The utility of the SCAS-C/P to detect specific anxiety disorders among clinically anxious children

Symptoms of Selective Mutism in Middle Childhood: Psychopathological and Temperament Correlates in Non-clinical and Clinically Referred 6- to 12-year-old Children

The purpose of this study was to study psychopathological and temperamental correlates of selective mutism (SM) (symptoms) in a mixed sample of non-clinical (n = 127) and clinically referred (n = 42, of whom 25 displayed the selective non-speaking behavior that is prototypical for SM) 6- to 12-year-old children. Parents completed questionnaires to measure their child's symptom levels of selective mutism, social anxiety, autism spectrum disorder, and the temperament trait of behavioral inhibition. The results first and foremost showed that SM symptoms were clearly linked to social anxiety and an anxiety-prone temperament (behavioral inhibition), but findings also suggested that autism spectrum problems are involved in the selective non-speaking behavior of children. While the latter result should be interpreted with caution given the methodological shortcomings of this study, findings align well with the notion that SM is a heterogeneous psychiatric condition and that clinical assessment and treatment need to take this diversity into account.

Assessment of anxiety symptoms in children and adolescents: Italian validation of the short version of the spence children's anxiety scale for parents

The assessment of anxiety symptoms in children and adolescents requires a valid and reliable single instrument able to detect various anxiety symptoms early and systematically collect data from other informant such as parents. The present study aimed to test the one-factor structure of the SCAS-P-8 and to examine its psychometric properties and invariance across sex and age in an Italian sample of 769 parents of children and adolescents aged 3-18 years (50.8% females). Confirmatory factor analysis confirmed the one-factor structure of the SCAS-P-8, which showed good reliability and invariance by sex and age. When examining mean differences by sex and age, results showed that female schoolchildren had higher anxiety scores than males and other age groups. A strong correlation with emotional problems demonstrated convergent validity, while discriminant validity resulted from the weak correlations with externalizing symptoms and relationship problems with peers. Overall, findings support the SCAS-P-8 as a valid brief instrument to assess anxiety symptoms in children and adolescents for clinical and research purposes and demonstrate its invariance across sex and age.

Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C): Development and evaluation of a new instrument measuring anticipatory avoidance-based emotion regulation in anxiety eliciting situations

Avoidance-based emotion regulation plays a central role in the development and maintenance of anxiety disorders across the life span. However, measures for children that account for different avoidance strategies, are scarce. Derived from Gross' Process Model of Emotion Regulation, the Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C) was developed to assess avoidance strategies (cognitive avoidance, behavioural avoidance, verbal reassurance, and social reassurance) and reappraisal in anticipatory anxious situations. In the present study, the BAER-C was administered to 129 school children aged 8 to 14 and 199 children with anxiety disorders aged 8 to 16 and their parents, along with established measures on anxiety, psychopathology, and emotion regulation. Factor structure, internal consistency, convergent, divergent and construct validity were analysed. Results of the anxious sample showed a satisfactory internal consistency (McDonald's ω = .94) for all scales as well as positive correlations with anxiety symptoms (all rs > .17, all ps < .05). Factor analysis supported a five-factor model. This model was confirmed in the student sample. Children with an anxiety disorder scored higher on behavioural avoidance, verbal reassurance, and social reassurance than school children (F (5,304) = 12.63, p = .003, ηp2 = .17). Results for construct validity were ambiguous. Our analyses suggest that the BAER-C is a promising theory-based new instrument to reliably assess different avoidance strategies in children. More research is needed to further analyse construct validity with other emotion regulation questionnaires.

Early detection of anxiety problems in childhood: Spanish validation of the brief Spence Children's Anxiety Scale for parents

The small percentage of children with anxiety problems who receive psychological treatment, and the negative psychological consequences associated with these problems highlight the need for early detection. Although assessment instruments with appropriate measurement properties exist, they tend to be extensive, making it difficult to apply them in clinical settings, schools, or primary care practices. This study aimed to adapt the Spanish brief version for parents of the Spence Children's Anxiety Scale (SCAS-P-8). For this purpose, information on 215 children between 8 and 12 years of age was reported by 163 parents. The Spanish version of the SCAS-P-8 adequately fit a one-factor structure, χ² = 44.25; df = 19; comparative fit index = .97; Tucker-Lewis index = .96; root mean square error of approximation: .07 (.04, .09); standardized root mean squared residual = .08. Evidence of internal consistency of the total SCAS-P-8 score was good (α = 0.82), and the direct correlations obtained between the SCAS-P-8 and internalizing problems showed evidence of convergent validity. Moreover, the appropriate measurement properties of the SCAS-P-8 were shown to be independent of gender. Differences in sociodemographic variables and SDQ-P between children with anxiety symptoms and those without anxiety symptoms were also discussed. Information reported by parents can help the clinician carry out an accurate diagnosis. A brief assessment scale can be easily applied in schools or primary care settings.

Potential Sociodemographic Predictors of Childhood Anxiety Disorders: A Cross-Sectional Study

Background:

Previous studies have shown that the prevalence of anxiety among primary school students in rural areas is relatively high. Also, this stage is a critical developmental stage of academic life. Childhood anxiety disorders lead to significant disruption and interference with other aspects of life, including behavioral, emotional, cognitive, and academic achievement.

Aims:

This study aimed to find the frequency of 6 subtypes of anxiety disorders and to determine the potential sociodemographic factors of anxiety disorders among primary school students in a rural area of Malaysia.

Methods:

This was a cross-sectional study in which 411 students answered the Spence Children’s Anxiety Scale-Child version (SCAS-C). Descriptive analyses elucidated at-risk students, and multivariate analysis of variance and multiple linear regression presented potential predictors of anxiety disorders.

Results:

The most common abnormal level was for social phobia (SP) (n = 109/18.6%), and the least common were panic/agoraphobia (n = 85/14.1%) and physical injury fears (PIF) (n = 82/13.6%). Multivariate analysis of variance revealed that age ( P < .05), gender ( P < .05), father’s employment ( P < .05), and mother’s educational level (EL) P < .05) were predictors of overall anxiety. A Tukey post-hoc test revealed that older children are more likely to suffer from overall anxiety, separation anxiety (SA), SP, and obsessive-compulsive problems. Children of low-income families were less likely to suffer from SA than those of middle-income families. Children of stay-at-home mothers were less likely to suffer from overall anxiety, SA, and SP than mothers who worked more than 8 h per day. Multiple linear regression could predict 6 models of anxiety based on sociodemographic factors.

Conclusion:

According to our findings in this study, promoting mental health by providing preventive strategies and screening programs is more recommended for students with sociodemographic risk factors for anxiety disorders.

'It opened my eyes': Parents' experiences of their child receiving an anxiety disorder diagnosis

Anxiety disorders are the most common mental health disorders among children, however there is limited guidance on the process of assessing child anxiety disorders and sharing diagnostic outcomes with families. This study aimed to identify aspects of the diagnostic process that are helpful and/or unhelpful for families, and ways to mitigate any potential negative consequences of receiving a child anxiety disorder diagnosis. A qualitative study was conducted with parents of 11 children (aged 7-12 years) with a primary diagnosis of an anxiety disorder, identified through a child mental health service. We used an inductive thematic analysis approach. Elements of the diagnostic process considered helpful or less helpful for families related to four themes: clarity and insight, being heard, the anxiety label and access to support. Findings illustrate the importance of sharing diagnoses compassionately in the context of ensuing treatment, and the benefits of providing families with personalised verbal and written diagnostic information, that is tailored for both parents and children.

Personalized Assessment of Anxiety and Avoidance in Children and Their Parents-Development and Evaluation of the Anxiety and Avoidance Scale for Children

In treating childhood anxiety disorders, therapists use highly individualized anxiety hierarchies to assess anxiety-eliciting situations and to personalize treatment. In contrast, psychometric assessment of anxiety symptoms in children usually consists of standardized questionnaires, assessing either total anxiety or disorder-specific symptom scores, prioritizing comparability over individual information. To account for interindividual differences, the Anxiety and Avoidance Scale for Children (AVAC) was developed, following a precise, personalized, assessment approach. In responding to the questionnaire, children and parents identify the most anxiety-eliciting situations before starting treatment, and rate them for anxiety and avoidance. Ratings are repeated over the course of treatment. The aim of this study is to introduce the new questionnaire and present first data on psychometric properties. The AVAC was administered to 389 children with separation anxiety disorder (N = 148), social anxiety disorder (N = 110) or specific phobia (N = 131) aged 8 to 16 and their parents, along with other measures of anxiety and psychopathology before and after cognitive behavioral treatment. Results showed adequate to good test-retest reliability. The AVAC items correlated significantly with established anxiety questionnaires, indicating convergent construct validity. Regarding divergent construct validity, the AVAC showed only small correlations with externalizing symptoms, demonstrating its precision in measuring anxiety and avoidance. The questionnaire was also sensitive to change after treatment, with medium to large effects in the reduction of anxiety and avoidance. The present analyses suggest that the new personalized assessment approach with the AVAC is a reliable and valid assessment of individualized anxiety and avoidance, as well as change in those constructs over the course of CBT treatment.

Annual Research Review: Immersive virtual reality and digital applied gaming interventions for the treatment of mental health problems in children and young people: the need for rigorous treatment development and clinical evaluation

BACKGROUND

Mental health problems in children and young people are common and can lead to poor long-term outcomes. Despite the availability of effective psychological interventions for mental health disorders, only a minority of affected children and young people access treatment. Digital interventions, such as applied games and virtual reality (VR), that target mental health problems in children and young people may hold a key to increasing access to, engagement with, and potentially the effectiveness of psychological treatments. To date, several applied games and VR interventions have been specifically developed for children and young people. This systematic review aims to identify and synthesize current data on the experience and effectiveness of applied games and VR for targeting mental health problems in children and young people (defined as average age of 18 years or below).

METHODS

Electronic systematic searches were conducted in Medline, PsycINFO, CINAHL, and Web of Science.

RESULTS

Nineteen studies were identified that examined nine applied games and two VR applications, and targeted symptoms of anxiety, depression, and phobias using both quantitative and qualitative methodologies. Existing evidence is at a very early stage and studies vary extensively in key methodological characteristics. For applied games, the most robust evidence is for adolescent depressive symptoms (medium clinical effect sizes). Insufficient research attention has been given to the efficacy of VR interventions in children and young people.

CONCLUSIONS

The evidence to date is at a very early stage. Despite the enthusiasm for applied games and VR, existing interventions are limited in number and evidence of efficacy, and there is a clear need for further co-design, development, and evaluation of applied games and VR before they are routinely offered as treatments for children and young people with mental health problems.

The role of the endogenous oxytocin system under psychosocial stress conditions in adolescents suffering from anxiety disorder: study protocol for a parallel group controlled trial

BACKGROUND

In social neuroscience, the linkage between the endocrinological system and the etiology and symptomatology of mental health problems has received increasing attention. A particular focus is given to the neuropeptide oxytocin with its anxiolytic and stress-buffering effect and the resulting therapeutic potential for anxiety disorders. Even though anxiety disorders are the most prevalent mental health disorders in childhood and adolescence worldwide, the reactivity of the endogenous oxytocin system to an acute stressor (Trier Social Stress Test, TSST) has so far only been investigated in healthy children. It has been shown that peripheral oxytocin levels increased under psychosocial stress conditions. In the present study, it is hypothesized that the endogenous oxytocin system in children and adolescents suffering from a clinically diagnosed anxiety disorder is dysregulated. Three primary outcome parameters will be analyzed: significant differences between participants with anxiety disorders compared to healthy controls in basal oxytocin levels, varying salivary oxytocin release after stress exposure and the correlation between the cortisol peak/-decrease and oxytocin level over time. Secondary outcome criteria are significant differences in physiological (heart rate) and psychological (perceived stress, anxiety, insecurity, tension) responses.

METHODS

The present study is a single-center experimental observation study to investigate the reactivity of the endocrinological system to a psychosocial stressor (TSST). 32 children and adolescents (11-18 years) suffering from anxiety disorder will be compared to a matched healthy control group. After a detailed psychological assessment, saliva samples will be taken to measure oxytocin levels before and after psychosocial stress exposure at eight different time points. Additionally, the stress hormone cortisol will be analyzed according to the same procedure.

DISCUSSION

Due to the high prevalence and comorbidity rate with numerous other psychiatric disorders and mental health problems, there is an urgent need to strengthen research in possible neurobiological underpinnings of anxiety disorders. To our knowledge, the proposed experiment is the first study to examine the endocrinological oxytocin and cortisol reaction to an acute psychosocial stressor in children and adolescents with mental health disorders. Trial registration The study is registered in the German Clinical Trials Register since 11 September 2019, DRKS00017793, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017793 .

Using Evaluative Criteria to Review Youth Anxiety Measures, Part II: Parent-Report

This Evidence Base Update of parent-report measures of youth anxiety symptoms is a companion piece to our update on youth self-report anxiety symptom measures (Etkin et al., 2021). We rate the psychometric properties of the parent-report measures as Adequate, Good, or Excellent using criteria developed by Hunsley and Mash (2008) and Youngstrom et al. (2017). Our review reveals that the evidence base for parent-report measures is considerably less developed compared with the evidence base for youth self-report measures. Nevertheless, several measures, the parent-report Screen for Child Anxiety-Related Emotional Disorders, Multidimensional Anxiety Scale for Children, and Spence Children's Anxiety Scale, were found to have Good to Excellent psychometric properties. We conclude our review with suggestions about which parent-report youth anxiety measures are best suited to perform different assessment functions and directions for additional research to expand and strengthen the evidence base.

Anxiety characteristics in individuals with Williams syndrome

BACKGROUND

Williams syndrome anxiety research predominantly focuses on disorder prevalence and symptomatology, categorised using standardised mental health classifications. However, the use of these assessments may not fully capture the phenotypic features of anxiety in Williams syndrome. In this study, we examined characteristics of anxiety using a formulation framework.

METHOD

A semi-structured interview was conducted with thirteen parents of individuals with Williams syndrome (median age: 19, age range: 12-45, 8 females).

RESULTS

Various anxiety triggers were reported, including anxiety triggered by phobias, uncertainty and negative emotions in others. The range of described behaviours was diverse with both avoidant and active coping strategies for anxiety management reported.

CONCLUSIONS

Many of the characteristics described were consistent with findings in the intellectual disability and typically developing literature, although novel information was identified. The study demonstrates the utility of a formulation framework to explore anxiety characteristics in atypical populations and has outlined new avenues for research.

Using Evaluative Criteria to Review Youth Anxiety Measures, Part I: Self-Report

Evidence-based assessment serves several critical functions in clinical child psychological science, including being a foundation for evidence-based treatment delivery. In this Evidence Base Update, we provide an evaluative review of the most widely used youth self-report measures assessing anxiety and its disorders. Guided by a set of evaluative criteria (De Los Reyes & Langer, 2018), we rate the measures as Excellent, Good, or Adequate across their psychometric properties (e.g., construct validity). For the eight measures evaluated, most ratings assigned were Good followed by Excellent, and the minority of ratings were Adequate. We view these results overall as positive and encouraging, as they show that these youth anxiety self-report measures can be used with relatively high confidence to accomplish key assessment functions. Recommendations and future directions for further advancements to the evidence base are discussed.

Practitioner Review: Anxiety disorders in children and young people - assessment and treatment

Despite significant advancements in our knowledge of anxiety disorders in children and adolescents, they continue to be underrecognised and undertreated. It is critical that these disorders are taken seriously in children and young people as they are highly prevalent, have a negative impact on educational, social and health functioning, create a risk of ongoing anxiety and other mental health disorders across the life span and are associated with substantial economic burden. Yet very few children with anxiety disorders access evidence-based treatments, and there is an urgent need for widespread implementation of effective interventions. This review aimed to provide an overview of recent research developments that will be relevant to clinicians and policymakers, particularly focusing on the development and maintenance of child anxiety disorders and considerations for assessment and treatment. Given the critical need to increase access to effective support, we hope this review will contribute to driving forward a step change in treatment delivery for children and young people with anxiety disorders and their families.