Anxiety Disorders In Children Research Articles

Integrated Behavior Therapy for Exclusively Anxious Selective Mutism: A Nonconcurrent Multiple-Baseline Design across Five Participants.

Selective mutism (SM) is a rare childhood anxiety disorder which may be markedly detrimental to a child's academic and social functioning if left untreated. Cognitive-behavioral treatments for social anxiety disorders have been found to be effective for SM, yet a paucity of published studies have explored manualized treatment approaches carried out by novice clinicians. The purpose of the present study was to examine the adherence, effectiveness, and acceptability of a condensed, 16-session version of Integrated Behavior Therapy for Selective Mutism (IBTSM; Bergman, 2013), the first manualized treatment for SM. A nonconcurrent multiple-baseline single-case design was used across five children diagnosed with SM, exclusively anxious subtype. IBTSM was implemented with excellent adherence (M = 98%) over an average of 19 weeks (range = 16-22 weeks). Visual analyses of weekly caregiver ratings of social anxiety and speaking behaviors did not demonstrate a replicated intervention effect; however, Tau-U effect sizes and Reliable Change Index (RCI) calculations demonstrated significant individual improvements in social anxiety and speaking behaviors over time on several measures. Three children (60%) no longer met diagnostic criteria for SM following treatment. All caregivers rated IBTSM as acceptable, with specific endorsements of acceptability in the areas of time required and treatment quality.

How are the relationships between childhood temperament, personality development and interpersonal function, and risk to depressive and other mood disorders, best conceptualised? What are the implications for preventive or treatment research?

One of the long-standing challenges in the field of depressive and other mood disorders is to have a clear conceptualisation of the relationships between childhood temperaments, personality development and adult self and interpersonal function, and depressive and other mood disorders. Some biologically-based dispositional (or temperamental) traits are present from birth and are relatively stable from infancy through to adulthood. These characteristics (e.g., anxious attachment or social inhibition) are commonly seen as ‘at-risk’ traits for later formal diagnoses of anxiety disorders in pre-pubertal children and anxiety and depression in teenagers (Compas et al., 2004; Rothbart, 2007).

Fear conditioning and fear generalization in children and adolescents with anxiety disorders

Overgeneralization of conditioned fear is associated with anxiety disorders (AD). Most results stem from studies done in adult patients, but studies with children are rare, although the median onset of anxiety disorders lies already in childhood. Thus, the goal of the present study was to examine fear learning and generalization in youth participants, aged 10–17 years, with AD (n = 39) compared to healthy controls (HC) (n = 40). A discriminative fear conditioning and generalization paradigm was used. Ratings of arousal, valence, and US expectancy (the probability of an aversive noise following each stimulus) were measured, hypothesizing that children with AD compared to HC would show heightened ratings of arousal and US expectancy, and decreased positive valence ratings, respectively, as well as overgeneralization of fear. The results indicated that children with AD rated all stimuli as more arousing and less pleasant, and demonstrated higher US expectancy ratings to all stimuli when compared to HC. Thus, rather than displaying qualitatively different generalization patterns (e.g., a linear vs. quadratic slope of the gradient), differences between groups were more quantitative (similar, but parallel shifted gradient). Therefore, overgeneralization of conditioned fear does not seem to be a general marker of anxiety disorders in children and adolescents.

Intervention effect of head acupuncture therapy combined with traditional music aesthetic education on children’s social anxiety disorders

BackgroundSocial Anxiety Disorder (SAD) is a highly prevalent anxiety disorder characterized by the excessive or irrational fear of particular external objects and situations. The study proposes to treat social anxiety disorders in children with the help of head acupuncture therapy. Considering the pathological features of anxiety disorders in children, a combined intervention with traditional music aesthetic education is also proposed.Subjects and Methods Children suffering from social anxiety disorder were taken as research subjects and randomly divided into experimental and control groups. Both groups were treated with head acupuncture. The experimental group added a traditional music aesthetic education intervention to help the children relieve their anxiety through music and learning. The experimental intervention time was six weeks, and the experimental data were statistically analyzed with the help of the Hamilton Anxiety Scale (HAMA) and Social Anxiety Scale for Children (SASC). The difference was statistically significant at P<0.05.ResultsAfter the experimental intervention, it was found that there was a statistically significant difference between the social anxiety scale scores of the two groups of children (P<0.05), with a significant effect of decreasing the scores of the SASC scale for children in the experimental group by more than 15%.Conclusions Aesthetic education is a combination of aesthetic and beauty teaching, and its combination with cephalic acupuncture therapy can better alleviate the symptoms of children’s social anxiety disorder and help and guide their cognitive behavior.

1.5 Concordance Between Parents and Children for the Reporting of Symptoms in Child Anxiety Disorders

1.5 Concordance Between Parents and Children for the Reporting of Symptoms in Child Anxiety Disorders

Cognitive Behavior Group Therapy for Children and Adolescents With Social Anxiety Disorder

Abstract: Background: Social anxiety disorder (SAD) in children is highly prevalent but current treatments are not effective for all patients. Aim: A group treatment based on empirically driven etiological models including psychoeducation, cognitive restructuring, exposure, and social skills training was examined. Method: The study examined treatment success using a SAD-specific cognitive behavior group therapy in a randomized controlled trial ( N = 74, 8 – 12 years, blind randomized allocation to treatment [CBT; n = 42] and waitlist [WLC; n = 32]). Results: Compared to WLC, parents of children in the CBT group reported a decrease in symptoms (CBT: d = 1.02, WLC: d = 0.06), while children did not differ in two measures of social anxiety. An estimate of total treatment effects showed a steady decrease in social anxiety symptoms (child report pre- to posttreatment: d = 0.50 – 0.52, posttreatment to follow-up: d = 0.37 – 0.39; parent report pre- to posttreatment: d = 0.92, posttreatment to follow-up: d = 0.69). Conclusion: While group treatment is most likely an effective approach, parents reported stronger social anxiety symptom reduction than children. The selection of measures for the assessment of SAD and treatment success and further modifications of exposure-based approaches are to be considered in future research.

Escitalopram and Sertraline Population Pharmacokinetic Analysis in Pediatric Patients.

Escitalopram and sertraline are commonly prescribed for anxiety and depressive disorders in children and adolescents. The pharmacokinetics (PK) of these medications have been evaluated in adults and demonstrate extensive variability, but studies in pediatric patients are limited. Therefore, we performed a population PK analysis for escitalopram and sertraline in children and adolescents to characterize the effects of demographic, clinical, and pharmacogenetic factors on drug exposure. A PK dataset was generated by extracting data from the electronic health record and opportunistic sampling of escitalopram- and sertraline-treated psychiatrically hospitalized pediatric patients aged 5-18 years. A population PK analysis of escitalopram and sertraline was performed using NONMEM. Concentration-time profiles were simulated using MwPharm++ to evaluate how covariates included in the final models influence medication exposure and compared to adult therapeutic reference ranges. The final escitalopram cohort consisted of 315 samples from 288 patients, and the sertraline cohort consisted of 265 samples from 255 patients. A one-compartment model with a proportional residual error model best described the data for both medications. For escitalopram, CYP2C19 phenotype and concomitant CYP2C19 inhibitors affected apparent clearance (CL/F), and normalizing CL/F and apparent volume of distribution (V/F) to body surface area (BSA) improved estimations. The final escitalopram model estimated CL/F and V/F at 14.2 L/h/1.73 m2 and 428 L/1.73 m2, respectively. For sertraline, CYP2C19 phenotype and concomitant CYP2C19 inhibitors influenced CL/F, and empirical allometric scaling of patient body weight on CL/F and V/F was significant. The final sertraline model estimated CL/F and V/F at 124 L/h/70 kg and 4320 L/70 kg, respectively. Normalized trough concentrations (Ctrough) for CYP2C19 poor metabolizers taking escitalopram were 3.98-fold higher compared to normal metabolizers (151.1 ng/mL vs 38.0 ng/mL, p < 0.0001), and normalized Ctrough for CYP2C19 poor metabolizers taking sertraline were 3.23-fold higher compared to normal, rapid, and ultrarapid metabolizers combined (121.7 ng/mL vs 37.68 ng/mL, p < 0.0001). Escitalopram- and sertraline-treated poor metabolizers may benefit from a dose reduction of 50-75% and 25-50%, respectively, to normalize exposure to other phenotypes. To our knowledge, this is the largest population PK analysis of escitalopram and sertraline in pediatric patients. Significant PK variability for both medications was observed and was largely explained by CYP2C19 phenotype. Slower CYP2C19 metabolizers taking escitalopram or sertraline may benefit from dose reductions given increased exposure.

Anxiety levels and school performance of Ecuadorian children from 3 to 5 years old: a cross-sectional study

Anxiety Disorder is common in kindergarten children. The high rates of anxiety disorder impact neurodevelopment and consequently may contribute to poor school performance. Thus, this study aimed to evaluate the influence of anxiety rates on the school performance of kindergarten children. It used the Screen for Child Anxiety Related Disorders (SCARED) parent version in parents of Ecuadorian children. The statistical analyses included one hundred fourteen responses from parents of kindergarten children. The binomial logistic regression model for the SCARED rating for parents' answers was statistically significant for Generalized Anxiety Disorder (odds [OR], 0.036; 95% confidence interval and p &lt;0.001. A statistically substantial score (odds [OR], 0.037; 95% confidence interval and p &lt;0.001, was presented in Social Anxiety Disorder. Finally, school refusal was evaluated (odds [OR], 0.038; 95% confidence interval [CI] 0.004-0.340) with a (p &lt;0.003). A positive statistical correlation between social disorder and school avoidance correlated with anxiety disorder in kindergarten children. In conclusion, our results showed that Anxiety Disorders are common in kindergarten children. We did not find a correlation between anxiety levels and the school performance of our children sample. There is a positive relationship between anxiety and school avoidance in Ecuadorian children. Keywords: Anxiety Disorder; Kindergarten; Children; School performance Social disorder; School avoidance.

Expectations and perspectives of cognitive behavioural therapy for childhood anxiety and related disorders.

Anxiety disorders are the most frequently diagnosed psychiatric conditions in children and adolescents. Cognitive behavioural therapy (CBT) is a well-established and effective treatment for anxiety and related disorders across the lifespan. Expectations of psychotherapy have been demonstrated to affect outcomes, yet there is sparse existing literature on adolescent patient and parent perspectives of CBT prior to engagement with treatment. This study aimed to qualitatively explore the expectations and perceptions of CBT for anxiety and related disorders among adolescent patients and parents. Fourteen adolescent patients and 16 parents participated in semi-structured individual interviews or focus groups consisting of 2-3 participants. Interview transcripts were analysed using inductive analysis. Three themes were identified: worries about CBT, expectations and knowledge of the CBT process, and the role of parents and families. Overall, we found that adolescents and parents had generally positive views of CBT. The outset of CBT saw adolescents and parents express concern about stigma as well as the ambiguity of CBT. Parents continued to express a lack of understanding of what CBT entailed during their child's treatment course. These results suggest that both adolescents and parents would benefit from early discussion and reinforcement of expectations for CBT treatment. Further research efforts are warranted and should be directed towards determining appropriate expectations for parental involvement in a child's CBT course and effective communication of treatment expectations to both adolescents and parents.

Investigation of anxiety, depression, obsessive-compulsive disorder, and quality of life of children of healthcare workers during the COVID-19 pandemic

BackgroundThis study aimed to evaluate the anxiety, depression, obsessive-compulsive disorder symptoms, and quality of life of children whose parents were healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic period. MethodsThe participants completed a sociodemographic questionnaire, the depression inventory for children (CDI), the screening for anxiety disorders in children (SCARED), the Maudsley obsessive compulsive question list (MOCQL), and the pediatric quality of life inventory (PedsQL) using online applications. A total of 153 children and adolescents whose parents were healthcare workers and 356 children and adolescents whose parents were not healthcare workers were included in the study. ResultsOne tenth of all children participating in our study had a high level of depression, and nearly half of them had a high level of anxiety. There was no significant difference in CDI (p = 0.306), SCARED (p = 0.841), and PedsQL (p = 0.863) scale scores between the two groups. The MOCQL scale scores were higher in the group whose parents were not health professionals for cleanliness (p<0.001), slowness (p = 0.001), and total score (p<0.001). ConclusionIt was found that all participants were affected by anxiety, depression, and quality of life decline; moreover, obsessive-compulsive symptoms were more common in children whose parents were healthcare workers. In this context, our findings could help determine possible mental health problems of children and adolescents whose parents are or are not healthcare workers.

Implementation and Preliminary Outcomes of an Exposure-Based Summer Camp for Pediatric OCD and Anxiety

Despite the high prevalence of anxiety disorders in children and adolescents and the existence of effective evidence-based treatments for them, access to psychological care remains a major public health concern. Summer camps may provide an effective treatment avenue for youth who might not otherwise have access to care. This study describes the design and implementation of Fear Facers, a semistructured, 5-day, daytime exposure-therapy-based summer camp designed for youth with a primary diagnosis of obsessive-compulsive disorder (OCD), social anxiety, separation anxiety, or a specific phobia. Preliminary data regarding feasibility and patient outcomes is also reported. Among 52 children and adolescents aged 7 to 16 who attended one of six camp sessions between 2018 and 2021, significant reductions in anxiety (d = 0.54) and OCD symptoms (d = 0.57) were observed from pre-camp to immediately post-camp. A subset of campers who were followed for an additional 3 months post-camp (n = 22) showed maintenance of treatment gains. Retention rates for the intervention were high. Our investigation provides further support for the use of a camp-based design for cognitive-behavioral approaches, and may provide a unique setting to maximize elements of inhibitory learning in exposures. We also discuss a number of elements regarding feasibility that need consideration for those hoping to develop similar interventions.

An Updated Characterization of Childhood Selective Mutism: Exploring Clinical Features, Treatment Utilization, and School Services.

Selective mutism (SM) is a severe but understudied childhood anxiety disorder. Most epidemiological research on SM was conducted decades ago and is limited by small sample sizes. This study analyzes parent-reported clinical data from 230 children with diagnosed and suspected SM to provide current information about the presentation of this disorder. Overall, anxiety and social anxiety symptoms were elevated. Gender ratio, comorbidities and family history of psychopathology were generally aligned with previous research. However, age of onset and diagnosis were both earlier than previously reported, with an average delay of 2years between onset and diagnosis. The majority of children received therapy and school accommodations for their SM, yet there was large variability in types of interventions. This is the largest survey of children with SM conducted primarily within the US and it constitutes the first systematic inquiry into interventions and accommodations received within clinical and school settings.

Early childhood anxiety disorders: continuity and predictors in adolescence.

Anxiety disorders are among the most common disorders in early childhood. Although many older children and adolescents with anxiety disorders recover and remain well, little is known about the continuity of early childhood anxiety and the factors that predict persistence/recurrence in later childhood and adolescence. We followed 129 children who met anxiety disorder criteria at age 3 and/or 6 and determined how many continued to experience an anxiety disorder between age 7 and 15, as well as the continuity of specific anxiety disorders. We explored whether biological sex, number of anxiety disorders, early childhood persistence (i.e., anxiety diagnosis at both age 3 and 6), childhood comorbidities, temperamental behavioral inhibition, a maternal history of anxiety, and authoritarian and overprotective parenting predicted persistence/recurrence of an anxiety disorder from age 7 to 15. Sixty-five (50.4%) of the adolescents with an early childhood anxiety disorder met anxiety disorder criteria during the age 7-15 interval. Homotypic continuity from early childhood to school-age/mid-adolescence was observed for social anxiety disorder, separation anxiety disorder, and generalized anxiety disorder (GAD). Early childhood agoraphobia predicted school-age/mid-adolescent GAD and early childhood GAD predicted school-age/mid-adolescent specific phobia. In bivariate analyses, number of anxiety disorders, persistence of anxiety from age 3 to 6, and having a mother with a history of anxiety predicted the persistence/recurrence of anxiety disorders from age 7 to 15. Only early childhood persistence of anxiety uniquely predicted the persistence/recurrence of an anxiety disorder over and above the other predictors. Early intervention efforts should focus on identifying and intervening with young children who demonstrate a protracted course of anxiety.

Novel mechanism-based treatments for pediatric anxiety and depressive disorders.

Pediatric anxiety and depressive disorders are common, can be highly impairing, and can persist despite the best available treatments. Here, we review research into novel treatments for childhood anxiety and depressive disorders designed to target underlying cognitive, emotional, and neural circuit mechanisms. We highlight three novel treatments lying along a continuum relating to clinical impact of the disorder and the intensity of clinical management required. We review cognitive training, which involves the lowest risk and may be applicable for problems with mild to moderate impact; psychotherapy, which includes a higher level of clinical involvement and may be sufficient for problems with moderate impact; and brain stimulation, which has the highest potential risks and is therefore most appropriate for problems with high impact. For each treatment, we review the specific underlying cognitive, emotional, and brain circuit mechanisms that are being targeted, whether treatments modify those underlying mechanisms, and efficacy in reducing symptoms. We conclude by highlighting future directions, including the importance of work that leverages developmental windows of high brain plasticity to time interventions to the specific epochs in childhood that have the largest and most enduring life-long impact.

Parental Perceptions and Usage of Unlicensed Cannabidiol Products in Children With Anxiety and Neurodevelopmental Disorders.

Data evaluating the use of unlicensed cannabidiol (CBD) products for the treatment of -symptoms associated with anxiety and neurodevelopmental disorders in children are limited despite increasing -product availability. The objectives of this study are to quantify the usage of unlicensed CBD products among pediatric patients diagnosed with anxiety and neurodevelopmental disorders and compare the -perceptions of CBD between parents who administer a CBD product to a child and parents who do not. A survey containing 31 items was designed after pretesting with pediatric health care professionals. The refined survey was distributed using Qualtrics Panels to a representative sample of US parents of a child 7 to 18 years of age diagnosed with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and/or generalized anxiety disorder (GAD). Responses were analyzed with descriptive -statistics and compared using a χ2 or Mann-Whitney U test. Of the 518 completed surveys, 162 parents (31.3%) reported the administration of an unlicensed CBD product to a child with ADHD, ASD, and/or GAD. The highest prevalence of use was found in the West geographic region and among children diagnosed with GAD or with 2 or more diagnoses (i.e., ADHD, ASD, GAD). Parents who administered CBD products had more positive views of product safety and higher -perceived community support for usage. Nearly one-third of parents have administered an unlicensed CBD product to a child with ADHD, ASD, and GAD. Health care providers should assess pediatric patients for CBD use and be prepared to engage parents in conversations regarding the safety of these products.

Mental Health Difficulties in Children who Develop Misophonia: An Examination of ADHD, Depression & Anxiety.

Misophonia is a sound sensitivity disorder characterized by unusually strong aversions to a specific class of sounds (e.g., eating sounds). Here we demonstrate the mental health profile in children who develop misophonia, examining depression, anxiety and ADHD. Our participants were members of the birth cohort ALSPAC (Avon Longitudinal Study of Parents and Children). We screened them for misophonia as adults, then analysed their retrospective mental health data from ages 7 to 16 years inclusive, reported from both children and parents. Data from their Development and Wellbeing Assessments (7-15 years) and their Short Mood and Feelings Questionnaires (9-16 years) show that our misophonia group had a greater likelihood of childhood anxiety disorder and depression in childhood (but not ADHD). Our data provide the first evidence from a large general population sample of the types of mental health co-morbidities found in children who develop misophonia.

The role of stress factors in the formation of gastroesophageal reflux disease in children: characteristics of anxiety-phobic and depressive disorders

Introduction. There is enough evidence of the influence of the psycho-emotional state of children on the development of gas-troesophageal reflux disease, numerous studies reveal anxiety and depressive disorders in them. However, there is no common understanding of the specific causal relationships underlying the pathogenesis of this disease.Aim. To identify the features and possible causes of anxiety and depressive disorders in children with gastroesophageal reflux disease and analyze their role using Yu.I. Burlan's system-vector psychology.Materials and methods. 677 adolescents aged 11-17 years were examined on the basis of the pediatric department in the Clinic of the Research Institute of Medical Problems of the North (Krasnoyarsk). The gastroesophageal reflux diseasewas diagnosed by testing according to the Russian version of the Gastroesophageal Reflux Disease Questionnaire. Computerized testing “The Development and Well-Being Assessment” was used to identify mental disorders.Results. In children with gastroesophageal reflux disease, all kinds of fears were significantly more common: fear of separation - 50.0 (25.1-74.9)%; darkness, thunderstorms, thunder, heights - 66.7 (38.6-86.1)%; blood injections, wounds - 58.3 (31.6-80.8)%; loud noise - 33.3 (13.9-61.4)%; to be far from home - 41.7 (19.2-68.4)%. 41.7 (19.2-68.4)% of children had manifestations of depression, which is 2 times more often than in the control group, and every fourth had self-harm. Separation from friends, panic attacks, fear of death, melancholy, resentment, learning problems, appearance were indicated as the causes of depression.Conclusions. The causal relationships disclosed by the system-vector psychology, according to which certain stress factors play an important role in the development of gastroesophageal reflux disease. These factors depend on the type of character: for emotional children, these are all kinds of fears, phobias, breaking emotional ties, problems in relationships with others, and for obedient and calm children - resentment, learning problems and any factor of novelty (change of the usual environment, living conditions, team).

Examining Community Clinicians Use of Imaginal Exposure with Childhood Anxiety Disorders.

Although community therapists rarely use exposure when treating youth with anxiety disorders, they are more likely to endorse the use of imaginal exposure, relative to in vivo or interoceptive exposure. Such use of imaginal exposure could reflect a sub-optimal replacement for in vivo exposure or a targeted intervention to address anxiety-provoking thoughts, such as in generalized anxiety disorder. The current study used the survey responses of 178 community-based clinicians to examine these competing hypotheses. The results indicated that therapist endorsement of more clearly defined imaginal exposure was significantly lower than other techniques such as cognitive restructuring, and that imaginal exposure was most often used instead of more intensive forms of exposures. In addition, most of the endorsed interventions were targeted at helping youth cope with anxiety rather than corrective learning. Alternatively, there was no observed association between imaginal exposure and treatment of general anxiety. These finding suggest that community therapist use of imaginal exposure is suboptimal and unlikely to improve treatment outcomes.

Child Anxiety, Depression, and Post-traumatic Stress Disorder Following Orthopedic Trauma.

Many children and adolescents are exposed to different types of trauma, e.g., abuse or various disasters. Trauma can cause severe and long-term impairment and consequences, the most studied of which are post-traumatic stress disorder (PTSD) and PTSD symptoms (PTSS). PTSD is highly prevalent in clinical practice (with a frequency of about 7%) and is a debilitating consequence of trauma. The current study aimed to assess childhood injuries and their associated anxiety, depression, and post-traumatic stress disorder following orthopedic trauma. A descriptive cross-sectional study was conducted, including all pediatric patients with trauma at Abha Maternity and Children Hospital in the Seer region of Saudi Arabia, as well as pediatric patients with trauma at Abha Maternity and Children Hospital during the period from January 1, 2021 to December 31, 2022. Data were collected from the children's caregivers using a direct interview questionnaire to assess the children's personal data, depression, anxiety, and post-traumatic stress disorder. Children's trauma-related data were extracted from their medical records using a pre-structured data extraction sheet. A total of 100 children with trauma were included. Children ranged in age from eight to 12 years, with a mean age of 7.3 ± 3.4 years. In all, 67 (67.0%) children were males, and only 6 (6.0%) had chronic health problems. The vast majority of the children with trauma had a low-severity experience of depression and anxiety following trauma (97.1% for each), and only one child had a high-severity experience of depression and anxiety. In all, 5 (4.9%) children with trauma experienced clinically significant PTSD, and the vast majority of them showed a low likelihood of the disorder. Multiple fractures and undergoing surgery were significant predictors of developing PTSD (P < 0.05). In conclusion, the current study revealed that bone trauma was frequent among children, mainly due to playing accidents. Also, a low prevalence of post-traumatic stress disorders and their mental consequences was estimated.

Randomised controlled trial of cultural-adapted and programme-adopted cognitive behavioural therapy for children and adolescents’ anxiety in Japan: protocol for a Multi-, Inter-, and Cross-cultural Clinical Child Study (MIXCS)

IntroductionThe primary objective of the Multi-, Inter-, and Cross-cultural Clinical Child Study (MIXCS) is to evaluate the hypothesis that the effects of cultural-adapted cognitive behavioural therapy (CA-CBT) and programme-adopted cognitive...