Self-reported anxiety in children and adolescents: a three-year follow-up study

Using a longitudinal network structure to subgroup depressive symptoms among adolescents

BACKGROUND

Network modeling has been proposed as an effective approach to examine complex associations among antecedents, mediators and symptoms. This study aimed to investigate whether the severity of depressive symptoms affects the multivariate relationships among symptoms and mediating factors over a 2-year longitudinal follow-up.

METHODS

We recruited a school-based cohort of 1480 primary and secondary school students over four semesters from January 2020 to December 2021. The participants (n = 1145) were assessed at four time points (ages 10-13 years old at baseline). Based on a cut-off score of 5 on the 9-item Patient Health Questionnaire at each time point, the participants were categorized into the non-depressive symptom (NDS) and depressive symptom (DS) groups. We conducted network analysis to investigate the symptom-to-symptom influences in these two groups over time.

RESULTS

The global network metrics did not differ statistically between the NDS and DS groups at four time points. However, network connection strength varied with symptom severity. The edge weights between learning anxiety and social anxiety were prominently in the NDS group over time. The central factors for NDS and DS were oversensitivity and impulsivity (3 out of 4 time points), respectively. Moreover, both node strength and closeness were stable over time in both groups.

CONCLUSIONS

Our study suggests that interrelationships among symptoms and contributing factors are generally stable in adolescents, but a higher severity of depressive symptoms may lead to increased stability in these relationships.

Children's and adolescent's narratives about pain and negative experiences in diabetes treatment

Pain and fear associated with needle procedures have been found to be more common among children and adolescents treated for type 1 diabetes (T1D) than among others in their age group. Furthermore, high glycated haemoglobin (HbA1c) values are associated with needle-related fear.

AIM

To describe negative experiences of needle procedures in childhood diabetes treatment from children's and adolescents' own perspectives.

METHODS

Short written narratives (n = 83) and drawings (n = 2) from children and adolescents treated for T1D, aged 7-18 years, were subjected to inductive qualitative content analysis.

RESULTS

Negative experiences with needle procedures had many facets, such as pain and fear, changing over time and affecting everyday life. All kinds of needle procedures caused difficulties, but venipunctures were described as the worst.

CONCLUSION

All needle procedures involved in diabetes treatment are potentially experienced as creating pain and fear, but the negative experiences are multifaceted and vary between individuals. These experiences create suffering for children and adolescents, and influence their daily lives. Besides finding techniques to decrease the number of needle procedures in the treatment, research should focus on implementing methods to decrease pain, fear, and other negative experiences as well as to promote self-coping. This is urgent, since needle-related fear has an impact on glycaemic control and therefore increases the risk of long-term complications.

CLINICAL IMPLICATIONS

When caring for children and adolescents with diabetes, their previous experiences with needle procedures need to be considered.

The occurrence of internalizing problems and chronic pain symptoms in early childhood: what comes first?

Chronic pain and internalizing problems are characterized by concurrent associations but the directionality of this relationship in early childhood remains unclear. This prospective study aimed to investigate the bidirectional effect of chronic pain and internalizing problems and test the persistence of pain over time in a population-based sample of preschoolers. The study was embedded in Generation R, a large population-based cohort. Mothers of 3,996 children assessed their child's experienced pain and internalizing problems at 3 and 6 years. At 3 years, paternal reports were available too. Reports of family functioning, discipline practices and parental psychopathology were also collected. The prevalence of chronic pain was 2.7% (106) and 8.0% (294) at baseline and follow-up, respectively. The presence of internalizing problems at child age 3 years predicted chronic pain at 6 years, for both maternal (OR 1.05, 95% CI 1.02,1.07, p < 0.001) and paternal (OR 1.03, 95%CI 1.00, 1.06, p < 0.05) internalizing problem reports, when adjusted for potential confounding factors. In contrast, chronic pain did not increase the likelihood of internalizing problems. The temporal relationship between chronic pain and internalizing problems appears to follow a largely unidirectional trend in early childhood, with internalizing problems increasing the likelihood of concurrent physical symptoms. Current understanding of the directionality of this relationship, highlights the importance for comprehensive assessment of psychiatric problems contributing to the manifestation of chronic pain.

Experimental evidence for a child-to-adolescent switch in human amygdala-prefrontal cortex communication: A cross-sectional pilot study

Interactions between the amygdala and prefrontal cortex are fundamental to human emotion. Despite the central role of frontoamygdala communication in adult emotional learning and regulation, little is known about how top-down control emerges during human development. In the present cross-sectional pilot study, we experimentally manipulated prefrontal engagement to test its effects on the amygdala during development. Inducing dorsal anterior cingulate cortex (dACC) activation resulted in developmentally-opposite effects on amygdala reactivity during childhood versus adolescence, such that dACC activation was followed by increased amygdala reactivity in childhood but reduced amygdala reactivity in adolescence. Bayesian network analyses revealed an age-related switch between childhood and adolescence in the nature of amygdala connectivity with the dACC and ventromedial PFC (vmPFC). Whereas adolescence was marked by information flow from dACC and vmPFC to amygdala (consistent with that observed in adults), the reverse information flow, from the amygdala to dACC and vmPFC, was dominant in childhood. The age-related switch in information flow suggests a potential shift from bottom-up co-excitatory to top-down regulatory frontoamygdala connectivity and may indicate a profound change in the circuitry supporting maturation of emotional behavior. These findings provide novel insight into the developmental construction of amygdala-cortical connections and implications for the ways in which childhood experiences may influence subsequent prefrontal function.

Social Anxiety and Subjective Quality of Life Among Chinese Left-Behind Children: The Mediating Role of Social Support

The issue of left-behind children has become a key focus in China. In this study, we investigate the mediating role of social support between social anxiety and the subjective quality of life among left-behind children in China (N = 379, M_age = 13.65). A total of 710 junior high school students were recruited using clustering random sampling from five middle schools in China and investigated using the Social Anxiety Scale for Children, Social Support Rating Scale for Adolescents, and Inventory of Subjective Life Quality. The results show that social anxiety is negatively associated with social support and subjective quality of life, and social support is positively correlated with subjective quality of life. In addition, social support partially mediates the relationship between social anxiety and subjective quality of life. In conclusion, these findings provide new insights to improve the subjective quality of life of left-behind children. The focus should be on alleviating social anxiety and increasing social support in order to help left-behind children improve their subjective quality of life.

How children's anxiety symptoms impact the functioning of the hypothalamus-pituitary-adrenal axis over time: A cross-lagged panel approach using hierarchical linear modeling

Anxiety symptoms in childhood and adolescence can have a long-term negative impact on mental and physical health. Although studies have shown dysregulation of the hypothalamus-pituitary-adrenal axis is associated with anxiety disorders, it is unclear how and in what direction children's experiences of anxiety symptoms, which include physiological and cognitive-emotional dimensions, impact the functioning of the hypothalamus-pituitary-adrenal axis over time. We hypothesized that higher physiological symptoms would be contemporaneously associated with hypercortisolism, whereas cognitive-emotional symptoms would be more chronic, reflecting traitlike stability, and would predict hypocortisolism over time. One hundred twenty children from the Concordia Longitudinal Risk Research Project were followed in successive data collection waves approximately 3 years apart from childhood through midadolescence. Between ages 10-12 and 13-15, children completed self-report questionnaires of anxiety symptoms and provided salivary cortisol samples at 2-hr intervals over 2 consecutive days. The results from hierarchical linear modeling showed that higher physiological symptoms were concurrently associated with hypercortisolism, involving cortisol levels that remained elevated over the day. In contrast, longitudinal results over the 3 years between data collection waves showed that chronic worry and social concerns predicted hypocortisolism, showing a low and blunted diurnal cortisol profile. These results have implications for broadening our understanding of the links between anxiety, the stress response system, and health across the course of development.

Implications of the Research Domain Criteria project for childhood anxiety and its disorders

Anxiety disorders are among the most prevalent psychiatric disorders in youth; however, progress in treatment for childhood anxiety has stalled over the past decade. The National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) project represents a shift toward a dimensional and interdisciplinary approach to psychiatric disorders; this shift can reframe developmental psychopathology for childhood anxiety and facilitate novel advances in its classification and treatment. Here we highlight constructs in the Systems for Social Processes and the Negative Valence System domains of RDoC, as they relate to childhood anxiety disorders. Childhood anxiety relates to both RDoC domains. In terms of social processes, through natural reliance on parents to reduce children's fear, attachment represents one particular social process, which plays a central role in anxiety among youth. In terms of negative valence, considerable research links threat conditioning to pediatric anxiety. Finally, fronto-amygdala circuitry relates to all three entities, as it has been shown to underly both attachment processes and threat learning, while it also has been consistently implicated in anxiety disorders across development. Through integrative and translational approaches, RDoC provides unique opportunities and simultaneous challenges for advancing the understanding and treatment of childhood anxiety disorders.

A Prospective Examination of the Relations Between Emotional Abuse and Anxiety: Moderation by Distress Tolerance

Anxiety, the most common and impairing psychological problem experienced by youth, is associated with numerous individual and environmental factors. Two such factors include childhood emotional abuse (CEA) and low distress tolerance (DT). The current study aimed to understand how CEA and low DT impacted anxiety symptoms measured annually across 5 years among a community sample of youth. We hypothesized DT would moderate the relationship between CEA and anxiety, such that youth with higher levels of CEA and lower levels of DT would have elevated anxiety over time. Community youth (N = 244) were annually assessed across 5 years using the Revised Child Anxiety and Depression Scale, Childhood Trauma Questionnaire, and Behavioral Indicator of Resiliency to Distress. Higher CEA at baseline was associated with higher anxiety at baseline, higher anxiety at each annual assessment, and with greater overall decreases in anxiety over time. Lower DT was associated with higher anxiety at baseline, but did not predict changes in anxiety over time. Baseline DT significantly moderated the relationship between baseline CEA and anxiety, such that youth with both higher CEA and lower DT had the highest anxiety at each annual assessment. Youth with lower DT and higher CEA scores had the highest level of anxiety symptoms across time.

Maternal postnatal depression and anxiety and their association with child emotional negativity and behavior problems at two years

Postnatal maternal depression is associated with poorer child emotional and behavioral functioning, but it is unclear whether this occurs following brief episodes or only with persistent depression. Little research has examined the relation between postnatal anxiety and child outcomes. The present study examined the role of postnatal major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptom chronicity on children’s emotional and behavioral functioning at 24 months. Following postnatal screening mothers (n = 296) were identified as having MDD, GAD, MDD and GAD, or no disorder at 3 months postnatal; the average age was 32.3 (SD = 5.0), 91.9% self-identified as Caucasian, and 62.2% were married. Maternal disorder symptom severity was assessed by questionnaires and structured interview at 3, 6, 10, 14, and 24 months postpartum. At 24 months, child emotional negativity and behavior were assessed using questionnaires and by direct observation. Latent trait–state-occasion modeling was used to represent maternal disorder symptom chronicity; both stable trait and time-specific occasion portions of maternal symptomatology were examined in relation to child outcomes. Only the stable trait portion of maternal MDD and GAD symptom severity were related to maternal report of child behavior problems and higher levels of emotional negativity. Persistent maternal MDD, but not GAD, symptom severity was related to higher levels of child emotional negativity as measured observationally. These data suggest that children’s behavior problems and emotional negativity are adversely affected by persistent maternal depression, and possibly anxiety. This has implications for interventions to prevent negative effects of postnatal psychopathology on children.

The natural course of anxiety symptoms in early adolescence: factors related to persistence

BACKGROUND AND OBJECTIVES

Anxiety disorders are the most common mental health problems during childhood and adolescence. This study examined the course of anxiety symptoms in early adolescents from the general population over three phases.

DESIGN

Prospective cohort study.

METHODS

Two hundred and forty-two participants (mean-age of 13.52) from a baseline sample of 1514 (mean-age of 10.23) were followed up three times. Of the 1514 children, those with emotional risk and controls without risk constituted the second-phase sample (n = 562; mean-age of 11.25). The Screen for Child Anxiety Related Emotional Disorders-SCARED was administered in all three phases.

RESULTS

Fifty-six percent and 32% of respondents showed total scores above the SCARED cutoff point at one and three years follow-up, respectively. Eight percent showed fluctuating symptoms. Fifty-five percent of respondents showed high scores for any subtype of anxiety over three years. Social phobia and generalized anxiety symptoms were the most prevalent and persistent. Participants with persistent separation anxiety showed the highest co-occurrence with symptoms of other psychopathological disorders. Participants with persistent anxiety showed lower academic performance. Being male was a protective factor against persistence.

CONCLUSIONS

The data support anxiety maintenance during early adolescence. Early adolescence is a critical period which may involve other serious academic, social, and family problems.

Sleep, Affect, and Social Competence from Preschool to Preadolescence: Distinct Pathways to Emotional and Social Adjustment for Boys and for Girls

Using a normative sample of 1,057 children studied across 4 waves over 6 years with multiple informants, we investigated transactional relations for sleep problems, anxious-depressed symptoms, and social functioning from preschool to preadolescence, assessing cumulative effects on children's emotional and social adjustment. To examine sex differences in the developmental processes, we conducted separate analyses for boys and girls. For both boys and girls, longitudinal cross-lagged panel analyses showed that preschool sleep problems directly predicted anxious-depressed symptoms 2 years later; indirect effects continued into preadolescence. For girls, early and later sleep problems directly or indirectly predicted a wide variety of preadolescent emotional and social adjustment domains (e.g., depressive symptoms, school competence, emotion regulation, risk-taking behaviors). For boys, social competence played a more important role than sleep problems in predicting preadolescent adjustment. Among the first set of findings that demonstrate longitudinal relations between sleep problems and social functioning in middle childhood and preadolescence, these results support Dahl's and Walker's neurological models of sleep and emotional functioning. We discuss these findings in light of relations between sleep and affect during pre-pubertal development and discuss differential findings for boys and girls.

The association of children's distress during venepuncture with parent and staff behaviours

Venepuncture and other needle-related procedures can distress children and have a lasting negative impact. Adults' behaviour during these procedures may affect children's reactions. However, the literature is contradictory and rarely considers verbal and non-verbal behaviour together. This study therefore examined the effect of adults' verbal and non-verbal behaviour on children's distress during venepuncture. Participants comprised 51 child and carer dyads and 10 staff members. Child anxiety was measured before the procedure. The procedure was recorded. The resulting audio-visual data were coded using the Child-Adult Medical Procedure Interaction Scale-Revised. Correlation analysis identified variables that were significantly associated with child distress: child anxiety, carer distress-promoting behaviour, staff distress-promoting behaviour and intimate distance. These were included in a path diagram of child distress. Exploration of the diagram identified that children's anxiety was mostly strongly associated with children's distress during venepuncture. Staff and carer behaviour did not increase children's distress. The results suggest interventions to reduce children's distress during venepuncture may be more effective if they focus on reducing children's anxiety beforehand.

Expectation prior to human papilloma virus vaccination: 11 to 12-Year-old girls' written narratives

Expectations prior to needle-related procedures can influence individuals' decision making and compliance with immunization programmes. To protect from human papilloma virus (HPV) and cervical cancer, the immunization needs to be given before sexual debut raising interest for this study's aim to investigate how 11 to 12-year-old girls narrate about their expectations prior to HPV vaccination. A total of 27 girls aged 11 to 12 years participated in this qualitative narrative study by writing short narratives describing their expectations. The requirement for inclusion was to have accepted HPV vaccination. Data were subjected to qualitative content analysis. Findings showed the following expectations: going to hurt, going to be scared and going to turn out fine. The expectations were based on the girls' previous experiences, knowledge and self-image. The latent content revealed that the girls tried to transform uneasiness to confidence. The conclusion drawn from this study is that most girls of this age seem confident about their ability to cope with possible unpleasantness related to vaccinations. However, nurses need to find strategies to help those children who feel uneasy about needle-related procedures.

Moderating Effects of Gender on Outcomes Associated with Stressful Life Events Among Elementary School-Age Youth

Stressful life events have been associated with child and adolescent maladjustment, including elevated levels of aggression and anxiety (Attar et al. in J Clin Child Psychol 23:391-400, 1994; Fox et al. in J Adolesc 33:43-54, 2010). However, gender specific outcomes associated with stressful life events among elementary school-age youth are less known. Accordingly, the current study examined the role of gender in the associations between stressful life events and anxiety and proactive and reactive aggression. Participants included 294 elementary school-age children (M = 8.71, SD = 1.17, 50.7 % male). Regression analyses indicated that stressful life events were positively associated with anxiety and reactive, but not proactive, aggression. There were no gender differences with regard to the associations with anxiety symptoms or proactive aggression. However, gender moderated the association between stressful life events and reactive aggression, such that stressful life events were only positively associated with reactive aggression for boys. Future directions and implications of this research are presented.

Parenting as a Moderator of the Effects of Maternal Depressive Symptoms on Preadolescent Adjustment

The purpose of this study was to examine whether parenting moderated the association between maternal depressive symptoms and initial levels and growth of preadolescent internalizing and externalizing symptoms. This study used a community sample of preadolescent children (N = 214; 8-12 years old at Time 1), measuring maternal depressive symptoms and parenting at Time 1, and preadolescent internalizing and externalizing symptoms at each year for 3 years. After modeling latent growth curves of internalizing and externalizing symptoms, growth factors were conditioned on maternal depressive symptoms, positive (acceptance and consistent discipline) and negative (rejection and physical punishment) parenting, and the interactions of depression and parenting. Maternal rejection moderated the relation of maternal depression with internalizing symptoms, such that high rejection exacerbated the effects of maternal depressive symptoms on initial levels of preadolescent internalizing problems. There were no significant interactions predicting externalizing problems. The findings highlight how specific parenting behaviors may alter the way in which maternal depressive symptoms confer risk for behavior problems.

The Revised Children’s Manifest Anxiety Scale–Second Edition Short Form

The psychometric properties of a new, brief measure, the Revised Children’s Manifest Anxiety Scale–Second Edition (RCMAS-2) Short Form, were examined in a sample of 1,003 U.S. elementary and secondary students. The RCMAS-2 Short Form consists of the first 10 items of the RCMAS-2. The results of confirmatory factor analysis indicated that the modified one-factor model provided an adequate fit for students in Grades 2 to 12. The results of tests of measurement invariance supported configural, weak, and strong invariance of the RCMAS-2 Short Form across gender and configural, weak, and partial strong invariance of the RCMAS-2 Short Form across age. Gender and age differences were also examined on the RCMAS-2 Short Form. The results of latent mean analyses indicated that adolescents (ages 12-19) and females had significantly higher factor means than children (ages 7-11) and males, respectively, on the RCMAS-2 Short Form. Moderate correlations between the RCMAS-2 Short Form scores and scores of measures of test anxiety were found. Implications of the findings for researchers and clinicians who work with children and adolescents are discussed.

A Closer Look at the Psychometric Properties of the Revised Children’s Manifest Anxiety Scale–Second Edition Among U.S. Elementary and Secondary School Students

The psychometric properties of the Revised Children’s Manifest Anxiety Scale–Second Edition (RCMAS-2) were examined in a sample of 1,003 U.S. elementary and secondary students in Grades 2 to 12. Confirmatory factor analyses (CFAs) were performed comparing the five-factor (target) model consisting of three anxiety (Physiological Anxiety, Social Anxiety, and Worry) factors and two defensiveness (Defensiveness 1 and 2) factors with a three-factor model (one anxiety factor and two defensiveness factors). The results of the CFAs conducted indicated that the five-factor model provided a better fit to the data than the three-factor model. Tests of measurement invariance were also performed and the results provided support for configural, metric, and partial scalar invariance of the RCMAS-2 scores across gender. Latent mean analyses were also conducted and the results of these analyses indicated that females scored significantly higher than males on the three anxiety factors. These findings provide support for the construct validity of the RCMAS-2 scores. Implications of the findings for mental health professionals who work with elementary and secondary school students are discussed.

A theoretical model of continuity in anxiety and links to academic achievement in disaster-exposed school children

This study tested a theoretical model of continuity in anxious emotion and its links to academic achievement in disaster-exposed youth. An urban school based sample of youths (n = 191; Grades 4–8) exposed to Hurricane Katrina were assessed at 24 months (Time 1) and then again at 30 months (Time 2) postdisaster. Academic achievement was assessed through end of the school year standardized test scores (~31 months after Katrina). The results suggest that the association of traumatic stress to academic achievement was indirect via linkages from earlier (Time 1) posttraumatic stress disorder symptoms that predicted later (Time 2) test anxiety. Time 2 test anxiety was then negatively associated with academic achievement. Age and gender invariance testing suggested strong consistency across gender and minor developmental variation in the age range examined. The model presented advances the developmental understanding of the expression of anxious emotion and its links to student achievement among disaster-exposed urban school children. The findings highlight the importance of identifying heterotypic continuity in anxiety and suggest potential applied and policy directions for disaster-exposed youth. Avenues for future theoretical refinement are also discussed.

One-year stability, change and incidence in anxiety symptoms among early adolescents in the general population

To examine prospectively the stability, changes, and incidence in DSM-IV-related anxiety symptom clusters in a community sample of adolescents. On two occasions, 1 year apart, 946 Norwegian adolescents aged 13-16 years completed the SCARED, a 41-item multidimensional anxiety self-report scale that measures the levels of five principal DSM-IV-related anxiety symptom clusters. Seventy-three percent of the adolescents participated in the study at baseline, and only 7 % were lost to follow-up. Both sexes in all age cohorts, except girls aged 14-15 years, showed the same 1-year developmental pattern of stable scores, or small reductions in the total anxiety score, for all DSM-IV-related anxiety symptom clusters. Adolescents defined as "high anxiety scorers" showed a girl:boy ratio of 4:1. Whereas approximately half these students remained high scorers at the 1-year follow-up, the same proportion returned to normal anxiety levels. The 1-year incidence of high-level anxiety was 8.2 % for the whole sample, 12.6 % for the girls and 3.4 % for the boys. These results underscore the need for improved identification of adolescents in the general population with stable high anxiety levels, as opposed to those with transient high anxiety. The normative findings of this study also provide reference data with which to evaluate individual changes in clinical practice and the results of efficacy trials, including 1-year follow-up evaluations.

The Revised Child Anxiety and Depression Scale: A Psychometric Investigation with Australian Youth

The Revised Child Anxiety and Depression Scale (RCADS) is a 47-item self-report measure intended to assess children's symptoms corresponding to selected DSM-IV anxiety and major depressive disorders. The scale comprises six subscales (e.g., Separation Anxiety Disorder; Social Phobia; Obsessive Compulsive Disorder; Panic Disorder; Generalised Anxiety Disorder; and Major Depressive Disorder). To date, only one normative study of youth has been published with results providing strong initial support for the reliability and validity of this new measure (Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000). The present investigation provides additional psychometric data derived from an Australian sample comprising 405 youth aged 8 to 18 years. In general, the data were found to be consistent with those reported in the initial normative study. Internal consistency for the overall scale and its subscales was found to be adequate. Good convergent validity was demonstrated through moderate to strong correlations between the subscales of the RCADS with scores on the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI). Confirmatory factor analysis suggested reasonable fit for the six-factor model by Chorpita et al. (2000). Notwithstanding the need for additional validation, it is concluded that the RCADS is a promising instrument for use in both clinical and research settings.

Temperament variation in sensitivity to parenting: predicting changes in depression and anxiety

Temperament was examined as a moderator of maternal parenting behaviors, including warmth, negativity, autonomy granting, and guidance. Observations of parenting and questionnaire measures of temperament and adjustment were obtained from a community sample (N = 214; ages 8-12). Trajectories of depression and anxiety were assessed across 3 years. The pattern of parenting as a predictor of internalizing symptoms depended on temperament. Maternal negativity predicted increases in depression for children low in fear. Effortful control moderated sensitivity to maternal negativity, autonomy granting, and guidance. Children low in effortful control reported more symptoms in the presence of negative or poor-fitting parenting. The results support differential responding, but also suggest that temperament may render children vulnerable for the development of problems regardless of parenting.

Anxiety symptoms in African-American and Caucasian youth: relations to negative life events, social support, and coping

The purpose of the present study was to determine the relations among negative life events, social support, coping and anxiety symptoms in 709 Caucasian and African-American youth between 11 and 14 years of age. Results indicated that more negative life events, less social support, more coping efforts, and African-American status were related to more anxiety symptoms. Additionally, although active coping moderated the relationship between negative life events and anxiety, these relations were qualified in separate analyses for the African-American and Caucasian youth. Negative life events were related to anxiety symptoms only for the African-American participants. When these findings were explored further for males and females of each racial group, negative life events remained significant for African-American males but not African-American females. Implications of these findings are examined and future directions for research to understand the processes underlying these relations with both Caucasian and African-American youth are addressed.

Are anxiety and depression just as stable as personality during late adolescence? Results from a three-year longitudinal latent variable study

Although considerable evidence shows that affective symptoms and personality traits demonstrate moderate to high relative stabilities during adolescence and early adulthood, there has been little work done to examine differential stability among these constructs or to study the manner in which the stability of these constructs is expressed. The present study used a three-year longitudinal design in an adolescent/young adult sample to examine the stability of depression symptoms, social phobia symptoms, specific phobia symptoms, neuroticism, and extraversion. When considering one-, two-, and three-year durations, anxiety and personality stabilities were generally similar and typically greater than the stability of depression. Comparison of various representations of a latent variable trait-state-occasion (TSO) model revealed that whereas the full TSO model was the best representation for depression, a trait stability model was the most parsimonious of the best-fitting models for the anxiety and personality constructs. Over three years, the percentages of variance explained by the trait component for the anxiety and personality constructs (73-84%) were significantly greater than that explained by the trait component for depression (46%). These findings indicate that symptoms of depression are more episodic in nature, whereas symptoms of anxiety are more similar to personality variables in their expression of stability.

Mother–child relationships, family context, and child characteristics as predictors of anxiety symptoms in middle childhood

The goal of the study was to examine several factors that may explain the development of anxiety symptoms in middle childhood. Using data from the NICHD Study of Early Child Care (n = 1,364 families), we examined mother–child relationships, other aspects of family context, and child characteristics as predictors of anxiety in preadolescence. Latent growth curve analyses revealed that children who were more anxious at the beginning of middle childhood had been more behaviorally inhibited as preschoolers, and in middle childhood lived in families who experienced more negative life events and had mothers who were more anxious. Children who became more anxious across middle childhood were less behaviorally inhibited as preschoolers and in middle childhood perceived less security in their attachments to their mothers, experienced more negative life events, and had mothers who were more anxious. The findings illustrate the need to include a broad set of risk factors in etiological models of anxiety. In addition, the evidence for cumulative effects suggests several possible points of intervention with anxious children and their parents.

A longitudinal examination of factors predicting anxiety during the transition to middle school

The transition from elementary to middle or junior high school is commonly regarded as a period of stress and turmoil for young adolescents, and has been associated with changes in anxiety and other psychological problems. However, less is known about risk and resilience factors that may predict these changes. This study examined changes in anxiety, as well as predictors of these changes among 77, predominantly Caucasian (88%), male and female (52%) adolescents from Grades 6 to 8. Repeated measures analysis of variance was conducted to examine the predicted grade and gender differences. Multiple regression analyses were conducted to examine the prediction of eighth grade anxiety symptoms by sixth grade self-worth, perceived social acceptance, and social support, as well as the potential moderating role of gender in these relations. Results suggested a significant decrease in anxiety, particularly social anxiety, over this period for boys but not girls. Examination of predictors of changes in anxiety suggested that, in general, global self-worth, social acceptance, and gender were each associated with overall and social anxiety. Findings are integrated with extant literature on developmental changes associated with anxiety and school transitions and clinical implications of these findings are discussed.

Afraid of medical care school-aged children's narratives about medical fear

Fear can be problematic for children who come into contact with medical care. This study aimed to illuminate the meaning of being afraid when in contact with medical care, as narrated by children 7-11 years old. Nine children participated in the study, which applied a phenomenological hermeneutic analysis methodology. The children experienced medical care as "being threatened by a monster," but the possibility of breaking this spell of fear was also mediated. The findings indicate the important role of being emotionally hurt in a child's fear to create, together with the child, an alternate narrative of overcoming this fear.

Social fears during adolescence: is there an increase in distress and avoidance?

Mid-adolescence is considered as the time of onset for social phobia and is assumed to be related to a normative increase of social fears. People diagnosed with social phobia, however, do not only experience high levels of fear or distress, but also report avoidance behavior. Little attention has been paid to the development of avoidance behavior during adolescence. In the current study, a community sample with 9-17 year olds (n=260) completed a questionnaire derived from the Anxiety Disorders Interview Schedule for Children (ADIS-C) [Silverman, W. K., & Albano, A. M. (1996). Anxiety disorders interview schedule for DSM-IV child version, child interview schedule. San Antonio: The Psychological Corporation]. They rated their levels of distress and avoidance in a variety of social situations. The results showed an age related increase for formal speaking and interaction situations in both avoidance and distress, with a stronger increase in avoidance than in distress. The same pattern was found for girls for situations regarding observation by others. No effects were observed for informal speaking and interaction situations.

Adolescent siblings of individuals with an autism spectrum disorder: testing a diathesis-stress model of sibling well-being

The purpose of this study was to test a diathesis-stress model of well-being for siblings who have a brother or sister with an autism spectrum disorder (ASD). Data were collected from 57 adolescents and their mothers. Sisters reported higher levels of depressive and anxiety symptoms than brothers. Having a family history of ASDs was associated with depressive, but not anxiety, symptoms. A high level of maternal depression was also associated with more depressive and anxiety symptoms. A diathesis-stress model was partially supported, primarily through the findings that sibling sub-threshold autism characteristics were associated with depressive and anxiety symptoms in siblings, but only in the presence of a high number of stressful life events.

Development of the fear survey for adults with mental retardation

This paper describes the development of the fear survey for adults with mental retardation (FSAMR) and provides initial evidence of its psychometric properties. The FSAMR was designed to be sensitive to the assessment needs of individuals with mental retardation. The items were developed through open-ended interviews, a review of existing measures, expert input, and pilot testing. The sample consisted of 138 adults with mental retardation (73 from institutional settings and 65 from community settings). Cronbach's alpha internal consistency coefficients were 0.97 for the scale, and above the 0.60 threshold set for the study for all but the acquiescence response set (ARS) subscale. Significant concurrent validity coefficients with anxiety measures were in the moderate range (r=0.32 and 0.40) and are comparable to other similar studies. Implications for using the FSAMR are discussed.

Psychosocial outcomes of anxious first graders: a seven-year follow-up

This study examined the concurrent and long-term psychosocial outcomes associated with anxiety symptoms among a community sample of predominately low-income African Americans (N=149; 72 females). We classified first graders as high or low anxious using child, parent, and teacher reports. Academic, social, and psychological outcomes were assessed in the first and eighth grades. Logistic regressions with concurrent data revealed that highly anxious children were significantly more likely to score lower on measures of academic achievement and peer acceptance, but higher on measures of depression and aggression compared to their low-anxious peers. Longitudinal analyses revealed that high-anxious first graders, compared to their low-anxious peers, scored significantly lower on measures of academic achievement, aggression, and peer acceptance; and higher on measures of anxiety and depression in the eighth grade. Importantly, outcomes varied depending on informant. Findings suggest that, similar to European American youth, early-onset anxious symptoms in African American children are associated with both concurrent and long-term academic, social, and psychological difficulties.

The development and maintenance of anxiety symptoms from infancy through adolescence in a longitudinal sample

This study examined the etiology and course of anxiety symptoms from infancy through adolescence in a longitudinal high-risk community sample. One hundred fifty-five subjects were assessed using a variety of observational, projective, and objective measures. Results of path analyses revealed the following: (a) anxiety symptoms showed moderate stability during childhood and adolescence; (b) heightened neonatal biobehavioral reactivity and poor regulation predicted emotion regulation difficulties in preschool, which predicted anxiety symptoms in childhood; (c) developmental incompetence in childhood predicted anxiety symptoms in preadolescence, and anxiety symptoms in preadolescence predicted incompetence in adolescence; (d) insecure attachment relationships in infancy predicted negative peer relationship representations in preadolescence, and these representations predicted anxiety symptoms in adolescence; (e) compared to males, females showed similar rates of anxiety symptoms in childhood but greater and more stable rates in adolescence; however, males and females showed similar patterns of association between risk factors and anxiety symptoms across childhood and adolescence; and (f) the model tested was specific in predicting anxiety symptoms and not psychopathology in general. The results support a developmental model of the etiology and maintenance of anxiety symptoms in childhood and highlight factors to consider in efforts to prevent and treat childhood anxiety.

Catastrophic thinking about pain is independently associated with pain severity, disability, and somatic complaints in school children and children with chronic pain

OBJECTIVE

To investigate the value of pain catastrophizing in explaining pain, disability, and somatic complaints, beyond negative affectivity (NA).

METHOD

Two cross-sectional studies, one in a sample of school children (n = 193) and a second in a clinical sample of children with recurrent or chronic pain (n = 43), were conducted. In both studies, measures of pain catastrophizing and NA were examined for their ability to explain pain, disability, and somatic complaints.

RESULTS

In both studies, pain catastrophizing significantly accounted for the variance of pain, disability, and somatic complaints, beyond the effects of age, sex, and NA. Furthermore, pain catastrophizing significantly mediated the relationship between NA and somatic complaints in both studies and between NA and functional disability in study 1.

CONCLUSIONS

Results suggest the importance of assessing for pain catastrophizing in children. Pain catastrophizing is further discussed in terms of communicating distress to significant others.

The experience of being ill as narrated by hospitalized children aged 7-10 years with short-term illness

Children's illness has been investigated through the eyes of parents and nurses but the child's own perspective has been largely ignored. The aim of this study is to illuminate the 7-10-year-olds' experiences of being ill. Three girls and four boys were interviewed and narrated their experience about short-term illness. The data obtained was subjected to a thematic qualitative content analysis. The analysis suggests that the children combined reality and imagination and contrasts seemed to coexist such as being scared/confident, sad/cosy and hurt/having fun. They felt caught and tried to escape. The experience of illness as narrated by children can lead to a richer understanding and influence the way we care for paediatric patients.

A neuroimaging method for the study of threat in adolescents

Little is understood about the brain basis of anxiety, particularly among youth. However, threat paradigms with animals are delineating the relationship between anxietylike behaviors and brain function. We adapted a threat paradigm for adolescents using functional magnetic resonance imaging. The aim was to examine amygdala activation to fear. The threat was an aversive air blast directed to the larynx. Participants were explicitly informed that they might receive the air blast when viewing one stimulus (threat condition) and would not receive the blast when viewing the other stimulus (safe condition). Participants provided fear ratings immediately after each trial. Based on the relatively mild nature of the air blast, we expected participants to report varying degrees of fear. Those who reported increased fear showed right amygdala activation during the threat condition and left amygdala activation in the safe condition. These procedures offer a promising tool for studying youth with anxiety disorders.

A developmental analysis of self-reported fears in late childhood through mid-adolescence: social-evaluative fears on the rise?

BACKGROUND

The frequently reported decline in the overall frequency and intensity of fears during late childhood and adolescence may mask different developmental patterns for two broad subclasses of fears: fears concerning physical danger and fears concerning social evaluation. It was investigated if physical fears decrease between late childhood and mid-adolescence, while social-evaluative fears increase during this period. It was also studied if changes in both sets of fears are more strongly related to socio-cognitive maturity than to age, which itself is only a proxy measure of maturity.

METHODS

A non-clinical sample of 882 children and adolescents (ages 8-18) was recruited for study. Fears were assessed using the Ollendick Fear Survey Schedule for Children-Revised (FSSC-R). A Principal Components Analysis (PCA) was conducted to study the factor structure of the Failure and Criticism subscale of the FSSC-R. Level of development was assessed using the Sentence Completion Test for Youth (SCT-Y), a measure of socio-cognitive maturity that is based on Loevinger's model, and measure, of ego development.

RESULTS

The PCA of the Failure and Criticism subscale revealed three factors: Social Evaluation, Achievement Evaluation, and Punishment. As predicted, the significant decrease of overall fearfulness obscured two contradictory developmental patterns: (a) fears of physical danger and punishment decreased with age, whereas (b) fears of social and achievement evaluation increased with age. Hierarchical regression analyses showed that the age effect for social-evaluative fears was explained entirely on the basis of developmental differences in socio-cognitive maturity (controlling for verbal ability). In contrast, age was a better predictor of the decrease of physical and punishment fears (although socio-cognitive maturity still added to the predictive value of age).

CONCLUSION

The expression of social evaluation fears during adolescence appears not atypical and might be a corollary of socio-cognitive maturation. At the same time, the natural presence of those fears during adolescence appears to constitute a vulnerability for developing a social anxiety disorder.