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.     

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.     

Deficits in perceived social support associated with generalized social phobia

Social phobia is a common anxiety disorder associated with significant impairment in social and occupational functioning. To date, few studies have examined the relationship between social phobia and perceived social support, a construct with important relationships to physical and mental health. The present study examined data from 2 widely used measures of perceived social support administered to 132 individuals with DSM‐IV generalized social phobia. These data were compared with those obtained from a healthy control group and from several clinical and non‐clinical samples reported in the literature. Persons with generalized social phobia scored significantly lower on both measures of social support compared with all other groups. It is suggested that deficits in perceived social support associated with generalized social phobia may play a role in the development of co‐morbid problems and should be explicitly targeted by treatments for social phobia. Low correlations between perceived social support and social anxiety measures suggest that perceived support should be specifically evaluated in this population.     

Development of a Cognitive-Behavioral Intervention Program to Treat Anxiety and Social Deficits in Teens with High-Functioning Autism

Anxiety is a common co-occurring problem among young people with autism spectrum disorders (ASD). Characterized by deficits in social interaction, communication problems, and stereotyped behavior and restricted interests, this group of disorders is more prevalent than previously realized. When present, anxiety may compound the social deficits of young people with ASD. Given the additional disability and common co-occurrence of anxiety in ASD, we developed a manual-based cognitive-behavioral treatment program to target anxiety symptoms as well as social skill deficits in adolescents with ASD [Multimodal Anxiety and Social Skills Intervention: MASSI]. In this paper, we describe the foundation, content, and development of MASSI. We also summarize data on treatment feasibility based on a pilot study that implemented the intervention.     

Associations Among Anxiety Disorders and Non-anxiety Disorders,Functional Impairment and Medication in Children and Adolescents

This is a study of comorbid anxiety disorders and how they affect the clinical picture of comorbid cases. The sample consisted of 576 Spanish children aged 8 to 17 years receiving psychiatric outpatient consultation that were evaluated using a semi-structured diagnostic interview for both parents and children. A specific association of homotypic comorbidity among anxiety disorders that was independent of the presence of other disorders was found. There was heterotypic comorbidity between anxiety and depressive disorders, ADHD, anorexia and tic disorders. Relationships between non-anxiety disorders were, in general, independent of anxiety, but anxiety moderated the relationship between ADHD-Conduct disorder and Conduct disorder-enuresis. Comorbid anxiety increased difficulties in social interaction, was related with higher global impairment and had an impact on consultation and medication. Anxiety disorder comorbidity should be well recognized in order not to disregard the treatment of all present disorders.     

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.     

Deficits in perceived social support associated with generalized social phobia

Social phobia is a common anxiety disorder associated with significant impairment in social and occupational functioning. To date, few studies have examined the relationship between social phobia and perceived social support, a construct with important relationships to physical and mental health. The present study examined data from 2 widely used measures of perceived social support administered to 132 individuals with DSM-IV generalized social phobia. These data were compared with those obtained from a healthy control group and from several clinical and non-clinical samples reported in the literature. Persons with generalized social phobia scored significantly lower on both measures of social support compared with all other groups. It is suggested that deficits in perceived social support associated with generalized social phobia may play a role in the development of co-morbid problems and should be explicitly targeted by treatments for social phobia. Low correlations between perceived social support and social anxiety measures suggest that perceived support should be specifically evaluated in this population.     

The impact of an 8-day intensive treatment for adolescent panic disorder and agoraphobia on comorbid diagnoses

Previous research findings have shown positive effects of cognitive-behavioral therapy for primary anxiety disorders as well as for nonprimary, co-occurring anxiety disorders. In this study, we analyzed data from an existing randomized controlled trial of intensive treatment for panic disorder with or without agoraphobia (PDA) to examine the effects of the treatment on comorbid psychiatric diagnoses. The overall frequency and severity of aggregated comorbid diagnoses decreased in a group of adolescents who received an 8-day treatment for PDA. Results suggest that an 8-day treatment for PDA can alleviate the symptoms of some specific comorbid clinical diagnoses; in particular specific phobias, generalized anxiety disorder, and social phobia. These findings suggest that an intensive treatment for PDA is associated with reductions in comorbid symptoms even though disorders other than PDA are not specific treatment targets.     

Social anxiety modulates visual exploration in real life – but not in the laboratory

In clinical reports, individuals high on social anxiety are often described to avoid gaze at other people, whereas several experimental studies employing images of persons yielded conflicting results. Here, we show that gaze avoidance crucially depends on the possibility of social interactions. We examined gaze behaviour in individuals with varying degrees of social anxiety in real-life and in a second group of participants using a closely matched laboratory condition. In the real-life situation, individuals with a higher degree of social anxiety had a reduced bias to look at near persons compared to individuals with a lower degree of social anxiety, while gaze behaviour in the laboratory group was not modulated by social anxiety. This effect was specific to social attention since there was no corresponding effect regarding fixations on objects. The presence of anxiety effects in real-life but not in the laboratory condition, where participants do not expect to be evaluated by gazed-at conspecifics, points to critical deficits of current laboratory research paradigms in eliciting authentic social attentional mechanisms, possibly leading to spurious results.     

Validity of the distinction between generalized social phobia and avoidant personality disorder.

Disorders of pervasive social anxiety and inhibition are divided into 2 categories, generalized social phobia (GSP) and avoidant personality disorder (APD). We explored the discriminative validity of this categorization by examining the comorbidity of GSP and APD and by comparing these groups on anxiety level, social skills, dysfunctional cognitions, impairment in functioning, and presence of concurrent disorders. Results from 23 subjects showed high comorbidity of the 2 diagnoses: All subjects who met criteria for APD also met criteria for GSP. APD was associated with greater social anxiety, impairment in functioning, and comorbidity with other psychopathology, but no differences in social skills or performance on an impromptu speech. GSP and APD seem to represent quantitatively different variants of the same spectrum of psychopathology rather than qualitatively distinct disorders. We also investigated a proposed social phobia subtyping scheme.     

Sociodemographic and psychological features of social phobia in adolescents

The objective of this study is to analyze the demographic and clinical features of adolescent with social phobia based on the subtype. The sample included 120 adolescents diagnosed of Social Phobia (specific or generalized). The results show statistically significant differences between both subtypes of social phobia; so much in gender as on each measure that evaluate anxiety, social avoidance, fear of negative evaluation and other correlates. These data are consistent with results informed by several studies with adult population and provide useful information for the investigation and the clinical practice.     

Social Surrogacy and Adjustment: Exploring the Correlates of Having a “Social Helper” for Shy and Non-Shy Young Adolescents

A social surrogate is an individual who offers help and comfort in social situations or makes social events more exciting. In this study of 157 young adolescents (55% female; M_age = 13.84 years, SD = 0.75 years), the authors examined whether the linear and curvilinear associations between self-reported social surrogate use and adjustment outcomes (social problems, loneliness, anxiety symptoms, depressive symptoms) varied as a function of shyness and gender, after accounting for the effects of positive friendship quality. Regression analyses revealed that low and high levels of social surrogate use were related to greater social problems for all adolescents. In addition, shyness emerged as a moderator for several curvilinear effects. Specifically, results indicated that (a) high levels of social surrogate use were associated with greater anxiety for adolescents high in shyness; and (b) low levels of social surrogate use were associated with greater depressive symptoms for adolescents low in shyness. Findings highlight the developmental importance of specific types of relationship experiences during early adolescence and point to different implications of social surrogate use for shy and non-shy young adolescents.     

The Effects of Introducing Peer Support to Young People with a Chronic Illness

Peer support groups have been an increasingly popular way of limiting the adverse effects of life with a chronic illness for adolescents although few groups have been rigorously evaluated. This paper reports the findings of a realistic evaluation of a hospital based peer support program Chronic Illness Peer Support (ChIPS), in Sydney, Australia. We collected qualitative interview and focus group data from four participant groups; new ChIPS members, their parents, older members who had been in ChIPS for two or more years, and ChIPS co-ordinators past and present. Results of qualitative data have been aggregated and organised into three categories; program attendance: getting in and staying in; program outcomes for young people: personal growth and development; and social connection. Questionnaires were also administered to fourteen new ChIPS members but no significant changes in distress or self-esteem were recorded between the beginning and the end of the short study period. The ChIPS Introductory Program fulfilled its aim, entering young people with chronic illness into the peer support program. There was evidence of initial personal growth and development in those young people, with potential for enhanced social connection from ongoing participation in ChIPS activities.     

Distinctions between separation anxiety and social anxiety in children and adolescents

Separation anxiety and social phobia are intertwined to a considerable degree, and high comorbidity rates have been reported. The present study used latent class analysis (LCA) to investigate if classes of children and adolescents with-simultaneously-high rates of separation anxiety and low rates of social anxiety symptoms, or vice versa, could be identified. Eight- to 18-year-olds from a large general population (n=1000) and referred sample (n=735) were assessed with the Multidimensional Anxiety Scale for Children (MASC). With LCA, a separate class of referred 8-11-year-old children with high separation anxiety scores, and simultaneously lower social anxiety scores was identified, next to a class of children with high scores on separation anxiety and social anxiety. In the other groups (referred 12-18-year-olds and children and adolescents from the general population), a class with individuals who specifically scored high on separation anxiety could not be revealed. The results indicated that separation anxiety represents a different construct than social anxiety in referred children (but not in referred adolescents or in the general population). It can be concluded that, in referred children, research regarding etiology and treatment outcome of anxiety symptoms should be aimed specifically at separation anxiety and social anxiety, instead of just investigating a broader anxiety dimension.     

Obsessive-compulsive disorder, anxiety disorders, and self-esteem: an exploratory study.

In a preliminary investigation of the link between self-esteem and obsessional problems, patients with OCD were compared with people suffering from other anxiety disorders and non-anxious controls. A questionnaire was devised which allowed the reliable coding of open ended responses focussed on issues surrounding self-worth; standardized measures of self-esteem and clinical symptomatology were also administered. Results indicated that both clinical groups differed significantly from non-clinical controls on generalized self-esteem assessments. There was some evidence of OCD specific effects; obsessionals were more likely than anxious controls to link their self-worth to other people and their relationships. They also regarded the possibility of causing harm as likely to result in other people making extreme negative and critical judgements of them; the other groups expected the responses of others towards them to be more lenient. The implications for future research and for treatment of OCD are discussed.     

Rumination and Excessive Reassurance Seeking: Mediators of the Relationship Between Social Anxiety and Depression?

Social anxiety and depression are highly comorbid conditions. Although this has led researchers to suggest that social anxiety may convey risk for depression, few studies have examined mechanisms of comorbidity between these two conditions. The current study tested two mechanisms of comorbidity between symptoms of these disorders: brooding and excessive reassurance seeking. The data were evaluated in an undergraduate sample assessed three times over a 2 month period. Results suggested that brooding mediated the relationship between social anxiety at Time 1 and depression at Time 3, although no evidence was found for excessive reassurance-seeking as a mediator of these two variables. These findings support recent research suggesting that brooding may be a transdiagnostic process. Theoretical and clinical implications are discussed.     

Psychosocial implications of poor motor coordination in children and adolescents

Utilising Harter's theory of competence motivation (Harter, S. The determinants and mediational role of global self-worth in children. In: N. Eisenberg, Contemporary topics in developmental psychology, Wiley, New York, 1987, pp. 219-242.), the current study examined perceived competence and social support, and their influence on self-worth and anxiety in children and adolescents with and without developmental coordination disorder (DCD). A group of children aged 8-10 years, and a group of adolescents aged 12-14 years, with significant movement problems were compared with matched control groups on measures of perceived competence, perceived social support, self-worth and anxiety. Those with DCD were found to perceive themselves as less competent in several domains, and having less social support than control participants. Overall, DCD groups had lower self-worth and higher levels of anxiety than the control groups. Adolescents also perceived themselves as less competent with poorer social support and lower self-worth than younger children. In addition, anxiety was significantly higher for the adolescent group compared to their younger counterparts.     

Cognitions in generalized anxiety disorder and panic disorder patients. A prospective approach.

Self-observations of cognitions during episodes of anxiety were examined in 38 patients with generalized anxiety disorder and 36 patients with panic disorder. Two independent observers who where blind to the diagnoses categorised the cognitions. The inter-rater reliability was high (mean kappa 0.82). The GAD-patients had significantly more cognitions in the following categories: interpersonal confrontation, competence, acceptance, concern about others and worry over minor matters, while the PD-patients had significantly more cognitions in the physical catastrophe category. Furthermore, GAD-patients with a comorbidity of social phobia reported more cognitions regarding social embarrassment than did GAD-patients with other or no (axis-I) comorbidity. The results of this study support the cognitive theory regarding the cognitive specificity of anxiety disorders. The implications of these results are discussed, along with the issues of reliability and validity of the instrument used.     

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.     

A comparison of behavioral and emotional functioning in children and adolescents with Autistic Disorder and PDD-NOS.

Behavioral symptomatology was compared in 26 children and adolescents with Autistic Disorder ("autism") and 25 children and adolescents with Pervasive Developmental Disorder, Not Otherwise Specified ("PDD-NOS"). Relative to individuals with PDD-NOS, those with autism had more symptoms of depression, social withdrawal, atypical behavior, and immature social skills--and fewer family problems. These differences remained even when group differences in intellectual ability were statistically controlled. No group differences emerged in somatization, anxiety, or hyperactivity. Findings suggest that although both groups demonstrate considerable evidence of behavioral and emotional problems, those with autism are at particularly high risk for comorbid behavioral and emotional disabilities.