Childhood Anxiety Sensitivity Research Articles

Maternal temperament and anxiety sensitivity in children with foreign body aspiration.

Foreign body aspiration is one of the childhood emergencies that thoracic surgeons are interested in, and it can cause morbidity and mortality. Although the relationship between various behavioral problems related to children and foreign body aspiration has been investigated so far, there is no study investigating the relationship between maternal temperament and anxiety sensitivity. This study aimed to investigate the relationship between maternal emotional temperament, anxiety sensitivity, and foreign body aspiration. Mothers of 18 children with foreign body aspiration have been evaluated by a thoracic surgeon, and 18 healthy controls have also been included in the study. Maternal emotional temperament has been measured with the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego - Auto questionnaire scale, and anxiety sensitivity has been measured with the Anxiety Sensitivity Index-3. There has been no statistically significant difference between groups in terms of maternal emotional temperament and anxiety sensitivity. In the logistic regression analysis conducted to determine the predictors of foreign body aspiration, it is determined that the mother's anxious temperament has predicted foreign body aspiration significantly. As a result of the study, it can be concluded that mothers' anxious temperament can be considered a risk factor for foreign body aspiration because it affects parenting skills and children's ability to manage behavioral problems. Consistent results could be able to be obtained with studies including larger samples on the subject.

A multivariate genetic analysis of anxiety sensitivity, environmental sensitivity and reported life events in adolescents.

Despite being considered a measure of environmental risk, reported life events are partly heritable. One mechanism that may contribute to this heritability is genetic influences on sensitivity, relating to how individuals process and interpret internal and external signals. The aim of this study was to explore the genetic and environmental overlap between self-reported life events and measures of sensitivity. At age 17, 2,939 individuals from the Twins Early Development Study (TEDS) completed measures of anxiety sensitivity (Children's Anxiety Sensitivity Index), environmental sensitivity (Highly Sensitive Child Scale) and reported their experience of 20 recent life events. Using multivariate Cholesky decomposition models, we investigated the shared genetic and environmental influences on the associations between these measures of sensitivity and the number of reported life events, as well as both negative and positive ratings of life events. The majority of the associations between anxiety sensitivity, environmental sensitivity and reported life events were explained by shared genetic influences (60%-75%), with the remainder explained by nonshared environmental influences (25%-40%). Environmental sensitivity showed comparable genetic correlations with both negative and positive ratings of life events (rA = .21 and .15), anxiety sensitivity only showed a significant genetic correlation with negative ratings of life events (rA = .33). Approximately 10% of the genetic influences on reported life events were accounted for by influences shared with anxiety sensitivity and environmental sensitivity. Differences in how individuals process the contextual aspects of the environment or interpret their own physical and emotional response to environmental stimuli may be one mechanism through which genetic liability influences the subjective experience of life events.

Factor structure of the anxiety sensitivity index-3 in a sample of older adults.

The online version contains supplementary material available at 10.1007/s10433-022-00736-9.

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.

Health anxiety and associated constructs in school-age children and adolescents with congenital heart disease and their parents: A children's healthy-heart activity monitoring program in Saskatchewan cohort study.

Youth with congenital heart disease (CHD) have been found to experience higher levels of health anxiety and associated constructs than typically developing peers. The association between youth and parent health anxiety has been explored in typically developing youth but this association remains unknown in youth with CHD. This association was explored using a prospective, cross-sectional study that included 36 school-age children and adolescents with CHD (median age =10.5 years, IQR = 4) and 35 parents (median age = 44 years, IQR = 10.5). Participants completed a demographic form and measures of health anxiety, anxiety sensitivity, intolerance of uncertainty, and anxiety disorder symptom categories (youth) or general anxiety (parent). Associations were observed between child and adolescent panic/agoraphobia symptoms and parent state anxiety (r = .41), child and adolescent intolerance of uncertainty and parent state and trait anxiety (r = .37; r = .46, respectively), and child and adolescent anxiety sensitivity and parent state anxiety (r = .40). No association was observed between health anxiety in children and adolescents and parents nor between child and adolescent health anxiety and parent associated constructs. For parents, associations between health anxiety and all measures of associated constructs of interest were observed. Study findings will facilitate improved understanding of the psychological needs of school-age children and adolescents with CHD.

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.

Structural equation modeling of mindfulness skills, emotion regulation and anxiety sensitivity with social anxiety in Adolescent

The aim of this study was to investigate the structural relationships between mindfulness skills, emotion regulation and anxiety sensitivity with social anxiety in adolescents. The study population included all adolescents 12-14 years old in Isfahan city in the academic year 2015-2016, and finally 480 of them were randomly selected as the sample based on the Klein sample size estimation formula. For data gathering the following questionnaire were use. Emotion regulation checklist ((Shields, & Cicchetti, 1998)) , social anxiety (La Gerca & Lopez, 1998), child acceptance mindfulness measure (Baer, Smith, Gregory, Allen, 2005) and Anxiety Sensitivity Inventory (Silverman, Fleisig, Rabian, & Peterson, 1991). Data analysis was run by SPSS and AMOS software and path analysis method. Results showed significant relationships between social anxiety and emotion regulation (r=-0/22), mindfulness and social anxiety (r=-0/11) and anxiety sensitivity and social anxiety (r=0/41). Regression coefficients indicated that anxiety sensitivity predicted social anxiety by mediating role of emotion regulation (β=0/1) and also mindfulness skills were able to predict social anxiety by emotion regulation (β=0/04). So result demonstrated that emotion regulation is a good mediator between anxiety sensitivity and mindfulness with social anxiety.

Assessing parental cognitions about child anxiety: Are parents’ thoughts about child anxiety associated with child anxiety and anxiety sensitivity?

Anxiety sensitivity (AS) or the fear of anxious symptomatology, has garnered support in both adult and child samples for its predictive validity of anxiety disorders. Recent efforts to identify familial factors that predict anxiety amongst youth have identified a construct similar to AS amongst parents, but instead focused on the child rather than on the self. The overarching goal of the present study was to examine the extent to which two measures of this construct [the Parent Sensitivity to Child Anxiety Index (PSCAI) and the Parental Beliefs about Anxiety Questionnaire (PBA-Q)] correlated with child and parent AS and anxiety and how these measures explained the relationships between parent- and child-reported AS and anxiety. A secondary aim of the present study was to psychometrically compare the PSCAI and the PBA-Q with respect to not only their convergence with parent and child AS and anxiety, but also the extent to which each mediated the parent-child relationships between these variables. The PSCAI and PBA-Q significantly mediated the relationship between parent and child AS, each yielding small significant indirect effects. Support was also observed for a double mediation model in which parental anxiety predicted parental AS, which predicted parental beliefs about and parental sensitivity to child anxiety, which in turn predicted child anxiety. Findings suggest that both parental beliefs about and sensitivity to child anxiety are both correlated with and partially explain the relationship between parent and child AS and anxiety, providing potential points of intervention in treatment and prevention efforts for child anxiety.

Systems Biology Guided Gene Enrichment Approaches Improve Prediction of Chronic Post-surgical Pain After Spine Fusion.

ObjectivesIncorporation of genetic factors in psychosocial/perioperative models for predicting chronic postsurgical pain (CPSP) is key for personalization of analgesia. However, single variant associations with CPSP have small effect sizes, making polygenic risk assessment important. Unfortunately, pediatric CPSP studies are not sufficiently powered for unbiased genome wide association (GWAS). We previously leveraged systems biology to identify candidate genes associated with CPSP. The goal of this study was to use systems biology prioritized gene enrichment to generate polygenic risk scores (PRS) for improved prediction of CPSP in a prospectively enrolled clinical cohort.MethodsIn a prospectively recruited cohort of 171 adolescents (14.5 ± 1.8 years, 75.4% female) undergoing spine fusion, we collected data about anesthesia/surgical factors, childhood anxiety sensitivity (CASI), acute pain/opioid use, pain outcomes 6–12 months post-surgery and blood (for DNA extraction/genotyping). We previously prioritized candidate genes using computational approaches based on similarity for functional annotations with a literature-derived “training set.” In this study, we tested ranked deciles of 1336 prioritized genes for increased representation of variants associated with CPSP, compared to 10,000 randomly selected control sets. Penalized regression (LASSO) was used to select final variants from enriched variant sets for calculation of PRS. PRS incorporated regression models were compared with previously published non-genetic models for predictive accuracy.ResultsIncidence of CPSP in the prospective cohort was 40.4%. 33,104 case and 252,590 control variants were included for association analyses. The smallest gene set enriched for CPSP had 80/1010 variants associated with CPSP (p < 0.05), significantly higher than in 10,000 randomly selected control sets (p = 0.0004). LASSO selected 20 variants for calculating weighted PRS. Model adjusted for covariates including PRS had AUROC of 0.96 (95% CI: 0.92–0.99) for CPSP prediction, compared to 0.70 (95% CI: 0.59–0.82) for non-genetic model (p < 0.001). Odds ratios and positive regression coefficients for the final model were internally validated using bootstrapping: PRS [OR 1.98 (95% CI: 1.21–3.22); β 0.68 (95% CI: 0.19–0.74)] and CASI [OR 1.33 (95% CI: 1.03–1.72); β 0.29 (0.03–0.38)].DiscussionSystems biology guided PRS improved predictive accuracy of CPSP risk in a pediatric cohort. They have potential to serve as biomarkers to guide risk stratification and tailored prevention. Findings highlight systems biology approaches for deriving PRS for phenotypes in cohorts less amenable to large scale GWAS.

Childhood anxiety sensitivity, fear downregulation, and anxious behaviors: Vagal suppression as a moderator of risk.

Anxiety sensitivity-the fear that anxiety-related sensations will result in catastrophic physical, social, or psychological consequences-is a robust risk factor for clinical anxiety. However, less is known about how anxiety sensitivity may interact with physiological modulation of arousal to predict anxious children's fear responses. The present investigation examined vagal withdrawal as a moderator of the association between anxiety sensitivity and anxious children's ability to downregulate subjective feelings of fear in response to an anxiety-provoking speech task. Observer ratings of anxious behaviors and performance during the task were also examined. It was hypothesized that children's anxiety sensitivity levels would interact with respiratory sinus arrhythmia (RSA) suppression to explain unique variance in subjective fear downregulation, anxious behaviors, and task performance. Participants were 105 children with anxiety disorders (N = 105; M = 10.07 years, SD = 1.22; 57% female) who completed diagnostic interviews, questionnaires, a speech about their family, and an RSA assessment in baseline and speech conditions. Interactions between RSA suppression and anxiety sensitivity predicted unique variance in subjective fear downregulation. Specifically, the greatest difficulties downregulating subjective fear responses were exhibited by children with high anxiety sensitivity and low RSA suppression. Interactions between RSA suppression and anxiety sensitivity did not predict variance in observer ratings of anxious behaviors or task performance. However, higher baseline RSA and speech RSA were significantly associated with fewer anxious behaviors during the speech. Higher baseline RSA was also significantly associated with better speech performance. These findings highlight the importance of vagal withdrawal and its interaction with anxiety sensitivity in predicting downregulation of subjective fear among clinically anxious children. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Developmental Differences in Child and Adolescent Reasoning about Anxiety Sensations.

The development of reasoning as to the potential negative consequences of emotional sensations is a critical aspect of emotion knowledge and central to cognitive risk for anxiety disorders. The purpose of this paper is to explore the reasoning children and adolescents give for negative interpretations of anxiety sensations, testing a priori hypotheses quantitatively and exploring the content of the reasons qualitatively. This study used a cross sectional design with interviews as well as cognitive and emotional assessments in a sample of 227 youth aged 6-17 years. Coding schemes to assess the logical validity, affective valence, and qualitative reasons that youth give to evaluate anxiety sensations and anxiety situations were developed. Findings indicated diverse reasoning was used and responses could be reliably coded with developmental differences across age, cognitive, and verbal development. The logical sophistication of the reasoning used by youth increased across age in a non-linear manner and linearly with cognitive and verbal abilities. Child anxiety sensitivity and internalizing symptom levels moderated the main effect of age. The results add to the existing understanding of emotional development and are consistent with the idea that the process of cognitive-emotional understanding is not a simple linear one because various domains may show differential development.

The explanatory role of anxiety sensitivity in the association between effortful control and child anxiety and depressive symptoms

ABSTRACT The present study examined the underlying role of anxiety sensitivity in the association between effortful control and anxiety and depressive symptoms in a sample of clinically anxious children. It was hypothesized that effortful control would exert an indirect effect through anxiety sensitivity in relation to child anxiety and depressive symptoms. Clinically anxious children (N= 105; M age = 10.09 years, SD = 1.22; 56.7% female; 61% ethnic minority) and their mothers completed a diagnostic interview and a battery of questionnaires that included self- and mother-ratings of child effortful control, anxiety sensitivity, and anxiety and depressive symptoms. The indirect effect of effortful control via anxiety sensitivity on child anxiety and depressive symptoms was significant across child- and mother-completed measures. Among clinically anxious youth, greater effortful control was related to lower anxiety sensitivity, which was related to lower anxiety and depressive symptoms. Future work should evaluate whether targeting effortful control leads to clinically meaningful reductions in anxiety sensitivity and child anxiety and depressive symptoms.

Common genetic architecture and environmental risk factors underpin the anxiety-disordered eating relationship: Findings from an adolescent twin cohort.

Despite established comorbidity between anxiety and disordered eating (DE), and a plethora of research using various methodologies to examine this overlap, use of twin modeling to expose whether a shared genetic liability underpins these conditions remains rare. Data from a longitudinal sample of female twins were selected: measures of risk for DE from Wave 1 (N = 699, 351 pairs, aged 12-15 years), and the Eating Disorder Examination (EDE) and Children's Anxiety Sensitivity Index (CASI) from Wave 2 (N = 669, 338 pairs, aged 16-19 years). At this time, they also completed Children's Anxiety Sensitivity Index (CASI). Bivariate Cholesky decomposition models adjusting for age and body mass index centile investigated the covariance structure between the CASI and EDE. Modeling both genetic and nonshared environmental influences parsimoniously fit these data. All paths were significant. Additive genetic influences were notable for CASI and EDE phenotypes; 14% of the heritable variance was contributed by CASI to the expression of EDE. There was also a smaller but significant contribution of nonshared environmental influences. A multinomial logistic regression indicated body dissatisfaction (RRR = 1.53; 95% CI = 1.07-2.18) differentiated groups with highest EDE scores from the highest CASI scores. Shared genetic and environmental influences appear to underpin the relationship, and potentially the observed comorbidity, between anxiety sensitivity and DE. The age of onset is typically earlier for anxiety than DE, suggesting a significant opportunity for early intervention work to reduce the likelihood of subsequent development of DE.

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.

Child Anxiety and Parental Anxiety Sensitivity are Related to Parent Sick Role Reinforcement

SYNOPSISObjective. Parents can facilitate offspring anxiety in response to bodily arousal via “sick role reinforcement,” a process that may be important during adolescence. Although a sizeable body of work has examined the role of parent behavior in this process, no study to date has examined child-driven effects on parental sick role reinforcement. Furthermore, little work has examined whether parental factors are related to sick role reinforcement, including anxiety sensitivity. Design. The current study investigated the associations among these variables using a set of vignettes in which 225 parents were asked to imagine their adolescent offspring describing somatic sensations in either an anxious or non-anxious manner. Results. Effects of offspring descriptions, parental AS, and an interaction between the two emerged on parental sick role reinforcement behavior. Conclusions. These findings lay the groundwork for future work targeted at improving our understanding of the unique and interactive roles parents and offspring play in the sick role reinforcement process.

The role of parental anxiety sensitivity and learning experiences in children's anxiety sensitivity.

This study evaluated the impact of the mother's and father's anxiety sensitivity (AS) and learning experiences on children's AS, and the influence of two moderators: the children's femininity orientation and the children's emotional intelligence (EI). The sample comprised 200 non-clinical children, aged 9-13years, and their parents (mothers and fathers). Results revealed that the effect of parental AS on children's AS is moderated by the children's EI for maternal AS and by their femininity traits for paternal AS. Learning experiences following somatic sensations influenced the children's level of AS. More specifically, special attention by parents following a child's somatic sensations (reinforcement and transmission of information) was associated with high AS in children. Parental reactions of fear following a parent's somatic sensations (modelling) seem to predict higher scores for AS when the link is moderated by the child's femininity orientation. The implications of these findings are discussed. Statement of contribution What is already known on this subject The influence of parental factors in child's AS has been demonstrate, but these studies are limited. Specific mechanisms might condition the relationship between child's AS and parental factors. What does this study add? Learning experiences and parental AS influence the child's level of AS. It is important to consider the influence of mothers and fathers in child's AS. Child's emotional intelligence and expressive traits may moderate the effect of parental factors.