When Adolescents Experience Co-Occurring Social Anxiety and ADHD Symptoms: Links With Social Skills When Interacting With Unfamiliar Peer Confederates

Adolescents with elevated social anxiety commonly experience peer-related impairments – particularly with same-age, unfamiliar peers – stemming from their avoidant behaviors. Yet, peer-related impairments are not unique to social anxiety. For example, adolescents who experience social anxiety may also experience symptoms of attention deficit/hyperactivity disorder (ADHD), which also increase risk for peer-related impairments. Relative to social anxiety, peer-related impairments linked to ADHD symptoms more likely stem from hyperactivity (i.e., approach behaviors). These distinct pathways point to adolescents with elevated social anxiety and ADHD symptoms (i.e., social anxiety + ADHD) experiencing particularly high peer-related impairments, which commonly manifest as behavioral displays of low social skills when interacting with unfamiliar peers. We tested this notion in a mixed-clinical/community sample of 134 14- to 15-year-old adolescents and their parents. Adolescents participated in a series of social interaction tasks designed to simulate how adolescents interact with same-age, unfamiliar peers. Trained observers independently rated adolescents on observed social skills within these interactions. Both parents and adolescents completed parallel surveys of social anxiety and ADHD symptoms, which we used to identify social anxiety + ADHD adolescents as well as other combinations of social anxiety and ADHD symptoms (i.e., neither, elevated on one but not the other). Adolescents with social anxiety + ADHD displayed significantly lower social skills, relative to all other groups. Among adolescents, social anxiety + ADHD may have a compounding effect on social skills. As such, therapists working with social anxiety + ADHD adolescents should probe for peer-related impairments and factors implicated in the development and maintenance of these impairments.     

An Ecological Risk Model for Early Childhood Anxiety: The Importance of Early Child Symptoms and Temperament

Childhood anxiety is impairing and associated with later emotional disorders. Studying risk factors for child anxiety may allow earlier identification of at-risk children for prevention efforts. This study applied an ecological risk model to address how early childhood anxiety symptoms, child temperament, maternal anxiety and depression symptoms, violence exposure, and sociodemographic risk factors predict school-aged anxiety symptoms. This longitudinal, prospective study was conducted in a representative birth cohort (n = 1109). Structural equation modeling was used to examine hypothesized associations between risk factors measured in toddlerhood/preschool (age = 3.0 years) and anxiety symptoms measured in kindergarten (age = 6.0 years) and second grade (age = 8.0 years). Early child risk factors (anxiety symptoms and temperament) emerged as the most robust predictor for both parent-and child-reported anxiety outcomes and mediated the effects of maternal and family risk factors. Implications for early intervention and prevention studies are discussed.     

Social Anxiety and Peer Relations in Early Adolescence: Behavioral and Cognitive Factors

This study investigated factors associated with social anxiety during early adolescence using multiple informants, including self and peer perspectives, teacher ratings, and direct observations. Negative social performance expectations, maladaptive coping strategies, and social skill deficits were examined as correlates of social anxiety and mediators linking social anxiety with poor peer relations. Participants were 84 middle school students (47 girls, 37 boys) over-sampled for elevated social anxiety. Analyses revealed correlations linking social anxiety with decreased peer acceptance and increased peer victimization. Path analysis indicated that negative social performance expectations and social withdrawal-disengagement accounted for the association between social anxiety and decreased peer acceptance. Social anxiety, self-directed coping strategies, and social withdrawal-disengagement were each directly linked with increased peer victimization for boys. The results replicate findings based on clinical samples, extend understanding of cognitive, social, and behavioral factors associated with social anxiety in middle school, and provide new information regarding gender differences in the correlates of social anxiety.     

Temperament as Risk and Protective Factors in Obesogenic Eating: Relations Among Parent Temperament,Child Temperament,and Child Food Preference and Eating

Children’s food preferences and eating behaviors have implications for their health and weight status, serving as risk or protective factors for obesity. Although parent and child factors influence children’s eating, few studies have examined parent and child temperament simultaneously in relation to child food preference and eating behaviors. The authors addressed this research gap. Participants were 115 ethnically diverse children between 4 and 6?years old and their parents. Measures included parental temperament traits, parental anxiety, child temperament traits, and child food preference and eating behaviors observed using a laboratory procedure. Results show that children preferred candies over grapes, and that aspects of both child and adult temperament were related to child eating behaviors. Child surgency was linked to eating more candies, while child effortful control was linked to eating more grapes. Parent effortful control was related to children’s preference toward grapes. No relations were found between child eating behaviors and child or parent negative affectivity and parental anxiety. Overall, findings suggest that highly impulsive and poorly self-regulated children may be at risk for obesogenic eating habits.     

Developmental Trajectories of Anxiety Symptoms in Early Adolescence: The Influence of Anxiety Sensitivity

Children and adolescents seem to suffer from anxiety disorders at rates similar to adults. Interestingly, anxiety symptoms appear to generally decline over time within children as evidenced by lower rates in early and middle adolescence. There is some evidence that there may be heterogeneous subpopulations of adolescent children with different trajectories of anxiety symptoms, including a class of adolescents with elevated levels of anxiety that do not dissipate over time. Anxiety sensitivity has been identified as an important risk factor in the development of anxiety psychopathology. This study prospectively examined the development of anxiety symptoms in a sample of 277 adolescents (M _age?=?11.52; 44 % female, 56 % male) over a 3 year period including the influence of anxiety sensitivity on this development. Further, this study investigated whether there were distinct classes of adolescents based on their anxiety symptom trajectories and including anxiety sensitivity as a predictor. Consistent with other reports, findings indicated an overall decline in anxiety symptoms over time in the sample. However, three classes of adolescents were found with distinct anxiety symptom trajectories and anxiety sensitivity was an important predictor of class membership. Adolescents with elevated anxiety sensitivity scores were more likely to be classified as having high and increasing anxiety symptoms over time versus having moderate to low and decreasing anxiety symptoms over time. There are important implications for identification of adolescents and children who are at risk for the development of an anxiety disorder.     

Comorbidity Between Depression and Anxiety in Adolescents: Bridge Symptoms and Relevance of Risk and Protective Factors

Depression and anxiety are highly prevalent and comorbid in adolescents, and this co-occurrence leads to worse prognosis and additional difficulties. The relationship between depression and anxiety must be delineated to, in turn, reduce and prevent the comorbidity, however our knowledge is still limited. We used network analysis to investigate bridge symptoms; symptoms that connect individual depression and anxiety symptoms and thus can help explain the comorbidity. We also examined the role of relevant risk and protective factors in explaining these symptom-level associations between these disorders. We analyzed data from the Avon Longitudinal Study of Children and Parents (n?=?3670). Depression and anxiety symptoms, peer victimization, bullying, peer relational problems, prosocial behavior, and parental monitoring were assessed at a single time point around age 13 years. Stressful life events (SLEs) were assessed at age 11 years. We identified the most prominent bridge symptoms among depression (“feeling unhappy”, “feeling lonely”) and anxiety symptoms (“worrying about past”, “worrying about future”). Peer relational difficulties and SLEs were strongly associated with several depression and anxiety symptoms, such that these two risk factors created a link between individual depression and anxiety symptoms. Prosocial behavior had several negative associations with symptoms of both disorders, suggesting it can be an important protective factor.

     

Behaviors of ADHD and Peer Relationship Difficulties in Chinese and American Youths: Role of Co-Occurring Behaviors of Depression and Anxiety

Abstract

The co-occurrence of behaviors of attention-deficit/hyperactivity disorder (ADHD) with behaviors of anxiety or behaviors of depression is the norm, but little is known on how the co-occurrence accounted for youths’ peer relations. The authors report results on difficult peer relations in relation to behaviors of ADHD, co-occurring behaviors of depression, and behaviors of anxiety from three studies on 862 youths in China and in the United States. Study 1 included 313 ethnically and socioeconomically diverse American youths; Study 2 included 250 youths who were adopted out of Chinese orphanages by American parents; and Study 3 included 299 youths from Beijing, China. Data on difficult peer relations and behaviors of ADHD, depression, and anxiety were collected with the third edition of Behavior Assessment System for Children-Self Report of Personality. In all three studies, each type of problems alone significantly predicted difficult peer relations, but behaviors of ADHD were not significant when co-occurring behaviors of depression or co-occurring behaviors of anxiety were considered. Despite that the youths in our study had different cultural and personal backgrounds, there was no evidence that behaviors of ADHD were detrimental to youths’ peer relations when behaviors of depression or anxiety were considered. Implications for intervention were discussed.     

The Course of Childhood Anxiety Symptoms: Developmental Trajectories and Child-Related Factors in Normal Children

This three-wave longitudinal study explored developmental trajectories for various types of childhood anxiety symptoms (i.e., specific fears, social anxiety, generalized anxiety, and separation anxiety) and examined how these trajectories were associated with several factors thought to be involved in the pathogenesis of anxiety. Parents of a community sample of 224 children aged 4 to 11 years repeatedly completed a standardized questionnaire of anxiety symptoms during a 2-year period. At Time 1, parents also filled out scales for measuring children’s level of behavioral inhibition (BI), internalizing and externalizing symptoms, and prosocial behaviors, while an interview was conducted with children to assess Theory-of-Mind (TOM) ability. Growth Mixture Modeling identified multiple developmental trajectories in childhood anxiety symptoms of which the ‘stable-low’ or ‘stable-medium’ reflected the normative trajectories. Further, multinomial regression analyses indicated that the higher developmental trajectories of anxiety were associated with higher levels of BI and internalizing symptoms at Time 1. In sum, results show heterogeneity in the development of anxiety symptoms and underline the importance of early prevention programs for children at high risk for developing an anxiety disorder.     

Social Anxiety Among Adolescents: Linkages with Peer Relations and Friendships

This study examined the utility of modifying the Social Anxiety Scale for Children—Revised (SASC-R) for use with adolescents, and examined associations between adolescents' social anxiety (SA) and their peer relations, friendships, and social functioning. Boys (n = 101) and girls (n = 149) in the 10th through 12th grades completed the Social Anxiety Scale for Adolescents (SAS-A) and measures of social support, perceived competence, and number and quality of their best friendships. Factor analysis of the SAS-A confirmed a three-factor structure: Fear of Negative Evaluation, Social Avoidance and Distress in General, and Social Avoidance Specific to New Situations or Unfamiliar Peers. Girls reported more SA than boys, and SA was more strongly linked to girls' social functioning than boys'. Specifically, adolescents with higher levels of SA reported poorer social functioning (less support from classmates, less social acceptance), and girls with higher levels of SA reported fewer friendships, and less intimacy, companionship, and support in their close friendships. These findings extend work on the SASC-R to adolescents, and suggest the importance of SA for understanding the social functioning and close friendships of adolescents, especially girls.     

Multi-domain Models of Risk Factors for Depression and Anxiety Symptoms in Preschoolers: Evidence for Common and Specific Factors

Relatively few studies have examined multiple pathways by which risk factors from different domains are related to symptoms of anxiety and depression in young children; even fewer have assessed risks for these symptoms specifically, rather than for internalizing symptoms in general. We examined a theoretically- and empirically-based model of variables associated with these symptom types in a diverse community sample of 796 4-year-olds (391 boys, 405 girls) that included factors from the following domains: contextual (SES, stress and family conflict); parent characteristics (parental depression); parenting (support/engagement, hostility and scaffolding); and child characteristics including negative affect (NA) effortful control (EC) sensory regulation (SR), inhibitory control (IC) and attachment. We also compared the models to determine which variables contribute to a common correlates of symptoms of anxiety or depression, and which correlates differentiate between those symptom types. In the best-fitting model for these symptom types (a) SES, stress and conflict had indirect effects on both symptom types via long-chain paths; (b) caregiver depression had direct effects and indirect ones (mediated through parenting and child effortful control) on both symptom types; (c) parenting had direct and indirect effects (via temperament and SR); and temperament had direct effects on both symptom types. These data provide evidence of common risk factors, as well as indicate some specific pathways/mediators for the different symptom types. EC was related to anxiety, but not depression symptoms, suggesting that strategies to improve child EC may be particularly effective for treatment of anxiety symptoms in young children.     

Prospective Relations Among Fearful Temperament,Protective Parenting,and Social Withdrawal: The Role of Maternal Accuracy in a Moderated Mediation Framework

Early social withdrawal and protective parenting predict a host of negative outcomes, warranting examination of their development. Mothers’ accurate anticipation of their toddlers’ fearfulness may facilitate transactional relations between toddler fearful temperament and protective parenting, leading to these outcomes. Currently, we followed 93 toddlers (42 female; on average 24.76 months) and their mothers (9% underrepresented racial/ethnic backgrounds) over 3 years. We gathered laboratory observation of fearful temperament, maternal protective behavior, and maternal accuracy during toddlerhood and a multi-method assessment of children’s social withdrawal and mothers’ self-reported protective behavior at kindergarten entry. When mothers displayed higher accuracy, toddler fearful temperament significantly related to concurrent maternal protective behavior and indirectly predicted kindergarten social withdrawal and maternal protective behavior. These results highlight the important role of maternal accuracy in linking fearful temperament and protective parenting, which predict further social withdrawal and protection, and point to toddlerhood for efforts of prevention of anxiety-spectrum outcomes.     

Understanding Risk and Protective Factors for Maternal Maltreatment: A Population-Based Comparative Analysis

Journal of Child and Family Studies - This prospective population-based study explored whether mothers who maltreat had different risk and protective factors than mothers who don’t including...     

Adolescent Protective and Risk Factors for Incarceration through Early Adulthood

Journal of Child and Family Studies - With 2.3 million individuals incarcerated in the United States, incarceration remains a pressing social influence on health. While risk factors for...     

Temperament,Repetitive Negative Thinking,and Depressive Symptoms in Early Adolescence: a Prospective Study

Repetitive negative thinking (RNT) is a transdiagnostic vulnerability factor, involved in the maintenance of a variety of emotional problems. Recently, the Perseverative Thinking Questionnaire – Child version (PTQ-C) was developed as a content-independent measure of RNT in children and adolescents. The current study investigated the reliability and predictive validity of the PTQ-C and examined temperament as a developmental predictor of RNT. For this end, 701 early adolescents completed measures of RNT, depressive symptoms, stressors, and temperament, both at baseline and after three months. First, the factor structure of the PTQ-C was investigated by comparing a one-factor model and a three-factor higher-order model using confirmatory factor analyses. Both models showed good fit to the data, but the more parsimonious one-factor model was retained. Internal consistency, as measured by cronbach’s alpha and (hierarchical) omega, was found to be excellent for the total scale. Second, associations with depressive symptom levels were examined. RNT predicted both concurrent and prospective symptom levels, even when taking into account baseline depressive symptoms. RNT was further shown to act as a moderator strengthening the link between stress and levels of depressive symptoms, both concurrently and prospectively. Finally, associations with temperament were explored by investigating the mediating role of RNT in the association between temperament dimensions and depressive symptoms. One indirect effect was found, with low effortful control predicting increases in depressive symptoms through heightened levels of RNT. The current study supports the PTQ-C as a useful and psychometrically sound measure of dysfunctional RNT that may facilitate research on emotional problems in child and adolescent samples.     

A Review of Factors that Promote Resilience in Youth with ADHD and ADHD Symptoms

The vast majority of research on youth with ADHD has focused on risk factors and describing the types of impairment individuals with ADHD experience. However, functional outcomes associated with ADHD are heterogeneous, and although many youth with ADHD experience significant negative outcomes (e.g., school dropout), some are successful in multiple domains of functioning (e.g., pursue and graduate college). There is a growing body of literature supporting the existence of factors that protect youth with ADHD from experiencing negative outcomes, but there is no published synthesis of this literature. Accordingly, the goals of this review are to conceptualize risk–resilience in the context of ADHD using a developmental psychopathology framework and to systematically review and critique evidence for promotive and protective factors in the context of ADHD. The literature search focused specifically on resilience in the context of ADHD symptoms or an ADHD diagnosis and identified 21 studies, including clinic, school, and community samples. Findings of promotive and/or protective factors are summarized across individual, family, and social–community systems. Overall, we know very little of the buffering processes for these youth, given that the study of promotive and protective factors in ADHD is in its infancy. The strongest evidence to date was found for social- and family-level systems. Specifically, multiple longitudinal studies support social acceptance as a protective factor, buffering against negative outcomes such as poor academic performance and comorbid depressive symptoms for youth with ADHD. There was also compelling evidence supporting positive parenting as a promotive factor. In terms of individual-level factors, positive or modest self-perceptions of competence were identified as a promotive factor in multiple studies. Future directions for research that will catalyze the study of resilience with ADHD are provided, and the potential for targeting protective mechanisms with intervention and prevention is discussed.     

Anxiety Symptoms in African American Children: Relations with Ethnic Pride,Anxiety Sensitivity,and Parenting

This cross-sectional study examined the relations among children’s ethnic pride, perceived parenting behavior (i.e., parental control, parental acceptance), anxiety sensitivity, and child anxiety symptoms (i.e., physical symptoms, social anxiety symptoms, separation anxiety symptoms, and harm avoidance symptoms) in 266 African American school children (M = 9.98 years old; 55% girls). Structural equation modeling results indicated that high ethnic pride was associated with high parental acceptance. High perceived parental acceptance, in turn, was related to children reporting low levels of social anxiety symptoms and high levels of harm avoidance. In addition, high parental control was related to high anxiety sensitivity. Anxiety sensitivity partially mediated the relation between parental control and separation anxiety symptoms, such that parental control was both directly and indirectly related to separation anxiety symptoms. Parental control was indirectly related to physical symptoms, social anxiety symptoms, and harm avoidance symptoms through its direct link to anxiety sensitivity. The study’s results increment knowledge about factors influencing specific dimensions of anxiety in African American children.     

Emerging School Refusal: A School-Based Framework for Identifying Early Signs and Risk Factors

A student’s academic and social-emotional development is increasingly jeopardized with mounting absence from school. School refusal (SR) is one type of school attendance problem (SAP) that is often associated with absence from school. Once established, it can sometimes be difficult to treat. To prevent established SR and associated problems, indicators of emerging SR and risk for SR should be efficiently identified and acted upon. Risk factors are often discussed in relation to SAPs generally rather than considering risk for specific types of attendance problems. Based on literature review, this paper provides an account of the likely signs and risks for emerging SR. A school-based framework is provided to support school personnel and parents in working together to identify these signs and risks. Several challenges associated with the implementation of the framework are discussed.