Anxiety Disorders In Children Research Articles

Examining whether the impact of different types of interpersonal violence and mental disorders on attempted suicide is greater for bisexual women.

This national study examined whether different types of interpersonal violence and mental disorders were associated with greater risk for attempted suicide among bisexual women than heterosexual women. Data were used from participants in Wave II of the National Epidemiologic Survey on Alcohol and Related Conditions in the United States of America who identified as female and either heterosexual or bisexual (N = 19,261; 71% White). Logistic regression models tested the main and interactive effects of three types of interpersonal violence (i.e., childhood abuse, childhood neglect, or intimate partner violence [IPV]), four types of mental disorders (i.e., mood, anxiety, substance use, and posttraumatic stress) and sexual orientation (i.e., bisexual vs. heterosexual) on attempted suicide. A post hoc logistic regression also tested the main and interactive effects of four types of anxiety disorders (i.e., panic disorder, social phobia, specific phobia, and generalized anxiety disorder [GAD]) and sexual orientation on attempted suicide. Sexual orientation moderated the impact of childhood neglect, IPV, and anxiety disorders on attempted suicide. Bisexual women who experienced childhood neglect, IPV, or an anxiety disorder had 3.75, 1.43, and 6.24 greater odds, respectively, of attempted suicide, compared to heterosexual women who reported these problems. Additionally, bisexual women who had GAD had 1.66 greater odds of attempting suicide compared to heterosexual women who had GAD. Findings elucidate factors that may increase suicide risk in vulnerable populations as called for by the Centers for Disease Control and Prevention's suicide prevention strategic plan. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Risk of severe mood and anxiety disorders in the adult children of parents with alcohol use disorder: a nationwide cohort study

BackgroundGrowing up with parental alcohol use disorder (AUD) is a risk factor for psychiatric disorders. This study investigated the risk of mood disorders and of anxiety disorders in the adult...

Impact of supplementation with omega-3 fatty acids after maternal dietary deficiency on adolescent anxiety and microglial morphology.

Dietary maternal deficiency in omega-3 polyunsaturated fatty acids (n-3 PUFA) is a potential risk factor for the development of anxiety and other mood disorders in children and adolescents. Here, we used a previously characterized maternal n-3 PUFA dietary deficiency model in rats to determine the impact of postweaning supplementation on adolescent anxiety-like behaviors. We focused on two models of anxiety: innate anxiety tested by the elevated plus maze and a novel operant model of learned anxiety where animals learn that actions may be associated with a variable probability of harm. Given that recent basic and clinical studies have associated anxiety and other adverse effects of n-3 PUFA deficiency on inflammatory processes and microglial structure and function, we also assessed the impact of our dietary deficiency model and supplementation on adolescent microglial morphology in multiple brain regions. We found that the male and female adolescent n-3 PUFA-deficient groups exhibit increased innate anxiety, but only females showed enhanced learned anxiety. Supplementation after weaning did not significantly affect innate anxiety but ameliorated learned anxiety in females. Thus, the beneficial effects of supplementation on adolescent anxiety may be sex-specific and depend on the type of anxiety. We also found that n-3 PUFA deficiency influences microglia function in adolescents in the amygdala and nigrostriatal, but not mesolimbic, brain regions. Collectively, these data suggest that while n-3 PUFA dietary supplementation may be effective in reducing adolescent anxiety, this effect is context-, sex-, and brain network-specific. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Gene × environment effects and mediation involving adverse childhood events, mood and anxiety disorders, and substance dependence.

Adverse childhood events (ACEs) contribute to the development of mood and anxiety disorders and substance dependence. However, the extent to which these effects are direct or indirect and whether genetic risk moderates them is unclear. We examined associations among ACEs, mood/anxiety disorders and substance dependence in 12,668 individuals (44.9% female, 42.5% African American/Black, 42.1% European American/white). Using latent variables for each phenotype, we modelled direct and indirect associations of ACEs with substance dependence, mediated by mood/anxiety disorders (the forward or 'self-medication' model) and of ACEs with mood/anxiety disorders, mediated by substance dependence (the reverse or 'substance-induced' model). In a subsample, we tested polygenic scores for the substance dependence and mood/anxiety disorder factors as moderators in the mediation models. Although there were significant indirect paths in both directions, mediation by mood/anxiety disorders (the forward model) was greater than that by substance dependence (the reverse model). Greater genetic risk for substance use disorders was associated with a weaker direct association between ACEs and substance dependence in both ancestry groups (reflecting gene × environment interactions) and a weaker indirect association in European-ancestry individuals (reflecting moderated mediation). We found greater evidence that substance dependence reflects self-medication of mood/anxiety disorders than that mood/anxiety disorders are substance induced. Among individuals at higher genetic risk for substance dependence, ACEs were less associated with that outcome. Following exposure to ACEs, multiple pathways appear to underlie the associations between mood/anxiety disorders and substance dependence. Specification of these pathways could inform individually targeted prevention and treatment approaches.

Parent-coached exposure therapy versus cognitive behavior therapy for childhood anxiety disorders

Cognitive-behavioral therapy (CBT) is the strongest evidenced-based therapy for childhood anxiety disorders (CADs). However, CBT’s impact is limited by its lack of clear superiority over treatment as usual, excessive length, and greater than 50% of patients remaining symptomatic. Parent-coached exposure therapy (PCET) is designed to treat CADs more effectively and efficiently through a focus on exposure and working with parents and youth together. In a randomized controlled trial, 78 patients (78% female) aged 7 to 17 with CADs were assigned to PCET or the gold-standard CBT. The primary outcome was independent evaluator ratings of anxiety severity at mid- and post-treatment. Secondary outcomes were parent- and child-reported symptoms. Patients receiving PCET had significantly lower mean scores than those receiving CBT on the primary outcome measure at mid-treatment (3.03 ± 0.14, 95% CI, 2.75–3.32 vs. 3.77 ± 0.16 95% CI, 3.45–4.08, p = 0.0010) and post-treatment (2.79 ± 0.14, 95% CI, 2.50–3.07 vs. 3.33 ± 0.16, 95% CI, 2.02–3.64, p = 0.0153). Similar significant results were found with the secondary parent- and child-reported outcomes. These superior results were achieved in PCET with fewer sessions (6.62, SD = 2.8) than those in CBT (8.00, SD = 3.1), p = 0.041. The superior effectiveness and efficiency of PCET likely results from the greater focus on implementing exposure exercises compared to traditional CBT.

Coding of Childhood Psychiatric and Neurodevelopmental Disorders in Electronic Health Records of a Large Integrated Health Care System: Validation Study.

Mental, emotional, and behavioral disorders are chronic pediatric conditions, and their prevalence has been on the rise over recent decades. Affected children have long-term health sequelae and a decline in health-related quality of life. Due to the lack of a validated database for pharmacoepidemiological research on selected mental, emotional, and behavioral disorders, there is uncertainty in their reported prevalence in the literature. We aimed to evaluate the accuracy of coding related to pediatric mental, emotional, and behavioral disorders in a large integrated health care system's electronic health records (EHRs) and compare the coding quality before and after the implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding as well as before and after the COVID-19 pandemic. Medical records of 1200 member children aged 2-17 years with at least 1 clinical visit before the COVID-19 pandemic (January 1, 2012, to December 31, 2014, the ICD-9-CM coding period; and January 1, 2017, to December 31, 2019, the ICD-10-CM coding period) and after the COVID-19 pandemic (January 1, 2021, to December 31, 2022) were selected with stratified random sampling from EHRs for chart review. Two trained research associates reviewed the EHRs for all potential cases of autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), major depression disorder (MDD), anxiety disorder (AD), and disruptive behavior disorders (DBD) in children during the study period. Children were considered cases only if there was a mention of any one of the conditions (yes for diagnosis) in the electronic chart during the corresponding time period. The validity of diagnosis codes was evaluated by directly comparing them with the gold standard of chart abstraction using sensitivity, specificity, positive predictive value, negative predictive value, the summary statistics of the F-score, and Youden J statistic. κ statistic for interrater reliability among the 2 abstractors was calculated. The overall agreement between the identification of mental, behavioral, and emotional conditions using diagnosis codes compared to medical record abstraction was strong and similar across the ICD-9-CM and ICD-10-CM coding periods as well as during the prepandemic and pandemic time periods. The performance of AD coding, while strong, was relatively lower compared to the other conditions. The weighted sensitivity, specificity, positive predictive value, and negative predictive value for each of the 5 conditions were as follows: 100%, 100%, 99.2%, and 100%, respectively, for ASD; 100%, 99.9%, 99.2%, and 100%, respectively, for ADHD; 100%, 100%, 100%, and 100%, respectively for DBD; 87.7%, 100%, 100%, and 99.2%, respectively, for AD; and 100%, 100%, 99.2%, and 100%, respectively, for MDD. The F-score and Youden J statistic ranged between 87.7% and 100%. The overall agreement between abstractors was almost perfect (κ=95%). Diagnostic codes are quite reliable for identifying selected childhood mental, behavioral, and emotional conditions. The findings remained similar during the pandemic and after the implementation of the ICD-10-CM coding in the EHR system.

Adapting cognitive behavioral therapy for anxiety in autistic children: A commentary

Cognitive Behavioral Therapy (CBT) is a widely recognized intervention for addressing anxiety in both non-autistic and autistic youth. This commentary explores the landscape of implementing CBT for anxiety disorders in autistic children, as investigated by Cervin and colleagues in their 2023 study. While the study provides valuable insights, our commentary aims to broaden the scope of CBT, such as the perspectives of those with lived experiences and consideration of strength-based practices. For this reason, we draw attention to unexplored facets and potential limitations, advocating for further adaptations of CBT practices aligning with the neurodiversity-affirming perspective as we aim to enhance the effectiveness and accessibility of CBT for autistic individuals.

Невербальная синхронизация и альянс в экспозиционной психотерапии детской тревожности: анализ единичного случая

<p style="text-align: justify;">Exposure therapy (ET) has been shown to be effective in working with anxiety disorders in children. In the Russian literature, there are few protocols of ET, and no effectiveness studies have been found. Contribution to the effectiveness of work with anxiety is conditioned by the alliance between psychologist and client, as well as by the phenomenon of temporal attunement of physiological and behavioral parameters of two or more people during their interaction (interpersonal synchrony). This article presents the results of an observation of the dynamics of anxiety symptoms, psychologists' alliance, and synchrony at the behavioral level in a single case analysis of an intensive five-day ET intervention with child anxiety. It was found that high alliance scores and their positive dynamics, as well as the psychologist's adjustment to the client's movements, were observed simultaneously with de-escalation of anxiety symptoms. In addition to these findings, the article provides a detailed description of the research program and recommendations for researchers of the psychotherapeutic process and psychologists-practitioners.</p>

A Minority of Childhood Disorders of Gut-Brain Interaction Persist Into Adulthood: A Risk-Factor Analysis.

Disorders of gut-brain interaction (DGBIs) may originate in childhood. There are currently limited data on persistence of DGBI into adulthood and risk factors for persistence. Furthermore, there are no data on this question from general practice, where the majority of DGBIs are diagnosed and managed. This study documents the proportion of childhood-diagnosed DGBIs that persisted into adulthood and what factors were associated with persistence. General practice records were obtained for more than 60,000 patients whose medical record spanned both childhood and adulthood years. Patients with diagnosed organic gastrointestinal disorder were excluded. Medical records were also interrogated for potential risk factors. Eleven percent of patients with irritable bowel syndrome (IBS) and 20% of patients with functional dyspepsia (FD) diagnosed in childhood had repeat diagnoses of the same condition in adulthood. Female sex (odds ratio [OR] 2.02) was associated with persistence for IBS, while a childhood diagnosis of gastritis (OR 0.46) was risk-protective. Childhood non-steroidal anti-inflammatory drug use (OR 1.31, 95% confidence interval [CI] 1.09-1.56) was a risk factor for persistence in IBS. For FD, a childhood diagnosis of asthma (OR 1.30, 95% CI 1.00-1.70) was a risk factor, as was anxiety for both IBS (OR 1.24, 95% CI 1.00-1.54) and FD (OR 1.48 95% CI 1.11-1.97) with a similar finding for depression for IBS (OR 1.34, 95% CI 1.11-1.62) and FD (OR 1.88 95% CI 1.47-2.42). Childhood DGBIs persist into adulthood in 10%-20% of patients, suggesting that management monitoring should continue into adulthood. Those diagnosed with anxiety or mood disorders in childhood should receive particular attention, and prescription of non-steroidal anti-inflammatory drugs in children should be made judiciously.

The Relationship Between Childhood Trauma and Anxiety Disorders

This paper investigates the relationship between childhood trauma and anxiety disorders. Incorporating evidence from several previous studies about childhood trauma, this paper provides a comprehensive understanding of the relationship connecting childhood trauma and numerous anxiety disorders. External factors influencing the relationship between the two are discussed as well. Traumatic childhood experiences have a significant impact on a child's well-being. As children are undergoing a period of substantial growth and development, protecting them from experiencing such trauma is crucial. Therefore, significant figures in a child’s life should be aware of the relationship between childhood trauma and anxiety disorders to prevent children from future mental health conditions. Throughout this paper, focus is placed on how raising awareness of this relationship can be considerably beneficial in preventing further trauma and its major consequences on an individual. Numerous studies cited in this paper demonstrate a relationship between childhood trauma and anxiety. On this basis, future research should further examine the severity of the effects of childhood trauma rather than merely determining whether there is a link.

The Importance of Practicing at Home During and Following Cognitive Behavioral Therapy for Childhood Anxiety Disorders: A Conceptual Review and New Directions to Enhance Homework Using Mhealth Technology.

Practicing newly acquired skills in different contexts is considered a crucial aspect of Cognitive Behavioral Therapy (CBT) for anxiety disorders (Peris et al. J Am Acad Child Adolesc Psychiatry 56:1043-1052, 2017; Stewart et al. Prof Psychol Res Pract 47:303-311, 2016). Learning to cope with feared stimuli in different situations allows for generalization of learned skills, and experiencing non-occurrence of the feared outcome helps in developing non-catastrophic associations that may enhance treatment outcomes (Bandarian-Balooch et al. J Behav Ther Exp Psychiatry 47:138-144, 2015; Cammin-Nowak et al. J Clin Psychol 69:616-629, 2013; Kendall et al. Cogn Behav Pract 12:136-148, 2005; Tiwari et al. J Clin Child Adolesc Psychol 42:34-43, 2013). To optimize treatment outcome, homework is often integrated into CBT protocols for childhood anxiety disorders during and following treatment. Nevertheless, practicing at home can be challenging, with low motivation, lack of time, and insufficient self-guidance often listed as reasons for low adherence (Tang and Kreindler, JMIR Mental Health 4:e20, 2017). This conceptual review provides an overview of (1) how existing CBT childhood programs incorporate homework, and empirical evidence for the importance of homework practice, (2) evidence-based key elements of practice, and (3) how mHealth apps could potentially enhance practice at home, including an example of the development and application of such an app. This review therefore sets the stage for new directions in developing more effective and engaging CBT-based homework programs for childhood anxiety disorders.

The trajectory of anxiety in therapy: The role of ACEs.

The connection between adverse childhood experiences (ACEs) and anxiety disorders is well-documented. Additionally, therapy has been shown to be effective at reducing anxiety symptoms. Yet more needs to be known about how ACEs may shape the process of therapy and the trajectory of anxiety symptoms. This study was designed to compare the trajectory of improvement in anxiety symptoms over the course of 12 sessions of therapy in adults (N = 472), who reported more (greater than four) and fewer (fewer than four) ACEs using a multigroup latent growth curve analysis. Data were drawn from the Marriage and Family Therapy Practice Research Networkdatabase. Results suggested that the rate of improvement in those with more and fewer ACEs was not significantly different; however, those with more ACEs had a significantly higher average starting point of anxiety symptoms.

Brain volumes, behavioral inhibition, and anxiety disorders in children: results from the adolescent brain cognitive development study

BackgroundMagnetic resonance imaging (MRI) studies have identified brain changes associated with anxiety disorders (ADs), but the results remain mixed, particularly at a younger age. One key predictor of ADs is behavioral inhibition (BI), a childhood tendency for high avoidance of novel stimuli. This study aimed to evaluate the relationships between candidate brain regions, BI, and ADs among children using baseline data from the Adolescent Brain Cognitive Development (ABCD) study.MethodsWe analyzed global and regional brain volumes of 9,353 children (9–10 years old) in relation to BI and current ADs, using linear mixed models accounting for family clustering and important demographic and socioeconomic covariates. We further investigated whether and how past anxiety was related to brain volumes.ResultsAmong included participants, 249 (2.66%) had a current AD. Larger total white matter (Beta = -0.152; 95% CI [-0.281, -0.023]), thalamus (Beta = -0.168; 95% CI [-0.291, -0.044]), and smaller hippocampus volumes (Beta = 0.094; 95% CI [-0.008, 0.196]) were associated with lower BI scores. Amygdala volume was not related to BI. Larger total cortical (OR = 0.751; 95% CI [0.580;0.970]), amygdala (OR = 0.798; 95%CI [0.666;0.956]), and precentral gyrus (OR = 0.802; 95% CI [0.661;0.973]) volumes were associated with lower odds of currently having ADs. Children with past ADs had smaller total white matter and amygdala volumes.ConclusionsThe results show associations between brain volumes and both BI and ADs at an early age. Importantly, results suggest that ADs and BI have different neurobiological correlates and that earlier occurrences of ADs may influence brain structures related to BI and ADs, motivating research that can better delineate the similarities and divergence in the neurobiological underpinnings and building blocks of BI and ADs across their development in early life.

Thirty-year trends of anxiety disorders among adolescents based on the 2019 Global Burden of Disease Study

BackgroundAnxiety disorders are the most common psychiatric problems, affecting approximately 1 in 12 children and 1 in 4 adolescents. Understanding the incidence, burden and correlated risks of anxiety disorders among...

Separation anxiety

Anxiety disorders are the most common mental disorders in children and are often under-recognized. Untreated anxiety disorders in children can significantly affect the quality of life. They can lead to comorbid psychiatric conditions and interfere with social, emotional and academic development, including in adulthood. Separation anxiety disorder is one of the most common childhood anxiety disorders. It involves an exaggeration of the anxiety typical for the developmental process and is manifested by excessive distress at separation from the attachment figure or family environment. The etiology of separation anxiety disorder points to the interaction of biological and environmental factors, particularly the family environment in early childhood. Diagnostic criteria for SAD are provided by DSM-V and are used in the comprehensive assessment of the disorder, in combination with other internationally validated assessment tools. The diagnosis provides essential information for the elaboration of the therapeutic approach by the clinical specialists. In this sense, there are conclusive data on the effectiveness of combining psychotherapy with pharmacotherapy to achieve lasting results. Furthermore, the importance of coordinating inter-professional efforts is essential for the effectiveness of the comprehensive approach to TAS.

Sex-Specific Distributed White Matter Microarchitectural Alterations in Preadolescent Youths With Anxiety Disorders: A Mega-Analytic Study.

Anxiety disorders are among the most common psychiatric disorders in youths and emerge during childhood. This is also a period of rapid white matter (WM) development, which is critical for efficient neuronal communication. Previous work in preadolescent children with anxiety disorders demonstrated anxiety disorder-related reductions in WM microstructural integrity (fractional anisotropy [FA]) in the uncinate fasciculus (UF), the major WM tract facilitating prefrontal cortical-limbic structural connectivity. Importantly, this association was found only in boys with anxiety disorders. To confirm this finding and more comprehensively understand WM changes in childhood anxiety, this mega-analytic study characterizes WM alterations related to anxiety disorders and sex in the largest sample of preadolescent children to date. Diffusion tensor imaging data from published studies of preadolescent children with anxiety disorders and healthy volunteers (ages 8-12) (N=198) were combined with a new data set (N=97) for a total sample of 165 children with anxiety disorders and 132 healthy volunteers. Children with anxiety disorders met DSM-5 criteria for current generalized, separation, and/or social anxiety disorder. Analyses of tractography and voxel-wise data assessed between-group differences (anxiety disorder vs. healthy volunteer), effects of sex, and their interaction. Tract-based and voxel-wise analyses confirmed a significant reduction in UF FA in boys but not girls with anxiety disorders. Results also demonstrated other significant widespread anxiety disorder-related WM alterations specifically in boys, including in multiple commissural, association, projection, and brainstem regions. In addition to confirming male-specific anxiety disorder-related reductions in UF FA, the results demonstrate that anxiety disorders in boys and not girls are associated with broadly distributed WM alterations across the brain. These findings support further studies focused on understanding the extent to which WM alterations in boys with anxiety disorders are involved in pathophysiological processes that mediate anxiety disorders. The findings also suggest the possibility that WM microarchitecture could serve as a novel treatment target for childhood anxiety disorders.

Infant sleep and anxiety disorders in early childhood: Findings from an Australian pregnancy cohort study

AbstractEmphasis on continuous infant sleep overnight may be driven by parental concern of risk to child mental health outcomes. The Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) examined whether infant sleep at 6 and 12 months postpartum predicts anxiety disorders at 2–4 years, and whether this is moderated by maternal depression, active physical comforting (APC) or maternal cognitions about infant sleep. Data included 349 women and infants. Infant sleep was measured using the Brief Infant Sleep Questionnaire and child anxiety disorders by the Preschool Age Psychiatric Assessment. The risk of developing generalised anxiety or social phobia disorders at 3–4 years was reduced by 42% (p = 0.001) and 31% (p = 0.001), respectively, for a one standard deviation increase in total sleep at 12 months. No other infant sleep outcomes were associated. Maternal depression, APC and cognitions about infant sleep did not significantly moderate these relationships. Focus may need to be on total infant sleep, rather than when sleep is achieved.Highlights To assess whether infant sleep outcomes (i.e., frequency of nocturnal wakes; nocturnal wakefulness and total sleep per day) at 6 and 12 months predict early childhood anxiety disorders at 3–4 years of age. Maternally reported infant sleep outcomes were not associated with the risk of developing early childhood anxiety disorders at 3–4 years. It may be total infant sleep, irrespective of when sleep occurs or night waking and, independently, active physical comforting that requires further investigation.

Paradigms and Practice Shifts: A Topical Narrative Review of the Evolving Face of Exposure-Based Treatment for Youth

Abstract: Exposure therapy is the gold standard treatment for anxiety and obsessivecompulsive disorders in children, adolescents, and adults. Inhibitory Learning Theory offers a nuanced and advanced perspective on exposure treatment positing that violating threat expectancies is more important than habituation. This paper highlights the effectiveness of inhibitory learning theory-guided exposure procedures for youth with anxiety and OCD, chronic pain, and eating disorders. A topical review focusing on the theoretical foundations of inhibitory learning theory, crucial augmentations of the approach, and outcomes with pediatric patients diagnosed with anxiety, eating, and pain disorders is presented. The literature review indicated that inhibitory learning theory-driven exposure produced beneficent outcomes in the identified populations. Various limitations and future directions were discussed. Limitations notwithstanding, inhibitory learning theory-led exposure represents a viable treatment option for pediatric patients with anxiety, eating, and chronic pain disorders.

Prevalence and comorbidity of anxiety disorder in school-attending children and adolescents aged 6–16 years in China

BackgroundThe reported prevalence rate of anxiety disorder in the paediatric population varies widely between different counties. Currently, there is no national epidemiological survey of childhood anxiety disorder in China. This...

Treatment for Anxiety Disorders in Youth: Current Findings for Best Practice

Taken together, anxiety disorders are the most common mental health disorders, and typically onset in childhood or early adolescence. Left untreated, anxiety disorders in youth can lead to additional psychopathology and decreased overall functioning in adulthood. This article provides a review of recent findings regarding best practices in the psychosocial treatment of anxiety disorders in children and adolescents. Special topics, such as obsessive-compulsive disorder, parenting, technological advances, and psychopharmacology are also covered. [ Psychiatr Ann . 2024;54(3):e80–e87.]