Factor structure, reliability and validity of the Taiwanese version of the Multidimensional Anxiety Scale for Children

Adolescent-Caregiver Agreement Regarding the School Bullying and Cyberbullying Involvement Experiences of Adolescents with Autism Spectrum Disorder

School bullying and cyberbullying victimization and perpetration are prevalent in adolescents with autism spectrum disorder (AASD). However, the levels of adolescent-caregiver agreement regarding the bullying involvement of AASD and the factors associated with these levels remain to be evaluated. In the present study, we evaluated the levels of adolescent-caregiver agreement on the school bullying and cyberbullying involvement experiences of AASD and the factors associated with the levels of agreement. This study included 219 dyads of AASD and their caregivers. The school bullying and cyberbullying involvement experiences of the participating AASD were assessed using the School Bullying Experience Questionnaire and the Cyberbullying Experiences Questionnaire, respectively. Attention-deficit/hyperactivity disorder, oppositional defiant disorder (ODD), depressive and anxiety symptoms, and autistic social impairment were also assessed. AASD and their caregivers had poor to fair levels of agreement regarding the school bullying and cyberbullying victimization and perpetration experiences of AASD. Severe inattention, hyperactivity-impulsivity, ODD, depressive and anxiety symptoms, and autistic social impairment were associated with high levels of adolescent-caregiver agreement. When assessing the bullying involvement experiences of AASD, mental health professionals should obtain information from multiple sources. In addition, the factors influencing the levels of agreement should be considered.

Relationship between Bullying Victimization and Quality of Life in Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) in Taiwan: Mediation of the Effects of Emotional Problems and ADHD and Oppositional Defiant Symptoms

This cross-sectional study investigated the mediating effects of emotional problems including depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) symptoms on the association between bullying victimization and quality of life (QoL) among adolescents with ADHD in Taiwan. A total of 171 adolescents diagnosed as having ADHD participated in this study. Adolescents completed the School Bullying Experience Questionnaire, the Taiwanese Quality of Life Questionnaire for Adolescents, the Taiwanese version of the Children’s Depression Inventory and the Multidimensional Anxiety Scale for Children. Caregivers completed the Chinese version of the Swanson, Nolan, and Pelham Version IV Scale. Structural equation modeling (SEM) was used to examine the relationships among the variables. The results of SEM revealed that bullying victimization indirectly correlated with QoL through the mediation of emotional problems in adolescents with ADHD, whereas ADHD and ODD symptoms did not mediate the association between bullying victimization and QoL. Bullying victimization should be actively prevented and intervened on to ensure better QoL in adolescents with ADHD. Moreover, emotional problems should be alleviated among adolescents with ADHD with bullying victimization experience to maintain their QoL.

Social Anxiety in Victimization and Perpetration of Cyberbullying and Traditional Bullying in Adolescents with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder

Victimization and perpetration of cyberbullying and traditional bullying are prevalent among adolescents with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). The aims of this study were to examine the role of social anxiety in victimization and perpetration of cyberbullying and traditional bullying in adolescents with ASD and ADHD in Taiwan. A total of 219 adolescents with ASD and 287 adolescents with ADHD aged 11–18 years and their caregivers were recruited from the child psychiatry outpatient clinics into this study. The associations of social anxiety with victimization and perpetration of cyberbullying and traditional bullying were examined using logistic regression analysis. The results indicated that after the effects of sex, age, and autistic social impairment were controlled, social anxiety increased the risk of being a victim of cyberbullying (Odds Ratios (OR) = 1.048; 95% Confidence Interval (CI): 1.013–1.084), a victim of traditional bullying (OR = 1.066; 95% CI: 1.036–1.097), and a perpetrator of traditional bullying (OR = 1.061; 95% CI: 1.027–1.096) in adolescents with ASD. After the effects of sex, age, and ADHD symptoms were controlled for, social anxiety increased the risk of being a victim of traditional bullying in adolescents with ADHD (OR = 1.067; 95% CI: 1.039–1.096). Social anxiety was significantly associated with several forms of bullying involvement in adolescents with ASD and ADHD and warrants being considered into prevention and intervention programs for bullying involvement.

Child-Mother Agreement on Experiences of School Bullying Involvement in Children With ADHD

Objective: To examine the levels of agreement between the reports of 452 children and their mothers on children's experiences of bullying involvement at school and investigate the factors influencing the levels of agreement in children with ADHD. Method: The levels of agreement between children's and mothers' reports were examined. The influence of age, sex, ADHD symptoms, and psychiatric comorbidities on the levels of agreement was also examined. Results: The results indicated low agreement on the experiences of bullying involvement in child-mother ADHD dyads. Age and hyperactivity-impulsivity, oppositional, depressive, and anxiety symptoms significantly influenced the levels of agreement on the victimization of physical bullying. Age significantly influenced the levels of agreement on the perpetration of physical bullying. Conclusion: Multiple sources of information are required when clinicians assess the experiences of bullying involvement at school in children with ADHD. The factors influencing the levels of agreement should be considered.

Teacher Harassment Victimization in Adolescents with High-Functioning Autism Spectrum Disorder: Related Factors and Its Relationships with Emotional Problems

This study aimed to examine the prevalence, related factors, and emotional problems associated with teacher harassment victimization in adolescents with autism spectrum disorder (ASD) assessed by self-reports and parent reports. A total of 219 adolescents with ASD participated in this study. The self-reported and parent-reported rates of teacher harassment victimization were calculated. Sociodemographic characteristics, parent-reported social communication deficits, attention-deficit and hyperactivity disorder (ADHD) symptoms, oppositional defiant disorder (ODD) symptoms, self-reported depression and anxiety symptoms, and suicidality were surveyed. In total, 26 (11.9%) adolescents with ASD experienced teacher harassment based on self-reports or parent reports; the convergence between adolescent and parent reports on adolescent experiences of teacher harassment was low. Victims of teacher harassment exhibited more severe social communication deficits and ODD symptoms than nonvictims of teacher harassment. Victims of teacher harassment displayed more severe depression and anxiety and were more likely to have suicidality. Socio-communication deficits and ODD symptoms were related to teacher harassment victimization, which in turn was significantly associated with emotional problems among adolescents with ASD.

Role of School Bullying Involvement in Depression, Anxiety, Suicidality, and Low Self-Esteem Among Adolescents With High-Functioning Autism Spectrum Disorder

This study aimed to compare the severities of psychopathologies and the level of self-esteem among 219 adolescents with high-functioning autism spectrum disorder (ASD) who were classified into pure perpetrators, pure victims, perpetrator-victims, and neutrals in Taiwan. The experiences of school bullying involvement in the previous 1 year were measured using the Chinese version of the School Bullying Experience Questionnaire. The severities of depression, anxiety, and suicidality were measured using the Center for Epidemiological Studies Depression Scale, the Multidimensional Anxiety Scale for Children, and the 5-item questionnaire from the epidemiological version of the Kiddie Schedule for Affective Disorders and Schizophrenia, respectively. The level of self-esteem was measured using the Rosenberg Self-Esteem Scale. The results indicated that compared with the self-reported neutrals, the self-reported perpetrator-victims and pure victims had more severe depression and anxiety. No difference in depression, suicidality, anxiety, and self-esteem was found among the four groups of various parent-reported bullying involvement experiences. Mental health problems in adolescents with ASD who experienced bullying victimization should be routinely surveyed.

Cyberbullying Victimization and Perpetration in Adolescents with High-Functioning Autism Spectrum Disorder: Correlations with Depression, Anxiety, and Suicidality

The present study examined the associations between cyberbullying involvement and sociodemographic characteristics, autistic social impairment and attention-deficit/hyperactivity disorder and oppositional defiant disorder (ODD) symptoms in 219 adolescents with high-functioning autism spectrum disorder (ASD). Moreover, the associations between cyberbullying involvement and depression, anxiety, and suicidality were also examined. Adolescents self-reported higher rates of being a victim or perpetrator of cyberbullying than were reported by their parents. Increased age and had more severe ODD symptoms were significantly associated with being victims or perpetrators of cyberbullying. Being a victim but not a perpetrator of cyberbullying was significantly associated with depression, anxiety, and suicidality. Cyberbullying victimization and perpetration should be routinely surveyed in adolescents with high-functioning ASD.

Association between Facial Emotion Recognition and Bullying Involvement among Adolescents with High-Functioning Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that is characterized by impaired social interaction, communication and restricted and repetitive behavior. Few studies have focused on the effect of facial emotion recognition on bullying involvement among individuals with ASD. The aim of this study was to examine the association between facial emotion recognition and different types of bullying involvement in adolescents with high-functioning ASD. We recruited 138 adolescents aged 11 to 18 years with high-functioning ASD. The adolescents’ experiences of bullying involvement were measured using the Chinese version of the School Bullying Experience Questionnaire. Their facial emotion recognition was measured using the Facial Emotion Recognition Task (which measures six emotional expressions and four degrees of emotional intensity). Logistic regression analysis was used to examine the association between facial emotion recognition and different types of bullying involvement. After controlling for the effects of age, gender, depression, anxiety, inattention, hyperactivity/impulsivity and opposition, we observed that bullying perpetrators performed significantly better on rating the intensity of emotion in the Facial Emotion Recognition Task; bullying victims performed significantly worse on ranking the intensity of facial emotion. The results of this study support the different deficits of facial emotion recognition in various types of bullying involvement among adolescents with high-functioning ASD. The different directions of association between bully involvement and facial emotion recognition must be considered when developing prevention and intervention programs.

Psychosocial Determinants of Insomnia in Adolescents: Roles of Mental Health, Behavioral Health, and Social Environment

The theoretical explanation of human problems is derived from the complex interplay of psychological, social, economic, political, and physical factors.

Pain, Bullying Involvement, and Mental Health Problems Among Children and Adolescents With ADHD in Taiwan

OBJECTIVE

The aim of this study was to examine the relationships of pain and pain-induced functional impairment with bullying involvement, as well as the relationships between pain and mental health problems among 474 children and adolescents with ADHD.

METHOD

The levels of pain, pain-induced functional impairment, involvement in bullying, depression, anxiety, ADHD symptoms, and sleep quality were assessed.

RESULTS

Both victims of verbal and relational bullying and victims of physical bullying were more likely to have pain and pain-induced functional impairment than nonvictims. The perpetrators of verbal and relational bullying were more likely to have pain than the nonperpetrators. Participants with pain and pain-induced functional impairment experienced more severe depression and anxiety and worse sleep quality than did those without pain or pain-induced functional impairment.

CONCLUSION

Clinical and educational professionals should consider the possibility of involvement in bullying and comorbid depression, anxiety, and poor sleep quality among ADHD children and adolescents with pain problems.

Parental absence predicts suicide ideation through emotional disorders

The objectives of the study were to investigate the association between the parental absence and suicide ideation and to examine the roles of emotional disorders in the aforementioned relationship. Four thousand five hundred and thirteen children from rural areas in Jiangsu Province, China, participated in the study. Among the participants, 2416 were non-left-behind children (children living with both parents) and 1997 were left-behind children (children living with the absence of at least one parent). All participants responded to the Center for Epidemiological Studies Depression Scale for Children, the Multidimensional Anxiety Scale for Children, and a question regarding respondents’ suicide ideation. Results indicated that as compared with non-left-behind children, the left-behind children with both-parents absence were statistically more likely to show suicide ideation. Furthermore, all the three types parental absence—father absence, mother absence, and both-parents absence were significantly associated with negative emotional outcomes. Moreover, depression, social anxiety, and physical anxiety were shown to be significant mediators in the relationship of parental absence and suicide ideation of children. The stress of parental absence and its negative impact on children’s mental health are discussed.

Suicidality and its relationships with individual, family, peer, and psychopathology factors among adolescents with attention-deficit/hyperactivity disorder

The aim of this study was to examine the prevalence rates of suicidal intent and its correlates among adolescents diagnosed with ADHD in Taiwan. A total of 287 adolescents aged 11-18 years and diagnosed with ADHD participated in this study. Their suicidal ideation and suicide attempts were assessed. Logistic regression analysis was used to examine the associations of suicide with individual, family, peer, ADHD, and psychopathology factors. A total of 12.2% of the participants reported suicidal ideation or a suicide attempt. A logistic regression analysis model showed that adolescents who were older, were bullying perpetrators, and reported high depression level were more likely to have suicidal intent. These three factors were also significantly correlated with suicidal ideation; however, only having high depression level was significantly correlated with suicidal attempts. The results of this study showed that a high proportion of adolescents with ADHD reported suicidal ideation or a suicide attempt. Multiple factors were significantly associated with suicidal intent among adolescents with ADHD. Clinicians, educational professionals, and parents of adolescents with ADHD should monitor the possibility of suicide in adolescents with ADHD who exhibit the correlates of suicidal intent identified in this study.

Anxiety and depression among adolescents with attention-deficit/hyperactivity disorder: The roles of behavioral temperamental traits, comorbid autism spectrum disorder, and bullying involvement

The aim of this study was to examine the associations of behavioral temperamental traits, comorbid autism spectrum disorder (ASD), and bullying involvement with anxiety and depression among adolescents with attention-deficit/hyperactivity disorder (ADHD) in Taiwan. A total of 287 adolescents aged 11-18 years diagnosed with ADHD participated in this study. Their severities of anxiety and depression were assessed. Multiple regression analysis was used to examine the correlates of anxiety and depression. The results show that adolescents with ADHD who reported a higher behavioral inhibition system (BIS) score, had comorbid ASD, and were bullying victims, reported more severe anxiety and depressive symptoms. Adolescents with ADHD who bullied others reported more severe depressive symptoms than those who did not bully. The results of this study indicated that behavioral temperamental traits on the BIS, comorbid ASD, and bullying involvement were significantly associated with anxiety and depression among the adolescents with ADHD.

Physical Child Abuse and Teacher Harassment and Their Effects on Mental Health Problems Amongst Adolescent Bully-Victims in Taiwan

This study compared physical child abuse and teacher harassment of bully-victims with other groups and examined their associations with mental health problems in bully-victims. For 6,160 adolescents, experiences of physical child abuse, teacher harassment, peer bullying, and six mental health problem indicators were assessed. Adolescents that had experienced physical child abuse and teacher harassment were more likely to be bully-victims but not neutral or pure victims. Adolescents who reported physical child abuse were more likely to be bully-victims but not pure bullies. Bully-victims that had experienced teacher harassment exhibited more severe depression and insomnia than did those without teacher harassment. Gender had moderating effects on the difference in physical child abuse between bully-victims and neutrals and on the association between physical child abuse and suicidality in bully-victims. Physical child abuse and teacher harassment should be considered when preventive and intervention programs are developed for adolescents.

Eye movement desensitization and reprocessing for treating psychological disturbances in Taiwanese adolescents who experienced Typhoon Morakot

In this case-control study, we aimed to assess the intervention effects of four-session eye movement desensitization and reprocessing (EMDR) on reducing the severity of disaster-related anxiety, general anxiety, and depressive symptoms in Taiwanese adolescents who experienced Typhoon Morakot. A total of 83 adolescents with posttraumatic stress disorder related to Typhoon Morakot, major depressive disorder, or current moderate or high suicide risk after experiencing Typhoon Morakot were allocated to a four-session course of EMDR (N = 41) or to treatment as usual (TAU; N = 42). A multivariate analysis of covariance was performed to examine the effects of EMDR in reducing the severity of disaster-related anxiety, general anxiety, and depressive symptoms in adolescents by using preintervention severity values as covariates. The multivariate analysis of covariance results indicated that the EMDR group exhibited significantly lower preintervention severity values of general anxiety and depression than did the TAU group. In addition, the preintervention severity value of disaster-related anxiety in the EMDR group was lower than that in the TAU group (p = 0.05). The results of this study support that EMDR could alleviate general anxiety and depressive symptoms and reduce disaster-related anxiety in adolescents experiencing major traumatic disasters.

Self-reported depression and anxiety symptoms in school-aged Singaporean children

INTRODUCTION

Few studies have examined anxiety and depression experiences of primary (middle) school-aged children from ethnically diverse backgrounds, and most have relied on parents or others as informants. The present study aimed to investigate self-reported anxiety and depression symptoms in Singaporean primary school-aged children. Age, gender, and ethnic differences and interactions were explored as well as similarities and differences between Singaporean children and US norms.

METHODS

A large representative community sample of 1655 8- to 12-year-old Singaporean children (Chinese, Malay, and Indian) completed the Multidimensional Anxiety Scale for Children (MASC) and the Children's Depression Inventory (CDI) as part of a larger epidemiological study of mental health in Singaporean children.

RESULTS

Rates of clinically elevated symptoms of anxiety and depression were 9.3% and 16.9% on the MASC and the CDI, respectively. Separation and social anxieties were most common. Evidence of a gender difference in levels of emotional symptoms was most evident in Indian children, with girls reporting more symptoms than boys. The relationship between age and internalizing problems was weak.

DISCUSSION

A substantial minority of primary school-aged Singaporean children reported elevated anxious and depressive symptoms. Better understanding of the factors that contribute to the development and maintenance of these problems can help the development of culture-specific interventions and facilitate the planning of community-tailored services and initiatives.

Risk and Protective Factors of Suicidal Ideation and Attempt among Adolescents with Different Types of School Bullying Involvement

Suicide has been found to be prevalent among adolescents involved in bullying; however, there has been a lack of research examining whether the risk and protective factors of suicidal ideation and attempt are different among adolescents with different types of bullying involvement. The aims of this study were to examine the risk and protective factors of suicidal ideation and attempt among adolescents with different experiences of bullying involvement, victimization, and perpetration. A total of 4,533 adolescents participated in this study. Different groups of bullying involvement, victimization, and perpetration were determined through use of the Chinese version of the School Bullying Experience Questionnaire. The associations of suicidal ideation and attempt with possible risk factors (domestic violence, overweight, depression, anxiety, and alcohol abuse) and protective factors (family support and self-esteem) were examined using logistic regression analysis. Pure victims, pure perpetrators, and victim-perpetrators were more likely to report suicidal ideation and attempt than the neutral group. The risk and protective factors of suicidal ideation and attempt were different across adolescents with different experiences of bullying involvement, victimization, and perpetrators. The risk of suicide should be monitored among adolescents who are involved in any type of bullying. The risk and protective factors of suicide identified in this study should be taken into consideration in prevention and intervention programs for suicide in adolescents involved in bullying.

Cyberbullying among male adolescents with attention-deficit/hyperactivity disorder: prevalence, correlates, and association with poor mental health status

The aims of this study were to examine the prevalence rates and multilevel correlates of cyberbullying victims and perpetrators among male adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in Taiwan. The relationships between cyberbullying involvement and depression, anxiety, and suicidality were also examined. The experiences of cyberbullying victimization and perpetration in 251 male adolescents with ADHD were assessed. Logistic regression analysis was used to examine the correlates of cyberbullying victims and perpetrators. The relationships between cyberbullying involvement and depression, anxiety, and suicidality were examined using multiple regression analysis. A total of 48 (19.1%) and 36 (14.3%) participants reported that they were cyberbullying victims or perpetrators, respectively. Those who had increased age and a higher parental occupational socioeconomic status, and reported more severe traditional passive bullying victimization were more likely to be cyberbullying victims. Those who had increased age and combined-type ADHD, and reported lower BAS reward responsiveness, more severe Internet addiction and more severe traditional passive bullying perpetration were more likely to be cyberbullying perpetrators. Cyberbullying victims reported more severe depression and suicidality than those who were not cyberbullying victims. A high proportion of male adolescents with ADHD are involved in cyberbullying. Clinicians, educational professionals, and parents of adolescents should monitor the possibility of cyberbullying involvement among male adolescents with ADHD who exhibit the cyberbullying correlates identified in this study.

The association of Internet addiction symptoms with anxiety, depression and self-esteem among adolescents with attention-deficit/hyperactivity disorder

BACKGROUND

The aims of this study were to examine the associations of the severity of Internet addiction symptoms with various dimensions of anxiety (physical anxiety symptoms, harm avoidance, social anxiety, and separation/panic) and depression symptoms (depressed affect, somatic symptoms, interpersonal problems, and positive affect) and self-esteem among adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in Taiwan.

METHOD

A total of 287 adolescents aged between 11 and 18 years who had been diagnosed with ADHD participated in this study. Their severity of Internet addiction symptoms was assessed using the Chen Internet Addiction Scale. Anxiety and depression symptoms and self-esteem were assessed using the Taiwanese version of the Multidimensional Anxiety Scale for Children (MASC-T), the Center for Epidemiological Studies Depression Scale (CES-D), and the Rosenberg Self-Esteem Scale (RSES), respectively. The association between the severity of Internet addiction symptoms and anxiety and depression symptoms and self-esteem were examined using multiple regression analyses.

RESULTS

The results indicated that higher physical symptoms and lower harm avoidance scores on the MASC-T, higher somatic discomfort/retarded activity scores on the CES-D, and lower self-esteem scores on the RSES were significantly associated with more severe Internet addiction symptoms.

CONCLUSIONS

Prevention and intervention programs for Internet addiction in adolescents with ADHD should take anxiety, depression, and self-esteem into consideration.

Mediating effects of depression and anxiety on the relationship between bullying involvement and pain problems among adolescents in Taiwan

BACKGROUND

This study aimed to examine the mediating effects of depression and anxiety on the relationships of bullying victimization and perpetration with pain among adolescents in Taiwan.

METHOD

A total of 4976 students of junior and senior high schools completed the questionnaires. Bullying victimization and perpetration, pain problems, depression, and anxiety were assessed. The mediating effects of depression and anxiety on the relationship between bullying involvement and pain problems and the moderating effects of sex on the medicating roles of depression and anxiety were examined by structural equation model.

RESULTS

Both depression and anxiety were significant mediators of the relationship between bullying victimization and pain problems among adolescents. Depression was also a significant mediator of the relationship between bullying perpetration and pain problems among adolescents. Sex had no moderating effect on the mediating role of depression/anxiety on the association between bullying involvement and pain problems.

CONCLUSIONS

Medical and educational professionals should survey and intervene in depression and anxiety when managing pain problems among adolescents involved in bullying.

Association between ADHD symptoms and anxiety symptoms in Taiwanese adolescents

OBJECTIVE

The aims of this cross-sectional study were to examine the association between significant ADHD symptoms and the four domains of anxiety symptoms on the Taiwanese version of Multidimensional Anxiety Scale for Children (MASC-T) and to examine the moderating effects of sociodemographic characteristics on this association among Taiwanese adolescents in the community.

METHOD

A total of 4,716 adolescents in Grades 7 through 12 in southern Taiwan completed the MASC-T, the ADHD Self-Rated Scale, the Mandarin Chinese version of the Center for Epidemiological Studies Depression Scale, the Rosenberg Self-Esteem Scale, and a questionnaire about sociodemographic characteristics. Multiple regression analysis was used to examine both the association of significant ADHD symptoms with four domains of anxiety symptoms on the MASC-T and the moderating effects of sociodemographic characteristics on this association.

RESULTS

The adolescents with significant ADHD symptoms had more severe total anxiety symptoms, physical symptoms, social anxiety symptoms, and separation/panic symptoms for three domains of the MASC-T but less harm avoidance than did those without significant ADHD symptoms. Age, gender, and low self-esteem had moderating effects on the association between significant ADHD symptoms and anxiety symptoms for some domains of the MASC-T.

CONCLUSION

The results of this study suggest a significant association between significant ADHD symptoms and the severity of anxiety symptoms in adolescents. Clinicians must evaluate anxiety symptoms among adolescents with ADHD and arrange comprehensive treatment programs.

The multidimensional anxiety scale for children: a further validation with Australian adolescents with and without ADHD

OBJECTIVE

To examine the factor structure of the Multidimensional Anxiety Scale for Children (MASC) with Australian adolescents with and without ADHD.

METHOD

The MASC was administered to 210 high school-aged adolescents (109 males, 101 females), 115 of whom were clinically diagnosed as ADHD (86 males, 29 females). The remaining 95 were non-ADHD community comparisons.

RESULTS

Analyses supported a three-factor model, with a reduced item pool, which combined the Harm Avoidance and Separation Anxiety scales together. This model was invariant across younger and older participants, and across boys and girls. The model was largely invariant across ADHD and non-ADHD groups. The ADHD group had significantly higher Physical Symptom factor scores than the non-ADHD group.

CONCLUSION

The MASC is useful for assessing anxiety in adolescents with and without ADHD, but items reflecting the Harm Avoidance and Separation Anxiety scales may need revising.

A parental report of children's anxiety symptoms in Japan

Using parental reports, the current study investigated anxiety symptoms among Japanese children as part of the process of developing the Japanese version of the Spence Children's Anxiety Scale for Parents (SCAS-P). The participants were 677 parents and children aged 9-12 years. Confirmatory factor analysis on 568 parents and children supported that the SCAS-P had a 6-factor structure. The scale showed satisfactory internal consistency and good convergent validity. A MANOVA indicated no significant gender or age differences except for the obsessive-compulsive disorder subscale. Among Japanese children, the most prevalent symptoms within the parental report were items related to fear of the dark and of insects/spiders. Finally, we observed very low correlations between parental and child reports of anxiety symptoms; the relationships between child and parental reports were rather poor among Japanese children. We briefly discuss the utility of the SCAS-P as a screening instrument assessing parental reports of anxiety symptoms.

Effects of cognitive-behavioral therapy on improving anxiety symptoms, behavioral problems and parenting stress in Taiwanese children with anxiety disorders and their mothers

The aims of this intervention study were to examine the effects of individual cognitive-behavioral therapy (CBT) based on the modified Coping Cat Program on improving anxiety symptoms and behavioral problems in Taiwanese children with anxiety disorders and parenting stress perceived by their mothers. A total of 24 children with anxiety disorders in the treatment group completed the 17-session individual CBT based on the modified Coping Cat Program, and 26 children in the control group received the treatment as usual intervention. The Taiwanese version of the MASC (MASC-T), the Child Behavior Checklist for Ages 6-18 (CBCL/6-18) and the Chinese version of the Parenting Stress Index (C-PSI) were applied to assess the severities of anxiety symptoms, behavioral problems and parenting stress, respectively. The effects of CBT on improving anxiety symptoms, behavioral problems and parenting stress were examined by using linear mixed-effect model with maximum likelihood estimation. The results indicated that the CBT significantly improved the severities of MASC-T Physical Symptoms and Social Anxiety subscales, CBCL/6-18 DSM-oriented Anxiety Problem subscale, and C-PSI Child domains Mood and Adaptability subscales. Individual CBT based on the modified Coping Cat Program can potentially improve anxiety symptoms in Taiwanese children with anxiety disorders and some child domains of parenting stress perceived by their mothers.

Association between school bullying levels/types and mental health problems among Taiwanese adolescents

BACKGROUND

Few studies have compared the risks of mental health problems among the adolescents with different levels and different types of bullying involvement experiences.

METHOD

Bullying involvement in 6,406 adolescents was determined through use of the Chinese version of the School Bullying Experience Questionnaire. Data were collected regarding the mental health problems, including depression, suicidality, insomnia, general anxiety, social phobia, alcohol abuse, inattention, and hyperactivity/impulsivity. The association between experiences of bullying involvement and mental health problems was examined. The risk of mental health problems was compared among those with different levels/types of bullying involvement.

RESULTS

The results found that being a victim of any type of bullying and being a perpetrator of passive bullying were significantly associated with all kinds of mental health problems, and being a perpetrator of active bullying was significantly associated with all kinds of mental health problems except for general anxiety. Victims or perpetrators of both passive and active bullying had a greater risk of some dimensions of mental health problems than those involved in only passive or active bullying. Differences in the risk of mental health problems were also found among adolescents involved in different types of bullying.

CONCLUSIONS

This difference in comorbid mental health problems should be taken into consideration when assessing adolescents involved in different levels/types of bullying.

The associations between suicidal ideation and attempt and anxiety symptoms and the demographic, psychological, and social moderators in Taiwanese adolescents

The objectives of this study were to examine the associations between suicidal ideation and attempt and anxiety symptoms and the moderators in 5,027 Taiwanese adolescents. The associations between suicidal ideation and attempt and anxiety symptoms on the Taiwanese version of the Multidimensional Anxiety Scale for Children (MASC-T) were examined using logistic regression analysis. The moderating effects of demographic (gender and age), psychological (problematic alcohol use, severe depressive symptoms, and low self-esteem), and social factors (bullying victimization, and low family function) on the associations were examined. Adolescents who had anxiety symptoms were more likely to have suicidal ideation and attempt than those who did not have anxiety symptoms. Bullying victimization had a moderating effect on the association between suicidal ideation and anxiety symptoms. Assessment of suicidal ideation and attempt should be routine practice among adolescents who present with anxiety symptoms.

The relation between family adversity and social anxiety among adolescents in Taiwan: effects of family function and self-esteem

This study aimed to examine the relationship between three indicators of family adversity (domestic violence, family substance use, and broken parental marriage) and the severity of social anxiety among adolescents in Taiwan, as well as the mediating effects of perceived family function and self-esteem on that relationship, using structural equation modeling (SEM). A total of 5607 adolescents completed the social anxiety subscale of the Multidimensional Anxiety Scale for Children; the Family APGAR Index; the Rosenberg Self-Esteem Scale; and a questionnaire for domestic violence, family substance use, and broken parental marriage. The relation between family adversity and social anxiety, as well as the mediating effects of family function and self-esteem, was examined using SEM. SEM analysis revealed that all three indicators of family adversity reduced the level of family function, that decreased family function compromised the level of self-esteem, and that a low level of self-esteem further increased the severity of social anxiety. The results indicated that, along with intervening to change family adversity, evaluating and improving adolescents' self-esteem and family function are also important clinical issues when helping adolescents reduce their social anxiety.

Psychometric properties of the social phobia and anxiety inventory-child version in a Swedish clinical sample

The social phobia and anxiety inventory for children (SPAI-C) is a 26 item, empirically derived self-report instrument developed for assessing social phobic fears in children. Evidence for satisfactory psychometric properties of the SPAI-C has been found in multiple community studies. Since its development, however, no study has presented an extensive psychometric evaluation of SPAI-C in a sample of carefully diagnosed children with social phobia. The present study sought to replicate and expand previous studies by administrating the SPAI-C to a sample of 59 children that fulfilled DSM-IV criteria for social phobia, and 49 children with no social phobia diagnosis. An exploratory factor analysis resulted in a three factor solution reflecting: (1) fear of social interactions, (2) fear of public performance situations, and (3) physical and cognitive symptoms connected with social phobia. These factors appear to parallel domains of social phobia also evident in adults. The SPAI-C total scale and each factor was found to possess good internal consistency, good test-retest reliability and was generally strongly correlated with both self-report and clinician measures of anxiety and fears. The discriminative properties of the total scale were satisfactory.

Association between types of involvement in school bullying and different dimensions of anxiety symptoms and the moderating effects of age and gender in Taiwanese adolescents

OBJECTIVE

The aims of this cross-sectional study were to examine the associations of various types of school bullying involvement experiences with different dimensions of anxiety symptoms on the Multidimensional Anxiety Scale for Children (MASC) and to examine the moderating effects of gender and age on the associations in Taiwanese adolescent students aged at 11-18.

METHOD

Involvement in passive and physical bullying and belongings snatch and multiple dimensions of anxiety symptoms in 5537 adolescents were determined through use of the self-reported Chinese version of the School Bullying Experience Questionnaire (C-SBEQ) and the Taiwanese version of the MASC, respectively. The associations between four types of bullying involvement and four dimensions of anxiety symptoms and the moderating effects of gender and age were examined using linear mixed model analysis.

RESULTS

The results indicated that except for the non-significant association between victimization by verbal and relational bullying and harm avoidance, both victims of verbal and relational bullying and physical bullying and belongings snatch reported more severe anxiety symptoms on all four dimensions of MASC-T than non-bullied subjects. While the perpetrators of verbal and relational bullying reported more severe physical symptoms and social anxiety than did non-perpetrators of verbal and relational bullying, the perpetrators of physical bullying and belongings snatch reported less harm avoidance, social anxiety and separation/panic than did non-perpetrators of physical bullying and belongings snatch. Perpetrator-victims of verbal and relational bullying showed more physical symptoms than those who were pure victims or perpetrators of verbal and relational bullying. Perpetrator-victims of physical bullying and belongings snatch had more social anxiety than those who were pure victims or perpetrators. This study also found that gender and age had the moderating effect on the association between some forms of bullying involvement and some dimensions of anxiety symptoms.

CONCLUSIONS

The results of this study support the necessity to apply the multi-dimensional scale to evaluate anxiety symptoms in adolescents who are involved in bullying and to take the different directions of association into consideration when developing prevention and intervention programs.

A multidimensional anxiety assessment of adolescents after Typhoon Morakot-associated mudslides

The aims of this study were to examine the factor structure, reliability and validity of the Taiwanese version of the Multidimensional Anxiety Scale for Children (MASC-T) in a group of adolescents in mountainous regions worst affected by Typhoon Morakot-associated mudslides. In total, 271 adolescents in grades 7-9 completed the MASC-T and the Chinese version of the Impact of Events Scale-Revised (C-IES-R). They also received a diagnostic interview to determine whether they had post-traumatic stress disorder (PTSD). We examined adequacy of the original four-factor structure of the MASC-T using confirmatory factor analysis, as well as its internal reliability, discriminant and predictive validities for PTSD, and convergent validity with the C-IES-R. Results support adequacy of the four-factor structure and internal reliability of the MASC-T in adolescents affected by Typhoon Morakot. Scores for the total MASC-T and subscales significantly discriminated adolescents with PTSD from those without PTSD. However, levels of predictive values for PTSD and the convergent validity with the C-IES-R differed among the MASC-T subscales and the total scale. The physical symptoms and harm avoidance subscales had the highest and lowest predictive accuracies for presence of PTSD, respectively. The MASC-T combined with diagnostic interviews for PTSD and self-report measures for assessing PTSD-specific symptoms can be used to evaluate a broad range of anxiety symptoms.

Normative data on anxiety symptoms on the Multidimensional Anxiety Scale for Children in Taiwanese children and adolescents: differences in sex, age, and residence and comparison with an American sample

The aims of this study were to examine the differences in the levels of anxiety symptoms on the Taiwanese version of the Multidimensional Anxiety Scale for Children (MASC-T) between Taiwanese children and adolescents and the original American standardization sample across gender and age, and to examine differences in sex, age, and residential background in the levels of anxiety symptoms. A total of 10,566 Taiwanese children and adolescents in the community completed the MASC-T. Their levels of anxiety symptoms on the MASC-T were compared with the original American standardization sample in March's study. The differences in age, sex and residential background in the levels of anxiety symptoms were examined by three-way analysis of variance (ANOVA). The results found significant differences in the levels of anxiety symptoms on nearly all MASC-T scales between Taiwanese and American children and adolescents across sex and age. Girls had higher levels of anxiety symptoms on all scales of the MASC-T than boys. Those from 16 to 19 years old had the higher levels of physical symptoms and social anxiety and the lower levels of harm avoidance and separation/panic than those in the 8-11 year- old and 12-15 year- old groups. Those who lived in rural areas had higher levels of physical symptoms and separation/panic than those who lived in urban areas. Those who lived in urban areas had a higher level of harm avoidance than those who lived in rural areas. These results provide fundamental knowledge on anxiety symptoms in Taiwanese children and adolescents. Further study is needed to examine the reasons for socio-cultural differences and differences in individual characteristics in anxiety symptoms.

Measuring anxiety in youth with learning disabilities: reliability and validity of the Multidimensional Anxiety Scale for Children (MASC)

Youth with learning disabilities (LD) are at an increased risk for anxiety disorders and valid measures of anxiety are necessary for assessing this population. We investigated the psychometric properties of the Multidimensional Anxiety Scale for Children (MASC; March in Multidimensional anxiety scale for children. Multi-Health Systems, North Tonawanda, 1998) in 41 adolescents (ages 11-17 years) with LD. Youth and parents completed the MASC and were administered the semi-structured Anxiety Disorders Interview Schedule: Child and Parent Versions (ADIS: C/P; Silverman and Albano in The Anxiety Disorders Interview Schedule for DSM-IV-Child and Parent Versions. Psychological Corporation, San Antonio, 1996). Results found that child and parent reports of Social Anxiety on the MASC closely corresponded with ADIS-generated social phobia diagnoses, and parent total scores discriminated well among youth with and without any anxiety disorder. A multi-method multi-trait matrix provided evidence of the construct validity of the MASC total score for both parent and child reports. Our findings provide empirical evidence that parent and child versions of the MASC are useful for assessing anxiety in youth with LD.