Anxiety Disorders In Adolescents Research Articles

Mental Health Challenges Among First Nations Adolescents Living Off-Reserve in Ontario, Canada.

Limited data exist on the mental health challenges facing First Nations adolescents and the factors that modify these difficulties. The current study compared levels of common mental health challenges among 112 off-reserve First Nations and 3334 non-First Nations adolescents (12-17 years old) and examined the impact of maternal psychological distress on these mental health challenges. First Nations adolescents self-reported higher symptoms of conduct, oppositional-defiant, attention-deficit hyperactivity, major depressive, social phobia, generalized anxiety, and separation anxiety disorders and all associations remained statistically significant after adjusting for covariates. Moderation analyses found that increasing levels of maternal distress were associated more strongly with symptoms of oppositional defiant, attention-deficit hyperactivity, major depressive, and generalized anxiety disorders in First Nations adolescents. Future work aimed at improving the mental health of First Nations youth that focus on supporting these adolescents, and their mothers in particular, could result in substantial benefits.

Social anxiety disorder in adolescents: Prevalence and subtypes in the Young-HUNT3 study

BackgroundFew studies have examined the prevalence of social anxiety disorder (SAD) among adolescents and the associated sex-specific fears. No previous studies have reported variance in SAD prevalence among adolescents based on a stepwise diagnostic approach. MethodsUsing various diagnostic thresholds from the Anxiety Disorders Interview Schedule child version, and the diagnostic criteria from both the 4th and 5th editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), we explored the point prevalence of SAD among a population-based sample of 8216 adolescents aged 13–19 years. ResultsOverall, 2.6% of adolescents met the SAD diagnostic criteria. The prevalence varied from 2.0% to 5.7% depending on the criteria-set. Twice as many females met the overall SAD criteria. The DSM-IV generalized SAD subtype was assigned to 86.5% of the sample, while 3.5% met the DSM-5 performance-only subtype. Compared with males aged 16–19 years, significantly more of those aged 13–15 years met the SAD criteria; no significant age group differences were found among females. ConclusionsThis is the first study to demonstrate variance in SAD prevalence among adolescents based on the diagnostic threshold method. Depending on the threshold applied, SAD prevalence among adolescents varied from 2.0% to 5.7%. Age and sex differences in social fear experiences highlight the importance of considering developmental heterogeneity in SAD, especially for adapting prevention and treatment interventions.

Association Between Sleep Quality and Anxiety in Korean Adolescents.

ObjectivesAnxiety disorder is among the most prevalent mental illnesses among adolescents. Early detection and proper treatment are important for preventing sequelae such as suicide and substance use disorder. Studies have suggested that sleep duration is associated with anxiety disorder in adolescents. In the present study, we investigated the association between sleep quality and anxiety in a nationally representative sample of Korean adolescents.MethodsThis cross-sectional study was conducted using data from the 2020 Korea Youth Risk Behavior Web-based Survey. The Generalized Anxiety Disorder-7 questionnaire was used to evaluate anxiety. The chi-square test was used to investigate and compare the general characteristics of the study population, and multiple logistic regression analysis was used to analyze the relationship between sleep quality and anxiety.ResultsIn both sexes, anxiety was highly prevalent in participants with poor sleep quality (adjusted odds ratio [aOR], 1.56; 95% confidence interval [CI], 1.43 to 1.71 in boys; aOR, 1.30; 95% CI, 1.19 to 1.42 in girls). Regardless of sleep duration, participants with poor sleep quality showed a high aOR for anxiety.ConclusionsThis study identified a consistent relationship between sleep quality and anxiety in Korean adolescents regardless of sleep duration.

Ontogeny of the Corticolimbic System and the Risk of Anxiety Disorders in Adolescence

Ontogeny of the Corticolimbic System and the Risk of Anxiety Disorders in Adolescence

Do Metacognitions of Children and Adolescents with Anxiety Disorders Change after Intensified Exposure Therapy?

Metacognitive beliefs have repeatedly proven to play a role in anxiety disorders in children and adolescents, but few studies have investigated whether they change after cognitive behavioral therapy. This longitudinal intervention study explores whether positive and negative metacognitive beliefs in particular change after exposure-focused treatment, and if metacognitive changes predict reductions in anxiety symptoms. A sample of 27 children between 8 and 16 years of age with a primary diagnosis of specific phobia, separation-anxiety disorder or social phobia completed assessments of anxiety symptoms, metacognitive beliefs, worry and repetitive negative thoughts before and after 11 sessions of intensified exposure treatment. Metacognitive beliefs did not change significantly after intensified exposure, but post-hoc power analysis revealed a lack of power here. Change in negative metacognitive beliefs correlated with a change in anxiety symptoms, but did not independently contribute as a predictor variable. Differences between subsamples showed that patients with separation-anxiety disorder scored higher on negative metacognitive beliefs than those with specific or social phobia. Consideration of metacognition, and negative metacognitive beliefs in particular could help us further improve the understanding and treatment of anxiety disorders in children and adolescents and should therefore receive more attention in psychotherapy research.

Target to treatment: A charge to develop biomarkers of response and tolerability in child and adolescent psychiatry.

The current pediatric mental health crisis is characterized by staggering rates of depression, anxiety, and suicide. Beyond this, first‐line pharmacologic interventions for depressive and anxiety disorders in children and adolescents produce variable responses with two in five youths failing to respond. Given the heterogeneity of treatment response in pediatric depressive and anxiety disorders, pharmacodynamic biomarkers are necessary to develop precision therapeutics by identifying clear targets to guide treatment. This mini‐review summarizes candidate biomarkers and their development in pediatric mental health conditions. A framework for how these biomarkers may relate to safety, efficacy (e.g., surrogates for clinical endpoints), tolerability or target engagement (i.e., drug action) in children and adolescents is also presented. Taken together, accumulating data suggest that, in children and adolescents with myriad psychiatric disorders, pharmacodynamic biomarkers could facilitate developing drugs with well‐defined targets in specific populations, could inform treatment decisions, and hasten patients’ recovery.

Generalized Anxiety Disorder in Adolescents Treated with Homoeopathy: A Randomized, Single-Blind, Placebo-Controlled Trial

Generalised Anxiety Disorder is one of the anxiety disorders getting substantial rise but seldom diagnosed clinically in today’s society leading to low self esteem and disabling them from social interactions and academic achievement among adolescents. Common reasons are family, peer pressure, insecurities, friends, health & competition among peers in school performance. <i>Aim:</i> To assess the efficacy of homeopathic treatment of GAD among adolescents (11-17 years) in comparison with cognitive behavioral therapy (placebo group). <i>Objectives:</i> To study the clinical presentation of GAD among adolescents (11-17 years); To identify the various ailments leading to GAD among adolescents (11-17 years); To compare the pre score and post score of GAD among adolescents (11-17 years) with GAD questionnaire by APA in both groups. <i>Result: </i>62 subjects are divided according to the criteria of results as recovered, improved and not improved. Out 0f 31 patients in the study group 12 recovered, 16 improved and 3 not improved. Out of 31 subjects in the control group 4 recovered, 18 improved and 9 not improved. <i>Conclusion: </i>Efficacy of treatments is assessed through improvement of cases seen in no. of follow ups of both groups, where homeopathic treatment showed good results in the initial follow ups.

An evaluation of anxiety disorder and emotion regulation difficulty in children and adolescents with alopecia areata

The relationship between alopecia areata (AA) and emotion regulation difficulty has not yet been fully explained. The aim of the study was to investigate the levels of anxiety and emotion regulation difficulty in children diagnosed with AA. This case-control study was done in the university setting. Behavioral tests measuring anxiety and emotion regulation difficulties, and the measures assessing AA severity were applied to 32 AA patients consulted at Dermatology Clinic of Yozgat Bozok University. A control group was formed of 36 healthy children. Kolmogorov-Smirnov normality test, Mann-Whitney U test and Pearson's and Fisher's Chi-square tests and Spearman's correlation test. Evaluation was made of a total of 68 subjects (32 patients, 36 healthy subjects). The Difficulties in Emotion Regulation Scale (DERS)-total score and the DERS-clarity subscore were statistically significantly higher in the control group than in the patient group (P = 0.021, P = 0.003, respectively). No significant difference was determined between the two groups in respect of anxiety levels. No correlation was determined between disease severity and the scales. It was determined that as disease duration increased, so the DERS-non-acceptance subscale score increased, and with an increase in age, the SAI score of the AA patients increased. The DERS-impulse subscale score was seen to be statistically significantly higher in the boys with AA than in girls (P = 0.030). The results of this study showed that a visible, chronic, recurrent disease such as AA is not always seen with high psychiatric comorbidity and that together with the presence of the disease, patient age and disease duration are also important. It can be considered that AA may have been affected by the location, time and conditions of the study.

Evaluation of quantitative electroencephalogram changes in the assessment of anxiety disorders among children and adolescents

Background Anxiety disorders are considered a major health problem affecting children and adolescents with high incidence and prevalence in different societies.Aim The present study aimed at detecting the quantitative electroencephalogram (QEEG) changes in children and adolescents with anxiety disorders compared with healthy children. It also aimed to estimate sensitivity and specificity of QEEG in the identification of children with anxiety disorders.Patients and methods This is a case–control study, which was conducted on 20 children and adolescents with anxiety disorders and 20 healthy children and adolescents. Children were initially screened with the Arabic version of Screen for Child Anxiety Related Disorders and then furtherly subjected to interviewing children and caregivers and finally psychological testing using questionnaires for both the child and parents to verify diagnosis of anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders criteria. QEEG recording: QEEG recording was performed to cases and controls under comfortable light and calm room without artifacts to assess spectrum power.Results Using receiver operating characteristic curve analysis, theta wave spectrum power can significantly detect anxiety disorders in children and adolescents at cutoff less than or equal to 65.4 with a sensitivity and specificity of 80 and 65%, respectively. High-frequency beta wave spectrum power can significantly detect children and adolescents with anxiety disorders at a cutoff more than 23.7 with a sensitivity and specificity of 65 and 90%, respectively.Conclusion Children and adolescents with anxiety disorders have QEEG changes that coincide with their symptomatology proving that QEEG is a useful method in the assessment and diagnosis of anxiety disorders.

Screening Social Anxiety in Adolescents Through the Eyes of Their Carers.

Despite the availability of efficacious treatment and screening protocols, social anxiety disorder (SAD) in adolescents is considerably under-detected and undertreated. Our main study objective was to examine a brief, valid, and reliable social anxiety measure already tested to serve as self-report child measure but administered via Internet aimed at listening to the ability of his or her parent to identify social anxiety symptomatology in his or her child. This parent version could be used as a complementary measure to avoid his or her overestimation of children of social anxiety symptomatology using traditional self-reported measures. We examined the psychometric properties of brief and valid social anxiety measure in their parent format and administered via the Internet. The sample included 179 parents/legal guardians of adolescents (67% girls) with a clinical diagnosis of SAD (mean age: 14.27; SD = 1.33). Findings revealed good factor structure, internal consistency, and construct validity. Data support a single, strength-based factor on the SPAIB-P, being structure largely invariant across age and gender. The limited number of adolescents with a performance-only specifier prevented examining the utility of scale to screen for this recently established specifier. It is crucial to evaluate if these results generalize to different cultures and community samples. The findings suggest that the SPAIB-P evidences performance comparable with child-reported measure. Parents can be reliable reports of the social anxiety symptomatology of the adolescent. The SPAIB-P may be useful for identifying clinically disturbed socially anxious adolescents.

Sex-Specific Predictors of Exposure to Hospital-Treated Assaults Among Former Adolescent Psychiatric Inpatients.

This study examined the associations of psychiatric disorders, suicidal behavior and family-related characteristics during adolescence, to subsequent experiences of hospital-treated physical, or sexual assaults, among 508 young adults with a history of psychiatric inpatient care at adolescence (aged 13-17 years). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) based adolescent psychiatric disorders were assessed at index hospitalization using Schedule for Affective Disorder and Schizophrenia for School-Age children, Present and Lifetime version (K-SADS-PL). Treatment episodes for assaults were obtained from the health care register, provided by the Finnish National Institute for Health Welfare. About 14.4% of the participants had experienced physical or sexual assault during their lifetime. Results of logistic regression analysis indicated that anxiety disorder (odds ratio [OR] = 9.6) and nonsuicidal self-injury (OR = 3.7) in adolescence for males, and personality disorder (OR = 3.4) for females, were associated with increased likelihood for subsequent assault exposure leading to hospitalization. These findings can be used in targeting vulnerable adolescents and designing primary prevention strategies.

Evaluation of Cognitive-Behavioral Therapy Efficacy in the Treatment of Separation Anxiety Disorder in Childhood and Adolescence: a Systematic Review of Randomized Controlled Trials

Evaluation of Cognitive-Behavioral Therapy Efficacy in the Treatment of Separation Anxiety Disorder in Childhood and Adolescence: a Systematic Review of Randomized Controlled Trials

Increase in depression and anxiety disorder diagnoses during the COVID-19 pandemic in children and adolescents followed in pediatric practices in Germany.

The coronavirus pandemic and related restrictions impacted the daily lives of children and youth, partly due to the closure of schools and the absence of outdoor activities. The aim of this study was to investigate, quantify, and critically discuss the effect of the pandemic and related restrictions on consultations pertaining to depression and anxiety disorders in children and adolescents. This retrospective cross-sectional study was based on medical record data from the Disease Analyzer database (IQVIA) and included all children and adolescents aged 2–17 years with at least one visit to one of 168 German pediatric practices between April 2019 and December 2019 (n = 454,741) or between April 2020 and December 2020 (n = 417,979). The number of children and adolescents with depression and anxiety disorder diagnoses per practice and the prevalence of these diagnoses were compared for April 2020–December 2020 versus April 2019–December 2019. The number of children and adolescents with depression and anxiety diagnoses per practice increased in April 2020–December 2020 compared to the same period in 2019 (anxiety: + 9%, depression: + 12%). The increase was much greater in girls than in boys (anxiety: + 13% vs. + 5%; depression + 19% vs. + 1%). The prevalence of anxiety disorder increased from 0.31 to 0.59% (p < 0.001), and that of depression from 0.23 to 0.47% (p < 0.001). The biggest increases were observed for girls (anxiety from 0.35 to 0.72% (+ 106%, p < 0.001), depression from 0.28 to 0.72% (+ 132%, p < 0.001). This study shows an increase in the number of pediatric diagnoses of depression and anxiety disorders in the pandemic year 2020 compared to the previous year.

The acceptability of a therapist-assisted internet-delivered cognitive behaviour therapy program for the treatment of anxiety disorders in adolescents: a qualitative study

Computerized treatments have been shown to be effective in young people with anxiety disorders. However, there has been limited investigation into the experiences of adolescents in undertaking this treatment. This qualitative study explored adolescents’ experiences of being treated for an anxiety disorder, using an online intervention with therapist support, as part of a randomised controlled trial. Individual semi-structured interviews were conducted with thirteen adolescents aged between 13 and 17 years, who had received the online intervention. Data were analysed using reflexive thematic analysis. Two cross-cutting themes were identified: (i) Usability of the program, and (ii) Putting techniques into practice. Although the convenience of online sessions was recognised as positive, many of the adolescents expressed a preference for face-to-face sessions. The length of sessions and the large amount of reading involved was highlighted by most participants. The transdiagnostic nature of the content meant some elements of the programme were seen as less relevant. While many participants appreciated the ‘fun’ aspect of the program, others felt that certain aspects of the program were not suitable for their age group. Exposure, psychoeducation and cognitive restructuring were generally received positively, whereas responses to the use of relaxation and rewards were much more mixed. Our findings highlight the potential utility for online treatments delivered with therapist support. However, they also highlight how issues with both the format and treatment components can impact the acceptability of a program. As such, further work is warranted to improve the acceptability of online treatments for adolescents with anxiety disorders.

Cognitive Variables in Social Anxiety Disorder in Children and Adolescents: A Network Analysis

Clark and Wells’ prominent model of social anxiety disorder (SAD) assumes that cognitive variables such as negative expectations or dysfunctional cognitions play a central role in the symptomatology of SAD. In contrast to adults, it is less clear how well the cognitive model can be applied to children and adolescents. A network analysis with seven nodes was conducted to explore the importance of cognitive variables and their interaction with symptoms of SAD based on N = 205 children and adolescents (8–18 years, M = 11.54 years). Cognitive variables had a high but differential impact within the positively connected network of SAD. Dysfunctional cognitions were most strongly connected within the network. Dysfunctional cognitions, as predicted by Clark and Wells’ model, seem to act as a hub affecting several symptoms. The association between negative expectations and avoidance indicates that negative expectations may particularly contribute to the maintenance of SAD.

Possible correlations between cocaine use, generalized anxiety and panic disorders in adolescents and young adults: a review of the literature

BACKGROUND: Substance use disorders have been associated with a vast range of harmful behaviors. The purpose of this review is to evaluate the possible correlations between anxiety disorders, especially generalized anxiety disorder (GAD), panic disorder (PD), panic attacks and cocaine use among adolescents and young adults. METHODS: A literature search was conducted to evaluate pertinent studies up to July 06, 2020 in Google Scholar, PubMed, Embase and PsycInfo databases. RESULTS: A total of 20 articles were considered eligible; most studies reported that young people who experienced PD, panic attacks or GAD were more likely to have been cocaine users, with the risk being higher when individuals were addicted. CONCLUSIONS: The association between cocaine use, PD and GAD, poses significant challenges to health providers of adolescents and young adults, as comorbidity complicates the treatment, prognosis and course of the disorders.

Anxiety Disorders in Children and Adolescents

Anxiety Disorders in Children and Adolescents

IRRITABILITY AND REACTIVE AGGRESSION: IMPLICATIONS FOR DIAGNOSIS, TREATMENT, AND EQUITY

This session aims to facilitate discussion regarding irritability and its role in the diagnosis and treatment of childhood mental health disorders. The interpretation of irritability varies among child and adolescent psychiatrists and results in different diagnoses, treatments, and clinical outcomes. This session will describe the concept of irritability as a mood symptom, extrinsic factors that impact diagnostic patterns, considerations for improved diagnostic accuracy and equity, and treatment recommendations. Four presentations will discuss: 1) an overview of irritability as a mood symptom; 2) irritability in ADHD and autism spectrum disorder (ASD); 3) irritability diagnostic patterns in vulnerable and minority youth; and 4) treatment strategies for targeting mood and anxiety symptoms underlying irritability. Irritability is a core feature of externalizing and disruptive disorders, such as ODD and conduct disorder (CD); it is also highly associated with ADHD and adverse childhood experiences including traumatic stress, neglect, and abuse. Diagnostic patterns indicate that irritability is more often interpreted to be “disruptive” in Black and Brown youth, who receive fewer ADHD, DMDD, or affective/anxiety diagnoses than Non-Latinx White (NLW) youth with similar symptoms. Youth diagnosed with ODD are likely to have underlying anxiety or mood symptoms that are predictive of anxiety and depressive disorders in adolescence or adulthood and may therefore be better classified under one of these diagnoses. Similarly, youth with ASD experience irritability that may be best understood through their social communication deficits and impulsivity/anxiety symptoms, rather than through an ODD diagnosis. Treatment approaches that target underlying affective, anxiety, and neurodevelopmental disorders and instruct caregivers in appropriate management strategies may be most effective for these youth. 1) Irritability is a core feature of multiple child and adolescent mental illness diagnoses. 2) The resulting diagnosis is often driven by racial and socioeconomic factors. 3) Youth with co-occurring neurodevelopmental disorders are also at increased risk for misdiagnosis. 4) Targeting underlying mood and anxiety symptoms and bolstering caregiver skills are primary interventions.

28.12 Homicidal Ideation and Psychiatric Comorbidity in Inpatient Adolescents Aged 12 to 17 Years

Adolescents with homicidal tendencies are a serious growing concern in the United States. Research studies in the past have showcased the relationship between homicidal ideation (HI) and mental illnesses, but very limited information is available on the adolescent and inpatient population. We aim to evaluate the difference in the prevalence of demographic characteristics and mental health disorders in adolescents with and without HI. The adolescent population (ages 12-17 years) that admitted to the hospital with the diagnosis of HI was identified from the 2016 to 2018 National (Nationwide) Inpatient Sample dataset. Patients without HI were used as a control group. The prevalence of mental illness comorbidities between the group was compared using the Rao-Scott adjusted χ2 test. A total of 18,935 patients (mean age: 14.5 years) with HI diagnosis were identified in the study. The majority of the patients in the HI group were male compared to the control group (58.7% vs 41.2%; p < 0.001). Racially, it was more prevalent in the White race (56.0% vs 52.6%; p < 0.001) as well as the Black race (22.3% vs 17.8%; p < 0.001). It was less prevalent among the Hispanic race (14.9% vs 21.3%; p < 0.001). MDD prevalence was 48.2% in patients with HI and 22.3% in the control group. Bipolar disorders (17.7% vs 3.8%; p < 0.001), and anxiety disorders (49.5% vs 20.0%; p < 0.001) were highly prevalent among patients with HI. Suicidal ideation/attempt was prevalent in 66.9% of patients with HI. The study found a higher prevalence of mental illnesses such as depression, anxiety, and bipolar disorder in adolescents with HI. The White race was more prevalent in the homicidal group of the study. Further large-scale longitudinal research studies are warranted to establish the causal relationship between mental health disorders and HI among adolescents.

Optimism in Portuguese Adolescents: The Role of Anxiety and Positive Affect

The higher prevalence of anxiety and depression disorders in children and adolescents and the persistence of these disorders in adulthood show how important it is to investigate these concepts. Simultaneously, if we better understand the antecedents of, for example, anxiety, it will be more advantageous to define and implement some programs specifically for those ages. Like in adults, some investigations propose to study the effect of anxiety on optimism on samples of children or adolescents. In this study, we analyze the relations between anxiety, optimism, and affect in a sample of 155 students (mean age = 12 years). We took a particular interest in investigating the direction of influence between anxiety and optimism. The results showed a positive association between positive affect and anxious coping, and predictive power of these variables in explaining optimism, which seems to result from a contribution equivalent to that described on the two-factor structure of affectivity.