Parent-reported Anxiety Research Articles

The Association Between Anxiety Symptoms and Sleep in School-Aged Children: A Combined Insight From the Children’s Sleep Habits Questionnaire and Actigraphy

The current study assessed the association between anxiety symptoms and sleep in 90 school-aged children, aged 6–12 years (Mage = 108 months, 52.2% male). The Children’s Sleep Habits Questionnaire (CSHQ) and 14 nights of actigraphy were used to assess sleep. Anxiety was assessed using the Spence Children’s Anxiety Scale (SCAS). A significant association was found between parent-reported anxiety symptoms and current sleep problems (i.e., CSHQ total scores ≥ 41). An examination of SCAS subscales identified a specific association between generalized anxiety disorder (GAD) symptoms and increased parental sleep concerns, including sleep onset delay, sleep duration, and daytime sleepiness. Regarding actigraphy, whilst anxiety was not associated with average sleep variables, a relationship was identified between anxiety and the night-to-night variability of actigraphy-derived sleep schedules.

A neurofeedback video game (MindLight) to prevent anxiety in children: A randomized controlled trial

BackgroundChildhood anxiety is a global mental health concern. Interventions are needed that are effective, but also cost less, are more accessible and engage children long enough to build emotional resilience skills through practice. MethodsThe present randomized controlled study aimed to examine the prevention effects of a neurofeedback video game, MindLight, developed based on evidence-based practices with anxious youth. Over 750 children (7–13 years old) in elementary schools were screened for elevated anxiety; 136 selected children were randomly assigned to play Mindlight or a control game. Self- and parent-reported anxiety was assessed at pre-, post-intervention and 3-month follow up. Results/conclusionsIntent-to-treat analyses revealed an overall significant reduction in child- and parent-reported anxiety, but the magnitude of improvements did not differ between conditions. Future research comparing MindLight to cognitive-behavioral interventions is suggested, as well as testing a range of specific (e.g., exposure) and non-specific (e.g., expectations, motivation) therapeutic factors as mediators of outcomes.

Further Psychometric Evaluation of the Child Disgust Scale.

This study evaluated the psychometric properties of the Child Disgust Scale (CDS) among 457 youth (ages 8-17, M=14.77±1.98years) initiating residential treatment for obsessive-compulsive disorder and anxiety disorders. Confirmatory factor analysis supported a bifactor model with two distinct factors of Disgust Avoidance and Disgust Affect, in addition to an overall General Disgust factor. Strong internal consistency was observed for the CDS total and factor scores. In addition, CDS scores demonstrated generally modest and positive correlations with child-reported obsessive-compulsive and anxiety symptoms, weaker correlations with parent-reported anxiety and child-rated impairment, and non-significant correlations with parent-rated impairment. Findings suggest that the CDS displays strong psychometric properties and is developmentally appropriate for use in pediatric clinical populations with obsessive-compulsive and anxiety disorders.

Identifying Trajectories of Borderline Personality Features in Adolescence: Antecedent and Interactive Risk Factors.

To examine trajectories of adolescent borderline personality (BP) features in a normative-risk cohort (n = 566) of Canadian children assessed at ages 13, 14, 15, and 16 and childhood predictors of trajectory group membership assessed at ages 8, 10, 11, and 12. Data were drawn from the McMaster Teen Study, an on-going study examining relations among bullying, mental health, and academic achievement. Participants and their parents completed a battery of mental health and peer relations questionnaires at each wave of the study. Academic competence was assessed at age 8 (Grade 3). Latent class growth analysis, analysis of variance, and logistic regression were used to analyze the data. Three distinct BP features trajectory groups were identified: elevated or rising, intermediate or stable, and low or stable. Parent- and child-reported mental health symptoms, peer relations risk factors, and intra-individual risk factors were significant predictors of elevated or rising and intermediate or stable trajectory groups. Child-reported attention-deficit hyperactivity disorder (ADHD) and somatization symptoms uniquely predicted elevated or rising trajectory group membership, whereas parent-reported anxiety and child-reported ADHD symptoms uniquely predicted intermediate or stable trajectory group membership. Child-reported somatization symptoms was the only predictor to differentiate the intermediate or stable and elevated or rising trajectory groups (OR 1.15, 95% CI 1.04 to 1.28). Associations between child-reported reactive temperament and elevated BP features trajectory group membership were 10.23 times higher among children who were bullied, supporting a diathesis-stress pathway in the development of BP features for these youth. Findings demonstrate the heterogeneous course of BP features in early adolescence and shed light on the potential prodromal course of later borderline personality disorder.

Internet-delivered cognitive behavioural therapy for children with anxiety disorders: A randomised controlled trial

BackgroundCognitive behaviour therapy (CBT) has been shown to be an effective treatment for anxiety disorders in children, but few affected seek or receive treatment. Internet-delivered CBT (ICBT) could be a way to increase the availability of empirically supported treatments. AimsA randomised controlled trial was conducted to evaluate ICBT for children with anxiety disorders. MethodFamilies (N = 93) with a child aged 8–12 years with a principal diagnosis of generalised anxiety disorder, panic disorder, separation anxiety, social phobia or specific phobia were recruited through media advertisement. Participants were randomised to 10 weeks of ICBT with therapist support, or to a waitlist control condition. The primary outcome measure was the Clinician Severity Rating (CSR) and secondary measures included child- and parent-reported anxiety. Assessments were made at pre-treatment, post-treatment and at three-month follow-up. ResultsAt post-treatment, there were significant reductions on CSR in the treatment group, with a large between-group effect size (Cohen's d = 1.66). Twenty per cent of children in the treatment group no longer met criteria for their principal diagnosis at post-treatment and at follow-up this number had increased to 50%. Parent-reported child anxiety was significantly lower in the treatment group than in the waitlist group at post-treatment, with a small between-group effect size (Cohen's d = 0.45). There were no significant differences between the groups regarding child-ratings of anxiety at post-treatment. Improvements were maintained at three-month follow-up, although this should be interpreted cautiously due to missing data. ConclusionsWithin the limitations of this study, results suggest that ICBT with therapist support for children with anxiety disorders can reduce clinician- and parent-rated anxiety symptoms. Trial registrationClinicaltrials.gov: NCT01533402.

Influences on Outcomes in Childhood Traumatic Brain Injury

Several recent studies have examined outcomes in children with traumatic brain injury (TBI) of varying severity. Peterson and colleagues studied a series of 278 children with mild TBI (mean age, 15 years; 56% male) who were referred for neuropsychological testing because of persistent symptoms (mean, 2 months). Overall, 48% had a previous TBI; 61% had sports-related TBIs. On a well-validated instrument assessing emotional and behavioral functioning, parent-reported preinjury anxiety was …

Mechanisms of anxiety related attentional biases in children with autism spectrum disorder.

Children with autism spectrum disorder (ASD) have high levels of anxiety. It is unclear whether they exhibit threat-related attentional biases commensurate with anxiety disorders as manifest in non-ASD populations, such as facilitated attention toward, and difficulties disengaging engaging from, threatening stimuli. Ninety children, 45 cognitively able with ASD and 45 age, perceptual-IQ, and gender matched typically developing children, aged 7-12 years, were administered a visual dot probe task using threatening facial pictures. Parent-reported anxiety symptoms were also collected. Children with ASD showed similarly high levels of anxiety compared with normative data from an anxiety disordered sample. Children with ASD had higher levels of parent-reported anxiety but did not show differences in disengaging from, or facilitated attention toward, threatening facial stimuli compared with typically developing children. In contrast to previously published studies of anxious children, in this study there were no differences in attentional biases in children with ASD meeting clinical cutoff for anxiety and those who did not. There were no correlations between attentional biases and anxiety symptoms and no gender differences. These findings indicate the cognitive mechanisms underlying anxiety in cognitively able children with ASD could differ from those commonly found in anxious children which may have implications for both understanding the aetiology of anxiety in ASD and for anxiety interventions.

Positive and negative expressions of shyness in toddlers: Are they related to anxiety in the same way?

Shyness has generally been investigated as a negative and unpleasant emotional state, strongly related to social anxiety and loneliness. However, recent evidence has suggested that shyness may have a positive and socially adaptive form. We examined whether the positive expression of shyness differs from the negative expression of shyness during toddlerhood, and whether a negative relation to anxiety exists. Participants were 30-month-old children (N=102; 56 girls) who were asked to mimic animal sounds with a novel person (performance) and then to watch their performance (self-watching). Their expression of pleasure (positive reactions) and distress (negative reactions), as well as their positive and negative expressions of shyness, were coded. Children's temperamental level of shyness, sociability, and anxiety were measured with parent-reported questionnaires. Toddlers produced more positive and negative displays of shyness in the performance task than in the self-watching task. Children's positive expression of shyness was associated with lower parent-reported anxiety and higher sociability. Negative reactions, but not negative shyness, were related to children's higher anxiety levels and lower sociability. Multiple linear regression analyses confirmed a negative predictive role of the positive expression of shyness on anxiety. These results suggest that the positive expression of shyness can regulate early anxiety symptoms and already serves a social function in interpersonal interactions in early childhood.

Physiological and behavioral stress and anxiety in children with autism spectrum disorders during routine oral care.

Background. Children with autism spectrum disorders (ASD) commonly exhibit uncooperative behaviors which impede oral care. Previous studies have utilized dentist-report measures of uncooperative behaviors in children with ASD but none have utilized an objective measure of children's behavior or a physiological measure of distress. This study investigated behavioral and physiological distress in children with ASD during routine oral care and examined factors associated with this distress. Methods. Participants were 44 children (n = 22 typical, n = 22 ASD) aged 6–12 receiving routine dental cleanings. Behavioral and physiological measures of stress and anxiety were collected during dental cleanings. Results. Children with ASD exhibited greater distress, compared to the typical group, on dentist-report and researcher-coded measures of overt distress behaviors and on physiological measures. Correlations between physiological and behavioral measures of distress were found in the ASD but not in the typical group. Behavioral distress was correlated with age in the typical group and with expressive communication ability and sensory processing difficulties in the ASD group; physiological distress was correlated with parent-report of anxiety in the typical group and sensory processing difficulties in the ASD group. Conclusions. Novel strategies may be required to decrease behavioral and physiological distress in children with ASD in the dental clinic.

Mediators of Cognitive Behavioral Therapy for Anxiety-Disordered Children and Adolescents: Cognition, Perceived Control, and Coping

The purpose is to investigate whether a change in putative mediators (negative and positive thoughts, coping strategies, and perceived control over anxious situations) precedes a change in anxiety symptoms in anxiety-disordered children and adolescents receiving cognitive behavioral therapy (CBT). Participants were 145 Dutch children (8–18 years old, M = 12.5 years, 57% girls) with a primary anxiety disorder. Assessments were completed pretreatment, in-treatment, posttreatment, and at 3-month follow-up. Sequential temporal dependencies between putative mediators and parent- and child-reported anxiety symptoms were investigated in AMOS using longitudinal Latent Difference Score Modeling. During treatment an increase of positive thoughts preceded a decrease in child-reported anxiety symptoms. An increase in three coping strategies (direct problem solving, positive cognitive restructuring, and seeking distraction) preceded a decrease in parent-reported anxiety symptoms. A reciprocal effect was found for perceived control: A decrease in parent-reported anxiety symptoms both preceded and followed an increase in perceived control. Using a longitudinal design, a temporal relationship between several putative mediators and CBT-outcome for anxious children was explored. The results suggest that a change in positive thoughts, but not negative thoughts, and several coping strategies precedes a change in symptom reduction and, therefore, at least partly support theoretical models of anxiety upon which the anxiety intervention is based.

Internet-Delivered CBT for Children with Specific Phobia: A Pilot Study

Background: Cognitive behavior therapy (CBT) has been shown to be an effective treatment for specific phobia in youth, but not all affected seek or receive treatment. Internet-delivered CBT could be a way to increase the availability of empirically supported treatments. Aims: An open trial was conducted to evaluate Internet-delivered CBT for children with specific phobia. Method: Children (N = 30) aged 8–12, and their parents, with a principal diagnosis of specific phobia were recruited through media advertisement. Participants received six weeks of Internet-delivered CBT with therapist support. The treatment was aimed for the parents and the children, with the first part being only for the parents. The primary outcome measure was the Clinician Severity Rating (CSR), and secondary measures included clinician-rated global functioning and child- and parent-reported anxiety and quality of life. All assessments were made at pretreatment, posttreatment, and three-month follow-up. Results: At posttreatment, there were significant reductions on the CSR, with a large within-group effect size (Cohen's d = 1.0) and 35% of children no longer meeting criteria for specific phobia. Self-report measures from parents and children showed significant effects on anxiety, with small to moderate effect sizes. Effects were maintained at three-month follow-up. Conclusions: Results show that Internet-delivered CBT with therapist support for children with specific phobia has the potential to reduce symptom severity. Randomized controlled trials are needed to further evaluate this treatment format.

Fatigue, emotional functioning, and executive dysfunction in pediatric multiple sclerosis

Objective: Fatigue, depression, anxiety, and executive dysfunction are associated with multiple sclerosis (MS) in adults. Existing research suggests similar problems in pediatric MS, but relationships between these variables have not been investigated. This study investigates the associations between executive functioning and fatigue, emotional functioning, age of onset, and disease duration in pediatric MS.Methods: Twenty-six MS or Clinically Isolated Syndrome (CIS) patients, ages 7 to 18, were evaluated through a multidisciplinary demyelinating diseases clinic. Participants completed neuropsychological screening including Verbal Fluency, Digit Span, and Trail-Making Test. Parents completed rating forms of behavioral, emotional, and executive functioning. Patients and parents completed questionnaires related to the patient’s quality of life and fatigue. Pearson’s correlation coefficients were calculated to investigate relationships between fatigue, emotional functioning, and executive functioning, as well as to examine correlations between parent and child reports of fatigue.Results: Rates of parent-reported anxiety, depression, fatigue, and executive dysfunction varied widely. Means were below average on the Trail-Making Test and average on Verbal Fluency and Digit Span, though scores varied widely. Various fatigue and emotional functioning indices—but not age of onset or disease duration—significantly correlated with various performance-based measures of executive functioning.Conclusion: Results indicate pediatric MS is associated with some degree of fatigue, emotional difficulties, and executive dysfunction, the latter of which is associated with the two former. Notably, age of onset and disease duration did not significantly correlate with executive functioning. Results advance understanding of psychological and clinical variables related to neurocognitive outcomes in pediatric MS.

Characteristics of Children With ADHD and Comorbid Anxiety

Objective: The following comorbid subgroups of ADHD have been proposed: ADHD Only, ADHD + anxiety disorders (ANX), ADHD + oppositional defiant disorder/conduct disorder (ODD/CD), and ADHD + ODD/CD + ANX. The current study examined a subset of these groups. Method: A total of 134 children and adolescents (M age = 9.92; range = 6-17) from a clinic-referred sample (n = 407) were grouped based on a semistructured diagnostic interview: ADHD only (n = 41), ADHD + ANX (n = 31), and ANX Only (n = 62). Results: Findings supported greater parent-reported anxiety symptoms in anxiety groups, and greater parent- and teacher-reported attention problems in ADHD groups. ADHD groups performed worse on a continuous performance test, whereas ADHD + ANX performed worse on working memory than ADHD Only. ADHD + ANX reported more physical anxiety symptoms than ADHD Only. Conclusion: Comorbid anxiety should be considered in ADHD assessment and treatment.

Evaluation of Children With Selective Mutism and Social Phobia: A Comparison of Psychological and Psychophysiological Arousal

Although children with social phobia (SP) and selective mutism (SM) present similarly in a clinical setting, it remains unclear whether children with SM are unable to speak due to overwhelming anxiety, or whether withholding speech functions as an avoidance mechanism. A total of 35 children (ages 5-12 years) with either SM (n = 10), SP (n = 11), or no diagnosis (n = 14) participated in the current study. Measurements included clinician, child, and parent ratings as well as behavioral observations and psychophysiological measures. Independent evaluators and clinicians rated children with SM as more severely impaired, more anxious, and less socially effective, but the groups did not differ in self- or parent-reported anxiety. Psychophysiological measures indicated that children in the SM group experienced less arousal than other children during social interaction tasks. The authors postulate that lack of speech may serve as an avoidance mechanism and thus account for this lack of arousal.

Convergent and Discriminant Validity and Reliability of the Pediatric Anxiety Rating Scale in Youth with Autism Spectrum Disorders

The psychometric properties of the Pediatric Anxiety Rating Scale (PARS), a clinician-administered measure for assessing severity of anxiety symptoms, were examined in 72 children and adolescents diagnosed with an autism spectrum disorder (ASD). The internal consistency of the PARS was 0.59, suggesting that the items were related but not repetitive. The PARS showed high 26-day test-retest (ICC=0.83) and inter-rater reliability (ICC=0.86). The PARS was strongly correlated with clinician-ratings of overall anxiety severity and parent-report anxiety measures, supporting convergent validity. Results for divergent validity were mixed. Although the PARS was not associated with the sum of the Social and Communication items on the Autism Diagnostic Observation System, it was moderately correlated with parent-reported inattention, aggression and externalizing behavior. Overall, these results suggest that the psychometric properties of the PARS are adequate for assessing anxiety symptoms in youth with ASD, although additional clarification of divergent validity is needed.

Do Symptoms of Sluggish Cognitive Tempo in Children With ADHD Symptoms Represent Comorbid Internalizing Difficulties?

Objective: Symptoms of sluggish cognitive tempo (SCT) are correlated with inattention and internalizing difficulties. The purpose of the present study was to determine whether symptoms of SCT reflect comorbid internalizing disorder with ADHD or a separate syndrome. Method: Using a clinical sample of youth evaluated for behavioral and learning difficulties (N = 73), this study examined whether SCT remains associated with symptoms of ADHD after accounting for comorbid symptoms of anxiety and depression reported by children and parents. Results: SCT symptoms were correlated with inattention and parent reports of child depression, but not with parent-reported anxiety or child reports of internalizing problems. Inattention (in the absence of hyperactivity/impulsivity) remained uniquely associated with SCT even after accounting for internalizing problems. Conclusion: The findings confirm SCT as a correlate of inattention and support its construct validity as separate from comorbid internalizing problems. Further research on the clinical utility of SCT is needed.

Emotion Reporting Using Electronic Diaries Reduces Anxiety Symptoms in Girls With Emotion Dysregulation

Theory and empirical research suggest that electronic diaries, which require children to report on their emotional experiences, might encourage emotional processing and facilitate a reduction in symptoms of anxiety, particularly for children exhibiting emotion-related deficits. Electronic diaries were given to 52 children (aged 7–12) to track their emotions and associated intensity for 7 days; anxiety was assessed prior to and after the use of the electronic diary by both parent- and child-report. It was hypothesized that the use of an electronic diary to track emotional experiences would lead to a reduction in anxiety symptoms for those children high in poor awareness, high in expressive reluctance, and low in emotion coping. The use of electronic diaries was effective at reducing child self-reported anxiety symptoms in girls who reported low emotion coping and reducing parent-reported anxiety for girls who reported a high reluctance to express emotions. Current findings suggest that having children identify their emotions using electronic diaries may be particularly beneficial for girls who are reluctant to express emotions and who report poor coping abilities.

Parent Report of Community Psychiatric Comorbid Diagnoses in Autism Spectrum Disorders

We used a national online registry to examine variation in cumulative prevalence of community diagnosis of psychiatric comorbidity in 4343 children with autism spectrum disorders (ASD). Adjusted multivariate logistic regression models compared influence of individual, family, and geographic factors on cumulative prevalence of parent-reported anxiety disorder, depression, bipolar disorder, and attention deficit/hyperactivity disorder or attention deficit disorder. Adjusted odds of community-assigned lifetime psychiatric comorbidity were significantly higher with each additional year of life, with increasing autism severity, and with Asperger syndrome and pervasive developmental disorder—not otherwise specified compared with autistic disorder. Overall, in this largest study of parent-reported community diagnoses of psychiatric comorbidity, gender, autistic regression, autism severity, and type of ASD all emerged as significant factors correlating with cumulative prevalence. These findings could suggest both underlying trends in actual comorbidity as well as variation in community interpretation and application of comorbid diagnoses in ASD.

The Utility of Clinicians Ratings of Anxiety Using the Pediatric Anxiety Rating Scale (PARS).

Clinician ratings of anxiety hold the promise of clarifying discrepancies often found between child and parent reports of anxiety. The Pediatric Anxiety Rating Scale (PARS) is a clinician-administered instrument that assesses the frequency, severity, and impairment of common pediatric anxiety disorders and has been used as a primary outcome measure in several landmark treatment trials. However, no data on nonanxious youth have been published. The purpose of this study was to address this gap by examining clinician's ratings of anxiety on the PARS in a volunteer sample of youth without anxiety disorders (n = 84; ages 7-12; 51% female, 75% Caucasian). The nonanxious sample was comprised of youth with (At-risk; n = 36) and without (Healthy; n = 48) anxious parents. Data were also used to evaluate the reliability (i.e., internal consistency), convergent, and divergent validity of the clinician-rated PARS. In addition, a receiver operating curve analysis was used to determine optimum cut off scores indicative of clinical levels of anxiety by comparing PARS scores between these nonanxious youth and a clinically anxious sample (n = 77) randomized in the Research Units of Pediatric Psychopharmacology (RUPP) anxiety study (RUPP 2001). Results indicated that anxious and nonanxious youth were significantly different on all PARS severity items. Optimum cutoff scores of 11.5 (5-item total score) and 17.5 (7-item total score) discriminated youth with and without anxiety disorders. Cronbach alphas for the Healthy and At-risk sample were .90 and .91 and .75 and .81 for the 5- and 7-item total PARS scores respectively, supporting the measure's internal consistency among nonanxious youth. PARS total scores were positively correlated with other measures of anxiety (i.e., the Screen for Child Anxiety Related Emotional Disorders) for the At-risk but not Healthy subsample. PARS scores were not significantly correlated with depressive symptoms (i.e., Children's Depression Inventory). Overall, findings support the utility of clinician's assessments of anxiety symptoms for nonanxious youth. Using the PARS can help facilitate determining whether a child's anxiety level is more similar to those with or without an anxiety disorder.

Nighttime caregiving behaviors among parents of young children with Type 1 diabetes: Associations with illness characteristics and parent functioning.

Parents of young children with Type 1 diabetes describe daily management as relentless. Nighttime caregiving, including nocturnal blood glucose monitoring (NBGM), occurs and may increase parents' anxiety and stress. The goal of this study was to examine the frequency of NBGM among parents of young children with Type 1 diabetes, and to identify children's illness characteristics and parents' fear of hypoglycemia, anxiety, and parenting stress associated with nighttime monitoring. Parents (N = 71) of children with Type 1 diabetes ages 2 to 6 completed questionnaires to assess frequency of NBGM, illness characteristics and health outcomes, and parent concern. Approximately one third of parents reported regularly monitoring their child's blood glucose level after their child was asleep. Frequency of NBGM was positively associated with basal-bolus regimen, longer illness duration, and increased parent-reported anxiety and parenting stress (p < .05). NBGM is prevalent among parents of young children with Type 1 diabetes, suggesting that parents' nighttime caregiving practices and resulting sleep disruption should be routinely addressed in clinical practice. Further investigations of NBGM, child health outcomes, and parent quality of life are warranted.