Treating Anxiety Disorders in Inner City Schools: Results from a Pilot Randomized Controlled Trial Comparing CBT and Usual Care

BACKGROUND: The effectiveness of cognitive-behavioral treatment (CBT) in inner city schools, when delivered by novice CBT clinicians, and compared to usual care (UC), is unknown. OBJECTIVE: This pilot study addressed this issue by comparing a modular CBT for anxiety disorders to UC in a sample of 32 volunteer youth (mean age 10.28 years, 63% female, 84% African American) seen in school-based mental health programs. METHODS: Youth were randomly assigned to CBT (n = 17) or UC (n = 15); independent evaluators conducted diagnostic interviews with children and parents at pre- and post-intervention, and at a one-month follow-up. RESULTS: Based on intent-to-treat analyses, no differences were found in response rates between groups with 50 and 42% of the children in CBT, compared to 46 and 57% in UC no longer meeting criteria for an anxiety disorder at post-treatment and follow-up respectively. Similar improvements in global functioning were also found in both treatment groups. Baseline predictors of a positive treatment response included lower anxiety, fewer maladaptive thoughts, less exposure to urban hassles, and lower levels of parenting stress. Therapist use of more CBT session structure elements and greater competence in implementing these elements was also related to a positive treatment response. CONCLUSIONS: Findings from this small pilot failed to show that CBT was superior to UC when delivered by school-based clinicians. Large scale comparative effectiveness trials are needed to determine whether CBT leads to superior clinical outcomes prior to dissemination.

The oral microbiome in health and disease and the potential impact on personalized dental medicine

Every human body contains a personalized microbiome that is essential to maintaining health but capable of eliciting disease. The oral microbiome is particularly imperative to health because it can cause both oral and systemic disease. The oral microbiome rests within biofilms throughout the oral cavity, forming an ecosystem that maintains health when in equilibrium. However, certain ecological shifts in the microbiome allow pathogens to manifest and cause disease. Severe forms of oral disease may result in systemic disease at different body sites. Microbiomics and metagenomics are two fields of research that have emerged to identify the presence of specific microbes in the body and understand the nature of the microbiome activity during both health and disease. The analysis of the microbiome and its genomes will pave the way for more effective therapeutic and diagnostic techniques and, ultimately, contribute to the development of personalized medicine and personalized dental medicine.

Parental and peer predictors of social anxiety in youth

The aim of the current study was to extend etiological models of social anxiety in youth by examining the relative importance of parental (i.e., parental anxiety, rejection, and overcontrol) and peer factors (i.e., social acceptance, social support, and friendship quality). Sixty-three youth (ages 7–12; 52% male) and their parents participated in the study. Using multiple informants of these factors, results generally indicated that higher levels of parental anxiety, rejection, and overcontrol were related to higher levels of social anxiety. Higher levels of social support, acceptance, and validation were associated with lower levels social anxiety. The strongest predictors of social anxiety symptoms (as rated by an independent evaluator) were parental anxiety and friendship quality (i.e., validation from a peer). The strongest predictors of child rated social anxiety symptoms were parental overcontrol and perceived social acceptance. Findings are discussed in the context of current etiological models and suggest that interventions aimed at lowering social anxiety in youth address both parental anxiety and peer relationships.

Maternal anxiety, behaviors, and expectations during a behavioral task: relation to children's self-evaluations

This study examined the associations between maternal anxiety, behaviors, and expectations and children's self-evaluations of distress, coping, and performance during a stressful performance evaluation task. Seventy-five mothers (38 clinically anxious and 37 nonanxious) along with one of their children aged 6-14 (52.0% female; 78.7% Caucasian) were videotaped while preparing the child to deliver a speech about themselves. Child and parent assessments were obtained before and after the speech, and independent coders rated maternal behavior during the speech preparation. Maternal anxiety and behaviors accounted for a greater proportion of variance in children's self-evaluations than did maternal expectations, such that children of mothers who reported higher task anxiety and demonstrated more overcontrol and anxious behavior during the task evaluated themselves more negatively. These findings extend the literature by providing information about the relative associations between maternal factors and children's self-evaluations within the context of an in vivo stressful situation.

The Utility of Clinicians Ratings of Anxiety Using the Pediatric Anxiety Rating Scale (PARS)

Clinician ratings of anxiety hold the promise of clarifying discrepancies often found between child and parent reports of anxiety. The Pediatric Anxiety Rating Scale (PARS) is a clinician-administered instrument that assesses the frequency, severity, and impairment of common pediatric anxiety disorders and has been used as a primary outcome measure in several landmark treatment trials. However, no data on nonanxious youth have been published. The purpose of this study was to address this gap by examining clinician's ratings of anxiety on the PARS in a volunteer sample of youth without anxiety disorders (n = 84; ages 7-12; 51% female, 75% Caucasian). The nonanxious sample was comprised of youth with (At-risk; n = 36) and without (Healthy; n = 48) anxious parents. Data were also used to evaluate the reliability (i.e., internal consistency), convergent, and divergent validity of the clinician-rated PARS. In addition, a receiver operating curve analysis was used to determine optimum cut off scores indicative of clinical levels of anxiety by comparing PARS scores between these nonanxious youth and a clinically anxious sample (n = 77) randomized in the Research Units of Pediatric Psychopharmacology (RUPP) anxiety study (RUPP 2001). Results indicated that anxious and nonanxious youth were significantly different on all PARS severity items. Optimum cutoff scores of 11.5 (5-item total score) and 17.5 (7-item total score) discriminated youth with and without anxiety disorders. Cronbach alphas for the Healthy and At-risk sample were .90 and .91 and .75 and .81 for the 5- and 7-item total PARS scores respectively, supporting the measure's internal consistency among nonanxious youth. PARS total scores were positively correlated with other measures of anxiety (i.e., the Screen for Child Anxiety Related Emotional Disorders) for the At-risk but not Healthy subsample. PARS scores were not significantly correlated with depressive symptoms (i.e., Children's Depression Inventory). Overall, findings support the utility of clinician's assessments of anxiety symptoms for nonanxious youth. Using the PARS can help facilitate determining whether a child's anxiety level is more similar to those with or without an anxiety disorder.

Parental anxiety and child symptomatology: an examination of additive and interactive effects of parent psychopathology. [corrected]

The current study examined relations between parent anxiety and child anxiety, depression, and externalizing symptoms. In addition, the study tested the additive and interactive effects of parent anxiety with parent depression and externalizing symptoms in relation to child symptoms. Forty-eight parents with anxiety disorders and 49 parents without any psychiatric disorder participated with one of their children (ages 6 to 14 years; 46.4% male; 75.8% Caucasian). Parent anxiety was related to both child anxiety and depression, but not child externalizing symptoms. Hierarchical regression analyses showed that only parent externalizing symptoms had additive effects, beyond parent anxiety symptoms, in relation to child anxiety symptoms. Further, parent anxiety symptoms moderated the relationship between parent and child externalizing symptoms, such that the strength of this relationship was reduced in the presence of high levels of parent anxiety symptoms. Results of this study illuminate the role of parent comorbidity in understanding relations between parent and child symptoms.

Maternal control behavior and locus of control: examining mechanisms in the relation between maternal anxiety disorders and anxiety symptomatology in children

This study tested components of a proposed model of child anxiety and examined the mediational roles of (1) maternal control behavior, (2) maternal external locus of control, and (3) child external locus of control in the association between maternal and child anxiety. Thirty-eight clinically anxious mothers and 37 nonanxious mothers participated along with one of their children aged 6 to 14 (52.0% female; 78.7% Caucasian). Path analysis indicated that the overall model fit the data very well. Analyses also indicated that child external locus of control mediated the associations between (1) maternal and child anxiety and (2) maternal control behavior and child anxiety. Maternal anxiety was not related to maternal control behavior and maternal external locus of control was not associated with child anxiety. Findings are discussed in the context of theoretical models (e.g., Chorpita and Barlow 1998) regarding the transmission of maternal anxiety to their children and the specific roles of maternal behavior and child locus of control.

Cognitive measures of adolescent depression: unique or unitary constructs?

The factor structure of several self-report questionnaires assessing depression-relevant cognitions frequently employed in clinical research was examined in a sample of 390 adolescents (M age = 14.54; 216 girls; 74% Caucasian) with current major depressive disorder enrolled in the Treatment of Adolescents with Depression Study. A four-factor solution resulted, accounting for 65% of the total variance. The factors were labeled (a) Cognitive Distortions and Maladaptive Beliefs, (b) Cognitive Avoidance, (c) Positive Outlook, and (d) Solution-Focused Thinking. Internal consistencies for the factor-based composite scores were .83, .85, .84, and .82, respectively. Girls endorsed more negative cognitions than boys on three of the four factors. Maladaptive cognitions were positively related to severity of depression and predicted treatment response. Taken together, findings indicated that there are four distinct domains of cognitions that are present among adolescents with depression that are tapped by several widely used self-report measures of cognitions.

Dysfunctional attitudes scale perfectionism: a predictor and partial mediator of acute treatment outcome among clinically depressed adolescents

The effect of perfectionism on acute treatment outcomes was explored in a randomized controlled trial of 439 clinically depressed adolescents (12-17 years of age) enrolled in the Treatment for Adolescents with Depression Study (TADS) who received cognitive behavior therapy (CBT), fluoxetine, a combination of CBT and FLX, or pill placebo. Measures included the Children's Depression Rating Scale-Revised, the Suicidal Ideation Questionnaire-Grades 7-9, and the perfectionism subscale from the Dysfunctional Attitudes Scale (DAS). Predictor results indicate that adolescents with higher versus lower DAS perfectionism scores at baseline, regardless of treatment, continued to demonstrate elevated depression scores across the acute treatment period. In the case of suicidality, DAS perfectionism impeded improvement. Treatment outcomes were partially mediated by the change in DAS perfectionism across the 12-week period.

Behavior therapy for children with Tourette disorder: a randomized controlled trial

CONTEXT

Tourette disorder is a chronic and typically impairing childhood-onset neurologic condition. Antipsychotic medications, the first-line treatments for moderate to severe tics, are often associated with adverse effects. Behavioral interventions, although promising, have not been evaluated in large-scale controlled trials.

OBJECTIVE

To determine the efficacy of a comprehensive behavioral intervention for reducing tic severity in children and adolescents.

DESIGN, SETTING, AND PARTICIPANTS

Randomized, observer-blind, controlled trial of 126 children recruited from December 2004 through May 2007 and aged 9 through 17 years, with impairing Tourette or chronic tic disorder as a primary diagnosis, randomly assigned to 8 sessions during 10 weeks of behavior therapy (n = 61) or a control treatment consisting of supportive therapy and education (n = 65). Responders received 3 monthly booster treatment sessions and were reassessed at 3 and 6 months following treatment.

INTERVENTION

Comprehensive behavioral intervention.

MAIN OUTCOME MEASURES

Yale Global Tic Severity Scale (range 0-50, score >15 indicating clinically significant tics) and Clinical Global Impressions-Improvement Scale (range 1 [very much improved] to 8 [very much worse]).

RESULTS

Behavioral intervention led to a significantly greater decrease on the Yale Global Tic Severity Scale (24.7 [95% confidence interval {CI}, 23.1-26.3] to 17.1 [95% CI, 15.1-19.1]) from baseline to end point compared with the control treatment (24.6 [95% CI, 23.2-26.0] to 21.1 [95% CI, 19.2-23.0]) (P < .001; difference between groups, 4.1; 95% CI, 2.0-6.2) (effect size = 0.68). Significantly more children receiving behavioral intervention compared with those in the control group were rated as being very much improved or much improved on the Clinical Global Impressions-Improvement scale (52.5% vs 18.5%, respectively; P < .001; number needed to treat = 3). Attrition was low (12/126, or 9.5%); tic worsening was reported by 4% of children (5/126). Treatment gains were durable, with 87% of available responders to behavior therapy exhibiting continued benefit 6 months following treatment.

CONCLUSION

A comprehensive behavioral intervention, compared with supportive therapy and education, resulted in greater improvement in symptom severity among children with Tourette and chronic tic disorder.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00218777.

The effect of parental modeling of anxious behaviors and cognitions in school-aged children: an experimental pilot study

The current study tested: (1) the impact of parental modeling of anxious behaviors and cognitions on child anxiety level, anxious cognitions, desired avoidance, and objective performance using an experimental paradigm; and (2) whether the impact of parental modeling of anxious behaviors and cognitions differed by parent gender. Twenty-five parents (a random selection of 12 male and 13 female parents) participated with one of their children (ages 8-12 years; 56.0% male; 76.0% Caucasian). All children experienced two test conditions: an anxious condition in which their parent was trained to act anxiously before a planned spelling test and a non-anxious condition in which their parent was trained to act in a relaxed and confident manner before a planned spelling test. Results showed that, regardless of parent gender, children endorsed higher anxiety levels, anxious cognitions, and desired avoidance of the spelling test in the anxious relative to the non-anxious condition. Parental modeling of anxiety did not affect child spelling performance. Significant interaction effects indicated that fathers had a stronger impact on child anxiety level and cognitions than did mothers. Results highlight the importance of parental modeling and the potential role of both mothers and fathers in prevention and treatment for child anxiety.

Parent psychopathology and youth internalizing symptoms in an urban community: a latent growth model analysis

The present study examined the developmental trajectories of youth depression and anxiety symptoms from 6th through 12th grade in a low-income, urban sample (N = 141; mean age = 11.75 years; 88.7% African American). The study also tested the independent contribution of parent mood disorders, anxiety disorders, and substance use disorders assessed in early childhood to initial levels and rate of change in depression and anxiety symptoms from 6th through 12th grade. Possible gender differences in symptom course and strength of parent psychopathology predictors were examined using multiple-group analysis. Results indicated that depression symptoms declined over time for males, whereas depression symptoms initially declined, but then increased for females. In contrast, male and female adolescents each showed a decline in anxiety symptoms throughout adolescence. Findings also indicated that parent mood disorders were the only predictor of youth depression and anxiety symptoms for male and female adolescents in 6th grade. Parent anxiety disorders uniquely predicted the rate of change in depression symptoms among male adolescents. These results underscore the importance of targeting parents with mood and anxiety disorders in urban families in order to reduce the risk for internalizing difficulties in their adolescent youth.

Child/Adolescent Anxiety Multimodal Study (CAMS): rationale, design, and methods

OBJECTIVE

To present the design, methods, and rationale of the Child/Adolescent Anxiety Multimodal Study (CAMS), a recently completed federally-funded, multi-site, randomized placebo-controlled trial that examined the relative efficacy of cognitive-behavior therapy (CBT), sertraline (SRT), and their combination (COMB) against pill placebo (PBO) for the treatment of separation anxiety disorder (SAD), generalized anxiety disorder (GAD) and social phobia (SoP) in children and adolescents.

METHODS

Following a brief review of the acute outcomes of the CAMS trial, as well as the psychosocial and pharmacologic treatment literature for pediatric anxiety disorders, the design and methods of the CAMS trial are described.

RESULTS

CAMS was a six-year, six-site, randomized controlled trial. Four hundred eighty-eight (N = 488) children and adolescents (ages 7-17 years) with DSM-IV-TR diagnoses of SAD, GAD, or SoP were randomly assigned to one of four treatment conditions: CBT, SRT, COMB, or PBO. Assessments of anxiety symptoms, safety, and functional outcomes, as well as putative mediators and moderators of treatment response were completed in a multi-measure, multi-informant fashion. Manual-based therapies, trained clinicians and independent evaluators were used to ensure treatment and assessment fidelity. A multi-layered administrative structure with representation from all sites facilitated cross-site coordination of the entire trial, study protocols and quality assurance.

CONCLUSIONS

CAMS offers a model for clinical trials methods applicable to psychosocial and psychopharmacological comparative treatment trials by using state-of-the-art methods and rigorous cross-site quality controls. CAMS also provided a large-scale examination of the relative and combined efficacy and safety of the best evidenced-based psychosocial (CBT) and pharmacologic (SSRI) treatments to date for the most commonly occurring pediatric anxiety disorders. Primary and secondary results of CAMS will hold important implications for informing practice-relevant decisions regarding the initial treatment of youth with anxiety disorders.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00052078.

An exploratory analysis of the impact of family functioning on treatment for depression in adolescents

This article explores aspects of family environment and parent-child conflict that may predict or moderate response to acute treatments among depressed adolescents (N = 439) randomly assigned to fluoxetine, cognitive behavioral therapy, their combination, or placebo. Outcomes were Week 12 scores on measures of depression and global impairment. Of 20 candidate variables, one predictor emerged: Across treatments, adolescents with mothers who reported less parent-child conflict were more likely to benefit than their counterparts. When family functioning moderated outcome, adolescents who endorsed more negative environments were more likely to benefit from fluoxetine. Similarly, when moderating effects were seen on cognitive behavioral therapy conditions, they were in the direction of being less effective among teens reporting poorer family environments.

The Child Anxiety Prevention Study: intervention model and primary outcomes

The article presents the intervention model and primary outcomes of a preventive intervention designed to reduce anxiety symptoms and prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders. Participants were 40 volunteer children (mean age = 8.94 years; 45% girls; 90% Caucasian) whose parents met criteria for a broad range of anxiety disorders. Families were randomly assigned to an 8-week cognitive-behavioral intervention, the Coping and Promoting Strength program (CAPS; n = 20) or a wait list control condition (WL; n = 20). Independent evaluators (IEs) conducted diagnostic interviews, and children and parents completed measures of anxiety symptoms. Assessments were conducted pre- and postintervention and 6 and 12 months after the postintervention assessment. On the basis of intent to treat analyses, 30% of the children in the WL group developed an anxiety disorder by the 1-year follow-up compared with 0% in the CAPS group. IE and parent-reported (but not child-reported) levels of anxiety showed significant decreases from the preintervention assessment to the 1-year follow-up assessment in the CAPS but not the WL group. Parental satisfaction with the intervention was high. Findings suggest that a family-based intervention may prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders.

Factor structure and psychometric properties of the Multidimensional Anxiety Scale for Children in an African American adolescent sample

The current study examined the psychometric properties and factor structure of the Multidimensional Anxiety Scale for Children (MASC) among a community sample of 118 African American students (58 females; ages 14-19 years; mean age = 15.79) in an urban, parochial high school. Adolescents completed the MASC and several other self-report measures of anxiety, perceived competence, and symptoms of ADHD. The original MASC total and subscale mean scores were comparable to data reported in previous studies utilizing community samples of youth, though measures of internal consistency were lower. Factor analytic results supported a three factor solution (i.e., social anxiety, physical symptoms, harm avoidance) which accounted for 23.84% of the variance. While there was overlap in the underlying structure of anxiety between the original MASC publication and the current sample, items reflecting separation anxiety did not emerge as a separate factor. As expected, the MASC total score was positively correlated with measures of anxiety and perceived competence but unrelated to measures of hyperactivity. This study represents an important first step toward establishing more comprehensive age, race, and gender norms for the MASC.

Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety

BACKGROUND

Anxiety disorders are common psychiatric conditions affecting children and adolescents. Although cognitive behavioral therapy and selective serotonin-reuptake inhibitors have shown efficacy in treating these disorders, little is known about their relative or combined efficacy.

METHODS

In this randomized, controlled trial, we assigned 488 children between the ages of 7 and 17 years who had a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia to receive 14 sessions of cognitive behavioral therapy, sertraline (at a dose of up to 200 mg per day), a combination of sertraline and cognitive behavioral therapy, or a placebo drug for 12 weeks in a 2:2:2:1 ratio. We administered categorical and dimensional ratings of anxiety severity and impairment at baseline and at weeks 4, 8, and 12.

RESULTS

The percentages of children who were rated as very much or much improved on the Clinician Global Impression-Improvement scale were 80.7% for combination therapy (P<0.001), 59.7% for cognitive behavioral therapy (P<0.001), and 54.9% for sertraline (P<0.001); all therapies were superior to placebo (23.7%). Combination therapy was superior to both monotherapies (P<0.001). Results on the Pediatric Anxiety Rating Scale documented a similar magnitude and pattern of response; combination therapy had a greater response than cognitive behavioral therapy, which was equivalent to sertraline, and all therapies were superior to placebo. Adverse events, including suicidal and homicidal ideation, were no more frequent in the sertraline group than in the placebo group. No child attempted suicide. There was less insomnia, fatigue, sedation, and restlessness associated with cognitive behavioral therapy than with sertraline.

CONCLUSIONS

Both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety disorders; a combination of the two therapies had a superior response rate. (ClinicalTrials.gov number, NCT00052078.)

Depressive symptoms among reservation-based pregnant American Indian adolescents

OBJECTIVES

To examine rates and correlates of depressive symptoms among pregnant reservation-based American Indian (AI) adolescents from the Southwestern United States (N = 53).

METHODS

Data were derived from a study evaluating a home-visiting program designed to promote positive parenting among young families. Participants included a volunteer, convenience sample of expectant mothers who completed behavioral and mental health self-report questionnaires. Depressive symptoms were assessed using the Center for Epidemiological Studies-Depression scale (CES-D). Three risk domains were analyzed in relation to depressive symptoms: sociodemographics, family relations, and psychosocial functioning.

RESULTS

Forty-seven percent of expectant mothers scored at or above the widely accepted clinical cutoff score of 16 on the CES-D; 30% scored at or above 20, a score more likely to reflect elevated depressive symptoms among adolescents; and almost 20% scored at or above 28 (one standard deviation above the mean), a score suggestive of clinical depression. Higher levels of depressive symptoms were associated with less use of public assistance, external locus of control, less social support, and lower self-esteem.

CONCLUSIONS

Data suggest that a large proportion of pregnant AI adolescents reported elevated depressive symptoms, though rates are similar to non-pregnant AI adolescent samples.

Combining and sequencing medication and cognitive-behaviour therapy for childhood anxiety disorders

Despite the absence of data on the efficacy of combination therapy (i.e., psychosocial and medication) for the treatment of anxiety disorders in youths, clinicians in clinical practice often utilize this treatment approach. This paper discusses issues related to sequencing, combining, and integrating cognitive behavioural and pharmacological interventions for anxiety disorders in children and adolescents. We briefly summarize the empirical evidence for mono and combination therapy and raise a variety of issues that should be considered when making treatment decisions. Finally, we present an integrated treatment model to facilitate the delivery of a comprehensive treatment approach across care providers. These suggestions are geared toward optimizing clinical outcomes for anxious youths.

Prevention of anxiety disorders

Anxiety disorders are very common and burdensome conditions with early onsets. Thus, there has recently been increasing interest in preventing these illnesses. In this article we review recent prevention studies targeting populations at varying levels of risk and conclude that prevention using cognitive-behavioural interventions is promising, though establishing longer-term effects and the cost-effectiveness of such interventions are important next steps for the field. We discuss conceptual and practical issues with regard to prevention of anxiety disorders and note that theory-based models of prevention which are based on identified risk and protective factors, address the optimal timing of intervention delivery, and articulate specific mechanisms of action are greatly needed.

Sleep-related problems among children and adolescents with anxiety disorders

OBJECTIVE

The present study examined sleep-related problems (SRPs) among a large sample (n = 128) of youth with anxiety disorders (i.e., generalized, separation, and social). The frequency of eight specific SRPs was examined in relation to age, gender, type of anxiety disorder, anxiety severity, and functional impairment. The impact of pharmacological treatment (fluvoxamine versus pill placebo) in reducing SRPs also was examined.

METHOD

As part of a large, double-blind, randomized, controlled trial (Research Units on Pediatric Psychopharmacology Anxiety Study Group), clinician and parent reports of SRPs were examined among children and adolescents, ages 6 to 17 years, before and after treatment.

RESULTS

Eighty-eight percent of youth experienced at least one SRP, and a majority (55%) experienced three or more. Total SRPs were positively associated with anxiety severity and interference in family functioning. Significantly greater reductions in SRPs were found among children treated with fluvoxamine compared with placebo.

CONCLUSIONS

These findings indicate that SRPs are commonly associated with childhood anxiety disorders and suggest a need for the assessment of and attention to these problems in research and clinical settings.

Psychosocial outcomes of anxious first graders: a seven-year follow-up

This study examined the concurrent and long-term psychosocial outcomes associated with anxiety symptoms among a community sample of predominately low-income African Americans (N=149; 72 females). We classified first graders as high or low anxious using child, parent, and teacher reports. Academic, social, and psychological outcomes were assessed in the first and eighth grades. Logistic regressions with concurrent data revealed that highly anxious children were significantly more likely to score lower on measures of academic achievement and peer acceptance, but higher on measures of depression and aggression compared to their low-anxious peers. Longitudinal analyses revealed that high-anxious first graders, compared to their low-anxious peers, scored significantly lower on measures of academic achievement, aggression, and peer acceptance; and higher on measures of anxiety and depression in the eighth grade. Importantly, outcomes varied depending on informant. Findings suggest that, similar to European American youth, early-onset anxious symptoms in African American children are associated with both concurrent and long-term academic, social, and psychological difficulties.