Child-reported Depressive Symptoms Research Articles

Acculturation Stress Magnifies Child Depression Effect of Stressful Life Events for Latinx Youth 3 Years Later.

Experiences of stressful life events (SLEs) during childhood are associated with greater risk for youth psychopathology. Although SLEs are reported in greater frequency by Latinx families, Latinx populations remain largely absent in the SLE literature. Furthermore, Latinx populations face added stressors related to socio-political climate, acculturation, and racism and discrimination. The purpose of this study was to explore the intersection between parent-reported SLEs and acculturation (i.e., socio-political climate-related) stressors for Latinx youth. Greater frequency of caregiver reported SLEs were hypothesized to predict higher depressive symptoms in their children three years later, and acculturation stress was hypothesized to amplify these effects. The community-recruited, low-income sample for this study consisted of 198 Latinx caregivers (98.5% mothers, 77.3% foreign-born) and their children (M age = 7.4, 47.5% female). Study hypotheses were tested using MPlus. Consistent with prior literature, more SLEs reported at age 7 by parents were associated with more child-reported depressive symptoms at age 10 but only among boys. However, for both boys and girls, there was a significant interaction between acculturation stress and family SLEs. Specifically, as the amount of acculturation stress reported at age 7 increased, the negative impact of family SLEs on child-reported depressive symptoms at age 10 was magnified, regardless of gender. Adding to the literature on SLEs within Latinx families, these results indicate that acculturation and socio-political climate stressors need be considered in discussions of the effects of life stress on Latinx youth and their families.

Guided parent-delivered cognitive behavioural therapy for Japanese children and parents: a single-arm uncontrolled study.

Guided parent-delivered cognitive behavioural therapy (GPD-CBT) is an effective low-intensity treatment for childhood anxiety disorder in Western countries and can increase access to evidence-based psychological therapies. This study aimed to examine its feasibility in a Japanese sample. Twelve children with anxiety disorders and their parents participated in the study, and ten children and parents completed the program. Participants were assessed at pre-, post- and one-month follow-up using a diagnostic interview for anxiety disorders, self- and parent-report measures for anxiety, depression, parental behaviour, and parental anxiety. Four children (40% of completers) were free from their primary diagnoses immediately following the brief treatment, and seven children (70%) at the one-month follow-up. Changes in disorder severity, child and parent reported anxiety symptoms, and child reported depression symptoms were consistent with those found in Western trials of GPD-CBT and of Japanese trials of more intensive CBT for child anxiety disorders that involves both the child and the parent. Moderate increases were also found in child reported parental autonomy behaviours; however, there were only small changes in parent self-reported anxiety. These results support the potential of GPD-CBT to increase access to evidence-based treatments for anxiety disorders in Japanese children.

Cooperation with Teachers as a Mediator of the Relationship between Family Conflict and Children's Psychological Difficulties.

Parent–child conflict can have a series of negative consequences concerning youth emotional and behavioral development. The link between family conflict and children’s externalizing symptoms is well established, whereas the association with internalizing symptoms is less explored. Within the school context, children are engaged in other meaningful relationships (i.e., with teachers and peers) which contribute to their growth. This cross-sectional study aimed at understanding whether a cooperative behavior with the teachers is able to mediate the association between parent–child conflict and children’s psychopathological symptoms. We recruited 319 (150 boys) school-aged children (M = 11.3 years; SD = 1.8 years) and their parents and teachers. Children self-reported on their internalizing symptoms, whereas parents completed a questionnaire concerning their relationship with the child, and teachers rated children’s behavior and internalizing/externalizing symptoms. Analyses conducted through Hayes’ PROCESS tool showed that cooperation with the teacher partially mediated the association between parent–child conflict and child-reported depressive symptoms. Notably, cooperative behavior fully mediated the link between parent–child conflict and children’s internalizing and externalizing symptoms reported by teachers. Difficulties exhibited at school partly derive from a conflictual home environment. Our findings showed that such problems can be reduced thanks to a cooperative relationship with the teacher.

Psychometric properties of the children's emotion management scales within a psychiatric sample.

The Children's Emotion Management Scales (CEMS) are widely used measures of children's emotion regulation strategies in response to three specific emotions: sadness, anger, and worry. Original factor analyses suggested a three-factor subscale structure for each emotion: inhibition, dysregulation, and coping (Zeman et al., 2001, 2002, 2010). However, this factor structure had not been reexamined since it was originally developed, including within a racially diverse psychiatric sample. The present study attempted to address this gap for the Anger Management Scale and Sadness Management Scale separately, as well as testing the overarching structure of these two in combination. Participants included 302 children (ages 8-12; 70.4% boys; 55.72% African American; 39.3% White) from inpatient and outpatient centers and their primary caregivers. The three-factor structure replicated well with the Anger Management Scale and Sadness Management Scale separately in our sample. A bifactor model that included both higher order emotion factors (i.e., Anger and Sadness) and higher order strategy factors (i.e., Coping, Dysregulation, and Inhibition) best represented the overarching structure of the CEMS. Results from latent correlations and structural regressions showed that some of these factors were related to child-reported depressive symptoms and parent-reported disruptive behaviors, supporting the validity of the bifactor model conceptualization of scores on the CEMS. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Among Japanese Children: A Pilot Study.

At present, there is no established cognitive behavioral therapy (CBT) for treating emotional disorders in Japanese children. Therefore, we introduced the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) in Japan and adapted it to the Japanese context. We then examined its feasibility and preliminary efficacy using a single-arm pretest, posttest, follow-up design. Seventeen Japanese children aged between 8 and 12 years (female n = 11; male n = 6; M = 10.06 ± 0.97 years) with a principal diagnosis of anxiety, obsessive-compulsive, or depressive disorders, and their parents were enrolled in the study. The primary outcome was the overall severity of emotional disorders as assessed by psychiatrists using the Clinical Global Impression-Severity Scale. Secondary outcomes included child- and parent-reported anxiety symptoms, depressive symptoms, and functional status. No severe adverse events were observed. The feasibility was confirmed by the low dropout proportion (11.76%), high attendance proportion (children: 95.6%; parents: 94.6%), and sufficient participant satisfaction. Linear mixed models (LMMs) showed that the overall severity of emotional disorders and child- and parent-reported anxiety symptoms improved from pre-treatment to post-treatment, and that these treatment effects were maintained during the 3-month follow-up period. Additionally, child- and parent-reported functional status improved from pre-treatment to the 3-month follow-up. In contrast, child-reported depressive symptoms improved from pre-treatment to follow-up, but there was no significant change in parent-reported depressive symptoms between pre-treatment and other time points. These findings demonstrate the feasibility and preliminary efficacy of the Japanese version of the UP-C, suggesting that future randomized controlled trials (RCTs) are warranted (Clinical trial registration: UMIN000026911).

The cost and benefit of fear induction parenting on children's health during the COVID-19 outbreak.

The outbreak of the 2019 coronavirus disease (COVID-19) was an unprecedented global public health emergency with a significant psychological toll. This study aimed to understand how specific COVID-19 related stressors contributed to Chinese parents' fear induction practices, and how these practices, in turn, contributed to their children's disease prevention practices during the outbreak and depressive symptoms after the outbreak. Parents (N = 240, Mage = 38.50 years, 75% mothers) with elementary-school-age children (Mage = 9.48 years, 46% girls) in Wenzhou, 1 of the most impacted cities in China, reported on the presence of confirmed or suspected cases in their communities, their frequencies of consuming COVID-19-related information, fear induction practices, and their children's trait anxiety and disease prevention practices during the outbreak (January 28-30, 2020). Child-reported depressive symptoms were collected between March 7-11, 2020; during which there were very few remaining cases and no new confirmed cases or deaths. Parents' higher frequency of virus-related information consumption but not the presence of community infection was associated with their engagement in more fear induction practices, which was in turn associated with children's greater engagement in prevention practices during the outbreak, but more postquarantine depressive symptoms. Child trait anxiety exacerbated the association between parent fear induction and child depressive symptoms. Using fear induction parenting may promote children's willingness to cooperate and participate in disease prevention practices during the crisis but at the cost of children's long-term mental health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Contributions From Resting State Functional Connectivity and Familial Risk to Early Adolescent-Onset MDD: Results From the Adolescent Brain Cognitive Development Study

Abstract Background Family history of Major Depressive Disorder (MDD) is a robust predictor of MDD onset, especially in early adolescence. We examined the relationships between familial risk for depression and alterations to resting state functional connectivity (rsFC) within the default mode network (wDMN) and between the DMN and the left/right hippocampus (DMN-LHIPP/DMN-RHIPP) to the risk for early adolescent MDD onset. Methods We examined 9403 youth aged nine to eleven from the Adolescent Brain Cognitive Development study. Depressive symptoms were measured with the parent-reported Child Behavior Checklist. Both youth and their parents completed the Kiddie Schedule for Affective Disorders and Schizophrenia, which provided MDD diagnoses. A family history screen was administered to determine familial risk for depression. Youth underwent a resting state functional magnetic resonance imaging scan, providing us with rsFC data. Results Negative wDMN rsFC was associated with child-reported current depression, both child- and parent-reported past depression, and parent-reported current depressive symptoms. No difference was found in wDMN, DMN-LHIPP or DMN-RHIPP rsFC in children with or without familial risk for depression. Familial risk for depression interacted with wDMN rsFC in association with child-reported past MDD diagnosis and parent-reported current depressive symptoms. Limitations Information such as length of depressive episodes and age of onset of depression was not collected. Conclusions Altered wDMN rsFC in youth at familial risk for depression may be associated with increased risk for MDD onset in adolescence, but longitudinal studies are needed to test this hypothesis.

(In)Congruent Parent–Child Reports of Parental Behaviors and Later Child Outcomes

This study evaluated hypothesized relations of (in)congruent parent–child perceptions of parental warmth and hostility at age 7 with changes in child and parent reports of children’s depressive symptoms and rule-breaking behaviors from ages 7 to 10. Dyads consisted of 193 parents (93.3% biological mothers) and children (49.2% female; 46.1% Latinx) drawn from a longitudinal study of child development. Child and parent reports of parental warmth and hostility were collected using parallel measures at age 7. Child and parent reports of child depressive symptoms and rule-breaking behaviors were collected at ages 7 and 10. After controlling for children’s prior symptomatology and individual informant effects, polynomial regression analyses revealed a significant relation between (in)congruent perceptions of parental warmth and child-reported depressive symptoms. Specifically, congruent perceptions of high parental warmth at age 7 predicted decreased levels of child-reported depressive symptoms from ages 7 to 10, whereas congruent perceptions of low parental warmth predicted increased levels of child-reported depressive symptoms, especially among daughters. (In)congruent perceptions of parental hostility were related to child-reported rule-breaking behaviors. Specifically, congruent perceptions of high parental hostility predicted increased rates of child-reported rule-breaking behaviors, whereas incongruent perceptions of high parent-reported and low child-reported parental hostility predicted decreased rates of child-reported rule-breaking behaviors, especially among sons. This study documented the adaptive significance of parent–child (in)congruence in perceptions of parenting across middle childhood and revealed the potential specificity of relations by domain of adaptation and/or gender, thereby suggesting important implications for risk identification and treatment.

Investigation of children and adolescents’ mood and self-concept after acquired brain injury

ABSTRACT Few studies have examined the self-reported mental health of children with an acquired brain injury (ABI). The current study aimed to: 1) identify levels of child-reported depressive and anxiety symptoms and poor self-concept, 2) investigate demographic and injury-related factors associated with children’s mood and self-concept, and 3) examine associations between children’s self-reported mental health and parents’ reports of children’s emotional and behavioral functioning in children specifically with traumatic brain injury (TBI). 122 children (66% male) aged 8–16 years with ABI of mixed etiology were consecutively recruited through an outpatient rehabilitation clinic. Children were administered the Beck Youth Inventories – Second Edition, and parents completed the Adaptive Behavior Assessment System and the Child Behavior Checklist (CBCL). Relative to the norms, 16.4% of children scored in the clinical range for the depression and anxiety scales, and 24.6% reported clinically low self-concept. Children with lower functional status had greater anxiety symptoms. Older children (13–16 years) reported significantly higher depressive and anxiety symptoms and lower self-concept than younger children (8–12 years). A significant interaction between age and sex indicated that older girls reported greater depressive and anxiety symptoms than younger girls whereas no age-based differences were found for boys. Parent-reported total emotional and behavioral problems were positively associated with children’s self-reported depressive and anxiety symptoms and were negatively correlated with self-concept. These findings indicate that adolescents, particularly girls, may be at heightened risk of poor mental health following ABI. Further research investigating the reasons for these demographic differences may inform developmentally sensitive interventions.

Measurement of executive functioning with the National Institute of Health Toolbox and the association to anxiety/depressive symptomatology in childhood/adolescence

ABSTRACT Introduction Despite preliminary research, there remain inconsistent findings with regard to the role of executive functioning (EF) deficits in childhood anxiety and depression. This report examined the association of The National Institute of Health (NIH) Toolbox to clinical neuropsychological measures and to childhood, anxiety/depressive symptomatology. Methods: One-hundred eight children and adolescents completed the three EF measures from the NIH Toolbox (List Sorting Working Memory Test [LSWMT], Dimensional Change Card Sorting Test [DCCST], and Flanker Test of Attention and Inhibition [Flanker]) in an outpatient neuropsychology program. These tests were compared to established measures of EF in terms of linear correlations and detection of impairment. Heaton’s Global Deficit Score (GDS) was utilized to calculate impairment. The Toolbox-EF measures were paired with parent-reported EF symptoms (Behavior Rating Inventory of Executive Function [BRIEF2]) to identify the role of EF in childhood anxiety/depressive symptomatology. Results Toolbox-EF measures displayed medium sized correlations with their clinically comparable counterparts, and generally did not differ in their detection of impairment. Toolbox-GDS was associated with depression diagnosis and clinically significant child-reported anxiety and depressive symptoms. Together, Toolbox/BRIEF2 accounted for 26.8–30.9% of elevated depressive symptom variance, but only 13.2-14% of elevated anxiety symptom variance. Further, EF impairment was associated with depression across self report, parent report, and clinical diagnosis. Discussion The NIH Toolbox-EF measures display comparable psychometric properties to clinically available EF measures in a pediatric (primarily psychiatric) neuropsychology setting. The Toolbox appears to display an appropriate ability to detect EF deficits secondary to self-reported depression in childhood.

Child depressive symptoms: Associations with salivary cortisol and alpha amylase in two distinct challenges

Child depression has been inconsistency linked to cortisol and salivary alpha-amylase (sAA) reactivity. This study assessed three factors that contribute to inconsistencies: 1) the differential effectiveness of laboratory challenges to elicit cortisol and sAA; 2) the impact of cortisol-sAA coordination; and 3) variation in parent versus child ratings of depression. A community sample of 52 children participated in the Trier Social Stress Test-Child Version (TSST-C) and a competition challenge. Saliva was collected and assayed for cortisol and sAA. Analyses were conducted using multilevel modeling. Child-reported depressive symptoms were associated with a declining cortisol trajectory in the TSST-C. Mother-reported depressive symptoms were associated with higher baseline sAA in the TSST-C and the competition challenge. Further, child-reported depressive symptoms were associated with cortisol-sAA coordination in the competition challenge. Findings underscore the nature of the challenge and the behavioral informant as impacting associations between child depressive symptoms and cortisol and sAA secretion.

Teacher–child relationships, classroom climate, and children’s social-emotional and academic development.

Previous research has demonstrated that teacher–child relationship quality and classroom emotional climate are each related to children’s social-emotional and academic development, yet work examining interactional quality at both child and classroom levels simultaneously is limited. The current study examines whether teacher–child relationship quality as perceived by both teachers and children is associated with child social-emotional and academic outcomes over one school year and whether these associations are moderated by the quality of classroom emotional climate. Participants included 526 Grade 3–5 students and their 35 teachers from six urban public elementary schools. Higher child-reported relationship quality with teachers predicted lower child-reported depressive symptoms in spring, controlling for fall levels. Higher teacher-reported conflict was related to higher child-reported and teacher-reported aggression and lower ELA achievement. A significant cross-level interaction between classroom-level emotional support and teacher-reported conflict in predicting teacher-reported aggression indicated that higher quality classroom emotional climate may mitigate risk of aggression for children with poor-quality teacher relationships. Yet an overall lack of significant interaction effects indicates that classroom-level emotional support did not compensate for low-quality dyadic relationships, suggesting that teachers in upper elementary school should be trained and supported in developing and maintaining positive relationships with each of their students. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Ventral Striatal Function Interacts With Positive and Negative Life Events to Predict Concurrent Youth Depressive Symptoms

BackgroundLife events and reward-system functioning contribute to resilience and risk for depression. However, interactions between life events and neural responses to reward and loss have not been previously investigated in relation to depression symptoms in child and adolescent populations. MethodsAn unselected sample (N = 130) of 8- to 14-year-old girls (mean = 12.6 years) completed the Child Depression Inventory and a functional magnetic resonance imaging guessing task in which they won or lost money on each trial. Parents completed a measure of life events experienced by the child. Life events were separated by positive versus negative and whether they were likely related or unrelated to the daughter’s behavior (i.e., dependent vs. independent, respectively). Multiple regressions tested whether the interaction between ventral striatal (VS) response to wins or losses and recent life events were associated with child-reported depressive symptoms. ResultsA greater number of dependent positive life events related to decreased total depression symptoms when VS response to wins was robust. Conversely, a greater number of independent negative life events related to increased negative mood depression symptoms when VS response to losses was robust; this relationship was in the opposite direction when VS response to loss was low. ConclusionsVS response to reward and loss were independent moderators of the relationship between recent life events (positive and negative, respectively) and depressive symptoms. Findings suggest that targeting neural responses (i.e., increasing responses to winning or decreasing responses to losing) may be important for both improving resilience and reducing risk in different environmental contexts.

Maternal Impression Management in the Assessment of Childhood Depressive Symptomatology.

Self-report instruments are commonly used to assess for childhood depressive symptoms. Historically, clinicians have relied heavily on parent-reports due to concerns about childrens' cognitive abilities to understand diagnostic questions. However, parents may also be unreliable reporters due to a lack of understanding of their child's symptomatology, overshadowing by their own problems, and tendencies to promote themselves more favourably in order to achieve desired assessment goals. One such variable that can lead to unreliable reporting is impression management, which is a goal-directed response in which an individual (e.g. mother or father) attempts to represent themselves, or their child, in a socially desirable way to the observer. This study examined the relationship between mothers who engage in impression management, as measured by the Parenting Stress Index-Short Form defensive responding subscale, and parent-/child-self-reports of depressive symptomatology in 106 mother-child dyads. 106 clinic-referred children (mean child age = 10.06 years, range 7-16 years) were administered the Child Depression Inventory, and mothers (mean mother age = 40.80 years, range 27-57 years) were administered the Child-Behavior Checklist, Parenting Stress Index-Short Form, and Symptom Checklist-90-Revised. As predicted, mothers who engaged in impression management under-reported their child's symptomatology on the anxious/depressed and withdrawn subscales of the Child Behavior Checklist. Moreover, the relationship between maternal-reported child depressive symptoms and child-reported depressive symptoms was moderated by impression management. These results suggest that children may be more reliable reporters of their own depressive symptomatology when mothers are highly defensive or stressed.

Family-Based Interpersonal Psychotherapy for Depressed Preadolescents: Examining Efficacy and Potential Treatment Mechanisms

To conduct a randomized controlled trial to evaluate the preliminary efficacy of family-based interpersonal psychotherapy (FB-IPT) for treating depression in preadolescents (aged 7-12 years) as compared to child-centered therapy (CCT), a supportive and nondirective treatment that closely approximates the standard of care for pediatric depression in community mental health. Preadolescents with depression (N= 42) were randomly assigned FB-IPT or CCT. Pre- and posttreatment assessments included clinician-administered measures of depression, parent- and child-reported depression and anxiety symptoms, and parent-child conflict and interpersonal impairment with peers. Preadolescents receiving FB-IPT had higher rates of remission (66.0% versus 31%), a greater decrease in depressive symptoms from pre- to posttreatment, and lower depressive symptoms at posttreatment (R(2)= 0.35, ΔR(2)= 0.22; B=-8.15, SE= 2.61, t[37]=-3.13, p= .002, F(2)= 0.28) than did preadolescents with depression receiving CCT. Furthermore, preadolescents in the FB-IPT condition reported significant reductions in anxiety and interpersonal impairment compared with preadolescents in the CCT condition. Changes in social and peer impairment from pre- to posttreatment were associated with preadolescents' posttreatment depressive symptoms. There was a significant indirect effect for decreased social impairment accounting for the association between the FB-IPT and preadolescents' posttreatment depressive symptoms. Findings indicate FB-IPT is an effective treatment for preadolescent depression and support further investigation of interpersonal mechanisms by which FB-IPT may reduce preadolescent depression. Clinical trial registration information-Phase II Study ofFamily Based Interpersonal Psychotherapy (FB-IPT) forDepressed Preadolescents; http://clinicaltrials.gov; NCT02054312.

Child Perceived Parenting Behavior: Childhood Anxiety and Related Symptoms

Youth ages 7–14 (N = 175; 52.6% male) and parents were evaluated. Father's and mother's acceptance, psychological control, and firm/behavioral control were measured. Children were diagnosed, and self-, parent-, and teacher-reports were gathered. Children with anxiety disorders perceived higher parental control than children without. Regressions found child-reported maternal acceptance was associated with lower child anxiety, depression, and externalizing, whereas psychological control predicted higher symptoms. Child-reported depressive symptoms moderated the maternal psychological control and children's anxiety relationship (the relationship was weaker for anxious children with more depressive symptoms). Findings support that children's perception of parenting behavior is associated with anxiety.

Risk, Resilience, and the Rorschach: A Longitudinal Study of Children Who Experienced Sexual Abuse

Experiencing sexual abuse increases the risk that children will report or otherwise demonstrate problems with emotion, behavior, and health. This longitudinal study of 44 children who experienced sexual abuse examined whether information processing as assessed via the Rorschach Inkblot Test was associated with child-reported depression symptoms assessed via the Children's Depression Inventory (Kovacs, 1992) concurrently and an average of 15 months later. Children whose Rorschach protocols were relatively free of scores suggesting intense distress, complex processing, and sexual content were more likely to experience remission of depression symptoms at follow-up. Findings provide incremental validity for certain Rorschach indexes to inform prognosis regarding depression symptoms and perhaps their treatment.

Predictors and consequences of developmental changes in adolescent girls' self-reported quality of attachment to their primary caregiver

In an at-risk community sample of 2101 girls, we examined trajectories, predictors, and consequences of changes in a central aspect of adolescents' perceived quality of attachment (QOA), i.e., their reported trust in the availability and supportiveness of the primary caregiver. Results demonstrated two distinct epochs of change in this aspect of girls' perceived QOA, with a significant linear decrease in early adolescence (ages 11–14) followed by a plateau from 14 to 16. Baseline parent-reported harsh punishment, low parental involvement, single parent status, and child-reported depression symptoms predicted steeper decreases in attachment during early adolescence, which in turn predicted greater child-reported depression and conduct disorder symptoms in later adolescence. Results suggest that both parent and child factors contribute to trajectories of self-reported QOA in adolescence, and a faster rate of decrease in girls' perceived QOA to caregivers during early adolescence may increase risk for both internalizing and externalizing symptoms.

Children's adjustment following Hurricane Katrina: the role of primary caregivers.

Hurricane Katrina severely disrupted the lives of many children and families in the central Gulf Coast of the United States. Face-to-face interviews with child-caregiver dyads were conducted at approximately 1 year posthurricane (T1) and 6-10 months later (T2). The contribution of several factors-caregiver's self-reported symptomatology and coping advice and child perceptions of caregiver distress, unavailability, warmth, and caregiver-child conflict-to child-reported posttraumatic stress symptoms (PTSS) and depressive symptoms was examined. Findings provide partial support for the importance of the caregiving context to children's adjustment. Specifically, higher levels of caregiver-child conflict at T1 were associated with more PTSS at T2, controlling for baseline symptoms. In contrast, higher levels of caregiver education were negatively related to child PTSS at T2. After adjusting for objective hurricane exposure and symptoms at T1, none of the caregiving variables was related to child-reported depressive symptoms at T2. The implications of these findings for efforts to promote children's adjustment after disaster are discussed.

Role of Comorbid Depression and Co-occurring Depressive Symptoms in Outcomes for Anxiety-Disordered Youth Treated with Cognitive-Behavioral Therapy

This study examined the role of comorbid depressive disorders (major depressive disorder or dysthymic disorder) and co-occurring depressive symptoms in treatment outcome and maintenance for youth (N = 72, aged 7–14) treated with cognitive-behavioral therapy for a principal anxiety disorder (generalized anxiety disorder, separation anxiety disorder, or social phobia). Hierarchical linear modeling examined treatment outcome and maintenance in terms of severity of the principal anxiety disorder. Results indicated that higher levels of child-reported depressive symptoms predicted less favorable treatment outcome. Higher levels of mother-reported depressive symptoms predicted less favorable treatment maintenance at a 1-year follow-up. Results suggest that co-occurring depressive symptoms play a role in effective treatment for anxiety-disordered youth and support the merits of treatment adaptations for these youth.