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

Prevalence and associated factors of school bullying among adolescents in Inner Mongolia, China

Background

Although studies in China have found that school bullying is prevalent among adolescents, most relevant research has focused on southern China, while research in northern China is limited. This study aimed to explore ethnic disparities in the socio-demographic determinants of school bullying in Inner Mongolia, a northern region of China.

Methods

A cross-sectional study was conducted among 2891 adolescents in Inner Mongolia, China, from September to December 2022. Data on participants' sociodemographic characteristics and school bullying experiences were collected through questionnaires. Multivariate logistic regression analyses, stratified by ethnicity, were employed to examine factors associated with school bullying. Furthermore, subgroup analyses and interaction tests were conducted to explore potential effect modifiers of the relationship between ethnicity and bullying.

Results

The prevalence of school bullying was 18.99 % (549/2891) overall, with 17.96 % (420/2339) among Han and 23.37 % (129/552) among ethnic minorities. Minority adolescents faced a higher risk of bullying compared to Han (OR = 1.35, 95 % CI: 1.08-1.69, P < 0.05). Middle school students were more vulnerable to bullying than high school students (OR = 1.25, 95%CI:1.03-1.52, P < 0.05). Among Han adolescents, having a mother with high school education was protective against bullying (OR = 0.71, 95 % CI: 0.54-0.93, P < 0.05), while it was an associated factor for minorities (OR = 2.06, 95%CI:1.23-3.46, P < 0.05). Good family economic status was an associated factor for bullying among Han (OR = 1.62, 95%CI: 1.11-2.36, P < 0.05), but not among minorities. Belonging to other family structures (remarriage/foster family, intergenerational families, live with relatives and elders) was an associated factor for minorities (OR = 2.60, 95 % CI: 1.37-4.92, P < 0.05), but not for Han. Subgroup analyses revealed significant ethnic disparities in bullying experiences among middle school students, those from nuclear family, other family, and fair economic backgrounds (all P < 0.05). Interaction effects between ethnicity and these variables were not significant (all P > 0.05).

Limitations

This cross-sectional study has limitations in establishing causal relationships between identified associated factors and school bullying.

Conclusions

Ethnic minority adolescents in Inner Mongolia, China, especially middle school students, face a higher risk of school bullying than their Han peers. The differential impact of maternal education, family economic status, and family structure on bullying risk between Han and minority adolescents underscores the need for culturally sensitive, targeted interventions that consider the unique challenges faced by ethnic minority students.

If I Share With You, Will You Share With Me? A Quasi-Experimental Study on Social Anxiety and Self-Disclosure in Dictator Game

Social anxiety is characterized by a constant fear of negative evaluation, falling short of standards, low perceived likeability, and difficulties meeting social criteria. Using a quasi-experiment and a zero-acquaintance paradigm, this paper examines sharing behavior, which is represented by the willingness to give money in a Dictator Game. It explores gender and social anxiety differences related to this behavior, in terms of who is prone to receive more money. In addition to this, we investigated how the receiver's self-disclosure (positive or negative) influences the dictators' sharing behavior. Based on the original version of Dictator Game, involving a dictator and a receiver, one hundred and five adolescents aged 12-15, played Dictator Game in which they divided coins between themselves and the receiver. Our findings indicate that self-disclosure led to positive and gradual changes for non-anxious speakers. The anxious boy consistently achieved the highest money rate among all speakers, while the anxious girl received the lowest. However, her self-disclosure resulted in an increase in receiving. Across all situations, respondents reported slightly increased feelings of guilt and shame. Taken together, this study sheds light on adolescents' giving behavior by examining the interaction between adolescents' social traits and diverse social contexts throughout their developmental stages, ultimately influencing prosocial decision-making.

Childhood ADHD With and Without Co-occurring Internalizing/Externalizing Problems: Prospective Predictions of Change in Adolescent Academic and Social Functioning

OBJECTIVE

Internalizing and externalizing problems predict poor academic and social outcomes. However, ADHD co-occurs with internalizing and externalizing problems and is itself a risk factor, thus preventing precise inferences. This study evaluated childhood anxiety, depression, and aggression as predictors of change in adolescent academic and social outcomes, including moderation by childhood ADHD.

METHODS

182 ethnically-diverse 5- to 11-year-old youth with (54.7%) and without (45.3%) ADHD completed a separate baseline and 6- to 7-year prospective follow-up assessment, consisting of parallel measures across youth psychopathology, academic functioning (i.e., academic achievement, school competence), and friendship quality domains.

RESULTS

Whereas childhood ADHD inversely predicted academic competence, depression and aggression uniquely predicted worsening friendship quality. Interestingly, anxiety was unrelated to change in academic and friendship outcomes; similarly, neither ADHD, depression, nor aggression predicted change in objectively-measured academic achievement from a standardized assessment.

CONCLUSION

Implications for intervention and prevention are considered, including school-based approaches, within a developmental psychopathology framework.

Population-Based Teacher-Rated Assessment of Anxiety Among Canadian Kindergarten Children

Despite anxiety being a prevalent mental health problem in children, little data exist on the pervasiveness and levels of anxiety symptoms in kindergarteners. Data from the Early Development Instrument, a teacher-completed, population-level measure of child development, were collected across Canada from 2004 to 2015. The final analytic sample consisted of 974,319 children of whom 2.6% were classified as "highly anxious". Compared to children who exhibited "few to none" anxious behaviors, highly anxious children were more likely to be male, have English/French as a second language, and have a special needs designation. Furthermore, compared with their less anxious peers, highly anxious children had between 3.5 and 6.1 higher odds of scoring below the 10th percentile cut-off in physical, social, language/cognitive and communication domains. Our findings suggest that anxious behaviors are related to children's overall health and illustrate the consistency and extensiveness of anxiety at a very young age among Canadian children.

The Utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System and Strengths and Difficulties Questionnaire in Predicting Mental Disorders in the Project to Learn About Youth-Mental Health

We examined the predictive utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System (BASC-2-BESS) and Strengths and Difficulties Questionnaire (SDQ) in identifying students with a mental disorder. Data were collected in a two-stage study over 34 months with kindergarten-12th grade (K-12) students (aged 5-19 years) in four U.S. school districts. In Stage 1, teachers completed the BASC-2-BESS and the SDQ. In Stage 2, parents of 1,054 children completed a structured diagnostic interview to determine presence of a mental disorder. Results suggest that teacher versions of the BASC-2-BESS and SDQ have modest utility in identifying children meeting criteria for a mental disorder based on parent report. Area Under the Curve (AUC) statistics representing prediction of any externalizing disorder (.73 for both measures) were higher than the AUCs predicting any internalizing disorder (.58 for both measures). Findings can inform the use of teacher report in mental health screening, specifically the selection of measures when implementing screening procedures.

Impact of Psychotherapy for Children and Adolescents with Anxiety Disorders on Global and Domain-Specific Functioning: A Systematic Review and Meta-analysis

A substantial empirical base supports the use of psychotherapy to alleviate anxiety symptoms and diagnoses in children and adolescents. However, focusing only on symptom or diagnostic reduction provides an incomplete picture of clinically meaningful efficacy given that anxiety disorders in this age group are integrally associated with problems in functioning. A systematic review and meta-analysis (N studies = 40, N participants = 3094) evaluating the impacts of psychotherapy for anxiety was conducted on the following outcomes: global functioning, social functioning, academic functioning, and school attendance. Randomised controlled trials with a passive control condition, a child and/or adolescent sample (7-17 years) with a primary anxiety diagnosis, and receiving anxiety-focused psychotherapy were eligible for inclusion if they reported suitable outcome data. Results from the meta-analysis indicated that from pre- to post-treatment, psychotherapy led to significant improvements in global functioning according to clinician (d = 1.55), parent (d = 0.67), and child (d = 0.31) reports and on social functioning according to parent (d = 0.51), but not child (d = 0.31) reports. The qualitative review provided preliminary support psychotherapy's efficacy in increasing family functioning and school attendance, but not so much in enhancing academic performance. These results indicate that psychotherapy improves daily functioning in anxious children and adolescents. The study also highlighted the limited attention paid to measures of functioning in the empirical literature on treatment of childhood anxiety.Trial Registry: This study is registered with PROSPERO under the identification number CRD42021246565.

COVID-19 and mental health disorders in children and adolescents (Review)

The new coronavirus has been present for two years and has had a widespread and sustained impact worldwide. There is growing evidence in the literature that COVID-19 may have negative effects on mental illness in patients and in healthy populations. The unprecedented changes brought about by COVID-19, such as social isolation, school closures, and family stress, negatively affect people's mental health, especially that of children and adolescents. The purpose of this paper is to review the literature and summarize the impact of COVID-19 disorders on children's and adolescents' mental health, the mechanisms and risk factors, screening tools, and intervention and prevention. We hope that the mental dysfunction caused by the pandemic will be mitigated through appropriate and timely prevention and intervention.

Prevalence of elevated anxiety symptoms among children in quarantine with COVID-19 infection in the State of Qatar: A cross-sectional study

Background

Children are particularly vulnerable to the psychological effects of the COVID-19 pandemic. The disruption in daily life has impacted children significantly. Moreover, the increased worrying associated with the probability of getting infected or becoming seriously unwell due to infection can potentially precipitate anxiety disorders among children.

Objective

This study aimed to determine rates of elevated anxiety symptoms in children with COVID-19 infection. It also explored whether there were any differences in terms of age, gender, and residency status.

Method

A cross-sectional, questionnaire-based study with 88 participants (children aged 7-13 years, 54.5% males, 45.5% females) from two institutional quarantine centers. The Spence Children's Anxiety Scale and its validated Arabic version (self-reported questionnaires) were used to measure anxiety symptoms.

Results

36.3% children reported elevated anxiety symptoms. A lower rate of 32.8% was reported in younger children (7-11 years) compared to 45.8% in older children (12 and 13 years). 70.4% and 57.9% children reported physical injury fears and separation anxiety respectively. A higher prevalence of overall anxiety was reported in children from expatriate families (40.6%) compared to native children (25%). The difference in the mean scores between the expatriate and native group of children was found statistically significant for obsessive-compulsive symptoms.

Conclusions

The prevalence of elevated anxiety symptoms among children in quarantine with COVID-19 infection can be much higher than that reported in the general population. Older children can have elevated anxiety symptoms more commonly than their younger counterparts can. Expatriate children are likely to be more vulnerable to the psychological impact of the pandemic compared to children from local families. Our results suggest the crucial need of focusing on the psychological impact of COVID-19 pandemic on children. The prioritization and effective management of the mental health needs of children should be a vital component of the overall, global response to the pandemic.

Negative Life Events as Predictors of Anxiety Outcomes: An Examination of Event Type

Long-term follow-up studies of anxiety treatment have found that greater exposure to negative life events (NLEs) predicts poorer anxiety outcomes, but none have examined whether specific types of NLEs are differentially associated with child outcomes. This study examined the frequency of NLEs and whether specific types of NLEs were associated with increased risk of having an anxiety disorder 6.5 years post randomization. Participants were 319 adolescents and adults, ages 11 to 26 (M = 17), enrolled in Child/Adolescent Anxiety Multimodal Extended Long-term Study. At their first follow-up visit, participants completed a diagnostic interview and a 40-item Life Events Scale that reflected whether specific events occurred since their last post treatment assessment. Life events were categorized into domains (i.e., family, academic, health, and social) via researcher consensus. Participants reported having experienced an average of four NLEs. Participants with an anxiety disorder at follow-up were significantly more likely to have failed a grade in school (OR = 5.9) and experienced a negative change in acceptance by peers (OR = 4.9; ps < 0.001). After controlling for gender, age, race, and SES, a greater number of NLEs in the academic domain increased the odds of having an anxiety disorder at follow-up (OR = 2.4, p < 0.001). No other domains were predictive of disorder status at follow-up. Findings highlight the value of examining specific NLEs in relation to the long-term child anxiety outcomes.

The Relation between Specific Parenting Behaviors and Toddlers' Early Anxious Behaviors is Moderated by Toddler Cortisol Reactivity

Differential susceptibility theory posits that neurobiological reactivity (e.g., cortisol levels) should be considered as an individual index of susceptibility to both positive and negative environments. The current investigation separately examines cortisol reactivity and total concentration in toddlerhood as moderators of the longitudinal relation between maternal protection and encouragement of independence and increases or decreases in observed anxious behaviors, respectively. A total of 119 mother-toddler dyads participated in a laboratory visit when toddlers were 12- to 18-months-old. Mothers reported on their parenting behaviors and toddlers participated in a novelty episode from which their anxious behaviors were coded. Toddlers provided three saliva samples, yielding measures of cortisol reactivity and total cortisol concentration. One year later, dyads returned to the laboratory where toddlers participated in another novelty episode to observationally assess anxious behaviors. Results revealed that maternal protection tended to relate to greater increases in anxious behaviors one year later only for toddlers who displayed high cortisol reactivity. Cortisol reactivity also moderated the relation between maternal encouragement of independence and change in toddler anxious behaviors, with this parenting behavior relating to greater decreases in anxious behaviors only for toddlers with high cortisol reactivity. Results examining total cortisol concentration as a moderator were not significant. Results suggest the importance of considering toddler cortisol reactivity a context of susceptibility when examining the longitudinal relation between parenting behaviors and the development of anxious behaviors in toddlerhood.

Mechanisms Through Which a Family Caregiver Coaching Intervention Might Reduce Anxiety Among Children in Military Households

OBJECTIVES

Children of injured or disabled veterans and service members may be at risk for mental health and adjustment problems due to household stress. Yet, there are few widely available interventions to address the needs of this population. Reducing distress and improving coping skills of the parent who cares for the injured or disabled adult may improve child outcomes. This paper examines whether changes in caregiver psychosocial outcomes after a caregiver coaching intervention are associated with decreases in child anxiety.

METHODS

Using programmatic data collected between 2015 and 2019 from participants in a family caregiver coaching intervention (170 caregivers, 294 children), we apply linear mixed models to assess associations between changes in family caregiver well-being, including problem solving, depressive symptoms, burden, health complaints and quality of life, and changes in parent-reported child anxiety.

RESULTS

The baseline median Spence Children's Anxiety Scale-Parent score was 17; children aged 6-11 had slightly higher scores. Child anxiety scores decreased on average 2.8 points (SD 8.4) between baseline and follow-up. In adjusted models, decreases in caregiver depressive symptoms and health complaints were associated with decreases in child anxiety. Caregiver problem-solving skills, quality of life, and subjective burden were not associated with changes in child anxiety.

CONCLUSION

Family caregiver-focused interventions that decrease caregiver stress may positively affect children in the household. Few resources are directed at military children; therefore, practitioners should consider ways to leverage caregiver interventions to address child well-being, such as incorporating information on parenting strategies and addressing issues faced by military children.

Maternal Accuracy for Children's Fearful Distress in Toddlerhood and Kindergarten: Moderation of a Serial Indirect Effect by Toddler Fearful Temperament

OBJECTIVE

Drawing on existing literature concerning the interrelations among toddler fearful temperament, maternal protective parenting, and maternal cognitions, the current study sought to test how mothers' abilities to predict their children's distress expressions and behaviors in future novel situations ("maternal accuracy"), may be maintained from toddlerhood to children's kindergarten year.

DESIGN

A sample of 93 mother-child dyads completed laboratory assessments at child age 2 and were invited back for two laboratory visits during children's kindergarten year. Fearful temperament, age 2 maternal accuracy, and protective behavior were measured observationally at age 2, and children's social withdrawal and kindergarten maternal accuracy were measured observationally at the follow-up kindergarten visits.

RESULTS

We tested a moderated serial mediation model. For highly fearful children only, maternal accuracy may be maintained because it relates to protective parenting, which predicts children's social withdrawal, which feeds back into maternal accuracy.

CONCLUSIONS

Maternal accuracy may be maintained across early childhood through the interactions mothers have with their temperamentally fearful children. Given concurrent measurement of some of the variables, the role of maternal cognitions like maternal accuracy should be replicated and then further considered for inclusion in theories and studies of transactional influences between parents and children on development.

School functioning and internalizing problems in young schoolchildren

Background

Symptoms of anxiety and depression are common mental health problems in children and are often referred to as internalizing symptoms. Youth with such symptoms are at greater risk for poor academic achievement, school non-completion, and future mental health problems, all of which, lead to public health consequences and costs to society. The aim of the current study was to investigate associations between young school children’s internalizing symptoms and school functioning, as assessed separately by the teachers and the children.

Methods

This study is a cross-sectional study including children (N = 750. 58% girls) from the ages of 8–12 years with elevated levels of self-reported symptoms of anxiety (MASC-C) and/or depression (SMFQ). Teachers reported the academic achievement, school adaptation (TRF) and internalizing symptoms (BPM-T) of the children. Associations were analyzed using linear regression analyses.

Results

Both teacher-reported internalizing symptoms and children’s self-reported depressive symptoms were associated with poor academic achievement and school adaptation, while self-reported symptoms of anxiety were not. Symptoms of depression as assessed by the children were associated with teacher-rated internalizing symptoms, while self-reported symptoms of anxiety were not.

Conclusion

We found negative associations between school functioning and internalizing symptoms, as assessed by both the teachers and the children. The dual findings strengthen the validity of these relationships. Thus, prevention of depressive and anxiety symptoms in children may lead to positive changes in school domains such as academic achievement and school adaptation. We also identified a negative association between teacher-rated internalizing symptoms and children’s self-report of depressive symptoms, indicating that teachers may have difficulties recognizing children with these symptoms.

Trial registration

Clinical Trials NCT02340637, Registered on June 12, 2014, Retrospectively registered.

Future Directions for Research on Early Intervention for Young Children at Risk for Social Anxiety

Anxiety disorders are common among young children, with earlier onset typically associated with greater severity and persistence. A stable behaviorally inhibited (BI) temperament and subsequent shyness and social withdrawal (SW) place children at increased risk of developing anxiety disorders, particularly social anxiety. In this Future Directions article, we briefly review developmental and clinical research and theory that point to parenting and peer interactions as key moderators of both the stability of BI/SW and risk for later anxiety, and we describe existing interventions that address early BI/SW and/or anxiety disorders in young children. We recommend that future research on early intervention to disrupt the trajectory of anxiety in children at risk (a) be informed by both developmental science and clinical research, (b) incorporate multiple levels of analysis (including both individual and contextual factors), (c) examine mediators that move us closer to understanding how and why treatments work, (d) be developed with the end goal of dissemination, (e) examine moderators of outcome toward the goal of treatment efficiency, (f) consider transdiagnostic or modular approaches, (g) integrate technology, and (h) consider cultural norms regarding BI/SW/anxiety and parenting.

An Investigation of Executive Functioning in Pediatric Anxiety

Although science's understanding (e.g., etiology, maintaining factors, etc.) of pediatric anxiety and related problems has grown substantially over recent years, several aspects to anxiety in youths remain elusive, particularly with relation to executive functioning. To this end, the current study sought to examine several facets to executive functioning (i.e., cognitive flexibility, inhibition, planning, working memory) within a transdiagnostic sample of youths exhibiting varying degrees of anxiety symptoms. One hundred six youths completed a comprehensive battery, including several self-report measures (e.g., Multidimensional Anxiety Scale for Children [MASC] or MASC-2) and an automated neurocognitive battery of several executive functioning tasks (Intradimensional/Extradimensional [IDED], Stop Signal [SST], Spatial Span [SSP], Stockings of Cambridge [SOC] tasks). Regression analyses indicated that youths exhibiting marked anxiety symptoms demonstrated increased planning time and probability of inhibition compared with youths with minimal or no anxiety symptoms. Youths with marked anxiety symptoms similarly demonstrated better cognitive flexibility (i.e., set shifting) compared with youths with minimal anxiety. In addition, analyses indicated a trend such that youths exhibiting marked anxiety symptoms demonstrated poorer working memory compared with youths with no anxiety symptoms. Group classification did not predict remaining outcomes. Limitations and future areas of research are discussed.

Mental health difficulties and academic attainment: Evidence for gender-specific developmental cascades in middle childhood

We present a developmental cascade model of the longitudinal relationships between internalizing symptoms, externalizing problems, and academic performance in middle childhood, utilizing a large sample (N = 1,771) from the United Kingdom in a 3-year, cross-lag design. Three hypotheses were tested: adjustment erosion, academic incompetence, and (cumulative) shared risk. In addition, we sought to examine whether developmental cascade pathways varied across gender, while also statistically exploring indirect, mediation pathways. Structural equation models that accounted for within-time covariance, data nesting, and temporal stability provided evidence of gender-specific effects as follows: externalizing-attainment adjustment erosion pathways were found only in boys, while attainment-internalizing/externalizing academic incompetence pathways were found only in girls. Analysis of mediation pathways provided further support for these gender-specific longitudinal profiles. Protective longitudinal internalizing-externalizing and externalizing-internalizing pathways were found for both boys and girls. Finally, while it improved model fit for both genders, the influence of cumulative shared risk on the aforementioned pathways was relatively meager, substantively affecting only one (externalizing-attainment adjustment erosion pathway in boys). The implications of these findings are discussed, and study limitations noted.

Emotional Competence and Anxiety in Childhood and Adolescence: A Meta-Analytic Review

Anxiety is conceptualized as a state of negative emotional arousal that is accompanied by concern about future threat. The purpose of this meta-analytic review was to evaluate the evidence of associations between emotional competence and anxiety by examining how specific emotional competence domains (emotion recognition, emotion expression, emotion awareness, emotion understanding, acceptance of emotion, emotional self-efficacy, sympathetic/empathic responses to others' emotions, recognition of how emotion communication and self-presentation affect relationships, and emotion regulatory processes) relate to anxiety in childhood and adolescence. A total of 185 studies were included in a series of meta-analyses (N's ranged from 573 to 25,711). Results showed that anxious youth are less effective at expressing (r = -0.15) and understanding emotions (r = -0.20), less aware of (r = -0.28) and less accepting of their own emotions (r = -0.49), and report less emotional self-efficacy (r = -0.36). More anxious children use more support-seeking coping strategies (r = 0.07) and are more likely to use less adaptive coping strategies including avoidant coping (r = 0.18), externalizing (r = 0.18), and maladaptive cognitive coping (r = 0.34). Emotion acceptance and awareness, emotional self-efficacy, and maladaptive cognitive coping yielded the largest effect sizes. Some effects varied with children's age. The findings inform intervention and treatment programs of anxiety in youth and identify several areas for future research.

Anxiety in adolescence. Can we prevent it?

BACKGROUND

Emotions are potent modulators and motivators of the behaviour that the individual displays in the different situations they have to live and they can act as a protection factor or vulnerability of the adapted or maladaptive behaviour. This study focuses on anxiety in adolescence.

OBJECTIVES

The objective is, through a longitudinal study, to analyse the psychological processes and emotions that facilitate the symptoms of anxiety and those which protect the adolescent from these symptoms.

MATERIAL AND METHODS

417 adolescents (192 boys and 225 girls) participated in a three-wave longitudinal study in Valencia, Spain. In the first wave, adolescents were either in the third year of secondary school (81 boys and 85 girls) or the fourth year of secondary school (111 boys and 140 girls). The mean age was 14.70 (SD = 0.68; range = 13-17 years). This study monitored participating adolescents for three years.

RESULTS

The results indicate a differential profile in the evaluated emotions according to sex, with the girls being the ones to experiment more anxiety and more empathy, while the boys show more emotional instability and aggression.

CONCLUSIONS

It is concluded that the best predictors for anxiety are anger state, aggressive behaviour, empathic concern together with the lack of coping mechanisms focused on problem solving and the perception of stress as a threat.

Social Anxiety and Mental Health Service Use Among Asian American High School Students

Asian American adults endorse more symptoms of social anxiety (SA) on self-report measures than European Americans, but demonstrate lower prevalence rates of SA disorder in epidemiological studies. These divergent results create ambiguity concerning the mental health needs of Asian Americans. The present study is the first to investigate this issue in adolescents through assessment of self-reported SA in Asian American high school students. Parent and self-ratings of impairment related to SA and self-reported mental health service use for SA were also measured. Asian American students endorsed a greater number of SA symptoms and scored in the clinical range more frequently than other ethnic groups. Also, Asian American and Latino students endorsed more school impairment related to SA than other ethnic groups. No differences in parent-reported impairment or service utilization were identified. Implications for future research and treatment for SA among Asian American adolescents are discussed.

Mental health problems in adolescents with cochlear implants: peer problems persist after controlling for additional handicaps

The aims of the present multi-center study were to investigate the extent of mental health problems in adolescents with a hearing loss and cochlear implants (CIs) in comparison to normal hearing (NH) peers and to investigate possible relations between the extent of mental health problems of young CI users and hearing variables, such as age at implantation, or functional gain of CI. The survey included 140 adolescents with CI (mean age = 14.7, SD = 1.5 years) and 140 NH adolescents (mean age = 14.8, SD = 1.4 years), their parents and teachers. Participants were matched by age, gender and social background. Within the CI group, 35 adolescents were identified as “risk cases” due to possible and manifest additional handicaps, and 11 adolescents were non-classifiable. Mental health problems were assessed with the Strengths and Difficulties Questionnaire (SDQ) in the versions “Self,” “Parent,” and “Teacher.” The CI group showed significantly more “Peer Problems” than the NH group. When the CI group was split into a “risk-group” (35 “risk cases” and 11 non-classifiable persons) and a “non-risk group” (n = 94), increased peer problems were perceived in both CI subgroups by adolescents themselves. However, no further differences between the CI non-risk group and the NH group were observed in any rater. The CI risk-group showed significantly more hyperactivity compared to the NH group and more hyperactivity and conduct problems compared to the CI non-risk group. Cluster analyses confirmed that there were significantly more adolescents with high problems in the CI risk-group compared to the CI non-risk group and the NH group. Adolescents with CI, who were able to understand speech in noise had significantly less difficulties compared to constricted CI users. Parents, teachers, and clinicians should be aware that CI users with additionally special needs may have mental health problems. However, peer problems were also experienced by CI adolescents without additional handicaps.

Identification of Social Anxiety in Schools: The Utility of a Two-Step Screening Process

Social anxiety disorder (SAD) is highly prevalent yet largely undetected and untreated in adolescents despite the availability of effective treatments. Implementing interventions in schools enhances recognition and access to treatment for SAD. However, without reliable means to accurately identify youth in need of services, school-based interventions are not feasible. The purpose of this study is to evaluate the utility of a two-step, school-based screening approach to identify youth with SAD. Students at three public high schools were screened with self-report questionnaires or nominated by school personnel. Subsequently, a brief telephone assessment of student symptoms was completed with students' parents. Results showed that using both questionnaires and telephone assessments yielded acceptable detection rates, while school staff nominations were not beneficial. This study provides support for the use of a two-step screening procedure consisting of student self-reports followed by brief parent telephone interviews to identify youth with clinically impairing social anxiety. Implications for enhancing school-based detection of and intervention for socially anxious adolescents are discussed.

Cross-cultural adaptation of the Spence Children's Anxiety Scale in Malaysia

Introduction: Anxiety among children has increased in recent years. Culturally adapted questionnaires developed to measure the level of anxiety are the best screening instruments for the general population. This study describes the scientific translation and adaptation of the Spence Children's Anxiety Scale (SCAS) into the Malay language.Method: The process of scientific translation of this selfreport instrument followed the guidelines of the Task Force for Translation and Cultural Adaptation of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR).Results: The Malay version and its adaptation for a new cultural context are described.Conclusion: The Malay version achieved the aims of the original version and its conceptual and operational equivalence. It may be used as the first Malay instrument to measure anxiety among children in research and in clinical and community settings.

Assessment of anxiety symptoms in school children: a cross-sex and ethnic examination

We evaluated the cross-sex and -ethnic (Hispanic/Latino, non-Hispanic White) measurement invariance of anxiety symptoms based on the Spence Children's Anxiety Scale (SCAS) as well as SCAS anxiety symptoms' correspondence with scores on the 5-item Screen for Child Anxiety Related Emotional Disorders (SCARED) and teacher ratings of child anxiety. Based on data corresponding to 702 children (M age = 9.65, SD = 0.70; 51.9 % girls; 55 % Hispanic/Latino), findings showed some sex and ethnic variations in SCAS measured anxiety at the item and scale levels. Moreover, SCAS correspondence to the 5-item SCARED was found across ethnicity and sex. SCAS correspondence to teacher ratings was found for non-Hispanic White boys and non-Hispanic White girls, marginally in Hispanic/Latino boys, and poorly in Hispanic/Latino girls.

Consultants' perceptions of school counselors' ability to implement an empirically-based intervention for adolescent social anxiety disorder

Social anxiety is highly prevalent but goes untreated. Although school-based CBT programs are efficacious when delivered by specialized psychologists, it is unclear whether school counselors can implement these interventions effectively, which is essential to promote sustainable school programs. We present an initial consultation strategy to support school counselor implementation of group CBT for social anxiety and an evaluation of counselors' treatment fidelity. Counselors were highly adherent to the treatment, but competence varied based on measurement. Counselors and consultants demonstrated good agreement for adherence, but relatively modest correspondence in competence ratings. We discuss future directions for school-based implementation efforts informed by these initial findings.

Prevalence, comorbidity and predictors of anxiety disorders in children and adolescents in rural north-eastern Uganda

BACKGROUND

Child and adolescent anxiety disorders are the most prevalent form of childhood psychopathology. Research on child and adolescent anxiety disorders has predominantly been done in westernized societies. There is a paucity of data on the prevalence, comorbidity, and predictors of anxiety disorders in children and adolescents in non-western societies including those in sub-Saharan Africa. This paper investigates the prevalence, comorbidity, and predictors of anxiety disorders in children and adolescents in north-eastern Uganda.

OBJECTIVE

To determine the prevalence of DSM-IV anxiety disorders, as well as comorbidity patterns and predictors in children and adolescents aged 3 to 19 years in north-eastern Uganda.

METHODS

Four districts (Lira, Tororo, Kaberamaido and Gulu) in rural north-eastern Uganda participated in this study. Using a multi-stage sampling procedure, a sample of 420 households with children aged 3-19 years from each district was enrolled into the study. The MINI International Neuropsychiatric Interview for children and adolescents (MINI KID) was used to assess for psychiatric disorders in 1587 of 1680 respondents.

RESULTS

The prevalence of anxiety disorders was 26.6%, with rates higher in females (29.7%) than in males (23.1%). The most common disorders in both males and females were specific phobia (15.8%), posttraumatic stress disorder (PTSD) (6.6%) and separation anxiety disorder (5.8%). Children below 5 years of age were significantly more likely to have separation anxiety disorder and specific phobias, while those aged between 14-19 were significantly more likely to have PTSD. Anxiety disorders were more prevalent among respondents with other psychiatric disorders; in respondents with two or more co-morbid psychiatric disorders the prevalence of anxiety disorders was 62.1%. Predictors of anxiety disorders were experience of war trauma (OR = 1.93, p < 0.001) and a higher score on the emotional symptom scale of the SDQ (OR = 2.58, p < 0.001). Significant socio-demograghic associations of anxiety disorders were found for female gender, guardian unemployment, living in permanent housing, living without parents, and having parents without education.

CONCLUSION

The prevalence of anxiety disorders in children and adolescents in rural north-eastern Uganda is high, but consistent in terms of gender ratio and progression over time with a range of prior work in other contexts. Patterns of comorbidity and predictors of anxiety disorders in this setting are also broadly consistent with previous findings from western community studies. Both psychosocial stressors and exposure to war trauma are significant predictors of anxiety disorders.Prevention and treatment strategies need to be put in place to address the high prevalence rates of anxiety disorders in children and adolescents in Uganda.

Trends, correlates, and disease patterns of antidepressant use among children and adolescents in Taiwan

The authors used a population-based database to investigate antidepressant use among children and adolescents in Taiwan. The National Health Research Institutes provided a database of 1 000 000 random subjects for study. The authors adopted this sample of subjects who were younger than 18 years during 1997 to 2005. Subjects with at least 1 antidepressant prescription were identified. Trends, prevalence, associated factors, and disease patterns of antidepressant use were detected. The 1-year prevalence of pediatric antidepressant use increased from 0.27% in 1997 to 0.47% in 2005. The 1-year prevalence of tricyclic antidepressant, selective serotonin reuptake inhibitor, and other antidepressant use among pediatric population was 0.23%, 0.20%, and 0.08%, respectively, in 2005. The prevalence of pediatric antidepressant use increased from 1997 to 2005. Among pediatric subjects with antidepressant use, selective serotonin reuptake inhibitors, and other antidepressants were used the most for psychiatric disorders, whereas tricyclic antidepressant was used the most for nonpsychiatric disorders.

A measurement invariance examination of the Revised Child Anxiety and Depression Scale in a Southern sample: differential item functioning between African American and Caucasian youth

This study examined the psychometric properties of the Revised Child Anxiety and Depression Scale in a large sample of youth from the Southern United States. The authors aimed to determine (a) if the established six-factor Revised Child Anxiety and Depression Scale structure could be replicated in this Southern sample and (b) if scores were associated with measurement invariance across African American and Caucasian youth representative of youth from this region of the United States. The established six-factor model evidenced the best fit in comparison to one-, two-, and five-factor models in the total sample (N = 12,695), as well as in the African American (n = 4,906) and Caucasian (n = 6,667) subsamples. Multigroup confirmatory factor analysis also supported measurement invariance across African American and Caucasian youth at the levels of equal factor structure and equal factor loadings. Noninvariant item intercepts were identified, however, indicating differential functioning for a subset of items. Clinical and measurement implications of these findings are discussed and new norms are presented.

Stand der Forschung zum Zusammenhang von Gesundheit und Bildung

Zusammenfassung. Die Diskussion um den Zusammenhang von Gesundheit und Bildung konzentriert sich in Deutschland bislang vor allem auf die Frage, welchen Einfluss Bildung auf Gesundheit hat. Für die Gesundheitsförderung und Prävention, insbesondere in Bildungs- und Erziehungssettings, ist jedoch ebenfalls von Bedeutung, ob ein und welcher Einfluss von Gesundheit auf Bildung ausgeht. Ziel des vorliegenden Beitrages ist es daher, einen Überblick über die internationale Befundlage zum Einfluss von Gesundheit auf Bildung zu geben. Entsprechend des nationalen Gesundheitsziels „gesund aufwachsen” werden dabei die Themenbereiche Ernährung, Bewegung und psychische Gesundheit fokussiert. Über eine systematische Datenbankrecherche ließen sich insgesamt 39 Längsschnittstudien identifizieren. Die Befundlage weist darauf hin, dass Übergewicht, Adipositas, mangelnde körperliche Aktivität und psychische Probleme einen negativen Einfluss auf die Schulleistung (Schulnoten), die Schulanwesenheit, den Schulabschluss sowie auch die Aufnahme und den Abschluss eines Studiums haben können. Dabei ließen sich eine Reihe von bedeutsamen Drittvariablen identifizieren (z.B. Sozialstatus, Ausmaß an Stigmatisierung). Die Ergebnisse liefern Hinweise für eine empirische Bestätigung der Annahmen des Ansatzes der guten gesunden Schule und geben überdies Anregungen für die Implementation und Evaluation von Maßnahmen der schulischen Gesundheitsförderung.

Self-Disclosure and Mental Health Service Use in Socially Anxious Adolescents

Social anxiety disorder is highly prevalent in adolescence, persistent into adulthood, and associated with multiple impairments. Despite the development of efficacious treatments for socially anxious youth, few affected adolescents receive such treatment. This study examined service use in a sample of high school students (n = 1,574), as well as predictors of treatment delay and factors associated with adolescents' disclosure of social difficulties. Self-report measures of social anxiety and service utilization were administered by study staff to 10th- and 11th-grade classrooms across three public high schools. Consistent with the literature, results indicated low treatment utilization (14 %) and lengthy delays in treatment initiation. Symptom severity, impairment, and disclosing anxiety to school personnel were significant predictors of service utilization. Several demographic and illness-specific factors were associated with a higher likelihood of disclosing social discomfort. These findings underscore the important role of school personnel in identifying and referring youth with anxiety disorders. Implications are discussed for increasing access to services, including school-wide screenings and training of school personnel to recognize and provide intervention for anxious youth.

Anxiety and impairment in a large sample of children and adolescents with chronic pain

BACKGROUND

Anxiety is the most common psychiatric condition in children and adolescents, and is linked to significant disruptions across domains of function. Due to the avoidant nature of anxiety and pain-related disability, studying anxiety symptoms in children with chronic and recurrent pain conditions is important.

OBJECTIVES

To examine anxiety symptoms in a large cohort of children and adolescents evaluated for complex chronic and recurrent pain conditions.

METHODS

Through retrospective chart review, data on anxiety, pain and functional disability were collected from 655 children evaluated at a multidisciplinary pain clinic over a three-year period.

RESULTS

Approximately 11% of children and adolescents reported clinically elevated anxiety symptoms, with elevated levels across dimensions of anxiety ranging from 14% (social anxiety, worry) to 27% (physiological). In addition, a notable 31% of the sample potentially minimized their anxiety by responding in a socially desirable manner. Anxiety was linearly associated with greater pain-related functional disability, but was not directly correlated with pain. Moderation analyses revealed that at low levels of worry, higher levels of pain were associated with greater functional disability, whereas at high levels of worry, pain no longer predicted the level of functional disability.

CONCLUSIONS

These findings document the prevalence of anxiety in children and adolescents with chronic pain, and also extend recent studies examining the complex relationships among pain, anxiety and pain-related disability.

Peer Nominations of Emotional Expressivity among Urban Children: Social and Psychological Correlates

The current study examined associations between peer nominations of children's expression of negative emotions and psychological, social, and behavioral correlates in a sample of 523 first graders. Children (85% African American) completed a peer nomination measure for expressing negative emotions. In addition, three other domains of functioning were assessed using multiple raters: internalizing symptoms (self, parent), externalizing behavior (parent, teacher), and social competence (parent, teacher). Regression analyses indicated that peer nominations of negative emotions predicted higher levels of teacher-rated externalizing behavior and lower levels of teacher-rated social competence. Peer nominations of emotions were significantly associated with teacher ratings but unrelated to self- and parent-report measures. Adding to a small but growing literature, our findings underscore the importance of assessing peer perceptions of children's emotional expressivity and their associations to social and psychological functioning in an urban, predominantly African American sample.

Developmental cascades: externalizing, internalizing, and academic competence from middle childhood to early adolescence

The current study was initiated to increase understanding of developmental cascades in childhood in a sample of at-risk boys (N = 291; 52% White). Mothers, teachers, and boys reported on boys' externalizing problems, internalizing difficulties, and academic competence. Consistent with hypotheses regarding school-related transitions, high levels of externalizing problems were associated with both low levels of academic competence and high levels of internalizing problems during the early school-age period, and with elevations in internalizing problems during the transition to adolescence. Low levels of academic competence were associated with high levels of internalizing problems in middle childhood, and with high levels of externalizing problems during the transition from elementary school to middle school. Shared risk factors played a minimal role in these developmental cascades. Results suggest that there are cascading effects of externalizing problems and academic competence in childhood and early adolescence, and that some cascading effects are more likely to occur during periods of school-related transitions. Implications of developmental cascade effects for research and intervention are discussed.

Associations between poor health and school-related behavior problems at the child and family levels: a cross-sectional study of migrant children and adolescents in southwest urban China

BACKGROUND

Due to urbanization in China, the numbers of migrant children and adolescents in urban environments have increased. Previous studies have indicated that children and adolescents are more likely to suffer from health problems and poor school achievement. The present study identified associations between poor health and school-related behavior problems (ie, learning attitudes and learning disabilities [LL], antisocial behavior and risk behavior [AR], and social adaptation and role function [SR]) at the child and family levels.

METHODS

A cross-sectional design was used. Seven hundred and eighty-one participants were recruited in inclusive settings. Correlational analysis was conducted to assess the associations between demographic variables and the primary study variables. Logistic regression analysis was used to determine which study factors were the strongest predictors of general health problems.

RESULTS

School-aged migrants who had poorer health tended to be more likely to suffer from school-related behavior problems. Poor health was also found to hinder scholastic achievement in migrant children and adolescents through a higher prevalence of school-related behavior problems, including negative learning attitudes and learning disabilities, antisocial behavior and risk behavior, and social maladjustment. Health risk factors included inappropriate parental education methods, fewer classmates, and less social support.

CONCLUSIONS

Health and individual risk factors should be explored further to determine their causal role in migrant children and adolescents with school-related behavior problems. These results have implications for future school health education for these students.

Childhood anxiety and depressive symptoms: trajectories, relationship, and association with subsequent depression

The development of child anxiety and depressive symptoms from mean ages 5.3 to 9.3 years was examined in a community sample of 133 girls and 134 boys, using parent and teacher ratings. Reliable individual differences in anxiety and depressive symptoms at mean age 5.3 and in their change to mean age 9.3 were observed, with significant correlations between depressive and anxiety symptoms at mean age 5.3 years and between their changes with age. Positive cross-lagged correlations from anxiety to depressive symptoms and negative cross-lagged correlations from depressive to anxiety symptoms were apparent in teachers' ratings at 6- to 12-month intervals. Developmental changes in teacher-rated child anxiety symptoms were robust predictors of child self-reported depressive symptoms at mean age 9.3 years. These results suggest assessment and interventions for emotional problems may be usefully implemented during childhood in school and peer social environments.

Mood assessment via animated characters: a novel instrument to evaluate feelings in young children with anxiety disorders

We evaluated a novel, computerized feelings assessment instrument (MAAC) in 54 children with anxiety disorders and 35 nonanxious children ages 5 to 11. They rated their feelings relative to 16 feeling animations. Ratings of feelings, order of feeling selection, and correlations with standardized anxiety measures were examined. Positive emotions were rated more highly and visited earlier by nonanxious children. Children with anxiety disorders explored fewer emotions. MAAC ratings on several positive emotions showed inverse correlations with state anxiety. Although needing further evaluation, MAAC may facilitate feelings assessment in young children and may distinguish children with anxiety disorders from nonanxious children.