Anxiety Sensitivity Among Anxious Children

Employed the Diagnostic Interview Schedule for Children to show that children diagnosed with an anxiety disorder score significantly higher on the Childhood Anxiety Sensitivity Index (CASI) than nondiagnosed children. Interviews and self-report measures regarding the child were completed by 201 children and their parents from a metropolitan area military community who were participating in a National Institute of Mental Health epidemiological survey. An analysis of variance was used to compare CASI scoring across three groups: children receiving anxiety diagnoses, children receiving externalizing diagnoses but no anxiety diagnosis, and children receiving no diagnoses. Although scoring on the CASI differentiated anxious children from the no-diagnosis control group, it did not differentiate anxious children from those receiving externalizing diagnoses. Implications of the findings for the validity of the CASI, the issue of anxiety sensitivity as a component of some externalizing disorders, and suggestions for further investigation are discussed.     

Behavioral validation of the Childhood Anxiety Sensitivity Index in children

Examined the construct validity of the Childhood Anxiety Sensitivity Index (CASI) in young children through the use of a behavioral challenge task. Elementary-school children completed the CASI as well as seff-report measures of state and trait anxiety and subjective fear prior to and immediately following a stair-stepping task designed to increase physiological arousal. Results indicate that the CASI was a significant predictor of the degree of state anxiety and subjective fear reported in response to the challenge task, even after controlling for pretask levels of state anxiety and fear, respectively. Additionally, the CASI predicted changes in fear experienced in response to the challenge task. The findings lend support to the validity of the CASI in preadolescent children and suggest that the CASI possesses unique clinical utility relative to measures of trait anxiety. However, results of this study must be interpreted cautiously, because a large portion of the variance in response to arousal was left unaccounted for by the CASI and the overall model.     

Orphans No More: A Commentary on Anxiety and African American Youth

Conducting research on anxiety disorders among African American children and adolescents, prior to the early 1990s was considered an "orphan area" of psychology. The articles in this section, first authored by a new generation of researchers, appear to set a direction for future research. The findings underscore the importance of including culturally relevant variables in the assessment of African American children's anxiety and its disorders.     

Sensitive Parenting: From Infancy to Adulthood (Book)

Examined the reliability, validity, and factor structure of the Childhood Anxiety Sensitivity Index (CASI; Silverman, Fleisig, Rabian, &; Peterson, 1991) in a Dutch sample. Five hundred forty-four Dutch schoolchildren between 8 and 16 years of age completed Dutch translations of the CASI; the State-Trait Anxiety Inventory for Children (Spielberger, Edwards, Lushene, Montuori, &; Platzek, 1973); and the Fear Survey Schedule for Children-Revised (Ollendick, 1983). The Dutch CASI was found to have adequate internal consistency for use with children as well as adolescents. Results reveal that the CASI predicted fear beyond a measure of trait anxiety in this Dutch sample. Both exploratory and confirmatory factor analyses comparing different models were undertaken. The model with 3 first-order factors found in previous studies showed an acceptable fit in this cross-validation sample. Loadings on the 3 factors (Physical Concerns, Mental Concerns, and Publicly Observable Concerns) did not differ between children and adolescents. Results are compared with previous research on the CASI. Directions for future research are discussed.     

Cultural Barriers to African American Participation in Anxiety Disorders Research

Anxiety disorders are understudied, underdiagnosed, and undertreated in African Americans. Research focused on the phenomenology, etiology, and treatment of anxiety in African Americans has been hampered by lack of inclusion of this population in clinical research studies. The reason for exclusion is not well understood, although cultural mistrust has been hypothesized as a major barrier to research participation. This article reviews the relevant literature to date and examines the experience of 6 African American adults who participated in a larger clinical assessment study about anxiety. Drawing upon in-depth semistructured interviews about their subjective experiences, we examined participant perspectives about the assessment process, opinions about African American perception of anxiety studies, and participant-generated ideas about how to improve African American participation. Based on a qualitative analysis of responses, feelings of mistrust emerged as a dominant theme. Concerns fell under 6 categories, including not wanting to speak for others, confidentiality, self and group presentation concerns, repercussions of disclosure, potential covert purposes of the study, and the desire to confide only in close others. Suggestions for increasing African American participation are discussed, including assurances of confidentiality, adequate compensation, and a comfortable study environment.     

Separation Anxiety Disorder in Young Children: A Longitudinal and Family Analysis

We conducted a longitudinal study of young children with clinical, subclinical, or nonclinical levels of separation anxiety to evaluate the diagnostic stability and concomitant parent and family variables of separation anxiety disorder (SAD). Youngsters were assessed at age 3 years (n = 60) and 3.5 years later (n = 44). Data were collected from children, parents, teachers, and clinicians. Results revealed that most diagnoses of SAD were not stable during this developmental period, as many children drifted toward subclinical or nonclinical status. In addition, children with clinical SAD, compared to those with subclinical SAD or no symptoms of SAD, had a disproportionately higher number of comorbid diagnoses and experienced significantly greater somatic concerns, anxiety, and general internalizing behavior. In addition, their parents experienced greater depression, obsessive-compulsive behavior, phobic anxiety, and general distress. The results preliminarily support prior findings that most children experience a dissipation of SAD symptoms in young childhood but that some children continue to experience stable, significant distress. The results are consistent with prior research on older children that SAD remits for many but not all youth and suggest that parent and family variables may have much to do with cases of poor remission in this population.     

中文版焦虑敏感性指数-3在社区人群中的应用:基于双因素模型

目的:考察中文版焦虑敏感性指数-3的结构以及在社区样本中的适用性。方法:方便抽取黑龙江省某市和湖南省某市的社区人群609人填写问卷进行结构效度、信度等分析,其中101人进行间隔3周的重测,108人完成效标问卷。结果:中文版焦虑敏感性指数-3呈现出双因素结构,公共因素为焦虑敏感性,特殊因素分别为社会关注、认知关注和身体关注。双因素模型拟合良好(χ²/df=3.874,CFI=0.907,TLI=0.913,RMSEA=0.045,AIC=419.357,BIC=571.921)。量表的解释方差公共比例为0.585,未受影响的相关比例为0.706,同质性系数为0.774。总量表及社会关注、认知关注和身体关注分量表的合成信度分别为0.946、0.867、0.905、0.894,内部一致性信度分别为0.895、0.743、0.806、0.790,重测信度分别为0.842、0.773、0.760、0.815。焦虑敏感性及社会关注、认知关注和身体关注维度均与焦虑、抑郁、体验回避存在显著正相关。结论:中文版焦虑敏感性指数-3符合双因素模型结构,在社区人群中具有良好的信效度。     

Orphans no more: a commentary on anxiety and African American youth.

Conducting research on anxiety disorders among African American children and adolescents, prior to the early 1990s was considered an "orphan area" of psychology. The articles in this section, first authored by a new generation of researchers, appear to set a direction for future research. The findings underscore the importance of including culturally relevant variables in the assessment of African American children's anxiety and its disorders.     

Anxiety Reporting and Culturally Associated Interpretation Biases and Cognitive Schemas: A Comparison of Mexican,Mexican American,and European American Families

This study examined whether Mexican (n = 53), Mexican American (n = 50), and European American (n = 51) children differed in their reporting of anxiety symptoms and whether parental influence and specific cognitive schemas associated with Mexican culture were related to differences in anxiety reporting. As expected, Mexican and Mexican American children reported significantly more physiological and worry symptoms than the European American children. Mexican and Mexican American children endorsed collectivism as a cultural value more strongly than European American children, and the Mexican children evidenced greatest use of social strategies reflecting simpatia. In family discussions of ambiguous, potentially anxiety-arousing situations, Mexican and Mexican American parents verbalized a greater percentage of somatic interpretations than the European American parents. Results indicate potential linkages between cultural values, socialization practices, and anxiety reporting.     

Anxiety reporting and culturally associated interpretation biases and cognitive schemas: a comparison of Mexican, Mexican American, and European American families.

This study examined whether Mexican (n = 53), Mexican American (n = 50), and European American (n = 51) children differed in their reporting of anxiety symptoms and whether parental influence and specific cognitive schemas associated with Mexican culture were related to differences in anxiety reporting. As expected, Mexican and Mexican American children reported significantly more physiological and worry symptoms than the European American children. Mexican and Mexican American children endorsed collectivism as a cultural value more strongly than European American children, and the Mexican children evidenced greatest use of social strategies reflecting simpatia. In family discussions of ambiguous, potentially anxiety-arousing situations, Mexican and Mexican American parents verbalized a greater percentage of somatic interpretations than the European American parents. Results indicate potential linkages between cultural values, socialization practices, and anxiety reporting.     

An Introduction to Assessing Anxiety in Child and Adolescent Multiethnic Populations: Challenges and Opportunities for Enhancing Knowledge and Practice

Recognizing that researchers and clinicians are increasingly faced with assessing, treating, and studying ethnically, racially, and culturally diverse populations, one question is whether the appropriate tools exist. This special section aspires to advance the available assessment strategies that are appropriate for the treatment, prevention, and research of diverse children and adolescents with anxiety symptoms and disorders. This introduction presents an overview of anxiety and its disorders among multiethnic youth and identifies emerging challenges and opportunities in the assessment and treatment of anxiety symptoms and disorders among Asian American and Pacific Islander, Hispanic/Latino, African American, and European American children and adolescents within a sociocultural context.     

Childhood depression and family interaction: A naturalistic observation study

Investigated the phenomenon of anxiety sensitivity in children diagnosed with anxiety disorders using the Child ,4nxiety Sensitivity Index (CASI; Silverman, Fleisig, Rabian, &; Peterson, 1991). Among children 12 years and older, the CASI was found to predict unique variance in trait anxiety beyond simpler constructs of physical distress or fear. In 7- to 11-year olds, however, the CASI did not predict unique variance in the same analyses. Product-tern regression analysis demonstrated a significant nonlinear interaction of age with anxiety sensitivity. Although there is support for the construct of anxiety sensitivity in children with anxiety disorders, it appears that such a phenomenon may be limited to older developmental levels. Findings challenge existing notions of the applicability of the CASI across ages.     

Pre–Post Tornado Effects on Aggressive Children’s Psychological and Behavioral Adjustment Through One-Year Postdisaster

Using a risk-resilience framework, this study examined how varying levels of exposure to a natural disaster (EF-4 tornado) and children’s characteristics (sex; anxiety) influenced the behavioral and psychological adjustment of children who shared a common risk factor predisaster (elevated aggression) prior to exposure through 1-year postdisaster. Participants included 360 children in Grades 4–6 (65% male; 78% African American) and their parents from predominantly low-income households who were already participating in a longitudinal study of indicated prevention effects for externalizing outcomes when the tornado occurred in 2011. Fourth-grade children who were screened for overt aggressive behavior were recruited in 3 annual cohorts (120 per year, beginning in 2009). Parent-rated aggression and internalizing problems were assessed prior to the tornado (Wave 1), within a half-year after the tornado (Wave 2), and at a 1-year follow-up (Wave 3). Children and parents rated their exposure to aspects of tornado-related traumatic experiences at Wave 3. Children displayed less reduction on aggression and internalizing problems if the children had experienced distress after the tornado or fears for their life, in combination with their pre-tornado level of anxiety. Higher levels of children’s and parents’ exposure to the tornado interacted with children’s lower baseline child anxiety to predict less reduction in aggression and internalizing problems 1 year after the tornado. Higher levels of disaster exposure negatively affected at-risk children’s level of improvement in aggression and internalizing problems, when life threat (parent- and child-reported) and child-reported distress after the tornado were moderated by baseline anxiety.     

Assessment of Social Anxiety in Children and Adolescents With Autism Spectrum Disorder

Despite the high prevalence of social anxiety in individuals with autism spectrum disorder (ASD), there is little agreement on how to best assess such problems in this population. To inform evidence‐based assessment, we conducted a comprehensive review of research that has assessed social anxiety in children and adolescents with ASD without co‐occurring intellectual disability. Although some evidence in support of the reliability of existing measures exists, there are concerns about inflated estimates of the co‐occurrence of social anxiety because of symptom overlap with ASD diagnostic criteria, and the diagnostic sensitivity of existing measures is questionable. Recommendations for clinical assessment of social anxiety in this population and future directions for research on this topic, including the development of new measures, are provided.     

The Structure of Challenging Parenting Behavior and Associations With Anxiety in Dutch and Australian Children

Challenging parenting behavior (CPB), a novel construct involving active physical and verbal behaviors that encourage children to push their limits, has been identified as a potential buffer against child anxiety. This study aimed to (a) evaluate the measurement invariance of the Challenging Parenting Behavior Questionnaire (CPBQ4-6) across Dutch and Australian mothers and fathers of preschoolers, (b) examine differences in levels of CPB across mothers and fathers and across countries, and (c) examine whether parents’ CPB predicts less child anxiety symptoms and disorders. Participants were 312 families—146 Dutch and 166 Australian—with their 3- to 4-year-old child (55.8% girls). Fathers’ and mothers’ CPB was measured using the CPBQ4-6, and child anxiety symptoms and presence of anxiety disorders were assessed using maternal reports. Multigroup confirmatory factor analyses revealed equivalence of factor structure and factor loadings (all significant) of the CPBQ4-6 across mothers and fathers and across countries. Evidence of partial scalar invariance indicated that the groups differed on some subscales of the CPBQ4-6. Australian mothers scored lower on the CPB factor than Australian fathers and Dutch parents. Structural equation models showed that CPB predicted fewer child anxiety symptoms and anxiety disorders for all groups. The study confirms that the CPBQ4-6 is appropriate for use with Dutch and Australian parents of preschool-age children and identifies CPB as a multifaceted and coherent construct. The negative relations between CPB and child anxiety suggest that CPB has a protective role in childhood anxiety and is important to examine in future research and interventions.     

焦虑敏感问卷中文版的信度和效度

目的:翻译和修订焦虑敏感问卷,测试中文版的信效度。方法:翻译焦虑敏感量表,通过对中学生的三次测试,对量表的因素结构、信度和效度进行了检验。结果:修编的焦虑敏感问卷中文版通过探索性因素分析将原量表由36题缩减为15题,共包括三个因素:对生理唤醒的恐惧;对认知失控的恐惧;对社会评价的恐惧;三个因素的累积贡献率为52．29％,项目的因素负荷率在0．63～0．98之间;因素彼此之间的相关在0.37～0．53之间,因素与问卷总分之问的相关在0．72～0．84之间,因素内部的相关在0．68～0．78之间。问卷在各个因素上的内部一致性系数在0.73～0．78之间．分半信度在0．71～0．76之间,重测信度在0．70～0．78之间。结论:问卷的中文简化版在中学生中具有良好的信度和效度。     

A Preliminary Study of the Emotion Understanding of Youths Referred for Treatment of Anxiety Disorders

Examined the emotion understanding of children and adolescents referred for treatment of Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) anxiety disorders (separation anxiety disorder, generalized anxiety disorder, or social phobia). Referred youths (n = 17) and nonreferred youths (n = 21) and their parents participated by completing self-report and parent-report questionnaires and structured diagnostic interviews. We interviewed all youths by using an emotion understanding interview. Referred youths demonstrated poorer understanding of hiding emotions and changing emotions compared with nonreferred youth. The 2 groups were not significantly different regarding their understanding of emotion cues and multiple emotions, however. No statistically significant relation emerged between general intelligence and emotion understanding. Future research directions are discussed.     

Predicting Children's Presurgical Anxiety and Subsequent Behavior Changes

Addressed, in two studies, issues of children's medical anxietyhaving implications for efficient psychological preparation.Study I assessed behavioral distress and physiological arousalof 4- to 10-year-old, unprepared, nonsedated children (N = 50)as they separated from parents, waited in the operating room,and were given general anesthesia for minor surgery. Anxietyintensity varied widely among children and was most intenseat mask presentation. Mother's prediction of uncooperative behaviorand a history of prior surgery were the best predictors. Study2 examined anxiety of 37 children prior to surgery and behaviorchanges 2 weeks later. At follow-up, minor or transient problemswere common; 4 children developed significant problems. Elevatedpresurgical anxiety predicted later problems, but only amongchildren hospitalized after surgery. Findings suggest that presurgicalanxiety and later behavior problems are partially predictable.     

Emotion Regulation in Children With Anxiety Disorders

This study examined emotion management skills in addition to the role of emotional intensity and self-efficacy in emotion regulation in 26 children with anxiety disorders (ADs) ages 8 to 12 years and their counterparts without any form of psychopathology. Children completed the Children's Emotion Management Scales (CEMS) and Emotion Regulation Interview (ERI), and mothers reported on their children's emotion regulation using the Emotion Regulation Checklist (ERC). Results indicated that children who met Diagnostic and Statistical Manual for Mental Disorders (4th ed., American Psychiatric Association, 1994) criteria for an anxiety disorder had difficulty managing worried, sad, and anger experiences, potentially due to their report of experiencing emotions with high intensity and having little confidence in their ability to regulate this arousal. These findings indicate that emotion regulation needs to be considered centrally in research with anxious populations.     

Psychosocial Impairment Associated With Anxiety in Children

Children identified as highly anxious and withdrawn by their teachers were compared to nonanxious children on independent measures of adjustment. From a sample of 325 children, 24 were identified who received extremely high teacher ratings on the Revised Behavior Problem Checklist (RBPC) Anxiety-Withdrawal factor. When contrasted with children receiving low teacher ratings on the RBPC Anxiety-Withdrawal subscale, teacher-identified anxious children were found to demonstrate a broad range of psychosocial difficulties. As assessed by peer, teacher, and self-reports, anxious-withdrawn children showed impairment in peer relations and in levels of depression, self-esteem, attention, school performance, and social behavior when compared to nonanxious children. Overall, the present findings lend empirical support to the forms of psychopathology purported to be associated with childhood anxiety disorders in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980).