The Influence of Family and Experimental Context on Cognition in Anxious Children

Examined the influence of family on anxious children's cognition. Research by Barrett, Rapee, Dadds, and Ryan (1996) found anxious children reported increased avoidance after interacting with their parents. They labelled this finding the FEAR effect—Family Enhancement of Avoidant Responses. Whilst some subsequent studies have found similar results, others have not. These contradictory findings question whether the direction of parental influence on anxious children is determined by the perceived demands of the experimental context. Anxious children (N = 101) and their parents were asked to interpret seven ambiguous situations and to discuss what their child would do if the scenario actually occurred. Study 1 found that children in the anxious group and an externalizing control group were more likely to interpret ambiguous situations as threatening than nonclinic children were. Study 2 sought to examine changes in the children's responses from pre- to postfamily discussion, and to identify variables associated with the FEAR effect in anxious families. Interestingly, anxious children whose families completed the discussion task after they (children) had been offered treatment were more likely to show a FEAR effect than anxious families who completed the task as part of assessment. Study 3 examined predictors of enhanced avoidance in anxious families. Treatment context and maternal distress were correlated with the child's increased avoidance following family discussion. Limitations of these studies and directions for future research are discussed.     

The relations between cluster indexes of risk and promotion and the problem behaviors of 6- and 7-year-old children from economically disadvantaged families

This study examined the relations between alternative representations of poverty cofactors and promotion processes and teacher reports of the problem behaviors of 6- and 7-year-old children from economically disadvantaged families (N = 159). The results showed that single-index representations of risk and promotion variables predicted child aggressive behaviors but not child anxious/depressed behaviors. An additive model of individual risk indicators performed similarly. Smaller indexes representing clusters of parent adjustment variables and family instability variables, however, differentially predicted aggressive and anxious/depressed behaviors, respectively. The results suggest the importance of promotion processes and of representing environmental adversity at varying levels of specificity for children from economically disadvantaged families.     

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.     

Family enhancement of cognitive style in anxious and aggressive children

Previous research has shown that anxious adults provide more threat interpretations of ambiguous stimuli than other clinic and nonclinic persons. We were interested in investigating if the same bias occurs in anxious children and how family processes impact on these children's interpretations of ambiguity. Anxious, oppositional, and nonclinical children and their parents were asked separately to interpret and provide plans of action to ambiguous scenarios. Afterwards, Each family was asked to discuss two of these situations as a family and for the child to provide a final response. The results showed that anxious and oppositional children were both more likely to interpret ambiguous scenarios in a threatening manner. However, the two clinic groups differed in that the anxious children predominantly chose avoidant solutions whereas the oppositional children chose aggressive solutions. After family discussions, both the anxious children's avoidant plans of action and the oppositional children's aggressive plans increased. Thus, this study provides the first evidence of family enhancement of avoidant and aggressive responses in children. These results support a model of anxiety that emphasizes the development of an anxious cognitive style in the context of anxiety-supporting family processes.This research was supported by grants from The National Health and Medical Research Council of Australia, The University of Queensland, and The Myer Foundation of Australia. The authors would like to thank the families, all the anxiety project staff, and Candi Peterson for her helpful feedback in the draft of this paper.     

An examination of the interactions between mothers and children with anxiety disorders

This study examined the association between parenting styles and mother and child anxiety. Maternal overinvolvement and negativity/criticism were evaluated during a speech preparation task (N = 135 dyads) and a Five Minute Speech Sample (FMSS) from mothers (N = 155). During the speech task interaction, mothers of anxious children (aged 4–16 years), regardless of their own anxiety, were observed to be more overinvolved than mothers of nonanxious children. Similarly, the FMSS showed that mothers of anxious children (aged 4–17 years) were more overprotective, self-sacrificing, or nonobjective than mothers of nonanxious children, irrespective of maternal anxiety status. No differences in maternal negativity were found on the speech task between any of the groups. However, the FMSS showed that mothers of anxious children were more critical than mothers of nonanxious children, regardless of maternal anxiety status. These results support the relationship between overinvolved, critical parenting and child anxiety, but suggest that maternal anxiety is not associated with increased overinvolvement or criticism. Theoretical implications are discussed.     

Maternal Expectancy Versus Objective Measures of Child Skill: Evidence for Absence of Positive Bias in Mothers’ Expectations of Children with Internalizing Disorders

Parents of anxious children are thought to be more attuned to threat, which might translate into less positive bias in parental report of child coping and ability, unlike parents of non-anxious children. Maternal expectancy bias was examined in a sample of 43 clinically anxious (51 % female), 30 clinically anxious/depressed (50 % female), and 44 non-clinical control children (46 % female), 8–14 years of age. When compared to an objective observer’s ratings of the children, mothers of non-clinical children demonstrated a positive bias (i.e., over-rated their children’s performance) for both ratings of expected speech performance in absolute terms and relative to peers. Mothers in the clinical groups did not exhibit this positive expectancy bias. Moreover, mothers of clinical children reported lower expectations in absolute terms and relative to peers than mothers of non-clinical children. The data suggest that mothers of clinical children held accurate expectations for child performance when compared to the gold standard of an objective observer.     

Family-expressed emotion,childhood-onset depression,and childhood-onset schizophrenia spectrum disorders: Is expressed emotion a nonspecific correlate of child psychopathology or a specific risk factor for depression?

Expressed emotion (EE) was examined, using the brief Five Minute Speech Sample measure, in families of (1) children with depressive disorders, (2) children with schizophrenia spectrum disorders, and (3) normal controls screened for the absence of psychiatric disorder. Consistent with the hypothesis of some specificity in the association between EE and the form of child disorder, rates of EE were significantly higher among families of depressed children compared to families of normal controls and families of children with schizophrenia spectrum disorders. Within the depressed group, the presence of a comorbid disruptive behavior disorder was associated with high levels of critical EE, underscoring the need to attend to comorbid patterns and subtypes of EE in future research.This research was supported by a grant from the John D. and Catherine T. MacArthur Foundation as part of their Network on Risk and Protective Factors in the Major Mental Disorders. The authors wish to express their appreciation to Sybil Zaden and Ana Magana-Amato for their assistance coding the FMSS-EE data, to Gwen Gordon for her assistance with data analysis, and to the families participating in the project.     

Biases in Visual Attention in Children and Adolescents With Clinical Anxiety and Mixed Anxiety-Depression

Recent research has indicated that anxious adult and child patients and high trait-anxious adults selectively shift attention toward threatening stimuli. The present study extends this research and investigates the content-specificity of the effects in clinically anxious and mixed anxious–depressed children and adolescents. Twenty four generally anxious patients, aged 9 to 18, 19 mixed anxious–depressed patients, and 24 normal controls were comparable with respect to age, sex, verbal IQ, and vocabulary level. The participants carried out an attentional deployment task in which probe detection latency data were used to determine the distribution of visual attention for threat-related and depression-related material. The results showed that clinically anxious children, relative to controls, selectively allocated processing resources toward threat stimuli. However, mixed anxious–depressed children, relative to controls, did not show any attentional bias towards either threat- or depression-related stimuli. Preliminary data on age and gender differences are also presented. The results of this study are discussed in the light of previous research.     

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.     

Associations of Parent–Child Anxious and Depressive Symptoms When a Caregiver Has a History of Depression

We examined the associations between parent and child anxious and depressive symptoms controlling for co-occurring symptoms in both. One hundred and four families participated, including 131 9–15 year old children considered at risk for anxiety and/or depression due to a history of depression in a parent. Parents and children completed questionnaires assessing depressive and anxious symptoms. Linear Mixed Models analyses controlling for the alternate parent and child symptoms indicated that both parent and child depressive symptoms and parent and child anxious symptoms were positively associated. Parental depressive symptoms were not positively associated with child anxious symptoms, and parental anxious symptoms were not positively associated with child depressive symptoms. The findings provide evidence for positive specific links between parent and child development of same-syndrome, but not cross-syndrome, symptoms when a caregiver has a history of depression.     

Family process and child anxiety and aggression: An observational analysis

Barrett, Rapee, Dadds, and Ryan (1996) described a phenomenon whereby family discussions magnified the style of children's problem solving in a way characteristic of their particular clinical diagnosis. That is, anxious children became more avoidant, aggressive children more aggressive, and nonclinic children more prosocial, after discussing ambiguous hypothetical situations with their parents. This study examined specific sequences of communications exchanged between parents and children hypothesized to underlie this family exacerbation of child cognitive style. Family discussions were videotaped and categorized for groups of anxious, aggressive, and nonclinic children and their parents. Results revealed differences between groups of parents in frequency of agreeing with and listening to their child and the frequency of pointing out positive consequences. Conditional probability analyses showed that parents of anxious children were more likely to reciprocate avoidance, while parents of nonclinic children were more likely to agree with and listen to prosocial plans from their child. Differences in parent behaviors observed during the family discussions were reliably associated with the child's response to the ambiguous situation proposed after the family discussion. Results support a model of developmental anxiety and aggression that emphasizes the interaction of family processes and social-cognitive development in the child.This research was supported by grants from The National Health and Medical Research Council of Australia, The University of Queensland, and The Myer Foundation of Australia.     

A comparison of depressed and nondepressed disturbed children on measures of attributional style,hopelessness, life stress,and temperament

Upon admission to a hospital treatment program, clinically depressed and nondepressed children (aged 9–17 years) were assessed on measures of attributional style, hopelessness, depression, life stress, and child temperament. The depressed group tended to attribute positive events to specific and unstable factors when compared with the nondepressed sample. Group differences also were found on child temperament measures. However, no differences were reported between the diagnostic groups on self-reported depression, hopelessness, or life stress. The findings suggested that there may not be a unique constellation of cognitive characteristics in depressed children when compared with a nondepressed clinical sample. For both depressed and nondepressed groups, treatment did appear to affect self-reported depression and overall ratings of depressogenic attributional style.     

Vigilance and Avoidance of Threat in the Eye Movements of Children with Separation Anxiety Disorder

The vigilance-avoidance attention pattern is found in anxious adults, who initially gaze more at threatening pictures than nonanxious adults (vigilance), but subsequently gaze less at them than nonanxious adults (avoidance). The present research, using eye tracking methodology, tested whether anxious children show the same pattern. Children with separation anxiety disorder or no mental disorder viewed pairs of pictures, while the direction of their gaze was tracked. Each picture pair showed one picture of a woman separating from a child, the other picture of a woman reuniting with a child. The results supported the vigilance-avoidance model in children. Although the two groups’ gaze direction did not differ during the first second of viewing, anxious children gazed significantly more at separating (threatening) pictures than nonanxious children after a period of 1 s. But after 3 s the pattern reversed: anxious children gazed significantly less at the separating pictures than nonanxious children.     

The Significance of Family Structure in Internalizing (Anxious/Depressed) and Externalizing (Aggressive/Delinquent) Problems among Chinese Adolescents

The present pioneering study investigated the differences across various types of family structure among Chinese adolescents with proactive and reactive aggression. It aimed at providing frontline social workers and family therapists with inspirations for designing suitable interventions for adolescents with specific subtypes of aggressive behavior from different family structure backgrounds. After completing an online survey including the Reactive and Proactive Aggression Questionnaire (RPQ) and the subscales of the Child Behavior Checklist – Youth Self-report (CBCL-YSR) on aggressive behavior, delinquent behavior, and anxious/depressed symptom, 520 out of 13,338 Chinese adolescents aged 11 to 18 were randomly selected and stratified based on the types of family structure (intact family, single father family, single mother family, stepfather family, and stepmother family). Expectedly, boys elicited more proactive aggression, delinquent behaviors, and aggressive behaviors than girls. Besides, significant cross-structural differences were found between children from stepmother family, who showed more proactive aggression, anxious/depressed symptoms, aggressive behaviors, and delinquent behaviors, and those from intact family regardless of gender. The interaction effects between gender and family structure were significant for reactive aggression, anxious/depressed behavior, and aggressive behavior. An interaction effect showed boys from stepmother families were more reactively aggressive than those from intact families. In addition, more anxious/depressed symptoms were found in boys from stepmother family than those from intact and single mother families. In conclusion, the impacts of family structure on proactive aggression and delinquent behavior are not gender specific, but the impacts on reactive aggression and anxious/depressed behavior are only specific to boys.

     

Indero: Intergenerational Trauma and Resilience between Burundian Former Child Soldiers and Their Children

Since many former child soldiers are aging and having children of their own, this study aimed to understand how the effects of trauma are passed to the next generation. In this qualitative study, semistructured interviews, focus groups, and observations were conducted with 25 former child soldiers and 15 matched civilian parents. Analysis used a grounded‐theory approach. Trauma may be transmitted from former child soldiers to their offspring via (a) the effect on indero (how to raise a child); (b) severe parental emotional distress; and (c) community effects. Incorporating themes of indero values on how to raise children, the effects of parental posttraumatic stress and depressive symptoms on offspring, and the stigma associated with the families of former child soldiers may provide key areas of intervention in mental healing.     

Anxious Solitude and Clinical Disorder in Middle Childhood: Bridging Developmental and Clinical Approaches to Childhood Social Anxiety

It was hypothesized that children identified by their peers at school as anxious solitary would report more symptoms of social anxiety disorder on a self report questionnaire and, on the basis of child and parent clinical interviews, receive more diagnoses of social anxiety disorder and additional anxiety and mood disorders. Participants were 192 children drawn from a community sample of 688 children attending public elementary schools. Half of these children were selected because they were identified as anxious solitary by peers and the other half were demographically-matched controls. 192 children provided self reports of social anxiety disorder symptoms on a questionnaire, and 76 of these children and their parent participated in clinical interviews. Results indicate that children identified by their peers as anxious solitary in the fall of 4th grade, compared to control children, were significantly more likely to receive diagnoses of social anxiety disorder, specific phobia, and selective mutism based on parent clinical interviews. Additionally, there was a tendency for these children to be diagnosed with generalized anxiety disorder and post traumatic stress disorder based on parent clinical interviews. Furthermore, children who had been identified as anxious solitary at any time in the 3rd or 4th grades were more likely than control children to report symptoms of social anxiety disorder that fell in the clinical range and to receive diagnoses of social anxiety disorder and dysthymia (both trends) and major depression (a significant effect) according to parental clinical interview.     

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.     

Normal versus deviant children

The present study investigated differences between referred and nonreferred children and their families on the basis of home and clinic observations and parent questionnaires. Subjects were 28 families with children between 4 and 8 years of age who had been referred to a clinic for actingout behavior and 28 nonreferred controls matched on several variables. Home observation results indicated that referred children showed significantly more deviant behavior and less prosocial behavior than nonreferred children and that their parents emitted more negative and commanding behavior in contrast to the control group. Systematic observation in the clinic revealed significant differences only in parent negativeness and number of commands. Finally, all five factors of the parent attitude questionnaire yielded large and significant differences between groups. There was considerable overlap between groups on all behavior variables but less overlap on the parent attitude measure. Results from a stepwise discriminant analysis classified 90% of referred children and 90% of nonreferred children correctly on the basis of the parent attitude variable alone. Taken together, these results suggest that child behavior is not always the critical variable in referral and stress the importance of multiple assessment procedures for child-family problems when children are referred for treatment.This research was supported by National Institute of Mental Health Grant MH 19633. The authors would like to express their appreciation to Sheila Eyberg and Orin Bolstad, who assisted in the completion of various aspects of this work.     

Maternal characteristics,ratings of child behavior,and mother-child interactions in families of children with externalizing disorders

Relationships among maternal characteristics, ratings of child behavior, and observed mother-child interactions were examined in a sample of 40 4- to 12-year-old children with externalizing disorders. Mothers and children were observed in a task interaction and mothers provided self-reports of depressed mood, parenting self-esteem, marital satisfaction, social support, and life stress. Child behavior was rated by both mothers and teachers. Several significant correlations were found among observed mother and child behaviors and among maternal self-report measures. However, few significant relationships were found between maternal characteristics and observed mother or child behavior. Although life stress predicted increased child negativity, maternal depressed mood was related to more appropriate child behavior. Mother and teacher ratings of child behavior demonstrated few significant relationships with other measures. These results suggest that, in samples comprised primarily of children with attention deficit disorder from socially advantaged families, few relationships exist between maternal characteristics, parenting behavior, and child behavior.This study was part of a doctoral dissertation conducted by the first author at Florida State University, under the direction of the second author, and supported by the Social Sciences and Humanities Research Council of Canada. Portions of the data also appear in a chapter by Johnston titled A behavioral-family systems approach to assessment: Maternal characteristics associated with externalizing behavior in children. In R. Prinz (Ed.),Behavioral assessment of children and families (Vol. 4, pp. 163–189). Greenwich, CT: JAI Press. The authors express appreciation to Alan Lang, Barbara Licht, and Richard Tate, for their thoughtful comments. We are grateful to Beverley Atkeson and a dedicated group of coders and to Dr. C. E. Cunningham and the staff of the Chedoke Child and Family Center for their support. Finally, our thanks to the families who participated.     

Inhibition in ADHD,aggressive, and anxious children: A biologically based model of child psychopathology

In this study the stop signal task was employed to investigate inhibitory control in 15 children with attention deficit hyperactivity disorder (ADHD), 18 aggressive and 20 anxious children, and a group of 17 normal controls. The psychopathological groups were recruited from special educational services. Parent, teacher, and child questionnaires were used to select children with pervasive disorders. Controls attended regular classes and scored low on all questionnaires. Based on Quay's model of child psychopathology (Quay, 1988, 1993), we hypothesized a deficit in inhibitory control in children with externalizing disorders, whereas anxious children were predicted to be overinhibited. The ADHD group and the aggressive group showed poor inhibitory control and a slower inhibitory process. No evidence of overinhibition was found in anxious children.