A Multifactorial Model for the Etiology of Anxiety in Non-Clinical Adolescents: Main and Interactive Effects of Behavioral Inhibition, Attachment and Parental Rearing

There has been limited research examining the additive and interactive effects of multiple factors on the development of anxiety symptoms and anxiety disorders in youths. This study was an attempt to examine the reciprocal connections among temperament, attachment, and rearing style, and their unique and interactive relations to anxiety symptoms. Six hundred forty-four non-clinical children aged 11–15 years (mean age = 12.7 years) completed questionnaires measuring behavioral inhibition, attachment, parental rearing behavior, and anxiety symptoms. Results indicated that there were small to moderate positive correlations among various risk factors. Furthermore, modest but significant positive correlations were found between behavioral inhibition, attachment quality, and anxious and controlling rearing behaviors on the one hand, and anxiety scores on the other hand. That is, higher levels of behavioral inhibition, insecure attachment, and parental control and anxious rearing were associated with higher levels of anxiety symptoms. Finally, behavioral inhibition, attachment quality, parental control and anxious rearing each accounted for a small but unique proportion of the variance of anxiety disorders symptomatology. Little support was found for interactive effects of these vulnerability factors on childhood anxiety.     

Worry in children is related to perceived parental rearing and attachment

In a sample of 159 primary school children, the relationship between perceived parental rearing behaviours and self-reported attachment style, on the one hand, and worry, on the other hand, was investigated. Children completed (a) the EMBU, a questionnaire measuring perceptions of parental rearing behaviours, (b) a single-item measure of attachment style, and (c) the Penn State Worry Questionnaire for Children (PSWQ-C), an index of severity of worrying. Results showed that parental rearing behaviours, in particular rejection and anxious rearing, were positively associated with worry. Thus, children who perceived their parents as more rejective and anxious reported higher levels of worry. Furthermore, self-reported attachment style appeared to be related to worry. More specifically, children who classified themselves as avoidantly or ambivalently attached displayed higher levels of worry than did children who classified themselves as securely attached. These findings are consistent with the notion that family environment factors such as parental rearing and attachment style contribute to the severity of anxiety symptoms in children.     

Assessment of Anxious Rearing Behaviors with a Modified Version of “Egna Minnen Beträffande Uppfostran” Questionnaire for Children

This study examined the psychometric properties of a modified version of the EMBU for Children (EMBU-C), a 40-item questionnaire measuring youths' perceptions of three main types of parental rearing (i.e., emotional warmth, rejection, and overprotection) as well as anxious rearing behaviors. For this purpose, modified EMBU-C data were obtained in a large sample of children and adolescents (N = 1681). Results showed that the factor structure of the modified EMBU-C was satisfactory: a clear four-factor solution emerged representing the hypothesized types of parental rearing behaviors. Higher-order factor analysis demonstrated the presence of two superordinate dimensions of parental rearing, namely care and control. Furthermore, all modified EMBU-C scales appeared to be reliable in terms of internal consistency and test–retest stability. Finally, positive relationships were found between anxious rearing, overprotection, and rejection, on the one hand, and children's anxiety symptoms, on the other hand.     

Behavioral Inhibition as a Risk Factor for the Development of Childhood Anxiety Disorders: A Longitudinal Study

This longitudinal study examined the additive and interactive effects of behavioral inhibition and a wide range of other vulnerability factors in the development of anxiety problems in youths. A sample of 261 children, aged 5 to 8 years, 124 behaviorally inhibited and 137 control children, were followed during a 3-year period. Assessments took place on three occasions to measure children’s level of behavioral inhibition, anxiety disorder symptoms, other psychopathological symptoms, and a number of other vulnerability factors such as insecure attachment, negative parenting styles, adverse life events, and parental anxiety. Results obtained with Structural Equation Modeling indicated that behavioral inhibition primarily acted as a specific risk factor for the development of social anxiety symptoms. Furthermore, the longitudinal model showed additive as well as interactive effects for various vulnerability factors on the development of anxiety symptoms. That is, main effects of anxious rearing and parental trait anxiety were found, whereas behavioral inhibition and attachment had an interactive effect on anxiety symptomatology. Moreover, behavioral inhibition itself was also influenced by some of the vulnerability factors. These results provide support for dynamic, multifactorial models for the etiology of child anxiety problems.     

Parenting Behaviors and Childhood Anxiety: A Psychometric Investigation of the EMBU-C

Parent rearing behaviors, including both behavioral modeling and parent–child interactions, are associated with anxiety in children. Patterns of overprotection or rejecting behavior from parents may lead children to develop behavioral avoidance, lower self-confidence, and higher symptoms of anxiety. Additional research is needed to further elucidate the role that parenting behavior plays in the development of childhood anxiety. Unfortunately, few measures of parenting behavior exist. The EMBU-C is a 40-item child-report measure of these behaviors, but empirical data supporting the psychometric properties of the EMBU-C are limited. The current investigation examined the psychometric properties of the EMBU-C in the context of childhood anxiety. Participants were 213 children with an anxiety disorder and 150 recruited from the community (all aged 8–13 years). Overall, the EMBU-C demonstrated promising psychometrics. In terms of convergent validity, parent rearing behaviors described on the EMBU-C were significantly related to children’s anxiety symptoms, anxiety-related disability, parenting stress, family functioning and children’s externalizing behaviors. Further, the overprotection and anxious-rearing subscales discriminated between clinical and community participants. Finally, parental overprotection significantly predicted increases in child anxiety and anxiety-related disability 1 year later. Thus, the EMBU-C appears to have value as a clinical tool for assessing parental factors that may contribute to anxiety in children. Recommendations for further item development and measure improvement are offered.     

Child and parent predictors of perceptions of parent--child relationship quality

OBJECTIVE/METHOD: Predictors of perceptions of parent-child relationship quality were examined for 175 children with ADHD, 119 comparison children, and parents of these children, drawn from the follow-up phase of the Multimodal Treatment Study of Children with ADHD. RESULTS/CONCLUSION: Children with ADHD perceived their mothers and fathers as more power assertive than comparison children. Children higher on depressive symptomatology also perceived their mothers and fathers as less warm and more power assertive. Mothers perceived themselves as more power assertive and fathers perceived themselves as less warm if they were higher on depressive symptomatology themselves or had children with ADHD or higher levels of depressive symptomatology. Several interactions indicated that the association between child factors and parental perceptions of warmth and power assertion often depended on parental depressive symptomatology. The findings resolve a previous contradiction in the literature regarding the relationship between child depressive symptoms and parental perceptions of parent-child relationship quality.     

Predicting Parenting Stress in Families of Children with ADHD: Parent and Contextual Factors

We examined parental ADHD symptoms and contextual (parental education, social support, marital status) predictors of parent domain parenting stress (parental distress) as a function of child ADHD symptoms in a sample of 95 parents of 8 to 12 year-old children with and without ADHD. Parents’ perceptions of parental distress and social support were inversely-related. Parental ADHD symptomatology was the strongest predictor of parental distress of the variables considered. Models using teacher reports of child ADHD symptomatology and oppositionality differed from ones using parent reports, in that child oppositionality was only predictive of parental distress in the parent-report model. A post-hoc analysis showed that child factors did not predict parental distress over and above parent ADHD symptoms and contextual factors. These results suggest that parental ADHD symptomatology and parenting stress reduction should be considered in development of interventions for families of children with ADHD.     

Stability of anxious symptomatology in children

The stability of anxiety states and symptoms was assessed in a sample of 150 anxious and nonanxious children. A number of assessment methods including a semistructured interview, self-report instruments, psychophysiological measures, and parental reports were used initially and at intervals up to 6 months later. The majority of children with a diagnosed anxiety disorder at the initial assessment still manifested significant symptomatology at the 6 month follow-up. However, stability of specific anxiety symptoms when assessed by self- and parental reports was mixed. With respect to psychophysiological assessment, stability of responses was evident at 2 weeks but not after 6 months. Results are discussed in terms of the stability of diagnoses and symptomatology, and the need for thematically relevant self-reports and behavioral assessment tasks. Recommendations are made for the development of a reliable, multimethod strategy to assess the multiple domains of childhood anxiety.This study was supported in part by NIMH Grant MH43252.     

Anxious Solitude and Clinical Disorder in Middle Childhood: Bridging Developmental and Clinical Approaches to Childhood Social Anxiety

It was hypothesized that children identified by their peers at school as anxious solitary would report more symptoms of social anxiety disorder on a self report questionnaire and, on the basis of child and parent clinical interviews, receive more diagnoses of social anxiety disorder and additional anxiety and mood disorders. Participants were 192 children drawn from a community sample of 688 children attending public elementary schools. Half of these children were selected because they were identified as anxious solitary by peers and the other half were demographically-matched controls. 192 children provided self reports of social anxiety disorder symptoms on a questionnaire, and 76 of these children and their parent participated in clinical interviews. Results indicate that children identified by their peers as anxious solitary in the fall of 4th grade, compared to control children, were significantly more likely to receive diagnoses of social anxiety disorder, specific phobia, and selective mutism based on parent clinical interviews. Additionally, there was a tendency for these children to be diagnosed with generalized anxiety disorder and post traumatic stress disorder based on parent clinical interviews. Furthermore, children who had been identified as anxious solitary at any time in the 3rd or 4th grades were more likely than control children to report symptoms of social anxiety disorder that fell in the clinical range and to receive diagnoses of social anxiety disorder and dysthymia (both trends) and major depression (a significant effect) according to parental clinical interview.     

The Relationships Among Parental Anxiety, Parenting, and Children’s Anxiety: The Mediating Effects of Children’s Cognitive Vulnerabilities

Theoretical models have emphasized the roles played by parental anxiety and behavior in the development of childhood anxiety problems. Little is known regarding the differential impacts of mothers and fathers or regarding the processes that mediate these influences. The present study examines the relationships between maternal and paternal trait anxiety, overprotection, and emotional support on the one hand and anxiety symptoms in children on the other hand. This study also explores the mediating role of children’s cognitive vulnerabilities to anxiety disorders in the relationship between parental variables and children’s anxiety. A sample of 80 children and their parents (fathers and mothers), selected from an initial screening of 905 school-aged children, participated in this study. The results indicate that both parents had unique influences on children’s anxiety symptoms: maternal trait anxiety and paternal overprotection and concern were found to independently and positively contribute to children’s anxiety. Furthermore, children’s interpretative biases mediated the relation between maternal trait anxiety and children’s anxiety symptoms. The results of this study underline the importance of considering both paternal and maternal factors in the development of children’s anxiety problems. These findings also have implications for theoretical models of the etiology of anxiety and for the treatment of these problems in children.     

Anxiety and Depression Symptoms in Children with Asperger Syndrome Compared with Attention-Deficit/Hyperactivity Disorder and Depressive Disorder

The objective of this study was to examine (a) anxiety and depression symptoms in children with Asperger syndrome (AS) compared to children with attention-deficit/hyperactivity disorder (ADHD) and children with depressive disorder; (b) parental anxiety and depressive symptoms in the three groups; and (c) the association between the anxiety and depression symptoms of children and their parents. The emotional and behavioral problems of 56 children with AS (48 boys, 8 girls, mean age, 9.39 ± 2.01 years) were compared with 56 ADHD children and 56 depressive disorder children, matched for age and sex. Their parents’ anxiety and depression symptoms were also compared. Trait-anxiety and internalizing problems in AS children were higher than those in ADHD children and as high as those in depressive disorder children (F = 8.83, p < 0.001 and F = 8.21, p < 0.001). Parents’ anxiety and depression symptoms did not differ among the three groups, but correlations between maternal anxiety and depression and children’s emotional and behavioral problems were most prominent in the AS group. We suggest that the assessment and treatment of children with AS should involve detailed assessment, possible concomitant treatment for comorbid anxiety and depression, and parental education about the effect of parental emotional states on children.     

Parental Psychological Control and Childhood Anxiety: The Mediating Role of Perceived Lack of Control

Parental psychological control has been found to relate to the development of childhood anxiety; however, this relation has not been thoroughly examined. The purpose of this study was to understand the nature of the relation between parental psychological control and anxiety symptoms in children, as well as to understand whether this relation is mediated by children’s perceived control. Questionnaires were administered to children ages 8–11. Results indicated a significant relation between parental psychological control and child anxiety symptoms. Results further indicated that this relation was fully mediated by children’s perceptions of how much control they feel they have over events in their lives. These findings suggest that although parental psychological control and a child’s perceived control both contribute to the development of anxiety, it is possible that parental psychological control contributes to the development of anxiety by affecting a child’s perception of control.     

AD/HD Symptoms and Conduct Problems: Similarities and Differences in Maternal Perceptions

Several theories attempt to explain the high co-occurrence of Attention Deficit/ Hyperactivity Disorder (AD/HD) and Conduct Problems (CP). A strong possibility is that AD/HD behaviours lead to the development of CP, due to family coercive interaction patterns, maintained through parental false beliefs regarding child problem behaviour. We compared maternal perceptions about AD/HD behaviors and CP, and the possible reactions elicited by such behaviours. The sample consisted of 317 mothers of boys and girls aged 4–6. Four versions of The Parental Account of the Causes of Childhood Problems Questionnaire were used, in which a vignette was ascribed to either a boy or a girl displaying some of the major AD/HD behaviours or CP. The results showed that CP were perceived as significantly more severe than AD/HD behaviours. Moreover, AD/HD behaviours were attributed to biological causes more often than CP, and less strict rearing practices were chosen for AD/HD symptoms. Our findings provide evidence that mothers usually perceive AD/HD behaviours and CP as separate entities and may behave accordingly with their children.     

Behavioral Inhibition and Attentional Control in Adolescents: Robust Relationships with Anxiety and Depression

Behavioral inhibition (BI) has been associated with the development of internalizing disorders in children and adolescents. It has further been shown that attentional control (AC) is negatively associated with internalizing problems. The combination of high BI and low AC may particularly lead to elevated symptomatology of internalizing behavior. This study broadens existing knowledge by investigating the additive and interacting effects of BI and AC on the various DSM-IV based internalizing dimensions. A sample of non-clinical adolescents (N = 1806, age M = 13.6 years), completed the Behavioral Inhibition System/Behavioral Activation System Scales (BIS/BAS), the attentional control subscale of the Adult Temperament Questionnaire (ATQ) and the Revised Child Anxiety and Depression Scale (RCADS). As expected, BI was positively, and AC was negatively related to internalizing dimensions, with stronger associations of BI than of AC with anxiety symptoms, and a stronger association of AC than of BI with depressive symptoms. AC moderated the association between BI and all measured internalizing dimensions (i.e., symptoms of generalized anxiety disorder, social phobia, separation anxiety disorder, panic disorder, obsessive–compulsive disorder, and major depressive disorder). Since high AC may reduce the impact of high BI on the generation of internalizing symptoms, an intervention focused on changing AC may have potential for prevention and treatment of internalizing disorders.     

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.     

On the Links Between Attachment Style, Parental Rearing Behaviors, and Internalizing and Externalizing Problems in Non-Clinical Children

  We sought to investigate the relationships between negative family factors such as insecure attachment and adverse parental rearing, and internalizing and externalizing symptoms in a large sample of non-clinical children (N = 237) aged 9 to 12 years. All children completed a set of self-report questionnaires including a single-item measure of attachment style towards the mother and the father as well as an index of perceived parental rearing behaviors. Further, measures of internalizing symptoms (e.g., anxiety and depression) and externalizing symptoms (e.g., aggression) were completed. Results showed that perceived rearing behaviors of both mother and father (in particular rejection and anxious rearing) consistently accounted for a significant proportion of the variance in internalizing and externalizing symptoms. Attachment style was found to play a less prominent role. Some support for gender-specific relationships was found, indicating that the presence of negative family factors in fathers had more impact on symptoms in boys, whereas the presence of such factors in the mothers had more influence on symptoms in girls. Altogether, these results suggest that in addition to common pathways by which both parents promote psychopathological symptoms in children, there may also be separate pathways by which the father or the mother may have a unique impact on the development of such symptoms in boys or girls respectively.     

Changes in Anxiety Control Beliefs Following a Brief CBT Treatment and Their Association With Anxiety Symptom Reduction

Anxiety control beliefs (i.e., beliefs regarding one’s ability to cope with external, fear-inducing threats and internal reactions to those perceived threats) have been found to negatively predict anxiety symptoms in children and adults and to be modifiable by cognitive-behavioral therapy for anxiety disorders. The current study examines whether changes in anxiety control beliefs were seen following a brief, intensive treatment for specific phobias, and whether those changes were associated with improvements in the targeted phobia and comorbid anxiety disorder symptoms. Participants were 135 children and adolescents (M age = 9.01 years, 49% male) who received one-session treatment (OST) with or without parental involvement for their primary specific phobia. Results indicated that self-reported anxiety control beliefs significantly increased following treatment and that these increases significantly predicted reductions in specific phobia severity and symptoms of comorbid anxiety disorders 6 months and 1 year following treatment. Findings illustrate that involvement in a single 3-hour OST was associated with changes in anxiety control beliefs and demonstrate the potential importance of targeting control beliefs in pediatric anxiety treatment.     

DSM-defined anxiety disorders symptoms in South African youths: Their assessment and relationship with perceived parental rearing behaviors

This study investigated DSM-defined anxiety symptoms in South African youths. Children and adolescents (N = 701) from various cultural groups completed the SCARED and a questionnaire measuring perceived parental rearing behaviors. Results indicated that the psychometric properties of the SCARED were satisfactory in the total sample of South African youths, and acceptable in colored and black children and adolescents. Further, colored and black youths displayed higher SCARED scores than white youths, and there were also differences in the perceived parental rearing behaviors of the cultural groups. White youths generally rated their parents' rearing behaviors as less anxious, overprotective, and rejective, but more emotionally warm than colored and black youths. Finally, positive correlations were found between anxious rearing, overprotection, and rejection and anxiety symptoms. The clinical and research implications of these findings are briefly discussed.     

Mediators and Moderators of the Relation between Parental ADHD Symptomatology and the Early Development of Child ADHD and ODD Symptoms

The present study examined mediators and moderators of the relation between parental ADHD symptomatology and the development of child attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms across the preschool years. Participants included 258 (138 boys) 3-year-old children (M = 44.13 months, SD = 3.39) with and without behavior problems and their parents who took part in a 3-year longitudinal study. Maternal ADHD symptoms predicted later ADHD symptoms in children, controlling for early child symptomatology. Both family history of ADHD and paternal comorbid psychopathology predicted later child ADHD and ODD symptoms, but they did not account for the association between maternal and child ADHD symptoms. Although paternal ADHD symptoms were associated with age 3 child ADHD symptoms, they did not significantly predict later child ADHD symptoms controlling for early symptomatology. Family adversity moderated the relation between maternal ADHD and child ADHD symptoms, such that the relation between maternal and child ADHD symptoms was stronger for families with less adversity. Maternal overreactive parenting mediated the relation between maternal ADHD symptoms and later child ADHD and ODD symptoms. Our findings suggest that targeting paternal comorbid psychopathology and maternal parenting holds promise for attenuating the effects of parental ADHD on children’s ADHD.     

Parental Anxiety Disorders, Child Anxiety Disorders, and the Perceived Parent–Child Relationship in an Australian High-Risk Sample

This study was designed to explore the role of perceived parenting behavior in the relationship between parent and offspring anxiety disorders in a high-risk sample of adolescents. We examined the relationship between parental and child anxiety disorders and tested whether perceived parenting behavior acted as a mediator between these variables. Analyses were performed on a high-risk sample of 816 fifteen-year-olds drawn from a birth cohort in Queensland, Australia. Parental depression and income were covaried. Maternal anxiety disorder significantly predicted the presence of anxiety disorders in children; the association between paternal anxiety disorder and child anxiety disorder was not significant. There was no evidence that perceived parenting played a mediating role in the association between mother and child anxiety disorders. These results replicate earlier studies' findings of elevated rates of anxiety disorders among the offspring of anxious parents, but only when the child's mother is the anxious parent.