Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V

The Relations Among Anxiety, Movie-Watching, and in-Scanner Motion

Movie-watching fMRI has emerged as a theoretically viable platform for studying neurobiological substrates of affective states and emotional disorders such as pathological anxiety. However, using anxiety-inducing movie clips to probe relevant states impacted by psychopathology could risk exacerbating in-scanner movement, decreasing signal quality/quantity and thus statistical power. This could be especially problematic in target populations such as children who typically move more in the scanner. Consequently, we assessed: (1) the extent to which an anxiety-inducing movie clip altered in-scanner data quality (movement, censoring, and DVARS) in a pediatric sample with and without anxiety disorders (n = 78); and (2) investigated interactions between anxiety symptoms and movie-attenuated motion in a highly powered, transdiagnostic pediatric sample (n = 2058). Our results suggest anxiogenic movie-watching in fact reduces in-scanner movement compared to resting-state, increasing the quantity/quality of data. In one measure, pathological anxiety appeared to impact movie-attenuated motion, but the effect was small. Given potential boosts to data quality, future developmental neuroimaging studies of anxiety may benefit from the use of movie paradigms.

Moderating Effects of Age and Gender on the Relationship Between Pediatric Obsessive-Compulsive Symptoms and Parental Accommodation

Parental accommodation is a well-established anxiogenic parenting practice that is ubiquitous among parents of youth with obsessive-compulsive symptoms (OCS). Accommodation is associated with heightened symptom severity (i.e., high levels of accommodation reinforce and maintain OCS). The present study sought to evaluate whether child age and gender moderated the relationship between parental accommodation and symptom severity. Participants included parents of children with a broad range of psychiatric disorders, as well as some youth with no psychiatric disorder (N = 61, children ages 7-17). Parents completed questionnaires related to their accommodation practices and their child's obsessive-compulsive symptoms. Age significantly moderated the relationship between accommodation and symptom severity, such that the relationship was stronger among older children. Gender significantly moderated the relationship between accommodation and symptom severity, such that the relationship was stronger among boys. Additional research is needed to further delineate the impact of age and gender on parental accommodation and OCS.

EEG frontal alpha asymmetry mediates the association between maternal and child internalizing symptoms in childhood

BACKGROUND

Anxiety and depression are highly prevalent in youth and can cause significant distress and functional impairment. The presence of maternal anxiety and depression are well-established risk factors for child internalizing psychopathology, yet the responsible mechanisms linking the two remain unclear.

METHODS

We examined the potential mediating and moderating roles of EEG frontal alpha asymmetry (FAA) in the intergenerational transmission of internalizing symptoms in a longitudinal sample of N = 323 mother-child dyads. Self-report maternal internalizing symptoms were evaluated at child age 3 years and 5 years, child EEG at 5 years, and parent-report child internalizing symptoms at age 7 years. Mediation was evaluated via bootstrapped (N = 5,000) confidence intervals.

RESULTS

We found significant associations among maternal internalizing (anxiety, depressive) symptoms when their children were ages 3 and 5 years, child FAA at age 5 years, and child internalizing symptoms at age 7 years. There was a significant mediation effect, whereby greater maternal anxiety and depressive symptoms at age 3 years were significantly associated with FAA (greater relative right cortical activation) in children at age 5 years, which, in turn, was significantly associated with greater child internalizing symptoms at age 7 years (ps < .001). There was no moderating effect of FAA on the association between maternal internalizing symptoms at age 5 years and child internalizing symptoms at age 7 years.

CONCLUSIONS

Greater right frontal asymmetry may be a neurophysiological mechanism that mediates the intergenerational transmission of internalizing symptoms.

Anxiety Disorders Are Associated With Greater Tic Severity in Youth With Chronic Tic Disorder

BACKGROUND

Anxiety disorders are common in and may affect the severity of chronic tic disorder (CTD). We assessed anxiety phenotype in youth with CTD and evaluated for relationships among anxiety, tics, and related symptoms.

METHODS

Participants ages 6-17 years with a diagnosis of CTD were enrolled from clinic into a cross-sectional study. Participants and one parent were interviewed by a psychology study team member and a neurology study team member at separate visits. Anxiety disorder presence was determined by the Anxiety Disorders Interview Schedule Child/Parent Version (ADIS-IV). Anxiety symptom severity and specific anxiety symptom types were determined by the Pediatric Anxiety Rating Scale. Tic and premonitory urge severities were determined by clinician-administered instruments.

RESULTS

We enrolled 42 participants with CTD. Most participants had at least one anxiety disorder based on the ADIS-IV (n = 33, 79%). Generalized anxiety disorder was the most common anxiety diagnosis (n = 26, 62%). However, specific anxiety symptoms were often not isolated to specific diagnostic domains. Clinically significant anxiety as measured by the Pediatric Anxiety Rating Scale was present in most participants (n = 25, 60%). Presence of an anxiety disorder was associated with worse severity of tics (z = -3.58, p = 0.0003) and premonitory urge (z = 2.17, p = 0.03).

CONCLUSIONS

Assessing anxiety dimensionally rather than categorically is important. Worse anxiety severity is associated with worse severity of tics and premonitory urge. Understanding how anxiety impacts tics and urge in CTD may provide important insights into factors perpetuating tics and guide the approach managing symptoms in anxious youth with CTD.

Nucleus reuniens: Modulating emotional overgeneralization in peri-adolescents with anxiety

BACKGROUND

Anxiety affects 4.4-million children in the USA with an onset between childhood and adolescence, a period marked by neural changes that impact emotions and memory. Negative overgeneralization - or responding similarly to innocuous events that share features with past aversive experiences - is common in anxiety but remains mechanistically underspecified. The nucleus reuniens (RE) has been considered a crucial candidate in the modulation of memory specificity. Our study investigated its activation and functional connectivity with the medial prefrontal cortex (mPFC) and hippocampus (HPC) as neurobiological mechanisms of negative overgeneralization in anxious youth.

METHODS

As part of a secondary data analysis, we examined data from 34 participants between 9 and 14 years of age (mean age ± SD, 11.4 ± 2.0 years; 16 females) with varying degrees of anxiety severity. During the Study session participants rated images as negative, neutral, and positive. After 12 h, participants returned for a Test session, where they performed a memory recognition test with repeated (targets) and similar (lures) images. Labeling negative relative to neutral lures as "old" (false alarms) was our operational definition of negative overgeneralization.

RESULTS

Negative relative to neutral false alarmed stimuli displayed elevated RE activation (at Study and Test) and increased functional connectivity with the Cornu Ammonis (CA) 1 (at Test). Elevated anxiety severity was associated with reductions in the RE-mPFC functional coupling for neutral relative to negative stimuli. Exploratory analyses revealed similar patterns in activation and functional connectivity with positive stimuli.

CONCLUSIONS

Our findings demonstrate the importance of the RE in negative overgeneralization and anxiety.

Startle potentiation to unpredictable threat predicts adolescent development of generalized anxiety disorder

BACKGROUND

An elevated startle reflex in anticipation of unpredictable threat has been associated with concurrent anxiety disorders. However, only one study to date has examined whether startle potentiation in anticipation of unpredictable threat predicts the development of anxiety disorders.

METHOD

In a community sample of 309 adolescents, we examined whether the startle reflex in anticipation of predictable or unpredictable threat at age 15 predicted onset of generalized anxiety disorder (GAD) and social anxiety disorder (SAD) at age 18. To evaluate the specificity of these relationships, we also examined the development of depressive disorders. Startle reflex was measured using the no, predictable, and unpredictable threat task at age 15. Semi-structured diagnostic interviews were administered at both waves to assess lifetime anxiety disorders and depression.

RESULTS

Average startle reflex and startle potentiation to unpredictable, but not predictable, threat at age 15 predicted GAD at age 18, independent of lifetime GAD through age 15 and lifetime depression through age 18. Startle responses at age 15 did not predict SAD or depression at age 18.

CONCLUSIONS

The present study suggests that elevated startle potentiation in anticipation of unpredictable threat is a risk factor for the development of GAD in adolescence.

Preoperative anxiety and its impact on surgical outcomes: A systematic review and meta-analysis

Background

Preoperative anxiety is a common phenomenon affecting 60-80% of surgical patients, with potential implications for surgical outcomes. Despite its prevalence, there remains a lack of consensus on its precise effects and optimal management strategies.

Objective

This meta-analysis aimed to synthesize current evidence on the impact of preoperative anxiety on various surgical outcomes, including anesthetic and analgesic requirements, delirium, recovery times, and pain.

Methods

We conducted a comprehensive literature search and meta-analysis of studies examining the relationship between preoperative anxiety and surgical outcomes. Standardized mean differences (SMD), correlation (COR), and odds ratios (OR) with 95% confidence intervals were calculated.

Results

Our analysis revealed significant associations between preoperative anxiety and increased anesthetic requirements (SMD = 0.67, 95% CI: 0.32-1.01) and analgesic requirements (SMD = 0.89, 95% CI: 0.65-1.12). Preoperative anxiety was associated with postoperative delirium in adults (OR = 1.90, 95% CI: 1.11-3.26), unlike the pediatric population. Preoperative anxiety was associated with prolonged time to reach Modified Aldrete Score of 9 (SMD = 0.79, 95% CI: 0.50-1.07) and extubation time (SMD = 0.89, 95% CI: 0.58-1.21). Preoperative anxiety was positively correlated with propofol consumption (STAI-S COR = 0.35, 95%CI: 0.15-0.55). No significant association between preoperative anxiety and postoperative pain was found.

Conclusions

This meta-analysis provides evidence for the wide-ranging effects of preoperative anxiety on surgical outcomes. The findings emphasize the need for routine preoperative anxiety screening and the development of targeted interventions. Future research should focus on long-term impacts and the effectiveness of various anxiety management strategies.

Risk Factors and Clinical Predictors of Suicidal Behaviors and Non-Suicidal Self-Injury Among Pediatric Psychiatry Emergency Admissions Pre- and Post-Pandemic: A Retrospective Cohort Study

BACKGROUND

Suicidal behavior (SB) and non-suicidal self-injury (NSSI) are significant public health concerns among adolescents. The COVID-19 pandemic may have exacerbated these issues.

METHODS

This retrospective cohort study analyzed data from 341 adolescents (aged 6-18 years) presenting to a Romanian pediatric psychiatry emergency department during the years 2019 (pre-pandemic) and 2022 (post-pandemic). All participants underwent a thorough psychiatric assessment, and, together with their caregivers, were questioned on a wide range of potentially relevant issues, such as family, social, school, and life history factors. Logistic regression and random forest models were used to identify predictors of SB and NSSI.

RESULTS

SB was significantly predicted in regression models based on a prior suicidal ideation (OR = 68.410; p < 0.001), having a parent living abroad (OR = 11.438; p = 0.020), depression (OR = 6.803; p < 0.001), and conflicts with peers (OR = 0.325, p = 0.042), teachers (OR = 0.119, p = 0.024), or both (OR = 0.166, p = 0.012). The random forest model featured a slightly different order of the main predictors and highlighted the importance of additional predictors, such as prior suicide attempts, gender, and past non-suicidal self-injury. NSSI was mainly predicted by a history of self-harm (OR = 52.437; p < 0.001), the number of comorbid psychiatric disorders (OR = 1.709; p = 0.003), and conduct disorder (OR = 0.184; p < 0.001), to which are added, according to random forest models, new predictors, such as borderline personality disorder, suicidal ideation, and school performance. Post-pandemic increases were observed in depression, suicidal ideation, and possible psycho-traumatic negative life event exposure.

CONCLUSIONS

This study underscores the complex interplay of individual, familial, and societal factors influencing adolescent self-harm. Comprehensive interventions are needed, with early intervention crucial for those with a history of self-harm. Further research using prospective designs is recommended.

Maternal Social Phobia, but not Generalized Anxiety, Symptoms Interact with Early Childhood Error-Related Negativity to Prospectively Predict Child Anxiety Symptoms

The error-related negativity (ERN) has been called a putative neural marker of anxiety risk in children, with smaller ERN amplitudes denoting greater risk in early childhood. Children of anxious mothers are at elevated risk for anxiety problems compared to children of non-anxious mothers. Still unknown is whether discrete maternal symptoms interact with child ERN to predict different forms of child anxiety risk, knowledge of which could increase our understanding of the specificity of known conditions and pathways for transgenerational effects. Targeting two of the most prevalent forms of anxiety problems across children and adults, we tested whether maternal generalized anxiety disorder (GAD) and social phobia (SP) symptoms when children were 3 years old interacted with child ERN at age 4 years to predict child symptoms of overanxiousness and separation anxiety at age 5 years. We found that greater maternal SP, but not GAD, symptoms along with smaller (i.e., less negative) child ERN predicted more separation anxiety and overanxious symptoms in children, suggesting some specificity in prediction but less specificity in outcomes regarding the transmission of anxiety risk from mothers to offspring.

When talking goes awry: association between co-rumination and trait anxiety, test anxiety, and anxiety sensitivity in early and late adolescents

BACKGROUND AND OBJECTIVES

Friends are major sources of social support for adolescents. This support may sometimes lead to co-rumination when the problem is discussed exhaustively with a focus on negative feelings. Co-rumination has been associated with some forms of anxiety, including clinical symptoms. Further studies are needed to investigate whether this association extends to additional and non-clinical forms of anxiety in youth. This study aimed to explore the relationship between co-rumination and trait anxiety, test anxiety, and anxiety sensitivity using secondary data.

DESIGN AND METHODS

In this 2019 cross-sectional study, 1204 (59% girls) Canadian 6th-grade early adolescents (ages 11-12) and 11th-grade late adolescents (ages 16-17) completed self-report questionnaires measuring co-rumination, trait anxiety, test anxiety, and anxiety sensitivity.

RESULTS

Co-rumination was associated with anxiety sensitivity in early adolescents and with trait anxiety, test anxiety, and anxiety sensitivity in late adolescents.

CONCLUSIONS

Developmental factors may play a role in the association between co-rumination and different forms of anxiety. Anxiety sensitivity may appear alongside co-rumination in early adolescence and may broaden to trait and test anxiety in late adolescence. These results extend our understanding of the relationship between co-rumination and anxiety, as well as generate hypotheses for future longitudinal studies.

Exogenous estradiol impacts anxiety-like behavior of juvenile male and female Siberian hamsters in a dose-dependent manner

Anxiety is among the most prevalent mental health issues in children. While it is well established that gonadal steroids influence anxiety-like behavior in adulthood, a potential role in prepubertal juveniles has been overlooked because it is commonly thought that the gonads are quiescent during the juvenile period. However, the juvenile gonads secrete measurable amounts of steroids, and we have recently found that prepubertal ovariectomy decreases anxiety-like behavior of juvenile Siberian hamsters in the light/dark box test. The present study tested whether an injection of estradiol benzoate (1 μg or 10 μg, SC) to gonadectomized hamsters (Exp. 1) or chronic suppression of endogenous estradiol with the aromatase inhibitor, letrozole (2 mg/kg, PO), to intact hamsters (Exp. 2) affects anxiety-like behavior in the light/dark box test during the juvenile phase. Estradiol benzoate altered anxiety-like behavior of both male and female juveniles in a dose-dependent manner, with anxiolytic actions at the low dose, but no effect at the high dose. Similar effects were seen for activity measures, albeit only in females. Letrozole suppressed uterine weights demonstrating an active role for endogenous estradiol during the juvenile phase. Anxiety-like behavior, however, was impacted by the administration procedure itself, preventing conclusions on letrozole's actions on behavior. While the role for endogenous estradiol in juvenile anxiety-like behavior remains unresolved, the present findings indicate that the neural centers regulating affective behavior are responsive to exogenous estradiol prior to puberty. These findings highlight the potential impact of exogenous estrogen exposures on juvenile affective behavior.

The Influence of Temperament, Theory of Mind, Inhibitory Control, and Prosocial Behavior on Child Anxiety Symptoms in the First Five Years of Life

Anxiety disorders are among the most prevalent of all mental health disorders, often originating in early childhood and extending into later childhood, adolescence, and adulthood. Determining salient risk factors that precede their development is important for prevention and intervention efforts. Towards this end, we examined the role of temperament, theory of mind, inhibitory control, and prosocial behavior on child anxiety symptoms in the first 5 years of life. A community sample of children and their parents (N = 399) enrolled in a longitudinal study of emotion processing were assessed when the children were infants and at ages 2 years, 3 years, and 5 years. Linear mixed models and linear regression models revealed that greater anxiety at 5 years was associated with greater negative affectivity and behavioral inhibition, lower effortful control, lower theory of mind scores on the "desires" domain, and higher scores on the "intentions" domain (assessed from infancy to 3 years of age). These characteristics may be useful to assess in clinical settings to evaluate a patient's risk for developing anxiety. They may also be useful in developing interventions targeting specific vulnerabilities.

Exploring mismatch negativity in children with congenital Microtia-Atresia: A Preliminary study

BACKGROUND

To investigate the characteristics of mismatch negativity (MMN) in terms of latency and amplitude in children with bilateral congenital microtia using a Bone conduction implant (Bonebridge), and to explore the relationship between cortical level auditory discrimination, speech perception, and psychosocial well-being.

METHODS

This descriptive, observational, cross-sectional study compared three groups: eight children with bilateral congenital microtia and Bonebridge implants (bilateral group), eight children with unilateral congenital microtia and no hearing aids (unilateral group), and eight children with normal hearing (NH group). Participants underwent MMN evaluation using a classic oddball paradigm with a pure tone burst stimulus, featuring a 1000 Hz standard stimulus and a 1200 Hz deviant stimulus, presented in a sound field at 65 dBHL. Additionally, speech perception tests, the Meaningful Use of Speech Scale (MUSS), and psychosocial status questionnaires, including the Social Anxiety Scale for Children (SASC) and the Children's Loneliness Scale (CLS), were administered to all subjects.

RESULTS

The bilateral group's average MMN latency was 241.23 ± 29.47 ms, and the unilateral group's was 209.96 ± 54.32 ms, both significantly longer than the NH group's 146.05 ± 15.73 ms (p < 0.0001, F=3.509, 95 % CI 68.09 to 122.3 and p = 0.0097, F=11.92, 95 % CI 18.07 to 109.8, respectively). However, no significant difference was found in MMN latency between the bilateral and unilateral groups (p = 0.202, F=3.397, 95 % CI -18.84 to 81.36). The unilateral group scored significantly higher on the MUSS (38.63 ± 1.41 vs. 30.75 ± 3.80, p = 0.0001, F=7.276, 95 % CI -11.16 to -4.590), had lower CLS scores (47.13 ± 8.13 vs. 58.25 ± 8.39, p = 0.024, F=1.065, 95 % CI 1.652 to 20.60), and lower SASC scores (4.13 ± 2.09 vs. 6.50 ± 2.25, p = 0.062, F=1.204, 95 % CI -0.138 to 4.89) compared to the bilateral group. MMN latency in the bilateral group correlated with SASC scores.

CONCLUSION

The MMN latency in congenital microtia patients may serve as an indicator of central auditory discrimination capabilities. In children with bilateral congenital microtia and Bonebridge implants, MMN latency can reflect social anxiety conditions to a certain degree.

An Exploratory Analysis of Child Characteristics Predicting Clinical Outcomes in Parent-Led Cognitive Behavioral Teletherapy for Anxiety in Autistic Children

Parent-led cognitive behavioral therapy (CBT) is an efficient, promising form of therapy that may be well suited for autistic youth with anxiety disorders. A recent clinical trial found that parent-led CBT - in which parents led their child through a guided CBT workbook with varying degrees of therapist support - was efficacious for reducing anxiety and associated functional impairment. While such findings demonstrate promise for future intervention development and dissemination efforts with this population, more work is needed to elucidate clinical factors that impact response to treatment as well as drop-out. Using data from the aforementioned clinical trial (N = 87), the present exploratory study examined pre-treatment patient characteristics, including family accommodation (FA), anxiety severity, autism features, and externalizing psychopathology, and their relationship with relevant treatment outcomes (i.e., anxiety severity and functional impairment) at both post-treatment and three-month follow-up and drop-out/completer status. Our findings did not reveal any consistent relations between pre-treatment patient characteristics and clinical outcomes, with several isolated exceptions: (a) baseline autism features were associated with greater post-treatment functional impairment; (b) non-male (vs. male) gender was associated with greater functional impairment at 3-month follow-up; and (c) Hispanic ethnicity (vs. non-Hispanic) was associated with greater likelihood of premature treatment drop-out. Findings are discussed in the context of the importance of continuing to elucidate unique patient characteristics predictive of optimal clinical outcomes for autistic youth with anxiety disorders.

Temporal trends and social inequities in adolescent and young adult mental health disorders in Catalonia, Spain: a 2008-2022 primary care cohort study

BACKGROUND

The prevalence of mental health disorders in children, teens, and young adults is rising at an alarming rate. This study aims to explore time trends in the incidence of mental disorders among young people in Catalonia, Spain from 2008 to 2022, focusing on the effects of the COVID-19 pandemic and from the perspective of social inequities.

METHODS

A cohort study using primary care records from the SIDIAP database was conducted. It included 2,088,641 individuals aged 10 to 24 years. We examined the incidence of depressive, anxiety, eating, and attention deficit/hyperactivity disorders, stratified by sex, age, deprivation, and nationality.

RESULTS

All disorders reflected an increasing trend throughout the study period: depressive disorders (IRR: 2.44, 95% CI: 2.31-2.59), anxiety disorders (IRR: 2.33, 95% CI: 2.27-2.39), ADHD (IRR: 2.33, 95%CI: 2.17-2.50), and eating disorders (IRR: 3.29, 95% CI: 3.01-3.59). A significant increase in incidence was observed after the outbreak of the COVID-19 pandemic. In 2022, anxiety disorders were most frequent, with an incidence rate (IR) of 2,537 per 100,000 persons-year (95% CI: 2,503-2,571). Depressive disorders followed with an IR of 471 (95% CI: 458-486), ADHD with an IR of 306 (95% CI: 295-317) and eating disorders with an IR of 249 (95% CI: 239-259). Significant associations were reported with sex, age, deprivation, and nationality.

CONCLUSION

The incidence of all studied disorders has steadily increased, reaching unprecedented levels during the pandemic. Understanding these trends is essential for an appropriate healthcare response, while addressing the non-medical determinants, requires action across all sectors of society.

Prevalence and risk of subthreshold anxiety developing into threshold anxiety disorder in the general population

BACKGROUND

Subthreshold anxiety may act as a critical precursor and risk factor for the onset of threshold anxiety. However, accurate prevalence rates of subthreshold anxiety and its role in leading to threshold anxiety require further elucidation.

METHODS

We conducted a search on PubMed and Web of Science using predefined criteria and identified 45 articles with a total of 278,971 individuals to estimate the prevalence rates using a random effects model. The incidence risk ratio (IRR) was estimated by comparing the proportion of individuals with subthreshold anxiety who developed threshold anxiety to those without subthreshold anxiety in seven articles involving 18,693 individuals.

RESULTS

Our analysis revealed an overall prevalence of subthreshold anxiety of 6.19%. Specifically, among individuals with subthreshold generalized anxiety disorders, adolescents show the highest prevalence (9.47%), outpacing adults (4.69%) and the elderly (3.49%). Further analysis of seven studies showed an increased risk of developing threshold anxiety in individuals with subthreshold anxiety (IRR = 2.63), with a higher transition rate (9.59%) compared to those without subthreshold anxiety (3.65%).

CONCLUSIONS

Anxiety disorders may be conceptualized as a spectrum, with subthreshold anxiety serving as a significant prodromal state and risk factor for the development of threshold anxiety. Proactive management of subthreshold anxiety represents an effective approach for the prevention of its progression to threshold anxiety. Future research should investigate the risk of progression from subthreshold to threshold anxiety across various types, and explore how factors, such as social support and personality traits facilitate this progression.

Pre-pandemic Executive Function Protects Against Pandemic Anxiety in Children with and Without Autism Spectrum Disorder

The COVID-19 pandemic may have exacerbated depression, anxiety, and executive function (EF) difficulties in children with autism spectrum disorder (ASD). EF skills have been positively associated with mental health outcomes. Here, we probed the psychosocial impacts of pandemic responses in children with and without ASD by relating pre-pandemic EF assessments with anxiety and depression symptoms several months into the pandemic. We found that pre-pandemic inhibition and shifting difficulties, measured by the Behavior Rating Inventory of Executive Function, predicted higher risk of anxiety symptoms. These findings are critical for promoting community recovery and maximizing clinical preparedness to support children at increased risk for adverse psychosocial outcomes.

Emotional problems across development: examining measurement invariance across childhood, adolescence and early adulthood

Emotional problems (anxiety, depression) are prevalent in children, adolescents and young adults with varying ages at onset. Studying developmental changes in emotional problems requires repeated assessments using the same or equivalent measures. The parent-rated Strengths and Difficulties Questionnaire is commonly used to assess emotional problems in childhood and adolescence, but there is limited research about whether it captures a similar construct across these developmental periods. Our study addressed this by investigating measurement invariance in the scales' emotional problems subscale (SDQ-EP) across childhood, adolescence and early adulthood. Data from two UK population cohorts were utilised: the Millennium Cohort Study (ages 3-17 years) and the Avon Longitudinal Study of Parents and Children (4-25 years). In both samples we observed weak (metric) measurement invariance by age, suggesting that the parent-rated SDQ-EP items contribute to the underlying construct of emotional problems similarly across age. This supports the validity of using the subscale to rank participants on their levels of emotional problems in childhood, adolescence and early adulthood. However strong (scalar) measurement invariance was not observed, suggesting that the same score may correspond to different levels of emotional problems across developmental periods. Comparisons of mean parent-rated SDQ-EP scores across age may therefore not be valid.

Impaired Social Attention and Cognitive Empathy in a Paediatric Sample of Children with Symptoms of Anxiety

Impairments in social cognition, in particular empathy, have been associated with childhood psychopathology, though previous investigations have yielded inconsistent results. Measures of social attention can reveal processes involved in responses to emotional stimuli and highlight deficits in empathy, or emotional biases in those with anxiety. The current study examined symptoms of anxiety, cognitive and affective empathy scores, and eye-gaze patterns in a pediatric sample of children (n = 178; 51-98 months-old) referred by their teachers for emerging psychopathology symptoms at school. We used eye-tracking metrics to capture gaze patterns during a dynamic video task designed to elicit empathic responses. Anxiety symptomology was reported by parents using the Screen for Child Anxiety Related Disorders scale (SCARED). Associations between eye-tracking variables, cognitive and affective empathy, and anxiety scores were analysed dimensionally in accordance with the Research and Domain Criteria (RDoC) framework. Higher levels of anxiety were associated with lower cognitive empathy and shorter first and total fixation durations to the eyes, across emotions (happiness, sadness, fear). No such associations were found between affective empathy and anxiety. Hierarchical multiple regression analyses revealed that across emotion conditions, first fixation duration negatively predicted anxiety scores. Our results indicate that children high in anxiety display cognitive empathy impairments and shorter attention to the eyes. These findings could inform early intervention programs for individuals at risk of developing anxiety disorders, as educating those high in anxiety on ways to identify emotions in others through changes in social attention could help to reduce anxiety.

Intensive treatments for children and adolescents with anxiety or obsessive-compulsive disorders: A systematic review and meta-analysis

Anxiety and obsessive-compulsive disorders have a significant negative impact on youth. Cognitive behavioural therapy (CBT) is recommended and established as effective first-step treatment, but persistent symptoms and non-response are common. Intensive psychological treatments deliver more or longer sessions over a shorter time span, with fewer session gaps. However, an understanding of their effectiveness, characteristics, acceptability, and feasibility is lacking. Systematically searching five databases yielded four controlled and 36 uncontrolled studies (N=2707) involving youth with primary anxiety or obsessive-compulsive disorders, many of whom received prior treatments. Intensive treatments were acceptable and feasible, with low drop-out rates. Between-group analyses compared intensive treatment with standard treatment (k = 2) or waitlist (k = 2), revealing no significant post-treatment differences in symptom severity or remission. Uncontrolled within-group analyses of intensive treatments showed large improvements from pre- to post-treatment in symptoms (k = 47), remission (k = 17), impairment (k = 22), functioning (k = 5), and quality of life (k = 2), with larger effects at follow-ups. Intensive treatments show promise for youth with anxiety or obsessive-compulsive disorders by potentially offering high treatment completion rates and comparable outcomes to standard CBT, aiding earlier recovery and reducing overall suffering. This systematic review/meta-analysis provides a comprehensive overview of intensive treatments, their theoretical considerations, and empirical findings. Future RCTs should compare the effectiveness of standard and intensive treatments and identify optimal populations for their use.

Digital Media Use Preference Indirectly Relates to Adolescent Social Anxiety Symptoms Through Delta-Beta Coupling

Adolescence is a period of profound biological and social-emotional development during which social anxiety symptoms commonly emerge. Over the past several decades, the social world of teens has been transformed by pervasive digital media use (e.g., social media, messaging apps), highlighting the urgent need to examine links between digital media use and mental health. Prior work suggests that a preference to use digital media to communicate emotions, rather than face-to-face contexts, is associated with emotion regulation vulnerabilities. Difficulties with emotion regulation are a hallmark of elevated anxiety, and the maturation of frontal-subcortical circuitry underlying emotion regulation may make adolescents especially vulnerable to the possible detrimental effects of digital media use. The current study leveraged an emerging neurophysiological correlate of emotion regulation, delta-beta coupling, which captures cortical-subcortical coherence during resting state. We test links among digital media use preferences, delta-beta coupling, and anxiety symptoms with a sample of 80 adolescents (47 females; 33 males) ages 12-15 years (M = 13.9, SD = 0.6) (80% White, 2% Black/African American, 16% more than one race, 2% Hispanic/Latine). Youth had their EEG recorded during 6 min of resting-state baseline from which delta-beta coupling was generated. Youth self-reported their social anxiety symptoms and preferences for digital media use vs face-to-face modalities. Greater digital media use preferences for both positive and negative social-emotional communication were associated with elevated social anxiety symptoms indirectly through high delta-beta coupling. This suggests that neural regulatory imbalance may be a pathway through which adolescents' habitual preferences for digital media use over face-to-face communication relate to elevated social anxiety.

Effectiveness cognitive emotion regulation strategies to reduce social anxiety and improve social self-efficacy

BACKGROUND

This study aimed to investigate the effectiveness of a training program based on cognitive emotion regulation strategies to reduce social anxiety and improve social self-efficacy among Hashemite University students.

MATERIALS AND METHOD

The study sample comprised 57 students randomly divided into two groups: The experimental group consisted of 28 students, and the control group consisted of 29 students. The experimental group was exposed to the training program consisting of 18 sessions, while the control group did not receive any experimental treatment. The students in both experimental and control groups completed the social anxiety scale and social self-efficacy scales before and after the training program.

RESULTS

The study found differences in the mean score of the experimental group on the post-test of the social anxiety level in favor of the experimental group and in the mean score of the experimental group on the post-test of the social self-efficacy scale in favor of the experimental group.

CONCLUSION

The training program based on cognitive emotion regulation strategies is very effective in reducing the social anxiety and improving social self-efficacy.

A critical analysis of UK media characterisations of Long Covid in children and young people

Long Covid is the continuation or development of symptoms related to a SARSCoV2 infection. Those with Long Covid may face epistemic injustice, where they are unjustifiably viewed as unreliable evaluators of their own illness experiences. Media articles both reflect and influence perception and subsequently how people regard children and young people (CYP) with Long Covid, and may contribute to epistemic injustice. We aimed to explore how the UK media characterises Long Covid in CYP through examining three key actor groups: parents, healthcare professionals, and CYP with Long Covid, through the lens of epistemic injustice. A systematic search strategy resulted in the inclusion of 103 UK media articles. We used an adapted corpus-assisted Critical Discourse Analysis in tandem with thematic analysis. Specifically, we utilised search terms to locate concordances of key actor groups. In the corpus, parents highlighted minimisation of Long Covid, barriers to care, and experiences of personal attacks. Mothers were presented as also having Long Covid. Fathers were unmentioned. Healthcare professionals emphasised the rarity of Long Covid in CYP, avoided pathologising Long Covid, and overemphasised psychological components. CYP were rarely consulted in media articles but were presented as formerly very able. Manifestations of Long Covid in CYP were validated or invalidated in relation to adults. Media characterisations contributed to epistemic injustice. The disempowering portrayal of parents promotes stigma and barriers to care. Healthcare professionals' narratives often contributed to negative healthcare experiences and enacted testimonial injustice, where CYP and parents' credibility was diminished due to unfair identity prejudice, in their invalidation of Long Covid. Media characterisations reveal and maintain a lack of societal framework for understanding Long Covid in CYP. The findings of this study illustrate the discursive practices employed by journalists that contribute to experiences of epistemic injustice. Based on our findings, we propose recommendations for journalists.

A preliminary study of threat-anticipatory responding in Latina youth: associations with age, anxiety, and cortical thickness

Variation in prefrontal cortex neuroanatomy has been previously associated with elevated physiological responses to anticipated aversive events. The extent to which such associations extend beyond the specific ecology of treatment-seeking youth from upper-middle socioeconomic backgrounds is unknown. The current study tests the replicability of neuroanatomical correlates of anticipatory responding and the moderating roles of age and anxiety severity in a community sample of Latina girls, a historically underrepresented group exhibiting high levels of untreated anxiety. Forty pre-adolescent Latina girls (MAge = 10.01, s.d. = 1.25, range = 8-12 years) completed a structural magnetic resonance imaging scan. Participants also completed a differential threat and safety learning paradigm, during which skin conductance and subjective fear responding were assessed. Anxiety severity was assessed via the Screen for Child Anxiety Related Emotional Disorders. Ventromedial prefrontal cortex thickness was associated with reduced physiological responsivity to anticipated threat. Age- and anxiety-dependent associations emerged between dorsomedial prefrontal cortex thickness and individual differences in subjective fear responding to anticipated threat. This preliminary study extends work on neuroanatomical contributions to physiological threat responsivity to a community sample of Latina youth and highlights potential considerations for early identification efforts in this population when threat neurocircuitry is still developing.

Feasibility study of the e-learning version of the "Journey of the Brave:" a universal anxiety-prevention program based on cognitive behavioral therapy

BACKGROUND

School-based cognitive behavioral therapy (CBT) programs could contribute toward preventing anxiety disorders in children. However, setting aside class time for such programs is difficult. Internet-based CBT (I-CBT) is an efficient way to provide CBT. However, studies on I-CBT for anxiety prevention remain scarce, including I-CBT for school-based universal prevention programs. Therefore, we developed an e-learning version of a school-based anxiety-prevention CBT program, "Journey of the Brave," which was effective in Japan, to make it more flexible and accessible. This study evaluated its feasibility.

METHODS

We conducted a single-arm study based on 44 parents and children. Children aged 10-12 years took the e-learning program at home. Parents and children responded to a questionnaire three times: before the learning (Pre), after the learning (Post), and three months later (FU: Follow-up). Feasibility was comprehensively evaluated through dropout rates, satisfaction and learning records, and changes in scores on psychological scales assessing anxiety symptoms, emotion-regulation skills, and children's emotional and behavioral problems.

RESULTS

Of the 44 children, 42 started the e-learning, and 32 continued it (dropout rate of 23.8%). Furthermore, 83.9% of the children and 96.8% of the parents responded "agree" or "somewhat agree" regarding overall satisfaction. The parent-rated Spence Children's Anxiety Scale(SCAS) (SCAS-P) showed a significant decrease between Pre and FU (p = 0.014, 95% CI = (-9.22, -0.84)); however, the child-rated SCAS (SCAS-C) reduction was not significant (p = 0.08). The Emotion‑Regulation Skills Questionnaire (ERSQ) also increased significantly between Pre and FU (p = 0.045, 95% CI = (0.18, 18.31)). The Total Difficulties Score of the Strengths and Difficulties Questionnaire(SDQ) decreased significantly from Pre to Post (p = 0.025, 95% CI = (-3.62, -0.19)); however, it was not significantly different between Pre and FU (p = 0.67).

CONCLUSION

The e-learning version showed low dropout rates and high satisfaction ratings from parents and children. Moreover, this study did not rule out the possibility that the program reduced children's anxiety and improved their emotional-regulation skills. Therefore, its potential and feasibility were indicated.

TRIAL REGISTRATION

UMIN, UMIN000049182, Registered 11 October 2022.

Sex Differences in the Neurobiology of Fear and Anxiety

Although women are diagnosed with anxiety and stress-related disorders at twice the rate of men, there remains a lack of clarity around how to enhance treatment within each sex to reduce disparate rates of anxiety. However, in recent years, a growing literature has identified neural, cognitive, and physiological mechanisms that contribute to sex differences in fear and anxiety, with the promise of informing tailored treatment approaches. Here, we review recent findings, focusing on human studies among healthy populations as well as among patients with generalized anxiety, social anxiety disorder, post-traumatic stress disorder, and panic disorder. The literature reveals nuanced differences in the types of stimuli that preferentially evoke anxiety and stress responses in women and men, as well as sex differences in threat neurocircuitry that mediates the behavioral, physiological, and subjective components of fear and anxiety.

State of the Science: Disgust and the Anxiety Disorders

Anxiety disorders have long been conceptualized as disorders of fear, while other emotions have largely been overlooked. However, an emerging literature has increasingly implicated disgust in certain anxiety-related disorders, including obsessive-compulsive disorder, specific phobias (e.g., spider phobia), health anxiety, and posttraumatic stress disorder. Roughly two decades of research has accumulated evidence identifying various mechanisms linking disgust-related phenomena to these disorders. In the present "State of the Science" review, we sought to summarize the current state of the literature with respect to disgust-related mechanisms in anxiety disorders, including trait-level vulnerabilities (e.g., disgust proneness), cognitive processes (e.g., biases of attention and memory), and associated learning mechanisms (e.g., evaluative conditioning). Research in these areas has revealed important ways in which disgust differs from fear-related phenomena, which have important treatment implications. From there, we sought to summarize research on laboratory interventions that attempt to target and attenuate disgust, as well as the early research on formal cognitive-behavioral treatments that integrate disgust-related interventions for anxiety disorders. Although the past two decades of research have revealed important insights related to the role of disgust in psychopathology, much remains to be learned in this area. We propose some future directions, emphasizing the importance of a guiding framework that highlights studying disgust-related mechanisms across different levels of analysis.

Exploring Gamification and Serious Games for Mental Health: A Narrative Review

The development of serious video games using gamification techniques and applying them to the management of mental health problems has emerged as one of the significant innovations in technology and mental health. However, various issues exist from the design stage of video games to the implementation stage, which can lead to problems with usability and accessibility and have non-beneficial effects on the individual. This review article provides an overview of various gamification technologies currently used in video games and virtual reality-based video games. It discusses their strengths and limitations in managing common mental health problems like depression, anxiety, and stress, as well as their application in non-communicable diseases such as cancer, diabetes, and obesity, along with improving psychosocial well-being. This article highlights the technology currently available and the need to address the lacunae in effectively utilizing technological advancement in the development of serious video games using gamification strategies to manage mental health problems.

Overparenting and adolescent's trait anxiety: Unraveling the roles of basic psychological needs frustration and emotion dysregulation

Parental involvement is widely recognized for its beneficial impact on child development. However, helicopter parenting, as an excessive and developmentally inappropriate involvement, can lead to significant mental health challenges. While the general effects of overparenting on well-being have been well-documented, its specific underlying mechanisms are still underexplored. The present study aimed to examine the serial mediating roles of basic psychological needs (BPN) frustration and emotion dysregulation in the link between helicopter parenting and trait anxiety among 391 adolescents chosen via convenience sampling. The results of structural equation modeling revealed that helicopter parenting significantly predicted higher levels of trait anxiety (β=0.367, p < .01). Furthermore, the indirect effect of helicopter parenting on trait anxiety was statistically significant through the serial mediation of BPN frustration and emotion dysregulation (β=0.134, p < .01). In fact, over-controlling parenting can lead to frustration of adolescents' BPN and, in turn, restricted access to effective emotion regulation strategies, which may ultimately increase trait anxiety among adolescents. These findings underscore the critical need for balanced parental involvement to foster healthy psychological development of adolescents.

Promotive factors associated with reduced anxiety and depression across three years in a prospective clinical cohort of adolescents: Examining compensatory and protective models of resilience

The rates of anxiety and depression increase across adolescence, many experience recurrence after treatment, yet longitudinal studies examining promotive factors are scarce. We prospectively examined the role of the promotive factors structured style, personal and social competencies, family functioning, and social resources in homotypic and heterotypic continuity and discontinuity of anxiety and depression across three years in a clinical sample. Participants were adolescents with anxiety or depressive disorders aged 13-18 years at T1 (N = 717, 44% initial participation rate) and aged 16-21 years at T2 (N = 549, 80% follow-up participation rate). At T1, diagnoses were collected from medical records and participants responded to questionnaires. At T2, semi-structured diagnostic interviews were conducted. Higher levels of all promotive factors were associated with reduced probability of anxiety or depression three years later. The promotive factors were not associated with homotypic continuity of anxiety, whereas personal competence beliefs, social competence, and, less strongly, family functioning were associated with reduced homotypic continuity of depression and heterotypic continuity from depression to anxiety. Analyses with interaction terms did not indicate moderation by the promotive factors. Our findings suggest that bolstering promotive factors may be vital for increasing treatment success and preventing recurrence of anxiety and depression in the transition toward adulthood.

Time trends in anxiety disorders incidence across the BRICS: an age-period-cohort analysis for the GBD 2021

Background

Anxiety disorders are a significant global mental health concern, contributing to substantial disability-adjusted life years (DALYs) and imposing considerable social and economic burdens. Understanding the epidemiology of anxiety disorders within the BRICS nations (Brazil, Russian Federation, India, China, and South Africa) is essential due to their unique socio-economic landscapes and ongoing transformations.

Methods

This study utilized data from the Global Burden of Disease (GBD) 2021 database to evaluate anxiety disorder incidence trends in BRICS countries from 1992 to 2021. The Age-Period-Cohort (APC) model with an intrinsic estimator (IE) algorithm was employed to disentangle the effects of age, period, and cohort on incidence rates. Data were categorized into 5-year age groups, and 95% uncertainty intervals (UIs) were calculated to account for data variability.

Results

From 1992 to 2021, the global number of anxiety disorders cases increased by 73.44%, with age-standardized incidence rates rising by 21.17%. Among BRICS nations, India experienced the largest increase in cases (113.30%), while China had the smallest increase (2.79%). Globally, young (15-49 years) and oldest (80-94 years) age groups showed predominantly positive local drift values, indicating rising incidence rates. Brazil and India mirrored this trend, while China and South Africa mostly exhibited negative local drift values. Russia Federation had mixed trends with younger groups showing negative and older groups positive local drift values. The incidence of anxiety disorders exhibited an "M-shaped" age pattern with peaks at 10-14 and 35-39 years. Period effects were stable globally but varied in BRICS countries, with Brazil showing a decline and India an increase. Cohort effects were stable globally but showed increasing trends in Brazil and India post-1955-1959 cohort.

Conclusion

This study highlights a significant increase in anxiety disorders incidence globally and within BRICS nations over the past three decades, with marked variations across countries. The distinct trends observed in age, period, and cohort effects call for age-specific and gender-sensitive mental health policies. Continuous monitoring, research, and tailored public health strategies are essential to address the rising burden of anxiety disorders and improve mental health outcomes in these rapidly evolving regions.

Examining the Effectiveness of an Intensive Telemental Health Treatment for Pediatric Anxiety and OCD During the COVID-19 Pandemic and Pediatric Mental Health Crisis

Despite research supporting the efficacy of weekly outpatient videoconferencing-based cognitive behavioral therapy (VCBT), limited evidence exists about the benefits of leveraging VCBT for brief intensive formats. We examined the effectiveness of an intensive outpatient VCBT targeting pediatric anxiety and OCD. Quasi-experimental design was used to compare outcomes of intensive, in-person, group-based cognitive-behavioral therapy with medication management and caregiver guidance pre-pandemic, to a similar VCBT peri-pandemic (n = 130). Pretreatment and posttreatment assessments included patient- and caregiver-report of anxiety and functional impairment. Analyses of covariance were conducted, examining changes in anxiety and impairment between treatment groups, controlling for admission levels. No significant differences in posttreatment anxiety or impairment were observed between conditions. This study illustrates that intensive, group-based treatment for pediatric anxiety and OCD using VCBT is associated with comparable reductions in anxiety and impairment. It marks a crucial step toward providing broader access to quality care for youth in need.

Personalised transcranial magnetic stimulation for treatment-resistant depression, depression with comorbid anxiety and negative symptoms of schizophrenia: a narrative review

ABSTRACT

Transcranial magnetic stimulation (TMS) is a promising intervention for treatment-resistant psychiatric disorders. However, conventional TMS typically utilises a one-size-fits-all approach when determining stimulation targets. Recent retrospective brain circuit-based analyses using lesion network mapping have suggested that a left dorsal lateral prefrontal cortex target has a higher efficacy for alleviating depression symptoms, a dorsomedial prefrontal cortex target is more effective for anxiety symptoms, and a rostromedial prefrontal cortex target is effective for schizophrenia-associated psychiatric symptoms. Nonetheless, symptom-specific brain circuit targeting has not been tested prospectively. We conducted a narrative review of selected literature to investigate individualised targeting for TMS and discuss potential future directions to elucidate the efficacy of this approach.

Caregiver experienced racism, acculturative stress, and political hostility predict anxiety in Latinx families residing in the United States

OBJECTIVE

Cultural stress potently predicts mental health inequities, such as anxiety, among adult and adolescent immigrants in the United States. However, less work has focused on preadolescence, a period marked by neurodevelopmental and psychosocial changes that can exacerbate anxiety symptoms. Latina girls, who exhibit heightened levels of untreated anxiety, may be at elevated risk. The present study tests whether cultural stress predicts anxiety symptoms in Latina girls and their caregivers.

METHOD

The primary caregivers of 161 predominantly Mexican-identifying Latina girls (Mage = 10.70, SD = 1.68) reported their exposure to racism, acculturative stress, and political hostility. They also reported their own and their daughter's anxiety severity.

RESULTS

To index cultural stress, a principal component was extracted from composite scores of the racism, acculturative stress, and political hostility questionnaires. Hierarchical regression analyses then tested whether the multidetermined cultural stress component predicted caregiver and child anxiety, with child age, annual household income, and subjective socioeconomic status entered at the first step. Cultural stress positively predicted caregiver (ΔR² = .13, p < .001) and child (ΔR² = .15, p < .001) anxiety symptoms over and above the observed inverse effects of subjective socioeconomic status, such that higher levels of cultural stress were associated with elevated levels of caregiver (ß = .37, p < .001) and child (ß = .39, p < .001) anxiety symptoms.

CONCLUSIONS

The results of this study highlight the role of racism, acculturative stress, and political hostility in escalating anxiety symptoms in Latinx families and identify cultural stress as a factor that likely contributes to the high rates of anxiety in Latina girls during a key developmental period. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychometric Properties and Validity of the Screen for Child Anxiety Related Emotional Disorders: Parent Version (SCARED-P) in an Early Childhood Sample

The Screen for Child Anxiety Related Emotional Disorders: Parent Version (SCARED-P) was originally developed for use in middle childhood and adolescence. The present study examined the psychometric properties and validity of the SCARED-P in an early childhood sample (predominantly aged 4-7 years). The 41-item version of the SCARED-P was administered to the parents of 233 children (mean age = 6.31 years, SD = 1.08; females = 34.3%). Confirmatory factor analysis provided mixed support for the original five-factor model of the SCARED-P. The SCARED-P demonstrated good to excellent internal consistency (total α = .94, subscale α = .68-.89), and good construct validity with the Child Behavior Checklist, Strengths and Difficulties Questionnaire, and the Developmental and Well-being Assessment. These findings indicate overall initial support for the SCARED-P's utility as a measure of anxiety in early childhood, but further psychometric and validation studies are needed in larger community-based samples of young children.

Recent developments in intranasal drug delivery of nanomedicines for the treatment of neuropsychiatric disorders

Neuropsychiatric disorders are multifaceted syndromes with confounding neurological explanations. It includes anxiety, depression, autism spectrum disorder, attention deficit hyperactivity disorder, schizophrenia, Tourette's syndrome, delirium, dementia, vascular cognitive impairment, and apathy etc. Globally, these disorders occupy 15% of all diseases. As per the WHO, India has one of the largest populations of people with mental illnesses worldwide. The blood-brain barrier (BBB) makes it extremely difficult to distribute medicine to target cells in the brain tissues. However, it is possible through novel advancements in nanotechnology, molecular biology, and neurosciences. One such cutting-edge delivery method, nose-to-brain (N2B) drug delivery using nanoformulation (NF), overcomes traditional drug formulation and delivery limitations. Later offers more controlled drug release, better bioavailability, improved patient acceptance, reduced biological interference, and circumvention of BBB. When medicines are delivered via the intranasal (IN) route, they enter the nasal cavity and go to the brain via connections between the olfactory and trigeminal nerves and the nasal mucosa in N2B. Delivering phytochemical, bioactive and synthetic NF is being investigated with the N2B delivery strategy. The mucociliary clearance, enzyme degradation, and drug translocations by efflux mechanisms are significant issues associated with N2B delivery. This review article discusses the types of neuropsychiatric disorders and their treatment with plant-derived as well as synthetic drug-loaded NFs administered via the IN-delivery system. In conclusion, this review provided a comprehensive and critical overview of the IN applicability of plant-derived NFs for psychiatric disorders.

EEG frontal alpha asymmetry mediates the association between maternal and child internalizing symptoms in childhood

Background

Anxiety and depression are highly prevalent in youth and can cause significant distress and functional impairment. The presence of maternal anxiety and depression are well-established risk factors for child internalizing psychopathology, yet the responsible mechanisms linking the two remain unclear.

Methods

We examined the potential mediating and moderating roles of EEG frontal alpha asymmetry (FAA) in the intergenerational transmission of internalizing symptoms in a longitudinal sample of N = 323 mother-child dyads. Self-report maternal internalizing symptoms were evaluated at child age 3 years and 5 years, child EEG at 5 years, and parent-report child internalizing symptoms at age 7 years. Mediation was evaluated via bootstrapped ( N = 5000) confidence intervals.

Results

We found significant associations among maternal internalizing (anxiety, depressive) symptoms at child ages 3 and 5 years, child FAA at age 5 years, and child internalizing symptoms at age 7 years. There was a significant mediation effect, whereby greater maternal anxiety and depressive symptoms at age 3 years were significantly associated with greater relative right FAA in children at age 5 years, which, in turn, was significantly associated with greater child internalizing symptoms at age 7 years ( ps <.001). There was no moderating effect of FAA on the association between maternal internalizing symptoms at age 5 years and child internalizing symptoms at age 7 years.

Conclusions

Greater right frontal asymmetry may be a neurophysiological mechanism that mediates the intergenerational transmission of internalizing symptoms.

Parental Overprotection and Locus of Control as the Mechanisms Explaining the Relationship Between Parent and Child Anxiety: A Multiple Mediation Model

The study probes the role played by parenting control practices and parental locus of control in the relationship between parent and child anxiety. The study particularly aims at probing these matters in light of the parental gender-specific role, striving to improve our understanding of the differential etiological contribution of mothers' and fathers' anxiety and parental practices to child's anxiety. The study consisted of 316 parents (159 mothers and 157 fathers) who reported their own and their child's anxiety using valid instruments. The general path model used in the study exhibited an adequate fit to the data, generally confirming our theory regarding the direct and indirect associations between parent-child anxiety. Using SEM multiple group analysis for parental gender, a strong-direct unique association was found between parent and child anxiety. For mothers, this association was partially mediated by maternal overprotection. Finally, maternal external locus of control was positively associated with child anxiety, after accounting for the effects of all other maternal variables. The study's findings and limitations are profoundly discussed in light of parental gender differences.

The Role of Parental Verbal Threat Information in Children's Fear Acquisition: A Systematic Review and Meta-analysis

Children can acquire fears of novel stimuli as a result of listening to parental verbal threat information about these stimuli (i.e., instructional learning). While empirical studies have shown that learning via parental information occurs, the effect size of parental verbal threat information on child fear of a novel stimulus has not yet been measured in a meta-analysis. We conducted a systematic review and meta analysis to assess the effect of parents' verbal statements on their children's fear acquisition. Additionally, we explored potential moderators of this effect, namely, parent and child anxiety levels, as well as child age. WebOfScience, Pubmed, Medline, and PsycINFO were used to identify eligible studies that assessed children's (30 months to 18 years old) fear of novel stimuli after being exposed to parental verbal threat information. We selected 17 studies for the meta-analysis and 18 for the systematic review. The meta-analysis revealed a significant causal effect of parental verbal threat information on children's fear reaction towards novel stimuli [g = 1.26]. No evidence was found for a moderation of verbal learning effects, neither by child or parent anxiety levels nor by child age. The effect of parents' verbal threat information on children's fear of novel stimuli is large and not dependent on anxiety levels or child age.

Association of problems, coping styles, and preferred online activity with depression, anxiety, and other psychological disorders in Turkish adolescents diagnosed with chronic kidney disease

BACKGROUND

To assess depression, anxiety, and other psychological disorders in adolescents with chronic kidney disease (CKD) and determine the significant factors and the effect of digital media use on its scores among these patient groups.

METHODS

The study was conducted as a cross-sectional study and included 84 adolescents with CKD and 68 healthy controls. The participants completed the Revised Child Anxiety and Depression Scale (RCADS). We recorded their age, gender, the most problematic issue in their lives, coping methods with problems, and online applications they prefer in their leisure time.

RESULTS

Elevated rates (scores > 70) of separation anxiety, panic disorder, obsession, depression, total anxiety, and total depression scales were statistically higher in the CKD group. Separation anxiety, panic disorder, obsession, total anxiety, and total depression scales were higher in girls, and panic disorder, obsession, depression, total anxiety, and total depression scores were higher in younger ages in multivariate analysis. In the CKD group, family issues/problems increased panic disorder, obsession, depression, total anxiety, and total depression scales. Crying in tears/yelling response in children while facing a problem was associated with increased separation anxiety and social phobia rates. Also, preferring video applications was associated with separation anxiety and messaging applications with depression, total anxiety, and total depression.

CONCLUSIONS

Adolescents with CKD are at risk for depression, anxiety, obsession, and panic disorders. Also, crying in tears/yelling response may be at greater risk for anxiety among CKD adolescents. Early psychiatric evaluation and routine psychiatric follow-ups initiated early may improve the mental health of this vulnerable population.

Obstructive Sleep Apnea and Mental Health Disorders in the Pediatric Population: A Retrospective, Population-based Cohort Study

Rationale: Information is limited about the association between obstructive sleep apnea (OSA) and mental health disorders in children. Objectives: In children, 1) to evaluate the association between OSA and new mental healthcare encounters; and 2) to compare mental healthcare encounters 2 years after to 2 years before OSA treatment initiation. Methods: We conducted a retrospective longitudinal cohort study using Ontario health administrative data (Canada). Children (0-18 yr) who underwent diagnostic polysomnography (PSG) 2009-2016 and met criteria for definition of moderate-severe OSA (PSG-OSA) were propensity score weighted by baseline characteristics and compared with children who underwent PSG in the same period but did not meet the OSA definition (PSG-No-OSA). Children were followed until March 2021. Weighted cause-specific Cox proportional hazards and modified Poisson regression models were used to compare time from PSG to first mental healthcare encounter and frequency of new mental healthcare encounters per person time, respectively. Among those who underwent adenotonsillectomy (AT) or were prescribed and claimed positive airway pressure therapy (PAP), we used age-adjusted conditional logistic regression models to compare 2 years post-treatment to pretreatment odds of mental healthcare encounters. Results: Of 32,791 children analyzed, 7,724 (23.6%) children met criteria for moderate-severe OSA. In the PSG-OSA group, 7,080 (91.7%) were treated (AT or PAP). Compared with PSG-No-OSA, the PSG-OSA group had a shorter time from PSG to first mental healthcare encounter (hazard ratio, 1.08; 95% confidence interval [CI], 1.05-1.12) but less frequent mental healthcare encounters in follow-up (rate ratio, 0.92; 95% CI, 0.87-0.97). OSA treatment (AT or PAP) was associated with lower odds of mental healthcare encounters 2 years after treatment initiation compared with 2 years before (odds ratio, 0.69; 95% CI, 0.65-0.74). Conclusions: In this large, population-based study of children who underwent PSG for sleep disorder assessment, OSA diagnosis/treatment was associated with an improvement in some mental health indicators, such as fewer new mental healthcare encounters compared with no OSA and lower odds of mental healthcare encounters compared with before OSA treatment.

"Nobody Here Likes Her"-The Impact of Parental Verbal Threat Information on Children's Fear of Strangers

Parental verbal threat (vs. safety) information about strangers may induce fears of these strangers in adolescents. In this multi-method experimental study, utilizing a within-subject design, parents provided standardized verbal threat or safety information to their offspring (N = 77, Mage = 11.62 years, 42 girls) regarding two strangers in the lab. We also explored whether the impact of parental verbal threat information differs depending on the social anxiety levels of parents or fearful temperaments of adolescents. Adolescent's fear of strangers during social interaction tasks was assessed using cognitive (fear beliefs, attention bias), behavioral (observed avoidance and anxiety), and physiological (heart rate) indices. We also explored whether the impact of parental verbal threat information differs depending on the social anxiety levels of parents or fearful temperaments of adolescents. The findings suggest that a single exposure to parental verbal threat (vs. safety) information increased adolescent's self-reported fears about the strangers but did not increase their fearful behaviors, heart rate, or attentional bias. Furthermore, adolescents of parents with higher social anxiety levels or adolescents with fearful temperaments were not more strongly impacted by parental verbal threat information. Longitudinal research and studies investigating parents' naturalistic verbal expressions of threat are needed to expand our understanding of this potential verbal fear-learning pathway.

Reduced early neural processing of faces in children and adolescents with social anxiety disorder

Social anxiety disorder (SAD) is one of the most common mental disorders during childhood and adolescence. Yet, little is known about its maintenance in youth. Cognitive models of SAD indicate that attentional biases play a key role in the dysfunctional processing of social information, such as emotional faces. However, previous research investigating neural correlates of childhood SAD has produced inconsistent findings. The current study aims to investigate neural face processing in children and adolescents with SAD, while taking into consideration methodological limitations of previous studies. We measured event-related potentials (P100, N170, EPN, LPP) in response to happy, neutral, and angry adult faces, and non-social household objects, in a sample of youth (aged 10-15 years) with SAD (n = 57), clinical controls with specific phobias (SP; n = 41), and healthy controls (HC; n = 61). Participants completed an emotion/object identification task while continuous EEG was recorded. Analyses revealed lower N170 amplitudes in the SAD group compared to HCs, irrespective of emotion. In addition, younger children (aged 10-12 years) with SAD showed lower EPN amplitudes and higher early LPP amplitudes (only trend level) in response to neutral and happy faces compared to younger HCs. These effects were specific to faces and were not evident in the neural processing of non-social household objects. Overall, the findings indicate that different neural response patterns are already present in youth with SAD. Group differences, particularly in younger children, suggest age-related differences in neural face processing in childhood SAD and underpin the necessity of developmental approaches.

Effectiveness of a cognitive behavioural therapy (CBT)-based intervention for reducing anxiety among adolescents in the Colombo District, Sri Lanka: cluster randomized controlled trial

Anxiety disorders are found to be the most prevalent psychological problems among children and adolescents. Cognitive behaviour therapy (CBT) was found to be effective at reducing anxiety. The purpose of this study was to assess the effectiveness of a universal school-based intervention for reducing anxiety among Grade 9 schoolchildren. A randomized controlled cluster trial was conducted by randomly assigning 36 schools in the Colombo district in Sri Lanka into study and control arms, each comprising 18 schools with 360 students. The levels of anxiety, self-esteem and depression status were assessed using the validated Screen for Child Anxiety Related Disorders (SCARED) tool and the Rosenberg self-esteem scale, respectively, and the Depression, Anxiety and Stress Scale 21 (DASS-21) at baseline, after intervention, and after 3 months. A CBT-based universal intervention package was administered weekly by a trained teacher for eight weeks with a one-month self-practice period to a randomly selected Grade 9 class in each school in the study arm. The control arm received routine care. Anxiety and self-esteem scores and depression status were compared between the two arms after the intervention and at 3 months of follow-up using the generalized estimation equation (GEE), controlling for confounding and clustering. The nonresponse and loss to follow-up rates were < 1%. When comparing the study arm with the control arm using GEE, anxiety levels were significantly lower [β = (-0.096), 95% CI = (-0.005) - (-0.186), p = 0.038] at follow-up but not postintervention [β = (-0.024), 95% CI = 0.006 - (-0.055), p = 0.115]. There were no significant differences in depression status after intervention (OR = 0.257, 95% CI =0.052-1.286; p = 0.098) or follow-up (OR = 0.422, 95% CI 0.177-1.008; p = 0.052), and self-esteem significantly increased after intervention (β = 0.811, 95% CI = 0.314-1.309; p = 0.001) but not at follow-up [β=0.435, 95% CI=(-0.276)-1.145, p=0.231]. This study revealed that the universal package based on CBT is effective at reducing anxiety and improving self-esteem among adolescents. The trial registration number and date were SLCTR/2018/018 and 19th of June 2018 respectively.

School-based intervention for anxiety using group cognitive behavior therapy in Pakistan: a feasibility randomized controlled trial

BACKGROUND

Anxiety and mood disorders are the main cause of illness in people under the age of 25, accounting for 45% of the global disease burden, whereas 4.6% of teenagers aged 15 to 19 are predicted to experience anxiety. Pakistan country, with a population of 200 million, has the worst mental health indicators and fewer than 500 psychiatrists. Despite the existence of various treatments for anxiety, this goes unrecognized and untreated. Due to a lack of awareness, evaluation, prevention, and interventional programs related to being implemented among adolescents in Pakistan, there is a rise in mental health issues in the earlier years of life. It calls for a critical need for indigenous, evidence-based interventions. The present study aimed to evaluate the feasibility of cognitive behavioral therapy (CBT)-based interventions to reduce anxiety symptoms among school children in Pakistan.

METHODS

This study was a pre-post design, two-arm, single-blinded, feasibility, randomized controlled trial. Thirty-four participants (experimental group, n = 17; control group, n = 17) were recruited from four semi-government schools in Rawalpindi with a mean age of 15 (M = 15, SD = 0.73). Two instruments Beck Anxiety Inventory for Youth (BAI-Y II) and BASC-3 Behavioural and Emotional Screening System Student (BESS-SF) were used to assess the severity of symptoms. Participants in the intervention arm received eight-group therapy CBT sessions. A two-way factorial analysis was used to examine the efficacy of CBT in reducing symptom severity.

RESULTS

This study's findings showed that in comparison to the wait-list control group, CBT successfully improved anxiety symptoms among school children while enhancing their social skills.

CONCLUSION

This study will help improve the treatment for anxiety in Pakistan by prioritizing school-based intervention and group-based CBT intervention.

TRIAL REGISTRATION

The trial has been registered at the American Economic Association's registry for randomized controlled trials.

RCT ID

AEARCTR-0009551 . Registered 2022-07-04.

Psychopathology of cognitive disengagement syndrome (CDS): a network analysis based on CBCL scales in 72,106 Chinese school students

Cognitive Disengagement Syndrome (CDS) is a cluster of behavioral problems that severely affect an individual's functioning. Currently, there is no consensus on the main clinical features of CDS, and further exploration in large samples is needed. Using a cluster-stratified random sampling method, 72,106 children and adolescents were recruited from five provinces in mainland China for this study. Using both the traditional two-factor scoring method and the CBCL DSM-oriented scales, we assessed individual behavioral problems from psychopathological and DSM-oriented perspectives. Network analysis was employed to explore the relationship between CDS and behavioral problems. The various networks were compared by gender and age subgroups. Among 72,106 participants (mean age, 11.49 years; minimum age, 5 years; maximum age, 16 years), there were 36,449 males (50.5%) and 35,657 females (49.5%). From a psychopathological perspective, the motor symptoms node was associated with the sad node and the withdrawn node, while the cognitive symptoms node was linked to the nervous node and the self-conscious node. In terms of gender, males had stronger associations of the motor symptoms node with the sad node and the withdrawn node than females (P = 0.043), and weaker associations of the cognitive symptoms node with the nervous node than females (P = 0.027). In terms of growth stage, the adolescent group had stronger associations of the cognitive symptoms node with the nervous node and the self-conscious node than the child group (P = 0.016, 0.001). From DSM perspective, motor symptoms node were associated with sad node, and cognitive symptoms node were related to can't concentrate node, nervous node, and worthless node. With increasing age, there was an upward trend in the strength of the cognitive and motor symptoms node. CDS is closely linked to psychological and behavioral issues, especially internalizing problems, with differences observed by gender and growth stage. The connection between CDS and the affective, anxiety, and ADH symptoms is particularly pronounced.

Physiological correlates of anxiety in childhood and adolescence: A systematic review and meta-analysis

Anxiety is one of the most prevalent problems that affects children and adolescents. The vast majority of diagnostic tools for anxiety depend on written or verbal reports from children and adolescents or their significant others. The validity and reliability of such reports can be compromised by their subjective nature. Thus, there is growing interest in whether anxiety can be indexed with objective physiological measures. The key aim of this systematic review and meta-analysis was to determine which physiological measures are most reliably associated with elevated levels of anxiety amongst children and adolescents. Online databases (e.g., PsycINFO, Embase, Medline) were searched for relevant studies according to pre-determined criteria. Twenty-five studies comprising 2502 participants (N = 1160 with high anxiety) met inclusion, identifying 11 groups of physiological measures. Our meta-analysis revealed that skin conductance level is the most sensitive measure of anxiety (d = 0.83), followed by electromyography (EMG) measures (d = 0.71) and skin conductance response (d = 0.58). However, the included studies varied in terms of subjective measures, study designs, experimental task measures, and physiological measures. Consideration of these differences in methodology offer potential directions for future research.

Preference for digital media use, biobehavioral attention bias, and anxiety symptoms in adolescents

Adolescence is a critical developmental period of biological and social change during which 1 in 3 youth experience significant anxiety symptoms. The social-emotional lives of the majority of adolescents are largely conducted via digital media use (DMU; e.g., social media, text messaging). Yet the past decade of research on DMU and anxiety has yielded mixed results (e.g., Keles et al., 2020 review), leaving the complex role that DMU might play in the emergence and maintenance of anxiety poorly understood. A key step forward is to leverage psychophysiology to identify individual differences in cognitive and emotional processes that confer vulnerability to potential negative effects of DMU. Further, given the ubiquity of DMU, a greater focus is needed on measurements that move beyond sheer frequency to capture DMU in comparison to face-to-face (FTF) social interactions. This study examined attention bias (AB), characterized by selective and exaggerated attention toward or away from threat, as a moderator of the link between DMU and anxiety in adolescents (N = 75; 42 female) aged 12-14 years (M = 13.28, SD = 0.87). AB was indexed during a dot probe task using reaction time metrics (i.e., trial-level bias) and via ERPs capturing attentional selection and discrimination (N170) and cognitive control (N2) to threat compared to neutral faces. AB moderated associations between DMU and anxiety. A greater preference to use DMU vs FTF predicted greater anxiety among those with a greater behavioral bias away from threat, blunted N170, and blunted N2 in the presence of threat. Future research should examine potential causal and bidirectional links between DMU and anxiety and explore whether preferences for technology-mediated interactions and individual differences in threat processing increase risk.

Daily-life reactivity and emotion regulation in children with social anxiety disorder

Prominent models of adult social anxiety disorder emphasize the role of hyperreactivity and emotion regulation (ER) difficulties. However, it is unclear whether these factors are relevant in childhood, a critical period for the development of this disorder. We used ecological momentary assessment with mobile phones to assess daily-life emotional reactivity and use and effectiveness of ER strategies in children aged 10-13 years. We compared three groups: Social anxiety disorder (n = 29), clinical controls with mixed anxiety disorders (n = 27) and healthy controls (n = 31). We also investigated long-term effects of ER on trait social anxiety 12 months later. Hierarchical linear modelling revealed higher emotional reactivity and more use of suppression in children with social anxiety disorder compared to clinical and healthy controls. Contrary to our expectations, children with social anxiety disorder reported more use of avoidance and reappraisal compared to clinical, but not healthy, controls. The groups did not differ in subjective effectiveness of ER strategies. Use of suppression, avoidance, and rumination each predicted an increase in social anxiety 12 months later. Taken together, our results extend previous findings from lab and questionnaire studies and illustrate the role of maladaptive ER for child social anxiety disorder.

Late positive potential reveals sustained threat contingencies despite extinction in adolescents but not adults

BACKGROUND

Major theories link threat learning processes to anxiety symptoms, which typically emerge during adolescence. While this developmental stage is marked by substantial maturation of the neural circuity involved in threat learning, research directly examining adolescence-specific patterns of neural responding during threat learning is scarce. This study compared adolescents and adults in acquisition and extinction of conditioned threat responses assessed at the cognitive, psychophysiological, and neural levels, focusing on the late positive potential (LPP), an event-related potential (ERP) component indexing emotional valence.

METHOD

Sixty-five adults and 63 adolescents completed threat acquisition and extinction, 24 h apart, using the bell conditioning paradigm. Self-reported fear, skin conductance responses (SCR), and ERPs were measured.

RESULTS

Developmental differences emerged in neural and psychophysiological responses during threat acquisition, with adolescents displaying heightened LPP responses to threat and safety cues as well as heightened threat-specific SCR compared to adults. During extinction, SCR suggested comparable reduction in conditioned threat responses across groups, while LPP revealed incomplete extinction only among adolescents. Finally, age moderated the link between anxiety severity and LPP-assessed extinction, whereby greater anxiety severity was associated with reduced extinction among younger participants.

CONCLUSIONS

In line with developmental theories, adolescence is characterized by a specific age-related difficulty adapting to diminishing emotional significance of prior threats, contributing to heightened vulnerability to anxiety symptoms. Further, LPP appears to be sensitive to developmental differences in threat learning and may thus potentially serve as a useful biomarker in research on adolescents, threat learning, and anxiety.