Anxious Youth Research Articles

Ketamine for mood disorders, anxiety, and suicidality in children and adolescents: a systematic review.

Mood disorders, anxiety, and suicidality in youth are increasing and rapid-acting treatments are urgently needed. One potential is ketamine or its enantiomer esketamine, which was FDA approved in 2019 to treat major depressive disorder with suicidality in adults. This systematic review evaluated the evidence for the clinical use of ketamine to treat mood disorders, anxiety, and suicidality in youth. The PRISMA guidelines were used, and a protocol registered prospectively ( https://osf.io/9ucsg/ ). The literature search included Pubmed/MEDLINE, Ovid/MEDLINE, Scopus, CINAHL, PsychInfo, and Google Scholar. Trial registries and preprint servers were searched, and authors contacted for clarification. Studies reported on the clinical use of ketamine to treat anxiety, depression, bipolar disorder, or suicidality in youth ≤19years old and assessed symptoms before and after ketamine use. Study screening and data extraction were conducted independently by 2-4 authors. Safety, tolerability, and efficacy data were collected. The Cochrane Risk of Bias guidelines assessed the quality of the evidence. Twenty-two published reports based on 16 studies were identified: 7 case studies, 6 observational studies, 3 randomized trials, and 6 secondary data analyses. Studies reported immediate improvements in depression, anxiety, and suicidality. Improvements were maintained for weeks-months following treatment. Ketamine was well-tolerated with the most common side effects being dizziness, nausea, and mild dissociation. Transient hemodynamic changes were reported, all of which resolved quickly and did not require medical intervention. Initial evidence suggests ketamine is safe and may be effective for mood disorders, anxiety, and suicidality in youth. Further randomized trials are warranted.

Strengthening Youth Resilience via Social Work Internship Placements within Boys and Girls Clubs: A Process Evaluation

Background: There is a growing mental health crisis among youth in the United States. The objective of the current study was to conduct a process evaluation of Strengthening Youth Resilience (SYR), a unique program aimed at decreasing youth anxiety and depression via social work internship placements within after-school programs in three historically underserved communities in a large city in Southern California. The SYR program utilizes the School Social Work Practice Model as a framework for interacting with youth within community settings by providing a tiered system of service delivery. Methods: Focus group discussions and interviews were used to examine the unique perspectives of social work interns, program leaders, and Boys and Girls Clubs of America (BGCA) staff. Results: Results emphasized the importance of trust, clear communication, and shared decisionmaking as a foundation for successful program site integration. Additionally, several unanticipated barriers to implementation arose, including difficulty obtaining informed parental consent to work individually with youth, challenges aligning internship schedules with the fluid structure of after-school programs, and the need for a private welcoming space to work. Conclusion: In conclusion, the SYR program successfully integrated within BGCA sites and was able to provide support to youth. BGCA sites expressed great satisfaction with the program and were eager to continue and expand upon their collaboration with the local university

Illness Anxiety Disorder: A Review of the Current Research and Future Directions

Purpose of ReviewWe review recent evidence on Illness Anxiety Disorder (IAD), including risk factors and precipitants, diagnostic classification, clinical characteristics of the disorder, and assessment and treatment in both children and adults.Recent FindingsIAD places a substantial burden on both individuals and society. Despite its impact, understanding of the disorder is lacking and debates remain about whether IAD should be classified as an anxiety disorder and whether it is distinct from Somatic Symptom Disorder. Cognitive behavioural therapy (CBT) is an effective treatment for IAD and there are multiple validated measures of health anxiety available. However, research on health anxiety in children and youth is limited.SummaryIAD is chronic, and debilitating, but when identified, it can be effectively treated with CBT. Research using DSM-5 IAD criteria is lacking, and more research is needed to better understand the disorder, particularly in children and youth.

The effect of physical activity on anxiety symptoms among children and adolescents with mental health disorders: a research brief.

Anxiety is prevalent among children and adolescents (termed youths), and leads to reduced quality of life, disability, loss of education and reduced life-span. Physical activity has shown promising effects on symptoms of anxiety in adult populations, and an increasing amount of research has also demonstrated some effect in youth. However, physical activity is not widely used in youth mental health care, and research is very limited. This single arm, pre-post study explores the effect of a manualized physical activity-based 14-session intervention termed Confident, Active and Happy Youth. Participants are youth attending specialized mental health care (N=51, M age = 13.4, SD = 2.2). Changes in anxiety symptoms are examined using mixed models with residual maximum likelihood (REML). The potential effect of anxiety subtype differences, participant age, comorbidity, and time spent in out-patient care are explored. Youths did not report any effect on anxiety symptoms after participation in CAHY, however, their parents report a significant reduction in youth's anxiety symptoms in general (b = -0.11, 95%, CI: -0.21 to -0.01) and specifically for social phobia (b = -0.19, 95% CI: -0.35 to -0.03). Age and comorbidity showed no significant effect on anxiety symptoms post treatment. Prior treatment time in youth mental health care demonstrated inconclusive results. The study finds initial evidence of symptomatic change in a clinical population of youth's receiving a physical activity-based intervention. Our research provides preliminary support for physical activity as a supplementary treatment method for mental health disorders among youths. clinicaltrials.gov, NCT05049759.

Sex-Based Asymmetry in the Association between Challenging Behaviours and Five Anxiety Disorders in Autistic Youth

The presence of sex-based asymmetry in the behaviours of youths with Autism Spectrum Disorder (ASD) is currently under research scrutiny. ASD is characterised by challenging behaviour (CB) and is often accompanied by anxiety, both of which often exacerbate social interaction difficulties. The present study examined the presence of sex-based asymmetry in the prevalence of CB and anxiety and in the association between CB and anxiety in a sample including 32 male autistic youths (M age = 10.09, SD = 3.83, range = 6–18 yr) and 32 female autistic youths (M age = 10.31, SD = 2.57, range = 6–15 yr) matched for age, IQ, and ASD severity (p > .101). While the prevalence and severity of behavioural characteristics across males and females with ASD were similar (p = .767), representing symmetry, there was asymmetry in the ways that CBs and anxiety were associated with each other across the two sexes. Specifically, there were 3 instances of symmetry (r > .3, p < .05)), but there were also 10 occurrences of sex-based asymmetry (r < .3, p > .05) in the association between five aspects of CB and five anxiety disorders. These findings emphasise the underlying sex-based symmetry in the prevalence of ASD-related behaviours, also highlighting unique sex-based asymmetry in the association between CBs and anxiety in autistic youths.

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

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

Diffusion Tensor Imaging Before and After 8 Weeks of Exposure-Centered Cognitive Behavioral Therapy in Anxious Youth

Diffusion Tensor Imaging Before and After 8 Weeks of Exposure-Centered Cognitive Behavioral Therapy in Anxious Youth

65. Restful Nights, Resilient Minds: Exploring Sleep Duration's Impact on Anxiety and Fear Extinction-Related Neural Responses in Youth

65. Restful Nights, Resilient Minds: Exploring Sleep Duration's Impact on Anxiety and Fear Extinction-Related Neural Responses in Youth

Anxiety among youth with food allergy.

Anxiety is among the major psychological concerns for children living with food allergy (FA). Yet research exploring the variables driving anxiety symptoms in FA remains sparse, and most studies still utilize homogeneous samples to assess anxiety symptoms. The current study seeks to evaluate the rates of clinically significant anxiety symptoms among a diverse sample of youth with FA and examine whether a heightened risk perception of FA outcomes and FA burden (vs. FA medical history) is associated with anxiety in youth. 94 youth ages 10-14 and their parents were recruited from FA clinics at a mid-Atlantic children's hospital. Both youth and parents completed demographic and FA medical history questionnaires, the Screen for Child Anxiety Related Emotional Disorders, and the Food Allergy Independent Measure as part of a longitudinal study about FA adjustment and adherence. Over a third (37%) of youth scored above clinical cut-offs for overall anxiety symptoms. At least 25% of youth reported clinically significant scores on panic disorder, generalized anxiety, social anxiety, separation anxiety, and school avoidance subscales. Perception of risk of adverse FA outcomes and burden-but not FA medical history-were associated with total anxiety, generalized anxiety, panic disorder, and school avoidance symptoms, but not social anxiety and separation anxiety. Having more FAs was associated with higher social anxiety scores but not with other anxiety subscales. Youth with FA might benefit from psychosocial interventions that address FA risk perception management and promote appropriate FA vigilance to cope with anxiety symptoms.

Anxiety, depression, and suicidal ideation among early adolescents during the COVID-19 pandemic.

Anxiety and depression are among the most common and debilitating psychiatric disorders affecting youth, with both related to increased suicide risk. While rates of youth anxiety and depression were increasing before the COVID-19 pandemic, the pandemic further negatively impacted adolescent mental health. Unfortunately, few studies have examined prevalence of these concerns among early adolescents (ages 10-13) longitudinally during the pandemic. The current study examined self-reported anxiety and depression symptoms, and suicidal ideation amongst a general pediatrics population of 11- to 13-year-olds (n = 623) from March through September 2020 (early-pandemic) and approximately 7 months later (September 2020 through May 2021; mid-pandemic). Paired samples proportions were used to examine changes in prevalence of moderate to severe anxiety, depression, and suicidal ideation from early- to mid-pandemic. Results highlight high initial rates and stability in anxiety and suicidal ideation, as well as a significant increase in depression (42.9% increase; p < .05) among the full sample during the COVID-19 pandemic. Prevalance of concerns were greatest for females and Hispanic youth during the early-pandemic, and generally highest for females and Medicaid insured youth at mid-pandemic. Results extend recent research and underscore the need for continued monitoring of mental health concerns across development for youth who grew up during the COVID-19 pandemic; highlighting the need for sustainable, effective, and accessible early detection, prevention, and intervention strategies. Improving these services is critical to support youth who experienced pandemic-related stressors, and to prepare for supporting youth during future disruptive and isolating events.

Childhood maltreatment, parenting style and anxiety in Chinese youths: A case-control study

BackgroundAlthough evidence in supporting the associations between childhood maltreatment (CM), parenting style and anxiety in children and adolescents exists, few high-quality analytical epidemiological studies which focusing on clinically diagnosed anxiety disorders (AD) had been published. ObjectiveThe aim of this study was to further corroborate the associations between CM, parenting style, and AD in a large representative sample of Chinese children and adolescents. Participants and settingStudy subjects were derived from the Mental Health Survey for Children and Adolescents in Yunnan (MHSCAY), a population-based cross-sectional program. MethodsIndividually matched case-control study design was adopted. Univariate and multivariate conditional binary logistic regression models were used to estimate the associations between CM, parenting style and AD. Dose-response trends were estimated using the Cochran-Armitage Chi-square test. A series of stratified analyses were conducted to explore effect modification on exposure-outcome association by some important features. ResultsTotally we screened out 202 cases and 404 matched controls, with an age mean of 14.43 years. Conditional logistic regression models revealed that EA and a higher level of parental over-protection were significantly associated with increased risk of AD, with adjusted ORs of 3.39 (95 % CI: 2.07–5.56) and 1.93 (95 % CI: 1.28–2.90). Stratified analysis identified noticeable effect modification by sex, age, and whether the only child in the family. ConclusionsMajor findings of this study suggested that children and adolescents who had experienced EA or raised up by over-protective parents are at increased risk of AD. Targeted intervention measures should be developed and implemented for these high-risk youths.

Preliminary evaluation of behavior technician burnout when working with boarded and traditional psychiatric inpatients diagnosed with developmental disabilities.

The COVID-19 pandemic has led to a youth mental health crisis, with research demonstrating an increased prevalence of depression, anxiety, and disruptive behavior in youth compared to pre-pandemic years. Consequently, the insurgence of emergency psychiatric evaluations has increased the demands for extended inpatient stay (or patient boarding) at various licensed treatment facilities. Questions remain about the extent of burnout being experienced by behavior technicians who are caring for these patients. The Shirom-Melamed Burnout Measure was used to evaluate symptoms of burnout of behavior technicians practicing at a specialized psychiatric inpatient unit. Comparisons were made for instances of caring for boarded (meeting criteria for discharge but unable to be discharged due to disposition) and traditional patients (short-term treatment). Behavior technicians caring for boarded patients reported significantly higher scores in overall stress, physical exhaustion, cognitive fatigue, and emotional exhaustion than those managing patients getting traditional care. Extensive burnout can have adverse impacts at both the personal level (staff well-being, individual staff-patient interactions) and clinic level (daily operations and service, general quality of care). Efforts need to be made to address this issue to prevent staff turnover.

Codesigned online cognitive bias modification of interpretations for anxiety and depression in children: study protocol of a randomised controlled trial

IntroductionPrevious research has shown that cognitive bias modification of interpretations (CBM-I) may be a promising intervention for anxiety in youth; however, results are mixed. Given the high comorbidity between anxiety...

The associations among sleep-related difficulties, anxiety, and error-related brain activity in youth

Given the high prevalence of anxiety disorders and their associated impairment, elucidating neural mechanisms related to these disorders has been increasingly prioritized. The error-related negativity (ERN) has been identified as a neural marker that indexes risk for anxiety across development. The ERN seems to confer risk for developing anxiety, especially in the context of stressful life events. The present study sought to examine sleep-related difficulties as another stressful factor that might impact the ERN. In a sample of 221 girls, aged 8 to 15 years old, we first examined the relationship between longer-term (i.e., over the past month) and shorter-term (i.e., over the past week) sleep difficulties and the ERN. We then investigated whether specific sleep difficulties uniquely predict the ERN. In exploratory analyses, we assessed whether sleep difficulties moderate the relationship between the ERN and anxiety. Results indicated that youth who report longer-term lower sleep duration, longer-term worse sleep, and shorter-term lower sleep duration on school days over the past week have a larger (i.e., more negative) ERN. Additionally, only shorter-term sleep duration on school days over the past week uniquely predicted the ERN. Finally, an elevated ERN predicted greater clinical anxiety in the context of longer-term sleep difficulties. Future studies should clarify the direction of these associations via longitudinal designs.

Reductions in Anxiety are Associated with Decreased Expressive Suppression and Increased Cognitive Reappraisal After Cognitive-Behavioral Treatment: A Naturalistic Study in Youth.

Broad deficits in emotion regulation skills have been observed in children with anxiety-related disorders. These deficits typically improve during cognitive-behavioral therapy (CBT), but few studies have examined changes in expressive suppression and cognitive reappraisal in youth with anxiety disorders and/or obsessive-compulsive disorder (OCD) during CBT, especially in real-world settings. In a naturalistic treatment-seeking sample, 123 youth completed measures of anxiety, depression, and emotion regulation strategy use before and after 15 sessions of CBT. For anxious youth, anxiety and expressive suppression decreased over treatment, while cognitive reappraisal increased. Reductions in expressive suppression and increases in cognitive reappraisal were significantly associated with improvements in anxiety and remained significantly associated with post-treatment anxiety after accounting for baseline anxiety and depression. Changes in expressive suppression and cognitive reappraisal over the course of treatment were not found for youth with primary OCD. Thus, CBT improves emotion regulation abilities in anxious youth, and these improvements are associated with anxiety reduction; improvements in emotion regulation do not appear to drive changes in OCD symptoms. Further research is needed to determine whether changes in emotion regulation strategies mediate changes in anxiety among youth receiving CBT.

Smaller hippocampal volume is associated with anxiety symptoms in high-risk Black youth

Although there is an established link between smaller hippocampal volume and anxiety, the longitudinal relations between hippocampus structure and anxiety in diverse youth are not well understood. The present longitudinal study investigated hippocampal volumes related to anxiety symptoms in a sample of Black 8–14-year-old youth (N = 64), a population historically underrepresented in neuroimaging research. Smaller hippocampal volumes were associated with greater anxiety symptoms independent of age, sex, intracranial volume and trauma exposure. Exploratory longitudinal analyses showed smaller hippocampal volume as a predictor for anxiety symptoms (n = 37) and not a consequence of anxiety symptoms (n = 32), however results were inconclusive as this finding was no longer significant after correcting for baseline anxiety symptoms. Overall, this data increases our understanding of potential neurobiological mechanisms for anxiety in a high-risk sample of Black youth and suggests future directions into studying trajectories of developmental risk.

Investigating the Effects of Transdiagnostic Processes on Anxiety and Depression Symptoms in Autistic Young People: the Mediating Role of Emotion Dysregulation.

Internalising symptoms are elevated in autism compared to the general population. Few studies have investigated emotional dysregulation (ED) as a potential mediator between specific transdiagnostic processes and anxiety and depression symptoms in autistic youth. In a sample of 94 autistic young people aged 5-18years referred to a specialist clinic for an autism evaluation, we tested the effects of ED as a mediator between cognitive inflexibility (CI), intolerance of uncertainty (IU) and alexithymia with anxiety and depression symptoms, using structural equation modelling. Effect sizes were compared to a non-autistic comparison group (n = 84). CI and alexithymia did not significantly predict depression symptoms in autistic young people, directly nor via ED. Relationships between CI/alexithymia and depression were fully mediated by ED in the non-autistic sample. There was a direct effect of CI on anxiety in the non-autistic group but not in those with a diagnosis. IU predicted depression symptoms in the autism group; and ED mediated this relationship only in those who did not receive a diagnosis. IU directly predicted anxiety in both groups and this relationship did not occur via ED. The finding of a direct pathway from IU to anxiety and depression in autistic youth is consistent with the literature. The finding that CI did not predict anxiety or depression in those with autism is novel, as was the finding that ED mediated relationships between alexithymia and anxiety/depression symptoms in both samples. The findings may have important implications for the delivery of psychological interventions for autistic youth.

“Where are the pediatricians in all this?”: Family perspectives on the role of pediatricians in mental healthcare and suicide prevention

Rising rates of youth anxiety, depression, and suicide mean that pediatricians are increasingly likely to encounter children struggling with their mental health in their clinical practices. Despite pediatric professional organizations encouraging pediatricians to contribute more to mental healthcare and suicide prevention, research on the role of pediatricians and whether families consider them a resource is limited. Drawing on original survey (N = 1230) and interview data (N = 102), we investigate how families conceptualize and involve pediatricians in their children’s mental healthcare, including during suicidal crises. Our survey data show that while families considered mental health professionals the ideal point of contact, pediatricians were a close second, confirming that families view pediatricians as a mental health resource. Parent interviews clarify that parents most often turn to pediatricians for medication and referrals to other mental health professionals or because mental health professionals were inaccessible. We also examine how pediatricians helped (by connecting families promptly to appropriate care) or hurt (by stigmatizing suicide or by providing interventions associated with harm) during a child’s suicidal crisis. We conclude by emphasizing the importance of proper suicide prevention training for pediatricians, as well as suggesting directions for future research.

Efficacy of Cognitive Behavioral Therapy in Managing Anxiety Disorders among Adolescents: An In-Depth Analysis of Individual, Group, and Digital Approaches

This research article delves into the efficacy of Cognitive Behavioral Therapy (CBT) in addressing adolescent anxiety disorders. It explores various facets of CBT, including its theoretical underpinnings and mechanisms of change, highlighting its role in altering dysfunctional beliefs and thought patterns that contribute to anxiety. The article underscores the advantages of CBT, such as its structured approach, cost-effectiveness, and the provision of practical coping skills, making it a preferred choice for dealing with adolescent anxiety. The study then investigates the efficacy of different CBT approaches, including individual, group, and computerized CBT (cCBT) in details, specifically in the context of the COVID-19. It encompasses a range of research, from meta-analyses to controlled trials, evaluating the impact of these treatments on anxiety symptoms and their long-term efficacy. Research demonstrates CBT's high efficacy in treating youth anxiety, offering sustained symptom reduction and complementing psychopharmacological treatments backed by extensive studies and neuroimaging advancements. Group CBT for adolescents shows effectiveness in anxiety treatment, offering peer support and shared experiences in a communal setting, enhancing coping strategies and social skill development. The findings indicate cCBT's effectiveness in providing accessible mental health support to adolescents, aligning well with their tech-savvy tendencies. In conclusion, this research underlines CBT’s flexibility in addressing adolescent anxiety in both traditional and digital formats, with an emphasis on the promising potential of cCBT. It calls for future research to focus on standardizing CBT practices and validating the long-term effectiveness of cCBT.

Family Accommodation in Anxious Irritable and Anxious Nonirritable Youth

Family accommodation is a significant contributor to the maintenance and course of youth anxiety. There is also high co-occurrence of anxiety and irritability in youth. Research is lacking, however, on the influence of irritability in the association between anxiety and family accommodation, including among youth with clinically diagnosed anxiety disorders. We therefore examined this issue in a sample of clinic-referred anxious irritable and anxious nonirritable youth. Youth (N = 645, Mage = 9.86 years, SD = 2.92) and their parents completed diagnostic interviews and questionnaires assessing youth anxiety, irritability, and family accommodation. Based on both youth and parent ratings, family accommodation was significantly and positively associated with youth anxiety and irritability. Anxious irritable youth rated family accommodation significantly higher than anxious nonirritable youth. In addition, youth self-rated irritability levels significantly moderated the association between their anxiety and family accommodation. No moderation effect was found for the parent ratings. Based on the youth ratings, our overall findings show that parents of anxious irritable youth are more accommodating of their children’s anxiety, compared with parents of anxious nonirritable youth. Anxiety levels also predict family accommodation more strongly in youth with lower levels of irritability. Our findings provide novel insights about accommodation behaviors in families of anxious irritable youth and suggest its potential utility as a treatment target when working with anxious irritable youth.