Preschool environment and temperament as predictors of social and nonsocial anxiety disorders in middle adolescence

Evaluating the long-term effects of cognitive behavioural therapy as an early intervention for at-risk anxiety disorders among preschool children in Asia

There are few evaluations of early intervention for the prevention of anxiety disorders in East Asia, and those that exist generally evaluate outcomes to a maximum of 6-12 months. The current study evaluated the long-term effect (5 years) of an anxiety prevention program presented to preschool children and their parents in Japan. Participants for the study were 10 inhibited children 5-6 years old and their parents. The parent's and children's program comprised group sessions of a cognitive-behavioural program. Parents and teachers completed the anxious/depressed, withdrawn and behavioural inhibition at pre-post-intervention and 3-month follow-up. Five years after starting the intervention, participants were invited to a diagnostic interview, Anxiety Disorders Interview Schedule (ADIS) to examine a long-term preventive effect of the intervention. The majority of children showed a reduction in anxious/depressed, behavioral inhibition, and approximately half showed reliable change according to parents' and teachers' reports. Moreover, the results indicated that 9 of the 10 children did not met the diagnostic criteria for anxiety disorders. These results suggested that the early intervention had preventive effects because the diagnostic criteria for anxiety disorders were not met in the follow-up assessment conducted five years later.

Maternal mental health mediates the effect of prenatal stress on infant temperament: The Harvey Mom Study

Prenatal maternal stress and mental health problems are known to increase risk for developmental psychopathology in offspring, yet pathways leading to risk or resiliency are poorly understood. In a quasi-experimental design, we prospectively examined associations between disaster-related prenatal stress, maternal mental health symptoms, and infant temperament outcomes. Mothers who were pregnant during Hurricane Harvey (N = 527) reported on objective hardships (e.g., loss of belongings or income, evacuation, home flooding) related to the storm and subsequent mental health symptoms (anxiety/depression, posttraumatic stress) across time. At a postpartum assessment, mothers reported on their infant's temperament (negative affect, positive affect, orienting/regulatory capacity). Greater objective hardship indirectly predicted higher levels of infant orienting/regulatory capacity through its association with increased maternal posttraumatic stress symptoms. Greater objective hardship also indirectly predicted higher levels of infant negative affect through its association with increased maternal anxiety/depression symptoms across time. Our findings suggest a psychological mechanism linking prenatal stress with specific temperamental characteristics via maternal mental health symptoms. Findings point to the importance of high-quality assessment and mental health services for vulnerable women and young children.

Anxiety disorders in children and adolescents: A summary and overview of the literature

Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances.

Fearful temperament in middle childhood predicts adolescent attention bias and anxiety symptoms: The moderating role of frontal EEG asymmetry

The current study provided first analyses of the moderating effect of baseline-to-task frontal EEG asymmetry on the associations between 9-year fearful temperament and adolescent attention bias to threat as well as anxiety symptoms. Participants include a community sample of 122 children (60 boys, 62 girls; Mage = 14.66 years; Range = 11.82-18.13 years). Baseline-to-task frontal EEG asymmetry at age 9 moderated the relation between fearful temperament at age 9 and adolescent anxiety symptoms. Specifically, fearful temperament predicted adolescent anxiety symptoms when children showed greater right activation from baseline to an executive function task, but not greater left activation. Baseline-to-task frontal EEG asymmetry moderated the association between fearful temperament and sustained (i.e., stimulus onset asynchrony is 1250 ms) but not automatic attention bias (i.e., stimulus onset asynchrony is 500 ms). Children with greater left frontal activation from baseline to task more efficiently direct attention away from threat. Adolescent automatic attention bias to threat was related to concurrent anxiety symptoms. These findings illustrate the importance of considering frontal EEG asymmetry to shape how fearful children process threat and to influence their behavioral problems.

Serotonin transporter (5-HTT) gene network moderates the impact of prenatal maternal adversity on orbitofrontal cortical thickness in middle childhood

In utero, the developing brain is highly susceptible to the environment. For example, adverse maternal experiences during the prenatal period are associated with outcomes such as altered neurodevelopment and emotion dysregulation. Yet, the underlying biological mechanisms remain unclear. Here, we investigate whether the function of a network of genes co-expressed with the serotonin transporter in the amygdala moderates the impact of prenatal maternal adversity on the structure of the orbitofrontal cortex (OFC) in middle childhood and/or the degree of temperamental inhibition exhibited in toddlerhood. T1-weighted structural MRI scans were acquired from children aged 6-12 years. A cumulative maternal adversity score was used to conceptualize prenatal adversity and a co-expression based polygenic risk score (ePRS) was generated. Behavioural inhibition at 18 months was assessed using the Early Childhood Behaviour Questionnaire (ECBQ). Our results indicate that in the presence of a low functioning serotonin transporter gene network in the amygdala, higher levels of prenatal adversity are associated with greater right OFC thickness at 6-12 years old. The interaction also predicts temperamental inhibition at 18 months. Ultimately, we identified important biological processes and structural modifications that may underlie the link between early adversity and future deviations in cognitive, behavioural, and emotional development.

[Modern principles of primary headaches prevention in children and adolescents]

Headaches in children and adolescents are an actual problem of modern medicine. In most cases, headaches are regarded as a manifestation of vertebrogenic or cerebrovascular pathology, or as a manifestation of autonomic dystonia syndrome which leads to an erroneous diagnosis and treatment. The review considers the factors of occurrence and chronicity of primary headaches (hypodynamia, postural disorders, magnesium and vitamin D deficiency, anxiety and depression, central sensitization, alexithymia), methods for their diagnosis and treatment.

Bi-directional relations between attention and social fear across the first two years of life

This study examined longitudinal relations between attention and social fear across the first two years of life. Our sample consisted of 357 infants and their caregivers across three sites. Data was collected at 4, 8, 12, 18, and 24 months of age. At all 5 assessments, the infants participated in 2 eye-tracking tasks (Vigilance and Overlap) which measured different components of attention bias (orientation, engagement, and disengagement), and parents completed questionnaires assessing infant temperament. For the first three assessments, social fear was measured using the Infant Behavioral Questionnaire-Revised (IBQ-R; Gartstein & Rothbart, 2003) focused on interactions with strangers, and for the final two time points, we used the social fearfulness subscale on the Toddler Behavior Assessment Questionnaire (TBAQ; Goldsmith, 1996). The results of a random intercept cross-lagged panel model showed intermittent evidence of uni-directional and reciprocal relations between attention to both threatening and positive emotion facial configurations and social fear. Our findings suggest that characteristics of behaviorally inhibited temperament-in this case, social fear-begin to interact with attention biases to emotion in the very first year of life, which carries implications for the timing of future interventions designed to mitigate the early development of maladaptive patterns of attention.

Bidirectional effects of toddler temperament and maternal overprotection on maternal and child anxiety symptoms across preschool

INTRODUCTION

Existing research highlights interactions among child temperament, parents' own anxiety symptoms, and parenting in predicting increased risk for anxiety symptom development. Theoretical models of child-elicited effects on parents have proposed that parents' behaviors are likely not independent of children's temperament; fearful children likely elicit more protective responses from parents and these parenting behaviors reinforces child anxiety and parents' own anxiety.

METHOD

The current study tests this model and examines whether there are bidirectional influences between early fearful temperament (i.e., dysregulated fear [DF]), maternal overprotection, and subsequent trajectories of maternal and child anxiety symptoms across early childhood. A total of 166 children and mothers participated in a multimethod, longitudinal study of temperament risk from 2 to 6 years.

RESULTS

Results largely support our hypotheses, replicating and extending the prior literature. DF was associated with more maternal overprotective behavior, subsequent child anxiety symptoms, and maternal anxiety symptoms. Moreover, there were indirect (mediated) associations through maternal overprotective behavior and both child and mother anxiety symptoms.

CONCLUSION

Results support the hypothesis that intergenerational transmission of anxiety was meditated through maternal behaviors and that the child-driven temperament effects are central to trajectories of child and maternal anxiety trajectories.

Targeting risk factors for inhibited preschool children: An anxiety prevention program

OBJECTIVE

Children with a behaviorally inhibited temperament during early childhood have been shown to have an increased risk for developing anxiety disorders. This study evaluated the efficacy of an anxiety prevention program aimed at reducing the risk of anxiety in behaviorally inhibited preschool children.

METHOD

Participants were 86 children aged 41-57 months and their mothers. Children were selected if their mothers reported high levels of child behavioral inhibition on a screening measure. Participants were randomly allocated to a nine-session intervention or a waitlist control condition. Mothers and children both participated in the intervention.

RESULTS

At follow-up, the intervention group had significantly fewer clinician-rated child anxiety disorders and fewer mother-reported child anxiety symptoms than at baseline but this change was not significantly different to the change seen in the waitlist control group.

CONCLUSIONS

On average, across the course of the study, anxiety decreased in all children irrespective of group. A number of potential reasons for this are discussed along with implications for research and clinical practice.

Fearful Temperament and the Risk for Child and Adolescent Anxiety: The Role of Attention Biases and Effortful Control

Fearful temperament represents one of the most robust predictors of child and adolescent anxiety; however, not all children with fearful temperament unvaryingly develop anxiety. Diverse processes resulting from the interplay between automatic processing (i.e., attention bias) and controlled processing (i.e., effortful control) drive the trajectories toward more adaptive or maladaptive directions. In this review, we examine the associations between fearful temperament, attention bias, and anxiety, as well as the moderating effect of effortful control. Based on the reviewed literature, we propose a two-mechanism developmental model of attention bias that underlies the association between fearful temperament and anxiety. We propose that the sub-components of effortful control (i.e., attentional control and inhibitory control) play different roles depending on individuals' temperaments, initial automatic biases, and goal priorities. Our model may help resolve some of the mixed findings and conflicts in the current literature. It may also advance our knowledge regarding the cognitive mechanisms linking fearful temperament and anxiety, as well as facilitate the continuing efforts in identifying and intervening with children who are at risk. Finally, we conclude the review with a discussion on the existing limitations and then propose questions for future research.

Toddler dysregulated fear predicts continued risk for social anxiety symptoms in early adolescence

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.

Prospective Association between Childhood Behavioral Inhibition and Anxiety: a Meta-Analysis

Behavioral inhibition (BI) is a risk factor for anxiety. However, the estimates of the strength of this association vary widely. In addition, while BI is a strong predictor of social anxiety disorder (SAD), its association with other anxiety disorders is unclear. The current study sought to establish the relationship between BI and anxiety and to quantify this association for a range of anxiety disorders. We searched PsycInfo, PubMed and Embase for articles published before May 18th, 2019 using search terms for BI, anxiety and prospective study design. We selected articles which assessed the prospective relationship between BI in childhood and anxiety. Using random-effects meta-analysis with robust variance estimation, which allowed for the inclusion of multiple follow-ups of the same sample, we established the association between BI and any anxiety. We also explored the association between BI and individual anxiety disorders. Data from 27 studies consisting of 35 follow-ups of 20 unique samples indicated that BI prospectively increases the odds of anxiety (OR = 2.80, 95% CI 2.03 to 3.86, p < 0.001). There was also a positive association between BI and all individual anxiety disorders, with effect sizes ranging from small in the case of specific phobia (OR = 1.49, 95% CI 1.03 to 2.14, p = 0.03) to large in the case of SAD (OR = 5.84, 95% CI 3.38 to 10.09, p < 0.001). BI in early childhood is a strong risk factor for anxiety. Targeting BI may help reduce the number of children who will develop anxiety disorders.

Association Between Family Structure and Anxiety Disorder Among Pre-schoolers: A Cross-Sectional Study in Urban Chongqing, China

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.

Factors Associated With Anxiety Symptoms in Australian Deaf or Hard of Hearing Children

Deaf/deaf or hard of hearing (DHH) children are at an increased risk of developing mental health problems, with growing evidence that they may experience greater anxiety symptoms than hearing peers. The present study investigated whether Australian children with varying degrees of hearing loss experienced increased anxiety symptoms compared to hearing children. Furthermore, we examined whether child anxiety symptoms were associated with known risk factors including psychological symptoms of anxiety and depression in parents, age at detection, early intervention and device fitting, type of hearing device, and peer problems. Participants were 65 parents of children with hearing loss aged between 4 and 11 years old (M = 6.05, SD = 1.60) seeking treatment for hearing loss at a specialized hearing clinic in Australia. Based on parent reports, we found that the children with hearing loss had fewer anxiety symptoms than their hearing peers (using normative data). Psychological distress of parents was the only factor that uniquely associated with child anxiety. Parents of children with hearing loss were found to experience greater emotional distress compared to parents of hearing children. This suggests parents may require additional support to cope with the social and economic strains associated with childhood hearing loss.

Academic Stress in the Final Years of School: A Systematic Literature Review

Heightened academic stress in the final years of schooling is a common concern, yet little is known about how stress changes over time and what individual, school and family factors are associated with distress. We conducted a systematic review to examine the nature of distress in students in their final two years of secondary school. Sixty studies were eligible for inclusion. The main findings indicated severity of distress differed across the 17 countries sampled and measures used. There was some consistencies suggesting about 1 in 6 students experienced excessive distress. Female gender and anxiety proneness were consistently associated with increased distress, and freedom from negative cognitions with reduced distress. There was some evidence that individual characteristics (perfectionism, avoidance, coping, self-efficacy, resilience), lifestyle (sleep, homework), school, family and peer connectedness were associated with distress. Overall at-risk students can be predicted by theoretical models of anxiety and distress targeted with psychological interventions.

Prevalence, comorbidity and predictors of anxiety disorders among children and adolescents

Childhood anxiety may lead to serious health consequences in later life. The present study provides the prevalence, comorbidity, and predictors of anxiety disorders among children and adolescents. This was a cross-sectional national project that was implemented on 28,698 children and adolescents in Iran. Participants entered the study by multistage cluster sampling with an equal number of each gender and three age groups (6-9, 10-14, and 15-18 years) within each cluster. The tools used in this research were the demographic questionnaire and K-SADS-PL. To analyze the data logistic regression and chi-square tests were used in SPSS (ver. 16). The prevalence of anxiety disorder in children and adolescents was 13.2 in boys and 15.1 in girls. Furthermore, gender, age, place of residence and history of psychiatric hospitalization of parents could predict anxiety disorders. Anxiety disorders had comorbidity with behavioral disorders, neurodevelopmental disorders, mood disorders, psychotic disorders, substance abuse disorders, and elimination disorders. According to our findings in this study, anxiety disorders affect the performance, health and life of children and adolescents, identifying the childhood anxiety, as well as finding diseases that are associated with anxiety disorders, can help in the prevention of the disorder.

Effect of Puppet Show on Children's anxiety and pain levels during the circumcision operation: A randomized controlled trial

INTRODUCTION

Surgical procedures are the most common causes of anxiety and pain in hospitalized children. One of the most common surgical procedures for children is circumcision. Surgical procedures such as circumcision in hospitals are the most common causes of pain, fear, and anxiety in children. Therapeutic play methods as non-pharmacological applications are being developed recently for children who use analgesics in the treatment of pain and anxiety. Nurses can use the game in three areas such as a care strategy for hospitalized children during daily routine practices, surgery, and invasive or painful treatment procedures. An extensive literature review revealed that there were therapeutic game plays performed before and after the surgical procedure. Nonetheless, no therapeutic game play performed during the surgical procedure were reported. In addition, no reported study of puppet show which is one of the therapeutic game methods were found.

OBJECTIVE

The aim of this study was to investigate the effect of the puppet show demonstrated to 7-11 years old children during circumcision on the anxiety and pain level of children.

DESIGN

The study was designed as a randomized controlled experiment.

MATERIALS AND METHODS

The population of the study was the children between 7 and 11 years of old and being circumcised in the urology clinic at Research and Training Hospital in Karabük Turkey between 1 May and 1 September 2017. A total of 81 (experimental group: 40, control group: 41) children were included in the study. "Participant Information Form", "Wong Baker Faces Pain Rating Scale" and "State-Trait Anxiety Inventory for Children" were used as implemented in the literature.

RESULTS

The median pain score of the experimental group during and after the procedure was statistically lower than the control group. The level of anxiety during and after the procedure in the experimental group showed a statistically significant decrease compared to the pre-treatment level and the level of anxiety after the procedure showed a statistically significant decrease compared to the procedure. In the control group, while the level of anxiety during the procedure showed a statistically significant increase compared to the pre-treatment level, the level of anxiety after the procedure showed a statistically significant decrease compared to the one during the procedure.

CONCLUSION

It was concluded that the puppet show performed during the circumcision procedure was effective in reducing the pain and anxiety that developed during the circumcision and continued after the procedure.

Exploring the stress sensitization theory with temperamentally inhibited children: a population-based study

BACKGROUND

This study explored whether temperamentally inhibited children who experience early trauma are vulnerable to developing internalizing problems in the face of later life-stressors.

METHODS

A validated screen for temperamental inhibition was distributed to parents of young children attending preschools in six government regions of Melbourne, Australia. Screening identified 11% of children as inhibited (703 of 6347 screened) and eligible for a prevention study. Participants were 545 parents of inhibited preschoolers (78% uptake), of whom 84% were followed into mid childhood (age 7-10 years: wave 1, n = 446; wave 2, n = 427; wave 3, n = 426). Parents and children then completed questionnaires for child internalizing (anxious and depressive) symptoms, and parents received a diagnostic interview for child anxiety disorder. In mid-childhood parents also completed questionnaires annually to describe recent life-stressors experienced by their child, and any potentially traumatic events in the first four years of life.

RESULTS

Only one in 14 temperamentally inhibited children had experienced a potentially traumatic event in early childhood. In mid childhood 56% experienced recent life-stressors. Inhibited children who had early life trauma experienced slightly more anxiety disorder and symptoms in mid childhood. Those children with more recent life-stressors in mid childhood also had slightly more symptoms of anxiety and depression. In contrast to stress sensitization, inhibited children with early trauma plus recent stressors did not show especially high mid-childhood internalizing difficulties.

CONCLUSIONS

Early life trauma and recent life-stressors each convey a small risk for children with an inhibited temperament to develop internalizing problems. Nevertheless, early life stress may not always result in negative sensitization for children in the general population.

Limbic and prefrontal neural volume modulate social anxiety in children at temperamental risk

BACKGROUND

Clinical levels of a social anxiety disorder (SAD) often appear during childhood and rise to a peak during late adolescence. The temperament trait behavioral inhibition (BI), evident early in childhood, has been linked to increased risk for SAD. Functional and structural variations in brain regions associated with the identification of, and response to, fear may support the BI-SAD relation. Whereas relevant functional studies are emerging, the few extant structural studies have focused on adult samples with mixed findings.

METHODS

A moderated-mediation model was used to examine the relations between BI, SAD symptoms, and brain-volume individual differences in a sample of children at risk for anxiety (ages 9-12; N = 130, 52 BI).

RESULTS

Our findings indicate that at higher levels of BI, children with smaller anterior insula volumes showed stronger correlations between BI and SAD. In addition, larger ventrolateral prefrontal cortex (vlPFC) volumes were associated with fewer SAD symptoms.

CONCLUSIONS

These findings support previous reports linking SAD levels with variations in volume and reactivity in both limbic (insula) and prefrontal (vlPFC) regions. These findings set the foundation for further examination of networks of neural structures that influence the transition from BI to SAD across development, helping further clarify mechanisms of risk and resilience.

A Clinical Staging Model for Obsessive-Compulsive Disorder: Is It Ready for Prime Time?

Recent changes to the diagnostic classification of obsessive-compulsive disorder (OCD), including its removal from the anxiety/neurotic, stress-related and somatoform disorders chapters of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and International Classification of Diseases 11th Revision (ICD-11), are based on growing evidence of unique pathogenic signatures and linked diagnostic and treatment approaches. In this review, we build on these recent developments and propose a 'clinical staging model' of OCD that integrates the severity of symptoms and phase of illness for personalised case management. A clinical staging model is especially relevant for the early identification and management of subthreshold OCD - a substantial and largely neglected portion of the population who, despite having milder symptoms, experience harms that may impact personal relationships, work-related functioning and productivity. Research on the pathogenesis, classification and management of such cases is needed, including the development of new outcomes measures that prove sensitive to changes in future clinical trials. Early intervention strategies in OCD are likely to yield better long-term outcomes.

Secure attachment style appears to compensate for the effect of prenatal maternal distress regarding difficult infant temperament development

Objective: Secure attachment style is a known protective factor regarding psychopathological development. The infant's attachment style, which is developed during the first two years of life, is therefore considered a moderating factor on the association between prenatal maternal distress and child temperament development which has repeatedly been reported in previous studies. Method: In this longitudinal study on a new sample of 51 mother-child-dyads, reported maternal distress and maternal empathy were assessed during pregnancy. Infant temperament and motor development were assessed at 12 months, while additionally controlling for the infant's attachment style as a postnatal factor. Results: Infants with secure attachment style whose mothers had experienced higher prenatal distress showed slightly better gross motor development at the age of 12 months. No association could be found between prenatal maternal distress and infant temperament. Conclusions: The results support the view that secure attachment style in children is a protective factor and softens the effects of prenatal maternal distress on difficult temperament development.

Behavioral Markers of Emergent Stranger Anxiety in Infants and Toddlers with Fragile X Syndrome

Studying anxiety in neurogenetic syndromes may inform the intersection of biological and developmental risks, facilitating effective and targeted interventions. We longitudinally examined stranger fear in infants and toddlers with fragile X syndrome (FXS; n = 46) and typical controls (n = 33), as well as associations between observed stranger fear and rating scales of anxiety, withdrawal and autism features within FXS. Results indicated atypical facial fear in FXS, although facial fear did not index anxiety, autistic symptoms or social withdrawal. Instead, lower withdrawal was associated with decreased distress vocalizations across age, and higher autistic symptoms were associated with lower intensity escape behaviors. Early stranger fear in FXS reflects both typical and atypical dimensions and may help index emergence of social anxiety in this population.

Stranger Fear and Early Risk for Social Anxiety in Preschoolers with Fragile X Syndrome Contrasted to Autism Spectrum Disorder

This study investigated behavioral indicators of social fear in preschool boys with fragile X syndrome (FXS) with a low degree of autism spectrum disorder (ASD) symptoms (FXS-Low; n = 29), FXS with elevated ASD symptoms (FXS-High; n = 25), idiopathic ASD (iASD; n = 11), and typical development (TD; n = 36). Gaze avoidance, escape behaviors, and facial fear during a stranger approach were coded. Boys with elevated ASD symptoms displayed more avoidant gaze, looking less at the stranger and parent than those with low ASD symptoms across etiologies. The iASD group displayed more facial fear than the other groups. Results suggest etiologically distinct behavioral patterns of social fear in preschoolers with elevated ASD symptoms.

Unique Associations between Childhood Temperament Characteristics and Subsequent Psychopathology Symptom Trajectories from Childhood to Early Adolescence

Existing research suggests that temperamental traits that emerge early in childhood may have utility for early detection and intervention for common mental disorders. The present study examined the unique relationships between the temperament characteristics of reactivity, approach-sociability, and persistence in early childhood and subsequent symptom trajectories of psychopathology (depression, anxiety, conduct disorder, and attention-deficit hyperactivity disorder; ADHD) from childhood to early adolescence. Data were from the first five waves of the older cohort from the Longitudinal Study of Australian Children (n = 4983; 51.2% male), which spanned ages 4-5 to 12-13. Multivariate ordinal and logistic regressions examined whether parent-reported child temperament characteristics at age 4-5 predicted the study child's subsequent symptom trajectories for each domain of psychopathology (derived using latent class growth analyses), after controlling for other presenting symptoms. Temperament characteristics differentially predicted the symptom trajectories for depression, anxiety, conduct disorder, and ADHD: Higher levels of reactivity uniquely predicted higher symptom trajectories for all 4 domains; higher levels of approach-sociability predicted higher trajectories of conduct disorder and ADHD, but lower trajectories of anxiety; and higher levels of persistence were related to lower trajectories of conduct disorder and ADHD. These findings suggest that temperament is an early identifiable risk factor for the development of psychopathology, and that identification and timely interventions for children with highly reactive temperaments in particular could prevent later mental health problems.

The Relations Between Maternal Prenatal Anxiety or Stress and Child's Early Negative Reactivity or Self-Regulation: A Systematic Review

In the present review, we examine the association between maternal prenatal stress or anxiety and children's early negative reactivity or self-regulation. The review includes 32 studies that focus on pregnancy-related anxiety, state or trait anxiety, perceived stress, and stressful life events in relation to child's crying, temperament, or behavior during the first 2 years of life. We searched four electronic databases and 32 studies were selected based on the inclusion criteria. Twenty-three studies found an association between maternal prenatal anxiety or stress and a child's negative reactivity or self-regulation, and typically the effect sizes varied from low to moderate. The association was found regardless of the form of prenatal stress or anxiety and the trimester in which the prenatal stress or anxiety was measured. In conclusion, several forms of prenatal anxiety and stress may increase the risk of emotional and self-regulatory difficulties during the first 2 years of life.

Combining child social skills training with a parent early intervention program for inhibited preschool children

BACKGROUND

Previous studies have demonstrated the efficacy of early intervention for anxiety in preschoolers through parent-education. The current study evaluated a six-session early intervention program for preschoolers at high risk of anxiety disorders in which a standard educational program for parents was supplemented by direct training of social skills to the children.

METHODS

Seventy-two children aged 3-5 years were selected based on high behavioural inhibition levels and concurrently having a parent with high emotional distress. Families were randomly assigned to either the intervention group, which consisted of six parent-education group sessions and six child social skills training sessions, or waitlist. After six months, families on waitlist were offered treatment consisting of parent-education only.

RESULTS

Relative to waitlist, children in the combined condition showed significantly fewer clinician-rated anxiety disorders and diagnostic severity and maternal (but not paternal) reported anxiety symptoms and life interference at six months. Mothers also reported less overprotection. These gains were maintained at 12-month follow-up. Parent only education following waitlist produced similar improvements among children. Quasi-experimental comparison between combined and parent-only interventions indicated greater reductions from combined intervention according to clinician reports, but no significant differences on maternal reports.

CONCLUSIONS

Results suggest that this brief early intervention program for preschoolers with both parent and child components significantly reduces risk and disorder in vulnerable children. The inclusion of a child component might have the potential to increase effects over parent-only intervention. However, future support for this conclusion through long-term, randomised controlled trials is needed.

Review: Prevention of anxiety among at-risk children and adolescents - a systematic review and meta-analysis

BACKGROUND

Anxiety disorders are common, often start in childhood and run a chronic course. As such there is a need for effective prevention.

METHODS

We conducted a systematic review and meta-analyses of randomized, controlled trials to prevent the onset of anxiety disorders in 'at risk' young people. Diagnostic and symptom outcomes were examined. Putative moderators were tested as was publication bias.

RESULTS

We included 16 trials (2545 young people). Two trials reported diagnostic outcomes, and significant effects were found for these at end-of-programme (RR = .09, 95%CI = .02 to .16), 6- (RR = .17, 95%CI = .06 to .27) and 12-month (RR = .31, 95%CI .17 to .45) follow-ups. Based on 16 trials, improved anxiety symptoms were significant compared to nonattention controls only, with small effect sizes reported by young people at the end-of-programmes, 6- and 12-month follow-ups; and by parents at the end of the programmes and 12-, but not 6-, month follow-ups. There was no evidence of significant moderation or publication bias.

CONCLUSIONS

Fourteen studies included children and young people who presented with elevated anxiety symptoms, but anxiety disorder was not ruled out in the participants in these studies. Hence, these studies might be reporting results of mixed prevention/early intervention programmes. Prevention programmes that target developmental risk factors, not only disorder maintaining factors, appear most promising. The clinically meaningful impact of anxiety disorder prevention programmes remains unknown.

Depression and Anxiety in Preschoolers: A Review of the Past 7 Years

This article reviews recent empirical literature on the prevalence, correlates, assessment, and treatment of preschool-onset internalizing disorders. Major advances in the acceptance and recognition of both preschool-onset depression and anxiety have occurred over the past decade. This work has been greatly enhanced by the discovery of genetic, neural, and physiologic indicators, which further validate these constellations of symptoms in young children. Despite this growth in research, much work still needs to be done to further elucidate the cause, risk, treatment, and protective factors for preschool-onset internalizing disorders.

Temperament Distinguishes Persistent/Recurrent from Remitting Anxiety Disorders Across Early Childhood

Up to 20% of preschool-age children meet criteria for anxiety disorders and, for a large subset, anxiety appears to persist throughout early childhood. However, little is known about which factors predict persistence/recurrence of anxiety in young children. Temperament, including behavioral inhibition (BI), negative emotionality (NE), and positive emotionality (PE), predict the onset of anxiety disorders, but to our knowledge no study has examined whether temperament predicts the course of anxiety in young children. From a community sample of 3-year-olds, we identified 89 children (79.8% White, non-Hispanic; 41.6% female) who met criteria for an anxiety disorder and examined whether observed and parent-reported BI, NE, and PE at age 3 distinguished children who continued to meet criteria for an anxiety disorder from those who remitted by age 6. Higher levels of BI and lower levels of PE assessed in the laboratory and higher parent-reported BI and shyness and lower surgency at age 3 significantly predicted persistence/recurrence of anxiety disorders from age 3 to 6. These data are the first to demonstrate the influence of temperament on the course of anxiety disorders in young children. These findings can enhance assessment and treatment of anxiety by focusing intervention efforts on children who are at risk for persistent or recurring anxiety rather than children who are displaying transient, and possibly developmentally normative, anxiety.

The aetiology and maintenance of social anxiety disorder: A synthesis of complimentary theoretical models and formulation of a new integrated model

BACKGROUND

Within maintenance models of social anxiety disorder (SAD), a number of cognitive and behavioural factors that drive the persistence of SAD have been proposed. However, these maintenance models do not address how SAD develops, or the origins of the proposed maintaining factors. There are also models of the development of SAD that have been proposed independently from maintenance models. These models highlight multiple factors that contribute risk to the onset of SAD, but do not address how these aetiological factors may lead to the development of the maintaining factors associated with SAD.

METHODS

A systematic review of the literature was conducted to identify aetiological and maintenance models of SAD. We then united key factors identified in these models and formulated an integrated aetiological and maintenance (IAM) model of SAD. A systematic review of the literature was then conducted on the components of the IAM model.

RESULTS

A number of aetiological and maintaining factors were identified in models of SAD. These factors could be drawn together into the IAM model. On balance, there is empirical evidence for the association of each of the factors in the IAM model with social anxiety or SAD, providing preliminary support for the model.

LIMITATIONS

There are relationships between components of the IAM model that require empirical attention. Future research will need to continue to test the IAM model.

CONCLUSIONS

The IAM model provides a framework for future investigations into the development and persistence of SAD.

Genetic and Environmental Contributions to Behavioral Stability and Change in Children 6-36 months of Age Using Louisville Twin Study Data

The Infant Behavior Record (IBR) from the Bayley Scales of Infant Development has been used to study behavioral development since the 1960s. Matheny (1983) examined behavioral development at 6, 12, 18, and 24 months from the Louisville Twin Study (LTS). The extracted temperament scales included Task Orientation, Affect-Extraversion, and Activity. He concluded that monozygotic twins were more similar than same-sex dizygotic twins on these dimensions. Since this seminal work was published, a larger LTS sample and more advanced analytical methods are available. In the current analyses, Choleksy decomposition was applied to behavioral data (n = 1231) from twins 6-36 months. Different patterns of genetic continuity vs genetic innovations were identified for each IBR scale. Single common genetic and shared environmental factors explained cross-age twin similarity in the Activity scale. Multiple shared environmental factors and a single genetic factor coming on line at age 18 months contributed to Affect-Extraversion. A single shared environmental factor and multiple genetic factors explained cross-age twin similarity in Task Orientation.

Nature and psychological management of anxiety disorders in youth

Anxiety disorders affect around 5% of the paediatric population at any given time and are associated with high social and personal impact. These disorders typically begin early in life, and children with anxiety disorders are at increased risk for a variety of later difficulties across the life-span. Although causes of anxiety in childhood are not fully understood, there is a strong heritable component. Additional risk factors include temperament, parent psychopathology, parent handling and peer interactions. Psychological treatments have demonstrated good efficacy with around 60% of anxious youth being in diagnostic remission immediately following treatment and a further 10% remitting over the following months. Because young people with anxiety disorders are among the least likely to seek appropriate help, paediatricians are in a unique position to identify anxious young people, educate families and recommend appropriate intervention.