Maternal anxiety predicts favourable treatment outcomes in anxiety-disordered adolescents

Objective: To determine the differential impact of maternal and paternal internalizing psychopathology on cognitive‐behavioural treatment (CBT) outcome of anxiety‐disordered children and adolescents. Method: Participants consisted of 127 children and 51 adolescents with a primary anxiety diagnosis. Children were randomly assigned to a standardized group CBT or individual CBT; adolescents received individual CBT. Parents received four training sessions. Participants were evaluated at pre‐ and post‐treatment with a clinical interview and with self‐ and parent‐reported questionnaires. Lifetime anxiety and mood disorders in parents were obtained with a clinical interview. Results: For children, no associations were found between maternal and paternal anxiety or mood disorders and treatment outcome. For adolescents, however, maternal lifetime anxiety disorders were positively associated with pre‐post‐treatment improvement in clinician severity ratings and with treatment success. Conclusion: Lifetime maternal anxiety disorders were significantly associated with favourable treatment outcomes in adolescents. Paternal disorders were not associated with treatment response.     

Psychosis in a pediatric mood and anxiety disorders clinic: phenomenology and correlates

OBJECTIVES: To examine the demographics and phenomenology of psychosis in a sample of children and adolescents referred to a mood and anxiety disorders clinic. METHOD: Patients (N = 2,031) were assessed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present Episode version and classified as definite, probable, or nonpsychotic. Clinical and demographic characteristics of the groups were compared,and symptoms of psychosis were analyzed using factor analysis. RESULTS: Definite psychotic symptoms were seen in approximately 90 (4.5%) patients: 80% of these reported hallucinations (mainly auditory), 22% delusions, and 3.3% thought disorder. Of the patients with definite psychotic symptoms, 24% had bipolar disorder, 41% had major depression, 21% had subsyndromal depression, and 14% had schizophrenia spectrum disorders (schizophrenia and schizoaffective disorders). Factor analysis of the definite psychotic symptoms yielded 4 factors: hallucinations, thought disorder, delusions, and manic thought disorder. Psychotic patients had a higher frequency of comorbid disorders and suicidal ideation than nonpsychotic patients. CONCLUSIONS: Outpatient youngsters with mood disorders frequently present with psychotic symptoms, in particular auditory hallucinations. These patients commonly have comorbid psychiatric disorders and suicidal ideation.     

Obsessive compulsive disorder in children and adolescents: phenomenology and family history

Phenomenology and family history in 21 clinically referred children and adolescents with obsessive compulsive disorder are described. Each child and family participated in a standard clinical psychiatric assessment. The most frequently reported symptoms were repeating rituals, washing, ordering and arranging, checking, and contamination concerns. Controlling behaviors involving other family members were seen in 57% of the patients. Associated psychopathology was common: 38% received an anxiety disorder diagnosis; 29% received a mood disorder diagnosis; tics were observed in 24%. Fifteen (71%) of the children had a parent with either obsessive compulsive disorder (N = 4) or obsessive-compulsive symptoms (N = 11). The clinical and research implications of these findings are discussed.     

Generalized anxiety disorder in referred children and adolescents

OBJECTIVE: There are insufficient data on generalized anxiety disorder in children and adolescents. Symptoms and comorbidity of generalized anxiety disorder are described as a function of age, gender, and comorbidity in a consecutive series of referred children and adolescents. METHOD: One hundred fifty-seven outpatients (97 males and 60 females, 50 children and 107 adolescents, age range 7-18 years, mean age 13.4 +/- 2.7 years) were diagnosed as having generalized anxiety disorder, using historical information and a structured clinical interview (Diagnostic Interview for Children and Adolescents-Revised) according to the DSM-IV. RESULTS: Feelings of tension, apprehensive expectations, negative self-image, need for reassurance, irritability, and physical complaints were reported in more than 75% of the participants. Differences in symptomatology according to age and gender were nonsignificant. Depressive disorder was the most frequent comorbidity, being present in 56% of the patients. Comorbid anxiety disorders were present in about 75% of the patients, and 21% showed externalizing disorders. Subjects with comorbid depression had less anxiety comorbidity, subjects with comorbid separation anxiety disorder had higher rates of panic disorder, and subjects with comorbid externalizing disorders had higher rates of bipolar disorder. CONCLUSIONS: Referred children and adolescents with generalized anxiety disorder are heavily symptomatic and have frequent comorbidity. A more precise definition of the clinical picture may help early diagnosis and prevention of superimposed mental disorders.     

Response to 5% carbon dioxide in children and adolescents: relationship to panic disorder in parents and anxiety disorders in subjects

BACKGROUND: Carbon dioxide (CO(2)) sensitivity is postulated to be a familial risk marker of panic disorder (PD). Exaggerated responses to CO(2) inhalation have been reported in adults with PD and their unaffected adult relatives, as well as in clinic-referred children with anxiety disorders. OBJECTIVE: To test in a family-based design whether CO(2) hypersensitivity is a familial risk marker for PD and associated with current anxiety disorders in children and adolescents. SETTING AND PARTICIPANTS: One hundred forty-two offspring (aged 9-19 years) of parents with PD, major depressive disorder, or no disorder. Forty-five (32%) had a current anxiety disorder, excluding specific phobia. DESIGN AND MAIN OUTCOME MEASURES: Parents and offspring received diagnostic assessments. Offspring underwent 5% CO(2) inhalation at home. Panic symptoms and panic attacks were rated with the Acute Panic Inventory at baseline, while anticipating CO(2) delivery ("threat"), and during CO(2) inhalation. Respiratory rate and volume were measured with spirometry. RESULTS: No group differences were found in Acute Panic Inventory ratings at baseline or in respiratory measures during threat. Risk for PD was not associated with CO(2) sensitivity (panic symptoms and respiratory physiologic response). During CO(2) inhalation, offspring with anxiety disorders, relative to offspring without anxiety disorders, experienced significantly more panic symptoms and panic attacks, as well as elevated respiratory rates. During threat, panic symptoms were significantly and independently associated with both parental PD and offspring anxiety disorders. CONCLUSIONS: No support was obtained for CO(2) hypersensitivity as a familial risk marker for PD in children and adolescents. Links between childhood anxiety disorders and CO(2) sensitivity were replicated. Familial risk for PD in children and adolescents may be associated with vulnerability to anticipatory anxiety.     

Effectiveness of a meditation-based stress management program as an adjunct to pharmacotherapy in patients with anxiety disorder

OBJECTIVE: The objective of this study was to examine the effectiveness of a meditation-based stress management program in patients with anxiety disorder. METHODS: Patients with anxiety disorder were randomly assigned to an 8-week clinical trial of either a meditation-based stress management program or an anxiety disorder education program. The Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory, and the Symptom Checklist--90-Revised (SCL-90-R) were used to measure outcome at 0, 2, 4, and 8 weeks of the program. RESULTS: Compared to the education group, the meditation-based stress management group showed significant improvement in scores on all anxiety scales (HAM-A, P=.00; STAI state, P=.00; STAI trait, P=.00; anxiety subscale of SCL-90-R, P=.00) and in the SCL-90-R hostility subscale (P=.01). Findings on depression measures were inconsistent, with no significant improvement shown by subjects in the meditation-based stress management group compared to those in the education group. The meditation-based stress management group did not show significant improvement in somatization, obsessive-compulsive symptoms, and interpersonal sensitivity scores, or in the SCL-90-R phobic anxiety subscale compared to the education group. CONCLUSIONS: A meditation-based stress management program can be effective in relieving anxiety symptoms in patients with anxiety disorder. However, well-designed, randomized, and controlled trials are needed to scientifically prove the worth of this intervention prior to treatment.     

Children and adolescents with psychotic disorder not otherwise specified: a 2- to 8-year follow-up study.

Although psychotic phenomena in children with disruptive behavior disorders are more common than expected, their prognostic significance is unknown. To examine the outcome of pediatric patients with atypical psychoses, a group of 26 patients with transient psychotic symptoms were evaluated with clinical and structured interviews at the time of initial contact (mean age, 11.6 +/- 2.7 years) and at follow-up 2 to 8 years later. Measures of functioning and psychopathology were also completed at their initial assessment. Risk factors associated with adult psychotic disorders (familial psychopathology, eyetracking dysfunction in patients and their relatives, obstetrical complications, and premorbid developmental course in the proband) had been obtained at study entry. On follow-up examination (mean age, 15.7 +/- 3.4 years), 13 patients (50%) met diagnostic criteria for a major axis I disorder: three for schizoaffective disorder, four for bipolar disorder, and six for major depressive disorder. The remaining 13 patients again received a diagnosis of psychotic disorder not otherwise specified (NOS), with most being in remission from their psychotic symptoms. Among this group who had not developed a mood or psychotic disorder, disruptive behavior disorders were exceedingly common at follow-up and were the focus of their treatment. Higher initial levels of psychopathology, lower cognitive abilities, and more developmental motor abnormalities were found in patients with a poor outcome. Obstetrical, educational, and family histories did not differ significantly between the groups. Through systematic diagnostic evaluation, children and adolescents with atypical psychotic disorders can be distinguished from those with schizophrenia, a difference with important treatment and prognostic implications. Further research is needed to delineate the course and outcome of childhood-onset atypical psychoses, but preliminary data indicate improvement in psychotic symptoms in the majority of patients and the development of chronic mood disorders in a substantial subgroup.     

Correlation between anxiety and oppositionality in a children's mood and anxiety disorder clinic.

OBJECTIVE: While parents and clinicians have described oppositional features as interfering with the management of children with anxiety, research on this relation is lacking. We designed this study to investigate the presence of oppositional symptoms in children presenting with mood and anxiety symptoms. METHOD: In a mood and anxiety disorders clinic, we used the DSM-IV Child Symptom Inventory to document the presence and correlates of oppositional defiant symptoms in 145 preadolescents assessed during a 2-year period. RESULTS: Oppositional defiant symptoms were found to correlate (P < 0.01) with generalized anxiety symptoms in both parent and teacher ratings. Correlations remained significant after controlling for the presence of symptoms of attention-deficit hyperactivity disorder (ADHD). Parents found both boys and girls to be equally oppositional, while teachers found boys to be significantly more oppositional. CONCLUSION: Oppositional features are found in clinically referred children with anxiety and are potentially significant for treatment and prognosis of anxiety disorders in children.     

Impact of comorbid anxiety disorders on outcome in a cohort of patients with bipolar disorder

BACKGROUND: High rates of comorbid anxiety disorders have been described in individuals with bipolar disorder. Although it is well recognized that anxiety disorders often co-occur with bipolar disorder, few studies have examined the impact of more than 1 anxiety disorder on long-term outcome in patients with bipolar disorder. METHOD: The rates of DSM-IV generalized anxiety disorder, panic disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder were determined using structured clinical interviews in 138 patients with bipolar disorder who presented consecutively between 1994 and 1999. Patients were then followed for up to 3 years with longitudinal clinical surveillance. The impact of 1 or more comorbid anxiety disorders on mood symptoms and general function was evaluated. RESULTS: In our sample, 55.8% of the patients had at least 1 comorbid anxiety disorder, and 31.8% had 2 or more anxiety disorder diagnoses. The most common anxiety disorder was generalized anxiety disorder, followed by panic disorder. The presence of an anxiety disorder led to significantly (p <.05) worse outcome on global as well as specific illness measures, including illness severity, proportion of patients characterized as euthymic, and proportion of the year spent ill. Number of anxiety disorders was less important than type, with generalized anxiety disorder and social phobia having the most negative impact on outcome. CONCLUSION: Our data suggested that multiple anxiety disorder comorbidities were not infrequent in bipolar disorder and that generalized anxiety disorder and social phobia were more likely to be associated with poor outcome. We discuss some potential mechanisms and implications in our findings.     

Phenomenology and comorbidity of dysthymic disorder in 100 consecutively referred children and adolescents: beyond DSM-IV.

OBJECTIVE: Diagnostic criteria and nosological boundaries of juvenile dysthymic disorder (DD) are under-researched. Two different sets of diagnostic criteria are still discussed in the DSM-IV, the first giving major weight to somatic and vegetative symptoms and the second, included in the appendix, to more affective and cognitive symptoms. The aim of this study was to describe prototypical symptomatology and comorbidity of DD, according to DSM-IV criteria, in a consecutive series of referred children and adolescents, as a function of age and sex. METHOD: One hundred inpatients and outpatients (36 children and 64 adolescents, 57 males, 43 females, age range 7 to 18 years, mean age 13.3 years) received a diagnosis of DD without comorbid major depressive disorder (MDD), using historical information, the Diagnostic Interview for Children and Adolescents-Revised (DICA-R), and symptoms ratings according to the DSM-IV criteria. RESULTS: Irritability, low self-esteem, fatigue or loss of energy, depressed mood, guilt, concentration difficulties, anhedonia, and hopelessness were present in more than 50% of subjects. Differences in symptomatic profile between male and female patients were not significant. Anxiety disorders were commonly comorbid with DD, mainly generalized anxiety disorder, simple phobias, and in prepuberal children, separation anxiety disorder. Externalizing disorders were reported in 35% of the patients, with higher prevalence in male patients. Adolescents showed more suicidal thoughts and anhedonia than children. CONCLUSIONS: The clinical picture of early-onset DD we found, based entirely on a pure sample without current and past MDD, is not totally congruent with the diagnostic criteria according to DSM-IV. A more precise definition of the clinical picture may help early diagnosis and prevention of superimposed mental disorders.     

Psychiatric comorbid conditions in a clinic population of 241 patients with tuberous sclerosis complex

Psychiatric symptoms were retrospectively assessed in a clinic population of 241 children and adults with tuberous sclerosis complex (TSC). Sixty-six (27%) patients had a history of mood disorder symptoms, 66 (27%) had a history of anxiety disorder symptoms, 73 (30%) had a history of attention-deficit hyperactivity disorder (ADHD) symptoms, and 68 (28%) had a history of aggressive/disruptive behavior disorder symptoms. Significant relationships were found between these symptoms and patient age, gender, genetic mutation, seizure history, surgical history, cognitive impairment, features of autism or pervasive developmental disorder, and neurological manifestations of TSC. In 43 patients seen by at least one of two affiliated psychiatrists, the most common formal diagnoses were anxiety disorders (28%), mood disorders (26%), adjustment disorders (21%), ADHD (21%), and mental disorders not otherwise specified due to general medical condition (42%). Citalopram demonstrated efficacy in treating anxiety and depression, and risperidone, in treating problematic behaviors.     

An exploration of concomitant psychiatric disorders in children with autism spectrum disorder

ObjectiveWe explored patterns of concomitant psychiatric disorders in a large sample of treatment-seeking children and adolescents with autism spectrum disorder (ASD).MethodsParticipants were 658 children with ASD (age 3–17 years; mean = 7.2 years) in one of six federally-funded multisite randomized clinical trials (RCT) between 1999 and 2014. All children were referred for hyperactivity or irritability. Study designs varied, but all used the Child and Adolescent Symptom Inventory or Early Childhood Inventory to assess Attention Deficit Hyperactivity Disorder (ADHD), Oppositional-Defiant Disorder (ODD), Conduct Disorder (CD), Anxiety Disorders, and Mood Disorders. In addition, several measures in common were used to assess demographic and clinical characteristics.ResultsOf the 658 children, 73% were Caucasian and 59% had an IQ >70. The rates of concomitant disorders across studies were: ADHD 81%, ODD 46%, CD 12%, any anxiety disorder 42%, and any mood disorder 8%. Two or more psychiatric disorders were identified in 66% of the sample. Of those who met criteria for ADHD, 50% also met criteria for ODD and 46% for any anxiety disorder. Associations between types of concomitant disorders and a number of demographic and clinical characteristics are presented.ConclusionIn this well-characterized sample of treatment-seeking children with ASD, rates of concomitant psychiatric disorders were high and the presence of two or more co-occurring disorders was common. Findings highlight the importance of improving diagnostic practice in ASD and understanding possible mechanisms of comorbidity.     

Clinical features of depressed children and adolescents with various forms of suicidality

OBJECTIVE: To examine various forms of suicidality specified in DSM-IV and their clinical characteristics in a large sample of children and adolescents with major depressive disorder (MDD). METHOD: Subjects included 553 children and adolescents (aged 7.0-14.9 years) recruited between April 2000 and December 2004 from 23 mental health facilities in Hungary. Subjects received standardized clinical evaluations and best-estimate consensus DSM-IV diagnoses of MDD. All subjects were in a current episode of MDD at their assessment date. RESULTS: Approximately 68% of the sample had recurrent thoughts of death, 48% had suicidal ideation, 30% had suicide plan, and 12% had attempted suicide. Compared with nonsuicidal peers, suicidal children and adolescents were more severely depressed, had more depressive symptoms, and more likely had comorbid disorders. However, depressed children and adolescents with various forms of suicidality were very similar in clinical characteristics. Feelings of worthlessness, depressed mood, psychomotor agitation, and comorbid separation anxiety and conduct disorders were independent correlates of at least 1 form of suicidality. Only feelings of worthlessness was related to all 4 suicidal behaviors, after adjustment for other depressive symptoms, comorbid disorders, and demographics. CONCLUSION: Clinical characteristics differ between nonsuicidal and suicidal children and adolescents but are very similar across various forms of suicidality. Feelings of worthlessness may play a central role in the development of suicidal behavior. Interventions toward the enhancement of self-esteem and amelioration of underlying psychopathology may be crucial for the prevention of suicide attempts in depressed children and adolescents.     

Depressive symptoms in children and adolescents with dysthymic disorder

This report examines clinical features of 'pure' dysthymic disorder (DD, without superimposed major depressive disorder, MDD) in a sample of children and adolescents. Profiles of symptomatology and comorbidity as a function of age and gender are described. The sample consisted of 48 subjects (22 males, 26 females, age range 7-18 years, mean age 12.1 years) screened from consecutively referred children and adolescents. All subjects were comprehensively diagnosed with structured diagnostic interviews (Schedule for Affective Disorders and Schizophrenia for School Age, Diagnostic Interview for Children and Adolescents-Revised), according to DSM-IV criteria. Depressed mood, irritability, loss of energy and fatigue, guilt and low self-esteem were present in more than 70% of the subjects. Differences in symptomatic profile between males and females were not significant. Children showed less symptoms than adolescents, but the symptomatic profile was comparable (only anhedonia was significantly more frequent in adolescents). Anxiety disorders were more commonly comorbid with DD, especially separation anxiety disorder in children (33%) and generalised anxiety disorder in adolescents (67%). Externalising disorders were less frequently represented in our sample (14%). An early diagnosis of 'pure' DD before the first episode of MDD is crucial for a timely intervention.     

Multiple anxiety disorder comorbidity in patients with mood spectrum disorders with psychotic features

OBJECTIVE: The authors investigated frequencies and clinical correlates of multiple associations of panic disorder, obsessive-compulsive disorder (OCD), and social phobia in patients with severe mood disorders. METHOD: Subjects were 77 consecutively hospitalized adults with psychotic symptoms and with a diagnosis of bipolar I disorder, major depression, or schizoaffective disorder, bipolar type. Principal diagnosis and comorbidity were assessed by the Structured Clinical Interview for DSM-III-R-Patient Version. RESULTS: Of the entire cohort, 33.8% had a single anxiety disorder and 14.3% had two or three comorbid diagnoses. Patients with multiple comorbidity had significantly higher scores on the Brief Psychiatric Rating Scale and SCL-90 and abused stimulants more frequently than did those without anxiety disorders. CONCLUSIONS: Multiple associations of panic disorder, OCD, and social phobia are not rare among patients with affective psychoses and are likely to be associated with more severe psychopathology than is found in patients without anxiety disorders.     

Nature of anxiety comorbid with attention deficit hyperactivity disorder in children from a pediatric primary care setting

The clinical characteristics of children with comorbid anxiety and attention deficit hyperactivity disorder (ADHD were examined. A sample of children from a pediatric primary care practice was assessed for anxiety disorders and ADHD. We defined four groups of children: (1) anxiety disorders only with no ADHD (n=54); (2) ADHD-only with no anxiety disorder (n=15); (3) neither ADHD nor an anxiety disorder (n=107); and (4) comorbid ADHD and anxiety disorder (n=14). Approximately 50% of children with ADHD had a comorbid anxiety disorder, and approximately 20% of children with an anxiety disorder had comorbid ADHD. The presence of comorbid ADHD and anxiety was associated with more attentional problems, school fears, and mood disorders and lower levels of social competence compared to children who had either ADHD-only or anxiety-only. Children with comorbid anxiety disorders and ADHD have more severe symptoms and are more impaired than children with either condition alone. Interventions need to be tailored to address the complexity of these comorbid conditions and their associated sequelae.     

Clinical characteristics of depressive symptoms in children and adolescents with major depressive disorder

OBJECTIVE: Very few studies have compared the symptoms of major depressive disorder (MDD) and rates of comorbid psychiatric disorders between depressed children and adolescents. The aim of this study was to reproduce and extend these findings. METHOD: The Kiddie Schedule for Affective Disorders and Schizophrenia, present version (KSADS-P) was administered to parents (about their children) and in face-to-face interviews with 916 subjects aged 5.6 to 17.9 years with MDD (DSM criteria) (715 adolescents and 201 children; 348 male and 568 female). The subjects were consecutive referrals to an outpatient mood and anxiety disorders clinic. RESULTS: Depressed adolescents had significantly more hopelessness/helplessness, lack of energy/tiredness, hypersomnia, weight loss, and suicidality compared with children (p values < or = .001). In comparison with children, adolescents had significantly more substance abuse and less comorbid separation anxiety disorder and attention-deficit/hyperactivity disorder (p values < or = .001). Depressed female adolescents had significantly more suicidality than depressed male adolescents (p < or = .001). There were no other sex differences between males and females. The symptoms of depressed adolescents grouped into 3 factors (endogenous, negative cognitions/suicidality, and appetite/weight), whereas the symptoms in children grouped into 2 factors (endogenous/negative cognitions/suicidality and appetite/weight). CONCLUSIONS: These results provide further evidence for the continuity of MDD from childhood to adolescence.     

Symptoms of depression and anxiety (MHI) following acute medical/surgical hospitalization and post-discharge psychiatric diagnoses (DSM) in 839 geriatric US veterans

OBJECTIVE: We addressed the relatively unexplored use of screening scores measuring symptoms of depression and/or anxiety to aid in identifying patients at increased risk for post-discharge DSM-IV Axis I diagnoses. We were unable to find such studies in the literature. METHOD: Elderly veterans without recent psychiatric diagnoses were screened for depression and anxiety symptoms upon admission to acute medical/surgical units using the Mental Health Inventory (MHI). Following discharge, those who had exceeded cut-off scores and had been randomized to UPBEAT Care (Unified Psychogeriatric Biopsychosocial Evaluation and Treatment, a clinical demonstration project) were evaluated for DSM diagnoses. We report on 839 patients, mostly male (96.3%; mean age 69.6 +/- 6.7 years), comparing three groups, i.e. those meeting screening criteria for symptoms of (i) depression only; (ii) anxiety only; and (iii) both depression and anxiety. RESULTS: Despite absence of recent psychiatric history, 58.6% of the 839 patients received a DSM diagnosis post-discharge (21.8% adjustment; 15.4% anxiety; 7.5% mood; and 14.0% other disorders). Patients meeting screening criteria for both depression and anxiety symptoms received a DSM diagnosis more frequently than those meeting criteria for anxiety symptoms only (61.9% vs 49.0%, p = 0.017), but did not differ significantly from those meeting criteria for depressive symptoms only (61.9% vs 56.8%, p = 0.174). Although exceeding the MHI screening cut-off scores for depression, anxiety, or both helped to identify patients with a post-discharge DSM diagnosis, the actual MHI screening scores failed to do so. CONCLUSION: Screening hospitalized medical/surgical patients for symptoms of depression, anxiety, and particularly for the combination thereof, may help identify those with increased risk of subsequent DSM diagnoses, including adjustment disorder.     

The impact of depression and anxiety disorder symptoms on the health-related quality of life of children and adolescents with epilepsy

This study evaluated the effects of depression and anxiety disorder symptoms on the health-related quality of life (HRQOL) of children and adolescents with epilepsy. Sixty children and adolescents and their parents participated in the study. Symptoms of anxiety disorders were identified by the Screen for Child Anxiety Related Emotional Disorders questionnaire (SCARED) and symptoms of depression by the Mood and Feeling Questionnaire (MFQ). The Pediatric Quality of Life Inventory (PedsQL) was used for HRQOL assessments. A series of simple and partial correlations revealed that the levels of HRQOL significantly decrease as symptoms of depression or anxiety disorders increase and vice versa. Stepwise regression method of children's ratings resulted in a final model of school achievement and symptoms of generalized anxiety and separation anxiety disorder as predictors that explain 50.9% of the variation in HRQOL (F = 11.21, p < 0.000). For parents' ratings, the final model included symptoms of depression and separation anxiety disorder as predictors that explain 38.4% of the variation in HRQOL (F = 10.82, p < 0.000). In summary, symptoms of depression and generalized and separation anxiety disorders have the most significant impact on HRQOL.     

Patterns and predictors of comorbidity of DSM-IV anxiety disorders in a clinical sample of children and adolescents

This study examined the comorbidity of anxiety disorders and its predictors in a large, clinically referred sample of children and adolescents. Participants were 608 youth aged 4–18 years presenting at a large anxiety clinic for assessment and treatment of anxiety or mood related problems. The diagnoses were determined using the Anxiety Disorder Interview Schedule, Child/Parent versions. Sixty three percent of the participants had an additional diagnosis of an anxiety or depressive disorder. Comorbidity patterns differed based on the principal diagnostic category. Older children and females with anxiety were more likely to have a comorbid anxiety disorder. The presence of a medical condition increased the odds of having a comorbid anxiety disorder as well. This is the largest clinical sample of children and adolescents in which comorbidity of emotional disorders has been examined. Understanding the common patterns of comorbidity has important implications for future classification and treatment planning of childhood anxiety disorders.