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Labonte AK, Camacho MC, Moser J, Koirala S, Laumann TO, Marek S, Fair D, Sylvester CM. Precision Functional Mapping to Advance Developmental Psychiatry Research. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:100370. [PMID: 39309212 PMCID: PMC11416589 DOI: 10.1016/j.bpsgos.2024.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 09/25/2024] Open
Abstract
Many psychiatric conditions have their roots in early development. Individual differences in prenatal brain function (which is influenced by a combination of genetic risk and the prenatal environment) likely interact with individual differences in postnatal experience, resulting in substantial variation in brain functional organization and development in infancy. Neuroimaging has been a powerful tool for understanding typical and atypical brain function and holds promise for uncovering the neurodevelopmental basis of psychiatric illness; however, its clinical utility has been relatively limited thus far. A substantial challenge in this endeavor is the traditional approach of averaging brain data across groups despite individuals varying in their brain organization, which likely obscures important clinically relevant individual variation. Precision functional mapping (PFM) is a neuroimaging technique that allows the capture of individual-specific and highly reliable functional brain properties. Here, we discuss how PFM, through its focus on individuals, has provided novel insights for understanding brain organization across the life span and its promise in elucidating the neural basis of psychiatric disorders. We first summarize the extant literature on PFM in normative populations, followed by its limited utilization in studying psychiatric conditions in adults. We conclude by discussing the potential for infant PFM in advancing developmental precision psychiatry applications, given that many psychiatric disorders start during early infancy and are associated with changes in individual-specific functional neuroanatomy. By exploring the intersection of PFM, development, and psychiatric research, this article underscores the importance of individualized approaches in unraveling the complexities of brain function and improving clinical outcomes across development.
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Affiliation(s)
- Alyssa K. Labonte
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri
- Neurosciences Graduate Program, Washington University in St. Louis, St. Louis, Missouri
| | - M. Catalina Camacho
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri
| | - Julia Moser
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, Minnesota
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota
| | - Sanju Koirala
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, Minnesota
| | - Timothy O. Laumann
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri
| | - Scott Marek
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Damien Fair
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, Minnesota
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Chad M. Sylvester
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri
- Taylor Family Institute for Innovative Psychiatric Research, Washington University School of Medicine, St. Louis, Missouri
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Vossoughi M, Kharazi M, Mani A, Safari F, Habibi P, Zarei L, Sarikhani Y, Heydari ST, Lankarani KB. Psychological strains after the crisis: evaluating separation anxiety among Iranian children and adolescents in the post-COVID-19 era. BMC Psychol 2024; 12:471. [PMID: 39232816 PMCID: PMC11375825 DOI: 10.1186/s40359-024-01945-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/12/2024] [Indexed: 09/06/2024] Open
Abstract
OBJECTIVES The objective of this study was to specifically investigate Separation Anxiety Disorder (SAD), as one of the noteworthy disorders within the spectrum of anxiety disorders, among children and adolescents, after overcoming the crises caused by the Coronavirus Disease 2019 (COVID-19) pandemic. Efforts were also made to identify socio-demographic factors that could be associated with changes in SAD level and also to assess the effect of different constituting dimensions of SAD on the severity of this disorder. METHODS In this cross-sectional study, face-to-face interviews were conducted with the parents of 317 (7-13-year-old) Iranian students, who were selected through a multi-stage random sampling method in the city of Shiraz. During the interviews, socio-demographic data were collected, and subsequently, SAD symptoms and dimensions were assessed using the Separation Anxiety Assessment Scale (Parent Version) (SAAS-P) questionnaire. Later, employing the Partition Around Medoids (PAM) statistical method, the participants were categorized into two groups with low and high levels of SAD. Also, to understand the interaction between the different dimensions of SAD, the network analysis method was employed. Finally, univariate analysis and logistic regression were utilized, with a significance level of 0.05, to determine potential associating factors with the level of SAD. RESULTS The sample included 128 girls and 189 boys with a mean age of 9.63 ± 2.63 and 9.63 ± 1.95 years respectively. Based on the PAM method, 51.1% of the participants presented a high level of SAD. According to network analysis, it was demonstrated that the "fear of abandonment" dimension plays a central role in high levels of SAD. Based on logistic regression, female gender, age ≥ 10 years, parents' unacademic educational background, mother's employment, and child's history of physical/mental problems were significantly associated with the high level of SAD. CONCLUSIONS A considerable number of the participants in this study presented a high level of SAD with the "fear of abandonment" being a key influential dimension of elevated levels of this disorder. Maternal employment, female gender, child's history of health issues, and low parental education were identified as important contributors to the high SAD level. Considering these factors allows for more effective diagnostic and therapeutic interventions. However, the need for further studies remains crucial.
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Affiliation(s)
- Mehrdad Vossoughi
- Mental Health Research Center, Psychosocial Health Research Institute (PHRI), Iran University of Medical Sciences, Tehran, Iran
| | - Mani Kharazi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Mani
- Research Center of Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farima Safari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pardis Habibi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Zarei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yaser Sarikhani
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Kamran B Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Copeland WE, Keen R, Tong G, Shanahan L. Negative Life Events and Emotional Symptoms From Ages 2 to 30 Years. JAMA Netw Open 2024; 7:e2429448. [PMID: 39207754 PMCID: PMC11362870 DOI: 10.1001/jamanetworkopen.2024.29448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/18/2024] [Indexed: 09/04/2024] Open
Abstract
Importance Exposure to different types of negative life events, including traumatic events, is common across the lifespan and associated with increased mental health symptoms. Objective To assess whether vulnerability to negative life events varies across 5 developmental periods from preschool to young adulthood. Design, Setting, and Participants This cohort study analyzed data from 3 community-representative studies set in the southeastern US (1992-2015) with harmonized assessment approaches that included a total of 13 775 assessments of individuals aged 2 to 30 years with up to 21 years of follow-up. Data analysis occurred from July 2023 to June 2024. Exposures Each study assessed lifetime exposure to (1) traumatic events (ie, severe events associated with posttraumatic stress disorder) and (2) recent stressful events (eg, loss of a friend or moving). All assessments were completed with structured interviews with participants and/or their caregivers. Main Outcomes and Measures The primary outcome was emotional symptoms (ie, anxiety and depressive symptoms). Associations of both categories of life events with emotional symptoms were compared across preschool (<7 years), childhood (7-12 years), adolescence (13-17 years), late adolescence (18-22 years), and young adulthood (23-30 years). Results Analyses were based on 13 775 assessments of 3258 participants (1519 female [weighted percentage, 50.0%]). Recent stressful events were associated with emotional symptoms across each developmental period, ranging from a low in preschool (B =0.14; SE = 0.05) to a high in young adulthood (B = 0.57; SE = 0.12) in cross-sectional analyses and ranging from a low in childhood (B = 0.10; SE = 0.06) to a high adolescence (B = 0.19; SE = 0.05) in longitudinal analyses. Lifetime traumatic events were associated with emotional symptoms across each developmental period, ranging from a low in preschool (B = 0.18; SE = 0.05) to a high in adolescence (B = 0.28; SE = 0.04) in cross-sectional analyses and ranging from a low in childhood (B = 0.09; SE = 0.06) to a high in late adolescence (B = 0.21; SE = 0.05) in longitudinal analyses. Associations had overlapping 95% CIs across the different developmental periods with one exception: stressful events had a larger-magnitude cross-sectional association with emotional symptoms in young adulthood than in other developmental periods. Results were consistent with additive, rather than interactive, associations of traumatic and stressful events with emotional symptoms at each developmental period. Conclusions and Relevance In this cohort study of 3 community-representative samples, vulnerability to traumatic and stressful events was generally similar across the first 3 decades of life; both types of events had an independent association with emotional functioning. These findings suggest response to stressful events is similar from childhood to adulthood.
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Affiliation(s)
| | - Ryan Keen
- Harvard University, Cambridge, Massachusetts
| | - Guangyu Tong
- Department of Internal Medicine and Biostatistics, Yale University, New Haven, Connecticut
| | - Lilly Shanahan
- Department of Psychology, University of Zurich, Zürich, Switzerland
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Hattangadi N, Kay T, Parkin PC, Birken CS, Maguire JL, Szatmari P, van den Heuvel M, Borkhoff CM, Charach A. Screening Accuracy of the Parent-Report Preschool Strengths and Difficulties Questionnaire in Primary Care. Acad Pediatr 2024; 24:800-809. [PMID: 37907129 DOI: 10.1016/j.acap.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To evaluate the screening test accuracy and reliability of the parent-report preschool Strengths and Difficulties Questionnaire (P-SDQ) in primary care settings. METHODS Children 24 to 48 months were recruited at scheduled primary care visits in Toronto, Canada. Parents completed the P-SDQ at baseline, 2, and 12 weeks. At 12 weeks, parents were invited to a semistructured diagnostic phone interview, the Preschool Age Psychiatric Assessment (PAPA). Criterion validity between baseline P-SDQ scores (Total Difficulties Score [TDS], internalizing and externalizing subscale) and Diagnostic and Statistical Manual, 5th edition diagnoses on PAPA was evaluated using area under the curve (AUC) and calculating screening test properties (sensitivity and specificity). Test-retest reliability at baseline and 2 weeks was evaluated using intraclass correlation coefficient. RESULTS A total of 183 children were enrolled, mean age 39.3 (SD 7.4) months, 46.4% male, 120 (66%) completed P-SDQ at 2 weeks, 107 (58%) completed PAPA at 12 weeks. Of those with a PAPA, 26 (24%) had any psychiatric diagnosis, 17 (16%) had internalizing disorders and 4 (4%) had externalizing disorders. TDS identified any diagnosis with AUC = 0.67 (95% confidence intervals (CI): 0.55, 0.79); internalizing subscale identified internalizing disorders with AUC = 0.61 (95% CI: 0.47, 0.74); externalizing subscale identified externalizing disorders with AUC = 0.77 (95% CI: 0.60, 0.94). Sensitivity and specificity, and test-retest reliability were satisfactory for TDS and externalizing subscale, and less satisfactory for the internalizing subscale. CONCLUSIONS The externalizing subscale has sufficient accuracy and reliability to identify children aged 2 to 4 years at risk for attention deficit/hyperactivity disorder and disruptive behavior disorders in primary care.
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Affiliation(s)
- Nayantara Hattangadi
- Department of Psychiatry (N Hattangadi, T Kay, P Szatmari, and A Charach), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tatjana Kay
- Department of Psychiatry (N Hattangadi, T Kay, P Szatmari, and A Charach), Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, Toronto Metropolitan University, Canada
| | - Patricia C Parkin
- Pediatric Outcomes Research Team (PORT) (PC Parkin, CS Birken, Mv den Heuvel, and CM Borkhoff), Division of Pediatric Medicine and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation (PC Parkin, CS Birken, JL Maguire, CM Borkhoff, and A Charach), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics (PC Parkin, CS Birken, JL Maguire), Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Joannah & Brian Lawson Centre for Child Nutrition (PC Parkin, CS Birken, JL Maguire, and Mv den Heuvel), Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S Birken
- Pediatric Outcomes Research Team (PORT) (PC Parkin, CS Birken, Mv den Heuvel, and CM Borkhoff), Division of Pediatric Medicine and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation (PC Parkin, CS Birken, JL Maguire, CM Borkhoff, and A Charach), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics (PC Parkin, CS Birken, JL Maguire), Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Joannah & Brian Lawson Centre for Child Nutrition (PC Parkin, CS Birken, JL Maguire, and Mv den Heuvel), Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Institute of Health Policy, Management and Evaluation (PC Parkin, CS Birken, JL Maguire, CM Borkhoff, and A Charach), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics (PC Parkin, CS Birken, JL Maguire), Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Joannah & Brian Lawson Centre for Child Nutrition (PC Parkin, CS Birken, JL Maguire, and Mv den Heuvel), Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; The Centre for Urban Health Solutions (JL Maguire), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Pediatrics (JL Maguire), St. Michael's Hospital, Toronto, Ontario, Canada
| | - Peter Szatmari
- Department of Psychiatry (N Hattangadi, T Kay, P Szatmari, and A Charach), Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychiatry (P Szatmari and A Charach), Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health (P Szatmari), Toronto, Ontario, Canada
| | - Meta van den Heuvel
- Pediatric Outcomes Research Team (PORT) (PC Parkin, CS Birken, Mv den Heuvel, and CM Borkhoff), Division of Pediatric Medicine and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics (PC Parkin, CS Birken, JL Maguire), Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Joannah & Brian Lawson Centre for Child Nutrition (PC Parkin, CS Birken, JL Maguire, and Mv den Heuvel), Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Pediatric Outcomes Research Team (PORT) (PC Parkin, CS Birken, Mv den Heuvel, and CM Borkhoff), Division of Pediatric Medicine and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation (PC Parkin, CS Birken, JL Maguire, CM Borkhoff, and A Charach), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute (CM Borkhoff), Women's College Hospital, Toronto, Ontario, Canada
| | - Alice Charach
- Department of Psychiatry (N Hattangadi, T Kay, P Szatmari, and A Charach), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation (PC Parkin, CS Birken, JL Maguire, CM Borkhoff, and A Charach), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry (P Szatmari and A Charach), Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Ysbæk-Nielsen AT. Exploring volumetric abnormalities in subcortical L-HPA axis structures in pediatric generalized anxiety disorder. Nord J Psychiatry 2024; 78:402-410. [PMID: 38573199 DOI: 10.1080/08039488.2024.2335980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Pediatric generalized anxiety disorder (GAD) is debilitating and increasingly prevalent, yet its etiology remains unclear. Some believe the disorder to be propagated by chronic dysregulation of the limbic-hypothalamic-pituitary-adrenal (L-HPA) axis, but morphometric studies of implicated subcortical areas have been largely inconclusive. Recognizing that certain subcortical subdivisions are more directly involved in L-HPA axis functioning, this study aims to detect specific abnormalities in these critical areas. METHODS Thirty-eight MRI scans of preschool children with (n = 15) and without (n = 23) GAD underwent segmentation and between-group volumetric comparisons of the basolateral amygdala (BLA), ventral hippocampal subiculum (vSC), and mediodorsal medial magnocellular (MDm) area of the thalamus. RESULTS Children with GAD displayed significantly larger vSC compared to healthy peers, F(1, 31) = 6.50, pFDR = .048. On average, children with GAD presented with larger BLA and MDm, Fs(1, 31) ≥ 4.86, psFDR ≤ .054. Exploratory analyses revealed right-hemispheric lateralization of all measures, most notably the MDm, F(1, 31) = 8.13, pFDR = .024, the size of which scaled with symptom severity, r = .83, pFDR = .033. CONCLUSION The BLA, vSC, and MDm are believed to be involved in the regulation of anxiety and stress, both individually and collectively through the excitation and inhibition of the L-HPA axis. All were found to be enlarged in children with GAD, perhaps reflecting hypertrophy related to hyperexcitability, or early neuronal overgrowth. Longitudinal studies should investigate the relationship between these early morphological differences and the long-term subcortical atrophy previously observed.
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Grieshaber A, Silver J, Bufferd SJ, Dougherty L, Carlson G, Klein DN. Early childhood anxiety disorders: continuity and predictors in adolescence. Eur Child Adolesc Psychiatry 2024; 33:1817-1825. [PMID: 37620672 DOI: 10.1007/s00787-023-02287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
Anxiety disorders are among the most common disorders in early childhood. Although many older children and adolescents with anxiety disorders recover and remain well, little is known about the continuity of early childhood anxiety and the factors that predict persistence/recurrence in later childhood and adolescence. We followed 129 children who met anxiety disorder criteria at age 3 and/or 6 and determined how many continued to experience an anxiety disorder between age 7 and 15, as well as the continuity of specific anxiety disorders. We explored whether biological sex, number of anxiety disorders, early childhood persistence (i.e., anxiety diagnosis at both age 3 and 6), childhood comorbidities, temperamental behavioral inhibition, a maternal history of anxiety, and authoritarian and overprotective parenting predicted persistence/recurrence of an anxiety disorder from age 7 to 15. Sixty-five (50.4%) of the adolescents with an early childhood anxiety disorder met anxiety disorder criteria during the age 7-15 interval. Homotypic continuity from early childhood to school-age/mid-adolescence was observed for social anxiety disorder, separation anxiety disorder, and generalized anxiety disorder (GAD). Early childhood agoraphobia predicted school-age/mid-adolescent GAD and early childhood GAD predicted school-age/mid-adolescent specific phobia. In bivariate analyses, number of anxiety disorders, persistence of anxiety from age 3 to 6, and having a mother with a history of anxiety predicted the persistence/recurrence of anxiety disorders from age 7 to 15. Only early childhood persistence of anxiety uniquely predicted the persistence/recurrence of an anxiety disorder over and above the other predictors. Early intervention efforts should focus on identifying and intervening with young children who demonstrate a protracted course of anxiety.
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Affiliation(s)
- Alexander Grieshaber
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11790-2500, USA.
| | - Jamilah Silver
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11790-2500, USA
| | - Sara J Bufferd
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Lea Dougherty
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Gabrielle Carlson
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11790-2500, USA
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Davis MM, Navarro E, Carpenter KLH, Copeland WE, Small B, Egger HL, Sheridan MA. Early life adversity and psychopathology in preschoolers: mechanisms and moderators. Eur Child Adolesc Psychiatry 2024; 33:1945-1954. [PMID: 37725168 DOI: 10.1007/s00787-023-02295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
Developmental theories suggest that exposure to early life adversity (ELA) alters developing emotional response systems, predicting risk for psychopathology across the life span. The present study examines whether negative emotionality (NE), a trait-like measure of emotionality that develops during early childhood, mediates the association between ELA and psychopathology in a representative sample of 917 preschoolers (Mage = 3.84). Additionally, we explored whether cognitive control, which supports attentional focusing and inhibition and has been identified as a transdiagnostic protective factor, moderates the impact of heightened emotionality following adversity on psychopathology risk. We utilized parent report of adversity, psychopathology, and NE and parent report and task-based measures of cognitive control. Structural equation modeling of cross-sectional data revealed that NE partially mediated the link between ELA and psychopathology symptoms. Moreover, parent-reported cognitive control buffered this link such that the effect of ELA on psychopathology through NE was stronger in children with low versus high cognitive control. These results identify elevated NE as one mechanism linking ELA and psychopathology, specifically among children with poorer top-down control, informing our understanding of key risk and protective factors among adversity-exposed children.
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Affiliation(s)
- Megan M Davis
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 E. Cameron St., Chapel Hill, NC, 27599, USA.
| | - Esmeralda Navarro
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 E. Cameron St., Chapel Hill, NC, 27599, USA
| | | | | | | | | | - Margaret A Sheridan
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 E. Cameron St., Chapel Hill, NC, 27599, USA
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Cleary M, West S, McLean L, Johnston-Devin C, Kornhaber R, Hungerford C. When the Education System and Autism Collide: An Australian Qualitative Study Exploring School Exclusion and the Impact on Parent Mental Health. Issues Ment Health Nurs 2024; 45:468-476. [PMID: 38593464 DOI: 10.1080/01612840.2024.2328251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Autistic students experience elevated rates of school exclusion, whether this be through expulsion, suspension, informal suspension, refusal of enrolment, or school refusal. This exclusion can come about from a range of factors, including sensory or cognitive overload, a lack of training in neurodiversity for teachers, an absent sense of safety by the student at school, or poor attitudes towards the inclusion of autistic students in schools. The impacts of this exclusion on parents can be logistical, financial, and psychological, with a range of mental health outcomes. This Australian qualitative study presents case studies of seven parents of autistic students, as well as four themes that capture the recommendations of parents to address school exclusion. The findings demonstrate that parents experience stress in finding a suitable school for their child, working with staff to meet the needs of the child, and attempting to maintain employment and other commitments when the child experiences exclusion. Parents recommend greater acceptance of autism by education systems, better communication and use of neuro-affirming language, the option for flexible learning, and individualised support by the school for the student.
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Affiliation(s)
- Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, CQUniversity, Sydney, New South Wales, Australia
| | - Sancia West
- School of Nursing, Midwifery & Social Sciences, CQUniversity, Sydney, New South Wales, Australia
| | - Loyola McLean
- Dip Psychodynamic Psychotherapy, Cert ATP, Accredited AAI Coder and Trainer. Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Psychotherapy Program for Complex Traumatic Disorders, Western Sydney Local Health District, Parramatta, New South Wales, Australia
- Western Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Colleen Johnston-Devin
- School of Nursing, Midwifery & Social Sciences, CQUniversity, Brisbane, Queensland, Australia
| | - Rachel Kornhaber
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Catherine Hungerford
- School of Nursing, Midwifery & Social Sciences, CQUniversity, Sydney, New South Wales, Australia
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Alacha HF, Isaac AJ, Gemmell N, Dougherty LR, Olino TM, Bufferd SJ. Comparison of Global and Daily Ratings of Associations between Anxiety and Depressive Behaviors and Impairment in Preschool-Aged Children. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01697-z. [PMID: 38578584 DOI: 10.1007/s10578-024-01697-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
Anxiety and depressive difficulties can emerge during early childhood and cause impairment in functioning. Anxiety and depressive behaviors and impairment are typically assessed with global questionnaires that require recall of children's behavior over an extended period which could reduce the accuracy of parent report of children's behavior and functioning. The current study compared parents' report of children's anxiety and depressive behaviors and impairment when evaluated with global measures versus a daily diary measure. Participants (N = 901 parents of 3-5-year-old children) completed global and daily measures of children's behavior and impairment during enrollment to the study. Global measures were completed at baseline and the 14 daily diary measures were completed consecutively for two weeks. Across most measures, daily associations between parent-reported anxiety and depressive behaviors and impairment were stronger compared to associations with global measures. These results suggest that daily measures may better capture links between young children's typical behavior and functioning compared to global measures. In addition, daily assessment might be more effective for measuring mild to moderate yet still impairing behaviors that may be missed on global reports that require longer periods of recall.
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Affiliation(s)
| | | | | | | | | | - Sara J Bufferd
- University of Louisville, Kentucky, USA.
- Department of Psychological & Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA.
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Gunther KE, Fu X, MacNeill LA, Jones M, Ermanni B, Pérez-Edgar K. Now it's your turn!: Eye blink rate in a Jenga task modulated by interaction of task wait times, effortful control, and internalizing behaviors. PLoS One 2024; 19:e0294888. [PMID: 38457390 PMCID: PMC10923458 DOI: 10.1371/journal.pone.0294888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 11/10/2023] [Indexed: 03/10/2024] Open
Abstract
Dopamine is a versatile neurotransmitter with implications in many domains, including anxiety and effortful control. Where high levels of effortful control are often regarded as adaptive, other work suggests that high levels of effortful control may be a risk factor for anxiety. Dopamine signaling may be key in understanding these relations. Eye blink rate is a non-invasive proxy metric of midbrain dopamine activity. However, much work with eye blink rate has been constrained to screen-based tasks which lack in ecological validity. We tested whether changes in eye blink rate during a naturalistic effortful control task differ as a function of parent-reported effortful control and internalizing behaviors. Children played a Jenga-like game with an experimenter, but for each trial the experimenter took an increasingly long time to take their turn. Blinks-per-second were computed during each wait period. Multilevel modeling examined the relation between duration of wait period, effortful control, and internalizing behaviors on eye blink rate. We found a significant 3-way interaction between effortful control, internalizing behaviors, and duration of the wait period. Probing this interaction revealed that for children with low reported internalizing behaviors (-1 SD) and high reported effortful control (+1 SD), eye blink rate significantly decreased as they waited longer to take their turn. These findings index task-related changes in midbrain dopamine activity in relation to naturalistic task demands, and that these changes may vary as a function of individual differences in effortful control and internalizing behaviors. We discuss possible top-down mechanisms that may underlie these differences.
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Affiliation(s)
- Kelley E. Gunther
- Department of Psychology, Yale University, New Haven, CT, United States of America
| | - Xiaoxue Fu
- Department of Psychology, The University of South Carolina, Columbia, SC, United States of America
| | - Leigha A. MacNeill
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Morgan Jones
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, United States of America
| | - Briana Ermanni
- Department of Psychology, Virginia Tech, Blacksburg, VA, United States of America
| | - Koraly Pérez-Edgar
- Department of Psychology, The Pennsylvania State University, State College, PA, United States of America
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11
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Sylvester CM, Luby JL, Pine DS. Novel mechanism-based treatments for pediatric anxiety and depressive disorders. Neuropsychopharmacology 2024; 49:262-275. [PMID: 37608220 PMCID: PMC10700626 DOI: 10.1038/s41386-023-01709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
Pediatric anxiety and depressive disorders are common, can be highly impairing, and can persist despite the best available treatments. Here, we review research into novel treatments for childhood anxiety and depressive disorders designed to target underlying cognitive, emotional, and neural circuit mechanisms. We highlight three novel treatments lying along a continuum relating to clinical impact of the disorder and the intensity of clinical management required. We review cognitive training, which involves the lowest risk and may be applicable for problems with mild to moderate impact; psychotherapy, which includes a higher level of clinical involvement and may be sufficient for problems with moderate impact; and brain stimulation, which has the highest potential risks and is therefore most appropriate for problems with high impact. For each treatment, we review the specific underlying cognitive, emotional, and brain circuit mechanisms that are being targeted, whether treatments modify those underlying mechanisms, and efficacy in reducing symptoms. We conclude by highlighting future directions, including the importance of work that leverages developmental windows of high brain plasticity to time interventions to the specific epochs in childhood that have the largest and most enduring life-long impact.
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Affiliation(s)
- Chad M Sylvester
- Washington University Department of Psychiatry, St. Louis, MO, USA.
- Washington University Department of Radiology, St. Louis, MO, USA.
| | - Joan L Luby
- Washington University Department of Psychiatry, St. Louis, MO, USA
| | - Daniel S Pine
- National Institute of Mental Health, Emotion and Development Branch, St. Louis, MO, USA
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12
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Garon-Carrier G, Ansari A, Margolis R, Fitzpatrick C. Maternal Labor Force Participation During the Child's First Year and Later Separation Anxiety Symptoms. HEALTH EDUCATION & BEHAVIOR 2023; 50:792-801. [PMID: 37522632 PMCID: PMC10638856 DOI: 10.1177/10901981231188137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Separation anxiety symptoms are frequent among preschool-aged children, but it is also a possible gateway for diagnosis of separation anxiety disorder. Early maternal employment after childbirth can increase the risk for the development of separation anxiety symptoms. From an economic perspective, however, securing employment is one effective strategy to ensure child well-being. This study investigated how mothers' participation in the labor force (vs. maternal leave) and the financial state of families when the child was 5 months old was prospectively associated with separation anxiety symptoms. This study is based on 1,295 Canadian families with children assessed longitudinally from 17 months to age 6 on their levels of separation anxiety. Separation anxiety was measured during face-to-face interviews with the mothers. Maternal labor force participation, financial status, and risk factors were measured at 5 months. Results adjusted for propensity scores and for sample weight revealed that children of working mothers, despite having sufficient income (n = 245, 18.9%), were at higher risk of separation anxiety during early childhood. In contrast, maternity leave was most beneficial for children's separation anxiety, whether they were in a family with sufficient income (n = 950, 73.4%) or temporary low income (n = 100, 7.7%). Children of mothers in maternity leave were at risk of heightened separation anxiety only if they experienced chronic economic hardship. Therefore, maternity leave uptake could help prevent the development of separation anxiety. Providing families with opportunity to care for the baby as their main occupation during this sensitive developmental period could help improve children's mental health.
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Affiliation(s)
| | - Arya Ansari
- The Ohio State University, Columbus, OH, USA
| | | | - Caroline Fitzpatrick
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
- University of Johannesburg, Johannesburg, South Africa
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13
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Nazzal H, Baccar M, Ziad T, Al-Musfir T, Al Emadi B, Matoug-Elwerfelli M, Narasimhan S, Khan Y, Reagu S. Prevalence of anxiety, sleep bruxism and temporomandibular disorders during COVID-19 in Qatari children and adolescents: a cross-sectional study. Eur Arch Paediatr Dent 2023; 24:787-795. [PMID: 37848680 PMCID: PMC10657298 DOI: 10.1007/s40368-023-00847-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Understanding the impact of coronavirus disease-2019 (COVID-19) pandemic social restrictions on the lives of children and adolescents is of utmost importance to enable timely diagnosis and treatment. Therefore, the aim of this study was to explore the prevalence of anxiety, sleep bruxism, temporomandibular disorders (TMD) and change in dietary and brushing habits and their association with COVID-19 social restrictions. METHODS Parents of fit and healthy Qatari children and adolescents were recruited and interviewed by the research team, whereby validated questioners were used to assess the prevalence of children's/adolescents' anxiety, sleep bruxism and TMD. Furthermore, changes in dietary and brushing habits were also evaluated. RESULTS A total of 199 parents of children and adolescents (mean age = 9.3 ± 3.2 years old) were included. Overall anxiety symptoms, sleep bruxism and TMD were evident in 29.6%, 5.7% and 23.1%, respectively. An increased consumption of food, sweets and worsening of brushing habits were evident in 51.8%, 62.8% and 31.2%, respectively. CONCLUSION Within the limitations of this study, pandemic-related social restrictions could result in elevated levels of anxiety, specifically, social phobia, amongst children and adolescents, which could inevitably lead to unwanted dental consequences.
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Affiliation(s)
- H Nazzal
- Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - M Baccar
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - T Ziad
- Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar
- NYU Langone Dental Medicine, Advanced Education in Pediatric Dentistry, Brooklyn, NY, USA
- Pediatric Dental Services, Sun Life Health, Casa Grande, Arizona, USA
| | - T Al-Musfir
- Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar
| | - B Al Emadi
- Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar
| | | | - S Narasimhan
- Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar
| | - Y Khan
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - S Reagu
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine, Doha, Qatar
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14
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Janus M, Ryan J, Pottruff M, Reid-Westoby C, Brownell M, Bennett T, Birken CS, Duku E, Ferro MA, Forer B, Georgiades S, Gorter JW, Guhn M, Maguire J, Manson H, Pei J, Santos R, Coplan RJ. Population-Based Teacher-Rated Assessment of Anxiety Among Canadian Kindergarten Children. Child Psychiatry Hum Dev 2023; 54:1309-1320. [PMID: 35244815 PMCID: PMC8894824 DOI: 10.1007/s10578-022-01332-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/13/2022]
Abstract
Despite anxiety being a prevalent mental health problem in children, little data exist on the pervasiveness and levels of anxiety symptoms in kindergarteners. Data from the Early Development Instrument, a teacher-completed, population-level measure of child development, were collected across Canada from 2004 to 2015. The final analytic sample consisted of 974,319 children of whom 2.6% were classified as "highly anxious". Compared to children who exhibited "few to none" anxious behaviors, highly anxious children were more likely to be male, have English/French as a second language, and have a special needs designation. Furthermore, compared with their less anxious peers, highly anxious children had between 3.5 and 6.1 higher odds of scoring below the 10th percentile cut-off in physical, social, language/cognitive and communication domains. Our findings suggest that anxious behaviors are related to children's overall health and illustrate the consistency and extensiveness of anxiety at a very young age among Canadian children.
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Affiliation(s)
- Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
| | - Julia Ryan
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Molly Pottruff
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Caroline Reid-Westoby
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Marni Brownell
- Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Teresa Bennett
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Catherine S Birken
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Mark A Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Barry Forer
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Stelios Georgiades
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jonathon Maguire
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Rob Santos
- Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Robert J Coplan
- Department of Psychology, Carleton University, Ottawa, ON, Canada
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15
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Ivanova MY, Hall A, Weinberger S, Buckingham SL, Copeland WE, Crockett P, Dainer-Best J, D'Alberto C, Dewey L, Foret D, Galano M, Goodrich L, Holly L, Lane N, Leahey M, Lerner M, Marsh J, McGinnis E, Paiva-Salisbury M, Shaw JS, Swift P, Tinker R, Hudziak JJ. The Vermont Family Based Approach in Primary Care Pediatrics: Effects on Children's and Parents' Emotional and Behavioral Problems and Parents' Health-Related Quality of Life. Child Psychiatry Hum Dev 2023; 54:1297-1308. [PMID: 35246775 PMCID: PMC9793330 DOI: 10.1007/s10578-022-01329-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 01/30/2023]
Abstract
This randomized controlled trial tested the Vermont Family Based Approach (VFBA) in primary care pediatrics. The VFBA is a model of healthcare delivery that shifts the focus from the individual to the family, emphasizes emotional and behavioral health, and uses evidence-based health promotion/prevention along with the treatment of emotional and behavioral problems. Participants were 81 families of 3-15-year-olds. For children, the VFBA was associated with greater reductions than the Control condition on the Child Behavior Checklist Emotionally Reactive, Withdrawn, Sleep Problems, Aggressive Behavior and Total Problems scales. For parents, the VFBA was associated with greater reductions than the Control condition on the Adult Self-Report Anxious/Depressed, Rule-Breaking Behavior, Internalizing Problems and Total Problems scales. The VFBA was also associated with greater improvement than the Control condition in the parents' health-related quality of life, as indicated by all scales of the Medical Outcomes Study Health Survey.
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Affiliation(s)
- Masha Y Ivanova
- Department of Psychiatry, University of Vermont, Burlington, VT, USA.
| | - Allison Hall
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | - Sara L Buckingham
- Department of Psychology, University of Alaska Anchorage, Anchorage, AK, USA
| | | | - Phoenix Crockett
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | | | - Lauren Dewey
- Department of Psychological Sciences, University of Vermont, Burlington, VT, USA
| | - DeShan Foret
- University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Maria Galano
- Department of Psychological and Brain Sciences, University of Massachusetts at Amherst, Amherst, MA, USA
| | - Lisa Goodrich
- University of Vermont Medical Center, Burlington, VT, USA
| | - Lindsay Holly
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Nalini Lane
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Maureen Leahey
- University of Vermont Medical Center, Burlington, VT, USA
| | - Mathew Lerner
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jasmine Marsh
- University of Vermont Medical Center, Burlington, VT, USA
| | - Ellen McGinnis
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | - Judith S Shaw
- Department of Pediatrics, University of Vermont, Burlington, VT, USA
| | - Pamela Swift
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Rebekah Tinker
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - James J Hudziak
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
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16
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Bedregal P, Lermanda V, Sierra R, Viviani P. Risk factors associated with higher scores in internalizing and externalizing behaviors in Chilean preschoolers. Infant Ment Health J 2023; 44:663-678. [PMID: 37608475 DOI: 10.1002/imhj.22082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/02/2023] [Accepted: 05/21/2023] [Indexed: 08/24/2023]
Abstract
Early detection of behavioral disorders in children is necessary for intervention. Available data show a high prevalence of child and adolescent psychiatric disorders in Chile (22.5%), but behavioral problems in younger children have not been evaluated. This work assesses behavioral disorders in preschoolers and their association with sociodemographic variables of the family and the child. The data was collected during the impact assessment of the Biopsychosocial Development Support Program "Chile Crece Contigo", using a multistage and representative random sample of 1377 preschoolers, aged between 30 and 48 months, who attended public health services. Homes were visited to apply a questionnaire and the Child Behavior Checklist (CBCL, 1.5-5 years). Results: Multivariable regression model for total raw scores shows that child's age, the number of chronic diseases in the child, and history of exposure to mother's alcohol consumption in pregnancy, remain significant when adjusted for all variables included (R2 of 17.8% and η2 of .19 (95% CI: .14-.22)). In externalizing and internalizing explanatory models, child's chronic diseases and a higher score of authoritarian beliefs about parenting show the two largest effect sizes. These results add to the evidence of urgent problems in preschool mental health.
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Affiliation(s)
- Paula Bedregal
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Victoria Lermanda
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Sierra
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Santiago, Chile
| | - Paola Viviani
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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17
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Machlin L, Egger HL, Stein CR, Navarro E, Carpenter KLH, Goel S, Patel KK, Copeland WE, Sheridan MA. Distinct Associations of Deprivation and Threat With Alterations in Brain Structure in Early Childhood. J Am Acad Child Adolesc Psychiatry 2023; 62:885-894.e3. [PMID: 36775117 PMCID: PMC10412726 DOI: 10.1016/j.jaac.2023.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 11/30/2022] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE The dimensional model of adversity and psychopathology hypothesizes deprivation and threat impact distinct neurobiological pathways, such as brain structure. This hypothesis has not been examined longitudinally or in young children. This study tested longitudinal associations between threat and deprivation measured in preschool and brain structure in childhood. It was hypothesized that threat would be associated with amygdala and hippocampal subcortical volume and deprivation would be associated with cortical thickness in association cortex. METHOD The study included T1-weighted scans from 72 children (5-10 years old, 54.2% female participants). Threat was measured by the presence of domestic violence, sexual abuse, physical abuse, or neighborhood violence. Deprivation was measured by the presence of neglect. Associations of deprivation or threat with brain structure were examined controlling for other dimension (deprivation or threat) and nuisance covariates using whole-brain vertex-wise analyses. Subcortical volume was extracted, and the same associations were examined using multiple regression. RESULTS Threat was associated with widespread decreases in cortical surface area across the prefrontal cortex and other regions. Threat was not associated with amygdala or hippocampal volume. Deprivation was associated with increased thickness in occipital cortex, insula, and cingulate. CONCLUSION Results suggest distinct associations of deprivation and threat on brain structure in early childhood. Threat is associated with widespread differences in surface area, and deprivation is associated with differences in cortical thickness. These observations are consistent with work in adolescence and adulthood and reflect how dimensions of adversity differentially impact neural structure.
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18
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Köcher LM, Schlömer-Böttner S, Christiansen H. Metacognitive Transmission Between Parents and Children in the Context of Anxiety Disorders. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01577-y. [PMID: 37501041 DOI: 10.1007/s10578-023-01577-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
One in ten children is affected by an anxiety disorder. Current state of research shows that transgenerational transmission as well as positive (POS) and negative (NEG) metacognitive beliefs are relevant in the context of anxiety disorders in youth. We investigated whether transgenerational transmission is also evident in conjunction with POS and NEG and cross-sectionally surveyed POS, NEG, anxiety symptoms and worry in 8-16-year-old children and adolescents with anxiety disorders (n = 71) and non-clinical controls (n = 40) and one of their parents. Our results revealed significant transgenerational correlations for NEG in both samples, and for POS in the non-clinical sample only. Mediation analysis showed that children's NEG did at least partly mediate the relationship between parents' NEG and children's anxiety and worry. Children's and parents' POS did not correlate in either sample with children's anxiety and worry. Further research on the transgenerational transmission of metacognition and longitudinal data is needed.
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Affiliation(s)
- Laura Marie Köcher
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-Universität Marburg, Frankfurter Straße 35, 35037, Marburg, Germany.
| | - Silke Schlömer-Böttner
- Psychotherapy Practice for Children and Adolescents, Alter Kirchhainer Weg 5, 35039, Marburg, Germany
| | - Hanna Christiansen
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-Universität Marburg, Frankfurter Straße 35, 35037, Marburg, Germany
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19
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Marakovitz SE, Sheldrick RC, Copeland WE, Restrepo B, Hastedt I, Carpenter KLH, McGinnis EW, Egger HL. Associations of preschool reactive bed-sharing with sociodemographic factors, sleep disturbance, and psychopathology. Child Adolesc Psychiatry Ment Health 2023; 17:62. [PMID: 37198711 DOI: 10.1186/s13034-023-00607-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/02/2023] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE To advance understanding of early childhood bed-sharing and its clinical significance, we examined reactive bed-sharing rates, sociodemographic correlates, persistence, and concurrent and longitudinal associations with sleep disturbances and psychopathology. METHODS Data from a representative cohort of 917 children (mean age 3.8 years) recruited from primary pediatric clinics in a Southeastern city for a preschool anxiety study were used. Sociodemographics and diagnostic classifications for sleep disturbances and psychopathology were obtained using the Preschool Age Psychiatric Assessment (PAPA), a structured diagnostic interview administered to caregivers. A subsample of 187 children was re-assessed approximately 24.7 months after the initial PAPA interview. RESULTS Reactive bed-sharing was reported by 38.4% of parents, 22.9% nightly and 15.5% weekly, and declined with age. At follow-up, 48.9% of nightly bed-sharers and 88.7% of weekly bed-sharers were no longer bed-sharing. Sociodemographics associated with nightly bed-sharing were Black and (combined) American Indian, Alaska Native and Asian race and ethnicity, low income and parent education less than high school. Concurrently, bed-sharing nightly was associated with separation anxiety and sleep terrors; bed-sharing weekly was associated with sleep terrors and difficulty staying asleep. No longitudinal associations were found between reactive bed-sharing and sleep disturbances or psychopathology after controlling for sociodemographics, baseline status of the outcome and time between interviews. CONCLUSIONS Reactive bed-sharing is relatively common among preschoolers, varies significantly by sociodemographic factors, declines during the preschool years and is more persistent among nightly than weekly bed-sharers. Reactive bed-sharing may be an indicator of sleep disturbances and/or anxiety but there is no evidence that bed-sharing is an antecedent or consequence of sleep disturbances or psychopathology.
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Affiliation(s)
- Susan E Marakovitz
- Brigham and Women's Hospital, Department of Pediatric Newborn Medicine, Boston, MA, USA
| | - R Christopher Sheldrick
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
| | - William E Copeland
- Vermont Center for Children, Youth and Families, University of Vermont, 1 S. Prospect Street, Burlington, VT, 05401, USA.
| | | | - Ingrid Hastedt
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Kimberly L H Carpenter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Ellen W McGinnis
- Vermont Center for Children, Youth and Families, University of Vermont, 1 S. Prospect Street, Burlington, VT, 05401, USA
| | - Helen L Egger
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hopsital at NYU Langone, New York, NY, USA
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20
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Ding X, Ma S, Liu H, Wang H, Li N, Song Q, Su W, Liang M, Guo X, Sun L, Qin Q, Chen M, Sun Y. The relationships between sleep disturbances, resilience and anxiety among preschool children: A three-wave longitudinal study. J Psychosom Res 2023; 168:111203. [PMID: 36868111 DOI: 10.1016/j.jpsychores.2023.111203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 02/09/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE This study, based on a three-wave longitudinal study, aimed to examine bidirectional relationships between sleep disturbances, resilience and anxiety symptoms among preschool children. METHODS In total, 1169 children in the junior class of preschools were investigated three times with an interval of one year, in Anhui Province, China. Children's sleep disturbances, resilience and anxiety symptoms were all assessed in the three-wave surveys. Then, 906 children at baseline (T1), 788 children in the first follow-up study (T2), and 656 children in the second follow-up study (T3) were included in the analysis. Autoregressive cross-lagged modeling analyses were performed to examine bidirectional relationships between sleep disturbances, resilience and anxiety symptoms using Mplus 8.3. RESULTS The mean age of the children was 3.6 ± 0.4 years at T1, 4.6 ± 0.4 years at T2, and 5.6 ± 0.4 years at T3, respectively. The results indicated that sleep disturbances at T1 significantly predicted anxiety symptoms at T2 (β = 0.111, P = 0.001); and sleep disturbances at T2 significantly predicted anxiety symptoms at T3 (β = 0.108, P = 0.008). Resilience only at T2 significantly predicted anxiety symptoms at T3 (β = -0.120, P = 0.002). Anxiety symptoms did not significantly predict the two variables (sleep disturbances and resilience) at any wave. CONCLUSION This study suggests that more sleep disturbances are longitudinally associated with subsequent high anxiety symptoms; inversely, high resilience will alleviate subsequent anxiety symptoms. These findings highlight the importance that early screening for sleep disturbances and anxiety, and strengthening resilience are beneficial to prevent preschool children from developing higher anxiety symptoms.
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Affiliation(s)
- Xiuxiu Ding
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Shaodi Ma
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Haixia Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Hao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Ning Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Qiuxia Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Wanying Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Mingming Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Xianwei Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Liang Sun
- Fuyang Center for Disease Control and Prevention, No.19, Zhongnan Avenue, Fuyang 236069, Anhui, China
| | - Qirong Qin
- Ma'anshan Center for Disease Control and Prevention, No.849, Jiangdong Avenue, Ma'anshan 243011, Anhui, China
| | - Mingchun Chen
- Changfeng Center for Disease Control and Prevention, Hefei 231199, Anhui, China
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Chaohu Hospital, Anhui Medical University, No. 64 Chaohubei Road, Hefei 238000, Anhui, China.
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21
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McGinnis EW, Copeland W, Shanahan L, Egger HL. Parental perception of mental health needs in young children. Child Adolesc Ment Health 2022; 27:328-334. [PMID: 34653306 PMCID: PMC9010484 DOI: 10.1111/camh.12515] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is evidence of unmet psychiatric needs in children under 6. These young children are dependent on their parents to identify their mental health needs. This study tested child and parent associations with parent perception of young child mental health need. METHOD Parents of 917 children (aged 2-6 years) completed a diagnostic interview about their child assessing depression, anxiety, ODD/CD, ADHD, and impairment. Parents were surveyed about their own depression, anxiety, and asked about their psychiatric impairment. Parents were also asked whether they perceived their child as having a mental health need. RESULTS Only 38.8% of children who met criteria for a diagnosis were perceived by their parents as having a need, similar to previously studied rates in school-aged children. Perception of need was associated with higher levels of symptoms and impairment. Thresholds for at least half of parents perceiving their child as having a need were relatively high: 19 or more symptoms, or 4 or more impairments. There was evidence of specificity: children with depressive disorders were more likely to be perceived as in need compared with other disorders. In terms of parent factors, more parental depressive symptoms were associated with higher perception of child need when the child had a diagnosis. Parental psychological impairment was associated with higher perception of need when the child had no diagnosis. CONCLUSIONS Most preschool children that meet criteria for a psychiatric disorder are not perceived as needing help by their parents, which is dependent on both child and parent factors.
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Affiliation(s)
| | | | - Lilly Shanahan
- Psychology & Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Helen L Egger
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, New York, NY, USA
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22
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Ehrenberg D, Lohaus A, Konrad K, Lüning L, Heinrichs N. How Anxious are German Preschool Children? Child Psychiatry Hum Dev 2022; 53:992-1003. [PMID: 33966151 PMCID: PMC9470646 DOI: 10.1007/s10578-021-01185-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Abstract
The experience of fear is universal and is among the earliest of all forms of psychopathology, if excessively present. To prevent negative developmental outcomes due to early-onset excessive fears in children, it is important to systematically assess these experiences as early as possible. Using the preschool anxiety scale (PAS), we aimed to assess the frequency and structure of anxiety symptoms of 489 preschool-aged children raised in their biological family and 88 raised in foster care (as a high-risk sample) in Germany. While these young children displayed the same types of anxiety most commonly as young children in other countries, the overall occurrence seems to be reported less often by parents in Germany compared to parents from other countries. Anxiety symptoms clustered into five correlated factors (generalized anxiety, social anxiety, obsessive-compulsive disorder (OCD), physical injury fear and separation anxiety). Young children in foster care exhibited more OCD and significantly less social anxiety symptoms indicating early repetitive and social disturbances in children in foster care.
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Affiliation(s)
- Daniela Ehrenberg
- Department of Psychology, Institute of Clinical Psychology, Psychotherapy and Assessment, University of Braunschweig, Humboldtstraße 33, 38106, Braunschweig, Germany.
| | - Arnold Lohaus
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Kerstin Konrad
- Child Neuropsychology Section, Institute of Molecular Neuroscience and Neuroimaging (INM-11), RWTH Aachen University Hospital and Research Center Jülich, University Hospital Aachen, Juelich, Aachen, Germany
| | - Lorena Lüning
- Department of Psychology, Institute of Clinical Psychology, Psychotherapy and Assessment, University of Braunschweig, Humboldtstraße 33, 38106, Braunschweig, Germany
| | - Nina Heinrichs
- Department of Psychology, Institute of Clinical Psychology, Psychotherapy and Assessment, University of Braunschweig, Humboldtstraße 33, 38106, Braunschweig, Germany
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Bremen, Bremen, Germany
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23
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Delineating the developmental sequelae of children's risky involvement in interparental conflict. Dev Psychopathol 2022; 34:922-935. [PMID: 33436113 PMCID: PMC8275663 DOI: 10.1017/s0954579420001959] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The present study examined the developmental value of parsing different forms of children's risky involvement in interparental conflict as predictors of children's subsequent psychological adjustment. Participants included a diverse sample of 243 preschool children (Mage = 4.6 years) and their mothers across two measurement occasions spaced 2 years apart. Three forms of risky involvement (i.e., cautious, caregiving, and coercive) were identified using maternal narratives describing children's emotional and behavioral reactivity during and immediately following interparental conflict. Utilizing a multimethod, multi-informant design, findings revealed that each form of involvement prospectively predicted unique configurations of children's developmental outcomes. Greater coercive involvement was associated with higher levels of externalizing problems, callous and unemotional traits, and extraversion. Higher levels of caregiving involvement were linked with greater separation anxiety. Finally, cautious involvement predicted more separation anxiety and social withdrawal.
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24
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Gunther KE, Petrie D, Pearce AL, Fuchs BA, Pérez-Edgar K, Keller KL, Geier C. Heterogeneity in PFC-amygdala connectivity in middle childhood, and concurrent interrelations with inhibitory control and anxiety symptoms. Neuropsychologia 2022; 174:108313. [PMID: 35798067 DOI: 10.1016/j.neuropsychologia.2022.108313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Abstract
The prefrontal cortex (PFC) is a key brain area in considering adaptive regulatory behaviors. This includes regulatory projections to regions of the limbic system such as the amygdala, where the nature of functional connections may confer lower risk for anxiety disorders. The PFC is also associated with behaviors like executive functioning. Inhibitory control is a behavior encompassed by executive functioning and is generally viewed favorably for adaptive socioemotional development. Yet, some research suggests that high levels of inhibitory control may actually be a risk factor for some maladaptive developmental outcomes, like anxiety disorders. In a sample of 51 children ranging from 7 to 9 years old, we examined resting state functional connectivity between regions of the PFC and the amygdala. We used Subgrouping Group Iterative Multiple Model Estimation (S-GIMME) to identify and characterize data-driven subgroups of individuals with similar networks of connectivity between these brain regions. Generated subgroups were collapsed into children characterized by the presence or absence of recovered connections between the PFC and amygdala. For subsets of children with available data (N = 38-44), we then tested whether inhibitory control, as measured by a stop signal task, moderated the relation between these subgroups and child-reported anxiety symptoms. We found an inverse relation between stop-signal reaction times and reported count of anxiety symptoms when covarying for connectivity group, suggesting that greater inhibitory control was actually related to greater anxiety symptoms, but only when accounting for patterns of PFC-amygdala connectivity. These data suggest that there is a great deal of heterogeneity in the nature of functional connections between the PFC and amygdala during this stage of development. The findings also provide support for the notion of high levels of inhibitory control as a risk factor for anxiety, but trait-level biopsychosocial factors may be important to consider in assessing the nature of risk.
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25
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Stein CR, Sheridan MA, Copeland WE, Machlin LS, Carpenter KLH, Egger HL. Association of adversity with psychopathology in early childhood: Dimensional and cumulative approaches. Depress Anxiety 2022; 39:524-535. [PMID: 35593083 PMCID: PMC9246999 DOI: 10.1002/da.23269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The association between adversity and psychopathology in adolescents and adults is characterized by equifinality. These associations, however, have not been assessed during early childhood when psychopathology first emerges. Defining adversity using both dimensional and cumulative risk approaches, we examined whether specific types of adversity are differentially associated with psychopathology in preschool-aged children. METHODS Measures of threat, deprivation, and total adversities (i.e., cumulative risk) were calculated based on parent-reported information for 755 2- to 5-year old children recruited from pediatric primary care clinics. Logistic regression was used to estimate cross-sectional associations between type of adversity and anxiety, depression, ADHD, and behavioral disorder diagnoses. RESULTS Threat and cumulative risk exhibited independent associations with psychopathology. Threat was strongly related to behavioral disorders. Cumulative risk was consistently related to all psychopathologies. CONCLUSIONS Using mutually adjusted models, we identified differential associations between threat and psychopathology outcomes in preschool-aged children. This selectivity may reflect different pathways through which adversity increases the risk for psychopathology during this developmentally important period. As has been observed at other ages, a cumulative risk approach also effectively identified the cumulative impact of all forms of adversity on most forms of psychopathology during early childhood.
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Affiliation(s)
- Cheryl R Stein
- Department of Child and Adolescent Psychiatry, Hassenfeld Children’s Hospital at NYU Langone
| | - Margaret A Sheridan
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | - Laura S Machlin
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | - Helen L Egger
- Department of Child and Adolescent Psychiatry, Hassenfeld Children’s Hospital at NYU Langone
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26
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Koet LB, de Schepper EI, Bohnen AM, Bindels PJ, Gerger H. Anxiety problems in children and adolescents: a population-based cohort study on incidence and management in Dutch primary care. Br J Gen Pract 2022; 72:e405-e412. [PMID: 35440466 PMCID: PMC9037188 DOI: 10.3399/bjgp.2021.0557] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Due to a large strain on youth mental health care, general practice is suggested as an alternative treatment setting for children and adolescents with anxiety problems. However, research on the current management of these children and adolescents within general practice is scarce. AIM To investigate the incidence of coded anxiety in general practice using the International Classification of Primary Care (ICPC), and GPs' management of children and adolescents presenting with anxiety problems. DESIGN AND SETTING Population-based cohort study using electronic medical records of 51 212 children (aged 0-17 years) in primary care in the Rotterdam region between 1 January 2012 and 31 December 2018. METHOD Incidence of ICPC codes for anxiety were calculated, then the characteristics of children and adolescents consulting their GP with anxiety and the GPs' management were assessed qualitatively using quantitative content analysis. RESULTS Incidence of ICPC codes for anxiety in children and adolescents was 5.36 (95% confidence interval [CI] = 5.02 to 5.71) per 1000 person-years. Adolescent females had the highest incidence with 14.01 (95% CI = 12.55 to 15.58) per 1000 person-years. Of the 381 children and adolescents consulting their GP with an initial anxiety problem (median age 13.3 years, 40.4% male), GPs referred 59.3% to mental health care in the first year while 26.5% of children and adolescents were managed by a specialised practice nurse within general practice. Of the 381 children and adolescents, 10.5% received psychiatric medication during the first year, with the trend being for increased prescriptions during adolescence. CONCLUSION In general practice children and adolescents frequently received one of two ICPC codes for anxiety, especially adolescent females. Most presenting to their GP with anxiety problems are referred externally or seen by a specialised practice nurse within general practice.
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Affiliation(s)
- Lukas Bm Koet
- Department of General Practice, Erasmus Medical Centre, the Netherlands
| | | | - Arthur M Bohnen
- Department of General Practice, Erasmus Medical Centre, the Netherlands
| | | | - Heike Gerger
- Department of General Practice, Erasmus Medical Centre, the Netherlands; Department of General Practice and Family Medicine, University of Bielefeld, Bielefeld, Germany
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27
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Gouze KR, Hopkins J, Lavigne JV, Bryant FB. A Multi-level Longitudinal Model of Risk Factors for Generalized and Separation Anxiety Symptoms in a Community Sample of 6-year-olds. Child Psychiatry Hum Dev 2022; 53:405-417. [PMID: 33590383 DOI: 10.1007/s10578-021-01132-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/29/2022]
Abstract
The current longitudinal study examined the relations between variables in four domains-contextual (SES, family conflict, stress), parent (caretaker depression), parenting (support hostility, autonomy granting), and child (negative affect, effortful control, sensory regulation, attachment)-and both the presence of generalized and separation anxiety symptoms at age 6 in a community sample of 796 children and the change in these anxiety symptoms from ages 4 to 6. Anxiety was highly stable over time. Specific results revealed both direct and indirect pathways between age 4 and age 5 variables, and age 6 anxiety. Caretaker depression and the child variables of attachment, effortful control, negative affect, and sensory regulation were directly related to anxiety symptoms at age 6. Contextual variables (SES) at age 4 were indirectly related to age 6 anxiety through parent depression at age 5. Parent depression was indirectly related to age 6 anxiety through age 5 child negative affect. Child negative affect at age 4 was indirectly related to age 6 anxiety through age 5 effortful control and age 4 effortful control was indirectly related to age 6 anxiety through age 5 negative affect. With the exception of attachment, there was a reduction in the impact of other variables when initial levels of anxiety symptoms were included in the model. Implications of results for early intervention and further study are discussed.
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Affiliation(s)
- Karen R Gouze
- Pritzker Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave. #10, Chicago, Illinois, 60611, USA.
| | - Joyce Hopkins
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - John V Lavigne
- Pritzker Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave. #10, Chicago, Illinois, 60611, USA
| | - Fred B Bryant
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
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28
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Qanbari Alaee E, Saed O, Khakpoor S, Ahmadi R, Ali Mohammadi M, Yoosefi Afrashteh M, Morovati Z. The efficacy of transdiagnostic cognitive behavioural therapy on reducing negative affect, anxiety sensitivity and improving perceived control in children with emotional disorders - a randomized controlled trial. RESEARCH IN PSYCHOTHERAPY: PSYCHOPATHOLOGY, PROCESS AND OUTCOME 2022; 25. [PMID: 35532025 PMCID: PMC9153761 DOI: 10.4081/ripppo.2022.588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/08/2022] [Indexed: 01/04/2023]
Abstract
In response to the high rate of comorbidity among different types of emotional disorders in children, Transdiagnostic Unified Protocol of Emotional disorder in children (UP-C) was developed to address common underlying mechanisms in the development and maintenance of emotional disorders using empirically supported cognitive and behavioural strategies. Although, studies supported the effectiveness of this protocol in the treatment of wide range of emotional disorders, further studies are needed to examine its effect on transdiagnostic factors. The present study aimed to investigate the efficacy of the UP-C on negative affect, anxiety sensitivity and perceived control in children with emotional disorders. During this randomized controlled trial, 34 children aged 7 to 13 with emotional disorders were randomly assigned to treatment (n=18) and control (n=16) groups. The treatment group and their parents received 15 sessions of UP-C. Negative Affect Schedule for Children (PANASNA- C), Children’s Anxiety Sensitivity Index (CASI), Anxiety Control Questionnaire-Children (ACQ-C) were carried out in all phases (pre-treatment, post-treatment, 3 and 8 months follow- up). The results showed that following UP-C, negative affect (hedges’g=2.01) and anxiety sensitivity (hedges’g=1.05) were significantly reduced, and perceived control (hedges’g= –2.36) was significantly improved. The results remained relatively constant during the follow-ups. Findings provide evidence that the UP-C has significant effect on negative affect, anxiety sensitivity and perceived control as roots of emotional disorders.
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29
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Comer JS, Conroy K, Cornacchio D, Furr JM, Norman SB, Stein MB. Psychometric evaluation of a caregiver-report adaptation of the Overall Anxiety Severity and Impairment Scale (OASIS) for use with youth populations. J Affect Disord 2022; 300:341-348. [PMID: 34979182 PMCID: PMC8828693 DOI: 10.1016/j.jad.2021.12.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/24/2021] [Accepted: 12/30/2021] [Indexed: 01/09/2023]
Abstract
Background Despite progress in youth anxiety assessment, there is need for a measure that is simultaneously (a) free, (b) brief, (c) focused broadly on anxiety and avoidance severity, frequency, and interference, and (d) concerned with the past week. The adult overall anxiety severity and impairment scale (OASIS) was adapted to yield a caregiver-report of past week youth anxiety and interference (OASIS-Y). Methods In a sample of diverse youth seeking anxiety services (N = 132; 67% racial/ethnic minority) and their caregivers, analyses examined the OASIS-Y factor structure, internal consistency, and convergent and divergent validity. Hierarchical linear modeling in a participant subset examined OASIS-Y sensitivity to treatment-related change. Results OASIS-Y internal consistency was high and confirmatory factor analysis supported a single-factor structure similar to that found in adults. OASIS-Y convergent validity was supported by a medium-sized association with an established, commercially available measure of youth anxiety, and divergent validity was supported by the absence of unique associations with measures of youth attention and externalizing problems. In a sample subset, session-by-session OASIS-Y scores significantly declined across treatment, and declined at a steeper rate among treatment "responders" versus "non-responders," providing evidence of OASIS-Y sensitivity to treatment-related change. Limitations This study focused on a clinical sample and cannot speak to OASIS-Y performance in community settings. Shared method-variance may have also influenced findings. Conclusions This study offers the first psychometric evaluation of the OASIS-Y, and underscores the promising clinical utility of the measure for assessing past week youth anxiety and impairment and for supporting routine outcome monitoring.
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Affiliation(s)
- Jonathan S. Comer
- Center for Children and Families, Department of Psychology, Florida International University
| | - Kristina Conroy
- Center for Children and Families, Department of Psychology, Florida International University
| | | | - Jami M. Furr
- Center for Children and Families, Department of Psychology, Florida International University
| | - Sonya B. Norman
- Department of Psychiatry, University of California, San Diego
| | - Murray B. Stein
- Department of Psychiatry, University of California, San Diego
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30
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Gupta A, Bhatt RR, Rivera-Cancel A, Makkar R, Kragel PA, Rodriguez T, Graner JL, Alaverdyan A, Hamadani K, Vora P, Naliboff B, Labus JS, LaBar KS, Mayer EA, Zucker N. Complex functional brain network properties in anorexia nervosa. J Eat Disord 2022; 10:13. [PMID: 35123579 PMCID: PMC8817538 DOI: 10.1186/s40337-022-00534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a disorder characterized by an incapacitating fear of weight gain and by a disturbance in the way the body is experienced, facets that motivate dangerous weight loss behaviors. Multimodal neuroimaging studies highlight atypical neural activity in brain networks involved in interoceptive awareness and reward processing. METHODS The current study used resting-state neuroimaging to model the architecture of large-scale functional brain networks and characterize network properties of individual brain regions to clinical measures. Resting-state neuroimaging was conducted in 62 adolescents, 22 (21 female) with a history of AN and 40 (39 female) healthy controls (HCs). Sensorimotor and basal ganglia regions, as part of a 165-region whole-brain network, were investigated. Subject-specific functional brain networks were computed to index centrality. A contrast analysis within the general linear model covarying for age was performed. Correlations between network properties and behavioral measures were conducted (significance q < .05). RESULTS Compared to HCs, AN had lower connectivity from sensorimotor regions, and greater connectivity from the left caudate nucleus to the right postcentral gyrus. AN demonstrated lower sensorimotor centrality, but higher basal ganglia centrality. Sensorimotor connectivity dyads and centrality exhibited negative correlations with body dissatisfaction and drive for thinness, two essential features of AN. CONCLUSIONS These findings suggest that AN is associated with greater communication from the basal ganglia, and lower information propagation in sensorimotor cortices. This is consistent with the clinical presentation of AN, where individuals exhibit patterns of rigid habitual behavior that is not responsive to bodily needs, and seem "disconnected" from their bodies.
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Affiliation(s)
- Arpana Gupta
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA. .,David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA. .,Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, 90095, USA.
| | - Ravi R Bhatt
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA.,Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine at USC, University of Southern California, Los Angeles, USA
| | | | - Rishi Makkar
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA
| | | | - Thomas Rodriguez
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA
| | - John L Graner
- Department of Psychology and Neuroscience, Duke University, Durham, USA
| | - Anita Alaverdyan
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA
| | - Kareem Hamadani
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA
| | - Priten Vora
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA
| | - Bruce Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA.,David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, 90095, USA
| | - Jennifer S Labus
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA.,David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, 90095, USA
| | - Kevin S LaBar
- Department of Psychology and Neuroscience, Duke University, Durham, USA
| | - Emeran A Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA.,David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, 90095, USA.,Ahmanson-Lovelace Brain Mapping Center, UCLA, Los Angeles, CA, 90095, USA
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA.,Department of Psychology and Neuroscience, Duke University, Durham, USA
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31
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Do Metacognitions of Children and Adolescents with Anxiety Disorders Change after Intensified Exposure Therapy? CHILDREN 2022; 9:children9020168. [PMID: 35204889 PMCID: PMC8869889 DOI: 10.3390/children9020168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
Metacognitive beliefs have repeatedly proven to play a role in anxiety disorders in children and adolescents, but few studies have investigated whether they change after cognitive behavioral therapy. This longitudinal intervention study explores whether positive and negative metacognitive beliefs in particular change after exposure-focused treatment, and if metacognitive changes predict reductions in anxiety symptoms. A sample of 27 children between 8 and 16 years of age with a primary diagnosis of specific phobia, separation-anxiety disorder or social phobia completed assessments of anxiety symptoms, metacognitive beliefs, worry and repetitive negative thoughts before and after 11 sessions of intensified exposure treatment. Metacognitive beliefs did not change significantly after intensified exposure, but post-hoc power analysis revealed a lack of power here. Change in negative metacognitive beliefs correlated with a change in anxiety symptoms, but did not independently contribute as a predictor variable. Differences between subsamples showed that patients with separation-anxiety disorder scored higher on negative metacognitive beliefs than those with specific or social phobia. Consideration of metacognition, and negative metacognitive beliefs in particular could help us further improve the understanding and treatment of anxiety disorders in children and adolescents and should therefore receive more attention in psychotherapy research.
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32
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Kemper AR, Letostak TB, Hostutler CA, Stephenson KG, Butter EM. Screening for Anxiety in Pediatric Primary Care: A Systematic Review. Pediatrics 2021; 148:peds.2021-052633. [PMID: 34475269 DOI: 10.1542/peds.2021-052633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 12/19/2022] Open
Abstract
CONTEXT Anxiety is common, screening tools are available, and treatment can be effective. Recently, anxiety screening has been recommended for adolescent girls beginning at 13 years of age. OBJECTIVE To evaluate the evidence regarding anxiety screening test accuracy in primary care for children and adolescents and assess the effectiveness of treatment of individuals identified through screening. DATA SOURCES We searched PubMed, the Cochrane library, and references to potentially eligible studies cited in other articles. STUDY SELECTION Screening studies were included if they were conducted in primary care or a similar population and employed a reference standard based on DSM criteria. Treatment studies were included if subjects were identified through screening and there was at least 1 comparator intervention or a placebo arm. DATA EXTRACTION At least 2 reviewers evaluated each identified reference. RESULTS Two screening studies (1 with low risk of bias and 1 with high risk of bias) and 1 treatment study with a low risk of bias were included. The screening study with a low risk of bias reported a sensitivity of 56% and specificity of 80%. The treatment study found individual cognitive behavioral therapy to be effective for screen-detected adolescents with social phobia. LIMITATIONS This review only included screening or treatment studies with clear evidence that the study populations were derived from an unselected population reflective of typical primary care. Relevant studies not indexed in PubMed or the Cochrane library could have been missed. CONCLUSIONS There are significant gaps in evidence related to anxiety screening in the primary care setting.
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Affiliation(s)
| | | | | | | | - Eric M Butter
- Psychology, Nationwide Children's Hospital, Columbus, Ohio
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Report of Early Childhood Traumatic Injury Observations & Symptoms: Preliminary Validation of an Observational Measure of Postconcussive Symptoms. J Head Trauma Rehabil 2021; 37:E102-E112. [PMID: 33935228 DOI: 10.1097/htr.0000000000000691] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report preliminary empirical data on a novel, developmentally appropriate, observational postconcussive symptoms inventory for infants, toddlers, and preschoolers. SETTING Emergency departments of 2 tertiary, urban pediatric hospitals. PARTICIPANTS Ninety-eight children (0-8 years of age; mean age at injury = 33.00, SD = 24.7 months) with mild traumatic brain injury (concussion) divided into younger (0-2 years) and older (3-8 years) age groups. DESIGN Observational study. MAIN MEASURE The Report of Early Childhood Traumatic Injury Observations & Symptoms (REACTIONS) documents 17 postconcussive symptoms representing observable manifestations thereof and was completed by parents in the acute (24-48 hours; n = 65), subacute (7-14 days; n = 78), and/or persistent phase (25-35 days; n = 72) post-mild traumatic brain injury. RESULTS Different patterns of postconcussive symptoms were reported by age group, with behavioral manifestations particularly salient in younger children. More children younger than 2 years had sleep and comfort-seeking symptoms at each of the 3 postinjury time points. CONCLUSION Postconcussive symptoms may manifest differently after mild traumatic brain injury sustained during early childhood. To fully understand and address their presence and evolution, developmentally sound measures such as the REACTIONS inventory are required.
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Toddler dysregulated fear predicts continued risk for social anxiety symptoms in early adolescence. Dev Psychopathol 2021; 33:252-263. [PMID: 32115004 DOI: 10.1017/s0954579419001743] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Identifying early risk factors for the development of social anxiety symptoms has important translational implications. Accurately identifying which children are at the highest risk is of critical importance, especially if we can identify risk early in development. We examined continued risk for social anxiety symptoms at the transition to adolescence in a community sample of children (n = 112) that had been observed for high fearfulness at age 2 and tracked for social anxiety symptoms from preschool through age 6. In our previous studies, we found that a pattern of dysregulated fear (DF), characterized by high fear in low threat contexts, predicted social anxiety symptoms at ages 3, 4, 5, and 6 years across two samples. In the current study, we re-evaluated these children at 11-13 years of age by using parent and child reports of social anxiety symptoms, parental monitoring, and peer relationship quality. The scores for DF uniquely predicted adolescents' social anxiety symptoms beyond the prediction that was made by more proximal measures of behavioral (e.g., kindergarten social withdrawal) and concurrent environmental risk factors (e.g., parental monitoring, peer relationships). Implications for early detection, prevention, and intervention are discussed.
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Perino MT, Yu Q, Myers MJ, Harper JC, Baumel WT, Petersen SE, Barch DM, Luby JL, Sylvester CM. Attention Alterations in Pediatric Anxiety: Evidence From Behavior and Neuroimaging. Biol Psychiatry 2021; 89:726-734. [PMID: 33012520 PMCID: PMC9166685 DOI: 10.1016/j.biopsych.2020.07.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/30/2020] [Accepted: 07/08/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Pediatric anxiety disorders involve greater capture of attention by threatening stimuli. However, it is not known if disturbances extend to nonthreatening stimuli, as part of a pervasive disturbance in attention-related brain systems. We hypothesized that pediatric anxiety involves greater capture of attention by salient, nonemotional stimuli, coupled with greater activity in the portion of the inferior frontal gyrus (IFG) specific to the ventral attention network (VAN). METHODS A sample of children (n = 129, 75 girls, mean 10.6 years of age), approximately half of whom met criteria for a current anxiety disorder, completed a task measuring involuntary capture of attention by nonemotional (square boxes) and emotional (angry and neutral faces) stimuli. A subset (n = 61) completed a task variant during functional magnetic resonance imaging. A priori analyses examined activity in functional brain areas within the right IFG, supplemented by a whole-brain, exploratory analysis. RESULTS Higher clinician-rated anxiety was associated with greater capture of attention by nonemotional, salient stimuli (F1,125 = 4.94, p = .028) and greater activity in the portion of the IFG specific to the VAN (F1,57 = 10.311, p = .002). Whole-brain analyses confirmed that the effect of anxiety during capture of attention was most pronounced in the VAN portion of the IFG, along with additional areas of the VAN and the default mode network. CONCLUSIONS The pathophysiology of pediatric anxiety appears to involve greater capture of attention to salient stimuli, as well as greater activity in attention-related brain networks. These results provide novel behavioral and brain-based targets for treatment of pediatric anxiety disorders.
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Affiliation(s)
- Michael T Perino
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
| | - Qiongru Yu
- Department of Psychology, San Diego State University, San Diego, California; Department of Psychiatry, University of California San Diego School of Medicine, San Diego, California
| | - Michael J Myers
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Jennifer C Harper
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - William T Baumel
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Steven E Petersen
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, Missouri; Department of Neuroscience, Washington University School of Medicine in St. Louis, St. Louis, Missouri; Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri; Department of Psychological and Brain Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Chad M Sylvester
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
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Black CJ, Hogan AL, Smith KD, Roberts JE. Early behavioral and physiological markers of social anxiety in infants with fragile X syndrome. J Neurodev Disord 2021; 13:11. [PMID: 33743580 PMCID: PMC7980359 DOI: 10.1186/s11689-021-09356-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 02/16/2021] [Indexed: 12/16/2022] Open
Abstract
Background Social anxiety is highly prevalent in neurotypical children and children with fragile X syndrome (FXS). FXS is a genetic syndrome that is characterized by intellectual disability and an increased risk for autism spectrum disorder. If social anxiety is left untreated, negative outcomes are highly prevalent later in life. However, early detection of social anxiety is challenging as symptoms are often subtle or absent very early in life. Given the prevalence and impairment associated with childhood social anxiety, efforts have accelerated to identify risk markers of anxiety. A cluster of early features of anxiety have been identified including elevated behavioral inhibition, attentional biases, and physiological dysregulation that index early emerging markers of social anxiety. Infants with FXS provide a unique opportunity to study the earlier predictors of social anxiety. The current study utilized a multi-method approach to investigate early markers of social anxiety in 12-month-old infants with FXS. Method Participants included 32 infants with FXS and 41 low-risk controls, all approximately 12 months old. Parent-reported social behavioral inhibition was recorded from the Infant Behavior Questionnaire (IBQ-R). Direct observations of behavioral inhibition and attention were measured during a stranger approach task with respiratory sinus arrhythmia collected simultaneously. Results Parent-reported social behavioral inhibition was not significantly different between groups. In contrast, direct observations suggested that infants with FXS displayed elevated behavioral inhibition, increased attention towards the stranger, and a blunted respiratory sinus arrhythmia response. Conclusions Findings suggest that infants with FXS show both behavioral and physiological markers of social anxiety at 12 months old using a biobehavioral approach with multiple sources of input. Results highlight the importance of a multi-method approach to understanding the complex early emergent characteristics of anxiety in infants with FXS.
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Affiliation(s)
- Conner J Black
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC, 29208, USA
| | - Abigail L Hogan
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC, 29208, USA
| | - Kayla D Smith
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC, 29208, USA
| | - Jane E Roberts
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC, 29208, USA.
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Iniesta-Sepúlveda M, Rodríguez-Jiménez T, Lebowitz ER, Goodman WK, Storch EA. The Relationship of Family Accommodation with Pediatric Anxiety Severity: Meta-analytic Findings and Child, Family and Methodological Moderators. Child Psychiatry Hum Dev 2021; 52:1-14. [PMID: 32246361 DOI: 10.1007/s10578-020-00987-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Given the importance of family accommodation for the course, treatment and prognosis of anxiety in pediatric populations, we conducted a meta-analysis to estimate the magnitude and potential moderators of the relationship between accommodation and anxiety severity. Study selection criteria were: (1) included quantitative measures of accommodation and anxiety severity, (2) sampled participants younger than 19 years, (3) a sample size greater than 10, (4) reported statistical data needed to compute effect sizes, and (4) be in English or Spanish. Search procedures included assessment of electronic databases, systematic reviews and empirical studies, and email inquiries. Effect size was Pearson correlation coefficient, assuming a random-effects model. Positive moderate association was observed for measures administered to parents. This was moderated by the percentage of children with separation anxiety and selective mutism. Global effect sizes were small for measures administered to children and when accommodation was reported by parents and anxiety by children. Implications for assessment and treatment are discussed.
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Affiliation(s)
- Marina Iniesta-Sepúlveda
- Department of Psychology, Catholic University of Murcia, Campus de los Jerónimos, 135 Guadalupe, 30107, Murcia, Spain.
| | - Tíscar Rodríguez-Jiménez
- Department of Psychology, Catholic University of Murcia, Campus de los Jerónimos, 135 Guadalupe, 30107, Murcia, Spain
| | | | - Wayne K Goodman
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Melero S, Morales A, Espada JP, Orgilés M. Improving Social Performance Through Video-feedback with Cognitive Preparation in Children with Emotional Problems. Behav Modif 2021; 46:755-781. [PMID: 33511861 DOI: 10.1177/0145445521991098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anxious children report a more negative perception of their social performance and increased nervous behaviors. The video-feedback with cognitive preparation allows children to contrast and modify their negative social self-image, increasing their self-confidence and decreasing anxiety behaviors. This study aimed to examine the effectiveness of the Super Skills for Life (SSL) program in improving social performance in a sample of children with emotional symptoms. Results indicated that both objective and subjective evaluation showed positive effects of the SSL program on the children's social performance, enhancing their social skills and reducing anxiety behaviors in social situations, both during the program and in the last session. Girls felt more comfortable and showed better speech and social performance than boys. Our findings increase the evidence about the short-term effects of the video-feedback with cognitive preparation of the SSL program and provide a useful transdiagnostic protocol for application in the clinical setting.
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Hu H, Wu T, Wang S, Chen P, Zhang J, Zhao X. Association Between Family Structure and Anxiety Disorder Among Pre-schoolers: A Cross-Sectional Study in Urban Chongqing, China. Front Psychiatry 2021; 12:626377. [PMID: 34721092 PMCID: PMC8548734 DOI: 10.3389/fpsyt.2021.626377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: This study explores the current situation of anxiety disorder of pre-schoolers and assesses the association between family structure and anxiety disorder (AD) among pre-schoolers in Chongqing, China. Methods: This is a cross-sectional study of 499 main fosterers of children aged 3-6 years who completed the 28-item Chinese version of the Spence Pre-school Anxiety Scale (PAS). Multinomial logistic regression with three models was used to assess the association of the family structure with the different AD. Results: The prevalence of AD was 31.46%, whose score of PAS were more than 48. Among the five different PAS sub-scales, the prevalence of obsessive-compulsive disorder (OCD) was the highest (50.10%), followed by separation anxiety disorder (SAD, 39.28%), fear of physical harm (FPH, 37.68%), generalized anxiety disorder (GAD, 33.47%), and social phobia (SP, 25.85%). Pre-schoolers from inter-generational families were more probably have AD than those from nuclear families (OR = 3.73, p < 0.05). The participants from inter-generational families were more likely to have SAD (OR = 3.39, p < 0.05), FPM (OR = 2.80, p < 0.05), or OCD (OR = 2.40, p < 0.05), in comparison with participants from other family structures. Conclusion: Anxiety disorder among pre-schoolers aged 3-6 in Chongqing is widespread. Pre-schoolers from inter-generational families were more probably have AD, SAD, FPM, and OR and pre-schoolers from stem families may be less likely to have SAD compared with those from nuclear families. Relieving the anxiety of pre-schoolers may be possible with additional interventional efforts in inter-generational families.
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Affiliation(s)
- Hongmei Hu
- College of Pre-school Education, Chongqing University of Education, Chongqing, China.,Children's Research Institute, Chongqing University of Education, Chongqing, China.,Chongqing Collaborative Innovation Center for Functional Food, Chongqing University of Education, Chongqing, China.,Family Education Guidance Center for 0-6 Years Old, Chongqing University of Education, Chongqing, China
| | - Tingting Wu
- Chongqing Collaborative Innovation Center for Functional Food, Chongqing University of Education, Chongqing, China.,Department of Food and Nutrition, College of Medical and Life Sciences, Silla University, Busan, South Korea
| | - Shanshan Wang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Peiling Chen
- College of Pre-school Education, Chongqing University of Education, Chongqing, China
| | - Jiaqiong Zhang
- College of Pre-school Education, Chongqing University of Education, Chongqing, China.,Children's Research Institute, Chongqing University of Education, Chongqing, China.,Family Education Guidance Center for 0-6 Years Old, Chongqing University of Education, Chongqing, China
| | - Xin Zhao
- Chongqing Collaborative Innovation Center for Functional Food, Chongqing University of Education, Chongqing, China
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Ding X, Wang J, Li N, Su W, Wang H, Song Q, Guo X, Liang M, Qin Q, Sun L, Chen M, Sun Y. Individual, Prenatal, Perinatal, and Family Factors for Anxiety Symptoms Among Preschool Children. Front Psychiatry 2021; 12:778291. [PMID: 34987428 PMCID: PMC8721098 DOI: 10.3389/fpsyt.2021.778291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/19/2021] [Indexed: 01/21/2023] Open
Abstract
Anxiety is one of the most common psychological disorders among children. Few studies have investigated the prevalence and comprehensive factors for anxiety among preschool children in China. This study aimed to assess the prevalence of anxiety and explore influential factors at multiple levels including individual, prenatal and perinatal, and family factors, associated with anxiety symptoms among preschool children. The multisite cross-sectional study was conducted in Anhui Province and included 3,636 preschool children aged 3-6 years. Anxiety symptoms of children were assessed using the Chinese version of the Spence Preschool Anxiety Scale. Logistic regression analyses were performed to explore associations between factors at multiple levels and significant anxiety symptoms, and the model was validated internally using 10-fold cross-validation. Among the participants, 9.1% of children had significant anxiety symptoms. Girls reported more significant anxiety symptoms. Children's poor dietary habits, sleep disturbances, autistic tendencies, and left-behind experience; maternal poor prenatal emotional symptoms; and more caregivers' anxiety symptoms were significantly associated with anxiety symptoms among children. The result of 10-fold cross-validation indicated that the mean area under the curve, sensitivity, specificity, and accuracy were 0.78, 70.45%, 78.18%, and 71.15%, respectively. These factors were slightly different among different subtypes of anxiety symptoms. The results of this study suggested that anxiety symptoms in preschool children were prevalent, particularly in girls. Understanding early-life risk factors for anxiety is crucial, and efficient prevention and intervention strategies should be implemented in early childhood even pregnancy.
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Affiliation(s)
- Xiuxiu Ding
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Jun Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China.,Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Ning Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Wanying Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Hao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Qiuxia Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Xianwei Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Mingming Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Qirong Qin
- Ma'anshan Center for Disease Control and Prevention, Ma'anshan, China
| | - Liang Sun
- Fuyang Center for Disease Control and Prevention, Fuyang, China
| | - Mingchun Chen
- Changfeng Center for Disease Control and Prevention, Changfeng, China
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
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Mian ND, Pincus DB, Perrin EC, Bair-Merritt M. Identifying and Making Recommendations for Pediatric Anxiety Disorders in Primary Care Settings: A Video-Based Training. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11033. [PMID: 33324746 PMCID: PMC7732138 DOI: 10.15766/mep_2374-8265.11033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/04/2020] [Indexed: 06/12/2023]
Abstract
Introduction Pediatric anxiety disorders have high rates of prevalence and confer risk for later disorders if they go undetected. In primary care, they are underdiagnosed, partly because pediatricians often lack relevant training. We developed a brief, video-based training program for pediatric residents aimed at improving early identification of anxiety disorders in primary care. Methods Video content was consistent with the American Academy of Pediatrics Behavioral Health Competencies, as applied to the evaluation of anxiety disorders and guidance for discussing treatment options. This training can be delivered in two formats: videos (43 minutes) can be shown in a live, group-based format, or accessed via an online, asynchronous training. We tested this training program using both formats and developed surveys to evaluate knowledge about child anxiety, perceived evaluation skills, and satisfaction with the training. We also developed a video-based vignette to measure sensitivity to detecting disorders (how much the condition is interfering, diagnostic severity, and referral urgency). Results Pediatric residents from two residency programs completed the training and pre- and posttraining assessments to evaluate program efficacy. Residents' knowledge and perceived evaluation skills increased posttraining, with large effect sizes. Residents also demonstrated increased sensitivity to detecting anxiety disorders on the vignette-based assessment and reported high levels of satisfaction. Discussion Our results suggested that residents participating in this training improved their evaluation skills and that residents found the training beneficial. Video-based trainings can significantly supplement existing education. This cost-effective and minimally burdensome training program can be used to enhance resident education in a much-needed area.
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Affiliation(s)
- Nicholas D. Mian
- Assistant Professor, Department of Life Sciences, University of New Hampshire
| | - Donna B. Pincus
- Associate Professor, Department of Psychological and Brain Sciences, Boston University
| | - Ellen C. Perrin
- Professor, Department of Pediatrics, Tufts University School of Medicine
| | - Megan Bair-Merritt
- Professor of Pediatrics, Department of Pediatrics, Boston University Medical School; Director of BMC Pediatrics Center for the Urban Child and Healthy Family
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Costantini I, Paul E, Caldwell DM, López-López JA, Pearson RM. Protocol for a systematic review and network meta-analysis of randomised controlled trials examining the effectiveness of early parenting interventions in preventing internalising problems in children and adolescents. Syst Rev 2020; 9:244. [PMID: 33076982 PMCID: PMC7574314 DOI: 10.1186/s13643-020-01500-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/07/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Internalising problems, such as depression and anxiety, are common and represent an important economical and societal burden. The effectiveness of parenting interventions in reducing the risk of internalising problems in children and adolescents has not yet been summarised. The aims of this review are to assess the effectiveness of parenting interventions in the primary, secondary and tertiary prevention of internalising problems in children and adolescents and to determine which intervention components and which intervention aspects are most effective for reducing the risk of internalising problems in children and adolescents. METHODS Electronic searches in OVID SP versions of MEDLINE, EMBASE and PsycINFO; Cochrane Central Register of Controlled Trials; EBSCO version of ERIC and ClinicalTrials.gov have been performed to identify randomised controlled trials or quasi-randomised controlled trials of parenting interventions. At least two independent researchers will assess studies for inclusion and extract data from each paper. The risk of bias assessment will be conducted independently by two reviewers using the Cochrane Collaboration's Risk of Bias Assessment Tool. Statistical heterogeneity is anticipated given potential variation in participant characteristics, intervention type and mode of delivery, and outcome measures. Random effects models, assuming a common between-study variability, will be used to account for statistical heterogeneity. Results will be analysed using a network meta-analysis (NMA). If appropriate, we will also conduct a component-level NMA, where the 'active ingredients' of interventions are modelled using a network meta-regression approach. DISCUSSION Preventing and reducing internalising problems could have major beneficial effects at the economic and societal level. Informing policy makers on the effectiveness of parenting interventions and on which intervention's component is driving the effect is important for the development of treatment strategies. SYSTEMATIC REVIEW REGISTRATION International Prospective Register for Systematic Reviews (PROSPERO) number CRD42020172251.
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Affiliation(s)
- Ilaria Costantini
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BP UK
| | - Elise Paul
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BP UK
| | - Deborah M. Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BP UK
| | - José A. López-López
- Department of Basic Psychology & Methodology, University of Murcia, Murcia, Spain
| | - Rebecca M. Pearson
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BP UK
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Abstract
Preschoolers are presenting in increasing numbers to primary care providers and mental health clinics with emotional and behavioural impairment. Preschoolers in the US have the highest rates of school expulsion of all age groups. Because young children are limited in their capacity to convey distress and internal states, impairment is most often expressed behaviourally. Disruptive behaviour, frequently in the form of aggression or dysregulation, is a final common pathway for many disorders in this age group. Tools and training to diagnose pre-school disorders are limited, and while some effective non-medication interventions exist, the evidence base for medication use in this age group is extremely limited. This article reviews approaches to assessing common pre-school disorders including attention deficit hyperactivity disorder (ADHD), disruptive behaviour disorders, anxiety and mood disorders, perceptual disturbances and psychosis, and trauma related disorders. The evidence base for both therapeutic and psychopharmacologic interventions for these disorders is discussed.
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Affiliation(s)
- Nadia Zaim
- Division of Child and Adolescent Psychiatry, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joyce Harrison
- Division of Child and Adolescent Psychiatry, The Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Psychiatry, Kennedy Krieger Institute, Baltimore, MD, USA
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Charach A, Mohammadzadeh F, Belanger SA, Easson A, Lipman EL, McLennan JD, Parkin P, Szatmari P. Identification of Preschool Children with Mental Health Problems in Primary Care: Systematic Review and Meta-analysis. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2020; 29:76-105. [PMID: 32405310 PMCID: PMC7213917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 10/19/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Primary care practitioners determine access to care for many preschool children with mental health (MH) problems. This study examined rates of mental health (MH) problem identification in preschoolers within primary healthcare settings, related service use, and MH status at follow-up. The findings may inform evidence-based policy and practice development for preschool MH. METHOD For this systematic review, MEDLINE®, EMBASE®, PsycInfo®, and ERIC ® were searched from inception to March 7, 2018 for reports in which a screening measure was used to identify MH problems in children aged 24-72 months, seen in primary and community health care settings. Meta-analyses, using random effects models to provide pooled estimates, were used when three or more studies examined identification rates. Findings on service use and persistence of disorders are summarized. RESULTS Thirty-five publications representing 21 studies met the inclusion criteria. MH problems were identified in 17.6% of preschoolers (95% Confidence Interval (CI): 11.1-24.1), Q = 4.9, p > 0.1 by primary/community healthcare practitioners. Psychiatric diagnoses were identified in 18.4% of preschoolers (95% CI: 12.3 - 24.4), Q= 1.6, p > 0.1. Based on three studies, parents of 67-72% of identified children received advice and 26-42% received specialist referrals. In the subset of studies examining persistence of MH disorders, 25-67% of identified children had MH disorders after one to three years. CONCLUSION While the identification rate by primary/community practitioners is similar to the diagnostic rate, these may not consistently be the same children. Substantial variability in management and outcomes indicate need for more rigorous evaluation of primary care services for this population.
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Affiliation(s)
- Alice Charach
- Department of Psychiatry, University of Toronto Faculty of Medicine, and The Hospital for Sick Children, Toronto, Ontario
| | - Forough Mohammadzadeh
- Department of Psychiatry, The Hospital for Sick Children, Toronto, and Qvella Corporation, Richmond Hill, Ontario
| | - Stacey A Belanger
- Département de Pédiatrie, Faculté de Médicine, Université de Montréal and CHU Sainte Justine, CIRENE (Centre Intégré du Réseau en Neurodéveloppement de L'Enfant), Montréal, Quebec
| | - Amanda Easson
- Department of Psychology, University of Toronto and Rotman Research Institute, Baycrest Center for Geriatric Care, Toronto, Ontario
| | - Ellen L Lipman
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences McMaster University, McMaster Children's Hospital and Offord Centre for Child Studies, Hamilton Ontario
| | - John D McLennan
- Children's Hospital of Eastern Ontario-Research Institute, Ottawa, Ontario, and Department of Pediatrics, University of Calgary, Calgary, Alberta
| | - Patricia Parkin
- Department of Pediatrics, University of Toronto Faculty of Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto Dalla Lana School of Public Health, and The Hospital for Sick Children, Toronto, Ontario
| | - Peter Szatmari
- Department of Psychiatry, University of Toronto Faculty of Medicine, The Hospital for Sick Children, and The Centre for Addiction and Mental Health, Toronto, Ontario
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Family-Centered Cognitive Behavioral Therapy for Anxiety in Very Young Children with Autism Spectrum Disorder. J Autism Dev Disord 2020; 50:3905-3920. [PMID: 32146598 DOI: 10.1007/s10803-020-04446-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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46
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Maternal Anxiety and Separation Anxiety in Children Aged Between 3 and 6 Years: The Mediating Role of Parenting Style. J Dev Behav Pediatr 2019; 39:621-628. [PMID: 29877991 DOI: 10.1097/dbp.0000000000000593] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Maternal anxiety is known to be associated with childhood separation anxiety. However, there is little research on the mediating factors of this relationship, despite the possible consequences separation anxiety might have for children's development and autonomy. The objective of this study was to analyze the possible mediating effects of 4 parenting styles (overprotective, assertive, punitive, and inhibited) on the relationship between maternal anxiety and child separation anxiety. METHODS Participants were 235 mothers with children aged 3 to 6 years, recruited from 6 preschools in the southeast of Spain. Maternal trait anxiety, maternal parenting style, and child separation anxiety were evaluated. RESULTS A parallel multiple-mediation analysis revealed that the overprotective parenting style was a significant mediator of the relationship between maternal trait anxiety and child separation anxiety. In addition, mothers with higher trait anxiety scores exhibited a greater likelihood of using an overprotective, punitive, or less assertive parenting style. Younger mothers were more likely to use an overprotective parenting style, and compared with girls, boys were more exposed to the assertive style. CONCLUSION This study provides initial evidence that parenting style acts as a mediator of the relationship between maternal anxiety and child separation anxiety.
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Carpenter KLH, Baranek GT, Copeland WE, Compton S, Zucker N, Dawson G, Egger HL. Sensory Over-Responsivity: An Early Risk Factor for Anxiety and Behavioral Challenges in Young Children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 47:1075-1088. [PMID: 30569253 PMCID: PMC6508996 DOI: 10.1007/s10802-018-0502-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Anxiety disorders are prevalent and significantly impact young children and their families. One hypothesized risk factor for anxiety is heightened responses to sensory input. Few studies have explored this hypothesis prospectively. This study had two goals: (1) examine whether sensory over-responsivity is predictive of the development of anxiety in a large prospective sample of children, and (2) identify whether anxiety mediates the relationship between sensory over-responsivity and behavioral challenges. Children's sensory and anxiety symptoms were assessed in a community sample of 917 at 2-5 and again in 191 of these children at 6 years old. Parents also reported on a number of additional behavioral challenges previously found to be associated with both sensory over-responsivity and anxiety separately: irritability, food selectivity, sleep problems, and gastrointestinal problems. Forty three percent of preschool children with sensory over-responsivity also had a concurrent impairing anxiety disorder. Preschool sensory over-responsivity symptoms significantly and positively predicted anxiety symptoms at age six. This relationship was both specific and unidirectional. Finally, school-age anxiety symptoms mediated the relationship between preschool sensory over-responsivity symptoms and both irritability and sleep problems at school-age. These results suggest sensory over-responsivity is a risk factor for anxiety disorders. Furthermore, children who have symptoms of sensory over-responsivity as preschoolers have higher levels of anxiety symptoms at school-age, which in turn is associated with increased levels of school-age behavioral challenges.
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Affiliation(s)
- Kimberly L H Carpenter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA.
| | - Grace T Baranek
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant Hall, CB #7120, Chapel Hill, NC, 27599-7120, USA
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar Street, CHP 133, Los Angeles, CA, 90089-9003, USA
| | - William E Copeland
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Helen L Egger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, 1 Park Avenue, 7th Floor, New York, NY, 10016, USA
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48
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Bufferd SJ, Dougherty LR, Olino TM. Mapping the frequency and severity of anxiety behaviors in preschool-aged children. J Anxiety Disord 2019; 63:9-17. [PMID: 30731395 PMCID: PMC6414242 DOI: 10.1016/j.janxdis.2019.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/09/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
Although anxiety can be early-emerging, impairing, and persistent, behaviors relevant to anxiety mirror typical development in early childhood. To better understand the spectrum of typical to problematic behavior, this study characterizes the range of frequency and severity of separation and social anxiety behaviors and associated impairment in preschool-aged children using a novel daily diary method. Primary caregivers of 291 3-5-year-old children reported the frequency of children's daily separation and social anxiety behaviors and related impairment for 14 days. Frequencies of each separation and social anxiety behavior were computed and item response theory analyses revealed the specific frequencies at which the behavior was considered psychometrically severe/rare. Patterns varied across items; for example, worry that caregiver would not return and shyness with familiar adults had to occur at least 3-4 times over 14 days for the behavior to be considered severe/rare, whereas shyness around peers and new people were not severe at any frequency. In addition, behaviors were associated with impairment. To our knowledge, these data are the first to delineate empirical, dimensional information about the frequency and severity of anxiety behaviors and associated impairment in early childhood. Such data could be useful for clinical practice to enhance empirically-driven assessment of anxiety.
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Affiliation(s)
- Sara J Bufferd
- California State University San Marcos, Department of Psychology, 333 S. Twin Oaks Valley Road, San Marcos, CA, 92096-0001, United States.
| | - Lea R Dougherty
- Department of Psychology, University of Maryland, 4094 Campus Dr., College Park, MD, 20742, United States.
| | - Thomas M Olino
- Department of Psychology, Temple University, 1701 N 13th St, Philadelphia, PA, 19122, United States.
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Jobs I, Müller JM, Skorozhenina O, Romer G. Homo- and Heterotypic Trajectories in a Preschool to Primary-School Clinical Sample: A Prospective Study Related to Maternal Psychopathology. Front Psychiatry 2019; 10:153. [PMID: 30967803 PMCID: PMC6440442 DOI: 10.3389/fpsyt.2019.00153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 03/01/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Most longitudinal or follow-up mental health studies describe developmental pathways using dimensional measures of psychopathology, but seldom using pathways described by clinical disorders. Objective: We aim to describe diagnostic pathways by homotypic (within the disorder continuity) and heterotypic development (between the disorder continuity), with maternal psychopathology as moderator for both trajectories. Methods: Clinically referred children (0-7 years; N = 83) were assessed at preschool age and at primary-school age through a clinical interview. We built a disorder cluster of emotional disorders (ED; F32, F40, F42, F43, F93.0, F93.1, F93.2, F93.8, F95), behavioral disorders (BD; F68.8, F90, F91, F91.3, F93.3, F93.9, F94), and specific early onset disorders (SEO; F50, F51, F70, F98.0, F98.1, F98.2, F98.8, F98.9). We describe the prevalence, comorbidity, and clinical trajectories of various types of homotypic and heterotypic development. Results: We observed a high rate of comorbidity throughout the study (62.6% at admission and 67.5% at follow-up) and in general, a high continuity of mental health problems from preschool to primary-school age children (69.9% of the sample showed continuity), with 50.6% of the sample showing homotypic and 44.6% showing heterotypic development. Hierarchical multiple regression analyses suggest that heterotypic development may be influenced by maternal psychopathology. Conclusion: Currently, evidence-based mental health guidelines for preschool populations are designed and evaluated assuming a homotypic development. However, our findings indicate that treatment interventions and outcome measures should also be designed and evaluated for heterotypic development especially in case of increased maternal psychopathology.
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Affiliation(s)
- Isabell Jobs
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Jörg Michael Müller
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
- Health Psychology and Applied Diagnostics, University of Wuppertal, Münster, Germany
| | - Olena Skorozhenina
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
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50
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Comer JS, Hong N, Poznanski B, Silva K, Wilson M. Evidence Base Update on the Treatment of Early Childhood Anxiety and Related Problems. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 48:1-15. [PMID: 30640522 DOI: 10.1080/15374416.2018.1534208] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The controlled evaluation of treatments for early childhood anxiety and related problems has been a relatively recent area of investigation, and accordingly, trials examining early childhood anxiety treatment have not been well represented in existing systematic reviews of youth anxiety treatments. This Evidence Base Update provides the first systematic review of evidence supporting interventions specifically for the treatment of early childhood anxiety and related problems. Thirty articles testing 38 treatments in samples with mean age < 7.9 years (N = 2,228 children) met inclusion criteria. We applied Southam-Gerow and Prinstein's (2014) review criteria, which classifies families of treatments according to one of five levels of empirical support-Well-Established, Probably Efficacious, Possibly Efficacious, Experimental, and of Questionable Efficacy. We found family-based cognitive-behavioral therapy (CBT) to be a Well-Established treatment, and Group Parent CBT and Group Parent CBT + Group Child CBT to both be Probably Efficacious treatments. In contrast, play therapy and attachment-based therapy are still only Experimental treatments for early childhood anxiety, relaxation training has Questionable Efficacy, and there is no evidence to date to speak to the efficacy of individual child CBT and/or medication in younger anxious children. All 3 currently supported interventions for early childhood anxiety entail exposure-based CBT with significant parental involvement. This conclusion meaningfully differs from conclusions for treating anxiety in older childhood that highlight the well-established efficacy of individual child CBT and/or medication and that question whether parental involvement in treatment enhances outcomes.
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Affiliation(s)
- Jonathan S Comer
- a Mental Health Interventions and Technology (MINT) Program, Center for Children and Families , Florida International University
| | - Natalie Hong
- a Mental Health Interventions and Technology (MINT) Program, Center for Children and Families , Florida International University
| | - Bridget Poznanski
- a Mental Health Interventions and Technology (MINT) Program, Center for Children and Families , Florida International University
| | - Karina Silva
- a Mental Health Interventions and Technology (MINT) Program, Center for Children and Families , Florida International University
| | - Maria Wilson
- a Mental Health Interventions and Technology (MINT) Program, Center for Children and Families , Florida International University
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