Improving Treatment Response for Paediatric Anxiety Disorders: An Information-Processing Perspective

Cognitive behavioural therapy (CBT) is considered the treatment of choice for paediatric anxiety disorders, yet there remains substantial room for improvement in treatment outcomes. This paper examines whether theory and research into the role of information-processing in the underlying psychopathology of paediatric anxiety disorders indicate possibilities for improving treatment response. Using a critical review of recent theoretical, empirical and academic literature, the paper examines the role of information-processing biases in paediatric anxiety disorders, the extent to which CBT targets information-processing biases, and possibilities for improving treatment response. The literature reviewed indicates a role for attentional and interpretational biases in anxious psychopathology. While there is theoretical grounding and limited empirical evidence to indicate that CBT ameliorates interpretational biases, evidence regarding the effects of CBT on attentional biases is mixed. Novel treatment methods including attention bias modification training, attention feedback awareness and control training, and mindfulness-based therapy may hold potential in targeting attentional biases, and thereby in improving treatment response. The integration of novel interventions into an existing evidence-based protocol is a complex issue and faces important challenges with regard to determining the optimal treatment package. Novel interventions targeting information-processing biases may hold potential in improving response to CBT for paediatric anxiety disorders. Many important questions remain to be answered.     

The relationship between prospective memory and episodic future thinking in younger and older adulthood

Episodic future thinking (EFT), the ability to project into the future to “preexperience” an event, and prospective memory (PM), remembering to perform an intended action, are both examples of future-oriented cognition. Recently it has been suggested that EFT might contribute to PM performance but to date few studies have examined the relationship between these two capacities. The aim of the present study was to investigate the nature and specificity of this relationship, as well as whether it varies with age. Participants were 125 younger and 125 older adults who completed measures of EFT and PM. Significant, positive correlations between EFT and PM were identified in both age groups. Furthermore, EFT ability accounted for significant unique variance in the young adults, suggesting that it may make a specific contribution to PM function. Within the older adult group, EFT did not uniquely contribute to PM, possibly indicating a reduced capacity to utilize EFT, or the use of compensatory strategies. This study is the first to provide systematic evidence for an association between variation in EFT and PM abilities in both younger and older adulthood and shows that the nature of this association varies as a function of age.     

Judging trustworthiness from faces: Emotion cues modulate trustworthiness judgments in young children

By adulthood, people judge trustworthiness from appearances rapidly and reliably. However, we know little about these judgments in children. This novel study investigates the developmental trajectory of explicit trust judgments from faces, and the contribution made by emotion cues across age groups. Five‐, 7‐, 10‐year‐olds, and adults rated the trustworthiness of trustworthy and untrustworthy faces with neutral expressions. The same participants also rated faces displaying overt happy and angry expressions, allowing us to investigate whether emotion cues modulate trustworthiness judgments similarly in children and adults. Results revealed that the ability to evaluate the trustworthiness of faces emerges in childhood, but may not be adult like until 10 years of age. Moreover, we show that emotion cues modulate trust judgments in young children, as well as adults. Anger cues diminished the appearance of trustworthiness for participants from 5 years of age and happy cues increased it, although this effect did not consistently emerge until later in childhood, that is, 10 years of age. These associations also extended to more subtle emotion cues present in neutral faces. Our results indicate that young children are sensitive to facial trustworthiness, and suggest that similar expression cues modulate these judgments in children and adults.     

“Big” Sounds Bigger in More Widely Spoken Languages

Larger communities face more communication barriers. We propose that languages spoken by larger communities adapt and overcome these greater barriers by increasing their reliance on sound symbolism, as sound symbolism can facilitate communication. To test whether widely spoken languages are more sound symbolic, participants listened to recordings of the words big and small in widely spoken and less common languages and guessed their meanings. Accuracy was higher for words from widely spoken languages providing evidence that widely spoken languages harbor more sound symbolism. Preliminary results also suggest that widely spoken languages rely on different sound symbolic patterns than less common languages. Community size can thus shape linguistic forms and influence the tools that languages use to facilitate communication.     

Are you for real? Exploring language use and unexpected process questions within the detection of identity deception

The current study was to test whether reality monitoring and language use could distinguish identity liars from truth tellers when answering outcome questions and unexpected process questions. Truth tellers (n = 30) and liars (n = 30) discussed their identity in a recruitment interview. No differences emerged between truth tellers and liars in the details they provided. In terms of language use, liars used more positive language than truth tellers, whereas truth tellers used more cognitive process words than liars. However, neither were more pronounced when asking process questions. Overall, process questions elicited more cognitive process and cause words than outcome questions. Therefore, process questions may be able to contribute to the cognitive load approach. The findings suggest that reality monitoring may not be diagnostic when applied to identity deception. We discuss the language use differences in relation to impression management theory.     

Facial expression coding in children and adolescents with autism: Reduced adaptability but intact norm-based coding

Individuals with autism spectrum disorder (ASD) can have difficulty recognizing emotional expressions. Here, we asked whether the underlying perceptual coding of expression is disrupted. Typical individuals code expression relative to a perceptual (average) norm that is continuously updated by experience. This adaptability of face-coding mechanisms has been linked to performance on various face tasks. We used an adaptation aftereffect paradigm to characterize expression coding in children and adolescents with autism. We asked whether face expression coding is less adaptable in autism and whether there is any fundamental disruption of norm-based coding. If expression coding is norm-based, then the face aftereffects should increase with adaptor expression strength (distance from the average expression). We observed this pattern in both autistic and typically developing participants, suggesting that norm-based coding is fundamentally intact in autism. Critically, however, expression aftereffects were reduced in the autism group, indicating that expression-coding mechanisms are less readily tuned by experience. Reduced adaptability has also been reported for coding of face identity and gaze direction. Thus, there appears to be a pervasive lack of adaptability in face-coding mechanisms in autism, which could contribute to face processing and broader social difficulties in the disorder.     

Increased wait-list time predicts dropout from outpatient enhanced cognitive behaviour therapy (CBT-E) for eating disorders

Between 30 and 70% of patients with eating disorders drop out from outpatient treatment. However, research has been unable to identify factors that consistently predict dropout from eating disorder treatment. Most studies have exclusively investigated the role that individual patient characteristics play in dropout and have ignored more process-based factors such as expectations about treatment, the therapeutic alliance, or time spent on a treatment waiting list. This study aimed to investigate the roles of both individual patient characteristics and process-based factors in dropout from outpatient treatment for eating disorders. The study involved data collected from consecutive eating disorder referrals to the only public specialist eating disorder service for youth and adults in Perth, Western Australia. The standard treatment provided at this service is Enhanced Cognitive Behaviour Therapy on an individual basis. The study involved 189 patients referred to the service between 2005 and 2010. Forty five percent of this sample dropped out of treatment. Results showed that, in this sample, two individual factors, lowest reported weight and the tendency to avoid affect, and one process-based factor, time spent on the wait list for treatment, were significant predictors of dropout. These findings are valuable because a process-based factor, such as wait-list time, may be easier to address and modify than a patient's weight history or the trait of mood intolerance. Increased resources for eating disorder services may reduce waiting list times which would help to reduce dropout and maximize treatment outcomes.     

Assessing the prevalence of mental health disorders and mental health needs among preschool children in care in England

Although school‐aged children living in foster care have been identified as a high‐risk group for mental health and developmental disorders, there is a paucity of data relating to preschool children in care (CIC). This study aimed to identify the prevalence of mental health and developmental disorders along with corresponding need for interventions in preschool CIC. All CIC aged 0 to 5 years in an inner city local authority underwent comprehensive, multifaceted assessments consisting of the Ages and Stages Questionnaire (J. Squires, D. Bricker, & E. Twombly, 2003), interviews with caregivers based on the Preschool Age Psychiatric Assessment (H.L. Egger & A. Angold, 2006), Mullen Scales of Early Learning (E.M. Mullen, 1995 ), and systematic clinical observation. Of 58 eligible preschoolers, 43 completed the assessment. At least one mental health disorder was found in 26 (60.5%) participants, and at least one developmental disorder was found in 11 (25.6%). When mental health and/or developmental disorders were considered together, 30 (69.8%) preschoolers fulfilled criteria for at least one diagnosis, and 18 (41.9%) had two or more comorbid conditions. Whereas 36 (83.7%) of the preschoolers needed an intervention, only 3 of these had received adequate input. In conclusion, preschool CIC constitute a high‐risk group for mental health and developmental disorders. Without age‐appropriate assessments, their needs go undetected, and opportunities for early intervention are being missed.     

Overcoming Collaborative Inhibition through Error Correction: A Classroom Experiment

Research in classrooms has shown mixed evidence for benefits of collaborative learning compared with learning individually. Moreover, laboratory research has shown that individuals working in dyads or groups often perform worse than individuals working alone — a robust finding called the collaborative inhibition effect. Despite these findings, we hypothesize that some classroom activities may afford benefits for collaborative learning over individual learning. We created a classroom writing activity that incorporated features such as shared prior knowledge and error‐correction processes, which have been hypothesized to eliminate collaborative inhibition and to support constructive collaboration. Students participated in this activity either individually or in dyads. Results showed that the individuals who worked collaboratively performed equally well as those who worked individually and also showed better learning as measured by performance on a future writing assignment. Copyright © 2011 John Wiley & Sons, Ltd.