The Utility of Measures of Child and Adolescent Anxiety: A Meta-Analytic Review of the Revised Children's Manifest Anxiety Scale,the State–Trait Anxiety Inventory for Children,and the Child Behavior Checklist

We evaluated the ability of the Revised Children's Manifest Anxiety Scale (RCMAS), the State–Trait Anxiety Inventory for Children (STAIC), and the Child Behavior Checklist (CBCL) to (a) discriminate between youth with an anxiety disorder and youth without a disorder, (b) discriminate between youth with an anxiety disorder and youth with either externalizing disorders or affective disorders, and (c) measure treatment change. In addition, variables, including age and sex, were explored as possible moderators of instrument utility. A meta-analysis of 43 articles was conducted. A large effect size was found when the instruments were used to compare youth with an anxiety disorder to youth without a disorder. When comparing anxious youth to psychiatric control groups, the picture was mixed; the instruments were found to be useful when discriminating between youth with an anxiety disorder and youth with an externalizing disorder, but not between youth with an anxiety disorder and children and adolescents with an affective disorder. The RCMAS, STAIC, and CBCL were found to be moderately sensitive to treatment gains.     

Assessment of anxiety disorders in asthmatic children.

The study's objective was to determine whether the State Trait Anxiety Inventory for Children, Trait version (STAIC), is suitable for the assessment of DSM-IV anxiety disorders in asthmatic children and adolescents. Ninety-two outpatients were given a semistructured diagnostic interview. They completed STAIC; another questionnaire about anxiety, the Echelle Comportementale d'Anxiété et de Peurs (ECAP); and the Child Depression Inventory. The parents filled in the Child Behavior Check-List (CBCL) and the Conners Parent Rating Scale (CPRS). A group of healthy children was assessed with STAIC. Thirty asthmatic children had anxiety disorders. They had significantly higher STAIC scores than the nonanxious asthmatic and the nonasthmatic children. STAIC scores were independent of age and sex and were correlated with ECAP, CPRS anxiety subscore, CBCL total score, internalizing score, and CBCL anxiety-depression subscore. Internal consistency was 0.75. With a threshold value of 34 for anxiety disorders, this method had a sensitivity of 73% and a specificity of 70%. STAIC was thus a useful method for anxiety disorder screening in a pediatric population.     

Sleep-Related Problems and the Effects of Anxiety Treatment in Children and Adolescents

This study examined (a) demographic and clinical characteristics associated with sleep-related problems (SRPs) among youth with anxiety disorders, and (b) the impact of anxiety treatment: cognitive-behavioral therapy (CBT; Coping Cat), medication (sertraline), their combination, and pill placebo on SRPs. Youth (N?=?488, ages 7–17, 50% female, 79% White) with a principal diagnosis of generalized anxiety disorder, separation anxiety disorder, or social phobia participated. SRPs were reported by parents and youth. Findings differed by informant and by type of SRP, with evidence that SRPs are associated with age, anxiety severity, externalizing problems, functional impairment, and family burden at pretreatment. Anxiety treatment reduced SRPs; effect sizes were small to medium. Reductions in parent-reported separation-related sleep difficulties were significantly greater in active treatment than in the placebo condition, with the greatest reductions reported by parents of youth whose active treatment was multimodal or included sertraline. Youth whose anxiety treatment involved CBT reported significantly greater decreases in dysregulated sleep (e.g., sleeplessness). Both CBT for anxiety and sertraline appear to be somewhat effective in reducing SRPs, and multimodal treatment may be preferable depending on the symptom presentation. To inform practice, future research should examine a broad range of SRPs, incorporate objective measures of sleep, and evaluate the impact of behavioral strategies that directly target SRPs in youth with anxiety disorders.     

Diagnostic Efficiency of Caregiver Report on the SCARED for Identifying Youth Anxiety Disorders in Outpatient Settings

This study investigated the diagnostic and clinical utility of the parent-rated Screen for Child Anxiety Related Emotional Disorders (SCARED-P) for detecting youth anxiety disorders. Youth ages 6 to 12 years, 11 months were recruited from 9 outpatient mental health clinics (N = 707). Consensus diagnoses were based on semistructured interviews (Schedule for Affective Disorders and Schizophrenia for School-Age Children) with youth and caregivers; 31% were diagnosed with at least one anxiety disorder. Caregivers completed the SCARED-P to describe youth anxiety levels. SCARED-P scores were not considered during the consensus diagnoses. Areas under the curve (AUCs) from receiver operating characteristic analyses and diagnostic likelihood ratios (DLRs) quantified performance of the SCARED-P total score and subscale scores (generalized anxiety disorder and separation anxiety disorder). SCARED-P total scores had variable efficiency (AUCs = .69–.88), and Generalized Anxiety Disorder and Separation Anxiety subscale scores were excellent (AUCs = .86–.89) for identifying specific anxiety disorders. Optimal subscale cutoff scores were computed to help rule in (DLRs = 2.7–5.4) or rule out (DLRs < 1.0) anxiety disorders among youth. Results suggest that the Generalized Anxiety Disorder and Separation Anxiety SCARED-P subscales accurately identify their respective matched diagnoses. DLRs may aid clinicians in screening for youth anxiety disorders and improve accuracy of diagnosis.     

Child and Adolescent Adherence With Cognitive Behavioral Therapy for Anxiety: Predictors and Associations With Outcomes

Cognitive behavioral therapy (CBT) for anxiety disorders is effective, but nonadherence with treatment may reduce the benefits of CBT. This study examined (a) four baseline domains (i.e., demographic, youth clinical characteristics, therapy related, family/parent factors) as predictors of youth adherence with treatment and (b) the associations between youth adherence and treatment outcomes. Data were from 279 youth (7–17 years of age, 51.6% female; 79.6% White, 9% African American), with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) diagnoses of separation anxiety disorder, generalized anxiety disorder, and/or social phobia, who participated in CBT in the Child/Adolescent Anxiety Multimodal Study. Adherence was defined in three ways (session attendance, therapist-rated compliance, and homework completion). Multiple regressions revealed several significant predictors of youth adherence with CBT, but predictors varied according to the definition of adherence. The most robust predictors of greater adherence were living with both parents and fewer youth comorbid externalizing disorders. With respect to outcomes, therapist ratings of higher youth compliance with CBT predicted several indices of favorable outcome: lower anxiety severity, higher global functioning, and treatment responder status after 12 weeks of CBT. Number of sessions attended and homework completion did not predict treatment outcomes. Findings provide information about risks for youth nonadherence, which can inform treatment and highlight the importance of youth compliance with participating in therapy activities, rather than just attending sessions or completing homework assignments.     

焦虑性障碍儿童行为问题与自我意识研究

目的:探讨焦虑性障碍儿童的行为问题与自我意识特点。方法:对湖南中小学生心理健康状况流行病学调查中的全部研究对象进行DSM-IV临床诊断,最后选出单纯儿童焦虑性障碍组(n1=110人)、正常对照组(n2=113人),入组儿童由父母填写Achenbach儿童行为量表(CBCL),其本人(三年级及其以上学生)填写儿童自我意识量表(CSCS)。结果:①焦虑障碍组的行为问题总分高于对照组,除性问题外其余各因子得分焦虑障碍组均高于对照组(P<0.05);社会能力各因子分及总分均低于对照组(P<0.05)。②Piers-Harris儿童自我意识量表各分量表得分及总分焦虑障碍组均低于对照组(P<0.05)。结论:焦虑障碍儿童与正常儿童相比较其行为问题比较多,自我评价低。     

Anxiety, depression and anger in Dutch Resistance veterans from World War II.

In this study, 147 Dutch Resistance veterans from WW II are evaluated on psychometric instruments for anxiety, depression and anger. Resistance veterans appeared to be more anxious, depressive and angry on these instruments compared to controls from the validation studies of the respective instruments. Veterans currently suffering from PTSD (56%) were significantly more anxious, depressed, and angry than veterans without PTSD. With respect to staying in Nazi concentration camps, which is an extremely severe stressor, and in which half of the veterans were imprisoned, no difference on the three instruments was found. Anxiety, depression and anger were observed to be highly interrelated in PTSD. The close interrelationship between anxiety and depression, anxiety and danger, and depression and anger mediated by way of anxiety is, however, not unique for traumatized subjects. It is argued that for Resistance veterans only the intrusive reminiscences of the stressful events discriminate this constellation of symptoms from subjects with an anxious-depressive symptomatology.     

Anxiety Sensitivity Among Anxious Children

Employed the Diagnostic Interview Schedule for Children to show that children diagnosed with an anxiety disorder score significantly higher on the Childhood Anxiety Sensitivity Index (CASI) than nondiagnosed children. Interviews and self-report measures regarding the child were completed by 201 children and their parents from a metropolitan area military community who were participating in a National Institute of Mental Health epidemiological survey. An analysis of variance was used to compare CASI scoring across three groups: children receiving anxiety diagnoses, children receiving externalizing diagnoses but no anxiety diagnosis, and children receiving no diagnoses. Although scoring on the CASI differentiated anxious children from the no-diagnosis control group, it did not differentiate anxious children from those receiving externalizing diagnoses. Implications of the findings for the validity of the CASI, the issue of anxiety sensitivity as a component of some externalizing disorders, and suggestions for further investigation are discussed.     

Children Awaiting Invasive Medical Procedures: Do Children and Their Mothers Agree on Child's Level of Anxiety?

Examined correspondence between mother and child reports ofchild anxiety immediately preceding a scheduled invasive medicalprocedure. The State-Trait Anxiety Inventory for Children (STAIC)was administered to 101 children ages 10–18 years. Motherscompleted the STAIC and the State-Trait Anxiety Inventory toassess their perceptions of the child's anxiety and their ownlevel of anxiety, respectively. Children were reported to havesignificantly more state anxiety as perceived by themselvesand their mothers relative to the normative sample. Resultsalso revealed low overall mother—child correspondenceon child anxiety, particularly for mothers reporting more anxietyin themselves. Additionally, while age, gender, and socioeconomicstatus were not associated with mother-child correspondence,an unexpected relationship between race and correspondence emerged.Overall, our findings indicate that reliance on parents' perceptionsof child anxiety prior to an invasive medical precedure is notsufficient.     

Discriminant validity and clinical utility of the CBCL with anxiety-disordered youth.

This study investigated the utility of several scales of the Child Behavior Checklist (CBCL) when diagnosing anxiety disorders in youth. Participants were the mothers and fathers of 130 children (ages 7 to 14; M = 9.61 years, SD = 1.74; 69 boys, 61 girls) who were evaluated at a specialty mental health clinic (100 were referred for treatment; 30 were nonanxious volunteers). For both mothers' and fathers' reports, the highest correlations were found between the Anxious/Depressed subscale and the severity of generalized anxiety disorder (GAD); the second highest relations were between the Withdrawn subscale and the severity of social phobia (SP). Using either mothers' reports or fathers' reports, receiver operating characteristics (ROC) analyses identified cutoff scores that were useful in ruling in the presence of an anxiety disorder in general but did not identify cutoff scores to rule in the presence of principal GAD or principal SP. For mothers' reports only, receiver operating characteristics analyses identified a useful cutoff score to rule out the presence of an anxiety disorder, as well as a cutoff score to rule out the presence of principal GAD. Finally, discriminant function analyses determined the most useful subscales for ruling in and ruling out an anxiety disorder in general, as well as principal GAD and principal SP. Findings are discussed with regard to diagnosis of child anxiety and the clinical utility of the CBCL with anxious youth.     

Discriminant Validity and Clinical Utility of the CBCL With Anxiety-Disordered Youth

This study investigated the utility of several scales of the Child Behavior Checklist (CBCL) when diagnosing anxiety disorders in youth. Participants were the mothers and fathers of 130 children (ages 7 to 14; M = 9.61 years, SD = 1.74; 69 boys, 61 girls) who were evaluated at a specialty mental health clinic (100 were referred for treatment; 30 were nonanxious volunteers). For both mothers' and fathers' reports, the highest correlations were found between the Anxious/Depressed subscale and the severity of generalized anxiety disorder (GAD); the second highest relations were between the Withdrawn subscale and the severity of social phobia (SP). Using either mothers' reports or fathers' reports, receiver operating characteristics (ROC) analyses identified cutoff scores that were useful in ruling in the presence of an anxiety disorder in general but did not identify cutoff scores to rule in the presence of principal GAD or principal SP. For mothers' reports only, receiver operating characteristics analyses identified a useful cutoff score to rule out the presence of an anxiety disorder, as well as a cutoff score to rule out the presence of principal GAD. Finally, discriminant function analyses determined the most useful subscales for ruling in and ruling out an anxiety disorder in general, as well as principal GAD and principal SP. Findings are discussed with regard to diagnosis of child anxiety and the clinical utility of the CBCL with anxious youth.     

Concurrent Validity of the Anxiety Disorders Section of the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions

Evaluated the concurrent validity of the Anxiety Disorders Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994): Child and Parents Versions (ADIS for DSM-IV-C/P; Silverman & Albano, 1996) social phobia, separation anxiety disorder (SAD), generalized anxiety disorder (GAD), and panic disorder diagnoses. Children referred to an outpatient anxiety disorder clinic (N = 186; ages 8 to 17), and their parents completed the Multidimensional Anxiety Scale for Children (MASC; March, 1998) and the ADIS-C/P interview. There was no convergence between MASC scores and ADIS-C/P GAD diagnoses. However, there was strong correspondence between ADIS-C/P social phobia, SAD, and panic disorder diagnoses and the empirically derived MASC factor scores corresponding to these disorders. These results provide support for the concurrent validity of the anxiety disorders section of the ADIS-C/P.     

Treatment of Anxiety Disorders in School Maladaptation with Adaptol

A total of 336 children aged 7–14 years with signs of school maladaptation (SMA) were studied. Anxiety disorders were detected in 167 (49.7%) of the cohort: generalized anxiety disorder in 87 (25.9%), phobic disorders in 40 (11.3%), separation-associated anxiety disorder in 14 (4.2%), and social anxiety disorder in 26 (7.7%). These rates were significantly different from a reference group (children without SMA). Children with generalized anxiety disorder (n = 32) were treated with Adaptol at a dose of 1000 mg/day for 30 days. Adaptol was found to be highly effective in terms of both clinical and psychological investigations, had good tolerance, and produced virtually no side effects.     

Joint Factor Analysis of the Children's Depression Inventory and the Revised Children's Manifest Anxiety Scale

Used a joint factor analysis with the Children's Depression Inventory (CDI; Kovacs, 1980/81, 1992) and Revised Children's Manifest Anxiety Scale (RCMAS; C. R. Reynolds & Richmond, 1978, 1985) to identify items that uniquely measured depression and anxiety. Data from 750 youngsters in Grades 4 through 7 were analyzed using principal-axis factoring with an oblique rotation. Salient factors were identified using guidelines provide by Gorsuch (1997). Item overlap and the large negative affectivity component across instruments were evident. Items that overlapped or had nonsalient loadings were eliminated. The sample was randomly split into 2 groups of 375 and analyses were repeated. Results indicated that a unique 9-item depression factor composed largely of items representing a negative view of oneself existed. In addition, a unique 7-item anxiety factor emerged that consisted of items reflecting worry. The validity of these abbreviated scales was explored using a separate sample of 131 students in Grades 4 through 9. The abbreviated scales were correlated with scales of positive and negative affect consistent with predictions. Findings suggest exploring alternative scoring strategies for the CDI and RCMAS to eliminate problems associated with overlapping items.     

Fear and Missing Out: Youth Anxiety and Functional Outcomes

Anxiety disorders are prevalent and associated with functional impairments. Outcome research has focused on symptom reduction, rather than positive factors such as life satisfaction and improved functioning. We review the impact of youth anxiety disorders and elevated anxiety symptoms on academic, occupational, family, social, and legal functioning. Emphasis is placed on the degree to which developmental trajectories differ for youth with and without anxiety disorders. In some areas, psychopathology generally, rather than anxiety specifically, is associated with functional impairment. Other studies support youth anxiety as a unique predictor of functional impairment. In particular, social anxiety is associated with impairments in social functioning throughout development. The short‐ and long‐term impacts of anxiety treatment in youth are discussed. Last, research directions are suggested.     

Testing the Habituation-Based Model of Exposures for Child and Adolescent Anxiety

Exposure has been identified as key to effective treatment of youth anxiety. However, the precise theoretical mechanisms of exposure are a matter of debate. Emotional processing theory emphasizes the need for fear activation during exposure and its habituation both within and across exposures. Despite the popularity of the theory to explain exposure, it has not been tested with anxious youth. To determine whether emotional processing theory parameters predict anxiety severity, coping abilities, and global functioning after cognitive-behavioral treatment. The present study examined 72 youth (M_age = 10.50 years; 45% female; 87.5% non-Hispanic Caucasian) diagnosed with an anxiety disorder and who received family or individual CBT. Three exposure habituation variables—initial fear activation (peak anxiety), within-session habituation, and between-session habituation—were assessed using Subjective Units of Distress and examined as predictors of outcome at posttreatment and at 1-year follow-up. Outcomes were measured using the Coping Questionnaire, Multidimensional Anxiety Scale for Children, Revised Children’s Manifest Anxiety Scale, Children’s Global Assessment Scale, and clinician severity ratings on the Anxiety Disorder Interview Schedule. Emotional processing theory variables did not predict any anxiety outcomes at posttreatment or follow-up with one exception: Initial fear activation predicted less anxiety at follow-up among youth without GAD. In addition, within- and between-session habituation were not associated with one another. Between-session habituation was not associated with initial fear activation. These findings suggest a limited role of habituation within cognitive-behavioral therapy for anxiety in youth. An alternative to emotional processing theory, inhibitory learning theory, is discussed.     

Anxiety disorders comorbidity in mood disorder subgroups: data from a mood disorders clinic

BACKGROUND: Previous research has identified a high rate of anxiety disorders comorbidity in patients with a primary mood disorder diagnosis. Discrepancies between studies in the comorbidity prevalence of specific anxiety disorders in mood disorders, and of anxiety disorders comorbidity between unipolar depression and bipolar mood disorder are in part due to differences in sampling and diagnostic assessment methodology. METHOD: The authors reviewed the charts of 138 patients who received the SCID-P for DSM-III on enrollment in a Mood Disorders Clinic during the period 1982 through 1988. The comorbidity of specific DSM-III Anxiety Disorders with specific mood disorders was determined and comparatively examined using non-parametric statistics. RESULTS: There was high overall comorbidity of anxiety disorders that did not differ between bipolar and unipolar subjects. There were no differences in the comorbidity of individual anxiety disorder diagnoses in the unipolar vs. bipolar groups. However, in unipolar patients with, compared to those without an additional diagnosis of dysthymia, there was greater overall anxiety disorders comorbidity, with a particularly high prevalence of generalized anxiety disorder. LIMITATION: The subgroup of patients with bipolar I disorder was relatively small (N=8). CONCLUSION: Mood and anxiety disorders comorbidity is complex and presents a continuing challenge for both clinicians and researchers.     

Anxiety disorders and suicidal behaviours in adolescence and young adulthood: findings from a longitudinal study

BACKGROUND: The aim of this study was to estimate the extent to which anxiety disorders contribute to an increase in suicidal behaviour after controlling for both observed and non-observed sources of confounding. METHOD: Data were collected from the Christchurch Health and Development Study (CHDS), a 25-year longitudinal study of over 1000 participants. Measures of anxiety disorders [phobia, generalized anxiety disorder (GAD), panic disorder], major depression (MD), substance use disorders, conduct/antisocial personality disorder, stressful life events, unemployment, and suicidal ideation/attempts for subjects aged 16-18, 18-21 and 21-25 years were used to fit random and fixed effects regression models of the associations between anxiety disorders and suicidal behaviours. RESULTS: Anxiety disorders were strongly associated with suicidal ideation/attempts. Any single anxiety disorder increased the odds of suicidal ideation by 7.96 times [95% confidence interval (CI) 5.69-11.13] and increased the rate of suicide attempts by 5.85 times (95% CI 3.66-9.32). Control for co-occurring mental disorders, non-observed fixed confounding factors and life stress reduced these associations [suicidal ideation odds ratio (OR) 2.80, 95% CI 1.71-4.58; suicide attempts incidence rate ratio (IRR) 1.90, 95% CI 1.07-3.39]. Rates of suicidal behaviour also increased with the number of anxiety disorders. Estimates of the population attributable risk suggested that anxiety disorders accounted for 7-10% of the suicidality in the cohort. CONCLUSIONS: Anxiety disorders may be a risk factor for suicidality, even after controlling for confounding, with risks increasing with multiple anxiety disorders. Management of anxiety disorders may be an important component in strategies to reduce population rates of suicide.     

Differential Occurrence of Comorbidity Within Childhood Anxiety Disorders

Investigated differences in comorbidity in children ages 8 to 13 (N = 199) with primary diagnoses of generalized anxiety disorder (GAD), separation anxiety disorder (SAD), or social phobia (SP). Children with primary SAD were found to have the highest number of comorbid diagnoses. Specific phobias were more common in children with primary SAD than in those with primary SP, whereas neither group differed from children with primary GAD. Mood disorders were more common in children with GAD or SP than in children with primary SAD. Comorbid externalizing disorders, although present in 17% of the sample, were not found to vary across diagnostic groups. Functional enuresis was most common in children with primary SAD. Results are discussed with respect to diagnostic and treatment issues.     

The relationship between obsessive-compulsive disorder and anxiety and affective disorders: results from the Johns Hopkins OCD Family Study

OBJECTIVE: This study investigates the relationship of specific anxiety and affective disorders to obsessive-compulsive disorder (OCD) in a blind, controlled family study. METHOD: Eighty case and 73 control probands, as well as 343 case and 300 control first-degree relatives of these probands, participated in the study. Subjects were examined by psychologists or psychiatrists using the Schedule for Affective Disorder and Schizophrenia-Lifetime Anxiety version (SADS-LA). Two experienced psychiatrists independently reviewed all clinical materials, and final diagnoses were made according to DSM-IV criteria, by consensus procedure. RESULTS: Except for bipolar disorder, all anxiety and affective disorders investigated were more frequent in case than control probands. Substance dependence disorders were not more frequent. Generalized anxiety disorder (GAD), panic disorder, agoraphobia, separation anxiety disorder (SAD) and recurrent major depression were more common in case than control relatives. These disorders occurred more frequently if the relative was diagnosed with OCD. Only GAD and agoraphobia were more frequent in case relatives independent of OCD. CONCLUSION: GAD and agoraphobia share a common familial aetiology with OCD. The other anxiety and affective disorders, when comorbid with OCD, may emerge as a consequence of the OCD or as a more complex syndrome.