A questionnaire for screening a broad range of DSM-defined anxiety disorder symptoms in clinically referred children and adolescents

Effectiveness of exposure-based treatment for childhood anxiety disorders: An open clinical trial to test its relation with indices of emotional processing and inhibitory learning

BACKGROUND AND OBJECTIVES

The current study examined how effectiveness of exposure-based CBT was related to indices of emotional processing and inhibitory learning during exposure exercises.

METHODS

Adolescents with anxiety disorder(s) (N = 72; age 11-19; 85% girls) received a group-based, intensive two-week treatment of which effectiveness was indexed by the SCARED and by ratings of anxiety and approach towards individualized goal situations. To index emotional processing, subjective units of distress (SUDs) were used to indicate both initial and final fear level, and absolute, relative, and total dose of fear reduction. To index inhibitory learning, subjective threat expectancies (STEs) were used to indicate initial and final threat expectancy, and absolute, relative, and total dose of expectancy change.

RESULTS

From pre-treatment to follow-up, there was a large-sized reduction of anxiety symptoms, small-sized decrease of subjective anxiety and a large-sized increase in subjective approach towards individual treatment goals. Higher fear levels prior to exposure were related to a larger decrease of symptoms. Higher threat expectancies after exposure exercises were independently associated with less decrease of anxiety and increase of approach towards treatment goals. Total dose of experienced fear reduction and total dose of experienced expectancy change were (partly) independently related to more increase in approach towards individualized goal situations.

LIMITATIONS

As patients also received other treatment elements, the results cannot be interpreted unequivocally.

CONCLUSIONS

The pattern of findings seems to indicate that emotional processing (as indexed by fear reduction) and inhibitory learning (as indexed by expectancy change) are both relevant in exposure-based CBT.

Development of Neural Mechanisms Underlying Threat Processing: Associations With Childhood Social Reticence and Adolescent Anxiety

Background

Social reticence in early childhood is characterized by shy and anxiously avoidant behavior, and it confers risk for pediatric anxiety disorders later in development. Aberrant threat processing may play a critical role in this association between early reticent behavior and later psychopathology. The goal of this longitudinal study is to characterize developmental trajectories of neural mechanisms underlying threat processing and relate these trajectories to associations between early-childhood social reticence and adolescent anxiety.

Methods

In this 16-year longitudinal study, social reticence was assessed from 2 to 7 years of age; anxiety symptoms and neural mechanisms during the dot-probe task were assessed at 10, 13, and 16 years of age. The sample included 144 participants: 71 children provided data at age 10 (43 girls, meanage = 10.62), 85 at age 13 (46 girls, meanage = 13.25), and 74 at age 16 (36 girls, meanage = 16.27).

Results

A significant interaction manifested among social reticence, anxiety symptoms, and time, on functional connectivity between the left amygdala and the left dorsolateral prefrontal cortex, voxelwise p < .001, clusterwise familywise error p < .05. Children with high social reticence showed a negative association between amygdala-dorsolateral prefrontal cortex connectivity and anxiety symptoms with age, compared to children with low social reticence, suggesting distinct neurodevelopmental pathways to anxiety.

Conclusions

These findings were present across all conditions, suggesting task-general effects in potential threat processing. Additionally, the timing of these neurodevelopmental pathways differed for children with high versus low social reticence, which could affect the timing of effective preventive interventions.

Factor Structure and Measurement Invariance Across Age, Gender, and Clinical Status of the Screen for Children Anxiety Related Emotional Disorders

Abstract. The purpose of this study was to examine evidence of reliability, validity, and equity, for the Romanian version of The Screen for Child Anxiety Related Emotional Disorders (SCARED), the 41-item child- (1,106 children and adolescents ranging from 9 to 16 years old) and parent-ratings (485 parents). Both versions of the instrument showed moderate to high internal consistency, with most subscales reaching acceptable levels. Results showed support for the original five-factor structure of the scale. Positive correlations with other measures of anxiety symptoms, such as The Penn State Worry Questionnaire, The Social Anxiety Scale for Adolescents, The Children’s Automatic Thoughts Scale, whereas weak correlations with the syndrome scales for rule-breaking and aggressive behavior of the Youth Self-Report, respectively, Child Behavioral Checklist have demonstrated similar construct validity for the Romanian version of the scale as compared to the original one. Also, strict measurement invariance across age, gender, and clinical status was established. The current research provides evidence of reliability, validity, and equity for SCARED, arguing for its utility as a screening instrument for anxiety symptoms. Implications for theory, assessment, and future research are discussed.

Symptom-level networks of youth- and parent-reported depression and anxiety in a transdiagnostic clinical sample

Depression and anxiety disorders confer a significant public health concern for youth and their co-occurrence places youth at a higher risk for poorer psychosocial outcomes. In the present study, we use network analysis to investigate the role of and interactions among individual depression and anxiety symptoms in a treatment-seeking clinical sample.

METHODS

We estimate regularized partial correlation networks for youth- and parent reported symptoms in a transdiagnostic sample of youth (N = 417, ages 8-18). We examined features of the symptom-level networks such as network stability, centrality, bridge symptoms, and communities in both youth- and parent-reported networks.

RESULTS

Results indicate stable networks with disorder-specific clustering, such that symptoms were more interconnected within compared to between disorders. Symptoms related to self-comparison to peers and negative views of the future were most central in both networks. Symptoms of depression and anxiety were connected by worries for the future and hopelessness in the youth-reported network, whereas self-comparison to peers and low self-efficacy were bridge symptoms in the parent network. Distinct symptom clusters emerged in the parent- and youth-reported networks.

CONCLUSIONS

Our findings indicate that negative self-evaluation, negative views of the future, and repetitive negative thinking more generally are influential symptoms in the presentation and co-occurrence of depression and anxiety and as such may be promising targets in the treatment and prevention of depression and anxiety in youth.

The Cool Kids as a School-Based Universal Prevention and Early Intervention Program for Anxiety: Results of a Pilot Study

The efficacy of the Cool Kids program has been consistently demonstrated both within Australia and internationally, but limited data are available on the use of Cool Kids as a universal program. The purpose of the study is to evaluate Cool Kids as a universal program for preventing childhood anxiety in the school context. There were 73 Italian children (35 boys and 36 girls, ages 10–13 years) attending the last year of primary school and the first year of middle school who participated in an active intervention based on a school adaptation of the Cool Kids protocol. Results of t-test analyses highlighted a downward trend of anxiety symptoms, especially in total anxiety, somatic anxiety, generalized anxiety, separation anxiety, social anxiety and school phobia at post-treatment assessed by children. Even the score of depression symptoms, measured as a second outcome measure, decreased after the treatment. This study contributes to the evidence base for the Cool Kids program as a universal program for preventing childhood anxiety in the school context. Although these preliminary results show some promise, their replication in future research is necessary given current study limitations.

Examining a developmental pathway from early behavioral inhibition to emotion regulation and social anxiety: The moderating role of parenting

We examined the longitudinal relation between behavioral inhibition (BI) and social anxiety symptoms and behavior and the mediating role of emotion regulation (ER). Moreover, we investigated the influence of parenting behavior on the development of ER strategies. Participants were 291 children (135 male) followed longitudinally from 2 to 13 years. Mothers were predominantly well educated and non-Hispanic Caucasian. Children were screened for BI using maternal report and observational measures (ages 2 and 3), parenting behavior was observed while children and their mothers participated in a fear-eliciting task (age 3), ER strategies were observed while children completed a disappointment task (age 5), and socially anxious behavior was measured via multimethod assessment at 10 and 13 years. Children who exhibited high BI in early childhood exhibited more socially anxious behavior across ages 10 and 13, and there was a significant indirect effect of BI on socially anxious behavior through ER strategies. Children who were high in BI demonstrated less engaged ER strategies during the disappointment task, which in turn predicted more socially anxious behavior. Furthermore, parenting behavior moderated the pathway linking early BI and ER strategies to social anxiety outcomes such that children who exhibited high BI and who received more affectionate/oversolicitous behavior from their mother displayed less engaged ER strategies and more socially anxious behavior than children low in BI or low in oversolicitous parenting behaviors. These findings expand on our understanding of the role that ER strategies and parenting play in the developmental pathway linking early BI to future social anxiety outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Family accommodation mediates the impact of childhood anxiety on functional impairment

BACKGROUND

Anxiety disorders are the most common childhood-onset psychiatric disorders and are extensively associated with child functional impairment. Data suggest that family accommodation plays a role in the association between anxiety severity and functional impairment in children, but more empirical evidence is needed.

METHODS

Participants were 425 clinically anxious children (ages 6-17 years), and their mothers. We first examined associations between child anxiety symptom severity, family accommodation, and child functional impairment. Next, we investigated the hypothesized mediation pathway linking anxiety severity to child impairment through increased family accommodation using structural equation modeling. We tested two models: one using parent ratings of their child's anxiety and the other using the child's self-ratings. Finally, we estimated the effect sizes of the mediation pathway in both models.

RESULTS

Family accommodation was significantly correlated with all the study variables. Child functional impairment was significantly correlated with parent-rated and self-rated child anxiety severity. Both structural equation models provided excellent fit for the data and supported the theoretical model by which family accommodation significantly explains part of the association between anxiety symptoms and functional impairment. The indirect effect sizes indicate that family accommodation accounts for between a fifth and a half of the impairment associated with symptom severity.

CONCLUSIONS

The data provide important empirical evidence that family accommodation mediates the association between child anxiety and functional impairment and accounts for up to 50 % of this association. These findings contribute to the growing understanding of the critical role of family accommodation and underscore the importance of assessing accommodation when evaluating and treating anxious children.

Measurement-Based Care in the Treatment of Anxiety

Treatment of pediatric anxiety disorders is complicated by their number, comorbidity, and the differential impact of a child's anxiety on the child and parents. Measurement-based care, using patient-level rating scales, can guide clinical decisions, track symptom improvement, and monitor treatment response. We review instruments for measurement-based care in pediatric anxiety. Measures used to track pediatric anxiety should be brief, accessible, sensitive to change, and reliable. Because parent-child agreement about a child's anxiety tends to be low, measures from both should be obtained. Measurements can also track functional improvement, expectancy related to treatment, and readiness to change.

Developmental pathways to social anxiety and irritability: The role of the ERN

Early behaviors that differentiate later biomarkers for psychopathology can guide preventive efforts while also facilitating pathophysiological research. We tested whether error-related negativity (ERN) moderates the link between early behavior and later psychopathology in two early childhood phenotypes: behavioral inhibition and irritability. From ages 2 to 7 years, children (n = 291) were assessed longitudinally for behavioral inhibition (BI) and irritability. Behavioral inhibition was assessed via maternal report and behavioral responses to novelty. Childhood irritability was assessed using the Child Behavior Checklist. At age 12, an electroencephalogram (EEG) was recorded while children performed a flanker task to measure ERN, a neural indicator of error monitoring. Clinical assessments of anxiety and irritability were conducted using questionnaires (i.e., Screen for Child Anxiety Related Disorders and Affective Reactivity Index) and clinical interviews. Error monitoring interacted with early BI and early irritability to predict later psychopathology. Among children with high BI, an enhanced ERN predicted greater social anxiety at age 12. In contrast, children with high childhood irritability and blunted ERN predicted greater irritability at age 12. This converges with previous work and provides novel insight into the specificity of pathways associated with psychopathology.

Risk factors associated with developing anxiety in Inuit adolescents from Nunavik

This study aimed to examine the relation between anxiety among the at-risk population of Inuit adolescents and diverse developmental risk factors including exposure to environmental chemicals, a subject of concern in Nunavik. Anxiety was assessed in 89 Inuit participants (mean age = 18.4 years; range = 16.2-21.9) with the Screen for Child Anxiety Related Emotional Disorders (SCARED) and the State-Trait Anxiety Inventory (STAI). Potential risk factors for anxiety were documented at birth, 11 years of age and 18 years of age, including blood levels of chemicals (mercury, lead, PCBs) and nutrients, as well as age, sex, estimated IQ, drug and alcohol use, bullying, exposure to domestic violence, food insecurity, crowding and socio-economic status. Results showed that participants scored high on both measures of anxiety, particularly the SCARED, for which the mean score was above the clinical threshold. Multiple regression results show that significant risk predictors obtained from the SCARED scores were female sex (β = 0.32), higher current blood mercury concentration (β = 0.26), food insecurity (β = 0.26) and bullying experiences in the last year (β = 0.21). The significant predictors for the STAI trait anxiety were food insecurity (β = 0.25) and lower estimated IQ (β = -0.31), whereas food insecurity (β = 0.21), lower blood levels of vitamin E (β = -0.25) and higher cord blood mercury concentrations (β = 0.25) were found for STAI situational anxiety. Further regression analyses suggested that the adolescent-related variables were the most important risk factors. Our findings show that Inuit adolescents are at risk for anxiety via multiple contributing factors, particularly current exposure to mercury, food insecurity and female sex.

Combining fMRI during resting state and an attention bias task in children

Neuroimaging studies typically focus on either resting state or task-based fMRI data. Prior research has shown that similarity in functional connectivity between rest and cognitive tasks, interpreted as reconfiguration efficiency, is related to task performance and IQ. Here, we extend this approach from adults to children, and from cognitive tasks to a threat-based attention task. The goal of the current study was to examine whether similarity in functional connectivity during rest and an attention bias task relates to threat bias, IQ, anxiety symptoms, and social reticence. fMRI was measured during resting state and during the dot-probe task in 41 children (M = 13.44, SD = 0.70). Functional connectivity during rest and dot-probe was positively correlated, suggesting that functional hierarchies in the brain are stable. Similarity in functional connectivity between rest and the dot-probe task only related to threat bias (puncorr < .03). This effect did not survive correction for multiple testing. Overall, children who allocate more attention towards threat also may possess greater reconfiguration efficiency in switching from intrinsic to threat-related attention states. Finally, functional connectivity correlated negatively across the two conditions of the dot-probe task. Opposing patterns of modulation of functional connectivity by threat-congruent and threat-incongruent trials may reflect task-specific network changes during two different attentional processes.

Evidence of Disturbed Sleep in Children With Eosinophilic Esophagitis and Persistent Epigastric Pain

Objective

To determine whether the experience of persistent epigastric pain is associated with sleep disturbances in children with eosinophilic esophagitis (EoE). We hypothesized that children with EoE and persistent epigastric pain would (1) self-report greater current and worst pain severity, and (2) experience more disturbed sleep on objective and subjective measures in comparison with children with EoE but no persistent pain and healthy children.

Methods

Fifty children with EoE were recruited for this cross-sectional study, of which 24 (48%) reported experiencing persistent epigastric pain. The remaining 26 (52%) children with EoE denied experiencing persistent pain. An additional 25 healthy children without EoE or persistent pain were included. All children provided severity ratings of current pain and worst pain experienced over the past week. Children then completed 12 consecutive nights of ambulatory sleep monitoring via actigraphy in the home. Caregivers provided information regarding their child's sleep patterns and internalizing symptoms.

Results

Children with EoE and persistent pain reported significantly greater severity of current pain (p < .001) and worst pain over the past week (p < .001) compared with EoE without persistent pain and healthy children. Compared with the other groups, children with EoE and persistent pain also demonstrated greater actigraphic sleep disturbances, lower sleep efficiency (p = .004) and greater wake after sleep onset (p = .034).

Conclusions

This study provides novel evidence that a significant proportion of children with EoE experience persistent symptoms of epigastric pain. Persistent pain was associated with significant sleep disturbances in children with EoE.

Are changes in children's communication patterns predictive of treatment outcomes for children with anxiety?

Anxiety is the most prevalent childhood psychopathology. Cognitive behavioural therapy is considered the most effective treatment, but outcomes remain variable. This study investigated children's communication patterns in child-therapist conversations and whether changes in these patterns, from rigid to more flexible, were associated with better treatment outcomes. Fifty-three children (31% boys), with a mean age in years of M = 9.68 (SD = 1.85), completed a 12-week cognitive behavioural therapy program. Maternal as well as children's reports of children's anxiety were assessed pretreatment and posttreatment. Additionally, 15-min segments of two therapy sessions were audiotaped and children's conversational turns were coded for properties of response and initiative. The structure of children's communication patterns was further quantified using recurrence quantification analysis. As expected children entering treatment were characterised by rigid and inhibited conversational behaviour. Children who became less repetitive and deterministic over time had better maternal-rated treatment outcomes. These findings did not generalize to child reports. Last, the hypothesis that the positive relation between the breaking of rigid communication patterns and treatment outcome would be mediated by increases in proactive conversational behaviours of the child was only partly supported. These study findings contribute to the emergent literature on processes of change in childhood anxiety treatment by providing initial support for the hypothesis that breaking rigid (communication) patterns may be a prerequisite of clinical change.

Psychometric Properties of the SCARED in a Nationally Representative U.S. Sample of 5-12-Year-Olds

OBJECTIVE

To examine the factor structure of the Screen for Child Anxiety Related Emotional Disorders - Parent Report (SCARED-P) in young children and elucidate normative levels of parent-reported anxiety using a nationally representative sample of parents of children ages 5-12 years living in the United States.

METHOD

The 41-item SCARED-P was administered to parents of 1,570 youth who were selected to match the U.S. population on key demographic variables. SCARED-P model fit and mean score differences by age, race/ethnicity, and sex were assessed.

RESULTS

SCARED-P model fit and subscale reliability appeared almost identical in younger children (ages 5-8) and older children (ages 9-12), although model fit for a five-factor model was poor in both groups. Symptoms of generalized anxiety increased from age 5 to 12, while symptoms of separation anxiety disorder decreased. Parents reported significantly more symptoms of social anxiety in females than males. No significant differences by race/ethnicity were found for mean levels of anxiety or model fit.

CONCLUSIONS

The SCARED-P shows some utility as an anxiety screening instrument in a representative sample of U.S. youth as young as 5-years-old, but caution should be used when interpreting subscale scores.

A Longitudinal Study on the Relations Among Fear-Enhancing Parenting, Cognitive Biases, and Anxiety Symptoms in Non-clinical Children

This longitudinal study explored the relations between fear-enhancing parenting behaviors (modeling and threat information transmission) and children's cognitive biases and anxiety symptoms on three subsequent time points over a one-year period. Participants were 216 children aged 7-12 years (114 boys and 102 girls), and their mothers (n = 199) and/or fathers (n = 117). On each time point, children and parents completed the Parental Enhancement of Anxious Cognitions scale, which measures parental modeling and threat information transmission. Furthermore, children filled in a measure of anxiety disorder symptoms. In addition, confirmation bias and interpretation bias were measured by means of a number of computerized tasks. The results yielded support for a circular model in which cognitive biases enhanced anxiety symptoms, which in turn promoted cognitive biases on each of the three time points. However, no evidence was found for longitudinal effects of cognitive biases on anxiety or vice versa. In contrast to what we expected, cognitive biases and anxiety appeared to promote parental modeling and threat information rather than the other way around. These findings extend research on the relations between parenting behaviors, cognitive biases, and childhood anxiety symptoms, and suggest valuable leads for assessment and intervention.

Frontal alpha asymmetry moderates the relations between behavioral inhibition and social-effect ERN

Behavioral inhibition (BI) is an early temperamental precursor of anxiety disorders, characterized by withdrawal from novel situations. Some but not all young children with BI go on to display anxiety disorders. Neural correlates, such as frontal alpha asymmetry or event-related negativity (ERN), could moderate the relations between early BI and later anxiety. The goal of this longitudinal study was to test frontal alpha asymmetry as a potential moderator of the relation between BI and later anxiety, and of the relation between BI and the social-effect ERN. 100 children were assessed for BI at ages 2 and 3, and we collected EEG during resting state and the social Flanker task at age 12. Frontal alpha asymmetry did not correlate with BI or anxiety, nor did it moderate the relation between early BI and later anxiety. However, frontal alpha asymmetry did moderate the relation between BI and the social-effect ERN. This suggests that, in adolescents who previously manifested BI, a pattern of resting EEG associated with avoidance predicts hypersensitivity to errors in a social context.

Screening for childhood anxiety: A meta-analysis of the screen for child anxiety related emotional disorders

BACKGROUND

The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a commonly used instrument that evaluates anxiety symptoms in children and adolescents.

METHODS

This meta-analysis examined the psychometric properties of the SCARED instrument, including total instrument and subscale internal reliabilities for the parent and child versions, test-retest reliabilities, and the extent to which responses from the parent version correspond with responses from the child version. Databases reviewed included ERIC, PubMed, PsycINFO, ProQuest Dissertations and Theses, and Google Scholar RESULTS: Responses to the SCARED instrument for children and parents using a mixture of the 38-, 41-, 66-, 69-, and 71-item versions of the SCARED were analyzed for 65 studies conducted between 1997 and 2017. The results from the random-effects models suggested homogeneity of variance for all the effects examined. The weighted averages of the psychometric properties indicated the parent and child versions of the SCARED have exhibited excellent internal consistencies on the total score, panic disorder, generalized anxiety, separation anxiety, social anxiety, post-traumatic stress, and animal phobia subscales. Furthermore, the SCARED demonstrated moderate to large test-retest reliabilities and moderate to large parent-child agreement rates. The school avoidance, obsessive-compulsive disorder, blood phobia, and situational phobia subscales did not demonstrate reliabilities considered appropriate for a screening instrument.

LIMITATIONS

Publications that could not be translated to English or could not be retrieved due to not being published or archived were not included in the analysis.

CONCLUSIONS

Overall the child and parent versions of the SCARED have robust psychometric properties and perform consistently well in community and clinical settings across various countries. The SCARED is clinically relevant as mental health providers and researchers can use it during diagnostic procedures and to monitor intervention effectiveness.

Neural correlates of attention bias to masked facial threat cues: Examining children at-risk for social anxiety disorder

Background

Behavioral inhibition (BI) is an early-appearing temperament trait and a robust predictor of social anxiety disorder (SAD). Both BI and anxiety may have distinct patterns of emotion processing marked by heightened neural responses to threat cues. BI and anxious children display similar frontolimbic patterns when completing an emotion-face attention bias task with supraliminal presentation. Anxious children also show a distinct neural response to the same task with subliminal face presentations, probing stimulus-driven attention networks. We do not have parallel data available for BI children, limiting our understanding of underlying affective mechanisms potentially linking early BI to the later emergence of anxiety.

Method

We examined the neural response to subliminal threat presentation during an emotion-face masked dot-probe task in children oversampled for BI (N = 67; 30 BI, 9–12 yrs).

Results

Non-BI children displayed greater activation versus BI children in several regions in response to threat faces versus neutral faces, including striatum, prefrontal and temporal lobes. When comparing congruent and incongruent trials, which require attention disengagement, BI children showed greater activation than non-BI children in the cerebellum, which is implicated in rapidly coordinating information processing, aversive conditioning, and learning the precise timing of anticipatory responses.

Conclusions

Non-BI children may more readily engage rapid coordinated frontolimbic circuitry to salient stimuli, whereas BI children may preferentially engage subcortical circuitry, in response to limbic “alarms” triggered by subliminal threat cues. These data help reveal the extent to which temperamental risk shares similar neurocircuitry previously documented in anxious adolescents and young adults in response to masked threat.

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All children displayed amygdala activation in response to brief threat cues.

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Non-BI children displayed activation in striatum, PFC and temporal lobes.

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BI children showed greater activation in the cerebellum.

Examining the Mechanisms of Therapeutic Change in a Cognitive-Behavioral Intervention for Anxious Children: The Role of Interpretation Bias, Perceived Control, and Coping Strategies

This study examined the role of theoretically meaningful mediators of therapeutic change-interpretation bias, perceived control, and coping strategies-in a cognitive-behavioral intervention for anxious youth. This is one of the few studies that examined the change in potential mediator and outcome variables by means of a longitudinal design that included four assessment points: pretreatment, in-treatment, post-treatment, and at 4-months follow-up. Forty-seven 8- to 12-year-old children with a principal DSM-IV diagnosis of anxiety disorder participated in the study. On each assessment point, questionnaires assessing the mediator variables and a standardized anxiety scale were administered to the children. The results showed that perceived control and interpretation bias (but not coping strategies) accounted for a significant proportion in the variability of various types of anxiety symptoms, providing a preliminary support for the notion that these cognitive dimensions' act as mechanisms of therapeutic change in cognitive-behavioral therapy for anxious children.

The Validity of the Screen for Child Anxiety Related Emotional Disorders Revised (SCARED-R) Scale and Sub-Scales in Swedish Youth

We evaluated the clinical utility of the Swedish SCARED-R in child- and adolescent psychiatric outpatients (n = 239) and validated it against Longitudinal Expert All Data (LEAD) DSM IV diagnoses based on the Children's Schedule for Affective Disorders and Schizophrenia (KSADS) and subsequent clinical work-up and treatment outcome. The SCARED-R total score and subscales had acceptable sensitivity/specificity for child and parent reports for cut-offs based on Receiver Operating Characteristics (ROC) curves, with mostly moderate area under the curve. Sensitivity ranged from 75% (parent rated social anxiety) to 79% [child rated Generalized Anxiety Disorder (GAD)]. Specificity, ranged from 60% for child-rated GAD to 88% for parent rated social anxiety. Parent-child agreement was moderate, and each informant provided unique information contributing to most diagnoses. In conclusion, the SCARED-R is useful for screening anxiety symptoms in clinical populations. However, it cannot replace interview based diagnoses, nor is it adequate to use just one informant.

A Neurobehavioral Mechanism Linking Behaviorally Inhibited Temperament and Later Adolescent Social Anxiety

OBJECTIVE

Behavioral inhibition (BI) is a temperament identified in early childhood that is a risk factor for later social anxiety. However, mechanisms underlying the development of social anxiety remain unclear. To better understand the emergence of social anxiety, longitudinal studies investigating changes at behavioral neural levels are needed.

METHOD

BI was assessed in the laboratory at 2 and 3 years of age (N = 268). Children returned at 12 years, and an electroencephalogram was recorded while children performed a flanker task under 2 conditions: once while believing they were being observed by peers and once while not being observed. This methodology isolated changes in error monitoring (error-related negativity) and behavior (post-error reaction time slowing) as a function of social context. At 12 years, current social anxiety symptoms and lifetime diagnoses of social anxiety were obtained.

RESULTS

Childhood BI prospectively predicted social-specific error-related negativity increases and social anxiety symptoms in adolescence; these symptoms directly related to clinical diagnoses. Serial mediation analysis showed that social error-related negativity changes explained relations between BI and social anxiety symptoms (n = 107) and diagnosis (n = 92), but only insofar as social context also led to increased post-error reaction time slowing (a measure of error preoccupation); this model was not significantly related to generalized anxiety.

CONCLUSION

Results extend prior work on socially induced changes in error monitoring and error preoccupation. These measures could index a neurobehavioral mechanism linking BI to adolescent social anxiety symptoms and diagnosis. This mechanism could relate more strongly to social than to generalized anxiety in the peri-adolescent period.

The Youth Anxiety Measure for DSM-5 (YAM-5): Correlations with anxiety, fear, and depression scales in non-clinical children

The Youth Anxiety Measure for DSM-5 (YAM-5) is a newly developed rating scale for assessing anxiety disorder symptoms of children and adolescents in terms of the contemporary classification system. In the present study, 187 children aged 8-12 years completed the new measure as well as the trait version of the State-Trait Anxiety Inventory for Children (STAIC), the Short Form of the Fear Survey Schedule for Children-Revised (FSSC-R-SF), the Spence Children's Anxiety Scale (SCAS), the Selective Mutism Questionnaire (SMQ), and the Children's Depression Inventory (CDI). Results indicated that part one of the YAM-5, which measures symptoms of the major anxiety disorders, was most substantially linked with the trait anxiety scale of the STAIC, whereas part two, which measures phobic symptoms, was most clearly associated with the FSSC-R-SF. The correlation between the YAM-5 and the SCAS was also robust, and particularly strong correlations were found between subscales of both questionnaires that assessed similar symptoms. Further, the selective mutism subscale of the YAM-5 was most clearly linked to the SMQ. Finally, the YAM-5 was also significantly correlated with depression symptoms as indexed by the CDI. These findings provide further support for the concurrent validity of the YAM-5.

Discriminant validity, diagnostic utility, and parent-child agreement on the Screen for Child Anxiety Related Emotional Disorders (SCARED) in treatment- and non-treatment-seeking youth

The Screen for Child Anxiety and Related Emotional Disorder (SCARED) may be differentially sensitive to detecting specific or comorbid anxiety diagnoses in treatment-seeking and non-treatment-seeking youth. We assessed the SCARED's discriminant validity, diagnostic utility, and informant agreement using parent- and self-report from healthy and treatment-seeking anxious youth (Study 1, N=585) and from non-treatment-seeking anxious youth (Study 2, N=331) diagnosed with generalized anxiety disorder (GAD), social anxiety disorder (SAD), or comorbid GAD+SAD. Among treatment-seeking youth, the SCARED showed good diagnostic utility and specificity, differentiating healthy, comorbid, and non-comorbid anxious youth. Child-parent agreement was modest: healthy child self-reports were higher than parent-reports whereas anxious child self-reports were similar or lower than parent-reports. Less consistent results emerged for diagnostic utility, specificity, and informant agreement among non-treatment-seeking youth. Given the number of non-treatment seeking anxious youth (N=33), generalizability of these findings may be limited. Together, results suggest informants may provide distinct information about children's anxiety symptoms.

Socioeconomic Status, Amygdala Volume, and Internalizing Symptoms in Children and Adolescents

The associations among socioeconomic disadvantage, amygdala volume, and internalizing symptoms in children and adolescents are unclear and understudied in the extant literature. In this study, we examined associations between socioeconomic status (SES) and amygdala volume by age across childhood and adolescence to test whether socioeconomic disadvantage would be associated with larger amygdala volume at younger ages but with smaller amygdala volume at older ages. We then examined whether SES and amygdala volume were associated with children's levels of anxiety and depression. Participants were 3- to 21-year-olds from the Pediatric Imaging, Neurocognition, and Genetics study (N = 1,196), which included structural magnetic resonance imaging. A subsample (n = 327; 7-21 years of age) completed self-report measures of anxiety and depression. Lower family income and parental education were significantly associated with smaller amygdala volume in adolescence (13-21 years) but not significantly associated with amygdala volume at younger ages (3-12 years). Lower parental education, but not family income, was significantly associated with higher levels of anxiety and depression, even after accounting for family history of anxiety/depression. Smaller amygdala volume was significantly associated with higher levels of depression, even after accounting for parental education and family history of anxiety/depression. These findings suggest that associations between SES and amygdala structure may vary by age. In addition, smaller amygdala volume may be linked with an increased risk for depression in children and adolescents.

Measuring Anxiety in Children: The Importance of Separate Mother and Father Reports

Background

Previous research suggests that it is important to use parental reports when assessing children’s anxiety, but it remains unclear to what extent there are differences between mothers’ and fathers’ scores and whether these potential differences have any repercussions for the psychometric properties of the scale being used.

Objective

This study was conducted to investigate parental differences on the Parent version of the Screen for Child Anxiety Related Emotional Disorders-Revised (SCARED-RP), a rating scale for measuring child anxiety symptoms. The second aim was to re-examine the reliability and validity of the SCARED-RP, in light of these possible differences.

Methods

The SCARED-RP and the Child Behaviour Checklist (CBCL) were administered to parents of clinically anxious children (n = 81), and control children (n = 108). All children (n = 189) completed the SCARED-R.

Results

Significant correlations between mother and father reports were found within the clinically anxious sample. Mothers showed significantly more correspondence with their children in the control group than fathers. The SCARED-RP internal consistency on total scale was excellent (mothers: .94; fathers: .94) and moderate to good for all subscales (from .66 Situational-Environmental Phobia to .93 Animal Phobia). The SCARED-RP differentiated well between clinically anxious and control children (mother and father data). The concurrent validity was supported by strong correlations with the CBCL anxious-depressed scale.

Conclusion

Differences between mother and father reports suggest the importance of obtaining information from both parents separately. Furthermore, the SCARED-RP is a useful instrument for assessing children’s anxiety disorder symptoms in clinical and research settings.

The role of stress reactivity in the long-term persistence of adolescent social anxiety symptoms

Social Anxiety Disorder (SAD) symptoms demonstrate a marked persistence over time, but little is known empirically about short-term processes that may account for this long-term persistence. In this study, we examined how self-reported and physiological stress reactivity were associated with persistence of SAD symptoms from early to late adolescence. A community sample of 327 adolescents (56% boys, M_age=13.01 at T₁) reported their SAD symptoms for 6 successive years and participated in a public speaking task, during which self-reported (i.e., perceived nervousness and heart rate) and physiological (i.e., cortisol and heart rate) measures of stress were taken. Overall, our results point to a developmental process in which adolescents with a developmental history of higher SAD symptoms show both heightened perceived stress reactivity and heart rate reactivity, which, in turn, predict higher SAD symptoms into late adolescence.

The Efficacy of Augment of D-Cycloserine and Cognitive-behavioral Therapy on Adolescent with one Type of Anxiety Disorders: A Double-blind Randomized Controlled Trial

Background:

This study was designed to investigating the effect of combining D-cycloserine (DCS) and cognitive-behavioral therapy (CBT) on adolescent with at least one type of anxiety disorders.

Materials and Methods:

The present study was conducted as a double-blind randomized controlled trial on 36 adolescent with anxiety disorders. Patients were assessed in two groups. In addition to 4 sessions of weekly CBT in both groups; case group, received a 50-mg DCS capsules, control group, received Placebo daily for a month. Patients received DCS capsules or placebo 1 h before sessions of CBT. Age, sex, kind of anxiety disorders “screen for child anxiety related disorders (SCARED)” and “cognitive abilities test (CATS)” scores were evaluated and compared between groups.

Results:

The mean age of the studied patients (29 females (80.6%) and 7 males (19.4%)) was 14.1 ± 1.8 years. The most frequent anxiety disorder among the study population was generalized social disorder (GAD) (77.7%). Age, sex and the frequency of anxiety disorders were not statistically significant between the study groups (P > 0.05). The mean score of “SCARED” and “CATS” at before starting the treatment, after treatment and three month after the treatment were not statistically significant between groups (P > 0.05). Also, decrease in values of “SCARED” and “CATS” during the evaluation time periods was not statistically significant between groups (P > 0.05).

Conclusions:

Findings of this study showed that there has been no difference in symptoms improvement in adolescent with anxiety disorder who received treatment protocol including 4 sessions of CBT, weekly, together with 50 mgs of DCS compared to the patients of the control group.

Cognitive Bias as a Mediator in the Relation Between Fear-Enhancing Parental Behaviors and Anxiety Symptoms in Children: A Cross-Sectional Study

The present cross-sectional study explored the relations between fear-enhancing parenting behaviors (modeling and threat information transmission) and children's cognitive biases and anxiety symptoms. Participants were 258 children aged 7-12 years (132 boys and 126 girls), and their mothers (n = 199) and/or fathers (n = 117). Children and parents completed the Parental Enhancement of Anxious Cognitions questionnaire, which measures parental modeling and threat information transmission, while children also filled in a scale for assessing anxiety symptoms. In addition, children conducted a number of computerized tasks for measuring confirmation and interpretation bias. The data indicated that both biases mediated the relationship between threat information transmission (of both parents) and children's anxiety symptoms. Only interpretation bias significantly mediated the relationship between modeling (of mothers) and anxiety symptoms. These findings give partial support for the hypothesis that cognitive biases play a mediating role in the relation between fear-enhancing parental behaviors and children's anxiety symptoms.

The Screen for Child Anxiety-Related Emotional Disorders Is Sensitive but Not Specific in Identifying Anxiety in Children with High-Functioning Autism Spectrum Disorder: A Pilot Comparison to the Achenbach System of Empirically Based Assessment Scales

Validated brief screening instruments are needed to improve the detection of anxiety disorders in autism spectrum disorder (ASD). The Screen for Child Anxiety-Related Emotional Disorders (SCARED), a 41-item parent- and self-reported scale measuring anxiety, was compared to the Achenbach System of Empirically Based Assessment (ASEBA) scales. One hundred participants with a clinical diagnosis of high-functioning ASD, aged 8-18 years, and their parents completed the above scales. We hypothesized that the SCARED would be useful in screening for anxiety and its results for total scores of anxiety would converge with ASEBA syndrome scales for anxiety and internalizing disorders. Significant correlations were shown between the SCARED and the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) across a broad spectrum of scales. The CBCL syndrome scale for anxious/depressed showed the highest correlation and predicted anxiety scores on the SCARED. While many of the YSR scales significantly correlated with child ratings of anxiety, none of the scales predicted the SCARED child scores. Differences in self and parent reports suggest that parents interpret externalizing behaviors as signs of anxiety in ASD, whereas youth may describe internalized symptoms as anxiety. Females were more likely to self-report anxiety than males. Results support the use of the SCARED as a screening tool for anxiety in high-functioning ASD, but it should be supplemented with other tools to increase the specificity of its results.

The Youth Anxiety Measure for DSM-5 (YAM-5): Development and First Psychometric Evidence of a New Scale for Assessing Anxiety Disorders Symptoms of Children and Adolescents

The Youth Anxiety Measure for DSM-5 (YAM-5) is a new self- and parent-report questionnaire to assess anxiety disorder symptoms in children and adolescents in terms of the contemporary classification system. International panels of childhood anxiety researchers and clinicians were used to construct a scale consisting of two parts: part one consists of 28 items and measures the major anxiety disorders including separation anxiety disorder, selective mutism, social anxiety disorder, panic disorder, and generalized anxiety disorder, whereas part two contains 22 items that focus on specific phobias and (given its overlap with situational phobias) agoraphobia. In general, the face validity of the new scale was good; most of its items were successfully linked to the intended anxiety disorders. Notable exceptions were the selective mutism items, which were frequently considered as symptoms of social anxiety disorder, and some specific phobia items especially of the natural environment, situational and other type, that were regularly assigned to an incorrect category. A preliminary investigation of the YAM-5 in non-clinical (N = 132) and clinically referred (N = 64) children and adolescents indicated that the measure was easy to complete by youngsters. In addition, support was found for the psychometric qualities of the measure: that is, the internal consistency was good for both parts, as well as for most of the subscales, the parent-child agreement appeared satisfactory, and there was also evidence for the validity of the scale. The YAM-5 holds promise as a tool for assessing anxiety disorder symptoms in children and adolescents.

Psychological Inflexibility and Child Anxiety

Psychological flexibility is the main outcome of acceptance commitment therapy. Insight into the usefulness of measuring psychological flexibility is an important step to enable studies on the effectiveness of acceptance commitment therapy in middle-aged children (8-10 years). For this purpose, we examined the factor structure, the construct validity and the reliability of the Avoidance and Fusion Questionnaire for Youth. The Avoidance and Fusion Questionnaire for Youth taps psychological inflexibility (the opposite of psychological flexibility) in children and adolescents. Although the questionnaire has been extensively validated in older children, this is not the case for middle-aged children. The Avoidance and Fusion Questionnaire for Youth contains 17 items and is constituted of the subscales cognitive fusion, experiential avoidance and behavioral ineffectiveness. A shortened 8-item version also exists, the Avoidance and Fusion Questionnaire for Youth-8, which does not distinguish between these subscales. We performed a confirmatory factor analysis. Additionally, we assessed the relationship between psychological flexibility and child anxiety. Children, aged 8-10 years, were recruited via regular primary schools. Of the 459 approached children, 267 (58 %) parents signed informed consents for their children (Age: M = 9.18; SD = .79; Sex: n_boys = 137, 51 %). Children completed the questionnaires during regular classes. In this sample, the 17-item version of the Avoidance and Fusion Questionnaire for Youth was less appropriate for measuring psychological inflexibility than the 8-item version. Furthermore, we found a significant positive relationship between psychological inflexibility and child anxiety. We argue that acceptance commitment therapy would be an interesting candidate for intervening early on in dysfunctional child anxiety, as acceptance commitment therapy's cognitive elements require cognitive skills that children are likely to master early on.

Family accommodation mediates the association between anxiety symptoms in mothers and children

OBJECTIVE

The link between child anxiety and maternal anxiety has been well established but the factors underlying this association are not well understood. One potential factor is family accommodation, which describes ways in which parents change their behaviour to help a child avoid or alleviate anxiety. Family accommodation has been associated with greater symptom severity, more impairment and poorer treatment outcomes in the child. The aim of this study was to investigate whether maternal accommodation mediates the relation between parent and child anxiety.

METHOD

Mothers of children (N = 85) aged 7-17 years (M = 11.79) completed measures of their own anxiety (State-Trait Anxiety Inventory (STAI)), their child's anxiety (Screen for Child Anxiety Related Disorders (SCARED)), and family accommodation (Family Accommodation Scale Anxiety (FASA)). Structural equation modelling (SEM) was used to test the mediational role of accommodation linking parent and child anxiety.

RESULTS

Family accommodation was found to significantly mediate the link between maternal anxiety and child anxiety.

CONCLUSION

These results inform theory and imply that the development of interventions designed to target family accommodation may improve the prognosis of those diagnosed with paediatric anxiety disorders and youth with subclinical anxiety symptoms by reducing both parent and child anxiety.

The Revised Child Anxiety and Depression Scale 25-Parent Version: Scale Development and Validation in a School-Based and Clinical Sample

To help facilitate the dissemination and implementation of evidence-based assessment practices, we examined the psychometric properties of the shortened 25-item version of the Revised Child Anxiety and Depression Scale-parent report (RCADS-25-P), which was based on the same items as the previously published shortened 25-item child version. We used two independent samples of youth-a school sample ( N = 967, Grades 3-12) and clinical sample ( N = 433; 6-18 years)-to examine the factor structure, reliability, and validity of the RCADS-25-P scale scores. Results revealed that the two-factor structure (i.e., depression and broad anxiety factor) fit the data well in both the school and clinical sample. All reliability estimates, including test-retest indices, exceeded benchmark for good reliability. In the school sample, the RCADS-25-P scale scores converged significantly with related criterion measures and diverged with nonrelated criterion measures. In the clinical sample, the RCADS-25-P scale scores successfully discriminated between those with and without target problem diagnoses. In both samples, child-parent agreement indices were in the expected ranges. Normative data were also reported. The RCADS-25-P thus demonstrated robust psychometric properties across both a school and clinical sample as an effective brief screening instrument to assess for depression and anxiety in children and adolescents.

Emotion Understanding in Clinically Anxious Children: A Preliminary Investigation

Children’s understanding of the nature, origins and consequences of emotions has been intensively investigated over the last 30–40 years. However, few empirical studies have looked at the relation between emotion understanding and anxiety in children and their results are mixed. The aim of the present study was to perform a preliminary investigation of the relationships between emotion understanding, anxiety, emotion dysregulation, and attachment security in clinically anxious children. A sample of 16 clinically anxious children (age 8–12, eight girls/boys) was assessed for emotion understanding (Test of Emotion Comprehension), anxiety (Screening for Child Anxiety Related Emotional Disorders-Revised and Anxiety Disorder Interview Schedule), emotion dysregulation (Difficulties in Emotion Regulation Scale) and attachment security (Security Scale). Children who reported more overall anxiety also reported greater difficulties in regulating their emotions, and were less securely attached to their parents. The results also showed that more specific symptoms of anxiety (i.e., OCD and PTSD) correlated not only with emotion dysregulation and attachment insecurity but also with emotion understanding. Finally, there were interrelations among emotion understanding, attachment security, and emotion dysregulation. The present results provide the first comprehensive evidence for a socio-emotional framework and its relevance to childhood anxiety.

Die Erfassung von Ängsten im Urteil von Kindern/Jugendlichen und ihren Eltern

Zusammenfassung. Ziel dieser Arbeit ist die Analyse der psychometrischen Qualität des Fremd- und des Selbstbeurteilungsbogens zur Erfassung von Angst- und Zwangsstörungen (FBB-ANZ/SBB-ANZ) in zwei klinischen Stichproben (n = 182 bzw. n = 130). Ergänzend wurde die Faktorenstruktur der Bögen in zwei Feldstichproben (n = 724 bzw. n = 281) untersucht. Für die Skalen beider Fragebögen ergaben sich größtenteils zufriedenstellende interne Konsistenzen (.59 ≤ α ≤ .93). Exploratorische Hauptachsenanalysen mit Promax-Rotation ergaben stichprobenübergreifend für beide Fragebögen Faktoren, welche die a priori definierten, ICD-10- und DSM-IV-basierten Subskalen weitgehend abbilden. Zwischen den Subskalen innerhalb der Fragebögen zeigten sich geringe bis moderate Interkorrelationen, die für eine gute Abgrenzbarkeit der Skalen sprechen. Es fanden sich größtenteils moderate Beurteilerübereinstimmungen zwischen den korrespondierenden Skalen des Fremd- und Selbstbeurteilungsbogens. Die Ergebnisse weisen darauf hin, dass die Fragebögen überwiegend reliable und valide Instrumente darstellen. Weiterer Untersuchungsbedarf besteht insbesondere hinsichtlich der konvergenten und divergenten Validität der Subskalen.

Frontolimbic functioning during threat-related attention: Relations to early behavioral inhibition and anxiety in children

Children with behavioral inhibition (BI), a temperament characterized by biologically-based hyper-vigilance to novelty, display threat-related attention biases (AB) that shape developmental trajectories of risk for anxiety. Here we explore the relations between BI, neural function, and anxiety. Fifty-six 9-12-year-olds (23 behaviorally inhibited) performed the dot-probe task while undergoing fMRI. AB scores were not associated with BI group or parent-rated anxiety symptoms. Trials requiring attention orienting away from threat engaged an executive and threat-attention network (dlPFC, vlPFC, mPFC, and amygdala). Within that network, behaviorally inhibited children showed greater activation in the right dlPFC. Heightened dlPFC activation related to increased anxiety, and BI levels accounted for the direct relation between dlPFC activation and anxiety. Behaviorally inhibited children may engage the executive attention system during threat-related processing as a compensatory mechanism. We provide preliminary evidence that the link between PFC functioning and anxiety might be attributed to early-emerging temperamental vulnerabilities present before the emergence of clinical anxiety.

The Structured Clinical Interview for DSM-IV Childhood Diagnoses (Kid-SCID): first psychometric evaluation in a Dutch sample of clinically referred youths

The Structured Clinical Interview for DSM-IV Childhood Disorders (Kid-SCID) is a semi-structured interview for the classification of psychiatric disorders in children and adolescents. This study presents a first evaluation of the psychometric properties of the Kid-SCID in a Dutch sample of children and adolescents who had been referred to an outpatient treatment centre for mental health problems. Results indicated that the inter-rater reliability of the Kid-SCID classifications and the internal consistency of various (dimensional) criteria of the diagnoses were moderate to good. Further, for most Kid-SCID diagnoses, reasonable agreement between children and parents was found. Finally, the correspondence between the Kid-SCID and the final clinical diagnosis as established after the full intake procedure, which included the information as provided by the Kid-SCID, ranged from poor to good. Results are discussed in the light of methodological issues pertaining to the assessment of psychiatric disorders in youths. The Kid-SCID can generally be seen as a reliable and useful tool that can assist clinicians in carrying out clinical evaluations of children and adolescents.

Does anxiety improve during weight restoration in anorexia nervosa? A systematic review

Weight restoration is considered a principal outcome for treatment of Anorexia Nervosa (AN) due to the significant physiological disturbances resultant from acute states of malnutrition. Treatment outcomes for populations with AN are relatively poor, with increasing evidence suggesting that weight restoration alone is insufficient for long-term recovery. Research aimed at understanding the psychological sequaele of AN, in particular during weight restoration, nevertheless remain scarce. This systematic review aimed to evaluate existing research regarding anxiety symptoms during treatment for AN, and the relationship of anxiety symptomology and weight restoration. Twelve articles were identified from a systematic search of three electronic databases (PsycINFO, MEDLINE, and Web of Science), and were eligible for inclusion. Study methodology, results and quality were reviewed. Results regarding change in anxiety symptomology were inconsistent, though evidence did not support a relationship between anxiety change and weight restoration. Reasons for these inconsistencies and limitations of included studies were reviewed. Further research is warranted to elucidate the role of anxiety in AN and its implications for treatment and longer-term outcome.

Factors associated with the referral of anxious children to mental health care: the influence of family functioning, parenting, parental anxiety and child impairment

This study aims to identify factors that predict the mental health care referral of anxious children. In total, 249 children and families, aged 8-13 years, participated: 73 children were referred with anxiety disorders to mental health care [mean (M) age = 10.28, standard deviation (SD) = 1.35], 176 non-referred anxious children recruited in primary schools (M age = 9.94, SD = 1.22). Child anxiety and other disorders were assessed with semi-structured interviews. Child anxiety symptoms, behavioural problems, parental anxiety, the parenting styles overprotection, autonomy encouragement, rejection, and the family functioning dimensions control and relational functioning, were assessed with child, father and mother report on questionnaires. The summed interference rating of children's anxiety disorders was a predictor of referral, consistent over child and parent reports, but not comorbidity. Most family and parenting variables did not predict referral, nor differed between the referred and non-referred sample. Contrary to our hypothesis, maternal self-reported anxiety decreased the odds of referral and child reported parental autonomy granting increased, while child reported overprotection decreased the odds of referral. The impairment for the child due to the number and severity of their anxiety disorder(s) is, based on child, mother and father report associated with referral. This indicates that those who need it most, receive clinical treatment.

Development of the pediatric accommodation scale: reliability and validity of clinician- and parent-report measures

The present study developed parallel clinician- and parent-rated measures of family accommodation (Pediatric Accommodation Scale, PAS; Pediatric Accommodation Scale-Parent Report; PAS-PR) for youth with a primary anxiety disorder. Both measures assess frequency and impact of family accommodation on youth and families. Studying youth ages 5-17 (N=105 caregiver-youth dyads), results provide evidence for the psychometric properties of the PAS, including internal consistency, inter-rater reliability, and convergent and discriminant validity. The PAS-PR exhibited good internal consistency and convergent validity with the PAS. Nearly all parents (>95%) endorsed some accommodation and accommodation frequency was associated with parent-rated impairment (home and school), and with youth-rated impairment (school only). Greater impact of accommodation on parents was associated with parent self-reported depressive symptoms. Findings support the common occurrence of family accommodation in youth with anxiety disorders, as well as for the use of the PAS and PAS-PR to measure family accommodation in this population.

Sensory over-responsivity in a sample of children seeking treatment for anxiety

OBJECTIVE

Sensory over-responsivity (SOR) refers to an exaggerated, intense, or prolonged behavioral response to ordinary sensory stimuli. The relationship of SOR to psychiatric disorders remains poorly understood. The current study examined the SOR construct within typically developing children with clinically significant anxiety, including the prevalence and course of SOR symptoms and relationship between SOR symptoms, demographic factors, and psychopathology.

METHOD

Children presenting at an anxiety specialty clinic (n = 88) completed a psychiatric diagnostic assessment, which included parent-report measures of SOR, anxiety, obsessive-compulsive disorder (OCD), and global behavior and child-report measures of anxiety, depression, and OCD.

RESULTS

Sensory over-responsivity symptoms were very common: 93.2% were bothered by at least 1 tactile or auditory sensation, and the mean number of bothersome sensations was 9.2 (SD = 7.4). SOR symptoms were reported to be "moderately bothersome" on average and to onset at an early age. Sensory Over-Responsivity Inventory (SensOR) scores did not differ by psychiatric disorder diagnosis, but SensOR scores significantly correlated with measures of OCD and depression. Higher SensOR scores were associated with greater global impairment.

CONCLUSION

A high rate of SOR symptom occurrence was observed in this sample of children seeking anxiety treatment, suggesting that SOR may not be entirely independent of anxiety and may be closely associated with OCD. Future research on the validity and nosology of SOR using psychiatric samples is warranted.

The implementation of life space crisis intervention in residential care and special education for children and adolescents with EBD: an effect study

When working with children and adolescents with emotional and behavioural disorders, conflicts are a part of daily life. At present, a variety of conflict resolution or conflict management programs, that can be divided into three categories, are described in the literature. A first category contains programs that focus on training for children and adolescents, and are often curriculum-based. The second category focuses on training for parents, and the third category contains programs that focus on training for professionals. The presents study was designed to evaluated the effectiveness of Life Space Crisis Intervention (LSCI), a therapeutic and verbal strategy developed by Long that fits into this third category of conflict management programs. Throughout a four-year project, al staff in a Flemish centre offering residential care and special education were trained in LSCI. On a yearly basis, data with regard to time in program, academic achievement, behavioural problems and anxiety problems were collected. The results show an increase in time spent in program and in academic achievement, and a decrease in youths' anxiety, indicating that the implementation of LSCI contributes constructively to the treatment of children and adolescents with EBD.

Characteristics of initial fearful spells and their associations with DSM-IV panic attacks and panic disorder in adolescents and young adults from the community

BACKGROUND

Few studies examined characteristics of initial fearful spells (FS) or panic attacks (PA) and their relation to DSM-IV PA and panic disorder (PD).

METHODS

A community sample of adolescents and young adults (N=3021) was followed up in 4 waves (T0-T3) over up to 10 years. FS, PA, and PD were assessed at each wave using the DSM-IV/M-CIDI. Characteristics of the initial FS/PA including perceived reasons/triggers, appraisal, duration, and behavioral/emotional consequences of the initial FS/PA were retrospectively assessed at T1 and T2 in those reporting the experience of lifetime FS or PA at these waves (N=363). Multinomial logistic regressions adjusted for sex and age were used to reveal associations of initial FS/PA characteristics (aggregated data from T1 and T2) with PA only (N=88) and PD (N=62; lifetime incidences cumulated across assessment waves) (reference group: No PA/PD).

RESULTS

Alcohol consumption, drugs/medication, and physical illness as perceived reasons for the initial FS/PA were associated with PA-only (OR 2.46-5.44), while feelings of depression, feelings of anxiety, and having always been anxious/nervous as perceived reasons for the initial FS/PA, appraising the initial FS/PA as terrible and long-term irritating/burdensome, subsequent feelings of depression, subsequent avoidance, and subsequent consumption of medication, alcohol, or drugs were associated with PD (OR 2.64-4.15). A longer duration until "feeling okay again" was associated with both PA-only (OR=1.29 per category) and PD (OR=1.63).

LIMITATIONS

Initial FS/PA characteristics were necessarily assessed retrospectively by self-report only. Thus, our data might be subject to recall/evaluation biases. Aggregated data were used and strictly prospective-longitudinal studies are necessary that replicate our findings.

CONCLUSION

Assessing initial FS/PA characteristics might be useful to identify individuals at increased risk for more severe panic pathology.

Anxiety in youth in Flemish care: a multi-informant study

Purpose

– The purpose of this paper is to investigate the prevalence of anxiety in youngsters with emotional and behavioral disorders, and its relation to other problems, using different informants.

Design/methodology/approach

– Data were collected in a Flemish treatment center. Educators completed a Child Behavior Checklist (CBCL) for each child, teachers completed a Teacher Report Form (TRF), and youth themselves completed a Youth Self Report (YSR) and a Screen for Child Anxiety Related Emotional Disorders (SCARED).

Findings

– Analyses indicated an explicit presence of anxiety. A clear relation was found between anxiety symptoms and internalizing problem behavior on the YSR, whereas only a slight relationship was found with the CBCL, and practically no relationship was found with the TRF. Only few correlations between anxiety and externalizing problems were found. Finally, youth themselves indicated strong correlations between anxiety and thought problems, whereas educators indicated strong correlations between youths’ anxiety and social problems.

Originality/value

– Several studies describe professionals’ difficulties to get a comprehensive perceptions of youths’ problems. This paper provides detailed insights in the nature of the informant discrepancies.