Agreement and discrepancy between mother and child in the evaluation of children's anxiety symptoms and anxiety life interference

Assessing Anxiety-Related Impairment in Children and Adolescents

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

Cumulative Risk Exposure and Social Isolation as Correlates of Carer and Child Mental Health During the COVID-19 Pandemic: An Online Study with Families from Various Europeans Countries

This study adopted a cumulative risk approach to examine the relations between various domains of risk factors (i.e., social isolation and home confinement, other pandemic-related risk factors, and pre-existing psychosocial risk factors) and carers' and children's mental health during the first wave of the COVID-19 pandemic in Europe. The sample consisted of 1475 carers of 6- to 16-year-old children and adolescents residing in five European countries (Portugal, United Kingdom, Romania, Spain, and The Netherlands) who completed an online survey. The results showed that each of the three domains of adversity accounted for unique variation in carers' and children's mental health outcomes. Also, the results indicated that pre-existing psychosocial risk factors moderated the relationship between pandemic-related risk factors and children and carers' anxiety and between social isolation and confinement and carers' well-being. Simple slopes analysis suggested a stronger relationship between these domains of adversities and mental health outcomes in already more vulnerable families. It is important to consider the implications of social isolation measures and confinement for families' mental health, paying special attention to families with pre-existing psychosocial vulnerabilities.

Early detection of anxiety problems in childhood: Spanish validation of the brief Spence Children's Anxiety Scale for parents

The small percentage of children with anxiety problems who receive psychological treatment, and the negative psychological consequences associated with these problems highlight the need for early detection. Although assessment instruments with appropriate measurement properties exist, they tend to be extensive, making it difficult to apply them in clinical settings, schools, or primary care practices. This study aimed to adapt the Spanish brief version for parents of the Spence Children's Anxiety Scale (SCAS-P-8). For this purpose, information on 215 children between 8 and 12 years of age was reported by 163 parents. The Spanish version of the SCAS-P-8 adequately fit a one-factor structure, χ² = 44.25; df = 19; comparative fit index = .97; Tucker-Lewis index = .96; root mean square error of approximation: .07 (.04, .09); standardized root mean squared residual = .08. Evidence of internal consistency of the total SCAS-P-8 score was good (α = 0.82), and the direct correlations obtained between the SCAS-P-8 and internalizing problems showed evidence of convergent validity. Moreover, the appropriate measurement properties of the SCAS-P-8 were shown to be independent of gender. Differences in sociodemographic variables and SDQ-P between children with anxiety symptoms and those without anxiety symptoms were also discussed. Information reported by parents can help the clinician carry out an accurate diagnosis. A brief assessment scale can be easily applied in schools or primary care settings.

Psychometric Properties of the Dominic Interactive in a Sample of French Canadian Sexually Abused Children

There are few computerized questionnaires assessing mental health in children. Although the psychometric properties of the Dominic Interactive have been verified for clinical and nonclinical populations, no study has specifically targeted sexually abused children. This study aimed to explore the reliability and validity of the Dominic Interactive with a sample of sexually abused children. The sample consisted of 687 children aged from 6 to 11 recruited in specialized intervention centers in Quebec. We conducted confirmatory factor analysis to assess the factorial structure of the questionnaire and assessed the internal consistency of the subscales with Cronbach alphas and McDonalds omegas. Subscales of the Dominic Interactive showed good fit with the factorial structure and met the prescribed criteria, except for Specific Phobias and Separation Anxiety subscales that showed high interitem correlations. After accounting for intercorrelation errors, all model fit indices showed good adjustment to the factorial structure and met the fit indices criteria. The different subscales of the DI were found to be significantly correlated (r ranging from .13 to .30) with their equivalent parent-reported assessments. The results extend previous findings and suggest that the Dominic Interactive is a valid tool to quickly diagnose various behavioural problems in sexually abused children.

Prepubertal Internalizing Symptoms and Timing of Puberty Onset in Girls

Stressful environments have been associated with earlier menarche. We hypothesized that anxiety, and possibly other internalizing symptoms, are also associated with earlier puberty in girls. The Lessons in Epidemiology and Genetics of Adult Cancer From Youth (LEGACY) Girls Study (2011-2016) included 1,040 girls aged 6-13 years at recruitment whose growth and development were assessed every 6 months. Prepubertal maternal reports of daughter's internalizing symptoms were available for breast onset (n = 447), pubic hair onset (n = 456), and menarche (n = 681). Using Cox proportional hazard regression, we estimated prospective hazard ratios and 95% confidence intervals for the relationship between 1 standard deviation of the percentiles of prepubertal anxiety, depression, and somatization symptoms and the timing of each pubertal outcome. Multivariable models included age, race/ethnicity, study center, maternal education, body mass index percentile, and family history of breast cancer. Additional models included maternal self-reported anxiety. A 1-standard deviation increase in maternally reported anxiety in girls at baseline was associated with earlier subsequent onset of breast (hazard ratio (HR) = 1.22, 95% confidence interval (CI): 1.09, 1.36) and pubic hair (HR = 1.15, 95% CI: 1.01, 1.30) development, but not menarche (HR = 0.94, 95% CI: 0.83, 1.07). The association of anxiety with earlier breast development persisted after adjustment for maternal anxiety. Increased anxiety in young girls may indicate risk for earlier pubertal onset.

Rumination, Catastrophizing, and Other-Blame: The Cognitive-Emotional Regulation Strategies Involved in Anxiety-Related Life Interference in Anxious Children

Childhood anxiety problems have a great impact on the daily functioning of children and their families. The first objective of this study was to compare whether the use of cognitive-emotional regulation strategies differs in children with and without anxious symptomatology. A second objective was to analyze the possible mediating role of regulation strategies in the relationship between the presence of anxious symptomatology and its subsequent interference in children's lives. In total, 315 children (53.7% boys) between 8 and 12 years old participated. Mann-Whitney-Wilcoxon U-test was used to analyze differences in the use of cognitive-emotional regulation strategies between children with and without anxious symptomatology. In order to identify the cognitive-emotional regulation strategies which mediate the relation between anxiety and the consequent interference in children's lives, mediation analyses were carried out. As expected, children with anxious symptomatology used more maladaptive regulatory strategies than those without such symptomatology. Multiple mediation models in parallel showed that catastrophizing, rumination, and other-blame mediated the relationship between anxiety problems and their consequent interference. The identification of functional or dysfunctional patterns of cognitive-emotion regulation may favor the inclusion of new components in the evidence-based interventions currently available, in an attempt to increase rates of remission of anxiety.

Meta-Analysis of the RDoC Social Processing Domain across Units of Analysis in Children and Adolescents

OBJECTIVE

This meta-analysis advances a framework to understand correspondence among units of analysis of the social processing construct within Research Domain Criteria (RDoC).

METHOD

As requested for this special issue, eligible studies cited an RDoC-initiative paper or mentioned RDoC in the abstract, title, or keywords were empirical and peer reviewed, and described a correlation or regression analysis (r, β, or odds ratio) between two different units of analysis in the social processing domain in youth. We examined the frequency (descriptive statistics) and magnitude of correspondence between unit-pairs (random effects models), and predefined moderators (meta-regression).

RESULTS

Eight of the twenty-eight possible unit-by-unit pairs were identified, with subjective-by-behavior units being the most common. Of those, only subjective-by-circuit had significant correspondence between units. Moderator analysis revealed that the age and diagnosis of generalized anxiety disorder moderated correspondence between subjective-by-circuit units of analysis, and that a diagnosis of autism spectrum disorder moderated correspondence between subjective-by-gene units of analysis. Younger ages and inclusion of either diagnostic group reduced correspondence.

CONCLUSIONS

These findings indicate that the RDoC initiative has generated limited research within the social processing domain across units of analysis in youth to date. Moreover, National Institute of Mental Health (NIMH)-funded studies do not appear to be biased toward supporting the RDoC framework. However, the limited number of included studies precludes the generalizability of these findings and underscores the need for further research. Despite this, results suggest that the NIMH model for providing standard batteries of measurement tools may effectively reduce spurious correlations between subjective-by-behavior units of analysis.

Determining at What Age Children Provide Sound Self-Reports: An Illustration of the Validity-Index Approach

In psychological assessment of children, it is pivotal to establish from what age on self-reports can complement or replace informant reports. We introduce a psychometric approach to estimate the minimum age for a child to produce self-report data that is of similar quality as informant data. The approach makes use of statistical validity indicators such as person-fit and long-string indices, and can be readily applied to data commonly collected in psychometric studies of child measures. We evaluate and illustrate the approach, using self-report and informant-report data of the PedsQL, a pediatric health-related quality of life measure, from 651 child-mother pairs. To evaluate the approach, we tested various hypotheses about the validity of the self-report data, using the Gnp person-fit index as the validity indicator and the mother informant-data as a benchmark for validity. Results showed that Gnp discriminated between self-reports of younger and older children, between self-reports of children that completed the PedsQL alone or with a parent, and between self-reports and informant reports. We conclude that the validity-index approach has good potential for future applications. Future research should further evaluate the approach for different types of questionnaires (e.g., personality inventories) and using different validity indices (e.g., response-bias indices).

Agreement and Discrepancy on Emotional and Behavioral Problems Between Caregivers and HIV-Infected Children and Adolescents From Uganda

Background: HIV-infected children and adolescents (CA-HIV) face significant mental health challenges related to a broad range of biological and psychosocial factors. Data are scarce on the agreement and discrepancy between caregivers and CA-HIV regarding emotional and behavioral problems (EBPs) in CA-HIV. Objectives: We determined agreement between self- versus caregiver- reported EBPs and describe factors associated with informant discrepancy among caregiver-youth dyads who participated in the "Mental health among HIV-infected CHildren and Adolescents in KAmpala and Masaka, Uganda" (CHAKA) study. Methods: In a cross-sectional sample, caregiver-reported EBPs were assessed with the Child and Adolescent Symptom Inventory-5 (CASI-5), and self-reported problems were evaluated with the Youth Inventory-4 (YI-4) in 469 adolescents aged 12-17 years and the Child Inventory-4 (CI-4) in 493 children aged 8-11 years. Adolescents were questioned about experiences of HIV stigma. Caregiver psychological distress was assessed with the Self-Reporting Questionnaire (SRQ-20). Linear regression models were applied to identify variables associated with discrepancy scores. Results: Self-reported emotional problems (EPs) were present in 28.8% of adolescents and 36.9% of children, and 14.5% of adolescents self-reported behavioral problems (BPs). There was only a modest correlation (r ≤ 0.29) between caregiver- and CA-HIV-reported EBPs, with caregivers reporting more EPs whereas adolescents reported more BPs. Informant discrepancy between adolescents and caregivers for BPs was associated with adolescent age and caregiver's employment and HIV status. Among adolescents, EP discrepancy scores were associated with adolescent's WHO HIV clinical stage, caregiver level of education, and caregivers caring for other children. Among children, EP discrepancy scores were associated with child and caregiver age, caregiver level of education, and caregiver self-rated health status. HIV stigma and caregiver psychological distress were also associated with discrepancy, such that adolescents who experienced HIV stigma rated their EPs as more severe than their caregivers did and caregivers with increased psychological distress rated EBPs as more severe than CA-HIV self-rated. Conclusions: EBPs are frequently endorsed by CA-HIV, and agreement between informants is modest. Informant discrepancy is related to unique psychosocial and HIV-related factors. Multi-informant reports enhance the evaluation of CA-HIV and informant discrepancies can provide additional insights into the mental health of CA-HIV.

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.

Predictors of Parent-Teacher Agreement in Youth with Autism Spectrum Disorder and Their Typically Developing Siblings

This study evaluated the magnitude of informant agreement and predictors of agreement on behavior and emotional problems and autism symptoms in 403 children with autism and their typically developing siblings. Parent-teacher agreement was investigated on the Child Behavior Checklist (CBCL) and Social Responsiveness Scale (SRS). Agreement between parents and teachers fell in the low to moderate range. Multiple demographic and clinical variables were considered as predictors, and only some measures of parent broad autism traits were associated with informant agreement. Parent report on the SRS was a positive predictor of agreement, while teacher report was a negative predictor. Parent report on the CBCL emerged as a positive predictor of agreement, while teacher report emerged as a negative predictor.

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.

Psychometric Properties of the Parent Version of the Revised Child Anxiety and Depression Scale in a Clinical Sample of Turkish Children and Adolescents

The Revised Child Anxiety and Depression Scale-Parent version (RCADS-P) is a self-report questionnaire that assesses dimensions of DSM-based anxiety and depressive disorders in children and adolescents. The present study examined the psychometric properties of the Turkish version in a clinical sample of 483 children and adolescents. The child and parent versions of the RCADS, parent versions of the Screen for Child Anxiety Related Emotional Disorders, the Strengths and Difficulties Questionnaire and Adolescent Symptom Inventory-Depression Scale were administered. Current psychiatric diagnoses were assessed via the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present Version. The RCADS-P demonstrated high internal consistency and test-retest reliability, and good convergent, divergent, and discriminant validity. Confirmatory factor analysis supported the DSM-related six-factor structure. With its demonstrated favorable psychometric properties, the Turkish RCADS-P is currently the only validated parent-report instrument that assesses DSM-based anxiety and depressive disorders in children and adolescents in Turkey.

Developmental relations between amygdala volume and anxiety traits: Effects of informant, sex, and age

Although substantial human and animal evidence suggests a role for the amygdala in anxiety, literature linking amygdala volume to anxiety symptomatology is inconclusive, with studies finding positive, negative, and null results. Clarifying this brain–behavior relation in middle to late childhood is especially important, as this is a time both of amygdala structural maturation and the emergence of many anxiety disorders. The goal of the current study was to clarify inconsistent findings in previous literature by identifying factors moderating the relation between amygdala volume and anxiety traits in a large sample of typically developing children aged 6–13 years (N = 72). In particular, we investigated the moderating effects of informant (parent vs. child), age, and sex. We found that children's reports (i.e., self-reports) were related to amygdala volume; children who reported higher anxiety levels had smaller amygdalae. This negative relation between amygdala volume and anxiety weakened with age. There was also an independent effect of sex, such that relations were stronger in males than in females. These results indicate the importance of considering sample and informant characteristics when charting the neurobiological mechanisms underlying developmental anxiety.

The Broader Autism Phenotype in Mothers is Associated with Increased Discordance Between Maternal-Reported and Clinician-Observed Instruments that Measure Child Autism Spectrum Disorder

Autism spectrum disorder (ASD) diagnosis relies on parent-reported and clinician-observed instruments. Sometimes, results between these instruments disagree. The broader autism phenotype (BAP) in parent-reporters may be associated with discordance. Study to Explore Early Development data (N = 712) were used to address whether mothers with BAP and children with ASD or non-ASD developmental disabilities were more likely than mothers without BAP to 'over-' or 'under-report' child ASD on ASD screeners or interviews compared with clinician observation or overall impression. Maternal BAP was associated with a child meeting thresholds on a maternal-reported screener or maternal interview when clinician ASD instruments or impressions did not (risk ratios: 1.30 to 2.85). Evidence suggests acknowledging and accounting for reporting discordances may be important when diagnosing ASD.

Identifying Symptoms of Distress in Youth Living with Neurofibromatosis Type 1 (NF1)

Children and adolescents with Neurofibromatosis type 1 (NF1) are at increased risk for wide-ranging behavioral, developmental, and cognitive impairments and decreased quality of life. To date, no psychosocial screening tool has been developed to quickly assess the symptoms that 1) can be addressed during routine medical appointments in children with NF1, 2) can produce interpretable and actionable results, 3) can be integrated into medical care, and 4) can quickly identify patients at risk in order to better address that the provision of appropriate care are available. This study was conducted to test the overall usability of the Distress Thermometer (DT) and symptom checklist and concordance of DT ratings between pediatric patients, their caregivers and medical providers. Eighty youth (ages 7-21) living with NF1 completed the DT and an accompanying checklist. The findings of this study suggest the DT and symptom checklist was acceptable and feasible to complete in a clinic setting. A small subset reported high distress that required further assessment and intervention. Significant discordance between distress ratings of caregivers and children and healthcare providers was also found. Overall, the DT and accompanying symptom checklist provide important information to identify the presence of distress and contextualize the child's distress but is limited by not assessing whether these symptoms interfere with the child's daily life.

Parenting Strategies to Deal with Children's Anxiety: Do Parents Do What They Say They Do?

Parents' perceptions about their strategies to deal with children's anxiety have been minimally explored. Based on a mixed-method approach, the current study compared the strategies that parents said they use more frequently to deal with their child's anxious behaviors and the strategies they actually used during two mildly anxiogenic interactions with their child. Forty-two parents of children with anxiety disorders, aged 9-12 years, participated in the study. Semi-structured interviews were administered to identify parental perceptions about their strategies to deal with their children's anxiety. Subsequently dyadic interactions were observed and coded by two independent coders. We found discrepancies relating to four strategies. Significantly more parents used strategies based on overinvolvement and anxious behavior during the interactions than had been reported by them in the interviews. In contrast, reassurance and reinforcement of avoidance/dependence were used in interactions by fewer parents than would be expected, according to the interviews. Relevant implications for assessment and intervention with families of anxious children are suggested.

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.

All anxiety is not created equal: Correlates of parent/youth agreement vary across subtypes of anxiety

Research has examined patterns and correlates of parent/youth informant discrepancies in the reporting of youth anxiety. However, little work has examined whether it is better to conceptualize patterns and correlates of informant disagreement across anxiety broadly, or more useful to consider disagreement on specific symptom clusters. Using data from the Child Adolescent/Anxiety Multimodal Study (CAMS; N = 488; Walkup et al., 2008), the current study applied the most recent recommended analytic strategies to study informant discrepancies and examined differences in the magnitude and patterns of disagreement for: (a) broadband anxiety symptoms, versus (b) symptoms of specific anxiety diagnoses (or anxiety subtypes; e.g., separation, social anxiety). Correlates of informant discrepancies were also examined. Results indicated that there was variability in agreement across anxiety subtypes, with parent/youth agreement higher on separation anxiety and school refusal symptoms relative to other domains. Parental psychopathology was associated with disagreement on broadband anxiety symptoms, such that parental psychopathology was highest when parents reported higher symptoms than their children; however, this finding was largely driven by a relationship between parental psychopathology and disagreement on separation anxiety symptoms. Age was associated with disagreement on total and separation anxiety symptoms. Gender was not associated with disagreement. Clinical implications are discussed.