Childhood-Onset Multiple Sclerosis and Mood Disorders: A Case Study

Multiple Sclerosis (MS) is rare in children. Little research exists regarding emotional and behavioral disorders in childhood-onset MS, despite the occurrence of such problems in adults with MS. This paper describes the cognitive and behavioral characteristics of a boy diagnosed with MS at age 9 and mood disorder at age 10. He displayed no cognitive or behavioral problems prior to the onset of physical symptoms of MS. Three years after diagnosis, this child showed persistent problems with speed of processing, visual-motor skills, and parent and teacher-reported executive functioning. In addition, he had difficulties with emotional lability, behavioral disinhibition, depression, and social interaction. As with adults, children with MS may be at increased risk for mood disorder compared to their peers. Mood disorders in children with MS are likely to be multiply determined, although the specific causal mechanisms are unknown.     

Recognition of Facial Expressions of Emotion by Children with Emotional and Behavioral Disorders

Interpreting and responding appropriately to facial expressions of emotion are important aspects of social skills. Some children, adolescents, and adults with various psychological and psychiatric disorders recognize facial expressions less proficiently than their peers in the general population. We wished to determine if such deficits existed in a group of 133 children and adolescents with emotional and behavioral disorders (EBD). The subjects were receiving in-patient psychiatric services for at least one of substance-related disorders, adjustment disorders, anxiety disorders, mood disorders or disruptive behavior disorders. After being read stories describing various emotional reactions, all subjects were tested for their ability to recognize the 6 basic facial expressions of emotion depicted in Ekman and Friesen's (1976) normed photographs. Overall, they performed well on this task at levels comparable to those occurring in the general population. Accuracy increased with age, irrespective of gender, ethnicity, or clinical diagnosis. After adjusting for age effects, the subjects diagnosed with either adjustment disorders, mood disorders, or disruptive behavior disorders were significantly more accurate at identifying anger than those without those diagnoses. In addition, subjects with mood disorders identified sadness significantly more accurately than those without this diagnosis, although the effect was greatest with younger children.     

Posttraumatic stress and worry as mediators and moderators between political stressors and emotional and behavioral disorders in Palestinian children

This study was designed to assess whether the symptoms of posttraumatic stress mediate or moderate the relationship between political stressors and emotional and behavioral disorders in Palestinian children. It was hypothesized that (a) posttraumatic stress and worry mediate the effect of political stressors on behavioral and emotional disorders and (b) the relationship between political stressors and behavioral and emotional disorders should be attenuated for children with low levels of worry and posttraumatic stress and strengthened for children with high levels of worry and posttraumatic stress. The total sample was 1267 school age children of both sexes with a mean age of 11.97 years. Interviews were conducted with children at school. As hypothesized, the results indicated that posttraumatic stress and worry mediated and moderated the relationship between political stressors and emotional and behavioral disorders in children. Cognitive-behavioral therapy may be used to reduce the incidence of posttraumatic stress and decrease self-reported worry, somatic symptoms, general anxiety, and depression among children exposed to political trauma. Cognitive-behavioral treatment that exclusively targets excessive worry can lead to clinical change in the other interacting subsystems at the cognitive, physiological, affective and behavioral levels.     

Prediction of childhood problems at three years in children experiencing disorders of regulation during infancy

The objective of this study was to determine if symptoms of regulatory disorder (RD) during infancy were related to clinical status at three years. Two age‐matched RD groups based on severity (N = 10 in mild RD group; N = 22 in moderate–severe RD group) and an age‐matched control group (N = 38) were evaluated at 7 and 30 months. A fourth group with pervasive developmental disorders (N = 18) also were tested. Problems with self‐regulation, including sleep, feeding, state control, self‐calming, sensory reactivity, mood regulation, and emotional and behavioral control, were documented during infancy. Children were retested at 36 months in their development, behavior, and play. Two child psychiatrists unfamiliar with the subjects' diagnostic classification during infancy provided diagnoses at 36 months. At 36 months, 60% of children with mild regulatory disorders did not meet criteria for any disorders, while 95% of infants with moderate regulatory disorders had diagnoses that fell into two diagnostic clusters: (1) delays in motor, language, and cognitive development and (2) parent–child relational problems. Most toddlers in the pervasive developmental disorder group were diagnosed as having PDD or autism with mental retardation or borderline intelligence at 36 months. Early symptoms are discussed as they relate to later diagnostic outcomes for the clinical samples. © 2000 Michigan Association for Infant Mental Health.     

Confirmatory factor analysis of the behavior rating inventory of executive function in a neuro-pediatric sample and its application to mental disorders

The construct validity of the 9-scale version of the Behavior Rating Inventory of Executive Function (BRIEF) parent form was examined in a clinical sample of children and adolescents with neurological and neurodevelopmental disorders (N = 281). Confirmatory factor analysis supported a three-factor model separating the inhibitory behavioral control dimension from the emotional control and metacognitive problem-solving dimensions. The Metacognitive factor was also related to a diagnosis of attention deficit/hyperactivity disorder (ADHD) after controlling for age, gender, IQ, adaptive functioning, and a conventional behavioral rating scale, which included inattention-hyperactivity symptoms. The Emotional Regulation factor was related to a diagnosis of oppositional defiant disorder. Correlational analyses indicated that child comorbid emotional and behavioral problems may exacerbate parental BRIEF reporting. Accordingly, when assessing executive function among children with neurological and neurodevelopmental disorders, the BRIEF should be complemented with assessments of mental health problems.     

Interactions between emotion regulation strategies and affective style: Implications for trait anxiety versus depressed mood

Affective style reflecting approach and inhibition is thought to be associated in distinct ways with anxious versus depressed mood; relatively few studies, however, consider how the interaction between affective style and the strategies individuals use to regulate mood and emotion might influence these associations. Sixty-seven non-disordered adults self-reported on their use of two emotion regulation strategies (cognitive reappraisal and expressive suppression), behavioral approach (BAS) and behavioral inhibition sensitivity (BIS) dimensions of affective style, and anxious and depressed mood (trait anxiety and symptoms of depression). Trait anxiety versus depressed mood was associated with unique interactive patterns of emotion regulation and affective style: enhanced use of reappraisal was linked to less depressed mood in those reporting low BAS, whereas high suppression was linked to greater trait anxiety in those reporting low BIS. The implications of findings for typical emotional processes and for clinical disorders and interventions are discussed.     

The Effect of Physical Activity on Children With ADHD: A Quantitative Review of the Literature

Research on the effects of physical activity on children with attention deficit hyperactivity disorder is promising, yet no attempt has been made to integrate current findings using meta-analytic techniques. Using a meta-regression, the present study examined the effectives of physical activity for children with attention deficit hyperactivity disorder on a number of cognitive, behavioral, and emotional outcomes. From 20 empirical studies, 164 effect sizes quantifying the effectiveness of physical activity for children with attention deficit hyperactivity disorder were extracted from 22 independent samples. Results indicated an overall moderate-to-large effect for physical activity on children with attention deficit hyperactivity disorder, with a significant effect for emotion/mood. Limitations of the study, future directions, and implications for school professionals are discussed.     

Executive functioning and its relation to ASD and ADHD symptomatology in 22q11.2 deletion syndrome*

Children with 22q11.2 deletion syndrome (22q11DS; velo-cardio-facial-syndrome) are at risk for the developmental disorders, attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). In this study, the relation between executive functioning (EF) and the severity of ADHD and ASD symptoms is examined, since EF is known to be important in relation to emotional and behavioral problems. The participants consist of 58 children (38 females) with a mean age of 13.5 years (SD 2.6). Standardized assessment was used to evaluate the severity of ASD and ADHD symptomatology. The major aspects of EF, i.e., cognitive flexibility, inhibition, sustained attention, distractibility, working memory and reaction speed, were evaluated. The profile of EF in 22q11DS was found to be characterized by weaker performance compared to the norms on all subdomains of EF. Poor cognitive flexibility and inhibition, as well as high distractibility, were found to be related to more severe ASD symptoms, while poor quality of sustained attention and high distractibility were found to be related to more severe ADHD symptoms. It is concluded that children with 22q11DS experience impairments in EF, and that the degree of impairment on specific EF subdomains is related to the severity of ASD and/or ADHD symptomatology. These results may help in defining the mediating role of neurocognitive dysfunctions in the development of social and behavioral problems in 22q11DS.     

情绪障碍及其干预:心理表象的视角

心理表象在多种情绪障碍中均表现出病理性特点。研究者基于心理表象主要对创伤后应激障碍、抑郁心境、双相障碍情绪和社交焦虑进行了心理病理学解释,尤其关注闪回和过度概化记忆等两种典型症状,并且重视心理表象在情绪症状维持中的作用。概括而言,研究者强调记忆形成与提取过程的异常、认知与行为的保护性策略的负强化、对事件及自我的认知偏差等三类因素对情绪障碍的致病作用。目前,针对或运用心理表象的干预与训练方法包括减少消极表象、改变消极表象内容、提高积极表象能力、提高记忆的具体性等四类。未来应注重侵入性表象的功能分析以及相关的心理病理学模型研究,并拓展干预与训练研究。     

Emotional, behavioral, and cognitive factors that differentiate obsessive-compulsive disorder and other anxiety disorders in youth

Abstract The current study examined specific emotional, behavioral, and cognitive variables that may distinguish obsessive-compulsive disorder (OCD) from generalized anxiety disorder (GAD), social phobia (SoP), and separation anxiety disorder (SAD) in youth. Youth with OCD (n=26) and other anxiety disorders (ADs; n=31), aged 7-12 years (56.1% males), and their parents participated. The study compared the two anxious groups on levels of emotional, behavioral, and cognitive functioning, as well as impairment associated with the disorder. Results indicated that in comparison to youth with GAD, SoP, or SAD, youth with OCD were found to have poorer emotion regulation skills, as well as greater oppositionality, cognitive problems/inattention, and parent impairment associated with the disorder. The findings suggest that there are unique characteristics of OCD that may differentiate this disorder from other ADs in youth. Potential clinical implications and directions for future research are discussed.     

Using item response theory to understand comorbidity among anxiety and unipolar mood disorders

The authors hypothesized that anxiety and unipolar mood disorders are often comorbid because each disorder indicates a broad, higher order factor. In a clinical subsample of the nationally representative National Comorbidity Survey participants (N = 251), a one-factor model fit the correlations among 7 dichotomous anxiety and unipolar mood diagnoses. Following the lead provided by literature on the structure of emotional and behavioral problems in children, we labeled this factor internalizing. Item response theory was used to explore how each diagnosis mapped onto the internalizing factor. The test information function derived from the 7 diagnoses suggested that they measure primarily the higher end of the factor. In addition, very high scores on internalizing (meeting criteria for 6-7 disorders) were associated with increased social costs, a phenomenon not well captured by the "comorbidity" concept. The results underscore the need to develop clinical assessment instruments that span the full range of the internalizing factor and measure both the shared and distinctive features of anxiety and unipolar mood disorders in a graded, continuous fashion.     

Targeting Common Factors Across Anxiety and Depression Using the Unified Protocol for the Treatment of Emotional Disorders in Adolescents

Clinical approaches to mood and anxiety disorders in children and adolescents have historically been confined to either diagnosis- [e.g., for obsessive–compulsive disorder vs. generalized anxiety disorder (GAD), etc.] or domain-specific (e.g., for anxiety disorders vs. depressive disorders) treatments. However, as conceptualizations of mental illness shift towards a more dimensional model [e.g., the recent Research Domain Criteria (RDoC) from the National Institutes of Health], transdiagnostic treatments, such as the unified protocol for the treatment of emotional disorders in adolescents (UP-A; Ehrenreich et al. in Child Fam Behav Ther 31(1):20–37, 2008), are gaining support in the empirical literature. This paper reviews the common treatment targets across three emotional disorders commonly found in adolescence: GAD, social anxiety disorder, and major depressive disorder. In particular, similarities and differences across potential treatment mechanisms, including cognitive and information processing deficits, problem-solving difficulties, and avoidance strategies are examined. Finally, the case of 17-year-old “Andrea” is presented to demonstrate how transdiagnostic approaches like the UP-A can be effective in treating a range of emotional disorders in youth.     

Creativity,Mood Disorders,and Emotional Intelligence

The study addressed two findings in the creativity literature that show, on the one hand, that bipolar disorder and other clinical dysfunctions are overrepresented among eminently creative people, and that positive affect is positively associated with creativity. The central hypothesis of the study was that emotional intelligence could be an intervening variable between clinical conditions and creative production. A sample of 412 undergraduates completed a wide range of divergent thinking and creative production measures, and the Emotional Intelligence Scale; 11 percent of the sample reported that they had completed treatment for mood disorder and 5 percent report that they were currently in treatment. A combination of regression and ANOVA analyses revealed: The link between mood disorders and creative production persisted after emotional intelligence was statistically removed; the same was true for ideational fluency and flexibility of cognitive style. The link between emotional intelligence and creative production persisted after the effect of clinical disorders was removed. Ideational fluency and emotional intelligence were higher among people who completed treatment compared to people in treatment. The tentative interpretation is that emotional intelligence serves as a counterweight against mood disorders in enhancing creative production.     

Emotional,behavioral, and cognitive factors that differentiate obsessive-compulsive disorder and other anxiety disorders in youth

Abstract

The current study examined specific emotional, behavioral, and cognitive variables that may distinguish obsessive-compulsive disorder (OCD) from generalized anxiety disorder (GAD), social phobia (SoP), and separation anxiety disorder (SAD) in youth. Youth with OCD (n=26) and other anxiety disorders (ADs; n=31), aged 7–12 years (56.1% males), and their parents participated. The study compared the two anxious groups on levels of emotional, behavioral, and cognitive functioning, as well as impairment associated with the disorder. Results indicated that in comparison to youth with GAD, SoP, or SAD, youth with OCD were found to have poorer emotion regulation skills, as well as greater oppositionality, cognitive problems/inattention, and parent impairment associated with the disorder. The findings suggest that there are unique characteristics of OCD that may differentiate this disorder from other ADs in youth. Potential clinical implications and directions for future research are discussed.     

Anxiety and Related Disorders and Concealment in Sexual Minority Young Adults

Sexual minorities face greater exposure to discrimination and rejection than heterosexuals. Given these threats, sexual minorities may engage in sexual orientation concealment in order to avoid danger. This social stigma and minority stress places sexual minorities at risk for anxiety and related disorders. Given that three fourths of anxiety disorder onset occurs before the age of 24, the current study investigated the symptoms of generalized anxiety disorder, social phobia, panic disorder, posttraumatic stress disorder, and depression in sexual minority young adults relative to their heterosexual peers. Secondarily, the study investigated sexual orientation concealment as a predictor of anxiety and related disorders. A sample of 157 sexual minority and 157 heterosexual young adults matched on age and gender completed self-report measures of the aforementioned disorders, and indicated their level of sexual orientation concealment. Results revealed that sexual minority young adults reported greater symptoms relative to heterosexuals across all outcome measures. There were no interactions between sexual minority status and gender, however, women had higher symptoms across all disorders. Sexual minority young women appeared to be at the most risk for clinical levels of anxiety and related disorders. In addition, concealment of sexual orientation significantly predicted symptoms of social phobia. Implications are offered for the cognitive and behavioral treatment of anxiety and related disorders in this population.     

Assessment of Long-Term Psychosocial Sequelae Among POW Survivors of the Korean Conflict

Psychological and psychiatric assessments were performed among 20 prisoner-of-war (POW) Korean-Conflict survivors. Results revealed extraordinary biological and psychological abuse with weight losses exceeding 35% of preservice weights and long-term cognitive, emotional, and behavioral sequelae. The full range of posttraumatic stress disorder symptoms was seen in 90% to 100% of the cases with high prevalence of co-morbidity, specifically mood (75%), other anxiety disorders. Documented by clinical investigators at (45%), and alcohol abuse (20%) POW release and now more than 30 years later, symptoms of apprehensiveness, confusion, detachment, and depression reflect the persistence of psychiatric morbidity over time.     

Interventions for Children's Anxiety Disorders

ABSTRACT

Anxiety problems represent common types of childhood disorders that can range from simple to complex, and are characterized as comprising cognitive, behavioral, physiological, and affective components. Current diagnostic nomenclature describes three types of childhood anxiety disorders: separation anxiety disorder, overanxious disorder, and avoidant anxiety disorder. Also, test anxiety may be manifested in school-aged children, in which concerns about performance contribute to lowered achievement. This article describes the nature of childhood anxiety disorders and test anxiety, and discusses interventions that may be effective in remediation efforts.     

Assessment of long-term psychosocial sequelae among POW survivors of the Korean Conflict

Psychological and psychiatric assessments were performed among 20 prisoner-of-war (POW) Korean-Conflict survivors. Results revealed extraordinary biological and psychological abuse with weight losses exceeding 35% of preservice weights and long-term cognitive, emotional, and behavioral sequelae. The full range of posttraumatic stress disorder symptoms was seen in 90% to 100% of the cases with high prevalence of co-morbidity, specifically mood (75%), other anxiety (45%), and alcohol abuse (20%) disorders. Documented by clinical investigators at POW release and now more than 30 years later, symptoms of apprehensiveness, confusion, detachment, and depression reflect the persistence of psychiatric morbidity over time.