A Review of “Child Anxiety Disorders: A Family-Based Treatment Manual for Practitioners”

This study investigated the relationship between intimate partner violence (IPV) perpetrated by women and the attachment style of each partner in 20 couples in which the male partner was in therapy for abusive men. Results confirmed the presence of a relationship between IPV and attachment style. Men with an avoidant attachment reported higher physical abuse victimization and higher use of negotiation during conflict, as revealed by their partner. Women with an anxious attachment reported having inflected more injuries and were less likely to use negotiation during conflict, as revealed by their partner. Findings highlight the relational basis of IPV.     

Children’s Perspectives of an Enhanced Cognitive-Behavioral Treatment for Child–Parent Dyads With Anxiety Disorders

Prior research has extensively evaluated the efficacy of cognitive-behavioral therapy (CBT) for child anxiety disorders—however, few studies have investigated anxious children’s perspectives and experiences of participating in CBT. This qualitative study explored children’s acceptability of a newly developed enhanced CBT intervention, designed specifically for the treatment of anxiety disorders in children with a clinically anxious parent. The study also explored children’s perceptions and experiences of individual (child only) and joint observational (child–parent) exposure activities that were key to the intervention. Ten children (age range 6–11, M = 8.5 years) and their mothers (age range 34–45, M = 39.5 years) completed in-depth semistructured interviews to investigate child participants’ anticipated and experiential acceptability of the enhanced CBT intervention. Thematic analysis revealed seven major themes broadly reflecting the acceptability, appropriateness, and perceived benefit of the intervention elements, with particular value credited to exposure tasks and the dyadic nature of the intervention. Findings suggest that future experimental evaluation of the enhanced intervention is warranted. Further, the study highlights that CBT for child anxiety disorders, where exposure work is a feature, is acceptable and perceived to be effective by its intended treatment recipients. Trial prospectively registered, preresults, ANZCTR1261900033410.     

Perceived Control,Family Environment,and the Etiology of Child Anxiety—Revisited

In 1998, Chorpita, Brown, and Barlow published a now seminal study in Behavior Therapy examining the development of anxiety in children and adolescents using Barlow’s 1988 model of the development of anxiety in adults. Mindful of developmental considerations, parental control and children’s perceptions of control were considered key factors in this revised model. Since that study, mixed support has accumulated for the role of control, both parental control and children’s perceptions of that control, in the development of childhood anxiety. As a result, the measurement of these constructs has been critically examined and refined in recent years and encouraging findings have been obtained. Unfortunately, however, the Chorpita and colleagues study as well as the studies that have followed have used cross-sectional designs and the directionality of effects has not been clearly established. Longitudinal studies are required. Here, we present a qualitative review of these developments and provide directions for future research.     

Childhood Anxiety/Withdrawal, Adolescent Parent–Child Attachment and Later Risk of Depression and Anxiety Disorder

Previous research has shown that children with high levels of early anxiety/withdrawal are at increased risk of later anxiety and depression. It has also been found that positive parent–child attachment reduces the risk of these disorders. The aim of this paper was to examine the extent to which positive parent–child attachment acted to mitigate the risk of later internalising disorders amongst children with high levels of early anxiety/withdrawal using data from a 30 years longitudinal study of a New Zealand birth cohort. The findings of this study showed that: (a) increasing rates of early anxiety/withdrawal were associated with an increased risk of later anxiety and depression; (b) positive parent–child attachment in adolescence was associated with a decline in the risk of later anxiety and depression; and (c) these associations persisted even after controlling for confounding factors. The implications of these findings for the role of parent–child attachment in mitigating the adverse effects of early anxiety/withdrawal are discussed. It is concluded that positive parent–child attachment in adolescence may act as a compensatory factor which buffers the adverse effects of childhood anxiety/withdrawal on risks of developing later anxiety and depression.     

What Do Youth Referred for Anxiety Problems Worry About? Worry and Its Relation to Anxiety and Anxiety Disorders in Children and Adolescents

This study examined worry and the parameters of worry that may be associated with clinical anxiety in a sample of 119 children and adolescents referred to a childhood anxiety disorders specialty clinic. Using an interviewing procedure, results indicated that the types of worries reported by the children were similar to those reported in previous studies of nonreferred community children. Also similar to previous community studies were findings showing moderate but significant correlations between different indices of worry (i.e., number, intensity, and frequency of the worries) and children's scores on self-rating scales of anxiety. Results further indicated that worry contributed additional variance beyond that of anxiety in predicting fear. In addition, intensity differentiated clinic children's worries from nonreferred children's. Intensity, and number of worries differentiated subsamples of children within the clinic-referred sample (i.e., children with overanxious disorder or generalized anxiety disorder and children with simple phobia). The importance of examining children's worries to further understand anxiety and its disorders in youth is discussed.     

Parental Modeling,Reinforcement, and Information Transfer: Risk Factors in the Development of Child Anxiety?

The purpose of this article is to provide a comprehensive review and a conceptual integration of research examining the potential role of learning from parents in the development of child anxiety. Specifically, research in this area is discussed within the framework of three specific mechanisms: parental modeling, information transfer, and parental reinforcement of anxious/avoidant behavior. Implications of the research in this area are discussed, as well as limitations and directions for future research.     

Prenatal Maternal Distress: A Risk Factor for Child Anxiety?

The deleterious association between various types of prenatal maternal psychological distress (PNMS, anxiety, depression, psychological distress, stress) and childhood anxiety symptomatology (internalizing behaviors, anxiety symptoms) has been established using both retrospective and prospective longitudinal studies across varied demographic cohorts and throughout development. Yet, the existing literature cannot claim maternal distress during pregnancy to be a specific risk factor for anxiety symptomatology, as studies utilizing such observational designs are unable to adequately account for confounding of potential genetic factors and the postnatal environment. In this review, we examine studies that attempt to minimize such confounding and thus disentangle the unique intrauterine exposure effect of varying types of PNMS on childhood anxiety symptomatology. Such methodologies include paternal versus maternal comparison studies, sibling comparisons, prenatal cross-fostering designs and timing of exposure studies (including disaster studies). Of the identified studies, findings indicate that prenatal maternal distress is likely to constitute a risk factor for anxiety symptomatology, although more studies are needed to replicate current findings in order to determine whether there are clear differences in effects across specific types of PNMS and for specific subpopulations. We review the methodological limitations and strengths of the literature prior to exploring avenues of future research and implications for theory and clinical practice.     

Child conduct problems: Disorders in conduct or social continuity?

This paper outlines data and speculations relevant to a social continuity hypothesis regarding the development of children's conduct problems. According to the hypothesis, conduct problems arise from an absence of continuity in the child's relationship with parents. This absence constitutes an unpredictable and aversive context for the child, and because the youngster's disruptive conduct can generate short term continuity, that behavior is likely to be reinforced. A review of research concerning this hypothesis is presented and the conclusions focus on evidence of continuity in cooperative parent-child exchanges and discontinuity in non-compliant exchanges. The grounding of this hypothesis within social learning and theory is outlined and its heuristic value for future research and clinical interventions is presented.     

Unique Roles of Mothering and Fathering in Child Anxiety; Moderation by Child’s Age and Gender

We examined the associations between the parenting dimensions autonomy granting, over control, and rejection and children’s anxiety, in relation to parent and child gender and child age. Elementary school-aged children (n = 179, M _age = 10.27, SD = 1.30), adolescents (n = 127, M _age = 15.02, SD = 1.54) and both their parents completed questionnaires on parenting and children’s anxiety. Parenting was more strongly related to child anxiety in elementary school children than in adolescents. Maternal over control was uniquely related to elementary school-aged children’s anxiety whereas paternal over control was more important during adolescence. Opposite to our expectations, we found higher levels of parental autonomy granting to be related to higher levels of anxiety for younger elementary school-aged children (age < 10). For adolescents, the association between paternal over control and anxiety was stronger for older adolescents (age > 15), with higher levels of over control related to higher levels of anxiety. For both elementary school-aged children and adolescents, the associations between parenting and child anxiety did not differ as a function of the child’s gender. If we are to understand the associations between parenting and children’s anxiety, it is important to distinguish parental autonomy granting from parental over control and to consider the role of parent gender and the age of the child.     

A Parent–Child Interactional Model of Social Anxiety Disorder in Youth

In this paper, one of the most common disorders of childhood and adolescence, social anxiety disorder (SAD), is examined to illustrate the complex and delicate interplay between parent and child factors that can result in normal development gone awry. Our parent–child model of SAD posits a host of variables that converge to occasion the onset and maintenance of this disorder. Specifically, five risk factors—temperamental characteristics of the child, parental anxiety, attachment processes in the parent–child dyad, information processing biases, and parenting practices—will be highlighted. While it is acknowledged that other factors including genetic influences and peer relationships may also be important, they are simply not the focus of this paper. Within these constraints, the implications of our parent–child interaction model for prevention, treatment, research, and practice will be explored.     

Anxiety in Children with Mood Disorders: A Treatment Help or Hindrance?

This study examined the role of comorbid anxiety in treatment outcome for children with mood disorders (N = 165; age 8–11) participating in Multi-Family Psychoeducational Psychotherapy (MF-PEP). Assessments occurred at baseline, 6, 12, and 18 months for two randomly assigned groups: immediate treatment and 1-year wait-list. Most children (69%) had comorbid anxiety disorders. Baseline comorbid anxiety, as reported on the Children’s Interview for Psychiatric Syndromes (ChIPS), was associated with higher Children’s Depression Rating Scale- Revised (CDRS-R) scores but not Young Mania Rating Scale (YMRS) scores. Higher levels of anxiety symptoms were associated with lower Children’s Global Assessment Scale (C-GAS) scores. Participation in MF-PEP did not significantly reduce anxiety symptoms (p = 0.62). However, presence of comorbid anxiety did not impede reduction in depressive (CDRS-R, p = 0.74) or manic (YMRS scores, p = 0.94) symptoms following MF-PEP. More baseline anxiety symptoms were associated with greater improvement in C-GAS scores post-treatment (p = 0.02). Implications are discussed.     

Computer‐Aided Psychotherapy for Anxiety Disorders: A Meta‐Analytic Review

Computer‐aided psychotherapy (CP) is said to (1) be as effective as face‐to‐face psychotherapy, while requiring less therapist time, for anxiety disorder sufferers, (2) speed access to care, and (3) save traveling time. CP may be delivered on stand‐alone or Internet‐linked computers, palmtop computers, phone‐interactive voice response, DVDs, and cell phones. The authors performed a meta‐analysis of 23 randomised controlled studies (RCTs) that compared CP with non‐CP in anxiety disorders: phobias, n = 10; panic disorder/agoraphobia, n = 9; PTSD, n = 3; obsessive–compulsive disorder, n = 1. Overall mean effect size of CP compared with non‐CP was 1.08 (95% confidence interval: 0.84–1.32). CP and face‐to‐face psychotherapy did not differ significantly from each other (13 comparisons, d = ?0.06). Much caution is needed when interpreting the findings indicating that outcome was unrelated to type of disorder, type of comparison group, mode of CP delivery (Internet, stand‐alone PC, palmtop), and recency of the CP system and that effect size decreased when more therapist time was replaced by the computer. Because CP as a whole was as effective as face‐to‐face psychotherapy, certain forms of CP deserve to be integrated into routine practice.     

Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders

Despite striking empirical support, exposure-based treatments for anxiety disorders are underutilized. This is partially due to clinicians’ concerns that patients may reject exposure or experience severe side effects, particularly in intensive forms of exposure. We examined acceptance and side effects of two randomly assigned variants of prediction error-based exposure treatment differing in temporal density (1 vs. 3 sessions/week) in 681 patients with panic disorder, agoraphobia, social anxiety disorder, and multiple specific phobias. Treatment acceptance included treatment satisfaction and credibility, engagement (i.e., homework completion), and tolerability (i.e., side effects, dropout, and perceived treatment burden). Side effects were measured with the Inventory for the Balanced Assessment of Negative Effects of Psychotherapy (INEP). We found treatment satisfaction, credibility, and engagement to be equally high in both variants of exposure-based treatment, despite higher treatment burden (β = 0.25) and stronger side effects (β = 0.15) in intensified treatment. 94.1% of patients reported positive effects in the INEP. 42.2% reported side effects, with treatment stigma (16.6%), low mood (14.8%) and the experience to depend on the therapist (10.9%) being the most frequently reported. The mean intensity of side effects was low. We conclude that prediction error-based exposure treatment is well accepted by patients with different anxiety disorders and that patients also tolerate temporally intensified treatment, despite higher perceived treatment burden and stronger side effects. Clinicians should be aware of the most frequent side effects to take appropriate countermeasures. In sum, temporal intensification appears to be an acceptable strategy to achieve faster symptom reduction, given patients’ well-informed consent.     

Experiential Avoidance and Anxiety Sensitivity: Independent and Specific Associations with Children’s Depression,Anxiety, and Social Anxiety Symptoms

Experiential avoidance (EA) is a key component in acceptance and commitment therapy (ACT) theory and research. EA is associated with a wide range of psychopathology in adults including anxiety, in particular social anxiety, and depression, yet little research exists on EA in youth. Anxiety sensitivity (AS), like EA, has been viewed as a form of distress tolerance or emotion regulation. In a sample of 124 children (age 10 to 12), this study examined the independent and specific relations of EA and AS to children’s depression, anxiety, and social anxiety symptoms, both before and after controlling for comorbid symptoms. EA and AS had independent associations with each of children’s depression, anxiety, and social anxiety; and EA had significantly stronger relations than AS with each of children’s social anxiety and anxiety. After controlling for depression, only EA (and not AS) was uniquely related to both children’s anxiety and social anxiety. After controlling for anxiety and social anxiety, only AS (and not EA) was uniquely related to depression. After controlling for depression and social anxiety, neither EA nor AS was significantly related to anxiety. In contrast, after controlling for depression and anxiety, EA (and not AS) showed a significant and unique relation to children’s social anxiety. These findings indicate: 1) there are distinctions between EA and AS; 2) EA and AS are overlapping yet independent correlates for each of depression, anxiety and social and anxiety; and 3) EA and AS show some differential relations with children’s depression, anxiety, and social anxiety when comorbid symptoms are considered. Theoretical and treatment implications are highlighted.     

(Re)Conceptualizing Sleep Among Children with Anxiety Disorders: Where to Next?

Children with anxiety disorders (AD) characteristically complain of sleep problems and the extent to which cognitive behavioral treatments (CBT) for childhood anxiety produce sleep-based improvements is a topic of increasing interest. The current paper reviews available evidence for subjective sleep complaints and objective sleep alterations in children and adolescents with AD, including investigations of potential changes in sleep following anxiety-focused CBT. Despite pervasive complaints of poor sleep, the empirical literature provides minimal evidence for actual sleep–wake alterations in this population of youth and evidence for sleep-based changes following treatment for anxiety is minimal. In line with calls for more comprehensive models of the role of sleep in developmental psychopathology, several fundamental gaps in understanding are described and highlighted as essential avenues for clarifying the nature and consequences of poor quality sleep among youth with clinical levels of anxiety. In a second section of the paper, an emerging body of novel, translational research investigating more intricate sleep–anxiety relationships is introduced with potential implications for both etiological models and treatment design and delivery.     

Exposure Quality in Cognitive Behavioral Treatment for Youth Anxiety Disorders—Predictors and Associations with Outcomes

Journal of Child and Family Studies - To optimize cognitive behavioral therapy (CBT) outcomes for anxiety disorders in youth, more knowledge is needed about how specific CBT components work....     

Gender Difference of Chinese High School Students’ Math Anxiety: The Effects of Self-Esteem,Test Anxiety and General Anxiety

Sex Roles - The present study aimed to explore gender differences in, and the effects of, self-esteem on math anxiety. A total of 751 (450 young women) junior and senior high school students...     

Comorbidity of Pediatric Obsessive–Compulsive Disorder and Anxiety Disorders: Impact on Symptom Severity and Impairment

This study explored the impact of comorbidity on symptom severity and treatment outcome in a sample of 75 pediatric Obsessive–Compulsive Disorder (OCD) patients. Forty received cognitive–behavioral therapy (CBT). Overall, 56% had a comorbid disorder. Results revealed that youth with comorbid disorders (anxiety or otherwise) endorsed significantly more anxiety symptoms than youth with OCD only. Youth with comorbidities instead of or in addition to anxiety exhibited more severe OCD symptoms than youth with OCD alone or an anxiety-only comorbidity. Youth in the comorbidities instead of or in addition to anxiety group had the poorest CBT response relative to the other groups. These results suggest that relative to those with OCD alone or with an anxiety disorder comorbidity, youth with comorbidities instead of or in addition to anxiety have a differing clinical presentation (e.g., more severe symptoms) and worse psychotherapy outcome.

Interaction Effects between Maternal Lifetime Depressive/Anxiety Disorders and Correlates of Children��s Externalizing Symptoms

We investigated the interaction effects between mother??s lifetime depressive/anxiety disorders and psychosocial correlates of 6 to 11 year-old children??s self-reported externalizing symptoms in the Quebec Child Mental Health Survey. A representative subsample of 1,490 Quebec children aged 6 to 11 years was selected from the original sample. We conducted multiple linear regression analyses using externalizing symptoms as reported by children through the Dominic questionnaire and multiple child, family and socioeconomic characteristics. Two variables interacted significantly with mother??s lifetime depressive/anxiety disorders to predict 6 to 11 year-old children??s self-reported externalizing symptoms: physical/sexual abuse and mother??s caring behaviours. Results underline the main contribution of mother-child relationship and stressful events in the association between mother??s lifetime depressive/anxiety disorders and children??s externalizing symptoms. It is suggested to develop preventive intervention programs oriented towards children of lifetime depressed/anxious parents who also report parent-child relational difficulties.