Prevention of Anxiety Disorders: Results of a Universal Trial with Young Children

We examined a brief program aimed at preventing anxiety and other problems in early childhood. Participants (N = 734, age 3–6 years) were drawn from 25 preschools across Brisbane, Australia. Assessments occurred four times over 14 months, with a diagnostic interview at follow-up. Parent and teacher reports included information on child temperament, social behavior, inhibition, parent characteristics, and parent-child interactions. REACH for RESILIENCE, a universal prevention program developed for this study, consisted of a six-session training program for parents focusing on building positive expectations and social competency in children. Parents rated the program positively and attended well, especially highly stressed parents who thus became over-represented in the treatment group as time progressed. Despite this difficulty with interpreting results, the intervention resulted in decreases in child problems via teacher report for both internalizing and externalizing problems. However, the effect sizes were not impressive and no changes were noted in parent’s diagnostic ratings. Results, directions for further research, and refinement of methods are discussed.

A Meta-Analysis of Universal School-Based Prevention Programs for Anxiety and Depression in Children

Anxiety and depression are among the most common mental health issues experienced in childhood. Implementing school-based prevention programs during childhood, rather than adolescence, is thought to provide better mental health outcomes. The present meta-analysis aimed to investigate the efficacy of universal school-based prevention programs that target both anxiety and depression in children (aged 13 years or below), and examine three moderators (i.e., program type, primary target of program, and number of sessions) on prevention effects. PsycINFO, PubMED, and Google Scholar were systematically searched for relevant articles published up to and including January 2018. Fourteen randomised controlled trials, consisting of 5970 children, met eligibility criteria. Prevention programs led to significantly fewer depressive symptoms at post-program (g?=?0.172) and at long-term follow-up periods (g?=?0.180), but not at short-term follow-up. Programs were not found to prevent anxiety symptoms across any time point. Considerable heterogeneity was observed for all effects. Program type and length were found to moderate the relationship between prevention program and outcomes. Prevention programs were effective in preventing depressive symptoms at post-program and long-term follow-up, while no significant preventative effect on anxiety symptoms was observed. The FRIENDS Program and programs which contained a greater number of sessions showed beneficial effects on anxiety and depressive symptoms. Universal programs aimed at preventing both anxiety and depression in children are limited. Future research should investigate the long-term evaluation of school-based prevention programs for anxiety and depression in children.     

Examining the Cultural Validity of Fear Survey Schedule for Children: The Contemporary Fears of Turkish Children and Adolescents

The authors examined the cultural validity of Fear Survey Schedule for Children (FSSC-AM) developed by J. J. Burnham (2005) with Turkish children. The relationships between demographic variables and the level of fear were also tested. Three independent data sets were used. The first data set comprised 676 participants (321 women and 355 men) and was used for examining factor structure and internal reliability of FSSC. The second data set comprised 639 participants (321 women and 318 men) and was used for testing internal reliability and to confirm the factor structure of FSCC. The third data set comprised 355 participants (173 women and 182 men) and used for analyses of test–retest reliability, inter-item reliability, and convergent validity for the scores of FSSC. The sum of the first and second samples (1,315 participants; 642 women and 673 men) was used for testing the relationships between demographic variables and the level of fear. Results indicated that FSSC is a valid and reliable instrument to examine Turkish children's and adolescents’ fears between the ages of 8 and 18 years. The younger, female, children of low-income parents reported a higher level of fear. The findings are discussed in light of the existing literature.     

Anxiety Symptoms and Fears in Hispanic and European American Children: Cross-Cultural Measurement Equivalence

The cross cultural equivalence of child (n = 217) and parent (n = 283) versions of the revised children’s manifest anxiety scale (RCMAS), multidimensional anxiety scale for children (MASC), and the fear survey schedule for children—revised (FSSC-R) was examined in Mexican youth in Mexico, and Hispanic and white European American youth in the USA. The RCMAS, MASC, and FSSC-R showed cross ethnic measurement equivalence. The Mexican and Hispanic youth reported more worries, and the Mexican youth reported more somatic symptoms than the European American youth. Per mother report, Mexican and Hispanic youth express more somatic symptoms than European American youth who also show the least number of fears of the unknown and fears of danger and death. The results support the validity of commonly used child anxiety measures with these populations and accrue evidence for greater anxiety and fear expression by Hispanic and Mexican youth in certain domains.

Long-Term Outcome of a Cluster-Randomized Universal Prevention Trial Targeting Anxiety and Depression in School Children

The present study concerns a 3-year follow-up of a universal prevention trial targeting anxiety and depressive symptoms in school children. In addition to evaluating the long-term effect of the prevention program, we also examined attrition and its effect on the outcome. High rates of attrition have commonly been observed in studies in the field. However, the role of attrition is not sufficiently understood regarding internal and external validity biases. The current study comprised 695 children (aged 8–11 at baseline) from 17 schools in Sweden. Schools were cluster-randomized to either the intervention or control condition. Children completed measures of anxiety and depressive symptoms and parents completed measures of their child’s anxiety and general mental health. We found no evidence of long-term effects of the prevention program, except for a small effect regarding parent reports of child anxiety. However, that effect was not found to be of clinical significance. Regarding attrition, children with missing data at the 3-year follow-up displayed higher levels of psychiatric symptoms at baseline and increasing symptoms across time. Furthermore, children in the control condition with missing follow-up data were found to be significantly deteriorated across time compared to the corresponding children in the intervention condition regarding depressive symptoms and total difficulties. In other words, attrition served as a moderator of the effect, which suggests that the overall result was biased toward a null-result. Our study highlights that large and nonrandom attrition severely limits the validity of the results. Further, given the common problem of retaining participants in long-term evaluations of school-based prevention trials, previous studies may suffer from the same limitations as the current study.     

Contemporary Fears of Children and Adolescents: Coping and Resiliency in the 21st Century

This study was prompted by the continual exposure of youth to disasters (e.g., 9/11, Iraq War, Hurricane Katrina, school violence) and the call for revisions in fear assessments to reflect contemporary fears. Fears of 1,033 students in Grades 2–12 were examined using the American Fear Survey Schedule for Children (J. J. Burnham, 2005). Results indicated that new fears have emerged in the 21st century, alerting counselors to consider preventative and intervention activities to address contemporary fears.     

The Metacognitive Model of Generalized Anxiety Disorder in Children and Adolescents

Worry is a common phenomenon in children and adolescents, with some experiencing excessive worries that cause significant distress and interference. The metacognitive model of generalized anxiety disorder (Wells 1995, 2009) was developed to explain cognitive processes associated with pathological worry in adults, particularly the role of positive and negative beliefs about worry. This review evaluates the application of the model in understanding child and adolescent worry. Other key issues reviewed include the link between cognitive and metacognitive development and worry, and the measurement of worry and metacognitive worry in young people. Implications of these findings and directions for future research are discussed.     

Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis

There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders. However, it is less clear which of the specific DSM-IV anxiety disorders occur most in this population. The present study used meta-analytic techniques to help clarify this issue. A systematic review of the literature identified 31 studies involving 2,121 young people (aged <18 years) with ASD, and where the presence of anxiety disorder was assessed using standardized questionnaires or diagnostic interviews. Across studies, 39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder, the most frequent being specific phobia (29.8%) followed by OCD (17.4%) and social anxiety disorder (16.6%). Associations were found between the specific anxiety disorders and ASD subtype, age, IQ, and assessment method (questionnaire versus interview). Implications for the identification and treatment of anxiety in young people with ASD are discussed.     

Predictors of Social Anxiety in Children and Adolescents with Sickle Cell Disease

The aim of this study was to examine the potential moderating effect of age on the child-reported pain–social anxiety relationship in children and adolescents with sickle cell disease (SCD). Participants were children and adolescents (ages 8–17; 33 girls, 25 boys) diagnosed with SCD who completed measures of social anxiety and severity of usual pain. Caregivers provided demographic information, and mean hemoglobin levels were computed as a measure of objective disease severity. Ratings of more severe pain were associated with greater social anxiety, including fear of negative evaluation, for older children and adolescents only, revealing a moderating effect of age. Increased relevancy of peer relationships in adolescence, limited social contacts due to SCD complications, and misreading of social cues (e.g., maladaptive coping response to pain) may explain why older children and adolescents reported greater social anxiety in the presence of a stressor such as pain.     

The Prevention of Children's Maladaptive Fears

The authors address the prophylactic value of behavioral techniques in relation to children's maladaptive fears. The major settings of interest from the viewpoint of preventing children's maladaptive fears are the home, school and health-care settings. Encouraging findings have been reported in the use of film-modeling with children about to undergo dental treatment, tonsillectomies, injections, etc. Several theoretical explanations (stimulus pre-exposure, reciprocal inhibition, reinforcement contingencies, self-efficacy) of the success of such interventions can be advanced to affect the outcome of maladaptive fear prevention programs.     

Phenomenology of Clinic-Referred Children and Adolescents with Oppositional Defiant Disorder and Comorbid Anxiety

This study examined profiles of clinic-referred youth with co-morbid oppositional defiant disorder (ODD) and anxiety disorders (ADs) compared to youth with ODD without ADs. One hundred and twenty seven clinic-referred youth with ODD (ages 7–14, 85.6 % Caucasian) were assessed through a multi-method, multi-informant approach. Global functioning, ODD symptom impairment, child internalizing symptoms, caregiver distress, and parent-child relationship quality were explored to test group differences based on AD diagnosis. Youth with ODD and comorbid ADs generally had higher levels of global impairment, internalizing symptoms, caregiver distress, and parent-child relationship problems as compared to youth with ODD only. These findings, which generally suggest greater impairment in the group of youth with ODD/AD, offer support for the presence of distinct clinical features in youth with ODD/AD compared to youth with ODD alone. Such findings may have important implications for assessment and treatment of ODD in youth. For example, interventions to target broader child internalizing symptoms, caregiver distress, and parent-child relationships may be particularly important in youth with ODD/AD profiles.     

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.     

Computerised Cognitive Behavioural Therapy for the Prevention and Treatment of Depression and Anxiety in Children and Adolescents: A Systematic Review

Research has shown that computerised cognitive behaviour therapy (cCBT) can be effective in the treatment of depression and anxiety in adults, although the outcomes with children and adolescents are unclear. The aim of the study is to systematically review the literature on the effectiveness of cCBT for the prevention and treatment of depression and anxiety in children and adolescents. EMBASE, PsychInfo and Pubmed were searched using specific terms and inclusion criteria for cCBT studies involving young people under the age of 18. A hand search was also conducted, and the authors were contacted to identify additional papers. Ten studies met the inclusion criteria. These included case series and randomised controlled trials concerned with both treatment and prevention. Six different software packages were described that varied in length and the nature and extent of professional contact and supervision. All studies reported reductions in clinical symptoms and also improvements in variables such as behaviour, self-esteem and cognitions. Satisfaction with treatment was moderate to high from both children and parents, though levels of drop out and non-completion were often high. Additional randomised controlled trials are required, as the literature is currently limited. However, preliminary evidence suggests that cCBT is an acceptable and effective intervention for this age group.     

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.

Optimising Exposure for Children and Adolescents with Anxiety,OCD and PTSD: A Systematic Review

Clinical Child and Family Psychology Review - Cognitive behavioural therapy is an effective treatment for anxiety disorders in children and young people; however, many do not benefit. Behavioural...     

Comorbid ADHD: Implications for the Treatment of Anxiety Disorders in Children and Adolescents

Despite high comorbidity rates and potential clinical implications, the influence of co-occurring attention-deficit/hyperactivity disorder (ADHD) on outcomes of cognitive-behavioral treatment (CBT) for anxious youth remains poorly understood. In this qualitative review, the current literature on the influence of comorbid ADHD on CBT of youth with diverse anxiety disorders is explored. Peer-reviewed studies examining ADHD, at the diagnostic and symptom level, received highest priority. In addition, inasmuch as some studies did not isolate the effects of ADHD from other disruptive behavior disorders (DBDs: oppositional defiant disorder, conduct disorders), studies with the three DBDs were explored as well. Ten studies met our specified methodological criteria. Findings are discussed in relation to the following two factors: type of anxiety disorder and measurement of ADHD (diagnostic or symptom level) in these studies. There was evidence that youth with a variety of anxiety disorders and with co-occurring ADHD fared worse than their counterparts without ADHD. Additionally, grouping ADHD with other DBDs tended to obscure the negative impact of ADHD on treatment outcomes. Additional research is needed to delineate the influence of comorbid ADHD specifically on treatment outcomes for the various anxiety disorders. Clinical implications of treating anxious youth with comorbid ADHD are explored.     

青少年抑郁的预防:青少年应变力辅导计划简介

1　背景　　抑郁是精神疾病的‘普通感冒’。联合国卫生组织研究指出单相重性抑郁是 1 990年世界致残的首要原因 ,并预测到 2 0 2 0年 ,抑郁将成为全世界引起死亡和残疾因素中的第二位。美国男性患重性抑郁的可能性是 1 :1 0 ,女性为 1 :4 ;澳大利亚男性在其一生中得抑郁的比例是 1 :6,女性为 1 :4。我国成人流行率为男性1 6 7% ,女性 1 9 5%。抑郁症的平均发病率为 2 5岁 ,大多发病于 1 5-1 9及 2 5-2 9年龄段。 6% -7%的青少年被诊断为抑郁症 ,2 %左右的 6-1 2岁儿童患有抑郁症。有抑郁症状却有没有达到临床标准的儿童的比例和成人相似 ( …