Estimated Risk of Developing Selected DSM-IV Disorders Among 5-Year-Old Children with Prenatal Cocaine Exposure

We estimated childhood risk of developing selected DSM-IV Disorders, including Attention-Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Separation Anxiety Disorder (SAD), in children with prenatal cocaine exposure (PCE). Children were enrolled prospectively at birth (n = 476) with prenatal drug exposures documented by maternal interview, urine and meconium assays. Study participants included 400 African-American children from the birth cohort, 208 cocaine-exposed (CE) and 192 non-cocaine-exposed (NCE), who attended a 5-year follow-up assessment and whose caregiver completed the Computerized Diagnostic Interview Schedule for Children. Under a generalized linear model (logistic link), Fisher’s exact methods were used to estimate the PCE-associated relative risk (RR) of these disorders. Our results indicated a modest but statistically robust elevation of ADHD risk associated with increasing levels of PCE (p < 0.05). Binary comparison of CE versus NCE children indicated no PCE-associated RR. Estimated cumulative incidence proportions among CE children were 2.9% for ADHD (vs 3.1% NCE); 1.4% for SAD (vs 1.6% NCE); and 4.3% for ODD (vs 6.8% NCE). Our findings suggest evidence of increased risk of ADHD (but not ODD or SAD) in relation to an increasing gradient of PCE during gestation.     

The Implementation of Modified Parent-Child Interaction Therapy for Youth with Separation Anxiety Disorder

Separation Anxiety Disorder (SAD) is the most prevalent anxiety disorder experienced by children, and yet empirical treatment studies of SAD in young children are virtually nonexistent. This paper will describe the development and implementation of an innovative treatment for SAD in young children. First, we will highlight the rationale for developing interventions specifically for SAD in young children. Second, we will describe an existing empirically supported treatment, Parent-Child Interaction Therapy (PCIT; Brinkmeyer, M. Y., & Eyberg, S.M., (2003)), that may have particular applicability to very young children with SAD and their parents. We present how results from 10 pilot participants were utilized to modify PCIT to better address the needs of children with SAD and their families. The benefits and challenges of implementing this modified version of PCIT are reviewed, along with potential directions for future research in this area.     

Specificity of peer difficulties to social anxiety in early adolescence: categorical and dimensional analyses with clinical and community samples

Background and Objectives: We investigated the specificity of social difficulties to social anxiety by testing associations of social anxiety and other anxiety presentations with peer acceptance and victimization in community and treatment-seeking samples of adolescents aged 12–14 years.

Design: Cross-sectional, quantitative survey.

Methods: Adolescents from the community (n?=?116) and a clinical setting (n?=?154) completed ratings of anxiety symptoms, perceived social acceptance, and peer victimization. Their parents also completed ratings of the adolescents’ anxiety and social acceptance.

Results: Social acceptance was lowest among adolescents with social anxiety disorder (SAD) and lower among adolescents with other anxiety disorders than in the community sample. Anxiety symptoms were negatively correlated with social acceptance, but these associations were not unique to social anxiety symptoms. Girls in the community sample reported more overt victimization than girls with SAD and with other anxiety diagnoses. Relational victimization was associated with social and nonsocial anxiety symptoms only in the community sample.

Conclusions: Our findings supplement recent laboratory-based observational studies on social functioning among adolescents with SAD and other anxiety disorders. Although social anxiety may be associated with unique social skill deficits and impairment, concerns about peer relations should also be considered among adolescents with other anxiety symptoms.     

Factor solutions of the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) in a Swedish population

Culturally validated rating scales for social anxiety disorder (SAD) are of significant importance when screening for the disorder, as well as for evaluating treatment efficacy. This study examined construct validity and additional psychometric properties of two commonly used scales, the Social Phobia Scale and the Social Interaction Anxiety Scale, in a clinical SAD population (n?=?180) and in a normal population (n?=?614) in Sweden. Confirmatory factor analyses of previously reported factor solutions were tested but did not reveal acceptable fit. Exploratory factor analyses (EFA) of the joint structure of the scales in the total population yielded a two-factor model (performance anxiety and social interaction anxiety), whereas EFA in the clinical sample revealed a three-factor solution, a social interaction anxiety factor and two performance anxiety factors. The SPS and SIAS showed good to excellent internal consistency, and discriminated well between patients with SAD and a normal population sample. Both scales showed good convergent validity with an established measure of SAD, whereas the discriminant validity of symptoms of social anxiety and depression could not be confirmed. The optimal cut-off score for SPS and SIAS were 18 and 22 points, respectively. It is concluded that the factor structure and the additional psychometric properties of SPS and SIAS support the use of the scales for assessment in a Swedish population.     

Heightened sensitivity to emotional expressions in generalised anxiety disorder,compared to social anxiety disorder,and controls

Few studies have examined potential differences between social anxiety disorder (SAD) and generalised anxiety disorder (GAD) in the sensitivity to detect emotional expressions. The present study aims to compare the detection of emotional expressions in SAD and GAD. Participants with a primary diagnosis of GAD (n?=?46), SAD (n?=?70), and controls (n?=?118) completed a morph movies task. The task presented faces expressing increasing degrees of emotional intensity, slowly changing from a neutral to a full-intensity happy, sad, or angry expressions. Participants used a slide bar to view the movie frames from left to right, and to stop at the first frame where they perceived an emotion. The frame selected thus indicated the intensity of emotion required to identify the facial expression. Participants with GAD detected the onset of facial emotions at lower intensity of emotion than participants with SAD (p?=?0.002) and controls (p?=?0.039). In a multiple regression analysis controlling for age, race, and depressive symptom severity, lower frame at which the emotion was detected was independently associated and GAD diagnosis (B?=?–5.73, SE?=?1.74, p?相似文献   

Rumination in Children with Social Anxiety Disorder: Effects of Cognitive Distraction and Relation to Social Stress Processing

According to cognitive models of social anxiety disorder (SAD), both anticipatory processing and post-event processing are core mechanisms in disorder maintenance leading to dysfunctional coping with social situations through negative self-evaluation and increased anxiety. To date, little is known about these processes during late childhood, a critical period for disorder development. Further, it remains unclear if dysfunctional rumination in children can be altered through psychotherapeutic interventions such as cognitive distraction. In the current study, children aged 9 to 13 years with SAD and age- and gender-matched healthy controls (HCs, each: n?=?30) participated in an experimental laboratory social stress task while anticipatory processing, post-event processing, subjective anxiety, self-evaluations, and autonomic arousal (skin conductance level) were assessed. Further, the impact of a brief cognitive distraction intervention on post-event processing was assessed. Children with SAD reported more negative anticipatory and post-event processing compared to HC children. Further, negative anticipatory processing was associated with higher subjective anxiety and reduced subjective performance ratings during the social stress task. In the aftermath of the stressor, distraction led to reduced subjective anxiety in the group with SAD and lower autonomic arousal in all children but did not alter post-event processing. The current study suggests that both anticipatory and post-event processing already play a key role in the maintenance of SAD in childhood. While distraction may be beneficial in reducing prolonged subjective anxiety and autonomic arousal after social situations, more research on interventions targeting ruminative processes is needed.

     

An atypical anxious‐impulsive pattern of social anxiety disorder in an adult clinical population

An atypical subgroup of Social Anxiety Disorder (SAD) with impulsive rather than inhibited traits has recently been reported. The current study examined whether such an atypical subgroup could be identified in a clinical population of 84 adults with SAD. The temperament dimensions harm avoidance and novelty seeking of the Temperament and Character Inventory, and the Liebowitz Social Anxiety Scale were used in cluster analyses. The identified clusters were compared on depressive symptoms, the character dimension self‐directedness, and treatment outcome. Among the six identified clusters, 24% of the sample had atypical characteristics, demonstrating mainly generalized SAD in combination with coexisting traits of inhibition and impulsivity. As additional signs of severity, this group showed low self‐directedness and high levels of depressive symptoms. We also identified a typically inhibited subgroup comprising generalized SAD with high levels of harm avoidance and low levels of novelty seeking, with a similar clinical severity as the atypical subgroup. Thus, higher levels of harm avoidance and social anxiety in combination with higher or lower levels of novelty seeking and low self‐directedness seem to contribute to a more severe clinical picture. Post hoc examination of the treatment outcome in these subgroups showed that only 20 to 30% achieved clinically significant change.     

Emotional variability and clarity in depression and social anxiety

Recent research has underscored the importance of elucidating specific patterns of emotion that characterise mental disorders. We examined two emotion traits, emotional variability and emotional clarity, in relation to both categorical (diagnostic interview) and dimensional (self-report) measures of major depressive disorder (MDD) and social anxiety disorder (SAD) in women diagnosed with MDD only (n?=?35), SAD only (n?=?31), MDD and SAD (n?=?26) or no psychiatric disorder (n?=?38). Results of the categorical analyses suggest that elevated emotional variability and diminished emotional clarity are transdiagnostic of MDD and SAD. More specifically, emotional variability was elevated for MDD and SAD diagnoses compared to no diagnosis, showing an additive effect for co-occurring MDD and SAD. Similarly diminished levels of emotional clarity characterised all three clinical groups compared to the healthy control group. Dimensional findings suggest that although emotional variability is associated more consistently with depression than with social anxiety, emotional clarity is associated more consistently with social anxiety than with depression. Results are interpreted using a threshold and dose–response framework.     

Change in gaze-based attention bias in adolescents with Social Anxiety Disorder

ABSTRACT

Although attention bias (AB) toward threat has been associated with Social Anxiety Disorder (SAD), concerns regarding the ability of current measures to detect change in AB following treatment exist. We sought to examine change in bias, as measured via eye-tracking, in adolescents with SAD receiving either attention-bias modification training (ABMT) or attention-control training (ACT). Gaze-based AB was associated (r?=??0.361) with symptoms of social anxiety prior to treatment, whereas there was no association between bias as measured via dot probe and social anxiety. Moreover, gaze-based bias to same-age face stimuli showed change following treatment. Large effects are seen for condition (ABMT or ACT) and for time, independent of treatment condition, in gaze-based AB to same-age stimuli. Findings suggest that further research on gaze-based bias, to assess stability over time outside of treatment and sensitivity to change following intervention, is warranted.     

Psychological health in long-term cancer survivorship: an Italian survey on depression and anxiety

Since long-term survivorship is now a reality for an increasingly number of people with a history of cancer, understanding their psychological health can inform health care policy as well as help supporting individual patients. This study was aimed to describe depression and anxiety (i.e. two of the most common psychological symptoms reported in oncology) in a sample of Italian long-term cancer survivors (LTCSs) defined as people who have been free from cancer and cancer treatments for at least five years. Four hundred and four Italian adult LTCSs completed a battery of questionnaires including the Zung Self-rating Depression Scale and the State Anxiety sub-scale of the State-Trait Anxiety Inventory respectively for depression and anxiety assessment. 16.5% of the sample displayed mild depression, 11.1% moderate depression, and 7.1% severe depression. depression was negatively associated with education (p = .017), perceived social support as provided by the family (p = .028), and perceived social support provided by friends (p = .008), and it was positively associated with occupational status (p = .023), presence of health issues (p = .010), and anxiety (p < .001). 8.7 and 15.8% of the sample were respectively possible and probable cases of anxiety. Anxiety was negatively associated with occupational status (p = .038) and it was positively associated with depression (p < .001). These data support ongoing assessment and monitoring of depression and anxiety in LTCSs, and stimulate the development and testing of psychological interventions for such individuals. In addition, they encourage further study on the psychological health of this specific population.     

Emotion regulation and biological stress responding: associations with worry,rumination, and reappraisal

ABSTRACT

Individual differences in the habitual use of emotion regulation strategies may play a critical role in understanding psychological and biological stress reactivity and recovery in depression and anxiety. This study investigated the relation between the habitual use of different emotion regulation strategies and cortisol reactivity and recovery in healthy control individuals (CTL; n?=?33) and in individuals diagnosed with social anxiety disorder (SAD; n?=?41). The tendency to worry was associated with increased cortisol reactivity to a stressor across the full sample. Rumination was not associated with cortisol reactivity, despite its oft-reported similarities to worry. Worry and rumination, however, were associated with increased cortisol during recovery from the stressor. The only difference between CTL and SAD participants was observed for reappraisal. In the CTL but not in the SAD group, reappraisal predicted recovery, such that an increased tendency to reappraise was associated with greater cortisol recovery. These results suggest an important role of the habitual use of emotion regulation strategies in understanding biological stress reactivity and recovery.     

Sensitivity to criticism and theory of mind: A cross cultural study on Japanese and Italian children

Although recent studies have shown cross-cultural differences in theory of mind (ToM) between children in Western and Eastern cultures, little is known about cross-cultural differences pertaining to social correlates. The present research investigated cultural variations in the relationship between sensitivity to criticism and ToM. Japanese (n = 76) and Italian (n = 76) 6-year-olds completed a sensitivity-to-criticism task (either the teacher condition or the peer condition), second-order false-belief tasks, and a verbal ability test. The results replicated previous findings of an association between ability rating after teacher criticism and ToM in both countries. Cultural variation was found in emotional response and motivation after teacher, but nor peer, criticism. Japanese children responded to teacher criticism more positively than did Italian children. Moreover, Japanese children who failed the second-order false-belief task were more motivated after teacher criticism than were Italian children. These results are discussed in relation to differences in cultural factors.     

Social anxiety disorder in children and youth: A research update on aetiological factors

Social Anxiety Disorder (SAD) is a heterogeneous and distressing problem for many children and youth. This review focuses on the etiology and maintenance of SAD, and examines research findings in several key areas of investigation: genetic or hereditary factors (twin and family studies), temperament characteristics (behavioural inhibition), and parent–child interactions (attachment, parenting styles). It is concluded that genetic influences, behavioural inhibition, and parent–child interactions play significant and interactive roles in the development and maintenance of SAD. Other influences such as peer relationships, social skills deficits, and traumatic experiences are also acknowledged. Ultimately, an understanding of such pathways should facilitate effective early screening and intervention of children at risk for severe social anxiety.     

An open trial of mindfulness‐based stress reduction for young adults with social anxiety disorder

The present study investigated mindfulness‐based stress reduction (MBSR) for young adults with a social anxiety disorder (SAD) in an open trial. Fifty‐three young adults in a higher education setting underwent a standard eight‐week MBSR program. Eight participants (15%) did not complete the program. Participants reported significant reductions in SAD symptoms and global psychological distress, as well as increases in mindfulness, self‐compassion, and self‐esteem. Using intention‐to‐treat (ITT) analyses, effect sizes ranged from large to moderate for SAD symptoms (Cohen's d = 0.80) and global psychological distress (d = 0.61). Completer analyses yielded large effect sizes for SAD symptoms (d = 0.96) and global psychological distress (d = 0.81). The largest effect sizes were found for self‐compassion (d = 1.49) and mindfulness (d = 1.35). Two thirds of the participants who were in the clinical range at pretreatment reported either clinically significant change (37%) or reliable improvement (31%) on SAD symptoms after completing the MBSR program, and almost two thirds reported either clinically significant change (37%) or reliable improvement (26%) on global psychological distress. MBSR may be a beneficial intervention for young adults in higher education with SAD, and there is a need for more research on mindfulness and acceptance‐based interventions for SAD.     

Early evidence of the Italian validation of Separation Anxiety Assessment Scale for Children

The current study examined the validity of the Separation Anxiety Assessment Scale for Children (SAAS-C) in a sample of 1397 Italian children (aged 8–11 years). Scalar invariance across gender was established. Results reported higher levels of separation anxiety in girls and younger children. Moreover, the measure demonstrated good convergent validity with the Spence Children Anxiety Scale. Overall, findings support the validity of the SAAS-C as a brief diagnostic tool to assess separation anxiety disorder in Italian children in line with DSM-5 criteria.     

Aroused at Home: Basic Autonomic Regulation during Orthostatic and Physical Activation is Altered in Children with Social Anxiety Disorder

Previous research has documented altered autonomic nervous system (ANS) reactivity to laboratory-based social stress tasks in children with social anxiety disorder (SAD). It is unclear, however, whether these alterations are caused by the unfamiliar and possibly threatening lab environment or whether they generalize to other, more representative contexts. Sympathetic and parasympathetic autonomic functioning was assessed in the home (minimizing environmental threat) during a supine baseline phase and two physical activation phases (orthostatic stress, stair stepping) in children (9–13 years) with SAD (n?=?27) and healthy control children (n?=?27). Relative to controls, children with SAD showed tonic autonomic hyperarousal as indicated by higher heart rate and electrodermal activity during the supine baseline phase. Further, there was evidence for stronger cardiac and vascular sympathetic reactivity (T-wave amplitude, pulse wave transit time) to moderate physical activation in children with SAD. Higher autonomic arousal during rest was related to measures of trait social anxiety and general psychopathology. Groups did not differ on parasympathetic parameters. Our results extend previous laboratory findings and provide the first evidence for alterations in children with SAD during basal autonomic regulation and in the absence of explicit social evaluative threat. They may further help to clarify conflicting study results from previous laboratory studies. The findings underline the importance of psychophysiological assessment using different environments and tasks to elucidate the physiological bases of SAD.     

Early evidence of the Italian validation of the Trait Anxiety Scale of the State-Trait Anxiety Inventory for Children

Anxiety is one of the most widespread disorders in childhood. Researchers claim the need for a tool useful to assess the core constructs common to multiple anxiety disorders, to catch the generalized propensity to be anxious and to assess anxiety stability across the lifespan. The Trait Anxiety Scale of the State-Trait Anxiety Inventory for Children (STAIC-T) seems to fill these gaps. The present study examined STAIC-T validity in a sample of 1324 Italian children aged 8–13 years old. Scalar invariance across gender was established. Internal consistency was good. Results reported higher levels of anxiety in girls, whereas no gender differences were found. The measure demonstrated good convergent validity with the Spence Children Anxiety Scale. Findings support the validity of the STAIC-T as a brief and concise diagnostic tool to assess the anxiety proneness in Italian children.     

Onset of Illness and Developmental Factors in Social Anxiety Disorder: Preliminary Findings from a Retrospective Interview

Although many advances have been made in the treatment of Social Anxiety Disorder (SAD), less is known about its onset and factors related to its course and severity. The current study aimed to investigate developmental factors (e.g., onset of illness, behavioral inhibition, socially traumatic experiences) that research has suggested are related to the course and severity of SAD in a sample of adults diagnosed with generalized SAD. Results showed behavioral inhibition to be the only consistent predictor of current severity. Results for age of onset were consistent with previous studies suggesting an early childhood and later adolescent pattern. In addition, an earlier age of onset negatively impacted improvement in cognitive behavior therapy for SAD, but no other developmental factors were related to treatment outcome. Future research using longitudinal designs and multiple informants is needed to confirm findings from retrospective reports.

Comparing Cognitive Behavioral Therapy and Systemic Therapy for Social Anxiety Disorder: Randomized Controlled Pilot Trial (SOPHO-CBT/ST)

This randomized controlled trial (RCT) aimed to pilot the newly developed manualized and monitored systemic therapy (ST) for social anxiety disorder (SAD), as compared to manualized and monitored cognitive behavioral therapy (CBT). We conducted a prospective multicenter, assessor-blind pilot RCT on 38 outpatients (ICD F40.1; Structured Clinical Interview for DSM (SCID); Liebowitz Social Anxiety Scale, LSAS-SR >30). The primary outcome was level of social anxiety (LSAS-SR) at the end of treatment. A total of 252 persons were screened, and 38 patients were randomized and started therapy (CBT: 20 patients; ST: 18 patients; age: M = 36 years, SD = 14). Within-group, simple-effect intent-to-treat analyses (ITT) showed significant reduction in LSAS-SR (CBT:d = 1.04; ST:d = 1.67), while ITT mixed-design ANOVA demonstrated the advantage of ST (d = 0.81). Per-protocol analyses supported these results. Remission based on reliable change indices also demonstrated significant difference (LSAS-SR: 15% in CBT; 39% in ST;h: 0.550), supported by blind diagnosticians’ ratings of those who completed therapy (SCID; 45% in CBT, 78% in ST,p = .083). No adverse events were reported. CBT and ST both reduced social anxiety, supporting patient improvement with the newly developed ST for SAD; this has yet to be verified in a subsequent confirmatory RCT.     

Factor Structure and Psychometric Properties of the Modified Childhood Anxiety Sensitivity Index in a Sample of Croatian Children and Adolescents

Anxiety sensitivity (AS) refers to a person’s tendency to fear anxiety-related symptoms due to the belief that they have harmful consequences. The Childhood Anxiety Sensitivity Index (CASI) is a well accepted operationalization of the AS construct in children and adolescents. This study evaluated the factor structure, gender stability and psychometric properties of the CASI, modified to a 5-point scale, in a sample of Croatian children and adolescents (N = 1,679). Exploratory and confirmatory analysis and a Schmid-Leiman solution confirmed the multidimensional and hierarchical structure of the CASI, which consisted of three lower-order factors and a single higher-order factor. Further, the modification of the CASI to a 5-point scale resulted in higher reliability, while maintaining acceptable levels of factor stability and validity.