Relations between emotional and social functioning in children with anxiety disorders

Maternal alcohol dependence symptoms, maternal insensitivity to children's distress, and young children's blunted emotional reactivity

Maternal insensitivity to children's emotional distress (e.g., expressions of sadness or fearfulness) is one mechanism through which maternal alcohol dependence may increase children's risk for psychopathology. Although emotion dysregulation is consistently associated with psychopathology, it remains unclear how or why alcohol dependence's effects on caregiving responses to children's distress may impact children's emotion regulation over time, particularly in ways that may engender risks for psychopathology. This study examined longitudinal associations between lifetime maternal alcohol dependence symptoms, mothers' insensitivity to children's emotional distress cues, and children's emotional reactivity among 201 mother-child dyads (Mchild age = 2.14 years; 56% Black; 11% Latino). Structural equation modeling analyses revealed a significant mediational pathway such that maternal alcohol dependence predicted increases in mothers' insensitivity to children's emotional distress across a one-year period (β = .16, p = .013), which subsequently predicted decreases in children's emotional reactivity one year later (β = -.29, p = .009). Results suggest that mothers with alcohol dependence symptoms may struggle to sensitively respond to children's emotional distress, which may prompt children to suppress or hide their emotions as an adaptive, protective strategy. The potential developmental benefits and consequences of early, protective expressive suppression strategies are discussed via developmental psychopathology frameworks.

Preventing anxiety in the children of anxious parents - feasibility of a brief, online, group intervention for parents of one- to three-year-olds

BACKGROUND

The evidence suggests an increased risk of developing anxiety problems in children of anxious parents. The current study explored the feasibility and acceptability of an intervention with anxious parents of young children, to inform the possibility of further trials.

METHODS

Participants were recruited through primary and secondary care psychological services and social media. Participants who had a current or recent anxiety disorder and a child aged 12-47 months were included. Assessments of parental and child outcomes occurred at baseline, after the intervention (week-2) and follow-up (week-8). The intervention was delivered in a small group format, in two sessions, one week apart, using videoconferencing.

RESULTS

Out of 32 participants, 30 (94%) attended the full intervention. All found the intervention acceptable and reported it as useful and relevant. There was a reduction in parental depression (MD = 2.63, 95%CI 1.01-4.26), anxiety (MD = 3.93, 95%CI 2.49-5.37) and stress (MD = 4.60, 95% CI 3.02-6.18) and increases in parenting confidence.

CONCLUSIONS

The online group intervention was feasible and acceptable. There were moderate to large effects on parental mental health and no adverse effects on children (decline on outcome measures). This indicates that intervening early in parenting with anxious parents is possible and warrants further investigation to establish prevention efficacy with a larger, controlled trial.

The Bifactor Structure of the Emotion Expression Scale for Children in a Sample of School-Aged Portuguese Children

The Emotion Expression Scale for Children (EESC) is a 16-item self-report questionnaire assessing children's difficulties in emotion expression (i.e., poor emotion awareness and reluctance to express emotions). Considering the inconsistent findings regarding its factorial structure and dimensionality, this study aims to explore the factor structure and psychometric properties of the EESC in a sample of 286 Portuguese children (8-12 years). Three competing models were analyzed through confirmatory factor analysis (correlated two-factor model, one-factor model, and bifactor model). The bifactor model provided a better fit than the competing models, and the results suggested a strong general factor of "difficulties in emotion expression." The validity of the EESC was also indicated by its positive correlations with variables assessing child anxiety, depression, and behavioral avoidance and its negative correlation with mindfulness skills. The EESC is a valid measure of children's difficulties in emotion expression and the use of its total score is recommended.

Does Anxiety Symptomatology Affect Bullying Behavior in Children and Adolescents with ADHD?

Background

Anxiety disorders are common comorbidities in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) who are also at a high risk of bullying behavior. However, little is known about the roles of anxiety symptomatology in the relationship between ADHD and bullying behavior.

Objective

This cross-sectional, clinic-based study aims to investigate the associations between anxiety symptomatology and bullying involvement in youth with ADHD.

Method

One hundred and eighty children and adolescents with ADHD aged 10–18 years participated in the study. The Screen for Child Anxiety-Related Emotional Disorders (SCARED) was self-rated, and the participants were interviewed with the Revised Olweus Bully/Victim Questionnaire to categorize bullying involvement. Data were analyzed through percentage, nonparametric statistics, chi-squared statistics, and logistic regression analysis.

Results

Sixty-nine percent of youth with ADHD reported involvement in bullying, of which 33.3%, 8.9%, and 27.2% were classified as victims, bullies, and bully-victims, respectively. The means and 95% confidence intervals of the total SCARED scores showed a significant difference among bullying behavior groups. The highest SCARED scores could be noticed in the victim and bully-victim groups, with the lowest scores observed in the bully group. Youth with ADHD who had comorbid anxiety were 3.51 times more likely to be bullied than those who did not have anxiety.

Conclusions

A differential effect of anxiety symptomatology on bullying behavior in youth with ADHD was evident. These results highlight the utility of including anxiety in the conceptualization of bullying problems in youth with ADHD to plan successful anti-bullying interventions.

Effectiveness of the Super Skills for Life programme in enhancing the emotional wellbeing of children and adolescents in residential care institutions in a low- and middle-income country: A randomised waitlist-controlled trial

BACKGROUND

The present study examined the effectiveness of a transdiagnostic prevention programme, Super Skills for Life (SSL), among children and adolescents with emotional problems in residential care institutions (RCIs) in the low- and middle-income country of Mauritius using a randomised waitlist-controlled trial (RCT). SSL is based on the principles of cognitive behavioural therapy, behavioural activation, social skills training, and uses video-feedback and cognitive preparation as part of the treatment.

METHODS

The RCT involved 100 children and adolescents aged 9 to 14 years, from six RCIs, randomly allocated to either an SSL intervention group (IG) or a waitlist-control (WLC) group. A set of questionnaires measuring internalising and externalising problems, emotion regulation and self-esteem, and experimental tasks measuring attentional bias and inhibitory control, were completed at baseline, post-intervention and 3-month follow-up. Participants also completed a 2-min video speech task during the first and final sessions of the SSL intervention.

RESULTS

Children and adolescents in the IG showed significant improvements in internalising symptoms (e.g. anxiety and depression), externalising symptoms (e.g. conduct problems and hyperactivity), and inhibitory control, and an increase in adaptive (except putting into perspective strategy) and decrease in maladaptive emotion regulation strategies, at both post-intervention and follow-up. These findings were not replicated among children in the WLC.

LIMITATIONS

The small sample size and lack of an active control group were the major limitations of this study.

CONCLUSIONS

This study provides evidence for the effectiveness of a transdiagnostic prevention programme for emotional problems in RCIs in a low- and middle-income country.

Emotion regulation processes linking peer victimization to anxiety and depression symptoms in adolescence

Difficulties with emotion regulation can take many forms, including increased sensitivity to emotional cues and habitual use of maladaptive cognitive or behavioral regulation strategies. Despite extensive research on emotion regulation and youth adjustment, few studies integrate multiple measures of emotion regulation. The present study evaluated the underlying structure of emotion regulation processes in adolescence using both task- and survey-based measures and determined whether differences in these emotion regulation latent factors mediated the association between peer victimization and internalizing psychopathology. Adolescents aged 16-17 years (n = 287; 55% female; 42% White) recruited in three urban centers in the United States completed baseline and follow-up assessments 4 months apart. Three models of emotion regulation were evaluated with confirmatory factor analysis. A three-factor model fit the data best, including cognitive regulation, behavioral regulation, and emotional reactivity latent factors. Task-based measures did not load onto these latent factors. Difficulties with behavioral regulation mediated the association between peer victimization and depression symptoms, whereas cognitive regulation difficulties mediated the association with anxiety symptoms. Findings point to potential targets for intervention efforts to reduce risk for internalizing problems in adolescents following experiences of peer victimization.

An examination of the association between anxiety and social functioning in youth with ADHD: A systematic review

Although up to 50% of children with Attention-Deficit/Hyperactivity Disorder (ADHD) meet criteria for an anxiety disorder, it is unclear how comorbid anxiety influences social functioning for this population. Understanding the factors associated with social functioning in ADHD is important given the limited efficacy of existing social skills interventions for this population. This systematic review aimed to determine the association between anxiety and social functioning (social problems, peer status, and social skills/ competence) in children and adolescents with ADHD. A standardised search protocol was used, identifying 4807 articles for screening with 31 included in the final review. Anxiety symptom severity was associated with lower levels of social skills and higher levels of social problems in young people with ADHD. However, few differences emerged when defining anxiety based on diagnostic measures. Although the results varied considerably amongst studies, a number of key variables emerged that influenced the associations between anxiety and social functioning including the type of reporter and sample characteristics such as age, sex, ADHD subtype and other mental health comorbidities. These findings have implications for social functioning interventions in ADHD given the role of anxiety symptoms in predicting poorer social functioning.

Longitudinal relations between emotional awareness and expression, emotion regulation, and peer victimization among urban adolescents

INTRODUCTION

There are potential long-term psychosocial effects of experiencing peer victimization during adolescence, including: internalizing symptoms, externalizing behaviors, and risks behaviors such as substance use. While social-emotional theories of development note associations between deficits in emotion competencies and peer victimization in childhood, these associations are less established among adolescent samples. Identifying which inadequacies in emotional competence place particular adolescents at risk for peer victimization may provide insight into the developmental pathways leading to unfavorable outcomes.

METHODS

The current study examined the relation between emotional competence and overt peer victimization among adolescents. Adolescents living in a mid-sized urban city in the southeastern region of the United States (N = 357; Mage = 12.14 years, 92% African American) reported their emotional awareness and reluctance to express emotion at baseline. Two years later, adolescents reported their regulation of anger and caregivers reported on adolescents' global emotion regulation. Adolescents also reported on occurrences of overt peer victimization during the previous 30 days at baseline and during the two-year follow up.

RESULTS

Our hypothesized model fit the data adequately. Greater emotion awareness was associated with higher scores on caregiver-rated emotion regulation and adolescent-rated anger regulation two years later, and in turn, lower frequencies of overt victimization by peers. Further, greater expressive reluctance was associated with greater anger regulation, and in turn, lower frequencies of overt victimization by peers. Patterns of associations did not vary by sex or age.

CONCLUSIONS

The present study extends models of social-emotional development and peer interactions into the development age stage of adolescence.

Premorbid adjustment in individuals at ultra-high risk for developing psychosis: a case-control study

AIM

Deterioration in premorbid adjustment is related to ultra-high risk (UHR) individuals developing psychosis, but it has not been examined how UHR individuals' development differs compared to healthy controls. This study investigates differences in premorbid adjustment between UHR individuals and a healthy control group.

METHOD

A total of 48 UHR individuals and 50 healthy controls matched on group level for age, gender and parents' socio-economic status were included in the study. Both groups were assessed with the Premorbid Adjustment Scale (PAS). Based on the PAS scores, composite social and academic scales were computed.

RESULTS

Compared to the healthy controls the UHR individuals' social and academic premorbid adjustment declined across age periods. Social premorbid adjustment declined particularly between late adolescence and adulthood. Academic premorbid adjustment declined particularly between childhood and early adolescence. The UHR individuals had more premorbid adjustment difficulties on both the social and academic scale, and on the individual PAS scales.

CONCLUSION

From childhood UHR individuals have lower levels of social and academic premorbid adjustment compared to healthy controls, and the difficulties increase with age. As such, social and academic premorbid adjustment could be an important focus for early intervention.

Childhood Predictors of Young Adult Social Functioning in 22q11.2 Deletion Syndrome

The primary objectives of the current prospective longitudinal study were to (a) describe social functioning outcomes and (b) identify childhood predictors of social functioning in young adults with 22q11.2 deletion syndrome (22q11.2DS). Childhood predictors of young adult social functioning were examined. Family environment and parental stress in adolescence were investigated as potential mediators between childhood variables and adult social functioning. Parent rated childhood internalizing symptoms significantly predicted young adult social functioning in 22q11.2DS, even after controlling for concurrent positive symptoms of psychosis, and problem behaviors contributing to parenting stress in adolescence partially mediated this relationship. These findings highlight child internalizing symptoms and adolescent problem behaviors as potential targets for social functioning interventions in 22q11.2DS.

Reluctance to express emotion explains relation between cognitive distortions and social competence in anxious children

Guided by social information processing and affective social competence models, the focal objective of this research was to examine the relations among anxious children's cognitive distortions, social skill competence, and reluctance to express emotion. In addition, we explored whether children's attention control played any meaningful role. Using a sample of 111 anxious children (M_age  = 9.63, SD = 0.73; 75.7% girls; 56% Hispanic/Latino), we found that cognitive distortions were negatively related to social competence. In addition, tests of moderated mediation showed that the negative association between cognitive distortions and social skill competence was indirect via reluctance to express emotion, but this only was the case for anxious children with high attention control and for distortions in the academic domain. The findings of this study may set the stage for new ways to conceptualize the role of higher attention control among anxious youth. Statement of contribution What is already known on this subject? Cognitive errors are prevalent in anxious youth Anxious children show socio-emotion deficits What does this study add? Cognitive errors are related to socio-emotion deficits in anxious youth Relations depend on attention control.

Posttraumatic Stress Disorder Symptoms Among Trauma-Exposed Inpatient Adolescents: The Role of Emotional Nonacceptance and Anxiety Symptom Severity

The present investigation examined the role of anxiety symptom severity in the relation between emotional nonacceptance and posttraumatic stress disorder (PTSD) symptoms in a diverse sample of trauma-exposed adolescents admitted for acute psychiatric care at an inpatient state hospital (N = 50; 52.0% women; 44% white; mean [SD] age, 15.1 [0.51] years; range, 12-17 years). Anxiety symptom severity partially accounted for the association between emotional nonacceptance and PTSD total symptoms, and fully accounted for the association between emotional nonacceptance and PTSD symptom cluster severity, even after controlling for covariates. Reverse model testing provided confidence in the direction of hypothesized effects. These findings add to a body of literature underscoring the detrimental effect of nonaccepting reactions to negative emotions in the context of PTSD and provide preliminary support for a possible underlying role of anxiety symptom severity in the association between emotional nonacceptance and PTSD symptoms.

Preschoolers' psychophysiological responses to mood induction tasks moderate the intergenerational transmission of internalizing problems

To identify factors that can both exacerbate risk for, and protect against, internalizing problems during early childhood, the present study examined whether children's respiratory sinus arrhythmia (RSA) suppression in response to emotionally-laden film clips would moderate the association between maternal and child anxious/depressive symptoms in a cross-sectional sample of 108 mothers (M age=30.68years, SD=6.06) and their preschool-age children (M age=3.50years, SD=0.52, 61.30% male). Results indicated that RSA suppression in response to the fear clip moderated the positive association between maternal and child anxious/depressive symptoms, such that higher suppression served a protective-stabilizing function while lower suppression exacerbated children's risk for internalizing symptoms in the context of higher maternal symptoms. Moderation findings involving RSA suppression in response to a happiness-inducing clip were consistent with biological sensitivity to context; the association between maternal and child symptoms was strongest for children higher in suppression.