Parental and peer predictors of social anxiety in youth

Computational modeling of social evaluative decision-making elucidates individual differences in adolescent anxiety

Adolescents experience significant developmental changes during a time of heightened sensitivity to social cues, particularly rejection by peers, which can be especially overwhelming for those with elevated levels of social anxiety. Social evaluative decision-making tasks have been useful in uncovering the neural correlates of information processing biases; however, linking youths' task-based performance to individual differences in psychopathology (e.g., anxiety symptoms) has proven more elusive. Here, we address this weakness with drift diffusion modeling to decompose youths' performance on the social judgment paradigm (SJP) to determine if this approach is useful in discovering individual differences in anxiety symptoms, as well as puberty, age, and sex. A sample of 103 adolescents (55 males, Mage = 14.49, SD = 1.69) completed the SJP and self-report measures of anxiety, as well as self- and parent-reported measures of puberty. The decision threshold parameter, reflecting the amount of evidence needed to make a social evaluative decision, predicted youth self-reported anxiety, above and beyond typical metrics of SJP performance. Our results highlight the potential advantage of parsing task performance according to the underlying cognitive processes. Future research would likely benefit from applying computational modeling approaches to social judgment tasks when attempting to uncover performance-based individual differences in psychopathology.

The general impact of self-stigma of mental illness on adult patients with depressive disorders: a systematic review

BACKGROUND

Mental illness stigma is often common among mentally ill patients. This stigma can come from others or the patients themselves, which is called 'self-stigma'. The present study explored the widespread impacts of self-stigma on adult patients with depression. Additionally, this review compared the severity of self-stigma levels among psychiatric disorders and to review and update thoughts about self-stigma of depression.

METHODS

An etiology and risk systematic review was conducted using the Joanna Briggs Institute (JBI) approach as a guideline. The search process was performed via research databases including MEDLINE, EMBASE and CINAHL. The inclusion criteria are studies include participants diagnosed with depressive disorders, both genders, participants' exposure to mental illness self-stigma, participants' experience of self-stigma consequences and any geographical site or clinical settings are included, the type of the included studies must be observational studies. The included studies were limited to the English language studies that were published from 2016 and onwards. Patients with depression under the age of eighteen and patients diagnosed with multiple mental illnesses were excluded. The JBI critical appraisal checklist were adopted to assess the risk of bias.

RESULTS

In December 2022, a comprehensive search yielded eight cross-sectional studies that were included in this systematic review, involving a total of 783 patients diagnosed with depression, and 28 studies were excluded for not fulfilling the inclusion criteria of the review. The findings were extracted and synthesized through textual narrative synthesis into three main categories negatively affected by self-stigma of depression. These are: (1) the impact on the quality of life, (2) the impact on self-esteem and (3) the impact on self-worth. Moreover, in regard to the comparison of self-stigma levels among psychiatric disorders, self-stigma for people with schizophrenia was higher than self-stigma of depression.

CONCLUSION

Self-stigma of depression has negatively impacted multiple aspects of the patient's life. Thus, the review brings the following recommendations: increase community awareness, educate the healthcare providers, include the topic of mental illness stigma in academic curriculums. The main limitation of the review is the limited number of included studies.

TRIAL REGISTRATION

The research proposal for this review has been registered to Prospero (ID number: CRD42022366555).

The relationship between maternal-fetus attachment and perceived parental bonds in pregnant women: Considering a possible mediating role of psychological distress

Maternal-Fetal Attachment (MFA) delineates the emotional, cognitive, and behavioral aspects that mothers develop toward the unborn baby during pregnancy. The literature indicates that optimal attachment in pregnancy represents a protective factor for the mother-child attachment bond after birth and child development outcomes. To date, there are few studies that have investigated associated factors of MFA. This study sets out to explore the association between perceived parental bonds and maternal-fetal bonding in pregnant women, accounting for factors such as psychological distress, socio-demographic and obstetric characteristics.

Methods

In this cross-sectional study, 1,177 pregnant women answered the Parental Bonding Instrument, the Maternal-Fetal Attachment Scale, State-Trait Anxiety Inventory (STAI-Y), and Beck-Depression Inventory (BDI-II).

Results

We found out that perceived maternal and paternal care had significant direct effects on maternal-infant bonding during the pregnancy period when controlling for some confounders, including gestational age and mother age among others. Such maternal and paternal perceived care effects were not mediated by levels of psychological distress, which in turn resulted to be a "borderline" significant predictor of prenatal attachment. Interestingly, the gestational age and the mother age emerged to have a significant and synergic nonlinear effect, suggesting the influence on the MFAS of the gestational age depends on the values of the mother age, and likewise, the effect of mother age on MFAS depends on the gestational week.

Conclusion

This study expands our knowledge of the intergenerational transmission of attachment pointing out the effects of a woman's perceived bond in relation to her parental figures during the development of the prenatal attachment process. Findings also suggests that parenting support interventions may have benefits that are realized across generations.

Racial Socialization Messages in White Parents' Discussions of Current Events Involving Racism With Their Adolescents

This study presents a thematic analysis of socialization messages about race and racism in White parents' reports of their discussions with adolescents about current events involving racism (e.g., police brutality toward Black Americans). Two samples of White parents of primarily White adolescents ages 14-17 were recruited online in September 2019 (Study 1, N = 123) and June 2020 (Study 2, N = 104). Key themes included color-conscious messages, color-blind messages, endorsing equal treatment, and references to Whiteness. Rates of discussion in 2020 (79-81%) were double that of 2019 (40.2-43.4%). However, color-conscious messages were less common in 2020 compared to 2019, and references to Whiteness were rare in 2020. Color-blind messages were similarly prevalent across both studies.

Trends in the incidence and DALYs of anxiety disorders at the global, regional, and national levels: Estimates from the Global Burden of Disease Study 2019

BACKGROUND

Anxiety disorders are the second leading mental health-related cause of disability-adjusted life-years (DALYs) and years lived with disability (YLDs) worldwide. This study aimed to quantitatively assess the burden of anxiety disorders at the global, regional, and national levels in 1990 and 2019 and the trends over this period.

METHODS

We used data for incidence cases, DALYs, age-standardized incidence rate (ASIR) and age-standardized DALYs rate (ASDR) from Global Burden of Disease Study 2019 (GBD 2019) and calculated the estimated annual percentage changes (EAPCs) to assess the incidence rate and DALYs rate trends for anxiety disorders.

RESULTS

The incidence cases of anxiety disorders increased by 47.19%, from 31.13 million in 1990 to 45.82 million in 2019, and DALYs increased by 53.70%, from 18.66 million in 1990 to 28.68 million in 2019. Over the past 29 years, the changes of ASIR and ASDR worldwide were stable (EAPC = 0.011 and -0.001, respectively). Women were more likely to experience anxiety disorders. Participants aged 10-14 had the highest incidence rate, followed by those aged 35-44. Those aged 15-19 and 40-44 had the highest estimated DALYs rate. The ASIR and ASDR were estimated to be the highest in Iran and Portugal, and Portugal and Brazil, respectively. Both of ASIR and ASDR were high in high- sociodemographic index regions in 2019.

LIMITATIONS

Further exploration of related risk factors needs to be analyzed in the future studies.

CONCLUSIONS

Compared with 1990, the absolute increase in incidence cases and DALYs of anxiety disorders in 2019 still remained high. Our findings contribute to the formulation of health policies for controlling and preventing anxiety disorders in different countries and regions.

Grandparent-child cohesion, friendship quality, and left-behind children's positive/negative affect in rural China

This study examined the roles of grandparent-child cohesion and friendship quality in left-behind children's positive and negative affect compared with non-left-behind children. Data from 557 participants indicated that grandparent-child cohesion and friendship quality predicted children's emotional adaptation. Friend trust and support and intimate exchange had a stronger predictive effect on positive affect among non-left-behind children. Moreover, the interaction effects between grandparent-child cohesion and friendship quality on children's positive affect supported the reinforcement model, while the interaction effects on negative affect supported the reinforcement model among left-behind children but supported the compensation model among non-left-behind children.

Social Anxiety in 15-19 Year Adolescents in Association with Their Subjective Evaluation of Mental and Physical Health

BACKGROUND

Studies show that social anxiety in adolescence have negative impact on quality of life. The study evaluates social anxiety links with mental and physical health factors in adolescents aged 15-19 years.

METHODS

The research was performed in 2018 in secondary schools in Lithuania and included 1722 participants (46.1% males and 53.9% females). The social anxiety was assessed using Social Anxiety and Avoidance Scale for Adolescents. The main results were obtained using univariate and multivariate logistic regression analysis.

RESULTS

Total of 58.5% of adolescents were characterized by high social anxiety and 14.7% by high avoidance. Females more often were characterized by high anxiety compared to males. Multivariate logistic regression revealed that good mental health was a significant protective factor against high SA in adolescents. For females, high anxiety and avoidance were associated with living with both parents, for males, high anxiety was linked with mother's university education. Very common stomach and abdominal pain in females as well as severe and very common stomach or abdominal pain in males, increase the risk of major social anxiety.

CONCLUSIONS

High social anxiety were more prevalent between females than males and was linked with various well-being and health aspects in adolescents.

Examining the Relationships Among Parental Overprotection, Military Life Adjustment, Social Anxiety, and Collective Efficacy

The purpose of this study was to verify the relationships among parental overprotection (PO), military life adjustment (MLA), social anxiety, and collective efficacy (CE). There have been studies examining the influence of each of these variables in isolation, but no study has examined these variables simultaneously. Two hundred and thirty-one male conscript soldiers participated in the study. Results indicated that all four variables were correlated with one another. Through hierarchical regression analysis, we determined that social anxiety fully mediated the relationship between PO and MLA. Furthermore, we found that CE moderated the relationship between PO and social anxiety. Finally, we confirmed the moderated mediation effect of CE in our proposed model. We discuss the implications and limitations of this model.

The risk of anxiety disorders in children of parents with severe psychiatric disorders: a systematic review and meta-analysis

BACKGROUND

Several studies have investigated the association between parental severe psychiatric disorders and anxiety disorder risk in offspring, but the findings across these studies have been inconsistent.

METHODS

Using the PRISMA guideline, a rigorous electronic and manual search was conducted in four electronic databases EMBASE, PubMed, PsychINFO, and Scopus to identify relevant studies. All observation studies (cohort and case-control studies) that examined the association between parental severe psychiatric disorders and the risk of offspring anxiety disorders were identified. Summary risk ratios (RRs) and 95% confidence intervals (95%CI) were synthesized using a fixed and random effect meta-analysis.

RESULTS

Twenty-five studies were included in the final analysis (14 cohort and 11 case-control studies). The meta-analysis showed that parental severe psychiatric disorder was associated with a higher risk of social phobia, panic, obsessive-compulsive, post-traumatic stress, separation anxiety, and generalized anxiety disorders in the offspring. When considering specific severe psychiatric disorders in parents as exposure, parental bipolar disorder was associated with an increased risk of obsessive-compulsive and generalized anxiety disorders in the offspring, whereas parental depressive disorder was associated with an increased risk of social phobia, separation anxiety, and generalized anxiety disorders in the offspring. Conversely, parental schizophrenia was not associated with offspring anxiety disorder CONCLUSION: This review suggests that the offspring of parents with severe psychiatric, bipolar, and depressive disorders are at an increased risk of developing a range of anxiety disorders. These findings suggest that targeted early screening and intervention programs are imperative in exposed offspring.

Toward an Integrated Model of Supportive Peer Relationships in Early Adolescence: A Systematic Review and Exploratory Meta-Analysis

Supportive peer relationships (SPR) are crucial for mental and physical health. Early adolescence is an especially important period in which peer influence and school environment strongly shape psychological development and maturation of core social-emotional regulatory functions. Yet, there is no integrated evidence based model of SPR in this age group to inform future research and practice. The current meta-analysis synthetizes evidence from 364 studies into an integrated model of potential determinants of SPR in early adolescence. The model encompasses links with 93 variables referring to individual (identity, skills/strengths, affect/well-being, and behavior/health) and environmental (peer group, school, family, community, and internet/technology) potential influences on SPR based on cross-sectional correlational data. Findings suggest the central importance of identity and social-emotional skills in SPR. School environment stands out as a compelling setting for future prevention programs. Finally, we underscore an alarming gap of research on the influence of the virtual and online environment on youth's social realm given its unquestionable importance as a globally expanding social interaction setting. Hence, we propose an integrated model that can serve as organizational framework, which may ultimately lead to the adoption of a more structured and integrated approach to understanding peer relationship processes in youth and contribute to overcoming marked fragmentation in the field.

Social Anxiety and Depression Stigma Among Adolescents

BACKGROUND

The stigma associated with mental disorders in adolescence has a range of detrimental consequences, negatively impacting help-seeking behaviours and quality of life. Social anxiety typically has its onset during adolescence, but the associated stigma is not well understood. This study was designed to improve understanding of social anxiety and depression stigma in adolescence by examining demographic and personal variables that predict them both.

METHODS

Three hundred and fifteen adolescents (150 males, 165 females), from 2nd and 4th year of secondary school (mean ages 13.92 and 15.92 years respectively), completed the Peer Mental Health Stigmatization Scale to measure both personal and perceived stigma towards vignettes depicting social anxiety and depression. They also answered demographic questions and completed the Social Anxiety Scale for Adolescents.

RESULTS

Hierarchical multiple regression revealed that gender predicted both personal and perceived stigma towards depression and personal stigma towards social anxiety. Males scored higher on measures of personal stigma whereas females had higher scores on perceived stigma. Ability to accurately identify symptoms described in a vignette, predicted lower personal stigma towards social anxiety and higher perceived stigma towards depression. Depression was more stigmatized than social anxiety.

LIMITATIONS

The study used vignettes to represent individuals with depression and social anxiety so participant responses may not reflect their behaviour towards real peers.

CONCLUSIONS

Findings emphasise the importance of separately considering personal and perceived stigma for each condition and highlight gender differences in stigma responses that need to be considered in intervention design.

Parenting Characteristics among Adults With Social Anxiety and their Influence on Social Anxiety Development in Children: A Brief Integrative Review

The purposes of this brief integrative review are to identify and critically evaluate recent work in the area of parenting processes that are disproportionately observed among parents with social anxiety disorder (SAD) that may ultimately increase risk among offspring, and to further link these processes to specific targets for intervention. Accordingly, we first evaluate the relevance of specific parenting styles as they pertain to increased risk of developing SAD among offspring. Second, we link these parenting processes to observations of certain unfavorable consequences among socially anxious youth, such as low perceived autonomy and poorer social skills. Finally, in light of these consequences we extend our conclusions into potentially modifiable targets among parents with SAD, focusing on the enhancement of autonomy and facilitating offspring's normative period of transition into independence during adolescence. Overall, we conclude that parenting behaviors commonly observed among adults with SAD, such as overcontrol and low parental warmth, likely have a direct impact on the development of social anxiety symptoms among their children. However, these parenting behaviors are plausibly modifiable and therefore repurposing existing interventions for use among parents with SAD in conjunction with interventions with their offspring is likely to provide direct clinical benefit.

Parent and peer social support compensation and internalizing problems in adolescence

The general benefits of social support are well-documented; however, little is understood about the unique contributions of social support from specific sources, such as parents and peers. In addition, it is unknown whether social support from some sources might buffer against a lack of social support from another source for the outcome of internalizing problems. The current study investigated two research questions: (a) What is the association between social support from mothers, fathers, classmates, and close friends and internalizing problems for adolescent boys and girls? and (b) Can social support from one source (e.g., mothers) buffer against internalizing problems when social support from another source (e.g., fathers) may be lacking? Do these associations vary by gender? These research questions were examined with a sample of 364 middle school students (61.3% female). Students completed a series of self-report questionnaires assessing social support and internalizing symptoms. Multiple group structural equation models indicated that social support provided general benefits from all sources for early adolescent boys and girls. Regarding stress-buffering with low support as a stressor, no evidence was found for compensation between mothers and fathers. Mother support compensated for low classmate support for both boys and girls and father support compensated for low classmate support for boys. Classmate support compensated for low close friend support for boys. Implications in the context of the school environment for both boys and girls are discussed.

Adolescents’ Peer Friendship and Anxiety and Depression among First-Generation Immigrant BAME Families in the UK

There is equivocal evidence on how being a child in a Black, Asian and Minority Ethnic (BAME) immigrant family affects internalizing symptoms such as anxiety. This cross-sectional study examined the relationships between peer friendships and anxiety/depression symptoms in BAME immigrant adolescents (IA) and white native adolescents (WNA). Method: Sixty-two adolescents from the UK (IA = 26, WNA = 36, mean age = 14 years) were assessed on close friendship, social competence, social anxiety, and depression. Immigrant family parents (n = 23) were also assessed on cultural orientation. There were no significant differences in anxiety and depression between groups. Bayes factors supported the conclusion that the groups did not differ. However, IA and WNA groups had different patterns of associations between close friendship/social competence and anxiety and depression symptoms. Close friendships were more strongly associated with lower anxiety/depression in IAs than WNAs, and social competence was more strongly associated with lower anxiety/depression in WNAs than IAs. Moderation analyses indicated that the relationship between close friendship and social and separation anxiety was significantly moderated by ethnic group, as was the relationship between social competence and generalized anxiety. The findings suggest that social and separation anxiety are more strongly associated with close friendships for BAME immigrant children than for non-immigrant adolescents. As such, activities that help BAME immigrant children to foster close relationships may have positive effects on their well-being.

Relationships Between Theory of Mind (ToM) and Attachment Properties in Adolescent with Social Axiety Disorder

Introduction

Studies have suggested that attachment styles are associated with social anxiety disorder (SAD). Recent studies found that individuals with a diagnosis of SAD were significantly impaired relative to healthy controls on tasks of theory of mind (ToM). We aimed to investigate the association of ToM and attachment styles in adolescents diagnosed with SAD in this study.

Methods

Drug-naïve 42 adolescents diagnosed with SAD and aged between 12 to 18, without psychiatric comorbidity were enrolled in the patient group. Forty-two adolescents in the same age range without any psychiatric disorders were matched as the healthy control group. The diagnosis was made by experienced clinicians using the Kiddie and Young Adult Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version and diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. The severity of SAD symptoms was evaluated with the Social Anxiety Scale for Adolescents. ToM was evaluated with Reading the Mind in the Eyes task and faces test. Parent and Peer Attachment Inventory was used for assessing attachment properties.

Results

Adolescents with SAD compared to healthy control groups have more difficulties both in Reading the Mind in the Eyes task and faces test. We found a statistically significant decrease in peer and parent attachment scores when compared with SAD and healthy controls (p<0.05). A negative correlation between the severity of SAD and both ToM tasks and attachment has been found.

Conclusions

The results of this study indicate that ToM deficits and insecure attachment style may play an important role in the etiology and treatment of SAD in adolescents.

Quality of life in children and adolescents with obsessive-compulsive disorder: The Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q)

The current study examined quality of life (QOL) and its clinical correlates among 225 intensive treatment-seeking children and adolescents with obsessive-compulsive disorder (OCD) using the Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q). Youth completed the PQ-LES-Q along with self-report measures assessing functional impairment, anxiety sensitivity, OCD symptoms, nonspecific anxiety, depression, and social anxiety. Parents completed measures on their child's anxiety, the presence of inattention/hyperactivity, depression, functional impairment, and frequency of family accommodation of symptoms. Contrary to expectation, child-reported OCD symptoms did not significantly predict QOL; however, lower overall QOL was strongly associated with the presence of comorbid major depressive disorder (g=3D -0.76) and slightly related to comorbid social phobia (g=3D -0.36). These results suggest that assessing and addressing comorbid conditions in the treatment of youth with OCD is an important component of intensive treatment.

Friendship Quality Moderates the Relation Between Maternal Anxiety and Trajectories of Adolescent Internalizing Symptoms

The current study examined the moderating role of friendship quality on the relation between maternal anxiety and internalizing symptoms in a 3-year prospective study of adolescent development. Participants included 177 adolescents (M _age = 16.05, SD _age = 0.91) and their mothers. Mothers reported their own levels of anxiety; youth completed self-reports of internalizing symptoms and friendship quality. Positive friendship quality moderated the relation between maternal anxiety and initial levels of internalizing symptoms. Maternal anxiety was associated with steeper increases in internalizing symptoms over time, but only for those with greater negative peer interactions. Findings underscore the important role of both parental and peer relationships in the development of internalizing symptoms and highlight specific avenues for clinical interventions.

Personal psychological resources mediate parent-child relationship and mental health among left-behind children

Discrepant findings on the impact of parental migration on left-behind children's (LBC) psychological health have been noted in the literature. While several studies have shown the negative effects of parental migration, burgeoning research has demonstrated contradictory findings. The present study aimed to clarify this issue by examining the association between family resources and mental health as mediated by personal psychological resources (PPRs). A sample comprised of 466 LBC (aged 11-17 years) answered a set of questionnaires assessing parent-child relationship, PPRs, and mental health symptoms. The results showed that PPRs, particularly emotional resources, significantly mediated the link between family resources and mental health. This suggests that LBC who have rich family resources (i.e., close parent-child relationship) have lower mental health problems due to higher emotional resources (i.e., satisfaction in life). Conversely, those who reported having poor family resources experienced a lower level of PPRs (i.e., emotional well-being), which in turn, increased their risk of having psychological distress. The "caravanning" of resources from family to personal resources is vital in protecting LBC's mental health.

Social anxiety symptoms among youth with chronic health conditions: trajectories and related factors

Purpose: This study explored three-year trajectories of social anxiety symptoms among youth with chronic health conditions and investigated factors influencing those trajectories.Methods: Participants (N = 439) were recruited from eight pediatric rehabilitation centers. The Social Anxiety Scale for Children-Revised measured social anxiety across four time points. Latent Class Growth Analysis was used to study trajectories and logistic regression to identify related factors.Results: A three-class solution was supported: a "high anxiety and stable" group (17.1%), a "moderate anxiety and stable" group (44.4%), and a "low anxiety and stable" group (38.5%). Youth in the "moderate and stable" group were less likely to be male compared to the "low and stable" group. Youth in the "high and stable" group were more likely to have greater cognitive symptoms and less likely to have higher levels of social participation compared to the "low and stable" group. Youth in both the "high and stable" and "moderate and stable" groups were less likely to have high support from classmates or close friends compared to the "low and stable" group. Moreover, both the "high and stable" and "moderate and stable" groups were less likely to have positive family functioning.Conclusion: Youth with chronic conditions belonging to "high and stable" and "moderate and stable" social anxiety trajectories can be distinguished from those in a "low and stable" trajectory using personal, functional, and environmental level variables.Implications for RehabilitationYouth with chronic health conditions are at risk of developing and maintaining moderate to high levels of social anxiety symptoms as they move through adolescence.Compared to youth with "low and stable" social anxiety, those with "moderate and stable" social anxiety are less likely to be male, have high peer support or high family functioning.Compared to youth with "low and stable" social anxiety, those with "high and stable" social anxiety are more likely to have greater cognitive symptoms, and less likely to have high social participation, high peer support, or high family functioning.Rehabilitation and other professionals should not only consider factors that are functional in nature; they should also consider personal and environmental level factors when supporting youth with chronic health conditions who experience social anxiety symptoms.

Nurturant-involved parenting and adolescent substance use: Examining an internalizing pathway through adolescent social anxiety symptoms and substance refusal efficacy

Research has clearly established the important role of parents in preventing substance use among early adolescents. Much of this work has focused on deviance (e.g., antisocial behavior, delinquency, and oppositional behavior) as a central pathway linking parenting behaviors and early adolescent substance use. This study proposed an alternative pathway; using a four-wave longitudinal design, we examined whether nurturant-involved parenting (Fall sixth grade) was inversely associated with adolescent drunkenness, marijuana use, and cigarette use (eighth grade) through social anxiety symptoms (Spring sixth grade) and subsequent decreases in substance refusal efficacy (seventh grade). Nurturant-involved parenting is characterized by warmth, supportiveness, low hostility, and low rejection. Analyses were conducted with a sample of 687 two-parent families. Results indicated that adolescents who were in families where fathers exhibited lower levels of nurturant-involved parenting experienced subsequent increases in social anxiety symptoms and decreased efficacy to refuse substances, which in turn was related to more frequent drunkenness, cigarette use, and marijuana use. Indirect effects are discussed. Findings were not substantiated for mothers' parenting. Adolescent gender did not moderate associations. The results highlight an additional pathway through which parenting influences youth substance use and links social anxiety symptoms to reduced substance refusal efficacy.

A Preliminary Examination of the Link Between Maternal Experiential Avoidance and Parental Accommodation in Anxious and Non-anxious Children

Studies point to parental experiential avoidance (EA) as a potential correlate of maladaptive parenting behaviors associated with child anxiety. However, research has not examined the relationship between EA and parental accommodation of child anxiety, nor the extent to which parental negative beliefs about child anxiety help explain such a relationship. In a sample of mothers (N = 45) of anxious and non-anxious children, the present study investigated the potential link between maternal EA and accommodation of child anxiety and whether this link may be indirectly accounted for via maternal negative beliefs about child anxiety. EA was significantly and positively associated with accommodation of child anxiety, but when negative beliefs about child anxiety were incorporated into the model this direct effect was no longer significant. Findings highlight the contribution of parental emotions and cognitions to behaviors that may exacerbate child anxiety, and may inform treatment and prevention efforts with families of anxious youth.

Maternal Acceptance Moderates Fear Ratings and Avoidance Behavior in Children

Avoidance is a hallmark feature of anxiety disorders, and avoidance-related impairment is often key to meeting diagnostic criteria. In children and adolescents with anxiety disorders, levels of avoidance vary considerably. Using a novel motion-tracking measure of avoidance behavior, we examined whether maternal acceptance, characterized by warm and accepting responses to child feelings and behaviors, moderates the association between fear of spiders and behavioral avoidance of spider stimuli in 103 clinically anxious children. As hypothesized, maternal acceptance significantly moderated children's avoidance behavior. Child's fear of spiders was significantly associated with behavioral avoidance when mothers were low in acceptance, as rated by either mothers or children. When mothers were high in acceptance, as rated by either mothers or children, child self-rated fear of spiders was not significantly associated with child avoidance. These are the first results to empirically demonstrate the moderating role of maternal acceptance in anxious children's avoidance behavior.

Friendship Security, But Not Friendship Intimacy, Moderates the Stability of Anxiety During Preadolescence

A two-wave longitudinal study of 380 preadolescents (M age = 10.87) from largely middle-class schools in Montréal, Québec, Canada, assessed the hypothesis that friendship security, but not friendship intimacy, moderates the stability of anxiety during adolescence. This central but largely overlooked question about peer relations concerns which aspects of friendship account for the effects of friendship on emotional adjustment. Anxiety and friendship quality were measured via self-report questionnaires, employing the Network of Relationships Inventory for security and intimacy items. An index of friendship durability, which combined reciprocity and stability within first- and second-best friendship choices, was derived from sociometric measures. A latent variable path analysis examined with structural equation modeling showed that anxiety was less stable for children who perceived their friendships as secure. The moderating effect of intimacy was statistically nonsignificant. A follow-up analysis showed that the effects of security did not result from friendship durability. These findings provide support for the long-standing but previously unaddressed hypothesis that security, rather than intimacy, accounts for friendship's effect on anxiety reduction during early adolescence.

Social anxiety in pre-adolescent children: What do we know about maintenance?

The cognitive theory of social anxiety disorder (SAD) is one of the most widely accepted accounts of the maintenance of the disorder in adults, yet it remains unknown if, or to what extent, the same cognitive and behavioral maintenance mechanisms that occur in adult SAD also apply to SAD among pre-adolescent children. In contrast to the adult literature, current models of SAD in children mostly account for etiology and maintenance processes are given limited attention. Consequently, their clinical utility for the treatment of SAD in children may be limited. This narrative review, first, critically examines the different theoretical conceptualizations of the maintenance of social anxiety in the child and adult literature and illustrates how these have resulted in different treatment approaches and clinical understanding. Second, it reviews the available evidence relating to hypotheses about the maintenance of SAD in children as derived from adult cognitive and etiological models. Third, it highlights the need to attend directly to child specific maintenance mechanisms in SAD, to draw on cognitive theory, and to account for the influence of childhood-specific contextual (e.g. family and school-based interactions) and developmental factors on children's social experiences.

Co-rumination buffers the link between social anxiety and depressive symptoms in early adolescence

OBJECTIVES

We examined whether co-rumination with online friends buffered the link between social anxiety and depressive symptoms over time in a community sample.

METHODS

In a sample of 526 participants (358 girls; Mage  = 14.05) followed at three time points, we conducted a latent cross-lagged model with social anxiety, depressive symptoms, and co-rumination, controlling for friendship stability and friendship quality, and adding a latent interaction between social anxiety and co-rumination predicting depressive symptoms.

RESULTS

Social anxiety predicted depressive symptoms, but no direct links between social anxiety and co-rumination emerged. Instead, co-rumination buffered the link between social anxiety and depressive symptoms for adolescents with higher but not lower levels of social anxiety.

CONCLUSIONS

These findings indicate that co-rumination exerted a positive influence on interpersonal relationships by diminishing the influence from social anxiety on depressive symptoms over time.

The Role of Environmental Factors in the Aetiology of Social Anxiety Disorder: A Review of the Theoretical and Empirical Literature

Social anxiety disorder (SAD) is characterised by a marked and persistent fear of social/performance situations, and a number of key environmental factors have been implicated in the aetiology of the disorder. Hence, the current article reviews theoretical and empirical evidence linking the development of SAD with parenting factors, traumatic life events, and aversive social experiences. Specifically, research suggests that the risk of developing SAD is increased by over-controlling, critical and cold parenting, an insecure attachment style, aversive social/peer experiences, emotional maltreatment, and to a lesser extent other forms of childhood maltreatment and adversity. Moreover, these factors may lead to posttraumatic reactions, distorted negative self-imagery, and internalised shame-based schemas that subsequently maintain SAD symptomatology. However, further research is necessary to clarify the nature, interactions, and relative contributions of these factors. It is likely that SAD develops via a complex interplay of biological and environmental factors, and that multiple aetiological pathways underlie the development of the disorder.

The Relationship between Parenting Styles and Adolescents' Social Anxiety in Migrant Families: A Study in Guangdong, China

Previous studies indicated that parenting styles were important influencing factors for the development of children’s well-being. It is known that mass migration to the cities in China will affect family relations. However, few studies focused on the relationship between parenting styles and adolescents’ mental health in migrant families. Thus, this study aimed to investigate how parenting styles could affect adolescent’s social anxiety in migrant families. A total number of 1,345 adolescents in migrant families from four non-government-funded junior middle schools in Guangdong province formed the research sample. Parenting styles were measured using short-form of the Egna Minnen Beträffande Uppfostran, and social anxiety was evaluated using Social Anxiety Subscale of Self-Consciousness Scale. The results showed that emotional warmth, overprotection and rejection were significantly more often perceived from mothers than from fathers. Significant group differences between high social anxiety group and low social anxiety group were found in both father’s rearing styles and mother’s rearing styles. Furthermore, in migrant families, paternal emotional warmth could decrease adolescents’ social anxiety, whereas maternal overprotection could increase it.

Self-perceived competence and social acceptance of young children who stutter: Initial findings

PURPOSE

The goals of this study were to determine whether young children who stutter (CWS) perceive their own competence and social acceptance differently than young children who do not stutter (CWNS), and to identify the predictors of perceived competence and social acceptance in young speakers.

METHOD

We administered the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (PSPCSA; Harter & Pike, 1984) to 13 CWS and 14 CWNS and examined group differences. We also collected information on the children's genders, temperaments, stuttering frequencies, language abilities, and phonological skills to identify which of these factors predicted PSPCSA scores.

RESULTS

CWS, as a group, did not differ from CWNS in their perceived general competence or social acceptance. Gender predicted scores of perceived general competence, and stuttering frequency predicted perceived social acceptance. Temperament, language abilities, and phonological skills were not significant predictors of perceived competence or social acceptance in our sample.

CONCLUSIONS

While CWS did not significantly differ from CWNS in terms of perceived competence and social acceptance, when both talker groups were considered together, girls self-reported greater perceived competence than boys. Further, lower stuttering frequency was associated with greater perceived social acceptance. These preliminary findings provide motivation for further empirical study of the psychosocial components of childhood stuttering.

LEARNING OUTCOMES

Readers will be able to describe the constructs of perceived competence and social acceptance in young children, and whether early stuttering plays a role in the development of these constructs.

Barriers to access and participation in community mental health treatment for anxious children

BACKGROUND

Anxiety disorders are the most common psychiatric disorders among children in the United States; yet many children do not receive treatment due to barriers to treatment access and participation. This study examined common barriers to treatment access and participation among anxious children who participated in computer-assisted cognitive behavioral therapy. Differences in barriers reported by treatment completers/non-completers were examined, as was the association with sociodemographic characteristics, anxiety severity, and impairment. The impact of barriers on treatment response was assessed, as well as the relationship with treatment expectancy and satisfaction.

METHOD

Barriers to access and participation, demographics, anxiety severity/impairment, treatment credibility and satisfaction were assessed among parents and children with anxiety (N=100; ages 7-13) who were enrolled in a community-based randomized clinical trial.

RESULTS

The most common access barrier was parents not knowing where or from whom to seek services (66%). Differences among completers and non-completers were related to stigma, confidentiality, and costs. The most common parent-reported barrier to participating was stress (32.4%) and child-reported barrier to participation was not having enough time to complete homework (22.1%). Of the sociodemographic, clinical and treatment characteristics, minority status, satisfaction, and treatment response were associated with barriers to treatment participation, although these associations varied by barriers related to treatment and external factors.

LIMITATIONS

Cross sectional design and lack of well-established psychometric properties for barriers measures were limitations.

CONCLUSION

Findings suggest that accessible, time-efficient, cost-effective service delivery methods that minimize stigma and maximize engagement when delivering evidence-based treatment for pediatric anxiety are needed.

Parental involvement: contribution to childhood anxiety and its treatment

Anxiety disorders are prevalent in youth. Despite demonstrated efficacy of cognitive behavioral therapy (CBT), approximately 40% of anxiety-disordered youth remain unresponsive to treatment. Because developmental and etiological models suggest that parental factors are relevant to the onset and maintenance of childhood anxiety, researchers have proposed and investigated family-based interventions with increased parent work in treatment, aiming to improve the efficacy of treatment for childhood anxiety. However, contrary to what theoretical models suggest, data to date did not indicate additive benefit of family-based CBT in comparison with child-centered modality. Is parent/family involvement unnecessary when treating childhood anxiety disorders? Or could there be the need for specificity (tailored family-based treatment) that is guided by a revised conceptualization that improves the implementation of a family-based intervention? The current review examines (1) relevant parental factors that have been found to be associated with the development and maintenance of childhood anxiety and (2) interventions that incorporate parental involvement. Relevant findings are integrated to formulate a "targeted" treatment approach for parental involvement in CBT for youth anxiety. Specifically, there is potential in the assessment of parent/family factors prior to treatment (for appropriateness) followed by a target-oriented implementation of parent training.

Parent Psychopathology and Children's Psychological Health: Moderation by Sibling Relationship Dimensions

Offspring of anxious adults are at heightened risk for psychological maladjustment; however factors that protect youth in the context of this risk have been rarely explored. Supported by literature showing the meaningful role of sibling relationships for children's psychological outcomes, this study examined the protective role of the sibling relationship for children in the context of risk for psychological maladjustment due to having a parent with a clinical anxiety disorder. Participants were 81 children ages 7 to 12 years (58% female; 82 % Caucasian), and their parents. Parents met DSM-IV-TR diagnostic criteria for a primary anxiety disorder, and youth did not meet diagnostic criteria for any psychiatric disorder. Parents completed questionnaires on their own psychological distress and use of parenting behaviors, and on their children's psychological adjustment. Children self-reported on the quality of their sibling relationship based on their closest-age sibling. Parenting behaviors were also coded based on a parent-child interaction task. Results of hierarchical regression models demonstrated that sibling relationship quality moderated the relation between parental psychological distress and child adjustment. Post-hoc simple slopes analyses showed that parental distress was significantly positively associated with greater child psychological problems only for children reporting low sibling companionship or high sibling conflict. Aspects of the sibling relationship did not moderate the association between self-rated or observer-rated parenting behaviors and child anxiety symptoms. Findings are consistent with developmental models and empirical literature emphasizing the protective role of sibling relationships for youth's psychological outcomes. Sibling relationships may be a salient target for youth psychological preventive or treatment interventions.

Adolescent and Parental Contributions to Parent-Adolescent Hostility Across Early Adolescence

Early adolescence is characterized by increases in parent-adolescent hostility, yet little is known about what predicts these changes. Utilizing a fairly large sample (N = 416, 51 % girls, 91 % European American), this study examined the conjoint and unique influences of adolescent social anxiety symptoms and parental intrusiveness on changes in parent-adolescent hostility across early adolescence. Higher mother and father intrusiveness were associated with increased mother- and father-adolescent hostility. An examination of reciprocal effects revealed that mother- and father-adolescent hostility predicted increased mother and father intrusiveness. Significant associations were not substantiated for adolescent social anxiety symptoms. These findings suggest that intrusive parenting has important implications for subsequent parent-adolescent interactions and that similar patterns may characterize some aspects of mother- and father-adolescent relationships.

Variations in the influence of parental socialization of anxiety among clinic referred children

This study examined the relations between parental socialization of child anxious behaviors (i.e., reinforcement, punishment, modeling, transmission of information) and child anxiety and related problems at varying child sensitivity levels. Data corresponding to 70 clinic-referred children (M age = 9.86 years; 50% girls; 49% Hispanic/Latino, 51% Caucasian) showed that for children with low (but not high) anxiety sensitivity, anxiety-related parental socialization behaviors were associated with more child anxiety and depression symptoms. Findings also indicated that parental socialization of anxious behaviors and anxiety sensitivity functioned similarly in the prediction of anxiety and depression across Caucasian and Hispanic/Latino children. There were no significant mean level variations across child sociodemographic characteristics in general, but anxiety-promoting parenting behaviors were twice as high in Hispanic/Latino compared to Caucasian families.

The Yin and Yang of support from significant others: Influence of general social support and partner support of avoidance in the context of treatment for social anxiety disorder

Support from social networks is generally considered to protect against mental disorder but in some circumstances support for negative behaviours (such as avoidance) may be counterproductive. Given the critical interplay between social anxiety disorder and social interactions, it is surprising that the relationship of support from significant others to this disorder has received so little attention. The current study evaluated the reciprocal relationships between perceived social support and perceived partner support for avoidance behaviours (avoidance support) among a sample of 131 participants with social anxiety disorder who were assessed three times within the context of a treatment outcome study. A new measure of partner support for avoidance behaviours was developed, called the Avoidance Support Measure, and showed adequate internal consistency and construct validity. Correlations at baseline showed significant negative relationships between perceived social support and social anxiety and significant positive relationships between avoidance support and social anxiety. Path analysis showed that perceived social support at Times 1 and 2 negatively predicted future social anxiety at Times 2 and 3. On the other hand, only a single predictive relationship involving avoidance support was significant and showed that social anxiety at Time 1 positively predicted avoidance support at Time 2. These early results point to the different ways that support from significant others might relate to social anxiety and suggest that further work in this area may be fruitful.

The social ties that bind: social anxiety and academic achievement across the university years

Given that engagement and integration in university/college are considered key to successful academic achievement, the identifying features of social anxiety, including fear of negative evaluation and distress and avoidance of new or all social situations, may be particularly disadvantageous in the social and evaluative contexts that are integral to university/college life. Thus, the purpose of this study was to examine the direct effects of social anxiety on academic achievement, as well as investigate an indirect mechanism through which social anxiety might impact on academic achievement, namely, the formation of new social ties in university. The participants were 942 (71.7 % female; M = 19 years at Time 1) students enrolled in a mid-sized university in Southern Ontario, Canada. Students completed annual assessments of social anxiety, social ties, and academic achievement for three consecutive years. The results from an autoregressive cross-lag path analysis indicated that social anxiety had a significant and negative direct relationship with academic achievement. Moreover, the negative indirect effect of social anxiety on academic achievement through social ties was significant, as was the opposing direction of effects (i.e., the indirect effect of academic achievement on social anxiety through social ties). These findings highlight the critical role that social ties appear to play in successful academic outcomes and in alleviating the effects of social anxiety during university/college.

Linking lack of care in childhood to anxiety disorders in emerging adulthood: the role of attachment styles

BACKGROUND

Emotional neglect can be characterized as cold or critical parenting and denotes a parent intentionally or unintentionally overlooking the signs that a child needs comfort or attention and ignoring its emotional needs. Parental emotional neglect is widely posited as an antecedent of anxiety disorder, with attachment researchers arguing for anxious-ambivalent attachment style as a mediating factor.

METHOD

Childhood experience of neglect and abuse, including antipathy (cold, critical parenting), attachment styles, and anxiety disorders were assessed in a high-risk sample of 160 adolescents and young adults by means of interview measures.

RESULTS

Antipathy was associated with 12-month prevalence of anxiety disorders in the sample. Anxious-ambivalent attachment scores statistically mediated the relationship between antipathy and anxiety disorders.

CONCLUSIONS

Clinicians treating anxiety disorders in youths need to consider that emotional neglect in childhood in the form of antipathy could lead to anxious-ambivalent internal working models operating around fear of rejection and fear of separation.