Childhood Anxiety Sensitivity Index Research Articles

Maternal attachment security modulates the relationship between vulnerability to anxiety and attentional bias to threat in healthy children

This study aimed to investigate whether attentional bias to threat, commonly observed in clinically anxious children, also manifests in healthy children, potentially aiding the early detection of at-risk individuals. Additionally, it sought to explore the moderating role of parent–child attachment security on the association between vulnerability factors (anxiety sensitivity, intolerance of uncertainty, perseverative cognitions) as indicators of vulnerability to anxiety, and attentional bias towards threat in healthy children. A total of 95 children aged 8 to 12 years completed the Visual Search Task to assess attentional bias. Vulnerability to anxiety was measured using a composite score derived from the Childhood Anxiety Sensitivity Index, Intolerance of Uncertainty Scale for Children, and Perseverative Thinking Questionnaire. Parent–child attachment security was assessed using the Security Scale-Child Self-Report. Analyses revealed that higher vulnerability to anxiety was associated with faster detection of anger-related stimuli compared to neutral ones, and this association was further influenced by high maternal security. These findings in healthy children suggest an interaction between specific factors related to anxiety vulnerability and the security of the mother–child relationship, leading to cognitive patterns resembling those seen in clinically anxious individuals. These results hold promise for early identification of children at risk of developing anxiety disorders.

A cross-sectional analysis of the relationships between anxiety sensitivity and youth irritability: the mediated roles of insomnia and selective attention for threat

BackgroundIrritability is common in multiple psychiatric disorders and is hallmark of disruptive mood dysregulation disorder. Child irritability is associated with higher risk of suicide and adulthood mental health problems. However, the psychological mechanisms of irritability are understudied. This study examined the relationship between anxiety sensitivity and irritability among youth, and further explored three possible mediated factors: selective attention for threat, delayed reward discounting, and insomnia.MethodsParticipants were 1417 students (51.7% male; mean age 13.83 years, SD = 1.48) recruited from one high school in Hunan province, China. Self-report questionnaires were used to measure irritability (The Affective Reactivity Index and The Brief Irritability Test), anxiety sensitivity (The Childhood Anxiety Sensitivity Index), selective attention for threat (The Davos Assessment of Cognitive Biases Scale-attention for threat bias subscale), insomnia (The Youth Self-Rating Insomnia Scale), and delayed reward discounting (The 27-item Monetary Choice Questionnaire). Structural equation modal (SEM) was performed to examine mediated relations.ResultsAnxiety sensitivity was modestly related to irritability and insomnia (r from 0.25 to 0.54) and slightly correlated with selective attention for threat (r from 0.12 to 0.28). However, there is no significant relationship of delayed rewards discounting with anxiety sensitivity and irritability. The results of SEM showed that selective attention for threat (indirect effect estimate = 0.04) and insomnia (indirect effect estimate = 0.20) partially mediate the relationship between anxiety sensitivity and irritability, which explained 34% variation.ConclusionsAnxiety sensitivity is an important susceptibility factor for irritability. Selective attention for threat and insomnia are two mediated mechanisms to understand the relationship between anxiety sensitivity and irritability.

Cortisol reactivity and emotional cognitive processes in healthy youth presenting elevated vulnerability to anxiety

Children diagnosed with anxiety disorders show altered reactive cortisol levels and emotional cognitive processes. To date, it remains unclear whether anxiety pathologies lead to these dysregulations or whether they are detectable in healthy children. If the latter is true, this may provide insight into their vulnerability to developing anxiety disorders. Various personality factors (anxiety sensitivity, intolerance of uncertainty, perseverative cognitions) have been found to increase one’s vulnerability to developing clinical anxiety. The purpose of this study was to examine whether vulnerability to anxiety was associated with cortisol reactivity, attentional biases towards threat, and perceptual information needed to identify emotional faces in healthy youth. In total, 114 children (8-12 y/o) were exposed to the Trier Social Stress Test for Children while saliva samples were collected for later cortisol quantification. Children completed two cognitive tasks to assess attentional biases and visual perception of emotional information. Vulnerability to anxiety was assessed using a composite score of the Childhood Anxiety Sensitivity Index, Intolerance of Uncertainty Scale for Children, and the Perseverative Thinking Questionnaire. Results showed that higher vulnerability to anxiety was associated with enhanced cortisol reactivity for boys, as well as faster reaction times to anger-related stimuli and less perceptual information needed to identify angry faces for boys and girls. These results indicate that endocrine and cognitive patterns characterizing anxiety disorders are detectable in healthy children who exhibit a high level of self-reported vulnerability to anxiety. These results could aid in the early identification of children at risk of developing an anxiety disorder.

Effect of therapeutic play based training program on pre- and post-operative anxiety and fear: A study on circumcision surgery in Turkish Muslim children

Developmentally appropriate pre-surgical educational programs can help alleviate the anxiety of both children and parents. As one of the most common pediatric surgical procedures is circumcision; and they may experience anxiety and fear before and after this surgical procedure, this study is considered to make an important contribution to the literature. This study aimed to examine the effect of therapeutic play based training program on pre- and post-operative anxiety and fear levels of children aged 8-11 years who would undergo circumcision. This was a quasi-experimental study that consisted of a pre- and post-intervention and control groups; and concluded with 60 children aged 8-11 years (intervention group: 30 and no intervention/control group: 30). Child and Parent Information Form, Childhood Anxiety Sensitivity Index (CASI) and Fear for Medical Procedures Scale (FMPS) were used as data collection tools. Children in the intervention group applied a "therapeutic play-based training program" 2h before they underwent circumcision surgery. Therapeutic toys used in the educational program has designed by researchers. After the training program, children in the intervention group obtained lower CASI (preop t=6.383, p<.001; postop t=8.763, p<.001) and FMPS (preop t=6.331, p<.001; postop t=9.366, p<.001) total mean scores than those in the control group. This study was concluded that the therapeutic play based training program used to prepare children for circumcision surgery was effective in reducing their pre- and post-operative anxiety and medical fears. Considering that male circumcision is a religious and cultural necessity in Turkey, further studies can also examine whether the anxiety and medical fear scores differ in study groups that include children who are not Muslim or live in a different country, and whether the training program will be effective in reducing their anxiety and medical fears. A therapeutic play based training program can be used to prepare children for circumcision in the preoperative period.

Vulnerability to anxiety differently predicts cortisol reactivity and state anxiety during a laboratory stressor in healthy girls and boys

BackgroundChildren diagnosed with anxiety disorders show altered cortisol and state anxiety reactivity to stressful situations. To date, it remains unclear whether these dysregulations emerge after the pathology or whether they are also detectable in healthy children. If the latter is true, this may provide insight into children's vulnerability to develop clinical anxiety. Various personality factors (anxiety sensitivity, intolerance of uncertainty, perseverative cognitions) increase youth's vulnerability to develop anxiety disorders. This study aimed to examine whether vulnerability to anxiety was associated with cortisol reactivity and state anxiety in healthy youth. Methods114 children (8–12 y/o) were exposed to the Trier Social Stress Test for Children (TSST-C), where saliva samples were collected for cortisol quantification. State anxiety was assessed 20 min before and 10 min after the TSST-C using the state form of the State-Trait Anxiety Inventory for Children. Vulnerability to anxiety was assessed using a composite score of the Childhood Anxiety Sensitivity Index, Intolerance of Uncertainty Scale for Children, and Perseverative Thinking Questionnaire. ResultsHigher vulnerability to anxiety was associated with enhanced cortisol reactivity in boys. Irrespective of vulnerability level, girls reported greater changes in state anxiety in response to the TSST. LimitationsGiven the correlational nature of this study, the directionality of the results remains to be elucidated. ConclusionsThese results indicate that endocrine patterns characterizing anxiety disorders are detectable in healthy boys who exhibit a high level of self-reported vulnerability to anxiety. These results could aid in the early identification of children at risk of developing anxiety disorders.

The Spanish Version of the Childhood Anxiety Sensitivity Index: Factorial Dimensions and Invariance across Gender in a Sample of Adolescents.

Anxiety sensitivity is a transdiagnostic construct that has been associated with the etiology of emotional disorders, especially panic and other anxiety disorders. Although it is well known that, for the adult population, the factor structure of anxiety sensitivity includes three separate facets (physical, cognitive, and social concerns), the facets of anxiety sensitivity for adolescents have not yet been established. The main goal of the present study was to examine the factor structure of the Spanish version of the Childhood Anxiety Sensitivity Index (CASI). A large sample of nonclinical adolescents completed the Spanish version of the CASI in school settings (N = 1655; aged 11-17 years; 800 boys and 855 girls). Exploratory and confirmatory factor analyses of the full scale (CASI-18) indicate that a three first-order factor solution represents appropriately the three anxiety sensitivity facets previously defined for the adult population. The 3-factor structure had a better fit and was more parsimonious than a 4-factor solution. Results also indicate that the 3-factor structure remains invariant across genders. Girls scored significantly higher than boys on the total scale and on all three dimensions of anxiety sensitivity. In addition, the present study provides information concerning normative data for the scale. The CASI holds promise as a useful tool for assessing general and specific facets of anxiety sensitivity. It could be helpful for the assessment of this construct in clinical and preventive settings. The limitations of the study and suggestions for further research are outlined.

FKBP5 intron 7 methylation is associated with higher anxiety proneness and smaller right thalamus volume in adolescents.

Dysregulation of stress response systems may mediate the detrimental effects of childhood trauma (CT) on mental health. FKBP5 regulates glucocorticoid receptor sensitivity and exerts pleiotropic effects on intracellular signaling, neurobiology and behavior. We investigated whether CT, alone and in combination with rs1360780 genotype, is associated with altered FKBP5 methylation and whether CT-associated methylation profiles are associated with anxiety proneness (AP) and structural brain volumes. Ninety-four adolescents completed the Childhood Trauma Questionnaire, and a composite AP score was generated from the Childhood Anxiety Sensitivity Index and the State-Trait Anxiety Inventory-Trait measure. Mean methylation values for 12 regulatory regions and 25 individual CpG sites were determined using high-accuracy measurement via targeted bisulfite sequencing. FKBP5 rs1360780 genotype and structural MRI data were available for a subset of participants (n = 71 and n = 75, respectively). Regression models revealed an inverse association between methylation of three intron 7 CpG sites (35558438, 35558566 and 35558710) and right thalamus volume. CpG35558438 methylation was positively associated with AP scores. Our data indicate that an intron 7 methylation profile, consistent with lower FKBP5 expression and elevated high sensitivity glucocorticoid receptor levels, is associated with higher AP and smaller right thalamus volume. Research into the mechanisms underlying the intron 7 methylation-thalamus volume relationship, and whether it confers increased risk for long-term psychopathology by altering the regulatory threshold of stress responding, is required.

Pre-pandemic socio-emotional vulnerability, internalizing and externalizing symptoms predict changes in hair cortisol concentrations in reaction to the COVID-19 pandemic in children

The COVID-19 pandemic led to increased distress in many children, particularly in girls. Socio-emotional vulnerability, as well as psychiatric symptomatology prior to or during the initial stages of the pandemic, have been identified as important predictors of this distress. Still, it is unclear whether the pandemic also had physiological repercussions in children. If so, it remains to be determined whether these same predictors could provide insight into inter-individual variability. This longitudinal study aimed to investigate the effects of socio-emotional vulnerability, as well as pre-pandemic internalizing and externalizing symptoms, on hair cortisol concentrations (HCC) in response to the COVID-19 pandemic in healthy youth. In June 2020 (T1), 69 healthy children (M = 11.57 y/o) who visited the laboratory between 2017 and 2019 (T0) provided a 6 cm hair sample. This technique allowed us to quantify cortisol secretion during the three months preceding the COVID-19 pandemic (Segment A) and during the first three months of the first wave of the pandemic in Quebec, Canada (Segment B). At T0, participants completed the Dominic Interactive to assess pre-pandemic internalizing and externalizing symptoms. A socio-emotional composite score (SECS) was derived using a weighted z-score with the following constructs: anxiety sensitivity (Childhood Anxiety Sensitivity Index) measured at T0, trait anxiety (Trait subscale of the State-Trait Anxiety Inventory for Children (STAI-C)), intolerance of uncertainty (Intolerance of Uncertainty Scale for Children), and trait rumination (Children’s Response Style Scale) measured at T1. A linear regression was conducted using the percent change in HCC across Segment A and B as the dependent variable, where SECS, pre-pandemic internalizing and externalizing symptoms, and sex were used as predictors. We found a main effect of sex, with girls presenting increased HCC reactivity compared to boys. We also found that SECS and internalizing symptoms negatively predicted HCC, whereas the opposite relationship was found between externalizing symptoms and HCC reactivity. For healthy children, our results suggest that previous psychiatric symptoms and socio-emotional vulnerability may be risk factors for the presentation of diverging cortisol response patterns in response to an adverse life event (such as the COVID-19 pandemic).

Risk Factors Associated With Increased Anxiety Sensitivity in Children and Adolescents in Northwest China During COVID-19 Pandemic Lockdown.

PurposeA large body of evidence has revealed that the sudden outbreak of public health emergencies induces dramatic effects on the mental health of the general public. We aimed to investigate the level of anxiety sensitivity and its risk factors in children and adolescents from northwest China during the COVID-19 pandemic lockdown in early 2020.MethodsA cross-sectional survey was conducted through the Wenjuanxing platform using a convenience sampling method between 18 and 26 February 2020. The self-designed questionnaire contained sociodemographic characteristics, factors associated with the COVID-19 pandemic, and the Childhood Anxiety Sensitivity Index (CASI) scale. The data from 1,091 valid questionnaires from students aged 9–17 years were analyzed using ANOVA, multiple linear regression, and binary logistic regression.ResultsThe average CASI scores were 11.47 ± 6.631, and 642 students (58.9%) had prominent anxiety sensitivity. Gender, education level, family members participating in anti-COVID-19 work, getting ill and needing medical help during the lockdown, feeling afraid or having heart palpitations on hearing things associated with COVID-19, believing that COVID-19 would have adverse impacts on themselves or their family in the future, and fear of infection were identified as significant factors for elevated levels of anxiety sensitivity (p < 0.05). We established a multiple linear regression model for the anxiety sensitivity score. Risk factors found for anxiety sensitivity in children and adolescents during the COVID-19 lockdown included studying in secondary or high school, becoming ill during the pandemic, feeling afraid or experiencing rapid heartbeat or palpitations on hearing about the COVID-19 pandemic, thinking that COVID-19 would have an adverse impact on themselves or their family in the future, and fear of infection.ConclusionsDuring the COVID-19 pandemic and home quarantine, scores measuring the prevalence of anxiety sensitivity in children and adolescents from northwest China were elevated. We should develop measures that especially target possible risk factors to intervene against and prevent anxiety sensitivity in children and adolescents in both the current and future pandemics.

A longitudinal investigation of psychological distress in children during COVID-19: the role of socio-emotional vulnerability

ABSTRACT Background Although the COVID-19 pandemic has increased the incidence of distress in youth, some children show increased resilience, emphasizing the need to better understand the predictors of distress in youth. Objective This longitudinal study aimed to assess the combined impact of known socio-emotional predictors of stress-related psychopathology, namely anxiety sensitivity, anxiety trait, intolerance to uncertainty, and rumination, on COVID-related distress in healthy youth. Method A total of 92 parent-child dyads that previously participated in a laboratory-based experiment assessing observational fear learning in families between 2017 and 2019 (T0) were recontacted. Of them, 84 children aged between 9 and 14 agreed to participate. They completed online questionnaires in June 2020 (T1), September 2020 (T2), December 2020 (T3), and March 2021 (T4). Participants were free of mental illness at T0 and T1. To create a socio-emotional composite score (SECS), we measured anxiety sensitivity (Childhood Anxiety Sensitivity Index) at T0, trait anxiety (Trait subscale of the State-Trait Anxiety Inventory for Children (STAI-C)), intolerance to uncertainty (Intolerance of Uncertainty Scale for Children), and trait rumination (Children’s Response Style Scale) at T1 and created a weighted z-score. To assess symptoms of anxiety, post-traumatic stress (PTS), and depression in reaction to COVID-19, participants completed the State subscale of the STAI-C, the Children’s Revised Impact of Event Scale, and the Children’s Depression Inventory at T1–T4. Three general linear models were run with sex, age group (9–11 and 12+ years old), and SECS as predictors. Results Analyses revealed a SECS*Time interaction, with higher SECS predicting elevated anxiety symptoms at T1 and T4, and elevated PTS symptoms at T1 and T2. Conclusion These results suggest that healthy youth endorsing high levels of socio-emotional vulnerability to psychopathology have a higher risk of suffering from anxiety and PTS, but not depressive symptoms, in the year following a major stressor.

Anxiety and depression in adolescents with asthma: a study in clinical practice.

Background:Anxiety and depression may affect asthma control. Previously, it has been reported that the hospital anxiety depression scale (HADS) questionnaire was fruitful in the management of adolescents with asthma. This study compared the scores of two different questionnaires, namely the Childhood Anxiety Sensitivity Index (CASI) and Children’s Depression Inventory (CDI), with asthma control level and lung function in asthmatic adolescents, evaluated in a real-life setting.Methods:A group of adolescents with asthma was consecutively enrolled. Asthma was diagnosed according to the GINA document, and consistently the symptom control grade was assessed. The adolescents completed the CASI, CDI, and Asthma Control Test (ACT) questionnaires. Visual Analogue Scale (VAS) for asthma symptoms perception and doctor’s asthma control evaluation were considered. Lung function and clinical characteristics were also assessed.Results:Totally, 87 asthmatic adolescents (60 males, 27 females, median age 14.2 years) were evaluated. 16.1% of asthmatic adolescents had anxious symptoms detected by CASI, and 11.5% depressive symptoms revealed by CDI. High scores of both CASI and CDI were significantly associated with uncontrolled asthma (p= 0.013 and 0.043, respectively).Conclusions:This study showed that anxiety and depression affected asthma control. Thus, in clinical practice, the psychological assessment could be included in asthmatic adolescents’ asthma work-up. (www.actabiomedica.it)

Pediatric Pain Screening Tool: A Simple 9-Item Questionnaire Predicts Functional and Chronic Postsurgical Pain Outcomes After Major Musculoskeletal Surgeries

Reliable, clinic-friendly screening for Chronic postsurgical pain (CPSP) risk is unavailable. Within a prospective, observational study, we evaluated Pediatric Pain Screening Tool (PPST), a concise 9-item questionnaire, as a preoperative screening tool to identify those at higher risk for CPSP (Numerical Rating Scale > 3/10 beyond 3 months post-surgery) and poor function (disability/Functional Disability Inventory [FDI]/quality of life/ Pediatric Quality of Life) after spine fusion and Nuss procedures. Incidence of CPSP was 34.86% (38/109). We confirmed PPST scale stability, test re-test reliability (ICC = 0.68; P< .001); PPST measures were positively correlated with known CPSP risk factors (P< .001) preoperative pain (Pearson or Spearman Correlation Coefficient [SCC]:0.672), Child anxiety sensitivity index (SCC:0.357), Patient Related Outcome Measures Information System pain interference (SCC:0.569), Patient Related Outcome Measures Information System depression (SCC:0.501), Pediatric Quality of Life (SCC:-0.460) and insomnia severity index (SCC0.567). Preoperative PPST and PPST physical sub-scores (median(IQR) were higher in CPSP (2[0.5,4], 1[0,2]) compared to non-CPSP (1[0,3], 0[0,1.5]) groups (P= .026, P= .029) respectively. PPST scores/sub-scores positively correlated with higher FDI at 6 months but only PPST total and PPST psychosocial subscore correlated with higher FDI at 12 months. Based on ROC, optimal PPST cutoff for CPSP was 2 (63.9% sensitivity, 64.7% specificity). CPSP risk was high (48.94% risk) if PPST ≥ 2 (n = 47) and medium (22.81%) if PPST < 2 (n = 57) after spine/pectus surgery. General and risk-strata specific, targeted psychosocial non-pharmacological interventions, need to be studied. Findings need validation in diverse, larger cohorts. ClinicalTrials.gov IdentifierNCT02998138. PerspectiveThe article supports Pediatric Pain Screening Tool, a simple 9-item questionnaire, as a preoperative screening tool for CPSP and function 6-12 months after spine/pectus surgeries. PPST measures correlate with known risk factors for CPSP. Risk stratification and targeted preventive interventions in high-risk subjects are proposed.

Guided Relaxation-Based Virtual Reality for Acute Postoperative Pain and Anxiety in a Pediatric Population: Pilot Observational Study.

BackgroundDistraction-based therapies, such as virtual reality (VR), have been used to reduce pain during acutely painful procedures. However, distraction alone cannot produce prolonged pain reduction to manage sustained postoperative pain. Therefore, the integration of VR with other pain-reducing therapies, like guided relaxation, may enhance its clinical impact.ObjectiveThe goal of this pilot study was to assess the impact of a single guided relaxation–based VR (VR-GR) session on postoperative pain and anxiety reduction in children. We also explored the influence of pain catastrophizing and anxiety sensitivity on this association.MethodsA total of 51 children and adolescents (7-21 years) with postoperative pain and followed by the Acute Pain Service at Cincinnati Children’s Hospital were recruited over an 8-month period to undergo a single VR-GR session. Prior to VR, the patients completed 2 questionnaires: Pain Catastrophizing Scale for Children (PCS-C) and the Child Anxiety Sensitivity Index (CASI). The primary outcome was a change in pain intensity following the VR-GR session (immediately, 15 minutes, and 30 minutes). The secondary outcomes included changes in pain unpleasantness and anxiety.ResultsThe VR-GR decreased pain intensity immediately (P<.001) and at 30 minutes (P=.04) after the VR session, but not at 15 minutes (P=.16) postsession. Reductions in pain unpleasantness were observed at all time intervals (P<.001 at all intervals). Anxiety was reduced immediately (P=.02) but not at 15 minutes (P=.08) or 30 minutes (P=.30) following VR-GR. Patients with higher CASI scores reported greater reductions in pain intensity (P=.04) and unpleasantness (P=.01) following VR-GR. Pain catastrophizing was not associated with changes in pain and anxiety.ConclusionsA single, short VR-GR session showed transient reductions in pain intensity, pain unpleasantness, and anxiety in children and adolescents with acute postoperative pain. The results call for a future randomized controlled trial to assess the efficacy of VR-GR.Trial RegistrationClinicalTrials.gov NCT04556747; https://clinicaltrials.gov/ct2/show/NCT04556747

Transient Reductions in Postoperative Pain and Anxiety with the Use of Virtual Reality in Children.

Virtual reality is a promising method to manage pain. Distraction-based virtual reality (VR-D) is thought to reduce pain by redirecting attention. Although VR-D can reduce pain associated with acutely painful procedures, it is unclear whether VR-D can reduce pain after surgery. We assessed the ability of a single VR-D session to decrease postoperative pain and anxiety and explored whether pain catastrophizing and anxiety sensitivity influenced these outcomes in children after surgery. Single-center, prospective, pilot study. Cincinnati Children's Hospital Medical Center (CCHMC). Fifty children (7-21 years of age) with postoperative pain followed by the Acute Pain Service. Patients received one VR-D session after surgery. Before the session, patients completed pain catastrophizing (Pain Catastrophizing Scale for Children) and anxiety sensitivity (Child Anxiety Sensitivity Index) questionnaires. The primary outcome consisted of changes in pain intensity after VR-D (immediately, 15 minutes, and 30 minutes). Secondary outcomes included changes in pain unpleasantness and anxiety. VR-D use was associated with a decrease in pain intensity immediately and 15 minutes after VR-D. Reductions in pain unpleasantness were observed up to 30 minutes after VR-D. VR-D was also associated with a reduction in anxiety immediately and at 15 minutes. Although patients with higher pain catastrophizing had higher baseline pain intensity and unpleasantness, they did not show larger pain reductions after VR-D than those with lower pain catastrophizing. VR-D may be beneficial in transiently reducing pain intensity, unpleasantness, and anxiety in children with postoperative pain. This study informs the design of a larger, randomized, controlled study assessing VR-D for acute postoperative pain and anxiety management.

How Do Childhood and Parental Anxiety Features Affect the Consequences of Child Sexual Abuse?

ABSTRACTThe purpose of the study was to investigate the anxiety features of children who experience child sexual abuse (CSA) and their parents, along with the features and consequences of sexual abuse in the environment of Child Advocacy Centers (CAC). The sample of this study comprised 150 children affected by CSA and one of their parents who were admitted to İzmir CAC between June 2016 and November 2016.The children-age range 9 to 13 years-and one of their parents were asked to complete the State-Trait Anxiety Inventory separately. The children also completed the Childhood Anxiety Sensitivity Index (CASI). During psychiatric evaluations of the children, sociodemographic characteristics and features of sexual abuse were noted and all psychiatric conditions were examined. The statistical analyses yielded significant correlations between the STAI scores of the parents and STAI-C and CASI scores of the children. There were statistically significant differences between the CASI scores, STAI-C subscale scores, and STAI subscale scores according to some variables of CSA along with their psychiatric diagnosis. Our findings showed that having higher anxiety sensitivity and trait anxiety levels and having parents with higher trait anxiety might be considered as risk factors for being diagnosed as having a psychiatric disorder due to CSA.

Translation, Adaptation and Implementation of Coping Cat Program with Pakistani Children

Pakistan is a Lower and Middle Income Country with a scarcity of resources for mental health services but high prevalence of mental health problems particularly anxiety and depression. Cognitive behavioral therapy (CBT) has been deemed an empirically supported treatment for anxiety disorders among children, but evidence is lacking from countries like Pakistan. The present project translated and adapted the Coping Cat Program, a CBT based program for children and adolescents having anxiety disorders, for Pakistani children. The translated (Urdu) version of Coping Cat program was tested (N = 24) using repeated measure and a between group design in an orphanage school setting over a period of 6 months. The outcome measures were the Screen for Children Anxiety Related Disorders and the Childhood Anxiety Sensitivity Index. Intent-to-Treat analysis indicated significant decreases in self-reported anxiety sensitivity (η2 = .69); anxiety (η2 = 0.50); generalized anxiety disorder (η2 = .44) and panic disorder (η2 = .30) in the treated group from pre- to follow-up compared to the control group. Therapists rated treatment protocol as easy to implement and 80% of participants rated the treatment manual as useful and effective. The Coping Cat program appeared culturally appropriate for this group, has implementation feasibility and clinical utility for the children having anxiety related problems. Further research is needed to evaluate its effectiveness as an indicated preventive intervention for Pakistani children.

Examining the Hierarchical Influences of the Big-Five Dimensions and Anxiety Sensitivity on Anxiety Symptoms in Children.

Anxiety sensitivity (AS), namely the fear of anxiety symptoms, has been described as a precursor of sub-threshold anxiety levels. Sexton et al. (2003) posited that increased AS would arise from an elevated neuroticism and that both would act as vulnerability factors for panic disorder (PD), obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD) symptoms. Accordingly, this study aimed to (1) evaluate the applicability of this model to a pediatric population and (2) examine the influences of the other Big-Five personality dimensions on the four lower-order dimensions of AS (cognitive, physical, control, and physical) and on social phobia (SP), separation anxiety disorder (SAD) and depression symptoms. 200 children (104 girls) aged between 8 and 12 years old (mean age = 132.52 months, SD = 14.5) completed the Childhood Anxiety Sensitivity Index (Silverman et al., 1991), the Big Five Questionnaire for Children (Barbaranelli et al., 2003), and the Revised’s Children Anxiety and Depression Scale (Chorpita et al., 2000). Regression analyses confirmed that AS and neuroticism together significantly predicted the presence of PD, OCD, and GAD symptoms but also SP, SAD, and depression symptoms. Moreover, neuroticism interacted with extraversion, conscientiousness and agreeableness to significantly predict SP, GAD, and depression. Surprisingly, the global AS score was only predicted by agreeableness, while AS dimensions also specifically related to openness. Finally, AS dimensions did not predict the presence of specific anxiety symptoms. To conclude, the predicting model of anxiety symptoms in children sets neuroticism and AS on the same level, with an unexpected influence of agreeableness on AS, raising the importance of other trait-like factors in the definition of such models. Moreover, AS should be considered as a unitary construct when predicting the presence of anxiety symptoms in children. Future interventions must consider these associations to help children detect and recognize the symptoms of their anxiety and help them to interpret them correctly.

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.

A Systematic Review of the Factor Structure of Anxiety Sensitivity Among Children: Current Status and Recommendations for Future Directions

Child anxiety sensitivity (AS) is measured almost exclusively using the Childhood Anxiety Sensitivity Index (CASI). Yet, in the context of significant discrepancies regarding the CASI factors and how they are scored and reported, it remains unclear whether the CASI reliably and validly assesses the purported multifactorial AS construct. This paper will: (1) provide a comprehensive summary of previous CASI factor analyses by which these factor structures were identified, (2) evaluate evidence regarding the multifactorial nature of AS in youth, and (3) discuss potential directions for continued research in this area. In a PsycInfo search, peer-reviewed studies published between 1991 and 2018 were identified for inclusion if they examined the factor structure of the CASI or reported data on the CASI subscales as administered to child participants. Findings from the 50 studies reviewed suggested that (1) the 18-item CASI does not consistently yield internally reliable assessments of specific AS facets, (2) significant discrepancies exist regarding the CASI subscales identified, the items comprising these scales, and their predictive validity in terms of anxiety, and (3) alternatives to assess the multifactorial construct of AS in youth do exist, but they have not been systematically examined in the literature. Directions for future study include further examining expanded scales for AS in youth, continued study of shorter scales assessing more consistently reliable AS content, and evaluating the utility of an expanded response scale for the CASI.

Enrichment of Genomic Pathways Based on Differential DNA Methylation Associated With Chronic Postsurgical Pain and Anxiety in Children: A Prospective, Pilot Study

We have reported child anxiety sensitivity (Child Anxiety Sensitivity Index [CASI]) predicts chronic postsurgical pain (CPSP). Herein, we evaluated DNA methylation profiles to understand the gene–environment interactions underlying CPSP and CASI, to identify shared, enriched, genomic pathways. In 73 prospectively recruited adolescents undergoing spine fusion, preoperative CASI and pain data over 12 months after surgery were collected. DNA from the peripheral blood of evaluable subjects with (n = 16) and without CPSP (n = 40) were analyzed using MethylationEPIC arrays. We identified 637 and 2,445 differentially DNA methylated positions (DMPs) associated with CPSP and CASI, respectively (P ≤ .05). Ingenuity pathway analysis of 39 genes with DMPs for both CPSP and CASI revealed enrichment of several canonical pathways, including GABA receptor (P = .00016 for CPSP; P =.0008 for CASI) and dopamine-DARPP32 feedback in cyclic adenosine monophosphate (P = .004 for CPSP and P =.00003 for CASI) signaling. Gene–gene interaction network enrichment analysis revealed participation of pathways in cell signaling, molecular transport, metabolism, and neurologic diseases (P < 10-8). Bioinformatic approaches to identify histone marks and transcription factor (TF) binding events underlying DMPs, showed their location in active regulatory regions in pain pathway relevant brain cells. Using Enrichr/Pinet enrichment and Library of Integrated Network-Based Cellular Signatures knockdown signatures, we identified TFs regulating genes with DMPs in association with CPSP and CASI. In conclusion, we identified epigenetically enriched pathways associated with CPSP and anxiety sensitivity in children undergoing surgery. Our findings support GABA hypofunction and the roles of the dopamine–DARPP32 pathway in emotion/reward and pain. This pilot study provides new epigenetic insights into the pathophysiology of CPSP and a basis for future studies in biomarker development and targetable interventions. PerspectiveDifferential DNA methylation in regulatory genomic regions enriching shared neural pathways were associated with CPSP and CASI in adolescents undergoing spine surgery. Our findings support GABA hypofunction and the roles of the dopamine–DARPP32 pathway in emotion/reward contributing to behavioral maintenance of pain 10 to 12 months after surgery.