Parent-Child Interactions in Clinically Anxious Children and Their Siblings

Examines the value and importance of theory in child psychology, particularly with respect to clinical practice. Although it is readily apparent that theory is not an essential element of treatment, the role of theory is to provide a coherent framework for clinical intervention. Theory provides a foundation for understanding the presenting pathology, the factors that affect it, the patient's and therapist's roles within the context of treatment, and the specific intervention strategies to be utilized. Therapeutic commonalities are considered as they may affect treatment outcome, but they are not viewed as the essential factors in efficacy. The value and meaning of eclecticism are also discussed.     

Evaluating the FRIENDS Program: A Cognitive-Behavioral Group Treatment for Anxious Children and Their Parents

Conducted the 1st randomized clinical trial evaluating the efficacy of the FRIENDS program, a family-based group cognitive-behavioral treatment (FGCBT) for anxious children. Children (n = 71) ranging from 6 to 10 years of age who fulfilled diagnostic criteria for separation anxiety (SAD), generalized anxiety disorder (GAD), or social phobia (SOP) were randomly allocated to FRIENDS or to a 10-week wait-list control group. The effectiveness of the intervention was evaluated at posttreatment and 12-month follow-up. Results indicated that 69% of children who completed FGCBT were diagnosis-free, compared to 6% of children completing the wait-list condition. At 12-month follow-up, 68% of children were diagnosis-free. Beneficial treatment effects were also evident on the self-report measures completed by the children and their mothers. Parents and children reported high treatment satisfaction. Results suggest that FRIENDS is an effective treatment for clinically anxious children. Limitations of this study and directions for future research are discussed.     

Mediators of Treatment Outcomes for Anxious Children and Adolescents: The Role of Somatic Symptoms

Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors are effective treatments for pediatric anxiety disorders. However, the mechanisms of these treatments are unknown. Previous research indicated that somatic symptoms are reduced following treatment, but it is unclear if their reductions are merely a consequence of treatment gains. This study examined reductions in somatic symptoms as a potential mediator of the relationship between treatment and anxiety outcomes. Participants were 488 anxious youth ages 7–17 (M = 10.7), 50.4% male, 78.9% Caucasian, enrolled in Child/Adolescent Anxiety Multimodal Study, a large randomized control trial comparing 12-week treatments of CBT, sertraline, a combination of CBT and sertraline, and a pill placebo. Causal mediation models were tested in R using data from baseline, 8-, and 12-week evaluations. Somatic symptoms were assessed using the Panic/Somatic subscale from the Screen for Child Anxiety Related Emotional Disorders. Youth outcomes were assessed using the Pediatric Anxiety Rating Scale and Children’s Global Assessment Scale. Reductions in somatic symptoms mediated improvement in anxiety symptoms and global functioning for those in the sertraline-only condition based on parent report. Conditions involving CBT and data based on child reported somatic symptoms did not show a mediation effect. Findings indicate that reductions in somatic symptoms may be a mediator of improvements for treatments including pharmacotherapy and not CBT. Although the overall efficacy of sertraline and CBT for anxiety may be similar, the treatments appear to function via different mechanisms.     

The Cognitive Content of Thought-Listed Worry Episodes in Clinic-Referred Anxious and Nonreferred Children

We investigated the cognitive content of worry in 8- to 13-year-old clinic-referred anxious (n = 38) and nonreferred (n = 51) children. The children were interviewed individually. They thought-listed their latest worry episodes, rated the uncontrollability of the episodes, and reported on the strategies they used to terminate worry. Content analyses showed that children's worry episodes contained predominantly thoughts reflecting negative outcome anticipation, but other types of thought content also were present. These included problem-solving, ruminating, and self-blaming thoughts. Compared to clinic-referred children, nonreferred children reported more problem solving and less ruminating. In the nonreferred group, increasing age was associated with more problem solving and less ruminating. No such age-related associations were found in the clinic-referred group. The 2 groups did not differ in the types of worry-termination strategies they reported, but clinic-referred children were more likely to keep worrying until the perceived threat was removed. The results suggest that the problem-solving function of worry is still emerging during late childhood and that developmental delays in problem solving may be associated with excessive and uncontrollable worrying.     

Analysis on Anxious Emotion and Its Influencing Factors of Parents of Hospitalized Children

目的 探讨住院患儿家长焦虑情绪变化的影响因素,分析患儿病情、家庭状况、社会支持等因素与家长焦虑情绪的关系.方法 采用焦虑、简易应对方式、社会支持及家庭环境评定等量表,对住院患儿家长进行问卷调查,应用SPSS 11.0软件分析家长焦虑情绪的影响因素.结果 女性、无职业、低经济收入的家长焦虑情绪体验高(t=2.924、3.322和7.088,P均＜0.01),且城市和城郊各有特点.多因素分析显示,不良客观支持(β=-0.246,P=0.006)、较差家庭经济状况(β=-0.179,P=0.040)和家庭亲密度低(β=-0.165,P=0.046)是城市家长焦虑情绪的促发因素,家庭亲密度低(β=-0.471,P＜0.001)和可利用社会资源多(β=0.251,P=0.011)是城郊家长的焦虑情绪促发因素.结论 家庭亲密度是城市和城郊家长焦虑情绪发生的共同影响因素;可利用社会资源多是城郊家长焦虑情绪另一促发因素;良好的客观支持,较好的家庭经济状况有助于减少城市家长焦虑情绪的发生.     

住院患儿家长焦虑情绪影响因素分析

目的探讨住院患儿家长焦虑情绪变化的影响因素,分析患儿病情、家庭状况、社会支持等因素与家长焦虑情绪的关系。方法采用焦虑、简易应对方式、社会支持及家庭环境评定等量表,对住院患儿家长进行问卷调查,应用SPSS 11.0软件分析家长焦虑情绪的影响因素。结果女性、无职业、低经济收入的家长焦虑情绪体验高(t=2.924、3.322和7.088,P均<0.01),且城市和城郊各有特点。多因素分析显示,不良客观支持(β=-0.246,P=0.006)、较差家庭经济状况(β=-0.179,P=0.040)和家庭亲密度低(β=-0.165,P=0.046)是城市家长焦虑情绪的促发因素,家庭亲密度低(β=-0.471,P<0.001)和可利用社会资源多(β=0.251,P=0.011)是城郊家长的焦虑情绪促发因素。结论家庭亲密度是城市和城郊家长焦虑情绪发生的共同影响因素;可利用社会资源多是城郊家长焦虑情绪另一促发因素;良好的客观支持,较好的家庭经济状况有助于减少城市家长焦虑情绪的发生。     

多动儿童焦虑抑郁自评与父母他评一致性研究

目的探讨注意缺陷多动障碍(ADHD)伴情绪问题儿童自我情绪评价与父母他评在临床诊断中的一致性。方法41例ADHD伴情绪问题儿童及父母分别完成儿童焦虑性情绪障碍筛查诊断量表(SCARD)、儿童抑郁障碍自评量表(DSRSC)。结果儿童焦虑性情绪障碍筛查诊断量表(SCARD)、儿童抑郁障碍自评量表(DSRSC),儿童自评与父母他评之间差异有显著性(P0.01),两者诊断一致性程度不高,存在差异性(Kappa0.4,P0.05)。结论重视ADHD儿童对自身情绪问题的表达,对早期发现ADHD儿童共病情绪障碍有一定价值。     

Clinical Predictors of Primary Immunodeficiency Diseases in Children

Purpose

To promote awareness of primary immunodeficiency (PID), the "10 warning signs" of PID and an immunodeficiency-related (IDR) score were developed. However, their efficiency in identifying PID cases was not sufficiently evaluated in clinical practice. The objective of this study was to test the validity of the 10 warning signs and IDR score in identifying PID among children with recurrent infections at a tertiary pediatric hospital in Egypt.

Methods

A retrospective analysis of the medical records of 204 patients was performed. Of these patients, 92 had defined PID diseases and 112 were considered non-PID cases because investigations were inconclusive.

Results

Demonstrating two warning signs and an IDR score of 6 led to sensitivities of 94 and 66%, respectively, and specificities of 64 and 75%, respectively, in identifying PID cases. The strongest predictor of PID was family history that, if combined with the need for intravenous antibiotics, recurrent deep-seated infections, and failure to thrive, could identify 81% of PID patients. A family history of PID, sibling death, and/or parental consanguinity would predict 92% of combined immunodeficiencies, 92% of phagocyte defects, 87% of well-identified immunodeficiency syndromes, and 84% of antibody deficiency if the need for intravenous antibiotics is considered in the latter.

Conclusions

The 10 warning signs and IDR score do not aid in an early diagnosis of severe PID. Educational campaigns should target pediatricians aiming to increase PID awareness and to address family history of PID, parental consanguinity, and previous sibling death as key predictors of PID in communities with a high prevalence of consanguineous marriages.     

Predictors of Stress in Parents of Developmentally Disabled Children

Child diagnos type of early invervention program, social supportnetwork, and perceived control were examined as moderators ofstress responding in mothers of developmentally disabled children.Sixty-seven mothers completed a battery of questionnaires assessingchild characteristics, parent mood, social support, and locusof control. Child diagnosis and type of intervention did nothave a significant effect on stress response measures. Spousesupport, perceived control, and child characteristics each accountedfor significant variance in a multiple regression predictionof stress scores. Further, the amount of spouse support, lowvs. high, interacted with mothers' degree of perceived controlsuch that mothers with an internal locus of control and lessspouse support obtained considerably higher stress scores acrossall stress response measures. The role of the child as a stressorand parent moderator variables in the prediction of parentalstress are disscussed in terms of models of stress and futureresearch.     

Neuropsychological Predictors of ODD Symptom Dimensions in Young Children

Oppositional defiant disorder (ODD) is a commonly diagnosed childhood behavior disorder, yet knowledge of relations between ODD and early neuropsychological functions, particularly independent of attention deficit/hyperactivity disorder (ADHD), is still limited. In addition, studies have not examined neuropsy chological functioning as it relates to the different ODD symptom dimensions. Structural equation modeling was used to investigate how preschool neuropsychological functioning predicted negative affect, oppositional behavior, and antagonistic behavior symptom dimensions of ODD in 224 six-year-old children, oversampled for early behavior problems. Working memory, inhibition, and sustained attention predicted negative affect symptoms of ODD, controlling for ADHD, whereas delay aversion uniquely predicted oppositional behavior, controlling for ADHD. Delay aversion also marginally predicted antagonistic behavior, controlling for ADHD. Results demonstrate that different ODD symptom dimensions may be differentially predicted by different neuropsychological functions. The findings further underscore the importance of future research on ODD to take into account the possible heterogeneity of both symptoms and underlying neuropsychological functioning.     

Error-Related Negativity in a Visual Go/No-Go Task: Children vs. Adults

Thirteen young adults (ages 21–25) and nine children (ages 7–11) were tested on a visual go/no-go task comparing response times (RTs), error rates, and amplitude and latency changes of error-related negativity (ERN). All experimental conditions were identical for both age groups. Results are consistent with the previous flanker task research showing an increase in ERN amplitude as children age. However, the present results indicate that the peak amplitude of ERN for 9–11 year old children is larger than that of 7–8 year old children, with no difference overall between young adults and children. ERN responses elicited by the flanker task continue to develop until late adolescence. Comparative results suggest that the visual go/no-go task may be more sensitive cognitive measure than the flanker task of mistakes made by children. Differences in time pressure to respond, complexity of the task, and feedback are discussed as possible explanations of differences in the two paradigms.     

Psychophysiological Predictors of Attentional Dysfunction in Children with Congenital Heart Defects

Cardiac responses to non-signal stimuli and to signal stimuli in a vigilance task were examined in children born with congenital heart defects (CHD), and in normal and attention deficit disordered (ADD) subjects. Overall task performance was lower in subjects with heart defects and in the ADD group. Cardiac measures revealed that normal children displayed significantly larger heart rate deceleration to the target stimuli than did either of the clinical groups. Moreover, although no group differences were observed in the cardiac response to non-signal auditory stimuli, exaggerated heart rate deceleration was observed to vibrotactile stimuli in both the clinical groups. Regression analyses revealed that the magnitude of the cardiac response to somatosensory stimuli was predictive of task performance (both within and between subject groups), with larger responses associated with higher error rates and lower perceptual sensitivity. Results were suggestive of a predictive relationship between somatosensory reactivity and neuropsychological maturation.     

Frequency Analysis of the EEG in Children with Sickle Cell Disease

An automated technique for EEG frequency analysis was employed in the study of nine children with sickle cell disease. Quotients, Q₁ (delta+theta/alpha+beta) and Q₂ (theta/alpha+8), were calculated from the computed power in each frequency range. Recordings from occipital-parietal and temporal-frontal areas resulted in a higher Q₁ for sickle cell disease patients than for reported normals (p<.002 and p<.05 respectively). Q₂ value from the occipital-parietal sites were also higher for the sickle cell group (p<.05).     

Prevalence and Correlates of Frequent Nightmares: A Community-Based 2-Phase Study

Study Objectives:

To determine the prevalence of frequent nightmares and their correlates in a large community-based cohort of middle-aged Hong Kong Chinese.

Design:

A 2-phase design involving a cross-sectional survey of 8558 subjects (men, 47.6%) with a mean age of 40.9 years (SD 5.5, range 20-78) and subsequently followed by a detailed clinical evaluation of the psychopathology and personality profile of 252 subjects.

Setting:

Community.

Interventions:

N/A.

Measurements and Results:

The prevalence of frequent nightmares, as defined by at least once per week, was 5.1%. Female sex, low monthly family income, insomnia symptoms, sleep-disordered breathing symptoms, and sleep-related daytime consequences were significantly associated with nightmare frequency. The risk of having a psychiatric disorder was 5.74 times greater for subjects with frequent nightmares (95% confidence interval 2.03-16.26), especially mood disorders (odds ratio = 15.57, 95% confidence interval 3.77-64.37). After exclusion of concomitant psychiatric morbidities, subjects with frequent nightmares still scored significantly higher on neuroticism in the personality scale (P < 0.05).

Conclusions:

Frequent nightmares were not uncommon in the general population and were associated with a constellation of factors, including sociodemographic characteristics and comorbid sleep and psychiatric disorders. Moreover, frequent nightmares were independently related to the neuroticism personality trait, irrespective of psychiatric diagnosis. Prospective studies should be conducted to investigate various predisposing, precipitating, and perpetuating factors and the associated repercussions of nightmares.

Citation:

Li SX; Zhang B; Li AM; Wing YK. Prevalence and correlates of frequent nightmares: a community-based 2-phase study. SLEEP 2010;33(6):774-780.     

Nightmares: Familial aggregation and association with psychiatric disorders in a nationwide twin cohort

We quantified the genetic influences affecting the liability to nightmares, and the association between nightmares and psychiatric disorders in a community-based sample. In 1990, 1,298 monozygotic (MZ) and 2,419 dizygotic (DZ) twin pairs aged 33–60 years responded to a questionnaire study in the Finnish Twin Cohort. Structural equation modeling was used to estimate genetic and environmental components of variance in the liability to nightmares. Records on hospitalization and long-term antipsychotic medication were used to estimate the period prevalence of serious psychiatric disorders. Nightmares were reported more frequently in females both in childhood and as adults. The correlation between occurrence in childhood and as adults was 0.69 in males and 0.71 in females. Polychoric correlations of occurrence within the twin pairs were 0.45 in MZ and 0.21 in DZ pairs in childhood, and as adults 0.39 and 0.18, respectively. The best fitting genetic model was that specifying additive genetic and unshared environmental effects. The estimated proportion of genetic effects in childhood was in males 44% (95% confidence interval [CI] 35–52%) and in females 45% (95% CI 38–52%) of the phenotypic variance. As adults the values were in males 36% (95% CI 27–44%) and in females 38% (95% CI 31–45%). Nightmare frequency and psychiatric disorders were linearly associated. Among those with the most frequent nightmares odds ratios (95% CI) were 3.67 (2.48–5.42) for childhood and 5.87 (4.08–8.45) for adults compared with those never having nightmares. Nightmares are quite a stable trait from childhood to middle age. There are persistent genetic effects on the disposition to nightmares both in childhood and adulthood. Nightmares are significantly associated with psychiatric disorders. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 88:329–336, 1999. © 1999 Wiley-Liss, Inc.