Relations among perceived parental rearing behaviors, attachment style, and worry in anxious children

Family Factors in the Development and Management of Anxiety Disorders

Theoretic models of anxiety disorders have emphasized the impact of caregiving on the development and maintenance of childhood anxiety. Familial factors demonstrate a reciprocal relationship with child anxiety, including family stressors, parenting control, and family accommodation. The inclusion of parents in intervention for youth anxiety has demonstrated a superior outcome in several studies and is recommended as an area to evaluate when child anxiety is presented for assessment and treatment. This review examines familial variables in their contribution to clinical levels of anxiety in youth, focusing on genetic, family environment, and parental behaviors and recommendations for prevention and treatment intervention.

Insecure Parental Attachment and Anxiety in Vocational College Students: The Mediating Role of Subjective Well-Being and the Moderating Role of Self-Esteem

Purpose

Although insecure parental attachment (IPA) has been shown to play an important role in anxiety, little is known about the mediating and moderating mechanisms underlying this relationship.

Patients and Methods

In the present study, we examined the mediating role of subjective well-being (SWB) in the association between IPA and anxiety and the moderating role of self-esteem. 947 Chinese vocational college students completed the measures of IPA, anxiety, SWB, and self-esteem.

Results

The results indicated that IPA was significantly and positively associated with anxiety, and SWB partially mediated this relationship. Moreover, the results indicated that self-esteem moderated the relationship between IPA and anxiety. The higher the level of self-esteem, the weaker the effect of insecure attachment on the anxiety of vocational college students.

Conclusion

This study highlights the significance of identifying the mechanisms of mediating and moderating paths between IPA and anxiety in vocational college students.

Maternal attachment security modulates the relationship between vulnerability to anxiety and attentional bias to threat in healthy children

This study aimed to investigate whether attentional bias to threat, commonly observed in clinically anxious children, also manifests in healthy children, potentially aiding the early detection of at-risk individuals. Additionally, it sought to explore the moderating role of parent-child attachment security on the association between vulnerability factors (anxiety sensitivity, intolerance of uncertainty, perseverative cognitions) as indicators of vulnerability to anxiety, and attentional bias towards threat in healthy children. A total of 95 children aged 8 to 12 years completed the Visual Search Task to assess attentional bias. Vulnerability to anxiety was measured using a composite score derived from the Childhood Anxiety Sensitivity Index, Intolerance of Uncertainty Scale for Children, and Perseverative Thinking Questionnaire. Parent-child attachment security was assessed using the Security Scale-Child Self-Report. Analyses revealed that higher vulnerability to anxiety was associated with faster detection of anger-related stimuli compared to neutral ones, and this association was further influenced by high maternal security. These findings in healthy children suggest an interaction between specific factors related to anxiety vulnerability and the security of the mother-child relationship, leading to cognitive patterns resembling those seen in clinically anxious individuals. These results hold promise for early identification of children at risk of developing anxiety disorders.

Youth Anxiety: The Moderating Effects of Accommodation and Emotional Warmth

Parental accommodation (i.e., modifying behavior to reduce child distress) is among the most empirically supported anxiety enhancing parenting practices; while emotional warmth (i.e., support and affection) has demonstrated a less clear link to anxiety. The current study aims to explore the interactive nature of emotional warmth within the context of accommodation. We hypothesized that accommodation would moderate the relationship between emotional warmth and anxiety. The sample included parents of youth (N = 526) ages 7-17. A simple moderation analysis was conducted. Accommodation significantly moderated the relationship [B = 0.03, C.I. (0.01, 0.05), p = 0.01]. Additional variance was accounted for by adding the interaction term to the model (R² = 0.47, p < 0.001). At high levels of accommodation, emotional warmth significantly predicted child anxiety symptoms. This study affirms that emotional warmth is significantly related to anxiety in the context of high accommodation. Future work ought to build upon these findings to explore these relationships. Limitations of the study include sampling and parent-report data.

Assessment of factors and father-infant attachment levels among Turkish's fathers of preterm infants

PURPOSE

Identify the factors affecting father-infant attachment among Turkishs fathers of preterm infants.

DESIGN AND METHODS

This cross-sectional study included 63 fathers of preterm infants between the ages of 6-12 months. Data were collected using the Father-Infant Descriptive Information Form and the Paternal-Infant Attachment Scale (PIAS). Descriptive statistics, independent sample t-tests, mann-whitney test, the kruskal wallis test, the tamhane test, spearman correlation analysis, and linear stepwise regression were used to evaluate the data.

RESULTS

The average PIAS scores of the fathers in the study was 62.97 ± 8.94. A statistically significant difference was found between the birth weight, clinical picture, and length of stay in the Neonatal Intensive Care Unit (NICU) and PIAS total score of preterm infants (p < 0.01). There was a significant difference between the unplanned hospitalization of the baby after discharge and the father's changing the baby's clothes and the PIAS score (p < 0.05). Birth weight and unplanned hospitalization explained 31% of PIAS total score.

CONCLUSIONS

According to the results, father-infant attachment levels of fathers of preterm infants were low. Father's involvement in changing the baby's clothes, preterm birth weight, clinical picture, and length of stay in the NICU were found to be associated with PIAS.

PRACTICAL IMPLICATIONS

It should be remembered that babies can be attached to their fathers as much as they are to their mothers. NICU nurses should initiate father-infant interaction early and ensure fathers' involvement in infant care in the NICU.

COVID-related fear maintains controlling parenting behaviors during the pandemic

The direct threat posed by the 2019 novel coronavirus (COVID-19), uncertainty surrounding best safety practices, and secondary consequences of the virus have led to widespread stress and declining mental health across communities and individuals. These stresses may impact parenting behaviors, potentially leading to negative consequences for children. Controlling parenting behaviors increase in the face of perceived environmental threat and are associated with adverse mental health outcomes for children; however, determinants of parenting behaviors have not been investigated during the COVID-19 pandemic. The current study prospectively evaluated parenting behaviors during the pandemic (N=87). Results indicated that all negative affect emotions investigated were positively associated with controlling parenting behaviors. However, only COVID-related fear predicted changes in controlling parenting behaviors across timepoints. Specifically, although controlling parenting behaviors decreased in the overall sample from time 1 to time 2, higher COVID-related fear scores at time 1 predicted maintenance of high levels of controlling parenting behaviors at time 2. Additionally, this effect was specific to controlling, as opposed to more adaptive, parenting behaviors. Future studies should investigate the association between parents' COVID-related fear, controlling parenting behaviors, and adverse mental health outcomes for children in the context of the COVID-19 pandemic.

Prefrontal cortex and amygdala anatomy in youth with persistent levels of harsh parenting practices and subclinical anxiety symptoms over time during childhood

Childhood adversity and anxiety have been associated with increased risk for internalizing disorders later in life and with a range of brain structural abnormalities. However, few studies have examined the link between harsh parenting practices and brain anatomy, outside of severe maltreatment or psychopathology. Moreover, to our knowledge, there has been no research on parenting and subclinical anxiety symptoms which remain persistent over time during childhood (i.e., between 2.5 and 9 years old). Here, we examined data in 94 youth, divided into four cells based on their levels of coercive parenting (high / low) and of anxiety (high / low) between 2.5 and 9 years old. Anatomical images were analyzed using voxel-based morphometry (VBM) and FreeSurfer. Smaller gray matter volumes in the prefrontal cortex regions and in the amygdala were observed in youth with high versus low levels of harsh parenting over time. In addition, we observed significant interaction effects between parenting practices and subclinical anxiety symptoms in rostral anterior cingulate cortical thickness and in amygdala volume. These youth should be followed further in time to identify which youth will or will not go on to develop an anxiety disorder, and to understand factors associated with the development of sustained anxiety psychopathology.

Perceived Parental Rearing in Paediatric Obsessive-Compulsive Disorder: Examining the Factor Structure of the EMBU Child and Parent Versions and Associations with OCD Symptoms

Parental rearing behaviours characterised by high levels of rejection and overprotection have been implicated in the development and maintenance of child psychopathology, including paediatric obsessive-compulsive disorder (OCD). The Egna Minnen Beträffande Uppfostran (EMBU) is a commonly used measure of perceived parental rearing. Using confirmatory factor analysis, the factor structure of the EMBU child and parent versions were examined in a sample of children and youth with OCD (n = 176), and their mothers (n = 162). Associations between rearing and clinical correlates of OCD were explored. For parents, a 4-factor model provided the best fit. For children, a higher order model was the best fit. Greater parent and child perceived negative rearing behaviours and lower perceived positive behaviours were associated with greater OCD severity, comorbid symptoms and impairment. The EMBU has a conceptually meaningful factor structure and provides a useful measure for assessing perceived rearing behaviours within paediatric OCD.

The association between parenting and the error-related negativity across childhood and adolescence

Anxiety is the most common form of psychopathology, and it is often characterized by chronic impairment across the lifespan. Researchers have identified core neural markers that confer risk for anxious outcomes. An increased error-related negativity (ERN) in anxious individuals has been shown to prospectively predict onset of anxiety disorders across development. Hence, it is critical to examine environmental factors that may shape the ERN. In the current study, we use a large sample of 170 female adolescents aged 10-17 to investigate whether the ERN mediates the relationship between parenting style and anxiety diagnostic status. This study replicates previous findings, and it extends previous work by suggesting that this relationship is more robust in young children as compared to adolescents. Interventions targeting the ERN via parenting may be most effective during childhood.

Is a mother's recalled parental rearing behavior, her attributions of her child's behavior, and her psychopathology associated with her mother-child relationship quality?

BACKGROUND

The mother-child relationship quality (MCRQ) may represent a transgenerational transmission mechanism of mental health problems. In this context, we examine the mother's recalled parental rearing behavior, actual attributions of her child's behavior, and her current psychopathology.

METHOD

A clinical sample of mother-child dyads was assessed with the Questionnaire for the Assessment of Recalled Parental Rearing Behavior, the Parent Cognition Scale, and the Symptom Checklist at the Child Psychiatric Family Day Hospital for preschool children in Münster, Germany, at admission. MCRQ was assessed with the Parent-Infant Relationship Global Assessment Scale, a structured interview with the child (Strukturiertes Interview zur Erfassung der Kind-Eltern-Interaktion), and the Multiperspective Parent-Child Relationship Questionnaire.

RESULTS

Multiple regression analyses showed no direct association between the mother's recalled parental rearing behavior and any measure of the MCRQ. However, maternal dysfunctional attributions about her child's behavior and her actual psychopathology showed the expected negative associations with the multiperspective measures of MCRQ. The relationship quality assessments did not correlate significantly with each other.

CONCLUSION

The divergent measures of MCRQ, which seem to assess different aspects, are a barrier to investigate the association between the mother's recalled parental rearing behavior and MCRQ. However, low MCRQ is associated with increased maternal psychopathology and maternal dysfunctional attributions on child behavior.

The direct and indirect effect of attachment insecurity and negative parental behavior on anxiety in clinically anxious children: it's down to dad

BACKGROUND

Theoretically, insecure attachment and negative parental behaviors are risk factors for childhood anxiety. However, few empirical studies have examined their relative contribution including differences between mothers and fathers. To date, only one study has examined a mediational model including these factors, albeit in a nonclinical sample.

METHOD

This study ameliorates this limitation by investigating direct and indirect relations between maternal and paternal attachment and behaviors, and clinical anxiety in children (mean age 9.6 years). The study recruited 54 families. Anxiety symptoms were measured by the Spielberger State-trait Inventory for Children, attachment relationships by the Security Scale, and parental behaviors using the Rearing Behavior Questionnaire.

RESULTS

Neither insecure attachment relationship with mother nor maternal negative behavior was a significant predictor of anxiety in children. However, insecure attachment to father accounted for a significant proportion of variance in anxiety, and also fully mediated the relationship between paternal rejection and anxiety.

CONCLUSIONS

Our findings highlight the importance of assessing the relative contribution of risk factors and the importance of including fathers when investigating the development and maintenance of childhood anxiety.

Looking into some of the risk factors of mental health: the mediating role of maladaptive schemas in mothers’ parenting style and child anxiety disorders

Purpose

Anxiety disorders have a high prevalence in children. Those children with anxious symptoms are more likely to experience significant disruption in their lives. This disruption can interrupt or even stop a child from participating in a variety of typical childhood experiences. It is understood that genetic and environmental factors may cause this disorder. The purpose of this paper is to focus on environmental factors, namely, the mediating role of maladaptive schemas in mothers’ child-rearing and childhood anxiety disorders.

Design/methodology/approach

This study used correlation-modeling to assess the analysis. The sample included 326 students (aged 9-12 years old) and their mothers. The parenting style (Baumrind, 1973), Early Maladaptive Schema (Rijkeboer and de Boo, 2010), and anxiety disorders (Muriset al., 2006) questionnaires were used in this study.

Findings

The results showed a relationship between parenting styles of mothers and childhood anxiety disorders, a significant correlation between childhood maladaptive schemas and childhood anxiety disorders, a relation between child-rearing styles and childhood maladaptive schemas, and finally a mediating role on childhood anxiety disorders and mothers’ child-rearing styles for some childhood maladaptive schemas.

Originality/value

This research contributes to the knowledge base of the importance of children’s mental health. The paper analyzes the relationship of mothers’ parenting styles and children’s anxiety. It also focuses on maladaptive schemas as a mediator and its relationship with childhood anxiety disorders.

Parenting and Anxiety: Bi-directional Relations in Young Children

Developmental psychopathologists have long posited a reciprocal relation between parenting behaviors and the development of child anxiety symptoms. Yet, little empirical research has utilized a longitudinal design that would allow exploration of this bi-directional influence. The present study examined the reciprocal relations between parental respect for autonomy, parental hostility, and parental support, and the development of childhood anxiety during a critical developmental period-the transition from preschool to kindergarten and then first grade. Study participants included a community sample of 391 male and 405 female socioeconomically, racially and ethnically diverse 4 to 6-7 year olds. 54 % of the sample was White, non-Hispanic, 16.8 % was African American, 20.4 % was Hispanic, 2.4 % were Asian and 4.4 % self-identified as Other or mixed race. Parent report and observational methodology were used. Parenting and anxiety were found to interact reciprocally over time. Higher levels of age 4 anxiety led to reduced respect for child autonomy at age 5. At age 4 higher levels of parental hostility led to small increases in age 5 anxiety, and increased age 5 anxiety led to increased levels of age 6 parent hostility. Parental support at age 5 resulted in decreased anxiety symptoms at age 6-7 while higher age 5 anxiety levels were associated with reductions in age 6-7 parental support. No relations were found between these variables at the younger ages. Although the magnitude of these findings was small, they suggest that early treatment for childhood anxiety should include both parent intervention and direct treatment of the child's anxiety symptoms.

Environmental transmission of generalized anxiety disorder from parents to children: worries, experiential avoidance, and intolerance of uncertainty

Generalized anxiety disorder (GAD) runs in families. Building on recent theoretical approaches, this review focuses on potential environmental pathways for parent-to-child transmission of GAD. First, we address child acquisition of a generalized pattern of fearful/anxious and avoidant responding to potential threat from parents via verbal information and via modeling. Next, we address how parenting behaviors may contribute to maintenance of fearful/anxious and avoidant reactions in children. Finally, we consider intergenerational transmission of worries as a way of coping with experiential avoidance of strong negative emotions and with intolerance of uncertainty. We conclude that parents with GAD may bias their children's processing of potential threats in the environment by conveying the message that the world is not safe, that uncertainty is intolerable, that strong emotions should be avoided, and that worry helps to cope with uncertainty, thereby transmitting cognitive styles that characterize GAD. Our review highlights the need for research on specific pathways for parent-to-child transmission of GAD.

Childhood attachment and behavioral inhibition: Predicting intolerance of uncertainty in adulthood

Intolerance of uncertainty (IU), the tendency to react negatively to uncertain situations, has been identified as an important cognitive component of anxiety disorders, yet little is known about its etiology. Links to temperament, particularly behavioral inhibition (BI), and insecure attachment have been proposed in the development of IU, but no prospective empirical investigation has been performed thus far. In the current study, attachment to caregiver and BI of 60 children were assessed at age 6, using observational measures. Mother's anxiety symptoms were assessed when participants were 14 years old. IU was reported by participants when they were 21 years old, as was neuroticism. Two types of insecure attachment (ambivalent and disorganized-controlling) and BI were positively related to IU over a 15-year span, even after controlling for participants' neuroticism and maternal anxiety. Attachment and BI had no significant interacting effect on the development of IU. Maternal anxiety was positively related to child BI and insecure attachment, but not IU. This study is the first to provide empirical support for a link between ambivalent and disorganized-controlling attachment and BI in preschool children to the development of IU in adulthood. Results have etiological and preventative implications not only for anxiety disorders but also for all disorders related to IU.

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

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

The joint contribution of maternal history of early adversity and adulthood depression to socioeconomic status and potential relevance for offspring development

BACKGROUND

We examined the interactive effects of maternal childhood adversity and later adulthood depression on subsequent socioeconomic status (SES).

METHODS

Our community sample ranged from 230 to 243 mothers (across measures) drawn from a prospective, longitudinal cohort study. Maternal childhood adversity scores were derived using an integrated measure derived from the Childhood Trauma Questionnaire (CTQ) and the Parental Bonding Index (PBI). Maternal depression was measured in the prenatal period with the Center for Epidemiologic Studies Depression Scale (CES-D). SES measures included maternal highest level of education and family income as obtained prenatally.

RESULTS

The analyses yielded significant interaction effects between maternal childhood adversity and prenatal depression that predicted income, prenatally. Women who reported higher levels of childhood adversity combined with higher levels of self-reported depressive symptoms were significantly more likely to live in low SES environments. Results also showed that level of education was predicted by childhood adversity independent of maternal symptoms of depression.

CONCLUSION

The results suggest that SES is influenced by a life course pathway that begins in childhood and includes adversity-related mental health outcomes. Since child health and development is influenced by both maternal mental health and SES, this pathway may also contribute to the intergenerational transmission of the risk for psychopathology in the offspring. The results also emphasize the importance of studying potential precursors of low SES, a well-documented environmental risk factor for poor developmental outcomes in the offspring.

Developmental risk factors in generalized anxiety disorder and panic disorder

BACKGROUND

There is a lack of clarity regarding specific risk factors discriminating generalized anxiety disorder (GAD) from panic disorder (PD).

GOAL

This study investigated whether GAD and PD could be discriminated through differences in developmental etiological factors including childhood parental loss/separation, psychological disorders, and maternal and paternal attachment.

METHOD

Twenty people with adult generalized anxiety disorder (GAD), 20 with adult panic disorder (PD), 11 with adult comorbid GAD and PD, and 21 adult non-anxious controls completed diagnostic interviews to assess symptoms of mental disorders in adulthood and childhood. Participants also reported on parental attachment, loss and separation.

RESULTS

Childhood diagnoses of GAD and PD differentiated clinical groups from controls as well as from each other, suggesting greater likelihood for homotypic over heterotypic continuity. Compared to controls, specific phobia was associated with all three clinical groups, and childhood depression, social phobia, and PTSD were uniquely associated with adult GAD. Both maternal and paternal attachment also differentiated clinical groups from controls. However, higher levels of subscales reflecting maternal insecure avoidant attachment (e.g., no memory of early childhood experiences and balancing/forgiving current state of mind) emerged as more predictive of GAD relative to PD. There were no group differences in parental loss or separation.

CONCLUSIONS

These results support differentiation of GAD and PD based on developmental risk factors. Recommendations for future research and implications of the findings for understanding the etiology and symptomatology of GAD and PD are discussed.

Self-Reported and Observed Punitive Parenting Prospectively Predicts Increased Error-Related Brain Activity in Six-Year-Old Children

The error-related negativity (ERN) is a negative deflection in the event-related potential (ERP) occurring approximately 50 ms after error commission at fronto-central electrode sites and is thought to reflect the activation of a generic error monitoring system. Several studies have reported an increased ERN in clinically anxious children, and suggest that anxious children are more sensitive to error commission--although the mechanisms underlying this association are not clear. We have previously found that punishing errors results in a larger ERN, an effect that persists after punishment ends. It is possible that learning-related experiences that impact sensitivity to errors may lead to an increased ERN. In particular, punitive parenting might sensitize children to errors and increase their ERN. We tested this possibility in the current study by prospectively examining the relationship between parenting style during early childhood and children's ERN approximately 3 years later. Initially, 295 parents and children (approximately 3 years old) participated in a structured observational measure of parenting behavior, and parents completed a self-report measure of parenting style. At a follow-up assessment approximately 3 years later, the ERN was elicited during a Go/No-Go task, and diagnostic interviews were completed with parents to assess child psychopathology. Results suggested that both observational measures of hostile parenting and self-report measures of authoritarian parenting style uniquely predicted a larger ERN in children 3 years later. We previously reported that children in this sample with anxiety disorders were characterized by an increased ERN. A mediation analysis indicated that ERN magnitude mediated the relationship between harsh parenting and child anxiety disorder. Results suggest that parenting may shape children's error processing through environmental conditioning and thereby risk for anxiety, although future work is needed to confirm this hypothesis.

Stressful Life Events and Child Anxiety: Examining Parent and Child Mediators

While a number of factors have been linked with excessive anxiety (e.g., parenting, child temperament), the impact of stressful life events remains under-studied. Moreover, much of this literature has examined bivariate associations rather than testing more complex theoretical models. The current study extends the literature on life events and child anxiety by testing a theory-driven meditational model. Specifically, one child factor (child cognitions/locus of control), two parent factors (parent psychopathology and parenting stress), and two parent-child relationship factors (parent-child dysfunctional interaction and parenting style) were examined as mediators in the relationship between stressful life events and severity of child anxiety. One hundred and thirty anxious parents and their nonanxious, high-risk children (ages ranged from 7 to 13 years) participated in this study. Results indicated that levels of parenting stress, parental anxious rearing, and dysfunctional parent-child interaction mediated the association between stressful life events and severity of anxiety symptoms. Child cognition and parent psychopathology factors failed to emerge as mediators. Findings provide support for more complex theoretical models linking life events and child anxiety and suggest potential targets of intervention.

Parenting Behaviors and Anxiety in Young Adults

Parenting behaviors – specifically behaviors characterized by high control, intrusiveness, rejection, and overprotection – and effortful control have each been implicated in the development of anxiety pathology. However, little research has examined the protective role of effortful control in the relation between parenting and anxiety symptoms, specifically among adults. Thus, we sought to explore the unique and interactive effects of parenting and effortful control on anxiety among adults (N = 162). Results suggest that effortful control uniquely contributes to anxiety symptoms above and beyond that of any parenting behavior. Furthermore, effortful control acted as a moderator of the relationship between parental overprotection and anxiety, such that overprotection is associated with anxiety only in individuals with lower levels of effortful control. Implications for potential prevention and intervention efforts which specifically target effortful control are discussed. These findings underscore the importance of considering individual differences in self-regulatory abilities when examining associations between putative early-life risk factors, such as parenting, and anxiety symptoms.

Adult attachment as a moderator of treatment outcome for generalized anxiety disorder: Comparison between cognitive-behavioral therapy (CBT) plus supportive listening and CBT plus interpersonal and emotional processing therapy

OBJECTIVE

To determine whether baseline dimensions of adult insecure attachment (avoidant and anxious) moderated outcome in a secondary analysis of a randomized controlled trial comparing cognitive-behavioral therapy (CBT) plus supportive listening (CBT + SL) versus CBT plus interpersonal and emotional processing therapy (CBT + I/EP).

METHOD

Eighty-three participants diagnosed with generalized anxiety disorder (GAD) were recruited from the community and assigned randomly to CBT + SL (n = 40) or to CBT + I/EP (n = 43) within a study using an additive design. PhD-level psychologists treated participants. Blind assessors evaluated participants at pretreatment, posttreatment, 6-month, 12-month, and 2-year follow-up with a composite of self-report and assessor-rated GAD symptom measures (Penn State Worry Questionnaire, Hamilton Anxiety Rating Scale, Clinician's Severity Rating). Avoidant and anxious attachment were assessed using self-reported dismissing and angry states of mind, respectively, on the Perceptions of Adult Attachment Questionnaire.

RESULTS

Consistent with our prediction, at all assessments higher levels of dismissing styles in those who received CBT + I/EP predicted greater change in GAD symptoms compared with those who received CBT + SL for whom dismissiveness was unrelated to the change. At postassessment, higher angry attachment was associated with less change in GAD symptoms for those receiving CBT + I/EP, compared with CBT + SL, for whom anger was unrelated to change in GAD symptoms. Pretreatment attachment-related anger failed to moderate outcome at other time points and therefore, these moderation effects were more short-lived than the ones for dismissing attachment.

CONCLUSIONS

When compared with CBT + SL, CBT + I/EP may be better for individuals with GAD who have relatively higher dismissing styles of attachment.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Worry and generalized anxiety disorder: a review and theoretical synthesis of evidence on nature, etiology, mechanisms, and treatment

Generalized anxiety disorder (GAD) is associated with substantial personal and societal cost yet is the least successfully treated of the anxiety disorders. In this review, research on clinical features, boundary issues, and naturalistic course, as well as risk factors and maintaining mechanisms (cognitive, biological, neural, interpersonal, and developmental), are presented. A synthesis of these data points to a central role of emotional hyperreactivity, sensitivity to contrasting emotions, and dysfunctional attempts to cope with strong emotional shifts via worry. Consistent with the Contrast Avoidance model, evidence shows that worry evokes and sustains negative affect, thereby precluding sharp increases in negative emotion. We also review current treatment paradigms and suggest how the Contrast Avoidance model may help to target key fears and avoidance tendencies that serve to maintain pathology in GAD.

Is adolescent generalized anxiety disorder a magnet for negative parental interpersonal behaviors?

BACKGROUND

Previous studies have found that perceived parental interpersonal interaction behaviors, such as rejection, overcontrol, and negative attachment behaviors, increase adolescent generalized anxiety disorder (GAD) symptoms. However, most of these studies have been cross-sectional, as opposed to longitudinal, and have examined these perceived parental interaction behaviors individually. Hence, the goal of this longitudinal study is to examine these perceived parental behaviors and adolescent GAD symptoms together, in one model, to examine the unique effects each has on one another.

METHODS

Participants were 923 adolescents from the general community. The adolescent population was comprised of both boys (50.7%) and girls (49.3%) with an average age of 12 at the first measurement. In a prospective, 5-year longitudinal design, the adolescents completed questionnaires of parental interaction behaviors and adolescent GAD symptoms on the first, third, and fifth years of the study.

RESULTS

Structural equation modeling cross-lagged panel model analyses were conducted to examine the effects perceived parental interaction behaviors and adolescent GAD have on one another. It was found that adolescent GAD consistently predicted parental interpersonal interaction behaviors longitudinally.

CONCLUSIONS

It is suggested that adolescent GAD influences the perception of parental interpersonal behaviors. And the influence adolescent GAD may have on these perceived parental interpersonal behaviors is to create an environment in which the parents are perceived to begin to disengage in their interactions with their adolescent.

The development of anxiety disorders: considering the contributions of attachment and emotion regulation

Anxiety disorders are among the most common psychiatric disorders in childhood. Nonetheless, theoretical knowledge of the development and maintenance of childhood anxiety disorders is still in its infancy. Recently, research has begun to investigate the influence of emotion regulation on anxiety disorders. Although a relation between anxiety disorders and emotion regulation difficulties has been demonstrated, little attention has been given to the question of why anxious individuals have difficulties regulating their emotions. The present review examines the evidence of the link between emotion regulation and anxiety. It also explores the unique contributions of attachment style and dysfunctional emotion regulation to the development of anxiety disorders.

Preadolescent anxiety: an epidemiological study concerning an Italian sample of 3,479 nine-year-old pupils

The epidemiology of anxiety traits was examined in a large sample of Italian preadolescent children, and 3,479 Italian nine-year-old subjects were enrolled. Anxious traits were observed in 10.5% of children. No significant gender differences were found, but children of separated couples presented a relative risk for anxious traits that was 50% higher, than children of cohabiting or married parents. Moreover, large families (more than 4 members) with a stay-at-home mother were also associated with anxiety in the offspring. Currently, this is the first study carried out in a large sample of preadolescent children, all of the same age.

The role of meta-cognition and parenting in adolescent worry

In the meta-cognitive model of worry, positive, and negative beliefs about worry interact to make worry problematic. These beliefs have been found to be associated with anxiety in adolescents, but it is unknown whether they are associated with worry. Furthermore, it may be via cognitive mechanisms such as these, or directly through behavior, that parents influence their child's worry. The current study aimed to explore whether adolescent meta-cognition and parenting behaviors and meta-cognitions were associated with adolescent worry. Results indicated that meta-cognitions were specifically associated with worry in adolescents, but there was little evidence that parenting was. Parental worry on the other hand was associated with both parent and child reported parenting. It is concluded that the meta-cognitive model of worry may be relevant in adolescents, but that further research is required to explore how parents influence adolescent worry.

Relations among perceived control over anxiety-related events, worry, and generalized anxiety disorder in a sample of adolescents

This study examined the associations among perceived control over anxiety-related events, worry, and both symptoms and diagnoses of generalized anxiety disorder (GAD). The sample was comprised of 140 adolescents (60 girls) between the ages of 10 and 17 years (M ( age ) = 14.6 years; SD = 2.25) recruited from the general community. Findings were consistent with hypotheses. Self-reported perceived control over anxiety-related events related negatively to worry as well as symptoms and diagnoses of GAD even after accounting for variance associated with age, gender, and negative affectivity. Results are discussed in terms of the theoretical implications that perceived control over anxiety-related events may have for understanding GAD symptomatology among youth.

Temperament and the environment in the etiology of childhood anxiety

Anxiety disorders are prevalent throughout childhood and adolescence. As such, identifying the factors and mechanisms that precede, maintain, or exacerbate anxiety disorders is essential for the development of empirically based prevention and intervention programs. The current review focuses on child temperament (i.e., behavioral inhibition) and the child's environment, including parenting, childcare, and peer relationships, as these factors have been linked to internalizing problems and anxiety diagnoses. Research programs are needed that examine the associations between the environment and anxiety in temperamentally at-risk populations. In order to be successful, early intervention and prevention programs require a more detailed analysis of the interplay between various environmental contexts, both distal and proximal to the child, and the child's temperamental reactivity to novelty and threat. Furthermore, conducting these investigations across multiple levels of analysis in large-scale, longitudinal samples would be an important addition to the literature on the developmental psychopathology of anxiety.

The correlates and consequences of early appearing social anxiety in young children

Social anxiety is the fear of social situations and being negatively evaluated by others. Most previous studies of childhood social anxiety have employed clinical samples of children aged 10 years and older. The current study explored the correlates of social anxiety in an unselected sample of young children. Participants were n=178 elementary school children in grade 2 (aged 7-8 years). Children were individually administered the Social Anxiety Scale for Children-Revised (SASC-R), as well as measures of socio-emotional adjustment. Teachers completed measures of children's socio-emotional problems and school adjustment. Results indicated that social anxiety was positively associated with self-reported loneliness, school avoidance, and internalizing coping, and negatively related to school liking. However, social anxiety was mostly unrelated to teacher-rated outcomes. Findings are discussed in terms of use of the SASC-R for this type of population and reasons for the disparity between child and teacher reports of adjustment outcomes.

Childrearing style in families of anxiety-disordered children: between-family and within-family differences

This study examined whether (1) parents of anxiety-disordered (AD) children differed from those of non-clinical controls in their childrearing style, and whether (2) the child-rearing style of parents towards AD children is different from that towards their siblings. A clinical sample of 25 AD children, age range 8-13 years, was compared with 25 siblings and a non-clinical control group (n = 25). Childrearing was assessed by means of parental self-report, child report and through an expressed emotion interview measure. AD children perceived more parental rejection than non-clinical control children or the AD children's siblings. High-expressed emotion was scored significantly more often towards AD children than non-clinical control children, or their siblings. On [Symbol: see text]care' and [Symbol: see text]control' parental self-report showed some differences regarding AD children on the one hand and non-clinical control children or siblings of AD children on the other. These results suggest that the rearing of AD children differs significantly both from the rearing of their siblings and that of non-clinical control children.

The role of perceived parenting in familial aggregation of anxiety disorders in children

This study was designed to explore the role of perceived parenting style in the familial aggregation of anxiety disorders. We examined the association between parental and child anxiety diagnoses, and tested whether this association was partly due to a perceived parenting style. The study was conducted in a clinical sample as well as in a control sample. Parental lifetime and current anxiety diagnoses were significantly associated with child anxiety diagnoses. When maternal and paternal lifetime and current anxiety diagnoses were entered as separate predictors, only maternal current anxiety diagnoses appeared to be significant. Perceived parenting style was assessed with the dimensions "overprotection," "emotional warmth," "rejection," and "anxious rearing." Results indicated that only maternal and paternal 'overprotection' was significantly but negatively associated with child anxiety. However, further analyses showed that 'overprotection' did not have a significant mediating role in the familial aggregation of anxiety disorders.