The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics

Attention bias toward threat in pediatric anxiety disorders

OBJECTIVE

To examine attention bias toward threat faces in a large sample of anxiety-disordered youths using a well-established visual probe task.

METHOD

Study participants included 101 children and adolescents (ages 7-18 years) with generalized anxiety disorder, social phobia, and/or separation anxiety disorder enrolled in a multisite anxiety treatment study. Nonanxious youths (n = 51; ages 9-18 years) were recruited separately. Participants were administered a computerized visual probe task that presents pairs of faces portraying threat (angry), positive (happy), and neutral expressions. They pressed a response key to indicate the spatial location of a probe that replaced one of the faces on each trial. Attention bias scores were calculated from response times to probes for each emotional face type.

RESULTS

Compared to healthy youths, anxious participants demonstrated a greater attention bias toward threat faces. This threat bias in anxious patients did not significantly vary across the anxiety disorders. There was no group difference in attention bias toward happy faces.

CONCLUSIONS

These results suggest that pediatric anxiety disorders are associated with an attention bias toward threat. Future research may examine the manner in which cognitive bias in anxious youths changes with treatment.

Pediatric anxiety disorders: management in primary care

PURPOSE OF REVIEW

Anxiety disorders are common in children and adolescents, with prevalence rates varying from 6 to 20%. These disorders can result in significant academic, social, and familial impairment. Early identification in pediatric primary care and effective management may help improve outcomes.

RECENT FINDINGS

Self-report measures of pediatric anxiety can supplement the clinical interview and assist in screening children and adolescents for separation anxiety disorder, generalized anxiety disorder, and social phobia. Substantial evidence supports the use of cognitive behavioral therapy and selective serotonin reuptake inhibitors in the treatment of pediatric anxiety disorders. Although treatment with serotonin reuptake inhibitors may lead to a small increase in the risk for suicidal ideation in children and adolescents, the risk benefit ratio for serotonin reuptake inhibitor use in pediatric anxiety disorders is favorable with appropriate monitoring.

SUMMARY

Although evidence-support treatments have emerged for pediatric anxiety disorders, their effectiveness in pediatric primary care has not been evaluated. Future research should assess the delivery of manual-based cognitive behavioral therapy for anxiety disorders by mental health professionals integrated into the primary care settings, the effectiveness of serotonin reuptake inhibitor prescription by pediatric primary care clinicians, and the use of collaborative models for providing anxiety treatments for children and adolescents in primary care settings.

Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents

The article reviews psychosocial treatments for phobic and anxiety disorders in youth. Using criteria from Nathan and Gorman (2002), 32 studies are evaluated along a continuum of methodological rigor. In addition, the treatments evaluated in each of the 32 studies are classified according to Chambless et al.'s (1996) and Chambless and Hollon's (1998) criteria. Findings from a series of meta-analyses of the studies that used waitlists also are reported. In accordance with Nathan and Gorman, the majority of the studies were either methodologically robust or fairly rigorous. In accordance with Chambless and colleagues, although no treatment was well-established, Individual Cognitive Behavior Therapy, Group Cognitive Behavior Therapy (GCBT), GCBT with Parents, GCBT for social phobia (SOP), and Social Effectiveness Training for children with SOP each met criteria for probably efficacious. The other treatments were either possibly efficacious or experimental. Meta-analytic results revealed no significant differences between individual and group treatments on diagnostic recovery rates and anxiety symptom reductions, as well as other youth symptoms (i.e., fear, depression, internalizing and externalizing problems). Parental involvement was similarly efficacious as parental noninvolvement in individual and group treatment formats. The article also provides a summary of the studies that have investigated mediators, moderators, and predictors of treatment outcome. The article concludes with a discussion of the clinical representativeness and generalizability of treatments, practice guidelines, and future research directions.

Psychometric properties and diagnostic ability of the separation anxiety scale for children (SASC)

This research describes the psychometric properties of a new child self-report measure, the separation anxiety scale for children (SASC), which assesses the frequency of symptoms of separation anxiety in children from 8 to 11. The factor solution with a sample of 1,201 children from 8 to 11, isolated three factors, discomfort from separation, worry about separation, and calm at separation, tested by confirmatory factor analysis, which accounted for 32.80% of the total variance. Results indicated that the SASC has a high internal consistency (alpha = 0.83). The results revealed a high test-retest reliability of the instrument, and a high number of correctly diagnosed cases. The correlation of scores with other anxiety measures shows that the variable most associated with separation anxiety is trait-anxiety.

No differences between group versus individual treatment of childhood anxiety disorders in a randomised clinical trial

BACKGROUND

The present study compares an individual versus a group format in the delivery of manualised cognitive-behavioural therapy (FRIENDS) for children with anxiety disorders. Clinically referred children (aged 8 to 12) diagnosed with Separation Anxiety Disorder (n = 52), Generalised Anxiety Disorder (n = 37), Social Phobia (n = 22) or Specific Phobia (n = 16) were randomly assigned to individual (n = 65) or group (n = 62) treatment.

METHOD

Analyses were conducted separately for the intent-to-treat sample and the sample of children who completed treatment. Analyses included chi-square comparisons and regression analyses with treatment format as a predictor.

RESULTS

Forty-eight percent of the children in the individual versus 41% in the group treatment were free of any anxiety disorder at post-treatment; 62% versus 54% were free of their primary anxiety disorder. Regression analyses showed no significant difference in outcome between individual and group treatment.

CONCLUSIONS

Children improved in both conditions. Choice between treatments could be based on pragmatic considerations such as therapeutic resources, referral rates, and the preference of the parents and the child.

Family-based interpersonal psychotherapy for depressed preadolescents: an open-treatment trial

AIM

To conduct an open-treatment trial to evaluate the feasibility, acceptability and clinical outcomes of using a family-based adaptation of Interpersonal Psychotherapy for Depressed Adolescents with a sample of preadolescents (ages 9-12) presenting for outpatient treatment for depression.

METHODS

Sixteen preadolescents who met criteria for a depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition participated in this open-treatment trial of family-based interpersonal psychotherapy (FB-IPT). Parents chose whether their preadolescents should receive FB-IPT only (n = 10) or FB-IPT with antidepressant medication (n = 6). Pre- and post-treatment assessments included clinician-administered measures of depression and global functioning, and parent- and child-reported anxiety symptoms.

RESULTS

FB-IPT was associated with high treatment compliance rates (88%) and was associated with significant decreases in preadolescents' depressive and anxiety symptoms. Preadolescents who received FB-IPT only were as likely as those receiving FB-IPT and medication to have significant reductions in depressive symptoms and anxiety symptoms, and to experience significant improvement in global functioning. Parents were more likely to choose combination treatment when their depressed preadolescents had a comorbid anxiety disorder.

CONCLUSIONS

Further research on FB-IPT is needed to establish its efficacy as compared with usual outpatient treatment, its ability to be disseminated to child clinicians with varying levels of training and in adequately powered randomized controlled trials that can detect group differences.

Psychometric properties of the Social Phobia and Anxiety Inventory for Children using a non-American population-based sample

Although previous studies have examined the factor structure of the SPAI-C, adequate factor analytic methodology has not been employed. This study explored the psychometric properties of the Social Phobia and Anxiety Inventory for Children (SPAI-C), using a non-American population-based sample of older children and young adolescents 11-14 years of age. Initially an exploratory factor analysis was conducted followed 1 year later by a confirmatory factor analysis. Five factors labeled Assertiveness, Public Performance, Physical/Cognitive Symptoms, Social Encounter, and Avoidance were retained and confirmed. The Public Performance and Assertiveness factors were the most stable and consistent factors or traits of social anxiety over a 1-year period. Results revealed adequate concurrent validity, internal consistency and moderate 12-month test-retest reliability of the SPAI-C total scale. The SPAI-C was found to assess levels of both social anxiety and social anxiety disorder according to DSM-IV criteria. Findings suggest that the SPAI-C is applicable in clinical treatment studies designed to assess sensitivity to change in various aspects of social anxiety disorder.

Comparing children's and parents' perspectives of health outcome in paediatric hydrocephalus

This study exampled the properties of a child-completed version of the Hydrocephalus Outcome Questionnaire (cHOQ) and compared these with parental responses to the HOQ (parent version). This was a cross-sectional study in the outpatient clinics at three Canadian paediatric hospitals (Toronto, Vancouver, and Halifax). All cognitively-capable children with previously treated hydrocephalus who were aged between 6 and 19 years were eligible. Parents completed the HOQ and the Health Utilities Index Mark 3; children completed the cHOQ. A total of 273 children participated (146 males, 127 females; mean age 14 y 1 mo, SD 2 y 7 mo). Internal consistency of the cHOQ was 0.93 and test-retest reliability was 0.86 (95% confidence interval 0.78-0.92). Mother-child agreement and father-child agreement were 0.57 (0.40-0.68) and 0.62 (0.48-0.73) respectively. Agreement was higher for assessments of physical health, but lower for assessments of cognitive health and social-emotional health. There was greater parent-child agreement for older children. When there was disagreement, it seemed that children tended to rate their health better than their parents did. In older children with hydrocephalus, the cHOQ appears to be a scientifically reliable means of assessing long-term outcome. The differences in child and parent perceptions of health need to be appreciated when conducting outcome studies in this population.

Anxiety trajectories and identity development in adolescence: a five-wave longitudinal study

The aim of this five-wave longitudinal study was to investigate the relationship between anxiety and adolescent identity development. Participants were 1,313 adolescents who annually completed measures of anxiety and identity. Growth Mixture Modeling (GMM) analyses demonstrated that the adolescent population was best typified by two latent growth trajectory classes: a low anxiety class (n = 1,199) characterized by a low initial level of anxiety that decreased over time and a high anxiety class (n = 114) characterized by a higher initial level of anxiety that increased over time. To answer our research question, we tested a model in which the anxiety classes predicted initial levels and rates of change of three identity dimensions: commitment, in-depth exploration, and reconsideration of commitment. Findings indicated that the high anxiety adolescents displayed a more troublesome identity development than their low anxiety peers, since their commitments became weaker with age, and they reconsidered them intensively.

Disgust sensitivity and psychopathological symptoms in non-clinical children

There is clear evidence in the adult literature that disgust sensitivity is implicated in various psychopathological syndromes. The current study examined the link between disgust sensitivity and psychopathological symptoms in youths. In a sample of non-clinical children aged 9-13 years, disgust sensitivity was assessed by two self-report questionnaires (i.e., the Disgust Scale and the Disgust Sensitivity Questionnaire) and a behavioural test. Furthermore, children completed scales for measuring the personality trait of neuroticism and various types of psychopathological symptoms. Results showed that disgust measures had sufficient to good convergent validity. Further, significant positive correlations were found between disgust sensitivity and symptoms of specific phobias (i.e., spider phobia, blood-injection phobia, small-animal phobia), social phobia, agoraphobia, obsessive-compulsive disorder (OCD), and eating problems, and these links were not attenuated when controlling for neuroticism. The possible role of disgust sensitivity in the aetiology of child psychopathology is discussed.

The moderating role of health fear on the relation between smoking status and panic symptoms among adolescents

The present study examined the moderating role of health fear on the concurrent relation between smoking status and panic attack symptoms among 249 adolescents (132 females, M(age)=14.86 years). As hypothesized, youth high in health fear reported elevations in panic attack symptoms, whereas this relation was relatively weak among those low in health fear. Importantly, these associations were significant after controlling for age, gender, negative affectivity, and anxiety sensitivity. Also as expected, health fear did not moderate the association between smoking status and depressive symptoms, supporting model specificity. Results are discussed in terms of implications for the panic-smoking association among youth.

Reliability and validity of the screen for child anxiety related emotional disorders (SCARED) in Chinese children

The present study examined the psychometric properties of the screen for child anxiety related emotional disorders (SCARED) in a large community sample of Chinese children. The 41-item version of the SCARED was administered to 1559 primary and junior high school students (774 boys and 785 girls, mean age 11.8+/-2.11) in 12 Chinese cities. The SCARED demonstrated moderate to high internal consistency (alpha=0.43-0.89) and test-retest reliability (intraclass correlation coefficients=0.46-0.77 over 2 weeks and 0.24-0.67 over 12 weeks), moderate parent-child correlation (r=0.49-0.59) and good discriminant validity (between anxiety and non-anxiety disorders). The SCARED total score was significantly correlated with the internalizing factor of the child behavior checklist (0.41). Factor analyses revealed the same five-factor structure as the original SCARED. These findings support that the SCARED is a reliable and valid anxiety screening instrument in Chinese children.

Developmental trajectories of adolescent anxiety disorder symptoms: a 5-year prospective community study

OBJECTIVE

This study prospectively examined the developmental trajectories of anxiety disorder symptoms in a large sample of adolescents from the general population.

METHOD

Two cohorts of early and middle adolescents (1,318 junior high and high school students) completed the Screen for Child Anxiety Related Emotional Disorders during 5 consecutive years. The Screen for Child Anxiety Related Emotional Disorders is a questionnaire that measures self-rated child and adolescent anxiety symptoms that map onto DSM-IV-TR anxiety disorders. At the first wave of measurement, the early and middle adolescent cohorts were an average of 12 and 16 years of age, respectively. Age and sex differences in the developmental trajectories of adolescent anxiety disorder symptoms over time were examined by means of latent growth modeling.

RESULTS

Over the course of 5 years, there was a slight decrease in the panic disorder, school anxiety, and separation anxiety disorder symptoms for all of the adolescents, with the exception of social phobia symptoms, which remained fairly stable over time. Adolescent girls showed a slight increase of generalized anxiety disorder symptoms over time, whereas these symptoms decreased among adolescent boys.

CONCLUSIONS

This study replicates and extends earlier findings on the developmental trajectories of anxiety symptoms during adolescence. By using individually focused, trajectory-based analyses rather than group score differences, this study extends earlier findings and advances our understanding of age and sex differences in the development of adolescent anxiety symptoms.

Early childhood OCD: preliminary findings from a family-based cognitive-behavioral approach

OBJECTIVE

To examine the relative efficacy of family-based cognitive-behavioral therapy (CBT) versus family-based relaxation treatment (RT) for young children ages 5 to 8 years with obsessive-compulsive disorder (OCD).

METHOD

Forty-two young children with primary OCD were randomized to receive 12 sessions of family-based CBT or family-based RT. Assessments were conducted before and after treatment by independent raters blind to treatment assignment. Primary outcomes included scores on the Children's Yale-Brown Obsessive Compulsive Scale and Clinical Global Impressions-Improvement.

RESULTS

For the intent-to-treat sample, CBT was associated with a moderate treatment effect (d = 0.53), although there was not a significant difference between the groups at conventional levels. For the completer sample, CBT had a large effect (d = 0.85), and there was a significant group difference favoring CBT. In the intent-to-treat sample, 50% of children in the CBT group achieved remission as compared to 20% in the RT group. In the completer sample, 69% of children in the CBT group achieved a clinical remission compared to 20% in the RT group.

CONCLUSIONS

Results indicate that children with early-onset OCD benefit from a treatment approach tailored to their developmental needs and family context. CBT was effective in reducing OCD symptoms and in helping a large number of children achieve a clinical remission.

Antecedents and sequelae of sudden parental death in offspring and surviving caregivers

OBJECTIVES

To examine the psychiatric antecedents that put parents at risk for early death, and the psychological sequelae of bereavement in offspring and caregivers.

DESIGN

A population-based study.

SETTING

Bereaved families were recruited through the coroner's records and by advertisement. Control families were recruited by random-digit dialing and advertisement.

PARTICIPANTS

Families with biological offspring from 7 to 25 years of age in which 1 parent died of suicide, accident, or sudden natural death were included (n = 140). Controls (n = 99) had 2 living parents and their biological offspring and had no death of a first-degree relative within the past 2 years.

MAIN OUTCOME MEASURES

Lifetime psychiatric history for deceased parents (probands) and new-onset psychiatric disorders, self-reported symptoms, and functional status in offspring and surviving caregivers.

RESULTS

Bipolar disorder, substance abuse, and personality disorders are more common in probands who died of suicide or accident than in control parents. Bereaved offspring and their caregivers were at increased risk for depression and posttraumatic stress disorder. Bereaved offspring had a 3-fold (95% confidence interval, 1.3-7.0) increased risk of depression, even after controlling for antecedent and concomitant risk factors. Offspring bereaved by suicide showed similar outcomes compared with those bereaved by other types of death.

CONCLUSIONS

Bereavement conveys an increased risk of depression and posttraumatic stress disorder above and beyond other vulnerability factors. Better integration of medical and psychiatric care may prevent premature parental death, but once it occurs, physicians should be alert to the increased risk for depression and posttraumatic stress disorder in bereaved offspring and their caregivers.

Corpus callosum in maltreated children with posttraumatic stress disorder: a diffusion tensor imaging study

Contrary to expectations derived from preclinical studies of the effects of stress, and imaging studies of adults with posttraumatic stress disorder (PTSD), there is no evidence of hippocampus atrophy in children with PTSD. Multiple pediatric studies have reported reductions in the corpus callosum--the primary white matter tract in the brain. Consequently, in the present study, diffusion tensor imaging was used to assess white matter integrity in the corpus callosum in 17 maltreated children with PTSD and 15 demographically matched normal controls. Children with PTSD had reduced fractional anisotropy in the medial and posterior corpus, a region which contains interhemispheric projections from brain structures involved in circuits that mediate the processing of emotional stimuli and various memory functions--core disturbances associated with a history of trauma. Further exploration of the effects of stress on the corpus callosum and white matter development appears a promising strategy to better understand the pathophysiology of PTSD in children.

Anger correlated with psychosocial variables in rural youth

Uncontrolled anger is a contributing force in the three leading causes of adolescent death: homicide, suicide, and injuries. Anger may be one of the early warning signs which could lead to violent behavior. The purpose of this study was to examine the relationship between anger experience and expression with the potential correlates of life events, perceived social support, self-esteem, optimism, drug use, anxiety, and depressive symptoms in rural adolescents. The participants (n = 193) were aged 14 to 17 years old in ninth through eleventh grades enrolled at three rural Western Pennsylvania public high schools. Participants completed nine questionnaires. Negative life events, anxiety, drug use, and depressive symptoms had significant positive correlations with anger. In addition, anger was found to have significant negative correlations with the adolescents' perceived family support, self-esteem, and optimism. With this knowledge, health promotion programs conducted by pediatric nurses can target anxiety, drug use, and depressive symptoms while bolstering family support, self-esteem, and optimism to promote anger management in adolescent health care.

Objective sleep in pediatric anxiety disorders and major depressive disorder

OBJECTIVE

To examine objective and subjective sleep problems in early-onset anxiety and depression.

METHOD

Children and adolescents (46% female, ages 7 to 17 years) with anxiety disorders (n = 24), major depressive disorder (MDD) without comorbid anxiety disorders (n = 128), or no history of psychiatric disorder (n = 101) spent two consecutive nights in a sleep laboratory and completed self-reports of sleep quality.

RESULTS

On objective measures, the anxiety group exhibited more awakenings than the MDD group, less slow-wave sleep than the control or MDD group, and greater night 2 sleep latency than the MDD or control group. The anxiety group exhibited no decrease in rapid eye movement latency from the first night to the second. The MDD group exhibited less time awake than the control group and less stage 1 sleep than the anxiety or control group. On subjective measures, young people with anxiety reported greater sleep latency on the second night and no decrease in sleep latency. Age was covaried in analyses.

CONCLUSIONS

Findings provide objective and subjective evidence of sleep disturbance in children and adolescents with anxiety disorders and replicate findings of limited objective sleep disturbance in those with MDD. Sleep problems are an important consideration when treating young people with anxiety.

Is onset of Tourette syndrome influenced by life events?

The aim of this study is to investigate the possible relationship between stressful life events, personality, and onset of Tourette syndrome in children. The study group included 93 subjects aged 7-18 years: 41 with Tourette syndrome (TS), 28 with obsessive-compulsive disorder (OCD), and 24 healthy controls. Diagnoses were based on the Child Schedule for Schizophrenia and Affective Disorders (K-SADS). All children were tested with the Screen for Child Anxiety Related Emotional Disorders, Children's Yale Brown Obsessive Compulsive Scale, Beck Depression Inventory or Children's Depression Inventory, the Life Experience Survey, and the Junior Temperament and Character Inventory. The findings were compared among the groups. Subjects with Tourette syndrome and healthy controls had significantly less stressful life events than subjects with (OCD). There were no significant differences between the TS subjects and the healthy controls. This finding applied to total lifetime events, total lifetime negative events, and events in the year before and after illness onset. Subjects with TS and the healthy controls also showed a significantly lesser impact of life events than subjects with OCD. The Tourette syndrome group showed a significantly lesser impact of stressful life events than controls. Harm avoidance tended to be higher in the patients with Tourette syndrome and comorbid attention deficit hyperactivity disorder and obsessive-compulsive disorder than in patients with Tourette syndrome only. There seemed to be no association between life events, diagnosis, and personality. Although there is some research suggesting that tics can be influenced by the environment, the onset of Tourette syndrome does not seem to be related to stressful life events, nor to an interaction between stressful life events and personality.

Predicting children's anxiety from early attachment relationships

This study assessed whether infants with anxious-ambivalent attachment develop higher levels of anxiety later in childhood than do infants with secure attachment. Infants (N=136) participated in Ainsworth's Strange Situation Procedure at 12 months of age. The Screen for Child Anxiety Related Emotional Disorders (SCARED) was completed by children and their mothers at 11 years of age. Results show that compared with children who were securely attached in infancy, children who were ambivalently attached had higher levels of school phobia, and, that compared with boys who were securely attached boys who were ambivalently attached had higher levels of social phobia at 11 years. However, in this normative sample, anxious-ambivalent attachment was not related to anxiety levels that approach pathological significance. These findings are discussed within the context of previous research on associations between attachment and anxiety disorders.

Nature of anxiety comorbid with attention deficit hyperactivity disorder in children from a pediatric primary care setting

The clinical characteristics of children with comorbid anxiety and attention deficit hyperactivity disorder (ADHD were examined. A sample of children from a pediatric primary care practice was assessed for anxiety disorders and ADHD. We defined four groups of children: (1) anxiety disorders only with no ADHD (n=54); (2) ADHD-only with no anxiety disorder (n=15); (3) neither ADHD nor an anxiety disorder (n=107); and (4) comorbid ADHD and anxiety disorder (n=14). Approximately 50% of children with ADHD had a comorbid anxiety disorder, and approximately 20% of children with an anxiety disorder had comorbid ADHD. The presence of comorbid ADHD and anxiety was associated with more attentional problems, school fears, and mood disorders and lower levels of social competence compared to children who had either ADHD-only or anxiety-only. Children with comorbid anxiety disorders and ADHD have more severe symptoms and are more impaired than children with either condition alone. Interventions need to be tailored to address the complexity of these comorbid conditions and their associated sequelae.

A space odyssey: experimental manipulation of threat perception and anxiety-related interpretation bias in children

This study provides a first test of an experimental method, the "space odyssey" paradigm, that was designed to manipulate interpretation bias in children. Seventy non-clinical children aged 8-12 years first completed a standardized anxiety questionnaire. Following this, they completed the space odyssey paradigm to induce either a negative or a positive interpretation bias. After this stage of interpretation training, children were presented with a series of ambiguous vignettes for which they had to rate perceived levels of threat as an index of interpretation bias. Results indicated that the space odyssey paradigm was successful in training interpretations: children in the negative training condition quickly learned to choose negative outcomes, while children in the positive training condition rapidly learned to select positive outcomes. Most importantly, children's subsequent threat perception scores for the ambiguous vignettes were affected by the manipulation. That is, children in the negative training condition perceived more threat than children in the positive training condition. Interestingly, the effects of training were most pronounced in high anxious children. Directions for future research with this paradigm are briefly discussed.

Fear conditioning in adolescents with anxiety disorders: results from a novel experimental paradigm

OBJECTIVE

Considerable research examines fear conditioning in adult anxiety disorders but few studies examine youths. Adult data suggest that anxiety disorders involve elevated fear but intact differential conditioning. We used a novel paradigm to assess fear conditioning in pediatric anxiety patients.

METHOD

Sixteen individuals with anxiety disorders and 38 healthy comparisons viewed two photographs of actresses displaying neutral expressions. One picture served as the conditioned stimulus (CS), paired with a fearful expression and a shrieking scream (CS+), whereas the other picture served as a CS unpaired with the aversive outcome (CS-). Conditioning was indexed by self-reported fear. Subjects participated in two visits involving conditioning and extinction trials.

RESULTS

Both groups developed greater fear of the CS+ relative to CS-. Higher fear levels collapsed across each CS characterized anxious relative to healthy subjects, but no significant interaction between group and stimulus type emerged. Fear levels at visit 1 predicted avoidance of visit 2. Fear levels to both CS types showed stability even after extinction.

CONCLUSIONS

Consistent with adult data, pediatric anxiety involves higher fear levels following conditioning but not greater differential conditioning. Extending these methods to neuroimaging studies may elucidate neural correlates of fear conditioning. Implications for exposure therapies are discussed.

Recognition of facial emotions among maltreated children with high rates of post-traumatic stress disorder

OBJECTIVE

The purpose of this study is to examine processing of facial emotions in a sample of maltreated children showing high rates of post-traumatic stress disorder (PTSD). Maltreatment during childhood has been associated independently with both atypical processing of emotion and the development of PTSD. However, research has provided little evidence indicating how high rates of PTSD might relate to maltreated children's processing of emotions.

METHOD

Participants' reaction time and labeling of emotions were measured using a morphed facial emotion identification task. Participants included a diverse sample of maltreated children with and without PTSD and controls ranging in age from 8 to 15 years. Maltreated children had been removed from their homes and placed in state custody following experiences of maltreatment. Diagnoses of PTSD and other disorders were determined through combination of parent, child, and teacher reports.

RESULTS

Maltreated children displayed faster reaction times than controls when labeling emotional facial expressions, and this result was most pronounced for fearful faces. Relative to children who were not maltreated, maltreated children both with and without PTSD showed enhanced response times when identifying fearful faces. There was no group difference in labeling of emotions when identifying different facial emotions.

CONCLUSIONS

Maltreated children show heightened ability to identify fearful faces, evidenced by faster reaction times relative to controls. This association between maltreatment and atypical processing of emotion is independent of PTSD diagnosis.

An open-label trial of escitalopram in children and adolescents with social anxiety disorder

Social anxiety disorder (SAD) is a highly prevalent and disabling disorder in children and adolescents. This study was designed to evaluate the efficacy and safety of a highly potent and selective serotonin reuptake inhibitor, escitalopram, in the treatment of SAD in children and adolescents. Twenty outpatients with a primary diagnosis of SAD were treated in a 12-week open trial with escitalopram. The primary outcome variable was the change from baseline to end point in Clinical Global Impression-Improvement scale (CGI-I). Secondary efficacy measures included the CGI-Severity scale (CGI-S), the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Screen for Child and Anxiety Related Emotional Disorders (SCARED)-Child and Parent version, and The Youth Quality of Life Instrument-Research Version (Y-QOL-R). On the CGI-I scale, 13 of 20 patients (65%) had a score < or =2, meaning response to treatment. All symptomatic and quality of life measures showed improvements from baseline to week 12, with large effect sizes ranging from 0.9 to 1.9 (all p < 0.001). Escitalopram was generally well-tolerated. These results suggest that escitalopram may be an effective and safe treatment for pediatric SAD. Future double-blind, placebo-controlled, randomized clinical trials are warranted.

Serotonin transporter polymorphism (5-HTTLPR) and citalopram effectiveness and side effects in children with depression and/or anxiety disorders

OBJECTIVE

The aim of this study was to examine the association between polymorphism in the serotonin transporter gene and citalopram effectiveness and side effects in children and adolescents with major depressive disorder (MDD) and/or anxiety disorders.

METHODS

Outpatients, aged 7- 18 years with a Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) MDD and/or anxiety disorder were treated in an 8-week open trial with 20-40 mg/day of citalopram. Subjects were genotyped with respect to short (s) versus long (l) forms of the 5-HTTLPR polymorphism of the serotonin transporter, and the relationship between genotype and outcome and side effects was assessed.

RESULTS

Subjects with 5-HTTLPR ss genotype showed a less vigorous response with regard to depressive symptoms measured by the Children's Depression Rating Scale-Revised (CDRS-R) scores over time compared to subjects with sl/ll genotypes (beta = 0.67, z = 2.02, p = 0.04). In addition, the 5-HTTLPR ss group exhibited lower rates of agitation compared to those with sl/ll genotype (6.3% vs. 32.8%, p = 0.05). Also, subjects with 5-HTTLPR ss genotype had consistently higher scores of suicidality at each week compared to the sl/ll group (beta = 0.76, z = 2.04, p = 0.04) as measured by item number 13 of the CDRS-R.

CONCLUSIONS

The 5-HTTLPR ss genotype was associated with a poorer clinical response with regard to depressive symptoms as well with fewer reports of agitation. The 5-HTTLPR polymorphism may be a genetic marker of response to citalopram in children and adolescents with depression and/or anxiety.

Social anxiety disorder in children and adolescents: epidemiology, diagnosis, and treatment

Social anxiety disorder (SOC) is characterized by marked and persistent fear of one or more social performance situations in which the person is exposed to unfamiliar people or to possible scrutiny. The person fears that she or he might act in a way that will be humiliating or embarrassing. Children and adolescents with this disorder often have great impairment in their academic performance, social skills, peer relationships, and family life. Early diagnosis is vital. Primary care providers are in a unique situation to first diagnose and treat SOC in children and adolescents. There is evidence of successful pharmacologic and psychosocial treatment in pediatric SOC. Serotonin reuptake inhibitors, which are considered first-line medications for SOC, have shown promising results in open-label and double-blind trials. Studies have demonstrated that psychosocial treatments, specifically cognitive-behavioral therapy and group therapy, are efficacious in pediatric SOC. There is some evidence that the use of combination therapy, both pharmacology and psychosocial treatment, is beneficial in the management of pediatric SOC.

Callous-unemotional behaviors in young girls: shared and unique effects relative to conduct problems

Among girls, little is known about the shared and unique associations that callous-unemotional (CU) behaviors and conduct problems have with aspects of emotional and behavioral dysregulation and with parenting practices. This study examined these associations using a large community-based sample of young girls (N = 990). The findings revealed that hyperactivity-impulsivity and negative emotionality were positively and uniquely associated with conduct problems, but not with CU behaviors, after controlling for co-occurring conduct problems. Conduct problems were also positively associated with both generalized anxiety and panic/somatic anxiety. In contrast, CU behaviors were negatively related to generalized anxiety problems after controlling for co-occurring conduct problems. The results also indicated that conduct problems were more closely associated with harsh punishment and low parental warmth among girls with low versus high CU behaviors.

Validation of the Children's Interview for Psychiatric Syndromes (ChIPS) with psychiatrically hospitalized adolescents

OBJECTIVE

To examine the concurrent validity of the Children's Interview for Psychiatric Syndromes (ChIPS) for adolescent inpatients.

METHOD

Participants included 97 adolescents ages 12 to 18 admitted to an adolescent inpatient unit. Participants were administered the ChIPS and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (present questions only). Participants also completed self-report measures of adjustment (e.g., the Reynolds Adolescent Depression Scale-2).

RESULTS

More diagnoses were made with the ChIPS (mean 4.44) compared to the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (mean 3.04; p <.001). The percentage of agreement ranged from 59% to 98%. Kappa coefficients indicated agreement ranging from slight for oppositional defiant disorder (kappa = .18) to substantial for substance use (kappa = .66); the majority of kappa values ranged from .26 to.60. When ChIPS endorsements were examined relative to construct-specific self-report measures of impairment, adolescents diagnosed by the ChIPS with a disorder scored significantly higher than adolescents who were not diagnosed with a disorder.

CONCLUSIONS

The findings indicate moderate agreement between ChIPS diagnoses and Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version diagnoses. ChIPS diagnoses appear consistent with self-report measures of adjustment.

Capturing the dynamics of identity formation in various ethnic groups: development and validation of a three-dimensional model

The aim of this study was to develop a model of identity formation comprising three structural dimensions: commitment, in-depth exploration and reconsideration of commitment. A new tool, the Utrecht-Management of Identity Commitments Scale, was designed to assess these processes. Early and middle adolescents (N=1952) participated in this study. Confirmatory factor analyses revealed that the three-factor model provided a better fit than alternative one- and two-factor models. The model applied not only to the whole adolescent sample, but also to male and female subsamples and to early and middle adolescent age groups. Additionally, we established interethnic equivalence of the model, in that it also fit well for ethnic minority adolescents. In accordance with hypotheses, regression analyses showed that commitment, in-depth exploration and reconsideration of commitment were significantly related to measures of self and personality, psychosocial problems and parent-adolescent relations. Implications and suggestions for future research are discussed.

Psychiatric morbidity in adolescents operated in childhood for congenital cyanotic heart disease

AIM

The aim of the present study was to assess psychiatric morbidity of adolescents operated in childhood for congenital cyanotic heart disease (CCHD) and their parents.

METHODS

Participants were 31 adolescents (19 boys, 12 girls) aged 10-21 (mean +/- SD, 14.7 +/- 0.3) years, who had undergone cardiac surgery 13.7 +/- 2.48 years before the study assessment period. Twenty-two mothers and nine fathers participated in the study. Assessment tools for adolescents included: the UCLA Post Traumatic Stress Disorder-Reaction Index, The Screen for Child Anxiety Related Emotional Disorders, and The Beck Depression Inventory; for the parents: The Posttraumatic Stress Diagnostic Scale, The Spielberger State Trait Anxiety Inventory, and The Beck Depression Inventory.

RESULTS

Nine out of 31 adolescents (29.03%) were defined as 'full post-traumatic stress disorder (PTSD) likely' with a total post-traumatic stress symptom (PTSS) score significantly higher than that of the non-PTSS subgroup (P < 0.001). A non-significant trend was noted for more adolescents with 'anxiety disorder likely' (P = 0.096, NS) in the PTSS versus the non-PTSS subgroups. A non-significant trend was detected showing that on all symptom domains of PTSD, as well as on anxiety and depressive measures, parents of children with PTSS received higher scores than parents of children without PTSS (P = 0.095, 0.03, 0.04, respectively, NS).

CONCLUSION

Children undergoing cardiac surgery for CCHD may be at a high risk for long-term PTSS.

Stability and change in personality type membership and anxiety in adolescence

Although the stability and changeability of personality has long been debated, many studies now agree that personality changes over the life course. Although the changes in rank-order and mean-level stability are well established, the stability in personality type membership during adolescence is not yet clear. Little research has been conducted on the associations between change in personality type membership and anxiety. A total of 827 adolescents (10-20 years) completed personality and anxiety questionnaires on 2 waves of the CONflict And Management Of RElationships study (CONAMORE). We found that the stability in personality type membership was moderate. The change from undercontroller to overcontroller was the most frequently occurring change. Furthermore, the stability in type membership was related to stability in anxiety level and change in type membership was related to anxiety change. More specifically, the resilient-overcontroller group demonstrated an increase in anxiety level, whereas the overcontroller-resilient group demonstrated a decrease.

Depression and anxiety in children at the end of life

A significant component of palliative care is the prompt diagnosis and management of distress, anxiety, and depression. This article reviews the symptoms and treatment of anxiety and depressive disorders in children at the end of life. Distinguishing between symptoms and disorders, the importance of open communication, consideration of the child's understanding of death, diagnostic challenges in chronically ill children, and suicidality are discussed. Because treatment options are available, it is imperative that symptoms are recognized and addressed. Understanding the issues involved in screening and diagnosis and the risks and benefits of available treatments can lead to an informed approach to the management of these disorders in the palliative care setting.

[Mental health of children and adolescents in Germany. Results from the BELLA study within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]

The Mental Health Module (BELLA study) examines emotional well-being and behaviour in a representative sub-sample of 2,863 families with children aged 7 to 17 from the National Health Interview and Examination Survey for Children and Adolescents (KiGGS). The prevalence of mental health problems was determined using the Strengths and Difficulties Questionnaire (SDQ) and additional standardised screening measures. Of children and adolescents, 21.9 % (95 %CI: 19.9-24.0) showed signs of mental health problems. The psychiatric disorders observed included anxiety (10.0 %; 95 % CI: 8.7-11.6), conduct disorder (7.6 %; 95 % CI: 6.5-8.7) and depression (5.4 %; 95 % CI: 4.3-6.6). Of the risk factors examined, adverse family climate and low socioeconomic status stand out particularly as negative contributors. When several risk factors occur simultaneously, the prevalence of mental health problems increases markedly. Conversely, positive individual, family and social resources coincide with an absence of mental health problems. Children and adolescents with mental health problems display distinctly impaired health-related quality of life, and far from all of them are receiving treatment. Identifying high risk groups therefore requires the assessment of available resources in addition to the usual risk factors for mental and subjective health. Strengthening these resources should be a key objective, both in prevention and in interventions.

Are prenatal psychological or physical stressors associated with suboptimal outcomes in neonates born to adolescent mothers?

Examined whether prenatal psychological stress and/or physical stress were associated with suboptimal neonatal outcomes in a pilot study of adolescent mothers (n=20). The results provide preliminary support for associations between prenatal psychological stress and little evidence for the association between prenatal physical stress and suboptimal neonatal outcomes.

Specificity of facial expression labeling deficits in childhood psychopathology

BACKGROUND

We examined whether face-emotion labeling deficits are illness-specific or an epiphenomenon of generalized impairment in pediatric psychiatric disorders involving mood and behavioral dysregulation.

METHOD

Two hundred fifty-two youths (7-18 years old) completed child and adult facial expression recognition subtests from the Diagnostic Analysis of Nonverbal Accuracy (DANVA) instrument. Forty-two participants had bipolar disorder (BD), 39 had severe mood dysregulation (SMD; i.e., chronic irritability, hyperarousal without manic episodes), 44 had anxiety and/or major depressive disorders (ANX/MDD), 35 had attention-deficit/hyperactivity and/or conduct disorder (ADHD/CD), and 92 were controls. Dependent measures were number of errors labeling happy, angry, sad, or fearful emotions.

RESULTS

BD and SMD patients made more errors than ANX/MDD, ADHD/CD, or controls when labeling adult or child emotional expressions. BD and SMD patients did not differ in their emotion-labeling deficits.

CONCLUSIONS

Face-emotion labeling deficits differentiate BD and SMD patients from patients with ANX/MDD or ADHD/CD and controls. The extent to which such deficits cause vs. result from emotional dysregulation requires further study.

School-based intervention for prevention and treatment of elementary-students' terror-related distress in Israel: a quasi-randomized controlled trial

A school-based intervention for preventing and reducing children's posttraumatic stress-related symptoms, somatic complaints, functional impairment, and anxiety due to exposure to terrorism was evaluated. In a quasi-randomized controlled trial, elementary school students were randomly assigned to an eight-session structured program, "Overshadowing the Threat of Terrorism" or to a waiting list control comparison group. Two months postintervention, the study group reported significant improvement on all measures. The authors conclude that a school-based universal intervention may significantly reduce posttraumatic stress disorder- (PTSD-) related symptoms in children repeatedly exposed to terrorist attacks and propose that it serve as a component of a public mental health approach dealing with children exposed to ongoing terrorism in a country ravaged by war and terrorism.

A pilot randomized controlled trial of combined trauma-focused CBT and sertraline for childhood PTSD symptoms

OBJECTIVE

To examine the potential benefits of adding a selective serotonin reuptake inhibitor, sertraline, versus placebo, to trauma-focused cognitive-behavioral therapy (TF-CBT) for improving posttraumatic stress disorder and related psychological symptoms in children who have experienced sexual abuse.

METHOD

Twenty-four 10- to 17-year-old female children and adolescents and their primary caretakers were randomly assigned to receive TF-CBT + sertraline or TF-CBT + placebo for 12 weeks.

RESULTS

Both groups experienced significant improvement in posttraumatic stress disorder and other clinical outcomes from pre- to posttreatment with no significant group x time differences between groups except in Child Global Assessment Scale ratings, which favored the TF-CBT + sertraline group.

CONCLUSIONS

Only minimal evidence suggests a benefit to adding sertraline to TF-CBT. A drawback of adding sertraline was determining whether TF-CBT or sertraline caused clinical improvement for children with comorbid depression. Current evidence therefore supports an initial trial of TF-CBT or other evidence-supported psychotherapy for most children with PTSD symptoms before adding medication.

Anxiety-related biases in children's avoidant responses to a masked angry face

While anxious children often show escape and withdrawal behaviours towards threats, few studies have experimentally assessed avoidance. The present study examined whether children with high levels of anxiety showed more avoidant responses to a neutral conditioned cue (CS+) that was paired with an unconditioned threat stimulus (UCS), a masked angry facial expression. Thirty-six 10 and 11 year-olds participated in a task, which involved choosing between two CS card stimuli of different colours to win points. Whilst both cards awarded the same number of points, one colour was systematically paired with a masked angry face (CS+), whilst the other colour was paired with a masked neutral face (CS-). Children with higher anxiety scores had an overall tendency to choose the card associated with the neutral face, with some evidence suggesting that this tendency emerged gradually across trials. These results suggest a relationship between anxiety and stimulus-response learning for CS+-UCS associations that support behavioural avoidance.

Reliability and validity of the Chinese version of the multidimensional anxiety scale for children among Chinese secondary school students

The objective of the current study was to develop a Chinese translation of the Multidimensional Anxiety Scale for Children (MASC) [March (1997) Multidimensional anxiety scale for children: Technical manual, Multi health systems, Toronto, ON], and to evaluate its reliability and validity. The original version of the MASC was translated into Chinese (MASC-C) and administered to 1,538 Chinese adolescents between the ages of 14 and 19. In comparison to the American normative sample [March (1997) Multidimensional anxiety scale for children: Technical manual, Multi health systems, Toronto, ON], Chinese adolescents reported significantly higher scores on the subscales of social anxiety and separation anxiety. Girls reported higher levels of anxiety on all subscales than males. Participants between the ages of 16 and 19 reported higher scores on the physical symptoms and harm avoidance subscales. The MASC-C exhibited strong internal consistency (Cronbach's alpha coefficient was 0.91 and the mean inter-item correlation coefficient was 0.20) and moderate test-retest reliability (intra-class correlation coefficient was 0.84 over a one-month interval). MASC scores inter-correlated a small to moderate degree with measures assessing negative life events and depressive symptoms indicating acceptable convergent validity. The results of confirmatory factor analyses indicated that the four-factor structure of the MASC was suitable for the Chinese sample. The four factor structure was also invariant across sex and age. As the Chinese translation of the MASC indicated high levels of reliability and validity, the MASC-C is appropriate for assessing anxiety in Chinese adolescents.

Comparison of the PSC-17 and alternative mental health screens in an at-risk primary care sample

OBJECTIVE

To validate the 17-item version of the Pediatric Symptom Checklist (PSC-17) as a screen for common pediatric mental disorders in primary care.

METHOD

Patients were 269 children and adolescents (8-15 years old) whose parents completed the PSC-17 in primary care waiting rooms. Children were later assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). The PSC-17's subscales were compared with K-SADS-PL diagnoses and measures of anxiety, depression, general psychopathology, functioning, and impairment.

RESULTS

In receiver operating characteristics analyses, the PSC-17 subscales performed as well as competing screens (Child Depression Inventory, the parent and child Screens for Child Anxiety-Related Disorders) and Child Behavior Checklist subscales (Aggressive, Anxious-Depressed, Attention, Externalizing, Internalizing, and Total) in predicting diagnoses of attention-deficit/hyperactivity disorder, externalizing disorders, and depression (area under the curve > or =0.80). The instrument was less successful with anxiety (area under the curve = 0.68). None of the screens were highly sensitive, many were insensitive, and all would have low positive predictive value in low-risk primary care populations.

CONCLUSIONS

The PSC-17 and its subscales are briefer than alternative questionnaires, but performed as well as those instruments in detecting common mental disorders in primary care. Continued research is needed to develop brief yet sensitive assessment instruments appropriate for primary care.

Incentive-related modulation of cognitive control in healthy, anxious, and depressed adolescents: development and psychopathology related differences

BACKGROUND

Developmental changes in cognitive and affective processes contribute to adolescent risk-taking behavior, emotional intensification, and psychopathology. The current study examined adolescent development of cognitive control processes and their modulation by incentive, in health and psychopathology. Predictions include 1) better cognitive control in adults than adolescents, and in healthy adolescents than anxious and depressed adolescents, and 2) a stronger influence of incentives in adolescents than adults, and in healthy adolescents than their depressed and anxious counterparts.

METHODS

Antisaccadic eye movement parameters, which provide a measure of cognitive control, were collected during a reward antisaccade task that included parameterized incentive levels. Participants were 20 healthy adults, 30 healthy adolescents, 16 adolescents with an anxiety disorder, and 11 adolescents with major depression. Performance accuracy and saccade latency were analyzed to test both developmental and psychopathology hypotheses.

RESULTS

Development and psychopathology group differences in cognitive control were found. Specifically, adults performed better than healthy adolescents, and healthy adolescents than anxious and depressed adolescents. Incentive improved accuracy for all groups; however, incremental increases were not sufficiently large to further modulate performance. Incentives also affected saccade latencies, pushing healthy adolescent latencies to adult levels, while being less effective in adolescents with depression or anxiety. This latter effect was partially mediated by anxiety symptom severity.

CONCLUSIONS

Current findings evidence the modulation of cognitive control processes by incentives. While seen in both healthy adults and healthy adolescents, this modulatory effect was stronger in youth. While anxious and depressed adolescents exhibited improved cognitive control under incentives, this effect was smaller than that in healthy adolescents. These findings suggest differential incentive and/or cognitive control processing in anxiety and depression, and across development. Differences could result from disorder specific, or combined developmental and pathological mechanisms.

Effects of Math Anxiety and Perfectionism on Timed versus Untimed Math Testing in Mathematically Gifted Sixth Graders

This study was designed to examine the effects of math anxiety and perfectionism on math performance, under timed testing conditions, among mathematically gifted sixth graders. We found that participants had worse math performance during timed versus untimed testing, but this difference was statistically significant only when the timed condition preceded the untimed condition. We also found that children with higher levels of either math anxiety or perfectionism had a smaller performance discrepancy during timed versus untimed testing, relative to children with lower levels of math anxiety or perfectionism. There were no statistically significant gender differences in overall test performance, nor in levels of math anxiety or perfectionism; however, the difference between performance on timed and untimed math testing was statistically significant for girls, but not for boys. Implications for educators are discussed.

Phenomenology and correlates of complicated grief in children and adolescents

OBJECTIVE

To describe the phenomenology of complicated grief (CG) in parentally bereaved children and adolescents and to examine its correlates.

METHOD

This is a preliminary report from an ongoing 5-year, population-based, longitudinal study of the impact of parental loss on family members. Analyses of cross-sectional data at intake are presented. The sample consists of 129 children and adolescents of parents who died by suicide, accident, or sudden natural death. Their average age is 13.3 +/- 3.1 years (range 7-18 years). A modified version of the Inventory of Complicated Grief-Revised (ICG-R) was administered and its factor structure, internal consistency, and convergent and discriminant validity were examined.

RESULTS

CG was significantly related to functional impairment even after controlling for current depression, anxiety, and posttraumatic stress disorder. CG was also associated with other measures of psychopathology, including suicidal ideation.

CONCLUSIONS

In this preliminary analysis, CG appears to be a clinically significant syndrome in children and adolescents. Longitudinal data will help to clarify the prognostic significance of CG as well as to examine the interrelationship of CG and other psychopathology over time.

Pubertal status and emotional reactivity to a voluntary hyperventilation challenge predicting panic symptoms and somatic complaints: a laboratory-based multi-informant test

The main and interactive effects of pubertal status and emotional reactivity to bodily sensations elicited by a voluntary hyperventilation challenge were examined in relation to panic symptoms and self- and parent-reported somatic complaints among 123 (56 females) adolescents between the ages of 12 and 17 years (M(age) = 15.05; SD = 1.50). As expected, after controlling for baseline anxiety, age, and gender, there was a significant interaction between pubertal status and challenge response in predicting the outcome variables. Specifically, adolescents reporting more advanced pubertal status and greater reactivity to the challenge evidenced greater levels of panic symptoms and somatic complaints, whereas pubertal status had relatively less of an effect on these variables among adolescents who did not respond as fearfully to the challenge. Results are discussed in terms of extant theory and research on anxiety vulnerability among adolescents.

Does the level of expressed emotion (LEE) questionnaire have the same factor structure for adolescents as it has for adults?

BACKGROUND

The level of expressed emotion (LEE) is a four-factor questionnaire that measures expressed emotion (EE) as perceived by the recipient. These factors are: perceived lack of emotional support, perceived intrusiveness, perceived irritation, and perceive criticism. The four factors of the LEE has previously been found to be related to psychological disorders and has good psychometric properties for adults. However, it has not previously been studied in adolescent populations.

METHODS

A total of 311 adolescents participated in this study. Using structural equation modeling, confirmatory factor analyses were conducted to examine if the LEE also had the same four-factor structure for adolescents as it does for adults.

RESULTS

The confirmatory factor analyses demonstrated that the LEE's four-factor structure also applied to adolescents. The internal consistency of the scales were good and all the inter-correlations between the scales were significant. Additionally, the factors were significantly correlated to adolescent depressive and anxiety symptom score dimensions.

CONCLUSION

These findings seem to indicate that the LEE may be a good instrument in the measurement of adolescents perceived EE.

Childhood anxiety in a diverse primary care population: parent-child reports, ethnicity and SCARED factor structure

OBJECTIVE

To explore in a multiethnic primary care population the impact of child gender and of race/ethnicity on parent and child reports of school-age anxiety and on the factor structure of the Screen for Childhood Anxiety and Related Emotional Disorders (SCARED).

METHOD

A consecutive sample of 515 children (8 to <13 years) and their parent presenting for primary care completed self-report (C) and parent-report (P) versions of the SCARED-41.

RESULTS

Neither SCARED scores nor parent-child difference varied significantly with race/ethnicity. Predictors of higher SCARED scores were less parental education, younger child age and female gender. Exploratory factor analysis conducted separately for SCARED-C and SCARED-P yielded four factors. There was large variation in factor structure between SCARED-C and SCARED-P and across ethnic and gender subgroups, greatest for somatic/panic/generalized anxiety and Hispanic children.

CONCLUSIONS

Primary care triage of anxious children requires data from both the parent and child and must go beyond cross-sectional symptom inventories. Clinicians must elicit from each family their perhaps culturally bound interpretation of the child's somatic and psychological symptoms.

Reliability and validity of parent and child versions of the multidimensional anxiety scale for children in community samples

OBJECTIVE

To evaluate the psychometric properties of the Multidimensional Anxiety Scale for Children (MASC), which measures physical symptoms, harm avoidance, social anxiety, and separation/panic.

METHOD

Using a community sample of Australian children (8-13 years old), the internal stability, factor structure, and convergent validity of child- and parent-report versions of the MASC were examined. A total of 499 children participated at time 1, which represented 18% of children invited to participate; 91% were retained at 12-month follow-up.

RESULTS

Moderate to strong internal reliability was exhibited across all MASC subscales, and support was found for the original four-factor structure of the measure. A higher-order anxiety factor was found to account for the intercorrelation between the four factors. Low parent-child agreement was found on the MASC, whereas correlations between the MASC and the Spence Children's Anxiety Scales demonstrated good convergent validity within reporter (excepting the harm avoidance scale). Scores over a 12-month period showed greater stability for parent reports than for child reports.

CONCLUSIONS

This study is the first to demonstrate that the factor structure of the MASC holds for both child and parent reports of anxiety. The MASC is useful for directly comparing symptom reporting across children and parents during clinical assessment.

Assessing gene-environment interactions on anxiety symptom subtypes across childhood and adolescence

Consistent evidence shows both genetic and stress-related risks on child and adolescent anxiety, yet few studies have considered the degree to which genetic effects are moderated by stress (gene-environment interaction). We used longitudinal data from both a child and adolescent sample of twins to examine three novel issues on the presence of gene-environment interaction on anxiety symptoms. First, we assessed moderation of genetic risks on anxiety symptoms by negative life events in each age group. Second, by distinguishing between "stable" and "age-specific" genetic factors, we explored the continuity of gene-environment interaction across time and/or its emergence at specific ages. Third, we compared the presence of gene-environment interaction across different symptom types (general, panic, social, and separation). Genetic effects on separation anxiety symptoms in childhood (mean age = 8 years, 6 months) and panic anxiety symptoms in adolescence (mean age = 15 years) increased across independent negative life events. Shared environmental effects on separation anxiety symptoms and non shared environmental effects on general anxiety symptoms in adolescence were also moderated by negative life events. We interpret these preliminary findings tentatively in the context of gene-environment interaction on anxiety in general, and on early separation and later panic anxiety in particular.