Generalized anxiety disorder in a nonclinical sample of children: symptom presentation and predictors of impairment

Presentation of generalized anxiety disorder (GAD) in a nonclinical sample of children (7-11 years old) and factors that predict overall impairment were examined. Symptom presentation was compared in children with GAD (n=49) and anxious children without GAD (n=42). Children with GAD endorsed significantly more worries, greater intensity of worries, and more DSM-IV associated symptoms than anxious children without GAD. Eighty-six percent of children with GAD had a comorbid diagnosis with 4% having a depressive disorder. Number of associated symptoms was most predictive of GAD impairment based on child perspective and intensity of worry was most predictive based on clinician perspective. Overall, findings from the current study are consistent with reports based on clinical samples. The DSM-IV-TR criteria for GAD were supported, with the exception that children with GAD typically present with several associated symptoms, rather than only one.     

Childhood anxiety in a diverse primary care population: parent-child reports, ethnicity and SCARED factor structure

OBJECTIVE: To explore in a multiethnic primary care population the impact of child gender and of race/ethnicity on parent and child reports of school-age anxiety and on the factor structure of the Screen for Childhood Anxiety and Related Emotional Disorders (SCARED). METHOD: A consecutive sample of 515 children (8 to <13 years) and their parent presenting for primary care completed self-report (C) and parent-report (P) versions of the SCARED-41. RESULTS: Neither SCARED scores nor parent-child difference varied significantly with race/ethnicity. Predictors of higher SCARED scores were less parental education, younger child age and female gender. Exploratory factor analysis conducted separately for SCARED-C and SCARED-P yielded four factors. There was large variation in factor structure between SCARED-C and SCARED-P and across ethnic and gender subgroups, greatest for somatic/panic/generalized anxiety and Hispanic children. CONCLUSIONS: Primary care triage of anxious children requires data from both the parent and child and must go beyond cross-sectional symptom inventories. Clinicians must elicit from each family their perhaps culturally bound interpretation of the child's somatic and psychological symptoms.     

Factors affecting the diagnosis and prediction of PTSD symptomatology in children and adolescents

OBJECTIVE: In a cohort that spanned all of childhood and suffered equivalent types of traumas, the authors examined diagnostic validity and risk factors for posttraumatic stress disorder (PTSD). For older children, parent-child agreement was investigated. METHOD: Sixty-two children ages 0-18 years who were hospitalized with injuries were assessed 2 months later for PTSD. Mothers were interviewed, and concurrent interviews were conducted with 24 adolescents. RESULTS: Children did not attain the DSM-IV threshold of three criterion C items until age 7. The 0-6-year-old group had significantly fewer criterion C symptoms (mean=0.43) than the 12-18-year-olds (mean=1.17). The impact of altering thresholds for criteria C and D was examined. Older children reported symptoms meeting criterion B significantly more often (79.2%) than parents (45.8%). Combined parent-child reports yielded significantly more symptoms and higher rates for criteria B, C, and D (almost a twofold increase) and for the overall diagnosis (37.5%) than parent report alone (4.2%). This 8.9-fold increase in diagnosis from combined reports suggests that the diagnostic rates for children who cannot make self-reports may greatly underestimate the true numbers. The interaction between pretrauma externalizing behavior and witnessing a threat to a caregiver had a significant effect on the total number of PTSD symptoms. CONCLUSIONS: These findings provide additional support for lowering the requirement of three criterion C symptoms for preschool children and raise questions about the appropriateness of this threshold for prepubertal children. The validity of studies that do not assess symptoms with combined parent and child reports is limited.     

The Validity of the Screen for Child Anxiety Related Emotional Disorders Revised (SCARED-R) Scale and Sub-Scales in Swedish Youth

We evaluated the clinical utility of the Swedish SCARED-R in child- and adolescent psychiatric outpatients (n?=?239) and validated it against Longitudinal Expert All Data (LEAD) DSM IV diagnoses based on the Children’s Schedule for Affective Disorders and Schizophrenia (KSADS) and subsequent clinical work-up and treatment outcome. The SCARED-R total score and subscales had acceptable sensitivity/specificity for child and parent reports for cut-offs based on Receiver Operating Characteristics (ROC) curves, with mostly moderate area under the curve. Sensitivity ranged from 75% (parent rated social anxiety) to 79% [child rated Generalized Anxiety Disorder (GAD)]. Specificity, ranged from 60% for child-rated GAD to 88% for parent rated social anxiety. Parent-child agreement was moderate, and each informant provided unique information contributing to most diagnoses. In conclusion, the SCARED-R is useful for screening anxiety symptoms in clinical populations. However, it cannot replace interview based diagnoses, nor is it adequate to use just one informant.     

Ethnic Differences in Somatic Symptom Reporting in Children With Asthma and Their Parents

ObjectivesThe purpose of this study is to examine the association between child and parent somatic symptom reporting and pediatric asthma morbidity in Latino and non-Latino white children.MethodThe study consists of 786 children, 7 to 15 years of age, in Rhode Island (RI) and Puerto Rico. Children's and parents' levels of general somatic symptoms were assessed with well-established self-report measures. Clinician-determined asthma severity was based on reported medication use, asthma symptom history, and spirometry results. Asthma-related health care use and functional morbidity was obtained via parent self-report.ResultsChild and parent reports of general somatic symptoms were significantly related to pediatric asthma functional morbidity when controlling for poverty, parent education, child's age, and asthma severity. In controlling for covariates, Latino children in RI reported higher levels of somatic symptoms than Island Puerto Rican children, and RI Latino parents reported more somatic symptoms than RI non-Latino white parents (p < .05).ConclusionsThis study replicates and extends to children in previous research showing higher levels of symptom reporting in Latinos relative to whites. Results also provide new insight into the relation between general somatic symptom reports and pediatric asthma. Ethnic differences in somatic symptom reporting may be an important factor underlying asthma disparities between Latino and non-Latino white children.     

Parental reports of somatic symptoms in preschool children: prevalence and associations in a Spanish sample

OBJECTIVE: To document prevalence and associations of somatic symptoms in Spanish preschool children. METHOD: Subjects were 3- to 5-year-olds attending nurseries (8 urban, 30 rural). Parental questionnaires (response rate 77%) were used to inquire about somatic symptoms in the child in the 2 weeks prior to assessment, about preschool absence and pediatric help-seeking, chronic family health problems, and recent stressful life events for the child. Parents completed questionnaires on child psychopathology (Early Childhood Inventory 4) and their own mental health (General Health Questionnaire). Children who were reported as complaining of symptoms frequently (four or more times) were compared to noncomplaining children. RESULTS: Parents reported that 452 of the 807 (56%) children complained of somatic symptoms at least once, significantly more so in urban than in rural areas. Frequent somatic complaints were reported for 165 of the 807 (20%) (abdominal pains 7.9%, tiredness 5.7%, leg pains 4%, headaches 2%, dizziness 0.4%). There were significant associations of frequent symptom reporting with days off preschool and pediatric clinic attendance, with emotional and behavioral symptoms in children, mental distress in parents, and urban abode. CONCLUSIONS: Somatic symptoms are common in preschool children. Results point to family influences.     

Generalized anxiety disorder in adolescents and young adults with mild mental retardation

This report examines clinical features of generalized anxiety disorder in adolescents and young adults with mild mental retardation (MR), compared with children and adolescents with normal IQ. Frequency of symptoms, comorbidity, agreement between reports of subjects and parents, correlation between IQ and severity of disorder, and comparison between frequency of symptoms in the experimental and control groups are described. Twenty-two subjects with MR (12 males and 10 females aged 11-25 years; mean age = 16.3), 30 children (19 males and 11 females aged 7-11.11; mean age = 10), and 30 adolescents (18 males and 12 females aged 12.1-18; mean age = 15.2) participated in the study. All the subjects were comprehensively diagnosed with diagnostic interviews (K-SADS or DICA-R). According to our data, generalized anxiety disorder can be diagnosed in adolescents with mild MR, with high agreement between self-reports and parent reports. Phenomenology of GAD in mildly developmentally delayed persons grossly paralleled that of normal IQ people, except for brooding, somatic complaints, and sleep disorders. Number and severity of symptoms did not correlate with Full Scale and Verbal IQs. High rates of comorbidity with depression were evident both in normal IQ and in developmentally delayed subjects.     

Generalized Anxiety Disorder in youth: diagnostic considerations

Background: Generalized Anxiety Disorder (GAD) in youth is characterized by excessive worry across domains for ≥6 months, an inability to stop worrying, and at least one physiological symptom. This study examined the multiple domains that optimally distinguish (1) GAD youth from nonanxiety‐disordered youth and (2) GAD youth from other anxiety‐disordered youth. Methods: Receiver operating characteristic analyses examined a sample of youth (N=180) aged 7–13 (M=10.10; 52% male), to determine optimal cut scores to distinguish GAD youth from (1) nonanxiety‐disordered youth and (2) other anxiety‐disordered youth. The diagnostic efficiency of worries and physiological symptoms was also examined. Results: By parent report, three worries and four physiological symptoms had favorable cut scores, and several specific worries possessed high diagnostic efficiency. Children endorsed fewer GAD symptoms. Conclusions: Recommendations are made regarding the criteria for GAD in youth and interview sequencing of symptom queries. Depression and Anxiety, 2011.© 2010 Wiley‐Liss, Inc.     

Generalized Anxiety Disorder and Social Anxiety Disorder in Youth: Are They Distinguishable?

The current study was designed to examine diagnostic validity of social anxiety disorder (SOC) and generalized anxiety disorder (GAD) in youth, and implications of comorbidity of the disorders for nosology. Children (n = 130) with SOC, GAD, or both disorders (COMORBID) and their parents were administered diagnostic interviews and self-report measures. Confirmatory factor analyses (CFAs) and ANOVAs were performed for the three groups (SOC, GAD, COMORBID). Second-order CFAs for both parent and child informants suggested that SOC and GAD are two specific facets of a general anxiety factor. ANOVA analyses revealed the two pure groups differed only on parent-reported SOC symptoms and GAD worry symptoms, as hypothesized. COMORBID children had higher scores than SOC group on parent-reported GAD symptoms, worry, and behavioral inhibition, and COMORBID children had higher scores than GAD group on parent-reported SOC symptoms and social anxiety. Results may have implications for assessment of GAD and SOC.     

Screening for childhood anxiety symptoms in primary care: integrating child and parent reports

OBJECTIVE: Parents' concerns typically determine the focus of a primary care visit. This study examined which information is lost if child reports are excluded from screening for anxiety. It also explores the use in primary care of the Screen for Child Anxiety Related Emotional Disorders (SCARED) and the Pediatric Symptom Checklist (PSC-17). METHOD: Two hundred thirty-six children (8-12 years 11 months) and their parents completed SCARED and PSC-17 before a primary care visit occurring during discrete periods between June 1999 and March 2001. RESULTS: Child reports yielded higher SCARED scores than parent reports (mean=18.12, SD=12.14 versus 14.43, SD=10.34, p <.001). Somatic/panic and separation anxiety accounted for 73.8% of the excess score from children's reports. The level of parent-reported symptoms did not vary with demographics. Female gender and younger age predicted greater excess reporting by children. Parent and child scores were moderately to highly correlated (R=0.55 total score; 0.40-0.58 subfactors). CONCLUSIONS: There are discrete anxiety domains in which children's reports are likely to yield more information than that of parents. This phenomenon is almost entirely attributable to variations in the level of symptoms reported by children. Studies are needed to design brief screening procedures that integrate parent and child reports and carry age- and gender-adjusted thresholds.     

Somatic Complaints in Children with Anxiety Disorders and their Unique Prediction of Poorer Academic Performance

The present study aimed to examine somatic complaints in children with anxiety disorders compared to non-anxious control children and whether somatic complaints predict poorer academic performance. The sample consisted of 108 children and adolescents (aged 8–14 years) assessed by a structured diagnostic interview: 69 with a principal (i.e., most severe and/or interfering) anxiety disorder diagnosis and 39 non-anxious community controls. Established child and parent report measure of somatic complaints, anxiety, and internalizing symptoms were completed. The participants’ primary teacher was used to assess academic performance. Findings indicated that children with anxiety disorders reported more somatic complaints than the non-anxious community controls. Furthermore, a greater frequency of somatic complaints uniquely predicted poorer academic performance beyond that accounted for by anxiety and internalizing symptoms based on both child and parent report measures. Knowledge about somatic complaints in children with anxiety disorders and their relation to academic functioning may allow for early identification and prevent academic problems.     

A brief group cognitive-behavioral intervention for social phobia in childhood

Twenty-three preadolescent children (ages 8-11) meeting criteria for social phobia were randomly assigned to either a 3-week cognitive-behavioral group intervention or a wait-list control group. The intervention consisted of psychoeducation, cognitive strategies, and behavioral exposure. Outcome measures included diagnostic interview as well as parent and child report measures of anxiety and depression. Improvements were observed at posttest, with results stronger for parent report and interviewer ratings than for child self-report. At 3-week follow-up, children receiving the intervention demonstrated significant improvements on the majority of child, parent, and interviewer reports of social anxiety and related symptoms relative to wait-list participants. Preliminary support is provided for the utility of a brief intervention for preadolescent children with social phobia. Limitations and implications for future research are discussed.     

Child-reported depression and anxiety in preadolescence: I. Associations with parent- and teacher-reported problems

OBJECTIVE: To examine a wide range of parent- and teacher-reported behaviors in relation to child-reported depression and anxiety in preadolescence. METHOD: Subjects were participants in a longitudinal study of 420 preschool children from the general population that started in 1989. At second follow-up 8 years later (ages 10-11 years), usable parent information was obtained for 358 children. For this study, 274 children for whom complete child, parent, and teacher reports were obtained at age 10 to 11 years were included. Measures included the Dimensions of Depression Profile for Children, the State-Trait Anxiety Inventory for Children, the Child Behavior Checklist/4-18, and the Teacher's Report Form. RESULTS: Of 120 parent-reported problem items, only 11 and 9 were associated with child-reported depression and anxiety, respectively. For teachers, 33 and 20 items (of 120) were significantly associated with child-reported depression and anxiety, respectively, including items referring to withdrawal, anxiety, depression, social problems, and academic problems. CONCLUSIONS: Teachers are more likely than parents to notice internalizing problems and related problems such as social and academic problems in children reporting depression or anxiety.     

Fathers' and mothers' perceptions of their child and maternal depressive symptoms

Fathers' reports concerning their children have seldom been considered in the previous studies on maternal depression and child development. The literature on parental reports in general suggests that discrepancies in mothers' and fathers' perceptions are associated with the psychological state of the parent and the gender of the child. As part of a prospective follow-up study, fathers' and mothers' perceptions of children's social competence and behavioural/emotional problems were assessed by the Child Behavior Checklists (CBCLs) when the firstborn children were 8-9 years old. The depressive symptoms of the mothers were screened by the Edinburgh Postnatal Depression Scale (EPDS) at the same time point. The level of children's social competence and behavioural/emotional problems reported by the fathers were analysed by background factors. The reports of both parents were explored by the gender of the child and by the presence of maternal depressive symptoms. The concordance of parental reports concerning child's social competence was high, but fathers usually reported lower problem levels than mothers, particularly for boys' problems. The presence of maternal depressive symptoms was associated with child's high problem levels from both fathers' and mothers' perspective. Parental ratings of children's externalizing problems in particular were associated with high maternal depressive symptom level.     

Learning Processes Associated with Panic-Related Symptoms in Families with and Without Panic Disordered Mothers

The present study compared learning processes associated with panic-related symptoms in families with and without panic disordered mothers. Using a multi-informant approach, 86 mothers [of whom 58 had a primary diagnosis of panic disorder (PD)], their partners and teenage children (mean age, 16.67 years) reported about parents’ behavior (modeling and operant learning) in response to children’s and parents’ experience of panic-related symptoms. Both, maternal and child reports revealed that mothers with PD were more likely to show panic-maintaining behavior and to involve their children in their own experience of panic-related symptoms than mothers without PD. Mothers with PD reported more often to be punished by others for their experience of panic-related symptoms than mothers without PD. Conversely, parent and child reports did not reveal differences between parents’ reactions to their children’s experience of panic-related symptoms in families with and without a PD mother. Given that mothers with PD were reported to behave differently in relation to their own experience of panic-related symptoms but not in relation to their children’s experience of panic-related symptoms, the present study offers preliminary evidence that modeling, rather than operant learning, might affect children’s sensitivity to somatic symptoms.     

A Parental Report of Children’s Anxiety Symptoms in Japan

Using parental reports, the current study investigated anxiety symptoms among Japanese children as part of the process of developing the Japanese version of the Spence Children’s Anxiety Scale for Parents (SCAS-P). The participants were 677 parents and children aged 9–12 years. Confirmatory factor analysis on 568 parents and children supported that the SCAS-P had a 6-factor structure. The scale showed satisfactory internal consistency and good convergent validity. A MANOVA indicated no significant gender or age differences except for the obsessive–compulsive disorder subscale. Among Japanese children, the most prevalent symptoms within the parental report were items related to fear of the dark and of insects/spiders. Finally, we observed very low correlations between parental and child reports of anxiety symptoms; the relationships between child and parental reports were rather poor among Japanese children. We briefly discuss the utility of the SCAS-P as a screening instrument assessing parental reports of anxiety symptoms.     

Characteristics of parent- and child-reported anxiety in psychostimulant medication naïve, clinically referred children with attention deficit hyperactivity disorder, combined type (ADHD-CT)

OBJECTIVE: Anxiety is a frequent comorbid condition in referred primary school-age children with attention deficit hyperactivity disorder, combined type (ADHD-CT), yet there has been relatively little systematic research of the nature of this comorbid anxiety. We describe the characteristics of parent-reported child anxiety disorders and child-reported anxiety disorders in primary school-age children with ADHD-CT. METHOD: A cross-sectional study of 75 clinically-referred psychostimulant medication na?ve children with ADHD-CT examining separately parent and child reports of anxiety, defined categorically and dimensionally. A two-year follow up of 12 children with parent-reported child anxiety and 12 children with child-reported anxiety was also completed. RESULTS: There was no significant association between the child and parent reports of anxiety. Generalized anxiety disorder (GAD), separation anxiety disorder (SAD), specific phobia (SpPh) and social phobia (SoPh) were the most common anxiety disorder diagnoses reported by parents and children. Two-year follow-up data revealed no decrease in the parent report but a significant decrease in the child report of anxiety disorders. CONCLUSIONS: The dissonance between the parent report of child anxiety and the child report of anxiety, emphasizes the importance of careful and thorough clinical assessment of the child's perspective. The nature of parent-reported child anxiety and children's self-report of anxiety requires further systematic research.     

Comparison of parent and teacher reports of attention-deficit/hyperactivity disorder symptoms from two placebo-controlled studies of atomoxetine in children.

BACKGROUND: The validity of parent reports regarding children's attention-deficit/hyperactivity disorder (ADHD) symptoms has been questioned. This study assessed whether parent reports were as sensitive as teacher reports to document change in ADHD symptoms during clinical trials with atomoxetine. METHODS: Data were compared from two randomized, double-blind, placebo-controlled clinical trials of atomoxetine using different versions (parent or teacher) of the same rating scale (Attention-Deficit/Hyperactivity Disorder Rating Scale-IV [parent or teacher] Version: Investigator Administered and Scored - ADHD RS). Exclusion criteria included history of bipolar disorder, psychosis, seizures, alcohol abuse, or positive drug screen. Patients (6-16 years old) were treated with atomoxetine (titrated to a maximum dose of 1.8 mg/kg/day) administered once daily for up to 7 weeks. Parent and teacher ratings were compared using an analysis of covariance (ANCOVA) model. RESULTS: The analysis (n = 318) showed that treatment effects (mean change, baseline to endpoint) were similar between parent and teacher ratings (total, p = .762; inattention, p = .519; hyperactive/impulsive, p = .955). Effect sizes also were similar based on total scores (parent ratings = .69; teacher ratings = .63). CONCLUSIONS: Parent reports are as sensitive as teacher reports in assessing the efficacy of long-acting pharmacologic treatment for ADHD in children during clinical trials using the nonstimulant atomoxetine.     

Profile of children investigated for sexual abuse: association with psychopathology symptoms and services

Sexually abused children may have poor mental health because of their victimization as well as preexisting or co-occurring family problems. However, few studies consider psychopathology in relation to both abuse and other family experiences. This study uses data from the National Survey of Child and Adolescent Well-Being (NSCAW) to create latent subgroups of 553 children investigated for sexual abuse. The study investigates children's psychological symptoms and child welfare service (CWS) patterns to understand how children's needs relate to mental health services. Analyses were conducted by child age: 3-7, 8-11, and 12-14. Factor mixture modeling and regression analyses were used. Results show meaningful subgroups of children that relate to different symptom patterns. Among 3- to 7-year-olds, behavioral symptoms are associated with caregiver domestic violence and mental illness. Among 8- to 11-year-olds, depressive symptoms are associated with severe abuse and multiple family problems, whereas posttraumatic stress is associated with chronic, unresolved abuse. Although many children received mental health services, services are not well matched to children's needs--the substantiation status of the abuse explains services. Implications for CWS and mental health services are discussed.     

Factors Associated with Parent–Child Discrepancies in Reports of Mental Health Disorders in Young Children

The study compares parent and child reports of child mental health to determine the relationship between parent–child disagreement and parental psychological and attitudinal factors, and to determine how parent–child disagreement is associated with the use of specialized services. A cross-sectional study was conducted with 1268 children aged 6–11 years using the Dominic Interactive and the Strengths and Difficulties Questionnaire. Psychological distress and negative parental attitudes were associated with greater reporting of mental health problems, leading to greater parent-child agreement on symptom presence, and to parental over-reporting of symptoms. Parent/child agreement was associated with 43.83% of contact with a mental health provider for externalizing and 33.73% for internalizing problems. The contribution of key parental psychological and attitudinal factors in parent–child disagreement on child mental health status may prove helpful in improving the identification of children in need of specialized services.