The Course of Childhood Anxiety Symptoms: Developmental Trajectories and Child-Related Factors in Normal Children

This three-wave longitudinal study explored developmental trajectories for various types of childhood anxiety symptoms (i.e., specific fears, social anxiety, generalized anxiety, and separation anxiety) and examined how these trajectories were associated with several factors thought to be involved in the pathogenesis of anxiety. Parents of a community sample of 224 children aged 4 to 11 years repeatedly completed a standardized questionnaire of anxiety symptoms during a 2-year period. At Time 1, parents also filled out scales for measuring children’s level of behavioral inhibition (BI), internalizing and externalizing symptoms, and prosocial behaviors, while an interview was conducted with children to assess Theory-of-Mind (TOM) ability. Growth Mixture Modeling identified multiple developmental trajectories in childhood anxiety symptoms of which the ‘stable-low’ or ‘stable-medium’ reflected the normative trajectories. Further, multinomial regression analyses indicated that the higher developmental trajectories of anxiety were associated with higher levels of BI and internalizing symptoms at Time 1. In sum, results show heterogeneity in the development of anxiety symptoms and underline the importance of early prevention programs for children at high risk for developing an anxiety disorder.     

Peer victimization, depressive symptoms, and high salivary cortisol predict poorer memory in children

The predictive relations of peer victimization, depressive symptoms, and salivary cortisol on memory in 168 children aged 12 at Time 1 (T1) were examined using a longitudinal design in which data were collected on four occasions over a 2-year period. Results indicated that: (1) peer victimization, depressive symptoms, and evening cortisol were stable over time, (2) peer victimization and elevated symptoms of depression were concurrently linked at each time, (3) T1 peer victimization predicted elevated symptoms of depression at T2 which in turn predicted lower cortisol levels at T3, and (4) controlling for earlier associations, T3 peer victimization, depressive symptoms, and higher morning and evening cortisol levels uniquely predicted memory deficits at T4. The links between elevated cortisol, symptoms of depression, and poor memory are consistent with published research on depressed adults and extend the findings to children exposed to peer victimization. These findings highlight that peer abuse is harmful and may impact children's long-term mental health and memory functioning.     

Cortisol and Children’s Adjustment: The Moderating Role of Sympathetic Nervous System Activity

We examined relations among cortisol, markers of sympathetic nervous system (SNS) activity (including salivary alpha-amylase and skin conductance level), and children's adjustment. We also tested the Bauer et al. (Journal of Developmental and Behavioral Pediatrics, 23(2), 102-113, 2002) hypothesis that interactions between the SNS and cortisol would be associated with internalizing and externalizing problems. Saliva samples were obtained from 8- to 9-year-olds before and after a laboratory assessment battery, and were assayed for cortisol and alpha-amylase (sAA). Basal skin conductance level (SCL) was measured during resting conditions. Parents reported on child adjustment. Interactions between basal SNS and cortisol levels explained moderate amounts of unique variance in children's externalizing and internalizing problems. More specifically, higher basal cortisol levels were positively associated with higher internalizing and externalizing problems among children with higher SNS activity, as compared to children with lower SNS activity. Findings underscore the utility of including information about the coordination between hypothalamic-pituitary-adrenal (HPA) and SNS activity in biosocial models of atypical child development.     

The Role of Perfectionism in Relation to an Intervention to Reduce Anxious and Depressive Symptoms in Children

Research has demonstrated an association between perfectionism and depressive and anxious symptoms in children. We examined whether a school-based program targeting anxious and depressive symptoms would reduce perfectionism, and whether perfectionism would interfere with intervention outcomes. The participants were 78 school-age children identified as at-risk for anxiety and/or depression. At-risk children took part in a randomized controlled trial of a school-based intervention program. Levels of perfectionism, depression, and anxiety were assessed at pre-treatment (Time 1) and again at post-treatment (Time 2) after participating in either a cognitive behavioral group or a structured activity group. Participation in either group was associated with significant reductions in overall levels of self-oriented perfectionism, anxious symptoms, and depressive symptoms. Supplementary analyses indicated that pre-treatment self-oriented perfectionism influenced post-treatment depression scores, suggesting that perfectionism interferes with treatment outcome. Perfectionism in children appeared amenable to group-based intervention, and identifying perfectionism may be important for treating children with depressive symptoms.     

Effects of Maternal Depression Symptoms and Alcohol Use Problems on Child Internalizing and Externalizing Behavior Problems

Empirical evidence suggests maternal behavioral health problems are significant predictors of child behavioral health difficulties, but it is unclear of the specific relation of maternal alcohol use problems and depression symptoms with child internalizing and externalizing behavior problems. The purpose of the study is to examine the impact of maternal depression symptoms and alcohol use problems on children’s internalizing and externalizing behavior problems over a period of 5 years. Implications for intervention may differ depending on which type of maternal behavioral health concerns predicts which child behavior problem. A total of 1874 families eligible for Early Head Start participated. Maternal depression symptoms and alcohol use problems were assessed when children were in preschool, and internalizing and externalizing behavior problems were assessed when children were in fifth grade. Clinical internalizing behavior problems was best predicted by maternal depression symptoms, whereas clinical externalizing behavior problems was best predicted by maternal alcohol use problems. Children were almost twice as likely to have clinical internalizing behavior problems when mothers exhibited very elevated depression symptoms compared to when mothers displayed minimal symptoms. A similar relation was found with maternal alcohol use problems and clinical externalizing behavior problems. Our findings highlight the importance of understanding and treating various kinds of behavioral health concerns in mothers of young children.     

Parent-directed cognitive behavioral therapy for young anxious children: a pilot study

Anxiety in children age 8 years and above has been successfully treated with cognitive behavioral therapy (CBT). However, the efficacy of CBT for anxious children ages 4-7 years has not, to date, been fully investigated. This paper piloted a CBT intervention targeting child anxiety that was delivered exclusively to parents of 26 children with anxiety symptoms ages 4-7 years. The intervention consisted of four 2-hour group sessions of four to six parents (couples). These group sessions were followed by four individual telephone sessions, once per week across a 4-week period. The pre- and postintervention assessment involved measures of multiple constructs of child anxiety (anxiety symptoms, children's fears, behavioral inhibition, and internalizing symptoms) from multiple informants (parents, children, and teachers). Parents also reported parenting strategies they were likely to use to manage their children's anxiety pre- and postintervention. Results indicated a significant decrease in child anxiety and behavioral inhibition as reported by parents and teachers. Furthermore, mothers reported significant increases in their use of positive reinforcement, and modeling and reassurance, and a significant decrease in their use of reinforcement of dependency directly after treatment. Taken together, parent-directed CBT appears to be an effective approach for treating children ages 4-7 years with anxiety symptoms. Limitations of the current research are discussed.     

The Effects of Parental Depressive Symptoms,Appraisals, and Physical Punishment on Later Child Externalizing Behavior

Examined a cognitive-behavioral pathway by which depressive symptoms in mothers and fathers increase risk for later child externalizing problem behavior via parents’ appraisals of child behavior and physical discipline. Participants were 245 children (118 girls) at risk for school-age conduct problems, and their parents and teachers. Children were approximately 3 years old at Time 1 (T1) and 5 ½ years old at Time 2 (T2). At T1, mothers and fathers reported their depressive symptoms, perceptions of their child’s reciprocal affection and responsiveness, frequency of physical punishment, and child externalizing problems. Mothers, fathers, and teachers provided ratings of externalizing behavior at T2. Structural equation modeling revealed that parents’ negative attributions mediated positive relations between their depressive symptoms and frequency of physical punishment for both fathers and mothers. More frequent physical punishment, in turn, predicted increased child externalizing behavior at T2. In future research, transactional mechanisms underlying effects of clinical depression on child conduct problems should be explored at multiple stages of development. For parents showing depressive symptoms, restructuring distorted perceptions about their children’s behavior may be an important component of intervention programs.     

Intra- and interpersonal factors and adolescent wellbeing during COVID-19 in three countries

COVID-19 has altered adolescents' opportunities for developing and strengthening interpersonal skills and proficiencies. Using data from adolescents in Italy, the United States, and the United Kingdom, we examined the relation between internalizing symptoms assessed pre-pandemic or when pandemic-related restrictions were lifted (Time 1) and associated internalizing symptoms during a subsequent restrictive pandemic period (Time 2). Across all 3 countries, we found significant and consistent effect sizes in the relation between Time 1 and Time 2 internalizing symptoms. We further examined the direct and moderating impact of self-efficacy and contextual supports for adolescents' internalizing symptoms. Higher self-efficacy was associated with lower levels of internalizing symptoms at Time 2 in all 3 countries. Additionally, the relation between Time 1 and 2 internalizing symptoms was buffered by regulatory self-efficacy and peer support in Italy, but in the U.S., higher levels of general self-efficacy instead had an exacerbating effect on the relation between Times 1 and 2 internalizing symptoms. Results are discussed in the context of utilizing cross-national datasets to examine similarities in adolescent well-being over time and in the face of varying government responses to the pandemic.     

Predicting mothers' reports of children's mental health three years after Hurricane Katrina

This study explored pathways through which hurricane-related stressors affected the psychological functioning of elementary school aged children who survived Hurricane Katrina. Participants included 184 mothers from the New Orleans area who completed assessments one year pre-disaster (Time 1), and one and three years post-disaster (Time 2 and Time 3, respectively). Mothers rated their children's behavior problems at Time 3 only (n = 251 children; 53.0% male; mean age: 10.19 years, SD = 1.68 years). A path analytic model indicated that hurricane-related stressors were associated with increased maternal psychological distress and school mobility in the first post-disaster year, which were associated with higher child internalizing and externalizing symptoms three years post-disaster. Mediation analysis indicated that hurricane-related stressors were associated with child symptoms indirectly, through their impact on maternal psychological distress. Findings underscore the importance of interventions that boost maternal and child mental health and support children through post-disaster school transitions.     

Child personality and parental behavior as moderators of problem behavior: variable- and person-centered approaches

Parenting x Child Personality interactions in predicting child externalizing and internalizing behavior were investigated in a variable-centered study and a person-centered study. The variable-centered study used data from a 3-year longitudinal study of 600 children 7 to 15 years old at Time 1 and 512 children 10 to 18 years old at Time 2. Parents rated child personality (five factor model), negative control, positive parenting, and child problem behavior, whereas children rated parental behavior. Hierarchical moderated regression analyses showed significant Parenting x Child Personality (benevolence and conscientiousness) interactions, principally for externalizing behavior. The interactions were largely replicable across informants and across time. The person-centered study, which classified participants into 3 types, showed that negative parental control was more related to externalizing behavior for undercontrollers than for resilients. Negative parental control enhanced internalizing behavior for overcontrollers.     

Longitudinal Relations Between Parent–Child Conflict and Children’s Adjustment: The Role of Children’s Sleep

Sleep was examined as a process variable in relations between verbal and physical parent–child conflict and change in children’s internalizing and externalizing symptoms over time. Participants were 282 children at T1 (M age?=?9.44 years; 48 % girls), 280 children at T2 (M age?=?10.41 years), and 275 children at T3 (M age?=?11.35 years). Children reported on parent–child conflict, sleep was assessed with actigraphy, and parents reported on children’s internalizing and externalizing symptoms. Autoregressive effects for sleep and internalizing and externalizing symptoms were controlled to examine change over time. Supportive of intervening processes, physical parent–child conflict at T1 and increased change in internalizing and externalizing symptoms at T3 were indirectly related through their shared association with reduced sleep continuity (efficiency, long wake episodes) at T2. Findings build on a small but growing literature and highlight the importance of considering the role of sleep in relations between family conflict and child development.     

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.     

Relations Between Emotion Regulation, Parenting, and Psychopathology in Young Maltreated Children in Out of Home Care

Young maltreated children, birth to three years, represent the age group with the highest rates of maltreatment in the United States (ACYF 2007). There are few studies to date that have investigated early childhood maltreatment and its effects on emotion regulatory processes and psychopathology. In response, the current investigation uses a dyadic assessment procedure to examine the relationship between parenting, emotion regulation, and symptoms of psychopathology among maltreating and non-maltreating parent–child interactions. The participants in this study were 123 children (66 maltreated and 57 nonmaltreated) from ages 1–3. Child and parent affect and child effortful control were observed during a parent–child interaction task. Symptoms of psychopathology were measured using the Child Behavior Checklist. The maltreated children exhibited more anger, more internalizing symptomatology, and less positive affect compared to non-maltreated children. Among maltreated children, emotion dysregulation was associated with internalizing symptomatology. Moreover, these data reveal parental positive affect was associated with lower child internalizing symptomatology and parental anger was associated with higher child internalizing symptomatology in the entire sample. This investigation offers evidence that emotion dysregulation subsequent to poor dyadic interactions is associated with early child maltreatment. These data suggest that maltreated children experience difficulties in emotion regulation which may be related to their higher levels of behavioral symptomatology.     

Within-Family Differences in Internalizing Behaviors: The Role of Children’s Perspectives of the Mother-child Relationship

The goal of this exploratory, within-family, longitudinal study was to examine whether children’s perspectives of the mother-child relationship explained within-family differences in children’s responses to a shared family stressor (maternal depressive symptoms) over time. Children (ages 8 to 15 years; N = 68) residing in 34 families were drawn from a general population study in the UK. Predictor variables were assessed at Time 1 and change in internalizing behavior from Time 1 to Time 2 (2 years later) was examined. As children were nested within families, data were analyzed using multilevel modeling, controlling for previous child behavior. Child perspective of the mother-child relationship, in interaction with maternal depressive symptoms, was found to explain within-family differences in internalizing over time. Children with a negative perspective (compared to mothers’ perspectives) were the most vulnerable to the adverse effects of maternal depressive symptoms.     

Behavioral Problems in Taiwanese Children of Adolescent and Adult Mothers

The purpose of this study was to estimate child behavioral problems over time and determine gender differences in behavioral problems between children born to adolescent and adult mothers in Taiwan. The consistency between parent’s and teacher’s reports was also examined. Secondary analysis of a longitudinal dataset from Taiwan was conducted. A matched sample of 107 children born to adolescent mothers and 111 children born to adult mothers were recruited. Child behavioral problems were assessed by parents at Time 1 (1^st and 2^nd grades) and by teachers at both Time 1 and Time 2 (5^th and 6^th grades). Generalized estimating equations and paired t-test were used. At Time 1, compared to children of adult mothers, children of adolescent mothers had had more behavioral problems by both parental and teacher’s reports. Both parents and teachers reported that boys had more behavioral problems than girls. Moreover, according to teacher reports, children of adolescent mothers and boys had more behavioral problems and these differences persisted over time, even controlling for sociodemographic characteristics. In addition, parents reported higher scores of behavioral problems than teachers. In conclusion, child behavioral problems in Taiwan are associated with maternal age at child birth and child’s gender. Interventions may profitably focus on determining the mechanisms that lead to behavior problems in children of adolescent mothers, and/or reducing adolescent pregnancy as a way of decreasing child behavioral problems. Screening and preventive interventions for child behavior problems may need to be gender-specific.     

Exploring predictors of change in behavioral problems over a 1-year period in preterm born preschoolers

ObjectiveAlthough predictors of the prevalence of behavioral problems in preterm-born children have been frequently studied, predictors of behavioral change in these children remain unknown. Therefore, in this study we explore predictors of short-term changes in problem behavior in preterm-born preschoolers, an age period characterized by rapid behavioral change.MethodTwo- to 5-year-old children born with a gestational age <32 weeks and/or birth weight <1500 g were eligible, because of their high risk for behavioral problems. Following screening, 59 children with a t-score ≥60 on either the internal, external or total problem scale of the Child Behavior Checklist were included in the study. Linear mixed modeling was used to investigate predictors of change in behavior over a 1-year period.ResultsHigher levels of parenting stress, parent perceived child vulnerability, and parental hostility towards the child and lower educational levels of the mother significantly predicted increases in externalizing behavior. The higher the age of the child, the more internalizing problems decreased.ConclusionsParenting stress, parent perceived child vulnerability and parental hostility towards the child were the only modifiable predictors of increases in externalizing behavior, whilst no modifiable predictors of internalizing behavior were found. There may be a reciprocal interaction between stress in parents and child externalizing problems. Furthermore, stress and worries may directly influence parents’ reports on behavioral measures, because it could cause them to be concerned by behavior otherwise perceived as normal. Therefore, future interventions for parents of preterm-born children should primarily address parental stress and concerns regarding their child.     

Psychological and Sociocultural Adaptation of Children Adopted from Russia and their Associations with Pre-Adoption Risk Factors and Parenting

We investigated academic and behavioral outcomes of internationally adopted children and the associations between these outcomes and age at adoption, time spent in the adoptive family, and parenting. At two time points (T1 and T2, ~15 months apart), we examined early academic skills (school readiness), and parent-reported behavioral adjustment (internalizing and externalizing behavior) and adaptive functioning of a sample of 75 children (45.9% boys, mean age?=?5.17 years) adopted from Russia into US families. We also collected parents’ self-assessments of their parenting at T1. Children who were adopted at a younger age showed higher levels of early academic skills. Correlations between age at adoption and other outcomes were overall small and mostly non-significant. However, adoptees’ academic and behavioral progress differed notably in several respects. Specifically, adoptees improved in early academic skills over time, whereas, as a group, their adaptive functioning and behavioral adjustment remained stable within the normal range. Early academic skills were not related to behavioral adjustment at each time point and over time. The time spent in the adoptive family was positively related to early academic skills at T2. Whereas outcomes showed little to no relation to parenting as reported by mother and father separately, higher discrepancies between mothers' and fathers' reports of positive parenting were related to higher levels of behavioral symptoms and lower levels of adaptive skills at T2. These differential results may be explained in part by drawing upon the notion of dissociated domains of psychological and sociocultural adaptation and acculturation, outlined in the immigration literature. These results also bring to light the possible importance of between-parent consistency in parenting for adoptees’ behavioral outcomes.     

Catching sight of children with internalizing symptoms in upper elementary classrooms

Teachers play a crucial role in the assessment of children's internalizing symptoms but may not always succeed in accurately identifying such symptoms in class. Using a multilevel structural equation modeling (MSEM) approach, this study aimed to explore teacher and child characteristics that may explain measurement bias in teachers' ratings of internalizing symptoms at the between- and within-teacher level. Upper elementary school teachers (N = 92, 74.9% female) filled out the Strengths and Difficulties Questionnaire, Student-Teacher Relationship Scale, and Student-Specific Teacher Self-Efficacy Scale for randomly selected children (N = 690, 50.5% girls, Grades 3–6) from their classrooms. Participating teachers and children also responded to several background questions. Multilevel SEMs suggested that teachers' self-efficacy beliefs toward, relationship experiences with, and externalizing symptom ratings of individual children affected their ratings of these children's internalizing symptoms at the within-teacher level. Specifically, given equal levels of internalizing behavior, teachers were likely to systematically under-identify symptoms of anxiety and over-identify bullying for children with more externalizing behavior and conflictual relationships, or in circumstances where teachers had lower self-efficacy. Children with high levels of closeness received systematically higher ratings on somatic complaints and lower ratings on solitary behavior and peer problems. At the between-teacher level, less experienced teachers were more likely to over-identify symptoms of worries than were more experienced teachers, given equal levels of internalizing symptoms. As such, these findings extend the limited body of evidence on children's internalizing symptoms in upper elementary school.     

Mother–Child Agreement on Reports of Internalizing Symptoms Among Children Referred for Evaluation of ADHD

The effects of maternal (bias), child (age, severity of behavior problems), and measurement characteristics (similarity of parent and child measures; types of internalizing symptoms) on mother–child agreement on reports of children's internalizing symptoms were examined for 65 children referred for evaluation of ADHD. Agreement was low and did not improve when parents and children completed parallel measures. Mothers and children were more likely to agree on severity of internalizing symptoms rated as behavioral than those rated as ideational. The majority of discordant reports were of the type that mothers, but not children, reported clinically elevated symptoms. This type of discordance appeared to be a function of maternal negative bias rather than underreporting of symptoms by children.