Childrearing Style of Anxiety-Disordered Parents

This study investigated whether anxiety-disordered (AD) parents differ in their childrearing style from non-disordered parents. A clinical sample of 36 AD parents with children aged 6–18 was compared with a normal control sample of 36 parents. Childrearing was assessed through parent report and child report. The results demonstrated significant differences in childrearing style between AD parents and non-disordered control parents, both from the perspective of the parent and from that of the child. AD parents reported a less nurturing and more restrictive rearing style than control parents. Their children did not report more rejection or less warmth than children of control parents; they did, however, report significantly more overprotection than children of control parents. The findings, from parental as well as child reports, apply to both AD mothers and AD fathers.     

Assessing anxiety with the Child Behavior Checklist and the Teacher Report Form

We evaluated the utility of Anxiety scales for the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF). The scales (CBCL-A; TRF-A) were examined using mothers and teachers of anxiety-disordered (AD; 157 mothers, 70 teachers) and non-anxiety-disordered (NAD; 100 mothers, 17 teachers) children. Separate samples of parents and teachers of AD (mothers=145, fathers=120, teachers=137) and NAD (mothers=35, fathers=29, teachers=27) children cross-validated the original findings. CBCL-A and TRF-A scores significantly discriminated AD children from NAD children and correlated significantly with other measures of child anxiety. The CBCL-A and TRF-A were sensitive to treatment changes. Relative to the CBCL/TRF Anxious/Depressed syndromes and Internalizing dimensions, the CBCL-A and TRF-A improved prediction of anxiety status. Relative to Achenbach, Demenci, and Rescorla's [Achenbach, T. M., Demenci, L., & Rescorla, L. A. (2003). DSM-oriented and empirically based approaches to constructing scales from the same item pools. Journal of Clinical Child and Adolescent Psychology, 32, 328-340] CBCL Anxiety subscale, the CBCL-A predicted comparably. Findings are discussed in terms of the CBCL-A and TRF-A as clinical tools.     

Assessment of Relevant Parenting Factors in Families of Clinically Anxious Children: The Family Assessment Clinician-Rated Interview (FACI)

Objective Research on child and adolescent anxiety disorders has seen a surge in investigations of parenting factors potentially associated with their etiology. However, many of the well-established parenting measures are limited by over-reliance on self-report or lengthy behavioral observation procedures. Such measures may not assess factors most salient to anxiety etiology, since most family functioning measures were not originally developed for this purpose. The Family Assessment Clinician Interview (FACI) was developed as a clinician-administered interview of parent and family factors associated with child and adolescent anxiety. The present study is the first to investigate the psychometric properties of the FACI. Method Using a clinical sample of 65 children with various anxiety disorders, and their parents, inter-rater reliability, convergent validity and associations with child-reported and clinician-evaluated anxiety severity were examined. Results suggest that the FACI has good to excellent inter-rater reliability with kappas ranging from 0.79 to 1.0 across FACI scales and subscales. Some evidence of convergent validity with relevant portions of the Family Environment Scale was observed, although the latter findings varied by respondent (mother versus father). The Family Warmth/Closeness subscale of the FACI was consistently associated with increased child anxiety symptoms. Contrary to expectations, higher levels of parental expectations were associated with lower levels of child anxiety. Conclusion Results suggest that the FACI is a promising measure of family anxiety constructs that may be useful in both research and clinical settings.     

首次住院儿童青少年精神障碍患儿父母压力调查及干预研究

目的 调查首次住院儿童少年精神障碍患儿父母的心理压力状况,并通过干预指导,改善父母心理状况.方法 采用心理身体紧张松弛测试表(PSTRI)和自编问卷的方法 ,对121例患儿父母的心理压力及对精神障碍相关知识了解程度进行了调查,并对其实施有针对性地干预指导.结果 通过干预,患儿出院时其父母心理压力状况明显优于患儿入院时,有显著性差异(X2=147.02,P<0.01);患儿父母在精神疾病基本知识、药物治疗知识、护理知识、促进康复知识、预防知识掌握上,入院时与出院时相比具有显著性差异(X2=144.39～171.68,P<0.01).结论 首次住院的儿童少年精神障碍患儿父母心理压力普遍较重,对其进行有针对性地干预指导,可有效改善父母心理状况,有助于精神障碍患儿的治疗及减少复发.     

Siblings of children with autism: Predictors of adjustment

As the prevalence of autism increases, so does the need to examine the effects of autism on family members of children with autism. The current study evaluated possible predictors of adjustment in siblings of children with autism. Aspects of the parents’ functioning as caregivers for a child with autism were examined to determine whether they predicted the adjustment of the child's sibling. Two hundred caregivers of 4–10-year-old children with autism who had at least one sibling without autism participated by filling out questionnaires online. Parental satisfaction with the role of caregiver for the child with autism was negatively correlated with difficulties in sibling adjustment, and it was the only significant predictor of sibling adjustment in a hierarchical regression analysis. Parental stress and parental self-efficacy were not unique contributors to sibling adjustment when other parental variables were considered. No significant relationship was found between parental therapy involvement and sibling adjustment, or between parental educational involvement and sibling adjustment. The lack of parental involvement as a predictor of sibling adjustment adds new findings to the current literature, which had found such a relationship in a previous study with a smaller sample.     

Parental expressed emotion and suicidal ideation in adolescents with bipolar disorder

Family environmental variables are risk factors for recurrent courses of mood disorder in adolescents. The present study examined the association between parental expressed emotion (EE)—critical, hostile and/or emotionally overinvolved attitudes toward a concurrently ill offspring—and suicidal ideation in adolescents with bipolar disorder. The sample consisted of 95 adolescents with a bipolar I or II diagnosis who had experienced a mood episode in the prior 3 months. Participants (mean age=15.54 years, S.D.=1.4) were interviewed and completed questionnaires regarding current and past suicidal ideation prior to their participation in a treatment trial. Parents completed five-minute speech samples from which levels of EE were assessed. High EE attitudes in parents were associated with current suicidal ideation in adolescents. This relationship was independent of the effects of age, gender, current depressive or manic symptoms, comorbid diagnoses, bipolar I/II subtypes, family adaptability, and family cohesion. These results underscore the importance of addressing the emotional reactivity of caregivers in treating adolescents with bipolar disorder who have suicidal ideation.     

Diagnosing Autism Spectrum Disorders in Pre-school Children Using Two Standardised Assessment Instruments: The ADI-R and the ADOS

The reliable diagnosis of Autism/Autism Spectrum Disorder in pre-school children is important for access to early intervention and for accurate ascertainment for research. This paper explores the combined use of two standardised assessment instruments—the Autism Diagnostic Interview Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS)—in a large sample of pre-school children. The children were recruited to research studies, and a ‘best estimate’ clinical diagnosis reached. The findings show good agreement between the instruments especially for children with core Autism. The instruments appear to have a complementary effect in aiding diagnosis and confirm the importance of a multidisciplinary assessment process with access to information from different sources and settings. The presence of repetitive behaviours during the ADOS appeared of diagnostic significance.     

Childhood Obsessive–Compulsive Disorder in the NIMH MECA Study: Parent Versus Child Identification of Cases

Because as many as 50% of obsessive–compulsive disorder (OCD) cases have had onset by age 15, interest in its detection in childhood is strong. Clinical experience indicates that children often try to keep their OCD secret and that parental report may give marked underestimates. The authors examined the prevalence of childhood OCD in the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, a four-site community survey which allowed comparison of both parent and child report of the child's OCD and related symptoms and disorders. OCD cases, based on structured interviews (DISC-2.3 with DSM-III-R criteria) with 1,285 caretaker-child pairs, were identified separately for parent and child (aged 9 through 17) informants from the MECA database. Cases were then examined for demographic characteristics, for obsessive–compulsive symptoms and other diagnoses reported in cases “missed” by one reporter, and for comorbid disorders. Of a total of 35 (2.7%) identified cases, four (0.3%) were identified by the parent and 32 (2.5%) were identified by the child, with only one overlapping case. In general, when OCD cases were “missed” by one reporter, that reporter did not substitute another disorder. These findings support clinical data that children with OCD often hide their illness and underscore the importance of child interviews for its detection.     

Social and Behavioral Problems of Children with Agenesis of the Corpus Callosum

Archival data from a survey of parent observations was used to determine the prevalence of social and behavioral problems in children with agenesis of the corpus callosum (ACC). Parent observations were surveyed using the Child Behavior Checklist (CBCL) for 61 children with ACC who were selected from the archive based on criteria of motor development suggesting a relatively high general level of functioning. Younger children with ACC (ages 2–5) were rated as primarily having problems with sleep. Older children with ACC (ages 6–11) manifested problems in attention, social function, thought, and somatic complaints. The older children with ACC were also compared to CBCL data from 52 children with autism who were selected from a previous study. Children with ACC were generally less impaired than children with autism on nearly all scales, with significantly less severe problems in the areas of attention, anxiety/depression, social function, and unusual thoughts. A further questionnaire related to diagnostic criteria for autism indicated that some children with ACC had traits that are among those that contribute to the diagnosis of autism within the domains of social interaction and social communication, but fewer who manifest repetitive and restricted behaviors.     

Brief report: Borderline personality symptoms and perceived caregiver criticism in adolescents

Despite findings of an association between adolescent psychopathology and perceived parental criticism, the relation between adolescent borderline personality disorder (BPD) symptoms and perceived parental criticism has not been examined. Given the centrality of interpersonal sensitivity to BPD (relative to other forms of psychopathology), we hypothesized that adolescent BPD symptoms would be uniquely related to perceived caregiver criticism, above and beyond other forms of psychopathology and general emotion dysregulation. Adolescents (N = 109) in a residential psychiatric treatment facility completed self-report measures of BPD symptoms, perceived caregiver criticism, emotion dysregulation, and symptoms of depression, anxiety, and posttraumatic stress disorder. Results revealed a unique relation of adolescent BPD symptoms to perceived caregiver criticism, above and beyond age, gender, and other forms of psychopathology. Findings suggest that adolescent BPD symptoms may have unique relevance for adolescents' perceptions of caregivers' attitudes and behaviors, increasing the likelihood of negative perceptions.     

社交焦虑障碍患者父母的人格特征和心理健康状况调查

目的探索社交焦虑障碍(SAD)患者父母的人格特征和心理健康状况。方法设研究组(SAD患者的父母)和对照组。入组时按要求进行艾森克人格问卷(EPQ)和症状自评量表(SCL-90)评定。结果SAD患者的父母在EPQ量表测验中的内外向因子标准分低于对照组;SAD患者的父母SCL-90各项因子除强迫和敌对因子,标准分低于对照组。结论SAD患者的父母的人格特征倾向内向,易安静、内省、离群、不喜欢接触人;SAD患者的父母更容易表现出躯体化症状、人际交往的困惑、抑郁、焦虑、恐怖和偏执。     

Targeted Behavioral Therapy for childhood generalized anxiety disorder: A time-series analysis of changes in anxiety and sleep

This study examined the efficacy of Targeted Behavioral Therapy (TBT), a newly developed intervention targeting features of childhood generalized anxiety disorder (GAD). Using a time-series design, 4 children (7–12 years) with primary GAD were treated with TBT, which includes sleep improvement strategies, systematic desensitization for reducing intolerance of uncertainty, and in vivo exposures for anxiety. Diagnostic interviews and questionnaires were administered at baseline, post-treatment and 3 months follow-up. Anxiety symptoms and sleep characteristics/problems were rated weekly during a 4-week baseline and 14-weeks of treatment. Two children remitted at post-treatment and no child had a GAD diagnosis at follow-up. Child but not parent report revealed improvements in both worry and sleep. Despite improvements from pre- to post-assessment, considerable symptom fluctuation observed during the baseline period preclude conclusion that symptom changes are specifically attributable to the course of treatment. Overall, preliminary support is provided for the efficacy of TBT for childhood GAD.     

The Obsessive-Compulsive Symptom (OCS) scale of the Child Behavior Checklist: a comparison between Swedish children with Obsessive-Compulsive Disorder from a specialized unit, regular outpatients and a school sample

To evaluate the discriminative power of various items as reported by parents in the OCS-scale extracted from the Child Behavior Checklist (CBCL) problem scale and to compare findings with outcomes of previous validation studies. Children referred to a specialized child psychiatric Obsessive-Compulsive Disorder (OCD) clinic (OCD group) (n=185) receiving a formal OCD diagnosis according to DSM IV criteria based on interviews with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) were compared to a sample recruited from regular child and adolescent psychiatric outpatient clinics (CPO group) (n=177). Both samples were compared to a normative school sample (SS group) and all three groups were matched for age and gender. Thirty seven CBCL items, mostly representing core internalizing symptoms and parts of the thought problem scale as well as physical and sleep problems, were first identified. Ten of these items (including all discriminative items in previous validation studies) could distinguish children with OCD from CPO patients. In a subsequent analysis, the results of a logistic regression showed that four CBCL items, "Obsessions," "Fearful and Anxious," "Compulsions," and "Worries" remained significant predictors. These four OCS items and previously used CBCL OCS-scales were further examined by means of ROC-analysis showing that the "Obsessions" and "Compulsions" CBCL items were the strongest predictors. These two CBCL items performed well as screens for OCS symptoms in children and adolescents and the addition of similar CBCL items did not further increase sensitivity or specificity. It is suggested that parental responses on these two items could preferably be used as screen for OCD in children and adolescents in regular child psychiatric clinics.     

Affect intensity and lability: the role of posttraumatic stress disorder symptoms in borderline personality disorder

Background: Emotion dysregulation is likely a core psychological process underlying the heterogeneity of presentations in borderline personality disorder (BPD) and is associated with BPD symptom severity. Emotion dysregulation has also been independently associated with posttraumatic stress disorder (PTSD), a disorder that has been found to co‐occur with BPD in 30.2% of cases in a nationally representative sample. However, relatively little is known about the specific relationships between emotion dysregulation and PTSD among those diagnosed with BPD. The purpose of this study was to evaluate relationships between PTSD symptom severity and negative affect intensity and affective lability among individuals with BPD. Method: Participants were 67 individuals diagnosed with BPD (79% women; M _age = 38, SD = 10), who reported one or more DSM‐IV PTSD Criterion A events. Results: Hierarchical multiple regression analyses indicated that when examined concurrently with BPD symptom severity, PTSD symptom severity, but not BPD symptom severity, was related to negative affect intensity and affective lability. Re‐experiencing symptoms uniquely predicted affective lability, and hyperarousal symptoms uniquely predicted negative affect intensity, lending additional support to emerging literature linking re‐experiencing and hyperarousal symptoms with emotion dysregulation. Conclusions: PTSD symptom severity among individuals with a BPD diagnosis is related to elevations in emotion dysregulation. It is important to evaluate whether early treatment of PTSD symptoms provided concurrently with BPD treatment leads to enhanced improvements in emotion regulation among individuals with co‐occurring PTSD and BPD. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Use of Melatonin in Children and Adolescents: Clinicians' and Parents' Perspective

Background:  There is a paucity of research on professionals' and parents' views on melatonin use in children and adolescents with sleep problems.
Method:  A two-stage survey was employed. First stage: Child psychiatrists and community paediatricians working in a health district were surveyed. Second stage: Parents/carers of children currently on melatonin under the care of these clinicians completed questionnaires.
Results:  Eighty-seven per cent of the participating clinicians prescribed melatonin, with most of them prescribing melatonin for chronic and treatment resistant cases. Differences in prescribing practices between child psychiatrists and community paediatricians were noted. All children were prescribed either 3 mgs or 6 mgs melatonin. None of them experienced any significant side effects.
Conclusions:  This research highlights that clinicians recognise melatonin as an effective treatment of childhood insomnia and parents value its usefulness too.
Key Practitioner Message:  Two-stage survey investigating the perspective of clinicians and parents on use of melatonin to treat sleep disorders in children.

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  87% (20/23) of the clinicians who participated in the survey prescribed melatonin.
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  Only 13% (3/23) of clinicians used pharmaceuticals as their first choice of treatment. 78% (18/23) used melatonin only in chronic or treatment resistant cases.
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  Parents (12) who participated in the survey noticed an improvement in sleep pattern and none reported any serious side-effects.

     

社交焦虑障碍患者父母养育方式分析

目的：探讨社交焦虑障碍（SAD）患者的发病与父母养育方式的关系。方法：采用自编社会人口学资料调查表、父母养育方式量表（EMBU）对30例SAD患者（患者组）和30名正常人（对照组）进行评估;以Liebowitz社交焦虑量表（LSAS）≥38分为界,评估SAD的严重程度。结果：患者组LSAS评分平均（78.0±27.8）分显著高于对照组的（22.2±9.0）分,两组比较差异有统计学意义（χ2=10.477,P〈0.01）。患者组EMBU中父亲的拒绝、否认因子分和过度保护因子分平均（11.10±3.93）分和（10.77±2.57）分显著高于对照组的（8.67±1.97）分和（9.30±1.77）分（t=3.035、2.578,P〈0.01或P〈0.05）;父亲的情感温暖、理解因子分和偏爱被试因子分平均（43.30±11.45）分和（10.50±2.91）分显著低于对照组的（51.20±8.10）分和（12.87±5.43）分（t=3.085、2.104,P〈0.01或P〈0.05）。母亲的拒绝、否认因子分平均（13.93±5.34）分显著高于对照组的（11.33±2.26）分（t=2.457,P〈0.05）,母亲的情感温暖、理解因子分和偏爱被试因子分平均为（43.07±12.07）分和（10.50±2.91）分显著低于对照组的（51.53±8.26）分和（12.87±5.43）分（t=3.170、2.104,P〈0.01或P〈0.05）。结论：SAD的发生与父母养育方式有关,不良的父母养育方式可能是SAD的发病原因之一。     

A Comparison of Father and Mother Report of Child Behaviour on the Strengths and Difficulties Questionnaire

To date there has been no comparison of father and mother report on the Strengths and Difficulties Questionnaire (SDQ), a standardised measure of child behaviour used widely in the UK in clinical practice and research. The objectives of the study were to investigate differences and agreement between parents on the various SDQ domains of child behaviour. Parents of 4–6 years olds were recruited via 13 UK general practices, and completed the SDQ and measures on depression, parenting, couple relationship, alcohol use and demographics. Parental SDQ ratings were compared. The SDQ was completed by 248 parent dyads. Mother and father ratings were correlated, however fathers reported higher mean scores than mothers for externalising behaviours. Higher reporting by fathers was related to alcohol misuse, the couple relationship, fathering, and father employment. Fathers did not report significantly more abnormal behaviours than mothers except for hyperactivity. There was high interparental agreement on normal/borderline behaviours (94.8–98.3% agreement), but lower agreement on abnormal behaviours (7.7–37.9%). There was higher interparental agreement on male rather than female children, but fathers were four times more likely to report hyperactivity among their boys compared with girls. Using combined parental reports in clinical settings would enhance the sensitivity of identifying children requiring clinical attention for their problem behaviours.     

Cognitive and Verbal Abilities of 24- to 36-month-old Siblings of Children with Autism

The cognitive and language skills of 30 siblings of children with autism (SIBS-A) and 30 siblings of typically developing children (SIBS-TD) were compared. Non-significant group differences emerged for cognition at both ages. At 24 months, significantly more SIBS-A demonstrated language scores one or two standard deviations below the mean compared to SIBS-TD. At 36 months, the groups differed significantly in receptive language, and more SIBS-A displayed receptive and expressive difficulties compared to SIBS-TD. Six SIBS-A (including one diagnosed with autism) revealed language scores more than two standard deviations below the mean at both ages, a pattern not seen in the SIBS-TD. Results are discussed in reference to language difficulties in autism spectrum disorders and the genetic liability for autism.