Anxiety disorders in children and adolescents: a review of the past 10 years

OBJECTIVE: To critically review the research on anxiety disorders in children and adolescents, focusing on new developments in the past 10 years. METHOD: This review includes recent articles which contribute to the conceptualization, assessment, and treatment of childhood anxiety disorders. RESULTS: Information was organized into a developmental framework. Anxiety disorders research has shown steady progress. CONCLUSIONS: More research is needed, particularly in the areas of neurobiological basis of anxiety disorders, longitudinal studies, and treatment.     

Use of atypical neuroleptics in child and adolescent psychiatry

BACKGROUND: This article reviews the published clinical experience with atypical neuroleptics in children and adolescents. METHOD: A computerized literature search was conducted (MEDLINE, 1974-1998) to retrieve all reports on the use of atypical neuroleptics in children and adolescents. A hand search was performed as well. All relevant clinical data were collated by type of drug. RESULTS: We found 5 blind placebo-controlled clinical trials (105 patients), 24 open-label clinical trials (387 patients), and 33 case series (115 patients) describing the use of the atypical neuroleptics clozapine, risperidone, olanzapine, sulpiride, tiapride, amisulpride, remoxipride, and clothiapine in children and adolescents. Some of these agents, especially clozapine, risperidone, and olanzapine, were found to be efficacious in the treatment of schizophrenia, bipolar disorders, and pervasive developmental disorders. The role of atypical neuroleptics as augmenters of serotonin reuptake inhibitors in obsessive-compulsive disorder is unclear. Risperidone appears to possess anti-tic properties in patients with Tourette's disorder. CONCLUSION: The most convincing evidence of the efficacy of atypical neuroleptics in children and adolescents concerns clozapine in the treatment of schizophrenia. Data on other atypical neuroleptics in other disorders are still sparse, and further research is needed. Some of the atypical neuroleptics may become the first-line treatment for childhood schizophrenia and pervasive developmental disorders.     

Review of Behavioral and emotional disorders in adolescents: Nature, assessment and treatments.

Reviews the book, Behavioral and emotional disorders in adolescents: Nature, assessment and treatment by David A. Wolfe and Eric J. Mash (see record 2005-16249-000). The primary goal of this edited volume is to capture the current state of knowledge about the important behavioural and emotional adjustment problems and disorders of adolescence. Through 20 chapters by foremost experts, the reader is apprised of the unique features of these disorders in adolescents in comparison with children and adults, and of the importance of developmental issues and a developmental perspective. Any thought that adolescent disorders are adequately addressed by upward extension of knowledge of child disorders and downward extension of knowledge of adult disorders is compellingly dispelled. The unique compilation of empirical findings specifically for adolescents is a boon to those pursuing research, teaching or evidence- based practice with this age group. This book will be mandatory reading for any mental health professional, including academics, graduate students, and clinicians working with or teaching about troubled adolescents. As a text, it is excellent for a graduate course on the subject, and an essential reference source for those teaching abnormal development at the undergraduate level or providing clinical service to adolescents and their families. The book will be a classic in the field and a mandatory starting point for any professional interested in a detailed overview of the state of the art in Western societies, including researchers interested in an overview of areas outside their own specific expertise. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital quality, parenting, and adolescent internalizing problems: A three-wave longitudinal study.

The present 3-wave, 3-year longitudinal study examined direct and indirect associations between marital quality, parenting, and adolescent internalizing problems, taking into account bidirectional associations between these concepts. Data were used from 428 Dutch families, consisting of 2 biological parents and 2 adolescents with mean ages of 13.4 and 15.2 years (at Time 1). Results from structural equation modeling analyses showed that low marital quality at Time 1 was directly related to adolescent internalizing problems at Time 2 in oldest siblings. However, support was not found for any indirect associations through parenting or for longitudinal associations from adolescent internalizing problems to parents' marital quality. Results are discussed in terms of implications for understanding the mechanism by which marital quality is related to adolescent internalizing problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child temperament moderates the impact of parental separation on adolescent mental health: The trails study.

The potential effect of parental separation during early adolescence on adolescent externalizing and internalizing problems was investigated in a longitudinal sample of adolescents (n = 1274; mean age = 16.27; 52.3% girls). Pre-separation mental health problems were controlled for. Building on a large number of studies that overall showed a small effect of parental separation, it was argued that separation may only or especially have an effect under certain conditions. It was examined whether child temperament (effortful control and fearfulness) moderates the impact of parental separation on specific mental health domains. Hypotheses were derived from a goal-framing theory, with a focus on goals related to satisfying the need for autonomy and the need to belong. Controlling for the overlap between the outcome domains, we found that parental separation led to an increase in externalizing problems but not internalizing problems when interactions with child temperament were ignored. Moreover, child temperament moderated the impact of parental separation, in that it was only related to increased externalizing problems for children low on effortful control, whereas it was only related to increased internalizing problems for children high on fearfulness. The results indicate that person-environment interactions are important for understanding the development of mental health problems and that these interactions can be domain-specific. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cloning and characterization of Rep-8 (D8S2298E) in the human chromosome 8p11.2-p12

Assessed the effect of co-occurring versus not co-occurring internalizing and externalizing behavior problems on the reasons parents reported for clinical referral of their adolescent child. Reasons for referral were coded for 181 inpatient adolescents, and parent ratings of internalizing and externalizing behavior were obtained for a general population sample of 500 adolescents. Parents concurrently reported internalizing and externalizing behavior as reasons for referral less frequently (p < .0001) than would be expected given the correlation between these two domains in the general population sample. This suggests that the presence of externalizing problems may decrease parents' concern or awareness of internalizing problems, the presence of internalizing problems may decrease parents' concern or awareness of externalizing problems, or both. Implications for the clinical referral of adolescents and for informal parental efforts at helping their children with externalizing and internalizing problems are discussed.     

Ubiquitin-immunohistochemical investigation of atypical Pick''s disease without Pick bodies

OBJECTIVE: To determine whether children between the ages of 8 and 12 years are able to reliably report internalizing symptoms over short to medium-length time intervals as measured by an objective self-report instrument of internalizing symptoms. METHOD: The Internalizing Symptoms Scale for Children (ISSC) was group-administered initially to 131 children and at subsequent intervals of 2 weeks, 4 weeks, and 12 weeks. RESULTS: Pearson product-moment correlations for the ISSC total scores of the participants were computed across the various retest intervals. At 2 weeks, the correlation was .84. At 4 weeks, the correlation was .76. After 12 weeks, the correlation was .74. CONCLUSIONS: These data indicate that children between 8 and 12 years old can reliably report their experience over short to medium-length intervals. These findings provide strong support for the ISSC as a research and clinical instrument for the assessment of internalizing symptoms in children between 8 and 12 years of age, which may ultimately prove beneficial in the identification and treatment of childhood internalizing disorders. Limitations and recommendations for future research are discussed.     

Evaluation and treatment of neurodevelopmental deficits in sexually aggressive children and adolescents.

Recent advances in developmental psychopathology demonstrate that comorbidities routinely appear in clinical samples of children and adolescents, particularly in those youngsters with disruptive behavior disorders and problems with aggressive behavior. This article discusses (a) the prevalence of comorbid neurodevelopmental deficits, particularly attention-deficit/hyperactivity disorder, in a clinical sample of 72 children and adolescents, ages 6-17, who displayed sexually aggressive behavior; (b) the theoretical implications of these findings; and (c) the relevance of this comorbidity for the clinical evaluation and treatment of sexually aggressive youth. Because adult models of psychopathology are limited, the need for a developmentally appropriate model for understanding sexual aggression in children is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Linking dimensional models of internalizing psychopathology to neurobiological systems: Affect-modulated startle as an indicator of fear and distress disorders and affiliated traits.

Integrative hierarchical models have sought to account for the extensive comorbidity between various internalizing disorders in terms of broad individual difference factors these disorders share. However, such models have been developed largely on the basis of self-report and diagnostic symptom data. Toward the goal of linking such models to neurobiological systems, we reviewed studies that have employed variants of the affect-modulated startle paradigm to investigate emotional processing in internalizing disorders as well as personality constructs known to be associated with these disorders. Specifically, we focused on four parameters of startle reactivity: fear-potentiated startle, inhibition of startle in the context of pleasant stimuli, context-potentiated startle, and general startle reactivity. On the basis of available data, we argue that these varying effects index differing neurobiological processes related to mood and anxiety disorders that are interpretable from the standpoint of dimensional models of the internalizing spectrum. Further, we contend that these empirical findings can feed back into and help reshape conceptualizations of internalizing disorders in ways that make them more amenable to neurobiological analysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relative plasticity, integration, temporality, and diversity in human development: A developmental contextual perspective about theory, process, and method.

Current research about adolescent development often is associated with ideas stressing that dynamic individual-context relations provide the bases of behavior and developmental change. The power of these ideas is constituted by 4 assumptive components of contemporary developmental theories: systematic change and relative plasticity; relationism and integration; embeddedness and temporality; and generalizability limits, diversity, and individual differences. A program of research adequate to address these ideas must involve longitudinal designs and diversity- and change-sensitive measures, multiple methods to appraise variables at multiple levels, and multiple cohorts to assess temporal change. Such theory-guided research may legitimate the possibility of enacting policies and programs to promote positive developmental trajectories in children and adolescents and thus capitalize on the human potential for plasticity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transmission intergénérationnelle des troubles intériorisés: Modèles théoriques et recherches empiriques.

It is well recognised that mental health disorders in parents are associated with internalizing disorders in their children. For better understanding of the nature of this association, this article presents a critical analysis of 5 theoretical models and of major findings from empirical studies conducted on this question in the past 15 years. Several psychosocial characteristics are found to be more frequent in families of depressed or anxious parents and are associated to a higher prevalence of internalizing disorders in their children. Two hypotheses are drawn from these findings : (a) The presence of internalizing disorders in a parent may contribute to the emergence of other at-risk conditions associated with internalizing disorders in children; and (b) the presence of some psychosocial characteristics may exacerbate the influence of being exposed to parental anxiety or depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric disorders and sexual risk among adolescents in mental health treatment.

Objective: To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and limited. Method: Eight hundred and forty adolescents (56% female, 58% African American, mean age = 14.9 years) and their parents completed computerized assessments of psychiatric symptoms via the Computerized Diagnostic Interview Schedule for Children (Shaffer, 2000a, 2000b). Adolescents also reported on sexual risk behaviors (vaginal/anal sex, condom use at last sex) and completed urine screens for a sexually transmitted infection (STI). Results: Adolescents meeting criteria for mania, externalizing disorders (oppositional defiant, conduct, and attention-deficit/hyperactivity disorders), or comorbid for externalizing and internalizing disorders (major depressive, generalized anxiety, and posttraumatic stress disorders) were significantly more likely to report a lifetime history of vaginal or anal sex than those who did not meet criteria for any psychiatric disorder (odds ratio [OR] = 2.0, 2.3, and 1.9, respectively). Adolescents meeting criteria for mania were significantly more likely to have 2 or more partners in the past 90 days (OR = 3.2) and to test positive for a STI (OR = 4.3) relative to adolescents who did not meet criteria for a psychiatric disorder. Conclusions: The presence of internalizing and externalizing disorders, especially mania, suggests the need for careful screening and targeting of adolescent sexual behavior during psychiatric treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risperidone treatment of children and adolescents with pervasive developmental disorders: a prospective open-label study

OBJECTIVE: To investigate the short-term safety and efficacy of risperidone in the treatment of children and adolescents with pervasive developmental disorders. METHOD: This was a 12-week, prospective, systematic, open-label trial that included 18 subjects (15 boys and 3 girls) with a mean age of 10.2 +/- 3.7 years. The sample included 11 subjects with autistic disorder, 3 with Asperger's disorder, 1 with childhood disintegrative disorder, and 3 with pervasive developmental disorder not otherwise specified. Fourteen subjects had comorbid mental retardation. Behavioral ratings were obtained during two baseline visits and again after 12 weeks of risperidone treatment. RESULTS: The optimal dose of risperidone for the 18 subjects was 1.8 +/- 1.0 mg/day. On the basis of the global improvement item of the Clinical Global Impression Scale, 12 of 18 subjects were considered responders. Significant improvement was seen in measures of interfering repetitive behavior, aggression and impulsivity, and some elements of impaired social relatedness. The most common side effect was weight gain (range 10 to 35 lb). CONCLUSIONS: These preliminary results suggest that risperidone may be effective for improving interfering behavioral symptoms in some children and adolescents with pervasive developmental disorders. Double-blind, placebo-controlled studies are needed before definitive statements of safety and efficacy can be made.     

Psychiatric Comorbidity and Substance Use Treatment Outcomes of Adolescents.

Treatment outcomes of 126 adolescents (13-18 years old) with comorbid substance use disorders (SUDs) and Axis I psychiatric disorders (mood, anxiety, conduct, and attention-deficit/hyperactivity disorders) were compared to 81 SUD adolescents with no additional Axis I disorder. Participants completed structured interviews and symptom measures while participating in an adolescent treatment program and at 6 months following treatment. Results indicated that comorbid youth received more treatment during the outcome period; despite this, more comorbid SUD-Axis I disordered adolescents used substances following treatment than SUD-only youth, even after controlling for socioeconomic status and ethnicity. Among comorbid youth, internalizing disordered adolescents were less likely to use substances during the follow-up period, and externalizing disordered youth returned to substance use most rapidly after discharge from treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbidity of anxiety and depression in children and adolescents.

Anxiety and depression in children and adolescents are reviewed, including differential diagnosis, assessment of symptoms, family history data, developmental features, and clinical correlates. Findings indicate that 15.9% to 61.9% of children identified as anxious or depressed have comorbid anxiety and depressive disorders and that measures of anxiety and depression are highly correlated. Family history data are inconclusive. Differences emerged among children with anxiety, depression, or both disorders. Anxious children were distinguishable from the other 2 groups in that they showed less depressive symptomatology and tended to be younger. The concurrently depressed and anxious group tended to be older and more symptomatic. In this group, the anxiety symptoms tended to predate the depressive symptoms. Findings are discussed in the context of a proposed developmental sequence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parental depression and interparental conflict: Children and adolescents’ self-blame and coping responses.

The present study examined the role of children and adolescents’ perceptions of self-blame specific to interparental conflict and children and adolescents’ coping behaviors in the context of parental depression as predictors of internalizing and externalizing symptoms in a sample of 108 youth (age 9–15 years old) of parents with a history of depression. Higher levels of current depressive symptoms in parents were associated with higher levels of interparental conflict and higher levels of internalizing symptoms in children and adolescents, and interparental conflict was positively associated with both internalizing and externalizing symptoms in children/adolescents. Consistent across a series of multiple regression models, children and adolescents’ perceptions of self-blame and use of secondary control coping (acceptance, distraction, cognitive restructuring, positive thinking) were significant, independent predictors of both internalizing and externalizing symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subtyping children and adolescents who are overweight: Different symptomatology and treatment outcomes.

Children and adolescents who are overweight are a heterogeneous group. Whether pretreatment characteristics, such as dietary restraint and psychopathology, are related to differential treatment outcomes was not studied before. Using cluster analysis, the authors of this study examined the validity of subtyping along dietary restraint and internalizing psychopathology in 2 independent samples of treatment-seeking children and adolescents who were overweight (Study 1: n = 200; Study 2: n = 120). Three subtypes emerged: a dietary restraint/internalizing (DR/IN) group, a pure internalizing (IN) group, and a nonsymptomatic (NS) group. The DR/IN subtype showed more problems than the NS subtype, with complete consistency across the 2 studies for 1/4 of the validating variables. Although total weight change was not different across subtypes, compared with NS, the DR/IN and IN subtypes had a less positive weight prognosis during follow-up. Restraint scores only showed increases over time in the initially low-restraint IN group. These findings suggest that individual characteristics, such as degree of dietary restraint and internalizing psychopathology, can be useful in (a) classifying children and adolescents who are overweight, (b) stipulating specific treatment guidelines, and (c) making differential prognoses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stressful life events, anxiety sensitivity, and internalizing symptoms in adolescents.

Anxiety sensitivity represents a robust risk factor for the development of anxiety symptoms among both adolescents and adults. However, the development of anxiety sensitivity among adolescents remains inadequately understood. In this study, the authors examined the role of stressful life events as a risk factor for the development of elevated anxiety sensitivity. Anxiety sensitivity was then examined in a longitudinal design as a mechanism linking stressful life events to changes in anxiety symptoms. Stressful life events, anxiety sensitivity, and internalizing symptoms were assessed in a diverse community sample of adolescents (N = 1,065) at 3 time points spanning 7 months. The results indicated that stressful life events were longitudinally associated with increases in anxiety sensitivity and that certain types of stressful life events, specifically events related to health and events related to family discord, were differentially predictive of increases in anxiety sensitivity. Moreover, anxiety sensitivity mediated the longitudinal relation between stressful life events and anxiety symptoms. Evidence was also found for the predictive specificity of anxiety sensitivity to symptoms of anxiety but not depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Panic disorder in children and adolescents: new developments, new directions

Reviewed panic attacks and panic disorders in children and adolescents critically and highlighted new developments. It is concluded that panic attacks and panic disorder are common in adolescence and that they are responsive to cognitive-behavioral treatment regimens. It is also concluded that although panic attacks and panic disorder are less common in children, they are nonetheless present. It is important to note, however, that their expression in childhood may vary from the clinical features seen in adolescence and adulthood. Specifically, it is suggested that most panic attacks in childhood are associated with particular events and are not unexpected or "out of the blue." Moreover, noncatastrophic interpretations of the symptoms of panic prevail. A developmental model for the onset, course, and correlates of panic in children is put forth.