Subjective, Autonomic, and Endocrine Reactivity during Social Stress in Children with Social Phobia

Reports of exaggerated anxiety and physiological hyperreactivity to social-evaluative situations are characteristic of childhood social phobia (SP). However, laboratory research on subjective, autonomic and endocrine functioning in childhood SP is scarce, inconsistent and limited by small sample sizes, limited breadth of measurements, and the use of non-standardized stressor tasks. We exposed 8–12-year-old children with DSM-IV SP (n = 41) and matched healthy control children (HC; n = 40) to the Trier Social Stress Test for Children (TSST-C) while measuring subjective anxiety, heart rate (HR) and salivary alpha-amylase (sAA) as well as salivary cortisol. The SP children showed heightened reactivity to the TSST-C on subjective anxiety compared to the HC children but not a heightened reactivity in HR, sAA or cortisol. However, the SP children showed chronically elevated HR levels throughout the whole laboratory session. Whereas subjective anxiety seems to respond specifically to social-evaluative stress in childhood SP, HR levels may be chronically elevated suggesting a more generalized autonomic hyperreactivity.     

Negative post-event processing and decreased self-appraisals of performance following social stress in childhood social anxiety: an experimental study

Cognitive models of social phobia (SP) assume that following social evaluative stress, individuals with SP engage into dysfunctional post-event processing (PEP), a detailed negative review of the past event. While previous research has already shown, that children with high levels of social fears suffer from more frequent negative PEP, it remains unclear how stable PEP is across time in this age group and whether it leads to degraded self-appraisals of performance. Therefore in the present study we exposed a group of high (HSA) and low socially anxious children (LSA; both n = 20), aged 10–12 years, to a social evaluative situation and assessed negative and positive PEP as well as self-rated performance at 2.5 h and one week after the task. Our results revealed that HSA children reported more negative PEP than LSA children, independent of levels of depression. Moreover, negative PEP was related to measures of social anxiety and performance ratings within the tasks. Only the performance ratings in HSA children worsened over the course of the following week and were related to more negative PEP. Thus, these results speak for the high clinical relevance dysfunctional PEP may have for the maintenance of social fears already in childhood.     

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

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

Social Skills Deficits and Vocal Characteristics of Children with Social Phobia or Asperger’s Disorder: A Comparative Study

Social skills deficits are commonly reported among children with social phobia (SP) and children with Asperger’s Disorder (AD); however, a lack of direct comparison makes it unclear whether these groups, both of which endorse the presence of social anxiety, have similar or unique skills deficits. In this investigation, the social behaviors of children with SP (n = 30) or AD (n = 30) were compared to a typically developing (TD) peer group (n = 30) during structured role play interactions. Data were analyzed using blinded observers’ ratings of overt behaviors and digital vocal analysis of verbal communication. Compared to children with AD and TD children, children with SP exhibited less overall social skill, an ineffective ability to manage the conversational topic (pragmatic social behavior), and deficient speech production (speech and prosodic social behavior). There were no differences in observer ratings between children with AD and TD children. However, using digital analysis of vocal characteristics (i.e., intensity, pitch), distinct vocal patterns emerged. Specifically, children with AD spoke more softly than TD children, and had lower vocal pitch and less vocal pitch variability than children with SP. This pattern may be subjectively heard as monotonic speech. Consistent with a vocal pattern associated with heightened anxiety, children with SP spoke more softly and had less voice volume variation than TD children, and had higher vocal pitch and more vocal pitch variability (jitteriness) than children with AD. Clinical implications of these findings are discussed.     

Patterns of Growth in Adaptive Social Abilities Among Children with Autism Spectrum Disorders

Adaptive social skills were assessed longitudinally at approximately ages 2, 3, 5, 9, and 13 years in a sample of 192 children with a clinical diagnosis of autism (n = 93), PDD-NOS (n = 51), or nonspectrum developmental disabilities (n = 46) at age 2. Growth curve analyses with SAS proc mixed were used to analyze social trajectories over time. Both individual characteristics and environmental resources emerged as key predictors of adaptive social behavior outcome. The gap between children with autism and the other two diagnostic groups widened with time as the social skills of the latter groups improved at a higher rate. However, within diagnostic groups, improvement ranged from minimal to very dramatic. Children with autism most at risk for problems with social adaptive abilities later in life can be identified with considerable accuracy at a very young age so they can be targeted for appropriate early intervention services.     

Emotional Intelligence in Social Phobia and Other Anxiety Disorders

This study examined the associations between clinical anxiety, domains of emotional intelligence (EI), and three clinician-rated indices of maladjustment. Of key interest was whether social phobia (SP) is unique among anxiety disorders in being characterized by lower levels of Interpersonal and, particularly, Intrapersonal EI, and whether these differentially predict maladjustment. Individuals with SP (n = 169) obsessive-compulsive disorder (n = 65) and panic disorder (n = 64), and nonclinical controls (n = 169) completed the short form self-report Emotional Quotient Inventory (EQ-i: S). All anxiety disorder groups showed lower total EI than controls, and differed among themselves with the SP group displaying the lowest levels of total EI and lower scores on two EQ-i:S subscales (Interpersonal and, more robustly, Intrapersonal). The Intrapersonal dimension alone predicted all indices of greater maladjustment in the SP group. These findings indicate a negative relationship between anxiety disorders and EI, and reaffirm the foremost link between Intrapersonal EI and SP and its functional outcomes.     

Emotion Regulation via the Autonomic Nervous System in Children with Attention-Deficit/Hyperactivity Disorder (ADHD)

Despite growing interest in conceptualizing ADHD as involving disrupted emotion regulation, few studies have examined the physiological mechanisms related to emotion regulation in children with this disorder. This study examined parasympathetic and sympathetic nervous system reactivity via measures of respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP) in children with ADHD (n = 32) and typically developing controls (n = 34), using a novel emotion task with four conditions: negative induction, negative suppression, positive induction, and positive suppression of affect. Both groups showed strong task-response effects in RSA. However, typically developing children showed systematic variation in parasympathetic activity (RSA) depending on both emotion valence (more activation for negative emotion, reduced activation for positive emotion) and task demand (more activation for suppression than induction). In contrast, children with ADHD displayed a stable pattern of elevated parasympathetic activity (RSA) across all task conditions compared to baseline. No group differences in sympathetic activity (PEP) were observed. It is concluded ADHD in childhood is associated with abnormal parasympathetic mechanisms involved in emotion regulation.     

A Developmental Examination of Story Recall and Coherence Among Children with ADHD

This study investigated developmental differences in story recall in children with attention-deficit/hyperactivity disorder (ADHD), N = 57 (77.2% male) and their comparison peers, N = 98 (61.2% male). Children at the ages of 4–6 or 7–9 completed a free recall immediately after viewing each of two televised stories, once in the presence of toys during viewing and once in their absence. This procedure was repeated with new stories 21 months later. Comparison children recalled more story events and showed a greater sensitivity to the thematic importance of the story events than did children with ADHD, a pattern that remained stable over time. Older comparison children showed a dramatic increase over time in the global coherence of their narrations, whereas the older children with ADHD showed limited improvement over time. The implications of these findings for academic performance and the possible need for remediation are discussed.     

A Model of Professional Development for Practicing Genetic Counselors: Adaptation of Communication Skills Training in Oncology

Ongoing professional development for practicing genetic counselors is critical in maintaining best practice. Communication skills training (CST) workshops for doctors in oncology, utilizing trained actors in role plays, have been implemented for many years to improve patient-centred communication. This model was adapted to provide professional development in counseling skills for practicing genetic counselors, already highly trained in counseling skills. Detailed evidence based scenarios were developed. Evaluation of participants’ experience and perceived outcomes on practice included surveys immediately post workshops (2002, 2004, 2005, 2008 (×2); n = 88/97), 2–5 years later (2007; n = 21/38) and a focus group (2007; n = 7). All rated workshops as effective training. Aspects highly valued included facilitator feedback, actors rather than role-playing with peers and being able to stop and try doing things differently. Perceived outcomes included the opportunity to reflect on practice; bring focus to communication; motivation and confidence. The high level of satisfaction is a strong endorsement for ongoing communication skills training in this format as part of professional development.     

Worry in Adults and Children: Developmental Differences in the Importance of Probability and Cost Judgments

This study investigated developmental differences in the relationship of probability and cost estimates to worrying. Adults, younger children (M age = 8.67 years) and older children (M age = 11.06 years) rated the extent to which they worry about a list of negative social and physical outcomes and provided subjective probability and cost estimates for the same outcomes. Adults reported worrying more about social outcomes and rated them as less ‘bad’ (or costly) but more likely to occur than physical outcomes. Unlike adults, children in both age groups reported worrying more about physical outcomes. However, similar to adults, they also rated social outcomes as less ‘bad’ but more likely to occur than physical outcomes. Regression analyses showed that probability ratings were the best predictors of worry in adults, both probability and cost ratings equally predicted worry in older children, but only cost ratings predicted worry in younger children.

The Effect of Induced Mood on Children’s Social Information Processing: Goal Clarification and Response Decision

We investigated whether induced mood influenced the social information processing steps of goal clarification and response decision in 480 1st–3rd graders, and in more selected groups of low accepted-aggressive (n = 39), average accepted-nonaggressive (n = 103), and high accepted-nonaggressive children (n = 68). Children participated in two sessions; in the first session peer assessments were administered. In the second session children were randomly assigned to receive either a happy, angry, or neutral mood induction prior to participating in a social cognitive interview assessing goals, outcome expectancies, and self efficacy for competent, hostile, and passive responses in the context of ambiguous provocations. Results revealed that an angry mood increased focus on instrumental goals. Low accepted-aggressive children were more susceptible to the effects of mood than were high accepted- and average-nonaggressive children. In addition, children’s predominant goal orientation was related to children’s response decisions; children with predominantly instrumental goals evaluated nonhostile responses to provocation more negatively and had higher self efficacy for hostile responses. Implications and future research directions are discussed.     

Can Executive Functions Explain the Relationship Between Attention Deficit Hyperactivity Disorder and Social Adjustment?

This study examined the ability of executive functions (EF) to account for the relationship between Attention Deficit Hyperactivity Disorder (ADHD) status and social adjustment as indexed by parent and teacher report and by performance on a standardized observational “chat room” task. Children with the Combined subtype (ADHD-C; n = 23), the Primarily Inattentive Subtype (ADHD-I; n = 33), and non-ADHD controls (n = 36) participated. EF did not mediate the relationship between ADHD status and parent or teacher report of social adjustment. EF accounted for about 40–50% of the variance between ADHD status and the ability of children to detect subtle verbal cues as well as memory for the conversation in the chat room task, but did not mediate the relationship between ADHD and the number of prosocial, hostile, or on-topic statements that were made. Results are consistent with other recent reports, and suggest that the role of EF deficits in the production of social skill deficits in ADHD may not be as prominent as is typically assumed. The implications for the development of intervention programs designed to target core cognitive etiologic factors are discussed.     

Further Evidence of the Reliability and Validity of the Multidimensional Anxiety

The psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) were examined in adolescent psychiatric inpatient samples. In Study 1 (n = 287), confirmatory factor analyses provided satisfactory fit for the four-factor (comparative fit index; CFI = 0.856) and higher-order (CFI = 0.854) solutions. Using parcels as items, the fit of the four-factor model was improved substantially (CFI = 0.935). Next, in the bifactor analyses, support was attained for a model that included a general factor and four domain specific subfactors. In Study 2 (n = 195 inpatient youths), the MASC showed good scale reliability and concurrent validity. Results of the receiver operating characteristic curve and binary logistic regression analyses provided adequate evidence for discriminative validity. In Study 3 (n = 40), test–retest reliability of scores on the MASC-10 scale over a 3-week period was adequate (r _tt = 0.83, p < 0.001) for children ages 8 to 11 years.     

How Distinctive are ADHD and RD? Results of a Double Dissociation Study

The nature of the comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and Reading Disability (RD) was examined using a double dissociation design. Children were between 8 and 12 years of age and entered into four groups: ADHD only (n = 24), ADHD+RD (n = 29), RD only (n = 41) and normal controls (n = 26). In total, 120 children participated in the study; 38 girls and 82 boys. Both ADHD and RD were associated with impairments in inhibition and lexical decision, although inhibition and lexical decision were more severely impaired in RD than in ADHD. Visuospatial working memory deficits were specific to children with only ADHD. It is concluded that there was overlap on lexical decision and to a lesser extent on inhibition between ADHD and RD. In ADHD, impairments were dependent on IQ, which suggest that the overlap in lexical decision and inhibition is different in origin for ADHD and RD. The ADHD only group was specifically characterized by deficits in visuospatial working memory. Hence, no double dissociation between ADHD and RD was found on executive functioning and lexical decision.     

Peer Victimization and Aggression: Moderation by Individual Differences in Salivary Cortiol and Alpha-Amylase

This research examined whether variations in salivary measures of the hypothalamic-pituitary-adrenal axis (cortisol) and autonomic nervous system (alpha amylase [sAA]) contribute to individual differences in the association between peer victimization and aggression. Children (N = 132; M age = 9.46 years, SD = 0.33) completed a measure of peer victimization, teachers rated children’s aggression, and children’s saliva was collected prior to, and following, participation in a laboratory-based peer-oriented social challenge task. Children rated their level of frustration at the end of the task. Results revealed that victimization interacted with cortisol and sAA measured in anticipation of the task to predict aggression; the victimization × cortisol contribution to aggression was partly mediated by children’s self-reported frustration level. Victimization also was associated with heightened frustration in girls with high task-related sAA reactivity. Task-related sAA reactivity was associated with heightened aggression, but only for girls. These findings suggest that associations between peer victimization and aggression are moderated by variation in the activity of the major components of the psychobiology of stress; results are discussed in relation to theoretical models of individual differences in biological sensitivity to context.     

Attentional Performance in Children and Adolescents with Tic Disorder and Co-Occurring Attention-Deficit/Hyperactivity Disorder: New Insights from a 2 × 2 Factorial Design Study

The aim of the present study was to investigate the effect of both tic disorder (TD) and attention-deficit/hyperactivity disorder (ADHD) on attentional functions. N = 96 children and adolescents participated in the study, including n = 21 subjects with TD, n = 23 subjects with ADHD, n = 25 subjects with TD+ADHD, and n = 27 controls. Attentional performance was tested based on four computerized attention tasks (sustained attention, divided attention, go/nogo and set shifting). The effect of TD as well as ADHD on attentional performance was tested using a 2 × 2 factorial approach. A diagnosis of TD had no negative impact on attentional functions but was associated with improved performance in the set shifting task. By contrast, regardless of a diagnosis of TD, subjects with ADHD were found to perform worse in the sustained attention, divided attention and go/nogo task. No interaction effect between the factors TD and ADHD was revealed for any of the attention measures. Our results add to findings from other areas of research, showing that in subjects with TD and ADHD, ADHD psychopathology is often the main source of impairment, whereas a diagnosis of TD has little or no impact on neuropsychological performance in most cases and even seems to be associated with adaptive mechanisms.     

Delay and Inhibition as Early Predictors of ADHD Symptoms in Third Grade

We used data from a large, longitudinal study of children in the community, the NICHD Study of Early Child Care and Youth Development, to examine how well earlier measures of delay capacity, inhibitory control, planning, and attention predicted symptoms of attention deficit hyperactivity disorder (ADHD) assessed in third grade. Children with elevated symptoms of both inattention and hyperactivity-impulsivity (n = 57) and with inattentive symptoms only (n = 80) were identified via mother and teacher reports using the “or” rule, as were children without significant symptoms (n = 790). Multinomial logistic regression analyses indicated that poorer performance on earlier measures of resistance to temptation, delay of gratification, response inhibition, attention, and planning obtained from 36 months to 1st grade predicted membership in the two symptom groups relative to the comparison group in 3rd grade, albeit with somewhat different patterns of predictors. Controls for 36 month school readiness and externalizing symptoms indicated that these results were generally robust and not an artifact of initial cognitive or behavioral differences. Implications for developmental models of ADHD are discussed.

The Effects of Social Identity and Perceived Autonomy Support on Health Behaviour Within the Theory of Planned Behaviour

The present study employed constructs from self-determination theory, social-identity theory, and the theory of planned behaviour to examine the combined effects that social identity and perceived autonomy support exerted on attitudes, intentions and health behaviour. A prospective design was employed measuring constructs from the theory of planned behaviour, group norms, group identification, and perceived autonomy support at baseline and physical activity behaviour 5 weeks later. Self-report questionnaires were administered to 231 pupils (male = 113, female = 118, M = 14.21 years, SD = .90). Hierarchical regression analysis demonstrated that group norms predicted participation in physical activities and attitudes, but only for participants who identified strongly with their group. Perceived autonomy support predicted attitudes, intentions and behaviour. The effects of perceived autonomy support and social-identity constructs were independent. It was concluded that both social identity and perceived autonomy support should be included in the theory of planned behaviour.     

Attention Biases to Threat Link Behavioral Inhibition to Social Withdrawal over Time in Very Young Children

Behaviorally inhibited children display a temperamental profile characterized by social withdrawal and anxious behaviors. Previous research, focused largely on adolescents, suggests that attention biases to threat may sustain high levels of behavioral inhibition (BI) over time, helping link early temperament to social outcomes. However, no prior studies examine the association between attention bias and BI before adolescence. The current study examined the interrelations among BI, attention biases to threat, and social withdrawal already manifest in early childhood. Children (N = 187, 83 Male, M _age  = 61.96 months) were characterized for BI in toddlerhood (24 & 36 months). At 5 years, they completed an attention bias task and concurrent social withdrawal was measured. As expected, BI in toddlerhood predicted high levels of social withdrawal in early childhood. However, this relation was moderated by attention bias. The BI-withdrawal association was only evident for children who displayed an attention bias toward threat. The data provide further support for models associating attention with socioemotional development and the later emergence of clinical anxiety.     

The Relation of Severity and Comorbidity to Treatment Outcome with Cognitive Behavioral Therapy for Childhood Anxiety Disorders

The present study investigated the impact of comorbidity over and above the impact of symptom severity on treatment outcome of Cognitive Behavioral Therapy for children with anxiety disorders. Children (aged 8–12, n = 124) diagnosed with an anxiety disorder were treated with a short-term CBT protocol. Severity was assessed with a composite measure of parent-reported behavior problems. Two approaches to comorbidity were examined; “total comorbidity” which differentiated anxiety disordered children with (n = 69) or without (n = 55) a co-occurring disorder and “non-anxiety comorbidity’ which differentiated anxious children with (n = 22) or without a non-anxiety comorbid disorder (n = 102). Treatment outcome was assessed in terms of Recovery, represented by post-treatment diagnostic status, and Reliable Change, a score reflecting changes in pre- to post-treatment symptom levels. Severity contributed to the prediction of (no) Recovery and (more) Reliable Change in parent-reported internalizing and externalizing symptoms and self-reported depressive symptoms. Total and non-anxiety comorbidity added to the prediction of diagnostic recovery. Non-anxiety comorbidity added to the prediction of Reliable Change in parent reported measures by acting as a suppressor variable. Non-anxiety comorbidity operated as a strong predictor that explained all of the variance associated with severity for self-reported depressive symptoms. The results support the need for further research on mechanisms by which treatment gains in children with higher symptom severity and non-anxiety comorbidity can be achieved.