Factor structure of a measure of anxiety sensitivity in children

Initial psychometrics, outcomes, and correlates of the Repetitive Body Focused Behavior Scale: Examination in a sample of youth with anxiety and/or obsessive-compulsive disorder

BACKGROUND

Body-Focused Repetitive Behaviors (BFRBs), including skin-picking, hair-pulling, and nail-biting, commonly occur in youth, even at elevated/problematic levels, and are associated with a number of other psychiatric symptoms. The present study examined the internal consistency of a brief screening tool for BFRBs as well as the prevalence, severity, and correlates of BFRBs in a sample of youth with a primary anxiety or obsessive-compulsive disorder (OCD).

METHODS

Ninety-three youth-parent dyads presenting for treatment for anxiety or OCD completed study measures including the Repetitive Body Focused Behavior Scale - Parent (RBFBS), which includes subscales for skin-picking, hair-pulling, and nail-biting, as well as a number of additional clinician-, parent-, and child-rated scales.

RESULTS

The RBFBS demonstrated good to excellent internal consistency. BFRBs were endorsed in 55% of youths, with elevated levels in 27%. Skin-picking was the most common BFRB (38%), followed by nail-biting (34%) and hair-pulling (4%). Youth with BFRBs, as compared to those without, were rated as more avoidant by their parents. Among those with BFRBs, more avoidant tendencies, anxiety sensitivity, and child-rated panic, separation, and generalized anxiety symptoms were associated with elevated BFRB severity. BFRBs were equally common but more likely to be elevated among youth with a primary anxiety, than OCD, diagnosis.

DISCUSSION

Results provide initial support for the RBFBS as a brief screening tool for the three common BFRBs. In addition, the results suggest avoidant tendencies and physical manifestations of distress may be particularly relevant to the escalation of BFRB symptoms in youth.

The Treatment Worries Questionnaire: Conjoined measures for evaluating worries about psychosocial treatment in youth and their parents

Treatment worries, which surround requirements and results of obtaining treatment, may represent an important construct; however, previous measures were limited by their specificity, format, and lack of parent report. Therefore the present study examined the initial outcomes and psychometrics of corresponding measures of treatment worries in youth (Treatment Worries Questionnaire - Child; TWQ-C) and their parents (Treatment Worries Questionnaire - Parent; TWQ-P). Participants were 94 youth (7-17-years old) and parent dyads presenting for treatment of an anxiety disorder. Dyads completed the TWQ-C and TWQ-P along with additional measures prior to initiating treatment. Treatment worries were endorsed in the mild-moderate range by youth and the TWQ-C demonstrated good-excellent internal consistency, a three-factor structure, and consistent convergent and divergent relationships. Treatment worries were endorsed in the low-mild range by parents and the TWQ-P demonstrated fair-good internal consistency, a four-factor structure, and consistent divergent relationships, but variable (by factor) convergent relationships. The results provide information on treatment worries and support the use of the TWQ-C and TWQ-P as broad assessments of the concept. Low endorsement of worries among parents likely relates to the treatment-seeking nature of the sample. Future investigations using the TWQ-C and TWQ-P in a variety of samples is warranted.

Predicting first onset of depression in young girls: Interaction of diurnal cortisol and negative life events

Interactions between biological vulnerability and environmental adversity are central to the pathophysiology of depression. Given evidence that the hypothalamic-pituitary-adrenal (HPA) axis influences biological responses to environmental events, in the current longitudinal study the authors examined HPA-axis functioning, negative life events, and their interaction as predictors of the first onset of depression. At baseline, girls ages 9 to 14 years provided saliva samples to assess levels of diurnal cortisol production, quantified by total cortisol production (area under the curve with respect to ground; AUCg) and the cortisol awakening response (CAR). The authors then followed these participants until they reached age 18 in order to assess their subsequent experience of negative life events and the onset of a depressive episode. They found that the influence of negative life events on the subsequent onset of depression depended on HPA-axis functioning at baseline. Specifically, negative life events predicted the onset of depression in girls with higher levels of AUCg, but not in girls with lower levels of AUCg. In contrast, CAR did not predict the onset of depression either alone or in interaction with negative life events. These findings suggest that elevated total cortisol production in daily life potentiates susceptibility to environmental adversity and signals the need for early intervention.

Variations in the influence of parental socialization of anxiety among clinic referred children

This study examined the relations between parental socialization of child anxious behaviors (i.e., reinforcement, punishment, modeling, transmission of information) and child anxiety and related problems at varying child sensitivity levels. Data corresponding to 70 clinic-referred children (M age = 9.86 years; 50% girls; 49% Hispanic/Latino, 51% Caucasian) showed that for children with low (but not high) anxiety sensitivity, anxiety-related parental socialization behaviors were associated with more child anxiety and depression symptoms. Findings also indicated that parental socialization of anxious behaviors and anxiety sensitivity functioned similarly in the prediction of anxiety and depression across Caucasian and Hispanic/Latino children. There were no significant mean level variations across child sociodemographic characteristics in general, but anxiety-promoting parenting behaviors were twice as high in Hispanic/Latino compared to Caucasian families.

Concordance of mother-daughter diurnal cortisol production: Understanding the intergenerational transmission of risk for depression

A growing body of research is demonstrating concordance between mother and child diurnal cortisol production. In the context of maternal history of depression, intergenerational concordance of cortisol production could contribute to hypercortisolemia in children of depressed mothers, which has been shown to increase risk for MDD. The current study is the first to examine concordance in diurnal cortisol production between mothers with a history of depression and their never-depressed, but high-risk, children. We collected salivary cortisol across 2 days from mothers with (remitted; RMD) and without (CTL) a history of recurrent episodes of depression and their never-depressed daughters. As expected, RMD mothers and their daughters both exhibited higher cortisol production than did their CTL counterparts. Moreover, both across and within groups, mothers' and daughters' cortisol production were directly coupled. These findings suggest that there is an intergenerational concordance in cortisol dysregulation that may contribute to hypercortisolemia in girls at familial risk for depression.

Anxiety modulates insula recruitment in resting-state functional magnetic resonance imaging in youth and adults

Research on resting-state functional connectivity reveals intrinsically connected networks in the brain that are largely consistent across the general population. However, there are individual differences in these networks that have not been elucidated. Here, we measured the influence of naturally occurring mood on functional connectivity. In particular, we examined the association between self-reported levels of anxiety and connectivity in the default mode network (DMN). Healthy youth (n=43; ages 10-18) and adult participants (n=24, ages 19-59) completed a 6-min resting-state functional magnetic resonance imaging scan, then immediately completed questionnaires assessing their mood and thoughts during the scan. Regression analyses conducted separately for the youth and adult samples revealed brain regions in which increases in connectivity differentially corresponded to higher anxiety in each group. In one area, the left insular cortex, both groups showed similar increased connectivity to the DMN (youth: -30, 26, 14; adults: -33, 12, 14) with increased anxiety. State anxiety assessed during scanning was not correlated with trait anxiety, so our results likely reflect state levels of anxiety. To our knowledge, this is the first study to relate naturally occurring mood to resting state connectivity.

Affective and physiological responses to stress in girls at elevated risk for depression

Children of depressed parents are significantly more likely to develop depression and other mental health disorders than are children of never-depressed parents. Investigations of the physiological mechanisms underlying this elevated risk have generally focused on basal functioning. It is important to note, however, that physiological reactivity or responses to stress are also critical determinants of mental and physical health. In the current study, we examined whether children of depressed parents exhibit altered physiological responses to stress. In two studies, never-depressed adolescent daughters of either recurrently depressed mothers (RISK) or never-depressed mothers (CTL) underwent social stressors while their physiological responses were measured (cortisol in Study 1, heart rate in Study 2). In both studies, affective responses to the stressors predicted physiological responses in RISK girls, but not in never-depressed girls. For RISK girls, decreased positive affect in response to stress predicted increased cortisol reactivity; in addition, decreased positive affect and increased negative affect were associated with poorer heart rate recovery and habituation, respectively. Future research is needed to examine explicitly whether this coherence between affect and physiology is a mechanism underlying the increased risk for psychopathology in children of depressed parents.

The facets of anxiety sensitivity in adolescents

This study examined the factor structure, reliability, and validity of the German translation of the Childhood Anxiety Sensitivity Index (CASI). A total of 1292 adolescents participated in the study. Analyses using the Schmid-Leiman solution showed the CASI to have one higher order factor and three orthogonal lower order factors. CASI scores correlated significantly with anxiety symptoms and with general difficulties. Hierarchical multiple regression showed CASI to make a significant contribution in predicting anxiety even after controlling for variance due to general difficulties, thus giving further support to the incremental validity of the CASI. The CASI is a potentially useful measure to include in longitudinal studies that examine the development of childhood and adolescent anxiety disorders.

The factor structure of the Childhood Anxiety Sensitivity Index in German children

The factor structure of the Childhood Anxiety Sensitivity Index (CASI) was investigated in four nonclinic German samples (N=1244, 225, 230, and 143) with participants aged 8-16-years-old. Factor solutions suggested for different CASI versions were tested using confirmatory factor analysis. The best goodness-of-fit indices were found for the 13-item CASI version with 4 factors (Disease Concerns, Unsteady Concerns, Mental Incapacitation Concerns, and Social Concerns). Testing for factorial invariance of this model with respect to age and gender revealed non-invariant factor loadings between children and adolescents as well as between boys and girls. The theoretical and clinical implications of these findings for anxiety sensitivity in children and adolescents are discussed.

Unique contributions of anxiety sensitivity to avoidance: A prospective study in adolescents

Examination of the prospective relation between anxiety sensitivity (AS) and behavioral avoidance is largely absent from the literature. In a longitudinal study of a community sample of 2246 adolescents, participants completed the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally (1986). Behaviour Research & Therapy, 24, 1-8), State-Trait Anxiety Inventory (STAI; Spielberger (1983). STAI: Manual for the Stait-Trait Anxiety Inventory. Palo Alto: Consulting Psychologists Press), and the Fear Questionnaire (Marks & Matthews (1979). Behaviour Research & Therapy, 17, 263-267) on an annual basis. To stringently test AS's ability to prospectively predict behavioral avoidance, linear regression was used to test whether AS factors predicted variance in follow-up behavioral avoidance scores after controlling for gender, trait anxiety, panic attacks, and baseline avoidance. Results indicted that the mental and physical subscales of the ASI predicted change in behavioral avoidance. The findings of the study are consistent with the view that AS may serve as a precursor to avoidant behavior and that, regardless of whether or not acute panic has been experienced, those who fear autonomic arousal may be more likely to avoid situations in which those sensations may be present.

A cross-sectional evaluation of the factorial invariance of anxiety sensitivity in adolescents and young adults

This study examined the cross-sectional factorial invariance of anxiety sensitivity in an ethnically diverse sample of adolescents (n = 173; mean age 15.5 years) and young adults (n = 291; mean age 20.1 years). Research in adult and youth samples suggests that anxiety sensitivity is best understood as a hierarchical construct with several lower-order factors. Factor models based on previous research using both adult and youth samples were compared and a hierarchical model with three lower-order factors provided the best fit to the data. Results supported the hypothesis that the factor structure of the Anxiety Sensitivity Index was invariant across age and gender. The factor scores also demonstrated differential correlations with symptoms of anxiety and depression. Results are discussed with regard to construct validation and understanding the structure of anxiety sensitivity in youth.

A prospective evaluation of agoraphobia and depression symptoms following panic attacks in a community sample of adolescents

In a community sample of high schoolers who experienced their first panic attack, we examined the prospective relationships among pre-panic vulnerabilities, panic attack severity, and post-panic agoraphobia and depression symptoms. Students were evaluated yearly over 4 years to test the following four hypotheses: (1) pre-panic anxiety sensitivity, negative affect, and childhood behavioral inhibition will serve as vulnerabilities that predict agoraphobia and depression symptoms following a panic attack; (2) these vulnerabilities will lead to more severe panic attacks; (3) severe and spontaneous panic attacks will predict subsequent agoraphobia and depressive symptoms; and (4) the interaction between panic severity and vulnerabilities will be associated with worse outcomes following a panic attack. Results supported the first three hypotheses, but no evidence emerged for an interactive effect. Findings are discussed in light of recent modernized classical conditioning models that address factors contributing to development of more severe panic related psychopathology after panic attacks.

Anxiety sensitivity in African-American adolescents: evidence of symptom specificity of anxiety sensitivity components

OBJECTIVE

To examine the specificity of components of anxiety sensitivity (phrenophobia, fear of cardiovascular sensations, and fear of unsteadiness) to anxiety and depression in a sample of African-American adolescents.

METHOD

Participants were 527 African-American adolescents (238 females, mean age 13.8 years) who were originally recruited as first graders in 1993 to 1994 for participation in the second-generation Johns Hopkins Prevention Intervention Research Center trials. Youths completed measures of anxiety sensitivity and anxious and depressive symptoms in the spring of 2001. Associations between anxiety sensitivity and depression and anxiety were examined using hierarchical linear regressions.

RESULTS

Anxiety sensitivity as a unitary construct was positively associated with symptoms of anxiety after adjusting for symptoms of depression. Fear of unsteadiness showed specificity to anxiety after adjusting for depression and phrenophobia. Phrenophobia was positively associated with anxiety and depression, after adjusting for the other symptom and fears of physical sensations.

CONCLUSIONS

Specificity of anxiety sensitivity to anxiety in a sample of African-American adolescents furthers understanding of the nature of anxiety sensitivity in this group and the potential roles of components of anxiety sensitivity in the development of psychopathology in general.

Assessing Anxiety Sensitivity in Inner-City African American Children: Psychometric Properties of the Childhood Anxiety Sensitivity Index

This study examined the psychometric properties of the Childhood Anxiety Sensitivity Index (CASI; Silverman et al., 1991) in a sample of urban African American elementary school children. One hundred forty-four 4th- and 5th-grade children completed the CASI as part of a larger project. In contrast to prior research with community samples, CASI total scores were higher and means did not differ by sex. Internal consistency (alpha =.82), 2-week test-retest reliability (r =.80), and convergent and divergent validity were good and consistent with prior research. The factor structure of the CASI differed from the structure found with White children. Results of exploratory factor analyses suggest two factors: physical concerns and mental incapacitation concerns. Implications for assessing anxiety and anxiety sensitivity among African American children are discussed.

The facets of anxiety sensitivity represented in the childhood anxiety sensitivity index: confirmatory analyses of factor models from past studies

Results of past factor analytic studies of the Childhood Anxiety Sensitivity Index and Anxiety Sensitivity Index were used to formulate hypotheses about factor models of anxiety sensitivity. Using a nonclinical sample of 767 children and adolescents and confirmatory factor analysis, hypothesized models with 2, 3, and 4 lower order factors (facets) were tested. Goodness-of-fit criteria indicated that a model with 4 facets fits these data well. Support was found for factorial invariance of the 4 facets across age and gender, using nonclinical and clinical samples. Results support a hierarchical factor model in that there was a strong general factor, explaining 71% of the variance. Findings are discussed in the context of anxiety sensitivity theory and research with children and adolescents.

Anxiety measures and their relationship to adolescent suicidal ideation and behavior

This study examines the psychometric properties of three recently published anxiety measures, including their incremental validity in predicting adolescent suicidal ideation and behavior. One hundred and eighteen adolescents aged 12-18 completed measures of anxiety, depression, positive and negative affect, and suicidal ideation and behavior. All of the anxiety scales showed limitations. For example, most of the anxiety scales appeared to lack divergent validity with regard to measures of depression and positive affect. Scales in the panic domain predicted suicidal ideation after controlling for depression. Surprisingly, scales in the social phobia domain were related to lower levels of suicidal behavior after controlling for depression and suicidal ideation. The implications of these results for research on adolescent suicide and the assessment of adolescent anxiety are discussed.

Anxiety sensitivity and panic attack symptomatology among low-income African-American adolescents

This study examined the concurrent and prospective relation between anxiety sensitivity (AS) and panic attack symptomatology among a community sample of African-American adolescents (N = 107; mean age 15.6 years) from predominantly low-income, single-parent households. On two occasions, 6 months apart, youth completed self-report measures of AS, measured by the Childhood Anxiety Sensitivity Index (CAS I), and panic symptomatology, measured by the Panic Attack Questionnaire (PAQ) and/or the Panic subscale of the Screen for Child Anxiety-Related Emotional Disorders (SCARED-P). Results indicated that adolescents with high levels of AS reported higher concurrent levels of panic symptomatology, compared to their less anxious peers. Earlier levels of AS were correlated with panic symptoms 6 months later but did not predict later panic symptoms once initial levels of panic were controlled. Panickers, compared to non-panickers, also reported significantly higher levels of AS at Time 2. Overall, these findings are consistent with research on AS and panic in adult and Caucasian populations and support the hypothesis that elevated levels of AS may be one of several risk factors implicated in the development of panic attack symptomatology.

The Anxiety Sensitivity Index for Children: factor structure and relation to panic symptoms in an adolescent sample

This study examines the factor structure underlying the Anxiety Sensitivity Index for Children (ASIC. J Anxiety Disord, 12 (1998) 307) in an adolescent sample. Three-hundred-and-eight adolescents, aged 12 to 18, completed the ASIC and measures of anxiety and depression. Factor analysis of the ASIC items resulted in a two-factor structure that is similar to that reported by Laurent et al. These two factors included a physical concerns dimension and a mental concerns dimension similar to those found in studies of adult anxiety sensitivity. Subscales measuring these two factors demonstrated concurrent validity, showing particularly close associations with measures of panic symptoms. In addition, both of these subscales showed incremental validity in predicting panic symptoms after controlling for the other anxiety sensitivity subscale and a measure of depression. These results provide evidence that the anxiety sensitivity construct is applicable during adolescence and support the use of the ASIC.

Anxiety sensitivity as a specific and unique marker of anxious symptoms in youth psychiatric inpatients

We addressed several questions regarding the relation of anxiety sensitivity to anxious symptoms among 47 youth psychiatric inpatients (18 boys, 29 girls), ages 9-17 (M = 14.23, SD = 1.89). Participants completed measures of anxiety sensitivity, anxious and depressive symptoms, trait anxiety, and positive and negative affect; chart diagnoses were available. Consistent with hypotheses, we found that (a) anxiety sensitivity was associated with anxious symptoms, even controlling for trait anxiety and depressive symptoms; and (b) anxiety sensitivity displayed symptom specificity to anxious versus depressive symptoms (i.e., was associated with anxiety controlling for depression but not with depression controlling for anxiety). Furthermore, regarding factors of anxiety sensitivity, we obtained mixed support for our prediction that phrenophobia would be associated with both depression and anxiety, whereas fear of physical arousal would be associated with anxiety but not depression. Implications for the construct validity of anxiety sensitivity were discussed.

The Dutch Childhood Anxiety Sensitivity Index: psychometric properties and factor structure

Examined the reliability, validity, and factor structure of the Childhood Anxiety Sensitivity Index (CASI; Silverman, Fleisig, Rabian, & Peterson, 1991) in a Dutch sample. Five hundred forty-four Dutch schoolchildren between 8 and 16 years of age completed Dutch translations of the CASI; the State-Trait Anxiety Inventory for Children (Spielberger, Edwards, Lushene, Montuori, & Platzek, 1973); and the Fear Survey Schedule for Children-Revised (Ollendick, 1983). The Dutch CASI was found to have adequate internal consistency for use with children as well as adolescents. Results reveal that the CASI predicted fear beyond a measure of trait anxiety in this Dutch sample. Both exploratory and confirmatory factor analyses comparing different models were undertaken. The model with 3 first-order factors found in previous studies showed an acceptable fit in this cross-validation sample. Loadings on the 3 factors (Physical Concerns, Mental Concerns, and Publicly Observable Concerns) did not differ between children and adolescents. Results are compared with previous research on the CASI. Directions for future research are discussed.

Anxiety sensitivity in adolescents: factor structure and relationships to trait anxiety and symptoms of anxiety disorders and depression

The current study examined the anxiety sensitivity construct in a large sample of normal Dutch adolescents aged 13-16 years (n=819). Children completed the Childhood Anxiety Sensitivity Index (CASI; Silverman, W. K., Fleisig, W., Rabian, B. & Peterson, R. A. (1991). Journal of Clinical Child Psychology, 20, 162-168) and measures of trait anxiety, anxiety disorder symptoms and depression. Results showed that (1) anxiety sensitivity as indexed by the CASI seems to be a hierarchically organized construct with one higher-order factor (i.e., anxiety sensitivity) and three or four lower-order factors, (2) anxiety sensitivity and trait anxiety were strongly correlated, (3) anxiety sensitivity was substantially connected to symptoms of anxiety disorders (in particular of panic disorder and agoraphobia) and depression, and (4) anxiety sensitivity and trait anxiety both accounted for unique proportions of the variance in anxiety disorder symptoms. Altogether these findings are in agreement with those of previous research in adult and child populations, and further support the notion that anxiety sensitivity should be viewed as an unique factor of anxiety vulnerability.

Predictors of panic attacks in adolescents

OBJECTIVE

To identify risk factors for onset of panic attacks in adolescents, a prospective cohort design was used to evaluate the following risk factors: negative affectivity, female sex, anxiety sensitivity, and childhood separation anxiety disorder. These risk factors were also evaluated for predicting onset of major depression to test their specificity.

METHOD

The sample consisted of 2,365 high school students assessed over a 4-year period. Assessments included self-report questionnaires and structured clinical interviews. Cox proportional hazards models were used to evaluate risk.

RESULTS

Consistent with previous studies, prior major depression predicted onset of panic attacks and a history of panic attacks predicted onset of major depression. After adjusting for the effects of prior major depression, negative affectivity and anxiety sensitivity, but not female sex or childhood separation anxiety disorder, predicted onset of 4-symptom panic attacks. However, female sex and negative affectivity but not anxiety sensitivity or childhood separation anxiety disorder predicted onset of major depression after adjustment for the effects of prior panic attacks.

CONCLUSION

Negative affectivity appears to be a nonspecific risk factor for panic attacks and major depression, whereas anxiety sensitivity appears to be a specific factor that increases the risk for 4-symptom panic attacks in adolescents.