Child-reported Anxiety Symptoms Research Articles

Treating child anxiety using family-based internet delivered cognitive behavior therapy with brief therapist guidance: A randomized controlled trial

Online treatment delivery has the potential to increase access to evidence-based mental health care for children with anxiety disorders. Using a randomized controlled trial design, we evaluated the efficacy of Cool Kids Online, a family-based and therapist supported internet-delivered cognitive behavioral treatment (CBT) designed to target anxiety disorders in children. Ninety-five children aged 7–12 years with a DSM-5 anxiety disorder were randomly allocated to Cool Kids Online or a waitlist control. Children were assessed at baseline, week 11, and 6-months following treatment. Children in waitlist received treatment after week 11 and also completed assessments immediately and six months after treatment, allowing treatment maintenance to be evaluated for all children. Compared to waitlist, Cool Kids Online led to significantly greater remission of anxiety disorders (primary and all anxiety diagnoses) and greater reduction of caregiver-reported anxiety symptoms and interference at week 11. Child-reported anxiety symptoms and interference and child- and caregiver-reported depressive or externalizing symptoms did not differ significantly between conditions. Medium to large within-treatment effects were observed for all children from pre to post treatment with post treatment effects maintained until follow-up. Overall, the findings provide support for the efficacy of the program in treating anxiety. Cool Kids Online compared to waitlist for the remission of anxiety disorders in clinically anxious children; anzctr.org.au; ACTRN12615000947505.

Anxiety symptoms and puberty interactively predict lower cingulum microstructure in preadolescent Latina girls

Preadolescence is a period of increased vulnerability for anxiety, especially among Latina girls. Reduced microstructure (fractional anisotropy; FA) of white matter tracts between limbic and prefrontal regions may underlie regulatory impairments in anxiety. However, developmental research on the association between anxiety and white matter microstructure is mixed, possibly due to interactive influences with puberty. In a sample of 39 Latina girls (8–13 years), we tested whether pubertal stage moderated the association between parent- and child-reported anxiety symptoms and FA in the cingulum and uncinate fasciculus. Parent- but not child-reported anxiety symptoms predicted lower cingulum FA, and this effect was moderated by pubertal stage, such that this association was only significant for prepubertal girls. Neither anxiety nor pubertal stage predicted uncinate fasciculus FA. These findings suggest that anxiety is associated with disruptions in girls’ cingulum white matter microstructure and that this relationship undergoes maturational changes during puberty.

Heterogeneity in PFC-amygdala connectivity in middle childhood, and concurrent interrelations with inhibitory control and anxiety symptoms

The prefrontal cortex (PFC) is a key brain area in considering adaptive regulatory behaviors. This includes regulatory projections to regions of the limbic system such as the amygdala, where the nature of functional connections may confer lower risk for anxiety disorders. The PFC is also associated with behaviors like executive functioning. Inhibitory control is a behavior encompassed by executive functioning and is generally viewed favorably for adaptive socioemotional development. Yet, some research suggests that high levels of inhibitory control may actually be a risk factor for some maladaptive developmental outcomes, like anxiety disorders. In a sample of 51 children ranging from 7 to 9 years old, we examined resting state functional connectivity between regions of the PFC and the amygdala. We used Subgrouping Group Iterative Multiple Model Estimation (S-GIMME) to identify and characterize data-driven subgroups of individuals with similar networks of connectivity between these brain regions. Generated subgroups were collapsed into children characterized by the presence or absence of recovered connections between the PFC and amygdala. For subsets of children with available data (N = 38–44), we then tested whether inhibitory control, as measured by a stop signal task, moderated the relation between these subgroups and child-reported anxiety symptoms. We found an inverse relation between stop-signal reaction times and reported count of anxiety symptoms when covarying for connectivity group, suggesting that greater inhibitory control was actually related to greater anxiety symptoms, but only when accounting for patterns of PFC-amygdala connectivity. These data suggest that there is a great deal of heterogeneity in the nature of functional connections between the PFC and amygdala during this stage of development. The findings also provide support for the notion of high levels of inhibitory control as a risk factor for anxiety, but trait-level biopsychosocial factors may be important to consider in assessing the nature of risk.

The Role of Social Skills in Predicting Treatment-Recovery in Children with a Social Anxiety Disorder

The current study investigated the role of social skills and its interaction with social anxiety as predictors of treatment outcome in children with an anxiety disorder either with or without a social anxiety disorder (SoAD). In total, 133 children (aged 8 to 13) with an anxiety disorder received a 10-session cognitive behavioral treatment (FRIENDS program). Pre- to post treatment Reliable Change (RC) and Treatment-Recovery (TR) were assessed from a multi-informant perspective, by including diagnostic information (ADIS C/P), child-reported anxiety symptoms (MASC) and parent-reported internalizing symptoms (CBCL-Int). Social skills were assessed with the parent-rated Social Skills Rating System (assertion, self-control, responsibility). Results showed that 1) parents of children with a SoAD reported significantly less favorable use of assertive and responsible social behavior in their children pre-treatment than parents of children without SoAD, 2) children with higher social skills had a better treatment recovery, and 3) children with anxiety and higher responsible behavior pre-treatment and without a SoAD had a better treatment recovery, but this effect did not show for children with SoAD. In conclusion, better use of social behavior increased the likelihood of treatment recovery but not of reliable change. Further studies on the role of social skills in the treatment of childhood (social) anxiety are needed to investigate the mechanisms by which social skills impact treatment outcome.

Amygdala Functional Connectivity and Negative Reactive Temperament at Age 4 Months

Infant amygdala connectivity correlates with maternal reports of infant temperament characterized by novelty-evoked distress and avoidance. However, no studies have examined how human infant amygdala connectivity relates to direct observations of novelty-evoked distress. This study examined the link between amygdala connectivity and infant novelty-evoked distress using direct observation of temperament. Novelty-evoked distress was assessed at 4 months of age (N= 90) using a standardized reactivity assessment and parent report. Within 3 weeks of assessment, resting-state functional magnetic resonance imaging was collected in a subset of infants (n= 34). Using a whole-brain voxelwise approach, amygdala connectivity associated with positive and negative affect during the reactivity assessment was examined. Regions where the association of amygdala connectivity with negative affect was higher than with positive affect were then examined. Associations between amygdala connectivity and parent report of temperament were also examined. Greater amygdala-cingulate and amygdala-superior frontal gyrus connectivity was associated with lower positive affect during the reactivity assessment. Further, the association between amygdala-cingulate connectivity was greater for negative affect compared with positive affect. There were no significant associations between latency to approach novelty (as measured by parent report) and amygdala connectivity. Validation analyses conducted using a large independent longitudinal sample (N= 323) demonstrated that negative reactivity was associated with increased child-reported anxiety symptoms in adolescence. These results provide novel insight into the developmental pathophysiology of novelty-evoked distress. This is consistent with research linking an altered cognitive control mechanism to temperamental risk for anxiety.

A Psychometric Evaluation of the Revised Childhood Anxiety Sensitivity Index (CASI-R) in a Child and Adolescent Sample

The multifactorial nature of anxiety sensitivity (AS) in children has been assessed almost solely with the Childhood Anxiety Sensitivity Index (CASI; Silverman et al. Journal of Clinical Child Psychology, 20(2), 162–168, 1991); however, multiple studies have suggested that the item content of the CASI is too limited to adequately assess multiple AS factors in youth. Here we examined the psychometric properties of the Revised Childhood Anxiety Sensitivity Index (CASI-R; Muris Behaviour Research and Therapy, 40, 299–311, 2002), developed to assess a higher-order global AS factor and four lower-order factors. In a non-clinical sample of youth aged 8–14 we (a) examined the psychometric properties of the CASI-R, comparing findings for children aged 11 and younger with those aged 12 and older, (b) evaluated and compared the internal consistency of the four-factor CASI-R and the three- and four-factor CASI, and (c) examined and compared the convergent validity of the CASI and CASI-R subscales with child-reported anxiety symptoms. Reliability estimates for the CASI-R total, Cardiovascular, and Respiratory scales were high for all youth; the Cognitive Dyscontrol and Publicly Observable Reactions scales yielded low estimates of internal consistency for the younger group. Compared to the parallel CASI scales, these CASI-R scales demonstrated stronger internal consistency in both the older and younger groups. Comparatively larger correlations between the CASI-R physical and cognitive scales with symptoms of panic and between the CASI-R social scale and symptoms of social anxiety were observed. These findings suggest continued use and examination of the CASI-R in child and adolescent non-clinical and clinical samples to comprehensively assess the AS construct in youth.

Parental Emotion Socialization Strategies and Their Interaction with Child Interpretation Biases Among Children with Anxiety Disorders

Children’s interpretations of events play a significant role in childhood anxiety, and research shows that the parenting environment, in particular, is an important contributor to the manner in which children interpret their experiences. This study examined associations between parental use of punitive and minimization reactions to children’s displays of negative affect, child interpretation biases (self-reports and computerized assessments), and child anxiety symptom severity in a clinical sample of children with anxiety disorders. Forty-four children between 8–12 years of age (M = 9.60, SD = 1.30; 52 % girls; 52 % African American) and their mothers (M = 38.48, SD = 6.86; 57 % married) participated in this study. Child interpretation biases were significantly associated with child-reported anxiety symptoms. Moderation analyses revealed a positive relation between self-reported interpretation biases and anxiety symptoms for children of low-minimization and low-punitive mothers. Likewise, a positive relation between computerized interpretation biases and mother-reported child anxiety symptoms was found for children of low-minimization and low-punitive mothers. However, a negative relationship between computerized interpretation biases and mother-reported child anxiety symptoms was found for children of high-minimization and high-punitive mothers. Findings and implications are discussed in the context of how these parental reactions may be addressed and incorporated in childhood anxiety treatments.

Bounce back: Effectiveness of an elementary school-based intervention for multicultural children exposed to traumatic events.

To evaluate the feasibility and acceptability of a school-based intervention for diverse children exposed to a range of traumatic events, and to examine its effectiveness in improving symptoms of posttraumatic stress, depression, and anxiety. Participants were 74 schoolchildren (Grades 1-5) and their primary caregivers. All participating students endorsed clinically significant posttraumatic stress symptoms. School clinicians were trained to deliver Bounce Back, a 10-session cognitive-behavioral group intervention. Children were randomized to immediate or delayed (3-month waitlist) intervention. Parent- and child-report of posttraumatic stress and depression, and child report of anxiety symptoms, were assessed at baseline, 3 months, and 6 months. Bounce Back was implemented with excellent clinician fidelity. Compared with children in the delayed condition, children who received Bounce Back immediately demonstrated significantly greater improvements in parent- and child-reported posttraumatic stress and child-reported anxiety symptoms over the 3-month intervention. Upon receipt of the intervention, the delayed intervention group demonstrated significant improvements in parent- and child-reported posttraumatic stress, depression, and anxiety symptoms. The immediate treatment group maintained or showed continued gains in all symptom domains over the 3-month follow-up period (6-month assessment). Findings support the feasibility, acceptability, and effectiveness of the Bounce Back intervention as delivered by school-based clinicians for children with traumatic stress. Implications are discussed.

An effectiveness study of individual vs. group cognitive behavioral therapy for anxiety disorders in youth

ObjectiveConducted a randomized controlled trial to investigate the effectiveness of cognitive behavioral therapy (CBT), and compared the relative effectiveness of individual (ICBT) and group (GCBT) treatment approaches for anxiety disorders in children and adolescents. MethodsReferred youth (N = 182, M age = 11.5 years, range 8–15 years, 53% girls) with separation anxiety, social phobia, or generalized anxiety disorder were randomly assigned to ICBT, GCBT or a waitlist control (WLC) in community clinics. Pre-, post-, and one year follow-up assessments included youth and parent completed diagnostic interview and symptom measures. After comparing CBT (ICBT and GCBT combined) to WLC, ICBT and GCBT were compared along diagnostic recovery rates, clinically significant improvement, and symptom measures scores using traditional hypothesis tests, as well as statistical equivalence tests. ResultsSignificantly more youth lost all anxiety disorders after CBT compared to WLC. Full diagnostic recovery rate was 25.3% for ICBT and 20.5% in GCBT, which was not significantly different. There was continued lack of significant differences between ICBT and GCBT at one year follow-up. However, equivalence between GCBT and ICBT could only be demonstrated for clinical severity rating of the principal anxiety disorder and child reported anxiety symptoms post-treatment. ConclusionFindings support the effectiveness of CBT compared to no intervention for youth with anxiety disorders, with no significant differences between ICBT and GCBT. However, the relatively low recovery rates highlight the need for further improvement of CBT programs and their transportability from university to community settings.

The Intolerance of Uncertainty Scale for Children (IUSC): Discriminating principal anxiety diagnoses and severity.

The specific relationship of intolerance of uncertainty (IU) to generalized anxiety disorder (GAD) in youth was examined by evaluating the ability of the Intolerance of Uncertainty Scale for Children (IUSC) to discriminate among principal anxiety disorder diagnoses. Analyses examined parent, child, and composite reports of principal anxiety diagnoses in youth aged 7 to 17 years. Results indicate that higher IU scores are associated with GAD by the composite diagnostic. Additionally, the IUSC significantly predicted child-reported anxiety severity. This relationship was not moderated by diagnostic group. The results indicate that IUSC scores are particularly associated with GAD, as well as with more severe child-reported anxiety symptoms.

Mediators of Cognitive Behavioral Therapy for Anxiety-Disordered Children and Adolescents: Cognition, Perceived Control, and Coping

The purpose is to investigate whether a change in putative mediators (negative and positive thoughts, coping strategies, and perceived control over anxious situations) precedes a change in anxiety symptoms in anxiety-disordered children and adolescents receiving cognitive behavioral therapy (CBT). Participants were 145 Dutch children (8–18 years old, M = 12.5 years, 57% girls) with a primary anxiety disorder. Assessments were completed pretreatment, in-treatment, posttreatment, and at 3-month follow-up. Sequential temporal dependencies between putative mediators and parent- and child-reported anxiety symptoms were investigated in AMOS using longitudinal Latent Difference Score Modeling. During treatment an increase of positive thoughts preceded a decrease in child-reported anxiety symptoms. An increase in three coping strategies (direct problem solving, positive cognitive restructuring, and seeking distraction) preceded a decrease in parent-reported anxiety symptoms. A reciprocal effect was found for perceived control: A decrease in parent-reported anxiety symptoms both preceded and followed an increase in perceived control. Using a longitudinal design, a temporal relationship between several putative mediators and CBT-outcome for anxious children was explored. The results suggest that a change in positive thoughts, but not negative thoughts, and several coping strategies precedes a change in symptom reduction and, therefore, at least partly support theoretical models of anxiety upon which the anxiety intervention is based.

Universal Prevention of Anxiety and Depression in a Recreational Camp Setting: An Initial Open Trial.

BACKGROUND: Anxiety and depressive disorders may pose a long-term, deleterious impact on youth, prompting a need for early and effective prevention of such concerns. A growing body of research has examined universal prevention programs targeting these emotional disorders in childhood. While most universal prevention programs are offered within the school setting, there is also a rationale for developing and investigating prevention programs within novel settings, including a recreational context. OBJECTIVE: This initial investigation utilized the Emotion Detectives Prevention Program (EDPP), a universal prevention protocol focusing on anxiety and depression symptoms within a recreational summer camp. The aims of this pilot study were to assess the EDPP's feasibility and participant satisfaction following its initial administration in a camp setting. METHOD: Forty children (ages 7-10 years, 70.7% male) were recruited from an existent recreational sports camp and participated in a non-randomized, open trial of the EDPP. The EDPP, a 15-session program, presents cognitive-behavioral strategies in a manner that emphasizes strategy applicability across a range of emotional experiences. RESULTS: Participating children reported a significant decrease in anxiety symptoms at post-prevention. No significant change in depression symptoms or other emotion regulation indices were reported. Moderate to high participant satisfaction was indicated. CONCLUSIONS: The EDPP appears to be a feasible program for the prevention of child-reported anxiety symptoms in a camp setting. Given the novelty of the prevention context, issues inherent in the conduct of research in a recreational camp setting and future directions for research in this setting are discussed.

Family‐based interpersonal psychotherapy for depressed preadolescents: an open‐treatment trial

To conduct an open-treatment trial to evaluate the feasibility, acceptability and clinical outcomes of using a family-based adaptation of Interpersonal Psychotherapy for Depressed Adolescents with a sample of preadolescents (ages 9-12) presenting for outpatient treatment for depression. Sixteen preadolescents who met criteria for a depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition participated in this open-treatment trial of family-based interpersonal psychotherapy (FB-IPT). Parents chose whether their preadolescents should receive FB-IPT only (n = 10) or FB-IPT with antidepressant medication (n = 6). Pre- and post-treatment assessments included clinician-administered measures of depression and global functioning, and parent- and child-reported anxiety symptoms. FB-IPT was associated with high treatment compliance rates (88%) and was associated with significant decreases in preadolescents' depressive and anxiety symptoms. Preadolescents who received FB-IPT only were as likely as those receiving FB-IPT and medication to have significant reductions in depressive symptoms and anxiety symptoms, and to experience significant improvement in global functioning. Parents were more likely to choose combination treatment when their depressed preadolescents had a comorbid anxiety disorder. Further research on FB-IPT is needed to establish its efficacy as compared with usual outpatient treatment, its ability to be disseminated to child clinicians with varying levels of training and in adequately powered randomized controlled trials that can detect group differences.

A new measure of children's optimism and pessimism: the youth life orientation test

Optimism and pessimism are positive and negative expectations linked with well-being in adults. Research on the importance of optimism and pessimism in children is limited by the lack of a developmentally appropriate measure of children's expectations. Based upon the Life Orientation Test-Revised (Scheier, Carver, & Bridges, 1994), the Youth Life Orientation Test (YLOT) is a sixteen-item self-report measure of children's optimism and pessimism. Reliability and validity of the YLOT was found with 204 3rd-6th graders. Optimism also predicted fewer child-reported depressive symptoms and parent-reported behavior problems assessed three months later. Pessimism predicted more child-reported anxiety symptoms and parent-reported social and academic deficits.