The nature of feared outcome representations in children

Development of the Perth Adolescent Worry Scale (PAWS)

Tools to assess worry among adolescents exist but do not capture the content of worries. This study reports on the development of a brief, psychometrically sound measure of worry for use with adolescents. Phase 1 involved identification of 27 potential items from existing instruments as well as item generation identified in interviews with students, teachers, school psychologists, and parents. In Phase 2, the candidate items were completed by 835 Australian adolescents (317 males, 508 females, 10 unspecified; Mean age = 13.55, SD = 1.31) from Grades 5 to 10. These data were randomly split in half, and an exploratory factor analysis on the first half identified a two-factor solution with 12 items: Peer Relationships (6 items) and Academic Success and the Future (6 items). On the second half of the data, confirmatory factor analyses supported the factor structure and supported strong invariance across age, socioeconomic status, and presence/absence of a diagnosed neurodevelopmental disorder. Weak invariance was evident across sex. Differences across groups are reported as are correlations with indicators of psychological wellbeing. In conclusion, the Perth Adolescent Worry Scale provides both applied professionals and researchers with a short, easy-to-administer, and psychometrically strong instrument to evaluate adolescents’ everyday worries.

Content-Specific Interpretation Bias in Children with Varying Levels of Anxiety: The Role of Gender and Age

The current study examined whether children varying in their levels of social anxiety, separation anxiety and spider fear exhibit a negative interpretation bias specific for their fears. Furthermore, age and gender were assessed as moderators of this relation. Children (N = 603) of the age of 7-12 years were asked to solve ambiguous scenarios reflecting social threat, separation threat or spider threat. Children's levels of anxiety were assessed with self-report questionnaires. Results indicated that children scoring higher on self-reported social anxiety, separation anxiety or spider fear, displayed a negative interpretation bias for the threat-scenarios pertaining to their specific anxiety or fear, even after controlling for comorbidity with other anxiety subtypes. Contrary to our hypotheses, we did not find moderating effects of age or gender. These results indicate that even in a community sample, content-specificity of negative interpretation biases is present.

The Role of Self-reports and Behavioral Measures of Interpretation Biases in Children with Varying Levels of Anxiety

We investigated the role of self-reports and behavioral measures of interpretation biases and their content-specificity in children with varying levels of spider fear and/or social anxiety. In total, 141 selected children from a community sample completed an interpretation bias task with scenarios that were related to either spider threat or social threat. Specific interpretation biases were found; only spider-related interpretation bias and self-reported spider fear predicted unique variance in avoidance behavior on the Behavior Avoidance Task for spiders. Likewise, only social-threat related interpretation bias and self-reported social anxiety predicted anxiety during the Social Speech Task. These findings support the hypothesis that fearful children display cognitive biases that are specific to particular fear-relevant stimuli. Clinically, this insight might be used to improve treatments for anxious children by targeting content-specific interpretation biases related to individual disorders.

Are there differences in the mental health status of adolescents in Puducherry?

The present study assessed the mental health of adolescents in Puducherry, India. This cross-sectional study was conducted on 291 students (121 male and 170 female) in the 14-17year old age group, grades IX and XI. The students were recruited from private, public, co-ed and single sex schools. Along with a Structured Questionnaire, the Mental Health Inventory was administered. We sought to investigate as to whether there would be differences in mental health status of adolescents based on age, class, gender and other demographic variables. There were significant age differences with respect to global mental health, psychological distress, anxiety and loss of behavioural/emotional control. Family type-wise significant differences in global mental health, life satisfaction and loss of behavioural/emotional control were also found. Significant differences were observed with respect to global mental health, psychological well-being, positive effects, psychological distress and depression across socio-economic groups. Number of siblings also accounted for differences in anxiety and emotional ties. However, no significant gender differences were observed across mental health sub-scales. Results suggest the need for promotion of mental health awareness and intervention programs for adolescents, their parents and teachers. There is also a need for advocacy in children and adolescent rights regarding welfare, well-being and protection from violence. The objective is to enhance psychological well-being and reduce psychological distress in students across different social strata.

A clinical study of anxiety disorders in children and adolescents from North Indian children and adolescents clinic

BACKGROUND AND OBJECTIVES

Anxiety disorders are the most common group of psychiatric disorders in children and adolescents. But few studies on specific anxiety disorders in children and adolescents are available in India. Therefore, this study was planned to identify anxiety disorders in children and adolescents in an Indian psychiatry outpatient setting and elicit its phenomenology and co-morbidities.

METHODS

1465 persons were screened using screen for child anxiety related emotional disorders (SCARED) scale. The screen positive patients were assessed and diagnosis of anxiety disorders was established according to DSM-IV-TR. Detailed assessment of the phenomenology of anxiety disorders was done by K-SADS-PL.

RESULTS

42 (2.86%) patients had different anxiety disorders. Out of which 16 (38.1%) patients had obsessive compulsive disorder, 10 (23.81%) patients with specific phobias, 6 (14.29%) patients with generalized anxiety disorder, 4 (9.52%) patients with social anxiety disorder and 3 (7.14%) patients each with separation anxiety disorder and panic disorder. Co-morbidities were found in 54% of patients with anxiety disorders. Dissociative disorder, specific phobias and social anxiety disorder were the common co-morbidities.

INTERPRETATION AND CONCLUSION

Anxiety disorders are less commonly found in clinic settings (2.86%). No case of posttraumatic stress disorder or acute stress reaction was found in this study.

Pediatric anxiety disorders

Anxiety disorders are the most common group of psychiatric disorders in children and adolescents. Anxiety disorders in children and adolescents can be chronic and disabling, and they can increase the risk of comorbid disorders. Anxiety is associated with substantial negative effects on children's social, emotional and academic success. Identifying and treating children and adolescents with anxiety disorders would reduce the burden of this disorder and may help in better management of the co-morbid conditions in these patients.

The relationships of child and parent factors with children's anxiety symptoms: parental anxious rearing as a mediator

A considerable body of research has identified various child and parent factors that contribute to and maintain anxiety symptoms in children. Yet relatively few studies have examined child factors (including threat-based cognitive bias, neuroticism, gender, puberty and age) as well as parent factors (including maternal anxiety and child-rearing style) in association with child anxiety symptoms, and the extent to which these factors serve as unique predictors of child anxiety. Moreover, research is lacking on whether parent factors such as child-rearing style, which is often targeted in early intervention and treatment programs, might mediate the association between child factors such as neuroticism, and child anxiety symptoms. In a sample of 85 children between 7 and 12 years of age with varying levels of anxiety, including those with diagnosed anxiety disorders, results showed that children were more anxious when they were reported to be more advanced in pubertal status by their parents, when they had a tendency to interpret more threat in ambiguous situations, and when they self-reported more neuroticism. Regarding parent factors, maternal self-reported trait anxiety and children's perceptions of their mother as having an anxious child-rearing style were associated with higher levels of child anxiety. Moreover, when these correlates of child anxiety were examined in a multivariate model to identify those that had direct as well as indirect associations via maternal anxious child-rearing style, child neuroticism remained as a significant and unique predictor of child anxiety that was also mediated by maternal anxious-rearing. Child neuroticism also mediated the relationship between child pubertal stage and anxiety symptoms. Results are discussed in terms of relevant theory and empirical evidence regarding the roles of both child and parent factors in the development of child anxiety.

Differential item functioning due to gender between depression and anxiety items among Chilean adolescents

BACKGROUND

Although much is known about the higher prevalence of anxiety and depressive disorders among adolescent females, less is known about the differential item endorsement due to gender in items of scales commonly used to measure anxiety and depression.

AIMS

We conducted a study to examine if adolescent males and females from Chile differed on how they endorsed the items of the Youth Self Report (YSR) anxious/depressed problem scale. We used data from a cross-sectional sample consisting of 925 participants (mean age = 14, SD 1.3, 49% females) of low to lower-middle socioeconomic status.

METHODS

A two-parameter logistic (2PL) IRT DIF model was fit.

RESULTS

RESULT

s revealed differential item functioning (DIF) by gender for six of the 13 items, with adolescent females being more likely to endorse a depression item while males were found more likely to endorse anxiety items.

CONCLUSIONS

Findings suggest that items found in commonly used measures of anxiety and depression symptoms may not equally capture the true levels of these behavioural problems in adolescent males and females. Given the high levels of mental disorders in Chile and the surrounding countries, further attention should be focused on increasing the number of empirical studies examining potential gender differences in the assessment of mental health problems among Latin American populations to better aid our understanding of the phenomenology and determinants of these problems in the region.

Do Children Differentiate Worry From Fear?

Worry has been defined as a primarily cognitive process closely related to fear or anxiety. This definition is widely accepted by clinicians and researchers investigating worry and is often provided to research participants, especially to children. The present study aimed to empirically test the proposition that both adults and children conceptualise worry as a cognitive process, and that they differentiate it from fear on the basis of worry's relatively stronger association with thinking. Groups of 45 adults and 70 children completed three versions of a worry list questionnaire, reporting on the extent to which they worry about, are afraid of, and think about a list of negative outcomes. Regression analyses showed that in adults, thinking about a negative outcome had a significant unique association with worrying. In children, however, worrying was more strongly associated with fear ratings, especially in the case of physical outcomes. The data suggest that adults and children report on different concepts when they rate their worries via questionnaires. This difference may reflect developmental changes in the worry process itself, or developmental changes in the way individuals interpret and respond to worry list questionnaires. Follow-up studies using alternative methodologies are now needed to further clarify the results.

Cognitive–Behavioural Therapy Combined With an Interpersonal Skills Component in the Treatment of Generalised Anxiety Disorder in Adolescent Females: A Case Series

The present study describes the outcomes of a manualised treatment for generalised anxiety disorder (GAD) in female adolescents that combined traditional cognitive–behavioural therapy (CBT) with an interpersonal skills (IP) component. The CBT component included psychoeducation, somatic management, cognitive restructuring, exposure therapy and problem-solving. The IP component targeted interpersonal avoidance, passive and aggressive interpersonal styles, and co-rumination. Four female adolescents with a principal diagnosis of GAD participated in 10 weekly 1-hour sessions. Adolescent- and parent-report diagnostic interviews and questionnaires were completed at pre-, mid-, and posttreatment, and at 3-months follow-up. Reductions in GAD and depressive symptoms and improvements in interpersonal functioning for all participants on both adolescent- and parent-report measures suggest that the combination of CBT and IP can benefit adolescent girls with GAD.

Interpretation of ambiguous situations: evidence for a dissociation between social and physical threat in williams syndrome

Williams syndrome (WS) is associated with an unusual profile of anxiety, characterised by increased rates of non-social anxiety but not social anxiety (Dodd and Porter, J Ment Health Res Intellect Disabil 2(2):89-109, 2009). The present research examines whether this profile of anxiety is associated with an interpretation bias for ambiguous physical, but not social, situations. Sixteen participants with WS, aged 13-34 years, and two groups of typically developing controls matched to the WS group on chronological age (CA) and mental age (MA), participated. Consistent with the profile of anxiety reported in WS, the WS group were significantly more likely to interpret an ambiguous physical situation as threatening than both control groups. However, no between-group differences were found on the ambiguous social situations.

Brave men and timid women? A review of the gender differences in fear and anxiety

Substantial evidence indicates that women report greater fear and are more likely to develop anxiety disorders than men. Women's greater vulnerability for anxiety disorders can be partly understood by examining gender differences in the etiological factors known to contribute to anxiety. This review examines evidence for gender differences across a broad range of relevant factors, including biological influences, temperamental factors, stress and trauma, cognitive factors, and environmental factors. Gender differences are observed with increasing consistency as the scope of analysis broadens to molar levels of functioning. Socialization processes cultivate and promote processes related to anxiety, and moderate gender differences across levels of analysis.

Manipulating perceptions of spider characteristics and predicted spider fear: evidence for the cognitive vulnerability model of the etiology of fear

The present study reports on an attempt to experimentally manipulate perceptions of uncontrollability, unpredictability and dangerousness related to an imaginal encounter with a spider in order to determine whether there is an effect on self-rated predicted spider fear. Experimental manipulations involved differing information in relation to both the spider and the imaginal task. The control, predictability and dangerousness manipulations all had significant main effects on task-related spider fear (TRSF). Measures of the perception of the spiders as uncontrollable, unpredictable and dangerous were also significantly associated with TRSF and accounted for 42% of the variance in predicted fear beyond that accounted for by the experimental manipulations. Results are discussed in terms of their implications for better understanding the etiology and maintenance of fear. The overall findings are consistent with the cognitive vulnerability model, with cognitive perceptions of an object or situation seen as causal determinants of the fear associated with the stimulus.

The etiology of social phobia: empirical evidence and an initial model

Research into the etiology of social phobia has lagged far behind that of descriptive and maintaining factors. The current paper reviews data from a variety of sources that have some bearing on questions of the origins of social fears. Areas examined include genetic factors, temperament, childrearing, negative life events, and adverse social experiences. Epidemiological data are examined in detail and factors associated with social phobia such as cognitive distortions and social skills are also covered. The paper concludes with an initial model that draws together some of the current findings and aims to provide a platform for future research directions.

The structure of child and adolescent psychopathology: generating new hypotheses

To begin to resolve conflicts among current competing taxonomies of child and adolescent psychopathology, the authors developed an interview covering the symptoms of anxiety, depression, inattention, and disruptive behavior used in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994), the International Statistical Classification of Diseases and Related Health Problems (ICD-10; World Health Organization, 1992), and several implicit taxonomies. This interview will be used in the future to compare the internal and external validity of alternative taxonomies. To provide an informative framework for future hypothesis-testing studies, the authors used principal factor analysis to induce new testable hypotheses regarding the structure of this item pool in a representative sample of 1,358 children and adolescents ranging in age from 4 to 17 years. The resulting hypotheses differed from the DSM-IV, particularly in suggesting that some anxiety symptoms are part of the same syndrome as depression, whereas separation anxiety, fears, and compulsions constitute a separate anxiety dimension.

A parent-report measure of children’s anxiety: psychometric properties and comparison with child-report in a clinic and normal sample

This study examined the psychometric properties of the parent version of the Spence Children's Anxiety Scale (SCAS-P); 484 parents of anxiety disordered children and 261 parents in a normal control group participated in the study. Results of confirmatory factor analysis provided support for six intercorrelated factors, that corresponded with the child self-report as well as with the classification of anxiety disorders by DSM-IV (namely separation anxiety, generalized anxiety, social phobia, panic/agoraphobia, obsessive-compulsive disorder, and fear of physical injuries). A post-hoc model in which generalized anxiety functioned as the higher order factor for the other five factors described the data equally well. The reliability of the subscales was satisfactory to excellent. Evidence was found for both convergent and divergent validity: the measure correlated well with the parent report for internalizing symptoms, and lower with externalizing symptoms. Parent-child agreement ranged from 0.41 to 0.66 in the anxiety-disordered group, and from 0.23 to 0.60 in the control group. The measure differentiated significantly between anxiety-disordered children versus controls, and also between the different anxiety disorders except GAD. The SCAS-P is recommended as a screening instrument for normal children and as a diagnostic instrument in clinical settings.

Psychometric properties of the Spence Children's Anxiety Scale with young adolescents

The psychometric properties of the Spence Children's Anxiety Scale (SCAS) were examined with 875 adolescents aged 13 and 14 years. This self-report measure was designed to evaluate symptoms relating to separation anxiety, social phobia, obsessive-compulsive disorder, panic-agoraphobia, generalized anxiety, and fears of physical injury. Results of confirmatory and exploratory factor analyses supported six factors consistent with the hypothesized subtypes of anxiety. There was support also for a model in which the first-order factors loaded significantly on a single second-order factor of anxiety in general. The internal consistency of the total score and sub-scales was high, and 12-week test-retest reliability was satisfactory. The SCAS correlated strongly with a frequently used child self-report measure of anxiety and significantly, albeit at a lower level, with a measure of depression.

The structure of negative self-statements in children and adolescents: a confirmatory factor-analytic approach

The aim of this study was to examine the nature and organization of a range of negative self-statements in children and adolescents, using a structural equations/confirmatory factor-analytic approach. A community sample of 978 children aged 7-16 years completed a questionnaire about the frequency with which they experienced a broad range of negative automatic thoughts. The outcome of comparative modeling provided strongest support for a model in which 4 distinct cognitive factors were all related to a single higher order factor. The 4 lower order factors related to cognitions on social threat, physical threat, personal failure, and hostility. The pattern of results was consistent across age and gender. Results were consistent with assumptions of cognitive specificity models of psychopathology, on the latent structure of automatic thoughts in children and adolescents.

A developmental analysis of self-reported fears in late childhood through mid-adolescence: social-evaluative fears on the rise?

BACKGROUND

The frequently reported decline in the overall frequency and intensity of fears during late childhood and adolescence may mask different developmental patterns for two broad subclasses of fears: fears concerning physical danger and fears concerning social evaluation. It was investigated if physical fears decrease between late childhood and mid-adolescence, while social-evaluative fears increase during this period. It was also studied if changes in both sets of fears are more strongly related to socio-cognitive maturity than to age, which itself is only a proxy measure of maturity.

METHODS

A non-clinical sample of 882 children and adolescents (ages 8-18) was recruited for study. Fears were assessed using the Ollendick Fear Survey Schedule for Children-Revised (FSSC-R). A Principal Components Analysis (PCA) was conducted to study the factor structure of the Failure and Criticism subscale of the FSSC-R. Level of development was assessed using the Sentence Completion Test for Youth (SCT-Y), a measure of socio-cognitive maturity that is based on Loevinger's model, and measure, of ego development.

RESULTS

The PCA of the Failure and Criticism subscale revealed three factors: Social Evaluation, Achievement Evaluation, and Punishment. As predicted, the significant decrease of overall fearfulness obscured two contradictory developmental patterns: (a) fears of physical danger and punishment decreased with age, whereas (b) fears of social and achievement evaluation increased with age. Hierarchical regression analyses showed that the age effect for social-evaluative fears was explained entirely on the basis of developmental differences in socio-cognitive maturity (controlling for verbal ability). In contrast, age was a better predictor of the decrease of physical and punishment fears (although socio-cognitive maturity still added to the predictive value of age).

CONCLUSION

The expression of social evaluation fears during adolescence appears not atypical and might be a corollary of socio-cognitive maturation. At the same time, the natural presence of those fears during adolescence appears to constitute a vulnerability for developing a social anxiety disorder.

Development and validation of a measure of children's automatic thoughts: the children's automatic thoughts scale

The aim of this study was to describe the history, factor structure and psychometric properties of the Children's Automatic Thoughts Scale (CATS). The CATS is a self-report measure designed to assess a wide range of negative self-statements in children and adolescents. The results of confirmatory factor analyses supported four distinct but strongly correlated factors relating to automatic thoughts on physical threat, social threat, personal failure and hostility. The internal consistency of the total score and subscales was high and test-retest reliability at 1 and 3 months was acceptable. The CATS effectively discriminated between control children and adolescents, and clinically anxious, depressed, or behavior disorder children and adolescents, and showed good discriminant validity across clinical subgroups on the subscales. Results suggest that the CATS is a promising instrument in the assessment of a range of negative automatic thoughts across both internalizing and externalizing problems in young people.

The structure of anxiety symptoms among preschoolers

This study examined whether anxiety symptoms in preschoolers reflect subtypes of anxiety consistent with current diagnostic classification systems, or should be better regarded as representing a single dimension. Parents of a large community sample of preschoolers aged 2.5 to 6.5 years rated the frequency with which their children experienced a wide range of anxiety problems. Exploratory factor analysis indicated four or five factors and it was unclear whether separation anxiety and generalized anxiety represented discrete factors. Results of confirmatory factor analyses indicated a superior fit for a five-correlated-factor model, reflecting areas of social phobia, separation anxiety, generalized anxiety, obsessive-compulsive disorder and fears of physical injury, broadly consistent with DSM-IV diagnostic categories. A high level of covariation was found between factors, which could be explained by a single, higher order model, in which first order factors of anxiety subtypes loaded upon a factor of anxiety in general. No significant differences were found in prevalence of anxiety symptoms across genders. Symptoms of PTSD in this sample were rare.

Social anxiety and depression in adolescents in relation to perceived competence and situational appraisal

The Social Anxiety and Phobia Inventory for Children (SPAI-C), the Children's Depression Inventory (CDI), Harter's (1982) Perceived Competence Scale for Children (PCSC), as well as an inventory of cost and likelihood appraisal of negative social and non-social events, were filled in by 184 adolescents (14-15 years old). It was expected that social anxiety would be specifically related to low perceived competence in the social domain and threat appraisal in the same domain, whereas depression would be related to more general perceived competence deficits. The relationships of social anxiety and depression to perceived competence and appraisal were largely supported. Social anxiety was most strongly related to perceived social competence as well as to both social cost and likelihood appraisals, whereas depression was more generally related to perceived competence, and appraisal of negative events did not improve the prediction of depression any more than the prediction based on perceived competence.

Structured and free-recall measures of worry themes: effect of order of presentation on worry report

Structured instruments (SI) or free-recall instruments (FRI) can be used to examine worry themes. In the case where both types are use jointly, order of presentation may influence number and content of free-recall worries. Half of a large undergraduate sample (N = 609) received the SI before the FRI and the other half received them in the opposite order. Highly prevalent worries (i.e., common worries reported by more than 25% of the sample) were more numerous when the FRI was used first. However, moderately prevalent and rare worries (reported by 5% to 24% and 0% to 4% of the sample, respectively) were more numerous when the FRI was administered second. Results are discussed in terms of a possible priming effect produced by SI on moderately prevalent and rare free-recall worries.

A measure of anxiety symptoms among children

The Spence Children's Anxiety Scale (SCAS) is a child self-report measure designed to evaluate symptoms relating to separation anxiety, social phobia, obsessive-compulsive disorder, panic-agoraphobia, generalized anxiety and fears of physical injury. The results of confirmatory and exploratory factor analyses supported six factors consistent with the hypothesized diagnostic categories. There was support also for a model in which the 1st-order factors loaded significantly on a single 2nd-order factor of anxiety in general. The internal consistency of the total score and subscales was high and 6 month test-retest reliability was acceptable. The SCAS correlated strongly with a frequently used child self-report measure of anxiety. Comparisons between clinically anxious and control children showed significant differences in total SCAS scores, with subscale scores reflecting the type of presenting anxiety disorder of the clinical samples.

Perceived threat and perceived control as predictors of the degree of fear in physical and social situations

Seventy-one nonclinical subjects indicated their degree of anxiety or fear in response to five physical threat situations and four social threat situations. In addition, for each situation, they rated the probability and consequences of danger or threat generally associated with each situation and the degree of perceived control that they believed they would personally have in each situation. Multiple regressions indicated that only general probability of threat predicted fear in physical situations while the general consequences of threat and the degree of personal control predicted fear in response to social situations.

The course of aggression in first-grade children with and without comorbid anxious symptoms

We studied the course of aggressive behavior in an epidemiologically defined sample of first graders with and without comorbid anxious symptoms. Our primary purpose in doing so was to understand whether the stability of aggression in young children was attenuated or strengthened in the presence of comorbid anxiety. Previous studies of older children and adolescents had produced equivocal findings in this regard. Data on anxious symptoms were obtained through an interview of the children, whereas aggressive behavior was assessed through the use of a teacher interview and peer nominations. Assessments were performed in the fall and spring of first grade. In contrast to children classified as aggressive alone in the fall of first grade, boys and girls classified as aggressive and anxious in the fall of first grade were significantly more likely to be classified as aggressive in the spring in terms of teacher ratings and/or peer nominations of aggression. Thus our findings suggest that the link between early and later aggression may be strengthened in the presence of comorbid anxious symptoms, rather than attenuated. Future studies are needed to identify the mechanisms by which the course of aggression is influenced by the presence of comorbid anxiety.

Family enhancement of cognitive style in anxious and aggressive children

Previous research has shown that anxious adults provide more threat interpretations of ambiguous stimuli than other clinic and nonclinic persons. We were interested in investigating if the same bias occurs in anxious children and how family processes impact on these children's interpretations of ambiguity. Anxious, oppositional, and nonclinical children and their parents were asked separately to interpret and provide plans of action to ambiguous scenarios. Afterwards, each family was asked to discuss two of these situations as a family and for the child to provide a final response. The results showed that anxious and oppositional children were both more likely to interpret ambiguous scenarios in a threatening manner. However, the two clinic groups differed in that the anxious children predominantly chose avoidant solutions whereas the oppositional children chose aggressive solutions. After family discussions, both the anxious children's avoidant plans of action and the oppositional children's aggressive plans increased. Thus, this study provides the first evidence of family enhancement of avoidant and aggressive responses in children. These results support a model of anxiety that emphasizes the development of an anxious cognitive style in the context of anxiety-supporting family processes.