War trauma and psychopathology in Bosnian refugee children

This paper describes the pattern of psychopathology in a sample of 95 children of 8-13 years, who had experienced war in Bosnia. The children were assessed with a battery of standardised measures during a psychosocial support programme in Northern Greece. They either came from refugee families (44%) or had suffered significant family loss (a parent had been killed in 28% and the father was injured or absent in 27% of cases). Children recalled a substantial number of war traumatic experiences. According to previously established cut-off scores on self-report measures, 45 children (47%) scored within the clinical range on the Depression Self-Rating Scale for Children, 28 (23%) on the Revised Children's Manifest Anxiety Scale, and 65 (28%) on the Impact of Event Scale (IES) measuring PTSD reactions. There was a significant association between the number of war traumatic experiences and the intrusion and avoidance scores on the IES. The findings are discussed in relation to setting up intervention programmes for children victims of war and their families.     

Somatic Symptoms in Traumatized Children and Adolescents

Childhood exposure to trauma has been associated with increased rates of somatic symptoms (SS), which may contribute to diminished daily functioning. One hundred and sixty-one children residing at a residential treatment home who had experienced neglect and/or abuse were administered the Trauma Symptom Checklist for Children (TSCC), the Multidimensional Anxiety Scale for Children, and the Children’s Depression Inventory (CDI). Primary caregivers completed the Child Behavior Checklist. Two composite measures of SS were formed to represent both child- and caregiver-rated SS. Over 95% of children endorsed at least one SS on the child-rated measure. Children who had experienced sexual abuse had higher rates of SS relative to children who had not. Child-rated SS were highly correlated with the CDI total score and the TSCC subscales of anxiety, depression, posttraumatic stress, dissociation, and anger. The TSCC anxiety subscale mediated the relationship between sexual abuse and child-rated SS.     

Factors Influencing Perceptions of Need for and Decisions to Solicit Child Mental Health Services by Parents of 9–12 Year-Old Korean Children

As children with emotional or behavioral problems often fail to receive the treatment available to them, this study examined (1) the degree of perceived need (PN) among Korean parents regarding mental health services for their children, (2) the factors associated with such perceptions, (3) the degree to which Korean parents actually engage mental health services for their children, and (4) the factors associated with such use. To determine the degrees of PN and actual use, 1,058 children aged between 9 and 12 years were asked to complete the Children’s Depression Inventory, while their parents completed the Child Behavior Checklist. About 11.4% of the parents demonstrated PN, compared to 2.7% who actually engaged child mental health services. While most of the CBCL factors were associated with PN, the child’s self-report significantly affected the perception as well. The attention problem score in the CBCL was the only factor that strongly corresponded to the actual use of services in Korea, a country where academic achievement is considered paramount, which suggests that cultural forces may play a powerful role in determining parents’ decisions regarding child mental health care.     

An analysis of the RCMAS Lie scale in a clinic sample of anxious children

Examined Revised Children's Manifest Anxiety Scale (RCMAS) Lie scores in a sample of 284 anxious children. Lie scores were examined in relation to children's age, ethnicity/race, and gender, and in relation to Total Anxiety scores. The utility of Lie scores also was examined in terms of whether they were predictive of children's anxiety levels as rated by children themselves, parents, and clinicians. Between-group differences in children's Lie scores were examined as well. Results indicated that younger children had significantly higher Lie scores than older children, and Hispanic American children had significantly higher Lie scores than European American children. There were no significant gender differences in Lie scores, and no significant relation was found between RCMAS Lie scores and Total Anxiety scores for the total sample. Subgroup analyses indicated that Lie scores were predictive of children's anxiety levels. Results also indicated that Lie scores were significantly different between children who presented with anxiety disorders and children who presented with anxiety and externalizing disorders. Findings are discussed in terms of the usefulness of RCMAS Lie scores.     

Development and Preliminary Psychometric Evaluation of the Children’s Saving Inventory

This study reports on the development and initial psychometric properties of the Children’s Saving Inventory (CSI), a parent-rated measure designed to assess child hoarding behaviors. Subjects included 123 children and adolescents diagnosed with primary Obsessive–Compulsive Disorder (OCD) and their parents. Trained clinicians administered the Children’s Yale-Brown Obsessive–Compulsive Scale (CY-BOCS), items assessing Family Accommodation and the Clinical Global Impressions—Severity index. Parents completed the CSI, Child Obsessive–Compulsive Impact Scale (COIS)—Parent Version and Child Behavior Checklist. Youth completed the COIS—Child Version, Obsessive–Compulsive Inventory Child Version (OCI-CV), Multidimensional Anxiety Scale for Children, and Children’s Depression Inventory—Short Form. A four factor solution was identified; factors were named Discarding, Clutter, Acquisition, and Distress/Impairment. Internal consistency for the CSI Total and factor scores were good. One-week test–retest reliability (n = 31) from a random subsample was excellent. Known groups validity was supported vis-à-vis higher CSI scores for those endorsing hoarding on the CY-BOCS Symptom Checklist. Convergent and discriminant validity was evidenced by weak relationships with OCI-CV Checking and Contamination factors but strong relationships with the OCI-CV Hoarding factor and with hoarding obsession/compulsions on the CY-BOCS. These findings provide initial support for the reliability and validity of the CSI for the assessment of hoarding behaviors among youth with OCD. Future studies are needed to extend these findings to non-OCD samples of youth.     

Traumatic experiences and posttraumatic stress reactions in children and their parents from Kurdistan and Sweden

This study was conducted to assess trauma scores and posttraumatic stress symptoms among Kurdistanian refugee children and their parents in Sweden and a comparable group of Swedish children and their parents. Comparative Kurdistanian and Swedish samples composed of 32 children each and their parents were interviewed by means of a specially devised trauma instrument (HUTQ-C), to identify traumatic events and to measure trauma scores, and with (PTSS-C) and (HTQ) to diagnose posttraumatic stress syndrome (PTSD) among children and adults, respectively. Although Kurdistanian parents reported considerably more traumatic events than Swedish parents, children in both samples showed more similarities than differences, both with regard to types and levels of traumatic events. Kurdistanian parents showed higher PTSD frequencies than Swedish parents. However, these differences proved to be significant with regard to both the mother's and the father's lifetime and current PTSD symptom scores. Kurdistanian parents have experienced more war traumas and differ with regard to trauma exposure and its consequences when compared with Swedish parents. Children from the two samples showed more similarities than differences with regard to reported trauma and PTSD-related symptoms. These results underline the significance of child-specific factors in trauma and PTSD.     

Thought-Action Fusion in Childhood: Measurement,Development, and Association with Anxiety,Rituals and Other Compulsive-like Behaviors

A new inventory assessing thought-action fusion (TAF) in children is presented. We explore the psychometric properties of this instrument and examine the associations between TAF, ritualistic and compulsive-like behavior (CLB) and anxiety. Three hundred thirteen children ages 7–14 (M = 10.16, SD = 1.92) representing six grades (grouped into three grade levels (grades 2–3, 4–5, and 6–7) completed the Thought-action Fusion Inventory for Children (TAFIC) and the Child Revised Manifest Anxiety Scale. One hundred thirty-five parents or guardians completed the Childhood Routines Inventory. Results revealed high internal consistency in the TAFIC (Cronbach’s α = .92). TAF scores changed with age: Older children reported less TAF than younger children. Stepwise multiple regression analyses revealed that: (1) physiological anxiety predicted CLB in early childhood; (2) TAF predicted CLB in older children. Consistent with structural developmental theories, TAF changes throughout development, but plays a role in the normative regulation of affective states, as well as in the development of ritualistic compulsive like behavior in children.     

Traumatic experiences and posttraumatic stress reactions in children and their parents from Kurdistan and Sweden

This study was conducted to assess trauma scores and posttraumatic stress symptoms among Kurdistanian refugee children and their parents in Sweden and a comparable group of Swedish children and their parents. Comparative Kurdistanian and Swedish samples composed of 32 children each and their parents were interviewed by means of a specially devised trauma instrument (HUTQ-C), to identify traumatic events and to measure trauma scores, and with (PTSS-C) and (HTQ) to diagnose posttraumatic stress syndrome (PTSD) among children and adults, respectively. Although Kurdistanian parents reported considerably more traumatic events than Swedish parents, children in both samples showed more similarities than differences, both with regard to types and levels of traumatic events. Kurdistanian parents showed higher PTSD frequencies than Swedish parents. However, these differences proved to be significant with regard to both the mother's and the father's lifetime and current PTSD symptom scores. Kurdistanian parents have experienced more war traumas and differ with regard to trauma exposure and its consequences when compared with Swedish parents. Children from the two samples showed more similarities than differences with regard to reported trauma and PTSD-related symptoms. These results underline the significance of child-specific factors in trauma and PTSD.     

Difference in anxiety symptoms between children and their parents facing a first seizure or epilepsy

Many studies have shown that anxiety disorders are common in children with epilepsy. We explored symptoms of anxiety simultaneously in children and their parents. We conducted a cross-sectional study using the Revised Children's Manifest Anxiety Scale in children and the State-Trait Anxiety Inventory for Adult in parents. We included 118 parents and 67 children, who were divided into three groups: (1) first seizure, (2) epilepsy, and (3) nonepileptic paroxysmal event. We found that the level of anxiety in parents and children differed. We observed a significant increase in the anxiety level of parents whose children have had a first seizure, while we found a significant increase in the anxiety level of children and adolescents followed for epilepsy. These findings suggest that there is no direct relationship in the anxiety of the parents and their child. Further studies are needed to understand this variation over time.     

Disclosure of distress among anxiety-disordered youth: differences in treatment outcome

The present study evaluated treatment outcome differences in anxiety-disordered youth who differed in their disclosure of internal distress as measured in a structured diagnostic interview. One hundred and seventy-one clinic-referred, anxiety-disordered children served as participants. Participants' primary diagnoses were one of three anxiety disorders: separation anxiety, generalized anxiety/overanxious, or social phobia/avoidance. At a pretreatment assessment, children and their parents were interviewed separately using the Anxiety Disorders Interview Schedule (ADIS) to determine the child's diagnosis. The child's status as a discloser of high distress or discloser of low distress was determined by the parents' endorsement of an anxiety disorder and the child's endorsement or lack of endorsement of an anxiety disorder, respectively. Parents, teachers, and children also completed measures assessing the child's psychopathology (e.g., Revised Children's Manifest Anxiety Scale, Child Behavior Checklist). In general, findings indicated that the level of distress reported by the children moderated treatment outcome. Although both groups benefited from treatment, the children disclosing high distress experienced greater treatment gains than the children disclosing low distress.     

Beyond Behaviour: Is Social Anxiety Low in Williams Syndrome?

Individuals with Williams syndrome (WS) exhibit striking social behaviour that may be indicative of abnormally low social anxiety. The present research aimed to determine whether social anxiety is unusually low in WS and to replicate previous findings of increased generalised anxiety in WS using both parent and self report. Fifteen individuals with WS aged 12–28 years completed the Spence Children’s Anxiety Scale (SCAS) and the Children’s Automatic Thoughts Scale (CATS). Their responses were compared to clinically anxious and community comparison groups matched on mental age. The findings suggest that WS is not associated with unusually low social anxiety but that generalised anxiety symptoms and physical threat thoughts are increased in WS, relative to typically developing children.     

Spanish validation of the Spence Children's Anxiety Scale

The purpose of this study was to investigate the factorial structure and psychometric properties of the Spence Children’s Anxiety Scale (SCAS) in a sample of 1,708 Spanish children aged between 8 and 12 years. The SCAS was demonstrated to have satisfactory internal consistency with the Spanish sample, and factor analysis confirmed the six-factor original model. Convergent validity was supported by correlations with the State-Trait Anxiety Inventory for Children and the welfare dimension of the Child Health and Illness Profile-Children Edition. Low correlations between the SCAS and the Children’s Depression Inventory supported the divergent validity. Analysis suggested that anxiety scores decrease with age, and girls reported higher scores than boys. Overall, the SCAS was shown to have good psychometric properties for use with Spanish children by clinicians and researchers.     

Child and Family Predictors of Therapy Outcome for Children with Behavioral and Emotional Problems

This study investigated the characteristics of 106 children primarily referred for externalizing behavior problems and their families, and assessed the prediction of treatment outcome following a standardized short-term, cognitive behavioral group program. Exploring Together comprised a children’s group (anger management, problem-solving and social skills training), a parents’ group (parenting skills training, dealing with parents’ personal, relationship and family-of-origin issues), and a combined children’s and parents’ group (to target parent–child interactions). The main predictors of reductions in externalizing and internalizing behaviors at home following treatment were children’s pre-existing levels of these behavioral and emotional problems (children with higher levels improved most), and positive parent–child interaction. Higher pre-existing levels of behavioral and emotional problems and low levels of attention problems predicted greater improvement in post-treatment school behaviors. Implications of the findings for improving interventions for childhood behavioral and emotional problems are discussed     

Attention deficit disorder and the internalizing dimension in males, ages 9-0 through 11-11

This study assessed the presence of internalizing psychological problems in 9- to 11-year-old males diagnosed with attention deficit hyperactivity disorder (ADHD). The participants' raw scores on the Behavior Assessment System for Children (BASC) Parent Scale, Teacher Rating Scale, and Self-Report of Personality (Reynolds & Kamphaus, 1992) along with the Revised Children's Manifest Anxiety Scale (Reynolds & Richmond, 1985) were compared to the normative sample for each respective measure. The results found that ADHD children presented with significantly (p <.05) higher levels of both anxiety and depression on the BASC and anxiety on the RCMAS when ratings were completed by parents, teachers, and self-report. The results were discussed in terms of the comorbidity of internalizing disorders with ADHD children and need to consider differential behavioral and medical intervention.     

Pilot study of anxiety and depression in prepubertal children

Early detection of anxiety and depression is important because of the relationship between these disorders, suicide and other problems (i.e. social, phobias, learning problems). This study screened prepubertal students in a school setting for symptoms of anxiety and depression using self-report measures (Revised Children's Manifest Anxiety Scale and the Children's Depression Inventory). Controls and children who scored high on measures of anxiety or depression or both were interviewed with their parents and were tested using the Diagnostic Interview for Children and Adolescents (computer version) and the Peabody Individual Achievement Test. Initial results indicated that anxiety is more prevalent in prepubertal children than depression. The correlation between different diagnostic measurements used in this project was calculated. A correlation was found between low scores of self-esteem and high scores of anxiety and depression on self-reports. It is concluded that self-report measures are good screening tools.     

Anxiety symptoms among children after the Wenchuan earthquake in China

Aim: We explore the prevalence and risk factors of anxiety symptoms among child survivors after an earthquake. Methods: This study was conducted among children aged 7-15 years in Qingchuan County 1 year after the Wenchuan earthquake. Trauma experiences and anxiety symptoms were assessed with a modified earthquake exposure scale and the Revised Children's Manifest Anxiety Scale. A total of 21,652 children participated in the survey. Results: The prevalence rate of anxiety symptoms was 18.9% among all participants. In a multivariate analysis, anxiety symptoms were significantly associated with gender, age, cultural differences and earthquake exposure. Anxiety symptoms were common among children in the Wenchuan earthquake area 1 year after the earthquake. Gender, age, culture and traumatic experiences from the earthquake may significantly influence anxiety symptoms among children. Discussion: This study provides baseline data about psychological outcomes among child survivors following an earthquake.     

Psychopathological status, behavior problems, and family adjustment of Kuwaiti children whose fathers were involved in the first gulf war

Objectives

Following the end of the Gulf War that resulted in the liberation of Kuwait, there are no reports on the impact of veterans' traumatic exposure and posttraumatic stress disorder (PTSD) on their children. We compared the severity of anxiety, depression, deviant behavior and poor family adjustment among the children of a stratified random sample of four groups of Kuwaiti military men, viz: the retired; an active -in-the-army group (AIA) (involved in duties at the rear); an in-battle group (IB) (involved in combat); and a prisoners -of- war (POWs) group. Also, we assessed the association of father's PTSD/combat status and mother's characteristics with child psychosocial outcomes.

Method

Subjects were interviewed at home, 6 years after the war, using: the Child Behavior Index to assess anxiety, depression, and adaptive behavior; Rutter Scale A2 for deviant behavior; and Family Adjustment Device for adjustment at home. Both parents were assessed for PTSD.

Results

The 489 offspring (250 m, 239 f; mean age 13.8 yrs) belonged to 166 father-mother pairs. Children of POWs tended to have higher anxiety, depression, and abnormal behavior scores. Those whose fathers had PTSD had significantly higher depression scores. However, children of fathers with both PTSD and POW status (N = 43) did not have significantly different outcome scores than the other father PTSD/combat status groups. Mother's PTSD, anxiety, depression and social status were significantly associated with all the child outcome variables. Parental age, child's age and child's level of education were significant covariates. Although children with both parents having PTSD had significantly higher anxiety/depression scores, the mother's anxiety was the most frequent and important predictor of child outcome variables. The frequency of abnormal test scores was: 14% for anxiety/depression, and 17% for deviant behavior.

Conclusion

Our findings support the impression that child emotional experiences in vulnerable family situations transcend culture and are associated with the particular behavior of significant adults in the child's life. The primacy of the mother's influence has implications for interventions to improve the psychological functioning of children in such families. Mental health education for these families has the potential to help those in difficulty.     

Anger and Sadness Perception in Clinically Referred Preschoolers: Emotion Processes and Externalizing Behavior Symptoms

This study examined emotion perception processes in preschool aged children presenting with clinically significant emotional and behavior problems, with emphasis on sadness perception accuracy (i.e., the ability to correctly identify sadness from expressive and situational cues) and anger perception bias (i.e., the tendency to perceive anger in the absence of concordant cues) as related to children’s externalizing symptoms. Participants were 82 children (3–5 years of age) admitted to a psychiatric day treatment program. Children participated in a structured puppet play activity to assess emotion understanding. Mothers reported on children’s externalizing symptoms and program staff reported on children’s emotion regulation and negative emotional lability. Young children in this clinical sample demonstrated generally age-appropriate ability to identify basic emotions as expressed within prototypical social situations. Most emotion perception errors involved the over-identification of sadness. Children’s decreased accuracy in sadness perception was associated with increased externalizing symptoms. Children’s negative emotional lability contributed unique variance to the prediction of externalizing symptoms, with more labile children also demonstrating increased symptoms. Results underscore the role of emotion processes in early childhood mental health problems, with implications for emotion-based treatments of early externalizing behavior symptoms.     

The Screen for Child Anxiety Related Emotional Disorders (SCARED) and traditional childhood anxiety measures

The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a self-report questionnaire that measures symptoms of DSM-IV linked anxiety disorders in children. This article presents two studies that investigated the relationship between the SCARED, on the one hand, and two other widely used anxiety measures for children, namely the Revised Children's Manifest Anxiety Scale (RCMAS) and the Fear Survey Schedule for Children-Revised (FSSC-R), on the other hand. Results indicate that SCARED scores are positively and in a theoretically meaningful way related to RCMAS and FSSC-R scores, and thus provide evidence for the concurrent validity of the SCARED.     

Children’s perceptions of dissimilarity in parenting styles are associated with internalizing and externalizing behavior

The purpose of this study was to examine the relationship between children’s perception of dissimilarity in parenting styles, and internalizing and externalizing problems in children. Children from the general population (n = 658) reported on the level of emotional warmth, rejection, and overprotection of both parents by filling out the child version of the Egna Minnen Betr?ffande Uppfostran (EMBU-C) and mothers completed the child behavior checklist (CBCL). Intraclass correlations were computed as measures of dissimilarity between parenting styles of mothers and fathers. Children’s perceived dissimilarity in parental emotional warmth is associated with internalizing and externalizing problems (β = 0.092, p < 0.05; β = 0.091, p < 0.05). Perceived dissimilarity between parents’ overprotection is associated with externalizing problems (β = 0.097, p < 0.05). Perceived dissimilarity between parenting styles is associated with externalizing and internalizing problems, over and above the effects of the level of the parenting styles. The results highlight the negative consequences of perceived dissimilarity between parents. To conclude, children have more internalizing and externalizing problems when they perceive their parents as more dissimilar in parenting styles.