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Dunn A, Alvarez J, Arbon A, Bremner S, Elsby-Pearson C, Emsley R, Jones C, Lawrence P, Lester KJ, Morson N, Simner J, Thomson A, Cartwright-Hatton S. Effectiveness of an unguided modular online intervention for highly anxious parents in preventing anxiety in their children: a parallel group randomised controlled trial. THE LANCET REGIONAL HEALTH. EUROPE 2024; 45:101038. [PMID: 39291249 PMCID: PMC11405817 DOI: 10.1016/j.lanepe.2024.101038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 08/01/2024] [Accepted: 08/07/2024] [Indexed: 09/19/2024]
Abstract
Background Children whose parents have anxiety problems are at increased risk of developing anxiety themselves. Parenting behaviors are a contributing factor to intergenerational transmission. Interventions which seek to limit anxiogenic parenting behaviors have shown potential in reducing anxiety in offspring but are not widely accessible. This prevention trial aimed to establish the effectiveness of an unguided modular online intervention for highly anxious parents in preventing anxiety in their children. Methods A parallel group, block-randomised controlled trial of unblinded participants in a 1:1 ratio was conducted to compare efficacy of the online course compared to a no-intervention control. The intervention comprised 8 modules, of approximately 20 min each, and participants progressed through the course at their own pace. The study was conducted entirely online with a self-referred UK-based community sample of parents (child 2-11 years) with substantial anxiety. The primary outcome measure was change in parent-reported child anxiety, as measured by the Spence Children's Anxiety Scale-Parent Report (SCAS-P) or Spence Pre-School Anxiety Scale-Parent Report (Preschool SCAS). Secondary outcomes were child internalising, externalising, and attentional symptoms (Pediatric Symptom Checklist), and parent anxiety (SCARED-Adult). Analyses using complete case analysis following intention to treat principles investigated intervention effects at 6 months (primary analysis) and additionally at 9 to 25-months' follow-up. Trial registration: ClinicalTrials.GovNCT04755933, https://clinicaltrials.gov/ct2/show/NCT04755933. Findings 1811 participants (intervention = 900; control = 911; 92.7% (1677/1810) female; 85.3% (1535/1800) White-British; 66.8% (1201/1799) university educated). Participant retention (based on primary outcome completion) at T2 (6-months post consent) was 67.6% overall (n = 1224) and substantially lower in the intervention arm 57.3% ((516/900) control = 77.8% (708/910)). Child anxiety was lower in the intervention group compared to control at 6-month follow-up (adjusted effect size estimate -0.15 (95% CI: -0.23 to -0.08, p < 0.001). There was very strong evidence that those in the intervention arm had lowered child anxiety (standardised SCAS score) compared to the control arm, with an effect size (Cohen's d) of -0.16 (95% CI: -0.23 to -0.08, p < 0.001). The difference in standardised Spence Child Anxiety Scale score between the arms was -0.15 standard deviations. On the original scales for SCAS-P (0-114) and Preschool SCAS (0-112), this corresponds to a reduction of -2.38 (95% CI: -3.59 to -1.16) and -2.68 (95% CI: -4.05 to -1.31), respectively. No reported harms. Interpretation A clinically unsupported online intervention designed for parents with high levels of anxiety is effective in reducing anxiety and internalising symptoms in their children, and also anxiety in parents. Given the low resource intensity of this intervention, and the positive effects reported here, these findings suggest it has promise in limiting the intergenerational transmission of severe anxiety. Funding This work was supported by Kavli Trust (grant 38/19).
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Affiliation(s)
- Abby Dunn
- University of Sussex, Falmer, United Kingdom
| | | | - Amy Arbon
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
| | - Stephen Bremner
- Brighton and Sussex Medical School, Brighton, United Kingdom
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Zhong Q, Niu L, Chen K, Lee TMC, Zhang R. Prevalence and risk of subthreshold anxiety developing into threshold anxiety disorder in the general population. J Affect Disord 2024; 367:815-822. [PMID: 39265868 DOI: 10.1016/j.jad.2024.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 09/02/2024] [Accepted: 09/08/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Subthreshold anxiety may act as a critical precursor and risk factor for the onset of threshold anxiety. However, accurate prevalence rates of subthreshold anxiety and its role in leading to threshold anxiety require further elucidation. METHODS We conducted a search on PubMed and Web of Science using predefined criteria and identified 45 articles with a total of 278,971 individuals to estimate the prevalence rates using a random effects model. The incidence risk ratio (IRR) was estimated by comparing the proportion of individuals with subthreshold anxiety who developed threshold anxiety to those without subthreshold anxiety in seven articles involving 18,693 individuals. RESULTS Our analysis revealed an overall prevalence of subthreshold anxiety of 6.19%. Specifically, among individuals with subthreshold generalized anxiety disorders, adolescents show the highest prevalence (9.47%), outpacing adults (4.69%) and the elderly (3.49%). Further analysis of seven studies showed an increased risk of developing threshold anxiety in individuals with subthreshold anxiety (IRR = 2.63), with a higher transition rate (9.59%) compared to those without subthreshold anxiety (3.65%). CONCLUSIONS Anxiety disorders may be conceptualized as a spectrum, with subthreshold anxiety serving as a significant prodromal state and risk factor for the development of threshold anxiety. Proactive management of subthreshold anxiety represents an effective approach for the prevention of its progression to threshold anxiety. Future research should investigate the risk of progression from subthreshold to threshold anxiety across various types, and explore how factors, such as social support and personality traits facilitate this progression.
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Affiliation(s)
- Qianting Zhong
- Cognitive Control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Lijing Niu
- Cognitive Control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Keyin Chen
- Cognitive Control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Tatia M C Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong, Hong Kong Special Administrative Region of China; Center for Brain Science and Brain-Inspired Intelligence, Guangdong-Hong Kong-Macao Greater Bay Area, Guangzhou, China
| | - Ruibin Zhang
- Cognitive Control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China; Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong-Hong Kong Joint Laboratory for Psychiatric Disorders, Southern Medical University.
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Okawa S, Rapee RM, Takahashi T, Reardon T, Arai H, Shimizu E, Creswell C. Psychometric Properties of the Japanese Translation of the Parent Overprotection Measure for Mother and Father Reports. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01753-8. [PMID: 39249182 DOI: 10.1007/s10578-024-01753-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2024] [Indexed: 09/10/2024]
Abstract
The Parent Overprotection Measure (POM) is a promising scale to measure parent overprotection toward a child from the parent's perspective. However, no Japanese translation of the scale has been developed, and whether the POM can be applied to a Japanese population is unknown. This study translated the POM into Japanese and examined its psychometric properties. Parents of 380 children aged 4 to 7 years (including 190 mothers and 190 fathers) completed online questionnaires. Exploratory and confirmatory factor analyses (CFA) indicated that the Japanese translation of the POM has a bi-factor structure, including one general factor (general overprotection) and two specific factors (care/attention and control/prevention). The measurement invariance of reports from mothers' and fathers' perspectives was confirmed by multiple group CFA. The McDonald's Omega was acceptable for all factors, but the general overprotection factor explained most scale variance. Pearson's correlation coefficients were more than .20 between the control/prevention factor and child anxiety symptoms in both mother and father reports. The correlation between the control/prevention factor and parent anxiety according to fathers' reports also exceeded .20. These results provided the factor structure and supported the reliability of the POM among a Japanese population; however, further investigation of the validity of the scale is needed.
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Affiliation(s)
- Sho Okawa
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
- Research Center for Child Mental Development, Chiba University, 1-8-1, Inohana, Chuo Ku, Chiba-Shi, Chiba, 260-8670, Japan.
- Department of Life Sciences, The University of Tokyo, 3-8-1, Komaba, Meguro-Ku, Tokyo, 153-8902, Japan.
| | - Ronald M Rapee
- Centre for Lifespan Health and Wellbeing, School of Psychological Sciences, Macquarie University, Balaclava Road, 2109, North Ryde, NSW, Australia
| | - Takahito Takahashi
- Faculty of Education, University of Miyazaki, 1-1 Gakuenkibanadai-Nishi, Miyazaki , 889-2192, Japan
| | - Tessa Reardon
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Honami Arai
- Center for Research on Counseling and Support Services, Tokyo University, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, 1-8-1, Inohana, Chuo Ku, Chiba-Shi, Chiba, 260-8670, Japan
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo Ku, Chiba-Shi, Chiba, 260-8670, Japan
| | - Cathy Creswell
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
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Klein AM, Van Niekerk RE, Allart Van Dam E, Rinck M, Verbraak MJPM, Hutschemaekers GJM, Becker ES. Fear-related associations in children of parents with an anxiety disorder. J Behav Ther Exp Psychiatry 2024; 84:101953. [PMID: 38593495 DOI: 10.1016/j.jbtep.2024.101953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/27/2023] [Accepted: 02/19/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND OBJECTIVES Children of parents with an anxiety disorder are at elevated risk for developing an anxiety disorder themselves. According to cognitive theories, a possible risk factor is the development of schema-related associations. This study is the first to investigate whether children of anxious parents display fear-related associations and whether these associations relate to parental anxiety. METHODS 44 children of parents with panic disorder, 27 children of parents with social anxiety disorder, and 84 children of parents without an anxiety disorder filled out the SCARED-71, and the children performed an Affective Priming Task. RESULTS We found partial evidence for disorder-specificity: When the primes were related to their parent's disorder and the targets were negative, the children of parents with panic disorder and children of parents with social anxiety disorder showed the lowest error rates related to their parents' disorder, but they did not have faster responses. We did not find any evidence for the expected specificity in the relationship between the parents' or the children's self-reported anxiety and the children's fear-related associations, as measured with the APT. LIMITATIONS Reliability of the Affective Priming Task was moderate, and power was low for finding small interaction effects. CONCLUSIONS Whereas clearly more research is needed, our results suggest that negative associations may qualify as a possible vulnerability factor for children of parents with an anxiety disorder.
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Affiliation(s)
- Anke M Klein
- Developmental and Educational Psychology, Leiden University, the Netherlands; Behavioural Science Institute, Radboud University Nijmegen, the Netherlands.
| | - Rianne E Van Niekerk
- Behavioural Science Institute, Radboud University Nijmegen, the Netherlands; Centre for Anxiety Disorders Overwaal, Pro Persona, the Netherlands
| | | | - Mike Rinck
- Behavioural Science Institute, Radboud University Nijmegen, the Netherlands
| | | | | | - Eni S Becker
- Behavioural Science Institute, Radboud University Nijmegen, the Netherlands
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Nimphy CA, Elzinga BM, Van der Does W, Van Bockstaele B, Pérez-Edgar K, Westenberg M, Aktar E. "Nobody Here Likes Her"-The Impact of Parental Verbal Threat Information on Children's Fear of Strangers. Dev Psychobiol 2024; 66:e22526. [PMID: 38979744 DOI: 10.1002/dev.22526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/03/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
Parental verbal threat (vs. safety) information about strangers may induce fears of these strangers in adolescents. In this multi-method experimental study, utilizing a within-subject design, parents provided standardized verbal threat or safety information to their offspring (N = 77, Mage = 11.62 years, 42 girls) regarding two strangers in the lab. We also explored whether the impact of parental verbal threat information differs depending on the social anxiety levels of parents or fearful temperaments of adolescents. Adolescent's fear of strangers during social interaction tasks was assessed using cognitive (fear beliefs, attention bias), behavioral (observed avoidance and anxiety), and physiological (heart rate) indices. We also explored whether the impact of parental verbal threat information differs depending on the social anxiety levels of parents or fearful temperaments of adolescents. The findings suggest that a single exposure to parental verbal threat (vs. safety) information increased adolescent's self-reported fears about the strangers but did not increase their fearful behaviors, heart rate, or attentional bias. Furthermore, adolescents of parents with higher social anxiety levels or adolescents with fearful temperaments were not more strongly impacted by parental verbal threat information. Longitudinal research and studies investigating parents' naturalistic verbal expressions of threat are needed to expand our understanding of this potential verbal fear-learning pathway.
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Affiliation(s)
- Cosima A Nimphy
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Bernet M Elzinga
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, The Netherlands
| | - Willem Van der Does
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden University Treatment Center (LUBEC), Leiden, The Netherlands
| | - Bram Van Bockstaele
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia
| | - Koraly Pérez-Edgar
- Department of Psychology, Child Study Center, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Michiel Westenberg
- Department of Developmental Psychology, Institute of Psychology, Leiden, The Netherlands
| | - Evin Aktar
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, The Netherlands
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Rudravaram S, Gupta A, Kalra B, Malhotra S, Gupta MK, Kamal G, Agarwal S, Parida R. Evaluation of parental anxiety following three methods of pre-anesthesia counseling: Video, brochure and verbal communication. Paediatr Anaesth 2024; 34:665-670. [PMID: 38661287 DOI: 10.1111/pan.14905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The purpose of this study is to provide comprehensive and efficient pre-anesthesia counseling (PAC) utilizing audiovisual aids and to examine their effect on parental anxiety. METHODS For this prospective, controlled study, 174 parents were recruited and randomized into three groups of 58 (Group A: video, Group B: brochure, and Group C: verbal). During pre-anesthesia counseling, the parent was provided with a detailed explanation of preoperative preparation, fasting instructions, transport to the operating room, induction, the emergence of anesthesia, and nursing in the post-anesthesia care unit based on their assigned group. We evaluated parental anxiety using Spielberger's State-Trait Anxiety Inventory before and after the pre-anesthesia counseling. RESULTS The results of our study show a statistically significant difference in the final mean STAI scores among the three groups (Group A: 34.69 ± 5.31, Group B: 36.34 ± 8.59, and Group C: 43.59 ± 3.39; p < .001). When compared to the brochure and verbal groups, the parents in the video group have the greatest difference in mean baseline and final Spielberger's State-Trait Anxiety Inventory scores (12.207 ± 5.291, p .001). CONCLUSION The results of our study suggest that pre-anesthesia counseling by video or a brochure before the day of surgery is associated with a higher reduction in parental anxiety when compared to verbal communication.
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Affiliation(s)
- Swetha Rudravaram
- Department of Anesthesiology, Chacha Nehru Bal Chikitsalaya Superspeciality (Autonomous) Children Hospital, Delhi, India
| | - Aikta Gupta
- Department of Anesthesiology, Chacha Nehru Bal Chikitsalaya Superspeciality (Autonomous) Children Hospital, Delhi, India
| | - Bhumika Kalra
- Department of Anesthesiology, Chacha Nehru Bal Chikitsalaya Superspeciality (Autonomous) Children Hospital, Delhi, India
| | - Shahzadi Malhotra
- Department of Clinical Psychology, Chacha Nehru Bal Chikitsalaya superspeciality (Autonomous) children hospital, Delhi, India
| | - Manoj Kumar Gupta
- Department of Anesthesiology, Chacha Nehru Bal Chikitsalaya Superspeciality (Autonomous) Children Hospital, Delhi, India
| | - Geeta Kamal
- Department of Anesthesiology, Chacha Nehru Bal Chikitsalaya Superspeciality (Autonomous) Children Hospital, Delhi, India
| | - Shilpa Agarwal
- Department of Anesthesiology, Chacha Nehru Bal Chikitsalaya Superspeciality (Autonomous) Children Hospital, Delhi, India
| | - Raunak Parida
- Department of Anesthesiology, Artemis Hospitals, Gurgaon, Haryana, India
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Subbiah GK, Reijneveld SA, Hartman CA, van der Zee-van den Berg AI, Boere-Boonekamp MM, Almansa J, de Kroon MLA. Impact of trajectories of maternal postpartum depression on infants' socioemotional development. Pediatr Res 2024; 96:519-524. [PMID: 37337109 DOI: 10.1038/s41390-023-02697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/27/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND We assessed (a) the effects of postpartum depression (PPD) trajectories until 6 months postpartum on infants' socioemotional development (SED) at age 12 months, and (b) the mediating role of maternal self-efficacy (MSE), and the additional effect of postpartum anxiety at age 12 months. METHODS We used data from POST-UP trial (n = 1843). PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 1, 3, and 6 months. Infants' SED was assessed at 12 months using the Ages and Stages Questionnaire-Social-Emotional (ASQ-SE). Structural equations were applied to estimate the effect of PPD trajectories on infants' SED and mediation by MSE. The additional effects of postpartum anxiety were assessed with conditional regression. RESULTS Higher levels of PPD over time were associated with a lower SED (coefficient for log-EPDS 3.5, 95% confidence interval 2.8; 4.2, e.g., an increase in the EPDS score from 9 to 13 worsens the ASQ-SE by 1.3 points). About half of this relationship was mediated by MSE. Postpartum anxiety had an independent adverse effect on SED. CONCLUSIONS PPD and postpartum anxiety have a negative impact on infants' SED. MSE as a mediator may be a potential target for preventive interventions to alleviate the negative effects of maternal psychopathology on infants' SED. IMPACT The trajectories of postpartum depression (PPD) from 1 month to 6 months were negatively related to infants' socioemotional development (SED) at age 12 months, underlining the importance of repeated assessment of PPD. Maternal self-efficacy (MSE) mediated the association between PPD and SED, implying MSE could be a potential target for preventive interventions. An additional independent negative effect of postpartum anxiety was identified, implying the assessment of postpartum anxiety also has a surplus value to identify mothers at risk.
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Affiliation(s)
- Gireesh Kumar Subbiah
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands.
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
| | - Catharina A Hartman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | | | - Magda M Boere-Boonekamp
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
| | - Josué Almansa
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
| | - Marlou L A de Kroon
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
- Department of Public Health and Primary Care, Environment and Health, KU Leuven, Kapucijnenvoer 35, P.O. Box 7001, 3000, Leuven, Belgium
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8
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Rask CU, Duholm CS, Poulsen CM, Rimvall MK, Wright KD. Annual Research Review: Health anxiety in children and adolescents-developmental aspects and cross-generational influences. J Child Psychol Psychiatry 2024; 65:413-430. [PMID: 37909255 DOI: 10.1111/jcpp.13912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 11/03/2023]
Abstract
Health anxiety involves excessive worries about one's health along with beliefs one has an illness or may contract a serious disease. Concerning evidence suggests that health anxiety is on the rise in society, possibly further fueled by the COVID-19 pandemic. Recent classification systems acknowledge that impairing health-related worries and beliefs can emerge in early childhood with significant levels of symptoms persisting throughout childhood, and possibly continuous with diagnostic considerations in adulthood. This narrative review summarizes recent research advances in health anxiety in children and adolescents, focusing on various developmental aspects of health anxiety and related concepts in youths. Findings suggest that health anxiety symptoms in young age groups are associated with impairment, distress, and increased healthcare use, as well as substantial comorbidity with mainly other emotional problems and disorders. Furthermore, longitudinal studies suggest that childhood health anxiety can persist across adolescence, perhaps with links to chronic courses in adulthood. The growing literature was further reviewed, thus extending our understanding of early risk factors, including the potential role of exposure to serious illness and transgenerational transmission of health anxiety. Learning more about developmental trajectories will be highly relevant to inform strategies for early detection and prevention. While modified cognitive behavioral therapies in adults are successful in treating health anxiety, specific interventions have not yet been tested in youths. Given substantial overlaps with other psychopathology, it could be important to develop and explore more transdiagnostic and scalable approaches that take advantage of common factors in psychotherapy, while also including a wider perspective on potential familiar maladaptive illness cognitions and behaviors.
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Affiliation(s)
- Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Steen Duholm
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Kristi D Wright
- Department of Psychology, University of Regina, Regina, SK, Canada
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DeVries L, Pickard K, Boles R, Blakeley-Smith A, Duncan A, Keefer A, Klinger L, Meyer A, Reaven J. The Role of Maternal Anxiety in Treatment Response for Youth with ASD and Co-occurring Anxiety. Child Psychiatry Hum Dev 2023; 54:1789-1798. [PMID: 35678890 DOI: 10.1007/s10578-022-01381-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/17/2022] [Accepted: 05/21/2022] [Indexed: 11/28/2022]
Abstract
Anxiety disorders occur at higher rates in youth with ASD than in neurotypical youth. Although the efficacy of CBT for anxiety in children with ASD is widely supported, factors that influence treatment outcomes are not well understood. This study examined the role of maternal anxiety in treatment outcomes for youth with ASD. Youth with ASD and anxiety (ages 8 to 14), along with their mothers (n = 87), participated in a group CBT intervention. Results indicated that maternal anxiety did not improve over the course of treatment. However, findings suggest that high levels of maternal anxiety at pre-treatment predicted higher levels of youth anxiety post-treatment. Importantly, the relationship between parent anxiety and youth outcomes was moderated by child age. The findings of the present study may provide initial insight into the role that maternal anxiety plays in treatment outcomes for children with ASD and co-occurring anxiety, particularly when considering child age.
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Affiliation(s)
- Lindsey DeVries
- Division of Developmental and Behavioral Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, 13123 East 16th Avenue, 80045, Aurora, CO, USA.
| | - Katherine Pickard
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Richard Boles
- Departments of Pediatrics and Psychiatry, JFK Partners, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Audrey Blakeley-Smith
- Departments of Pediatrics and Psychiatry, JFK Partners, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Amie Duncan
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Amy Keefer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Laura Klinger
- TEACCH Autism Program, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison Meyer
- Departments of Pediatrics and Psychiatry, JFK Partners, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Judy Reaven
- Departments of Pediatrics and Psychiatry, JFK Partners, University of Colorado Anschutz Medical Center, Aurora, CO, USA
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Creswell C, Chessell C, Halliday G. Parent-led cognitive behaviour therapy for child anxiety problems: overcoming challenges to increase access to effective treatment. Behav Cogn Psychother 2023; 51:512-532. [PMID: 36458498 DOI: 10.1017/s1352465822000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Anxiety problems have a particularly early age of onset and are common among children. As we celebrate the anniversary of the BABCP, it is important to recognise the huge contribution that cognitive behavioural therapy (CBT) has made to the treatment of anxiety problems in children. CBT remains the only psychological intervention for child anxiety problems with a robust evidence base, but despite this, very few children with anxiety problems access CBT. Creative solutions are urgently needed to ensure that effective treatments can be delivered at scale. Here we focus on parent-led CBT as this offers a potential solution that is brief and can be delivered by clinicians without highly specialised training. Over the last decade there has been a substantial increase in randomised controlled trials evaluating this approach with consistent evidence of effectiveness. Nonetheless clinicians, and parents, often have concerns about trying the approach and can face challenges in its delivery. METHOD We draw on empirical evidence and our clinical experience to address some of these common concerns and challenges, with particular emphasis on the key principles of empowering parents and working with them to provide opportunities for new learning for their children. CONCLUSIONS We conclude by highlighting some important directions for future research and practice, including further evaluation of who does and does not currently benefit from the approach, determining how it should be adapted to optimise outcomes among groups that may not currently get maximum benefits and across cultures, and capitalising on recent technological developments to increase engagement and widen access.
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Affiliation(s)
- Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Chloe Chessell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Gemma Halliday
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
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11
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Chockalingam M, Skinner K, Melvin G, Yap MBH. Modifiable Parent Factors Associated with Child and Adolescent School Refusal: A Systematic Review. Child Psychiatry Hum Dev 2023; 54:1459-1475. [PMID: 35397716 PMCID: PMC10435607 DOI: 10.1007/s10578-022-01358-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 03/21/2022] [Accepted: 03/26/2022] [Indexed: 11/03/2022]
Abstract
School refusal is a complex problem that refers to difficulty attending/remaining at school due to emotional distress about attendance. Despite its occurrence being associated with negative outcomes, many are unresponsive to the current treatment options. While parent factors have a key role to play in school refusal, they are not adequately addressed in existing treatments. Further research is needed to consolidate understanding and implement new treatments. Employing the PRISMA method, this review aims to identify modifiable parent factors associated with child and/or adolescent school refusal. Eight studies met inclusion criteria from which nine factors were identified. Factors found to be associated with school refusal included: parent psychopathology, family functioning and maternal overprotection (communication subdomain). Other factors such as maternal overprotection (affection, assistance and travel subdomains) and parental self-efficacy had weak or inconsistent results warranting further investigation. Overall, findings call for action in this field that has sparse and dated literature.
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Affiliation(s)
- Meena Chockalingam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Kayan Skinner
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Glenn Melvin
- School of Psychology, Centre for Social and Early Emotional Development, Deakin University, Melbourne, Australia.
| | - Marie B H Yap
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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12
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Lei Y, Wang YY, Wan JM, Patel C, Li H. Association between negative parent-related family interactions and child social anxiety: A cross-cultural systematic review and meta-analysis. J Anxiety Disord 2023; 99:102771. [PMID: 37729824 DOI: 10.1016/j.janxdis.2023.102771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 07/28/2023] [Accepted: 09/03/2023] [Indexed: 09/22/2023]
Abstract
This meta-analysis systematically evaluates the strength and direction of the association between negative parent-related family interactions and child social anxiety, and identifies several influencing moderators. Two investigators independently searched international (PsycINFO, PubMed, and Web of Science) and Chinese (CNKI, WanFang, and VIP) databases from their inception dates until March 5, 2023, for suitable articles. Of the 5771 identified records, 85 studies were selected based on inclusion of at least one of the following three dimensions of negative family interactions: insecure attachment (n = 27), parent-related family conflicts (n = 19), or negative parenting styles (n = 46). Meta-analyses showed that all three dimensions were significantly associated with child social anxiety (insecure attachment: r = 0.271, p < 0.0001; parent-related family conflicts: r = 0.226, p < 0.0001; negative parenting styles: r = 0.186, p < 0.0001). For all three dimensions, this association was stronger in children from East Asian culture than in those from European or American culture. In addition, age group, information source, and publication year also significantly moderated this association. Our findings will help guide further research and provide recommendations for the development of effective interventions for reducing social anxiety.
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Affiliation(s)
- Yi Lei
- Institute for Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China.
| | - Yuan-Yuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, China
| | - Jia-Ming Wan
- Institute for Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Chetna Patel
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, China
| | - Hong Li
- Institute for Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China; Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, China.
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13
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TEKBAŞ G, KOÇTÜRK N. Parent Participation in Cognitive Behavioral Therapy for Children and Adolescents: A Scoping Review. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1150920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
This research aims to evaluate the psycho-education and therapy programs prepared for children and adolescents with the Cognitive Behavioral Therapy approach and implemented between 2001-2021 in terms of parental involvement. This research, which was carried out in the descriptive model, is a review study. The articles covered in the research were accessed through Web of Science, ERIC, PubMed, Google Scholar, and ScienceDirect academic databases and were determined to be by the inclusion and exclusion criteria determined by the researchers, 10 of which were quasi-experimental with a control group and 7 in a randomized controlled study design. 17 articles were reviewed. Fifteen of the studies included child and adolescent sessions, while 2 included only children's sessions. According to the findings, it was determined that parent participation was used in all of the studies, the number of therapy sessions was between 8-30, and the session durations varied between 20 minutes and 1.5 hours in total, including the child/adolescent and parents It was stated that children and adolescents included in the treatment experienced various psychological disorders such as anxiety disorder, depression, obsessive-compulsive disorder, anger control disorder, attention deficit, and hyperactivity disorder, and eating disorder. These findings show that Cognitive Behavioral Therapy practices for different psychological disorders for children and adolescents benefit from parental involvement in 82% of the studies. The fact that the types of parental involvement and the presence of parental pathologies are not detailed in the studies constitute the shortcomings of parent involvement studies..
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Affiliation(s)
- Gözde TEKBAŞ
- Eskişehir Osmangazi Üniversitesi Eğitim Fakültesi
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14
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Chow CHT, Poole KL, Xu RY, Sriranjan J, Van Lieshout RJ, Buckley N, Moffat G, Schmidt LA. Children's Shyness, Frontal Brain Activity, and Anxiety in the Perioperative Context. Behav Sci (Basel) 2023; 13:766. [PMID: 37754044 PMCID: PMC10525976 DOI: 10.3390/bs13090766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Although preoperative anxiety affects up to 75% of children undergoing surgery each year and is associated with many adverse outcomes, we know relatively little about individual differences in how children respond to impending surgery. We examined whether patterns of anterior brain electrical activity (i.e., a neural correlate of anxious arousal) moderated the relation between children's shyness and preoperative anxiety on the day of surgery in 70 children (36 girls, Mage = 10.4 years, SDage = 1.7, years, range 8 to 13 years) undergoing elective surgery. Shyness was assessed using self-report approximately 1 week prior to surgery during a preoperative visit (Time 1), preoperative anxiety was assessed using self-report, and regional EEG (left and right frontal and temporal sites) was assessed using a dry sensory EEG headband on the day of surgery (Time 2). We found that overall frontal EEG alpha power moderated the relation between shyness and self-reported preoperative anxiety. Shyness was related to higher levels of self-reported anxiety on the day of surgery for children with lower average overall frontal alpha EEG power (i.e., higher cortical activity) but not for children with higher average overall frontal alpha EEG power (i.e., lower cortical activity). These results suggest that the pattern of frontal brain activity might amplify some shy children's affective responses to impending surgery. Findings also extend prior results linking children's shyness, frontal brain activity, and anxiety observed in the laboratory to a real-world, ecologically salient environment.
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Affiliation(s)
- Cheryl H. T. Chow
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.L.P.); (R.Y.X.); (J.S.); (L.A.S.)
| | - Kristie L. Poole
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.L.P.); (R.Y.X.); (J.S.); (L.A.S.)
| | - Richard Y. Xu
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.L.P.); (R.Y.X.); (J.S.); (L.A.S.)
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Jhanahan Sriranjan
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.L.P.); (R.Y.X.); (J.S.); (L.A.S.)
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Ryan J. Van Lieshout
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Norman Buckley
- Department of Anesthesia, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | | | - Louis A. Schmidt
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.L.P.); (R.Y.X.); (J.S.); (L.A.S.)
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15
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Fynn G, Porter M, Pellicano E. 'Playing a guessing game': Recognising and responding to anxiety in children with intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1150-1161. [PMID: 37381992 DOI: 10.1111/jar.13136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 04/21/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Children with intellectual disability are at greater risk of developing anxiety than the general population. Limited research has examined the challenges associated with recognising and responding to anxiety in children with intellectual disability, and its perceived impact. AIM This study aimed to explore anxiety in children with intellectual disability, from the child and parent perspective to better understand how parents and children recognise and respond to anxiety. METHOD AND PROCEDURES Six children with an intellectual disability (age range: 12-17, four boys) and their mothers participated in a semi-structured interview online. Interviews were transcribed verbatim and interpreted using thematic analysis. OUTCOME AND RESULTS Mothers elaborated on the difficulties with recognising signs of anxiety due to the impact of the child's primary diagnosis and the overlap of symptoms with co-occurring conditions. Mothers and children discussed the 'contagious' effect of anxiety within the household and how this influenced mothers' approaches to managing their child's anxiety. They reported that anxiety limited the meaningful activities in which children and families could engage. CONCLUSIONS AND IMPLICATIONS These findings highlight the importance of supporting mothers to recognise their children's anxiety and to assist them with strategies on how best to respond and cope. These findings have implications for future research, and practitioners working in this field.
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Affiliation(s)
- Gabrielle Fynn
- Macquarie School of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Melanie Porter
- Macquarie School of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Elizabeth Pellicano
- Macquarie School of Education, Macquarie University, Sydney, Australia
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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16
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Rapee RM, Creswell C, Kendall PC, Pine DS, Waters AM. Anxiety disorders in children and adolescents: A summary and overview of the literature. Behav Res Ther 2023; 168:104376. [PMID: 37499294 DOI: 10.1016/j.brat.2023.104376] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Cathy Creswell
- Departments of Psychiatry and Experimental Psychology, University of Oxford, Oxford, UK
| | - Philip C Kendall
- Department of Psychology, Temple University, Child and Adolescent Anxiety Disorders Clinic, USA
| | - Daniel S Pine
- National Institute of Mental Health Intramural Research Program (NIMH-IRP), USA
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Brisbane, Australia
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17
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Nimphy CA, Venetikidi M, Elzinga B, van der Does W, Aktar E. Parent to Offspring Fear Transmission via Modeling in Early Life: A Systematic Review and Meta-Analysis. Clin Child Fam Psychol Rev 2023; 26:751-772. [PMID: 37500947 PMCID: PMC10465674 DOI: 10.1007/s10567-023-00448-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
Infants can acquire fears vicariously by observing parents' fearful reactions to novel stimuli in everyday situations (i.e., modeling). To date, no systematic or meta-analytic review examined the role of modeling in parent-child transmission of fear and avoidance in early life. In our systematic review and meta-analysis, we aimed to investigate the effect of modeling parents' fearful reactions on infants' acquisition of fear and avoidance of novel stimuli and explore the moderation of this effect by child behavioral inhibition (BI) and parent trait anxiety. The search conducted in Web Of Science, Pubmed, Embase, and PsycINFO revealed 23 eligible studies for the systematic review and 19 for the meta-analysis. Eligible studies included published studies that measured infant fear and avoidance (infants aged up to 30 months) of novel stimuli following exposure to parental fearful expressions. Meta-analysis findings revealed a significant causal effect of modeling of parental fear on infants' fear [g = .44] and avoidance of novel stimuli [g = .44]. The findings support moderation by child BI on infant avoidance (not fear) acquisition, with the effects being larger for infants with higher BI. However, this moderation was only found, when including both experimental and correlational studies (p > .05), but not when exclusively including experimental studies (p = .17). This meta-analysis provides support for early parent-to-offspring fear transmission: a causal small to medium effect of parents' fearful reactions was shown on infants' fear and avoidance of novel stimuli. Elucidating parent-to-offspring anxiety transmission pathways can inform us about potential fear reduction and prevention strategies.
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Affiliation(s)
- Cosima Anna Nimphy
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands.
| | - Marianna Venetikidi
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Bernet Elzinga
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, The Netherlands
| | - Willem van der Does
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
- Leiden University Treatment Center (LUBEC), Leiden University, Leiden, The Netherlands
| | - Evin Aktar
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, The Netherlands
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18
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Mestermann S, Arndt M, Fasching PA, Beckmann MW, Kratz O, Moll GH, Kornhuber J, Eichler A. The Father's Part: Influences of Paternal Psychopathology and Parenting Behavior on Child and Adolescent Well-Being. Healthcare (Basel) 2023; 11:2119. [PMID: 37570360 PMCID: PMC10418667 DOI: 10.3390/healthcare11152119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/14/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
Family influences on child quality of life (QoL) are increasingly understood. Parenting behavior and parent individual psychopathology are among the established predictors of offspring mental health. However, literature often addresses these factors as 'parental', lacking further gender-specific differentiation while predominantly studying maternal aspects. Social and biological fathers are still underrepresented in family research. The aim of this study was to analyze paternal contributions to child well-being. A total of 197 father/mother-dyads gave a standardized self-report on parenting behavior and their own psychopathology at child primary school age (t1; 6-10 y). Ratings were compared mutually and associated with child self-rated QoL at t1 and adolescence (t2; 12-14 y). Fathers and mothers differed in psychopathology and most parenting behavior dimensions (positive parenting, involvement, responsible parenting, poor monitoring, and corporal punishment). Father psychopathology made a relevant predictive contribution to girls' QoL at t2. Boys' t1 QoL was significantly influenced by maternal parenting factors (positivity and corporal punishment). Compared to mothers, fathers are faced with different individual stressors; paternal parenting behavior is different, while fathers' influences are significant, particularly for daughters. Father-addressed pre- and intervention programs in child psychotherapeutic treatment are of high relevance.
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Affiliation(s)
- Stefan Mestermann
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany (A.E.)
| | - Marie Arndt
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany (A.E.)
| | - Peter A. Fasching
- Department of Obstetrics and Gynaecology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Matthias W. Beckmann
- Department of Obstetrics and Gynaecology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Oliver Kratz
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany (A.E.)
| | - Gunther H. Moll
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany (A.E.)
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Anna Eichler
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany (A.E.)
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19
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Lawrence PJ, Skripkauskaite S, Shum A, Waite P, Dodd H. Changes in UK pre-schooler's mental health symptoms over the first year of the COVID-19 pandemic: Data from Co-SPYCE study. JCPP ADVANCES 2023; 3:e12163. [PMID: 37753148 PMCID: PMC10519734 DOI: 10.1002/jcv2.12163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/24/2023] [Indexed: 09/28/2023] Open
Abstract
Background The COVID-19 pandemic caused significant disruption to the lives of children and their families. Pre-school children may have been particularly vulnerable to the effects of the pandemic, with the closure of childcare facilities, playgrounds, playcentres and parent and toddler groups limiting their opportunities for social interaction at a crucial stage of development. Additionally, for parents working from home, caring for pre-school aged children who require high levels of support and care, was likely challenging. We conducted an intensive longitudinal, but not nationally representative, study to examine trajectories of pre-schoolers' mental symptoms in the United Kingdom during the first year of the COVID-19 pandemic. Methods UK-based parents and carers (n = 1520) of pre-school-aged children (2-4 years) completed monthly online surveys about their pre-schoolers' mental health between April 2020 and March 2021. The survey examined changes in children's emotional symptoms, conduct problems and hyperactivity/inattention. Results In our final mixed-effects models, our predictors (fixed effects) accounted for 5% of the variance in each of conduct problems, emotional symptoms and hyperactivity/inattention symptoms scores, and the combined random and fixed effects accounted for between 64% and 73% of the variance. Pre-schoolers' emotional problems and hyperactivity/inattention symptoms declined from April through summer 2020 and then increased again during the autumn and winter 2020/2021 as lockdowns were re-introduced. Pre-schoolers who attended childcare showed greater decline in symptom severity than those who did not. Older children, compared to younger, showed greater lability of emotion symptom severity. Attending childcare predicted lower symptom severity across all three domains of conduct problems, emotional symptoms, and hyperactivity/inattention, while the opposite pattern was observed for children whose parent had a mental health problem. Conclusions Our findings reinforce the importance of examining pre-schoolers' mental health in the context of micro and macro-level factors. Interventions focussing on family factors such as parent mental health, as well as continued provision of childcare, may have most potential to mitigate the impact of COVID-19 on young children's mental health.
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Affiliation(s)
- Peter J. Lawrence
- Centre for Innovation in Mental HealthSchool of PsychologyUniversity of SouthamptonSouthamptonUK
| | - Simona Skripkauskaite
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Adrienne Shum
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Polly Waite
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
- Department of PsychiatryUniversity of OxfordOxfordUK
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Helen Dodd
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
- Children and Young People's Mental Health Research CollaborationExeter Medical SchoolUniversity of ExeterExeterUK
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20
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Chan EWT, Wong KTC, Clark LH. Challenging Parenting Behaviour and Anxiety Disorders in Emerging Adulthood. JOURNAL OF CHILD AND FAMILY STUDIES 2023; 32:663-677. [PMID: 36820403 PMCID: PMC9930716 DOI: 10.1007/s10826-022-02434-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 06/18/2023]
Abstract
Challenging parenting behaviour (CPB) refers to parental encouragement of behaviours where children push their own limits through engaging them engage in safe risks, such as rough-and-tumble play (Bögels & Phares, 2008). Preliminary evidence suggests that CPB reduces the risk of child anxiety however, little is known about the relationship between CPB and specific forms of anxiety disorders and the factors that influence this relationship. The present study aims to examine current maternal and paternal CPB in relation to symptoms of generalised anxiety disorder (GAD) and social anxiety disorder (SAD) in emerging adulthood, and to identify whether intolerance of uncertainty (IU) and cognitive avoidance (CA) sequentially mediate this relationship. A sample of 190 UK-based adults (aged 18-25) completed a battery of online self-report measures. Greater maternal CPB, but not paternal CPB, was found to predict lower symptoms of SAD, but not GAD. IU and CA did not sequentially mediate the relationship between CPB and symptoms of GAD or SAD. This study suggests that CPB may be associated with certain forms of anxiety disorders such as SAD, but further investigation is needed to understand the mechanisms between CPB and anxiety in young people.
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Affiliation(s)
| | | | - Laura H. Clark
- Department of Psychology, Northumbria University, Newcastle, UK
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21
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Bayer JK, Prendergast LA, Brown A, Bretherton L, Hiscock H, Nelson-Lowe M, Gilbertson T, Noone K, Bischof N, Beechey C, Muliadi F, Mihalopoulos C, Rapee RM. Prediction of clinical anxious and depressive problems in mid childhood amongst temperamentally inhibited preschool children: a population study. Eur Child Adolesc Psychiatry 2023; 32:267-281. [PMID: 34368891 DOI: 10.1007/s00787-021-01857-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/31/2021] [Indexed: 11/30/2022]
Abstract
Shy/inhibited young children are at risk for internalising difficulties; however, for many, this temperamental style does not result in mental health problems. This study followed a population-based sample of temperamentally inhibited preschool children into mid childhood to explore the aetiology of clinical-level anxious and depressive problems. Amongst inhibited preschool children, we aimed to predict each of clinical child anxiety and depressive problems in mid childhood from a broad range of potential risks (demographics, traumatic events and broader recent stressors, parents' well-being, and parenting practices). This study is based on data from a wider population trial of Cool Little Kids that recruited a representative sample of inhibited preschool children enrolled in their year before starting school. In 2011-2012, an inhibition screen was universally distributed to parents of children in their year before school (age 4 years) across eight diverse government areas in Melbourne, Australia. Participants were 545 parents of inhibited preschoolers (78% uptake, 545/703) who were followed to mid childhood (three annual waves 2015-2017, age 7-10 years) with 84% retention (456/545). Parents completed questionnaires spanning child ages 4-10 years, along with diagnostic interviews for child anxiety. Children also completed questionnaires in mid childhood. The questionnaires encompassed a variety of potential risks including sociodemographics, traumatic events, recent life stressors, parent wellbeing and parenting practices. In mid childhood, 57% (246/430) of inhibited preschoolers had a clinical level of anxiety problems while 22% (95/432) had depressive problems (by one or more sources). The aetiology analyses highlighted parent distress and parenting practices (overinvolved/protective, harsh discipline) as key predictors of inhibited preschoolers' internalising problems by mid childhood. Some high-risk families may not have participated. Child depression was not assessed with a diagnostic interview. The measures did not include every possible risk factor. The findings lend support to parenting programs for shy/inhibited young children that aim to prevent the development of anxiety and depression as they grow.
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Affiliation(s)
- Jordana K Bayer
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia.
- Murdoch Children's Research Institute, Melbourne, Australia.
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - Luke A Prendergast
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia
| | - Amy Brown
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Lesley Bretherton
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
| | - Margaret Nelson-Lowe
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Tamsyn Gilbertson
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Kate Noone
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Natalie Bischof
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Cassima Beechey
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Fenny Muliadi
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, Australia
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22
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Nimphy CA, Elzinga BM, Van der Does W, Aktar E. "Covid-19 is dangerous": The role of parental verbal threat information on children's fear of Covid-19. J Adolesc 2023; 95:147-156. [PMID: 36285347 PMCID: PMC9874763 DOI: 10.1002/jad.12105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/02/2022] [Accepted: 10/04/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Theoretical and empirical evidence suggests that the effect of parental verbal threat information on the offspring's fear acquisition of novel stimuli may be causal. The current study investigated this verbal fear acquisition pathway from parents to children in the unique context of Covid-19 as a novel environmental threat for parents and children. METHODS Using an online cross-sectional survey, we collected data about fear of Covid-19, parent-child communication, parental anxiety, and child temperament, in the period between June 11th 2020 and May 28th 2021. Participants were 8 to 18-year-old children (N = 195; Mage = 14.23; 113 girls) and their parents (N = 193; Mage = 47.82; 146 mothers) living in the Netherlands. RESULTS Children of parents with stronger Covid-19 fears also reported stronger Covid-19 fears. Moreover, parents who were more fearful of Covid-19 provided more threat-related information about the virus to their children. More parental threat information in turn was related to stronger fear of Covid-19 in their children, and partly mediated the link between parent and child fear of the virus. The link between parental threat information and children's fear of Covid-19 was not moderated by child temperament or parental anxiety. CONCLUSIONS Parental communication about Covid-19 may play a role in children's fear acquisition of Covid-19. The lack of moderation of this link by parental anxiety and child temperament may reflect the potentially adaptive nature of verbal fear transmission during the first year of the pandemic and the nonclinical levels of fear in this community sample.
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Affiliation(s)
- Cosima A. Nimphy
- Department of Clinical PsychologyLeiden UniversityLeidenThe Netherlands
| | - Bernet M. Elzinga
- Department of Clinical PsychologyLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and Cognition (LIBC)LeidenThe Netherlands
| | - Willem Van der Does
- Department of Clinical PsychologyLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and Cognition (LIBC)LeidenThe Netherlands
| | - Evin Aktar
- Department of Clinical PsychologyLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and Cognition (LIBC)LeidenThe Netherlands
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23
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Maternal symptoms of depression and anxiety during the postpartum period moderate infants' neural response to emotional faces of their mother and of female strangers. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2022; 22:1370-1389. [PMID: 35799031 DOI: 10.3758/s13415-022-01022-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 01/27/2023]
Abstract
Affective exchanges between mothers and infants are key to the intergenerational transmission of depression and anxiety, possibly via adaptations in neural systems that support infants' attention to facial affect. The current study examined associations between postnatal maternal symptoms of depression, panic and social anxiety, maternal parenting behaviours, and infants' neural responses to emotional facial expressions portrayed by their mother and by female strangers. The Negative Central (Nc), an event-related potential component that indexes attention to salient stimuli and is sensitive to emotional expression, was recorded from 30 infants. Maternal sensitivity, intrusiveness, and warmth, as well as infant's positive engagement with their mothers, were coded from unstructured interactions. Mothers reporting higher levels of postnatal depression symptoms were rated by coders as less sensitive and warm, and their infants exhibited decreased positive engagement with the mothers. In contrast, postnatal maternal symptoms of panic and social anxiety were not significantly associated with experimenter-rated parenting behaviours. Additionally, infants of mothers reporting greater postnatal depression symptoms showed a smaller Nc to their own mother's facial expressions, whereas infants of mothers endorsing greater postnatal symptoms of panic demonstrated a larger Nc to fearful facial expressions posed by both their mother and female strangers. Together, these results suggest that maternal symptoms of depression and anxiety during the postpartum period have distinct effects on infants' neural responses to parent and stranger displays of emotion.
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24
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Price NN, Kiel EJ. Maternal Worry Socialization and Toddler Inhibited Temperament: Transactional Associations and Stability across Time. Res Child Adolesc Psychopathol 2022; 50:1457-1469. [PMID: 35708816 PMCID: PMC9201259 DOI: 10.1007/s10802-022-00938-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/19/2022]
Abstract
Caregiver socialization of child emotions has consequences for both typical development and anxiety risk, with caregivers' non-supportive responses to worry perhaps especially salient to children's anxiety development. Children, in turn, impact the caregiving environment they receive through their temperament. We investigated transactional relations between maternal non-supportive responses to child worry (mother-reported) and two differently-measured child inhibited temperament indices (i.e., mother-perceived child inhibition to novelty, laboratory-observed child dysregulated fear) in a sample of 136 predominantly non-Hispanic, White mother-toddler dyads. Worry socialization and mother-reported inhibition to novelty were measured at each of three time points (toddler age 2, 3, 4 years), and dysregulated fear was measured at ages 2 and 3. Constructs showed stability across time, with effect sizes ranging from medium to large. Child inhibited temperament measures positively correlated within time point at ages 2 and 3, and laboratory-observed child dysregulated fear predicted mothers' later perceptions of their children's inhibition to novelty. At toddler age 2, mothers of children showing more dysregulated fear reported responding more non-supportively to worry. However, when controlling for one another, more mother-perceived child inhibition to novelty and less laboratory-observed child dysregulated fear at age 3 predicted mothers' greater non-supportive worry responses at child age 4. There was an indirect effect across time, such that children's greater laboratory-observed dysregulated fear predicted their mothers' heightened perceptions of inhibited temperament, which in turn predicted mothers' greater non-supportive worry responses. Findings lend support to anxiety-relevant construct stability in toddlerhood, as well as child-elicited, rather than parent-elicited, associations across time.
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Affiliation(s)
- Natalee N Price
- Department of Psychology, Miami University, 100 Psychology Building, 45056, Oxford, OH, USA.
| | - Elizabeth J Kiel
- Department of Psychology, Miami University, 100 Psychology Building, 45056, Oxford, OH, USA
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25
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Evans C, Kreppner J, Lawrence PJ. The association between maternal perinatal mental health and perfectionism: A systematic review and meta-analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1052-1074. [PMID: 35762187 PMCID: PMC9796248 DOI: 10.1111/bjc.12378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Perfectionism is an important feature of adult psychopathology. In the absence of a prior review of the role of perfectionism in perinatal psychopathology, we aimed to ascertain whether perfectionism was associated with symptoms of maternal perinatal depression and anxiety. METHOD We followed PRISMA guidance (PROSPERO: 42019143369), estimated weighted effect sizes and tested possible moderators: timing (pre or post- natal), scales used to measure constructs, infant gender, temperament and age; and rated study quality. RESULTS Fourteen studies met eligibility criteria. Perfectionism as a whole, and the perfectionistic concerns dimension, were moderately correlated with common maternal perinatal mental health difficulties r = .32 (95% Confidence Interval = 0.23 to 0.42). In sub-group analyses, perfectionistic concerns were associated with depression (r = .35, 95% CI = 0.26-0.43). We found no evidence of significant moderation of associations. LIMITATIONS Included studies had methodological and conceptual limitations. All studies examined depression and two examined anxieties; all examined perfectionistic concerns and four examined perfectionist strivings. CONCLUSIONS Perfectionism, namely perfectionistic concerns, is potentially associated with common maternal perinatal mental health problems. While further research is warranted, identification of perfectionism in the perinatal period may help focus resources for intervention, reducing the prevalence of perinatal mental health difficulties.
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Affiliation(s)
- Clare Evans
- Sussex Partnership NHS Foundation TrustWest SussexUK
| | - Jana Kreppner
- Centre for Innovation in Mental HealthSchool of PsychologyUniversity of SouthamptonSouthamptonUK
| | - Peter J. Lawrence
- Centre for Innovation in Mental HealthSchool of PsychologyUniversity of SouthamptonSouthamptonUK
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26
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Smith CG, Jones EJH, Charman T, Clackson K, Mirza FU, Wass SV. Anxious parents show higher physiological synchrony with their infants. Psychol Med 2022; 52:3040-3050. [PMID: 33563343 PMCID: PMC9693696 DOI: 10.1017/s0033291720005085] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Interpersonal processes influence our physiological states and associated affect. Physiological arousal dysregulation, a core feature of anxiety disorders, has been identified in children of parents with elevated anxiety. However, little is understood about how parent-infant interpersonal regulatory processes differ when the dyad includes a more anxious parent. METHODS We investigated moment-to-moment fluctuations in arousal within parent-infant dyads using miniaturised microphones and autonomic monitors. We continually recorded arousal and vocalisations in infants and parents in naturalistic home settings across day-long data segments. RESULTS Our results indicated that physiological synchrony across the day was stronger in dyads including more rather than less anxious mothers. Across the whole recording epoch, less anxious mothers showed responsivity that was limited to 'peak' moments in their child's arousal. In contrast, more anxious mothers showed greater reactivity to small-scale fluctuations. Less anxious mothers also showed behaviours akin to 'stress buffering' - downregulating their arousal when the overall arousal level of the dyad was high. These behaviours were absent in more anxious mothers. CONCLUSION Our findings have implications for understanding the differential processes of physiological co-regulation in partnerships where a partner is anxious, and for the use of this understanding in informing intervention strategies for dyads needing support for elevated levels of anxiety.
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Affiliation(s)
- C. G. Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - T. Charman
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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27
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McGovern HT, De Foe A, Biddell H, Leptourgos P, Corlett P, Bandara K, Hutchinson BT. Learned uncertainty: The free energy principle in anxiety. Front Psychol 2022; 13:943785. [PMID: 36248528 PMCID: PMC9559819 DOI: 10.3389/fpsyg.2022.943785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Generalized anxiety disorder is among the world's most prevalent psychiatric disorders and often manifests as persistent and difficult to control apprehension. Despite its prevalence, there is no integrative, formal model of how anxiety and anxiety disorders arise. Here, we offer a perspective derived from the free energy principle; one that shares similarities with established constructs such as learned helplessness. Our account is simple: anxiety can be formalized as learned uncertainty. A biological system, having had persistent uncertainty in its past, will expect uncertainty in its future, irrespective of whether uncertainty truly persists. Despite our account's intuitive simplicity-which can be illustrated with the mere flip of a coin-it is grounded within the free energy principle and hence situates the formation of anxiety within a broader explanatory framework of biological self-organization and self-evidencing. We conclude that, through conceptualizing anxiety within a framework of working generative models, our perspective might afford novel approaches in the clinical treatment of anxiety and its key symptoms.
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Affiliation(s)
- H. T. McGovern
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Alexander De Foe
- School of Educational Psychology and Counselling, Monash University, Melbourne, VIC, Australia
| | - Hannah Biddell
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Pantelis Leptourgos
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Philip Corlett
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Kavindu Bandara
- School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Brendan T. Hutchinson
- Research School of Psychology, The Australian National University, Canberra, ACT, Australia
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28
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Smith CG, Jones EJH, Wass SV, Pasco G, Johnson MH, Charman T, Wan MW. Infant Effortful Control Mediates Relations Between Nondirective Parenting and Internalising-Related Child Behaviours in an Autism-Enriched Infant Cohort. J Autism Dev Disord 2022; 52:3496-3511. [PMID: 34448110 PMCID: PMC9296408 DOI: 10.1007/s10803-021-05219-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 11/12/2022]
Abstract
Internalising problems are common within Autism Spectrum Disorder (ASD); early intervention to support those with emerging signs may be warranted. One promising signal lies in how individual differences in temperament are shaped by parenting. Our longitudinal study of infants with and without an older sibling with ASD investigated how parenting associates with infant behavioural inhibition (8-14 months) and later effortful control (24 months) in relation to 3-year internalising symptoms. Mediation analyses suggest nondirective parenting (8 months) was related to fewer internalising problems through an increase in effortful control. Parenting did not moderate the stable predictive relation of behavioural inhibition on later internalising. We discuss the potential for parenting to strengthen protective factors against internalising in infants from an ASD-enriched cohort.
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Affiliation(s)
- C G Smith
- Henry Wellcome Building, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - E J H Jones
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
| | - S V Wass
- School of Psychology, University of East London, London, UK
| | - G Pasco
- Henry Wellcome Building, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - M H Johnson
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK.,Department of Psychology, University of Cambridge, Cambridge, UK
| | - T Charman
- Henry Wellcome Building, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - M W Wan
- School of Health Sciences, University of Manchester, Manchester, UK
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29
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Kalenik AM, Topolski M, Górnik J, Wolańczyk T. The impact of the COVID-19 pandemic on the mental health of children with psychiatric diagnoses - multidimensional CCPCA Model. BMC Psychiatry 2022; 22:495. [PMID: 35870970 PMCID: PMC9308485 DOI: 10.1186/s12888-022-04144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aimed to assess the severity of symptoms of anxiety and depression in children with previously diagnosed psychiatric disorders during the COVID-19 pandemic in Poland. METHODS Online questionnaires were used to investigate three groups of subjects: patients with a psychiatric diagnosis, primary school pupils, and children from children's homes. A total of 167 children with their parents or guardians participated in the study. In addition to basic statistics, a multidimensional Centroid Class Principal Component Analysis (CCPCA) model was used. RESULTS It was found that the strongest fear of the coronavirus was experienced by children from children's homes, while the most severe depressive symptoms and state anxiety were observed among patients diagnosed with psychiatric disorders. Parental care by assisting with school education and lack of close contact with other people (less than two metres) at parents/guardians' work had the most potent protective effect in reducing the fear of COVID-19. CONCLUSIONS There is a need for further research in children and adolescents to develop effective strategies for protecting their mental well-being when faced with social isolation or disease.
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Affiliation(s)
- Anna Maria Kalenik
- Department of Child Psychiatry, Medical University of Warsaw, Żwirki i Wigury 63A, 02-191, Warsaw, Poland.
| | - Mariusz Topolski
- grid.7005.20000 0000 9805 3178Faculty of Information and Communication Technology, Wrocław University of Science and Technology, Wybrzeże Wyspiańskiego 27, 50-370 Wroclaw, Poland
| | - Justyna Górnik
- grid.13339.3b0000000113287408Department of Child Psychiatry, Medical University of Warsaw, Żwirki i Wigury 63A, 02-191 Warsaw, Poland
| | - Tomasz Wolańczyk
- grid.13339.3b0000000113287408Department of Child Psychiatry, Medical University of Warsaw, Żwirki i Wigury 63A, 02-191 Warsaw, Poland
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30
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Jewell C, Wittkowski A, Pratt D. The impact of parent-only interventions on child anxiety: A systematic review and meta-analysis. J Affect Disord 2022; 309:324-349. [PMID: 35460744 DOI: 10.1016/j.jad.2022.04.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/28/2022] [Accepted: 04/13/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Parent-only interventions for childhood anxiety may be an important alternative to resource and time intensive child-focused cognitive behavioural therapy (CBT). This systematic review and meta-analysis aimed to investigate the efficacy of parent-only interventions in reducing symptoms of anxiety disorders in school-aged children. METHODS A systematic search of five databases (inception to March 2021) identified 29 eligible studies. A range of study designs were captured, including randomised controlled trials (RCTs) and case series. A narrative synthesis was conducted. Random effects meta-analyses were performed on parent- and child-reported outcomes and pre-test post-test effect sizes were calculated for uncontrolled studies. RESULTS Findings indicated a significant treatment effect for parent-only interventions compared to waitlist controls. No significant differences were found when comparing parent-only interventions with other active interventions; anxiety symptoms reduced in both conditions. No significant treatment effects were found for child-rated outcomes. Calculated effect sizes for uncontrolled studies were typically large, although sample sizes were small. No clear evidence was found for a superior type, duration or format of intervention. LIMITATIONS The methodological quality of many studies in this review (19/29) was rated 'weak'. Only English language papers were included. CONCLUSIONS To date, this is the first systematic review and meta-analysis of the efficacy of parent-only interventions for reducing symptoms of child anxiety disorders. Our results suggest that parent-only interventions may be effective in reducing child anxiety. These findings are important for clinical practice because they suggest that efficient, low intensity interventions delivered to parents may lead to positive outcomes for children.
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Affiliation(s)
- C Jewell
- Centre for New Treatments and Understanding in Mental Health, School of Health Sciences, The University of Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK
| | - A Wittkowski
- Centre for New Treatments and Understanding in Mental Health, School of Health Sciences, The University of Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health Foundation Trust, Manchester, UK.
| | - D Pratt
- Centre for New Treatments and Understanding in Mental Health, School of Health Sciences, The University of Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health Foundation Trust, Manchester, UK
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31
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Gouze KR, Hopkins J, Lavigne JV, Bryant FB. A Multi-level Longitudinal Model of Risk Factors for Generalized and Separation Anxiety Symptoms in a Community Sample of 6-year-olds. Child Psychiatry Hum Dev 2022; 53:405-417. [PMID: 33590383 DOI: 10.1007/s10578-021-01132-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/29/2022]
Abstract
The current longitudinal study examined the relations between variables in four domains-contextual (SES, family conflict, stress), parent (caretaker depression), parenting (support hostility, autonomy granting), and child (negative affect, effortful control, sensory regulation, attachment)-and both the presence of generalized and separation anxiety symptoms at age 6 in a community sample of 796 children and the change in these anxiety symptoms from ages 4 to 6. Anxiety was highly stable over time. Specific results revealed both direct and indirect pathways between age 4 and age 5 variables, and age 6 anxiety. Caretaker depression and the child variables of attachment, effortful control, negative affect, and sensory regulation were directly related to anxiety symptoms at age 6. Contextual variables (SES) at age 4 were indirectly related to age 6 anxiety through parent depression at age 5. Parent depression was indirectly related to age 6 anxiety through age 5 child negative affect. Child negative affect at age 4 was indirectly related to age 6 anxiety through age 5 effortful control and age 4 effortful control was indirectly related to age 6 anxiety through age 5 negative affect. With the exception of attachment, there was a reduction in the impact of other variables when initial levels of anxiety symptoms were included in the model. Implications of results for early intervention and further study are discussed.
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Affiliation(s)
- Karen R Gouze
- Pritzker Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave. #10, Chicago, Illinois, 60611, USA.
| | - Joyce Hopkins
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - John V Lavigne
- Pritzker Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave. #10, Chicago, Illinois, 60611, USA
| | - Fred B Bryant
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
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32
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Galea S, Wade C, Salvaris CA, Yap MBH, Lawrence KA. Acceptability of an enhanced transdiagnostic CBT intervention for adults with anxiety disorders who are parenting an anxious child. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2055965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Samantha Galea
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Catherine Wade
- Parenting Research Centre, East Melbourne, Victoria, Australia
| | - Chloe A. Salvaris
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Marie B. H. Yap
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Katherine A. Lawrence
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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Chapman L, Hutson R, Dunn A, Brown M, Savill E, Cartwright-Hatton S. The impact of treating parental anxiety on children's mental health: An empty systematic review. J Anxiety Disord 2022; 88:102557. [PMID: 35397376 DOI: 10.1016/j.janxdis.2022.102557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 03/11/2022] [Accepted: 03/19/2022] [Indexed: 11/23/2022]
Abstract
Children of anxious parents are at heightened risk of developing an anxiety disorder of their own, but promising research indicates that targeting parenting behaviours can reduce the risk of intergenerational transmission of anxiety. Given there is extensive evidence for the efficacy of treatments for adult anxiety, the current review sought to identify whether interventions solely addressing parental symptoms had any effect on the mental health and wellbeing of their children. Randomised Controlled Trials of psychological interventions targeting adults with a probable anxiety disorder and which included a child mental health or wellbeing outcome were eligible for inclusion. Scopus, Web of Science, PubMed, PsychINFO, and PsychArticles were searched, and 2137 articles were systematically reviewed. However, no articles were identified that met the review criteria. Research into interventions targeting adult anxiety is failing to consider the potential benefit treatment may have on dependent children. This is a missed opportunity to evaluate a potential means of support for children who are known to be at risk of anxiety. Evaluation of psychological interventions for adult anxiety should consider including both adult and child mental health outcomes to determine potential preventative effects.
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Affiliation(s)
- Laura Chapman
- School of Psychology, University of Sussex, United Kingdom.
| | - Rosie Hutson
- School of Psychology, University of Sussex, United Kingdom
| | - Abby Dunn
- School of Psychology, University of Sussex, United Kingdom
| | - Maddy Brown
- School of Psychology, University of Sussex, United Kingdom
| | - Ella Savill
- School of Psychology, University of Sussex, United Kingdom
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Assessing Psychological Impact of COVID-19 among Parents of Children Returning to K-12 Schools: A U.S. Based Cross-Sectional Survey. Healthcare (Basel) 2022; 10:healthcare10050775. [PMID: 35627912 PMCID: PMC9141861 DOI: 10.3390/healthcare10050775] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 12/22/2022] Open
Abstract
Background and Purpose: While impacts of the pandemic on family well-being have been documented in the literature, little is known about the psychological challenges faced by children and their parents as schools reopen after mandated closures. Therefore, the purpose of this study was to determine if sending children back to in-person school impacts the mental health of parents and the perceived mental health of their children. Methods: This cross-sectional descriptive study recruited a nationally representative, non-probability sample of parents or guardians (n = 2100) of children attending grades K-12 in the United States (U.S.) through a 58-item web-based survey. The univariate, bivariate, and multivariate statistical tests were used to analyze the data. Results: The mean scores of parental Coronavirus anxiety and Coronavirus obsession were significantly different between race/ethnic groups of parents. Parents with children going to private schools had significantly higher mean scores for Coronavirus anxiety and obsession compared to parents whose children are attending public schools. Nearly 55% of parental Coronavirus anxiety was explained by the generalized anxiety, separation anxiety, child’s vulnerability to infection, and school type of the child. Similarly, 52% of parental Coronavirus obsession was explained by the generalized anxiety, separation anxiety, child’s vulnerability to infection, and social phobia of the children. Conclusions: The COVID-19 pandemic has a substantial impact on psychological well-being of parents and their school-going children. Findings of this study will inform policy makers in developing targeted interventions to address unique needs of families with school-going children.
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Salvadori EA, Colonnesi C, Elsammak L, Oort FJ, Messinger DS. Beyond the familial: The development of emotional communication with mothers, fathers, and strangers. INFANCY 2022; 27:836-862. [DOI: 10.1111/infa.12467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 02/04/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Eliala A. Salvadori
- Developmental Psychopathology Unit Research Institute of Child Development and Education Faculty of Social and Behavioral Sciences University of Amsterdam Amsterdam The Netherlands
- Yield, Research Priority Area University of Amsterdam Amsterdam The Netherlands
| | - Cristina Colonnesi
- Developmental Psychopathology Unit Research Institute of Child Development and Education Faculty of Social and Behavioral Sciences University of Amsterdam Amsterdam The Netherlands
- Yield, Research Priority Area University of Amsterdam Amsterdam The Netherlands
| | - Linnea Elsammak
- Developmental Psychopathology Unit Research Institute of Child Development and Education Faculty of Social and Behavioral Sciences University of Amsterdam Amsterdam The Netherlands
| | - Frans J. Oort
- Yield, Research Priority Area University of Amsterdam Amsterdam The Netherlands
- Methods & Statistics Unit Research Institute of Child Development and Education Faculty of Social and Behavioral Sciences University of Amsterdam Amsterdam The Netherlands
| | - Daniel S. Messinger
- Departments of Psychology, Pediatrics, Electrical & Computer Engineering, and Music Engineering University of Miami Coral Gables Florida USA
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Quo Vadis Psychiatry? Why It Is Time to Endorse Evolutionary Theory. J Nerv Ment Dis 2022; 210:235-245. [PMID: 35349502 DOI: 10.1097/nmd.0000000000001493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In recent decades, psychiatry and the neurosciences have made little progress in terms of preventing, diagnosing, classifying, or treating mental disorders. Here we argue that the dilemma of psychiatry and the neurosciences is, in part, based on fundamental misconceptions about the human mind, including misdirected nature-nurture debates, the lack of definitional concepts of "normalcy," distinguishing defense from defect, disregarding life history theory, evolutionarily uninformed genetic and epigenetic research, the "disconnection" of the brain from the rest of the body, and lack of attention to actual behavior in real-world interactions. All these conceptual difficulties could potentially benefit from an approach that uses evolutionary theory to improve the understanding of causal mechanisms, gene-environment interaction, individual differences in behavioral ecology, interaction between the gut (and other organs) and the brain, as well as cross-cultural and across-species comparison. To foster this development would require reform of the curricula of medical schools.
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Chronis-Tuscano A, Novick DR, Danko CM, Smith KA, Wagner NJ, Wang CH, Druskin L, Dougherty LR, Rubin KH. Early intervention for inhibited young children: a randomized controlled trial comparing the Turtle Program and Cool Little Kids. J Child Psychol Psychiatry 2022; 63:273-281. [PMID: 34184792 PMCID: PMC11270476 DOI: 10.1111/jcpp.13475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Children classified as behaviorally inhibited (BI) are at risk for social anxiety. Risk for anxiety is moderated by both parental behavior and social-emotional competence. Grounded in developmental-transactional theory, the Turtle Program involves both parent and child treatment components delivered within the peer context. Our pilot work demonstrated beneficial effects of the Turtle Program ('Turtle') over a waitlist control group. Herein, we report results of a rigorous randomized controlled trial (RCT) comparing Turtle to the best available treatment for young children high in BI, Cool Little Kids (CLK). METHODS One hundred and fifty-one parents and their 3.5- to 5-year-old children selected on the basis of BI were randomly assigned to Turtle or CLK, delivered in group format over 8 weeks. Effects on child anxiety, life interference, BI, and observed parenting were examined at post-treatment and 1-year follow-up. ClinicalTrials.gov registration: NCT02308826. RESULTS No significant main effect differences were found between Turtle and CLK on child anxiety; children in both programs evidenced significant improvements in BI, anxiety severity, family accommodation, and child impairment. However, Turtle yielded increased observed warm/engaged parenting and decreased observed negative control, compared with CLK. Parental social anxiety moderated effects; parents with higher anxiety demonstrated diminished improvements in child impairment, and parent accommodation in CLK, but not in Turtle. Children of parents with higher anxiety demonstrated more improvements in child BI in Turtle, but not in CLK. CONCLUSIONS Turtle and CLK are both effective early interventions for young children with BI. Turtle is more effective in improving parenting behaviors associated with the development and maintenance of child anxiety. Turtle also proved to be more effective than CLK for parents with social anxiety. Results suggest that Turtle should be recommended when parents have social anxiety; however, in the absence of parent anxiety, CLK may offer a more efficient treatment model.
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Affiliation(s)
| | | | | | - Kelly A. Smith
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Nicholas J. Wagner
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Christine H. Wang
- Division of Endocrinology and Diabetes, Children’s National Hospital, Washington, DC, USA
| | - Lindsay Druskin
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Lea R. Dougherty
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Kenneth H. Rubin
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
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Aktar E, Nimphy CA, van Bockstaele B, Pérez‐Edgar K. The social learning of threat and safety in the family: Parent-to-child transmission of social fears via verbal information. Dev Psychobiol 2022; 64:e22257. [PMID: 35312048 PMCID: PMC8944018 DOI: 10.1002/dev.22257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/22/2021] [Accepted: 01/21/2022] [Indexed: 11/18/2022]
Abstract
Parental verbal threat (vs. safety) information regarding the social world may impact a child's fear responses, evident in subjective, behavioral, cognitive, and physiological indices of fear. In this study, primary caregivers provided standardized verbal threat or safety information to their child (N = 68, M = 5.27 years; 34 girls) regarding two strangers in the lab. Following this manipulation, children reported fear beliefs for each stranger. Physiological and behavioral reactions were recorded as children engaged with the two strangers (who were blind to their characterization) in a social interaction task. Child attention to the strangers was measured in a visual search task. Parents also reported their own, and their child's, social anxiety symptoms. Children reported more fear for the stranger paired with threat information, but no significant differences were found in observed child fear, attention, or heart rate. Higher social anxiety symptoms on the side of the parents and the children exacerbated the effect of parental verbal threat on observed fear. Our findings reveal a causal influence of parental verbal threat information only for child-reported fear and highlight the need to further refine the conditions under which acquired fear beliefs persist and generalize to behavior/physiology or get overruled by nonaversive real-life encounters.
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Affiliation(s)
- Evin Aktar
- Department of Clinical PsychologyLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and Cognition (LIBC)Leiden UniversityLeidenThe Netherlands
| | - Cosima A. Nimphy
- Department of Clinical PsychologyLeiden UniversityLeidenThe Netherlands
| | - Bram van Bockstaele
- Department of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Koraly Pérez‐Edgar
- Department of PsychologyChild Study CenterThe Pennsylvania State UniversityState CollegePennsylvaniaUSA
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Lorenzo NE, Novick DR, Seddio K, Degnan KA, Henderson HA, Almas AN, Chronis-Tuscano A, Fox N. Bidirectional and interactive effects of child temperament and parenting in early childhood on the trajectory of social anxiety in adolescence. Depress Anxiety 2022; 39:192-200. [PMID: 34762343 PMCID: PMC8901539 DOI: 10.1002/da.23224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 10/05/2021] [Accepted: 10/30/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Research suggests that certain parenting behaviors are best suited to promote optimal child development, depending on a child's distinctive temperamental presentation. This multimethod, longitudinal study examines the interactive effect of parenting and temperament in early childhood on the developmental trajectory of social anxiety in adolescence. METHODS Longitudinal growth modeling was used to examine the developmental trajectory of child social anxiety from age 9-15 and the interactive effect of parenting and child temperament at 36 months on the developmental trajectory of child social anxiety from age 9-15. RESULTS The slope of social anxiety from age 9-15 suggested a decrease in social anxiety throughout early adolescence. Furthermore, 36-month behavioral inhibition (BI) predicted the trajectory of child social anxiety from age 9-15 when parents displayed low and high levels of dismissive and supportive parenting (at 36 months). CONCLUSIONS Results support an interactive effect of infant temperament and parenting in early childhood (at 36 months) on the developmental trajectory of child social anxiety from age 9-15. Specifically, results suggest that engaging highly inhibited children with high supportive and low dismissive parenting may help reduce social anxiety over time in adolescence. Furthermore, parenting needs may differ for children high or low in BI to impact the developmental trajectory of social anxiety in adolescence, such that children who are high BI seem to benefit from low dismissive and high supportive parenting, and children who are low in BI seem to benefit more from high dismissive parenting.
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Affiliation(s)
- Nicole E. Lorenzo
- University of Maryland at College Park, 3942 Campus Drive, College Park, Maryland, United States,Correspondence Nicole E. Lorenzo, University of Maryland at College Park, 3942 Campus Drive, College Park, Maryland, United States,
| | - Danielle R. Novick
- University of Maryland at College Park, 3942 Campus Drive, College Park, Maryland, United States
| | | | - Kathryn A. Degnan
- Catholic University, Washington, District of Columbia, United States
| | - Heather A. Henderson
- University of Waterloo, Department of Psychology, Waterloo, Ontario, United States
| | - Alisa N. Almas
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Chronis-Tuscano
- University of Maryland, Psychology, Biology/Psychology Bldg, College Park, Maryland, United States
| | - Nathan Fox
- University of Maryland, Human Development, 3304 Benjamin Bldg, College Park, Maryland, United States
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Zeytinoglu S, Neuman K, Degnan KA, Almas AN, Henderson H, Chronis-Tuscano A, Pine DS, Fox NA. Pathways from maternal shyness to adolescent social anxiety. J Child Psychol Psychiatry 2022; 63:342-349. [PMID: 34184279 PMCID: PMC9394112 DOI: 10.1111/jcpp.13477] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Social anxiety is amongst the most prevalent adolescent mental health problems; however, it is often unrecognized due to its comorbidity with other anxiety problems such as generalized anxiety. Thus, understanding the unique developmental pathways to social anxiety is critical for improving its prevention. We examined the pathway from maternal shyness, when children were 4 years old, to adolescents' social anxiety at age 15 through social wariness at age 7. We hypothesized that childhood social wariness would mediate the association between maternal shyness and social anxiety in adolescence. METHODS Participants (N = 291; 54% female) were followed from early childhood to adolescence. Mothers reported on their own shyness when children were 4 years old. Social wariness toward unfamiliar peers was observed in the laboratory at ages 4 and 7. Adolescent social anxiety and generalized anxiety were assessed via self-report, parent-report, and clinical diagnoses at age 15. RESULTS Maternal shyness was positively associated with adolescent social anxiety but not generalized anxiety at age 15. Higher levels of maternal shyness at age 4 predicted greater social wariness at age 7, which in turn predicted greater social anxiety but not generalized anxiety at age 15. Social wariness at age 7 partially mediated the association between maternal shyness and adolescent social anxiety. CONCLUSIONS This study identifies a unique developmental pathway from maternal shyness to adolescent social anxiety. Findings suggest that childhood social wariness connects maternal shyness to adolescent social anxiety.
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Affiliation(s)
- Selin Zeytinoglu
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park
| | - Keara Neuman
- Department of Psychology, Florida International University
| | | | - Alisa N. Almas
- School of Population and Public Health, University of British Columbia
| | | | | | - Daniel S. Pine
- Emotion and Development Branch, Section on Development and Affective Neuroscience, National Institute of Mental Health
| | - Nathan A. Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park
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Vocalization and physiological hyperarousal in infant-caregiver dyads where the caregiver has elevated anxiety. Dev Psychopathol 2022; 35:459-470. [PMID: 35105411 DOI: 10.1017/s095457942100153x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Co-regulation of physiological arousal within the caregiver-child dyad precedes later self-regulation within the individual. Despite the importance of unimpaired self-regulatory development for later adjustment outcomes, little is understood about how early co-regulatory processes can become dysregulated during early life. Aspects of caregiver behavior, such as patterns of anxious speech, may be one factor influencing infant arousal dysregulation. To address this, we made day-long, naturalistic biobehavioral recordings in home settings in caregiver-infant dyads using wearable autonomic devices and miniature microphones. We examined the association between arousal, vocalization intensity, and caregiver anxiety. We found that moments of high physiological arousal in infants were more likely to be accompanied by high caregiver arousal when caregivers had high self-reported trait anxiety. Anxious caregivers were also more likely to vocalize intensely at states of high arousal and produce intense vocalizations that occurred in clusters. High-intensity vocalizations were associated with more sustained increases in autonomic arousal for both anxious caregivers and their infants. Findings indicate that caregiver vocal behavior differs in anxious parents, cooccurs with dyadic arousal dysregulation, and could contribute to physiological arousal transmission. Implications for caregiver vocalization as an intervention target are discussed.
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Price NN, Kiel EJ. Longitudinal Links among Mother and Child Emotion Regulation, Maternal Emotion Socialization, and Child Anxiety. Res Child Adolesc Psychopathol 2022; 50:241-254. [PMID: 33821371 PMCID: PMC9218853 DOI: 10.1007/s10802-021-00804-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 02/03/2023]
Abstract
Models of transdiagnostic family emotion processes recognize parents' emotion-related characteristics and behaviors as key contributors to child emotional development and psychological functioning. One such psychological outcome, child anxiety, is prevalent and early emerging, underscoring the importance of identifying early family- and emotion-related mechanisms involved in anxiety risk. We investigated the extent to which mother and child emotion-related traits and behaviors related to child anxiety in a community sample of 175 mother-child dyads. Using three time-points (child ages 2-4 years, assessments 1 year apart), we examined how mothers' emotion dysregulation predicted their emotion socialization practices (either supportive or non-supportive) and children's emotion regulation (ER; either attention- or caregiver-focused) over time, in relation to later child anxiety. Models controlled for child inhibited temperament and also tested the role of maternal anxiety in these trajectories. Mothers reported on their emotion dysregulation, emotion socialization, and their own and their child's anxiety, whereas child ER and inhibited temperament were measured using laboratory observation. In supportive emotion socialization models, maternal emotion dysregulation predicted child anxiety 2 years later. An indirect effect emerged, such that greater maternal emotion dysregulation predicted greater non-supportive emotion socialization, which in turn related to children's greater caregiver-focused ER. Maternal emotion dysregulation, maternal anxiety, and child inhibited temperament each predicted child anxiety above and beyond other variables, although their shared variance likely accounted for some of the results. Findings lend partial support to current theoretical models of transdiagnostic family emotion processes and child anxiety development, suggesting promising avenues of future research.
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Galbally M, Watson SJ, van Rossum EFC, Chen W, de Kloet ER, Lewis AJ. The perinatal origins of childhood anxiety disorders and the role of early-life maternal predictors. Psychol Med 2022; 52:506-514. [PMID: 32597740 DOI: 10.1017/s0033291720002147] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The development of childhood anxiety disorders (CADs) is likely to depend on pathways that can be programmed by early-life risk factors. We test the hypothesis that early-life maternal factors can predict this programming effect on CAD. METHODS Data were obtained from 198 women and children from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a cohort study with data collected across pregnancy, postpartum and until 4 years of age. Maternal antenatal depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV), together with antenatal hair cortisol concentrations, maternal childhood trauma and parenting stress at 6 months postpartum. CAD was assessed with the Preschool Age Psychiatric Assessment and the Child Behaviour Checklist. RESULTS Antenatal depression, a history of maternal childhood trauma and lower gestational age at birth were each associated with anxiety disorders at 4 years of age in their children. A multivariate binary logistic model with these early predictors explained approximately 9% of variance in CAD outcome at 4 years of age; however, only maternal trauma and gestational age were significant predictors in the model. The effect of early parenting stress on CAD was found to vary by the concentration of maternal antenatal hair cortisol, whereby postpartum parenting stress was associated with CAD only when there were higher maternal antenatal cortisol levels. CONCLUSIONS This study suggests the importance of maternal factors pre-conception, pregnancy and in the postnatal period, which predict CADs and this is consistent with a developmental programming hypothesis for CAD.
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Affiliation(s)
- Megan Galbally
- 1. The College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
- School of Medicine, University of Notre Dame, Fremantle, Australia
- King Edward Memorial Hospital, Subiaco, Australia
| | - Stuart J Watson
- 1. The College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
- School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wai Chen
- School of Medicine, University of Notre Dame, Fremantle, Australia
- Graduate School of Education, University of Western Australia, Crawley, Australia
| | - Edo Ronald de Kloet
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew J Lewis
- 1. The College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
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Zhang L, Cao H, Lin C, Ye P. Family socio-economic status and Chinese Preschoolers' anxious symptoms during the COVID-19 pandemic: the roles of parental investment, parenting style, home quarantine length, and regional pandemic risk. EARLY CHILDHOOD RESEARCH QUARTERLY 2022; 60:137-149. [PMID: 35125643 PMCID: PMC8802162 DOI: 10.1016/j.ecresq.2022.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 05/15/2023]
Abstract
Using data from 16,161 families with target child of 3-6 years old in Hubei, China during COVID-19 pandemic, this study examined the association between family socio-economic status (SES) and preschoolers' anxious symptoms (PAS). Parental investment and parenting style were tested as mediators for this association. Home quarantine length was tested as a moderator for this direct association and for the associations between family SES and parenting processes, whereas regional pandemic risk was tested as a moderator for the entire model. Results support the utility of Family Stress and Family Investment Models in a Chinese context by identifying unique roles of parental investment and parenting style in mediating the link between family SES and PAS. Quarantine length moderated the link between family SES and authoritarian parenting: Strength of this negative association was stronger for families with longer quarantine than for those with shorter quarantine. Further, family SES was negatively associated with PAS through its negative association with authoritarian parenting, regardless of the quarantine length. Model comparison analyses between high-risk region versus low/medium-risk region groups indicated that the pandemic risk for living regions did not alter any pathway in the model. Such findings inform the designs of targeted interventions to help families cope with pandemic-related challenges. Promoting parental investment and adaptive patenting style represents an avenue to diminish consequences of family economic hardship for young children's mental health, regardless of macrolevel pandemic risk. Interventions should attend to home quarantine duration, as it contextualizes the links among family SES, parenting, and child well-being.
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Affiliation(s)
- Limin Zhang
- Department of Early Childhood Education, School of Education, Guangzhou University, 602 Xing Zheng Xi Building, No. 230 Wai Huan Xi Road, Guangzhou 510006 China
| | - Hongjian Cao
- Institute of Early Childhood Education, Faculty of Education, Beijing Normal University, China
| | - Chaopai Lin
- Department of Early Childhood Education, School of Education, Central China Normal University, China
| | - Pingzhi Ye
- Department of Early Childhood Education, School of Education, Guangzhou University, 602 Xing Zheng Xi Building, No. 230 Wai Huan Xi Road, Guangzhou 510006 China
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Gerdes ABM, Fraunfelter LA, Braband M, Alpers GW. Girls' Stuff? Maternal Gender Stereotypes and Their Daughters' Fear. Front Psychol 2022; 12:741348. [PMID: 35069322 PMCID: PMC8770317 DOI: 10.3389/fpsyg.2021.741348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022] Open
Abstract
One of the most robust findings in psychopathology is the fact that specific phobias are more prevalent in women than in men. Although there are several theoretical accounts for biological and social contributions to this gender difference, empirical data are surprisingly limited. Interestingly, there is evidence that individuals with stereotypical feminine characteristics are more fearful than those with stereotypical masculine characteristics; this is beyond biological sex. Because gender role stereotypes are reinforced by parental behavior, we aimed to examine the relationship of maternal gender stereotypes and children's fear. Dyads of 38 mothers and their daughters (between ages 6 and 10) were included. We assessed maternal implicit and explicit gender stereotypes as well as their daughters' self-reported general fearfulness, specific fear of snakes, and approach behavior toward a living snake. First, mothers' fear of snakes significantly correlated with their daughters' fear of snakes. Second, mothers' gender stereotypes significantly correlated with their daughters' self-reported fear. Specifically, maternal implicit gender stereotypes were associated with daughters' fear of snakes and fear ratings in response to the snake. Moreover, in children, self-reported fear correlated with avoidance of the fear-relevant animal. Together, these results provide first evidence for a potential role of parental gender stereotypes in the development and maintenance of fear in their offspring.
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Affiliation(s)
- Antje B. M. Gerdes
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
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46
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Elfström S, Ahlen J. Development and validation of the Modeling of Parental Anxiety Questionnaire. J Anxiety Disord 2022; 85:102515. [PMID: 34929432 DOI: 10.1016/j.janxdis.2021.102515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/06/2021] [Indexed: 12/17/2022]
Abstract
Parental anxious modeling is assumed to be a risk factor for child anxiety. Until now there has been no self-assessment scale available that measures parental modeling of anxiety in a comprehensive way. Our aim with this study was to bridge this gap by developing the Modeling of Parental Anxiety Questionnaire (MPAQ). To do this, we generated an item pool containing 51 statements covering different aspects of parental modeling of anxious and non-anxious behaviors. A sample of Swedish parents (N = 1092) of children aged 4-12, answered an online survey comprising the generated item pool, the Parental Overprotection Scale (OP) and the PROMIS Anxiety short forms (the adult version and the parent proxy report scale). A factor analysis of the items of parental modeling indicated a structure with four separate factors. These factors formed the final four subscales of MPAQ; (1) being curios and content, (2) being on guard, (3) displaying anxiety and avoidance, and (4) displaying stress. The Cronbach's alpha coefficients of the subscale scores ranged from moderate to good. Linear regression analysis showed that the displaying anxiety and avoidance-subscale had the strongest association with child anxiety symptoms. These findings show that MPAQ demonstrates adequate psychometric properties and has potential for being used in research and clinical settings, for example to identify potential targets for parenting interventions and to measure mediation effects.
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Affiliation(s)
- Sigrid Elfström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Johan Ahlen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Center for Epidemiology and Community Medicine, Health Care Services Stockholm County, Sweden
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Bayer JK, Brown A, Prendergast LA, Bretherton L, Hiscock H, Mihalopoulos C, Nelson-Lowe M, Gilbertson T, Noone K, Bischof N, Beechey C, Muliadi F, Rapee RM. Follow-up of the Cool Little Kids translational trial into middle childhood. J Child Psychol Psychiatry 2022; 63:88-98. [PMID: 34128236 DOI: 10.1111/jcpp.13464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Public health advocates have highlighted internalising problems as a leading cause of global burden of disease. Internalising problems (anxiety/depression) affect up to 20% of school-age children and can impact peer relations, school engagement and later employment and mortality. This translational trial aimed to determine whether a selective/indicated parenting group programme to prevent internalising distress in shy/inhibited preschool children had sustained effects in middle childhood. Translational design aspects were a brief parent-report screening tool for child inhibition offered universally across the population via preschools in the year before school, followed by an invitation to parents of all inhibited children to attend the parenting programme at venues in their local community. METHODS Design of the study was a randomised controlled trial. The setting was 307 preschool services across eight socioeconomically diverse government areas in Melbourne, Australia. Participants were 545 parents of inhibited four-year-old children of which 456 (84%) were retained during middle childhood (age of seven to 10 years). Early intervention was the Cool Little Kids parenting group programme, and control was 'usual care' access to available support services in the community. Primary outcomes were child anxiety and depression symptoms (parent and child report) and DSM-IV anxiety disorders (assessor masked). Secondary outcomes were parenting practices and parent mental health. RESULTS There was no significant difference in anxiety disorders between the intervention and control group during the three annual follow-ups of the cohort in middle childhood (2015 43% vs. 41%, 2016 40% vs. 36%, 2017 27% vs. 30%, respectively; p's > .05). There were also no significant differences in child anxiety or depression symptoms (by child or parent report), parenting practices or parent mental health, between the intervention and control group during middle childhood. However, a priori interaction tests suggested that for children with anxious parents, early intervention attenuated risk for middle childhood internalising problems. CONCLUSIONS An issue for population translation is low levels of parent engagement in preventive interventions. Initial effects of the Cool Little Kids parenting group programme in reducing shy/inhibited preschool children's internalising distress at school entry dissipated over time, perhaps due to low engagement. Future translational research on early prevention of internalising problems could benefit from screening preschool children in the population at higher risk (combining temperamental inhibition and parent distress) and incorporating motivational techniques to facilitate family engagement. Trial registration ISRCTN30996662 http://www.isrctn.com/ISRCTN30996662.
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Affiliation(s)
- Jordana K Bayer
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia
| | - Amy Brown
- Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Luke A Prendergast
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Vic, Australia
| | - Lesley Bretherton
- Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia.,Royal Children's Hospital, Melbourne, Vic, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Vic, Australia
| | | | | | - Kate Noone
- Royal Children's Hospital, Melbourne, Vic, Australia
| | - Natalie Bischof
- Eastern Health Child and Youth Mental Health Service, Melbourne, Vic, Australia
| | | | | | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
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Doom JR, Rozenman M, Fox KR, Phu T, Subar AR, Seok D, Rivera KM. The Transdiagnostic Origins of Anxiety and Depression During the Pediatric Period: Linking NIMH Research Domain Criteria (RDoC) Constructs to Ecological Systems. Dev Psychopathol 2021; 33:1599-1619. [PMID: 35281333 PMCID: PMC8916713 DOI: 10.1017/s0954579421000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In the last decade, an abundance of research has utilized the NIMH Research Domain Criteria (RDoC) framework to examine mechanisms underlying anxiety and depression in youth. However, relatively little work has examined how these mechanistic intrapersonal processes intersect with context during childhood and adolescence. The current paper covers reviews and meta-analyses that have linked RDoC-relevant constructs to ecological systems in internalizing problems in youth. Specifically, cognitive, biological, and affective factors within the RDoC framework were examined. Based on these reviews and some of the original empirical research they cover, we highlight the integral role of ecological factors to the RDoC framework in predicting onset and maintenance of internalizing problems in youth. Specific recommendations are provided for researchers using the RDoC framework to inform future research integrating ecological systems and development. We advocate for future research and research funding to focus on better integration of the environment and development into the RDoC framework.
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Buss KA, Zhou AM, Trainer A. Bidirectional effects of toddler temperament and maternal overprotection on maternal and child anxiety symptoms across preschool. Depress Anxiety 2021; 38:1201-1210. [PMID: 34255905 PMCID: PMC8664961 DOI: 10.1002/da.23199] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/16/2021] [Accepted: 06/25/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Existing research highlights interactions among child temperament, parents' own anxiety symptoms, and parenting in predicting increased risk for anxiety symptom development. Theoretical models of child-elicited effects on parents have proposed that parents' behaviors are likely not independent of children's temperament; fearful children likely elicit more protective responses from parents and these parenting behaviors reinforces child anxiety and parents' own anxiety. METHOD The current study tests this model and examines whether there are bidirectional influences between early fearful temperament (i.e., dysregulated fear [DF]), maternal overprotection, and subsequent trajectories of maternal and child anxiety symptoms across early childhood. A total of 166 children and mothers participated in a multimethod, longitudinal study of temperament risk from 2 to 6 years. RESULTS Results largely support our hypotheses, replicating and extending the prior literature. DF was associated with more maternal overprotective behavior, subsequent child anxiety symptoms, and maternal anxiety symptoms. Moreover, there were indirect (mediated) associations through maternal overprotective behavior and both child and mother anxiety symptoms. CONCLUSION Results support the hypothesis that intergenerational transmission of anxiety was meditated through maternal behaviors and that the child-driven temperament effects are central to trajectories of child and maternal anxiety trajectories.
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Affiliation(s)
- Kristin A. Buss
- Department of Psychology The Pennsylvania State University State College Pennsylvania USA
| | - Anna M. Zhou
- Department of Psychology The Pennsylvania State University State College Pennsylvania USA
| | - Austen Trainer
- Department of Psychology The Pennsylvania State University State College Pennsylvania USA
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Yirmiya K, Motsan S, Kanat-Maymon Y, Feldman R. From mothers to children and back: Bidirectional processes in the cross-generational transmission of anxiety from early childhood to early adolescence. Depress Anxiety 2021; 38:1298-1312. [PMID: 34254404 DOI: 10.1002/da.23196] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 04/30/2021] [Accepted: 06/15/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Maternal psychopathology and caregiving behavior are linked with child anxiety and these associations may be particularly salient when families face mass trauma together and members influence each other's symptomatology and resilience. Despite the well-known mother-to-child effects, less research addressed the longitudinal bidirectional effects of maternal and child's anxiety symptoms on each other. METHODS Mothers and children exposed to chronic war-related trauma from Sderot, Israel, and comparison group were followed at three time-points; Early childhood (T1:N = 232, MAge = 2.76 years), late childhood (T3:N = 176, MAge = 9.3 years), and early adolescence (T4:N = 110, MAge = 11.66 years). At each time-point maternal and child's anxiety symptoms were evaluated via questionnaires and maternal sensitivity was coded from videotaped observations of parent-child interactions. Bidirectional associations were examined using traditional cross-lagged panel model (CLPM) and CLPM with random intercepts (RI-CLPM). RESULTS Trauma-exposed mothers and children exhibited more anxiety symptoms and lower maternal sensitivity. Cross-lagged panel models revealed cross-time bidirectional associations between maternal anxiety and child anxiety from early to late childhood. Child anxiety at each time-point predicted maternal anxiety and maternal sensitivity at the next stage; however, maternal sensitivity did not show longitudinal associations with child anxiety, highlighting children's role in shaping caregiving. CONCLUSIONS Findings demonstrate bidirectional cross-generational influences of mother and child on each other's anxiety in contexts of trauma and pinpoint early childhood as a sensitive period for such mutual influences. Children's increased anxiety following trauma appears to be further exacerbated via its impact on increasing maternal anxiety and compromising sensitive caregiving, underscoring the potential benefits of parental and mother-child interventions for trauma-exposed populations.
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Affiliation(s)
- Karen Yirmiya
- Interdisciplinary Center, Herzliya, Israel.,Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Shai Motsan
- Interdisciplinary Center, Herzliya, Israel.,Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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