Academic Impairment and Impact of Treatments Among Youth with Anxiety Disorders

Associations Between Parents' Cognitions About Child Anxiety and Emotion Dysregulation in Clinically Anxious Children: The Unique Contribution of Fathers

This study examined the influence of parental cognition, including attitudes, beliefs, and understanding of anxiety, on emotion dysregulation in children with anxiety disorder. A total of 47 clinically anxious children (6-17 years old) and their parents were involved in the current study. The mothers and fathers separately completed a self-reported questionnaire assessing their attitudes, beliefs, and understanding of their children's anxiety, while the children completed a self-report questionnaire assessing emotion dysregulation. Pearson correlation and hierarchical regression analyses were used for data analysis. The results indicated that only fathers' higher levels of unhelpful attitudes, beliefs, and understanding of anxiety were positively and significantly associated with greater emotion regulation (ER) difficulties in anxious children. Furthermore, fathers' unhelpful cognitions regarding anxiety uniquely predicted their children's emotion regulation difficulties. These findings highlight the importance of including fathers in preventive and therapeutic interventions in promoting ER abilities in children with anxiety disorder.

Examination of Current Anxiety Problems with School Engagement and Volunteer and Paid Work among U.S. Adolescents

This study examined the relationships between current anxiety problems and school engagement, community service or volunteer work, and paid work among U.S. adolescents. The 2018-2019 National Survey of Children's Health (NSCH) dataset was analyzed and included 24,609 adolescents ages 12-17 years. We conducted unadjusted and adjusted logistic regression analyzes. A total of 12.6% of adolescents had healthcare provider-confirmed current anxiety problems. Adolescents with current anxiety were at decreased odds of engaging in school (aOR = 0.35, 95%CI = 0.29, 0.41) and participating in community service or volunteer work (aOR = 0.72, 95%CI = 0.59, 0.86) compared to adolescents without current anxiety. Adolescents with current anxiety were at increased odds of participating in paid work (OR = 1.18, 95%CI = 1.01, 1.38). This study reports that U.S. adolescents with anxiety were less likely to engage in school and participate in community service or volunteer work, but were more likely to participate in paid work compared to their peers without anxiety. Results should inform future interventions targeting adolescents.

Understanding Signs and Sources of Anxiety in Urban Elementary Schools Serving Predominately Ethnically/Racially Minoritized Children

OBJECTIVE

This mixed-methods study examined teachers' perceptions of student anxiety in urban elementary schools serving predominantly low-income and ethnically/racially minoritized youth.

METHOD

Most participating teachers were female (87.7%) and from minoritized backgrounds themselves (89.2%), teaching in schools serving predominantly Black/African American (40%) or Hispanic (60%) students, and in which > 70% of students are eligible for free meals. Teachers were asked in surveys (N = 82) and interviews (n = 12) about the nature of student anxiety, and cultural/contextual considerations that influence anxiety.

RESULTS

Overall, teachers reported prevalence and signs of student anxiety that were consistent with the literature, but they reported higher levels of impairment than in previous community samples. Regressions revealed that greater levels of student exposure to community violence and higher proportions of Black students were associated with higher teacher-perceived prevalence and concern about student anxiety, respectively. Moreover, greater emotional exhaustion in teachers was associated with higher reports of anxiety-related impairment in students. Thematic coding of interviews emphasized how teachers perceived 1) most student anxieties to be proportional responses to realistic threats and stress in students' lives (e.g. resource insecurity), 2) systems-level problems (e.g. pressure to perform on standardized tests) contribute to student anxiety, and 3) school-based anxiety sources often interact with traumas and stressors students experience outside of school (e.g. immigration experiences).

CONCLUSIONS

Relative to the predominant literature that has focused on biological, cognitive, and other intraindividual factors as sources of anxiety, the present work underscores the importance of considering how broader economic and systems-level influences exacerbate anxiety in marginalized youth.

Abnormal amygdala volume moderates parenting and anxiety symptoms in children and adolescents with anxiety disorder

Anxiety disorders (AD) usually onset in childhood or adolescence and are related to brain development and early experiences during this period. As the hub of the fear circuit, the amygdala plays a crucial role in the development of emotional processing, and abnormalities in its structure and function are associated with anxiety disorders. We aim to uncover the amygdala volume's moderation between parenting and anxiety severity in children and adolescents with AD. 129 children and adolescents with anxiety and 135 age- and sex-matched Health controls (HC) using the publicly available Healthy Brain Network (HBN) dataset were included. Anxiety severity was measured using the Screen for Child Anxiety Related Disorders Self-report (SCARED-SR) and parenting was measured using the Alabama Parenting Questionnaire Self-Report (APQ-SR). We investigated age-related differences in amygdala volume in children and adolescents with anxiety disorders. Further, we examined the role of amygdala volume in moderating the association between parental involvement, particularly the maternal involvement, and anxiety symptoms in this population. We found larger bilateral amygdala in the AD group compared with the HC among the age range of 7-12. And increases in amygdala volume tended to negatively moderate the linear relationships between maternal involvement and anxiety symptoms in the AD group. These findings provide new evidence of abnormal brain alteration in children and adolescents with anxiety and may reflect proactive adaptations of adolescent brain development.

Using Q-sort method to explore autistic students' views of the impacts of their anxiety at school

LAY ABSTRACT

Many autistic students experience anxiety, but there is little research that explores how anxiety might affect autistic students in the school environment. In this study, 45 autistic students, aged 7 to 17 years, completed an online sorting activity to tell us how anxiety impacts them at school. The students were given 21 statements about possible social and academic effects of anxiety (for example, 'When I'm worried it's hard to start my schoolwork' or 'When I'm worried I talk less to my friends or other students'), and sorted them based on how much they agreed each statement was true for them. The three statements most highly rated as being impacted by anxiety were difficulties related to schoolwork. By comparing the information provided by students, six smaller groups of students were identified who sorted the statements in a similar order. These groups show that anxiety affects different autistic students in different ways, including missing school or activities, communicating less with friends and teachers and finding it harder to complete schoolwork. This online sorting activity enabled autistic students themselves to report how anxiety affects them at school. The results suggest that it is important to provide individualised support for autistic students who experience anxiety at school, to reduce the impact of their anxiety on their participation, communication and interactions, and schoolwork. Further research about the effects of anxiety on the academic outcomes of autistic students is also needed.

Associations of generalized anxiety and social anxiety with perceived difficulties in school in the adolescent general population

INTRODUCTION

Generalized anxiety disorder (GAD), marked by excessive worry, and social anxiety disorder (SAD) are among the clinically most important anxiety disorders in the adolescent population. This study aimed to explore the associations between perceived difficulties in school and heightened levels of self-reported noncomorbid and comorbid GAD and SAD symptoms.

METHODS

Survey data of 37,905 Finnish upper secondary school students with a mean age of 17.33 years (SD = 0.63) were obtained from the School Health Promotion study, implemented in April and May 2015 in Finland. Exploratory factor analysis was used to determine indicators of academic and social difficulties in school. Logistic regression analysis was conducted to examine multivariate associations between anxiety symptoms and difficulties in the school. The anxiety symptom thresholds were based on the seven-item Generalized Anxiety Disorder Scale (≥10 points) for GAD-related symptoms and the Mini-SPIN (≥6 points) for SAD-related symptoms.

RESULTS

Self-reported generalized anxiety and social anxiety were both significantly associated with various perceived difficulties in school among this adolescent general population sample. Noncomorbid and comorbid GAD and SAD symptoms were both associated with an increased risk of academic and social difficulties, even when controlling for school performance. Comorbid symptoms were associated with significantly higher rates of social difficulties than noncomorbid symptoms of GAD or SAD. Furthermore, GAD symptoms were associated with a high risk for academic difficulties, irrespective of comorbidity.

CONCLUSIONS

Excessive worry, a defining feature of GAD, is central to school-related impairments among adolescents. The present study highlights the importance of school-based interventions for anxious adolescents. Interventions to improve adolescents'; school functioning should account for the interference of pathological worry related to GAD.

Internet Addiction and Academic Anxiety Among Chinese College Students During COVID-19: The Mediating Role of Psychological Contract

Purpose

The objective of this study is to investigate the underlying mechanism connecting internet addiction and academic anxiety, with the aim of assisting higher education professionals and administrators in developing comprehensive solutions to effectively mitigate the systemic risks associated with these issues.

Patients and Methods

This study utilizes the smart data collection instrument of Wenjuanxing to gather data from 270 Chinese college students through an online questionnaire survey. Through building and analyzing a structural equation model that consists of four latent variables, such as internet addiction, relational psychological contract, transactional psychological contract, and academic anxiety. The study analyzed the fundamental characteristics of the transformation mechanism of Internet addiction and academic anxiety. It specifically focused on conducting a mediating effects test of the psychological contract variable to validate the significant role of both relational psychological contract and transactional psychological contract in this transformation mechanism.

Results

First, the study found that internet addiction (β=0.094; p=0.179) cannot directly impact academic anxiety. It can only influence academic anxiety through the mediating effects of the relational psychological contract (β=0.088; p=0.022) and the transactional psychological contract (β=0.123; p=0.003), with the latter having a more significant impact. Second, the destructive effect of Internet addiction on relational psychological contracts (β=-0.496; p<0.001) is greater than that on transactional psychological contracts (β=-0.476; p<0.001). Third, compared to the weakening of the relational psychological contract (β=-0.177; p=0.017), the weakening of the transactional psychological contract (β=-0.258; p=0.001) has a more significant impact on college students' academic anxiety.

Conclusion

This study shows that the weakening of the corresponding psychological contract is the key link for the development of Internet addiction into academic anxiety. Stabilizing the psychological contracts at the psychological level of college students can help suppress the vicious transformation process from internet addiction to academic anxiety, ensuring students' mental health and reducing systemic risks in educational work.

Streamlined pediatric anxiety program for school mental health services

There needs to be serious transformation of evidence-based interventions (EBIs) into real-world solutions; otherwise, EBIs will never achieve the intended public health impact. In a randomized trial, we reported effects of a redesigned anxiety program. Herein, we described the redesign process that led to the program. Survey data revealed provider preferences for school mental health anxiety services. Focus groups and prototype feedback sessions revealed service barriers to uptake, implementation, and sustainability along with corresponding enabling strategies. Prototype feedback sessions also focused on refinement and fine-tuning of the redesign. In the end, traditional EBI strategies were transformed and packaged into six lessons, lasting 20-30 minutes each, and amenable to delivery in small-group format. The redesign achieved the intended purpose of retaining elements from cognitive and behavior therapy and social skills training for the target population of the intervention (e.g., 3rd to 5th graders with heterogeneous anxiety problems - identified and referred). The streamlined EBI is accessible from PBS LearningMedia™ - a service that hosts public, research-based, and school-ready materials.

Network analysis of anxiety and depression in the functionally impaired elderly

Background

Evidence from previous studies has confirmed that functionally impaired elderly individuals are susceptible to comorbid anxiety and depression. Network theory holds that the comorbidity emerges from interactions between anxiety and depression symptoms. This study aimed to investigate the fine-grained relationships among anxiety and depression symptoms in the functionally impaired elderly and identify central and bridge symptoms to provide potential targets for intervention of these two comorbid disorders.

Methods

A total of 325 functionally impaired elderly individuals from five communities in Xi'an, China, were recruited for our investigation. The GAD-7 and PHQ-9 were used to measure anxiety and depression, respectively. SPSS 22.0 software was used for descriptive statistics, and R 4.1.1 software was used for network model construction, expected influence (EI) evaluation and bridge expected influence (BEI) evaluation.

Results

In the network, there were 35 edges (indicating partial correlations between symptoms) across the communities of anxiety and depression, among which the strongest edge was A1 "Nervousness or anxiety"-D2 "Depressed or sad mood." A2 "Uncontrollable worry" and D2 "Depressed or sad mood" had the highest EI values in the network, while A6 "Irritable" and D7 "Concentration difficulties" had the highest BEI values of their respective community. In the flow network, the strongest direct edge of D9 "Thoughts of death" was with D6 "Feeling of worthlessness."

Conclusion

Complex fine-grained relationships exist between anxiety and depression in functionally impaired elderly individuals. "Uncontrollable worry," "depressed or sad mood," "irritable" and "concentration difficulties" are identified as the potential targets for intervention of anxiety and depression. Our study emphasizes the necessity of suicide prevention for functionally impaired elderly individuals, and the symptom "feeling of worthlessness" can be used as an effective target.

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.

Peer victimization, environmental and psychological distress, and academic performance among children in China: A serial mediation model moderated by migrant status

BACKGROUND

Despite robust evidence indicating the adverse academic, psychological, and school-related impacts of being victimized, the ways in which peer victimization indirectly affects children's academic performance by psychological and environmental distress remain poorly understood, especially in China.

OBJECTIVE

We sought to investigate how peer victimization negatively impacts academic performance via the serial mediation effects of environmental and psychological distress among migrant versus non-migrant children in China.

PARTICIPANTS AND SETTING

Participants were selected by multistage stratified cluster sampling, and data were collected with a cross-sectional survey administered in Nanjing and Guangzhou, China. The sample included 1747 students in Grades 4 to 9 (boys = 54.7 %, mean age = 11.7 years).

METHODS

Structural equation modeling and group comparison analysis were conducted to examine the hypothesized model.

RESULTS

Children's experiences with peer victimization significantly affected their academic performance and in relationships partially mediated by environmental distress (i.e., perception of school safety), followed by psychological distress (i.e., anxiety) (95 % CI: [-0.010, -0.001], B = -0.005, p < .01). The serial mediation model applied to non-migrant children only (95 % CI: [-0.026, -0.001], B = -0.008, p < .05), however, whereas environmental distress exerted a single mediating effect on the association between peer victimization and academic performance among migrant children only (95 % CI: [-0.125, -0.044], B = -0.076, p < .001).

CONCLUSION

Environmental and psychological distress exerted serial mediating effect on the association between peer victimization and academic performance. School-based comprehensive intervention programs designed for migrant versus non-migrant children are recommended.

A Brief Cognitive Behavioural Intervention for Parents of Anxious Children: Feasibility and Acceptability Study

Background

Parent-only psychological interventions can be effective treatments for child anxiety. Involving parents in treatment may be beneficial for children, ensuring that interventions are delivered effectively in a supportive environment. Few studies have investigated the feasibility and acceptability of parent-only interventions for child anxiety.

Objective

In this study, we report on feasibility, acceptability and preliminary clinical outcomes of a brief cognitive behavioural group intervention for parents of children (4- to 10-years-olds) experiencing anxiety in the absence of a diagnosed anxiety disorder.

Method

Parent participants attended a three-session group intervention delivered online. We collected feasibility information (recruitment and retention rates); parents and children (when appropriate) completed acceptability and clinical outcome measures after each session. Participants were also interviewed about the acceptability of the intervention and study processes.

Results

Nineteen parents consented to take part (child mean age 6.47, SD 1.23). Participant retention rates (68.4%) and intervention satisfaction (total mean CSQ score 28.52) were high​. Calculated effect sizes were moderate to large for parent-rated outcomes, small for child self-reported anxiety, and small to moderate for parent confidence/efficacy. Thematic analysis of interview data identified benefits, such as connecting with parents and learning strategies, as well as challenges associated with the intervention.

Conclusions

Attendance appeared to be associated with positive changes for parents and children. Overall, participants found this to be an acceptable and useful intervention. These findings demonstrated the potential benefit of a brief intervention for parents of anxious children. A larger trial is required to further investigate these preliminary findings.

Protocol for a longitudinal study investigating the role of anxiety on academic outcomes in children on the autism spectrum

BACKGROUND

Children on the autism spectrum are consistently reported to underachieve compared to ability. In typically developing children, anxiety is a strong predictor of poor school performance. Despite the high prevalence of anxiety disorders among children on the spectrum, the impact of their anxiety on academic achievement is under-researched. The main aim of this project is to determine the moderating role anxiety may have in the development of academic learning behaviours (academic enablers) in children on the spectrum. This project addresses a gap in knowledge about the possible associations between anxiety and academic achievement in children on the spectrum. Understanding these associations opens up the possibility of new intervention pathways to enhance academic outcomes through anxiety reduction/prevention.

METHODS

This longitudinal study will aim to recruit 64 children on the spectrum aged 4-5 years and their parents. Information will be gathered from children, parents and teachers. Children will be randomly assigned to one of two conditions in order to experimentally manipulate anxiety levels in the sample: experimental (to receive an anxiety reduction/prevention program, N = 32) or control (no intervention/treatment as usual, N = 32). The primary outcome measures are child academic skills and enabling behaviours assessed using the Academic Competence Evaluation Scales and the WIAT-II. Anxiety will be assessed through parent and teacher report. Assessments will be conducted at baseline, post-experimental manipulation of anxiety, and within the first year of formal schooling. It is hypothesised that anxiety will moderate the relationship between autism characteristics and academic enablers.

DISSEMINATION

Results will be disseminated through peer-reviewed manuscripts and conference presentations. Lay summaries will be provided to all participants and available on the research centre website.

Is concentration an indirect link between social anxiety and educational achievement in adolescents?

Social anxiety is associated with reduced educational achievement. Given that concentration is a predictor of educational achievement, and social anxiety symptoms are associated with reduced concentration in class, this prospective study examined the possibility that social anxiety may impair educational achievement through reduced classroom concentration. A sample of 509 participants (53.8% female; M age: 12.77 years [SD = 0.81]) recruited from secondary schools completed questionnaires assessing social anxiety symptoms, depressive symptoms, and concentration in class. Educational achievement was assessed by internal grades within schools. An indirect effect of social anxiety on later educational achievement via concentration was observed, over and above baseline achievement and depression symptoms; adolescents with higher levels of social anxiety tend to have more difficulties concentrating in class, which in turn is associated with poorer academic outcomes. Findings underscore the challenges socially anxious adolescents will face trying to learn in school, and the need for education providers and clinicians to consider the effect of social anxiety symptoms on concentration and learning.

Classroom-based cognitive behavioural therapy: a large-scale non-randomised controlled trial of the 'Journey of the Brave'

BACKGROUND

In Japan, 'Journey of the Brave', a cognitive behavioural therapy (CBT)-based anxiety preventive education programme, was previously developed and its effectiveness examined in two small-scale controlled trials. These studies had some limitations, including a small number of participants and not having regular classroom teachers as programme facilitators. Therefore, we conducted a large-scale controlled trial, with teachers as programme implementers.

METHODS

Twenty-seven elementary schools participated: 1622 and 1123 children were allocated to the intervention and control groups, respectively. The intervention group received a programme comprising ten 45-min sessions, while the control group underwent the regular school curriculum. Anxiety symptoms among participants were assessed using the Spence Children's Anxiety Scale (SCAS) at three stages (pre-intervention, post-intervention, and follow-up).

RESULTS

Following primary analysis, estimated mean changes in SCAS from baseline to follow-up were - 4.91 (95% CI - 5.91, - 3.90) in the intervention group and - 2.53 (95% CI - 3.52, - 1.54) in the control group; the group difference was 2.37 (95% CI 1.42, 3.33, p < 0.0001). Children in the intervention group showed significant reduction in their anxiety score versus children in the control group.

CONCLUSIONS

The results showed a statistically significant anxiety score reduction in the intervention group, thus verifying the programme's effectiveness. Trial registration The University Hospital Medical Information Network (UMIN): UMIN000032517. Registered 10 May 2018-Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037083.

Harnessing Home-School Partnerships and School Consultation to Support Youth With Anxiety

Youth with anxiety often experience significant impairment in the school setting. Despite the relevance and promise of addressing anxiety in schools, traditional treatment approaches to school-based anxiety often do not adequately address generalization to the school setting, or they require removing the student from the classroom to deliver time- and staff-intensive programs. Such programs often leave teachers and caregivers feeling ill-equipped to support the student with anxiety throughout the natural course of the school day. Given the heavy demands placed on teachers and documented burnout among school professionals, providing effective school supports requires collaborative partnerships among outpatient therapists/specialists, school personnel, and caregivers. Drawing from literature on collaborative models for externalizing problems, we offer recommendations for outpatient therapists and specialists working to implement evidence-based supports in school settings and promote home-school partnerships to benefit youth with anxiety in the school setting. Our recommendations touch upon several components of such school consultation, including (a) identification of key parties involved, (b) conducting a needs assessment, (c) collaborative goal setting and development of a fear hierarchy, (d) plan development and implementation (e.g., facilitating a school-based exposure mindset, promoting home-school communication, enhancing school relationships), and (e) progress monitoring and ongoing support. We conclude with a case example to bring these recommendations to life.

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.

Anxiety related disorders in adolescents in the United Arab Emirates: a population based cross-sectional study

Background

Anxiety disorders are common among children and adolescents. However, there is a paucity of up-to-date data on the prevalence and correlates of anxiety-related disorders among children and adolescents in the United Arab Emirates (UAE).

Methods

We conducted a cross sectional study to determine the prevalence of specific anxiety-related disorders (e.g., generalized anxiety disorder, panic disorder, separation anxiety, social anxiety) in the UAE, and identify correlations between these disorders and adolescents’ demographic variables. Participants were 968 adolescents aged 13–18 years attending secondary schools across the UAE. Convenience sampling was used to recruit participants. We collected demographic information and data about participants’ anxiety levels. Anxiety was assessed using the Arabic and English versions of the Screen for Child Anxiety Related Disorders scale. Univariate analyses (independent sample t-tests and analysis of variance) were performed to evaluate factors affecting participants’ anxiety scores. Chi-square tests were used to compare factors associated with anxiety disorders.

Results

Participants’ mean age was 16 ± 1.8 years, and 65.8% were female. The overall prevalence of anxiety disorders was 28%, with this being significantly higher in girls (33.6%) than boys (17.2%) (p < 0.0001). Participants aged < 16 years had higher generalized anxiety, separation anxiety, and social anxiety scores compared with those aged ≥16 years (p ≤ 0.05). Those from households with a maid had significantly higher generalized anxiety, panic disorder, separation anxiety, and significant school avoidance scores than those without a maid (p ≤ 0.05). In addition, participants from middle and low economic backgrounds had higher separation anxiety scores compared with children from high economic backgrounds (p ≤ 0.05). The multivariate analysis showed the main associated factors with anxiety were gender (being female, p < 0.001) and caregiver (other than mother and father together, p < 0.001).

Conclusions

We found a high incidence of anxiety-related disorders among school-aged adolescents in the UAE, with girls being more affected than boys. This suggests that age-appropriate initiatives are urgently needed to reduce the high rate of anxiety-related disorders. It may also be necessary to further investigate the two main associated factors with anxiety identified in this study (being female and non-parental caregivers).

School-Based Accommodations and Supports for Anxious Youth: Benchmarking Reported Practices Against Expert Perspectives

Objective: Although research has examined negatively reinforcing patterns of parental accommodation of youth anxiety, limited research considers school staff-led accommodations for students with anxiety. Further, the extent to which patterns of school staff-led accommodations/supports for anxiety align with anxiety expert perspectives remains unclear.Method: School staff across elementary, middle, and high schools who identified anxiety as their top student concern (N = 134) were surveyed about their use of 23 anxiety-focused accommodations/supports, as well as their own mental health literacy and emotional exhaustion. A youth anxiety expert panel (N = 28) independently rated the extent to which each of the 23 school-based accommodations/supports could (1) promote youth avoidance of anxiety, and (2) promote youth approach toward anxiety-provoking situations/experiences.Results: School staff reported using a broad range of accommodations/supports to address student anxiety, but these accommodations were mixed in alignment with anxiety expert perspectives. Although the two most commonly endorsed school-based accommodations/supports were rated by the expert panel as highly approach-oriented, 92.5% of school staff reported using at least one accommodation or support rated by the expert panel as highly avoidance-oriented. Higher emotional exhaustion among school staff predicted greater use of avoidance-oriented supports whereas higher mental health literacy predicted greater use of approach-oriented supports.Conclusions: Strategies may be needed to reduce the use of avoidance-oriented accommodations/supports with anxious students in school settings. In addition to promoting school staff awareness of expert perspectives on anxiety-focused accommodations/supports, efforts to curb staff burnout may have indirect effects on the quality of anxiety-focused accommodations and supports in school settings.

The Effects of Youth Anxiety Treatment on School Impairment: Differential Outcomes Across CBT, Sertraline, and their Combination

Youth anxiety disorders are highly prevalent and are associated with considerable school impairment. Despite the identification of well-supported strategies for treating youth anxiety, research has yet to evaluate the differential effects of these treatments on anxiety-related school impairment. The present study leveraged data from the Child/Adolescent Anxiety Multimodal Study to examine differential treatment effects of CBT, sertraline, and their combination (COMB), relative to placebo (PBO), on anxiety-related school impairment among youth (N = 488). Latent growth modeling revealed that all three active treatments demonstrated superiority over PBO in reducing anxiety-related school impairment over time, with COMB showing the most robust effects. According to parent report, medication strategies may have stronger effects on anxiety-related school impairment among males than among females. Results were discrepant across parents and youth. Findings are discussed in terms of clinical implications for anxious youth and the need for continued research to examine treatment effects on anxiety-related school impairment.

A pilot and feasibility study of a cognitive behavioural therapy-based anxiety prevention programme for junior high school students in Japan: a quasi-experimental study

BACKGROUND

There is a good deal of evidence that cognitive behavioural therapy is effective for children and adolescents with anxiety-related problems. In Japan, an anxiety prevention programme based on cognitive behavioural therapy called 'Journey of the Brave' has been developed, and it has been demonstrated to be effective for elementary school students (aged 10-11 years). The purpose of this study was to have classroom teachers deliver the programme to junior high school students (aged 12-13 years) and to test the feasibility and efficacy of the programme in this setting.

METHODS

This study was a prospective observational study and was approved by the Chiba University Review Board. An intervention group consisting of six classes of students in their first year of junior high school at two different schools (n = 149; 81 boys, 68 girls) received seven 50-min programme sessions. Participants in the control group were recruited from four classes of students in their second year of junior high school at one school (n = 89; 51 boys, 38 girls). All participants completed the Spence Children's Anxiety Scale at pre-test, post-test, and 2-3 month follow-up. Statistical analysis was conducted using a mixed-effects model for repeated measures model.

RESULTS

Mean total anxiety scores indicated a non-significant decrease at the 2-3 month follow-up for the intervention group compared to the control group. The group differences on the SCAS from baseline to post-test was - .71 (95% CI - 2.48 to 1.06, p = .43), and the 2-3 month follow-up was - .49 (95% CI - 2.60 to 1.61, p = .64).

CONCLUSIONS

In this pilot study, implementation of the programme confirmed the partial feasibility of the programme but did not elicit a significant reduction in anxiety scores. In addition, there are several methodological limitations to this study. In the future, we propose to test the feasibility and efficacy of the programme with the required sample size and by comparing groups with equal characteristics as well as by carrying out additional follow-up assessments.Trial registration UMIN000032517.

Incident Substance Use Disorder Following Anxiety Disorder in Privately Insured Youth

PURPOSE

Anxiety disorders in childhood might be associated with an increased risk of substance use disorders. Incident substance use-related diagnoses were quantified in the 2 years after youth were newly diagnosed with an anxiety disorder and in a similar cohort of youth without diagnosed anxiety.

METHODS

Privately insured youth (10-17 years) were identified in a commercial claims database who were newly diagnosed with an anxiety disorder (2005-2014), treatment naïve, and without baseline substance-related disorder diagnoses. The comparison cohort included age, sex, region, and date matched youth with equivalent baseline exclusions. We used Kaplan-Meier estimator to calculate 2-year cumulative incidence of substance use disorder diagnosis following a new office-based anxiety disorder diagnosis (or match date for comparison cohort).

RESULTS

In 131,271 youth with a new anxiety disorder diagnosis (male = 41%, median age = 14 years), 1.5% (95% confidence interval = 1.5-1.6) had an incident substance use disorder diagnosis 1 year after their anxiety diagnosis, 2.9% (95% confidence interval = 2.8-3.0) by 2 years. Over the same period, .5% and 1.1% of the comparison cohort had incident substance use disorder diagnoses (n = 1,321,701). In the anxiety cohort, 2-year incidence was higher in youth aged 14-17 years (4.6%) versus 10-13 years (.7%). Incidence of substance use diagnosis varied by anxiety disorder (e.g., 2-year incidence: 4.3% for post-traumatic stress disorder, 3.0% for generalized anxiety disorder).

CONCLUSION

Approximately 3% of youth newly diagnosed with anxiety received an incident substance use disorder diagnosis within 2 years, almost threefold the incidence in youth without an anxiety diagnosis, emphasizing the need for increased awareness and prevention of substance-related disorders in pediatric anxiety.

Cognitive-behavior therapy for children and adolescents with anxiety disorders: A meta-analysis of secondary outcomes

Anxiety-focused cognitive-behavioral therapy (CBT) effectively reduces anxiety in children and adolescents. An important remaining question is to what extent anxiety-focused CBT also affects broader outcome domains. Additionally, it remains unclear whether parental involvement in treatment may have impact on domains other than anxiety. A meta-analysis (n_studies = 42, n_participants = 3239) of the effects of CBT and the moderating role of parental involvement was conducted on the following major secondary outcomes: depressive symptoms, externalizing behaviors, general functioning, and social competence. Randomized controlled trials were included when having a waitlist or active control condition, a youth sample (aged<19) with a primary anxiety disorder diagnosis receiving anxiety-focused CBT and reported secondary outcomes. Controlled effect sizes (Cohen's d) were calculated employing random effect models. CBT had a large effect on general functioning (-1.25[-1.59;0.90], n_studies = 17), a small to moderate effect on depressive symptoms (-0.31[-0.41;-0.22], n_studies = 31) and a small effect on externalizing behaviors (-0.23[-0.38;-0.09], n_studies = 12) from pre-to post-treatment. Effects remained or even further improved at follow-up. Social competence only improved at follow-up (n_studies = 6). Concluding, anxiety-focused CBT has a positive effect on broader outcome domains than just anxiety. Higher parental involvement seemed to have beneficial effects at follow-up, with improvements in general functioning and comorbid symptoms.

Social and academic functioning in adolescents with anxiety disorders: A systematic review

BACKGROUND

Anxiety disorders are highly prevalent during adolescence. Although literature points out that anxiety symptoms are related to problems in social and academic functioning, the extent of these problems among adolescents with clinical anxiety disorders has not been systematically reviewed before.

METHODS

Electronic databases were searched up to October 2017, with keywords representing anxiety disorders, adolescents, and social or academic functioning. The inclusion criteria were studies with a sample of adolescents (10-19 years) with anxiety disorders that provided data regarding their social or academic functioning. 3431 studies were examined, of which 19 met the inclusion criteria.

RESULTS

Adolescents with anxiety disorders had a lower social competence relative to their healthy peers. They reported more negativity within interpersonal relationships, higher levels of loneliness, and victimization. Most adolescents with anxiety disorders felt impaired at school, however, findings of their average school results, compared to peers, were mixed. In addition, they had a higher risk for school refusal and entered higher education less often. Impairments in social and academic functioning differed across type and the number of anxiety disorders.

LIMITATIONS

Most studies examined social phobia or anxiety disorders in general and methodological approaches varied widely between studies.

CONCLUSIONS

This systematic review indicates that adolescents with anxiety disorders experience a range of significant problems in both social and academic functioning. These findings suggest that the assessment and treatment of anxiety disorders in adolescence should focus on improving functioning across domains.

Innovative Clinical Training Site for Psychiatric Mental Health Nurse Practitioner Students: Elementary School-Based Group Therapy (Manuscript ID UMHN-2017-0143)

The aim of this clinical training site innovation is to develop accessible pediatric mental health clinical training sites for psychiatric mental health nurse practitioner (PMHNP) students. Mental health services in school settings provide treatment in the child's community and create opportunities for innovation and collaboration with teachers, school counselors, and school psychologists. School settings provide opportunities for early recognition of anxiety symptoms and accessible treatment that can help close the gap in clinical training sites for this population. Mild and moderate symptoms of anxiety often go untreated and may affect academic performance negatively. Cognitive behavioral play therapy is an effective treatment modality provided by PMHNP students and supports the roles of school personnel.

School Nurse Perceptions of Student Anxiety

Anxiety disorders are common in youth. Because somatic complaints are a hallmark feature of anxiety, these students frequently visit their school nurse, creating an ideal opportunity for nurses to identify and assist them. In an effort to better understand current practices, we surveyed a large sample ( N = 93) of school nurses. Results indicated that the majority of nurses perceived anxiety as the most prevalent mental health issue in their students. Moreover, the majority of nurses reported that they did not use any formal screening tool or intervention protocol and stated wanting to expand their training in anxiety intervention. These data suggest that school nurses identify anxiety as a top problem but do not receive adequate training to address it. Data from this survey may be used to plan how best to fill gaps in nurse training and practices that can enhance nurses' capacity to optimize outcomes for anxious students.

Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders: A Systematic Review and Meta-analysis

Importance

Childhood anxiety is common. Multiple treatment options are available, but existing guidelines provide inconsistent advice on which treatment to use.

Objectives

To evaluate the comparative effectiveness and adverse events of cognitive behavioral therapy (CBT) and pharmacotherapy for childhood anxiety disorders.

Data Sources

We searched MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and SciVerse Scopus from database inception through February 1, 2017.

Study Selection

Randomized and nonrandomized comparative studies that enrolled children and adolescents with confirmed diagnoses of panic disorder, social anxiety disorder, specific phobias, generalized anxiety disorder, or separation anxiety and who received CBT, pharmacotherapy, or the combination.

Data Extraction and Synthesis

Independent reviewers selected studies and extracted data. Random-effects meta-analysis was used to pool data.

Main Outcomes and Measures

Primary anxiety symptoms (measured by child, parent, or clinician), remission, response, and adverse events.

Results

A total of 7719 patients were included from 115 studies. Of these, 4290 (55.6%) were female, and the mean (range) age was 9.2 (5.4-16.1) years. Compared with pill placebo, selective serotonin reuptake inhibitors (SSRIs) significantly reduced primary anxiety symptoms and increased remission (relative risk, 2.04; 95% CI, 1.37-3.04) and response (relative risk, 1.96; 95% CI, 1.60-2.40). Serotonin-norepinephrine reuptake inhibitors (SNRIs) significantly reduced clinician-reported primary anxiety symptoms. Benzodiazepines and tricyclics were not found to significantly reduce anxiety symptoms. When CBT was compared with wait-listing/no treatment, CBT significantly improved primary anxiety symptoms, remission, and response. Cognitive behavioral therapy reduced primary anxiety symptoms more than fluoxetine and improved remission more than sertraline. The combination of sertraline and CBT significantly reduced clinician-reported primary anxiety symptoms and response more than either treatment alone. Head-to-head comparisons were sparse, and network meta-analysis estimates were imprecise. Adverse events were common with medications but not with CBT and were not severe. Studies were too small or too short to assess suicidality with SSRIs or SNRIs. One trial showed a statistically nonsignificant increase in suicidal ideation with venlafaxine. Cognitive behavioral therapy was associated with fewer dropouts than pill placebo or medications.

Conclusions and Relevance

Evidence supports the effectiveness of CBT and SSRIs for reducing childhood anxiety symptoms. Serotonin-norepinephrine reuptake inhibitors also appear to be effective based on less consistent evidence. Head-to-head comparisons between various medications and comparisons with CBT represent a need for research in the field.

The Relationship Between Anger and Anxiety Symptoms in Youth with Anxiety Disorders

This study examined the relationship between anger and anxiety in youth in an outpatient anxiety treatment clinic. Participants included 40 primarily female and Caucasian youth, all diagnosed with a primary anxiety disorder. Youth provided ratings of anger, anxiety, and depressive symptoms. We also obtained parent and clinician ratings of anxiety severity. Analyses supported a significant relationship between trait anger and anxiety severity. When rated by youth, trait anger was significantly related to physical symptoms of anxiety and harm avoidance. Youth report of anger symptoms was not related to parent or clinician report of youth anxiety severity. Assessing symptoms of anger in youth with anxiety disorders may be important, as it may be related to higher anxiety symptom severity for some youth. Future research in larger samples is needed to understand the co-occurrence of different components of anger and anxiety disorders and its impact on prognosis and treatment process.

Anxiety

Anxiety disorders (separation anxiety disorder, selective mutism, specific phobias, social anxiety disorder, panic disorder, agoraphobia, and generalised anxiety disorder) are common and disabling conditions that mostly begin during childhood, adolescence, and early adulthood. They differ from developmentally normative or stress-induced transient anxiety by being marked (ie, out of proportion to the actual threat present) and persistent, and by impairing daily functioning. Most anxiety disorders affect almost twice as many women as men. They often co-occur with major depression, alcohol and other substance-use disorders, and personality disorders. Differential diagnosis from physical conditions-including thyroid, cardiac, and respiratory disorders, and substance intoxication and withdrawal-is imperative. If untreated, anxiety disorders tend to recur chronically. Psychological treatments, particularly cognitive behavioural therapy, and pharmacological treatments, particularly selective serotonin-reuptake inhibitors and serotonin-noradrenaline-reuptake inhibitors, are effective, and their combination could be more effective than is treatment with either individually. More research is needed to increase access to and to develop personalised treatments.