The relation between social anxiety and biased interpretations in adolescents with mild intellectual disabilities

Is interpretation bias for threat content specific to youth anxiety symptoms/diagnoses? A systematic review and meta-analysis

Anxiety is the most common mental health problem in youth. Numerous studies have identified that youth anxiety is associated with interpretation bias or the attribution of threatening meaning to ambiguity. Interpretation bias has been proposed as a mechanism underlying the development and maintenance of pediatric anxiety. Theoretically, interpretation bias should be content-specific to individual youth anxiety symptom domains. However, extant studies have reported conflicting findings of whether interpretation bias is indeed content specific to youth anxiety symptoms or diagnoses. The present meta-analysis aimed to synthesize the literature and answer the question: is the relationship between interpretation bias and anxiety content specific? Search of PubMed and PsycINFO databases from January 1, 1960 through May 28, 2019 yielded 9967 citations, of which 19 studies with 20 comparisons and 2976 participants met eligibility criteria. Meta-analysis with random effects models was conducted to examine an overall effect (Pearson r) between anxiety domain and content-specific interpretation bias in single sample studies, and an overall effect size difference (Cohen's d) in studies comparing anxious to non-anxious youth. Results support a content specific correlation between interpretation bias and anxiety symptom domain in single sample studies (r = 0.18, p = 0.03). However, it is currently undetermined whether this relationship holds in studies that compare the relationship between content-specific interpretation bias and anxiety in anxious versus non-anxious youth. A variety of methodologic considerations across studies are discussed, with implications for further investigation of interpretation bias and youth anxiety.

Studyholism and Study Engagement in Adolescence: The Role of Social Anxiety and Interpretation Bias as Antecedents

Studyholism (or obsession toward study) is a new potential clinical condition that, in contrast with Study Engagement, is associated with negative outcomes. However, previous studies showed that both Studyholism and Study Engagement predict social impairment due to study. Therefore, we analyzed the role of social anxiety and interpretation bias as predictors of Studyholism and Study Engagement in 541 adolescents (M_age = 16.30 ± 1.59; 66% girls). We performed a path analysis model, MANOVAs, and Mann–Whitney tests. Among the main findings, social anxiety is a positive predictor of both Studyholism and Study Engagement. Hence, this provides further support to the conceptualization of Studyholism as an OCD-related disorder (or as an internalizing disorder) and suggests the need of screening socially anxious adolescents for the presence of Studyholism and engaged students for the presence of high social anxiety. Moreover, Studyholism is predicted by a negative interpretation style in non-social situations, while a positive interpretation style predicts Study Engagement in social and non-social situations. Hence, Studyholism and social anxiety are two different diagnoses, even if social anxiety might fuel Studyholism. Moreover, interventions to reduce Studyholism should decrease the tendency to interpret non-social situations negatively or neutrally.

Interpersonal Cognitive Biases in Children and Young People with Neurodevelopmental Disorders: A Systematic Review

Purpose of Review

Interpersonal cognitive biases have been linked to externalising and internalising problems. This systematic review investigates their role in children and young people with neurodevelopmental disorders (NDD), who have a high risk of experiencing such problems.

Recent Findings

With 16 identified studies, this is a widely under-recognised research area. The three studies conducted within the last 5 years focused on threat interpretation and its association with anxiety. No difference between children and young people with and without NDD was found in the eleven studies investigating hostile attribution of intent, of which the most recent is nearly a decade old. No studies addressed attention or memory bias towards ambiguous interpersonal information.

Summary

The scarcity and heterogeneity of research highlighted in this paper demonstrate the urgency to use standardised and accessible research methods to develop a strong evidence base regarding the potential content-specific interpretation bias in individuals with NDD.

Adaptation of the Screen for Child Anxiety Related Emotional Disorders in Spanish with Nonspecific Intellectual Disability

Anxiety continues to be one of the most frequent disorders with typically developing children and youth. However, people with intellectual disability (ID) lack validated diagnostic tests backed by sufficient methodological rigor. Analyze the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in this clinical population, specifically in children and young Spanish with Nonspecific Intellectual Disability. Descriptive statistics and item analysis (N = 542), exploratory factorial analysis (n = 245) and confirmatory (n = 297) and scale reliability analyses were performed and evaluated the internal consistency with various indices (Cronbach's alpha and omega) and the stability of the measurement (test-retest) of the resulting scale with better goodness-of-adjustment indices. A new scale called SCARED-DI was obtained in this clinical sample with three factors and a smaller number of items (22), offering important goodness-of-fit indices (RMSEA [95% CI] 03[0.01; .04]; CFI = 0.99; TLI = 0.98; GFI = 0.88; AGFI = 0.89) and high internal consistency (α = 0.91; ω = 0.93) and adequate measurement stability (r_xx = 0.92). The importance of validating psychopathological anxiety tests for children and youth with ID in order to build good mental health is discussed, emphasizing the need to provide easy, short-duration tests on both cognitive and emotional aspects in this clinical sub-population. In addition, the results are assessed in terms of future research and practical implications. This new version of SCARED-ID represents a valid and reliable tool to evaluate the anxiety in people with intellectual disabilities.

Modification of hostile attribution bias reduces self-reported reactive aggressive behavior in adolescents

Aggressive individuals more readily interpret others' motives and intentions in ambiguous situations as hostile. This hostile attribution bias has been argued to be causally involved in the development and maintenance of aggression, making it a target for interventions. In our current study, adolescents selected for high levels of aggression (N = 39) were assigned to either a test-retest control group or a five-session hostile attribution bias modification training, in which they were trained to make more benign interpretations of ambiguously provocative social situations. Before and after the training, we assessed hostile attribution bias and both reactive and proactive self-reported aggression in both groups. The training not only tended to produce the expected reduction in hostile attribution bias but also crucially led to decreased levels of reactive but not proactive aggression compared with the control group. Our results thus support the idea that hostile attribution bias can be targeted using training techniques and that such training-induced changes in bias may reduce aggression. However, future studies using an active control group and multiple outcome measures are needed to address the long-term effects of training.

Inclusiveness of cognitive bias modification research toward children and young people with neurodevelopmental disorders: A systematic review

Cognitive bias modification (CBM) is increasingly used to target cognitive biases related to internalising or externalising problems, which are common in neurodevelopmental disorders (NDD). This systematic review assesses the available evidence for using CBM in children and young people with NDD, in particular regarding ambiguous interpersonal information, and the extent of their exclusion from this type of intervention research. PsycINFO, PsycARTICLES, MEDLINE, Cochrane Central Register of Controlled Trials and Science Citation Index were consulted using MeSH terms and synonyms of "neurodevelopmental disorders", "mental health problems", "cognitive bias", "modification" and "review". Data extraction focused on the efficacy of CBM for NDD, how CBM was delivered, whether studies adopted exclusion criteria relating to NDD and the rationale for such criteria. The search identified 2270 records, of which twenty-nine studies assessed CBM for interpretations and were included in the qualitative synthesis. Three studies targeted bias in NDD, whereas a third of studies explicitly excluded participants based on NDD-related criteria: most frequently intellectual impairment, reading or learning difficulties and autism spectrum disorder (ASD). Only one study provided a rationale for excluding NDD which related to the reading demands of their intervention. There is tentative evidence for the feasibility of using CBM to reduce interpretation bias in children and young people with mild intellectual disability, ASD or attention-deficit/hyperactivity disorder (ADHD). We recommend that CBM research should consider including participants with NDD, use CBM tasks and adaptations that enable this group's inclusion, or provide a sufficient rationale for their exclusion.

Preliminary Study on Psychometric Properties of an Anxiety Scale in Down Syndrome with Anxiety Symptoms

BACKGROUND

anxiety remains one of the most common disorders in typically developing children and young adults. Adolescents with Down syndrome (DS) lack diagnostic tests for evaluation.

METHODS

this study evaluated the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders inventory in its self-report version in 63 adolescents with anxiety symptoms with DS. The inclusion criteria for the studies were trisomy 21 and a chronological age between 8 and 17 years. Psychometric properties arestrictly evaluated with the sample exceeding a cutoff point in anxiety symptomatology. A confirmatory factorial analysis tested two models for the new evaluation test.

RESULTS

both models confirmed a four-factor structure (somatic/panic, social phobia, generalized anxiety, and separation anxiety). Model 2, nevertheless, had fewer items and a better fit, and it also showed a high correlation with other anxiety detection measures and adequate internal consistency.

CONCLUSIONS

the importance of validating psychopathological anxiety tests for children and young people with DS in order to build good mental health is discussed, emphasizing the need to provide easy and short-term tests on cognitive and emotional aspects in people with intellectual disabilities.

Differences between self- and peer-rated likability in relation to social anxiety and depression in adolescents with mild intellectual disabilities

BACKGROUND

Social anxiety and depressive symptoms are relatively common in adolescents with Mild to Borderline Intellectual Disabilities (MBID). Unfortunately, there are only a few studies that focus on examining processes underlying social anxiety and depression in these adolescents.

AIMS

The aim was to examine the differences between self- and peer-rated likability in relation to social anxiety and depression in the classroom environment.

METHODS AND PROCEDURES

631 normative non-clinical adolescents with MBID completed questionnaires to measure social anxiety, depression, and the estimation of their own likability by peers. Peer-reported likability was derived from peer-rating scales on likability.

OUTCOMES AND RESULTS

Adolescents with higher levels of social anxiety significantly rated their own likability as lower than their non-anxious peers. However, socially adolescents were equally liked by their peers. Adolescents with higher levels of depression were significantly less liked by their peers, but still underestimated their own likability than adolescents with lower levels of depression.

CONCLUSIONS AND IMPLICATIONS

Social anxiety and depression are linked to a biased interpretation of likability, but only depression is linked to actually being less liked by peers. Social anxiety and depression are partly based on similar underlying cognitive biases.

Cognitive Bias Modification Reduces Social Anxiety Symptoms in Socially Anxious Adolescents with Mild Intellectual Disabilities: A Randomized Controlled Trial

The goal of this study was to examine the effects of Cognitive Bias Modification training for Interpretation (CBM-I) in socially anxious adolescents with Mild Intellectual Disabilities (MID). A total of 69 socially anxious adolescents with MID were randomly assigned to either a positive or a neutral control-CMB-I-training. Training included five sessions in a 3-week period, and each session consisted of 40 training items. Adolescents in the positive training group showed a significant reduction in negative interpretation bias on the two interpretation bias tasks after training compared to adolescents in the control-training group. Furthermore, in contrast to the control-training group, adolescents in the positive training reported a significant reduction of their social anxiety symptoms 10 weeks post-training.