Anxiety Disorders In Children Research Articles

Therapists’ characteristics associated with the (non-)use of exposure in the treatment of anxiety disorders in youth: A survey among Dutch-speaking mental health practitioners

IntroductionAlthough there is consensus that exposure is the key ingredient in treating childhood anxiety disorders, several studies in the USA suggest exposure to be underused in clinical practice. Previous research pointed to therapists’ beliefs about exposure, their age, experience, caseload, training and theoretical orientation, as well as the level of the therapists’ own anxiety as important factors in the underusage of exposure in the treatment of adult anxiety disorders. This study examined what therapist characteristics may be involved in the (non-)use of exposure in treating childhood anxiety disorders. MethodsAn internet-based survey among 207 youth mental health care professionals in the Netherlands and Belgium was conducted to assess therapists’ beliefs about exposure, their age, experience, caseload, training and theoretical orientation, as well as the level of the therapists’ own anxiety, depression and stress. ResultsThe current survey showed that therapists used exposure in about half of their cases of childhood anxiety and that the non-use was independently associated with the relatively strong negative beliefs about exposure, therapists’ age, and non-CBT orientation. DiscussionFindings point to the importance of addressing negative beliefs about exposure in therapists’ training and supervision to resolve therapy drift away from exposure, and consequently improve utilization and delivery of exposure-based therapy for childhood anxiety disorders.

Lack of research on efficacy of virtual reality exposure therapy (VRET) for anxiety disorders in children and adolescents : Asystematic review.

SummaryAnxiety disorders are one of the most prevalent mental disorders in children and adolescents which may effectively be treated by several forms of exposure therapy. An emerging approach to exposure is virtual reality exposure therapy (VRET), but a literature search synthesis focusing specifically on the use of VRET in children and adolescents is still lacking. This systematic review sets out to provide an overview concerning VRET for the treatment of anxiety disorders in this age group. Four published trials covering an overall sample of 100 participants between the ages of 8 and 16 years were found during a systematic literature search and were included in the current review. Results reveal that participants show clinical improvements regarding anxiety symptoms after VRET. Nevertheless, the high potential of virtual reality as a tool for treating children and adolescents with anxiety disorders is contrasted by a considerable lack of controlled trials. Despite the evidence of VRET in adult samples, there is a need for more research with younger cohorts in order to be able to support this promising field of application.

The role of exposure in the treatment of anxiety in children and adolescents: protocol of a systematic review and meta-analysis

BackgroundIn children and adolescents, anxiety disorders (ADs) are among the most prevalent mental disorders. While there is a solid empirical foundation to support CBT as an evidence-based treatment for childhood ADs, the mechanisms underlying the efficacy of CBT are not well explored. Exposure is assumed to be vital to the efficacy of CBT in ADs, but empirical evidence (e.g., dismantling studies) showing that exposure is indeed a vital element of effective treatments is relatively scarce. The proposed meta-analysis aims to investigate the role of exposure in reducing symptoms of anxiety among children and adolescents.MethodsA systematic search of several electronic databases including PubMed/MEDLINE, PsycINFO, Psyndex plus, Web of Science, Scopus, and EMBASE will be conducted (from inception onwards). We will include randomized and non-randomized clinical trials examining exposure and anxiety among children and adolescents. If feasible, we will also include experimental, quasi-experimental, and observational studies. The primary outcome will be improvement in anxiety levels (recovery or change in anxiety rating scale) after exposure. Three reviewers will independently screen all citations, abstract data, and full-text articles. The methodological quality (or risk of bias) of individual studies will be appraised using an appropriate tool. If feasible, we will conduct mixed effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., dose of exposure, age group, methodological quality).DiscussionThis systematic review and meta-analysis will examine the role of exposure in reducing symptoms of anxiety among youth. The review will provide information on the working mechanisms underlying the efficacy of CBT. Our findings will be of interest to mental health professionals, researchers, and policy makers who wish to support children and adolescents with anxiety disorders by guiding well-informed treatment decisions.Systematic review registrationPROSPERO (CRD42019128667).

Evidence-based practice in child and adolescent mental health services - The challenge of implementing national guidelines for treatment of depression and anxiety.

Mental health problems are one of the most pressing public health concerns of our time. Sweden has seen a sharp increase in mental disorders among children and youth during the last decade. The evidence base for treatment of psychiatric conditions has developed strongly. Clinical practice guidelines aim to compile such evidence and support healthcare professionals in evidence-based clinical decision-making. In Sweden, the national guidelines for the treatment of depression and anxiety disorders in children and adolescents were launched in 2010. The aim of this study was two folded, (i) to explore to what extent these guidelines were known and adhered to by health professionals in Child and Adolescent Mental Health Services and (ii) to investigate factors influencing implementation of the guidelines informed by the Consolidated Framework for Implementation Research. A qualitative approach was used, and data were collected through interviews with 18 health professionals in Child Mental Health Services in Sweden and a combination of conventional and directed content analyses was used. The Consolidated Framework for Implementation Research guided and structured data collection and analysis. The guidelines were largely unknown by health professionals in Child Mental Health Services in all the clinics investigated. Adherence to guideline recommendations was reported as very low. Barriers to implementation were found in relation to the characteristics of the intervention, outer setting, inner setting and characteristics of the individuals involved. The government initiative to develop and disseminate the guidelines seems to have made very little impact on health professionals' clinical practice. The guidelines were poorly aligned with the health professionals' knowledge and beliefs about effective mental health services for children and youth with depression and anxiety disorders. Suggestions for future efforts to improve the development and implementation of guidelines in Child Mental Health Services settings are given.

Mothers' and children's metacognitions and the development of childhood anxiety: a longitudinal investigation of transmission.

Theory and preliminary evidence suggests that parental beliefs and cognitions may be transmitted to their offspring. Transmission of maladaptive cognitions may play a role in the development of anxiety disorders in childhood. However, few studies have investigated such transmission using longitudinal designs. The objective of this study was to investigate the interaction between maternal and child metacognitions and their role in the development of childhood anxiety. We used a longitudinal design with self-report measures of maternal and child anxiety symptoms and metacognitions. Participants were 107 mothers and their children who were assessed when the children were between 7 and 12years old and again 3years later. Child metacognitions at baseline did not predict later child anxiety symptoms. Baseline maternal metacognitions approached significance in predicting anxiety symptoms in children at the follow-up, when controlling for known risk factors, including female gender and higher levels of anxiety in mother and child at baseline. Mediation analyses revealed that child metacognitions at baseline, as well as at follow-up fully mediated the relationship between maternal baseline metacognitions and child anxiety 3years later. Examinations of how child and maternal metacognitions affect child anxiety levels after three years revealed that current levels of child metacognitions play a greater role in predicting child anxiety than child and maternal metacognitions at baseline.

Recognition of anxiety disorders in children: a cross-sectional vignette-based survey among general practitioners

ObjectiveTo quantify general practitioners’ (GPs) sensitivity to anxiety disorders (ADs) when confronted with the range of symptoms common to children with ADs. Also, to explore GPs’ conscious preferences and implicit...

Comparison of Effectiveness of Mindfulness and Happiness Training in Promoting Parent-Child Interaction Case Study: Mothers of Anxious Preschool Children in Shahrekord 2018

Introduction: Anxiety disorders are common psychiatric disorders in children and adolescents. It seems that the parent-child interaction affects or exacerbates the creation of anxiety disorders in children. The present study aimed to compare the effectiveness of mindfulness and happiness training in promoting parent-child interaction in mothers of anxious preschool children. Methods: The research method was experimental with a pretest-posttest design and control group. The statistical population included all mothers of pre-school anxious children in Shahrekord in 2018. Using the multistage sampling method, 45 people were selected and put randomly in the control and two experimental groups (n=15 per group). The Spence Children's Anxiety Scale (SCAS) and Pianta's Child-Parent Interaction Questionnaire (PACHIQ) were used for data collection. Experimental groups were put under mindfulness (eight 90-minute sessions) and happiness (ten 90-minute sessions) training, but the control group did not receive any intervention. Analysis of the data involved both inferential and descriptive statistics including mean, standard deviation. Data analysis was conducted using one-way analysis of variance (one-way ANOVA) and analysis of covariance (ANACOVA). SPSS version 24 was further used for analyzing the data. The significance level of research was considered to be α=0.05. Results: The results indicated that both mindfulness (p=0.0001) and happiness (p=0.0001) training increased parent-child interaction in mothers of anxious preschool children. The mean ± SD of the post-test score of parent-child interaction in the control group was 96.73±7.89 which was significantly different from the experimental groups (p=0.0001). Furthermore, there was no significant difference between the effectiveness of mindfulness (117.80±4.47) and happiness training (115.46±4.65) in promoting parent-child interaction in mothers of anxious children (p=0.599). Conclusion: Mindfulness and happiness training were effective in improving parent-child interaction in mothers of preschoolers with anxiety and could similarly change the parent-child interaction in mothers of anxious children.

SPACE, Parent-Based Treatment for Childhood and Adolescent Anxiety: Clinical Case Illustration

Efficacious treatments for childhood anxiety disorders include Cognitive Behavioral Therapy (CBT) and medications, yet there is urgent need for additional efficacious treatment modalities. Parent-based treatment provides such an alternative. Recent literature has supported that SPACE (Supportive Parenting for Anxious Childhood Emotions), an entirely parent-based treatment, is as efficacious as CBT in reducing child anxiety. SPACE focuses on systematically reducing family accommodation, or changes to parental behavior aimed at alleviating or avoiding a child's distress related to their anxiety disorder, while maintaining a supportive stance toward the child. To date, SPACE is the only intervention that places the reduction of parental accommodation at the center of its theoretical foundation and treatment objectives. This article provides theoretical and empirical background for SPACE and illustrates its implementation through a case description.

Parent and child emotion and distress responses associated with parental accommodation of child anxiety symptoms.

Parental accommodation contributes to the maintenance of child anxiety and related symptoms. The current study examines the contributions of parent and child factors to parental accommodation in a sample of anxious youth. Sixty-four treatment-seeking youth (6-16 years) and their mothers, as well as a subset of fathers (N = 41) reported on parental accommodation, parental distress and emotion regulation, child psychopathology, child externalizing behaviors, and child intolerance of uncertainty. Parental accommodation was not related to parental distress or emotion regulation. Parents who viewed their child as being more symptomatic (e.g., anxious, externalizing, and intolerant of uncertainty) were more likely to engage in accommodation. For mothers, child anxiety and externalizing symptoms were notable predictors of accommodation. Parent perceptions of child symptomology is an important factor significantly related to accommodation behaviors. This finding can be used to inform programming designed to target parental responses to child anxiety and related disorders.

Trajectories of childhood anxiety disorders in two generations at high risk.

The course of anxiety disorders during childhood is heterogeneous. In two generations at high or low risk, we described the course of childhood anxiety disorders and evaluated whether parent or grandparent major depressive disorder (MDD) predicted a persistent anxiety course. We utilized a multigenerational study (1982-2015), following children (second generation, G2) and grandchildren (third generation, G3) of generation 1 (G1) with either moderate/severe MDD or no psychiatric illness. Psychiatric diagnoses were based on diagnostic interviews. Using group-based trajectory models, we identified clusters of children with similar anxiety disorder trajectories (age 0-17). We identified three primary trajectories in G2 (N = 275) and G3 (N = 118) cohorts: "no/low anxiety disorder" during childhood (G2 = 66%; G3 = 53%), "nonpersistent" with anxiety during part of childhood (G2 = 16%; G3 = 21%), and "persistent" (G2 = 18%; G3 = 25%). Childhood mood disorders and substance use disorders tended to be more prevalent in children in the persistent anxiety trajectory. In G2 children, parent MDD was associated with an increased likelihood of being in the persistent (84%) or nonpersistent trajectory (82%) versus no/low anxiety trajectory (62%). In G3 children, grandparent MDD, but not parent, was associated with an increased likelihood of being in the persistent (83%) versus nonpersistent (48%) and no/low anxiety (51%) trajectories. Anxiety trajectories move beyond what is captured under binary, single time-point measures. Parent or grandparent history of moderate/severe MDD may offer value in predicting child anxiety disorder course, which could help clinicians and caregivers identify children needing increased attention and screening for other psychiatric conditions.

Attachment-Based Family Therapy for Adolescent Substance Use: A Move to the Level of Systems.

This paper provides an account of the theoretical basis of a family-based intervention called Behaviour Exchange and Systems Therapy (BEST). The model described here has also been applied to adolescents with substance abuse and other mental health problems such as depression and anxiety disorders in both children and adolescents. Evaluative studies of the model have been published including randomised clinical trials as well as qualitative analyses. The current paper discusses a theory of the family system as a discourse and represents an integration of aspects of attachment, psychoanalytic, and systems theories. Key concepts elaborated are the attachment-family system, the family as a single discourse, the use of segregation as a defense in relation to trauma and loss and its manifestation in a family narrative, and the role of the family secure base in affect regulation. The paper also briefly describes specific treatment techniques that are derived from the theoretical model. Our approach has wide application as a discourse focused treatment for children and adolescents using a family systems approach. Future work requires the comparison of this model to similar attachment-based models of intervention for children and families, further development and validation of measures able to be used for whole families in a clinical setting, and further empirical demonstration of treatment efficacy in a variety of clinical settings.

Clinically Significant Anxiety in Children with Autism Spectrum Disorder and Varied Intellectual Functioning

ABSTRACT Objective: To evaluate how distinct presentations of anxiety symptoms and intellectual impairment influence the measurement and estimated rate of clinically significant anxiety in autism spectrum disorder (ASD). Method: The sample included 75 children (ages 9–13 years) with ASD and varied IQ and 52 typically developing (TD) controls and parents. Parents completed anxiety symptom scales and a diagnostic interview, designed to (1) differentiate anxiety and ASD and (2) examine DSM-specified and unspecified (“distinct”) anxiety presentations in each child, including fears of change, special interests, idiosyncratic stimuli and social confusion rather than evaluation. Children completed standard intellectual and ASD diagnostic assessments. Results: 69% of those with ASD had clinically-significant anxiety, including 21% DSM-specified anxiety disorders, 17% distinct anxiety, and 31% both. Only 8% of TD children had clinically-significant anxiety, all DSM-specified. DSM-specified anxiety disorders in children with ASD and intellectual impairment (IQ<70) were predominantly specific phobias. DSM-specified anxiety other than specific phobia was significantly less common in children with, versus without, intellectual impairment; this was not the case for distinct anxiety. The sensitivities of anxiety scales were moderate to poor, particularly in cases with intellectual impairment. Conclusions: ASD is associated with more frequent and varied presentations of clinical anxiety, which may align with and differ from the specified anxiety disorders of the DSM. Standard parent report anxiety scales have reduced sensitivity to detect clinical anxiety in ASD, particularly in children with intellectual impairment.

Practitioner Review: Anxiety disorders in children and young people - assessment and treatment.

Despite significant advancements in our knowledge of anxiety disorders in children and adolescents, they continue to be underrecognised and undertreated. It is critical that these disorders are taken seriously in children and young people as they are highly prevalent, have a negative impact on educational, social and health functioning, create a risk of ongoing anxiety and other mental health disorders across the life span and are associated with substantial economic burden. Yet very few children with anxiety disorders access evidence-based treatments, and there is an urgent need for widespread implementation of effective interventions. This review aimed to provide an overview of recent research developments that will be relevant to clinicians and policymakers, particularly focusing on the development and maintenance of child anxiety disorders and considerations for assessment and treatment. Given the critical need to increase access to effective support, we hope this review will contribute to driving forward a step change in treatment delivery for children and young people with anxiety disorders and their families.

The role of maternal anxiety disorder subtype, parenting and infant stable temperamental inhibition in child anxiety: a prospective longitudinal study.

Social anxiety disorder (SAD) aggregates in families. To elucidate intergenerational transmission of risk, we examined whether childhood SAD and symptoms of anxiety were prospectively predicted by stable infant temperamental inhibition, maternal SAD, maternal generalized anxiety disorder (GAD) and maternal parenting behaviours. We conducted a longitudinal study beginning prenatally with follow-up at 4, 10, 14 and 58 months postnatally. Mothers were assessed for anxiety disorders prenatally and assigned to one of three groups: SAD (n=67), GAD (n=56) and nonanxious controls (n=94). We assessed infant temperamental inhibition at 4 and 14 months, maternal parenting behaviours at 10 and 58 months, and child anxiety disorders and symptoms at 58 months. Child SAD at 58 months was predicted by prenatal maternal SAD (OR=23.76, 95% CI=1.15-60.37), but not by prenatal maternal GAD (OR=7.44, 95% CI=0.32-124.49), stable temperamental inhibition or maternal behaviours. Child anxiety symptoms at 58 months were predicted specifically by maternal SAD (but not GAD), and also by concurrent maternal intrusiveness. Stable temperamental inhibition moderated the association between 10-month maternal encouragement and 58-month child anxiety symptoms. We found evidence for specificity of risk for child SAD and anxiety symptoms from maternal SAD compared to maternal GAD. Childhood anxiety symptoms were also predicted by an interaction between a lack of maternal encouragement in infancy and stable temperamental inhibition, as well as concurrent maternal intrusiveness. The findings have clinical implications for targeted prevention of child anxiety.

Modular CBT for Youth Social Anxiety Disorder: A Case Series Examining Initial Effectiveness

ABSTRACTCognitive Behavioral Therapy (CBT) is the most efficacious treatment for childhood anxiety disorders. At the same time, several studies showed that for children and adolescents with social anxiety disorder (SAD), standard protocolized CBT seems to be less efficacious than for youth with other types of anxiety disorders, suggesting that children with SAD need a different approach. The purpose of this study was to examine the effectiveness of a modularized cognitive behavioral therapy (CBT) for children with SAD, including mindfulness. Ten children and adolescents (50% girls, aged 8–17 years) referred for SAD were measured at pretreatment, posttreatment and 10 weeks follow-up. Results showed that 5 youths (50%) were free of their SAD posttreatment, and 8 (80%) at follow-up. Clinically meaningful improvements from pretest to follow-up were found in 90% and 60% of the cases, for the total anxiety symptom score and social anxiety symptom score, respectively. Pre-post-follow-up group analyses revealed significant improvements in SAD severity (combined parent and child report) and social anxiety symptoms across child, mother, and father report. The remission rate of 80% and substantial social anxiety symptom decline is promising, providing a starting point for improving treatments of youth with SAD.

Risk Factors and Prevention Strategies for Anxiety Disorders in Childhood and Adolescence.

Anxiety is prevalent in childhood and adolescence. Youth with maladaptive responses to common situations and stressors are at risk of having anxiety disorders. Persistent anxiety symptoms and anxiety disorders can be debilitating with long-term adverse outcomes in adulthood. Hence, decreasing the burden of anxiety disorders is an important public health priority. Development of anxiety disorders has a multifactorial etiology. There is a considerable complex interaction of genetics, temperament, parenting behavior, environmental triggers, and physiologic factors. Identification of these risk factors is key to early detection, prevention, and development of applicable management approaches. Despite several evidence-based treatments published, there are limited prevention strategies available. Effective implementation of prevention strategies is essential and can be achieved by either elimination or reduction of the negative risk factors or strengthening the protective factors on anxiety symptoms and anxiety disorders. This chapter reviews the common risk and protective factors and provides current literature on prevention strategies for pediatric and adolescent anxiety disorders.

Тревожные расстройства у детей с синдромом дефицита внимания с гиперактивностью

Aim: to assess the prevalence and presentations of anxiety in preschool children with attention deficit/hyperactivity disorder (ADHD). Patients and Methods: preschoolers (4–6 years) and their parents were enrolled. 30 children with ADHD and their parents were included in the study group and 15 healthy children and their parents were included in the control group. The study was performed in Moscow kindergartens. Clinical anamnestic, experimental psychological (Р. Temple, М. Dorkey, and Е.W. Amen anxiety test adapted by V.M. Astapov; “Fears in Houses” test modified by M.A. Panfilova; questionnaire for anxiety in children for a teacher and parents by G.P. Lavrent’eva and T.M. Titarenko), and statistical tests were applied. Results: in children with ADHD, a significantly higher level of anxiety was reported as demonstrated by Р. Temple, М. Dorkey, and Е.W. Amen anxiety test results (i.e., the test completed by children themselves). The percentage of children with 15 fears or more was significantly higher in the study group compared to the control group. Most preschoolers from both groups experience so-called age-related fears. In addition, age-inappropriate social fears (e.g., a fear of punishment or a fear of being late for kindergarten) were revealed in children with ADHD. These fears were much more common in the study group compared to the control group. Conclusions: our findings demonstrate a higher level of anxiety in children with ADHD compared to healthy children. Therefore, anxiety may be regarded as an ADHD-associated factor. In addition to typical age-related fears, children with ADHD experience so-called social fears. This phenomenon illustrates a fear of disapproval and punishment and a propensity for low self-esteem. KEYWORDS: attention deficit/hyperactivity disorder, anxiety disorders, preschoolers. FOR CITATION: Korabel’nikova E.A. Anxiety disorders in children with attention deficit/hyperactivity disorder. Russian Journal of Woman and Child Health. 2020;3(4):302–308. DOI: 10.32364/2618-8430-2020-3-4-302-308.

Psychopathology, quality of life, and related factors in pediatric liver transplantation candidates and recipients.

Liver transplantation (LT) has been accepted as a standard treatment of pediatric liver diseases that can progress to end-stage liver disease or lead to acute liver failure. However, there is a lack of studies clarifying quality of life (QoL) and the characteristics and the prevalence of common psychiatric disorders in children before and/or after LT. Thus, this study aimed to investigate QoL and the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) in children and adolescents before and after LT and to compare them with healthy controls. The study included 30 children aged 5-18years who were waiting for LT (pTx group) or had undergone LT (Tx group) as the study groups and 20 children for the control group. The PedsQL was used to evaluate QoL, and SCARED, CDI, and the CPTSD-RI were used to evaluate psychopathology. The QoL scores were higher in the control group compared with the study groups in all or most of the dimensions, depending on the reporter. The mean scores of anxiety, depression, and PTSD of the control group were significantly lower than those of the Tx and pTx groups. A significant positive correlation was found between depression, anxiety, and PTSD scores, and a negative correlation was observed between depression, anxiety, and PTSD scores and QoL. Waiting for LT and the transplantation process itself seem to be psychologically traumatic for children. Healthcare providers need to be trained to recognize the symptoms of the main psychiatric disorders.

Latino and Non-Latino Parental Treatment Preferences for Child and Adolescent Anxiety Disorders.

There is frequently a presumption that Latino parents have a greater preference for involvement in their child's treatment for anxiety compared to non-Latino white parents. However, parent involvement may increase burdens associated with treatment and research suggests thatLatino individuals already face significantly greater barriers to obtaining mental health treatment. In the current study, we compared Latino and non-Latino parents' preferences for parental involvement and perceptions of burdens in cognitive behavioral therapy (CBT) for youth anxiety. 117 parents (57 Latino) completed measures to assess child anxiety, perceptions of treatment involvement, and burdens associated with treatment. There were no significant differences between Latino and non-Latino parents except for a trend toward Latino parents reporting more concerns about the feasibility of obtaining CBT for their child's anxiety. Because Latino parents expressed concern about potential treatment barriers, cultural adaptations for treatment should focus on decreasing burdens associated with treatment rather than increasing parental involvement.

Association Between Emotional Disorders and Speech and Language Impairments: A National Population-Based Study.

Anxiety and depression are common emotional problems in children and adolescents. This study used a long-term tracking large database to investigate whether the proportion of children who were diagnosed with speech and language impairments were later diagnosed with anxiety or depression were significantly greater than that of matched group of the same age and gender without speech and language impairments. More than 4300 eligible children with speech and language impairments and matched controls were identified and assessed for anxiety and depression. The risk of anxiety and depressive disorders in children with speech and language impairments were examined with Cox regression analyses and adjusting for covariables (gender, age, and comorbidities). The results showed that speech and language impairments were positively associated with anxiety disorders (adjusted hazard ratio [AHR] 2.87, 95% confidence interval [CI] 2.20-3.76) and depressive disorders (AHR 2.51, 95% CI 1.52-4.13). The number of boys with speech and language impairments was more than twofold that of girls, but boys did not different from girls in the risk of anxiety disorders (AHR 0.95, 95% CI 0.75-1.20) and depressive disorders (AHR 0.72, 95% CI 0.47-1.11). Infantile autism and intellectual disabilities were positively associated with anxiety (AHR 1.54, 95% CI 1.07-2.21; AHR 1.47, 95% CI 1.09-1.98), and the latter was positively associated with depression (AHR 1.83, 95% CI 1.06-3.17). In addition to speech and language impairments interventions, our findings supported the necessity of identification and interventions in anxiety and depressive disorders among children with speech and language impairments from elementary school until youth.