Clinical assessment of anxiety symptoms in children and adolescents is gaining interest due to the need for brief, valid and reliable instruments that allow early screening through a multiple informant approach. The aim of the present study was to validate the brief self-reported version of the Spence Children's Anxiety Scale for children (SCAS-C-8) by examining its concordances and discrepancies with reports from other informant, for example, parents, as relevant and complementary information for screening. Italian children and early adolescents (N = 1019; 50.5% female) aged 8-12 years, their mothers and fathers were included in the study by completing the SCAS-C-8 and its parent-version (SCAS-P-8). The children and early adolescents also self-reported internalizing, that is, anxiety and emotional problems, and externalizing symptoms on the other scales. After confirming the one-factor structure of the SCAS-C-8 and its psychometric properties, that is, reliability, convergent validity with internalizing symptoms and discriminant validity with externalizing symptoms, and complete invariance across sex and age, both concordance and discrepancies between SCAS-C-8 and SCAS-P-8, were examined. Results confirmed the low/moderate agreement between reports of anxiety and that mothers overestimate levels compared to fathers. Sex and age differences emerged in patterns of discrepancy between reports as well. Overall, results confirm that the SCAS-C-8 is a valid, reliable, brief, and cross-domain instrument that, together with the parent-reported version, could help to expand the early detection of anxiety symptoms by adopting a systematic approach with multiple informants capable of integrating relevant and complementary information for prevention and intervention programs.

Retest improvements in self-reported anxiety may stem from inflated initial scores (initial elevation bias) rather than genuine symptom change. In this systematic review, we examined changes in anxiety scores reported by children and parents across repeated assessments in nonintervention control groups from randomized controlled trials across community, risk, and clinical samples, using four widely used anxiety measures for children and adolescents (Multidimensional Anxiety Scale for Children, Spence Children's Anxiety Scale, Revised Child Anxiety and Depression Scale, and Screen for Child Anxiety-Related Emotional Disorders). We searched BASE, MEDLINE, APA PsycInfo, Web of Science, and PubMed Central, alongside a cited reference search for seminal publications of the included measures. A random-effects model was used for meta-analysis. A total of 106 studies (N = 9,224 children) met inclusion criteria: 46 clinical samples, 37 risk samples, and 23 community samples. For child-rated anxiety, a weighted average effect of -0.25 (95% CI [-0.30, -0.21]) was found between the first and second assessments and -0.09 (95% CI [-0.18, -0.01]) between the second and third assessments. Metaregression showed that clinical and risk samples had larger decreases in anxiety scores, while the Screen for Child Anxiety-Related Emotional Disorders measure exhibited smaller decreases. For parent-rated child anxiety, the effect was -0.12 (95% CI [-0.17, -0.06]) between the first and second assessment. The findings support the presence of initial elevation bias mainly in child-reported anxiety. The results are unlikely to be explained by maturation, real improvements, or selective attrition, and they extend beyond the effects of regression to the mean as they appear even in community samples. Initial elevation bias complicates the interpretation of child anxiety ratings and has important implications for clinical practice and research. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Objective: From a family perspective, this study aimed to examine the effects of a 12-week digital platform-based parent-child exercise intervention on children's behavioral level (physical activity), psychological level (physical exercise attitude), and mental health. Methods: This study included 218 students aged 10-11 years who underwent a 12-week standardized parent-child exercise intervention. The intervention group completed two structured parent-child tasks per week through a digital platform (Ding Talk App) while maintaining regular physical education classes; the control group only maintained their regular physical education classes. Assessments were conducted using the Physical Activity Rating Scale, Exercise Attitude Scale, and mental health scales (The Spence Children's Anxiety Scale (SCAS) and The Patient Health Questionnaire-9 (PHQ-9)) at four stages: pre-intervention (T1), mid-intervention (T2), post-intervention (T3), and a 2-month follow-up period (T4). The intervention effects and effect sizes (ηp2) were examined using Repeated Measures Analysis of Variance. Results: At the behavioral level, a significant group × time interaction was found for physical activity volume (F = 17.651, p = 0.04, ηp2 = 0.138), indicating the presence of a moderate effect. At the psychological level, significant interactions were observed across exercise attitude dimensions (behavioral attitude: F = 3.699, p = 0.002, ηp2 = 0.033; perceived behavioral control: F = 4.189, p = 0.006, ηp2 = 0.037; subjective norm: F = 4.616, p < 0.001, ηp2 = 0.040) and mental health measures (depression: F = 4.009, p = 0.026, ηp2 = 0.044; anxiety: F = 3.1, p = 0.016, ηp2 = 0.020), though no significant effect was found for behavioral intention (F = 1.346, p = 0.259, ηp2 = 0.012), with all significant effects being relatively weak. Conclusions: The home-school collaborative, digital platform-based parent-child exercise intervention demonstrated positive effects on children's physical activity volume, exercise attitudes, and mental health, offering a feasible and promising strategy to support more integrated child health promotion initiatives.

This study was undertaken to investigate the comparative efficacy of a cognitive behavior therapy and biofeedback-based computer game (Starship Rescue: Vortex of Anxiety [SRVA]) and placebo well-being-focused computer game (Starship Rescue: Voyage of Wellness) for reducing symptoms of anxiety and improving quality of life among children and young people aged 8-18 with long-term physical conditions (LTPCs). A randomized controlled trial was conducted with 60 participants (30 per arm). Primary outcomes were change in anxiety symptoms on the Generalized Anxiety Disorder 7-item (GAD-7) and Spence Children's Anxiety Scale (SCAS) at 4 weeks. Secondary outcomes were changes in anxiety symptoms at 3 months; changes in quality of life using the Pediatric Quality of Life Inventory (PedsQL) at 4 weeks and 3 months; and acceptability of SRVA recorded at 4 weeks. Participants in both groups experienced reduced anxiety (from a moderate to mild level) and improved quality of life at 4 weeks and 3 months. There were no significant group differences or time-by-group interactions observed for GAD-7, SCAS, or PedsQL. While SRVA was broadly acceptable, some suggestions for improvement of content and design were provided by users. Although this is the second study to demonstrate that SRVA can reduce levels of anxiety in children and young people with LTPC, previous questions regarding its efficacy and component-related benefits and new questions regarding the clinical value of physical health-oriented eHealth interventions remain unanswered. Further research is needed before SRVA can be recommended for clinical use.

Background: Studies on mental health rates among primary school children are still limited, particularly related to psychological trauma and its relationship to other mental health challenges. Objective: The objective of this study was to 1) examine the prevalence of PTSD, depression, and anxiety symptoms in primary school children before the Covid-19 pandemic; 2) identify the relationship between PTSD, depression and anxiety symptoms; and 3) investigate potential gender differences in PTSD symptoms. Methods: This is the first cross-sectional study examining the rates of trauma exposure, posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in primary school children before the covid-19 pandemic in Malaysia. Two hundred and twenty-one students participated in this study. They were recruited from four primary schools that volunteered to participate in this study. PTSD Checklist for DSM-5 (PCL-5), Child PTSD Symptoms Scale-5 (CPSS-5), The Center for Epidemiologic Studies Depression Scale version (CESD), and the Spence Children's Anxiety Scale (SCAS) were used to survey psychological symptoms. Results: Most of the students, or 54.3% of them, have experienced at least one traumatic event. Of 221 students, 39.4% reported having PTSD symptoms, 38% reported having depressive symptoms, and 19% reported having anxiety symptoms. Female students were more likely to report PTSD symptoms compared to male students. The first regression analysis model indicated that depressive symptoms were the only significant predictors of PTSD. In the second model, religion, family income, anxiety, and PTSD symptoms were significant predictors of depressive symptoms. In the third model, depressive symptoms were the sole significant predictors of anxiety. Conclusion: The study reveals that primary school children experience high levels of trauma, PTSD, depression, and anxiety, especially before the COVID-19 pandemic. During the early phases of the pandemic, these mental health issues have been largely neglected in Malaysia, with limited preventative and therapeutic interventions available. Future research should focus on documenting the prevalence of these issues in relation to the COVID-19 pandemic.

To evaluate the associations between caregivers' climacteric symptoms and adolescent mental health. This cross-sectional study analyzed data from the 2023 wave of the Japan Adolescent and Youth (JAY) cohort, a nationally representative survey of caregiver-adolescent dyads. The sample included 1,541 dyads. Caregivers' symptoms were assessed using the Simplified Menopausal Index (SMI), comprising vasomotor, psychological, and somatic domains. Adolescent mental health was measured using the Strengths and Difficulties Questionnaire (SDQ), UCLA Loneliness Scale (UCLA-LS3), short version of the Spence Children's Anxiety Scale (Short-CAS), Patient Health Questionnaire-9 for Adolescents (PHQ-A), and Young's Diagnostic Questionnaire (YDQ) for internet addiction. Multivariable regression analyses assessed associations between SMI scores and adolescent outcomes, adjusting for caregiver age, adolescent age, adolescent sex, and household income. Among caregivers, 26.4% reported moderate to severe climacteric symptoms (SMI score ≥51), and 4.6% were currently under treatment for menopause. Among caregivers not undergoing treatment, higher SMI scores were significantly associated with greater caregiver-reported difficulties with their adolescents, and increased adolescent reports of loneliness, anxiety, depression, and problematic internet use. Among the three domains of symptoms (vasomotor, psychological, and somatic), psychological climacteric symptoms showed the strongest associations with adolescent health outcomes. Caregivers' climacteric symptoms are associated with poorer adolescent mental health. Given low care-seeking rates, greater awareness and support for midlife health may benefit both caregivers and children, promoting broader family well-being.

This study examined the impact of anxiety on academic burnout among migrant children who changed schools during the middle-to-upper primary grades. It further investigated the independent and sequential mediating roles of positive psychological capital and self-concept within this relationship. A cross-sectional survey was conducted with 473 migrant children in grades 5 and 6. The Spence Children's Anxiety Scale (SCAS), Positive Psychological Capital Questionnaire (PPQ), Piers-Harris Children's Self-Concept Scale (PHCSS), and Adolescent Learning Burnout Inventory (ALBI) were administered. Data analysis included common method bias assessment, descriptive and correlational analyses, hierarchical regression, and bootstrap mediation analysis. Anxiety showed a significant positive association with academic burnout. Both positive psychological capital and self-concept independently mediated this relationship. Furthermore, a significant chain-mediating effect was observed: anxiety was linked to lower positive psychological capital, which was associated with a weaker self-concept, ultimately contributing to higher levels of academic burnout. The findings suggest that internal protective resources play crucial roles in the link between anxiety and academic burnout among migrant children. Interventions aimed at reducing academic burnout may benefit from a dual focus on mitigating anxiety while proactively fostering positive psychological capital and a healthy self-concept.

What happens when a treatment developed in Western clinical settings is adapted for children growing up in Lagos, where family structures, spiritual beliefs, and the very language used to describe emotional distress differ fundamentally from the contexts in which cognitive behavioral therapy was conceived? This research evaluated the efficacy of a culturally adapted cognitive behavioral therapy (CBT) program for treating anxiety disorders in Nigerian children aged 7 to 12 years. A randomized controlled trial enrolled 117 children with a primary anxiety disorder diagnosis from three child mental health clinics in Lagos between June 2022 and August 2024. Participants were randomly assigned to either culturally adapted CBT (n = 63) or a 12-week waitlist control condition (n = 54). The CBT protocol comprised 12 weekly sessions adapted to incorporate Nigerian cultural values, family-inclusive practices, local proverbs, and religious coping strategies.Anxiety was measured using the Spence Children's Anxiety Scale (SCAS, Yoruba and English versions), the Screen for Child Anxiety Related Emotional Disorders (SCARED), and clinician-rated Clinical Global Impression scales. Generalized anxiety disorder was the most common subtype (31.6%), followed by social anxiety (22.2%) and separation anxiety (18.8%). At post-treatment, the CBT group showed a mean SCAS reduction of 29.7 points compared to 4.3 points in the control group (between-group difference: 25.4, p < 0.001, Cohen's d = 1.83). Remission (defined as loss of diagnostic status) was achieved by 52.4% of the CBT group versus 7.4% of controls (NNT = 2.22). Treatment response rates varied by anxiety subtype, with specific phobia showing the highest remission (66.7%) and social anxiety the lowest (42.3%). Treatment gains were maintained at 6-month follow-up. These results demonstrate that culturally adapted CBT is effective for childhood anxiety in a Nigerian context and that careful adaptation of therapeutic content and process enhances acceptability without compromising efficacy.

Little research has elucidated the effects of maternal autistic traits (MATs) on children's anxiety in normal populations, and their underlying mechanisms. The present study aimed to test this relationship and the mediating role of maternal negative meta-emotional philosophy (MEP) and children's emotional instability among Chinese people. This study recruited 590 mother-child dyads. These mothers have no other children with autism, and they completed the Autism Spectrum Quotient, Maternal Meta-Emotion Philosophy, Emotion Regulation Checklists, and the Chinese version of the Spence Children's Anxiety Scale. The chain mediation model was tested using SPSS software. (1) There are significantly positive correlations among MATs and children's anxiety. (2) Children's anxiety was affected by MATs through 3 different pathways: the mediating role of maternal MEP (dysfunction and noninvolvement emotional philosophy), the mediating role of children's emotional lability, and the chain mediating role of both MEP and children's emotional lability. This cross-sectional study demonstrates that MATs predict child anxiety through the sequential mediation of mothers' negative MEP and children's emotional instability. These findings deepen our understanding of the adverse effects of subclinical autistic traits within the general population. Furthermore, they suggest that early interventions for families with mothers exhibiting high autistic traits should focus not solely on the traits themselves, but on improving maternal MEP. Such a focus would help children develop adaptive emotion regulation strategies, thereby reducing the risk of anxiety. A primary limitation of this study is its cross-sectional design, which precludes causal inferences. Future longitudinal research is needed to clarify the temporal dynamics and long-term effects among these variables.

Gender- and sexuality-diverse (GSD) youths are at increased risk of depression and anxiety compared with their cisgender and heterosexual counterparts. Little is known about the risks for younger GSD adolescents (<15 years). To estimate the prevalence and odds of depression and anxiety for younger GSD adolescents. This cross-sectional study collected baseline data across 3 separate cohorts of year (grade) 8 students (August through September 2019; August through November 2020; and April 2021 through March 2022) in the Future Proofing Study, an Australian prospective study. All year 8 students from 134 secondary participating schools across Australia were invited to participate in the survey. Data were analyzed in April 2025. Gender diversity and sexuality diversity status. Self-reported depression symptoms were assessed using the Patient Health Questionnaire for Adolescents, and anxiety symptoms were assessed using the Spence Children's Anxiety Scale. The sample comprised 6388 adolescents (mean [SD] age, 13.9 [0.5] years); 5842 (91.5%) were born in Australia, 5982 (93.7%) spoke English at home, and 5009 (78.4%) lived in a 2-parent home. Sex at birth included 3329 (52.1%) female, 2968 (46.5%) male, 33 (0.5%) unsure, 51 (0.8%) prefer not to report, and 6 (0.1%) another. There were 6019 cisgender respondents (95.0%), 209 gender-diverse respondents (3.3%), and 109 prefer not to report about gender (1.7%); sexuality identity included 4472 heterosexual respondents (70.0%), 767 sexuality-diverse respondents (12.0%), 559 respondents (8.8%) unsure, 296 prefer not to report (4.6%), and 294 respondents (4.6%) missing these data. Of the 6388 adolescents in the sample, 3745 (58.6%) reported depression (2780 [43.5%] mild to moderate, 965 [15.1%] clinical levels), and 1888 (29.6%) reported anxiety (958 [15.0%] mild to moderate, 930 [14.6%] clinical levels). Larger proportions of GSD adolescents reported clinical levels of depression (gender diverse: 59.3% vs 13.3%, P < .001; sexuality diverse: 43.4% vs 10.1%, P < .001) and anxiety (gender diverse: 48.8% vs 13.1%, P < .001; sexuality diverse: 35.3% vs 10.9%, P < .001) than cisgender and heterosexual counterparts, respectively. Larger proportions of GSD adolescents faced greater demographic individual, psychosocial, and contextual adversities. In multivariable multinomial logistic models, GSD status was associated with higher odds of clinical-level depression (gender-diverse odds ratio [OR], 5.68 [95% CI, 3.46-9.33]; sexuality-diverse OR, 6.49 [95% CI, 4.66-9.03]) and anxiety (gender-diverse OR, 3.49 [95% CI, 2.46-4.95]; sexuality-diverse OR, 3.07 [95% CI, 2.40-3.93]) compared with cisgender and heterosexual peers. In this cross-sectional study, higher prevalence and risk of greater depression and anxiety symptoms were evident among younger GSD adolescents. To improve their mental health, prevention and interventions addressing identity-specific stressors and broader contextual risk and protective factors should be initiated by early adolescence.

AimThe coronavirus disease 2019 (COVID‐19) pandemic has had a significant psychological impact on children and adolescents, increasing depression, anxiety, and suicide‐related behaviors. In Japan, suicide remained the leading cause of death among individuals aged 10–19 years, with rates rising after the pandemic onset. However, few studies have examined these changes in psychiatric outpatient settings. We aimed to determine whether the prevalence of suicide‐related behaviors and associated psychiatric symptoms—depression and anxiety—differed pre‐ and post‐pandemic among elementary and junior high school students attending psychiatric outpatient clinics.MethodsIn this retrospective case–control study, we analyzed registry data from a child and adolescent psychiatric outpatient clinic in Japan. Patients were classified into pre‐ and post‐COVID‐19 groups based on the visit date (cutoff: March 2, 2020). Clinical characteristics were assessed at the initial visit through interviews and standardized rating scales: Depression Self‐Rating Scale for Children, Spence Children's Anxiety Scale, and Attention‐Deficit/Hyperactivity Disorder Rating Scale‐IV. Group differences were examined using univariate and multivariate logistic regression analyses.ResultsBetween 2016 and 2022, 2878 patients were included. The prevalence of suicide‐related behaviors increased post‐pandemic, from 3.0% to 6.9% among elementary school students and from 15.5% to 21.2% among junior high school students. In the post‐COVID‐19 group, elementary students more often exhibited antisocial behaviors and hyperactivity/conduct disorder diagnoses. Junior high students more often exhibited anxiety symptoms, particularly social anxiety, panic, and trauma‐related fear.ConclusionSuicide‐related behaviors significantly increased after the COVID‐19 pandemic, with distinct clinical characteristics observed across age groups.

Children commonly experience anxiety during hospitalization, especially when they are unfamiliar with the clinical environment. Therapeutic communication serves as an essential nursing skill that can reduce this anxiety and help young patients feel more secure. This study examines the relationship between nurses’ therapeutic communication abilities and the anxiety levels of hospitalized preschool children. Using a quantitative cross-sectional design, the research involved 48 participants selected through complete sampling, with data collected using structured questionnaires. Therapeutic communication was measured using a nurse communication assessment tool, while the Spence Children’s Anxiety Scale (SCAS) Preschool version was used to evaluate anxiety levels. The findings revealed that 22 respondents (45.8%) perceived nurses’ therapeutic communication as very poor, and 18 children (37.5%) showed moderate anxiety. Statistical analysis using the Spearman rank correlation test produced a p-value of 0.002 (p &lt; 0.05), demonstrating a significant negative relationship between nurses’ therapeutic communication and anxiety levels among preschoolers at Santa Elisabeth Hospital Medan in 2024, with a correlation coefficient of 0.440. These results suggest that implementing structured training programs in therapeutic communication could enhance nurses’ ability to provide supportive and anxiety-reducing care for young patients.

The present study aims to report on the psychosocial outcomes of children aged 6-12 years who did or did not respond to the Lidcombe Program. Thirty-seven 6- to 12-year-old children participated in a Phase II trial of the Lidcombe Program using video telehealth. Treatment progress was documented using stuttering severity ratings and three psychosocial outcome measures (Overall Assessment of the Speaker's Experience of Stuttering-School-Age Children, Communication Attitude Test, and Spence Children's Anxiety Scale). We examine the results of these psychosocial outcomes in relation to children who did and did not respond to the program. Significant improvements were observed across all psychosocial measures, irrespective of responsiveness group. Individual trajectories highlighted heterogeneity, but group data revealed statistically significant reductions in measures of stuttering impact, negative communication attitudes, and anxiety symptoms from pretreatment to 12 months posttreatment, with no evidence of differential effects between responsiveness groups. Findings suggest that the Lidcombe Program may provide psychosocial benefits beyond stuttering reduction to some children, potentially through the therapeutic alliance fostered between clinicians, children, and families. The Lidcombe Program appears to be psychologically safe and may confer psychosocial advantages for school-age children who stutter, regardless of whether their stuttering partially reduced, stopped, or persisted. Future research should explore longer term maintenance of these psychosocial gains and conduct a randomized controlled trial to evaluate the effect of the Lidcombe Program relative to a control group.

Introduction: The pervasive integration of digital media into pediatric life has shifted the clinical focus from screen time quantity to content quality. Emerging "metaphysical" sub-genres, such as algorithmic "Lucid Dreaming" tutorials, pose unique risks to preadolescents. This case report aims to document a novel presentation of acute sleep anxiety precipitated specifically by "Lucid Dreaming" tutorials. Case presentation: We report the case of a 10-year-old male of Balinese descent presenting with acute sleep onset insomnia (somniphobia), autonomic hyperarousal (resting heart rate 104 bpm), and separation anxiety. The precipitating event was the consumption of "Astral Projection" and "Reality Shifting" content, which the patient, being in the Concrete Operational stage of cognitive development, misinterpreted as a literal biological threat of "soul separation." Assessment via the Spence Children’s Anxiety Scale (SCAS) yielded a score of 46 (98th percentile), indicating severe anxiety. A four-week intervention was implemented, utilizing a Cultural Formulation approach that integrated Balinese spiritual coping with Cognitive Reframing and a Structured Parental Mediation Protocol (restrictive mediation and active co-viewing). Post-intervention analysis showed a statistically significant reduction in SCAS scores to 18 (Reliable Change Index &gt; 1.96) and normalization of sleep onset latency from 140 minutes to 25 minutes. Conclusion: This case identifies specific abstract digital content as a potential cognitive pathogen for vulnerable developmental stages. It highlights the necessity of auditing content quality and validates the efficacy of culturally responsive parental mediation in resolving digitally induced psychopathology.

Abstract Background Obesity in children and adolescents is a global health issue with increasing prevalence worldwide. In 2019, the World Obesity Federation estimated there would be 206 million children and adolescents aged 5–19 years living with obesity in 2025, and 254 million in 2030. Obesity increases the risk of prediabetes, type 2 diabetes, dyslipidaemia, hypertension, NAFLD, metabolic syndrome and cardiovascular diseases. Additionally, obesity in children and adolescents leads to poor self-esteem, distorted body image and poor peer relationships which leads to a negative psychological impact and increases the risk of psychiatric illnesses such as depression, anxiety and eating disorders. One of the most common psychiatric disorders in children and adolescents with obesity is anxiety disorders. Aim of the Work To assess the frequency of anxiety disorders in overweight and obese children attending the outpatient clinics at Ain Shams University Hospitals. Participants and Methods A cross sectional study was performed where a sample consisting of 93 male and female adolescents with either overweight or obesity were interviewed after exclusion of incompetent ones. The Spence Children’s Anxiety Scale (SCAS), a constructed interview questionnaire in the form of a scoring system, was used and data was collected after appropriate consent. Data from the interviews and scores of the SCAS questionnaire was collected and then analysed. Results Our results revealed that about 68.5% of the cases scored positive for anxiety according to the total score of SCAS with mean of 61.01 (SD 9.12), and more than half of participants scored positive for Generalized Anxiety Disorder (GAD), Social phobia, Separation anxiety, Panic disorder, and Physical injury fear with means of 59.15 (SD 10.19), 58.7 (SD 9.67), 61.3 (SD 10.24), 60.76 (SD 8.65) and 59.04 (SD 10.24), respectively. The total score of SCAS increased with increasing of BMI, suggesting that the total score of SCAS is directly related to the degree of obesity of an adolescent (p value 0.011). Regarding the T scores of the anxiety subscales both separation anxiety (p value 0.050) and physical injury fear (p value 0.039) were more frequent in the younger age group participants, meanwhile gender panic disorder was more frequent in female participants (p value 0.015). Conclusion Obesity increases the frequency of anxiety disorders in children and adolescents. The presence of anxiety was related to the degree of obesity of an adolescent. Age and gender were significant determinants of specific anxiety disorders. Both obesity and anxiety are preventable and treatable diseases in the pediatric population, thus screening is recommended.

Patients with transfusion-dependent thalassemia (TDT) are vulnerable to neurotoxicity due to frequent blood transfusions and the subsequent iron overload (IO) and inflammation. This vulnerability may contribute to the development of depression, anxiety, and chronic fatigue syndrome (CFS). This case-control study aims to investigate central nervous system injury biomarkers, including neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP), neurofilament light (NFL) and nestin, neuro-immune markers, such as C-reactive protein (CRP), interleukin (IL)-6, and IL-10, calcium, magnesium, copper, zinc, hematocrit, hemoglobin, iron and ferritin in 126 children with TDT and 41 healthy children. We examined the associations between these biomarkers and the Fibro-Fatigue (FF) Rating Scale, the Children's Depression Inventory (CDI), and the Spence Children's Anxiety Scale (SCAS) scores. Children with TDT showed significantly elevated FF, CDI, and SCAS scores, IO (as assessed using iron and ferritin levels), and higher NSE, GFAP, NFL, CRP, IL-6 and IL-10, and lower magnesium, zinc, and calcium as compared with healthy children. There were significant correlations between the CDI score and NFL, NSE and GFAP, SCAS score and NFL, and FF score and NFL and GFAP. The neuronal damage biomarkers were significantly associated with biomarkers of IO (including iron and ferritin) and the erythron (including lowered hematocrit and hemoglobin). These results suggest that IO-associated neurotoxicity and inflammation in children with TDT may contribute to symptoms of depression, anxiety, and chronic fatigue and may serve as potential therapeutic targets.

BackgroundAutistic children experience significantly higher rates of anxiety compared to nonautistic children. The precise relations between autism characteristics and anxiety symptoms remain unclear in this population. Previous work has explored associations at the domain level, which involve examining broad categories or clusters of symptoms, rather than the relationships between specific symptoms and/or individual characteristics. We addressed this gap by taking a network approach to understand the shared structure of autism characteristics and anxiety symptoms.MethodData were pooled from five studies from Canada, Singapore, the UK, and the USA, totaling 623 autistic children (17% female sex; aged 6–18 years), for whom the parent‐report Spence Children's Anxiety Scale (SCAS‐P) was available. We derived two undirected regularized networks, first from the SCAS‐P items only, and then by adding autism characteristics pertaining to social communication, highly focused and repetitive behavior, and sensory hypersensitivity. From these models' metrics, we extracted nodes' predictability, key bridging nodes, and community detection.ResultsThe anxiety‐only network was highly connected and consisted of four key clusters: General Anxiety, Social Anxiety, Separation Anxiety, and Panic/Agoraphobia. These broadly aligned with the existing SCAS‐P structure based on DSM‐IV‐TR criteria. In the autism‐anxiety network, the structure of anxiety remained mostly stable, with autism features forming their own community. Preference for predictability (i.e., sameness) and sensory hypersensitivity were key nodes that linked autistic features and anxiety symptoms, primarily through generalized anxiety.ConclusionThis study identified some of the key characteristics that bridge the broadly independent structures of autism characteristics and anxiety symptoms. The findings are discussed in the context of guiding the assessment, prevention, and treatment of anxiety in autism.

Anxiety is often experienced by students in their lives at the Islamic boarding school because it is very different from life outside the Islamic boarding school where a child is free to do activities and all needs are still handled by their parents. The anxious condition experienced will interfere with the students' learning process. Various ways of handling to reduce anxiety include using self-healing techniques combined with dhikr so that emotions and anger can be controlled. The Butterfly Hug method that creates suggestions, comfortable and calm conditions. To make these conditions more optimal, the researcher combined it with dhikr as a method of remembering and getting closer to Allah SWT which has never been studied. The design of this study is a quasi-experimental design with a pre and post without control group design. All 27 male students were used as samples. While the research instrument used the SCAS (Spence Children's Anxiety Scale) anxiety questionnaire. Before the administration of the combination therapy of Butterfly Hug and Dhikr, the level of anxiety was mild to high. After the administration of the combination therapy of Butterfly Hug and Dhikr, there was a change, namely the most was the level of moderate anxiety experienced by students. The results of the Wilcoxon Test obtained a p value of 0.000. Thus, it means that there is an effect of the combination therapy of Butterfly Hug and dhikr on anxiety in students at the Al Muslimun Islamic Boarding School, which was rejected. There is an effect of the combination therapy of Butterfly Hug and dhikr on reducing anxiety in students at the Al Muslimun Islamic Boarding School, Durenan Sidorejo Magetan. It is hoped that Butterfly Hug and Dhikr can be used as one of the therapies in overcoming anxiety that can be done independently by students at the Islamic boarding school.

IntroductionThere is no doubt that childhood is a crucial period in a person’s development. Anxiety disorders in modern times are at the forefront, with a huge number of children and adolescents suffering from them. An important asset, a protective shield against anxiety disorders that promotes mental well-being is self-esteem.ObjectivesThe present study aims to investigate the level of self-esteem and the differentiation of various anxiety disorders, as well as the assessment of the severity of anxiety symptoms exhibited by children aged 9-12 years, who were attending the 4th, 5th, and 6th grades of public primary schools in the Larnaca district of Cyprus. Additional objectives are to investigate possible associations between these variables and the socio-demographic characteristics of the students in combination with their teacher-reported school performance.MethodsTo 249 students were administered (a) a Sociodemographic Characteristics Questionnaire, (b) the Rosenberg Self-Esteem Scale, (c) the Spence Children’s Anxiety Scale (SCAS), and their teachers were given a questionnaire to assess the academic performance of each student individually.ResultsThe protective role of self-esteem in the development of anxiety disorders (p<0.001) and feelings of loneliness and the positive effect on school performance was confirmed by the study. Besides, high levels of self-esteem were associated with reduced feelings of loneliness (p 0.001), increased school performance (p 0.020) and greater satisfaction with teacher help (p 0.001). Additionally girls had more frequent anxiety disorder behaviours compared to boys (p 0.028), especially panic disorders, agoraphobia (p 0.020), specific phobias (p 0.012) and separation anxiety (p 0.005). Interestingly, the study found that stronger feelings of loneliness at school were associated with increased occurrence of anxiety disorders (p<0.001). It was also found that older students were less likely to develop anxiety disorder behaviours (p 0.002), while children with more siblings in a family showed worse ratings of student performance at school (p 0.001). Finally, it appears that school performance was associated with less social phobias (p 0.048) and that those children who received parallel support had lower performance than those who did not (p<0.001).ConclusionsPromoting increased levels of self-esteem, especially in children, is very important as it can help safeguard mental health. Anxiety disorders are a crucial problem in modern times, so their continuous study and treatment are essential. Holding informational and awareness-raising conferences for teachers, parents, and generally all professionals who come into frequent contact with children at this sensitive age is necessary and indisputable.Disclosure of InterestNone Declared

BackgroundSchool-based cognitive behavioral therapy (CBT) programs delivered by teachers are effective in preventing anxiety among children. Internet-based CBT has emerged as an efficient method for delivering such interventions. Our previous research demonstrated the feasibility of the e-learning version of Journey of the Brave in reducing anxiety among Japanese elementary school students in a home-based learning environment. This study aimed to evaluate the feasibility and acceptability of the e-learning version in school settings and to identify any practical implementation issues.MethodsWe conducted a single-arm study with 204 elementary school students aged 10–12 years. Participants completed the e-learning program during regular classroom hours. Of these, 180 students who completed more than 80% of the program and agreed to participate in the study were included in the analysis. We evaluated changes in anxiety symptoms using the Spence Children’s Anxiety Scale (SCAS), alongside learning logs and a post-program satisfaction questionnaire.ResultsThe estimated mean SCAS score, analyzed using a generalized linear mixed model, showed a significant decrease of 2.6 points from pre-intervention to follow-up (p = .04, 95% CI [-5.08, -0.09]). Subgroup analysis revealed a 6.4-point reduction in boys compared to a 0.5-point decrease in girls. In School A, the SCAS score slightly increased by 0.4 points, while in School B, it decreased by 3.1 points. Significant interaction effects were observed between time and gender (p = .03) and between time and school (p = .04). The mean comprehension test score (true/false) was 13.2 out of 16 (SD = 2.2).ConclusionThe Journey of the Brave e-learning version was feasible and well-accepted in school settings. Student self-reports suggested that they may have applied the CBT knowledge and skills in their daily lives. Future studies should explore the contextual factors influencing program effectiveness and determine optimal conditions for its implementation.Trial registration: UMIN, UMIN000057115, Registered February 21, 2025.