Behavioral Genetics as a Tool for Developmental Psychology: Anxiety and Depression in Children and Adolescents

Over the past decade there has been a huge increase in the number of behavioral genetic studies looking into anxiety and depression in children and adolescents. There are now enough data in this area to make a review of the results useful. This paper begins with an outline of the methods used in such research and moves on to review the results in extant studies. Overall, these studies indicate modest to moderate genetic influence on both anxiety and depression. However, behavioral genetic methods are also paramount for exploring environmental influences in addition to genetic influences. Shared environment (that which makes family members resemble one another) is rarely identified in adult studies of personality or psychopathology and does not appear to be a significant influence for depression but it is for anxiety. Nonshared environment, which makes family members differ from one another, is found to be a significant influence for both anxiety and depression. Patterns within these results due to rater effects, age effects, sex effects, the precise phenotype measured, and the study design are explored.     

Assessment of Tripartite Factors of Emotion in Children and Adolescents II: Concurrent Validity of the Affect and Arousal Scales for Children

The authors assessed the reliability and validity of the Affect and Arousal Scale for Children (AFARS; Chorpita, Daleiden, Moffitt, Yim, & Umemoto, 2000). The AFARS is a new measure of children's positive affect (PA), negative affect (NA), and physiological hyperarousal (PH). In the first study, 176 school children, 7 to 17 years of age, were administered measures of childhood worry, anxiety sensitivity, and autonomic arousal and their parents completed a child behavior problem checklist. In a second study, two groups of 100 and 114 school children, 8 to 18 years of age, were administered measures of childhood depression and anxiety, respectively, Also, 120 of these children took part in a 1-week retest administration of the AFARS. These studies provided preliminary evidence of acceptable 1-week test–retest reliability, convergent validity, and discriminant validity for the AFARS PA, NA, and PH scales. However, the predicted pattern of convergent and discriminant relations with parent-reported criterion only emerged for children over 11 years of age. Further, a consistent positive relation emerged between NA and PH, yet each of these scales accounted for unique variance in the prediction of criterion measures.     

Diagnosis and Assessment of Depression and Suicidality Using the NIMH Diagnostic Interview Schedule for Children (DISC-2.3)

The Diagnostic Interview Schedule for Children (DISC-2.3) was studied in a sample of 265 adolescent inpatients to determine type and concurrent validity of depressive symptoms and depressive disorder diagnoses for different DISC-2.3 informants (parent, adolescent, both). The Children's Depression Rating Scale — Revised, Reynolds Adolescent Depression Scale (RADS), Suicide Ideation Questionnaire — Junior, Spectrum of Suicide Behavior Scale, and clinical consensus diagnoses were used to assess concurrent validity. Results indicated that (1) parents, compared to adolescents, reported a higher prevalence of all depressive symptoms with the exception of weight change; (2) DISC-2.3 depressive and suicidality symptoms were related positively to independent validating criteria for all informant conditions, suggesting good concurrent validity; (3) the DISC-2.3 both informant condition correctly identified the most depressive disorders; and (4) the parent, but not the adolescent, DISC-2.3 Informant condition contributed to the prediction of clinical consensus diagnoses of depression after taking into account RADS scores.     

Brief Transdiagnostic Intervention for Parents With Emotional Disorder Symptoms During the COVID-19 Pandemic: A Case Example

Concerns regarding parent mental health and well-being during the COVID-19 pandemic are justifiably on the rise. Although anxiety, depression, and traumatic stress levels have risen precipitously across all demographics during the pandemic, parents residing with their children are under particular and unique strain. Caregivers with children in the home are responsible not only for their own health, financial security, and safety during this time, but often full-time caregiving, household management and, in many cases, their children’s schooling. In this case paper, we describe the development of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders for Caregivers (UP-Caregiver) and provide a case example of its implementation. This 4-session indicated prevention for caregivers is a modification of existing versions of the Unified Protocols for adults and children, modified to maximize its responsiveness to issues faced by parents and caregivers living with youth (ages 6–13) during the current pandemic. UP-Caregiver was offered as part of a randomized, controlled trial via telehealth in a small group format to any parent with a child in the specified age range with mild or greater anxiety, depression or traumatic stress symptoms during an initial screening. The case example provided is of a White, Hispanic mother with a range of self-reported emotional disorder concerns at an initial assessment. Declines in anxiety, depression and traumatic stress symptoms were all noted, as well as improvements in parenting self-efficacy and distress tolerance 6-weeks after initiating UP-Caregiver. An ongoing randomized, controlled trial of UP-Caregiver will further evaluate the utility and feasibility of this approach to alleviate parental distress during COVID-19.     

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.     

Beyond Negative Affectivity: A Hierarchical Model of Global and Transdiagnostic Vulnerabilities for Emotional Disorders

Background: Negative affectivity (NA) has been linked to anxiety and depression (DEP). Identifying the common factors between anxiety and DEP is important when explaining their overlap and comorbidity. However, general factors such as NA tend to have differential relationships with different disorders, suggesting the need to identify mediators in order to explicate these relationships. Methods: The current study tests a theoretically and empirically derived hierarchical model of emotional disorders including both a general factor (NA) and transdiagnostic risk factors [anxiety sensitivity (AS) and intolerance of uncertainty (IoU)] using structural equation modeling. AS was tested as a mid-level factor between NA and panic disorder/agoraphobia, while IoU was tested as a mid-level factor between NA and social phobia, generalized anxiety disorder, obsessive-compulsive disorder, and DEP. Data from 642 clinical outpatients with a heterogeneous presentation of emotional disorders were available for analysis. Results: The hierarchical model fits the data adequately. Moreover, while a simplified model removing AS and IoU fits the data well, it resulted in a significant loss of information for all latent disorder constructs. Limitations: Data were unavailable to estimate post-traumatic stress disorder or specific phobias. Future work will need to extend to other emotional disorders. Conclusions: This study demonstrates the importance of both general factors that link disorders together and semi-specific transdiagnostic factors partially explaining their heterogeneity. Including these mid-level factors in hierarchical models of psychopathology can help account for additional variance and help to clarify the relationship between disorder constructs and NA.     

Assessment of Tripartite Factors of Emotion in Children and Adolescents I: Structural Validity and Normative Data of an Affect and Arousal Scale

The authors developed and evaluated a self-report measure for children designed to assess factors of the tripartite model of emotion (Clark & Watson, 1991). Factor analytic results from a large, multi-ethnic sample (n = 1,289) supported the structural validity of the scale, with the additional suggestion that negative affect appeared to contain two lower order dimensions in the item pool. Confirmatory factor analysis in an independent sample of 300 children and adolescents suggested favorable structure. Consistent with prediction, positive and negative affect emerged as relatively orthogonal dimensions. Physiological hyperarousal was found to be positively correlated with negative affect. Normative data are presented, and tests for differences by sex, grade level, and ethnicity demonstrated nonsignificant or minimal differences between groups. The implications for the assessment of tripartite factors and their relation to psychopathology in youth are discussed.     

Efficacy of Dialectical Behavior Therapy for Adolescents in a Partial Hospitalization Program

This study evaluated dialectical behavior therapy for adolescents (DBT‐A) vs. treatment as usual within a 6‐week partial hospitalization program. The 103 adolescent participants (mean age = 15.27 years) were predominantly girls (n = 63, 61%) with a variety of primary mental health diagnoses. Results indicated that DBT‐A was superior for decreasing symptoms of depression and interpersonal sensitivity, but no statistically significant difference was detected for anxiety or hostility. Implications for treating youth with transdiagnostic identities are discussed.     

The Structure of Self-Consciousness in Children and Young Adolescents and Relations to Social Anxiety

Decades of research have examined the structure of self-consciousness in adults and its relationship to social anxiety. This study examined the structure of self-consciousness via the Self-Consciousness Scales (Fenigstein et al., J. Consult. Clin. Psychol. 43:522–527, 1975) in a school sample of 175 children and young adolescents (92 girls; mean age = 11.5). Confirmatory factor analysis best supported a five-factor solution (Internal State Awareness, Self-Reflectiveness, Appearance Consciousness, Style Consciousness and Social Anxiety). Although some factor based subscales evidenced low internal consistencies, convergent and discriminant correlations with self-report measures of social phobia, negative affect, and positive affect as well as parent-report measures of internalizing and externalizing problems provided additional support for the five-factor model. Future studies should further examine the multidimensional nature as well as the developmental course of self-consciousness and its relation to social anxiety longitudinally.

Naturalistic Partial Sleep Deprivation Leads to Greater Next-Day Anxiety: The Moderating Role of Baseline Anxiety and Depression

The detrimental effects of insufficient sleep on emotional functioning have been well established. Total sleep deprivation usually leads to increased anxiety and depressive symptoms the following day. However, no study has yet examined the relationships between unmanipulated partial sleep deprivation and next-day symptoms of anxiety and depression in everyday life, which this study sought to characterize. Participants (N = 94) completed daily diary surveys twice per day for 2 weeks without instructions to alter their sleep in any way. Nights of spontaneous, naturally occurring partial sleep deprivation were followed by increased levels of self-reported symptoms of anxious arousal the next day, but were unrelated to next-day symptoms of anhedonic depression or general distress. The relationship between partial sleep deprivation and next-day anxious arousal was found to be moderated by both baseline depressive symptoms and anxiety such that individuals reporting higher levels of depression or anxiety at baseline showed relatively greater increases in symptoms of anxiety following partial sleep deprivation. These results suggest that partial sleep deprivation occurring in everyday life can lead to higher next-day levels of anxious arousal, a relationship that is particularly deleterious for individuals with higher overall levels of anxiety or depressive symptoms.     

Prevalence of Anxiety and Depression in Australian Adolescents: Comparisons with Worldwide Data

Data from two Australian studies were combined so that the prevalence of anxiety and depression in a large, normative sample of Australian adolescents could be investigated. The combined sample comprised 1,299 adolescents randomly selected from metropolitan and country schools in Melbourne, a large Australian city. The data were examined in order to ascertain the percentages of adolescents who scored above the clinical cut-off on two self-report instruments-the Revised Children's Manifest Anxiety Scale (C. R. Reynolds & B. 0. Richmond, 1985) and the Reynolds Adolescent Depression Scale (W. M. Reynolds, 1986). The results of these analyses were then compared with previously reported prevalence rates from studies worldwide. This comparison revealed striking differences in the prevalence of anxiety and depression across different countries and cultures. Limitations attributable to different self-report measures and imposed-etic approaches are discussed. Issues pertaining to social and political climate are also raised.     

An Inhibitory Learning Approach to Cognitive-Behavioral Therapy for Children and Adolescents

Although exposure-based cognitive-behavioral therapy (CBT) is efficacious for childhood anxiety and obsessive–compulsive disorder (OCD), many youth do not adequately respond to treatment. Extinction learning is an important process in exposure-based CBT. However, youth with anxiety disorders and OCD exhibit impairments in extinction processes that are best characterized by deficits in inhibitory learning. Therefore, the utilization of strategies to optimize inhibitory learning during exposures may compensate for these deficits, thereby maximizing extinction processes and producing more robust treatment outcomes for exposure-based CBT. This paper reviews several strategies to optimize inhibitory learning in youth with anxiety disorders and OCD, and presents practical examples for each strategy. This paper also highlights the difference between inhibitory learning-based exposures and prior conceptual approaches to exposure therapy in clinical practice. It concludes with a discussion of future directions for clinical research on inhibitory learning and exposure-based CBT in youth.     

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.     

Anxiety sensitivity and daily cigarette smoking in relation to sleep disturbances in treatment-seeking smokers

ABSTRACT

Although the association between anxiety and sleep disturbance is well-documented, the underlying mechanisms are less clear. Anxiety sensitivity (AS), the fear of physiological arousal and bodily sensations, is a risk factor for anxiety and poor sleep. Smoking also contributes to poor sleep and may compound the effects of AS on sleep quality. This study evaluated the main and interactive effects of AS and cigarettes/day on sleep quality among smokers. Participants (n = 190) were adult treatment-seeking daily smokers who completed a baseline assessment as part of a larger smoking cessation trial. Sleep quality was self-reported. Results indicated that AS was significantly correlated with greater disturbance in sleep duration, subjective sleep quality, sleep onset latency, sleep disturbance, daytime dysfunction, and sleep medication use. There was a significant interaction between AS and cigarettes/day in terms of sleep onset latency, but not other sleep quality indices. AS was associated with significantly longer sleep onset latency minutes among heavier smokers, but not lighter smokers. Specifically, the association between AS and sleep onset latency was significant for those who smoked ≥ 33 cigarettes/day. AS is a psychological factor that may contribute to poor sleep quality, especially in heavy smokers, and thus may be a promising intervention target.     

Asthma-Specific Quality of Life in Older Adolescents and Young Adults with Long-Standing Asthma: The Role of Anxiety and Depression

The present study examined the influence of psychological comorbidity (i.e., anxiety and depression) on asthma-specific quality of life (QOL). Sixty-four older adolescents and young adults with childhood onset asthma completed measures of anxiety, depression, and asthma-specific QOL. Objective assessments of illness severity were obtained via a semistructured interview and pulmonary function test. Results revealed that the combination of anxiety and depression severity contributed significant variance to asthma QOL after statistically controlling demographic and disease covariates. Moreover, anxiety demonstrated a significant main effect on asthma QOL. Findings suggest that assessment of anxiety may help identify individuals who are at risk for poorer asthma-specific quality of life. Such early interventions can be effectively incorporated into comprehensive biopsychosocial treatment and behavioral self-management programs for individuals with asthma.     

Crisis Assessment and Psychiatric Hospitalization of Children and Adolescents in State Custody

We investigated the clinical characteristics and placement decisions among a group of children who were wards of the state and had been evaluated for a crisis assessment. The sample consisted of 383 children and adolescents (ages 2-20 years) who were wards of the Illinois Department of Children and Family Services (DCFS). This study retrospectively reviewed the symptoms, risk factors, functioning and co-morbid variables, and placement or system characteristics of these children using a structured assessment tool, the Childhood Severity of Psychiatric Illness (CSPI). Results indicated that risk behaviors as rated on the CSPI, including suicidality, dangerousness, and runaway tendency, were significant predictors of psychiatric hospitalization. The importance of more widespread usage of standardized assessment tools in evaluating children's mental health needs is discussed.     

Comorbidity of Anxiety and Depression in Children and Adolescents: An Integrative Review

Much evidence exists documenting the comorbidity of anxiety and affective disorders in youth. Furthermore, comorbidity appears to have serious implications both in terms of severity of impairment and course of disorder. Despite this, little is known about the meaning behind the high rate of co-occurrence of anxiety and depression in children and adolescents. Several conditions exist that may give rise to comorbidity. Specifically, two disorders may be comorbid when there is a high rate of symptom overlap between the disorders, when one underlying construct is split into two separate disorders, when the disorders share common risk or etiological factors, or because one disorder causes or increases the risk of developing the second disorder. The present paper examines each of these explanations as they relate to the comorbidity of anxiety and depression in youth.     

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.     

Group Intervention for Adolescent Anxiety and Depression: Outcomes of a Randomized Trial with Adolescents in Kenya

Youth mental health interventions in low-resource communities may benefit from including empirically supported elements, using stigma-free content, and using trained lay-providers. We developed and evaluated such an intervention, targeting adolescent depression and anxiety in Kenya, where mental health care is limited by social stigma and a paucity of providers. Kenyan adolescents (N = 51, ages 14–17, 60.78% female) from a school in an urban slum in Nairobi with self-reported moderate-to-severe symptoms of depression or anxiety were randomized to the 4-week “Shamiri” (“thrive”) group intervention or a study skills control intervention of equal duration. The Shamiri intervention included growth mindset, gratitude, and value affirmation exercises. The content was delivered by recent high school graduates (ages 17–21, 60% male) trained as lay-providers. Participants met in school once-a-week in groups of 9–12 youths (average group size 10). Compared to the study-skills control, Shamiri produced greater reductions in adolescent depression symptoms (p = .038; d = .32) and anxiety symptoms (p = .039; d = .54) from baseline to 4-week follow-up, and greater improvements in academic performance (p = .034; d = .32) from the school-term before versus after the intervention. There were no effects on overall social support or perceived control, but the Shamiri group showed larger increases in perceived social support from friends (p = .028, d = .71). This appears to be the first report that a brief, lay-provider delivered, community-based intervention may reduce internalizing symptoms and improve academic outcomes in high-symptom adolescents in Sub-Saharan Africa. Larger replications with extended follow-ups will help gauge the strength and durability of these effects.     

Anxiety and Depression in Children: A Preliminary Examination of the Utility of the PANAS-C

Recent research has questioned the validity of identifying depression and anxiety as separate constructs in children. The current investigation examined the usefulness of the Positive and Negative Affect Schedule for Children (PANAS-C) in differentiating between anxiety and depression in children while also providing needed reliability and validity data on the PANAS-C. In addition, the relationship between positive and negative affect and coping was examined. Subjects included 110 third through fifth graders from a semirural public school setting. Children completed the PANAS-C, as well as self-report measures of depression, anxiety, and coping strategies. Moderate item–total correlations and high internal consistency indicated that the PANAS-C has good reliability. Validity results were mixed: a two-factor solution resembled previous studies, and negative affect was associated with avoidance coping strategies whereas positive affect was associated with approach coping strategies, as expected. However, correlations of positive and negative affect, anxiety, and depression scales suggest that positive and negative affectivity are negatively related in children as opposed to separate and independent constructs. Results of the present investigation question the validity of the use of the PANAS-C for differentiating anxiety and depression with this age group and lend support to the possibility that high overlap between anxiety and depression in this age group may be specific for childhood depression.