Threat-Related Attentional Bias in Anxious Youth: A Review

The research literature suggests that children and adolescents suffering from anxiety disorders experience cognitive distortions that magnify their perceived level of threat in the environment. Of these distortions, an attentional bias toward threat-related information has received the most theoretical and empirical consideration. A large volume of research suggests that anxiety-disordered youth selectively allocate their attention toward threat-related information. The present review critically examines this research and highlights several issues relevant to the study of threat-related attentional bias in youth, including the influences of temperament, trait anxiety, and state anxiety on threat-related attentional bias. It furthermore identifies the need for developmental and methodological considerations and recommends directions for research.     

Avoidance in Adolescence: The Balloon Risk Avoidance Task (BRAT)

Journal of Psychopathology and Behavioral Assessment - A large body of work documents the utility of behavioral risk tasks for making inferences about adolescent risk-taking proclivities and...     

Peer Experiences of Anxious and Socially Withdrawn Youth: An Integrative Review of the Developmental and Clinical Literature

Prior research indicates that both anxious youth and socially withdrawn youth tend to experience challenges and difficulties in various aspects of their peer relationships and social functioning. While clinical psychology researchers have examined how anxiety relates to peer experiences using normative and clinically anxious samples, developmental psychologists have focused primarily on the peer experiences of shy and withdrawn children. Research from these two fields has progressed on related yet separate paths, producing similar results despite using different terminology and assessment techniques. The purpose of this review is to bring together the developmental and clinical bodies of literature on the peer experiences of anxious and socially withdrawn youth by identifying common themes and unique contributions of each discipline. Studies reviewed focus specifically on the peer constructs of acceptance, friendship, peer victimization, social skills, and social-cognitive processes. Limitations including methodological inconsistencies and insufficient examination of age-, gender-, and ethnicity-related issues are identified. Recommendations for future collaborations between developmental and clinical researchers as well as implications for interventions targeting the peer relations of anxious and withdrawn youth are discussed.     

Behavioral Complexity: A Review

The theoretical basis of behavioral complexity theory is reviewed. A selection of recent research data are considered under topics of interest to behavioral science and related disciplines.     

Societal Burden of Clinically Anxious Youth Referred for Treatment: A Cost-of-illness Study

A prevalence-based cost-of-illness study using a societal perspective was conducted to investigate the cost-of-illness in clinically anxious youth aged 8–18 in The Netherlands. Discriminant validity of the cost diary used was obtained by comparing costs of families with an anxious child (n = 118) to costs of families from the general population (n = 41). To examine the convergent validity, bottom-up acquired costs derived from cost diaries were compared to top-down acquired costs obtained from national registrations. Bottom-up acquired costs measured by means of cost diaries amounted to €2,748 per family of a clinically referred anxious child per annum. Societal costs of families with clinically anxious children were almost 21 times as high compared to families from the general population. With respect to convergent validity, total health care costs using the bottom-up approach from clinically anxious children were quite comparable to those of top-down data of anxious children, although costs within the subcategories differed considerably. Clinical anxiety disorders in childhood cost the Dutch society more than 20 million euros a year. Based on results of discriminate and convergent validity, the cost diary seems a valid method in establishing cost-of-illness in childhood anxiety disorders.     

Youth Self-Views,Coping with Stress,and Behavioral/Emotional Problems: The Role of Incremental Self-Theory

Previous research has established associations between stress and coping processes and internalizing and externalizing problems among adolescents and emerging adults. The purpose of the present study was to integrate this literature with research demonstrating the importance of self-theory—views that individuals hold about themselves and their abilities. We examined the extent to which self-theory may influence both coping processes and internalizing and externalizing problems among adolescents and emerging adults. Using moderated mediation, we tested whether coping serves as a mechanism through which self-theory of both intelligence and personality influences internalizing and externalizing problems among adolescents and emerging adults. One hundred and forty participants (adolescents aged 14–17; emerging adults aged 18–30; 60 % female; 8.5 % ethnic minority) completed questionnaires on self-theory, coping responses, and behavioral/emotional problems. Results of moderated mediation analyses were consistent with coping as a mechanism through which self-theory influences psychopathology symptoms such that more malleable beliefs are associated with increased productive coping strategies and lower levels of internalizing and externalizing problems. The current findings also indicate that these associations were significant for adolescents but not for emerging adults. Although cross-sectional, findings suggest that fostering malleable beliefs among adolescents may increase the use of productive coping strategies and positively influence adjustment.     

The Coping Cat Program for Anxious Youth: The FEAR Plan Comes to Life

Manual-based treatments (therapist manuals, child workbooks) exist for the treatment of anxiety disorders in youth. The current article describes a cognitive-behavioral treatment program, Coping Cat, for childhood anxiety, with an emphasis on its flexible application and implementation as well as video components to demonstrate aspects of the program. The Coping Cat program, in the context of a favorable working relationship, uses relaxation, cognitive restructuring, problem-solving, and exposure tasks to help youth learn to identify and cope with their anxious arousal. Video components and case vignettes are used to bring life to the organizational framework used in the program: the FEAR plan. The FEAR plan, which provides youth with an acronym to recall their acquired skills, is defined and illustrated. Recommendations for the flexible application of the manual-based treatment of anxious youth are provided.     

Brief Cognitive-Behavioral Therapy for Anxious Youth: Feasibility and Initial Outcomes

We developed and evaluated a brief (8-session) version of cognitive-behavioral therapy (BCBT) for anxiety disorders in youth ages 6 to 13. This report describes the design and development of the BCBT program and intervention materials (therapist treatment manual and child treatment workbook) and an initial evaluation of child treatment outcomes. Twenty-six children who met diagnostic criteria for a principal anxiety diagnosis of separation anxiety disorder, generalized anxiety disorder, and/or social phobia were enrolled. Results suggest that BCBT is a feasible, acceptable, and beneficial treatment for anxious youth. Future research is needed to examine the relative efficacy of BCBT and CBT for child anxiety in a randomized controlled trial.     

ADHD and Behavioral Inhibition: A Re-examination of the Stop-signal Task

The current study investigates two recently identified threats to the construct validity of behavioral inhibition as a core deficit of attention-deficit/hyperactivity disorder (ADHD) based on the stop-signal task: calculation of mean reaction time from go-trials presented adjacent to intermittent stop-trials, and non-reporting of the stop-signal delay metric. Children with ADHD (n = 12) and typically developing (TD) children (n = 11) were administered the standard stop-signal task and three variant stop-signal conditions. These included a no-tone condition administered without the presentation of an auditory tone; an ignore-tone condition that presented a neutral (i.e., not associated with stopping) auditory tone; and a second ignore-tone condition that presented a neutral auditory tone after the tone had been previously paired with stopping. Children with ADHD exhibited significantly slower and more variable reaction times to go-stimuli, and slower stop-signal reaction times relative to TD controls. Stop-signal delay was not significantly different between groups, and both groups’ go-trial reaction times slowed following meaningful tones. Collectively, these findings corroborate recent meta-analyses and indicate that previous findings of stop-signal performance deficits in ADHD reflect slower and more variable responding to visually presented stimuli and concurrent processing of a second stimulus, rather than deficits of motor behavioral inhibition.     

Approach and Avoidance Tendencies in Spider Fearful Children: The Approach-Avoidance Task

Fear in children is associated with the tendency to avoid situations related to the fear. In this study, the Approach-Avoidance Task (AAT) was evaluated as a test of automatic behavioral avoidance tendencies in children. A sample of 195 children aged between 9 and 12 years completed an AAT, a Behavioral Assessment Task (BAT), and two spider fear questionnaires. The results indicate that all children showed an automatic avoidance tendency in response to spider pictures, but not pictures of butterflies or neutral pictures. Girls who reported more fear of spiders on the self-reports and behaved more anxiously during the BAT also showed a greater avoidance tendency in the AAT. These relationships were absent in boys.     

Working From Home: An Initial Pilot Examination of Videoconferencing-Based Cognitive Behavioral Therapy for Anxious Youth Delivered to the Home Setting

Progress in evidence-based treatments for child anxiety has been hampered by limited accessibility of quality care. This study utilized a multiple baseline design to evaluate the pilot feasibility, acceptability, and preliminary efficacy of real-time, Internet-delivered, family-based cognitive-behavioral therapy for child anxiety delivered to the home setting via videoconferencing. Participants included 13 anxious youth (mean age = 9.85) with a primary/co-primary anxiety disorder diagnosis. Eleven participants (84.6%) completed treatment and all study procedures. Consistent with hypotheses, the intervention was feasible and acceptable to families (i.e., high treatment retention, high client satisfaction, strong therapeutic alliance, and low barriers to participation). Moreover, the novel videoconferencing treatment format showed preliminary efficacy: 76.9% of the intention-to-treat (ITT) sample and 90.9% of treatment completers were treatment responders (i.e., Clinical Global Impressions-Improvement Scale = 1 or 2 at posttreatment), and 69.2% of the ITT sample and 81.8% of treatment completers were diagnostic responders (as per the Anxiety Disorders Interview for Children). Gains were largely maintained at 3-month follow-up evaluation. Outcome patterns within and across subjects are discussed, as well as limitations and the need for further controlled evaluations. With continued support, videoconferencing treatment formats may serve to meaningfully broaden the reach of quality care for youth anxiety disorders.     

School-Based Supports and Interventions to Improve Social and Behavioral Outcomes with Racially and Ethnically Minoritized Youth: A Review of Recent Quantitative Research

School discipline disproportionality has long been documented in educational research, primarily impacting Black/African American and non-White Hispanic/Latinx students. In response, federal policymakers have encouraged educators to change their disciplinary practice, emphasizing that more proactive support is critical to promoting students’ social and behavioral outcomes in school. Results from a literature review conducted nearly a decade ago indicated that there was, at that point, a paucity of empirical research related to considering students’ culture (e.g., race, ethnicity) and supporting school behavior. The purpose of this study is to replicate and expand the previous review to summarize the characteristics of the most recent school-based quantitative research addressing interventions to promote social and behavioral outcomes for racially and ethnically minoritized youth. We screened 1687 articles for inclusion in the review. Upon coding 32 eligible research studies, we found that intervention and implementer characteristics within these studies varied, but noted strong intervention effects in studies that included established evidence-based practices, adapted interventions, as well as new practices piloted with student participants. Results inform recommendations to continue to study interventions that promote positive social and behavioral outcomes for racially and ethnically minoritized students to disrupt a long history of subjection to exclusionary discipline disproportionately.

     

Avoidance of emotional facial expressions in social anxiety: The Approach-Avoidance Task

The Approach–Avoidance Task (AAT) was employed to indirectly investigate avoidance reactions to stimuli of potential social threat. Forty-three highly socially anxious individuals (HSAs) and 43 non-anxious controls (NACs) reacted to pictures of emotional facial expressions (angry, neutral, or smiling) or to control pictures (puzzles) by pulling a joystick towards themselves (approach) versus pushing it away from themselves (avoidance). HSAs showed stronger avoidance tendencies than NACs for smiling as well as angry faces, whereas no group differences were found for neutral faces and puzzles. In contrast, valence ratings of the emotional facial expressions did not differ between groups. A critical discrepancy between direct and indirect measures was observed for smiling faces: HSAs evaluated them positively, but reacted to them with avoidance.     

Behavioral and Socio-emotional Functioning in Children with Selective Mutism: A Comparison with Anxious and Typically Developing Children Across Multiple Informants

We examined differences among 158 children, 44 with selective mutism (SM; M = 8.2 years, SD = 3.4 years), 65 with mixed anxiety (MA; M = 8.9 years, SD = 3.2 years), and 49 community controls (M = 7.7 years, SD = 2.6 years) on primary caregiver, teacher, and child reports of behavioral and socio-emotional functioning. Children with SM were rated lower than controls on a range of social skills, but the SM and MA groups did not significantly differ on many of the social skills and anxiety measures. However, children with SM were rated higher than children with MA and controls on social anxiety. Findings suggest that SM may be conceptualized as an anxiety disorder, with primary deficits in social functioning and social anxiety. This interpretation supports a more specific classification of SM as an anxiety disorder for future diagnostic manuals than is currently described in the literature. The present findings also have implications for clinical practice, whereby social skills training merits inclusion in intervention for children with anxiety disorders as well as children with SM.     

Disorder-specific Effects of CBT for Anxious and Depressed Youth: A Meta-analysis of Candidate Mediators of Change

The commonalities between anxiety and depression have been discussed before, but few have delineated the potentially different mechanisms through which treatments work for these populations. The current study conducted a comprehensive review of child and adolescent randomized clinical trials that tested cognitive-behavioral therapy (CBT) for anxiety or depression. All studies were required to have assessed both treatment outcomes and at least one theory-specific process target, including behavioral, physiological, cognitive, and coping variables. Using a meta-analytic approach, CBT demonstrated positive treatment gains across anxiety, depression, and general functioning outcomes. CBT for anxiety also produced moderate to large effects across behavioral, physiological, cognitive, and coping processes, with behavioral targets demonstrating potentially the greatest change. CBT for depression produced small effects for cognitive processes but nonsignificant effects for behavioral and coping variables. Findings were generally consistent with CB theory but suggest potentially different mediators in the treatment of anxiety and depression. Results are discussed in terms of implications for mechanisms research, theories of change, and treatment development.     

Experiential Avoidance as an Emotion Regulatory Function: An Empirical Analysis of Experiential Avoidance in Relation to Behavioral Avoidance,Cognitive Reappraisal,and Response Suppression

The purpose of the present study was to empirically test the suggestion that experiential avoidance in an emotion regulation context is best understood as an emotion regulatory function of topographically distinct strategies. To do this we examined whether a measure of experiential avoidance could statistically account for the effects of emotion regulation strategies intervening at different points of the emotion-generative process as conceptualized by Gross' (1998) process model of emotion regulation. The strategies under examination were behavioral avoidance, cognitive reappraisal, and response suppression. The specific hypotheses to be tested were (1) that behavioral avoidance, cognitive reappraisal, and response suppression would statistically mediate the differences in measures of psychological well-being between a clinical and nonclinical sample, but that (2) these indirect effects would be reduced to nonsignificant levels when controlling for differences in experiential avoidance. The results provide clear support for the first hypothesis with regard to all the studied strategies. In contrast to the second hypothesis, the results showed the predicted outcome pattern only for the response-focused strategy “response suppression” and not for cognitive reappraisal or behavioral avoidance. The results are interpreted and discussed in relation to theories on experiential avoidance and emotion regulation.