Cognitive coping and childhood anxiety disorders

To investigate differences in cognitive coping strategies between anxiety-disordered and non-anxious 9–11-year-old children. Additionally, differences in cognitive coping between specific anxiety disorders were examined. A clinical sample of 131 anxiety-disordered children and a general population sample of 452 non-anxious children were gathered. All children filled out the child version of the Cognitive Emotion Regulation Questionnaire (CERQ-k). Structured clinical interviews were used to assess childhood anxiety disorders. Results showed that anxiety-disordered children experience significantly more ‘lifetime’ negative life events than non-anxious children. Adjusted for the ‘lifetime’ experience of negative life events, anxiety-disordered children scored significantly higher on the strategies catastrophizing and rumination, and significantly lower on the strategies positive reappraisal and refocus on planning than non-anxious children. No significant differences in cognitive coping were found between children with specific anxiety disorders. Anxiety-disordered children employ significantly more maladaptive and less adaptive cognitive coping strategies in response to negative life events than non-anxious children. The results suggest that cognitive coping is a valuable target for prevention and treatment of childhood anxiety problems.     

An Investigation of Control Among Parents of Selectively Mute,Anxious, and Non-Anxious Children

The authors examined parent–child interactions among three groups: selectively mute, anxious, and non-anxious children in different contexts. The relation between parental control (granting autonomy and high power remarks), child factors (i.e., age, anxiety, verbal participation), and parent anxiety was investigated. Parental control varied by context but parents of children with SM were more controlling than parents in the comparison groups in all contexts. Regression analyses indicated that child and parent anxiety predicted parental control, with increased anxiety associated with increased control. Older child age predicted less parent control. Group categorization moderated the relation between age and high power remarks, such that age was not a significant predictor for children with SM. Finally child-initiated speaking predicted high power remarks over and above other variables. These results support previous theories that parents take over for their children when they fail to meet performance demands, especially when the child or parent is anxious.     

Somatic symptoms in children and adolescents referred for emotional and behavioral disorders

Medically unexplained physical symptoms are frequently endorsed by children and adolescents in both clinical and community samples. The aim of this exploratory study is to examine the prevalence of somatic symptoms in a sample of 162 Italian children and adolescents consecutively referred to a Division of Child Neurology and Psychiatry from emotional and/or behavioral disorders. The role of age, gender, and psychiatric status was considered as a variable. Each patient received a DSM-IV assessment, including a diagnostic structured interview (DICA-R). The sample was divided according to gender (96 males, 66 females), age (70 children younger and 92 adolescents older than 12 years), and psychiatric diagnosis (Anxiety, Depression, Depression/Anxiety, Other). The presence of medically unexplained somatic symptoms was based on the responses to the DICA-R. Somatic complaints were reported in 69.2% of the patients. Headache was the most frequent somatic symptom (50.6%). Younger children showed higher rates of abdominal complaints than adolescents. No gender differences in frequency of somatic complaints were reported. Subjects with anxiety and/or depression reported significantly higher rates of somatic complaints, namely headache, than subjects with other mental disorders. No differences in frequency of somatic symptoms were evident between patients with anxiety, depression, and comorbid anxiety-depression. Our data suggest that an unexplained somatic symptom can be often considered as indicative of a neglected anxiety and/or depressive disorder. A collaboration between primary care physicians, pediatricians, and child psychiatrists may promote early diagnoses and timely treatments and prevent negative social and scholastic consequences.     

Negative Affect and Child Internalizing Symptoms: The Mediating Role of Perfectionism

Separate lines of research have linked the temperament factor negative affect and perfectionism with internalizing disorders. Despite theory, no previous studies have connected these lines of research to examine internalizing pathology. The current study tested a path model to investigate the mediating effect of perfectionism domains on the relation between negative affect and child anxiety, worry, and depression symptoms. Participants were 61 parent–child dyads recruited from the community. Children were 7–13 years old (54.1 % male; 88.2 % Caucasian). Overall the model fit the data well. Analyses indicated that separate domains of perfectionism mediated separate relations between negative affect and child anxiety, worry, and depression symptoms. The findings suggest that domains of perfectionism may be implicated in specific paths between negative affect and child anxiety, depression, and worry. Implications and future directions are discussed.     

Preventive Intervention for Anxious Preschoolers and Their Parents: Strengthening Early Emotional Development

The high prevalence and early onset of anxiety disorders have inspired innovative prevention efforts targeting young at-risk children. With parent–child prevention models showing success for older children and adolescents, the goal of this study was to evaluate a parent–child indicated preventive intervention for preschoolers with mild to moderate anxiety symptoms. Sixteen children (ages 3–5) and at least one of their parents participated in Strengthening Early Emotional Development (SEED), a new 10-week intervention with concurrent groups for parents and children. Outcome measures included clinician-rated and parent-rated assessments of anxiety symptoms, as well as measures of emotion knowledge, parent anxiety, and parental attitudes about children’s anxiety. Participation in SEED was associated with reduced child anxiety symptoms and improved emotion understanding skills. Parents reported decreases in their own anxiety, along with attitudes reflecting enhanced confidence in their children’s ability to cope with anxiety. Reductions in child and parent anxiety were maintained at 3-month follow-up. Findings suggest that a parent–child cognitive-behavioral preventive intervention may hold promise for young children with mild to moderate anxiety. Improvements in parent anxiety and parental attitudes may support the utility of intervening with parents. Fostering increased willingness to encourage their children to engage in new and anxiety-provoking situations may help promote continued mastery of new skills and successful coping with anxiety.     

Peer Victimization in Youth with Tourette Syndrome and Other Chronic Tic Disorders

Chronic tic disorders including Tourette syndrome have negative impact across multiple functional domains. We explored associations between peer victimization status and tic subtypes, premonitory urges, internalizing symptoms, explosive outbursts, and quality of life among youth with chronic tic disorders, as part of the internet-based omnibus Tourette Syndrome Impact Survey. A mixed methods design combined child self-report and parental proxy-report (i.e., parent reporting on the child) demographic and quantitative data for affected youth ages 10–17 years addressing gender, mean age, ethnicity and other socioeconomic features, and presence of tic disorders and co-occurring psychiatric disorders. Peer “Victim” versus “Non-victim” status was determined using a subset of four questions about being bullied. “Victim” status was identified for those youth who endorsed the frequency of the occurrence of being bullied in one or more of the four questions as “most of the time” or “all of the time”. Data from 211 eligible youth respondents and their parents/guardians showed 26% reporting peer victimization. Victim status was associated with greater tic frequency, complexity and severity; explosive outbursts; internalizing symptoms; and lower quality of life. Peer victimization among youth with chronic tic disorders is common and appears associated with tic morbidity, anxiety, depression, explosive outbursts, and poorer psychosocial functioning. Anticipatory guidance, specific bullying screening and prevention, and further studies are indicated in this population.     

The Separation Anxiety Daily Diary: Child Version: Feasibility and Psychometric Properties

This report describes the feasibility and psychometric properties of the child version of the Separation Anxiety Daily Diary (SADD-C) in 125 children (ages 7–14 years) from German-speaking areas of Switzerland. Children with separation anxiety disorder (SAD; n = 58), “other” anxiety disorders (n = 36), and healthy controls (n = 31) recorded the frequency of parent–child separations, along with associated anxiety, thoughts, reactions and subsequent parental responses. Compliance rates were modest, consistent with past research on self-report diaries with anxious children. The SADD-C was better at discriminating children with SAD from controls than “other anxious” children. The SADD-C demonstrated good convergent validity with maternal and child self-reported anxiety (Revised Child Manifest Anxiety Scale, Separation Anxiety Inventory) and perceived quality of life (Inventory for Quality of Life in Children and Adolescents). Results provide support for the SADD-C as an acceptable and valid method of assessing child symptoms and parent behavior on separation. Findings are discussed with regard to the clinical utility of the SADD-C and strategies to improve compliance.     

Mental health problems in children of somatically ill parents, e.g. multiple sclerosis

Objectives Based on the investigation of 144 families (144 patients affected by Multiple Sclerosis (MS), 109 partners, and 192 children) examined in three different European child and adolescent psychiatric University centres by means of questionnaires, we evaluated the prevalence of psychological symptoms in the offspring and associated risk factors such as duration and severity of the disease as well as depression of the ill and the healthy parent. Results Indicate that the severe disease of MS is associated with depression of the ill and healthy parent. Ill parents, especially ill mothers, as well as depressed ill, or depressed healthy parents evaluate their children’s mental health problems with a higher prevalence within the internalizing spectrum. Healthy parents report normal psychological adjustment of their children. If two parents present a depressive state, the prevalence of relevant psychological internalizing symptoms is twice or three times as high as the age norms. Conclusion Children in families with a parent affected by MS and associated depression of the parental couple are at high risk of mental health problems, especially internalizing disorders. In focusing on the mental health of children one must also be aware of the potential opportunities to address the parents’ own psychological needs.     

Attention Bias Modification Treatment for children with anxiety disorders who do not respond to cognitive behavioral therapy: a case series

Evidence is emerging to support the promise of Attention Bias Modification Treatment (ABMT), a computer-based attention training program, in reducing anxiety in children. ABMT has not been tested as an adjuvant for children with anxiety disorders who do not respond to Cognitive-Behavioral Therapy (CBT). This case series presents findings from an open trial of ABMT among six children (four girls; M age = 11.2 years) who completed a CBT protocol and continued to meet diagnostic criteria for an anxiety disorder. All children completed the ABMT protocol with no canceled or missed sessions. Child self-ratings on anxiety symptoms and depressive symptoms significantly decreased from pretreatment to posttreatment, as did parent ratings on child anxiety-related impairment. Parent ratings on child anxiety and internalizing symptoms displayed non-significant decreases from pretreatment to posttreatment. These findings support the potential promise of ABMT as a feasible adjuvant treatment that reduces anxiety and impairment among child anxiety CBT nonresponders.     

Systematic Review and Meta-analysis of Parent Group Interventions for Primary School Children Aged 4–12 Years with Externalizing and/or Internalizing Problems

This systematic review and meta-analysis evaluates the efficacy of parent training group interventions to treat child externalizing and/or internalizing problems. A search identified 21 randomized controlled trials of parent group interventions aimed at ameliorating child externalizing and/or internalizing problems in children aged 4–12 years. Random effects meta-analyses yielded significant pooled treatment effect size (g) estimates for child externalizing (g?=??0.38) and internalizing problems (g?=??0.18). Child anxiety symptoms or internalizing problems evident in children with externalizing behavior problems did not change significantly following intervention. Study quality was a statistically significant moderator of treatment response for child externalizing problems, however hours of planned parent group treatment and treatment recipient were not. Findings support the use of parent group interventions as an effective treatment for reducing externalizing problems in children aged 4–12 years. Whilst statistically significant, programs had a limited impact on internalizing symptoms, indicating a need for further investigation.     

Child Internalizing Symptoms: Contributions of Child Temperament,Maternal Negative Affect,and Family Functioning

Research has traditionally focused on the role of genetic and environmental variables in the development and maintenance of childhood internalizing disorders. Temperament variables, such as negative affect and effortful control have gained considerable interest within the field of developmental psychopathology. Environmental factors such as mother–child interactions and family cohesion have also been linked with internalizing disorders. The current study examines the relationship between child negative affect, effortful control, maternal negative affect, family functioning, and internalizing symptoms in a sample of preschool-aged children using a path analysis approach. Sixty-five children, aged 3–5 years and their mothers completed measures on child temperament, family environment, maternal personality, and child internalizing symptoms. Results support a complex model for the influence of both direct and indirect factors on internalizing symptoms in preschool-aged children.     

Somatoform Disorders in Children and Adolescents: A Comparison with Other Internalizing Disorders

A chart review of children and adolescents attending a university-based psychiatric outpatient clinic over a 1-year period was done. Nineteen consecutive patients with somatoform disorders were compared with 26 consecutive patients with other internalizing disorders, i.e., depressive disorders and/or anxiety disorders without disruptive behavior problems. Mean age, sex distribution, cognitive level, and duration of symptoms were not different between groups. Self- and parent-reported levels of psychopathology, including depression, anxiety, suicidal ideation, and deliberate self-harm, differentiated between somatoform disorders and other internalizing disorders at the group level. Levels of adaptive functioning and functional somatic symptoms did not. High levels of medically unexplained symptoms should prompt the clinician for assessing depressive symptoms and anxiety. Findings also support the use of DSM-IV criteria in pediatric patients to differentiate somatoform disorders from other internalizing disorders.     

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.     

On the physiological symptom constellation in youth with Generalized Anxiety Disorder (GAD)

To investigate the physiological symptom constellation of Generalized Anxiety Disorder (GAD)/Overanxious Disorder (OAD) in children, the present study examined parent and child reports. Children (N=47; aged 9-13) were evaluated to meet criteria for a diagnosis of GAD. Child physiological symptoms were assessed including: (a) inability to sit still/relax, (b) difficulty paying attention/concentrating, (c) irritability/getting upset easily, (d) muscle aches, and (e) sleep disturbance. Separate child and parent reports were significantly discordant for each of the GAD somatic symptoms. Parents also endorsed significantly more somatic symptoms than their GAD children. Furthermore, 9- to 11-year-olds reported fewer somatic symptoms than 11- to 13-year-olds, whereas the number of parental endorsements of child symptoms remained consistent across child ages. Results of a separate analysis of treatment sensitivity suggest that somatic symptoms were responsive to cognitive-behavioral treatment (CBT) for anxiety. When assessing GAD in children, discrepancies between parent and child report of somatic symptomatology, as well as a child's age and developmental level, should be considered.     

Characteristics of parent- and child-reported anxiety in psychostimulant medication naïve, clinically referred children with attention deficit hyperactivity disorder, combined type (ADHD-CT)

OBJECTIVE: Anxiety is a frequent comorbid condition in referred primary school-age children with attention deficit hyperactivity disorder, combined type (ADHD-CT), yet there has been relatively little systematic research of the nature of this comorbid anxiety. We describe the characteristics of parent-reported child anxiety disorders and child-reported anxiety disorders in primary school-age children with ADHD-CT. METHOD: A cross-sectional study of 75 clinically-referred psychostimulant medication na?ve children with ADHD-CT examining separately parent and child reports of anxiety, defined categorically and dimensionally. A two-year follow up of 12 children with parent-reported child anxiety and 12 children with child-reported anxiety was also completed. RESULTS: There was no significant association between the child and parent reports of anxiety. Generalized anxiety disorder (GAD), separation anxiety disorder (SAD), specific phobia (SpPh) and social phobia (SoPh) were the most common anxiety disorder diagnoses reported by parents and children. Two-year follow-up data revealed no decrease in the parent report but a significant decrease in the child report of anxiety disorders. CONCLUSIONS: The dissonance between the parent report of child anxiety and the child report of anxiety, emphasizes the importance of careful and thorough clinical assessment of the child's perspective. The nature of parent-reported child anxiety and children's self-report of anxiety requires further systematic research.     

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.     

Treating comorbid anxiety and aggression in children

OBJECTIVE: The aim of the study was to evaluate the effectiveness of an intervention that targeted both anxious and aggressive behaviors in children with anxiety disorders and comorbid aggression by parent report. METHOD: The effects of a cognitive-behavioral therapy intervention targeting comorbid anxiety and aggression problems were compared with a standard cognitive-behavioral therapy intervention targeting anxiety only. The study was conducted over a period of 2 years, and 69 families were included, with participating children ranging in age from 8 to 14 years. Intervention effects were evaluated at posttreatment and 3 months following treatment. RESULTS: An intent-to-treat analysis identified few significant differences between conditions in level of improvement following treatment and at follow-up, with the exception of parent-reported stress, anxiety, and depression, which improved in the anxiety treatment condition. Both treatment programs led to significant reductions in parent-reported child externalizing and internalizing problems and child-reported internalizing problems and to improved parenting practices. CONCLUSIONS: Comorbidity did not appear to significantly affect treatment outcome for anxiety disorders, and combining existing treatments to address comorbid problems did not enhance treatment effectiveness. Further trials are required to assess the effectiveness of an expanded combined treatment program that allows adequate time to address both internalizing and externalizing problems.     

Preschoolers’ Contribution to their Diagnosis of Depression and Anxiety: Uses and Limitations of Young Child Self-Report of Symptoms

Background The assessment of psychopathology in preschool aged children has traditionally relied exclusively on adult informants as children under 6 years-of-age have been widely regarded as developmentally unable to serve as valid reporters of their own mental state. Based on the finding of a valid preschool depressive syndrome, methods to obtain self-report of symptoms of depression and related anxiety directly from the child are now needed. Methods The Berkeley Puppet Interview (BPI), a novel measure of psychopathology designed for the young child informant, was administered to N = 110 preschool study subjects aged 4.0–5.6 who participated in a comprehensive assessment of preschool depression. Parents filled out the Child Behavioral Checklists (CBCL) and the diagnosis was derived using parent report on the Diagnostic Interview Schedule for children, version IV (DISC-IV-YC) at baseline and 6 months later. Results Findings suggest that young children may serve as useful reporters of several core and basic symptoms of depression and anxiety based on significant correlations with a variety of parent report measures administered concurrently and 6 months later. However, no significant correlations were found between preschool reports of more complex or abstract symptoms. Conclusion These findings taken together suggest that the young child can validly self-report on some key aspects of depression and anxiety and that self-report of young children should be sought in these domains. Findings also suggested that these self-reports are limited to the core and basic symptoms of these disorders and that direct age appropriate approaches may not be useful beyond that domain.     

Cognitive-behavioral intervention with young anxious children

Despite evidence that preschool and early elementary school-age children can present with anxiety disorders that may put them at risk for later psychopathology and dysfunction, the cognitive-behavioral protocols available for treating anxiety in children have been tested almost exclusively in older children. However, there could be benefits to treating children earlier, before anxiety disorders begin to impair their social and academic development. This report discusses the adaptations necessary in providing cognitive-behavioral therapy to young anxious children and describes a manualized, cognitive-behavioral intervention, with child and parent components, that was piloted openly in nine families with children aged 4 to 7 years - each of whom had multiple risk factors for developing anxiety disorders, and most of whom had already presented with anxiety disorders. Eight of the nine children were judged "much" or "very much improved" at postintervention on number of anxiety diagnoses, number of DSM-IV anxiety symptoms, and ability to cope with feared situations. Cases are presented to illustrate the way that cognitive-behavioral therapy can be conducted with youngsters in this age range. Whereas randomized, controlled trials are needed to confirm the efficacy of this manualized treatment, our experience suggests that cognitive-behavioral protocols for anxiety can be adapted and successfully implemented with young children.     

Measuring anxiety: parent-child reporting differences in clinical samples

This study examines parent-child reporting differences for childhood anxiety in normal controls (n = 16) and in children with diagnosed anxiety disorders (ANX; n = 15), attention-deficit hyperactivity disorder (ADHD; n = 15), and comorbid ANX and ADHD (n = 16). Correspondence between child reports of anxiety on two self-report inventories and diagnosis based on structured parent interview was assessed for all four groups. Parent-child agreement did not appear to be measurement dependent but did differ by diagnostic group, with poorer agreement for clinical groups. Though needing replication, these findings suggest that it is inadvisable to rely exclusively on self-report measures when assessing childhood anxiety, especially in clinical populations. Such measures can be useful in monitoring clinical progress, however, provided parent and child reports are examined separately.