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Phillips KE, Buinewicz SAP, Kagan E, Frank HE, Dunning E, Benito KG, Kendall PC. The Pediatric Accommodation Scale: Psychometric Evaluation of a Therapist-Report Format. Child Psychiatry Hum Dev 2024; 55:667-679. [PMID: 36149550 DOI: 10.1007/s10578-022-01447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/03/2022]
Abstract
Anxiety disorders are the most common mental health problem in youth, and accommodation is prevalent among youth with anxiety disorders. The Pediatric Accommodation Scale (PAS) is an interview administered by trained evaluators and a parent-report form (PAS-PR) to assess accommodation and its impact. Both have strong psychometric properties including internal consistency, inter-rater reliability, and data supporting construct validity. The present study evaluates the Pediatric Accommodation Scale - Therapist Report (PAS-TR), a therapist-reported version of the PAS-PR. Participants were 90 youth enrolled in cognitive behavioral therapy for anxiety. Therapists completed the PAS-TR over 16 therapy sessions. Internal consistency at baseline, convergent validity, divergent validity, and parent-therapist agreement were evaluated. Results suggest that the PAS-TR has mixed psychometric qualities suggesting that while not strong prior to the initiation of treatment, the PAS-TR may be a useful measure for therapists to rate accommodation as treatment progresses. Implications for assessment, treatment, and research are discussed.
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Affiliation(s)
- Katherine E Phillips
- Department of Psychology, Temple University, Temple University, 1701 North 13th St, 19122, Philadelphia, PA, USA.
| | | | - Elana Kagan
- Massachusetts General Hospital, Boston, MA, USA
| | - Hannah E Frank
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Erin Dunning
- Department of Psychology, Temple University, Temple University, 1701 North 13th St, 19122, Philadelphia, PA, USA
| | - Kristen G Benito
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Temple University, 1701 North 13th St, 19122, Philadelphia, PA, USA
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2
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Lunde CE, Dudek MR, Talbert CA, Sieberg CB, Silva KE, Papadelis C, Ullrich NJ, Manley PE, Moulton EA. The long-term impact of cerebellar tumor resection on executive functioning, anxiety, and fear of pain: A mixed methodology pilot study. APPLIED NEUROPSYCHOLOGY. CHILD 2024:1-11. [PMID: 38604218 DOI: 10.1080/21622965.2024.2337208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
This pilot study investigated the long-term impact of a surgery-only treatment (no exposure to other treatments, such as chemotherapy and radiation) for pediatric cerebellar low-grade gliomas on executive function, anxiety, and fear of pain (FOP) beliefs. Twelve patients who underwent surgical glioma resection during childhood (surgery age was 4-16 years, study visit age was 10-28 years), and 12 pain-free controls matched for age, sex, race, and handedness were tested. The spatial extent of resection was precisely mapped using magnetic resonance imaging (MRI). Executive function, anxiety, and FOP were assessed using validated self-report age-appropriate questionnaires for children and adults. Structured clinical interviews at a post-surgery follow-up visit were completed (average: 89 months, range: 20-99). No significant differences in FOP (FOPQ-C t[14 = 1.81, p = 0.09; FOPQ-III t[4] = 0.29, p = 0.79), executive function scores (BRIEF t[20] = 0.30, p = 0.28), or anxiety scores (MASC t[16] = 0.19, p = 0.85; MAQ t[4] = 1.80, p = 0.15) were found in pediatric or adult patients compared to pain-free controls. Clinical interviews mainly categorized pediatric patients as not anxious. One participant reported mild/subclinical anxiety, and one had moderate clinical anxiety. Neither psychologists nor patients endorsed impairments to executive functioning, anxiety, or FOP. Our pilot results suggest that pediatric cerebellar tumor survivors treated with surgery-only have favorable long-term functioning related to these themes. While these results are promising, they will need to be replicated in a larger patient sample.
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Affiliation(s)
- Claire E Lunde
- Biobehavioral Pain Innovations Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, Massachusetts, USA
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Madison R Dudek
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Brain and Eye Pain Imaging Lab, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, Massachusetts, USA
| | - Cameron A Talbert
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Brain and Eye Pain Imaging Lab, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, Massachusetts, USA
| | - Christine B Sieberg
- Biobehavioral Pain Innovations Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, Massachusetts, USA
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Health Outcomes & Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Adolescent & Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Katie E Silva
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Brain and Eye Pain Imaging Lab, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, Massachusetts, USA
| | - Christos Papadelis
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, Texas, USA
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter E Manley
- Department of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric A Moulton
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Brain and Eye Pain Imaging Lab, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, Massachusetts, USA
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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3
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Salpekar J, Ertenu DD. Anxiety and school avoidance in an 8-year-old child with epilepsy. Epilepsy Behav Rep 2024; 26:100659. [PMID: 38532902 PMCID: PMC10963191 DOI: 10.1016/j.ebr.2024.100659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024] Open
Abstract
Anxiety is ubiquitous in school age children. Co-occurring medical illness adds to the complexity of identifying pathologic anxiety as opposed to that of typical development such as with social interactions or academic pressures. Anxiety may also occur in the context of cognitive difficulties or inattention, both of which may be exacerbated by epilepsy or by anti-seizure medicines themselves. Treatment strategies may require patience and long-term observations to account for the typical range of stressors that may be expected with disease progression or with development through childhood. This section illustrates the challenge of diagnosis and management of anxiety in the context of epilepsy in a school aged child and addresses nuances that neurology clinicians need to consider. Practical strategies for management including stepwise options for pharmacologic treatment will be emphasized.
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Affiliation(s)
- Jay Salpekar
- Neuropsychiatry Center, Kennedy Krieger Institute, Psychiatry and Neurology, Johns Hopkins University School of Medicine, 1741 Ashland Ave., Baltimore, MD 21205, United States
| | - D. Dilara Ertenu
- Neuropsychiatry Center, Kennedy Krieger Institute, Psychiatry and Neurology, Johns Hopkins University School of Medicine, 1741 Ashland Ave., Baltimore, MD 21205, United States
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Griffith JM, Young JF, Hankin BL. Parental Symptoms of Anhedonia, Parenting, and Youth Outcomes: A Multi-Method, Multi-Informant Investigation. Res Child Adolesc Psychopathol 2024; 52:413-427. [PMID: 37801270 DOI: 10.1007/s10802-023-01130-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/07/2023]
Abstract
Parental depression is a well-established risk factor for youth psychopathology; however, depression is highly heterogeneous, and different parental symptom profiles may be differentially associated with risk mechanisms and youth psychopathology outcomes. Thus, this study examined associations between parental anhedonic symptoms of depression, specifically, and (1) parenting and (2) youth outcomes using a multi-method, multi-informant approach. Participants included 595 parents (89% mothers) and youth (ages 8-16; M[SD] = 12.07[2.39]). Regression analyses indicated that parental self-reported anhedonic symptoms at baseline demonstrated relatively specific prospective associations with chronic parent-child stress assessed using contextual stress interview methods, as well as youth self-reported depressive symptoms at 18-month follow-up. Findings also indicated concurrent associations between parental anhedonic symptoms and observed parental criticism, conflict, and responsiveness in the context of a 5-min discussion task, as well as parent self-reported monitoring/supervision, although results were no longer significant after controlling for parental co-occurring non-anhedonic depressive symptoms. Findings suggest that parental anhedonic symptoms may contribute to relatively unique reductions in the quality of the parent-child relationship and may be a particularly salient risk factor for youth depression.
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Affiliation(s)
- Julianne M Griffith
- Department of Psychology, University of Illinois-Urbana Champaign, 603 E. Daniel Street, Champaign, IL, 61820, USA.
| | - Jami F Young
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Benjamin L Hankin
- Department of Psychology, University of Illinois-Urbana Champaign, 603 E. Daniel Street, Champaign, IL, 61820, USA
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Martinsen K, Lisøy C, Wentzel-Larsen T, Neumer SP, Rasmussen LMP, Adolfsen F, Sund AM, Ingul JM. School children's mental health during the COVID-19 pandemic. Front Psychol 2024; 14:1290358. [PMID: 38327509 PMCID: PMC10848797 DOI: 10.3389/fpsyg.2023.1290358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/13/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction The COVID-19 pandemic significantly impacted the daily routines of children, with social distancing and quarantine leading to reduced social interactions and potential increased conflicts within families. These factors can increase the risk for anxiety and depression while reducing overall quality of life. Methods Our study included 1843 school children aged 8 to 12 from 56 schools over a 2.5-year period before and during the pandemic. This multi-wave cross-sectional study utilized baseline data from an optimization trial of an indicated preventive intervention. The main outcomes were self-reported symptoms of anxiety and depression, and quality of life was the secondary outcome measure. Furthermore, responses to COVID-relevant questions were measured using a self-composed scale. Our objectives were to compare anxiety and depression symptom levels between cohorts of children who participated in the study before and during the pandemic, to examine if anxiety or depression predicted the COVID response, and whether anxiety and depression and subtypes of anxiety had an impact on quality of life during the pandemic. Linear regression and interaction models were used to examine relevant associations. Results Levels of anxiety and depression were higher in all waves compared to pre-pandemic levels. Quality of life was lower during the pandemic than before the pandemic, particularly among children with generalized anxiety symptoms. Quality of life was negatively associated with loneliness. Discussion Our study revealed that children reported higher anxious and depressive symptoms during the pandemic compared to pre-pandemic levels, as well as reduced quality of life. Lockdowns and restrictions may have contributed to this burden. Additionally, self-reported loneliness was a significant possible consequence of the restrictive measures imposed on children during the pandemic. Additional research is needed to investigate the long-term effects of the pandemic on children, particularly regarding the stability of elevated levels of anxiety and depression. Such studies could examine whether these conditions are indicative of a trajectory toward more severe internalizing disorders.Clinical trial registration: NCT04263558.
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Affiliation(s)
- Kristin Martinsen
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Carina Lisøy
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Tore Wentzel-Larsen
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Simon-Peter Neumer
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare - North, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Lene-Mari Potulski Rasmussen
- Regional Centre for Child and Youth Mental Health and Child Welfare - North, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Frode Adolfsen
- Regional Centre for Child and Youth Mental Health and Child Welfare - North, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Anne Mari Sund
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Jo Magne Ingul
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
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Coyle-Eastwick S, Escobar M, Wimmer J, Lindsey M, Thompson J, Warner CM. Social anxiety disorder in Black American adolescents: Cultural considerations in conceptualization, assessment, and treatment. Bull Menninger Clin 2024; 88:171-195. [PMID: 38836849 DOI: 10.1521/bumc.2024.88.2.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Social anxiety disorder (SAD) is characterized by significant distress and avoidance surrounding social and performance situations, with marked interpersonal and academic impairment. This review article highlights cultural considerations relevant to the conceptualization, identification, and treatment of SAD in Black youth. Research evaluating the utility of evidence-based measures to assess SAD suggests they are culturally relevant; however, gaps in knowledge regarding the psychometric properties of even the most widely used instruments are evident. In regard to intervention, cognitive behavioral therapy (CBT) approaches hold promise, yet there is a lack of research on the use of CBT with Black adolescents. Recommendations to incorporate cultural factors into CBT are provided, and future work investigating culturally adapted interventions is needed. Finally, given significant disparities in access and utilization of mental health services among Black youth, strategies to increase treatment engagement, such as school-based services, are important to consider.
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Affiliation(s)
| | - Melissa Escobar
- Department of Psychology, Montclair State University, Montclair, New Jersey
| | - Jessica Wimmer
- Department of Psychology, Montclair State University, Montclair, New Jersey
- Center for Research on Cultural and Structural Equity at the Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Michael Lindsey
- New York University Silver School of Social Work, New York, New York
| | - Jarius Thompson
- Liberty University School of Education, Lynchburg, Virginia, and John F. Kennedy High School Patterson, New Jersey
| | - Carrie Masia Warner
- Department of Psychology, Montclair State University, Montclair, New Jersey
- Center for Research on Cultural and Structural Equity at the Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
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Cawthorne T, Käll A, Bennett S, Baker E, Cheung E, Shafran R. Do single-case experimental designs lead to randomised controlled trials of cognitive behavioural therapy interventions for adolescent anxiety and related disorders recommended in the National Institute of Clinical Excellence guidelines? A systematic review. JCPP ADVANCES 2023; 3:e12181. [PMID: 37720579 PMCID: PMC10501697 DOI: 10.1002/jcv2.12181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/02/2023] [Indexed: 09/19/2023] Open
Abstract
Background Although Cognitive Behavioural Therapy (CBT) is effective for 60% of adolescents with anxiety disorders, only 36% are in remission post-intervention. This indicates that more effective treatments are needed which should be reflected in the NICE guidelines. We hypothesised that Single-case experimental designs (SCEDs) may provide a framework for accelerating the development of novel interventions. The primary purpose of this review was to investigate whether SCEDs are currently followed by randomised controlled trials (RCTs) of CBT intervention for adolescent anxiety disorders named in the NICE guidelines. The secondary objective was to investigate whether using SCEDs prior to RCTs could be a helpful approach. Method For the primary search of SCEDs five databases were used (PsycINFO, PubMed, PsycArticles, Web of Science and ProQuest). Nineteen articles met eligibility criteria including a total of 107 participants. For the secondary search of RCTs named in the NICE guidelines for adolescent anxiety disorders 53 articles met inclusion criteria and were included in the systematic review. Results The 19 SCED studies included in the review were conducted with participants with a diverse range of anxiety disorders and across a range of CBT formats. Two of the SCEDs were followed by RCTs, but neither of these were named in the NICE guidelines for anxiety disorders. All of the SCEDs identified were rated as low quality with none meeting the criteria for the highest or second highest quality rating. From the secondary searches, none of the RCTs named in the NICE guide were preceded by SCEDs. Conclusions It was concluded that currently SCEDs were not followed by RCTs of CBT interventions named in the NICE guidelines for adolescent anxiety disorders. However, it was suggested that SCEDs may provide an important framework for the development of more effective interventions for adolescents with anxiety.
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Affiliation(s)
- Tom Cawthorne
- Royal HollowayUniversity of LondonLondonUK
- Camden and Islington NHS Foundation TrustLondonUK
| | - Anton Käll
- Department of Behavioural Sciences and LearningDepartment of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Sophie Bennett
- UCL Great Ormond Street Institute of Child HealthLondonEngland
| | - Elena Baker
- Kent and Medway NHS and Social Care Partnership TrustGillinghamUK
| | - Emily Cheung
- UCL Great Ormond Street Institute of Child HealthLondonEngland
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child HealthLondonEngland
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Biagianti B, Conelea C, Dabit S, Ross D, Beard KL, Harris E, Shen E, Jordan J, Bernstein GA. A Mobile Application Adjunct to Augment Cognitive-Behavioral Group Therapy for Adolescents with Social Anxiety: Feasibility and Acceptability Results from the Wiring Adolescents with Social Anxiety via Behavioral Interventions Pilot Trial. J Child Adolesc Psychopharmacol 2023; 33:212-224. [PMID: 37471177 PMCID: PMC10458379 DOI: 10.1089/cap.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Objective: Cognitive-Behavioral Group Therapy (CBGT) is an established treatment for Social Anxiety (SA). However, diagnostic recovery rate is only 20.5% in CBGT, and up to 50% of patients remain symptomatic posttreatment. Using videocalls to deliver digital CBGT (dCBGT) is feasible, cost-effective, and efficacious. Yet, the impact of dCBGT on social functioning remains limited, as dCBGT does not offer opportunities for monitoring cognition and behavior in social situations. Wiring Adolescents with Social Anxiety via Behavioral Interventions (WASABI), a clinician-assisted application that uses ecological momentary assessments (EMAs), cognitive bias tests, and clinical self-reports, was investigated as an adjunct to dCBGT. Methods: A prospective, parallel arm, double-blind randomized controlled trial was employed in 24 SA adolescents randomly assigned to dCBGT versus dCBGT plus WASABI. Results: Study completion rates (83%) and exit survey data indicated that WASABI is feasible and acceptable. Engagement with EMAs varied from four to 244 EMAs completed per person. Cognitive bias tests and clinical self-reports were completed at least weekly by 53% and 69% of participants, respectively. While standard tests did not reveal statistically significant differences between dCBGT plus WASABI and dCBGT alone, effect sizes were greater for dCBGT plus WASABI on symptom severity, social skills, and functioning. Conclusions: Despite the small sample, preliminary results suggest that WASABI is feasible, acceptable, and may be an effective augmentation tool for treating SA in teenagers.
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Affiliation(s)
- Bruno Biagianti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Christine Conelea
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Masonic Institute for the Developing Brain, Minneapolis, Minnesota, USA
| | - Sawsan Dabit
- Department of R&D, Posit Science Corporation, San Francisco, California, USA
| | - Daniel Ross
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Masonic Institute for the Developing Brain, Minneapolis, Minnesota, USA
| | - Katie L. Beard
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Masonic Institute for the Developing Brain, Minneapolis, Minnesota, USA
| | - Elizabeth Harris
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Masonic Institute for the Developing Brain, Minneapolis, Minnesota, USA
| | - Erin Shen
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Masonic Institute for the Developing Brain, Minneapolis, Minnesota, USA
| | - Josh Jordan
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Gail A. Bernstein
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Masonic Institute for the Developing Brain, Minneapolis, Minnesota, USA
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Ojha A, Teresi GI, Slavich GM, Gotlib IH, Ho TC. Social threat, fronto-cingulate-limbic morphometry, and symptom course in depressed adolescents: a longitudinal investigation. Psychol Med 2023; 53:5203-5217. [PMID: 36117278 PMCID: PMC10024647 DOI: 10.1017/s0033291722002239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/05/2022] [Accepted: 06/28/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychosocial stressors characterized by social threat, such as interpersonal loss and social rejection, are associated with depression in adolescents. Few studies, however, have examined whether social threat affects fronto-cingulate-limbic systems implicated in adolescent depression. METHODS We assessed lifetime stressor severity across several domains using the Stress and Adversity Inventory (STRAIN) in 57 depressed adolescents (16.15 ± 1.32 years, 34 females), and examined whether the severity of social threat and non-social threat stressors was associated with gray matter volumes (GMVs) in the anterior cingulate cortex (ACC), amygdala, hippocampus, and nucleus accumbens (NAcc). We also examined how lifetime social threat severity and GMVs in these regions related to depressive symptoms at baseline and over 9 months. RESULTS General stressor severity was related to greater depression severity at baseline and over 9 months. Moreover, greater severity of social threat (but not non-social threat) stressors was associated with smaller bilateral amygdala and NAcc GMVs, and smaller bilateral surface areas of caudal and rostral ACC (all pFDR ⩽ 0.048). However, neither social threat nor non-social threat stressor severity was related to hippocampal GMVs (all pFDR ⩾ 0.318). All fronto-cingulate-limbic structures that were associated with the severity of social threat were negatively associated with greater depression severity over 9 months (all pFDR ⩽ 0.014). Post-hoc analyses suggested that gray matter morphometry of bilateral amygdala, NAcc, and rostral and caudal ACC mediated the association between social threat and depression severity in adolescents over 9 months (all pFDR < 0.048). CONCLUSIONS Social threat specifically affects fronto-cingulate-limbic pathways that contribute to the maintenance of depression in adolescents.
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Affiliation(s)
- Amar Ojha
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Giana I. Teresi
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Ian H. Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Tiffany C. Ho
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
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Cole SL, Mehra LM, Cibrian E, Cummings EM, Nelson BD, Hajcak G, Meyer A. Relational victimization prospectively predicts increases in error-related brain activity and social anxiety in children and adolescents across two years. Dev Cogn Neurosci 2023; 61:101252. [PMID: 37182336 DOI: 10.1016/j.dcn.2023.101252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/21/2023] [Accepted: 05/06/2023] [Indexed: 05/16/2023] Open
Abstract
Recent research has focused on identifying neural markers associated with risk for anxiety, including the error-related negativity (ERN). An elevated ERN amplitude has been observed in anxious individuals from middle childhood onward and has been shown to predict risk for future increases in anxiety development. The ERN is sensitive to environmental influences during development, including interpersonal stressors. Of note, one particular type of interpersonal stressor, relational victimization, has been related to increases in anxiety in adolescents. We tested whether relational victimization predicts increases in the ERN and social anxiety symptoms across two years in a sample of 152 child and adolescent females (ages 8 - 15). Results indicated that children and adolescents' baseline ERN was positively related to the ERN two years later. Furthermore, greater relational victimization at baseline predicted greater increases in the ERN two years later, controlling for baseline ERN. Moreover, relational victimization at baseline predicted increases in social anxiety, and this relationship was mediated by increases in the ERN. These results suggest that relational victimization impacts the developmental trajectory of the neural response to errors and thereby impacts increases in social anxiety among children and adolescents.
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Bernard DL, López CM, Banks DE, Hahn AM, Danielson CK. Developmental differences in the impact of racial discrimination on depression and anxiety among Black youth: Examining rumination as a mechanism. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2023; 93:293-303. [PMID: 37155290 PMCID: PMC10332661 DOI: 10.1037/ort0000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Experiences of racial discrimination are pervasive among Black youth, resulting in psychosocial problems such as depression and anxiety. Rumination plays a key role in linking racial discrimination and internalizing concerns. Developmental age has also been shown to influence the extent to which racial discrimination and rumination impact mental health; however, studies have yet to explore the interplay between these factors. This study examined the association between racial discrimination and internalizing concerns among Black youth, whether racial discrimination was indirectly associated with internalizing concerns through rumination, and whether developmental age moderated these direct and indirect effects. Participants included 158 pre- and early-adolescent youth recruited from a community sample (Mage = 11.56 years; 53% female). Data were from baseline questionnaire responses from a larger longitudinal study conducted in the Southeastern United States examining the effects of interpersonal stressors on youth mental health outcomes. Racial discrimination was directly and indirectly associated with internalizing concerns through rumination. Developmental age moderated the indirect link between racial discrimination and depressive symptoms via rumination with the association being stronger as participant age increased. The impact of racial discrimination on mental health among Black youth is informed by maladaptive coping strategies such as rumination and developmental age. Such factors help to identify who is most at risk for the impact of racial discrimination and potential intervening targets. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Donte L. Bernard
- Department of Psychological Sciences, University of Missouri Columbia
| | - Cristina M. López
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Devin E. Banks
- Department of Psychological Sciences, University of Missouri—St. Louis
| | - Austin M. Hahn
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Carla K. Danielson
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
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Rabner JC, Olino TM, Albano AM, Ginsburg GS, Compton SN, Piacentini J, Sakolsky D, Birmaher B, Gosch E, Kendall PC. Do youth anxiety measures assess the same construct consistently throughout treatment? Results are...complicated. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01515-y. [PMID: 36856912 DOI: 10.1007/s10578-023-01515-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
Interventionists interpret changes in symptoms as reflecting response to treatment. However, changes in symptom functioning and the measurement of the underlying constructs may be reflected in reported change. Longitudinal measurement invariance (LMI) is a statistical approach that assesses the degree to which measures consistently capture the same construct over time. We examined LMI in measures of anxiety severity/symptoms [i.e., Pediatric Anxiety Rating Scale (PARS), Multidimensional Anxiety Scale for Children (MASC), Screen for Child Anxiety and Related Disorders (SCARED)] in anxious youth at baseline and posttreatment. Initial fit was inadequate for 27 of 38 baseline and posttreatment models, but model modifications resulted in acceptable fit. Tests of LMI supported scalar invariance for the PARS and many, but not all, MASC and SCARED subscales. Findings suggest that the PARS, and many MASC and SCARED subscales can accurately be used to measure change over time, however, others may reflect changes in measurement properties.
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Affiliation(s)
- Jonathan C Rabner
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA.
| | - Thomas M Olino
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Anne Marie Albano
- Department of Psychiatry, Columbia University, New York City, NY, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, West Hartford, CT, USA
| | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elizabeth Gosch
- Department of Clinical Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Philip C Kendall
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
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13
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Berens A, LeMoult J, Kircanski K, Gotlib IH. ADHD symptoms and diurnal cortisol in adolescents: The importance of comorbidities. Psychoneuroendocrinology 2023; 148:105990. [PMID: 36462296 PMCID: PMC10193285 DOI: 10.1016/j.psyneuen.2022.105990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Altered regulation of diurnal cortisol has been associated with both dimensional symptoms and clinical diagnoses of attention deficit-hyperactivity disorder (ADHD). Indeed, a recent meta-analysis suggests that lower diurnal cortisol output may be a biomarker of attention deficit-hyperactivity disorder (ADHD); importantly, however, the influence of psychiatric comorbidities on this association has not been characterized. Approximately two-thirds of children with ADHD have at least one co-occurring neuropsychiatric condition, and altered HPA-axis function has been implicated in many of these conditions. Using dimensional measures of psychopathology, we examined whether comorbid symptoms influence the association of ADHD symptoms with daily cortisol output. METHODS 138 adolescents (ages 11-15 years) completed measures of symptoms of psychopathology and provided saliva samples over two days. We analyzed whether ADHD symptoms were related to morning, afternoon, and evening cortisol, the cortisol awakening response (CAR) and cumulative daily cortisol (area under the curve with respect to ground [AUCg]) while accounting for symptoms of three psychiatric disorders that are commonly comorbid with ADHD: conduct disorder (CD), anxiety, and depression. In sensitivity analyses, we included symptoms of oppositional defiant disorder (ODD) in place of CD symptoms. FINDINGS After controlling for symptoms of CD, anxiety, and depression, ADHD symptoms were associated significantly with higher cumulative diurnal cortisol (AUCg), morning cortisol, and afternoon cortisol. Symptoms of CD, anxiety and depression were not associated significantly with any cortisol metrics; however, in sensitivity analyses, ODD symptoms were associated with lower AUCg and morning cortisol. DISCUSSION Our findings highlight the distinct influence of ADHD and externalizing symptoms on cortisol output. Further work is needed to examine the specificity of altered HPA-axis activity as a biomarker of ADHD and to elucidate whether symptoms of ADHD differ in their association with diurnal cortisol as a function of their severity.
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Affiliation(s)
- Anne Berens
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Joelle LeMoult
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
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14
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Espil FM, Balters S, Li R, McCurdy BH, Kletter H, Piccirilli A, Cohen JA, Weems CF, Reiss AL, Carrion VG. Cortical activation predicts posttraumatic improvement in youth treated with TF-CBT or CCT. J Psychiatr Res 2022; 156:25-35. [PMID: 36228389 DOI: 10.1016/j.jpsychires.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/13/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Identifying neural activation patterns that predict youths' treatment response may aid in the development of imaging-based assessment of emotion dysregulation following trauma and foster tailored intervention. Changes in cortical hemodynamic activity measured with functional near-infrared spectroscopy (fNIRS) may provide a time and cost-effective option for such work. We examined youths' PTSD symptom change following treatment and tested if previously identified activation patterns would predict treatment response. METHODS Youth (N = 73, mean age = 12.97, SD = 3.09 years) were randomly assigned to trauma-focused cognitive behavioral therapy (TF-CBT), cue-centered therapy (CCT), or treatment as usual (TAU). Parents and youth reported on youth's PTSD symptoms at pre-intervention, post-intervention, and follow-up. Neuroimaging data (N = 31) assessed at pre-intervention were obtained while youth engaged in an emotion expression task. Treatment response slopes were calculated for youth's PTSD symptoms. RESULTS Overall, PTSD symptoms decreased from pre-intervention through follow-up across conditions, with some evidence of relative benefit of TF-CBT and CCT over TAU but significant individual variation in treatment response. Cortical activation patterns were correlated with PTSD symptom improvement slopes (r = 0.53). In particular, cortical responses to fearful and neutral facial stimuli in six fNIRS channels in the bilateral dlPFC were important predictors of PTSD symptom improvement. CONCLUSIONS The use of fNIRS provides a method of monitoring and assessing cortical activation patterns in a relatively inexpensive and portable manner. Associations between functional activation and youths' PTSD symptoms improvement may be a promising avenue for understanding emotion dysregulation in clinical populations.
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Affiliation(s)
- Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA.
| | - Stephanie Balters
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
| | - Rihui Li
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
| | - Bethany H McCurdy
- Department of Human Development and Family Studies, Iowa State University, USA
| | - Hilit Kletter
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
| | - Aaron Piccirilli
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
| | - Judith A Cohen
- Allegheny Health Network, Drexel University College of Medicine, USA
| | - Carl F Weems
- Department of Human Development and Family Studies, Iowa State University, USA
| | - Allan L Reiss
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA; Department of Radiology, Stanford University, USA; Department of Pediatrics, Stanford University, USA
| | - Victor G Carrion
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
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15
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Agreement, Stability, and Validity of Parent- and Youth-Reported Anxiety Symptoms from Childhood to Adolescence. Res Child Adolesc Psychopathol 2022; 50:1445-1455. [PMID: 35652991 PMCID: PMC10071959 DOI: 10.1007/s10802-022-00941-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 10/18/2022]
Abstract
The current study examined changes in the agreement, stability, and concurrent and predictive validity of parent- and self-reports on a frequently used measure of youth anxiety symptoms, the Screen for Child Anxiety Related Emotional Disorders (SCARED), from age 9 to 15. A community sample of 531 families (youth, mothers, and fathers) completed the SCARED and a semi-structured diagnostic interview when children were ages 9, 12, and 15. Agreement between youth and each parent on youth anxiety symptoms was weak at age 9 (r = 0.12-0.17), but moderate at age 12 (r = 0.31-0.36) and 15 (r = 0.31-0.46); mother-father (r = 0.50-0.53) agreement was greater than youth-parent agreement at every wave. Stability of youth-reported symptoms was low between age 9 and 12 (r = 0.25), but much higher from age 12 to 15 (r = 0.57); mother- and father-reported youth anxiety symptoms demonstrated high stability (r = 0.53-0.74) at both intervals. Self- and parent-reported youth symptoms were both significantly associated with youth anxiety disorder status, cross-sectionally and prospectively. When considered simultaneously at age 9, only parent-reported anxiety symptoms uniquely predicted concurrent and subsequent youth anxiety diagnoses. However, by age 12, parent- and youth-reported anxiety symptoms were each independently associated with concurrent and subsequent anxiety diagnoses. Agreement, stability, and concurrent and predictive validity of youth self-reported anxiety symptoms are poorer than parent-reports in middle childhood, but comparable by middle adolescence. However, all reporters provide unique information about youth anxiety at each of the developmental periods examined.
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16
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Phillips KE, Conroy K, Pinney EL, Comer JS, Kendall PC. School-based supports and accommodations among anxious youth in treatment. J Anxiety Disord 2022; 90:102603. [PMID: 35944449 DOI: 10.1016/j.janxdis.2022.102603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
Within pediatric anxiety, accommodation describes ways caregivers modify their behavior in an effort to alleviate distress shown by anxious youth. In schools, accommodation refers to school-based supports (SBS) placed to increase academic success for students with disabilities. The present study, using school documents provided at treatment, examined the types of SBS provided to youth (N = 76; ages 7-17; mean age 11.07; 47.4 % female) diagnosed with an anxiety disorder. SBS were rated by a panel of youth anxiety experts on the degree to which each SBS promoted (a) approach or (b) avoidance. School documents were coded for the presence of SBS and each SBS received a (a) total approach and (b) total avoidance score. Analyses revealed (a) approach and (b) avoidance promoting SBS were differentially associated with diagnostic status: youth with social anxiety disorder were more likely to be recommended SBS promoting avoidance and youth with a specific phobia were more likely to be recommended SBS promoting approach. Overall, the present study characterizes types of SBS being received by anxious youth and finds that SBS recommended to anxious youth vary in type and quality. Discussion considers the need for observations in schools to further address the merits/demerits of anxiety-related SBS.
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17
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Yildirim D, Vives J, Ballespí S. Why do I feel what I feel? Examining individual differences in meta-mood knowledge as a moderator of the relationship between anxiety and depression in adolescents. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2021.111407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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18
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Lockwood J, Williams L, Martin JL, Rathee M, Hill C. Effectiveness, User Engagement and Experience, and Safety of a Mobile App (Lumi Nova) Delivering Exposure-Based Cognitive Behavioral Therapy Strategies to Manage Anxiety in Children via Immersive Gaming Technology: Preliminary Evaluation Study. JMIR Ment Health 2022; 9:e29008. [PMID: 35072644 PMCID: PMC8822420 DOI: 10.2196/29008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Childhood anxiety disorders are a prevalent mental health problem that can be treated effectively with cognitive behavioral therapy, in which exposure is a key component; however, access to treatment is poor. Mobile-based apps on smartphones or tablets may facilitate the delivery of evidence-based therapy for child anxiety, thereby overcoming the access and engagement barriers of traditional treatment. Apps that deliver therapeutic content via immersive gaming technology could offer an effective, highly engaging, and flexible treatment proposition. OBJECTIVE In this paper, we aim to describe a preliminary multi-method evaluation of Lumi Nova, a mobile app intervention targeting mild to moderate anxiety problems in children aged 7-12 years using exposure therapy delivered via an immersive game. The primary objective is to evaluate the effectiveness, user engagement and experience, and safety of the beta version of Lumi Nova. METHODS Lumi Nova was co-designed with children, parents, teachers, clinicians, game industry experts, and academic partnerships. In total, 120 community-based children with mild to moderate anxiety and their guardians were enrolled to participate in an 8-week pilot study. The outcome measures captured the app's effectiveness (anxiety symptoms, child-identified goal-based outcomes, and functional impairment), user engagement (game play data and ease-of-use ratings), and safety (mood ratings and adverse events). The outcome measures before and after the intervention were available for 30 children (age: mean 9.8, SD 1.7 years; girls: 18/30, 60%; White: 24/30, 80%). Additional game play data were automatically generated for 67 children (age: mean 9.6, SD 1.53 years; girls: 35/67, 52%; White: 42/67, 63%). Postintervention open-response data from 53% (16/30) of guardians relating to the primary objectives were also examined. RESULTS Playing Lumi Nova was effective in reducing anxiety symptom severity over the 8-week period of game play (t29=2.79; P=.009; Cohen d=0.35) and making progress toward treatment goals (z=2.43; P=.02), but there were no improvements in relation to functional impairment. Children found it easy to play the game and engaged safely with therapeutic content. However, the positive effects were small, and there were limitations to the game play data. CONCLUSIONS This preliminary study provides initial evidence that an immersive mobile game app may safely benefit children experiencing mild to moderate anxiety. It also demonstrates the value of the rigorous evaluation of digital interventions during the development process to rapidly improve readiness for full market launch.
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Affiliation(s)
- Joanna Lockwood
- National Institute of Health Research MindTech MedTech Co-operative, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Laura Williams
- National Institute of Health Research MindTech MedTech Co-operative, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jennifer L Martin
- National Institute of Health Research MindTech MedTech Co-operative, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Claire Hill
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom
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19
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Gmuca S, Sonagra M, Xiao R, Mendoza E, Miller KS, Thomas NH, Young JF, Weiss PF, Sherry DD, Gerber JS. Characterizing Neurocognitive Impairment in Juvenile Fibromyalgia Syndrome: Subjective and Objective Measures of Dyscognition. Front Pediatr 2022; 10:848009. [PMID: 35281242 PMCID: PMC8908005 DOI: 10.3389/fped.2022.848009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our understanding of brain fog, or dyscognition, among youth with juvenile fibromyalgia syndrome is limited. We aimed to determine the prevalence of subjective (self-reported) and objective dyscognition, as well as factors associated with subjective dyscognition in juvenile fibromyalgia syndrome. METHODS A cross-sectional cohort study of patients (n = 31) 12-17 years old diagnosed with primary juvenile fibromyalgia syndrome and one of their parents from 2017 to 2019. Subjects completed a series of survey measures and patients completed a brief neurocognitive battery. Subjective dyscognition was determined based on scores on the Pediatric Quality of Life Inventory (PedsQL) Cognitive Functioning Scale and Behavior Rating Inventory of Executive Function (BRIEF-2) global executive composite (GEC). Objective dyscognition was defined as impairment of more than two standard deviations in any of the neurocognitive domains. We used Fisher's exact test or Wilcoxon rank-sum test, as appropriate, to compare clinical patients based on the presence of dyscognition. Multivariable logistic regression modeling was performed to determine factors associated with subjective dyscognition. RESULTS Of the 31 subjects, 65% reported subjective dyscognition and 39% had objective dyscognition, primarily in the domains of psychomotor speed (23%), executive function (23%), and attention (3%). Subjective dyscognition was not indicative of objective dyscognition. Subjective dyscognition was independently associated with functional disability (OR: 1.19 [95% CI: 1.02-1.40]) and anxiety (OR: 1.12 [95% CI: 1.02-1.24]). DISCUSSION Adolescents with fibromyalgia predominantly experience subjective dyscognition but more than 1/3 also experience objective dyscognition. Future research should explore the impact of interdisciplinary rehabilitation programs on the treatment of dyscognition in youth with JFMS.
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Affiliation(s)
- Sabrina Gmuca
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Maitry Sonagra
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Rui Xiao
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Elizabeth Mendoza
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Kimberly S Miller
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Nina H Thomas
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Center for Human Phenomic Science Behavioral Neuroscience Core, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Child and Adolescent Psychiatry and Behavioral Services, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jami F Young
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Child and Adolescent Psychiatry and Behavioral Services, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Pamela F Weiss
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David D Sherry
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeffrey S Gerber
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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20
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Kim SK, McKay D, Cepeda SL, Schneider SC, Wood J, Storch EA. Assessment of improvement in anxiety severity for children with autism spectrum disorder: The matched correspondence analysis approach. J Psychiatr Res 2021; 145:175-181. [PMID: 34923358 PMCID: PMC9198104 DOI: 10.1016/j.jpsychires.2021.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/06/2021] [Accepted: 12/10/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Clinical trials typically involve random assignment to treatment conditions. However, random assignment does not guarantee a lack of systematic variation in the outcomes, and application of covariation methods for multiple dependent measures requires complicated assumptions that are often not met. METHODS This study employed matched correspondence analysis (CA) for controlling systematic variation and handling multiple outcomes. One hundred nine children with autism spectrum disorder (ASD) were assessed for anxiety symptom severity across four studies, where participants were randomly assigned to either cognitive behavioral therapy (CBT) or treatment as usual or waitlist (TAU/WT). Matched CA is designed to optimally scale only the differences between baseline and posttreatment, rendering the systematic baseline carryover effects irrelevant. RESULTS Differences in treatment efficacy were observed. CBT showed treatment efficacy on anxiety severity and anxiety-related impairment relative to TAU/WT, after the control of baseline carryover effects. CONCLUSION This study provides a way to control systematic variation between groups at the outset of treatment trials and is expected to provide a novel pathway to more proper assessment of treatment efficacy for children with ASD and anxiety.
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Affiliation(s)
- Se-Kang Kim
- Department of Psychology, Fordham University, USA.
| | - Dean McKay
- Department of Psychology, Fordham University, USA
| | - Sandra L Cepeda
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, USA
| | - Sophie C Schneider
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, USA
| | - Jeffrey Wood
- Department of Education, University of California, Los Angeles, USA
| | - Eric A Storch
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, USA
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21
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Liang L, Zhu W, Yang J, Wang F. Anxiety and emotional-behavioral problems of adolescents in China: evidence for a serial mediation model of alexithymia and dependency. PSYCHOL HEALTH MED 2021:1-12. [PMID: 34806499 DOI: 10.1080/13548506.2021.2005249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/17/2021] [Indexed: 10/19/2022]
Abstract
High prevalence of emotional and behavioral problems among Chinese adolescence has been reported. This study seeks to investigate the mediating effect of alexithymia and dependency on anxiety and emotional-behavioral problems among adolescents. The study population included 519 adolescents. The assessments included the completion of standardized scales such as the Multidimensional Anxiety Scale (MASC), the Toronto Alexithymia Scale (TAS-20), the Depressive Experiences Questionnaire (DEQ), the Strengths and Difficulties Questionnaire (SDQ). Independent-sample t-tests, bivariate correlation, and serial mediation analyses were performed using SPSS23.0. Bivariate analyses revealed that anxiety, emotional-behavioral problem, alexithymia, and dependency were positively correlated. Alexithymia and dependency play a significant role in mediating the effect of multidimensional anxiety on emotional-behavioral problems. The effects of the two mediating paths were 69.86% and 7.81% for indirect effect through alexithymia, dependency, and specific indirect effect by alexithymia and dependency was 12.33%. Anxiety and emotional-behavioral problems mediate the relationship between alexithymia and dependency.
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Affiliation(s)
- Lijuan Liang
- Department of Psychology, The First Affiliated Hospital, Hainan Medical University, Haikou, China
- Department of Psychiatry, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Wei Zhu
- Department of Public Health, Hainan Medical University, Haikou, China
| | - Juan Yang
- Department of Psychology, The First Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Fei Wang
- Department of Psychiatry, The First Affiliated Hospital, China Medical University, Shenyang, China
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22
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Long EE, Young JF, Hankin BL. Stress Mediates the Within-Person Longitudinal Associations Between Depression and Different Anxiety Syndromes in Youth. Res Child Adolesc Psychopathol 2021; 50:403-416. [PMID: 34559342 DOI: 10.1007/s10802-021-00866-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
Depressive symptoms predict within-person change in physical symptoms of anxiety and social anxiety symptoms; however, potential mediators of these within-person associations remain understudied. The current study examined whether overall stress, interpersonal stress, and achievement stress mediate the associations between depressive symptoms and physical, social, and separation anxiety symptoms for girls and boys in a sample of 680 community youth aged 8-18 (M = 11.8, SD = 2.4; 55% female) using a random intercept cross-lagged panel model (RI-CLPM). Participants completed measures of anxiety symptoms, depression symptoms, and stress (Adolescent Life Events Questionnaire) every 3 months for 3 years (13 total assessments). Overall and interpersonal stress partly mediated the longitudinal, within-person associations between depression symptoms and physical symptoms of anxiety and between depression symptoms and social anxiety symptoms. Stress did not mediate the longitudinal associations between depression and separation anxiety symptoms. Multigroup models indicated that total stress mediated the associations between depression and physical symptoms of anxiety, and between depression and social anxiety for girls but not for boys. Results support the role of stress as a mediator of the association between depression and anxiety symptoms and suggest that, as youth experience depression-related impairment, they may generate additional stressors, which increase their symptoms of physical and social anxiety.
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Affiliation(s)
- Erin E Long
- Department of Psychology, University of Illinois-Urbana Champaign, 603 E. Daniel Street, Champaign, IL, 61820, USA.
| | - Jami F Young
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Benjamin L Hankin
- Department of Psychology, University of Illinois-Urbana Champaign, 603 E. Daniel Street, Champaign, IL, 61820, USA
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23
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Lebel CA, Gibbard WB, Tortorelli C, Pei J, Beaulieu C, Bagshawe M, McMorris CA. Prenatal Exposure And Child brain and mental Health (PEACH) study: protocol for a cohort study of children and youth with prenatal alcohol exposure. BMJ Open 2021; 11:e051660. [PMID: 33980537 PMCID: PMC8118071 DOI: 10.1136/bmjopen-2021-051660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Fetal alcohol spectrum disorder (FASD), which is caused by prenatal alcohol exposure (PAE), affects an estimated 4% of North Americans, and is the most common preventable cause of intellectual disability. Mental health problems, including anxiety and depression, are experienced by nearly all individuals with FASD. However, there is very limited knowledge about effective mental health treatments for individuals with FASD; effective treatments are hindered in part due to a lack of understanding of the basic neurobiology underlying internalising disorders in youth with FASD. METHODS AND ANALYSIS The Prenatal Exposure And Child brain and mental Health (PEACH) study includes children aged 7-18 years. We will use longitudinal neuroimaging (anatomical T1-weighted, diffusion and passive viewing function MRI) and mental health assessments (Behaviour Assessment Scale for Children, Multi-dimensional Anxiety Scale for Children, Children's Depression Inventory (CDI-2), Kiddie Scale of Affective Disorders) to: (1) characterise brain development trajectories in youth with FASD, (2) determine whether brain alterations mediate increased anxiety and depression in youth with FASD and (3) identify baseline brain features that predict changes of anxiety and depression symptoms over the next 2 years. All of this will be done while considering sex and adverse postnatal experiences, which can significantly impact mental health and brain outcomes. This project will forge new understanding of FASD and mental health from a neurobiological perspective, highlighting key time periods (ie, sensitive windows) and brain regions (ie, that may be susceptible to neurostimulation), while identifying factors that predict individual trajectories of anxiety and depression symptoms. ETHICS AND DISSEMINATION This study was approved by the University of Calgary Conjoint Health Research Ethics Board and the University of Alberta Health Research Ethics Board. Study results will be disseminated in peer-reviewed journals, at relevant conferences and in conjunction with our knowledge mobilisation partners.
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Affiliation(s)
- Catherine A Lebel
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - W Ben Gibbard
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Jacqueline Pei
- Faculty of Education, University of Alberta, Edmonton, Alberta, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Mercedes Bagshawe
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Carly A McMorris
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
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Vermilion J, Pedraza C, Augustine EF, Adams HR, Vierhile A, Lewin AB, Collins AT, McDermott MP, O'Connor T, Kurlan R, van Wijngaarden E, Murphy TK, Mink JW. Anxiety Symptoms Differ in Youth With and Without Tic Disorders. Child Psychiatry Hum Dev 2021; 52:301-310. [PMID: 32519083 DOI: 10.1007/s10578-020-01012-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We compared anxiety symptoms in youth with and without tic disorders by comparing scores on the Multidimensional Anxiety Scale for Children (MASC) in youth with tic disorders to those in a concurrent community control group and in a group of treatment-seeking anxious youth from the Child/Adolescent Anxiety Multimodal Study (CAMS). Data from 176 youth with tic disorders, 93 control subjects, and 488 CAMS participants were included. Compared to youth with tic disorders, controls had lower total MASC scores (p < 0.0001) and CAMS participants had similar total MASC scores (p = 0.13). Separation Anxiety (p = 0.0003) and Physical Symptom (p < 0.0001) subscale scores were higher in youth with tic disorders than in CAMS participants. We conclude that the anxiety symptom profile differs in youth with and without tic disorders, which may have important implications for targeting treatment of anxiety in youth with tic disorders.
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Affiliation(s)
- Jennifer Vermilion
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA. .,Division of Child Neurology, Department of Neurology, Box 631, 601 Elmwood Ave, Rochester, NY, 14642, USA.
| | | | - Erika F Augustine
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Heather R Adams
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Amy Vierhile
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Alyssa T Collins
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Thomas O'Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Roger Kurlan
- Center for Neurological and Neurodevelopmental Health, Voorhees, NJ, USA
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Jonathan W Mink
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
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Etkin RG, Lebowitz ER, Silverman WK. Using Evaluative Criteria to Review Youth Anxiety Measures, Part II: Parent-Report. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:155-176. [PMID: 33739908 DOI: 10.1080/15374416.2021.1878898] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
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.
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Suarez-Lopez JR, Nguyen A, Klas J, Gahagan S, Checkoway H, Lopez-Paredes D, Noble M. Associations of acetylcholinesterase inhibition between pesticide spray seasons with depression and anxiety symptoms in adolescents, and the role of sex and adrenal hormones on gender moderation. EXPOSURE AND HEALTH 2021; 13:51-64. [PMID: 33748533 PMCID: PMC7968045 DOI: 10.1007/s12403-020-00361-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/04/2020] [Accepted: 05/09/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND Cholinesterase inhibitor pesticides, especially organophosphates, are endocrine disruptors and a few existing studies have linked self-reports of exposure with increased depression and anxiety. Some evidence suggests that associations may be stronger in women, but the mechanism of this gender difference is unclear. We assessed whether acetylcholinesterase (AChE) inhibition between 2 time points (reflecting greater cholinesterase inhibitor exposure) during different agricultural seasons in the year was associated with anxiety/depression symptoms. METHODS We examined 300 adolescents (ages 11-17y, 51% female) living near agricultural settings in Ecuador (ESPINA study) twice in 2016: April and July-October. We assessed AChE activity (finger stick), estradiol, testosterone, dehydroepiandrosterone, cortisol (saliva) and anxiety and depression scales (CDI-2 and MASC-2). RESULTS The mean (SD) depression and anxiety scores were 52.8 (9.3) and 58.1 (9.6), respectively. The median (25th, 75th percentile) AChE change (July-October vs April) was -3.94% (-10.45%, 5.13%). For every 10% decrease in AChE activity, there was a 0.96 unit (95%CI: 0.01, 1.90) increase in depression symptoms and an OR of elevated depression score of 1.67 (1.04, 2.66). These associations were stronger in girls (OR=2.72 [1.23, 6.00]) than boys (1.18 [0.59, 2.37]). Adjustment for cortisol, testosterone and dehydroepiandrosterone reduced gender differences by 18-62%. No associations were observed with anxiety. DISCUSSION Inhibition of AChE activity at 2 points in time during different pesticide spray periods was associated with greater depression symptoms, affecting girls more than boys. Gender differences may be partly explained by endocrine disruption. These findings suggest that AChE inhibition may transiently affect the mood of adolescents.
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Affiliation(s)
- Jose R Suarez-Lopez
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA 92093, USA
| | - Andrew Nguyen
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA 92093, USA
| | - Joel Klas
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA 92093, USA
| | - Sheila Gahagan
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA
| | - Harvey Checkoway
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA 92093, USA
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
| | | | - Madison Noble
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA 92093, USA
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Kim SK, McKay D, Murphy TK, Bussing R, McNamara JP, Goodman WK, Storch EA. Age moderated-anxiety mediation for multimodal treatment outcome among children with obsessive-compulsive disorder: An evaluation with correspondence analysis. J Affect Disord 2021; 282:766-775. [PMID: 33601717 PMCID: PMC9555304 DOI: 10.1016/j.jad.2020.12.198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/02/2020] [Accepted: 12/28/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Anxiety expression varies by age in youth, and evaluation of putative mechanisms in treatment must consider both conjointly. Accordingly, age would moderate the mediation effect of anxiety in a youth obsessive-compulsive disorder (OCD) treatment trial. METHODS Fifty-six children ages 7 - 17 participated in an RCT comparing three treatments: CBT with standard dosing of sertraline, CBT with slow dosing of sertraline, and CBT with placebo. To examine the moderated-mediation effects for OCD symptom improvement, we discretized the continuous anxiety and OCD measures into three symptom outcome categories, "improved", "unchanged", and "deteriorated". To evaluate the moderating effect of age, we further examined the association of age and anxiety with the "improved" OCD category. For analysis, the age groups used as rows were cross tabulated with discretized anxiety and OCD measures. To estimate category associations with correlations, we adopted correspondence analysis. RESULTS The correlational results indicate that for all treatment conditions, age was a moderator of the mediation effect of physical anxiety symptoms for the improved OCD measures (outcomes). Specifically, age suppressed correlations with OCD outcomes, with Physical Symptoms as a mediator for the outcome measures. This moderated mediation effect was most evident for ages 8-10 in the CBT with placebo group. LIMITATIONS The moderated mediation effect manifest in this single RCT-based study should be validated in other studies. DISCUSSION Future research investigating a wider range of ages as a potential moderator of other symptom and emotion mediators of outcome is warranted, particularly in relation to individual symptom profiles of OCD.
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Affiliation(s)
- Se-Kang Kim
- Department of Psychology, Fordham University, U.S.A..
| | - Dean McKay
- Department of Psychology, Fordham University
| | | | | | | | - Wayne K. Goodman
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine
| | - Eric A. Storch
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine
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Suicidal risk and resilience in juvenile fibromyalgia syndrome: a cross-sectional cohort study. Pediatr Rheumatol Online J 2021; 19:3. [PMID: 33407630 PMCID: PMC7789563 DOI: 10.1186/s12969-020-00487-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/09/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To characterize suicidality among youth with juvenile fibromyalgia syndrome (JFMS) receiving treatment from pediatric rheumatologists at a tertiary care center in order to determine the prevalence of suicidality in JFMS and to explore risk factors for persistent suicidal ideation. METHODS We performed a cross-sectional cohort study of children 12-17 years old with JFMS seen in a specialty pediatric rheumatology pain clinic from 7/2017-9/2019. All subjects completed patient-reported outcomes measures, complemented by retrospective chart review. Subjects who endorsed item 8 on the Children's Depression Inventory, 2nd Edition (CDI-2) were categorized as endorsing suicidal ideation. We assessed for differences between the suicidal and non-suicidal patients using Wilcoxon-rank sum test. Logistic regression modeling was performed to identify psychosocial factors associated with suicidality. RESULTS Of the 31 subjects, more than one-quarter endorsed suicidality. Nearly 90% of teens with suicidal ideation were established in outpatient counseling. In bivariate analyses, suicidality was associated with lower resilience and greater depression and anxiety (all p < 0.05). Pain intensity trended towards a statistically significant positive association (OR: 1.16 [0.99-1.37]; p = 0.06). Lower resilience was independently associated with suicidality (OR: 0.90 [95% CI: 0.82-0.98]; p < 0.02). CONCLUSIONS Suicidality was prevalent among youth with JFMS and persistent despite concurrent receipt of mental health services. Higher patient-level resilience was independently associated with a reduced odds of suicidality. Future work should examine the role of resilience training on reducing psychological distress and mitigating the risk of suicidality in JFMS.
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Etkin RG, Shimshoni Y, Lebowitz ER, Silverman WK. Using Evaluative Criteria to Review Youth Anxiety Measures, Part I: Self-Report. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:58-76. [PMID: 32915074 PMCID: PMC7914129 DOI: 10.1080/15374416.2020.1802736] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
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.
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Flewelling KD, Koehler A, Shaffer J, Dill EJ. Correlates of health-related quality of life in youth with psychogenic non-epileptic seizures. Seizure 2020; 83:203-207. [PMID: 33227658 DOI: 10.1016/j.seizure.2020.09.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/19/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Few studies have examined factors associated with health-related quality of life (HRQoL) in youth with psychogenic non-epileptic seizures (PNES). In adults, internalizing symptoms such as depression have been shown to be more closely associated with HRQoL than seizure frequency, however, this has not been studied in samples of youth. Investigations into these areas are needed in order to enhance our understanding of the impact of this condition on children and adolescents and inform future clinical intervention. METHODS The current study includes 37 youth and one of their parents who attended a clinic visit for treatment of PNES. Children and parents completed measures of psychological functioning, and medical data were extracted from patient charts. RESULTS Parent-reported anxiety (B=-0.45, p = 0.05) and depression (B=-0.60, p = 0.01) were related to parent-report of HRQoL; self-report of depression was related to self-reported HRQoL (B=-0.90, p < 0.001). Seizure frequency, somatic complaints, and social problems were not related to HRQoL in this sample. CONCLUSIONS Internalizing symptoms, not seizure frequency, are associated with poorer overall functioning in youth with PNES. Interventions focused on improving anxiety and depression in addition to seizure cessation may contribute to improved HRQoL in youth with PNES more so than those focused on seizure cessation alone.
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Affiliation(s)
- Kassie D Flewelling
- University of Colorado Denver, Department of Psychology, Campus Box 173, PO Box 173364, Denver CO, 80217-3364, United States; Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States.
| | - Angelina Koehler
- Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States
| | - Jonathan Shaffer
- University of Colorado Denver, Department of Psychology, Campus Box 173, PO Box 173364, Denver CO, 80217-3364, United States
| | - Edward J Dill
- University of Colorado Denver, Department of Psychology, Campus Box 173, PO Box 173364, Denver CO, 80217-3364, United States
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Schneider RL, Long EE, Arch JJ, Hankin BL. The relationship between stressful events, emotion dysregulation, and anxiety symptoms among youth: longitudinal support for stress causation but not stress generation. ANXIETY STRESS AND COPING 2020; 34:157-172. [PMID: 33156724 DOI: 10.1080/10615806.2020.1839730] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There is a clear bi-directional link between stressful events and depressive symptoms in adolescence, but the directionality of this link for anxiety symptoms remains underexamined. We critically evaluate the longitudinal relationship between stressors and anxiety among youth. Specifically, we examine whether stressors predict anxiety symptoms over a 1.5-year period (stress causation), and whether anxiety symptoms predict stressors over this period (stress generation). We examine potential influencing factors, including stressor type (independent vs. dependent) and emotion dysregulation (nonacceptance; goal-directed difficulty). METHODS Social, separation, and physical anxiety symptoms, and frequency and stressor type, were assessed every 3 months for 1.5 years among community youth (n = 528, ages 8-17). Baseline emotion dysregulation was assessed. Time-lagged analyses evaluated the bi-directional relationship of stress and anxiety over time, controlling for previous anxiety and depression. RESULTS Interpersonal stressors predicted subsequent physical and social anxiety symptoms, but anxiety did not predict subsequent stressors. Both nonacceptance and goal-directed difficulties predicted subsequent anxiety symptoms and stressors, but did not moderate the relationship. CONCLUSION The findings supported the stress causation model for youth anxiety, but not the stress generation model. Nonacceptance and goal-directed difficulty predicted greater subsequent anxiety symptoms and stressors. We discuss implications for prevention and intervention.
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Affiliation(s)
- Rebecca L Schneider
- University of Colorado Boulder, Psychology and Neuroscience, Boulder, CO, USA
| | - Erin E Long
- University of Illinois, Psychology, Champaign, IL, USA
| | - Joanna J Arch
- University of Colorado Boulder, Psychology and Neuroscience, Boulder, CO, USA
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Flewelling KD, Koehler A, Shaffer J, Dill EJ. Medical and psychosocial outcomes of youth with psychogenic nonepileptic seizures: An observational study. Epilepsy Behav 2020; 112:107383. [PMID: 32882629 DOI: 10.1016/j.yebeh.2020.107383] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few studies have examined both medical and psychosocial outcomes of youth with psychogenic nonepileptic seizures (PNES). The current observational study aimed to fill this gap by examining changes in seizure frequency, school absences, emergency department (ED) visits, psychological functioning, and health-related quality of life (HRQoL) in youth attending a clinic for brief treatment of PNES. METHODS Nineteen youth with PNES and their families presented to an integrated clinic and received psychoeducation and recommendations by medical and mental health professionals. Patients returned to the clinic, on average six months later, for follow-up. Parent proxy-report and self-report measures of psychological functioning and HRQoL were collected at each visit, and medical data were extracted from patient charts. RESULTS Forty-six percent of youth in the study experienced a reduction in seizure frequency, and 58% reported improvements in school attendance. Emergency department visits decreased by over 50%, and significant improvements in parent proxy-report of depression and HRQoL were observed. CONCLUSIONS Results provide valuable information regarding the clinical profiles of youth with PNES and demonstrate the possibility for improved medical and psychosocial prognoses in response to psychoeducation and treatment guidance. Information obtained in this study may aid in the design of future clinical trials and research, assisting in the development of appropriate interventions.
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Affiliation(s)
- Kassie D Flewelling
- University of Colorado Denver Department of Psychology, Campus Box 173, PO Box 173364, Denver, CO, 80217-3364, United States of America; Children's Hospital Colorado, 13123 E 16th Ave., Aurora, CO 80045, United States of America.
| | - Angelina Koehler
- Children's Hospital Colorado, 13123 E 16th Ave., Aurora, CO 80045, United States of America
| | - Jonathan Shaffer
- University of Colorado Denver Department of Psychology, Campus Box 173, PO Box 173364, Denver, CO, 80217-3364, United States of America
| | - Edward J Dill
- University of Colorado Denver Department of Psychology, Campus Box 173, PO Box 173364, Denver, CO, 80217-3364, United States of America
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Walker JC, Teresi GI, Weisenburger RL, Segarra JR, Ojha A, Kulla A, Sisk L, Gu M, Spielman DM, Rosenberg-Hasson Y, Maecker HT, Singh MK, Gotlib IH, Ho TC. Study Protocol for Teen Inflammation Glutamate Emotion Research (TIGER). Front Hum Neurosci 2020; 14:585512. [PMID: 33192421 PMCID: PMC7604389 DOI: 10.3389/fnhum.2020.585512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/03/2020] [Indexed: 12/19/2022] Open
Abstract
This article provides an overview of the study protocol for the Teen Inflammation Glutamate Emotion Research (TIGER) project, a longitudinal study in which we plan to recruit 60 depressed adolescents (ages 13–18 years) and 30 psychiatrically healthy controls in order to examine the inflammatory and glutamatergic pathways that contribute to the recurrence of depression in adolescents. TIGER is the first study to examine the effects of peripheral inflammation on neurodevelopmental trajectories by assessing changes in cortical glutamate in depressed adolescents. Here, we describe the scientific rationale, design, and methods for the TIGER project. This article is intended to serve as an introduction to this project and to provide details for investigators who may be seeking to replicate or extend these methods for other related research endeavors.
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Affiliation(s)
- Johanna C Walker
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Giana I Teresi
- Department of Psychology, Stanford University, Stanford, CA, United States
| | | | - Jillian R Segarra
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Amar Ojha
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
| | - Artenisa Kulla
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Lucinda Sisk
- Department of Psychology, Yale University, New Haven, CT, United States
| | - Meng Gu
- Department of Radiology, Stanford University, Stanford, CA, United States
| | - Daniel M Spielman
- Department of Radiology, Stanford University, Stanford, CA, United States.,Department of Electrical Engineering, Stanford University, Stanford, CA, United States
| | - Yael Rosenberg-Hasson
- Human Immune Monitoring Center, Stanford University, Stanford, CA, United States.,Department of Microbiology and Immunology, Stanford University, Stanford, CA, United States
| | - Holden T Maecker
- Human Immune Monitoring Center, Stanford University, Stanford, CA, United States.,Department of Microbiology and Immunology, Stanford University, Stanford, CA, United States
| | - Manpreet K Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Tiffany C Ho
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
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Abstract
The Coping Questionnaire (CQ)-child and parent version-is an idiographic measure of youth's perceived ability to cope in anxiety provoking situations. Participants (N = 442; aged 7-17) met DSM-IV criteria for separation anxiety disorder, generalized anxiety disorder, or social anxiety disorder. The internal consistency of the CQ was supported, and retest reliability and parent/child agreement were, as expected, modest. The CQ scores were significantly correlated in the expected direction with measures of anxiety symptoms and functioning, providing evidence of convergent and divergent validity. The criterion validity of the CQ also was supported: the CQ scores were significantly correlated with the clinical severity rating of the youth's principal diagnosis on ADIS. There was a significant correlation between change in CQ scores and in anxiety severity and symptoms following treatment. Results support the CQ as a measure to assess coping efficacy in anxious youths as part of evidence-based assessment.
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Romba C, Lavigne J, Walkup J, Ballard R. Measurement-Based Care in the Treatment of Anxiety. Child Adolesc Psychiatr Clin N Am 2020; 29:645-661. [PMID: 32891367 DOI: 10.1016/j.chc.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Treatment of pediatric anxiety disorders is complicated by their number, comorbidity, and the differential impact of a child's anxiety on the child and parents. Measurement-based care, using patient-level rating scales, can guide clinical decisions, track symptom improvement, and monitor treatment response. We review instruments for measurement-based care in pediatric anxiety. Measures used to track pediatric anxiety should be brief, accessible, sensitive to change, and reliable. Because parent-child agreement about a child's anxiety tends to be low, measures from both should be obtained. Measurements can also track functional improvement, expectancy related to treatment, and readiness to change.
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Affiliation(s)
- Courtney Romba
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA.
| | - John Lavigne
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - John Walkup
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - Rachel Ballard
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
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Understanding Anxiety and Symptom Impact as Mediators Explaining Cognitive-Behavior Therapy and Pharmacotherapy Response in Childhood Obsessive-Compulsive Disorder. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09824-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Phillips KE, Norris LA, Kendall PC. Separation Anxiety Symptom Profiles and Parental Accommodation Across Pediatric Anxiety Disorders. Child Psychiatry Hum Dev 2020; 51:377-389. [PMID: 31907734 PMCID: PMC8109254 DOI: 10.1007/s10578-019-00949-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Parental accommodation refers to ways in which caregivers modify their behavior to decrease child distress in the short-term. Accommodation is prevalent among anxious youth and related to decreased treatment and functional outcomes. Although separation anxiety disorder (SAD) is associated with increased accommodation, SAD is not a predictor of treatment response, suggesting that a diagnosis of SAD alone may not be enough to clarify the relationship between accommodation and separation anxiety symptoms within a clinical context. Participants were youth with a primary anxiety disorder (N = 186; aged 7-17) enrolled in an outpatient anxiety clinic. Latent class analysis was used to extract profiles from parent-reported SAD symptoms using the Anxiety Disorders Interview Schedule for DSM-IV/5. Profiles were compared on pre-treatment accommodation. Low, moderate, and interfering SAD classes emerged. Interfering SAD was associated with high accommodation. Results help to clarify the association between SAD and accommodation and has implications for personalized intervention.
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Affiliation(s)
- Katherine E Phillips
- Department of Psychology, Temple University, 1701 North 13th St, Philadelphia, PA, 19122, USA.
| | - Lesley A Norris
- Department of Psychology, Temple University, 1701 North 13th St, Philadelphia, PA, 19122, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, 1701 North 13th St, Philadelphia, PA, 19122, USA.
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Binge eating and social anxiety in treatment-seeking adolescents with eating disorders or severe obesity. Eat Weight Disord 2020; 25:787-793. [PMID: 31020481 DOI: 10.1007/s40519-019-00689-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/09/2019] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Binge eating is a common behavior in children and adolescents who suffer from either eating disorders (EDs) or from severe obesity. The purpose of the current study was to explore the association between social anxiety and binge eating and compare prevalence rates of social anxiety between youth with severe obesity or EDs who did or did not engage in binge eating. METHODS Retrospective data on treatment-seeking youth's (n = 490) eating behaviors and social anxiety at assessment were analyzed. RESULTS Results indicate that those who engage in binge eating have higher rates of social anxiety; frequency of binges does not predict severity of social anxiety, though social anxiety predicts presence of binge eating. Adolescents with EDs had higher rates of social anxiety than those with obesity, and for both groups, rates of social anxiety were highest in those who binge. CONCLUSIONS Clinicians who treat youth with EDs and with obesity should be aware of the relationship between binge eating and social anxiety and of the need for treatment to address both these disorders. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Loevaas MES, Lydersen S, Sund AM, Neumer SP, Martinsen KD, Holen S, Patras J, Adolfsen F, Rasmussen LMP, Reinfjell T. A 12-month follow-up of a transdiagnostic indicated prevention of internalizing symptoms in school-aged children: the results from the EMOTION study. Child Adolesc Psychiatry Ment Health 2020; 14:15. [PMID: 32336987 PMCID: PMC7178617 DOI: 10.1186/s13034-020-00322-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 04/15/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Anxious and depressive symptoms in youth are highly prevalent, are often comorbid and have a high rate of relapse. Preventive interventions are promising, but follow-up results are lacking. The transdiagnostic EMOTION program is an indicated preventive cognitive behavioral therapy (CBT) intervention targeting children aged 8-12 years. METHODS The present study investigates the 12 months follow-up effects of the EMOTION intervention in a cluster randomized controlled trial (RCT) with 795 children that included both child self-reports and parental reports. RESULTS Mixed model analyses showed a larger decrease of symptoms in the intervention group than in the control group for child self-reported anxious symptoms (The Multidimensional Anxiety Scale for Children (MASC) difference 4.56, CI 1.83 to 7.29, p = .001). Parental reports for both anxious (MASC difference 2.50, CI .26 to 4.74, p = .029) and depressive (The Mood and Feelings Questionnaire-short form (SMFQ) difference 1.55, CI .83 to 2.26, p ≤ .001) symptoms in children also showed a reduction. No statistically significant difference was found for child self-reported depressive symptoms (SMFQ difference .69, CI - .22 to 1.60, p = .139). CONCLUSION The transdiagnostic EMOTION program has shown the potential for long-term reductions in symptoms of both anxiety and depression in school-aged children. However, results regarding depressive symptoms must be considered preliminary as only parental report indicated effect.Trial registration The regional ethics committee (REC) of Norway approved the study. Registration number: 2013/1909; Project title: Coping Kids: a randomized controlled study of a new indicated preventive intervention for children with symptoms of anxiety and depression. ClinicalTrials.gov Identifier; NCT02340637.
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Affiliation(s)
- M. E. S. Loevaas
- Department of Psychology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olavs University Hospital, Trondheim, Norway
| | - S. Lydersen
- Medical Faculty, Department of Mental Health, Regional Center for Child and Youth Mental Health and Child Welfare, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - A. M. Sund
- Department of Child and Adolescent Psychiatry, St. Olavs University Hospital, Trondheim, Norway
- Medical Faculty, Department of Mental Health, Regional Center for Child and Youth Mental Health and Child Welfare, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - S-P. Neumer
- Centre for Child and Adolescent Mental Health, RBUP East and South, Oslo, Norway
| | - K. D. Martinsen
- Centre for Child and Adolescent Mental Health, RBUP East and South, Oslo, Norway
| | - S. Holen
- Centre for Child and Adolescent Mental Health, RBUP East and South, Oslo, Norway
| | - J. Patras
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT Arctic University of Norway, Tromsø, Norway
| | - F. Adolfsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT Arctic University of Norway, Tromsø, Norway
| | - L-M. P. Rasmussen
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT Arctic University of Norway, Tromsø, Norway
| | - T. Reinfjell
- Department of Psychology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olavs University Hospital, Trondheim, Norway
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Co-Occurring Trajectories of Depression and Social Anxiety in Childhood and Adolescence: Interactive Effects of Positive Emotionality and Domains of Chronic Interpersonal Stress. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:823-837. [PMID: 32200465 DOI: 10.1007/s10802-020-00634-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Deficits in positive emotionality (PE) have been implicated in the etiology of both social anxiety and depression; however, factors that contribute to divergent social anxiety and depression outcomes among youth low in PE remain unknown. Extant research suggests that parent-child stress and peer stress demonstrate differential patterns of associations with social anxiety and depression. Thus, the present study examined prospective interactive effects of PE and chronic parent-child and peer stress on simultaneously developing trajectories of social anxiety and depression symptoms among 543 boys and girls (age 8-16 at baseline, M[SD] = 11.94[2.32] 55.6% female). Parents reported on youth PE at baseline. Domains of chronic interpersonal (parent-child and peer) stress occurring between baseline and 18-months were assessed via child-report by trained interviews using the Youth Life Stress Interview (Rudolph and Flynn Development and Psychopathology, 19(2), 497-521, 2007). Youth completed self-report measures of depression and social anxiety every three months from 18- to 36- months (7 assessments). Conditional bivariate latent growth curve models indicated that main effects of parent-child stress, but not peer stress, predicted trajectories of depression in boys and girls. In girls, high levels of chronic interpersonal stress in both domains predicted stable, elevated trajectories of social anxiety symptoms regardless of PE. In boys, PE contributed to a pattern of differential susceptibility whereby boys high in PE were particularly susceptible to the effects of chronic interpersonal stress, for better or worse.
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Kim SK, McKay D, Ehrenreich-May J, Wood J, Storch EA. Assessing treatment efficacy by examining relationships between age groups of children with autism spectrum disorder and clinical anxiety symptoms: Prediction by correspondence analysis. J Affect Disord 2020; 265:645-650. [PMID: 31787421 PMCID: PMC7042046 DOI: 10.1016/j.jad.2019.11.107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/09/2019] [Accepted: 11/22/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Autism spectrum disorders (ASD) are neurodevelopmental in nature and are frequently accompanied by anxiety. To fully assess treatment efficacy, we examined rates of anxiety symptom change by age groups following either cognitive behavioral therapy (CBT) or treatment as usual (TAU). METHODS One hundred sixty-three children with ASD and ASD-related anxiety symptoms were randomly assigned to either CBT or TAU. Utilizing prediction by correspondence analysis (CA), we evaluated the age effect (defined in three groups; ages 6-9, 10-12, and 13-16) and the changes in correlations between age and anxiety severity levels over the course of treatment. RESULTS Significantly greater anxiety symptom reduction was associated with CBT compared with TAU across the three age groups. Of particular note, the children ages 10-12 who received CBT showed the greatest improvement compared to all other groups. Late childhood, prior to adolescence, showed the best response to CBT for anxiety in ASD. DISCUSSION These findings suggest that treatment programs need to more closely address developmental factors within narrower bands of age groups. The present results are limited in their generalization to the CBT efficacy for a specific age band (ages 10-12). Longitudinal investigations are recommended to confirm whether the similar age group children who receive CBT experience the greatest benefit in reducing their ASD-related anxiety symptoms.
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Affiliation(s)
- Se-Kang Kim
- Fordham University, New York City, NY, United States.
| | | | | | - Jeffery Wood
- University of California, Los Angeles, CA, United States
| | - Eric A Storch
- Baylor College of Medicine, Houston, TX, United States
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Arens AK, Visser L. Personal peer victimization and ethnic peer victimization: Findings on their co-occurrence, predictors, and outcomes from a latent profile analysis. CHILD ABUSE & NEGLECT 2020; 99:104250. [PMID: 31835234 DOI: 10.1016/j.chiabu.2019.104250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/21/2019] [Accepted: 10/28/2019] [Indexed: 05/10/2023]
Abstract
BACKGROUND Findings on whether immigrant students suffer from higher levels of peer victimization have been inconsistent, perhaps due to a blend of measures for personal and ethnic peer victimization. OBJECTIVE In this study, we investigated personal and ethnic peer victimization using latent profile analyses. The profiles were related to various predictor and outcome variables. PARTICIPANTS AND SETTING The sample consisted of N = 4367 German elementary school students attending grades 3 and 4. METHODS The students responded to eight items addressing personal peer victimization and one item addressing ethnic peer victimization. RESULTS The findings indicated a three-profile solution. In Profile 1, students experienced a combination of personal and ethnic peer victimization; Profile 2 contained students without any victimization experiences; in Profile 3, students experienced personal peer victimization only. Relative to native German-speaking students, non-native German-speaking students had a higher chance to be classified in Profile 1 compared to Profiles 2 and 3. Both profiles of peer victimization (i.e., Profiles 1 and 3) were associated with negative outcomes including higher levels of different types of anxiety and depression, and lower levels of self-esteem and peer self-concept. CONCLUSIONS Student subgroups of different patterns of peer victimization were found, whereby ethnic peer victimization was blended with personal peer victimization in one subgroup, and personal peer victimization was experienced in a pure form in another subgroup. The two victimization subgroups did not differ with regard to outcomes, but were differentially predicted by students' native language.
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Affiliation(s)
- A Katrin Arens
- DIPF, Leibniz Institute for Research and Information in Education, Department on Research on Education and Human Development and Centre for Research on Individual Development and Adaptive Education of Children at Risk (IDeA), Rostocker Str. 6, D-60323 Frankfurt am Main, Germany.
| | - Linda Visser
- DIPF, Leibniz Institute for Research and Information in Education, Department on Research on Education and Human Development and Centre for Research on Individual Development and Adaptive Education of Children at Risk (IDeA), Rostocker Str. 6, D-60323 Frankfurt am Main, Germany
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Walter SM, Parker RD, Wang K, Dai Z, Starcher M. Feasibility of a self-management intervention in adolescents with headache (SMI-AH). Appl Nurs Res 2019; 51:151223. [PMID: 31822377 DOI: 10.1016/j.apnr.2019.151223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/21/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE This study assessed the acceptability and limited efficacy of a self-management intervention to improve lifestyle behaviors and headache outcomes among rural adolescents with recurrent headache. DESIGN AND METHODS Participants were randomly assigned to a self-management intervention for adolescent headache (SMI-AH, n = 13) or standard care group (n = 17). The SMI-AH group participated in goal-setting, self-monitoring, and information processing to modify lifestyle behaviors (missed meals, caffeine intake, and poor sleep). Independent samples t-test was used to compare the means of outcomes at baseline and 6-week follow-up between the treatment group and control group. Linear mixed model (LMM) was used to examine the intervention effects over time. RESULTS The mean age was 14.8 years (sd = 1.6, range, 12-17); with female participants accounting for 80% of the sample (n = 24) and persons reporting white race were 97% (n = 29). The SMI-AH group demonstrated a greater magnitude of change in lifestyle behaviors, including increased days of eating breakfast and lunch. The multivariate LMM showed significant intervention effect of lunch intake (p = 0.042 with Cohen's d = 0.42) and borderline significant effect of breakfast intake (p = 0.064 with Cohen's d = 0.38). Participants reported the intervention was easy to use and helpful to monitor behaviors. CONCLUSIONS Among rural adolescents, a self-management intervention is a feasible approach for engaging youth. The SMI-AH provides an opportunity for the adolescents to talk about their behaviors and participate in goal setting as well as the plan of care with the provider. Challenges identified in this study are manageable and a full study is feasible with modifications.
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Affiliation(s)
- Suzy Mascaro Walter
- Department of Family and Community Health, West Virginia University School of Nursing, Morgantown, WV 26506, United States of America.
| | - R David Parker
- Adelphi University College of Nursing and Public Health, Garden City, NY 11530, United States of America.
| | - Kesheng Wang
- Department of Family and Community Health, West Virginia University School of Nursing, Morgantown, WV 26506, United States of America.
| | - Zheng Dai
- West Virginia University School of Public Health, Morgantown, WV 26506, United States of America.
| | - Meg Starcher
- West Virginia University School of Public Health, Morgantown, WV 26506, United States of America.
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Rocha MS, Yaruss JS, Rato JR. Temperament, Executive Functioning, and Anxiety in School-Age Children Who Stutter. Front Psychol 2019; 10:2244. [PMID: 31636587 PMCID: PMC6788391 DOI: 10.3389/fpsyg.2019.02244] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 09/19/2019] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to examine temperament dimensions, executive functioning ability, and anxiety levels in school-age children who stutter and their non-stuttering peers. Participants were 100 Portuguese children aged 7 to 12 years (M = 9.13; SD = 1.70), including 50 children who stutter and 50 children who do not stutter. Analyses, which were performed separately for younger and older participants, sought to identify correlations between key variables. Temperament was evaluated through a parent questionnaire, executive functioning was evaluated through children’s responses on a performance test, and anxiety level was assessed through a self-perception scale. On the temperament measure, comparisons between children who stutter and their non-stuttering peers revealed that older children who stutter exhibited significantly higher scores on the Anger/Frustration, Impulsivity, and Sadness subscales, and lower averages on the Attention/Focusing, Perceptual sensitivity, and Soothability/Falling Reactivity subscales. On the executive functioning task, comparisons revealed that the group of younger children who stutter exhibited significantly higher average execution times than their non-stuttering peers. There were no statistically significant differences in anxiety between children who stutter and children who do not stutter, and there were no statistically significant correlations between temperament factors and measures of executive functioning. Children who stutter experienced lower ability to orient attention and greater emotional reactivity compared with their non-stuttering peers. Significant correlations were found between executive functioning and age and among the temperament factors themselves. These results, which support the need for a multidimensional view of stuttering, were interpreted in the context of the Dual Diathesis – Stressor model. Findings indicate that temperament and executive functioning abilities may contribute to the development of stuttering.
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Affiliation(s)
- Mónica Soares Rocha
- Institute of Health Sciences, Catholic University of Portugal, Lisbon, Portugal
| | - J Scott Yaruss
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, United States
| | - Joana R Rato
- Centre for Interdisciplinary Research in Health, Catholic University of Portugal, Lisbon, Portugal
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Discrete electrocortical predictors of anxiety and anxiety-related treatment response in youth with autism spectrum disorder. Biol Psychol 2019; 146:107710. [DOI: 10.1016/j.biopsycho.2019.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 12/28/2022]
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Separating within-person from between-person effects in the longitudinal co-occurrence of depression and different anxiety syndromes in youth. JOURNAL OF RESEARCH IN PERSONALITY 2019. [DOI: 10.1016/j.jrp.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Suarez-Lopez JR, Hood N, Suárez-Torres J, Gahagan S, Gunnar MR, López-Paredes D. Associations of acetylcholinesterase activity with depression and anxiety symptoms among adolescents growing up near pesticide spray sites. Int J Hyg Environ Health 2019; 222:981-990. [PMID: 31202795 DOI: 10.1016/j.ijheh.2019.06.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/09/2019] [Accepted: 06/07/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND The cholinergic system has an important role in mood regulation. Cholinesterase inhibitor pesticides (e.g. organophosphates) appear to increase depression and anxiety symptoms in the few existing animal and human studies. Human studies have not described such associations using biomarkers of exposure and studies among children are needed. METHODS We studied 529 adolescents (ages 11-17y) in agricultural communities in the Ecuadorian Andes (ESPINA study). Acetylcholinesterase (AChE) activity was measured in a finger-stick sample. Anxiety and depression symptoms were assessed using the CDI-2 and MASC-2 (greater scores reflect greater internalizing symptoms). Models adjusted for age, gender, hemoglobin, income among others. RESULTS The median age was 14.38y and 51% were female. The mean (SD) of the following parameters were: AChE 3.7 U/mL (0.55), depression T-score 53.0 (9.4) and anxiety T-score: 57.6 (9.8). Lower AChE activity (reflecting greater cholinesterase inhibitor exposure) was associated with higher depression symptoms (difference per SD decrease of AChE [β [95% CI:]]: 1.09 [0.02, 2.16]), was stronger among girls (β = 1.61) than boys (β = 0.69), and among younger (<14.38y, β = 1.61) vs. older children (β = 0.57). The associations were strongest among girls <14.38y (β = 3.30 [0.54, 6.05], OR for elevated symptoms per SD decrease in AChE = 2.58 [1.26, 5.27]). No associations were observed with anxiety scores. Analyses of AChE change between 2008 and 2016 concurred with these findings. DISCUSSION We observed associations between a biomarker of pesticide exposure and children's depression symptoms. Lower AChE activity may create risk for depression in teenagers, particularly among girls during early adolescence.
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Affiliation(s)
| | - Naomi Hood
- University of California, San Diego, La Jolla, CA, 92093, USA.
| | | | - Sheila Gahagan
- University of California, San Diego, La Jolla, CA, 92093, USA.
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Rozenman M, Piacentini J, O'Neill J, Bergman RL, Chang S, Peris TS. Improvement in anxiety and depression symptoms following cognitive behavior therapy for pediatric obsessive compulsive disorder. Psychiatry Res 2019; 276:115-123. [PMID: 31075706 PMCID: PMC7197731 DOI: 10.1016/j.psychres.2019.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 01/12/2023]
Abstract
Pediatric obsessive-compulsive disorder (OCD) co-occurs frequently with other mental health conditions, adding to the burden of disease and complexity of treatment. Cognitive behavioral therapy (CBT) is efficacious for both OCD and two of its most common comorbid conditions, anxiety and depression. Therefore, treating OCD may yield secondary benefits for anxiety and depressive symptomatology. This study examined whether anxiety and/or depression symptoms declined over the course of OCD treatment and, if so, whether improvements were secondary to reductions in OCD severity, impairment, and/or global treatment response. The sample consisted of 137 youths who received 12 sessions of manualized CBT and were assessed by independent evaluators. Mixed models analysis indicated that youth-reported anxiety and depression symptoms decreased in a linear fashion over the course of CBT, however these changes were not linked to specific improvements in OCD severity or impairment but to global ratings of treatment response. Results indicate that for youth with OCD, CBT may offer benefit for secondary anxiety and depression symptoms distinct from changes in primary symptoms. Understanding the mechanisms underlying carryover in CBT techniques is important for furthering transdiagnostic and/or treatment-sequencing strategies to address co-occurring anxiety and depression symptoms in pediatric OCD.
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Affiliation(s)
- Michelle Rozenman
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA.
| | - John Piacentini
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| | - Joseph O'Neill
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| | - R Lindsey Bergman
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| | - Susanna Chang
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| | - Tara S Peris
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
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Crawford EA, Burke TA, Siegel D, Jager-Hyman S, Alloy LB, Kendall PC. Somatic Symptoms of Anxiety and Suicide Ideation Among Treatment-Seeking Youth With Anxiety Disorders. Suicide Life Threat Behav 2019; 49:811-825. [PMID: 29900567 DOI: 10.1111/sltb.12479] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/27/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The severity of anxiety, in general, has been associated with suicide ideation (SI) among youth, but research has yet to examine the specific anxiety symptoms that may contribute to SI among youth. This study examined the severity of specific anxiety symptom clusters (i.e., tense/restless, somatic/autonomic symptoms, humiliation/rejection, performing in public, separation anxiety, perfectionism, and anxious coping) and SI in youth who met diagnostic criteria for an anxiety disorder. METHOD Participants (N = 87) were treatment-seeking children and adolescents ages 6-17 (M = 11.1 years, SD = 3.06; 52.9% male) diagnosed with a principal anxiety disorder. Youth and their parents completed measures of youth anxiety symptom severity, depression, and SI. RESULTS Hierarchical linear regressions revealed that when anxiety symptom clusters were entered simultaneously, only youth self-reported (and not parent-reported) somatic/autonomic symptoms of anxiety significantly predicted SI, after controlling for depression and sex. Importantly, the relationship between somatic/autonomic symptoms of anxiety and SI was stronger than that between depression and SI. CONCLUSIONS These results suggest that assessing somatic symptoms of anxiety is especially important when quantifying suicide risk among anxiety-disordered youth.
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Affiliation(s)
| | | | - David Siegel
- Psychology, Temple University, Philadelphia, PA, USA
| | - Shari Jager-Hyman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Haraden DA, Mullin BC, Hankin BL. Internalizing symptoms and chronotype in youth: A longitudinal assessment of anxiety, depression and tripartite model. Psychiatry Res 2019; 272:797-805. [PMID: 30832201 PMCID: PMC6498437 DOI: 10.1016/j.psychres.2018.12.117] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 12/01/2022]
Abstract
Biological rhythm theories highlight the reciprocal relations between dysregulated circadian patterns and internalizing psychopathology. Chronotype characterizes individuals' diurnal preference, as some exhibit more morningness or eveningness. Previous research suggests that eveningness prospectively predicts depression in adolescence. Anxiety often co-occurs with depression, but little is known about longitudinal, reciprocal associations between chronotype and anxiety, and whether this relationship remains after controlling for depression. We assessed different forms of anxiety (social, panic, separation), positive/negative affect, anxious arousal (from tripartite theory), and depression, in relation to chronotype to better understand the specificity and directionality of associations between chronotype and internalizing problems in adolescence. Community youth participated in three assessment time points: T1, T2 (18-months post-T1), and T3 (30-months post-T1) as part of a larger longitudinal study. Youth completed self-report measures of anxiety, depression, positive and negative affect, and chronotype. Regression analyses showed that eveningness: (1) concurrently associated with decreased separation anxiety, elevated symptoms of depression and low levels of positive affect, (2) was prospectively predicted by elevated depression, (3) did not predict later symptoms of anxiety. The reciprocal, prospective relationship between chronotype and internalizing psychopathology is specific to depression during adolescence.
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Affiliation(s)
- Dustin A. Haraden
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Benjamin C. Mullin
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, USA
| | - Benjamin L. Hankin
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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