Reliability and validity of the Revised Children's Manifest Anxiety Scale (RCMAS) across samples of Mexican, Mexican American, and European American children: a preliminary investigation1 Table of means, standard deviations, and correlations of the RCMAS indicators are available from the first author upon request

Do after-school activities help mitigate the negative impact of community violence exposure? A person-centered approach

The current study used a person-centered approach to identify classes of after-school activities that may reduce the harmful effects, including anxiety and depression, of community violence exposure (CVE) in Latino youth. Participants in the current study included 144 students (54.2% male, ages 14-19) who were recruited from a charter high school in a large, Midwestern city. Students provided information on after-school activities, CVE, and internalizing symptoms. Indices supported a two-class model. Classes were characterized by students who reported high participation in extracurricular activities at school (Class 1) and students who reported spending more time completing after school (Class 2). No between-class differences emerged in anxiety or depression symptoms and class membership did not moderate the relationship between CVE and internalizing symptoms. Findings provide a description of Latino youths' after-school activities and support an individualized, person-centered approach to understanding the risk and protection of environmental factors.

Anxiety sensitivity and acculturative stress: Concurrent relations to mental health among Spanish-speaking Latinx in primary care

The Latinx population suffers from mental health inequalities. Although past work has implicated acculturative stress and anxiety sensitivity as important individual difference factors for anxiety and depression in this group, it is presently unclear how they work together to influence more severe anxiety and depressive symptom expression among Latinx. To help address this gap in the existing literature, the current study evaluated the role of concurrent anxiety sensitivity and acculturative stress, in terms of anxiety and depressive symptoms and disorders, in a Latinx population in a primary care setting. Participants included 142 Latinx individuals (86.7% female; M_age = 39.66, SD = 11.34). After accounting for shared variance, the results indicated that both anxiety sensitivity and acculturative stress were significantly associated with anxious arousal symptoms, social anxiety, and depressive symptoms. However, anxiety sensitivity, but not acculturative stress, was significantly related to a number of mood and anxiety disorders. These findings suggest the importance of assessing both anxiety sensitivity and acculturative stress in routine mental health screening, as both factors may be related to poorer psychological health among this group.

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.

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.

Children's anxiety symptoms and salivary immunoglobulin A: A mutual regulatory system?

Anxiety can impact the immune system resulting in negative health outcomes. Salivary immunoglobulin A (sIgA) is a first line of defense against foreign antigens, with lowered levels indicative of weakened mucosal immunity. Little is known about how anxiety symptoms affect the diurnal rhythm of sIgA secretion, or the longitudinal transactional sequence between the two in children and adolescents. The goals of the two studies were to: (i) explore the concurrent associations between self-reported anxiety symptoms and diurnal variations of sIgA across the day using repeated daily samples of sIgA; and (ii) examine transactional relations between children's anxiety and aggregated total amount of sIgA levels across successive periods from middle childhood (Wave 1; ages 9-12) to early adolescence (Wave 2; ages 12-15), and from early to mid- adolescence (Wave 3; ages 15-18). Concurrent results showed a steeper (positive) rise in diurnal slope of sIgA from awakening to 5 hr post-awakening in children with higher anxiety. Longitudinally, higher levels of total anxiety, and specifically, worries at Wave 1 significantly predicted lower cumulative daily levels of sIgA 3 years later at Wave 2. Lowered sIgA levels at Wave 2 in turn predicted higher anxiety at Wave 3, illustrating a "vicious cycle" feedback loop. These findings broaden our understanding of the developmental links between anxiety symptoms, the immune system, and health.

Individual differences in anxiety trajectories from Grades 2 to 8: Impact of the middle school transition

This study examined the impact of the middle school transition on general anxiety trajectories from middle childhood to middle adolescence, as well as how youths’ individual vulnerability and exposure to contextual stressors were associated with anxiety trajectories. Participants were 631 youth (47% boys, M age = 7.96 years at Time 1), followed for 7 successive years from second to eighth grade. Teachers reported on youths’ individual vulnerability to anxiety (anxious solitude) in second grade; youth reported on their anxiety in second to eighth grade and aspects of their social contexts particularly relevant to the school transition (school hassles, peer victimization, parent–child relationship quality, and friendship quality) in sixth to eighth grade. The results revealed two subgroups that showed either strongly increasing (5%) or decreasing (14%) levels of anxiety across the transition and two subgroups with fairly stable levels of either high (11%) or low (70%) anxiety over time. Youth in the latter two subgroups could be distinguished based on their individual vulnerability to anxiety, whereas youth with increasing anxiety reported more contextual stressors and less contextual support than youth with decreasing anxiety. In sum, findings suggest that the middle school transition has the potential to alter developmental trajectories of anxiety for some youth, for better or for worse.

Behavioral Couples Treatment for Substance Use Disorder: Secondary Effects on the Reduction of Youth Internalizing Symptoms

This study examined the secondary effects of Behavioral Couples Treatment (BCT) for parents with substance use disorder on youth reports of internalizing symptoms (i.e., depressive and anxiety symptoms). Participants were 59 triads (father, mothers, and youth; 32 girls, 27 boys) in which one or both parents met criteria for drug or alcohol use disorder (or both). Mothers, fathers, and youth completed pretreatment, post-intervention, and 6-month post-intervention follow-up assessments. Two piecewise latent growth models examined whether number of sessions attended was associated with parents' relationship satisfaction or its growth over time, and in turn if parents' relationship satisfaction was uniquely associated with youth depressive/anxiety symptoms or their growth over time. A significant indirect effect at post-intervention revealed the number of sessions attended contributed to decreases in youth depressive symptoms via increases in mothers' and fathers' relationship satisfaction. Mothers' relationship satisfaction uniquely mediated the relationship between number of sessions attended and youth depressive symptoms at post-intervention. With regards to fathers, there was a non-significant trend such that increases in sessions attended was associated with decreases in youth depressive symptoms post- intervention via increasing relationship satisfaction among fathers. Findings suggest that BCT may have protective secondary effects in reducing youth reports of depressive symptoms among couples in which one or both parents have substance use disorder.

Can we really use available scales for child and adolescent psychopathology across cultures? A systematic review of cross-cultural measurement invariance data

In this systematic review, we assessed available evidence for cross-cultural measurement invariance of assessment scales for child and adolescent psychopathology as an indicator of cross-cultural validity. A literature search was conducted using the Medline, PsychInfo, Scopus, Web of Science, and Google Scholar databases. Cross-cultural measurement invariance data was available for 26 scales. Based on the aggregation of the evidence from the studies under review, none of the evaluated scales have strong evidence for cross-cultural validity and suitability for cross-cultural comparison. A few of the studies showed a moderate level of measurement invariance for some scales (such as the Fear Survey Schedule for Children-Revised, Multidimensional Anxiety Scale for Children, Revised Child Anxiety and Depression Scale, Revised Children's Manifest Anxiety Scale, Mood and Feelings Questionnaire, and Disruptive Behavior Rating Scale), which may make them suitable in cross-cultural comparative studies. The remainder of the scales either showed weak or outright lack of measurement invariance. This review showed only limited testing for measurement invariance across cultural groups of scales for pediatric psychopathology, with evidence of cross-cultural validity for only a few scales. This study also revealed a need to improve practices of statistical analysis reporting in testing measurement invariance. Implications for future research are discussed.

A Randomized Controlled Comparison of Emotional Freedom Technique and Cognitive-Behavioral Therapy to Reduce Adolescent Anxiety: A Pilot Study

OBJECTIVE

The objective of this pilot study was to compare the efficacy of Emotional Freedom Techniques (EFT) with that of Cognitive-Behavioral Therapy (CBT) in reducing adolescent anxiety.

DESIGN

Randomized controlled study.

SETTINGS

This study took place in 10 schools (8 public/2 private; 4 high schools/6 middle schools) in 2 northeastern states in the United States.

PARTICIPANTS

Sixty-three high-ability students in grades 6-12, ages 10-18 years, who scored in the moderate to high ranges for anxiety on the Revised Children's Manifest Anxiety Scale-2 (RCMAS-2) were randomly assigned to CBT (n = 21), EFT (n = 21), or waitlist control (n = 21) intervention groups.

INTERVENTIONS

CBT is the gold standard of anxiety treatment for adolescent anxiety. EFT is an evidence-based treatment for anxiety that incorporates acupoint stimulation. Students assigned to the CBT or EFT treatment groups received three individual sessions of the identified protocols from trained graduate counseling, psychology, or social work students enrolled at a large northeastern research university.

OUTCOME MEASURES

The RCMAS-2 was used to assess preintervention and postintervention anxiety levels in participants.

RESULTS

EFT participants (n = 20; M = 52.16, SD = 9.23) showed significant reduction in anxiety levels compared with the waitlist control group (n = 21; M = 57.93, SD = 6.02) (p = 0.005, d = 0.74, 95% CI [-9.76, -1.77]) with a moderate to large effect size. CBT participants (n = 21; M = 54.82, SD = 5.81) showed reduction in anxiety but did not differ significantly from the EFT (p = 0.18, d = 0.34; 95% CI [-6.61, 1.30]) or control (p = 0.12, d = 0.53, 95% CI [-7.06, .84]).

CONCLUSIONS

EFT is an efficacious intervention to significantly reduce anxiety for high-ability adolescents.

The Contribution of Ethnic Minority Status to Adaptive Style: A Comparison of Mexican, Mexican American, and European American Children

Ethnic minority status and health minority status (i.e., presence of illness) may facilitate repressive adaptive style (RAS) in an additive fashion, and a “double stigma” hypothesis has been proposed to explain this additive effect. The authors compare RAS in European American, Mexican American, and Mexican children and examine the association of RAS to the traditional values of simpatia and collectivism. Results do not confirm the hypothesis that minority status contributes to RAS; however, collectivism is a significant predictor of defensiveness supporting a cultural hypothesis for RAS.

Parenting practices, interpretive biases, and anxiety in Latino children

A number of factors are believed to confer risk for anxiety development in children; however, cultural variation of purported risk factors remains unclear. We examined relations between controlling and rejecting parenting styles, parental modeling of anxious behaviors, child interpretive biases, and child anxiety in a mixed clinically anxious (n=27) and non-clinical (n=20) sample of Latino children and at least one of their parents. Families completed discussion-based tasks and questionnaires in a lab setting. Results indicated that child anxiety was: linked with parental control and child interpretative biases, associated with parental modeling of anxious behaviors at a trend level, and not associated with low parental acceptance. Findings that controlling parenting and child interpretive biases were associated with anxiety extend current theories of anxiety development to the Latino population. We speculate that strong family ties may buffer Latino children from detrimental effects of perceived low parental acceptance.

Influence of mental health and substance use problems and criminogenic risk on outcomes in serious juvenile offenders

OBJECTIVE

To investigate the relations among certain mental health problems (MHPs; affective, anxiety, attention-deficit/hyperactivity disorder [ADHD], and substance use disorders), criminogenic risk, and outcomes in a sample of serious adolescent offenders.

METHOD

Using data from a longitudinal study of serious adolescent offenders (N = 949; mean age = 16 years, SD = 1.10 years; 84% male; 78% minority), we evaluated the association of MHPs with three distinct outcomes (rearrest, self-reported antisocial activity, and gainful activity), tested whether having an MHP contributed any unique explanatory power regarding these outcomes over and above criminogenic risk markers, and examined whether MHPs moderated the relationship between risk markers and outcomes. Negative binomial and ordinal regressions were used. Data for the study were derived primarily from youth self-report over a 7-year period, with parent collaterals reporting on ADHD, and official records as the source for rearrest information.

RESULTS

Of the sample, 57.5% met the criteria for at least one of the assessed MPHs. The presence of a substance use disorder showed consistent associations with the outcomes. After controlling for risk markers and demographic characteristics, MHPs were not associated with most outcomes. The co-occurrence of a substance use disorder and an MHP moderated the relations between several risk markers and outcomes.

CONCLUSIONS

Current juvenile justice policies that focus treatment efforts on both criminogenic and mental health factors (with particular emphasis on treating substance use disorders) appear to be well founded. It is unlikely that focusing solely on treating MHPs in serious offenders will have a distinct impact on later outcomes.

Cognitive-Behavioral Treatment of an 11-Year-Old Male Presenting With Emetophobia: A Case Study

The goal of the current case study was to illustrate an evidence-based assessment and the cognitive-behavioral treatment of an 11-year-old male with emetophobia. A multimodal assessment of the child’s anxiety symptoms was conducted, including a semistructured diagnostic interview (Anxiety Disorders Interview Schedule: Child and Parent Versions), parent report (Behavior Assessment System for Children—Second Edition.), and child self-report (Revised Children’s Manifest Anxiety Scale and Child Depression Inventory). Emetophobia symptoms were assessed via parent and child report of the Emetophobia Questionnaire. Treatment included graduated exposure, cognitive restructuring, and parent training. Improvement was seen within 22 sessions and maintained at a 6 months follow-up. In addition to a reduction in symptoms of emetophobia, discontinuation of medication, and no longer meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria for specific phobia, treatment gains also included a reduction in internalizing and somatization symptoms as well as an increase in the patient’s adaptive skills. This case study illustrates the use of CBT along with parent training as an efficacious treatment for children with emetophobia. It also demonstrates how to incorporate simple, everyday technology (i.e., Internet) to simulate exposures that are otherwise difficult to duplicate in the therapy session.

Parenting strategies and socio-cultural influences in childhood anxiety: Mexican, Latin American descent, and European American families

This study examined the relationship between anxiety in Latin American children and Latino cultural schemas, parenting strategies, being an ethnic minority, and assimilation. Latin American (n=72; LA) and white European-American (n=46; EA) children living in the U.S., Mexican children living in Mexico (n=99; M), and at least one parent per family (n=283) were administered measures assessing anxiety, parenting strategies, collectivism, family cohesion, simpatia, parent-child communication, and assimilation. M and LA children expressed more anxiety symptoms than EA children. More mother control and less father acceptance were associated with childhood anxiety across all three groups. However, father control was associated with more anxiety for the EA group but not the MA group, and mother acceptance was associated with more anxiety for the EA and MA groups but with less anxiety for the M group. Family cohesion was negatively associated with children's anxiety independent of ethnic group. Finally, differing from parents in assimilation did not influence LA children's anxiety.

The impact of acculturative stress and daily hassles on pre-adolescent psychological adjustment: examining anxiety symptoms

Acculturative stress in relation to anxiety symptoms has not been examined empirically in young Hispanic populations. The present study, conducted with 138 pre-adolescent Hispanic youngsters, investigated this relationship. The findings suggested that acculturative stress was related to physiological, concentration, and worrisome symptoms of anxiety. After decomposing acculturative stress, it became evident that perceived discrimination accounted for a large proportion of the variance in the relationship between acculturative stress and anxiety. Immigration-related stress was mostly associated with worry symptoms. Finally, total daily hassles were an independent predictor of concentration and physiological anxiety symptoms. Implications for prevention interventions and future research are discussed.

Anxiety symptoms in rural Mexican adolescents: a social-ecological analysis

BACKGROUND

We investigated the contributions of individual, family, and community-level factors for explaining anxiety symptoms among rural adolescents in Mexico.

METHOD

As part of a large-scale survey, 3,553 adolescents and their mothers from 333 poor, rural communities in seven Mexican states provided cross-sectional data on family level, socio-economic and psychosocial factors, and individual-level data on anxiety symptoms. Community standard of living indicators were also gathered.

RESULTS

Linear regressions adjusted for sampling design indicated that adolescents' anxiety symptoms were uniquely predicted by mothers' depressive symptoms, maternal perceived stress, larger family size, and lower maternal and adolescent educational attainment. Family income and community standard of living were not directly associated with adolescent symptoms. Adolescent females reported more symptoms than males, but gender did not moderate the relationship between the predictors and adolescents' symptoms.

CONCLUSIONS

We found that maternal mental health was a key factor in adolescent children's psychological wellbeing; this finding extends prior research in economically developed countries that emphasizes the importance of maternal functioning for child mental health. Family size, gender, and the educational attainment of mothers and adolescents also uniquely contributed to adolescents' anxiety symptoms in these rural Mexican communities.

Parenting practices and childhood anxiety reporting in Mexican, Mexican American, and European American families

Parenting practices reflecting over-control and lack of warmth and acceptance are associated with childhood anxiety in white non-Latino populations. In this study, we examined whether these parenting practices were related to childhood anxiety in Mexican-descent children. Mexican (M: n=46), Mexican American (MA: n=48), and European American (EA: n=47) families discussed three ambiguous, potentially anxiety provoking situations. Transcribed discussions were coded for parenting practices reflecting control and lack of warmth and acceptance. Controlling practices were associated with more anxiety for the M and EA groups and with less anxiety for the MA group. The MA parents generated more verbalizations indicative of control than the M parents and more verbalizations indicative of lack of warmth and acceptance than the EA parents. Implications for our understanding of anxiety development in Latino children are discussed.