Childhood Anxiety Sensitivity Research Articles

Cognitive Risk Factors to the Development of Anxiety and Depressive Disorders in Adolescents

This exploratory study examines cognitive risk factors, anxiety sensitivity, and positive and negative affect, as related to the development of anxiety and depression. In a mailed survey, adolescents completed the Child Anxiety Sensitivity Index and the Positive and Negative Affectivity Scale. Previous research utilized the broad and unified variable of anxiety sensitivity as a predictor of anxiety. In this study, we separate and examine the four specific factors of anxiety sensitivity: mental incapacitation concerns, social concerns, disease concerns, and unsteady concerns, and relate it to specific anxiety disorders and depression. Results indicate good convergent validity and improved divergent validity when utilizing the four factors of anxiety sensitivity as compared to using it as one construct. Results also suggest: (1) OCD and GAD share numerous similarities and (2) the importance of the role of negative affectivity in anxiety and depression. Being aware of the components of anxiety sensitivity and how they relate to specific anxiety disorders can help a social worker when rendering a diagnosis.

The factor structure of the Childhood Anxiety Sensitivity Index in German children

The factor structure of the Childhood Anxiety Sensitivity Index (CASI) was investigated in four nonclinic German samples ( N = 1244, 225, 230, and 143) with participants aged 8–16-years-old. Factor solutions suggested for different CASI versions were tested using confirmatory factor analysis. The best goodness-of-fit indices were found for the 13-item CASI version with 4 factors ( Disease Concerns, Unsteady Concerns, Mental Incapacitation Concerns, and Social Concerns). Testing for factorial invariance of this model with respect to age and gender revealed non-invariant factor loadings between children and adolescents as well as between boys and girls. The theoretical and clinical implications of these findings for anxiety sensitivity in children and adolescents are discussed.

Feeling anxious: a twin study of panic/somatic ratings, anxiety sensitivity and heartbeat perception in children

Little is known about mechanisms of genetic influence on panic, particularly in childhood. Cognitive theories of panic disorder highlight threatening interpretations of physical sensations, and increased awareness of such sensations. Specifically, anxiety sensitivity (AS) and heartbeat perception (HBP) have been associated with panic in adults and children. We examined genetic and environmental influences on childhood AS, HBP, panic/somatic ratings, and their associations. Self-ratings of AS and DSM-based anxiety (including panic/somatic items) were obtained from 300 eight-year-old twin pairs (600 individuals), selected for mother-rated child anxiety at age 7. HBP was also assessed. Panic/somatic ratings were significantly correlated with both AS (r = .55) and continuous HBP error scores (r = -.13). AS and HBP scores showed significantly greater correlations with panic/somatic ratings than with all other anxiety scales, except for HBP and school anxiety. Genetic influences on panic/somatic ratings were modest (15%), and moderate for both AS (37%), and HBP (30%). Non-shared environmental influences were substantial. The genetic correlations between panic/somatic ratings and both AS and HBP error scores were .98 (95% CI: .74-1.00) and -.46 (95% CI: -1.00-1.00) respectively. Self-ratings of panic and AS overlap genetically. Future research should consider whether AS mediates genetic risk for panic disorder.

Fears in Clinic-Referred Children: Relations With Child Anxiety Sensitivity, Maternal Overcontrol, and Maternal Phobic Anxiety

Relations among maternal phobic anxiety, maternal overcontrol, child anxiety sensitivity, and child level of fear were explored in 156 children referred to an outpatient clinic for psychological evaluation. In addition, these relations were examined separately in analyses of age, gender, and diagnostic status. Overall, age, gender, and child anxiety sensitivity, along with maternal ratings of an overly controlling parenting strategy were significant predictors of levels of fear. These four variables predicted approximately 50% of the variance associated with fear levels. Surprisingly, maternal phobic anxiety was not a significant predictor in this sample of clinic-referred children. In separate analyses of age, gender, and diagnostic status (presence or absence of an anxiety disorder), anxiety sensitivity was a significant predictor of fear levels for both older and younger children, for both boys and girls, and for both children with and without an anxiety disorder. However, maternal overly controlling parenting strategy was significant only for the younger children (and not the older ones) and only for girls (and not boys). Moreover, maternal overcontrol was a marginally significant predictor for the anxiety-disorder group (and not the non-anxiety-disordered group). Results are discussed within a developmental framework, and implications for treatment are explored.

Child Anxiety Sensitivity and Family Environment as Mediators of the Relationship between Parent Psychopathology, Parent Anxiety Sensitivity, and Child Anxiety

This study examined child anxiety sensitivity and family environment as mediators of the relationship between (1) parent psychopathology and anxiety sensitivity and (2) child anxiety in a community sample of 157 youths aged 7–18 years. Parents completed measures of anxiety sensitivity, psychopathology, and family environment. Youths completed measures of anxiety sensitivity and anxiety. One structural equation model was tested with child anxiety sensitivity as a mediator of (1) parent psychopathology and parent anxiety sensitivity and (2) child anxiety. Mediation was found with respect to parent psychopathology but not anxiety sensitivity. A second structural equation model was tested with family environment (conflict and control) as a mediator of (1) parent psychopathology and parent anxiety sensitivity and (2) child anxiety. Mediation was found with respect to parent psychopathology and anxiety sensitivity. Possible explanations for these pathways are discussed, including information transmission from parents to children, modeling anxiety-based reactions, temperament, and isolation of children from anxiety-provoking situations.

Taxometric and Factor Analytic Models of Anxiety Sensitivity Among Youth: Exploring the Latent Structure of Anxiety Psychopathology Vulnerability

This study represents an effort to better understand the latent structure of anxiety sensitivity (AS), a well-established affect-sensitivity individual difference factor, among youth by employing taxometric and factor analytic approaches in an integrative manner. Taxometric analyses indicated that AS, as indexed by the Child Anxiety Sensitivity Index (CASI; Silverman, Flesig, Rabian, & Peterson, 1991), demonstrates taxonic latent class structure in a large sample of youth from North America ( N = 4,462; M age = 15.6 years; SD = 1.3). Subsequent confirmatory factor analyses indicated that the latent continuous, multidimensional, 4-factor model of AS among youth (Silverman, Goedhart, Barrett, & Turner, 2003) provided good fit for the CASI data among the complement class (“normative form” of AS), but not among the taxon class (“high-risk form” of AS). EFAs supported the prediction that the AS taxon demonstrates a unique, heretofore unexplored latent continuous, unidimensional factor structure among youth. Findings are discussed in relation to refining our understanding of the latent structure of AS and the clinical implications that arise from it.

(918): Sex differences in anxiety sensitivity in children with chronic pain and healthy children

Anxiety sensitivity (AS) or the specific tendency to fear symptoms of anxious arousal has been implicated in the experience of chronic pain. Adult women report elevated AS and are at higher risk for developing clinical pain compared to adult men yet, there is a paucity of data on sex differences in AS among children. Specifically, extant research has not examined the extent to which sex differences in AS are evident in children with and without chronic pain. This study examined sex differences in global AS and AS dimensions (physical concerns, social concerns, and psychological concerns) in 136 children with chronic pain (70.6% girls; mean age = 14.2 + 2.4) and a comparison group of 202 healthy children (52% girls; mean age = 13.6 + 2.6). Global AS scores were compared using a 2 [group (healthy versus chronic pain)] × 2 [sex (girls versus boys)] ANCOVA, controlling for child age and ethnicity (Caucasian versus non-Caucasian). Sex differences across the three AS dimensions, were examined using a 2 [group (healthy versus chronic pain)] × 2 [sex (girls versus boys)] MANCOVA, controlling for child age and ethnicity. Girls in both the chronic pain and healthy groups reported elevated global AS, AS physical concerns and AS psychological concerns relative to their male counterparts. However, there were no overall differences in AS between the healthy and chronic pain groups, nor were there any significant group by sex interaction effects. These findings revealed heightened general fears of anxious arousal as well as elevated specific fears of the negative physical and psychological consequences of such arousal in girls with chronic pain as well as healthy girls relative to their male counterparts. AS appears to demonstrate female-specific associations in children irrespective of their experience with chronic pain.

Anxiety sensitivity, conscious awareness and selective attentional biases in children

The current study investigated whether physical anxiety sensitivity (AS) is associated with selective attentional biases to affective stimuli in children. The dot-probe paradigm was used to examine the deployment of attention towards words pertaining to anxiety symptomatology, socially threatening words, and positive words, in samples of 8–10-year-old children. Word pairs were presented under both masked and unmasked conditions. Irrespective of masking, children high in physical AS displayed an attentional vigilance for emotional words relative to neutral words, whereas those low in physical AS displayed a relative avoidance of such material. The results of this study are interesting as they not only suggest the presence of automatic AS-related biases in childhood, but that this is a general emotionality bias rather than one related to specific anxiety-related stimuli.

Parent and Child Anxiety Sensitivity: Relationship to Children’s Experimental Pain Responsivity

Anxiety sensitivity (AS) or fear of anxiety sensations has been linked to childhood learning history for somatic symptoms, suggesting that parental AS may impact children’s responses to pain. Using structural equation modeling, we tested a conceptual model in which parent AS predicted child AS, which in turn predicted a hypothesized latent construct consisting of children’s pain intensity ratings for 3 laboratory pain tasks (cold pressor, thermal heat, and pressure). This conceptual model was tested in 211 nonclinical parent-child pairs (104 girls, 107 boys; mean age 12.4 years; 178 mothers, 33 fathers). Our model was supported in girls only, indicating that the sex of the child moderated the hypothesized relationships. Thus, parent AS was related to child laboratory pain intensity via its contribution to child AS in girls but not in boys. In girls, 42% of the effect of parent AS on laboratory pain intensity was explained via child AS. In boys, there was no clear link between parent AS and child AS, although child AS was predictive of experimental pain intensity across sex. Our results are consistent with the notion that parent AS may operate via healthy girls’ own fear of anxiety symptoms to influence their responses to laboratory pain stimuli. Perspective The present study highlights sex differences in the links among parent and child anxiety sensitivity (fear of anxiety sensations) and children’s experimental pain responses. Among girls, childhood learning history related to somatic symptoms may be a particularly salient factor in the development of anxiety sensitivity and pain responsivity.

(970): Relationships among anxious symptomology, anxiety sensitivity and laboratory pain response in children

Anxiety sensitivity (AS) refers to the specific tendency to interpret arousal sensations (e.g., shortness of breath, rapid heart beat) as leading to harmful physical, psychological or social consequences. Previous work in adults has suggested that AS increases an individual’s propensity to experience pain-related anxiety which in turn enhances laboratory pain responsivity. Such relationships have not been examined in younger populations. Thus, the present study used structural equation modeling (SEM) to test a conceptual model in which AS would evidence an indirect relationship with pain intensity via its contribution to state-specific anticipatory anxiety in relation to a variety of laboratory pain tasks (cold pressor, thermal heat, and pressure pain) in 234 healthy children (116 girls; mean age= 12.6 years, range= 8-18 years). The model further hypothesized that existing anxious symptomology would demonstrate a direct relationship with pain intensity. The proposed conceptual model fit the data well (Satorra-Bentler Scaled chi-square (15, N=234)= 17.60, p=0.28, CFI= 0.97, NNFI=0.94, RMSEA=0.027). As expected, AS did not evidence a direct relationship with pain intensity but instead demonstrated a significant indirect effect on pain intensity through pain-related anticipatory anxiety. The total indirect effect of AS accounted for 29% of the variance in laboratory pain intensity via its effects on anticipatory anxiety. Anxious symptomology on the other hand, demonstrated a significant direct effect on pain intensity, accounting for 15% of variance. The combined effects of AS, anxiety symptoms, and anticipatory anxiety together explained 62% of the variance in pain intensity. These relationships did not differ for boys and girls indicating no moderating effect of sex in the conceptual model. The present results support the potential benefit of assessing both AS and anxiety symptoms in children prior to undergoing painful stimulation such as that induced by routine medical procedures.

Parent and Child Anxiety Sensitivity: Relationship in a Nonclinical Sample

Little is known about the relationship between parent and child anxiety sensitivity (AS), particularly in nonclinical samples. The present study examined this association in 207 healthy parent-child pairs including 244 children (mean age = 12.3 years, 103 girls) and 226 parent figures (175 mothers). Sequential multiple linear regression revealed that parent AS was significantly associated with child AS in girls, but not in boys. Parent AS accounted for 9% of incremental variance in child AS, after controlling for child age, parent depression, and parent anxiety. Analyses of parent AS dimensions indicated that the social concerns dimension accounted for 14% of incremental variance in child AS in girls only. Parent anxiety and depression showed no association with child AS, once parent AS was taken into account. The findings indicate that parent AS, especially AS social concerns, demonstrates a significant relationship with child AS in this nonclinical sample of girls.

Anxiety sensitivity taxonicity across gender among youth

The present investigation comparatively evaluated the latent class structure and parameters of anxiety sensitivity (AS) among female and male youth using the Childhood Anxiety Sensitivity Index [Silverman, W. K., Fleisig, W., Rabian, B., & Peterson, R. A. (1991). Child Anxiety Sensitivity Index. Journal of Clinical Child Psychology, 20, 162–168]. Participants were 4462 adolescents (2189 females) in grades 7–12 ( M age = 15.6 years ). Consistent with prediction, taxometric analyses indicated the latent structure of AS was taxonic in both males and females, demonstrating the taxonic latent structure of AS is similarly observed across gender. Also consistent with prediction, the base rate of the AS taxon differed between genders—higher for females (12%) compared to males (7%). These findings are discussed in terms of their implications for the study of AS and panic vulnerability among youth.

Anxiety Sensitivity in Children of Panic Disorder Patients

Anxiety sensitivity (AS), which refers to the tendency to interpret anxiety-related bodily sensations as having potentially harmful somatic, psychological or social consequences, has been proposed as a vulnerability factor for the development of panic disorder (PD). The current study examined the anxiety sensitivity levels in children of parents with panic disorder. Children of panic disorder patients (n = 68) and children of healthy parents (n = 68) filled out the Childhood Anxiety Sensitivity Index, while parents completed the Anxiety Sensitivity Index. Children of parents with panic disorder did not display higher levels of anxiety sensitivity than children of healthy parents. Furthermore, no association between anxiety sensitivity levels of parents with panic disorder and their children was found. Anxiety sensitivity is not clearly manifest in children of parents with panic disorder and might be a developing vulnerability factor that may increase towards late adolescence or early adulthood.

Structural equation modeling of the relationships among parent and child anxiety sensitivity and child laboratory pain

Structural equation modeling of the relationships among parent and child anxiety sensitivity and child laboratory pain

Role of anticipatory anxiety and anxiety sensitivity in children's and adolescents' laboratory pain responses.

To examine relationships among trait anxiety sensitivity, state task-specific anticipatory anxiety, and laboratory pain responses in healthy children and adolescents. Participants (N=118, 49.2% female, ages 8-18 years) completed a measure of anxiety sensitivity and rated anticipatory anxiety prior to undergoing thermal, pressure, and cold pain tasks. Linear and logistic regressions were used to test the hypothesis that anxiety sensitivity and anticipatory anxiety would predict incremental variance in pain response after controlling for sex, age, and anxious symptoms. Anticipatory anxiety accounted for 35-38% of unique variance in pain report across tasks, and 10% of unique variance in thermal tolerance. Anxiety sensitivity was unrelated to pain responses. Task-specific anxiety is an important predictor of pain report and, in certain cases, pain tolerance. Interventions designed to reduce task-specific anticipatory anxiety may help reduce pain responses in children and adolescents.

Anxiety in Children — The Importance of the Anxiety Sensitivity Factor

Anxiety sensitivity, the fear of anxiety-related bodily sensations, is a recently ldentified construct, which has become part of the conceptualisation of anxiety. Evidence in the research literature suggests that adults who have a high level of anxiety sensitivity combined with a high level of the more traditionally recognised trait anxiety reported a significantly higher incidence of anxiety disorders. The aim of the present study was to determine whether a high level of both anxiety sensitivity and trait anxiety in children results in more anxiety symptoms and therefore may be a risk factor for developing anxiety disorders. Anxiety sensitivity, trait anxiety and anxiety symptoms were examined in a sample of 455 primary school children in Grades 3, 4, 5 and 6 at schools in metropolitan, regional and country areas of Victoria, Australia. Results revealed that children who reported high anxiety sensitivity together with high trait anxiety experienced significantly more anxiety symptoms than other children. Significant gender and age differences were also found in relation to anxiety sensitivity, trait anxiety and anxiety symptoms. Anxiety disorders are debilitating and interfere with normal development. If children with a predisposition to developing anxiety disorders could be identified as those who report high anxiety sensitivity together with high trait anxiety then early intervention could prevent the onset of anxiety disorders in adolescence or adulthood.

Heart-beat perception, panic/somatic symptoms and anxiety sensitivity in children

There is considerable evidence implicating heart-beat perception (HBP) accuracy and anxiety sensitivity (AS) in the development of panic in adults. However, to date there have been no studies exploring the association between HBP, AS and childhood panic/somatic symptoms. Seventy-nine children aged 8 to 11 years completed a mental tracking paradigm (Psychophysiology 18 (1981) 483) to assess HBP, the Children’s Anxiety Sensitivity Index (J Clin Chil Psychol 20 (1991) 162) and the Screen for Childhood Anxiety Related Emotional Disorders (J Am Acad Child Adoles Psych 38 (1999) 1230). Those with good HBP ( n=7, 9%) had significantly higher panic/somatic symptoms ( t=−1.71, P<0.05), and AS ( t=−2.16, P<0.02) than those with poor HBP. There were no effects of age, sex or BMI on HBP. Those with high levels of panic/somatic symptoms were seven times more likely to have good HBP and had AS scores 1 S.D. higher than the remainder of the sample. Multivariate analyses revealed that these two phenotypes had independent associations with high panic/somatic symptoms. These results extend the literature on HBP and panic and suggest that in children, as in adults, increased panic/somatic symptoms are associated with enhanced ability to perceive internal physiological cues, and fear of such sensations.

Psychometric Properties of the Childhood Anxiety Sensitivity Index in A sample of Catalan School Children

This study tested the utility of assessing anxiety sensitivity (AS) in children by investigating the long term stability and psychometric properties of a Catalan version of the Childhood Anxiety Childhood Anxiety Sensitivity Index (CASI, Silverman et al ., 1991, Journal of Clinical Child Psychology , 20 , 162-168) in a sample of 291 elementary-school children. The Catalan CASI demonstrated acceptable internal consistency and convergent validity estimates, similar to previous research with the English version. The measure also showed incremental validity in relation to other measures of anxiety and test-retest analyses suggested considerable three month and one-year stability in children's level of AS. Finally, a principal component analysis of the Catalan CASI yielded five lower-order factors grouped on a unique higher-order factor. The similarity of the findings to previous research on the CASI and on AS in English speaking children and adults is discussed and some suggestions for future investigations are presented.

Anxiety sensitivity among children of parents with anxiety disorders: a controlled high-risk study

We investigated whether parental anxiety was related to anxiety sensitivity (AS) in offspring. Subjects were 261 offspring (aged 6–17 years) of parents with lifetime DSM-IV anxiety and/or mood disorders, and 79 offspring of parents with no lifetime anxiety, mood, or psychotic disorder. Parents and offspring were interviewed by blind clinicians. Children were administered the Child Anxiety Sensitivity Index (CASI). There were no significant differences between CASI scores of the offspring of parents with anxiety and/or mood disorders, and offspring of comparison parents. We conclude that parental anxiety or mood disorder does not predispose offspring to high anxiety sensitivity.

Relations between anxiety sensitivity and panic symptoms in nonreferred children and adolescents

Anxiety sensitivity (AS), the fear of anxiety-related sensations, has been posited to be a cognitive risk factor for the development of anxiety disorders but has been understudied in youth. The purpose of the present investigations was to evaluate relations between AS and panic symptoms in nonreferred children and adolescents. In Study 1, ( N=113, mean age, 13.98), scores on the Childhood Anxiety Sensitivity Index (CASI) predicted the experience of uncued panic attacks after controlling for general anxiety and depression, although the total variance accounted for was small. In Study 2 ( N=52; mean age, 9.48), the Panic/Agoraphobia subscale of the Spence Children's Anxiety Scale was used as the criterion variable. CASI score again predicted panic symptoms after controlling for trait anxiety and depression. Identification of a risk factor for panic attacks and panic disorder in youth will have important implications for etiologic theory, intervention, and prevention.