Worry In Children Research Articles

Searching for Danger: On the Link Between Worry and Threat-Related Confirmation Bias in Children

The present study examined the relationship between worry and threat-related confirmation bias in children. Forty non-clinical children aged 10–12 years completed the child version of the Penn State Worry Questionnaire as a cognitive index of anxiety proneness, and then were administered a modified version of the Wason Selection Task to assess verifying and falsifying reasoning strategies in response to conditional danger rules. Results demonstrated that children with high levels of worry displayed a stronger tendency towards verification and a weaker inclination towards falsification than children with low levels of worry. This finding indicates that confirmation bias occurs in individuals with a general vulnerability to anxiety, and fits well with current theoretical models in which cognitive distortions are viewed as risk factors predisposing to the development of fear and anxiety problems.

Specific Health-Related Quality of Life Concerns in Children with Intermittent Exotropia

Purpose: To assess the frequency of specific health-related quality of life (HRQOL) concerns in children with intermittent exotropia (XT) using the Intermittent Exotropia Questionnaire (IXTQ).Methods: Eighty children with intermittent XT (aged 5 to <17 years), plus one parent for each child, completed the Child and Proxy IXTQ respectively. Each item was scored from 0 to 100 (worst to best HRQOL). Mean scores were calculated for each item and items were ranked from lowest to highest impact (worst HRQOL). Analysis was repeated for sub-groups of 5- to <8-year-olds (n = 46) and 8- to <17-year-olds (n = 34).Results: Highest impact Child IXTQ items were: “It bothers me that I have to shut one eye when it is sunny,” “I worry about my eyes,” and “It bothers me because I have to wait for my eyes to clear up.” Highest impact Proxy IXTQ items were: “It bothers my child because he/she has to shut one eye when it is sunny” and “My child worries about his/her eyes.” Lowest impact Child and Proxy items were “My eyes make it hard to make friends” and “Kids tease me because of my eyes.” Ranking of items was similar for younger and older children.Conclusions: The greatest HRQOL concerns for children with intermittent XT were shutting one eye when sunny, waiting for their eyes to clear up, and worrying about their eyes. Items related to teasing and making friends were of least concern. Evaluation of HRQOL concerns using the IXTQ may be helpful in the clinical care of individual patients.

Relationships between 9-Year-Olds' Math and Literacy Worries and Academic Abilities

We investigated whether 9-year-olds experience math and/or literacy worries and, if they do, whether it is related to problem-solving abilities. Fifty-eight children judged the correctness of math, literacy, and mental rotation problems that differed in difficulty and rated their worry level about the correctness of judgments. Nonverbal IQ, general math, and literacy abilities were also assessed. Results showed children's worry ratings varied as a function of task and problem difficulty. Latent class analyses of math and literacy worry ratings revealed high-, moderate- and low-worry subgroups in both domains. The high-worry math subgroup exhibited poorer math performance than the other math subgroups, demonstrating a link between math worry and math performance. No relationship was found between worry literacy subgroups and literacy performance. Moreover, no relationship was found between teachers’ rating of children's academic and general worry and children’s own worry ratings. The relevance of the findings for understanding math and literacy worry is discussed.

The Role of Metacognition, Intolerance of Uncertainty, and Negative Problem Orientation in Children's Worry

Although worry is common in children, empirical models of worry remain largely untested in youth. A small number of studies have established preliminary links between cognitive variables and worry in children younger than 12 years old. These cognitive variables include positive and negative beliefs about worry, intolerance of uncertainty, and problem orientation. The current study examined these variables concurrently and their association with worry. We also examined the extent to which intolerance of uncertainty mediated the association between worry and beliefs about worry. Eighty elementary school children aged 8 to 12 years completed a battery of self-report measures. As a group, the cognitive variables significantly predicted worry scores; negative beliefs about worry was the only significant individual predictor. As a group, the four cognitive variables discriminated clinical from nonclinical levels of worry; positive beliefs about worry and intolerance of uncertainty were the only significant individual predictors. Finally, intolerance of uncertainty mediated the association between worry and both positive and negative beliefs about worry. Components of a cognitive model of worry are largely applicable to children. Negative beliefs about worry were associated with worry across the continuum, while intolerance of uncertainty and positive beliefs about worry were more strongly associated with clinical levels of worry. Intolerance of uncertainty accounted for a significant portion of the association between metacognition and worry and may be a particularly effective target for treatment. Further implications for conceptual models and treatment interventions are discussed.

Older Adults’ Driving Reduction and Cessation

Adult children are often directly affected by aging parents' decision to limit or stop driving. This qualitative study examined the process of driving reduction and cessation (DRC) from the perspective of adult children, with a focus on family communication. Four focus group interviews were conducted with 37 adult children (29/37 female; mean age = 45.5) of older parents using a structured protocol. Transcripts were analyzed by two independent coders to identify major themes. Themes represented three aspects of the DRC process: family communication and dynamics (i.e., discussion, negotiation, and planning; avoidance and side stepping; resignation and refusal), taking action to end a parent's driving career (i.e., engaging a third party; taking away the car), and post-cessation reflection (i.e., relief; social benefits; resentment and guilt). Despite the potential benefits of planning for DRC, families are unsure about how best to approach this topic. Adult children worry about assuming responsibility for their parents' transportation needs and their parents' reactions to restricted mobility. Despite a reluctance to communicate openly about DRC, adult children and their parents share similar and significant concerns that merit increased attention.

Do you know how I feel? Parents underestimate worry and overestimate optimism compared to child self-report

Three studies assessed parent–child agreement in perceptions of children’s everyday emotions in typically developing 4- to 11-year-old children. Study 1 (N=228) and Study 2 (N=195) focused on children’s worry and anxiety. Study 3 (N=90) examined children’s optimism. Despite child and parent reporters providing internally consistent responses, their perceptions about children’s emotional wellbeing consistently failed to correlate. Parents significantly underestimated child worry and anxiety and overestimated optimism compared to child self-report (suggesting a parental positivity bias). Moreover, parents’ self-reported emotions correlated with how they reported their children’s emotions (suggesting an egocentric bias). These findings have implications for developmental researchers, clinicians, and parents.

Children's perceptions of obesity and its relation to nutrition and physical activity

Data indicate that about one third of children in the US are overweight/obese (ov/ob). Understanding children's perceptions of obesity and related socio‐behavioral factors is important in crafting child‐receptive interventions to address this epidemic. In 2010 an online Harris Interactive Youth Query omnibus survey among 1224 children age 8–18 yrs in the US was commissioned to capture children's views. Though 46% of children knew that one third of US children are ov/ob another 46% believed that it was half or more. When asked to categorize themselves, only 28% reported being ov/ob compared to 35% among 6–18 yr olds nationally, underscoring the shift in cultural weight norms. 80% of self‐categorized ov/ob children worry about their weight compared to 31% of normal weight children. 92% of children felt it was important to not be overweight at their age and that it leads to teasing at school, inability to play sports well, and overweight and illness in adulthood. Children focused on eating habits (especially sugar intake) as the main reasons for childhood ov/ob. They did not report physical activity as a main reason. Children also focused on food more than physical activity when asked what adults need to know to help people their age achieve a healthy weight. The contemporary knowledge and views of children captured here should be addressed if interventions to reverse the childhood obesity epidemic are to be successful. RWJF

Applicability of a cognitive model of worry to children and adolescents

BackgroundIntolerance of uncertainly (IU), cognitive avoidance (CA) and positive beliefs about worry (PB) independently predict worry frequency in older adolescents and adults, and when targeted together in treatment produce significant reductions in both worry and anxiety in this age range. The present study addresses a gap in the literature by testing whether a cognitive model of excessive worry and anxiety incorporating these process variables is applicable to children and adolescents. MethodPrimary and secondary school students (n = 515; aged 7–19 years) completed modified self-report measures of worry frequency, anxiety, IU, CA and PB and a path analysis undertaken to test whether IU was a higher order variable for CA and PB and whether the relationship between IU/CA/PB and anxiety was mediated by worry frequency. ResultsSignificant (bivariate) correlations were observed between the measures of IU, PB, CA, worry and anxiety across the age range. However separate path models had to be fitted for children (aged 7–12 years) and adolescents (aged 13–19) with PB being dropped from the child model. CA was related to anxiety only through worry in children while IU showed direct paths to worry and anxiety in both children and adolescents. ConclusionsCognitive models of persistent worry in adults and older adolescents may, with some modification, have applicability to children. Further testing and refinement of these cognitive models of worry may lead to improvements in existing treatments for anxious youth.

The mediating effect of cognitive development on children's worry elaboration

The present study investigated how developmentally determined cognitive mechanisms, holding theoretical links to the worry process, mediate the relationship between Age and Worry Elaboration in children. Sixty-four children aged 3–7 (M = 5.58, SD = 1.28) were presented with a Conservation of Liquid task assessing their Cognitive Development (specifically Concrete Operational Skills), a false-belief task to measure possession of Belief–Desire Theory of Mind, and a task measuring the ability to acknowledge multiple possibilities. The ability to elaborate on potential negative outcomes was assessed using a Worry Elaboration task. Mediation analysis revealed that all three variables significantly mediated the relationship between Age and Worry Elaboration. A multiple mediation model is presented in which Concrete Operational Skills, Belief–Desire Theory of Mind and Multiple Possibilities understanding mediate the relationship between Age and Worry Elaboration.

Children of National Guard Troops Deployed in the Global War on Terrorism

This study examined deployment effects in children and spouses of National Guard troops using a longitudinal design to assess 18 children (ages 6 to 17 years) and 13 nondeployed spouses before, during, and after deployment. Both self- and parent reports revealed that children of deployed service personnel experienced emotional and behavioral symptoms during the deployment of their fathers relative to pre- and post-deployment. The children's worry and uncertainty, along with aspects of family interactions, may give rise to ambiguous loss associated with deployment in military families.

Worry, Beliefs about Worry and Problem Solving in Young Children

Childhood worry is common, and yet little is known about why some children develop pathological worry and others do not. Two theories of adult worry that are particularly relevant to children are Davey's problem-solving model in which perseverative worry occurs as a result of thwarted problem-solving attempts, and Wells' metacognitive model, in which positive and negative beliefs about worry interact to produce pathological worry. The present study aimed to test hypotheses that levels of worry in young children are associated with poor or avoidant solution generation for social problems, and poor problem-solving confidence. It also aimed to explore beliefs about worry in this age group, and to examine their relationships with worry, anxiety and age. Fifty-seven young children (6-10 years) responded to open ended questions about social problem-solving situations and beliefs about worry, and completed measures of worry, anxiety and problem-solving confidence. Children with higher levels of worry and anxiety reported using more avoidant solutions in social problem situations and children's low confidence in problem solving was associated with high levels of worry. Children as young as 6 years old reported both positive and negative beliefs about worry, but neither were associated with age, gender, or level of anxiety or worry. RESULTS indicate similarities between adults and children in the relationships between problem-solving variables and worry, but not in relationships between beliefs about worry and worry. This may be due to developmental factors, or may be the result of measurement issues.

An exploration of parents' and professionals' roles in sharing illness and treatment information with children who have cancer

BackgroundChildren aged 4–10 years with cancer rely on their parents for information. Inadequate and incomplete information about diagnosis and treatment increases children's worries and fears and compromises their abilities to...

The Developmental Psychopathology of Worry

Although childhood generalized anxiety disorder is generally understudied, worry, the cardinal feature of GAD, appears to be relatively common in youth. Despite its prevalence, there are few conceptual models of the development of clinical worry in children. The current review provides a framework for integrating the developmental psychopathology perspective, models of worry in adults, and data available on worry in children. General risk factors for the development of worry are considered, as well as potential pathways including genetics, temperament, cognitive, emotional and parenting influences, as well as the influence of cognitive development. Based on this review, it appears unlikely that main effects models will be able to explain the development of GAD or clinical worry in children and that a broad, complex model incorporating a number of factors and their interactions will best describe etiological and maintaining factors. With this perspective in mind, a number of suggestions for future work are offered.

Worry and problem-solving skills and beliefs in primary school children

To examine the association between worry and problem-solving skills and beliefs (confidence and perceived control) in primary school children. Children (8-11 years) were screened using the Penn State Worry Questionnaire for Children. High (N= 27) and low (N= 30) scorers completed measures of anxiety, problem-solving skills (generating alternative solutions to problems, planfulness, and effectiveness of solutions) and problem-solving beliefs (confidence and perceived control). High and low worry groups differed significantly on measures of anxiety and problem-solving beliefs (confidence and control) but not on problem-solving skills. Consistent with findings with adults, worry in children was associated with cognitive distortions, not skills deficits. Interventions for worried children may benefit from a focus on increasing positive problem-solving beliefs.

A Psychological Intervention for Pediatric Chest Pain: Development and Open Trial

Noncardiac chest pain (NCCP) is a common and persistent problem for children and adolescents; typically there is no clear medical cause. To date, no psychological intervention has been studied for chest pain in a pediatric sample. (a) We developed a brief psychological treatment for chest pain and associated worry in children and adolescents with NCCP. This program includes psychoeducation, breathing retraining, cognitive coping strategies, and 1 session of parent education and coaching regarding the impact of reinforcement on pain and coping behaviors. (b) We treated 9 youngsters with chronic NCCP, assessing pain, somatization, disability, anxiety and depressive symptoms, and coping. Assessments were conducted before, after, and 6 months following treatment. After treatment, there was a significant decrease in chest pain and somatization. Benefits were maintained at 6-month follow-up. There was no decrease in associated psychological symptoms. A brief psychological treatment for pediatric NCCP is feasible to administer and may help alleviate symptoms of pediatric NCCP. Further study in a randomized trial is needed.

The role of meta-cognition and parenting in adolescent worry

In the meta-cognitive model of worry, positive, and negative beliefs about worry interact to make worry problematic. These beliefs have been found to be associated with anxiety in adolescents, but it is unknown whether they are associated with worry. Furthermore, it may be via cognitive mechanisms such as these, or directly through behavior, that parents influence their child's worry. The current study aimed to explore whether adolescent meta-cognition and parenting behaviors and meta-cognitions were associated with adolescent worry. Results indicated that meta-cognitions were specifically associated with worry in adolescents, but there was little evidence that parenting was. Parental worry on the other hand was associated with both parent and child reported parenting. It is concluded that the meta-cognitive model of worry may be relevant in adolescents, but that further research is required to explore how parents influence adolescent worry.

Children and young people's experiences of cancer care: A qualitative research study using participatory methods

Background Little is known about whether children's cancer services actually meet children's needs, as the majority of previous research has sought the views of parents as proxies. Objectives To explore children's and young peoples’ views of cancer care and to present a conceptual model of communication and information sharing. Settings Three Principal Cancer Treatment centres in the United Kingdom. Participants Thirty-eight participants at different stages of the cancer journey (e.g. on treatment, near end of treatment, up to 18 months following treatment) were grouped for data collection by age: young children (4–5 years), older children (6–12 years) and young people (13–19 years). Methods Data were collected concurrently over 6 months using age-appropriate, participatory-based techniques. Techniques included play and puppets, the draw and write method, interviews and an activities day. Results Some findings confirmed previously reported issues, such as, young children's inabilities to voice their preferences, and the importance of familiar environments and parental support for all ages. New findings suggested children worry about the permanence of symptoms, and older children are unhappy about their parents leading communications with health professionals. As communication and information sharing featured as an area in which children's and young people's preferences changed most dramatically, we propose a conceptual model of communication roles of patients, their parents, and health professionals to illuminate communication patterns. The model suggests children (aged 4–12 years) reside in the background of information sharing with health professionals until they gain autonomy as young people (around age 13). They then move into the foreground, and their parents transition into a supportive background role. Reviewing this model may help younger children realise their abilities to voice their preferences and older children to move into the foreground. Parents and professionals, in turn, can learn to develop in their supportive background roles. We encourage further testing of the model to define roles within relevant contexts. Conclusions Overall, this study offers a perspective on the needs and preferences of children and young people receiving cancer care. Differences across ages were more striking with reference to preferences for communication. These differences are highly relevant to the way we communicate information to children and young people.

Headache: What Do Children and Mothers Expect From Pediatricians?

Headache is a frequent occurrence among children and adolescents, and one of the most common causes of medical consultation. While serious conditions presenting headache as the chief complaint are not common in the pediatric population, enormous sums are invested to perform very expensive and often unnecessary diagnostic investigations. Pediatricians should adopt a flexible and diversified diagnostic/therapeutic approach and, at the same time, should not forget to take into consideration the demands, expectations, and worries of children and their parents. The aim of this study was to assess simultaneously children's and mothers' expectations from the pediatric consultation concerning headache, and pediatricians' opinions about said expectations. In addition, we attempted to investigate mothers', children's, and pediatricians' opinions about symptomatic and prophylactic treatment of headache. A total of 100 young headache sufferers, 50 were male and 50 were female, from 10 to 16 years of age, were enrolled in this study. Two diversified, self-administered, ad hoc questionnaires about their expectations from the pediatric treatment of headache and about symptomatic and prophylactic treatment were delivered to each patient and their mother, to which they responded separately. A third self-administered questionnaire was delivered to a sample of 50 pediatricians. Our study showed that children and their mothers sometimes have different expectations about the consultation of the pediatrician and of the headache specialist. Frequency of pain was the main reason for pediatric consultation for 70% of mothers, whereas only 2% of them (as opposed to what pediatricians believed) consulted the pediatrician because they were worried about a tumor. Moreover, a high percentage of children and mothers expected from the pediatric consultation to be reassured that it is not a serious illness and to find out the causes of headache (60% and 47%, and 45% and 62%, respectively). A total of 26% of children wanted to know the progression of headache in the future, but only 3% of mothers shared the same demand. With regard to their expectations, pediatricians agree only in part with children and their mothers. On the contrary, the majority of children (68%), mothers (49%), and pediatricians (90%) agree that a symptomatic treatment was necessary in the presence of a severe pain. In addition, 61% of children, 37% of mothers, and 74% of pediatricians believed that a prophylactic treatment was necessary when the pain is severe and long-lasting. Pediatricians sometimes do not consider sufficiently children's and mothers' wishes and expectations and, consequently, could limit the outcome of their diagnostic-therapeutic approach. This is particularly important because, in the developmental age, an accurate recognition of patients' and parents' expectations represents an essential requirement for a favorable outcome of the consultation.

Pathological Worry in Children: What is Currently Known?

This review focuses on pathological worry in children. Research suggests that pathological worry in children may best be distinguished by its intensity and uncontrollability, but not by its frequency. Furthermore there is evidence that worry functions as a problem solving strategy in children and adolescents and in older children it may aid avoidance of thinking about more significant worries. These functions can go wrong however, with high levels of worry being associated with positive beliefs about worry, poor problem solving confidence, attentional and interpretation biases and cognitive avoidance strategies. Models and theories of GAD in adults also appear to be applicable to children and adolescents with these younger populations showing associations between worry, and intolerance of uncertainty and negative beliefs about worry. Behavioural inhibition, parenting, genetics and life events are discussed as potential origins of pathological worry in children and the review finally calls for more research into specific causal mechanisms that promote pathological worry in children.

Reliability and Validity of the Korean Version of the Penn State Worry Questionnaire in Primary School Children

Worry is a generalized psychological phenomenon seen among most people. When worry is excessive and nearly uncontrollable, people usually suffer psychological pain. The Penn State Worry Questionnaire for Children (PSWQ-C) was developed to measure worry objectively. It comprises 14 items for measuring excessive, generalized, and uncontrollable worry in children. This study, conducted with a large group of elementary children (3rd through 6th graders, ages 8-12 yr; N=973), investigated the reliability and validity of the Korean version of the Penn State Worry Questionnaire for Children (PSWQ-CK). The PSWQ-CK showed high reliability by test-retest and also excellent internal consistency results. To examine the validity of the PSWQ-CK, we calculated its correlation with the Revised Children's Manifest Anxiety Scale (RCMAS). The PSWQ-CK had a higher correlation with the worry/oversensitivity factor than with other subscales of the RCMAS, and it showed no correlation with the lie factor. When 3 reversed PSWQ-CK items were eliminated, the instrument showed higher internal consistency. However, this did not improve its correlation with other anxiety-measuring tools. In conclusion, the PSWQ-CK's reliability and validity were satisfactory, and it is a useful tool for objectively measuring the worry of Korean children of this age group.