Agreement between parents and children regarding anxiety and depression diagnoses in children with asthma

This study examined parent-child agreement regarding anxiety and depressive disorders in youth with asthma and evaluated key demographic and health differences associated with parent-child agreement. Of 756 outpatient youth with asthma, 122 (16.0%) were diagnosed with a DSM-IV anxiety or depression disorder using the Diagnostic Interview Schedule for Children (C-DISC). Parents reported on internalizing symptoms using the Child Behavior Checklist (CBCL). Logistic regression analyses were used to examine factors related to parent- and child-reported symptom agreement. Low rates of agreement (48.9%) between youth and parents regarding diagnosis of a DSM-IV anxiety or depressive disorder were found among youth with asthma. Increased agreement was associated with higher externalizing behavior score on the CBCL and more anxiety and depressive symptoms on the C-DISC. Children without behavioral problems and with less severe anxiety and depression were recognized significantly less often by their parents.     

Convergent and discriminant validity of the Children's Yale-Brown Obsessive Compulsive Scale-Symptom Checklist

The Children's Yale-Brown Obsessive Compulsive Scale-Symptom Checklist (CY-BOCS-SC; Scahill, L., Riddle, M. A., McSwiggin-Hardin, M., Ort, S. I., King, R. A., Goodman, W. K., et al. (1997). Children's Yale-Brown Obsessive Compulsive Scale: Reliability and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 844-852) is widely used to assess the presence of obsessions and compulsions in youth. Although factor analytic studies have established symptom dimensions of the CY-BOCS-SC, little is known of its psychometric properties. The present study sought to examine the convergent and discriminant validity of the CY-BOCS-SC. Eighty-six youth with obsessive compulsive disorder (OCD) and their parents were administered the CY-BOCS-SC, the CY-BOCS severity items, and the Anxiety Disorders Interview Schedule for DSM-IV: Parent Version (ADIS-IV-P). Children completed the Children's Depression Inventory and Multidimensional Anxiety Scale for Children. Internal consistency of CY-BOCS-SC symptom dimensions ranged from poor to good. The CY-BOCS-SC demonstrated good to excellent convergent validity, as demonstrated by large correlations with conceptually similar items on the ADIS-IV-P. The discriminant validity of the CY-BOCS-SC was also good, as evidenced by small, generally non-significant, correlations between the CY-BOCS-SC dimensions and depressive and anxiety symptoms, OCD symptom severity, and trichotillomania symptoms. These results provide initial psychometric support for the CY-BOCS-SC and support its use as a clinical and research instrument for assessing presence of a range of obsessive and compulsive symptoms in youth with OCD.     

Teacher Awareness of Anxiety Symptoms in Children

The present study aimed to determine which anxiety symptoms in children are associated with teacher awareness and whether teacher awareness differs according to student age and gender. The Multidimensional Anxiety Scale for Children (MASC) was completed by 453 second through fifth grade students and teachers nominated the three most anxious students in their classrooms. A multivariate analysis of variance was conducted with MASC scale scores as the dependent variables. Children identified by teachers as anxious had significantly higher levels of overall anxiety, physiological anxiety, social anxiety, and separation anxiety. Overall, teacher awareness did not differ based on student age or gender.Presented at the 50th Annual Meeting of the American Academy of Child and Adolescent Psychiatry, Miami Beach, October 2003     

Indicated prevention interventions for anxiety in children and adolescents: a review and meta-analysis of school-based programs

European Child & Adolescent Psychiatry - Anxiety disorders are among the most common youth mental health disorders. Early intervention can reduce elevated anxiety symptoms. School-based...     

DSM-IV-defined anxiety disorder symptoms in South African children

OBJECTIVE: To examine -defined anxiety disorder symptoms in a large sample of normal South African schoolchildren. METHOD: Children completed two self-report questionnaires: the Spence Children's Anxiety Scale (SCAS) and the 41-item version of the Screen for Child Anxiety Related Emotional Disorders (SCARED). RESULTS: Psychometric properties of the SCAS and the SCARED were moderate (convergent validity) to sufficient (reliability). Factor analyses yielded evidence for the presence of a number of hypothesized anxiety categories (i.e., social phobia, panic disorder, fears, and generalized anxiety disorder). Furthermore, anxiety levels of South African children were higher than those of Western (i.e., Dutch) children. Differences were found with regard to the content of prevalent anxiety symptoms among South African and Western children. CONCLUSION: Although psychometric properties of the SCAS and the SCARED in South African children somewhat deviated from those obtained in Western countries, both scales seem to be useful for assessing childhood anxiety symptoms in this country.     

Maternal depressive symptoms, and not anxiety symptoms, are associated with positive mother–child reporting discrepancies of internalizing problems in children: a report on the TRAILS Study

Maternal internalizing problems affect reporting of child’s problem behavior. This study addresses the relative effects of maternal depressive symptoms versus anxiety symptoms and the association with differential reporting of mother and child on child’s internalizing problems. The study sample comprised a cohort of 1,986 10- to 12-year-old children and their mothers from the Dutch general population in a cross sectional setup. Children’s internalizing problems were assessed with the DSM-IV anxiety and affective problem scales of the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). Current maternal internalizing problems were assessed with the depressive and anxiety symptom scales of the Depression Anxiety Stress Scale (DASS), while the TRAILS Family History Interview (FHI) measured lifetime maternal depression and anxiety. Results show that current and lifetime maternal depressive symptoms were associated with positive mother–child reporting discrepancies (i.e. mothers reporting more problems than their child). Considering the small amount of variance explained, we conclude that maternal depressive symptoms do not bias maternal reporting on child’s internalizing problems to a serious degree. Studies concerning long term consequences of mother–child reporting discrepancies on child’s internalizing problems are few, but show a risk for adverse outcome. More prognostic research is needed.     

Characteristics and anxiety symptom presentation associated with autism spectrum traits in youth with anxiety disorders

There is limited information about the nature of anxiety among youth with symptoms of autism spectrum disorder (ASD). The present study examined (a) differences in the clinical characteristics of anxious youth with and without symptoms of ASD and (b) the symptoms of anxiety that best distinguish between these groups. Results indicated that anxious youth with elevated ASD symptoms had significantly more diagnoses (e.g., specific phobias), and were more likely to meet diagnostic criteria for social phobia (and list social concerns among their top fears) than youth without elevated ASD symptoms. At the symptom level, severity of interpersonal worry based on parent report and severity of fear of medical (doctor/dentist) visits based on youth report best differentiated ASD status. The findings inform diagnostic evaluations, case conceptualization, and treatment planning for youth with anxiety disorders and ASD symptoms.     

Anxiety and Atopic Disease: Comorbidity in a Youth Mental Health Setting

Anxiety frequently co-occurs with atopic diseases (e.g., allergies) in community samples, although data are limited to community and pediatric medical samples. Little work has examined atopy rates among mental health treatment seeking youth or whether youth with comorbid anxiety and atopy present similarly to non-comorbid youth. Using initial intake data from a University-based specialty youth clinic for anxiety and depressive disorders (n = 189), rates of atopic comorbidity were benchmarked against lifetime prevalence estimates in epidemiological samples. Anxiety severity and parental stress were compared between youth with and without atopy. Results indicated high rates of atopy in the clinical sample (51.3 %) relative to population atopy estimates (34.5 %). Anxious youth with atopy exhibited more overall and generalized anxiety symptoms relative to non-atopic youth (ps < .05); parental stress was comparable between atopic and non-atopic anxious youth. This suggests potentially heightened clinical severity for youth with co-occurring anxiety and atopy.     

A School Nurse-Delivered Intervention for Anxious Children: An Open Trial

Anxiety disorders are common in children and severely impair their functioning. Because a hallmark symptom of anxiety is somatic complaints, anxious youth often seek help from their school nurse. Thus, school nurses are in an ideal position to identify anxious children and intervene early. This study assessed the feasibility of a brief nurse-administered intervention (CALM—Child Anxiety Learning Modules) based on cognitive behavioral strategies to reduce anxiety symptoms and improve academic functioning. Nine elementary school nurses completed a one-day training and administered the CALM intervention to 11 children with elevated symptoms of anxiety (M age: 8.09; range 5–11; 54% male; 91% White). Feasibility of the intervention was assessed using several indicators (e.g., training satisfaction, intervention satisfaction/helpfulness). Pre-post intervention child outcomes were collected from evaluators, parents, children, and teachers. Results indicated that the majority of nurses were highly satisfied with the training and reported the intervention was feasible. Paired t tests on pre-post outcome measures revealed significant reductions in anxiety, somatic symptoms, and concentration problems. Nurses (70%), parents (81%), and children (50%) reported that the intervention was either somewhat or very helpful. Preliminary results identified barriers to implementation but also suggest that the intervention is feasible and helpful. A sufficiently powered randomized controlled trial is needed to assess the intervention’s efficacy.     

Symptoms of Anxiety and Associated Risk and Protective Factors in Young Asian American Children

Anxiety is one of the most prevalent mental health problems in young children but there has been a dearth of studies focusing on Asian American children. This study examines the patterns and the predictors of childhood anxiety and related symptoms in young children in a diverse Asian American (ASA) sample (n = 101). Findings indicate that ASA children are at higher risk for anxiety, somatization, and depressive problems than their peers. Parents’ level of acculturation (i.e., American identity, English competence), parental negative emotion socialization, conflicted parent–child relationship, child emotional knowledge and adaptive skills, as well as teachers’ ethnic background and school class types were all associated with ASA children’s anxiety. A combination of cultural, family, and school factors explained from 17 to 39 % of the variance in anxiety symptoms. Findings inform prevention services for young ASA children.     

The co-occurrence of anxiety disorders in African American parents and their children

This study examined the co-occurrence of anxiety disorders, specifically the relationship between parent and youth anxiety, in a community-based sample of 100 African American parents and their biological child between the ages of 6 and 17 years. Data were provided by both the parent and child. Parents completed the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) Client Version about their own experiences with anxiety and related disorders and the Parent version for the child's experiences. Children were administered the ADIS-IV Child version to assess their experiences with anxiety and related disorders. Fifty-five parents met criteria for at least one anxiety disorder while 34 children met criteria for at least one anxiety disorder. Two logistic regressions were subsequently conducted to predict the presence of any form of psychopathology from the ADIS-IV and the presence of an anxiety disorder in African American offspring. Results indicated that African American offspring with an anxious parent were 4 times more likely to meet criteria for both an anxiety disorder and other forms of psychopathology.     

Predictors of Treatment Effectiveness for Youth with ASD and Comorbid Anxiety Disorders: It all Depends on the Family?

The study aimed to explore predictors of treatment effectiveness in a sample of 79 children with ASD who received cognitive behavioral therapy (CBT) for their anxiety disorders. Severity of anxiety disorders and anxiety symptoms were used to measure treatment effectiveness and was assessed pre-treatment, post-treatment, 3 months-, 1 and 2 years after CBT. Child characteristics and maternal anxiety did not predict treatment effect. Children with anxious fathers and children in ‘un-involved’ families had less anxiety symptoms at pre-treatment and displayed a less steep decline. Children from ‘authoritarian’ families showed higher pre-treatment anxiety levels but responded quite well to treatment. Findings stress the importance of parent (father) and family factors in the treatment of anxiety disorders in youth with ASD.     

Screen for Child Anxiety-Related Emotional Disorders (SCARED): convergent and divergent validity

The purpose of this study was to examine the Screen for Child Anxiety-Related Emotional Disorders' (SCARED) divergent and convergent validity and its ability to identify anxious children. The SCARED, the Child Behaviour Checklist (CBCL), and the State-Trait Anxiety Inventory for Children (STAIC) were administered to children, adolescents (n = 295), and their parents attending an outpatient mood and anxiety disorders clinic. DSM-IIIR/IV diagnoses were made using a semistructured interview (n = 130) or a symptom checklist (n = 165). The Multi-Trait Multi-Method Matrix was used to assess construct validity, and Receiver Operating Curve analysis was used to assess the sensitivity and specificity of the SCARED, CBCL, and STAIC. The SCARED correlated significantly better with the CBCL's internalizing factors than with the externalizing factors. In addition, parent and child forms of the SCARED correlated significantly with the trait and state subscales of the STAIC. Children with an anxiety disorder scored significantly higher on the SCARED than children with depression only or disruptive disorders only (P < 0.05), thus demonstrating the discriminant validity of the SCARED. The SCARED is a reliable and valid screening tool for clinically referred children and adolescents with anxiety disorders.     

Social Anxiety in High-functioning Children and Adolescents with Autism and Asperger Syndrome

We examined social anxiety and internalizing symptoms using the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Social Anxiety Scale for Children -Revised (SASC-R), and the Child Behavior Checklist (CBCL) in a sample of fifty-four high-functioning subjects with autism or Asperger syndrome (HFA/AS) (M = 11.2 ± 1.7 years) and 305 community subjects (M = 12.2 ± 2.2 years). Children and adolescents completed the SPAI-C and SASC-R, and their parents completed the CBCL Internalizing scale. Adolescents with HFA/AS scored higher than the community sample on all measures. Behavioural avoidance and evaluative social anxiety increased by age within the HFA/AS group, whereas behavioural avoidance decreased by age in control participants. Data support that HFA/AS in adolescents may be associated with clinically relevant social anxiety symptoms.     

Cognitive biases in childhood anxiety disorders: Do interpretive and judgment biases distinguish anxious youth from their non-anxious peers?

The purpose of this study was to compare interpretive biases (i.e., the tendency to interpret neutral stimuli in a negative way) and judgment biases (i.e., a lowered estimate of one's ability to cope with a threatening situation) in clinically anxious youth (n = 24) with a demographically matched group of non-referred youth (n = 48). Interpretive biases were assessed with the Children's Negative Cognitive Error Questionnaire (CNCEQ) and judgment biases were assessed with the Anxiety Control Questionnaire-child form (ACQ-C). Results indicated that (1) children in the clinic sample exhibited significantly more negative interpretive biases and less positive judgment biases relative to the control sample, (2) the ACQ-C demonstrated incremental validity over the CNCEQ in predicting diagnostic status, (3) the ACQ-C predicted diagnostic status while controlling for Generalized Anxiety Disorder symptoms and parent-reported internalizing and externalizing symptoms, (4) the relationship between the CNCEQ and diagnostic status was moderated by age and gender. Implications of the findings for theory and practice are discussed to highlight suggestions for future research and clinical practice.     

Do anxiety and depression cluster into distinct groups?: a test of tripartite model predictions in a community sample of youth

Because of their high comorbidity and strong associations, the distinctiveness of anxiety and depression in youth continues to be debated. In this study we used cluster analysis in a community sample (n=225) of youth to test tripartite model predictions regarding the grouping of individuals based on their levels of anxiety and depression symptoms. Findings were consistent with tripartite model predictions that four groups would emerge (primarily elevated on anxiety symptoms only, elevated on depression symptoms only, elevated on both anxiety and depression symptoms, and a low symptom group). Analyses using specific tripartite model variables and parent report of internalizing symptoms provided additional support for the groupings and tripartite model predictions. Across age groupings, the clustering of anxiety and depression symptoms was consistent with some hypothesized developmental differences in the expression of internalizing symptoms in youth. Findings add support for the tripartite model in youth, and support the idea that anxiety and depression do represent unique syndromes in youth. Depression and Anxiety 23:453-460, 2006. Published 2006 Wiley-Liss, Inc.     

Anxiety in ethnic minority youth. Methodological and conceptual issues and review of the literature

Although current research has documented a relatively high prevalence of anxiety disorders in American youth, this research has been conducted mainly with nonminority samples. Fair treatment and increasing numbers of ethnic minority persons in the United States require that more should be known about minority youth. However, research with majority youth cannot be safely generalized to minority youth for several reasons, such as potential differences in the manifestation of anxiety, differences in style of response to assessment devices, and different life circumstances. This review is presented in two major sections. First, the authors address definition of terms and fully examine the significance of studying anxiety in ethnic minority youth. Also considered are methodological issues such as sampling and participation biases. Second, the authors review anxiety in ethnic minority children and adolescents in the United States including studies addressing fears, worries, trait anxiety, test anxiety, and anxiety disorders.     

Sleep-related problems in pediatric obsessive-compulsive disorder

Although attention has been given to presence of sleep related problems (SRPs) in children with psychiatric conditions, little has been reported on SRPs in youth with obsessive-compulsive disorder (OCD). Sixty-six children and adolescents with OCD were administered the Children's Yale Brown Obsessive-Compulsive Scale and completed the Children's Depression Inventory and Multidimensional Anxiety Scale. Their parents completed the Child Behavior Checklist and Children's Obsessive-Compulsive Impact Scale. A subset of youth (n=41) completed a trial of cognitive-behavioral therapy. Frequency of eight specific SRPs was examined in relation to age, gender, OCD symptom severity, child-rated symptoms of depression and anxiety, parent-proxy ratings of internalizing and externalizing problems, and functional impairment. Ninety-two percent of youth experienced at least one SRP, with 27.3% reporting five or more SRPs. Total SRPs were positively associated with OCD symptom severity, child-rated anxiety, and parent-proxy ratings of internalizing problems. Total and several specific SRPs were reduced following cognitive-behavioral treatment. These results suggest that SRPs are relatively common in youth with OCD, are associated with symptom severity, and warrant attention during assessment and treatment.     

The Stability of Self-Reported Anxiety in Youth with Autism Versus ADHD or Typical Development

Children with autism spectrum disorder (ASD) are at risk for anxiety symptoms. Few anxiety measures are validated for individuals with ASD, and the nature of ASD raises questions about reliability of self-reported anxiety. This study examined longitudinal stability and change of self-reported anxiety in higher functioning youth with ASD (HFASD) compared to youth with symptoms of attention deficit hyperactivity disorder and typical development (TD) using the Multidimensional Anxiety Scale for Children (March, 2012; March et al. J Am Acad Child Adolesc Psychiatry 36(4):554–565, 1997). Diagnostic groups demonstrated comparable evidence of stability for most dimensions of anxiety. The HFASD group displayed higher anxiety than both comparison groups, especially physical symptoms. These findings have implications for identification and measurement of anxiety in ASD.     

The feelings club: randomized controlled evaluation of school‐based CBT for anxious or depressive symptoms

Background: Children with anxious or depressive symptoms are at risk of developing internalizing disorders and their attendant morbidity. To prevent these outcomes, school‐based cognitive‐behavioral therapy (CBT) has been developed, but few studies include active control conditions. We evaluated a preventive CBT program targeting internalizing symptoms relative to an activity contrast condition post‐intervention and at 1‐year follow‐up. Methods: One thousand one hundred and thirty‐nine children from Grades 3–6 from a diverse sample of schools, were screened with the Multidimensional Anxiety Scale for Children and Children's Depression Inventory. Those with t>60 on either measure were offered participation in a randomized 12‐week trial, school‐based group CBT versus a structured after‐school activity group of equal duration. We explored several therapeutic elements as potential predictors of change. Results: One hundred and forty‐eight children participated (84 boys, 64 girls; 78 CBT, 70 contrast; 57% Caucasian) and 145 completed the program. Self‐reported anxious and depressive symptoms decreased significantly over time (η²=.15 and .133, respectively), with no group by time interaction. There was a trend toward fewer children meeting diagnostic criteria for an anxiety disorder on the Anxiety Disorders Interview Schedule at 1‐year post‐CBT than post‐contrast (6/76 versus 12/69). Positive reinforcement of child behavior was associated with change in anxiety symptoms; checking homework was understood with change in depressive symptoms. Conclusions: Findings suggest that children with internalizing symptoms may benefit from both school‐based CBT and structured activity programs. Replication, longer follow‐up, and further studies of therapeutic elements in child CBT are indicated. ISRCTN Registry identifier: ISRCTN88858028, url: http://www.controlled‐trials.com/ Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.