Early anxious/withdrawn behaviours predict later internalising disorders

BACKGROUND: The aim of the study was to examine the association between anxious/withdrawn behaviours at age 8 and the development of internalising disorders in adolescence and young adulthood (ages 16-21). METHODS: Data were gathered over the course of a 21-year longitudinal study of a birth cohort of over 1,000 New-Zealand-born young people. Over the course of the study, data were gathered on: (a) anxious/withdrawn behaviour at age 8; (b) anxiety disorders and major depression at ages 16-18 and 18-21; (c) a range of potential confounding factors, including measures of adversity and family factors during childhood. RESULTS: Increasing anxious/withdrawn behaviour at age 8 was associated with increasing risks of social phobia; specific phobia; panic/agoraphobia; and major depression during adolescence and young adulthood. These associations persisted after adjustment for a series of confounding social, childhood, and family factors. CONCLUSIONS: Anxious/withdrawn behaviour in childhood is associated with elevated rates of anxiety disorders and major depression during adolescence and young adulthood. These data are consistent with, and extend, previous clinical and epidemiologic findings, by showing consistent linkages between childhood anxious/withdrawn behaviours at age 8 and increased risk for anxiety disorders and depression at ages 16-18 and 18-21 among young persons in the community. These results may point to the need to provide support and possibly intervention to children showing early anxious or withdrawn behaviours.     

Psychopathology, temperament and unintentional injury: cross-sectional and longitudinal relationships

BACKGROUND: Growing evidence indicates a link between unintentional injury and both disruptive and emotional psychopathology. We present further evidence of these associations and address the underlying mechanisms. We also examine the genetic contribution to unintentional injury. METHODS: The Virginia Twin Study of Adolescent Behavioral Development provides genetically informative multi-wave and multi-informant data regarding common psychopathology using the Child and Adolescent Psychiatric Assessment interview. The EASI temperament scales and child injury involvement were measured in parent-report questionnaires. RESULTS: Unintentional injury showed significant genetic effects in girls and significant shared environmental effects in boys and girls. Symptoms of over-anxious disorder (OAD), and the EASI temperament scales were independently associated with injury. Longitudinal modeling showed impulsivity and OAD symptoms were related prospectively to injury involvement. Injuries did not increase risk for later impulsivity or OAD symptoms but were related prospectively to separation anxiety disorder symptoms. CONCLUSIONS: Impulsivity and OAD symptoms increased risk of later injury. We discuss the processes that may be involved in these relationships.     

Nature and psychological management of anxiety disorders in youth

Anxiety disorders affect around 5% of the paediatric population at any given time and are associated with high social and personal impact. These disorders typically begin early in life, and children with anxiety disorders are at increased risk for a variety of later difficulties across the life‐span. Although causes of anxiety in childhood are not fully understood, there is a strong heritable component. Additional risk factors include temperament, parent psychopathology, parent handling and peer interactions. Psychological treatments have demonstrated good efficacy with around 60% of anxious youth being in diagnostic remission immediately following treatment and a further 10% remitting over the following months. Because young people with anxiety disorders are among the least likely to seek appropriate help, paediatricians are in a unique position to identify anxious young people, educate families and recommend appropriate intervention.     

Fear, Anxiety and Perceived Control in Children of Agoraphobic Parents

Sixteen children ( M = 11 years) of agoraphobic parents were compared with no children of parents with no history of psychopathology, matched on age. gender and socioeconomic status The majority (68%) of children of agoraphobic parents met DSM-III-R diagnostic criteria, anxiety disorders being must common. They reported more fear and anxiety and less control over various risks than did comparison children. Groups' perceptions of the prevalence and their vulnerability to these risks did nut differ. Agoraphobic mothers reported more separation anxiety than did comparison mothers, and maternal separation anxiety was negatively correlated with children's perceived control. Results are related to models of anxiety transmission.     

Anxiety, Antisocial Behavior, and Heart Rate Regulation in Adolescent Males

We explored relationships between anxiety and antisocial behavior and autonomic heart rate regulation in a homogenous sample ( N = 175 (of 15-year-ofd males. Measures for anxiety and antisocial behavior were obtained at yearly intervals over a period of 4–6 years. Components of heart rate variability associated with postural (sympathetic) and respiratory (vagal) change and transfer of respiratory to heart rate variability were estimated an age 15 using Spectral analytic techniques. Anxiety and antisocial behavior were predictably related to enhanced and diminished levels of mean heart rate, respectively. Anxiety was also predictably related to enhanced sympathetic mediation of phasic postural effects on heart rate. Antisocial behavior was unexpectedly related to disruption of vagally mediated, phasic respiratory effects on heart rate. Anxiety and antisocial behavior showed distinct relationships to heart rate, and to the autonomically mediated component, of heart rate variability from postural and respiration sources. Spectral analytic techniques helped elucidate these unique regulator; patterns, suggesting utility for future research in this area.     

Behavioral and emotional adjustment, family functioning, academic performance, and social relationships in children with selective mutism

This study addressed four questions which parents of children with selective mutism (SM) frequently ask: (1) Is SM associated with anxiety or oppositional behavior? (2) Is SM associated with parenting and family dysfunction? (3) Will my child fail at school? and (4) Will my child make friends or be teased and bullied? In comparison to a sample of 52 community controls, 52 children with SM were more anxious, obsessive, and prone to somatic complaints. In contrast, children with SM were less oppositional and evidenced fewer attentional difficulties at school. We found no group differences in family structure, economic resources, family functioning, maternal mood difficulties, recreational activities, or social networks. While parents reported no differences in parenting strategies, children with SM were described as less cooperative in disciplinary situations. The academic (e.g., reading and math) and classroom cooperative skills of children with SM did not differ from controls. Parents and teachers reported that children with SM had significant deficits in social skills. Though teachers and parents rated children with SM as less socially assertive, neither teachers nor parents reported that children with SM were victimized more frequently by peers.     

Maternal anxiety and depression,poverty and marital relationship factors during early childhood as predictors of anxiety and depressive symptoms in adolescence

BACKGROUND: This paper examines the degree to which symptoms of anxiety and depression at age 14 years are associated with early childhood experience of maternal anxiety and depression, poverty, and mother's marital relationship distress and break-up. METHODS: In a longitudinal study, 4434 families were followed-up from infancy to adolescence. RESULTS: Maternal anxiety and depression during early childhood were found to have small, but significant, influences upon the development of high anxiety-depression symptoms at age 14, after controlling for the effects of poverty and marital relationship factors. This effect was greater with repeated exposure to high maternal anxiety and depression. Poverty, distressed marital relationship and marital break-up during the child's first five years also produced small, but significant, increases in risk of high anxiety and depression symptoms in adolescence. Stable, single-parent status was not found to be a risk factor. There was no evidence of marked gender differences in risk factors, other than poverty, which had a stronger impact for girls than boys. CONCLUSIONS: Overall, the results suggest that maternal anxiety and depression, poverty, parent relationship conflict and marital break-up during early childhood are associated with small, but significant, increased risk of anxiety-depression symptoms in adolescence.     

Commentary: Integrative,multi-level explanatory models are needed to understand recent trends in sex,gender, and internalizing conditions,reflections on Keyes and Platt (2023)

Keyes' and Platt's (The Journal of Child Psychology and Psychiatry, 2023) review provides much-needed systematic evidence about why internalizing symptoms have increased and it clarifies the role of novel risk factors. The findings highlight that multiple factors at multiple levels are responsible for this phenomenon, many with small effects, within a complex interplay that is rarely well captured. As new insights emerge across disciplines, an important step is to renew efforts to integrate them to understand how internalizing symptoms develop for different people.     

Acne, anxiety, depression and suicide in teenagers: a cross-sectional survey of New Zealand secondary school students

AIM: To examine the associations between acne and depressive symptoms, anxiety and suicidal behaviours. METHODS: This was a secondary analysis of a cross-sectional survey -'Youth2000' (New Zealand national survey of youth health). A total of 9567 secondary school students aged 12-18 years participated in the survey. The main outcome measures were self-reported acne, depressive symptoms (Reynolds Adolescent Depression Scale > 77), anxiety (Anxiety Disorder Index from Multidimensional Anxiety Scale for Children) and self-reported suicide attempts. RESULTS: 'Problem acne' was associated with an increased probability of depressive symptoms, odds ratio 2.04 (95% confidence interval 1.70-2.45); anxiety, odds ratio 2.3 (1.74-3.00); and suicide attempts, odds ratio 1.83 (1.51-2.22) in a logistic model that included age, gender, ethnicity, school decile and socio-economic status. The association of acne with suicide attempts remained after controlling for depressive symptoms and anxiety, odds ratio 1.50 (1.21-1.86). CONCLUSION: Young people presenting with acne are at increased risk of depression, anxiety and suicide attempts. Attention should be paid to their mental health, and the importance of asking directly regarding suicide is emphasised.     

Adolescent Body Image Dissatisfaction: Relationships with Self-esteem, Anxiety, and Depression Controlling for Body Mass

The current study examined the relationships of anxiety, depression, and self-esteem with Perceived Body Image Dissatisfaction (PBID) in a nonclinical population of 516 adolescents, aged 12 to 18. The prevalence of PBID was comparative with previous findings. Interestingly, actual body mass and psychological well-being variables were found to be significantly related with PBID, whilst being independent of each other. Findings support proposals that PBID arises from a complex interplay of factors, including gender, self-esteem, and actual body mass. In particular, our findings highlight the need for future research of a prospective nature incorporating psychological, sociocultural, and maturational factors.     

Differences Between Children of Depressed and Non-depressed Mothers: Locus of Control, Anxiety and Self-esteem: a Research Note

Fifty-six mothers (26 depressed and 30 non-depressed) and their children were assessed on three measures: locus of control, anxiety and self-esteem. T-tests of results indicated significant differences between the groups of mothers across all three measures. There were significant differences between the two groups of children on state anxiety, total score on the self-esteem measure and social self-esteem, with the children of non-depressed mothers being lower on state anxiety and showing higher levels of self-esteem. Other aspects of self-esteem and locus of control did not show significant differences between the groups. A correlation matrix revealed that trait anxiety in the children of depressed mothers was significantly correlated with the mothers' depression, but not the mothers' anxiety. An analysis of discriminant functions found that a more anxious mood state and feelings of fear and worry were associated with the children of the depressed mothers.     

Accuracy of assessment of distress, anxiety, and depression by physicians and nurses in adolescents recently diagnosed with cancer

BACKGROUND: As staff members prioritize medical resources for patients, it is imperative to find out whether their assessments of patients' health status agree with patients' assessments. The degree to which physicians and nurses can identify the distress, anxiety, and depression experienced by adolescents recently diagnosed with cancer was examined here. PROCEDURE: Adolescents undergoing chemotherapy (13-19 years, n = 53), physicians (n = 48), and nurses (n = 53) completed a structured telephone interview, 4-8 weeks after diagnosis or relapse, investigating disease and treatment-related distress, anxiety, and depression. RESULTS: The accuracy of staff ratings of physical distress could be considered acceptable. However, problems of a psychosocial nature, which were frequently overestimated, were difficult for staff to identify. Staff underestimated the distress caused by mucositis and worry about missing school more than they overestimated distress. These aspects were some of the most prevalent and overall worst according to the adolescents. Both physicians and nurses overestimated levels of anxiety and depression. Nurses tended to show higher sensitivity than physicians for distress related to psychosocial aspects of distress, while physicians tended to show higher accuracy than nurses for physical distress. CONCLUSIONS: Staff was reasonably accurate at identifying physical distress in adolescents recently diagnosed with cancer whereas psychosocial problems were generally poorly identified. Thus, the use of staff ratings as a "test" to guide specific support seems problematic. Considering that the accuracy of staff ratings outside a research study is probably lower, identification of and action taken on adolescent problems in relation to cancer diagnosis and treatment need to rely on direct communication.     

Fragile X syndrome: an overview of cause,characteristics, assessment and management

Fragile X syndrome (FXS) is the most common identifiable cause of inherited intellectual disability and autism spectrum conditions, and is associated with a range of physical, cognitive and behavioural characteristics. Alongside intellectual disability, heightened rates of autism spectrum disorder, anxiety disorders, attention-deficit-hyperactivity disorder, self-injury and aggression are reported. Timely identification of FXS as well as assessments of common co-morbid psychological conditions and underlying health problems are essential to ensure individuals with FXS receive appropriate support. This article provides an overview for clinicians of current literature on the cause of FXS as well as the key physical, cognitive, and behavioural characteristics with a focus on children and adolescents.