Which fearful toddlers should we worry about? Context, fear regulation, and anxiety risk

In the current study, the author tested a model of risk for anxiety in fearful toddlers characterized by the toddlers' regulation of the intensity of withdrawal behavior across a variety of contexts. Participants included low-risk 24-month-old toddlers (N = 111) followed longitudinally each year through the fall of their kindergarten year. The key hypothesis was that being fearful in situations that are relatively low in threat (i.e., are predictable and controllable and in which children have many coping resources) is an early precursor to risk for anxiety development as measured by parental and teacher reports of children's anxious behaviors in kindergarten. Results supported the prediction such that it is not how much fear is expressed but when and how the fear is expressed that is important for characterizing adaptive behavior. Implications are discussed for a model of risk that includes the regulation of fear, the role of eliciting context, social wariness, and the importance of examining developmental transitions, such as the start of formal schooling. These findings have implications for the methods used to identify fearful children who may be at risk for developing anxiety-related problems.     

What is the revised Fear Survey Schedule for Children measuring?

This study was designed to investigate parameters of children's fear in terms of frequency of fearful thoughts and avoidance behaviour. It is suggested that current measures such as the Fear Survey Schedule for Children--Revised (FSSC-R) do not assess fearful behaviour in the sense of the occurrence of fearful responding in daily life, but rather reflect a negative affective response to the thought of occurrence of specific events. A modified version of the FSSC-R examined the frequency of fearful thoughts/feelings and avoidance activities amongst 376 children aged 7-12 yr. Contrary to predictions, it was found that children reported high levels of fearful thoughts and avoidance behaviour to those items identified as the greatest fears on the FSSC-R, namely fears of injury, illness, death and danger. These events were typically of low probability (e.g. earthquakes) and the question was raised as to what children are responding to when they are asked to rate their fearful responses. The same pattern of results was reflected in older compared to younger children. It is suggested that even when children are asked to rate frequency of fearful thoughts or avoidance behaviour, they tend to respond to fear questionnaire items according to their affective response to the image or thought of the stimulus situation rather than their actual fear responses. Both the FSSC-R and the modified version were found to discriminate between teacher nominated high and low fearful children and to correlate significantly with a self report measure of anxiety.     

Parent-directed cognitive behavioral therapy for young anxious children: a pilot study

Anxiety in children age 8 years and above has been successfully treated with cognitive behavioral therapy (CBT). However, the efficacy of CBT for anxious children ages 4-7 years has not, to date, been fully investigated. This paper piloted a CBT intervention targeting child anxiety that was delivered exclusively to parents of 26 children with anxiety symptoms ages 4-7 years. The intervention consisted of four 2-hour group sessions of four to six parents (couples). These group sessions were followed by four individual telephone sessions, once per week across a 4-week period. The pre- and postintervention assessment involved measures of multiple constructs of child anxiety (anxiety symptoms, children's fears, behavioral inhibition, and internalizing symptoms) from multiple informants (parents, children, and teachers). Parents also reported parenting strategies they were likely to use to manage their children's anxiety pre- and postintervention. Results indicated a significant decrease in child anxiety and behavioral inhibition as reported by parents and teachers. Furthermore, mothers reported significant increases in their use of positive reinforcement, and modeling and reassurance, and a significant decrease in their use of reinforcement of dependency directly after treatment. Taken together, parent-directed CBT appears to be an effective approach for treating children ages 4-7 years with anxiety symptoms. Limitations of the current research are discussed.     

An Examination of the Relationship Between Parent Language and Child Anxiety

Research suggests that parents of anxious children behave differently when interacting with their children than do parents of nonanxious children. However, the relationship between parent language use in this context and child anxiety remains unclear. The present study investigates how parent language use relates to child anxiety during parent–child interactions using a community sample recruited to participate in a study of familial anxiety. Results indicate that parent language use varies in relation to child anxiety. Further, this idiosyncratic pattern of parent linguistic activity uniquely predicts child anxiety diagnostic status. Implications of this study and future directions for research are discussed.     

Psychometric properties of the screen for child anxiety related emotional disorders (SCARED) among elementary school children in Finland

Anxiety disorders are the most common mental disorders in children and youth. Effective screening methods are needed to identify children in need of treatment. The Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire is a widely used tool to assess childhood anxiety. We aim toevaluate the psychometric properties of the SCARED questionnaire, test the SCARED factor structure, and evaluate the prevalence of anxiety symptoms in a community sample of Finnish elementary school children, based on both a child and parent report. The sample included all pupils (n = 1,165) in grades 2 through 6 (ages 8–13) in four elementary schools in the city of Turku, Finland. Children completed a Finnish translation of the SCARED questionnaire at school, with one parent report questionnaire per child completed at home. In total, 663 child‐parent dyads (56.9%) completed the questionnaire. Internal consistency was high for both child and parent reports on all subscales (0.71–0.92), except for school avoidance (0.57 child, 0.63 parent report). Inter‐rater reliability ranged from poor to fair across subscales (intraclass correlation 0.27–0.47). Self‐reported anxiety scores were higher than the parent reported scores. Females had significantly higher total scores than males based on the child reports (p = 0.003), but not the parent reports. In the confirmatory factor analysis, hypothesized models did not have a good fit with the data, and modification was needed. The Finnish SCARED questionnaire has good internal consistency. Low child‐parent agreement calls for the importance of including both child and parental reports in the assessment of anxiety symptoms.     

Separation anxiety in mothers of latency-age fearful children

The hypothesis that mothers of children who have symptoms indicative of separation anxiety are themselves separation-anxious was tested by scoring mothers' TAT themes for separation concerns. The stories of 15 mothers of fearful children were compared to the stories of 26 mothers of children manifesting behavior disorders and 21 mothers of children having had no psychiatric contact. Different kinds of separation concerns were found to differentiate the groups of mothers. The stories of mothers of fearful children expressed significantly more concerns about abandonment and rejection and more often expressed a desire to stay near the loved one; the mothers of children with behavior disorders were found to tell significantly more stories with nurturance-succorance themes. The results lend support to the theory of anxious attachment in that mothers of fearful children seem to share the same concerns that have been ascribed to their children. On the other hand, it seems that separation anxiety may not be a unidimensional construct as different components seem to be more relevant to some symptom clusters than to others.     

Emotion Reporting Using Electronic Diaries Reduces Anxiety Symptoms in Girls With Emotion Dysregulation

Theory and empirical research suggest that electronic diaries, which require children to report on their emotional experiences, might encourage emotional processing and facilitate a reduction in symptoms of anxiety, particularly for children exhibiting emotion-related deficits. Electronic diaries were given to 52 children (aged 7–12) to track their emotions and associated intensity for 7?days; anxiety was assessed prior to and after the use of the electronic diary by both parent- and child-report. It was hypothesized that the use of an electronic diary to track emotional experiences would lead to a reduction in anxiety symptoms for those children high in poor awareness, high in expressive reluctance, and low in emotion coping. The use of electronic diaries was effective at reducing child self-reported anxiety symptoms in girls who reported low emotion coping and reducing parent-reported anxiety for girls who reported a high reluctance to express emotions. Current findings suggest that having children identify their emotions using electronic diaries may be particularly beneficial for girls who are reluctant to express emotions and who report poor coping abilities.     

Test–Retest Reliability of Dominic Anxiety and Depression Items Among Young Children

Assessing anxiety and depressive symptoms through direct interviewing of young children has been found to be particularly difficult utilizing standard interview methods. Test–retest reliability of selected anxiety and depression items from the revised Dominic (Valla, Bergeron, Bidaut-Russell, St-Georges, & Gaudet, 1997), a cartoon-based questionnaire based on DSM diagnostic criteria, was investigated among two geographically diverse samples (Los Angeles and St. Louis; N = 37). Overall, kappas were higher for the anxiety items than for the depression items. In both cities the sample included clinic and non-clinic cases of African-American, Hispanic/Latino, and Caucasian children age 6–8; kappas for the anxiety and depression items were higher among the clinic cases than for the community cases. Given the need for psychometrically sound measures for culturally diverse samples of children, this initial report suggests that the use of selected Dominic items holds promise as a cartoon-based assessment of young children.     

The effects of social anxiety on emotional face discrimination and its modulation by mouth salience

People high in social anxiety experience fear of social situations due to the likelihood of social evaluation. Whereas happy faces are generally processed very quickly, this effect is impaired by high social anxiety. Mouth regions are implicated during emotional face processing, therefore differences in mouth salience might affect how social anxiety relates to emotional face discrimination. We designed an emotional facial expression recognition task to reveal how varying levels of sub-clinical social anxiety (measured by questionnaire) related to the discrimination of happy and fearful faces, and of happy and angry faces. We also categorised the facial expressions by the salience of the mouth region (i.e. high [open mouth] vs. low [closed mouth]). In a sample of 90 participants higher social anxiety (relative to lower social anxiety) was associated with a reduced happy face reaction time advantage. However, this effect was mainly driven by the faces with less salient closed mouths. Our results are consistent with theories of anxiety that incorporate an oversensitive valence evaluation system.     

How children describe their shy/withdrawn peers

In individual interviews, 227 children from the first, third, fifth, and seventh grades described the behaviours that characterize shyness in their peers. The categories of behaviour most frequently described included the following: doesn't talk, stays by self, doesn't play, walks/runs away from others, hides, looks away/avoids eye contact, physical signs of anxiety, stays near familiar people, cries, blushes, and gets mixed up when talking/stutters. The number of children mentioning hides, stays near familiar people, and cries decreased significantly across grade level, whereas the number mentioning doesn't talk, stays by self, blushes, and gets mixed up when talking/stutters increased across grade level. The situations in which children described the shy behaviours as occurring were classified as entailing either fearful shyness or self‐conscious shyness. The number of children who mentioned contexts involving fearful shyness declined across grade level grade, whereas the number mentioning contexts involving self‐conscious shyness increased with increasing grade level. Copyright © 2008 John Wiley & Sons, Ltd.     

Anxiety modulates the degree of attentive resources required to process emotional faces

The present study contributes to the ongoing debate over the extent to which attentive resources are required for emotion perception. Although fearful facial expressions are strong competitors for attention, we predict that the magnitude of this effect may be modulated by anxiety. To test this hypothesis, healthy volunteers who varied in their self-reported levels of trait and state anxiety underwent an attentional blink task. Both fearful and happy facial expressions were subject to a strong attentional blink effect for low-anxious individuals. For those reporting high anxiety, a blink occurred for both fearful and happy facial expressions, but the magnitude of the attentional blink was significantly reduced for the fearful expressions. This supports the proposals that emotion perception is not fully automatic and that anxiety is related to a reduced ability to inhibit the processing of threat-related stimuli. Thus, individual differences in self-reported anxiety are an important determinant of the attentional control of emotional processing.     

Transfer of fear reduction through systematic desensitization

Systematic desensitization therapy involves the presentation of fear-provoking situations through visualization As the visualizations cease to evoke emotional responses, the fear-provoking potential of the real situations decreases. Research has clearly shown that such transfer does indeed occur with a wide variety of fears. Transfer has been demonstrated, for example, with fear of small animals (Lang and Lazovik, 1963), interpersonal performance anxiety (Paul, 1966), classic phobias (Lazarus, 1961), test anxiety (Katahn, Strenger and Cherry, 1966), impotence (Wolpe, 1958) and frigidity (Lazarus, 1963). However, the nature of transfer has received little attention. Wolpe (1963) has claimed that transfer from therapy to the real life situation is almost complete and direct: “There is almost invariably a one-to one relationship between what the patient can imagine without anxiety and what he can experience in reality without anxiety”. This claim has received support from Rachman (1966) who found that fear reduction transferred immediately to the real situation in 82 per cent of his observations. Hoenig and Reed (1966) reported that after a brief delay, transfer effects were observed in the case of words representing fearful stimuli but were inconsistent in the case of the real stimuli. Agras (1967) found transfer to be delayed in all his cases. He further reported that, though all patients improved, a direct relationship between therapeutic progress and symptom reduction was not found. Both Hain et al. (1966) and Meyer and Crisp (1966) have described the failure of therapeutic effects to transfer to real life.These somewhat inconsistent reports may stem in part from the measurement of transfer effects at different times. Another possibility is that more fearful Ss may evidence less transfer than less fearful Ss. Lang and Lazovik (1963) reported that Ss who completed less than 75 per cent of the hierarchy showed little improvement although direct transfer effects were observed for less fearful Ss (those who complete 75 per cent or more hierarchy items). The present study of transfer effects was designed to remove confoundingof level of fear with extent of progress in systematic desensitization.     

Animal phobias versus claustrophobias: Exteroceptive versus interoceptive cues

The overall purpose of this investigation was to examine heterogeneity among specific phobias. In particular, the goals were to compare features of fear responding between individuals fearful of claustrophobic situations and individuals fearful of spiders/snakes, and to compare their response to hyperventilation challenges. By so doing, specific predictions were tested in relation to a conceptual model of exteroceptive and interoceptive fear cues. Using a nonclinical sample, 19 subjects with spider/snake phobias, 18 nonphobies, and 9 subjects with claustrophobias were exposed on two separate occasions to a live tarantula or python, a small closet, and a hyperventilation challenge. Dependent measures included subjective anxiety, panic attacks, physical symptoms, cognitive symptoms (or, fear of symptoms) and heart rate. In addition, subjects completed a standardized self-report scale that measures fear of bodily symptoms of arousal. It was found that subjects with claustrophobia reported more physical symptoms and cognitive symptoms than did subjects with snake/spider phobias, in response to their fear-relevant stimulus. In addition, claustrophobic subjects were more fearful of hyperventilation challenges and reported more fear of bodily symptoms, than did snake/spider phobic subjects. Finally, subjects with claustrophobia were as fearful of hyperventilation as they were of their fear-relevant stimulus. Theoretical and empirical implications of these findings are discussed.     

Anxiety in Swedish School Children: Situational Specificity,Informant Variability and Coping Strategies

In a school sample, 463 Swedish children aged between 8 and 12 years reported their experience of anxiety during 11 "typical" home and school setting activities. In addition to rating the frequency and type of anxiety experienced, the children reported whether they used coping strategies to reduce their anxiety. Parents and teachers also rated the anxiety levels in the same children. Nine percent of the children reported that they experienced anxiety "often" during at least 1 of the 11 home and school activities and 1.5% reported an anxiety level of "often" averaged across all of the 11 activities. The parents reported that 9% of the children experienced "moderate" to "very much" anxiety levels averaged across the home-related activities, whereas the teachers reported that 38.5% of the children had such anxiety levels at school. Overall, the children's ratings of their frequency levels of anxiety were found to depend more on age than on gender. The children and their parents both regarded anxiety to be most common during "leaving home for school" and "going to bed at night" activities. The correspondence between child, parent and teacher reports of overall anxiety in the children was low; similar findings were obtained for anxiety among children in the various setting activities. The 8-year-old children reported a higher use of various coping strategies than did the 12-year-olds. The results are discussed in view of the current literature on anxiety and fears in children.     

An instrument to assess self-statements during public speaking: scale development and preliminary psychometric properties

Public speaking is the most commonly reported fearful social situation. Although a number of contemporary theories emphasize the importance of cognitive processes in social anxiety, there is no instrument available to assess fearful thoughts experienced during public speaking. The Self-Statements During Public Speaking (SSPS) scale is a 10-item questionnaire consisting of two 5-item subscales, the "Positive Self-Statements" (SSPS-P) and the "Negative Self-Statements" subscale (SSPS-N). Four studies report on the development and the preliminary psychometric properties of this instrument.     

Dysfunctional Cognitions in Children with Social Phobia, Separation Anxiety Disorder, and Generalized Anxiety Disorder

According to cognitive theories of anxiety, anxious adults interpret ambiguous situations in a negative way: They overestimate danger and underestimate their abilities to cope with danger. The present study investigated whether children with social phobia, separation anxiety disorder, and generalized anxiety disorder have such a bias, compared to a clinical and a normal control group. Children were exposed to stories in which ambiguous situations were described, and asked to give their interpretations, using open and closed responses. Results showed that anxious children reported more negative cognitions than control children. However, anxious children did not overestimate danger on the free responses, but they did judge the situations as more dangerous on the closed responses. Anxious children had lower estimations of their own competency to cope with danger than the control groups on both open and closed responses. The results indicate that children with anxiety disorders have dysfunctional cognitions about ambiguous situations.     

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.     

Sensitivity of the Anxiety Disorder Interview Schedule IV in Detecting Potentially Traumatic Childhood Maltreatment

This study examined the sensitivity of the Anxiety Disorder Interview Schedule IV (ADIS-IV) in detecting potentially traumatic childhood abuse experiences in a sample of 50 consecutive adult anxiety disorder patients. Of 13 patients who reported traumatic childhood maltreatment experiences using a behaviorally specific abuse history questionnaire, seven failed to report these experiences during the ADIS-IV interview (a sensitivity of 46%). Findings suggest that the two omnibus gating questions on the ADIS-IV may be insufficient in capturing exposure to certain traumatic events, as stipulated by Diagnostic and Statistical Manual diagnostic criteria for a diagnosis of post-traumatic stress disorder (PTSD). This potential for under identification of trauma history suggests that caution is warranted regarding the use of the ADIS-IV to screen for self-reported trauma exposure in adult outpatients. Alternatives, including the use of PTSD-specific interviews and supplemental trauma event checklists, are discussed.     

Mothers' attitudes toward fat, weight, and dieting in themselves and their children

We examined how a mother's view of her body, and fatness in general, affects her attitude toward her child's weight and eating. Mothers (N = 118) of 3–5-year-old children filled out a questionnaire designed to assess weight satisfaction, anti-fat attitudes, and how concerned and restrictive they are with regards to their child's weight and eating. We found mothers who were more fearful of being or becoming overweight themselves worried more for their children, although fearful attitudes did not predict restricting a child's eating. These results suggest that maternal attitudes toward their own weight affect their beliefs about their children's weight.