USA
| | | | - Emily M Becker Haimes
- Center for Mental Health Policy and Services Research, University of Pennsylvania, USA
| | | | - Rinad S Beidas
- Center for Mental Health Policy and Services Research, University of Pennsylvania, USA
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Conelea CA, Selles RR, Benito KG, Walther MM, Machan JT, Garcia AM, Sapyta J, Morris S, Franklin M, Freeman JB. Secondary outcomes from the pediatric obsessive compulsive disorder treatment study II. J Psychiatr Res 2017; 92:94-100. [PMID: 28412602 PMCID: PMC5500971 DOI: 10.1016/j.jpsychires.2017.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 03/06/2017] [Accepted: 04/06/2017] [Indexed: 12/29/2022]
Abstract
UNLABELLED The Pediatric Obsessive-Compulsive Disorder Treatment Study II (POTS II) investigated the benefit of serotonin reuptake inhibitor (SRI) augmentation with cognitive behavioral therapy (CBT). Primary outcomes focused on OCD symptom change and indicated benefit associated with a full course of CBT. Given that the majority of youth with OCD suffer from significant comorbid symptoms and impaired quality of life, the current study examined POTS II data for effects on secondary outcomes. Participants were 124 youth ages 7-17 years with a primary diagnosis of OCD who were partial responders to an adequate SRI trial. Participants were randomized to medication management, medication management plus instructions in cognitive behavioral therapy (CBT), or medication management plus full CBT. Acute effects on non-OCD anxiety, depression, inattention, hyperactivity, and quality of life were examined across treatment conditions. Improvement across treatment was observed for non-OCD anxiety, inattention, hyperactivity, and quality of life. Changes were generally significantly greater in the group receiving full CBT. Child-rated depression was not found to change. OCD-focused treatment lead to improvement in other areas of psychopathology and functioning. For youth who are partial responders to SRI monotherapy, augmentation with full CBT may yield the greatest benefit on these secondary outcomes. CLINICAL TRIALS REGISTRATION Treatment of Pediatric OCD for SRI Partial Responders, Clinicaltrials.gov Identifier: NCT00074815, http://clinicaltrials.gov/show/NCT00074815.
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Affiliation(s)
- Christine A. Conelea
- Bradley Hospital Pediatric Anxiety Research Center, Riverside, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA,Corresponding author. Department of Psychiatry, F282/2A West Building, 2450 Riverside Avenue, Minneapolis, MN 55454, USA. (C.A. Conelea)
| | - Robert R. Selles
- Bradley Hospital Pediatric Anxiety Research Center, Riverside, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Kristen G. Benito
- Bradley Hospital Pediatric Anxiety Research Center, Riverside, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael M. Walther
- Bradley Hospital Pediatric Anxiety Research Center, Riverside, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Jason T. Machan
- Alpert Medical School of Brown University, Providence, RI, USA,Rhode Island Hospital, Providence, RI, USA
| | - Abbe M. Garcia
- Bradley Hospital Pediatric Anxiety Research Center, Riverside, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Sarah Morris
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Martin Franklin
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Jennifer B. Freeman
- Bradley Hospital Pediatric Anxiety Research Center, Riverside, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
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Lawrence PJ, Rooke SM, Creswell C. Review: Prevention of anxiety among at-risk children and adolescents - a systematic review and meta-analysis. Child Adolesc Ment Health 2017; 22:118-130. [PMID: 32680383 DOI: 10.1111/camh.12226] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anxiety disorders are common, often start in childhood and run a chronic course. As such there is a need for effective prevention. METHODS We conducted a systematic review and meta-analyses of randomized, controlled trials to prevent the onset of anxiety disorders in 'at risk' young people. Diagnostic and symptom outcomes were examined. Putative moderators were tested as was publication bias. RESULTS We included 16 trials (2545 young people). Two trials reported diagnostic outcomes, and significant effects were found for these at end-of-programme (RR = .09, 95%CI = .02 to .16), 6- (RR = .17, 95%CI = .06 to .27) and 12-month (RR = .31, 95%CI .17 to .45) follow-ups. Based on 16 trials, improved anxiety symptoms were significant compared to nonattention controls only, with small effect sizes reported by young people at the end-of-programmes, 6- and 12-month follow-ups; and by parents at the end of the programmes and 12-, but not 6-, month follow-ups. There was no evidence of significant moderation or publication bias. CONCLUSIONS Fourteen studies included children and young people who presented with elevated anxiety symptoms, but anxiety disorder was not ruled out in the participants in these studies. Hence, these studies might be reporting results of mixed prevention/early intervention programmes. Prevention programmes that target developmental risk factors, not only disorder maintaining factors, appear most promising. The clinically meaningful impact of anxiety disorder prevention programmes remains unknown.
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Affiliation(s)
- Peter J Lawrence
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK
| | - Sally M Rooke
- Academic Unit of Psychology, University of Southampton, Southampton, UK
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK
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Evans R, Thirlwall K, Cooper P, Creswell C. Using symptom and interference questionnaires to identify recovery among children with anxiety disorders. Psychol Assess 2017; 29:835-843. [PMID: 27845527 PMCID: PMC5490389 DOI: 10.1037/pas0000375] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 01/31/2023]
Abstract
Questionnaires are widely used in routine clinical practice to assess treatment outcomes for children with anxiety disorders. This study was conducted to determine whether 2 widely used child and parent report questionnaires of child anxiety symptoms and interference (Spence Child Anxiety Scale [SCAS-C/P] and Child Anxiety Impact Scale [CAIS-C/P]) accurately identify recovery from common child anxiety disorder diagnoses as measured by a 'gold-standard' diagnostic interview. Three hundred thirty-seven children (7-12 years, 51% female) and their parents completed the ADIS-IV-C/P diagnostic interview and questionnaire measures (SCAS-C/P and CAIS-C/P) before (Time 1) and after (Time 2) treatment or wait-list. Time 2 parent reported interference (CAIS-P) was found to be a good predictor of absence of any diagnoses (area under the curve [AUC] = .81). In terms of specific diagnoses, Time 2 SCAS-C/P separation anxiety subscale (SCAS-C/P-SA) identified recovery from separation anxiety disorder well (SCAS-C-SA, AUC = .80; SCAS-P-SA, AUC = .82) as did the CAIS-P (AUC = .79). The CAIS-P also successfully identified recovery from social phobia (AUC = .78) and generalized anxiety disorder (AUC = .76). These AUC values were supported by moderate to good sensitivity (.70-.78) and specificity (.70-.73) at the best identified cut-off scores. None of the measures successfully identified recovery from specific phobia. The results suggest that questionnaire measures, particularly the CAIS-P, can be used to identify whether children have recovered from common anxiety disorders, with the exception of specific phobias. Cut-off scores have been identified that can guide the use of routine outcome measures in clinical practice. (PsycINFO Database Record
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Affiliation(s)
- Rachel Evans
- School of Psychology and Clinical Language Sciences, University of Reading
| | - Kerstin Thirlwall
- School of Psychology and Clinical Language Sciences, University of Reading
| | - Peter Cooper
- School of Psychology and Clinical Language Sciences, University of Reading
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading
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Gonzalez A, Rozenman M, Langley AK, Kendall PC, Ginsburg GS, Compton S, Walkup JT, Birmaher B, Albano AM, Piacentini J. Social Interpretation Bias in Children and Adolescents with Anxiety Disorders: Psychometric Examination of the Self-report of Ambiguous Social Situations for Youth (SASSY) Scale. CHILD & YOUTH CARE FORUM 2017; 46:395-412. [PMID: 28740356 PMCID: PMC5521277 DOI: 10.1007/s10566-016-9381-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Anxiety disorders are among the most common mental health problems in youth, and faulty interpretation bias has been positively linked to anxiety severity, even within anxiety-disordered youth. Quick, reliable assessment of interpretation bias may be useful in identifying youth with certain types of anxiety or assessing changes on cognitive bias during intervention. OBJECTIVE This study examined the factor structure, reliability, and validity of the Self-report of Ambiguous Social Situations for Youth (SASSY) scale, a self-report measure developed to assess interpretation bias in youth. METHODS Participants (N=488, age 7 to 17) met diagnostic criteria for Social Phobia, Generalized Anxiety Disorder, and/or Separation Anxiety Disorder. An exploratory factor analysis was performed on baseline data from youth participating in a large randomized clinical trial. RESULTS Exploratory factor analysis yielded two factors (Accusation/Blame, Social Rejection). The SASSY full scale and Social Rejection factor demonstrated adequate internal consistency, convergent validity with social anxiety, and discriminant validity as evidenced by non-significant correlations with measures of non-social anxiety. Further, the SASSY Social Rejection factor accurately distinguished children and adolescents with Social Phobia from those with other anxiety disorders, supporting its criterion validity, and revealed sensitivity to changes with treatment. Given the relevance to youth with social phobia, pre- and post-intervention data were examined for youth social phobia to test sensitivity to treatment effects; results suggested that SASSY scores reduced for treatment responders. CONCLUSIONS Findings suggest the potential utility of the SASSY Social Rejection factor as a quick, reliable, and efficient way of assessing interpretation bias in anxious youth, particularly as related to social concerns, in research and clinical settings.
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Affiliation(s)
- Araceli Gonzalez
- California State University, Long Beach, Department of Psychology
| | - Michelle Rozenman
- University of California, Los Angeles Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry
| | - Audra K. Langley
- University of California, Los Angeles Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry
| | | | | | - Scott Compton
- Duke University Medical Center, Department of Psychiatry and Biobehavioral Sciences
| | - John T. Walkup
- Weill Cornell Medical College, Division of Child and Adolescent Psychiatry
| | - Boris Birmaher
- Western Psychiatric Institute and Clinics, University of Pittsburgh Medical Center
| | | | - John Piacentini
- University of California, Los Angeles Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry
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48
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Rozenman M, Peris T, Bergman RL, Chang S, O'Neill J, McCracken JT, Piacentini J. Distinguishing Fear Versus Distress Symptomatology in Pediatric OCD. Child Psychiatry Hum Dev 2017; 48:63-72. [PMID: 27225633 PMCID: PMC5860879 DOI: 10.1007/s10578-016-0653-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Prior research has identified OCD subtypes or "clusters" of symptoms that differentially relate to clinical features of the disorder. Given the high comorbidity between OCD and anxiety, OCD symptom clusters may more broadly associate with fear and/or distress internalizing constructs. This study examines fear and distress dimensions, including physical concerns (fear), separation anxiety (fear), perfectionism (distress), and anxious coping (distress), as predictors of previously empirically-derived OCD symptom clusters in a sample of 215 youth diagnosed with primary OCD (ages 7-17, mean age = 12.25). Self-reported separation fears predicted membership in Cluster 1 (aggressive, sexual, religious, somatic obsessions, and checking compulsions) while somatic/autonomic fears predicted membership in Cluster 2 (symmetry obsessions and ordering, counting, repeating compulsions). Results highlight the diversity of pediatric OCD symptoms and their differential association with fear, suggesting the need to carefully assess both OCD and global fear constructs that might be directly targeted in treatment.
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Affiliation(s)
- Michelle Rozenman
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA.
| | - Tara Peris
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - R Lindsey Bergman
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - Susanna Chang
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - Joseph O'Neill
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - James T McCracken
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
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The Temporal Sequence of Social Anxiety and Depressive Symptoms Following Interpersonal Stressors During Adolescence. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 44:495-509. [PMID: 26142495 DOI: 10.1007/s10802-015-0049-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Social anxiety and depressive symptoms dramatically increase and frequently co-occur during adolescence. Although research indicates that general interpersonal stressors, peer victimization, and familial emotional maltreatment predict symptoms of social anxiety and depression, it remains unclear how these stressors contribute to the sequential development of these internalizing symptoms. Thus, the present study examined the sequential development of social anxiety and depressive symptoms following the occurrence of interpersonal stressors, peer victimization, and familial emotional maltreatment. Participants included 410 early adolescents (53% female; 51% African American; Mean age =12.84 years) who completed measures of social anxiety and depressive symptoms at three time points (Times 1-3), as well as measures of general interpersonal stressors, peer victimization, and emotional maltreatment at Time 2. Path analyses revealed that interpersonal stressors, peer victimization, and emotional maltreatment predicted both depressive and social anxiety symptoms concurrently. However, depressive symptoms significantly mediated the pathway from interpersonal stressors, peer victimization, and familial emotional maltreatment to subsequent levels of social anxiety symptoms. In contrast, social anxiety did not mediate the relationship between these stressors and subsequent depressive symptoms. There was no evidence of sex or racial differences in these mediational pathways. Findings suggest that interpersonal stressors, including the particularly detrimental stressors of peer victimization and familial emotional maltreatment, may predict both depressive and social anxiety symptoms; however, adolescents who have more immediate depressogenic reactions may be at greater risk for later development of symptoms of social anxiety.
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50
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Martinsen KD, Neumer SP, Holen S, Waaktaar T, Sund AM, Kendall PC. Self-reported quality of life and self-esteem in sad and anxious school children. BMC Psychol 2016; 4:45. [PMID: 27624487 PMCID: PMC5022161 DOI: 10.1186/s40359-016-0153-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 08/31/2016] [Indexed: 11/10/2022] Open
Abstract
Background Anxiety and depressive symptoms are common in childhood, however problems in need of intervention may not be identified. Children at risk for developing more severe problems can be identified based on elevated symptom levels. Quality of life and self-esteem are important functional domains and may provide additional valuable information. Methods Schoolchildren (n = 915), aged 9–13, who considered themselves to be more anxious or sad than their peers, completed self-reports of anxiety (Multidimensional Anxiety Scale for children (MASC-C), depression (The Short Mood and Feelings Questionnaire; SMFQ), quality of life (Kinder Lebensqualität Fragebogen; KINDL) and self-esteem (Beck self-concept inventory for youth (BSCI-Y) at baseline of a randomized controlled indicative study. Using multivariate analyses, we examined the relationships between internalizing symptoms, quality of life and self-esteem in three at-risk symptom groups. We also examined gender and age differences. Results 52.1 % of the screened children scored above the defined at-risk level reporting elevated symptoms of either Anxiety and Depression (Combined group) (26.6 %), Depression only (15.4 %) or Anxiety only (10.2 %). One-way ANOVA analysis showed significant mean differences between the symptom groups on self-reported quality of life and self-esteem. Regression analysis predicting quality of life and self-esteem showed that in the Depression only group and the Combined group, symptom levels were significantly associated with lower self-reported scores on both functional domains. In the Combined group, older children reported lower quality of life and self-esteem than younger children. Internalizing symptoms explained more of the variance in quality of life than in self-esteem. Symptoms of depression explained more of the variance than anxious symptoms. Female gender was associated with higher levels of internalizing symptoms, but there was no gender difference in quality of life and self-esteem. Conclusion Internalizing symptoms were associated with lower self-reported quality of life and self-esteem in children in the at-risk groups reporting depressive or depressive and anxious symptoms. A transdiagnostic approach targeting children with internalizing symptoms may be important as an early intervention to change a possible negative trajectory. Tailoring the strategies to the specific symptom pattern of the child will be important to improve self-esteem. Trial registration Trial registration in Clinical trials: NCT02340637, June 12, 2014.
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Affiliation(s)
- Kristin D Martinsen
- Centre for Child and Adolescent Mental Health, Gullhaugveien 1-3, 0484, Oslo, Norway.
| | - Simon-Peter Neumer
- Centre for Child and Adolescent Mental Health, Gullhaugveien 1-3, 0484, Oslo, Norway
| | - Solveig Holen
- Centre for Child and Adolescent Mental Health, Gullhaugveien 1-3, 0484, Oslo, Norway
| | - Trine Waaktaar
- Department of Psychology, University of Oslo, Forskningsveien 3A, 0373, Oslo, Norway
| | - Anne Mari Sund
- NTNU, Regionalt kunnskapssenter for barn og unge (RKBU), Klostergata 46, 7030 Trondheim/St. Olav's Hospital, Trondheim, Norway
| | - Philip C Kendall
- Temple University, 1701 North 13th Street, Weiss Hall, Philadelphia, PA, USA
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