Social Anxiety in Children with Anxiety Disorders: Relation with Social and Emotional Functioning

Investigated the psychometric properties of the Social Anxiety Scale for children-Revised (SASC-R) as well as relations between social anxiety and children's social and emotional functioning. Participants were a clinic sample of children, ages 6–11 with anxiety disorders (N = 154) who completed the SASC-R. For a subset of these children, parent ratings of social skills, and self-ratings of perceived competence and peer interactions were also obtained. Factor analysis of the SASC-R supported the original three-factor solution and internal consistencies were in the acceptable range. Among children with simple phobia, scores on the SASC-R differentiated those with and without a comorbid social-based anxiety disorder. Social anxiety was also associated with impairments in social and emotional functioning. Specifically, highly socially anxious children reported low levels of social acceptance and global self-esteem and more negative peer interactions. Girls with high levels of social anxiety were also rated by parents as having poor social skills, particularly in the areas of assertive and responsible social behavior.     

11岁选择性缄默症女孩的箱庭治疗个案研究

采用箱庭疗法对11岁选择性缄默症女孩进行心理治疗的小M研究.经过18次个体箱庭和4次家庭箱庭治疗,来访者的箱庭作品由贫瘠、单调逐渐向丰富、多样转化,由孤立、静止走向开放、动态,自我力量逐步增强.来访者的学校适应、亲子关系也发生了积极改变.箱庭治疗使来访者的内心世界由创伤走向治愈.     

Integrated Behavior Therapy for Selective Mutism: A randomized controlled pilot study

Objective

To evaluate the feasibility, acceptability, and preliminary efficacy of a novel behavioral intervention for reducing symptoms of selective mutism and increasing functional speech.

Method

A total of 21 children ages 4 to 8 with primary selective mutism were randomized to 24 weeks of Integrated Behavior Therapy for Selective Mutism (IBTSM) or a 12-week Waitlist control. Clinical outcomes were assessed using blind independent evaluators, parent-, and teacher-report, and an objective behavioral measure. Treatment recipients completed a three-month follow-up to assess durability of treatment gains.

Results

Data indicated increased functional speaking behavior post-treatment as rated by parents and teachers, with a high rate of treatment responders as rated by blind independent evaluators (75%). Conversely, children in the Waitlist comparison group did not experience significant improvements in speaking behaviors. Children who received IBTSM also demonstrated significant improvements in number of words spoken at school compared to baseline, however, significant group differences did not emerge. Treatment recipients also experienced significant reductions in social anxiety per parent, but not teacher, report. Clinical gains were maintained over 3 month follow-up.

Conclusion

IBTSM appears to be a promising new intervention that is efficacious in increasing functional speaking behaviors, feasible, and acceptable to parents and teachers.     

Visual Information and the Control of Reaching in Children: A Comparison Between Children With and Without Developmental Coordination Disorder

Three experiments were performed on reach and grasp in 9- to 10-year-old children (8 controls and 8 with developmental coordination disorder [DCD]). In normal reaching, children in the DCD group were less responsive to the accuracy demands of the task in controlling the transport component of prehension and spent less time in the deceleration phase of hand transport. When vision was removed as movement began, children in the control group spent more time decelerating and reached peak aperture earlier. Children in the DCD group did not do that, although, like the control group, they did increase grip aperture in the dark. When depth cues were reduced and only the target or only the target and hand were visible, children in the control group used target information to maintain the same grip aperture in all conditions, but DCD children behaved as if the target was not visible. Throughout the studies, the control group of 9- to 10-year-olds did not produce adult-like adaptations to reduced vision, suggesting that they had not yet attained adult-like integration of sensory input. Compared with control children, children with DCD did not exhibit increased dependence on vision but showed less recognition of accuracy demands, less adaptation to the removal of vision, and less use of minimal visual information when it was available.     

Treating Youths With Selective Mutism With an Alternating Design of Exposure-Based Practice and Contingency Management

Selective mutism is a severe childhood disorder involving failure to speak in public situations in which speaking is expected. The present study examined 9 youths with selective mutism treated with child-focused, exposure-based practices and parent-focused contingency management via an alternating treatments design. Broadband measures of functioning were employed, but particular focus was made on behavioral assessment of words spoken audibly and daily in public situations. Treatment ranged from 8 to 32 sessions and resulted in positive end-state functioning for 8 of 9 participants. Broader analyses indicated greater effectiveness for exposure-based practice than contingency management. The results support recent case reports of behavioral treatment for this population but in more rigorous fashion. Clinical and research challenges are discussed, including caveats about length and intensity of treatment for this population and need to develop standardized daily measures.     

Selective Attention and Anxiety: A Perspective on Developmental Issues and the Causal Status

A plethora of studies on selective information processing in anxiety have been carried out over the past two decades. One of the most robust findings is that anxiety is associated with selective attention (SA) for threatening information. The rationale of research into SA is that it is assumed to play a vital role in the maintenance, and even in the etiology of anxiety disorders. It is the aim of this paper to explicate on the validity of this assumption. There is ample evidence that anxiety enhances SA. Although there is a lack of studies on the effect of SA on anxiety, there is now some evidence that SA increases the level of anxiety. This leads us to conclude that SA is not a by-product of anxiety only. Hence, the suggestion that SA plays a role in the maintenance of anxiety disorders seems to be justified. Studies on SA in children suggest that if SA plays any role at all in the development of anxiety disorders, it is not the SA in itself that is a vulnerability factor, but the continuation of this SA. Individuals who develop an anxiety disorder could have difficulty learning to inhibit this SA. Considering the finding that SA increases the level of anxiety, the authors suggest that anxiety in childhood causes failure to inhibit SA, which in turn enhances the vulnerability to anxiety disorder in adulthood.     

Emotion Regulation Therapy: An Integrative Approach to Treatment-Resistant Anxiety Disorders

Cognitive-behavioral, psychodynamic, and experiential approaches have historically been characterized by differing definitions of emotions and beliefs concerning their role in psychopathological process and treatment. However, given recent advances in the basic psychological sciences of emotion and emotion regulation, theoretical orientations are converging on similar viewpoints as to the functional role of emotions in conceptualizing and treating of a variety of disorders. One such area where emotions and their regulation may play a significant role is in chronic, complex, and treatment-resistant forms of anxiety disorders such as generalized anxiety disorder (GAD). A review of the historical approaches to emotions in the major theoretical orientations is presented. Following this, a model of emotion disruption and dysregulation is presented as it relates to anxiety disorders and GAD, in particular. Finally, a new treatment for GAD, emotion regulation therapy, aimed at ameliorating dysfunctional affective processes, is described.     

自闭症谱系障碍个体的焦虑：发生机制、评估与治疗

自闭症谱系障碍是一种神经发育性障碍, 主要表现为社会交往互动障碍和重复刻板性行为。焦虑或焦虑障碍常被认为是自闭症个体最普遍的共病之一。焦虑与自闭症之间的关系尚不明确, 自闭症个体的焦虑与无法忍受不确定性、杏仁核功能和体积、情绪调节策略、消极思维存在一定关联; 目前已经开发出专门用于自闭症个体焦虑的评估工具; 修订版认知行为疗法对自闭症个体焦虑的治疗取得了良好效果。未来的研究应着重探索自闭症个体焦虑的认知与神经机制, 检验专用评估工具的有效性, 继续关注现代技术(如虚拟现实技术)对自闭症个体焦虑的治疗效果。     

Anxiety and Threat Perception Abnormalities in Normal Children

The current study examined the relationship between childhood anxiety and threat perception abnormalities. Children (N = 105) were exposed to stories reflecting three types of anxiety: social anxiety, separation anxiety, and generalized anxiety. From children's reactions to the stories, a number of threat perception indices were derived. Children's level of anxiety was assessed by means of questionnaires and a structured diagnostic interview. Results indicated that high levels of anxiety, as measured by questionnaires and interview, were accompanied by a high frequency of threat perception, high ratings of threat, a high frequency of threatening interpretations, high levels of negative feelings and cognitions, and an early detection of threat. Furthermore, results seemed to suggest that threat perception abnormalities were mediated by children's general level of anxiety rather than by levels of specific anxiety symptoms.     

焦虑障碍的认知偏向矫正：应用与争议

认知偏向是焦虑障碍患者的重要认知特征, 是指患者或高焦虑个体对负性或威胁性信息存在认知加工方面的偏向。目前该领域的研究聚焦于注意偏向和解释偏向。近年来, 研究者致力于将认知偏向的矫正应用于焦虑障碍患者的临床治疗, 得到了不一致的结果。本文总结了将认知偏向矫正应用于临床实践的不同方式, 并从主观报告的疗效证据、行为及生理指标的疗效证据, 以及未发现疗效证据的研究三方面回顾了近年来的研究成果。对于结果的高度不一致, 本文从期望效应、干预对象、因变量和其它参数等方面探讨了可能的原因, 并讨论了未来可能的研究方向。     

Peer Perceptions and Liking of Children with Anxiety Disorders

Examined three aspects of childhood anxiety and peer liking: (1) whether or not children can detect anxiety in age-mates, (2) the degree to which peer-reported anxiety, self-reported anxiety, and presence of anxiety disorders are associated with peer liking, and (3) whether or not self-reported anxiety and presence of anxiety disorders are associated with peer liking after controlling for peer-reported anxiety. Peer raters (9.5–12.5 years) rated videotaped speech samples of target children with anxiety disorders (AD; 9.5–13 years) and target children without anxiety disorders (NAD; 9.5–13 years). Peer-rated anxiety was positively correlated with target children’s self-reported anxiety and was higher among children with AD and children with social phobia (SP). Peer liking was inversely related to peer-reported anxiety and was lower for target children with SP. Target children with SP were liked less regardless of how anxious peers perceived them to be. Peer rater and target child demographics did not moderate the relationship between peer-rated anxiety and peer liking.     

Allergies and Anxiety in Children and Adolescents: A Review of the Literature

  There is an increasing prevalence of anxiety disorders and allergic conditions in children and adolescents, with previous research showing that these illnesses are often comorbid. Knowledge of the association between anxiety and allergies in children and adolescents is important because these comorbid disorders may negatively impact functioning and development. This research is necessary for identification of at risk children and to develop intervention and prevention programs. A review of studies examining comorbid anxiety and allergies in children and adolescents demonstrated a consistent association between these disorders despite differences in methodology. Several methodological limitations are presented, followed by a discussion of theories which may explain the association between these conditions. Implications of this work and suggestions for future research are provided.     

Treating Childhood Social Anxiety Disorder With Virtual Environments and Serious Games: A Randomized Trial

Disseminating efficacious psychological treatments remains a challenge for researchers and clinicians. In the case of social anxiety disorder (SAD), Social Effectiveness Therapy for Children (SET-C) has been demonstrated as an efficacious intervention, but elements of the protocol, such as peer generalization sessions, remain challenging to conduct in typical clinical settings. To address this need, we developed an artificially intelligent, web-based application, Pegasys-VR™, designed to replace peer generalization sessions and enhance homework compliance. The feasibility of Pegasys-VR™ was tested in a randomized controlled trial in comparison to SET-C. The results indicated that both programs were equally efficacious in decreasing anxiety and improving social skill in social encounters. Sixty-three percent (63%) of children treated with SET-C and 60% treated with Pegasys-VR™ did not meet diagnostic criteria for SAD at posttreatment. Pegasys-VR™ is a feasible, efficacious, and dissemination-friendly element of a comprehensive treatment program for social anxiety disorder in children.     

Fear and Anxiety in COVID-19: Preexisting Anxiety Disorders

The general population has experienced a significant elevation in fear and anxiety during COVID-19 both as a direct result of the virus but also due to measures taken to prevent it spreading, such as the need to stay inside and increase hand-washing. Lockdown has been used in many/most countries to prevent widespread infection. The advice and imposed actions are necessary to prevent the virus from spreading, but they might exacerbate the problems experienced by people with a preexisting anxiety-related disorder. The treatment of anxiety-related disorders can be provided while in quarantine. Staying at home in self-isolation does not preclude obtaining psychological treatment for anxiety-related disorders. Dealing with cognitive biases, over-estimations of threat, intolerance of uncertainty, inflated responsibility and excessive safety behavior, are useful clinical directions.     

An Open Trial Investigation of a Transdiagnostic Group Treatment for Children With Anxiety and Depressive Symptoms

The current study investigates the feasibility and preliminary outcomes associated with a transdiagnostic emotion-focused group protocol for the treatment of anxiety disorders and depressive symptoms in youth. Twenty-two children (ages 7 to 12; M = 9.79) with a principal anxiety disorder and varying levels of comorbid depressive symptoms were enrolled in an open trial of the Emotion Detectives Treatment Protocol (EDTP; Ehrenreich-May & Bilek, 2009), an intervention adapted from existent unified protocols for the treatment of emotional disorders among adults and adolescents. Results indicate that participants experienced significant improvements in clinician-rated severity of principal anxiety disorder diagnoses (d = 1.38), the sum of all anxiety and depressive disorder severity ratings (d = 1.07), and child-reported anxiety (d = 0.47) and parent-reported depressive symptoms (d = 0.54) at the posttreatment assessment. EDTP had good retention rates and reports of high satisfaction. Thus, preliminary evidence suggests that EDTP is a feasible and potentially efficacious treatment of youth anxiety disorders and co-occurring depressive symptoms. Children experiencing a range of internalizing symptoms may benefit from this more generalized, emotion-focused treatment modality, as it offers flexibility to families and the mental health clinician, while maintaining a concurrent focus on the provision of cognitive-behavioral treatment skills vital to the amelioration of anxiety and depressive disorder symptoms in youth.     

Sensitivity for Treatment Effects of the Screen for Child Anxiety Related Emotional Disorders

The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a relatively new self-report questionnaire that measures DSM-defined anxiety disorders symptoms in children. The present study examined the treatment sensitivity of the SCARED. Eleven anxiety-disordered children aged 10 to 13 years received cognitive-behavioral treatment, an intervention that is generally known to be effective. Children completed the SCARED on three occasions: (1) 3 months before treatment (i.e., baseline), (2) at pretreatment, and (3) at posttreatment. Before and after treatment, scores on traditional childhood anxiety measures (i.e., State-Trait Anxiety Inventory for Children, Revised Children's Manifest Anxiety Scale, and Fear Survey Schedule for Children) were also obtained. Results showed that children's SCARED scores remained relatively stable from baseline to pretreatment. However, from pre- to post-treatment, significant decreases were evident for the SCARED and for all traditional measures. These results suggest that the SCARED reliably taps treatment effects and, thus, provide further support for its utility as a self-report index of childhood anxiety in clinical and research settings.     

Anxiety and Depression in Children and Adolescents: A Factor-Analytic Examination of the Tripartite Model

The tripartite model of Clark and Watson (1981) suggests that the oft-observed covariation between anxiety and depression can best be understood by examining three related yet distinct constructs: negative affectivity, positive affectivity, and elevated physiological arousal. In the present study, 510 boys and girls in the 4th, 7th, and 10th grades completed the Children's Depression Inventory and the Revised Children's Manifest Anxiety Scale. Confirmatory factor analyses were conducted to determine the goodness of fit of single-factor (i.e., negative affectivity), two-factor (i.e., anxiety and depression), and three-factor models (i.e., negative affectivity, positive affectivity, and physiological arousal). Analyses were conducted by examining each of the models in the whole sample first and then separately for boys and girls and for fourth, seventh, and tenth grade youths. Results failed to support the tripartite theory; rather, the findings supported a two-factor model in all cases. These factors represented the general constructs of anxiety and depression, and these factors remained significantly interrelated. Consistent with previous findings, the strength of these relations was stronger for boys than girls and for children than adolescents.     

Emotion Socialization in Families of Children With an Anxiety Disorder

Compared emotion socialization in 26 children with anxiety disorders ages 8–12 years and their mothers to 26 nonclinical counterparts without psychopathology. Children and their mothers participated in an emotion interaction task in which they discussed occasions when the child felt worry, sadness, and anger. Responses were coded for length of discussion, proportion of words spoken by child vs. mother, frequency of positive and negative emotion words, explanatory discussion of emotion, and maternal facilitation of emotion discussion. Children and their mothers also completed the Expressiveness and Control scales of the Family Environment Scale. Results indicated that mothers of children with an anxiety disorder spoke less frequently than their child, used significantly fewer positive emotion words, and discouraged their childrens emotion discussions more than did mothers of nonclinical children. Nonclinical children and their mothers indicated significantly more emotional expressiveness in their families than did children with an anxiety disorder and their mothers. These results highlight the potential role of truncated family emotional expressivity in the emotional development and functioning of children with an anxiety disorder.     

Selective Mutism and Its Relations to Social Anxiety Disorder and Autism Spectrum Disorder

In current classification systems, selective mutism (SM) is included in the broad anxiety disorders category. Indeed, there is abundant evidence showing that anxiety, and social anxiety in particular, is a prominent feature of SM. In this article, we point out that autism spectrum problems in addition to anxiety problems are sometimes also implicated in SM. To build our case, we summarize evidence showing that SM, social anxiety disorder (SAD), and autism spectrum disorder (ASD) are allied clinical conditions and share communalities in the realm of social difficulties. Following this, we address the role of a prototypical class of ASD symptoms, restricted and repetitive behaviors and interests (RRBIs), which are hypothesized to play a special role in the preservation and exacerbation of social difficulties. We then substantiate our point that SM is sometimes more than an anxiety disorder by addressing its special link with ASD in more detail. Finally, we close by noting that the possible involvement of ASD in SM has a number of consequences for clinical practice with regard to its classification, assessment, and treatment of children with SM and highlight a number of directions for future research.

     

Negative Thoughts in Children with Symptoms of Anxiety and Depression

This study examined whether negative thoughts are different in anxious, depressed, and chronically ill children. Screening of 1,316 children on anxiety, depression, and asthma resulted in the selection of 118 children. Four groups were formed: (1) a high anxiety group, (2) a high anxiety/depression group, (3) an asthma group, and (4) a low anxiety, low depression, and no chronic disease (control) group. The data yielded no pure depression group. Subsequently, the Negative Affectivity Self-Statement Questionnaire (NASSQ) and a Worry scale were administered. Results showed that cognitive scores were different in all groups. Highest scores were obtained from the high anxiety/depression group, and lowest from the control group. Children with asthma scored high on anxiety, not on depression. High correlations between scores on negative thoughts and conventional measures of negative emotions suggested that negative thoughts provided no unique information about the problems underlying emotional states in different groups of children. Implications for cognitive assessment in emotionally disturbed children are discussed.