Social Anxiety in Children with Anxiety Disorders: Relation with Social and Emotional Functioning

Investigated the psychometric properties of the Social Anxiety Scale for children-Revised (SASC-R) as well as relations between social anxiety and children's social and emotional functioning. Participants were a clinic sample of children, ages 6–11 with anxiety disorders (N = 154) who completed the SASC-R. For a subset of these children, parent ratings of social skills, and self-ratings of perceived competence and peer interactions were also obtained. Factor analysis of the SASC-R supported the original three-factor solution and internal consistencies were in the acceptable range. Among children with simple phobia, scores on the SASC-R differentiated those with and without a comorbid social-based anxiety disorder. Social anxiety was also associated with impairments in social and emotional functioning. Specifically, highly socially anxious children reported low levels of social acceptance and global self-esteem and more negative peer interactions. Girls with high levels of social anxiety were also rated by parents as having poor social skills, particularly in the areas of assertive and responsible social behavior.     

Emotion-Focused Cognitive-Behavioral Therapy for Youth with Anxiety Disorders: A Randomized Trial

Difficulties with emotion regulation are a core feature of anxiety disorders (ADs) in children and adults. Interventions with a specific focus on emotion regulation are gaining empirical support. Yet, no studies to date have compared the relative efficacy of such interventions to existing evidence-based treatments. Such comparisons are necessary to determine whether emotion-focused treatments might be more effective for youth exhibiting broad emotion-regulation difficulties at pretreatment. This study examined an emotion-focused cognitive-behavioral therapy (ECBT) protocol in comparison to traditional cognitive-behavioral therapy (CBT) in a sample of children with a primary anxiety disorder diagnosis. Moderation analyses examined whether children with higher levels of emotion dysregulation at pretreatment would show greater levels of improvement in ECBT than CBT. Ninety-two youth ages 7 to 12 years (58% male) with a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia were included. Participants were randomly assigned to ECBT or CBT. Results showed that youth in both conditions demonstrated similar improvements in emotion regulation and that pretreatment levels of emotion dysregulation did not moderate treatment outcomes. Additional analyses showed that ECBT and CBT were similarly effective on diagnostic, severity, and improvement measures. Future work is needed to further explore the ways that emotion regulation is related to treatment outcome for anxious youth.     

Maternal Sensitivity and Anxiety: Impacts on Child Outcome

ABSTRACT

Children of anxious parents have been shown to be at an increased risk of developing an anxiety disorder. Thus, it is critically important to identify factors that increase or decrease that risk. The depression literature has shown that maternal sensitivity decreases negative child outcome associated with maternal depression. The current study was designed to determine whether maternal sensitivity may buffer children of anxious mothers in a similar way. Three hypotheses were tested. First, that anxious mothers would display less sensitivity than nonanxious mothers in interactions with their children; that there would be an interaction between sensitivity and anxiety on child outcome; and that sensitivity would account for variance in child outcome beyond that attributed to anxiety. One hundred and twenty-five mothers (75 anxious) and their children (ages 3–12) completed the study. Mothers were administered the Anxiety Disorders Interview Schedule-IV and Parent, and a subset also completed the Beck Anxiety Inventory. Children completed the Anxiety Disorders Interview Schedule-Child. Dyads also engaged in two interaction tasks (one cognitive, one social) which were coded for maternal sensitivity and three child outcome behaviors. Results showed that anxious mothers displayed less sensitivity in the social task but not in the cognitive task. An interaction between anxiety and sensitivity was found only when predicting child negativity in the social task. Finally, maternal sensitivity was found to account for variance in child outcome beyond that of anxiety. Implications and directions for future research are discussed.     

Threat perception bias in nonreferred, socially anxious children

Investigated whether socially anxious children display a threat perception bias. A sample of 252 primary school children ages 8 to 13 years were exposed to ambiguous stories of social situations and instructed to find out as quickly as possible whether a story was scary. Furthermore, children were invited to tell how each story would end and to judge how they would feel when actually confronted with that situation. The main results can be summarized as follows. First, socially anxious children displayed lower thresholds for threat perception than control children. In other words, compared with control children, socially anxious children needed to hear fewer sentences of a story before deciding it was scary. Furthermore, socially anxious children more frequently perceived threat while listening to the stories than did control children. Finally, socially anxious children more often interpreted the stories as threatening and displayed higher levels of negative feelings and cognitions in relation to these stories compared with control children. These findings fit nicely in current information-processing theories of childhood anxiety. An additional aim of this study was to investigate the convergent validity of the social phobia scales of 2 recently developed self-report questionnaires for measuring anxiety disorder symptoms in children: the Spence Children's Anxiety Scale (Spence, 1998) and the Screen for Child Anxiety Related Emotional Disorders (Birmaher et al., 1997). Results indicated that the social phobia scale of the Spence Children's Anxiety Scale and the extended social phobia scale of the Screen for Child Anxiety Related Emotional Disorders correlated substantially with a specific measure of social anxiety, the Social Anxiety Scale for Children-Revised.     

Combined Emotional Socialization Training and Family Accommodation Modification: Impact on Emotional Regulation and Anxiety Symptoms in Anxious Children

Past studies show that emotional socialization and family accommodation are involved in children's anxiety, but research has yet to investigate whether targeting emotional socialization training (EST), family accommodation modification (FAM), or EST and FAM in tandem can reduce anxiety in children. The purpose of this study was to evaluate the efficacy of a combination of EST and FAM on improving emotion regulation (ER) and reducing anxiety symptoms in anxious children. The sample consisted of 80 children with an anxiety disorder (M_age = 6.7, SD = 0.1) and their mothers. Mothers were randomly assigned to an EST (n = 17), FAM (n = 16), Combined (n = 17), or a waitlist control (WLC) (n = 16) groups. Mothers completed The Emotion Regulation Checklist (ERC) and Spence Children’s Anxiety Scale (SCAS) at pre-test, post-test, and at 6-month of follow-up. The results showed that the EST, FAM, and Combined groups were more effective than WLC in improving ER and reducing anxiety severity at post-test and follow-up. Among the intervention groups, children in the combined group showed greater reductions in the severity of anxiety symptoms and emotion dysregulation than the other two groups. Assisting parents to use strategies that encourage healthy emotion regulation and decrease family accommodation might help reduce the severity of children's anxiety symptoms.     

Is Family Expressiveness as Reported by Mothers and Fathers Related to Children’s Social Anxiety Symptoms?

We examined family expressiveness as reported by mothers and fathers with respect to children’s report of social anxiety symptoms. Participants consisted of a clinical sample of 178 youth (8–16 years) and their parents. The sample was largely homogenous (163 Caucasians, 6 African American, 4 Hispanic, 5 Asian/Native American; 118 boys, 60 girls), and for analytic purposes, divided into two age groups: young children between 8 and 10 years and preadolescents and adolescents between 11 and 16 years. Youth completed the Social Anxiety subscale of the Multidimensional Anxiety Scale for Children and parents completed the Expressiveness subscale of the Family Environment Scale. The Expressiveness subscale measures the extent to which family members openly and directly express their emotions. We hypothesized that low levels of family expressiveness, as reported by mothers and fathers, would be associated with heightened symptoms of social anxiety for both age groups of the youth. Contrary to predictions, no significant associations were observed between young children’s social anxiety and expressiveness. For older children, however, maternal reports of family expressiveness were negatively related to social anxiety symptoms (as predicted) whereas paternal reports of family expressiveness were positively related to youth’s social anxiety symptoms (counter to predictions). This later finding suggests that the more expressive the father perceived the family to be, the higher the symptoms of social anxiety reported by the older youth. Findings are discussed in terms of differential perceptions of family expressiveness and socialization by mothers and fathers and gender role stereotypes.     

Behavioral and Socio-emotional Functioning in Children with Selective Mutism: A Comparison with Anxious and Typically Developing Children Across Multiple Informants

We examined differences among 158 children, 44 with selective mutism (SM; M = 8.2 years, SD = 3.4 years), 65 with mixed anxiety (MA; M = 8.9 years, SD = 3.2 years), and 49 community controls (M = 7.7 years, SD = 2.6 years) on primary caregiver, teacher, and child reports of behavioral and socio-emotional functioning. Children with SM were rated lower than controls on a range of social skills, but the SM and MA groups did not significantly differ on many of the social skills and anxiety measures. However, children with SM were rated higher than children with MA and controls on social anxiety. Findings suggest that SM may be conceptualized as an anxiety disorder, with primary deficits in social functioning and social anxiety. This interpretation supports a more specific classification of SM as an anxiety disorder for future diagnostic manuals than is currently described in the literature. The present findings also have implications for clinical practice, whereby social skills training merits inclusion in intervention for children with anxiety disorders as well as children with SM.     

An investigation into the psychosocial functioning of creative children: The impact of ADHD symptomatology

This study examined the relationship among creativity, ADHD symptomatology, temperament, and psychosocial functioning by comparing four groups of children aged 10–12 years: (1) 29 ADHD children without creativity, (2) 16 highly creative children displaying ADHD symptomatology, (3) 18 highly creative children without ADHD symptomatology, and (4) 30 normal controls. Children completed the TTCT, Child Depression Inventory, Revised Child Manifest Anxiety Scale, and Rosenberg Self‐Esteem Scale. Parents completed the Junior Temperament and Character Inventory, Family Environment Scale, and the parent version of the Kastan Children's Attributional Style Questionnaire. Parents completed the Conner's Rating Scales and Child Behavior Checklist, and teachers completed the Child Behaviour Checklist. Results showed that the presence of ADHD symptomatology in creative children was related to their temperamental characteristics, and parent reports of children's levels of anxiety and depression. However, family environment and mother's attributions did not appear to be related to the presence of ADHD symptomatology in creative children. These findings have implications for the development and management of creative children.     

Perceived parental rearing behaviour and anxiety disorders symptoms in normal children

The present study examined the relationship between perceptions of parental rearing behaviours and anxiety disorders symptomatology in a sample of normal school children. 45 children, aged 8 to 12 years, completed the EMBU for children, a questionnaire that measures perceptions of parental rearing practices. Additionally, they filled in the Screen of Child Anxiety Related Emotional Disorders (SCARED), an index of DSM-defined anxiety disorders symptoms. Significant and positive relationships were found between anxious rearing behaviours and parental control, on the one hand, and anxiety disorders symptomatology, in particular symptoms of generalized anxiety disorder, separation anxiety disorder and environmental–situational phobia, on the other hand.     

Early evidence of the Italian validation of the Trait Anxiety Scale of the State-Trait Anxiety Inventory for Children

Anxiety is one of the most widespread disorders in childhood. Researchers claim the need for a tool useful to assess the core constructs common to multiple anxiety disorders, to catch the generalized propensity to be anxious and to assess anxiety stability across the lifespan. The Trait Anxiety Scale of the State-Trait Anxiety Inventory for Children (STAIC-T) seems to fill these gaps. The present study examined STAIC-T validity in a sample of 1324 Italian children aged 8–13 years old. Scalar invariance across gender was established. Internal consistency was good. Results reported higher levels of anxiety in girls, whereas no gender differences were found. The measure demonstrated good convergent validity with the Spence Children Anxiety Scale. Findings support the validity of the STAIC-T as a brief and concise diagnostic tool to assess the anxiety proneness in Italian children.     

Theoretical Models of Affectionate Versus Affectionless Control in Anxious Families: A Critical Examination Based on Observations of Parent–Child Interactions

Psychosocial theories focused on the intrafamilial transmission of anxiety often concentrate on specific parenting behaviors that increase risk of anxiety disorders in children. Two such theories—affectionate versus affectionless control—both implicate parenting, although differently, in the pathogenesis of childhood anxiety. The present article reviews observational studies that focus on interactions between parents and children in anxious families in order to examine critically each of these two models. We divide these observational studies into two groups: those that seek to characterize the behavior of anxious parents (top-down studies) versus parents of anxious children (bottom-up studies). This approach reveals that there is a consistent relationship between controlling parental behavior in families with anxiety-disordered children as well as a consistent relationship between parental behavior low in warmth and families with anxiety-disordered parents. The present article discusses the implications of the pattern that unfolds from the observational studies of the last decade and provides suggestions for future research in the area.     

Mediating and Moderating Effects of Social Support in the Relationship Between Social Anxiety and Hope Levels in Children

This study aims to examine whether hope levels are predicted by social anxiety and social support and to investigate if the relationship between social anxiety and children’s hope levels is mediated and moderated by the social support of children. The Social Anxiety Scale for Children, Children’s Hope Scale, and Social Support Appraisals Scale for Children were administrated to a sample of 289 children (148 males and 141 females) enrolled in public school. To determine the relationships between variables, a Pearson correlation coefficient was utilized. Regression-based mediation and moderation analyses assessed whether social support mediates and moderates the relationship between social anxiety and children’s hope levels. Social anxiety and social support both correlated significantly with children’s hope levels; social anxiety had a negative correlation with children’s hope levels, while social support was positively correlated. Regression-based mediation and moderation analyses showed that social support mediates and moderates the relationship between social anxiety and children’s hope levels. The results of the present study emphasized the effects of social support on children; it had a positive effect on hope levels and a negative effect on social anxiety. Based on these results, it is recommended that the social support of children is increased via psycho-education programs for parents, caregivers, and teachers. It is further recommended that social-support-seeking behavior programs are developed in educational and mental health settings.     

Anxiety as a Predictor and Outcome Variable in the Multimodal Treatment Study of Children with ADHD (MTA)

Initial moderator analyses in the Multimodal Treatment Study of Children with ADHD (MTA) suggested that child anxiety ascertained by parent report on the Diagnostic Interview Schedule for Children 2.3 (DISC Anxiety) differentially moderated the outcome of treatment. Left unanswered were questions regarding the nature of DISC Anxiety, the impact of comorbid conduct problems on the moderating effect of DISC Anxiety, and the clinical significance of DISC Anxiety as a moderator of treatment outcome. Thirty-three percent of MTA subjects met DSM-III-R criteria for an anxiety disorder excluding simple phobias. Of these, two-thirds also met DSM-III-R criteria for comorbid oppositional-defiant or conduct disorder whereas one-third did not, yielding an odds ratio of approximately two for DISC Anxiety, given conduct problems. In this context, exploratory analyses of baseline data suggest that DISC Anxiety may reflect parental attributions regarding child negative affectivity and associated behavior problems (unlike fearfulness), particularly in the area of social interactions, another core component of anxiety that is more typically associated with phobic symptoms. Analyses using hierarchical linear modeling (HLM) indicate that the moderating effect of DISC Anxiety continues to favor the inclusion of psychosocial treatment for anxious ADHD children irrespective of the presence or absence of comorbid conduct problems. This effect, which is clinically meaningful, is confined primarily to parent-reported outcomes involving disruptive behavior, internalizing symptoms, and inattention; and is generally stronger for combined than unimodal treatment. Contravening earlier studies, no adverse effect of anxiety on medication response for core ADHD or other outcomes in anxious or nonanxious ADHD children was demonstrated. When treating ADHD, it is important to search for comorbid anxiety and negative affectivity and to adjust treatment strategies accordingly.     

A Psychometric Analysis of the Revised Child Anxiety and Depression Scales—Parent Version in a School Sample

The Revised Child Anxiety and Depression Scale—Parent Version (RCADS-P) is a parent-report questionnaire of youth anxiety and depression with scales corresponding to the DSM diagnoses of separation anxiety disorder, social phobia, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and major depressive disorder. The RCADS-P was recently developed and has previously demonstrated strong psychometric properties in a clinic-referred sample (Ebesutani et al., Journal of Abnormal Child Psychology 38, 249–260, 2010b). The present study examined the psychometric properties of the RCADS-P in a school-based population. As completed by parents of 967 children and adolescents, the RCADS-P demonstrated high internal consistency, test-retest reliability, and good convergent/divergent validity, supporting the RCADS-P as a measure of internalizing problems specific to depression and five anxiety disorders in school samples. Normative data are also reported to allow for the derivation of T-scores to enhance clinicians’ ability to make classification decisions using RCADS-P subscale scores.     

Association between anxiety and depression in children and adolescents with anxiety disorders

The relationship between anxiety and depression was examined in a sample of 106 children and adolescents referred to an outpatient anxiety disorder clinic for children. Twenty-eight percent of patients with DSM-III diagnoses of anxiety disorders displayed a concurrent major depression. Children with anxiety disorders plus major depression were found (1) to be older, (2) to demonstrate more severe anxiety symptomatology, and (3) to be diagnosed with different rates of certain anxiety-disorder subtypes, when compared to anxious patients without major depression. Nondepressed anxious children and adolescents did not differ from a psychopathological control group in severity of either anxiety or depression symptoms.     

Anxiety disorders in 8–11‐year‐old children: Motor skill performance and self‐perception of competence

Ekornås, B., Lundervold, A. J., Tjus, T. & Heimann, M. (2010). Anxiety disorders in 8–11‐year‐old children: Motor skill performance and self‐perception of competence. Scandinavian Journal of Psychology, 51, 271–277. This study investigates motor skill performance and self‐perceived competence in children with anxiety disorders compared with children without psychiatric disorders. Motor skills and self‐perception were assessed in 329 children aged 8 to 11 years, from the Bergen Child Study. The Kiddie‐SADS PL diagnostic interview was employed to define a group of children with an anxiety disorder without comorbid diagnosis, and a control group (no diagnosis) matched according to gender, age, and full‐scale IQ. Children in the anxiety disorder group displayed impaired motor skills and poor self‐perceived peer acceptance and physical competence compared with the control group. Two‐thirds of the anxious boys scored on the Motor Assessment Battery for Children (MABC) as having motor problems. The present study demonstrated impaired motor skills in boys with “pure” anxiety disorders. Anxious children also perceived themselves as being less accepted by peers and less competent in physical activities compared with children in the control group.     

Early evidence of the Italian validation of Separation Anxiety Assessment Scale for Children

The current study examined the validity of the Separation Anxiety Assessment Scale for Children (SAAS-C) in a sample of 1397 Italian children (aged 8–11 years). Scalar invariance across gender was established. Results reported higher levels of separation anxiety in girls and younger children. Moreover, the measure demonstrated good convergent validity with the Spence Children Anxiety Scale. Overall, findings support the validity of the SAAS-C as a brief diagnostic tool to assess separation anxiety disorder in Italian children in line with DSM-5 criteria.     

Parenting behaviors in parents with anxiety disorders

Anxiety disorders are familial, and although considerable evidence supports the role of genetic/biological parameters in their development, these alone do not entirely explain their etiology. In this study, the role of parenting behavior as a possible factor in the transmission of anxiety from parent to child was examined. Using interview, self-report, and direct behavioral observation, behaviors of parents with an anxiety disorder were compared to those of parents without an anxiety disorder on a number of dimensions, but particularly with respect to whether anxious parents actively inhibited their children from engaging in normal age appropriate activities. These behaviors were assessed during routine activities and in a structured non-conflictual play task. Although anxious parents did not overtly restrict their child's behavior in either type of activity, they reported higher levels of distress when their children were engaged in these activities. Similarly, the "emotional climate" in families with an anxious parent differed significantly from families without an anxious parent. The results are discussed in terms of how parenting behaviors might influence the development of maladaptive anxiety via social learning and information transfer, and their heuristic implications.     

Evaluating anxiety and depression symptoms in children and adolescents with prior mild traumatic brain injury: Agreement between methods and respondents

Psychological functioning can be adversely impacted after a mild traumatic brain injury (mTBI) and may be a potential target for intervention. Despite the use of symptom ratings or structured diagnostic interview to assess long-term anxiety and depression symptoms in children and adolescents post-injury, no known studies have considered the agreement between different assessment methods and between respondents. The objectives of this study were to investigate the agreement between symptom ratings and structured diagnostic interview and between children and parents’ symptom reporting. Participants (N = 33; 9–18 years old) were recruited from the Emergency Department and assessed on average 22.8 months (SD = 5.6) after their mTBI. Anxiety and depression symptoms were evaluated via subscales of a questionnaire (Behavior Assessment System for Children) and parts of a computerized structured diagnostic interview (generalized anxiety disorder and major depressive episode; Diagnostic Interview Schedule for Children – C-DISC-IV) administered individually to children and their parents. Results showed that the inter-method agreement to identify high levels of anxiety and depression was moderate to perfect in children while it was lower in parents. Although a similar percentage of participants with elevated anxiety or depression were identified by both children and parents, the agreement between youth and parents was variable, ranging from poor to good for anxiety and poor to moderate for depression. These results highlight the importance of collecting youth and parents’ reports of anxiety and depression symptoms and considering potential discrepancies between informants’ answers.