Evaluating a cognitive behavioral therapy group program for anxious five to seven year old children: a pilot study

Background: Cognitive Behavioral Therapy (CBT) has demonstrated benefits for anxious school‐aged children and adolescents; however, treatment programs have not been developed to teach CBT strategies to children under the age of eight. This pilot study examined a novel treatment program for children aged 5–7 years with anxiety disorders. Methods: Thirty‐two children (19 females) aged 5–7 years (mean age=6.51 years) with DSM‐IV anxiety disorders and their families completed a 12‐week, manualized CBT group program. Parent and child groups (5–8 children per group) were held separately but concurrently. Multiple measures of anxiety (Screen for Child Anxiety Related Emotional Disorders, Anxiety Disorders Interview Schedule for DSM‐IV—Parent Version, and clinician Children's Global Assessment Scale ratings) were completed pre and post each treatment series. A subset of participants (n=11; 8 females; mean age=6.34 years) completed an initial assessment followed by a wait period of approximately 3.5 months (range 2.5–5 months) with a second assessment just before treatment start. No treatment was received during this wait time. Results: With treatment, 43.8% of children no longer met criteria for any Axis 1 anxiety disorders whereas 71.9% had at least one anxiety disorder resolve. A series of paired, two‐tailed t‐tests revealed significant reduction in anxiety symptoms on standardized measures. Children who waited for treatment showed no significant change in anxiety symptoms during nontreatment but demonstrated improvement after program attendance. Conclusions: This pilot study suggests that CBT can be used effectively to treat anxious children as young as 5 years of age. Further research is warranted. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Sleep problems and their relation to cognitive factors,anxiety, and depressive symptoms in children and adolescents

Background: Existing research indicates sleep problems to be prevalent in youth with internalizing disorders. However, childhood sleep problems are common in the general population and few data are available examining unique relationships between sleep, specific types of anxiety and depressive symptoms among non‐clinical samples of children and adolescents. Methods: The presence of sleep problems was examined among a community sample of children and adolescents (N=175) in association with anxiety and depressive symptoms, age, and gender. Based on emerging findings from the adult literature we also examined associations between cognitive biases and sleep problems. Results: Overall findings revealed significant associations between sleep problems and both anxiety and depressive symptoms, though results varied by age. Depressive symptoms showed a greater association with sleep problems among adolescents, while anxiety symptoms were generally associated with sleep problems in all youth. Cognitive factors (cognitive errors and control beliefs) linked with anxiety and depression also were associated with sleep problems among adolescents, though these correlations were no longer significant after controlling for internalizing symptoms. Conclusions: Results are discussed in terms of their implications for research and treatment of sleep and internalizing disorders in youth. Depression and Anxiety, 2009. Published 2008 Wiley‐Liss, Inc.     

Symptoms of anxiety in depression: assessment of item performance of the Hamilton Anxiety Rating Scale in patients with depression

Background: Although diagnostically dissociable, anxiety is strongly co‐morbid with depression. To examine further the clinical symptoms of anxiety in major depressive disorder (MDD), a non‐parametric item response analysis on “blinded” data from four pharmaceutical company clinical trials was performed on the Hamilton Anxiety Rating Scale (HAMA) across levels of depressive severity. Methods: The severity of depressive symptoms was assessed using the 17‐item Hamilton Depression Rating Scale (HAMD). HAMA and HAMD measures were supplied for each patient on each of two post‐screen visits (n=1,668 observations). Option characteristic curves were generated for all 14 HAMA items to determine the probability of scoring a particular option on the HAMA in relation to the total HAMD score. Additional analyses were conducted using Pearson's product–moment correlations. Results: Results showed that anxiety‐related symptomatology generally increased as a function of overall depressive severity, though there were clear differences between individual anxiety symptoms in their relationship with depressive severity. In particular, anxious mood, tension, insomnia, difficulties in concentration and memory, and depressed mood were found to discriminate over the full range of HAMD scores, increasing continuously with increases in depressive severity. By contrast, many somatic‐related symptoms, including muscular, sensory, cardiovascular, respiratory, gastro‐intestinal, and genito‐urinary were manifested primarily at higher levels of depression and did not discriminate well at lower HAMD scores. Conclusions: These results demonstrate anxiety as a core feature of depression, and the relationship between anxiety‐related symptoms and depression should be considered in the assessment of depression and evaluation of treatment strategies and outcome. Depression and Anxiety, 2008. © 2008 Wiley‐Liss, Inc.     

Anxious and depressive symptoms in Parkinson's disease: The French cross‐sectionnal DoPaMiP study

Anxiety has been less extensively studied than depression in Parkinson's disease (PD). The DoPaMiP survey allowed assessing simultaneously anxiety and depressive symptoms in PD and comparing correlations of both symptoms with clinical and therapeutic features of the disease. Cross sectional survey conducted prospectively in 450 ambulatory nondemented PD patients and 98 patients with other disorders than PD. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), parkinsonism using the Unified Parkinson's Disease Rating Scale (UPDRS). Other clinical factors were measured using a structured standardized examination/questionnaire. The mean HADS‐A (anxiety) subscore was higher in PD patients than in the others (8.2 ± 3.9 vs. 6.5 ± 3.2, P < 10^?4) as was the HADS‐D (depressive) subscore (6.6 ± 3.8 vs. 3.9 ± 3.2, P < 10^?4). Patients with possible/probable anxious signs (HADS‐A ≥ 8) were more prevalent in PD (51% vs. 29%, P < 10^?4) as were those with depressive symptoms (40% vs. 10%, P < 10^?4). Conversely, anxiolytic and antidepressant medications consumption was not different between the 2 groups. Patients with anxious symptoms were more frequently female and younger than those without such symptoms, while those with depressive symptoms had more severe indices of parkinsonism, more comorbidities and lower cognitive function (Mini Mental State Exam). The logistic regression model revealed that patients with depressive symptoms received more frequently levodopa and less frequently a dopamine agonist. Anxiety and depressive symptoms were more frequent in PD patients than in medical control group. Both symptoms were commonly associated in the same PD patients, but were correlated with different clinical/therapeutic features, suggesting different underlying pathophysiological mechanisms. © 2009 Movement Disorder Society     

Clinical case study: CBT for depression in a Puerto Rican adolescent: challenges and variability in treatment response

Background: There is ample evidence of the efficacy of cognitive‐behavioral therapy (CBT) for depression in adolescents, including Puerto Rican adolescents. However, there is still a high percentage of adolescents who do not respond to a standard “dose” of 12 sessions of CBT. This clinical case study explores the characteristics associated with treatment response in a Puerto Rican adolescent and illustrates the challenges and variability inherent in CBT treatment for major depressive disorder (MDD) in youth. Methods: The patient is a 15‐year‐old adolescent female who at pretreatment presented a diagnosis of MDD with severe depressive symptoms, high suicidal ideation, low self‐concept, and highly dysfunctional attitudes. CBT treatment consisted of 12 standard individual therapy sessions plus four additional sessions, and one family intervention. A case study method was used. Both qualitative and quantitative data for the case are presented using self‐report instruments, clinical case notes and recordings of therapy sessions. Results: Some of the characteristics she presented that have been associated with partial or no response to therapy were: increased severity of depressive symptoms, a prior MDD episode, co‐morbidity with other mental disorders, and significant parental conflict. At termination the patient presented decreases in depressive symptoms, dysfunctional attitudes, and suicidal ideation, as well as improvements in self‐concept. These improvements were maintained up to 1 year posttreatment. Conclusions: Cultural issues are discussed in terms of the potential for parental conflict to perpetuate the patient's depressive symptoms. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

Role of depressive symptoms in early adolescents' online emotional responding to a peer evaluation challenge

Background: Problems regulating emotions effectively (emotion dysregulation) are implicated in many psychological problems. Depression in particular has been increasingly conceptualized as a disorder of emotion regulation. Methods: This study examines the linkage between children's depressive symptoms and the activation and regulation of positive and negative affect in response to an manipulated peer evaluation outcome. Participants (N=142) aged 10–13 played a computer contest (“Survivor”) and were randomized to either a negative (i.e., receiving the lowest “likeability” score from a group of peer judges), a positive (i.e., highest score), or a neutral peer evaluation outcome. Positive and negative affect were assessed at baseline, immediately post‐feedback, and after a 5 min post‐feedback waiting period. Results: No linkage was observed between depressive symptoms and emotional activation in response to either success or failure feedback. Consistent with expectations, we observed a negative linkage between depressive symptoms and children's up‐regulation of positive affect subsequent to receiving negative peer feedback. No such linkage was observed for the maintenance of mood improvement over time. Conclusions: Results suggest that depressive symptoms in children are not linked with deficits or excesses in the overall magnitude of emotional reactivity. However, it appears that elevated depressive symptoms interfere with the ability to swiftly transition out of negative affective states. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

School-based interventions for anxious children

OBJECTIVE: To compare the effectiveness of three school-based interventions for anxious children: group cognitive-behavioral therapy (CBT) for children, group CBT for children plus parent training group, and no-treatment control. METHOD: Students (7-11 years old) in three elementary schools (N = 453) were screened using the Multidimensional Anxiety Scale for Children and teacher nomination. Subsequently, 101 identified children and their parents completed the Anxiety Disorders Interview Schedule for DSM-IV, Child Version. Children with features or DSM-IV diagnoses of separation anxiety disorder, generalized anxiety disorder, and/or social phobia (n = 61) were randomized by school to one of three conditions. Active treatments were nine weekly sessions of either group CBT or group CBT plus concurrent parent training. RESULTS: Clinician-report, child-report, and parent-report measures of child anxiety demonstrated significant benefits of CBT treatments over the no-treatment control group. Effect size was 0.58 for change in composite clinician severity rating, the primary outcome measure, favoring collapsed CBT conditions compared with control. In addition, several instruments showed significantly greater improvement in child anxiety for group CBT plus parent training over group CBT alone. CONCLUSIONS: Both active CBT treatments were more effective than the no-treatment control condition in decreasing child anxiety symptoms and associated impairment. When parent training was combined with child group CBT, there were some additional benefits for the children.     

Symptom dimensions and cognitive-behavioural therapy outcome for pediatric obsessive-compulsive disorder

Objective: To examine whether obsessive‐compulsive disorder (OCD) symptom subtypes are associated with response rates to cognitive‐behavioural therapy (CBT) among pediatric patients. Method: Ninety‐two children and adolescents with OCD (range = 7–19 years) received 14 sessions of weekly or intensive (daily psychotherapy sessions) family‐based CBT. Assessments were conducted at baseline and post‐treatment. Primary outcomes included scores on the Children’s Yale‐Brown Obsessive‐Compulsive Scale (CY‐BOCS), remission status, and ratings on the Clinical Global Improvement (CGI) and Clinical Global Impression – Severity (CGI‐Severity) scales. Results: Seventy‐six per cent of study participants (n = 70) were classified as treatment responders. Patients with aggressive/checking symptoms at baseline showed a trend (P = 0.06) toward improved treatment response and exhibited greater pre/post‐treatment CGI‐Severity change than those who endorsed only non‐aggressive/checking symptoms. Step‐wise linear regression analysis indicated higher scores on the aggressive/checking dimension were predictive of treatment‐related change in the CGI‐Severity index. Regression analysis with CY‐BOCS score as the dependent variable showed no difference between OCD subtypes. Conclusion: Response to CBT in pediatric OCD patients does not differ substantially across subtypes.     

Predictors of treatment outcome in modular cognitive therapy for obsessive-compulsive disorder

Background: The present study sought to identify predictors of outcome for a comprehensive cognitive therapy (CT) developed for patients with obsessive–compulsive disorder (OCD). Methods: Treatment was delivered over 22 sessions and included standard CT methods, as well as specific strategies designed for subtypes of OCD including religious, sexual, and other obsessions. This study of 39 participants assigned to CT examined predictors of outcomes assessed on the Yale‐Brown Obsessive Compulsive Scale. A variety of baseline symptom variables were examined as well as treatment expectancy and motivation. Results: Findings indicated that participants who perceived themselves as having more severe OCD at baseline remained in treatment but more severe symptoms were marginally associated with worse outcome for those who completed therapy. Depressed and anxious mood did not predict post‐test outcome, but more Axis I comorbid diagnoses (mainly major depression and anxiety disorders), predicted more improvement, as did the presence of sexual (but not religious) OCD symptoms, and stronger motivation (but not expectancy). A small rebound in OCD symptoms at 1‐year follow‐up was significantly predicted by higher scores on personality traits, especially for schizotypal (but not obsessive–compulsive personality) traits. Conclusions: Longer treatment may be needed for those with more severe symptoms at the outset. CT may have positive effects not only on OCD symptoms but also on comorbid depressive and anxious disorders and associated underlying core beliefs. Findings are discussed in light of study limitations and research on other predictors. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Change in adolescents' internalizing symptomatology as a function of sex and the timing of maternal depressive symptomatology

ObjectiveThe purpose of this exploratory study was to examine change in internalizing symptoms from late childhood (age 10) into mid-adolescence (age 15) in a nationally representative sample of Canadian children. The roles of a child's sex, maternal depressive symptoms in late childhood, and their interactions were investigated.MethodThe sample was derived from the National Longitudinal Survey of Children and Youth. Mothers reported on their own depressive symptoms and children reported on their own internalizing symptoms at three time (T) points (T1: 1994/1995; T2: 1996/1997; T3: 1998/1999). Change in children's internalizing symptoms was investigated using multiple regression.ResultsGirls increased and boys decreased in their internalizing symptoms from T1 to T3. The effect of maternal depressive symptoms at T1 was moderated by sex and remained significant after controlling for maternal depressive symptoms at T2 and T3, with more adverse effects in girls.ConclusionsThe internalizing symptoms of girls increased from childhood to adolescence, whereas those for boys decreased. Female children exposed to maternal depressive symptoms T1 continued to show negative effects 4 years later.     

Neural alterations associated with anxiety symptoms in obstructive sleep apnea syndrome

Background: Neuropsychological comorbidities, including anxiety symptoms, accompany obstructive sleep apnea (OSA); structural and functional brain alterations also occur in the syndrome. The objective was to determine whether OSA patients expressing anxiety symptoms show injury in specific brain sites. Methods: Magnetic resonance T2‐relaxometry was performed in 46 OSA and 66 control subjects. Anxiety symptoms were evaluated using the Beck Anxiety Inventory (BAI); subjects with BAI scores>9 were classified anxious. Whole brain T2‐relaxation maps were compared between anxious and nonanxious groups using analysis of covariance (covariates, age and gender). Results: Sixteen OSA and seven control subjects showed anxiety symptoms, and 30 OSA and 59 controls were nonanxious. Significantly higher T2‐relaxation values, indicating tissue injury, appeared in anxious OSA versus nonanxious OSA subjects in subgenu, anterior, and mid‐cingulate, ventral medial prefrontal and bilateral insular cortices, hippocampus extending to amygdala and temporal, and bilateral parietal cortices. Brain injury emerged in anxious OSA versus nonanxious controls in bilateral insular cortices, caudate nuclei, anterior fornix, anterior thalamus, internal capsule, mid‐hippocampus, dorsotemporal, dorsofrontal, ventral medial prefrontal, and parietal cortices. Conclusions: Anxious OSA subjects showed injury in brain areas regulating emotion, with several regions lying outside structures affected by OSA alone, suggesting additional injurious processes in anxious OSA subjects. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

Pilot trial of dialectical behavior therapy‐enhanced habit reversal for trichotillomania

Background: Not all hair pullers improve acutely with cognitive–behavioral treatment (CBT) and few maintain their gains over time. Methods: We conducted an open clinical trial of a new treatment that addresses affectively triggered pulling and emphasizes relapse prevention in addition to standard CBT approaches. Ten female participants satisfying DSM‐IV criteria for trichotillomania (TTM) at two study sites received Dialectical Behavior Therapy (DBT)‐enhanced CBT consisting of 11 weekly sessions and 4 maintenance sessions over the following 3 months. Independent assessors rated hair pulling impairment and global improvement at several study time points. Participants completed self‐report measures of hair pulling severity and emotion regulation. Results: Significant improvement in hair pulling severity and emotion regulation, as well as hair pulling impairment and anxiety and depressive symptoms, occurred during acute treatment and were maintained during the subsequent 3 months. Significant correlations were reported between changes in emotion regulation and hair pulling severity during both the acute treatment and maintenance phases. Conclusions: This study offers preliminary evidence for the efficacy of DBT‐enhanced CBT for TTM and suggests the importance of addressing emotion regulation during TTM treatment. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Children of low‐income depressed mothers: psychiatric disorders and social adjustment

Background: Although several studies have documented a higher prevalence of psychiatric disorders in children of depressed than nondepressed parents, previous research was conducted in predominantly White, middle, or upper‐middle class populations. Only limited information is available on psychiatric disorders and psychosocial functioning in children of low‐income depressed mothers. Methods: We report the findings in children of mothers with and without a lifetime history of major depressive disorder, who were recruited from a large urban primary‐care practice. Bilingual clinical interviewers assessed 58 children with structured diagnostic interviews administered to most children (90%) and to their mothers as informants. Diagnostic assessments and best estimate diagnoses of the children were blind to the mothers' diagnostic status. Results: The families were poor and predominantly Hispanic, more than half of them headed by single mothers. After adjusting for child age and gender, and for any possible sibling correlation, children of depressed mothers had significantly higher rates of lifetime depressive, separation anxiety, oppositional defiant, and any psychiatric disorders than children of control mothers, with a lifetime prevalence of any psychiatric disorder of 84.6 versus 50.0%, respectively. Children of depressed mothers also reported significantly lower psychosocial functioning and had higher rates of psychiatric treatment. Conclusions: We conclude that the risk for psychiatric disorders may be particularly high in children of low‐income depressed mothers. The primary‐care setting offers a unique opportunity for early intervention with this underserved group. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

Contextual factors and anxiety in minority and European American youth presenting for treatment across two urban university clinics

The current study compared ethnic minority and European American clinically-referred anxious youth (N=686; 2-19 years) on internalizing symptoms (i.e., primary anxiety and comorbid depression) and neighborhood context. Data were provided from multiple informants including youth, parents, and teachers. Internalizing symptoms were measured by the Multidimensional Anxiety Scale for Children, Child Depression Inventory, Child Behavior Checklist and Teacher Report Form. Diagnoses were based on the Anxiety Disorders Interview Schedule for Children. Neighborhood context was measured using Census tract data (i.e., owner-occupied housing, education level, poverty level, and median home value). Ethnic minority and European American youth showed differential patterns of diagnosis and severity of anxiety disorders. Further, ethnic minority youth lived in more disadvantaged neighborhoods. Ethnicity and neighborhood context appear to have an additive influence on internalizing symptoms in clinically-referred anxious youth. Implications for evidence-based treatments are discussed.     

Anxiety does not predict response to duloxetine in major depression: results of a pooled analysis of individual patient data from 11 placebo‐controlled trials

Background: Uncontrolled antidepressant trials suggest that anxious patients with major depressive disorder (MDD) are less responsive to antidepressant treatment than less anxious patients. The objective of this study is to determine whether specific antidepressant effects, estimated by drug‐placebo differences, are reduced in anxious depression during treatment of MDD with duloxetine. Methods: This is a retrospective secondary pooled analysis of all placebo‐controlled trials of duloxetine at therapeutic doses conducted by the sponsor in outpatients with nonpsychotic unipolar MDD, using the Hamilton Depression Rating Scale (HAMD). Anxious depression was defined by ≥7 on the anxiety/somatization factor of the HAMD. Response was defined as ≥50% improvement from baseline to endpoint on the HAMD. Remission was defined as an endpoint HAMD≤7. Analyses were performed in the intent‐to‐treat sample with at least one post‐treatment rating. Results: Eleven trials included 2,841 patients of whom 1,326 were classified as anxious and 1,515 as nonanxious. Change on the HAMD was greater with duloxetine than placebo in both anxious (9.91 versus 7.55, P<.001) and nonanxious (6.65 versus 5.23, P<.001) patients. Level of anxiety had no effect on the drug–placebo differences. Response and remission rates were significantly greater in duloxetine than placebo‐treated patients and drug–placebo differences were unaffected by anxious status. Use of HAMD items psychic and somatic anxiety to define anxious subgroups had similar outcomes. Conclusions: Duloxetine was more effective than placebo in achieving response and remission in both anxious and nonanxious patients. Anxious status did not affect the magnitude of the drug effect. Depression and Anxiety, 2010. © 2009 Wiley‐Liss, Inc.     

Chronic family stress interacts with 5-HTTLPR to predict prospective depressive symptoms among youth

Background: Previous research, predominantly with adults, has shown that the serotonin transporter gene (5‐HTTLPR) interacts with stress (G × E) to predict depressive symptoms; however, few G × E studies have been conducted with youth using rigorous methods, particularly a prospective design and contextual interview to assess stress. This study examined the interaction between 5‐HTTLPR and stress, both chronic and episodic, to predict longitudinal change in depressive symptoms among children and adolescents. Methods: A general community sample of youth (N = 200; 57% girls; mean age: 12.09 years old) was genotyped for 5‐HTTLPR (rs 25531) at baseline. They were interviewed via contextual stress procedures to ascertain chronic family stress and episodic stressors and completed depressive symptoms questionnaires at baseline and 6 months later. Results: A significant G × E showed that chronic family stress predicted prospective increases in depressive symptoms over 6 months among youth possessing the high‐risk S allele. This G × E was not found for episodic stressors occurring in the last 6 months. There was no moderation by sex or pubertal status. Conclusions: These findings advance knowledge on G × E effects in depression among youth. This is the first study to show that chronic family stress, but not episodic stressors, when ascertained by rigorous stress interview, interacts with 5‐HTTLPR to prospectively predict depressive symptoms among children and adolescents. Depression and Anxiety, 2011. © 2011 Wiley Periodicals, Inc.     

Waitlist‐controlled trial of cognitive behavior therapy for hoarding disorder

Objective: This study investigated a multicomponent cognitive behavioral treatment (CBT) for hoarding based on a model proposed by Frost and colleagues and manualized in Steketee and Frost (2007). Method: Participants with clinically significant hoarding were recruited from the community and a university‐based anxiety clinic. Of the 46 patients randomly assigned to CBT or waitlist (WL), 40 completed the 12‐week assessment and 36 completed 26 sessions. Treatment included education and case formulation, motivational interviewing, skills training for organizing and problem solving, direct exposure to nonacquiring and discarding, and cognitive therapy. Measures included the Saving Inventory‐Revised (self‐report), Hoarding Rating Scale‐Interview, and measures of clinical global improvement. Between group repeated measures analyses using general linear modeling examined the effect of CBT versus WL on hoarding symptoms and moodstate after 12 weeks. Within group analyses examined pre‐post effects for all CBT participants combined after 26 sessions. Results: After 12 weeks, CBT participants benefited significantly more than WL patients on hoarding severity and mood with moderate effect sizes. After 26 sessions of CBT, participants showed significant reductions in hoarding symptoms with large effect sizes for most measures. At session 26, 71% of patients were considered improved on therapist clinical global improvement ratings and 81% of patients rated themselves improved; 41% of completers were clinically significantly improved. Conclusions: Multicomponent CBT was effective in treating hoarding. However, treatment refusal and compliance remain a concern, and further research with independent assessors is needed to establish treatment benefits and durability of gains. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Screening capacity of the Multidimensional Anxiety Scale for Children (MASC) for DSM-IV anxiety disorders

Background: The Multidimensional Anxiety Scale for Children (MASC) is a widely used self‐report questionnaire for the assessment of anxiety symptoms in children and adolescents. Methods: This study used receiver operating characteristic analyses to investigate the predictive value of the MASC total and scale scores for DSM‐IV anxiety diagnoses in a referred sample. Eight‐ to 18‐year‐olds (n=212) were assessed with the MASC and Anxiety Disorders Interview Schedule for Children (ADIS‐C). Results: The MASC total score did not exceed the threshold for being judged as fair in predicting any ADIS‐C/DSM‐IV anxiety diagnosis. The Separation Anxiety scale and the Physical Symptoms scale predicted Panic Disorder (PAD) and Agoraphobia fairly accurately. The Social Anxiety scale predicted Social Phobia, and the Separation Anxiety scale predicted PAD to a moderate degree. The MASC scale Harm Avoidance did not predict any ADIS‐C/DSM‐IV diagnosis. Conclusions: These results suggest that the MASC may not be a valid screening instrument for DSM‐IV diagnoses. Depression and Anxiety, 2008. © 2008 Wiley‐Liss, Inc.     

Examining academic self-concept as a mediator of the relationship between anxiety and depression: A longitudinal study

Background

Self-concept plays a role as a mediator in the development and maintenance of internalizing symptoms but mechanisms through which the early presence of anxiety symptoms is associated with the subsequent development of depression is unknown. The aim of this longitudinal study was to analyze the mediating role of different areas of self-concept in the relationship between the early development of anxiety symptoms and the later appearance of depressive symptoms.

Methods

A longitudinal study with 3 time-points was conducted, including baseline, 2 months and 12 months from the baseline assessment. A total of 217 children aged 8–12 years participated. Mediation analyses were conducted using PROCESS Macro for SPSS.

Results

Academic self-concept (Time 2) mediated the relationship between Anxiety (Time 1) and Depression (Time 3) when controlling for children's sex and, age, baseline value of the mediator, anxiety (at Times 2 and 3), and depression (at Times 1 and 2). Children with self-reports of higher anxiety symptoms (Time 1) presented lower Academic self-concept (Time 2). Children who reported lower levels of Academic self-concept and Family self-concept (Time 2) were more likely to develop depressive symptoms (Time 3).

Conclusions

Feeling competent in the school environment may be considered a protective factor against the development of depression in childhood. The identification of risk factors facilitates the development and implementation of preventive programs.     

The impact of neuropsychological functioning on treatment outcome in pediatric obsessive–compulsive disorder

Background: Scant research has examined the effect of neuropsychological (NP) functioning on treatment outcome in pediatric obsessive–compulsive disorder (OCD). This study sought to address this gap in existing research. Methods: A total of 63 youths were included in this study and asked to complete the Rey‐Osterrieth Complex Figure (ROCF) and specific subtests of the Wechsler Intelligence Scale for Children, Third Edition (WISC‐III). Results: Analyses suggest that 5 min recall accuracy (raw score) and percent recall from the ROCF, assessed before treatment may be predictors of treatment response among children with OCD. What is more, exploratory post hoc analyses indicated that performance on these ROCF tasks is particularly relevant among youths receiving cognitive‐behavior therapy (CBT) alone. These results may be driven by executive functioning ability. Additional analyses suggest a relationship between age, symptom severity, and NP functioning on select tasks from both the ROCF and WISC‐III. Conclusions: Although alternative explanations exist, these findings suggest that poorer performance on the ROCF and, in turn, poorer response to treatment, particularly among those youths receiving CBT alone, may be due to executive functioning difficulties. Clinicians and researchers should be sensitive to this fact and may warrant modification(s) to existing treatment protocols. Limitations to this study, however, suggest the need for replication and extension of these findings in the future. Depression and Anxiety, 2010. © 2009 Wiley‐Liss, Inc.