Genetic and environmental influences on anxiety dimensions in Italian twins evaluated with the SCARED questionnaire

Social versus non-social behavioral inhibition: Differential prediction from early childhood of long-term psychosocial outcomes

Behavioral inhibition (BI) is a temperamental style characterized by cautious and fearful behaviors in novel situations. The present multi-method, longitudinal study examined whether young children's observed and parent-reported BI in social versus non-social contexts predicts different long-term psychosocial outcomes. Participants (N = 279) were drawn from a longitudinal study of socioemotional development. BI in social contexts ("social BI") was measured via children's observed wariness toward unfamiliar adults and peers at 24 and 36 months and parents' reports of children's social fear/shyness at 24, 36, and 48 months. BI in non-social contexts ("non-social BI") was measured via children's observed fearful responses to masks and novel toys, and parents' reports of children's distress to non-social novelty at 9 months and non-social fear at 48 months. At 15 years, anxiety was assessed via adolescent- and parent-reports, and global internalizing and externalizing problems were assessed via parent-reports. Confirmatory factor analysis showed that a two-factor model fit the BI data significantly better than a single-factor model, providing evidence for the dissociation of BI in social versus non-social contexts. Social BI was uniquely associated with adolescent social anxiety, whereas non-social BI was specifically associated with adolescent separation anxiety. Neither social BI nor non-social BI predicted global internalizing and externalizing problems, providing evidence for the specific relations between BI and anxiety problems. Together, these results suggest that young children's inhibited responses in social versus non-social situations predict different subtypes of anxiety problems in adolescence, highlighting the multifaceted nature of BI and the divergent trajectories of different anxiety problems.

A Twin Study of the Relationships between Cognitive Disengagement Syndrome and Anxiety Phenotypes in Childhood and Adolescence

Data on the etiological factors underlying the co-occurrence of Cognitive Disengagement Syndrome (CDS) with anxiety symptoms are very limited. The present study investigated the nature of latent shared etiological elements in 400 Italian twin pairs aged 8-18, explaining the covariation between CDS and anxiety symptoms. Preliminary analysis demonstrated significant correlations between Child Behaviour Checklist/6-18 Sluggish Cognitive Tempo Scale and two (Somatic Anxiety, Generalized Anxiety) out of five Screen for Child Anxiety Related Disorders anxiety subscales. Results from causal analysis seem to exclude the hypothesis that co-occurrence between CDS and Anxiety Symptoms could be due to a direct phenotypic effect of one trait upon the other. Model fitting-analysis indicated that the aforementioned associations were partially explained by shared genetic and environmental factors influencing a common liability factor. A latent variable capturing the covariation between CDS and anxiety problems can be considered as a unifying (patho)physiological mechanism/system common to these constructs. Our results support the adoption of a broader view of the relationships between CDS and anxiety phenotypes in childhood and adolescence for both clinicians and educators.

The Cool Kids as a School-Based Universal Prevention and Early Intervention Program for Anxiety: Results of a Pilot Study

The efficacy of the Cool Kids program has been consistently demonstrated both within Australia and internationally, but limited data are available on the use of Cool Kids as a universal program. The purpose of the study is to evaluate Cool Kids as a universal program for preventing childhood anxiety in the school context. There were 73 Italian children (35 boys and 36 girls, ages 10–13 years) attending the last year of primary school and the first year of middle school who participated in an active intervention based on a school adaptation of the Cool Kids protocol. Results of t-test analyses highlighted a downward trend of anxiety symptoms, especially in total anxiety, somatic anxiety, generalized anxiety, separation anxiety, social anxiety and school phobia at post-treatment assessed by children. Even the score of depression symptoms, measured as a second outcome measure, decreased after the treatment. This study contributes to the evidence base for the Cool Kids program as a universal program for preventing childhood anxiety in the school context. Although these preliminary results show some promise, their replication in future research is necessary given current study limitations.

Psychometric Properties of Scared-C Scale in a Romanian Community Sample and Its Future Utility for Dental Practice

The psychological management of children and adolescents in need of pedodontics or orthodontic treatments continues to be an essential objective in dental activity because along with the accuracy of the techniques that are used, anxiety reduction, and knowledge of how to approach the patient are necessary for the treatment to be successful. Therefore, our study aimed to validate the Screen for Child Anxiety Related Emotional Disorders questionnaire, the child version of 41 items (SCARED-C) in the Romanian population for later use in pediatric dentistry. The instrument showed moderate to good internal consistency (α Cronbach from 0.63 to 0.91 for the total scale) and good test-retest reliability (0.70) on a subset of a sample comprising 85 children. A confirmatory factorial analysis (CFA) was conducted to test the factor structure of the Romanian version of the SCARED-C; the results showed that SCARED-C has good psychometric properties that can be used for screening anxiety in Romanian children and adolescents. The implications of using the SCARED-C in dental practice are discussed. Future studies need to be conducted to explore the convergent and discriminative validity of the instrument and its sensitivity to current DSM-V criteria. Application on a pediatric dental sample is also required.

The role of genetic and environmental factors in covariation between anxiety and anger in childhood

Higher levels of anger expression, as well as lower levels of anger control, have been reported for adults with anxiety disorders compared to individuals without anxiety disorders. Different to the research on adults, very few studies examined the relationship between anxiety and anger in childhood. In our study, we investigated 398 Italian twin pairs (74 MZ male, 70 MZ female, 134 same-sex dizygotic-53 male, 81 female-, and 120 unlike-sex dizygotic twin pairs), aged 8-17 (mean 13.06 ± 2.59): (i) the heritability of a childhood anger phenotype; (ii) the association between five anxiety domains and anger; (iii) the role of possible common etiological factors in explaining the observed comorbidity and overlap in the risk between anxiety phenotypes and anger. The study demonstrated that anger, assessed by CBCL items, is heritable in children at a similar rate to prior studies (40%). Our research found low to moderate rate of correlation between anger and anxiety (from 0.10 to 0.19). Finally, the present study found that the majority of etiological influences on anxiety and anger are independent of each other. Data showed that shared environmental influences have some small effects on the phenotypic covariation between the anxiety phenotypes and anger (12%); whereas unique environmental influences have an almost negligible effect (1%). Our analyses did not reveal the effect of genetic effects in explaining the covariation between these phenotypes.

A neurobiological framework of separation anxiety and related phenotypes

In the DSM-5, separation anxiety disorder (SAD) is newly classified in the chapter on anxiety, renewing research efforts into its etiology. In this narrative review, we summarize the current literature on the genetic, endocrine, physiological, neural and neuropsychological underpinnings of SAD per se, SAD in the context of panic disorder, separation anxiety symptoms, and related intermediate phenotypes. SAD aggregates in families and has a heritability of ~43%. Variants in the oxytocin receptor, serotonin transporter, opioid receptor µ1, dopamine D4 receptor and translocator protein genes have all been associated with SAD. Dysregulation of the hypothalamus-pituitary-adrenal axis, dysfunctional cortico-limbic interaction and biased cognitive processing seem to constitute further neurobiological markers of separation anxiety. Hypersensitivity to carbon dioxide appears to be an endophenotype shared by SAD, panic disorder and anxiety sensitivity. The identification of biological risk markers and its multi-level integration hold great promise regarding the prediction of SAD risk, maintenance and course, and in the future may allow for the selection of indicated preventive and innovative, personalized therapeutic interventions.

Italian validation of the Children's Shyness Questionnaire: Exploring associations between shyness and psychosocial functioning

BACKGROUND

In recent years, researchers have begun to explore the implications of shyness for the psychosocial wellbeing of children and adolescents, exploring its association with internalizing problems. Research in an Italian context is hindered by the lack of a validated self-report measure of shyness. We report two studies aimed to assess the psychometric properties of an Italian translation of the Children's Shyness Questionnaire (CSQ-it) and investigate its correlations with convergent and divergent constructs. The first study aimed to examine associations between CSQ-it and self-report measures of anxiety and somatic symptoms and attachment with parents and peers. The second study aimed to investigate its relations to internet addiction.

METHODS

The self-report measures were completed by 550 participants in the first study and 131 participants in the second study. Parents provided information on their child's problems. Psychometric properties were assessed by Cronbach's alpha in both studies and by exploratory and confirmatory factor analysis in Study 1. The relations between shyness and measures of internalizing problems and attachments were analyzed by correlational methods. In Study 2 a moderated mediation model tested the hypothesis that the relationship between shyness and internet addiction is mediated by somatic symptoms and that shyness moderates the relationship between somatic symptoms and internet addiction.

RESULTS

The reliability and validity of the Italian Version of the Children's Shyness Questionnaire were satisfactory. Results from confirmatory factor analyses confirmed the single-factor model of the questionnaire previously identified in North American and Chinese studies. There were significant correlations between shyness, anxious and somatic symptomatology, impaired psychosocial functioning and specific components of attachment relationships. In Study 2 the indirect effect of shyness on internet addiction through somatic symptoms was significant as well as significantly moderated for high shyness scores but not for low levels of shyness.

CONCLUSION

To our knowledge this is the first study that explored the psychometric proprieties of the Children's Shyness Questionnaire in the Italian context. Findings demonstrated that this self-reported measure of shyness has sound psychometric properties and can be used as a sensitive and appropriate instrument for the assessment of shyness in children and adolescents.

Psychometric Properties of the SCARED in a Nationally Representative U.S. Sample of 5-12-Year-Olds

OBJECTIVE

To examine the factor structure of the Screen for Child Anxiety Related Emotional Disorders - Parent Report (SCARED-P) in young children and elucidate normative levels of parent-reported anxiety using a nationally representative sample of parents of children ages 5-12 years living in the United States.

METHOD

The 41-item SCARED-P was administered to parents of 1,570 youth who were selected to match the U.S. population on key demographic variables. SCARED-P model fit and mean score differences by age, race/ethnicity, and sex were assessed.

RESULTS

SCARED-P model fit and subscale reliability appeared almost identical in younger children (ages 5-8) and older children (ages 9-12), although model fit for a five-factor model was poor in both groups. Symptoms of generalized anxiety increased from age 5 to 12, while symptoms of separation anxiety disorder decreased. Parents reported significantly more symptoms of social anxiety in females than males. No significant differences by race/ethnicity were found for mean levels of anxiety or model fit.

CONCLUSIONS

The SCARED-P shows some utility as an anxiety screening instrument in a representative sample of U.S. youth as young as 5-years-old, but caution should be used when interpreting subscale scores.

The genetic and environmental structure of fear and anxiety in juvenile twins

Fear and anxiety are conceptualized as responses to acute or potential threat, respectively. Adult twin studies found substantial interplay between genetic and environmental factors influencing fear disorders (phobias) and anxiety disorders. Research in children, however, has largely examined these factors independently. Thus, there exists a substantial knowledge gap regarding the underlying etiologic structure of these closely-related constructs during development. Symptom counts for five fear (criticism, the unknown, death, animal, medical) and four anxiety (generalized, panic, separation, social) dimensions were obtained for 373 twin pairs ages 9-14. Multivariate twin modeling was performed to elucidate the genetic and environmental influences distributed amongst these dimensions. The best fitting model contained one genetic, two familial environmental, and two unique environmental factors shared between fear and anxiety symptoms plus dimension-specific genetic and unique environmental factors. Although several environmental factors were shared between fear and anxiety dimensions, one latent factor accounted for genetic influences across both domains. While adult studies find somewhat distinct etiological differences between anxiety and phobic disorders, the current results suggest that their relative genetic and environmental influences are not as clearly demarcated in children. These etiological distinctions are more nuanced, likely contributing to the highly diffuse symptom patterns seen during development.

The Genetic and Environmental Relationship Between Childhood Behavioral Inhibition and Preadolescent Anxiety

This study uses novel approaches to examine genetic and environmental influences shared between childhood behavioral inhibition (BI) and symptoms of preadolescent anxiety disorders. Three hundred and fifty-two twin pairs aged 9-13 and their mothers completed questionnaires about BI and anxiety symptoms. Biometrical twin modeling, including a direction-of-causation design, investigated genetic and environmental risk factors shared between BI and social, generalized, panic and separation anxiety. Social anxiety shared the greatest proportion of genetic (20%) and environmental (16%) variance with BI with tentative evidence for causality. Etiological factors underlying BI explained little of the risk associated with the other anxiety domains. Findings further clarify etiologic pathways between BI and anxiety disorder domains in children.

Screening for childhood anxiety: A meta-analysis of the screen for child anxiety related emotional disorders

BACKGROUND

The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a commonly used instrument that evaluates anxiety symptoms in children and adolescents.

METHODS

This meta-analysis examined the psychometric properties of the SCARED instrument, including total instrument and subscale internal reliabilities for the parent and child versions, test-retest reliabilities, and the extent to which responses from the parent version correspond with responses from the child version. Databases reviewed included ERIC, PubMed, PsycINFO, ProQuest Dissertations and Theses, and Google Scholar RESULTS: Responses to the SCARED instrument for children and parents using a mixture of the 38-, 41-, 66-, 69-, and 71-item versions of the SCARED were analyzed for 65 studies conducted between 1997 and 2017. The results from the random-effects models suggested homogeneity of variance for all the effects examined. The weighted averages of the psychometric properties indicated the parent and child versions of the SCARED have exhibited excellent internal consistencies on the total score, panic disorder, generalized anxiety, separation anxiety, social anxiety, post-traumatic stress, and animal phobia subscales. Furthermore, the SCARED demonstrated moderate to large test-retest reliabilities and moderate to large parent-child agreement rates. The school avoidance, obsessive-compulsive disorder, blood phobia, and situational phobia subscales did not demonstrate reliabilities considered appropriate for a screening instrument.

LIMITATIONS

Publications that could not be translated to English or could not be retrieved due to not being published or archived were not included in the analysis.

CONCLUSIONS

Overall the child and parent versions of the SCARED have robust psychometric properties and perform consistently well in community and clinical settings across various countries. The SCARED is clinically relevant as mental health providers and researchers can use it during diagnostic procedures and to monitor intervention effectiveness.

Current evolutionary adaptiveness of anxiety: Extreme phenotypes of anxiety predict increased fertility across multiple generations

OBJECTIVE

Although recent research has begun to examine the impact of elevated anxiety on evolutionary fitness, no prior research has examined anxiety across a continuum. Such research is important as the effect of traits across a continuum on fertility hold important implications for the levels and distribution of the traits in later generations.

METHOD

In a three-generational sample (N = 2657) the linear and quadratic relationship between anxiety and the number of children, grandchildren, and great-grandchildren 15 years later was examined.

RESULTS

The findings suggested that anxiety had a positive quadratic relationship with the number of children, grandchildren, and great-grandchildren 15 years later. These relationships were not significantly moderated by sex. Moreover, most of the variance between anxiety and the number of great-grandchildren was explained by anxiety's influence on the number of children and grandchildren, as opposed to anxiety having an independent direct impact on the number of great-grandchildren.

CONCLUSION

These findings suggest that extreme values from the mean anxiety are associated with increased evolutionary fitness within the modern environment.

Evaluation of Mother-Child Agreement and Factorial Structures of the SCARED Questionnaire in an Italian Clinical Sample

Background: A great part of the literature has confirmed the importance of both child and parents reports as source of factual information, especially for childhood emotional syndromes. In our study we aimed at: (i) calculating mother-child agreement and (ii) evaluating factorial structure of the Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire in an Italian clinical sample. The novelty of this contribution is two-fold: first, from a clinical point of view, we investigated the parent-child agreement level and examined separately the factorial structures of both parent and child versions of the SCARED for the first time in an Italian clinical sample. Second, unlike previous studies, we used statistical approaches specifically suited to account for the ordinal nature of the collected variables.

Method: In a clinical sample of 171 children and adolescents aged 8–18 and their mothers we evaluated inter-rater agreement using weighted kappa indices to assess agreement for each item belonging to a certain SCARED subscale. Exploratory factor analysis for ordinal data was then performed on the polychoric correlation matrix calculated on SCARED items. Differences in the numbers of symptoms reported by children and parents were evaluated as well.

Results and Conclusions: Our results reveal moderate to strong mother-child agreement. A significant age effect is present. Two different factorial solutions emerged for parent and child SCARED versions (a 5 factor structure for parents and a 6 factor solution in the child version, including a new factor “Worry about Parents”). This study confirmed the importance of evaluating both child and parent reports in assessment protocols for anxiety disorders. Our findings could help clinicians to determine which information, and from which rater, must be accounted for in evaluating treatment decisions. Moreover, we find that patients characteristics, such as gender and age, should be taken into account when assessing agreement.

Family accommodation mediates the association between anxiety symptoms in mothers and children

OBJECTIVE

The link between child anxiety and maternal anxiety has been well established but the factors underlying this association are not well understood. One potential factor is family accommodation, which describes ways in which parents change their behaviour to help a child avoid or alleviate anxiety. Family accommodation has been associated with greater symptom severity, more impairment and poorer treatment outcomes in the child. The aim of this study was to investigate whether maternal accommodation mediates the relation between parent and child anxiety.

METHOD

Mothers of children (N = 85) aged 7-17 years (M = 11.79) completed measures of their own anxiety (State-Trait Anxiety Inventory (STAI)), their child's anxiety (Screen for Child Anxiety Related Disorders (SCARED)), and family accommodation (Family Accommodation Scale Anxiety (FASA)). Structural equation modelling (SEM) was used to test the mediational role of accommodation linking parent and child anxiety.

RESULTS

Family accommodation was found to significantly mediate the link between maternal anxiety and child anxiety.

CONCLUSION

These results inform theory and imply that the development of interventions designed to target family accommodation may improve the prognosis of those diagnosed with paediatric anxiety disorders and youth with subclinical anxiety symptoms by reducing both parent and child anxiety.

Factor Structure of the Screen for Child Anxiety-Related Emotional Disorders (SCARED) in a Community Sample of Hong Kong Chinese Adolescents

The current study tested the factor structure of the 41-item SCARED in assessing anxiety in a sample of Hong Kong adolescents. Data were collected from 5,226 youths (54.5 % boys) aged 12-18. Results showed that the scale and the five subscales had high internal consistency. However, confirmatory factor analyses showed that the original five-factor model did not fit the data collected in this sample. Instead, the results revealed a seven-factor model consisting of one second-order factor of anxiety and seven first-order factors: the four original factors of General Anxiety, Panic/Somatic Syndromes, Social Anxiety, and School Phobia and three new factors representing different aspects of Separation Anxiety. Group invariance in the Boys and Girls models was found. It is recommended that the three new factors (Fear of Loneliness, Separation Fear, Worry about Harm) be further developed by adding new items so as to enhance the content and construct validities of the SCARED when used with Hong Kong adolescents.

Genetic and environmental contributions to anxiety among Chinese children and adolescents--a multi-informant twin study

BACKGROUND

Child and adolescent anxiety has become a major public health concern in China, but little was known about the etiology of anxiety in Chinese children and adolescents. The present study aimed to investigate genetic and environmental influences on trait anxiety among Chinese children and adolescents. Rater, sex, and age differences on these estimates were also examined.

METHODS

Self-reported and parent-reported child's trait anxiety was collected from 1,104 pairs of same-sex twins aged 9-18 years. Genetic models were fitted to data from each informant to determine the genetic (A), shared (C), and non-shared environmental (E) influences on trait anxiety.

RESULTS

The parameter estimates and 95% confidence intervals (CI) of A, C, E on self-reported trait anxiety were 50% [30%, 60%], 5% [0%, 24%], 45% [40%, 49%]. For parent-reported data, the corresponding parameter estimates were 63% [47%, 78%], 13% [1%, 28%], and 24% [22%, 27%], respectively. The heritability of anxiety was higher in girls for self-reported data, but higher in boys for parent-reported data. There was no significant age difference in genetic and environmental contributions for self-reported data, but a significant increase of heritability with age for parent-reported data.

CONCLUSIONS

The trait anxiety in Chinese children and adolescents was highly heritable. Non-shared environmental factors also played an important role. The estimates of genetic and environmental effects differed by rater, sex and age. Our findings largely suggest the cross-cultural generalizability of the etiological model of child and adolescent anxiety.

Avoidance moderates the association between mothers' and children's fears: findings from a novel motion-tracking behavioral assessment

BACKGROUND

Fear and anxiety in children are associated with similar symptoms in parents. Parental modeling of fearful or avoidant behavior is believed to contribute to this association. We employed a novel motion-tracking experimentation platform to test the hypothesis that mothers' behavioral avoidance of spiders moderates the association between fear of spiders in mothers and children.

METHOD

Participants were 86 children (aged 7-17) presenting with an anxiety disorder, and their mothers. Children and mothers completed the Spider Phobia Questionnaire. Mothers completed a motion-tracking assessment of behavioral avoidance of spiders.

RESULTS

Fear of spiders in mothers was associated with fear of spiders in children (r85  = 0.48, 95%CI 0.30 - 0.63, P < 0.001). Two metrics of behavioral avoidance in mothers were associated with mothers' self-reported fear of spiders (r = -0.49, 95% CI 0.31-0.64, P < 0.001; and r = 0.42, 95%CI 0.23 - 0.58 P < 0.001). Mothers' behavioral avoidance moderated the association between fear of spiders in mothers and in children. When mothers' avoidance was intermediate or high the association was significant, and as mothers' behavioral avoidance increased the strength of the association increased. Fear of spiders in mothers with low behavioral avoidance was not associated with fear of spiders in their children.

CONCLUSIONS

The study demonstrates that behavioral avoidance can be measured using the motion-tracking platform and can be useful in understanding the links between symptoms of anxiety in mothers and children. Reducing parents' overt expressions of avoidance may lower the risk of fears being transmitted to children.

Genetic and environmental contributions to social anxiety across different ages: a meta-analytic approach to twin data

Social anxiety disorder (SAD) and social anxiety symptoms (SAS) have been largely studied both epidemiologically and genetically, however, estimates of genetic and environmental influences for these phenotypes widely vary across reports. Based upon available literature, 13 cohorts (42,585 subjects) were included in 3 meta-analytic estimates of the standardized variance components of aetiological influences on SAD/SAS, on the effect of age and of phenotype (symptoms vs. diagnosis). The proportions of variance accounted for by genetic and environmental factors were calculated by averaging estimates among studies, and pondered by the number of individuals in each sample. Meta-analytic estimations showed that genetic and non-shared environmental factors explain most of individual differences for SAD/SAS. In adults, the genetic contribution was half than that in younger patients, with higher contribution of non-shared environmental influences. In contrast, the shared environmental factors seem to be less relevant.

Genetic and environmental causes of variation in adolescent anxiety symptoms: a multiple-rater twin study

Heritability estimates for adolescent anxiety vary across studies, partly depending on who is rating the symptoms. The goal of our study was to estimate genetic and environmental influences using a multi-informant design with responses from a population-based sample of adolescent twins, their mothers and their fathers (N=1394 families). Results from multivariate biometrical modeling indicated quantitative, but no qualitative sex differences in etiology. The best fitting model was an AE Common Pathway model, defining anxiety as a latent factor common to all informants. This model offers error free estimates of genetic and environmental influences explaining the latent factor variance. Variation in the latent factor was highly genetic, with heritability estimates of 65% for boys and 74% for girls. Non-shared environmental effects explained the remaining variance. In addition, there were significant rater-specific genetic and environmental effects for both sexes. The observed rater differences underline the importance of using several informants when studying adolescent anxiety.

Preschool anxiety disorders in pediatric primary care: prevalence and comorbidity

OBJECTIVE

We sought to establish prevalence rates and detail patterns of comorbidity for generalized anxiety disorder, separation anxiety disorder, and social phobia in preschool-aged children.

METHOD

The Duke Preschool Anxiety Study, a screen-stratified, cross-sectional study, drew from pediatric primary care and oversampled for children at risk for anxiety. A total of 917 parents of preschool children (aged 2-5 years) completed the Preschool Age Psychiatric Assessment.

RESULTS

Generalized anxiety disorder, separation anxiety disorder, and social phobia are common in preschool-aged children attending pediatric primary care. Three-fourths of preschoolers with an anxiety disorder only had a single anxiety disorder. Generalized anxiety disorder displayed the greatest degree of comorbidity: with separation anxiety disorder (odds ratio [OR] = 4.1, 95% CI = 2.0-8.5), social phobia (OR = 6.4, 95% CI = 3.1-13.4), disruptive behavior disorders (OR = 5.1, 95% CI = 1.6-15.8), and depression (OR = 3.7, 95% CI = 1.1-12.4).

CONCLUSIONS

The weakness of association between generalized anxiety disorder and depression stands in contrast to substantial associations between these 2 disorders reported in older individuals. Attenuated associations in preschool-aged children could translate into clinical opportunities for targeted early interventions, aimed at modifying the developmental trajectory of anxiety disorders.

Anxiety in school students: Role of parenting and gender

BACKGROUND

The prevalence of anxiety is high in school going children; however pattern of parenting and gender of the child are important factors for the development of anxiety. Gender role and parenting patterns are important construct that vary across different sociocultural setting hence are important to be studied in Indian context.

MATERIALS AND METHODS

In a cross sectional study all students of both sexes studying in class VIII, were assessed using the Spence anxiety scale (children version).

RESULTS

The sample consisted of 146 (55% male and 45% female) with a mean age of 12.71 years. A total of 16 (11%) students scored above cutoff for high anxiety, the mean scores across gender shows that female students scored significantly higher in total and all sub types of anxiety. Most of the students perceived their parents 'Democratic' and other two authoritarian and permissive type of parenting were almost equal. There was significantly higher anxiety among the students who perceived their parents as authoritarian.

CONCLUSIONS

The prevalence of high anxiety was 11% in class VIII students. High anxiety in students was significantly associated with female gender and authoritarian parenting pattern as perceived by the children.

Examination of a cutoff score for the Screen for Child Anxiety Related Emotional Disorders (SCARED) in a non-clinical Spanish population

We aimed to find a valid cutoff score for the Screen for Child Anxiety Related Emotional Disorders, child (SCARED-C) and parent (SCARED-P) Spanish versions for detecting Anxiety Disorders (AD) in a non-clinical population. The predictive accuracy of the SCARED-C and SCARED-P was assessed using the Area Under the Curve (AUC) of ROC curves. In general, the predictive accuracy of the SCARED-C (full version, short version, and four factors) was good and better than that of the SCARED-P. To differentiate between children who meet the diagnostic criteria for any AD and children who do not, we propose cutoff scores of 25 and 17 for the SCARED-C and SCARED-P, respectively. The sensitivities are 75.9% and 62.8%, and the specificities are 68.5% and 69.5%. The SCARED-C factor that had the best predictive accuracy was Somatic panic followed by Separation Anxiety, Generalized Anxiety and Social Phobia. The SCARED-P factor with the best predictive accuracy was Separation Anxiety. The results support the use of SCARED-C as a screening test for Anxiety disorders while SCARED-P should only be used as complementary information.

An Update on the Italian Twin Register: Advances in Cohort Recruitment, Project Building and Network Development

The Italian Twin Register has been in place for more than 10 years. Since its establishment, it has been focusing, on the one hand, on a continuous update of the existing information, and on the other hand, on new phenotypes and sample collection. Demographic data on about 140,000 twins have been updated using the municipality registries. The Italian Twin Register has been carrying out several new studies during the last few years. A birth cohort of twins, Multiple Births Cohort Study, has been started and the enrolment is ongoing. For this cohort, data on pregnancy and birth are collected, and periodical follow-ups are made. DNA is being collected for the twins and their parents. In the area of behavioral genetics, most efforts have been directed to psychological well being assessed with self-reported tools. Research on age-related traits continues with studies on arteriosclerosis development, early biomarkers in mild cognitive impairment, and the relation between lifestyle habits and mutagen sensitivity. The Italian Twin Register biobanking has grown in its size and in its know-how in terms of both technical issues and ethical procedures implementation. Furthermore, attitudes toward biobank-based research, together with willingness and motivation for donation, are being investigated. A valuable key resource for the Italian Twin Register is the possibility of linking twin data with disease registries. This approach has been yielding several important results, such as the recent study on the heritability of type 1 diabetes.

Genetic and environmental contributions to separation anxiety: a meta-analytic approach to twin data

BACKGROUND

Separation anxiety disorder (SAD) and separation anxiety symptoms (SA) have been studied both epidemiologically and genetically; however, large between-studies discrepancies emerge relative to the role of genetic, shared-, and nonshared environmental influences on these conditions.

METHODS

Based upon available literature, 18 cohorts and 31,859 subjects belonging to twin samples in Europe, the United States, and Australia were included in three meta-analytic estimations of: the standardized variance components of etiological influences on SAD/SA, and on the effect of sex and rater.

RESULTS

Meta-analytic estimations carried out on all cohorts showed that within-family (genetic 43% and shared environmental 17%) factors explain most of individual differences for SAD/SA. Meta-heritability estimates were higher among females (.52) than males (.26), whereas nonshared environmental effects were stronger for the latter (.74) than for the former (.41). When SAD/SA was rated by parents, the shared environmental influences were higher than those obtained with self-assessment instruments (.23 versus .05), but this may reflect an age difference between subsamples.

CONCLUSIONS

A shared environmental effect is present and important in SAD/SA. Our results support at an etiological level the involvement of parents in treating SAD/SA in children, and the provision of specific strategies to parents to manage their own anxiety.

Psychometric Properties of the Social Phobia and Anxiety Inventory for Children (SPAI-C)

Reliable and valid self-report questionnaires could be useful as initial screening instruments for social phobia in both clinical settings and general populations. The present study investigates the factor structure and psychometric properties of the Social Phobia and Anxiety Inventory for Children (SPAI-C) in a sample of 228 children from the Italian general population aged 8 to 11. The children were asked to complete the Italian version of the SPAI-C and the Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire. Confirmatory factor analyses revealed that social phobia can be conceptualized as a unitary construct consisting of five distinct but interrelated symptom clusters named Assertiveness, General Conversation, Physical/Cognitive Symptoms, Avoidance, and Public Performance. Internal consistency of the SPAI-C total scores and two subscales was good; correlations between SPAI-C total scores and SCARED total scores/subscales ranged from moderate to high (Generalized Anxiety Disorder, for social phobia), with the SCARED Social Phobia subscale as the best predictor of SPAI-C total scores. The results indicate that the SPAI-C is a reliable and sensitive instrument suitable for identifying Social Phobia in the young Italian general population.

Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders in a rural high school population

PROBLEM

  Evaluate psychometric properties of the 41-item SCARED (Screen for Child Anxiety Related Emotional Disorders) when used with a rural community-dwelling sample.

METHODS

  As part of a randomized controlled trial, SCARED was administered to 193 adolescents in a rural high-school setting. Internal consistency, test-retest reliability, and factor structure were assessed.

FINDINGS

  Adequate internal consistency (α= 0.93) and test-retest reliability (r= 0.703) were demonstrated. Five factors were identified with a differing composition than previously reported.

CONCLUSIONS

  The SCARED was found to be a reliable tool in the rural adolescent population. Differences in some factors suggest further research is needed.

The Italian Twin Register: New Cohorts and Tools, Current Projects and Future Perspectives of a Developing Resource

Since its start as a database of ‘possible twins’, the Italian Twin Register has developed remarkably in terms of twin approach and recruitment, data-management tools, the cohorts enrolled, and the breadth of information gathered, making the Italian Twin Register a valuable resource for genetic epidemiological research. The Italian Twin Register is a random population of twins at both the national level and within targeted geographical areas or birth cohorts. Further, the Register is linked with disease records and has recently implemented a web-based method for volunteer twin recruitment specifically designed to promote the Register and to disseminate information on genetic epidemiology. To date, approximately 9000 twins have joined the Italian Twin Register, the majority of whom (approximately 70%) represent young adults aged 20 at time of enrolment. Although the total number of twins recruited to date is far below the expected figure initially predicted, the newly established standardized procedures guarantee an increase of around 2000 twins each year. Following the collaboration between the Italian Twin Register and the main Italian nonprofit association for blood donors, twin DNA sampling and storage has recently accelerated contributing to the large amount of phenotypic data collected. The Italian Twin Register is currently involved in both population and clinical based studies on various complex pheno-types and diseases, some conducted within large European consortia.

A meta-analysis of the cross-cultural psychometric properties of the Social Phobia and Anxiety Inventory for Children (SPAI-C)

Several studies have found that the Social Phobia and Anxiety Inventory for Children (SPAI-C), an empirically derived self-report instrument to assess DSM-IV social phobia in childhood and adolescence, has good psychometric properties. While these findings were replicated across different cultures, the overall strength of the psychometric properties of the SPAI-C remains unknown. We assessed the validity of the SPAI-C by meta-analytic techniques across studies collected from PubMed, PsycInfo and Eric databases, conducted in different countries, among subjects of different age, and sex. A total of 21 articles were retained, predominantly from Europe and North America. We found that the psychometric properties based on Cronbach alpha, mean score differences between sexes, and construct validity, were robust for the SPAI-C scale. Girls scored significantly higher than boys, and geographical differences played a moderating effect on sex-related score differences. These results further support the SPAI-C as an instrument to identify Social Phobia in youth.

Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in Brazilian children and adolescents

The aim of this study was to evaluate the psychometric properties of the Brazilian-Portuguese version of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in a large community sample of Brazilian children and adolescents. A total of 2410 students completed the 41-item Brazilian-Portuguese version of the SCARED. The one-factor and the five-factor structure of the SCARED fit this sample well. However, the five-factor model had a significantly better fit than the one-factor model and an adequate fit for age and gender subgroups. Anxiety symptoms in Brazilian youth were reported at a moderate-high level as compared to other studies. Females were found to score significantly higher on the total score and on all of the subscales as compared to the males. The total score and each of the five factors for both children and adolescents showed good internal consistency, test-retest and construct validity. According to our findings the Brazilian-Portuguese version of the SCARED is a reliable and valid instrument to assess anxiety in Brazilian children and adolescents.

Nine-year stability of type D personality: contributions of genes and environment

OBJECTIVE

To assess longitudinal changes in genetic and environmental influences on Type D personality and its subcomponents negative affectivity (NA) and social inhibition (SI) over a 9-year period. Most personality constructs have good retest reliability over long periods, with stability attributed to genes, and changes to environmental factors. Type D personality is stable across an 18-month period and is influenced by genetic factors. However, there is no knowledge on long-term stability, and the contributions of genes and environment to that stability.

METHODS

Type D personality was determined from survey data collected in 1991 (n = 3235; mean age = 17.3 years), 1997 (n = 3133; mean age = 25.3 years), and 2000 (n = 4456; mean age = 29.6 years) in a population sample of healthy twins. Multivariate structural equation modeling was employed.

RESULTS

Type D heritability ranged from 50% in 1997 to 34% in 2000, with the same genetic factor affecting Type D at all time points. Heritability of SI ranged from 49% (1991) to 42% (2000), with the same genetic factor influencing SI at all times. Heritability estimates for NA ranged from 45% (1991) to 40% (2000), with one genetic factor influencing NA at all times, and one genetic factor influencing NA at the second and third occasions. Different environmental factors acted on Type D, NA, and SI at each of the three measurement occasions.

CONCLUSION

Type D personality and both subcomponents are stable over time, which is largely due to genetic factors. Different unique environmental factors influence the Type D components at different occasions.

A meta-analysis of the cross-cultural psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED)

BACKGROUND

Accumulating studies have demonstrated that the Screen for Child Anxiety Related Emotional Disorders (SCARED), a modern youth anxiety questionnaire with scales explicitly designed to map onto specific DSM-IV-TR anxiety disorders, has good psychometric properties for children and adolescents from various countries. However, no study has yet been conducted as to the overall strength of the psychometric properties found in these studies.

METHODS

Studies were collected from the PsycINFO, PubMed, SSCI, SCI-Expanded, ERIC, and A&HCI databases from the year of the SCARED's first publication (1997) to the present. The inclusion criteria focused on all studies that examined the psychometric properties of the SCARED.

RESULTS

We retained 21 articles, reporting a total of 25 studies from predominantly Europe (Belgium, Germany, Italy, the Netherlands) and the USA, as well as South Africa and China, which matched our inclusion criteria. It was found that the psychometric properties were robust for the SCARED scales related to the symptoms of DSM-IV-TR anxiety disorders, that females scored significantly higher than males and that age had a moderating effect on male and female score differences.

CONCLUSIONS

This meta-analysis suggests that the SCARED can be utilized as a screening instrument for DSM-IV-TR anxiety disorder symptom dimensions for children and adolescents from various countries.

DSM-IV criteria for childhood separation anxiety disorder: informant, age, and sex differences

BACKGROUND

The present study examines frequency of DSM-IV symptom and diagnostic criteria for separation anxiety disorder (SAD) by informant, age, and sex.

METHODS

Children aged 4-15 years with a primary DSM-IV diagnosis of SAD (N=106) were assessed using structured diagnostic interviews (Kinder-DIPS; DSM-IV-TR Version). Frequency of DSM-IV symptom and diagnostic criteria were examined as a function of informant and child characteristics, along with impairment and distress ratings.

RESULTS

The most frequently reported symptoms were separation-related distress, avoidance of being alone/without an adult and sleeping away from caregivers or from home, with nightmares the least frequently endorsed criterion. Child report did not yield any significant sex or age differences. However, parent report revealed greater reluctance or avoidance of school attendance for girls than boys, and for younger children (<8 years). Parent report indicated greater symptom-related impairment than child report, and the number of symptoms was correlated with impairment based on parent report, and with distress based on child report.

CONCLUSIONS

The primary indicators of SAD appear to be separation distress, avoidance of being alone, and sleeping away from caregivers. Findings suggest that parents may be best placed to determine impairment, while children may be the most accurate reporters of more covert internal distress. Implications for clinicians are that reports from multiple informants should be used to gain the most comprehensive information about childhood SAD.

Genetic and environmental influences upon the CBCL/6-18 DSM-oriented scales: similarities and differences across three different computational approaches and two age ranges

Inasmuch as the newly established DSM-oriented CBCL/6-18 scales are to be increasingly employed to assess clinical/high-risk populations, it becomes important to explore their aetiology both within the normal- and the extreme range of variation in general population samples and to compare the results obtained in different age groups. We investigated by the Quantitative Maximum Likelihood, the De Fries-Fulker, and the Ordinal Maximum Likelihood methods the genetic and environmental influences upon the five DSM-oriented CBCL/6-18 scales in 796 twins aged 8-17 years belonging to the general population-based Italian Twin Registry. When children were analysed together regardless of age, most best-fitting solutions yielded genetic and non-shared environmental factors as the sole influences for DSM-oriented CBCL/6-18 behaviours, both for the normal and the extreme variations. When analyses were conducted separately for two age groups, shared environmental influences emerged consistently for Affective and Anxiety Problems in children aged 8-11. Oppositional-Defiant, Attention Deficit/Hyperactivity, and Conduct Problems appeared-with few exceptions-influenced only by genetic and non-shared environmental factors in both age groups, according to all three computational approaches. The De Fries-Fulker method appeared to be more sensitive in detecting shared environmental effects. Analysing the same set of data with different analytic approaches leads to better-balanced views on the aetiology of psychopathological behaviours in the developmental years.

The role of genes and environment in shaping co-occurrence of DSM-IV defined anxiety dimensions among Italian twins aged 8-17

This study investigated the ultimate causes of co-variation between symptoms of four common DSM-IV anxiety dimensions - Generalized Anxiety, Panic, Social Phobia and Separation Anxiety disorder - assessed with the Italian version of the Screen for Child Anxiety-Related Emotional Disorders questionnaire in a sample of 378 twin pairs aged 8-17 from the population-based Italian Twin Register. Genetic and environmental proportions of covariance between the targeted anxiety dimensions were estimated by multivariate twin analyses. Genetic influences (explaining from 58% to 99% of covariance) and unique environmental factors were the sole sources of co-variation for all phenotypes under study. Genetic influences associated with different anxiety dimensions coincide remarkably, as indicated by genetic correlations ranging from 0.40 to 0.61, while unique environmental overlap is less substantial. Thus, while additive genetic effects are important in explaining why children report symptoms from multiple anxiety disorders, environmental idiosyncratic factors seem to play a marginal role in shaping the co-occurrence of different anxiety dimensions in childhood.

Phenotypic and genetic differentiation of anxiety-related behaviors in middle childhood

BACKGROUND

Anxiety-related behaviors (ARBs) are commonly observed during typical development, yet few studies have investigated their etiology in middle childhood. This study aimed to examine both the phenotypic and genetic differentiation of ARB subtypes within the general population at age 7 and 9. It constituted a follow-up to an earlier study of ARBs in preschool children.

METHODS

We investigated the phenotypic structure of ARBs in a large population-based twin sample, comprising 7,834 twin pairs at age 7 and 3,644 twin pairs at age 9. Quantitative genetic modeling techniques were then used to determine the relative influences of genetic and environmental factors upon different types of ARB and upon the covariation between them.

RESULTS

Factor analysis supported the presence of five ARB factors at both ages: negative cognitions, negative affect, fear, obsessive-compulsive behaviors, and social anxiety. Multivariate genetic analyses revealed significant genetic effects and a small but significant influence of shared environment for all ARB subtypes. There was a moderate level of genetic specificity for each subtype as well as some shared genetic effects. Shared environmental influences correlated highly across all types of ARB, whereas nonshared environmental effects were largely subtype specific.

CONCLUSIONS

The current results suggest that ARBs can be differentiated both phenotypically and genetically within middle childhood, with subtypes reflecting symptom groupings of diagnosable disorders but also aspects of temperament. Although some etiological risk factors lead to a generalized vulnerability to anxiety, others may serve to differentiate between different types of ARBs.

Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in the general Italian adolescent population: a validation and a comparison between Italy and The Netherlands

In this study examination is given to the psychometric properties of the Italian version of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in a large community sample of adolescents. Additionally, a comparison was made between the anxiety scores of this Italian adolescent cohort (N=1975) and a comparative Dutch adolescent cohort (N=1115). Findings revealed that a five-factor structure of the SCARED applied not only to the Italian adolescents from the general community, but also to boys and girls, and to early and middle adolescents. Moreover, sex and age differences on anxiety scores within the Italian sample were found to be consistent with previous studies of adolescent anxiety disorders. Finally, Italian adolescents reported higher anxiety scores than their Dutch peers. Findings of this study highlight that the SCARED is a valid screening instrument to rate anxiety symptoms of Italian adolescents.

Entwicklungspsychopathologie Sozialer Angststörungen

Die Soziale Phobie (oder Soziale Angststörung) stellt eine häufige psychische Störung dar, die insbesondere aufgrund ihres chronischen Verlaufs mit umfassenden Beeinträchtigungen einhergeht. Voraussetzung für die langfristig wirksame Behandlung oder Prävention der Störung ist ein umfassendes Verständnis bedingender und aufrecht erhaltender Faktoren. Mittlerweile liegen neben einer Reihe deskriptiver Störungsmodelle zur Entstehung und Aufrechterhaltung eine Vielfalt empirischer Ergebnisse zu Risikofaktoren sozialer Ängste vor. Neben einem Überblick über Phänomenologie und Epidemiologie Sozialer Angststörungen liegt der Schwerpunkt der Arbeit auf der Diskussion möglicher Einflussfaktoren in einer Entwicklungspsychopathologie der Sozialen Phobie. Dabei werden internale Faktoren, wie Familiengenetik, Temperament, kognitive Stile und soziale Fertigkeiten, sowie externe Faktoren, wie Erziehungsverhalten der Eltern und Erfahrungen mit der sozialen Umwelt, berücksichtigt. Zur Integration dieser Befunde werden differenzierte Modelle zur Ausbildung und zu differenziellen Entwicklungsverläufen generalisierter und isolierter sozialer Ängste vorgeschlagen.

Developmental trajectories of adolescent anxiety disorder symptoms: a 5-year prospective community study

OBJECTIVE

This study prospectively examined the developmental trajectories of anxiety disorder symptoms in a large sample of adolescents from the general population.

METHOD

Two cohorts of early and middle adolescents (1,318 junior high and high school students) completed the Screen for Child Anxiety Related Emotional Disorders during 5 consecutive years. The Screen for Child Anxiety Related Emotional Disorders is a questionnaire that measures self-rated child and adolescent anxiety symptoms that map onto DSM-IV-TR anxiety disorders. At the first wave of measurement, the early and middle adolescent cohorts were an average of 12 and 16 years of age, respectively. Age and sex differences in the developmental trajectories of adolescent anxiety disorder symptoms over time were examined by means of latent growth modeling.

RESULTS

Over the course of 5 years, there was a slight decrease in the panic disorder, school anxiety, and separation anxiety disorder symptoms for all of the adolescents, with the exception of social phobia symptoms, which remained fairly stable over time. Adolescent girls showed a slight increase of generalized anxiety disorder symptoms over time, whereas these symptoms decreased among adolescent boys.

CONCLUSIONS

This study replicates and extends earlier findings on the developmental trajectories of anxiety symptoms during adolescence. By using individually focused, trajectory-based analyses rather than group score differences, this study extends earlier findings and advances our understanding of age and sex differences in the development of adolescent anxiety symptoms.

The co-occurrence between internalizing and externalizing behaviors. A general population twin study

Although Internalized and Externalized problem behaviors are described as separate phenomena at the psychometric and clinical levels, they frequently co-occur. Only few studies, however, have investigated the causes of such covariation. In a sample of 398 twin pairs aged 8-17 drawn from the general population-based Italian Twin Registry, we applied bivariate genetic analyses to parent-rated CBCL/6-18 Internalization and Externalization scores. Covariation of Internalizing and Externalizing problem behaviors was best explained by genetic and common environmental factors, while the influence of unique environmental factors upon covariance appeared negligible. Odds ratio values showed that a borderline/clinical level of Externalization is a robust predictor of co-existing Internalizing problems in the same child, or within a sibship. Our findings help to approximate individual risks (e.g., in clinical practice, predicting the presence of Internalization in an externalizing child, and vice-versa), and to recognize that several shared environmental and genetic factors can simultaneously affect a child's proneness to suffer from both types of problem behaviors.

A multivariate genetic analysis of specific phobia, separation anxiety and social phobia in early childhood

BACKGROUND

Comorbidity amongst anxiety disorders is very common in children as in adults and leads to considerable distress and impairment, yet is poorly understood. Multivariate genetic analyses can shed light on the origins of this comorbidity by revealing whether genetic or environmental risks for one disorder also influence another. We examined the genetic and environmental influences on the comorbidity between three common childhood anxiety disorders: Specific Phobia, Separation Anxiety and Social Phobia.

METHODS

Using a two-phase design 4,662 twin-pairs were screened in the first phase and 854 pairs were assessed in the second phase by maternal-informant diagnostic interview using DSM-IV criteria.

RESULTS

Multivariate genetic analysis revealed significant shared environmental over-lap between Specific Phobia and Separation Anxiety and significant familial and non-shared environmental over-lap between Specific Phobia and Social Phobia.

CONCLUSIONS

Familial influences, especially shared environment, are central to the comorbidity between Specific Phobia and both Separation Anxiety and Social Phobia.

Socioeconomic status mediates the genetic contribution of the dopamine receptor D4 and serotonin transporter linked promoter region repeat polymorphisms to externalization in preadolescence

The impact of socioeconomic status (SES) and genetic polymorphisms on individual differences for externalized behaviors have often been investigated separately in studies of children and adults. In a general population sample of 607 Italian preadolescents, we examined the independent and joint effects of SES and the dopamine receptor D4 (DRD4) and serotonin transporter linked promoter region (5-HTTLPR) polymorphisms upon rule-breaking and aggressive behaviors measured with the Child Behavior CheckList/6–18. We found evidence, which was based on both one locus and two-loci genotype analyses, that low SES andDRD4long and5-HTTLPRlong alleles, both alone and in interaction, are associated with higher aggressive behavior scores. The effects were similar but more modest and limited to one locus genotype analyses for rule-breaking behavior. Consistent with studies that showed the effects of societal moderators on the heritability of externalized behaviors across different segments of the population, we suggest that diminished social constraints associated with low parental SES may act as enhancers of the genetic influence of specificDRD4and5-HTTLPRalleles over aggressive behaviors in preadolescence.

A general population twin study of the CBCL/6-18 DSM-oriented scales

OBJECTIVE

To explore the contributions of genetic and environmental influences to individual variation and covariation of the Child Behavior Checklist (CBCL) DSM-oriented scales (DOS) originally proposed by Achenbach and associates in 2001.

METHOD

A classic twin study of 398 twin pairs ages 8 to 17 years belonging to the population-based Italian Twin Registry, assessed by parents using the CBCL for Ages 6 to 18 (CBCL/6-18).

RESULTS

Univariate analyses showed that compared with the classic CBCL/6-18 empirical subscales, the DOS have higher heritability (lowest 0.54 for Anxiety Problems, highest 0.71 for Conduct Problems) and simpler causal structure in that the phenotypic variance was satisfactorily explained by additive genetic and unique environmental factors only. Multivariate analyses showed that the causes of phenotypic correlation among the different DOS can be attributed to one common genetic factor and to two idiosyncratic environmental factors, each loading differently on the Internalizing (Anxiety and Affective Problems) and the Externalizing (Attention-Deficit/Hyperactivity, Oppositional Defiant, and Conduct Problems) CBCL/6-18 DOS.

CONCLUSIONS

Several common risk factors of both genetic and environmental nature can simultaneously affect a child's proneness to develop the psychopathological signs and symptoms captured by the CBCL/6-18 DOS.