Latent class analysis of anxiety and depressive symptoms of the Youth Self-Report in a general population sample of young adolescents

This study examined whether distinct groups of young adolescents with mainly anxiety or mainly depression could be identified in a general population sample. Latent class analysis was used on self-report ratings of DSM-IV symptoms of anxiety and depressive disorders, because it was hypothesized that these ratings provide a bigger chance to identify distinct groups than parent ratings of symptoms that are poorly associated with DSM-IV. Results from exploratory and confirmatory latent class analysis showed that only very small numbers of young adolescents had mainly anxiety or mainly depressive symptoms. Instead, a five-group model fitted the data best. These five groups contained young adolescents who either had a high, intermediate, or low probability to have comorbid symptoms of anxiety and depression. It was concluded that symptoms of DSM-IV anxiety and depressive disorders co-occur in young adolescents, and that latent class analysis on items that capture also severe symptoms like suicidal thoughts are needed to derive groups with specific comorbidity patterns in a general population sample.     

Prevention of anxiety symptoms in children: results from a universal school-based trial

The present study evaluated the effectiveness of a universal school-based cognitive behavior prevention program (the FRIENDS program) for childhood anxiety. Participants were 638 children, ages 9 to 12 years, from 14 schools in North Rhine-Westphalia, Germany. All the children completed standardized measures of anxiety and depression, social and adaptive functioning, coping strategies, social skills, and perfectionism before and after the 10-week FRIENDS program and at two follow-up assessments (6 and 12 months) or wait period. Children who participated in the FRIENDS program exhibited significantly fewer anxiety and depressive symptoms, and lower perfectionism scores than children in the control group at 12-month follow-up. Younger children (9-10-year-olds) displayed treatment gains immediately after the intervention, whereas older children (11-12-year-olds) showed anxiety reduction only at 6- and 12-month follow-up. Perfectionism and avoidant coping acted as mediators of pre- to postintervention changes in anxiety scores. This study provides empirical evidence for the utility of the FRIENDS program in reducing anxiety and depressive symptoms among German children.     

The natural course of anxiety symptoms in early adolescence: factors related to persistence

Background and objectives: Anxiety disorders are the most common mental health problems during childhood and adolescence. This study examined the course of anxiety symptoms in early adolescents from the general population over three phases.

Design: Prospective cohort study.

Methods: Two hundred and forty-two participants (mean-age of 13.52) from a baseline sample of 1514 (mean-age of 10.23) were followed up three times. Of the 1514 children, those with emotional risk and controls without risk constituted the second-phase sample (n?=?562; mean-age of 11.25). The Screen for Child Anxiety Related Emotional Disorders-SCARED was administered in all three phases.

Results: Fifty-six percent and 32% of respondents showed total scores above the SCARED cutoff point at one and three years follow-up, respectively. Eight percent showed fluctuating symptoms. Fifty-five percent of respondents showed high scores for any subtype of anxiety over three years. Social phobia and generalized anxiety symptoms were the most prevalent and persistent. Participants with persistent separation anxiety showed the highest co-occurrence with symptoms of other psychopathological disorders. Participants with persistent anxiety showed lower academic performance. Being male was a protective factor against persistence.

Conclusions: The data support anxiety maintenance during early adolescence. Early adolescence is a critical period which may involve other serious academic, social, and family problems.     

A preliminary study of the emotion understanding of youths referred for treatment of anxiety disorders

Examined the emotion understanding of children and adolescents referred for treatment of Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) anxiety disorders (separation anxiety disorder, generalized anxiety disorder, or social phobia). Referred youths (n = 17) and nonreferred youths (n = 21) and their parents participated by completing self-report and parent-report questionnaires and structured diagnostic interviews. We interviewed all youths by using an emotion understanding interview. Referred youths demonstrated poorer understanding of hiding emotions and changing emotions compared with nonreferred youth. The 2 groups were not significantly different regarding their understanding of emotion cues and multiple emotions, however. No statistically significant relation emerged between general intelligence and emotion understanding. Future research directions are discussed.     

Association between anxiety and depression in children and adolescents with anxiety disorders

The relationship between anxiety and depression was examined in a sample of 106 children and adolescents referred to an outpatient anxiety disorder clinic for children. Twenty-eight percent of patients with DSM-III diagnoses of anxiety disorders displayed a concurrent major depression. Children with anxiety disorders plus major depression were found (1) to be older, (2) to demonstrate more severe anxiety symptomatology, and (3) to be diagnosed with different rates of certain anxiety-disorder subtypes, when compared to anxious patients without major depression. Nondepressed anxious children and adolescents did not differ from a psychopathological control group in severity of either anxiety or depression symptoms.     

The structure of anxiety symptoms among preschoolers.

This study examined whether anxiety symptoms in preschoolers reflect subtypes of anxiety consistent with current diagnostic classification systems, or should be better regarded as representing a single dimension. Parents of a large community sample of preschoolers aged 2.5 to 6.5 years rated the frequency with which their children experienced a wide range of anxiety problems. Exploratory factor analysis indicated four or five factors and it was unclear whether separation anxiety and generalized anxiety represented discrete factors. Results of confirmatory factor analyses indicated a superior fit for a five-correlated-factor model, reflecting areas of social phobia, separation anxiety, generalized anxiety, obsessive-compulsive disorder and fears of physical injury, broadly consistent with DSM-IV diagnostic categories. A high level of covariation was found between factors, which could be explained by a single, higher order model, in which first order factors of anxiety subtypes loaded upon a factor of anxiety in general. No significant differences were found in prevalence of anxiety symptoms across genders. Symptoms of PTSD in this sample were rare.     

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.     

Childhood anxiety sensitivity index factors predict unique variance in DSM-IV anxiety disorder symptoms

Anxiety sensitivity (AS) is an established cognitive risk factor for anxiety disorders. In children and adolescents, AS is usually measured with the Childhood Anxiety Sensitivity Index (CASI). Factor analytic studies suggest that the CASI is comprised of 3 lower-order factors pertaining to Physical, Psychological and Social Concerns. There has been little research on the validity of these lower-order factors. We examined the concurrent and incremental validity of the CASI and its lower-order factors in a non-clinical sample of 349 children and adolescents. CASI scores predicted symptoms of DSM-IV anxiety disorder subtypes as measured by the Spence Children's Anxiety Scale (SCAS) after accounting for variance due to State-Trait Anxiety Inventory scores. CASI Physical Concerns scores incrementally predicted scores on each of the SCAS scales, whereas scores on the Social and Psychological Concerns subscales incrementally predicted scores on conceptually related symptom scales (e.g. CASI Social Concerns scores predicted Social Phobia symptoms). Overall, this study demonstrates that there is added value in measuring AS factors in children and adolescents.     

Childhood behavioral inhibition and the experience of social anxiety in American Indian adolescents

American Indian youth may be at increased risk for anxiety-related problems. Social anxiety is the most common form of anxiety experienced by adolescents, yet little research specific to American Indians has been conducted. Childhood temperament, especially behavioral inhibition (BI), has been identified as an important risk factor for social anxiety in other racial and ethnic groups. This study examined BI in relation to social anxiety in a cross-sectional community-based sample of 86 rural southeastern American Indian adolescents. Patterns of childhood BI suggested cultural variations in the way temperament relates to adolescent social anxiety. Specifically, nonsocially based fears in childhood were associated with social anxiety symptoms in adolescence, which is in contrast to previous findings in non American Indian samples that have suggested continuity between social inhibition in childhood and social anxiety in adolescence. It is recommended that major psychological risk factors, including temperament, be evaluated within the specific social and cultural context of the adolescent population of interest.     

The utility of screen for child anxiety related emotional disorders (scared) as a tool for identifying children at high risk for prevalent anxiety disorders

Abstract

The current study examined the utility of the Screen for Child Anxiety Related Emotional Disorders (SCARED) as a screening tool for the identification of children at high risk for prevalent childhood anxiety disorders. The child version of the Structured Clinical Interview for DSM (KSCID) was used as the diagnostic standard. It was investigated whether SCARED scores are indicative for the presence of generalized anxiety disorder, separation anxiety disorder, and social phobia. Five-hundred-and-thirty-seven children aged 7–14 years completed the SCARED. From this sample, 82 children were selected on the basis of their SCARED scores. A subgroup of these children scored relatively high on the generalized anxiety disorder, separation anxiety disorder, and/or social phobia scale(s) of the SCARED. A comparison group of children scored relatively low on these SCARED scales. Both groups of children then received the semi-structured interview to assess to what extent they fulfilled the DSM-IV criteria for the relevant anxiety disorders. Results provided some support for the predictive validity of the SCARED generalized anxiety disorder and separation anxiety disorder subscales. The implications of these findings for the detection of anxiety disorders in normal children are briefly discussed.     

Social anxiety disorder in childhood and adolescence: descriptive psychopathology

Although the presentation of social anxiety disorder (SAD) in adults is well documented, less is known about its clinical manifestation in children and adolescents. To date, most studies have included combined samples of children and adolescents despite the fact that this age range represents an extensive period of growth and development. This study compares and contrasts the clinical presentation of SAD among children (ages 7-12) and adolescents (ages 13-17). One hundred and fifty children (n=74) and adolescents (n=76) with a primary diagnosis of SAD participated in the study. The assessment battery included clinical ratings and behavioral observation as well as parental and self-report. The results indicate that, although the symptom presentation of children and adolescents with primary SAD shares many features, children tend to present with a broader pattern of general psychopathology, while adolescents have a more pervasive pattern of social dysfunction and may be more functionally impaired as a result of their disorder. These findings suggest that interventions for SAD need to carefully consider clinical presentation of the disorder as it manifests in childhood and adolescence.     

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.     

Children and adolescents who stutter: Further investigation of anxiety

PurposeDespite the greatly increased risk of social anxiety disorder in adults who stutter, there is no clear indication of the time of onset of this disorder in childhood and adolescence. The purpose of this study was to explore this issue further using the Revised Children's Manifest Anxiety Scale (RCMAS), so that appropriate interventions can be developed prior to adulthood. This is the first time the RCMAS has been completed by children younger than 11 years. Using the same test for both school-age children and adolescents can potentially identify when anxiety starts to develop from age 6 years through to adulthood.MethodsThe RCMAS was administered to 18 school-age boys, five school-age girls, 41 adolescent boys and nine adolescent girls who were seeking treatment for their stuttering. Participants also rated the severity of their own stuttering.ResultsAll mean scaled scores on the four RCMAS subscales and Total Anxiety scores were within normal limits. However, for both groups of boys, scores on the Lie Scale were significantly higher than scores on the other three subscales.ConclusionsExperts suggest high scores on the RCMAS Lie Scale are indicative of participants attempting to present themselves in a positive light and so cast doubt on the veracity of their other responses on the test. One interpretation, then, is that the boys were concealing true levels of anxiety about their stuttering. The results suggest why findings of anxiety studies in children and adolescents to date are equivocal. Clinical implications are discussed.Educational objectives: The reader will be able to: (a) discuss why understanding when anxiety starts in people who stutter is important, (b) describe the function of the RCMAS Lie sub scale and (c) summarize the possible implications of the RCMAS findings in this study.     

Adolescent Self-Reports of Social Anxiety: Can They Disagree with Objective Psychophysiological Measures and Still Be Valid?

We examined self-reported and parent-reported adolescent social anxiety symptoms and objective baseline measures of psychophysiological flexibility in 62 families. Measures completed by 31 adolescents referred for a clinical screening evaluation for social anxiety were compared to an age- and gender-matched community control sample of 31 adolescents (total sample: age range 14 to 17?years; 22 boys and 40 girls; M?=?15.32?years; SD?=?1.1). Clinic referred adolescents reported significantly fewer social anxiety symptoms than parents reported about adolescents. Further, for all adolescents, self-reported social anxiety symptoms exhibited low correspondence with objective psychophysiological measures. Yet, both measures uniquely discriminated between adolescents on whether they were clinic referred for a social anxiety screening. Further, adolescent self-reported social anxiety symptoms exhibited high levels of internal consistency and convergent validity. Findings indicate that researchers and practitioners should refrain from using disagreements between adolescent self-reports and other measures (e.g., parent report, objective measures) as indicators of the veracity of adolescent self-reports.     

Social anxiety and social adaptation among adolescents at three age levels

The aim of the study was to examine the relationship between social anxiety and social adaptation among adolescents. This is the first study to research these parameters among three age groups: early, middle and late adolescence. On the whole, a negative relation was found between social anxiety and social adaptation. Specifically, for adolescents aged 12?C13, social anxiety was positively associated with social rejection, and negatively associated with social acceptance and popularity. The same was true of adolescents aged 14?C15, but the correlations were lower. For late adolescents (aged 17?C18), social anxiety was not significantly correlated with any dimension of social adaptation. The results provide evidence that young adolescents (12?C13) suffer from higher levels of social anxiety than their older counterparts. The relation found between social anxiety and social adaptation may indicate that high levels of social anxiety may cause intense distress, which can be expected to impair adolescents?? social performance.     

Comorbidity of anxiety and depression in children and adolescents.

Anxiety and depression in children and adolescents are reviewed, including differential diagnosis, assessment of symptoms, family history data, developmental features, and clinical correlates. Findings indicate that 15.9% to 61.9% of children identified as anxious or depressed have comorbid anxiety and depressive disorders and that measures of anxiety and depression are highly correlated. Family history data are inconclusive. Differences emerged among children with anxiety, depression, or both disorders. Anxious children were distinguishable from the other 2 groups in that they showed less depressive symptomatology and tended to be younger. The concurrently depressed and anxious group tended to be older and more symptomatic. In this group, the anxiety symptoms tended to predate the depressive symptoms. Findings are discussed in the context of a proposed developmental sequence.     

Separation anxiety disorder in a sample of children of divorce

Anxiety in children through separation from parents is one of the most frequent psychological problems in the infantile population. Children of divorce are more vulnerable to suffer this disorder due to the abrupt separation from one of the parents after the break-up, which they may experience as a traumatic event that predisposes them to react anxiously in daily separations. The purpose of this study is to examine the presence of symptoms of separation anxiety and general anxiety in a Spanish sample of 95 students of ages between 8 and 12 years. They were compared to a group of children of similar ages and sex whose parents are not divorced. The results show that children of divorce present higher levels of separation anxiety than the children whose parents remain together. Moreover, they show significant levels of generalized anxiety, but similar to that of the other group of children (undivorced parents). The clinical implications of these findings are discussed, emphasizing the importance of cooperation and frequent contact of the children with both parents to promote their security and autonomy.     

A cognitive‐behavioral model of anxiety disorders in children and adolescents

This study investigated a cognitive‐behavioral model of anxiety disorders in Japanese children and adolescents. Participants comprised 532 children from elementary schools and 751 adolescents from junior high schools as a community group, and 41 children and adolescents who fulfilled the criteria for childhood anxiety disorders as a clinical group. All participants completed three questionnaires about anxiety symptoms, self‐statements, and cognitive errors. While the clinical group showed more anxiety symptoms, negative self‐statements, and cognitive errors than the community group, there was no significant difference in positive self‐statements. Multigroup structural equation modeling found the presence of cognitive links for the community and clinical groups. Specifically, cognitive errors generated negative self‐statements, exacerbating a higher‐order factor (childhood anxiety) affecting six anxiety symptoms corresponding to the diagnostic criteria of psychological disorders. Mediated relationships were supported in only the community sample. Clinical implications for prevention and treatment of anxiety disorders in children and adolescents are discussed.     

Parent and child agreement on anxiety disorder symptoms using the DISC predictive scales

Growing recognition of the negative impact of anxiety disorders in the lives of youth has made their identification an important clinical task. Multiple perspective assessment (e.g., parents, children) is generally considered a preferred method in the assessment of anxiety disorder symptoms, although it has been generally thought that disagreement between parent and youth ratings of the child's emotions is common. This study examined parent and child reports of the child's anxiety disorder symptoms using the Diagnostic Interview Schedule for Children-Predictive Scales (DISC-PS) in a clinic-referred sample of substance using adolescents. Parents and adolescents (N = 480) who were referred for substance abuse treatment were screened for anxiety disorder symptoms using the DISC-PS at pretreatment. Results suggest similar (low) levels of agreement between the parent report and child report versions as found with other anxiety symptom and anxiety disorder measures. Findings provide data on multi-informant agreement and highlight issues in the use of the DISC-PS to identify anxiety problems in youth.     

Evaluating anxiety and depression symptoms in children and adolescents with prior mild traumatic brain injury: Agreement between methods and respondents

Psychological functioning can be adversely impacted after a mild traumatic brain injury (mTBI) and may be a potential target for intervention. Despite the use of symptom ratings or structured diagnostic interview to assess long-term anxiety and depression symptoms in children and adolescents post-injury, no known studies have considered the agreement between different assessment methods and between respondents. The objectives of this study were to investigate the agreement between symptom ratings and structured diagnostic interview and between children and parents’ symptom reporting. Participants (N = 33; 9–18 years old) were recruited from the Emergency Department and assessed on average 22.8 months (SD = 5.6) after their mTBI. Anxiety and depression symptoms were evaluated via subscales of a questionnaire (Behavior Assessment System for Children) and parts of a computerized structured diagnostic interview (generalized anxiety disorder and major depressive episode; Diagnostic Interview Schedule for Children – C-DISC-IV) administered individually to children and their parents. Results showed that the inter-method agreement to identify high levels of anxiety and depression was moderate to perfect in children while it was lower in parents. Although a similar percentage of participants with elevated anxiety or depression were identified by both children and parents, the agreement between youth and parents was variable, ranging from poor to good for anxiety and poor to moderate for depression. These results highlight the importance of collecting youth and parents’ reports of anxiety and depression symptoms and considering potential discrepancies between informants’ answers.