Psychosocial correlates of childhood anxiety disorders

OBJECTIVE: This study explored psychosocial and "environmental" correlates of childhood anxiety disorders. The study examined relationships among parental psychiatric symptomatology, perceived family environment, temperament, and self-competence in children with a DSM-III-R anxiety disorder. METHOD: A community sample of third through sixth graders was screened initially for symptoms of test anxiety. Those with high and low scores were administered the Anxiety Disorders Interview Schedule for Children. Three groups (childhood anxiety disorder, test-anxious only, and normal controls) were identified and compared on the psychosocial variables. RESULTS: Children with an anxiety disorder had greater impairment on the indices of perceived self-competence and temperamental flexibility than controls, with the test-anxious children showing intermediate, yet significant, levels of disturbance. There was a trend for children with an anxiety disorder to describe their families as less promoting of independence than the other groups. Finally, measures of parental psychiatric symptomatology revealed more obsessive-compulsive symptoms for the fathers of both the anxiety disorder and test-anxious children compared with controls. CONCLUSIONS: Results are consistent with previous findings suggesting the familial transmission of anxiety disorders and recent speculations regarding a relationship between behavioral inhibition, environmental control, and anxiety. Further research may isolate psychosocial and family environmental factors as instrumental treatment targets in the management of childhood anxiety disorders.     

Coping and parenting: Mediators of 12-month outcomes of a family group cognitive–behavioral preventive intervention with families of depressed parents.

Objective: In a randomized clinical trial with 111 families of parents with a history of major depressive disorder (86% mothers, 14% fathers; 86% Caucasian, 5% African-American, 3% Hispanic, 1% American Indian or Alaska Native, 4% mixed ethnicity), changes in adolescents' (mean age = 11 years; 42% female, 58% male) coping and parents' parenting skills were examined as mediators of the effects of a family group cognitive–behavioral preventive intervention on adolescents' internalizing and externalizing symptoms. Method: Changes in hypothesized mediators were assessed at 6 months, and changes in adolescents' symptoms were measured at a 12-month follow-up. Results: Significant differences favoring the family intervention compared with a written information comparison condition were found for changes in composite measures of parent–adolescent reports of adolescents' use of secondary control coping skills and direct observations of parents' positive parenting skills. Changes in adolescents' secondary control coping and positive parenting mediated the effects of the intervention on depressive, internalizing, and externalizing symptoms, accounting for approximately half of the effect of the intervention on the outcomes. Further, reciprocal relations between children's internalizing symptoms and parenting were found from baseline to 6-month follow-up. Conclusion: The present study provides the first evidence for specific mediators of a family group cognitive–behavioral preventive intervention for families of parents with a history of major depressive disorder. The identification of both coping and parenting as mediators of children's mental health outcomes suggests that these variables are important active ingredients in the prevention of mental health problems in children of depressed parents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective four-year follow-up study of children at risk for ADHD: psychiatric, neuropsychological, and psychosocial outcome

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is a familial disorder that places the siblings of ADHD children at high risk for ADHD, conduct, mood, and anxiety disorders. Although the pattern of psychiatric risk has been well documented by prior family studies, neither the short- nor long-term outcome of these high-risk siblings has been prospectively examined. OBJECTIVE: To document the 4-year psychiatric, psychosocial, and neuropsychological outcome of the siblings of children with ADHD. METHOD: DSM-III-R structured diagnostic interviews and blind raters were used to conduct a 4-year follow-up of siblings from ADHD and control families. The siblings were also evaluated for cognitive, achievement, social, school, and family functioning. RESULTS: At follow-up, significant elevations of behavioral, mood, and anxiety disorders were found among the siblings of ADHD children. The high-risk siblings had high rates of school failure and showed evidence of neuropsychological and psychosocial dysfunction. These impairments aggregated among the siblings who had ADHD. CONCLUSIONS: The siblings of ADHD children are at high risk for clinically meaningful levels of psychopathology and functional impairment. In addition to supporting hypotheses about the familial transmission of ADHD, the results suggest that the high-risk siblings might be appropriate targets for primary preventive interventions.     

Social Effectiveness Therapy for Children: Three-Year Follow-Up.

This study reports the results of a 3-year follow-up assessment of children and adolescents diagnosed with social anxiety disorder (social phobia) and treated with Social Effectiveness Therapy for Children (SET-C), a comprehensive behavioral treatment program combining social skills training, peer generalization, and individualized exposure. Among 32 children initially treated with the protocol, 29 completed the follow-up assessment and were evaluated with a multidimensional assessment strategy, including self-report, parental report, clinician ratings, and behavioral assessment. Results indicated that the majority of posttreatment gains were maintained at 3-year follow-up, and 72% of treated children continued to be free of a social phobia diagnosis 3 years later. These findings support the long-term efficacy of SET-C for children and adolescents suffering from social phobia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral treatment of anxiety disorders in children: Long-term (6-year) follow-up.

Authors evaluated the long-term effectiveness of cognitive–behavioral therapy (CBT) for childhood anxiety disorders. Fifty-two clients (aged 14 to 21 years) who had completed treatment an average of 6.17 years earlier were reassessed using diagnostic interviews, clinician ratings, and self- and parent-report measures. Results indicated that 85.7% no longer fulfilled the diagnostic criteria for any anxiety disorder. On a majority of other measures, gains made at 12-month follow-up were maintained. Furthermore, CBT and CBT plus family management were equally effective at long-term follow-up. These findings support the long-term clinical utility of CBT in treating children and adolescents suffering from anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social skills, social outcomes, and cognitive features of childhood social phobia.

Social skills, social outcomes, self-talk, outcome expectancies, and self-evaluation of performance during social-evaluative tasks were examined with 27 clinically diagnosed social phobic children ages 7–14 and a matched nonclinical group. Results showed that, compared with their nonanxious peers, social phobic children demonstrated lower expected performance and a higher level of negative self-talk on social-evaluative tasks. In addition, social phobic children showed social skills deficits as assessed by self- and parent report, an assertiveness questionnaire, and direct behavioral observation. Furthermore, compared with the control group, social phobic children were rated by themselves and others as significantly less socially competent with peers and were found to be less likely to receive positive outcomes from peers during behavioral observation. Implications for the assessment and treatment of childhood social phobia are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting time to recovery among depressed adolescents treated in two psychosocial group interventions.

Aims were to identify the demographic, psychopathology, and psychosocial factors predicting time to major depressive disorder (MDD) recovery and moderators of treatment among 114 depressed adolescents recruited from a juvenile justice center and randomized to a cognitive behavioral treatment (CBT) condition or a life skills-tutoring control condition. Nine variables predicted time to recovery over 1-year follow-up (e.g., earlier MDD onset, attention-deficit/hyperactivity disorder, functional impairment, hopelessness, negative thoughts, low family cohesion, coping skills); suicidal ideation and parental report of problem behaviors were the best predictors. CBT resulted in faster recovery time relative to control treatment, specifically among adolescents of White ethnicity, with recurrent MDD, and with good coping skills. Results suggest that psychopathology plays a more prominent role in maintaining adolescent depression than demographic or psychosocial factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parental alcoholism and childhood psychopathology.

We reviewed studies about children of alcoholic parents published between 1975 and 1985 to clarify the relation between parental alcoholism and child psychopathology. We identified methodological problems in this body of literature and organized substantive findings around eight areas of outcome: (a) hyperactivity and conduct disorder; (b) substance abuse, delinquency, and truancy; (c) cognitive functioning; (d) social inadequacy; (e) somatic problems; (f) anxiety and depressive symptoms; (g) physical abuse; and (h) dysfunctional family interactions. The literature as a whole supported the contention that parental alcoholism is associated with a heightened incidence of child symptoms of psychopathology, in comparison with no increased incidence in offspring of nondisturbed parents. However, neither all nor a major portion of the population of children from alcoholic homes are inevitably doomed to childhood psychological disorder. Findings are discussed in terms of causality, child resiliency, and potential qualifying factors, such as variations in family disruption. Recommendations are presented regarding methodological improvements, possible mediating variables, and a multiple-risk conceptualization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of personality disorders among patients with anxiety disorders

Outpatients with a principal diagnosis of an anxiety disorder (n = 347) were administered the Structured Clinical Interview for DSM-III-R/Axis II Disorders (SCID-II) during their intake evaluation. At least one personality disorder was found in 35% of these patients. Patients with social phobia (61%) and generalized anxiety disorder (49%) were most often diagnosed with a personality disorder. Patients with simple phobia were rarely diagnosed with a personality disorder (12%). The most commonly diagnosed personality disorders were from the "anxious/fearful" cluster (27% received at least one diagnosis from cluster C), most notably avoidant and obsessive-compulsive personality. Our findings suggest that personality disorders, in general, are less prevalent among anxious patients than among depressive patients.     

Disentangling the overlap between Tourette's disorder and ADHD

OBJECTIVE: To identify similarities and differences in neuropsychiatric correlates in children with Tourette's syndrome (TS) and those with ADHD. METHOD: The sample consisted of children with Tourette's syndrome with ADHD (N = 79), children with Tourette's syndrome without ADHD (N = 18), children with ADHD (N = 563), psychiatrically referred children (N = 212), and healthy controls (N = 140). RESULTS: Disorders specifically associated with Tourette's syndrome were obsessive compulsive disorder (OCD) and simple phobias. Rates of other disorders, including other disruptive behavioral, mood, and anxiety disorders, neuropsychologic correlates, and social and school functioning were indistinguishable in children with Tourette's and ADHD. However, children with Tourette's syndrome plus ADHD had more additional comorbid disorders overall and lower psychosocial function than children with ADHD. CONCLUSIONS: These findings confirm previously noted associations between Tourette's syndrome and OCD but suggest that disruptive behavioral, mood, and anxiety disorders as well as cognitive dysfunctions may be accounted for by comorbidity with ADHD. However, Tourette's syndrome plus ADHD appears to be a more severe condition than ADHD alone.     

Anxiety and depression in children and adolescents: Negative affectivity and the utility of self-reports.

Self-reported depression and anxiety were examined in 233 inpatient children (aged 6–17 yrs) diagnosed with either an anxiety disorder or a depressive disorder. Depressed children reported more problems related to a loss of interest and low motivation, and they had a more negative view of themselves. Anxious children reported more worry about the future, their well-being, and the reactions of others. The groups did not differ in the degree of depressed affect reported in terms of being sad, lethargic, bothered by things, or feeling alone and isolated. Findings suggest that a general negative affectivity component is common to both anxiety and depression disorders and measures. Results demonstrate that anxiety and depression in children have distinguishing features that can be measured by common self-report instruments, and the findings indicate that one factor that may distinguish between anxiety and depression in children is positive affectivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intellectual ability and achievement in psychiatrically hospitalized children with conduct, anxiety, and affective disorders.

The IQ and academic achievement of psychiatrically hospitalized children were studied. The sample consisted of 76 children, with a mean age of 10 years, who received diagnoses of conduct, oppositional, anxiety, and affective disorders on the basis of a structured diagnostic interview. A relative deficit in verbal abilities was observed for conduct-disordered children, extending to preadolescents the findings previously obtained for adolescent delinquents. Depressed children were characterized by underachievement, which is consistent with the learned helplessness literature. Contrary to expectations, children with an anxiety disorder had a lower IQ than children without the disorder. No cognitive deficits were observed for children diagnosed as oppositional. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sleep Deprivation in social phobia and generalized anxiety disorder

BACKGROUND: Sleep deprivation has been shown to improve depressive symptoms in some patients with major depressive disorder, but it has not been tested in patients with generalized anxiety disorder (GAD) or social phobia (SP). METHODS: To determine if sleep deprivation altered anxiety or depressive symptoms in patients with GAD (n = 7) or SP (n = 8), we sleep deprived patients and normal controls (n = 18) for one night. RESULTS: On one measure of anxiety, GAD patients improved compared with controls, but there were otherwise no significant change differences between controls and SP or GAD patients. CONCLUSIONS: The lack of benefit is consistent with previous findings that sleep deprivation provides no benefit to patients with other anxiety disorders. Sleep deprivation may be a biological intervention that distinguishes anxiety from affective disorders.     

The Relationship Between Automatic Thoughts and Negative Emotions in Children and Adolescents: A Test of the Cognitive Content-Specificity Hypothesis.

The aim of this study was to test the cognitive content-specificity hypothesis in children and adolescents aged 7-16 years. Participants consisted of a community sample of 200 youth and a clinical sample of 160 youth with anxiety, depressive, or disruptive behavior disorders. Participants completed several self-report measures assessing a wide range of negative beliefs and symptoms of internalizing and externalizing problems. Multivariate analyses examining the interrelationships between beliefs and noncognitive symptoms revealed that thoughts on loss or personal failure were the strongest predictors of depressive symptoms, thoughts on social threat were the strongest predictors of anxiety symptoms, and thoughts on hostility or revenge were the strongest predictors of aggression. Results showed clear evidence of cognitive-affective specificity across both internalizing and externalizing problems in youth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of depressive, conduct, and comorbid disorders and social functioning in childhood

OBJECTIVE: To examine the relationship of depressive, conduct, and comorbid disorders and social functioning in psychiatrically referred youths. METHOD: Subjects were 94 boys and 67 girls (mean age at initial assessment = 11.5 years) who were repeatedly evaluated with standardized instruments during a mean interval of 4.4 years. On the basis of their diagnoses during the follow-up, children were designated as having had depressive, conduct, or both (comorbid) disorders or other conditions. Two domains of social functioning were assessed: social competence and self-esteem. RESULTS: Longitudinal analyses revealed that at any given point in time, depressive, conduct, and comorbid disorders were associated with low social competence and depressive disorder also was associated with low self-esteem. At the approximate age of 15 years, on average, children with a history of conduct or comorbid disorders had lower social competence than did children with a history of depressive disorder, but these groups endorsed similar levels of self-esteem. CONCLUSION: Some areas of social dysfunction associated with comorbid depressive and conduct disorders appear to reflect mostly the effects of conduct disorder. The latter condition has a more severe and longer-term impact on children's social competence than does depression. In addition, whereas depression has an adverse effect on self-esteem, this effect appears to be temporary.     

Parent, family, and disease factors as predictors of psychosocial functioning in children with cystic fibrosis.

Examined the relative contribution of disease, parental, and family factors on the psychological and social functioning of children with cystic fibrosis. 33 patients (7–16 yrs old) and 29 mothers completed a battery of tests, including a state-trait anxiety inventory, the Beck Depression Inventory, and a coping health inventory for parents developed by H. I. McCubbin et al (1983). Results show that Ss' self-esteem and occurrence of behavioral problems were associated with maternal trait anxiety, overprotection, and the impact of disease on family functioning. Social competence and athletic self-esteem were associated with nutritional status. Results reflect the need for clinicians to be sensitive to parental and family functioning when dealing with behavioral problems and to consider physical status when providing treatment of social problems. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integration of positive and negative affectivity and cognitive content-specificity: Improved discrimination of anxious and depressive symptoms.

In a sample of 159 psychiatric outpatient adults, negative affectivity (NA) was significantly correlated with a broad range of anxiety and depressive symptoms and was not useful for the differentiation of anxiety from depression. Low positive affectivity (PA) was significantly related only to depressive symptoms. Whereas depressive cognitions demonstrated discriminant capability, anxiety cognitions (in isolation) demonstrated nonspecificity. A combination of NA and anxious cognitions significantly predicted anxiety symptoms, better than did cognitions or affect alone. NA, depressive cognitions, and low PA significantly predicted depressive symptoms. Results support the integration of affective and cognitive models for the discrimination of anxious from depressive symptoms and have implications for measure development. Modifications in the cognitive content-specificity theory of anxiety states are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unique and common mechanisms of change across cognitive and dynamic psychotherapies.

The goal of this article was to examine theoretically important mechanisms of change in psychotherapy outcome across different types of treatment. Specifically, the role of gains in self-understanding, acquisition of compensatory skills, and improvements in views of the self were examined. A pooled study database collected at the University of Pennsylvania Center for Psychotherapy Research, which includes studies conducted from 1995 to 2002 evaluating the efficacy of cognitive and psychodynamic therapies for a variety of disorders, was used. Patient samples included major depressive disorder, generalized anxiety disorder, panic disorder, borderline personality disorder, and adolescent anxiety disorders. A common assessment battery of mechanism and outcome measures was given at treatment intake, termination, and 6-month follow-up for all 184 patients. Improvements in self-understanding, compensatory skills, and views of the self were all associated with symptom change across the diverse psychotherapies. Changes in self-understanding and compensatory skills across treatment were predictive of follow-up symptom course. Changes in self-understanding demonstrated specificity of change to dynamic psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trajectories of emotional well-being in mothers of adolescents and adults with autism.

Raising an adolescent or adult child with a developmental disability confers exceptional caregiving challenges on parents. We examined trajectories of 2 indicators of emotional well-being (depressive symptoms and anxiety) in a sample of primarily Caucasian mothers (N = 379; M age = 51.22 years at Time 1) of adolescent and adult children with an autism spectrum disorder (ASD; M age = 21.91 years at Time 1, 73.2% male). We also investigated within-person associations of child context time-varying covariates (autism symptoms, behavior problems, residential status) and maternal context time-varying covariates (social support network size and stressful family events) with the trajectories of emotional well-being. Data were collected on 5 occasions across a 10-year period. Average patterns of stable (depressive symptoms) and improved (anxiety) emotional well-being were evident, and well-being trajectories were sensitive to fluctuations in both child and maternal context variables. On occasions when behavior problems were higher, depressive symptoms and anxiety were higher. On occasions after which the grown child moved out of the family home, anxiety was lower. Anxiety was higher on occasions when social support networks were smaller and when more stressful life events were experienced. These results have implications for midlife and aging families of children with an ASD and those who provide services to these families. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal.

Using outpatients with anxiety and mood disorders (N?=?350), the authors tested several models of the structural relationships of dimensions of key features of selected emotional disorders and dimensions of the tripartite model of anxiety and depression. Results supported the discriminant validity of the 5 symptom domains examined (mood disorders; generalized anxiety disorder, GAD; panic disorder; obsessive-compulsive disorder; social phobia). Of various structural models evaluated, the best fitting involved a structure consistent with the tripartite model (e.g., the higher order factors, negative affect and positive affect, influenced emotional disorder factors in the expected manner). The latent factor, GAD, influenced the latent factor, autonomic arousal, in a direction consistent with recent laboratory findings (autonomic suppression). Findings are discussed in the context of the growing literature on higher order trait dimensions (e.g., negative affect) that may be of considerable importance to tube understanding of the pathogenesis, course, and co-occurrence of emotional disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)