Anxiety In Children Research Articles

Factor structure and measurement invariance of the Depression anxiety stress scale (DASS-21) in Chinese left-behind and non-left-behind children: an exploratory structural equation modeling approach

BackgroundComprehensive data has shown that adolescents often suffer from depression, anxiety, and low self-esteem, and are in a particularly fragile stage of psychological, physiological, and social development. Left-behind children in particular tend to have significantly higher, state anxiety and depression compared to non-left-behind children. The Depression, Anxiety, and Stress Scale (DASS-21) is an effective tool for evaluating depression, anxiety, and stress, and is used to measure levels of depression, anxiety, and stress in groups from a variety of backgrounds. The purpose of this study was to determine the effectiveness, reliability, and measurement invariance of the DASS-21 in Chinese left-behind children.MethodThe test and re-test method was used (N = 676), and the exploratory structural equation model (Mplus v.8.3) used to verify basic measurement models. For measurement invariance, the configural, weak, strong, and strict models were tested. The reliability of the DASS-21 was also tested using the collected data.ResultsAnalysis results showed that the DASS-21 had a stable three-factor structure in the sample of left-behind children in China. The measurement invariance test showed that gender and time not only had strong invariance, but also strict invariance. The results of cross left and non-left invariance indicated a lack of strict invariance. Finally, the McDonald’s omega coefficient of the DASS-21 total scale was 0.864, and the internal consistency of each subscale was also good.ConclusionsThe DASS-21 is shown to be an effective and reliable tool for measuring depression, anxiety and stress in Chinese left-behind children.

Effectiveness of Audiovisual Distraction in Reducing Children's Anxiety for Pain During Medical and Dental Treatments: A Systematic Review and Meta-analysis.

Audiovisual distraction is a potentially good technique to reduce medical treatment procedure-related fear and anxiety among children. However, few studies have assessed its effectiveness. To conduct a systematic review and meta-analysis for evaluating the effectiveness of audiovisual distraction in reducing pain anxiety in pediatrics. Randomized control trials and experimental studies that reported the use of audiovisual distraction during medical/dental treatments among children aged 3-8 years, used the Face, Legs, Activity, Cry, Consolability (FLACC) scale to assess pain, and were published between 2005-2021 and in English were retrieved from PubMed, Scopus, and Web of Science. A random-effects model was used for evidence analysis. A total of four studies were included in the systematic review and meta-analysis: two were from South Asia and one each were from Africa and North America. Three of these studies were randomized control trials. The variability among the studies was high. Three of the four studies found that AV techniques were significantly effective in reducing pain during procedures compared with the control group (P < 0.00001), while one study found no difference; the cumulative evidence in the forest plot was similar. Cumulative evidence suggests that the use of audiovisual distraction is an effective strategy in reducing medical/dental procedures-related pain anxiety among children aged 3-8 years. However, evidence on this is currently limited, and thus further studies are required using various AD techniques and on different populations to substantiate these findings. None. PROSPERO (Ref no.: CRD42021245874).

The Psychosocial Impact of the COVID-19 Pandemic on Italian Families: The Perception of Quality of Life and Screening of Psychological Symptoms.

Throughout the COVID-19 period, families were forced to stay indoors, adapting to online schooling, remote work, and virtual social engagements, inevitably altering the dynamics within households. There was a notable increase in mental health challenges in terms of anxiety and depression in children and adolescents. This study intended to explore the psychosocial effects of the COVID-19 pandemic on Italian families by adopting self- and proxy-report questionnaires on anxiety, anger, and health-related quality of life. The results showed that approximately 20% obtained a clinical anxiety score and only 10% obtained a clinical anger score. There was a difference in the perception of the quality of life reported by the child and that perceived by the parent. A stepwise regression model showed that total anxiety scores were predicted by sex, quality of life scores from the parents' self-report version, and the total anger score. Another stepwise regression model identified physiological and social anxiety as the best predictors that impact quality of life. Parental well-being actively influences the well-being of children, so it is fundamental to implement preventive programs and promote child well-being by providing parents the most adequate support possible.

Consequences of vestibular hypofunction in children with ADHD/DCD

BackgroundChildren with Attention Deficit Hyperactivity Disorder (ADHD) demonstrate a heterogeneous sensorimotor, emotional, and cognitive profile. Comorbid sensorimotor imbalance, anxiety, and spatial disorientation are particularly prevalent among their non-core symptoms. Studies in other populations presented these three comorbid dysfunctions in the context of vestibular hypofunction. ObjectiveTo test whether there is a subgroup of children with ADHD who have vestibular hypofunction presenting with concomitant imbalance, anxiety, and spatial disorientation. MethodsChildren with ADHD-only (n = 28), ADHD + Developmental Coordination Disorder (ADHD + DCD; n = 38), and Typical Development (TD; n = 19) were evaluated for vestibular function by the Dynamic Visual Acuity test (DVA-t), balance by the Bruininks-Oseretsky Test of motor proficiency (BOT-2), panic anxiety by the Screen for Child Anxiety Related Emotional Disorders questionnaire-Child version (SCARED-C), and spatial navigation by the Triangular Completion test (TC-t). ResultsChildren with ADHD vs. TD presented with a high rate of vestibular hypofunction (65 vs. 0 %), imbalance (42 vs. 0 %), panic anxiety (27 vs. 11 %), and spatial disorientation (30 vs. 5 %). Children with ADHD + DCD contributed more frequent and severe vestibular hypofunction and imbalance than children with ADHD-only (74 vs. 54 %; 58 vs. 21 %, respectively). A concomitant presence of imbalance, anxiety, and spatial disorientation was observed in 33 % of children with ADHD, all sharing vestibular hypofunction. ConclusionsVestibular hypofunction may be the common pathophysiology of imbalance, anxiety, and spatial disorientation in children. These comorbidities are preferentially present in children with ADHD + DCD rather than ADHD-only, thus likely related to DCD rather than to ADHD disorder. Children with this profile may benefit from a vestibular rehabilitation intervention.

Tingkat Kecemasan Preoperasi pada Anak di Instalasi Bedah Sentral Rumah Sakit Brayat Minulya Surakarta

Introduction: Preoperative is the initial stage of perioperative care which begins when the patient enters the reception room and ends when the patient is transferred to the operating table for surgery. At this stage, most people who undergo it will feel anxious, including pediatric patients. Pediatric patients often exhibit preoperative anxiety that influences intra- and postoperative nursing care. Mapping preoperative children's anxiety levels as a basis for determining preoperative treatment strategies for pediatric patients in the IBS Hospital reception room. Brayat Minulya needs to be done. Purpose: This study aims to identify the preoperative anxiety level of school-aged children in hospitals. Brayat Minulya Surakarta. Method: This research design is a descriptive study with a survey approach. Data collection was carried out using the Hamilton Anxiety Rating Scale (HARS) questionnaire. Sampling used total sampling with a sample size of 62 respondents who had adjusted to the inclusion and exclusion criteria. Data were analyzed using quantitative descriptive analysis methods. Results: Description of anxiety in preoperative school age children with no anxiety as many as 5 respondents (8.06%), mild anxiety as many as 21 respondents (33.87%), moderate anxiety as many as 27 respondents (43.55%), severe anxiety as many as 9 respondents (14.52%), and no respondents had very severe anxiety/panic. Conclusion: The number of children with moderate levels of anxiety is the largest, namely 43.55%. Future research can measure the relationship between gender and surgical experience with children's preoperative anxiety levels and use the gold standard, the State-Trait Anxiety Inventory for Children (STAIC) to measure children's anxiety levels.

Using non-pharmacological interventions to manage medical procedure-induced anxiety in children: a framework to guide best practice.

Medical procedure-induced anxiety in children can have short- and long-term negative effects. Research shows that children's anxiety can be affected by non-pharmacological interventions and adults' behaviours in a complex manner. This article presents a scoping review of the literature on non-pharmacological interventions to manage medical procedure-induced anxiety in children. Based on this review, the authors propose a framework comprising six strategies for effective non-pharmacological management of medical procedure-induced anxiety in children. A real-life, and anonymised, example is used to illustrate this framework in practice.

Anxiety Symptom Trajectories Predict Depression Symptom Trajectories up to Four Years After CBT for Youth Anxiety Disorders.

Long-term data on depression symptoms after cognitive behavioral therapy (CBT) for youth anxiety disorders are scant. We examined depression symptoms up to four years post CBT for anxiety addressing youth age and gender, family social class, and parent mental health as predictors. The sample comprised 179 youth (M age at pre-treatment = 11.5 years; SD = 2.1) in a randomized controlled trial. Clinically assessed anxiety diagnoses and youth and parent-reported anxiety and depression symptoms were measured before, after, and one and four years after CBT. Parent self-reported mental health was measured before CBT. We used regression analyses to determine whether full diagnostic recovery at post-CBT predicted depression trajectories across the four-year assessment period. We used growth curve models to determine whether anxiety trajectories predicted depression trajectories across the four-year assessment period. Youth who lost their anxiety diagnoses after CBT had significantly lower parent-reported depression levels over time, but not lower youth self-reported depression levels. The anxiety symptom trajectory predicted the depression symptom trajectory up to four years post-treatment. There was more explained variance for within-informant (youth-youth; parent-parent) than cross-informants. Being older, female, having lower socio-economic status and parents with poorer mental health were associated with more youth-rated depression over time. However, these demographic predictors were not significant when anxiety symptoms trajectories were added to the models. Successful CBT for anxiety in children is associated with less depression symptoms for as long as four years. Anxiety symptom improvement appears to be a stronger predictor that demographic variables and parent mental health.

Reading self-concept, trait emotional intelligence and anxiety of primary school children with dyslexia

IntroductionThe association between the cognitive and the affective domain in reading is well documented in research, especially when difficulties are manifested. The aim of this study was (a) to investigate levels of reading self-concept, trait emotional intelligence, and anxiety of students with dyslexia and compare them to students with no previous assessment and (b) explore the hypothesis that reading self-concept and trait emotional intelligence are negative predictors of state and trait anxiety taking into account students’ individual characteristics such as gender, school year, and school performance.MethodsA total of 794, fifth- and sixth-grade Greek primary school children aged 10 to 12 years old participated in the study. Of them, 50 children had a statement of dyslexia. The State and Trait Anxiety Inventory for Children, the Reading Self-Concept Scale, and the Trait Emotional Intelligence Questionnaire—Short Form were administered to the participants.ResultsThe results showed that children with dyslexia were more vulnerable in terms of their perceptions of reading self-concept and emotional intelligence as compared to typical peers. Moreover, students’ characteristics, i.e., grades in math and language and dyslexia, had a direct positive path to trait emotional intelligence and reading self-concept while trait emotional intelligence and reading self-concept predicted negative anxiety.DiscussionThe implications of the results in terms of the possible protective role of reading self-concept and emotional intelligence on anxiety for children with dyslexia are discussed, and suggestions for future research are presented.

Effectiveness of technology-assisted vs face-to-face cognitive behavioural therapy for anxiety and depression in children and young people: A systematic review and meta-analysis.

Cognitive Behavioural Therapy (CBT) has been proven to be effective for anxiety and depression in children and young people (CYP). Over the past 20 years there have been several attempts at delivering CBT through apps, online software, videogames, but also with a therapist via phone or videoconferencing platforms, with promising results for the "technology-assisted" versions. However, most research, have compared online CBT to waiting lists, and not many studies looked at the effectiveness of face-to-face (f2f) CBT versus technology-assisted CBT. Adopting the PRISMA guidelines, we evaluated 1849 citations and identified 10 eligible studies. Studies were identified through the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, PubMed/MEDLINE, Web of Science, and Scopus. Ten studies met our inclusion criteria. The studies included a variety of technology-assisted forms of CBT, including videoconferencing and online CBT. Of these, seven looked at the effectiveness of technology-assisted CBT for anxiety in CYP, and seven looked at depression. The meta-analyses had low heterogeneity and showed that technology-assisted CBT was non-inferior to f2f CBT for anxiety and depression in CYP (d = 0.06 and 0.12 respectively). Technology-assisted CBT may be a valid alternative for the treatment of anxiety and depression in CYP. Future studies should consider what specific delivery modalities are most cost-effective.

Effectiveness of cartoons for children's procedural pain: a systematic review with meta-analysis.

BACKGROUND: Cartoons are widely used distraction techniques for nonpharmacological management of procedural pain in pediatric settings. There are a few studies in the literature evaluate the effect of intervention on procedural pain, but a systematic review aimed at providing a summary of the overall effect is lacking. AIM: To summarize the available evidence on effectiveness of cartoons for children’s procedural pain. METHODS: Searching for parallel-group controlled trials was carried out on thirteen biomedical databases, five trial registries, web resources and gray literature sources from each database or resource setup date to 22 January 2023. Primary outcome was procedural pain, secondary outcome was anxiety. RoB 2 and ROBINS-I were used to assess risk of bias of included studies. RESULTS: 24 trials were selected for this review, which included a total of 3046 pediatric subjects. Children who watch cartoons during medical procedures experience less pain (SMD= -1.29; 95% CI: -1.75, -0.83; N=2239) and anxiety (UMD= -1.75; 95% CI: -2.94, -0.56; N=552) compared to children provided standard of care; for both outcomes, results are statistically significant. GRADE method shows moderate certainty/quality of evidence. CONCLUSIONS: Cartoons are more effective than standard of care in reducing procedural pain and anxiety in children. Pending future studies confirming the results, we recommend their implementation in daily clinical practice even in care settings with limited resources.

Network Analysis of Childhood Maltreatment, Anxiety, and Addictive Non-Suicidal Self-injury in Adolescents

AbstractNon-suicidal self-injury (NSSI) in adolescents is becoming a widespread health issue. Recent studies have suggested that repetitive NSSI is crucial in NSSI adolescents and can be conceptualized as an “addictive behavior.” The aim of this cross-sectional study was to explore the network relationships among child maltreatment, anxiety, and addictive NSSI in adolescents. In total, 542 adolescents (14.07 ± 2.15 years old, 18.6% males) with NSSI behavior completed the related questionnaires. Two types of psychometric approaches were used to analyze the data. First, the network analysis showed that emotional abuse (Expected Influence: 1.20) had the most central role among the networks, and the edges of emotional abuse–anxiety (weight: 0.25), emotional abuse-addictive NSSI (weight: 0.20), and anxiety–addictive NSSI (weight: 0.19) showed stronger positive associations of trans-symptom edges. Second, the network comparison test was used to examine the network differences between the male and female groups; however, no network differences were found. Overall, among all types of childhood maltreatment, our results suggest that emotional abuse should be more emphasized to prevent long-term mental adverse outcomes and addictive NSSI, and that anxiety may also mediate emotional abuse and addictive NSSI in NSSI adolescents.

A novel independence intervention to treat child anxiety: A nonconcurrent multiple baseline evaluation

Rates of child and adolescent anxiety have increased markedly over the past decade (Haidt & Twenge, 2023). Exposure-based cognitive-behavioral therapy is the gold standard in the treatment of anxious children (Hofmann et al. (2012)). However, many clinicians refrain from using exposure due to concerns about its safety, effectiveness, and ethics (Deacon et al., 2013; Whiteside et al., 2016). We propose a novel treatment approach for child anxiety composed of independence activities (IAs), which are child-directed, fun, unstructured, developmentally challenging tasks performed without parents’ help. These tasks are purposely topographically unrelated to the stimuli that cause anxiety, in direct contrast to exposure therapy. Despite this dissimilarity, IAs target putative mechanisms involved in the development and maintenance of child anxiety (e.g., parental accommodation and overinvolvement, child avoidance, unhelpful thinking styles). Using a nonconcurrent multiple baseline design, this five-session treatment provided preliminary evidence of high treatment acceptability from children and parents. Medium to large improvements were reported in child anxiety and avoidance, parent and child (behavioral and cognitive) mechanisms involved in the maintenance of child anxiety, and untargeted secondary outcomes such as child happiness. Results may suggest a new treatment paradigm, which is desperately needed, given unabated increases in child and adolescent anxiety despite vast resources being directed toward the problem.

Effect of Clown Therapy on Symptoms and Emotions of Children with Neoplastic Disease: A Systematic Review with Meta-Analysis

INTRODUCTION: Clown therapy is a widely used nonpharmacological intervention for the control and management of symptoms and emotions in pediatric settings. There are some studies evaluating the effect of the intervention on children with neoplastic disease, but a systematic review summarizing the overall benefit is lacking. OBJECTIVE: To evaluate the effect of clown therapy on the symptoms and emotions of children with neoplastic pathology. METHODS: Studies (randomized or quasi-randomized parallel-group controlled trials) were searched from biomedical databases, web resources, and trial registries. The intervention was compared with standard care; primary outcomes were pain and anxiety, and secondary outcomes were fear, stress, fatigue, depression, distress, and mood. Risk of bias was assessed with RoB 2, and the overall effect size was calculated with variable effects meta-analysis. The summary of results was illustrated in accordance with the GRADE method. RESULTS: Five quasi-randomized parallel-group trials with a high risk of bias were included (N = 376, mean age: 6.9-10.9 years). Children who received clown therapy manifested a reduction in anxiety (N = 181; SMD = -2.17 [95% CI: -4.20, -0.14], p &lt; 0.05) and fatigue (N = 176; SMD = -2.03 [95% CI: -5.39, 1.32], p &gt; 0.05). The certainty/quality of evidence is very low. CONCLUSIONS: Clown therapy seems more effective than standard care in reducing anxiety and fatigue in children with neoplastic disease. However, more studies are needed to confirm the results, as the very low certainty/quality of evidence currently does not justify routine implementation of the intervention in pediatric oncology.

Reading and emotional-behavioural development in Finnish children: a longitudinal study of associations

AbstractPoor reading has been linked to negative outcomes on a wide range of emotional-behavioural dimensions in children. However, little is known about the time course of these associations. In this study we analyse data from a sample of Finnish children (N = 199; 106 boys) which included measures of reading fluency in grade 1 (age 7 or 8), and emotional (anxiety, depression, and somatization) and behavioural (adaptability, aggression, attention, atypicality, hyperactivity, social skills, and withdrawal) development at ages 4, 5, 6 (pre-school) and 9 (school-aged). In a series of stepwise regression models that controlled for non-verbal IQ and family risk for dyslexia, we tested if pre-school emotional-behavioural measures were associated with school-aged reading fluency, and whether school-aged reading fluency was associated with later emotional-behavioural development. We also tested if these associations were moderated by reported gender. Consistent with previous longitudinal studies, we found that poorer attention before school was associated with poorer reading in the early school years which in turn was associated with higher levels of anxiety and inattention in children in middle school. None of these associations were moderated by gender.

Efficiency of a Sensory-Adapted Dental Environment Versus Regular Dental Environment in Neurotypically Healthy Children: A Parallel-Arm Interventional Study.

Introduction The basic principle of a sensory adaptive dental environment is that an individual's sensory experiences have a significant impact on their emotional and psychological well-being. Taste, smell, touch, hearing, and sight are the five basic senses that affect our perception and responses to the environment. The study aimed to assess the effectiveness of a Sensory-Adaptive Dental Environment (SADE) compared with a Regular Dental Environment (RDE) in reducing anxiety, improving behavior, and providinga smooth experience for children undergoing dental treatment. Materials and methods This parallel-arm pilot study was conducted at the outpatient Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Chennai,from January 2024 to March 2024. A total of 148 children who met the inclusion criteria were divided into two groups:Group I (intervention group) received SADE or MSE (Multi-Sensory Environment) intervention, while Group 2 (control group)underwent dental treatments in a Regular Dental Environment (RDE). Patient behavior was assessed using Frankl's behavior rating scale, and anxiety levels were measured using Ayesha's Oddbodd anxiety scale. Additionally, heart rate and oxygen saturation (SpO2) were evaluated using a pulse oximeter. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY), with significance set at a p-value less than 0.05. Results Before the procedure, there were no notable differences in behavior or anxiety levels. However, after the procedure, children undergoing treatment under SADE resulted in markedly improved behavior and notably lower anxiety levels. Also, this correlated with reduced anxiety levels, indicated by lower heart rates and higher oxygen saturation levels. Conclusion The study concluded that there were notable differences in patient experiences between SADE and RDE.After their dental procedures, participants in the SADE group were found to behave better and feel less nervous. Still, in the conventional setting, only improved behavior was noted, with no significant difference in anxiety levels. Overall, our study suggests that dental offices can significantly enhance patient experiences by providing a sensory-friendly setting that helps children feel more at ease, improves patient outcomes, and less nervous during their visits.

Perceived acceptability and appropriateness of a web-based program targeting risk for anxiety in young children and their parents

Abstract Objective This mixed-methods study examined perceived acceptability and appropriateness of a novel digital mental health program targeting anxiety risk (i.e., perfectionism or error sensitivity) in 5-to-7-year-old children and their parents. Methods Parent–child dyads participated in a modular, web-based cognitive-behavioral program targeting negative overreactions to making mistakes. The program, “Making Mistakes”, consisted of a 6-month series of short video clips, journaling activities, and weekly reminders, and modules were delivered to caregivers and children separately. 86 dyads completed self-report measures, 18 of whom participated in semi-structured interviews, following completion of the primary program module. A standard thematic analysis was used to elucidate themes from the parent and child interview content. Results Our quantitative and qualitative results were generally aligned. Children and parents viewed the novel digital mental health program as acceptable and appropriate, favoring the cognitive behavioral strategies such as modeling positive reactions to mistakes, responding positively to child mistakes, and emphasizing effort over outcome. Participants also provided helpful feedback related to program content, delivery, and engagement, as well as suggestions to enhance the program. Conclusions Findings have implications for design and content features of parent-based and dyad-based programs, as well as digital mental health programs focused on reducing anxiety risk.

Comparative analysis of pulmonary function in school-going adolescents: Examining the impact of depression and anxiety.

Given the rising concern over depression and anxiety among adolescents, this study aims to investigate their potential impact on respiratory health by comparing pulmonary function test (PFT) parameters between healthy adolescents and those with either depression or anxiety or those exhibiting symptoms of both depression and anxiety. In this cross-sectional study, a random sample of school-going adolescents aged 13-18 years from various schools in Sikkim, both males and females, were selected. Depression and anxiety were assessed using the Revised Children's Anxiety and Depression Scale-25, and pulmonary function was measured using a computerised spirometer-Spirolab III. The recorded variables included forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1), FEV1/FVC ratio, peak expiratory flow rate (PEFR) and forced expiratory flow at 25-75% (FEF 25-75%). Significant differences emerged in FVC (P = 0.034), PEFR (P = 0.013) and FEF 25-75% (P = 0.023) between healthy and depressed adolescents aged 13-18 years. Similarly, a significant difference was observed in PEFR (P = 0.022) and FEF 25-75% (P = 0.002) between healthy adolescents and those with symptoms of both depression and anxiety. These differences were more pronounced among students in higher grades. Furthermore, significant differences in PEFR (P = 0.015) and FEF 25-75% (P ≤ 0.001) were found while comparing healthy males and males with symptoms of both depression and anxiety. However, no such disparities were seen in girls. There was no significant difference in any of the parameters when compared between the healthy group and those with anxiety. Depressed adolescents exhibited significantly reduced FVC, PEFR and FEF 25-75% compared to their healthy counterparts, despite being otherwise healthy. This negative association was more pronounced in the higher age group. However, anxious adolescents did not show any significant difference in PFT compared to healthy peers.

Predictors of dropout, time spent on the program and client satisfaction in an internet-based, telephone-assisted CBT anxiety program among elementary school children in a population-based sample.

Increasing evidence has shown that childhood anxiety can be effectively treated by Internet-based cognitive behavioral therapy (ICBT). Being able to predict why participants decide to drop out of such programs enables scarce resources to be used appropriately. The aim of this study was to report dropout predictors for a population-based ICBT intervention aimed at children with anxiety, together with the time they and their parents spent on the program and client satisfaction rates. The study focused on 234 Finnish children aged 10-13 who received an ICBT intervention, with telephone support, for anxiety symptoms, as a part of a randomized control trial. Their parents also had access to Internet-based material and participated in the weekly telephone calls with the coach. Possible drop out factors were explored and these included various family demographics, child and parent psychopathology and therapeutic alliance. Just under a fourth (23.9%) of the children dropped out of the intervention. The risk was higher if the child did not fulfill the criteria for any anxiety diagnosis or reported a poorer therapeutic alliance. Family demographics and the COVID-19 pandemic did not increase the risk. The families spent an average of 127min on the webpage each week and an average of 32min on the phone calls. The overall satisfaction with the program was 87% for the children and 95% for the parents. Both the children and the parents found the telephone calls helpful. These findings are important in clinical practice when assessing a family's eligibility for ICBT.

Remimazolam for anesthesia and sedation in pediatric patients: a scoping review.

Anesthetic management of pediatric patients poses several challenges and the optimal anesthetic agent for use in this population is still a matter of debate. We systematically searched PubMed/MEDLINE and Google Scholar from their inception for studies that investigated the role and potential applications of remimazolam, a novel ultra-short-acting benzodiazepine, in pediatric patients. Furthermore, in March 2024, an update of the literature search along with an additional post-hoc search on the EMBASE database were performed. A total of fourteen pertinent studies which spanned the 2021-2023 period explored remimazolam as either the primary or adjuvant hypnotic agent for inducing and/or maintaining general anesthesia or sedation. Preliminary evidence derived from these studies highlighted that remimazolam is a safe and effective option for both sedation and general anesthesia in pediatric patients, particularly those with concurrent mitochondrial disorders, myopathic diseases, or at risk for malignant hyperthermia. Moreover, the current evidence suggested that remimazolam may contribute to reducing preoperative anxiety and postoperative delirium in children. Its favorable pharmacodynamic and pharmacokinetic profile demonstrated potential safety, effectiveness, and ease-of-use in various perioperative pediatric contexts, making it suitable for integration into specific protocols, such as intraoperative monitoring of evoked potentials and management of difficult intubation. Notwithstanding these promising findings, further research is essential to determine optimal dosages, establish conclusive evidence of its superiority over other benzodiazepines, and elucidate the impact of genetic factors on drug metabolism.

The influence of parents' education anxiety on children's learning anxiety: the mediating role of parenting style and the moderating effect of extracurricular tutoring.

This study investigates the intricate relationship between parents' education anxiety and children's learning anxiety, examining the mediating role of parenting style and the moderating effect of extracurricular tutoring. Utilizing data from the "Survey of Parents and Students in Primary and Secondary Schools," the study employs stratified sampling (n = 3,298) and various psychological scales to measure education anxiety, parenting styles, and extracurricular tutoring. This study reveals that parents' education anxiety significantly influences children's learning anxiety, with a notable positive correlation (r = 0.301**). Parenting styles particularly rejection and overprotection style increase this anxiety, while emotional warmth style decreases it. Academic tutoring serves as a moderator, reducing the impact of parental anxiety on children's learning anxiety (β = -0.033, p < 0.05). The study underscores the importance of addressing internal family dynamics to alleviate education anxiety. It advocates for a balanced approach to tutoring, emphasizing the benefits of arts and sports activities in reducing learning anxiety. Parents should be encouraged to adopt emotionally warm parenting styles and to engage their children in a variety of extracurricular activities.