Emotional reactivity and cognitive regulation in anxious children

Recent models of anxiety disorders emphasize abnormalities in emotional reactivity and regulation. However, the empirical basis for this view is limited, particularly in children and adolescents. The present study examined whether anxious children suffer both negative emotional hyper-reactivity and deficits in cognitive emotion regulation. Participants were 49 children aged 10-17 with generalized anxiety disorder, social anxiety, or separation anxiety disorder as their primary diagnosis, as well as 42 age- and gender-matched non-anxious controls. After completing a diagnostic interview and self-report questionnaires, participants were presented with pictures of threatening scenes with the instructions either to simply view them or to use reappraisal, a cognitive emotion regulation strategy, to decrease their negative emotional response. Emotion ratings, content analysis of reappraisal responses, and reports of everyday use of reappraisal were used to assess negative emotional reactivity, reappraisal ability, efficacy and frequency. Relative to controls, children with anxiety disorders (1) experienced greater negative emotional responses to the images, (2) were less successful at applying reappraisals, but (3) showed intact ability to reduce their negative emotions following reappraisal. They also (4) reported less frequent use of reappraisal in everyday life. Implications for the assessment and treatment of childhood anxiety disorders are discussed.     

Issues in diagnosing anxiety disorders

Research progress in the anxiety disorders is predicated on a useful classification system. In this paper, we review the reliability and validity data for theDiagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III) anxiety disorders and discuss the salient issues associated with both the conceptualization of anxiety disorders and the diagnostic criteria offered in the DSM-III. It is concluded that the diagnostic reliability for these disorders is, overall, satisfactory. A dearth of validity data, however, hinders progress in both the diagnosis and the treatment of the anxiety disorders. Nevertheless, the DSM-III work group has proposed several changes in the diagnostic criteria for the anxiety disorders. We find some of these proposed changes helpful in that they clarify current diagnostic criteria; changes in diagnostic criteria that alter the basic classification schema, however, seem to be premature.Preparation of this paper was supported in part by MIMH Research Grant 1368.On sabbatical leave from Indiana State University.     

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.     

Twenty-five Years of Research on Childhood Anxiety Disorders: Publication Trends Between 1982 and 2006 and a Selective Review of the Literature

We examined trends in publications on childhood anxiety disorders over the past 25 years. A PsycINFO search was carried out to find relevant research articles published between 1982 and 2006. Results indicated a gradual and significant rise in the frequency of publications on childhood anxiety disorders during the past 25 years, and this increase was particularly strong for post-traumatic stress disorder, obsessive–compulsive disorder, social phobia, and multiple anxiety disorders. Most studies concerned the phenomenology of childhood anxiety disorders (i.e., >50%). Considerable less research has been conducted on the etiology, intervention, and assessment of these disorders in youths. Nevertheless, the conclusion seems warranted that the research on childhood anxiety disorders has made significant advancements during the past decades. This notion is supported by a selective review of the literature, which highlights important developments in this field of study.     

Psychopathology in anxiety disorders

Complaints of anxiety, often meetingDiagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III), criteria for anxiety disorder, are among the most common problems presenting to health practitioners. In spite of the frequency of anxiety and anxiety disorders, little is known about the basic psychopathology of these conditions that would lead to the development of more efficient and effective treatments and possible preventive efforts. Recently, there has been an increase in research on the psychopathology of anxiety disorders from biological, psychological, and social perspectives. The National Institute of Mental Health's Clinical Research Branch sponsored a 2-day workshop of investigators representing diverse research approaches to discuss emerging issues and research practices within the anxiety disorders. Discussions centered on a review of the general areas of classification, phenomenology, and etiology. A selective summary of this workshop is presented along with recommendations for specific research directions.     

Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample.

The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders.     

The utility of screen for child anxiety related emotional disorders (scared) as a tool for identifying children at high risk for prevalent anxiety disorders

Abstract

The current study examined the utility of the Screen for Child Anxiety Related Emotional Disorders (SCARED) as a screening tool for the identification of children at high risk for prevalent childhood anxiety disorders. The child version of the Structured Clinical Interview for DSM (KSCID) was used as the diagnostic standard. It was investigated whether SCARED scores are indicative for the presence of generalized anxiety disorder, separation anxiety disorder, and social phobia. Five-hundred-and-thirty-seven children aged 7–14 years completed the SCARED. From this sample, 82 children were selected on the basis of their SCARED scores. A subgroup of these children scored relatively high on the generalized anxiety disorder, separation anxiety disorder, and/or social phobia scale(s) of the SCARED. A comparison group of children scored relatively low on these SCARED scales. Both groups of children then received the semi-structured interview to assess to what extent they fulfilled the DSM-IV criteria for the relevant anxiety disorders. Results provided some support for the predictive validity of the SCARED generalized anxiety disorder and separation anxiety disorder subscales. The implications of these findings for the detection of anxiety disorders in normal children are briefly discussed.     

Dual diagnosis: Clinical issues in the treatment of substance abuse,and affective,personality, and psychotic disorders

Co-morbidity of alcohol and substance with the spectrum of other psychiatric diagnoses is examined with specific emphasis on diagnostic indicators for anxiety and mood disorders. Diagnostic issues for the chemically dependent person are examined with the context of borderline personality disorder, schizophrenia and other psychiatric disorders. Clinical research related to the dually-diagnosed patient is explored     

Therapeutic Treatment Protocol for Enuresis Using an Enuresis Alarm

Enuresis, one of the most prevalent and chronic childhood disorders, imposes serious financial, physical, and emotional burdens on the child and the family affected by it. This article provides counselors with an overview of the complex etiologies, diagnostic criteria, and current treatment options for the disorder, as well as assessment tools and comprehensive treatment guidelines, including instructions on the use of an enuresis alarm. Supportive interventions and advocacy related issues are discussed.     

Comorbidity and the Treatment of Principal Anxiety Disorders in a Naturalistic Sample

This study examined the impact of comorbidity on treatment outcome and the effects of cognitive behavioral therapy (CBT) for anxiety and depressive disorders on comorbid disorders in a naturalistic sample of 150 patients presenting to an anxiety disorders clinic. The following results were observed across principal (i.e., most severe) diagnoses. Patients with comorbid anxiety and depressive disorders presented for treatment with higher severity of their principal disorder than patients without comorbidity. However, the presence of comorbidity did not predict dropout or poor treatment response, and patients demonstrated significant improvement in their principal disorders regardless of comorbidity. The frequency of clinically severe and subclinical (i.e., not severe enough to meet diagnostic criteria) comorbid conditions decreased significantly over the course of treatment. The implication of these findings for the classification and treatment of emotional disorders is discussed.     

Reliability of DSM-IV anxiety and mood disorders: implications for the classification of emotional disorders

The reliability of current and lifetime Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) anxiety and mood disorders was examined in 362 outpatients who underwent 2 independent administrations of the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). Good to excellent reliability was obtained for the majority of DSM-IV categories. For many disorders, a common source of unreliability was disagreements on whether constituent symptoms were sufficient in number, severity, or duration to meet. DSM-IV diagnostic criteria. These analyses also highlighted potential boundary problems for some disorders (e.g., generalized anxiety disorder and major depressive disorder). Analyses of ADIS-IV-L clinical ratings (0-8 scales) indicated favorable interrater agreement for the dimensional features of DSM-IV anxiety and mood disorders. The findings are discussed in regard to their implications for the classification of emotional disorders.     

Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis

There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders. However, it is less clear which of the specific DSM-IV anxiety disorders occur most in this population. The present study used meta-analytic techniques to help clarify this issue. A systematic review of the literature identified 31 studies involving 2,121 young people (aged <18 years) with ASD, and where the presence of anxiety disorder was assessed using standardized questionnaires or diagnostic interviews. Across studies, 39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder, the most frequent being specific phobia (29.8%) followed by OCD (17.4%) and social anxiety disorder (16.6%). Associations were found between the specific anxiety disorders and ASD subtype, age, IQ, and assessment method (questionnaire versus interview). Implications for the identification and treatment of anxiety in young people with ASD are discussed.     

Childhood Gender Identity … Disorder? Developmental,Cultural, and Diagnostic Concerns

Childhood gender identity development is reviewed in the context of biological, environmental, cultural, and diagnostic factors. With the upcoming 5th revision of the Diagnostic and Statistical Manual of Mental Disorders, the authors offer a critical consideration of childhood gender identity disorder, along with proposed diagnostic changes. They argue that meaningful understanding of issues surrounding gender identity is necessary for a conscientious assessment and diagnostic process that does not pathologize human diversity.     

Clarifying boundary issues in psychopathology: the role of taxometrics in a comprehensive program of structural research

Despite decades of debate, important questions about the boundaries that separate psychological disorder from normality and that distinguish 1 disorder from another remain largely unanswered. These issues pose empirical questions that may be addressed by assessing the latent structure of psychopathological constructs. Because these constructs are likely to be structurally complex, and no single statistical tool addresses all structural questions, it is proposed in this article that boundary issues be examined through programmatic research grounded in the taxometric method and elaborated by complementary analyses. The authors describe how such a program could delimit the structure of disorders and test competing explanations of diagnostic co-occurrence, emphasizing the potential to enhance the reliability and validity of assessment, maximize the power of research designs, and improve diagnostic classification.     

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.     

Neuropsychological profiles of children with depressive and anxiety disorders

The neuropsychological functioning of 56 children and young adolescents with diagnoses of unipolar depression (n = 17), anxiety disorder (n = 19), or comorbid anxiety/depressive disorder (n = 20) was examined. The neuropsychological profiles of the three groups were parallel, but not equal in level of performance. The three groups displayed similar patterns of performance with profiles suggesting diminished attention abilities. The groups, however, were not equal in level of performance. While subjects with an anxiety or a depressive disorder were similar in level of performance, subjects with a comorbid anxiety/depressive disorder generally performed worse than those with either an anxiety or depressive disorder alone. There was no significant evidence of asymmetrical cerebral dysfunction in any of the diagnostic groups. Results are discussed in relation to adult models of psychopathology with an emphasis on the importance of considering developmental factors when formulating models of childhood psychopathology.     

The Contribution of Temperamental and Cognitive Factors to Childhood Anxiety Disorder Symptoms: A Closer Look at Negative Affect,Behavioral Inhibition,and Anxiety Sensitivity

This study examined the role of anxiety sensitivity as an explanatory variable in the link between two temperamental dimensions (i.e., behavioral inhibition and negative affect) and anxiety disorder symptom severity in a sample of children with anxiety disorders. Forty-four children (52?% African American) between 8 and 12 years of age and their mothers participated in this study. An assessment battery consisting of diagnostic interviews, questionnaires, and behavioral assessment of behavioral inhibition was administered. Findings revealed that anxiety sensitivity was a significant explanatory variable linking child self-reports of behavioral inhibition and negative affect to anxiety disorder symptom severity. For parent-completed measures, only direct effects of behavioral inhibition on anxiety disorder symptom severity were found. The clinical implications of our findings, including the importance and feasibility of anxiety sensitivity and behavioral inhibition assessments as part of routine clinical care of children with anxiety disorders are discussed, along with the limitations of our study.     

Dimensional Assessment of Emotional Disorder Outcomes in Transdiagnostic Treatment: A Clinical Case Study

Current classification systems for mental disorders emphasize categorical assessment. In the domain of emotional disorders, this is inconsistent with a growing consensus that anxiety, depressive, and related disorders are best conceptualized as variations on shared underlying processes, chiefly heightened negative affect, and aversion to unwanted emotional experiences. Dimensional assessment of transdiagnostic emotional disorder constructs offers advantages for clinical and research applications, including increased parsimony and improved validity, yet there are drawbacks to many dimensional assessment systems for emotional disorders. The case presented in this paper illustrates the potential clinical utility of a new self-report instrument—the Multidimensional Emotional Disorders Inventory (MEDI)—which assesses nine dimensions characteristic of emotional disorders. MEDI scores for a highly comorbid patient are examined over the course of transdiagnostic emotion-focused cognitive-behavioral treatment. At baseline, midtreatment, and posttreatment, the MEDI offered information above and beyond DSM categorical assessment, including detection of subclinical symptoms and symptom change, while remaining parsimonious. Implications for possible use as a treatment planning instrument, integration with categorical assessment, and future research directions are discussed.     

Do childhood anxiety measures measure anxiety?

The Fear Survey Schedule for Children-Revised (FSSC-R), Revised-Children's Manifest Anxiety Scale (RCMAS), and the Modified State-Trait Anxiety Inventory for Children (STAIC-M) are three widely used self-report measures of childhood anxiety. While previous studies have established the reliability of these measures, their validity in discriminating anxious from non-anxious youngsters remains to be established. The present study examines the discriminant validity of the three measures by comparing clinic referred samples of boys with an anxiety disorder (n=105) or ADHD (n=59) with a community sample of never-psychiatrically-ill boys (n=49). Results indicated that the two patient groups differed significantly from the never-psychiatrically-ill group on the RCMAS and STAIC-M, but the anxious and ADHD groups did not differ from each other. None of the three groups differed on the FSSC-R. The implications of these findings for the assessment of childhood anxiety disorders are discussed.