Parent-Child Interactions in Anxious Families

A considerable amount of research has examined factors associated with the etiology and maintenance of anxiety disorders in children. The familial nature of anxiety has been well-established, with genetic studies showing that approximately 30% of the variance is accounted for by genetic factors. Research into the family environment documents behavioral differences in interactions between non-anxious parent-child and anxious parent-child dyads, including less granting of autonomy, and parental withdrawal and disengagement. Recent theoretical work in the field of anxiety suggests that attachment models and coercive operant patterns could create a bi-directional coercive interaction pattern, similar to that seen in interactions of parents and aggressive children. The current study investigated parent and child behaviors coded from interaction tasks across four groups based on anxiety status: anxious parent/anxious child, non-anxious parent/anxious child, anxious parent/non-anxious child, and non-anxious parent/non-anxious child to empirically examine hypothesized interactive patterns. The study sample consisted of 158 parent-child (ages 3–12 years) dyads. Results support an interaction between parent and child anxiety on behavior within dyads. The current study provides an important step in identifying processes linked to familial anxiety.     

Parents' cognitions and expectations about their pre‐school children: The contribution of parental anxiety and child anxiety

This study investigated the relative associations between parent and child anxiety and parents' cognitions about their children. One hundred and four parents of children aged 3–5 years completed questionnaires regarding their own anxiety level, their child's anxiety level and their cognitions about the child, specifically parents' expectations about child distress and avoidance, and parents' perceived control over child mood and behaviour. Both parent anxiety and parent report of child anxiety were significantly associated with parents' cognitions. Specifically, parent report of child anxiety correlated significantly with parent locus of control generally and, more specifically, with parental expectations and perceived control of child anxious mood and behaviour. Parent anxiety correlated significantly with locus of control and parents' expectations of child anxious mood and behaviour. Furthermore, when both child and parent anxiety were taken into account, only parental anxiety remained significantly associated with parental locus of control and perceived control of child anxious behaviour. For parents' perceived control of child anxious mood, only child anxiety remained significantly associated. The results suggest that parents' perceived control over their children's behaviour may primarily reflect parental anxiety, rather than child anxiety. Parental anxiety may, therefore, present an important target for interventions that aim to change parent's cognitions and behaviour.     

Exploring the relationships between maternal and child metacognitions and child anxiety

Research has shown that anxiety may be transmitted through verbal information pathways, for example, when parents share their anxious cognitions with their child. Less is known about the influence of parental metacognitions, that is, beliefs regarding thoughts, on child anxiety. We explored the relations between metacognitions in mothers and their children and anxiety in the children. Our study included 111 non‐clinical children aged 8 to 12 years and their mothers. Children rated their metacognitions, worry and anxiety, and mothers rated their metacognitions. Results indicated agreement between maternal and child metacognitions. Maternal metacognitions were positively associated with children's anxiety symptoms and worry, and this relation was mediated by the children's metacognitions. Our results warrant further examination of the role of parental metacognitions in child anxiety.     

Increasing access to low‐intensity interventions for childhood anxiety: A pilot study of a guided self‐help program for Scandinavian parents

Cognitive Behavior Therapy (CBT) is an effective treatment for child anxiety. However, access to treatment is limited. It has been suggested that low‐intensity formats of parent‐delivered CBT may improve access to treatment. Our aim was to develop and pilot‐test the acceptability and effect of a low‐intensity therapist‐guided parent‐delivered group program for anxious children (age 7–12 years) adjusted to the Scandinavian culture. The program required 1.5 hours of therapist‐time per family. Mothers, fathers and children reported on revised child anxiety and depression scale (RCADS) at referral, pre‐ and post‐treatment. Mothers and fathers also gave a qualitative account of their experiences. Thirty‐one families were enrolled and only one family dropped out. Mean age of the children was 9 years. Intent‐to‐treat analyses revealed significant reductions in anxiety and depressive symptoms from pre‐ to post‐treatment for all informants. Large effect sizes were found for child anxiety symptoms as reported by mothers and fathers, and for child depressive symptoms as reported by mothers. Medium to large effect sizes was found for the self‐reported anxiety symptoms by the children, and for depressive symptoms reported by both children and fathers. More than 93% of the parents would recommend the program. Results suggest that our program may provide a new approach to improve access to treatment for anxious children in Scandinavia; however, further research must be conducted before firm conclusions can be drawn.     

The impact of mothers' trait anxiety on their expectations of approach‐avoidance behaviour in anxious and non‐anxious children

This study investigated estimates of approach and avoidance behaviour in clinically anxious and non‐anxious children, and whether mothers' expectations of their children's avoidance differed as a function of high trait anxiety (HTA) versus low trait anxiety (LTA). Participants were 62 clinically anxious and 60 non‐anxious children aged 7–12 years and their mothers. Estimates of avoidance were obtained using an analogue task in which children and mothers were given threat and pleasant information about two novel animals and were asked to estimate children's avoidance of the threat animal's habitat when the threat animal was present (threat condition) and absent (safe condition) from the habitat and when its presence was uncertain (ambiguous condition). Contrary to expectation, anxious children did not differ from controls in estimates of avoidance in any condition. However, relative to HTA mothers of anxious children and LTA mothers of non‐anxious children, HTA mothers estimated greater approach behaviour by their non‐anxious children in the threat condition. Findings suggest that mothers' expectations of children's approach‐avoidance behaviour is influenced by both maternal and child factors.     

The impact of maternal control on children’s anxious cognitions, behaviours and affect: An experimental study

Controlling parenting is associated with child anxiety however the direction of effects remains unclear. The present study implemented a Latin-square experimental design to assess the impact of parental control on children’s anxious affect, cognitions and behaviour. A non-clinical sample of 24 mothers of children aged 4-5 years were trained to engage in (a) controlling and (b) autonomy-granting behaviours in interaction with their child during the preparation of a speech. When mothers engaged in controlling parenting behaviours, children made more negative predictions about their performance prior to delivering their speech and reported feeling less happy about the task, and this was moderated by child trait anxiety. In addition, children with higher trait anxiety displayed a significant increase in observed child anxiety in the controlling condition. The pattern of results was maintained when differences in mothers’ levels of negativity and habitual levels of control were accounted for. These findings are consistent with theories that suggest that controlling parenting is a risk factor in the development of childhood anxiety.     

Parents’ Reports of Children’s Internalizing Symptoms: Associations with Parents’ Mental Health Symptoms and Substance Use Disorder

This brief report examined the unique associations between parents’ ratings of child internalizing symptoms and their own depression and anxiety in families with parental substance use disorder (SUD). Further, we examined whether parental SUD (father only, mother only, both parents) was related to discrepancy in mothers’ and fathers’ reports of children’s internalizing symptoms. Participants were 97 triads (fathers, mothers) in which one or both parents met criteria for SUD. Polynomial regression analyses were conducted to examine whether father-mother reports of child internalizing symptoms had unique associations with parents’ own symptoms of depression and anxiety while controlling for child gender, child age, and SUD diagnoses. Controlling for fathers’ symptoms and other covariates, mothers experiencing more depression and anxiety symptoms reported more symptoms of child internalizing symptoms than did fathers. Mothers’ and fathers’ SUD was associated with higher anxiety symptoms among mothers after controlling for other variables. A second set of polynomial regressions examined whether father-mother reports of child internalizing symptoms had unique associations with parents’ SUD diagnoses while controlling for child gender and child age. After controlling for mothers’ symptoms and other covariates, parents’ reports of children’s internalizing symptoms were not significantly associated with either parent’s SUD or parental SUD interactions (i.e., both parents have SUD diagnoses). Taken together, mothers’ ratings of children’s internalizing symptoms may be accounted for, in part, by her reports of depression and anxiety symptoms.     

Intergenerational transmission of attentional bias and anxiety

Earlier evidence has revealed a bi‐directional causal relationship between anxiety and attention biases in adults and children. This study investigated the prospective and concurrent relations between anxiety and attentional bias in a sample of 89 families (mothers, fathers, and first‐born children). Parents’ and children's attentional bias was measured when children were 7.5 years old, using both a visual probe task and visual search task with angry versus happy facial expressions. Generalized and social anxiety symptoms in parents and children were measured when children were 4.5 and 7.5 years old. Anxiety in parents and children was prospectively (but not concurrently) related to their respective attentional biases to threat: All participants showed a larger attentional bias to threat in the visual search (but not in the visual probe) task if they were more anxious at the 4.5 (but not at the 7.5) year measurement. Moreover, parents’ anxiety levels were prospectively predictive of the visual search attentional bias of their children after controlling for child anxiety. More anxiety in mothers at 4.5 years was related to a faster detection of angry among happy faces, while more anxiety in fathers predicted a faster detection of happy among angry faces in children at 7.5 years. We found no direct association between parental and child attentional biases. Our study contributes to the recently emerging literature on attentional biases as a potential mechanism in the intergenerational transmission of anxiety by showing that parents’ anxiety rather than parents’ attentional bias contributes to the intergenerational transmission of risk for child anxiety.     

Threat interpretation bias as a vulnerability factor in childhood anxiety disorders

The present study examined threat interpretation biases in children 7-12 years of age with separation, social and generalised anxiety disorders (N=15), non-anxious offspring at risk due to parental anxiety (N=16) and non-anxious controls of non-anxious parents (N=14). Children provided interpretations of ambiguous situations to assess cognitive, emotional and behavioural responses. In comparison with non-anxious control children and at-risk children who did not differ from each other, anxious children reported stronger negative emotion and less ability to influence ambiguous situations. These results suggest that threat interpretation bias may be a cognitive factor associated with ongoing childhood anxiety but not a vulnerability factor associated with parental anxiety.     

Interpretation of Ambiguity in Children: A Prospective Study of Associations With Anxiety and Parental Interpretations

Interpretation of ambiguity is consistently associated with anxiety in children, however, the temporal relationship between interpretation and anxiety remains unclear as do the developmental origins of interpretative biases. This study set out to test a model of the development of interpretative biases in a prospective study of 110 children aged 5–9 years of age. Children and their parents were assessed three times, annually, on measures of anxiety and interpretation of ambiguous scenarios (including, for parents, both their own interpretations and their expectations regarding their child). Three models were constructed to assess associations between parent and child anxiety and threat and distress cognitions and expectancies. The three models were all a reasonable fit of the data, and supported conclusions that: (i) children’s threat and distress cognitions were stable over time and were significantly associated with anxiety, (ii) parents’ threat and distress cognitions and expectancies significantly predicted child threat cognitions at some time points, and (iii) parental anxiety significantly predicted parents cognitions, which predicted parental expectancies at some time points. Parental expectancies were also significantly predicted by child cognitions. The findings varied depending on assessment time point and whether threat or distress cognitions were being considered. The findings support the notion that child and parent cognitive processes, in particular parental expectations, may be a useful target in the treatment or prevention of anxiety disorders in children.     

Parenting Practices of Anxious and Non-Anxious Mothers: A Multi-method Multi-informant Approach

Anxious and non-anxious mothers were compared on theoretically derived parenting and family environment variables (i.e., over-control, warmth, criticism, anxious modeling) using multiple informants and methods. Mother-child dyads completed questionnaires about parenting and were observed during an interactional task. Findings revealed that, after controlling for race and child anxiety, maternal anxiety was associated with less warmth and more anxious modeling based on maternal-report. However, maternal anxiety was not related to any parenting domain based on child-report or independent observer (IO) ratings. Findings are discussed in the context of the impact of maternal anxiety on parenting and suggest that child, rather than maternal, anxiety may have a greater influence on parental behavior.     

The role of parental emotional distress in parent report of child anxiety

Evaluated the role of maternal and paternal emotional distress in parent report of anxiety in their child. Participants were 239 children (ages 7.5 to 15 years) diagnosed with a primary anxiety disorder and their parents (193 fathers, 238 mothers). Parents individually completed the State-Trait Anxiety Inventory, the Beck Depression Inventory (BDI), and the State-Trait Anxiety Inventory for Children-Parent Version (a report of the child's anxiety). Children completed the State-Trait Anxiety Inventory for Children. Mothers and fathers reported more anxiety in their children than the children reported themselves. No significant relations were found between parental anxiety and parent report of child anxiety. When we examined girls only, both maternal and paternal BDI scores were significant predictors of parent report of the child's anxiety after we controlled for parental anxiety. Separate analyses by child age revealed that parent reports of child anxiety were more correlated with the self-reports of younger children. The implications of these findings are discussed.     

Interpretation and Expectation in Childhood Anxiety Disorders: Age Effects and Social Specificity

Theory and treatment for childhood anxiety disorders typically implicates children’s negative cognitions, yet little is known about the characteristics of thinking styles of clinically anxious children. In particular, it is unclear whether differences in thinking styles between children with anxiety disorders and non-anxious children vary as a function of child age, whether particular cognitive distortions are associated with childhood anxiety disorders at different child ages, and whether cognitive content is disorder-specific. The current study addressed these questions among 120 7–12 year old children (53% female) who met diagnostic criteria for social anxiety disorder, other anxiety disorder, or who were not currently anxious. Contrary to expectations, threat interpretation was not inflated amongst anxious compared to non-anxious children at any age, although older (10–12 year old) anxious children did differ from non-anxious children on measures of perceived coping. The notion of cognitive-content specificity was not supported across the age-range. The findings challenge current treatment models of childhood anxiety, and suggest that a focus on changing anxious children’s cognitions is not warranted in mid-childhood, and in late childhood cognitive approaches may be better focussed on promoting children’s perceptions of control rather than challenging threat interpretations.     

Fathers' versus mothers' social referencing signals in relation to infant anxiety and avoidance: a visual cliff experiment

Infants use signals from others to guide their behavior when confronted with novel situations, a process called ‘social referencing’ (SR). Via SR, signs of parental anxiety can lead to infant anxiety. Little is known about differences in the effect of paternal and maternal SR signals on child anxiety. Using a visual cliff paradigm, we studied whether SR processes between fathers and their infants differed from mothers and their infants. Eighty‐one infants aged 10–15 months were randomly assigned to conduct the visual cliff task with their father (n = 41) or mother (n = 40). The infant was placed on the shallow side of the cliff and the parent, standing at the deep side, was instructed to encourage the infant to cross. Results showed that although mothers showed more intense facial expressions of encouragement than fathers, no differences occurred in how fast, and with how much anxiety, infants crossed the cliff with fathers and mothers. However, path analyses showed that paternal, but not maternal, expressed anxiety was positively associated with infant expressed anxiety and avoidance. For infants who participated with their mother, infants' anxious temperament was negatively associated with infant avoidance of the cliff. Infant anxious temperament moderated the link between paternal expressed anxiety and infant avoidance: the higher the level of infant anxious temperament the stronger the positive association between paternal expressed anxiety and infant's avoidance of the cliff. Lastly, parental encouragement was unrelated to infant expressed anxiety and avoidance. Our results suggest that SR processes between fathers and their infants differ from those between mothers and their infants.     

Do anxious parents interpretive biases towards threat extend into their child's environment?

Anxiety disorders are known to run in families [Turner, S. M., Beidel, D. C., & Costello, A. (1987). Psychopathology in the offspring of anxiety disorder patients. Journal of Consulting and Clinical Psychology, 55(2), 229–235] and environmental factors may largely account for the concordance between parental and child anxieties. Cognitive psychology models emphasise the importance of interpretive biases towards threat in the maintenance of anxiety and it is well established that anxious adults and children display similar interpretive biases and that these biases in anxious parents and their children are correlated. This raises the question of whether anxious cognitions/cognitive style may be transmitted from parent to child. We propose that this is more likely if anxious parents demonstrate interpretive biases not only about potential threats in their own environment but also about potential threats in their child's environment. Forty parents completed a recognition memory measure of interpretation bias adapted from Eysenck, Mogg, May, Richards, and Mathews (1991) [Bias in interpretation of ambiguous sentences related to threat in anxiety. Journal of Abnormal Psychology, 100(2), 144–150] to measure biases in response to potentially threat provoking situations involving themselves and their child. The interpretive biases demonstrated by parents were similar across situations involving themselves and their children. As expected, parental interpretive biases were further modified by anxiety with higher levels of parental anxiety associated with more negative interpretive biases about situations in their own and their child's environment, although this association was significantly stronger for potentially threat provoking situations in their own environment. These results are consistent with parent's interpretive biases extending beyond their own environment into their child's environment, although future research should continue to consider the mechanisms by which anxious parents may transmit fear cognitions to their children.     

Anxious children and their parents: what do they expect?

Assigned 73 children, ages 7 to 14, to 1 of 3 groups (anxious, clinical control, and nonclinical control) according to their diagnostic status. Within the anxious group, children were assigned to 1 of 2 further groups on the basis of self-reported parental anxiety--either the child anxiety only group or the child + parent anxiety group. All children completed an experimental task (giving a brief talk in front of a video camera), which was the focus for a series of structured family discussions between the child and his or her parents. The aims of the study were to measure and compare across groups (a) the evaluations of children and their parents regarding the child's predicted anxiety and skill level and (b) the effect of the family discussion on children's expectations. Results indicated that, prior to the family discussion, anxious children's expectations of their future performance did not differ from those of control children. Similarly, there were no differences in children's expectations between the child anxiety group and the child + parent anxiety group. Second, compared to mothers in the child anxiety group, mothers in the child + parent anxiety group expected that their children would be more anxious and more likely to choose an avoidant problem solution (but not less skilled). Finally, the family discussion was found to produce no changes in anxious children's expectations of their future performance. The implications of these findings are discussed.     

Paternal Child-Rearing Style and Child Social Anxiety: Investigation of Child Perceptions and Actual Father Behavior

This study examined associations among perceived and actual father behavior and child social anxiety. Forty-eight children (22 high socially anxious, 26 low socially anxious) completed self-report measures of social anxiety, general anxiety, and depression. Children also completed a measure of perceived parental style and subsequently collaborated with their fathers on a challenging task (origami). After controlling for general anxiety and depression, fathers of high socially anxious children exhibited more controlling behavior during the origami task; high and low socially anxious children, however, did not differ behaviorally from one another. Perceptions of father child-rearing style did not differ as a function of child social anxiety, nor were significant relations found between perceived parenting and specific father behaviors. Findings underscore the importance of assessing various types of internalizing symptoms (i.e., controlling for shared construct variance), obtaining children's perceptions of parental style in conjunction with conducting behavioral observations, and including fathers in psychopathology research.     

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.     

An Examination of the Relationship Between Parent Language and Child Anxiety

Research suggests that parents of anxious children behave differently when interacting with their children than do parents of nonanxious children. However, the relationship between parent language use in this context and child anxiety remains unclear. The present study investigates how parent language use relates to child anxiety during parent–child interactions using a community sample recruited to participate in a study of familial anxiety. Results indicate that parent language use varies in relation to child anxiety. Further, this idiosyncratic pattern of parent linguistic activity uniquely predicts child anxiety diagnostic status. Implications of this study and future directions for research are discussed.