Social phobia and separation anxiety symptoms in community and clinical samples of children and adolescents

Social versus non-social behavioral inhibition: Differential prediction from early childhood of long-term psychosocial outcomes

Behavioral inhibition (BI) is a temperamental style characterized by cautious and fearful behaviors in novel situations. The present multi-method, longitudinal study examined whether young children's observed and parent-reported BI in social versus non-social contexts predicts different long-term psychosocial outcomes. Participants (N = 279) were drawn from a longitudinal study of socioemotional development. BI in social contexts ("social BI") was measured via children's observed wariness toward unfamiliar adults and peers at 24 and 36 months and parents' reports of children's social fear/shyness at 24, 36, and 48 months. BI in non-social contexts ("non-social BI") was measured via children's observed fearful responses to masks and novel toys, and parents' reports of children's distress to non-social novelty at 9 months and non-social fear at 48 months. At 15 years, anxiety was assessed via adolescent- and parent-reports, and global internalizing and externalizing problems were assessed via parent-reports. Confirmatory factor analysis showed that a two-factor model fit the BI data significantly better than a single-factor model, providing evidence for the dissociation of BI in social versus non-social contexts. Social BI was uniquely associated with adolescent social anxiety, whereas non-social BI was specifically associated with adolescent separation anxiety. Neither social BI nor non-social BI predicted global internalizing and externalizing problems, providing evidence for the specific relations between BI and anxiety problems. Together, these results suggest that young children's inhibited responses in social versus non-social situations predict different subtypes of anxiety problems in adolescence, highlighting the multifaceted nature of BI and the divergent trajectories of different anxiety problems.

Early detection of paediatric and adolescent obsessive-compulsive, separation anxiety and attention deficit hyperactivity disorder using machine learning algorithms

Purpose

Mental health issues of young minds are at the threshold of all development and possibilities. Obsessive-compulsive disorder (OCD), separation anxiety disorder (SAD), and attention deficit hyperactivity disorder (ADHD) are three of the most common mental illness affecting children and adolescents. Several studies have been conducted on approaches for recognising OCD, SAD and ADHD, but their accuracy is inadequate due to limited features and participants. Therefore, the purpose of this study is to investigate the approach using machine learning (ML) algorithms with 1474 features from Australia's nationally representative mental health survey of children and adolescents.

Methods

Based on the internal cross-validation (CV) score of the Tree-based Pipeline Optimization Tool (TPOTClassifier), the dataset has been examined using three of the most optimal algorithms, including Random Forest (RF), Decision Tree (DT), and Gaussian Naïve Bayes (GaussianNB).

Results

GaussianNB performs well in classifying OCD with 91% accuracy, 76% precision, and 96% specificity as well as in detecting SAD with 79% accuracy, 62% precision, 91% specificity. RF outperformed all other methods in identifying ADHD with 91% accuracy, 94% precision, and 99% specificity.

Conclusion

Using Streamlit and Python a web application was developed based on the findings of the analysis. The application will assist parents/guardians and school officials in detecting mental illnesses early in their children and adolescents using signs and symptoms to start the treatment at the earliest convenience.

The Prevalence of Anxiety Among Children in Saudi Arabia During the COVID-19 Pandemic: A Cross-Sectional Study

BACKGROUND

The year 2021 was a year that can be perceived as a stressful event given the considerable lifestyle changes that have occurred worldwide due to the pandemic. Several studies have investigated the psychological impact on people during this time period. However, only a few of them have investigated the impact on young children in Saudi Arabia (SA) specifically. Therefore, this study aimed to investigate the prevalence of anxiety in children living in Jeddah, Saudi Arabia.

METHODS

This is a cross-sectional study that included the parents of 388 children aged 6-9 years living in Jeddah, Saudi Arabia. It was conducted from June to November 2021. The parents completed an electronic survey that included the Arabic version of the Spence Children's Anxiety Scale. The data were analyzed using John's Macintosh Project (JMP) software version 10.0 (SAS Institute Inc., Cary, NC).

RESULTS

A total of 388 responses were collected. The data revealed that 37 (9.5%) participants experienced anxiety. Furthermore, the prevalence of anxiety was higher among females (5.15%) as compared to males (4.38%), but the difference was not statistically significant.

CONCLUSION

These findings highlight the importance of recognizing the psychological burden in young populations and emphasize the importance of taking children's well-being into account.

Population-Based Teacher-Rated Assessment of Anxiety Among Canadian Kindergarten Children

Despite anxiety being a prevalent mental health problem in children, little data exist on the pervasiveness and levels of anxiety symptoms in kindergarteners. Data from the Early Development Instrument, a teacher-completed, population-level measure of child development, were collected across Canada from 2004 to 2015. The final analytic sample consisted of 974,319 children of whom 2.6% were classified as "highly anxious". Compared to children who exhibited "few to none" anxious behaviors, highly anxious children were more likely to be male, have English/French as a second language, and have a special needs designation. Furthermore, compared with their less anxious peers, highly anxious children had between 3.5 and 6.1 higher odds of scoring below the 10th percentile cut-off in physical, social, language/cognitive and communication domains. Our findings suggest that anxious behaviors are related to children's overall health and illustrate the consistency and extensiveness of anxiety at a very young age among Canadian children.

The personality and cognitive traits associated with adolescents' sensitivity to social norms

Little is known about the personality and cognitive traits that shape adolescents' sensitivity to social norms. Further, few studies have harnessed novel empirical tools to elicit sensitivity to social norms among adolescent populations. This paper examines the association between sensitivity to norms and various personality and cognitive traits using an incentivised rule-following task grounded in Game Theory. Cross-sectional data were obtained from 1274 adolescents. Self-administered questionnaires were used to measure personality traits as well as other psychosocial characteristics. Incentivised rule-following experiments gauged sensitivity to social norms. A series of multilevel mixed effects ordered logistic regression models were employed to assess the association between sensitivity to norms and the personality and cognitive traits. The results highlighted statistically significant univariate associations between the personality and cognitive traits and sensitivity to norms. However, in the multivariate adjusted model, the only factor associated with sensitivity to norms was gender. The gender-stratified analyses revealed differences in the personality and cognitive traits associated with sensitivity to norms across genders. For males need to belong was significantly negatively associated with sensitivity to norms in the multivariate model. By comparison, emotional stability was negatively associated with sensitivity to norms for females. This study reinforced the findings from an earlier study and suggested female adolescents had higher levels of sensitivity to norms. The results indicated no consistent pattern between sensitivity to norms and the personality and cognitive traits. Our findings provide a basis for further empirical research on a relatively nascent construct, and bring a fresh perspective to the question of norm-following preferences among this age group.

Validation of the Children's Separation Anxiety Scale - Parent Version (CSAS-P)

The main objective of this research was to validate the parents’ version of the Children’s Separation Anxiety Scale (CSAS-P), which assesses separation anxiety symptoms in pre-adolescence, the stage with the highest incidence of anxiety disorder due to separation. In Study 1, 1,089 parents, those children aged between 8 and 11 (M = 9.59, SD = 1.11), 51.7% girls, were selected by random cluster sampling, who completed the CSAS-P to obtain the factorial structure. Exploratory factor analysis identified four related factors: Worry, Opposition, Calm, and Distress, which explained 42.93% of the variance. In Study 2, 3,801 parents, those children aged between 8 and 11 (M = 9.50, SD = 1.10), 50.2% girls, completed the CSAS-P, and their children completed the Children’s Separation Anxiety Scale (CSAS). The four related-factor model from Study 1 was validated by confirmatory factor analysis. The CSAS-P had adequate internal consistency (α = 0.84), temporal stability (r = 0.72), and invariance across children’s age and gender and the parent who completed the scale. Age and gender differences were small: older children scored higher on Worry and younger children on Distress; the girls scored higher on all factors. Small differences were also found depending on the parent who completed the scale without finding a clear pattern. Parents scored significantly lower than the child on all four factors of the scale. The results support the reliability and validity of the CSAS-P, an instrument that complements the child’s self-report in the framework of the multi-source assessment.

Normative Beliefs about Social Withdrawal in Adolescence

The goal of this study is to explore normative beliefs about social withdrawal during adolescence. Participants were N = 419 adolescents (M_age  = 16.13 years), who completed measures of normative beliefs about social withdrawal and their own social withdrawal (shyness, unsociability). Among the results, adolescents reported greater overall acceptance of unsociability compared to shyness, however, some gender differences also emerged. Specifically, adolescents were more accepting of unsociability when depicted by hypothetical females, and more accepting of shyness when depicted by hypothetical males. Participant social withdrawal was associated with greater acceptance of socially withdrawn behaviors in others. These findings provide a first look at normative beliefs about social withdrawal during a developmentally critical age period for this construct.

Childhood anxiety disorders prevalence in Saudi Arabia

Objectives:

To investigate the prevalence of childhood anxiety disorders in Saudi Arabia.

Methods:

We conducted a cross-sectional study, between September and November 2019, in Saudi Arabia. The study group included the parents of 468 primary school children, aged 6-12 years. Parents completed the Screen for Child Anxiety Related Disorders (SCARED) screening instrument, translated to Arabic. The measured outcome was the prevalence of childhood anxiety disorders, determined from the scores on the SCARED instrument.

Results:

Childhood anxiety disorders prevalence were as follows: 32.7% had one anxiety, 18.4% had 2, 10.9% had 3, 8.1% had 4, and 7.7% had 5. Of note, 22.2% of children did not have an anxiety disorder.

Conclusion:

Our results reveal a high prevalence of childhood anxiety disorders among primary school age children in Saudi Arabia. Based on these findings, conducting awareness campaigns and providing educational programs on childhood anxiety disorders might be important to improve the health outcomes of children.

Characterization and Prediction of Anxiety in Adolescents with Autism Spectrum Disorder: A Longitudinal Study

Anxiety is one of the most common comorbidities in youth with autism spectrum disorder (ASD). The current study's aims were: To examine the frequency of elevated anxiety symptoms in adolescents diagnosed with ASD in toddlerhood; To explore the impact of comorbid anxiety in adolescents on clinical presentation; To evaluate variables in toddlerhood that associate with anxiety symptom severity in adolescence. The study included 61 adolescents (mean age = 13:8y) diagnosed with ASD in toddlerhood (T1). Participants underwent a comprehensive assessment of cognitive ability, adaptive skills and autism severity at T1 and again as adolescents (T2), and an evaluation of anxiety symptoms at T2. For the first aim, the most prevalent anxiety subtypes noted in adolescence were separation (39.3%), social (27.9%) and generalized anxiety (18.0%). For the second aim, cognitive ability, autism severity and adaptive skills in adolescents with and without elevated anxiety symptoms scores of any type did not differ significantly. For the third aim, younger age at adolescence was associated with more severe separation and generalized anxiety symptoms. Higher cognitive ability and adaptive skills in toddlerhood were associated with elevated generalized anxiety symptoms in adolescence. Lower adaptive behaviors and repetitive behaviors (RRBs) correlated with elevated social anxiety symptoms. Lower cognitive abilities and more severe RRBs in toddlerhood predicted separation anxiety in adolescence. The study sheds light on early characteristics in ASD that associate with anxiety symptom severity in adolescence. The type of elevated anxiety symptoms presented in adolescence associated with the level of cognitive ability, adaptive skills and RRBs in toddlerhood.

Predicting mental health improvement and deterioration in a large community sample of 11- to 13-year-olds

Of children with mental health problems who access specialist help, 50% show reliable improvement on self-report measures at case closure and 10% reliable deterioration. To contextualise these figures it is necessary to consider rates of improvement for those in the general population. This study examined rates of reliable improvement/deterioration for children in a school sample over time. N = 9074 children (mean age 12; 52% female; 79% white) from 118 secondary schools across England provided self-report mental health (SDQ), quality of life and demographic data (age, ethnicity and free school meals (FSM) at baseline and 1 year and self-report data on access to mental health support at 1 year). Multinomial logistic regressions and classification trees were used to analyse the data. Of 2270 (25%) scoring above threshold for mental health problems at outset, 27% reliably improved and 9% reliably deteriorated at 1-year follow up. Of 6804 (75%) scoring below threshold, 4% reliably improved and 12% reliably deteriorated. Greater emotional difficulties at outset were associated with greater rates of reliable improvement for both groups (above threshold group: OR = 1.89, p < 0.001, 95% CI [1.64, 2.17], below threshold group: OR = 2.23, p < 0.001, 95% CI [1.93, 2.57]). For those above threshold, higher baseline quality of life was associated with greater likelihood of reliable improvement (OR = 1.28, p < 0.001, 95% CI [1.13, 1.46]), whilst being in receipt of FSM was associated with reduced likelihood of reliable improvement (OR = 0.68, p < 0.01, 95% CI [0.53, 0.88]). For the group below threshold, being female was associated with increased likelihood of reliable deterioration (OR = 1.20, p < 0.025, 95% CI [1.00, 1.42]), whereas being from a non-white ethnic background was associated with decreased likelihood of reliable deterioration (OR = 0.66, p < 0.001, 95% CI [0.54, 0.80]). For those above threshold, almost one in three children showed reliable improvement at 1 year. The extent of emotional difficulties at outset showed the highest associations with rates of reliable improvement.

Children with dyslexia in different cultures: Investigation of anxiety and coping strategies of children with dyslexia in Indonesia and Germany

Hitherto the majority of research on anxiety and coping was undertaken on individuals with specific profiles (i.e., individuals with specific difficulties or in cross-cultural settings). However, to our knowledge, no studies have combined cross-cultural and specific difficulty settings to grant a complex analysis of this paradigm nor conducted an investigation of children to reveal the developmental trend in this phenomenon. This study investigates the anxiety profile and coping strategies of children with and without dyslexia from different cultures. A total of 124 children ranging from the age of eight to eleven from Indonesia (n = 64) and Germany (n = 60) were administered a coping and an anxiety scale. Around 50% of the sample were diagnosed with dyslexia and therefore were specifically asked what strategies they implemented in dealing with their difficulties in reading. Findings indicate that dyslexia and cultural factors have distinct contributions in explaining the variance of anxiety and coping strategies. Specifically, dyslexia has a significant effect on separation and generalized anxiety, while an incredible cultural effect is valid for the support-seeking coping strategy. Recommendations for future studies are also discussed.

Evaluation of the Effectiveness of a Musical Cognitive Restructuring App for Black Inner-City Girls: Survey, Usage, and Focus Group Evaluation

BACKGROUND

Research on mobile health (mHealth) app use during adolescence is growing; however, little attention has been paid to black adolescents, particularly black girls, who are generally underresearched and underserved in psychological intervention research. Cognitive restructuring is an important tool in anxiety and fear management and involves two parts: (1) recognizing and deconstructing erroneous thoughts and (2) replacing negative anxiety and stress-provoking thoughts with positive thoughts. In our work with black adolescent females, we found that cognitive restructuring is a difficult skill to practice on one's own. Thus, drawing upon the importance of music in the black community, we developed the Build Your Own Theme Song (BYOTS) app to deliver a musical form of the technique to middle-school black girls.

OBJECTIVE

Our aim in this mixed methods study is to evaluate the effectiveness of the BYOTS app. We hypothesize that participants will expect the app to be effective in reducing negative thoughts and that the app will meet their expectations and data generated from the app will demonstrate a reduction in negative thinking and anxiety.

METHODS

A total of 72 black or biracial seventh- and eighth-grade adolescent females were enrolled in Sisters United Now (SUN), an eight-session culturally infused and app-augmented stress and anxiety sister circle intervention. Before using the BYOTS app, girls completed the Multidimensional Anxiety Scale for Children 2 and the App Expectations Survey. Usage data collected from the app included an assessment of negative thinking before and after listening to their song. After completion of the intervention, focus groups were held to gather qualitative data on participants' app experience.

RESULTS

Results using paired sample t tests indicated negative thinking was significantly lower at day 7 than day 1 (t₃₁=1.69, P=.05). Anxiety from preuse to postuse of the app was also reduced (t₃₈=2.82, P=.004). Four effectiveness themes emerged from the focus groups: difference in behavior and temperament, promoted calmness, helpfulness in stressful home situations, and focused thinking via the SUN theme song.

CONCLUSIONS

The BYOTS app is a useful tool for delivering musical cognitive restructuring to reduce negative thinking and anxiety in an underserved urban population. Changes were supported both quantitatively and qualitatively. Participants, their peers, and their family noted the difference. Findings support expanding the research to black girls of various socioeconomic statuses and geographic diversity. Currently, the app augments SUN, a culturally relevant intervention. Future research will explore BYOTS as a stand-alone app.

Associations between Disorder-Specific Symptoms of Anxiety and Error-Monitoring Brain Activity in Young Children

Anxiety disorders are among the earliest emerging disorders and most common mental health problem across the lifespan. A common characteristic of individuals with anxiety is poor attentional and cognitive control. Therefore, researchers are interested in how cognitive functioning relates to anxiety in young children. In particular, research has demonstrated associations between anxiety and electrophysiological markers of cognitive control skills such as the error-related negativity (ERN). The nature of the anxiety-ERN relationship is not well understood, however. The purpose of the present study was to examine: 1) the association between the ERN and diagnostically-defined symptoms of different anxiety disorders; and 2) the extent to which disorder-specific symptoms of anxiety moderated the association between ERN and behavioral performance on a Go/No-Go task in a sample of 139 children 5-8 years of age (70 females and 69 males). Results suggest that more separation anxiety disorder (SAD) symptoms are associated with a smaller ΔERN, even after controlling for other anxiety disorder symptoms. Children with more SAD symptoms showed higher error rates and failed to exhibit the expected association between ΔERN and behavioral performance, suggesting ineffective error-monitoring in young children with SAD problems.

Different psychometric properties of the Emotional Reaction Instrument-English (ERI-E) between hospitalized African American and Caucasian children

PURPOSE

To demonstrate the psychometric properties of the Emotional Reactions Instrument-English (ERI-E) between hospitalized African American and Caucasian children aged 7-12 years.

DESIGN AND METHOD

A methodological study was conducted to examine validity and reliability of the ERI-E with 230 hospitalized African American and Caucasian children. Data were collected with sociodemographic and clinical forms, and using the ERI-E, and the Facial Affective Scale (FAS).

RESULTS

Different factor structures were found between hospitalized African American and Caucasian children. In psychometric testing of the ERI-E with African American children, four items, alone, lonely, shy, and bored, were removed from the original 16-item ERI-E after exploratory factor analysis. Three factors, including Fear, Anxiety, and Distress, were identified explaining 60.71% of the total variance. Cronbach's alpha coefficient for the revised 12-item scale was 0.85. Six items, happy, sad, afraid, frightened, hurt, and uncomfortable, in the ERI-E were significantly correlated with the FAS (r = 0.20-0.59) as evidence of concurrent validity. In the sample with hospitalized Caucasian children, two items, bored and uncomfortable, were eliminated from the original ERI-E after exploratory factor analysis. Four factors including Fear, Anxiety, Distress, and Loneliness were extracted with 62.61% of total variance. Cronbach's alpha coefficient for the revised 14-item in the ERI-E was 0.84 for hospitalized Caucasian children. As evidence of concurrent validity, 10 items, happy, sad, afraid, frightened, bad, lonely, scary, bored, hurt, and uncomfortable, in the ERI-E were significantly correlated with the FAS (r = 0.20-0.69).

PRACTICE IMPLICATION

Because children with different cultural backgrounds understand or use words differently, healthcare providers should assess the cultural norms of pediatric patients and ensure steps have been taken to ensure clear, effective communication with pediatric patients. In addition, healthcare providers should evaluate the meanings of faces in the FAS before using it in a clinical setting because faces have different cultural connotations. The explosive growth of ethnic minority children in the United States makes it paramount for healthcare providers and researchers to consider the measurement equivalence of any measure to better serve different racial and cultural groups.

Distinguishing Fear Versus Distress Symptomatology in Pediatric OCD

Prior research has identified OCD subtypes or "clusters" of symptoms that differentially relate to clinical features of the disorder. Given the high comorbidity between OCD and anxiety, OCD symptom clusters may more broadly associate with fear and/or distress internalizing constructs. This study examines fear and distress dimensions, including physical concerns (fear), separation anxiety (fear), perfectionism (distress), and anxious coping (distress), as predictors of previously empirically-derived OCD symptom clusters in a sample of 215 youth diagnosed with primary OCD (ages 7-17, mean age = 12.25). Self-reported separation fears predicted membership in Cluster 1 (aggressive, sexual, religious, somatic obsessions, and checking compulsions) while somatic/autonomic fears predicted membership in Cluster 2 (symmetry obsessions and ordering, counting, repeating compulsions). Results highlight the diversity of pediatric OCD symptoms and their differential association with fear, suggesting the need to carefully assess both OCD and global fear constructs that might be directly targeted in treatment.

Psychometric Properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in a Non-Clinical Sample of Children and Adolescents in Saudi Arabia

This paper examined the reliability, convergent validity and factor structure of the self-report Screen for Child Anxiety Disorders (SCARED; Birmaher et al. in J Am Acad Child Adolesc Psychiatry 36:545-553, 1997) in a large community sample of children and adolescents in Saudi Arabia. The questionnaire showed moderate to high internal consistency and satisfactory test-retest reliability over a 2 week period. In addition, there were significant positive correlations between reported anxiety symptoms with parent report behavioural difficulties. The five factor structure model of the SCARED also had a good model fit in this population. The results showed that self-report anxiety symptoms decreased with age (for boys and not girls) and were higher in adolescent girls. The results suggest that the SCARED could be useful in this population to identify individuals who are at risk of developing anxiety disorders in childhood with a view to implementing prevention and intervention methods to ensure positive developmental outcome over time.

Children and adolescents referred for treatment of anxiety disorders: differences in clinical characteristics

BACKGROUND

Reports of the clinical characteristics of children and adolescents with anxiety disorders are typically based on community populations or from clinical samples with exclusion criterion applied. Little is known about the clinical characteristics of children and adolescents routinely referred for treatment for anxiety disorders. Furthermore, children and adolescents are typically treated as one homogeneous group although they may differ in ways that are clinically meaningful.

METHODS

A consecutive series of children (n=100, aged 6-12 years) and adolescents (n=100, aged 13-18 years), referred to a routine clinical service, were assessed for anxiety and comorbid disorders, school refusal and parental symptoms of psychopathology.

RESULTS

Children with a primary anxiety disorder were significantly more likely to be diagnosed with separation anxiety disorder than adolescents. Adolescents with a primary anxiety disorder had significantly higher self and clinician rated anxiety symptoms and had more frequent primary diagnoses of social anxiety disorder, diagnoses and symptoms of mood disorders, and irregular school attendance.

LIMITATIONS

Childhood and adolescence were considered categorically as distinct, developmental periods; in reality changes would be unlikely to occur in such a discrete manner.

CONCLUSIONS

The finding that children and adolescents with anxiety disorders have distinct clinical characteristics has clear implications for treatment. Simply adapting treatments designed for children to make the materials more 'adolescent-friendly' is unlikely to sufficiently meet the needs of adolescents.

Symptoms and development of anxiety in children with or without intellectual disability

The purpose of this study was to examine group differences in presentation and trajectory of anxiety symptoms and disorders in children with moderate to borderline intellectual disability (ID) and children with typical cognitive development (TD). Examined anxiety disorders and symptoms in children with ID (n=74) or TD (n=116) annually from ages 5 through 9 using a parent structured interview and questionnaire. Logistic regression was used to examine odds of meeting anxiety criteria and hierarchical linear modeling was used to examine anxiety trajectory. Children with ID had significantly higher rates of clinical levels of anxiety on the Child Behavior Checklist at ages 8 and 9 and higher rates of separation anxiety disorder at age 5 compared to those with TD. Children with ID were also more likely to have externalizing problems co-occurring with anxiety. The rate of increase of anxiety symptoms over time was positive and similar in the two groups, and neither group showed sex differences in anxiety rates. Results suggest that children with ID have both higher rates of anxiety across time and are delayed in showing typical decreases in separation anxiety in early childhood. Implications for intervention are discussed in terms of the importance of screening for and treating anxiety in children with ID.

ADad 4: the symptomatology and clinical presentation of Anxiety Disorders among adolescents in a rural community population in India

OBJECTIVES

Anxiety Disorders (AD) in children and adolescents present with unique clinical features and exhibit phenotypic diversity. The symptom presentation varies with regard to age of onset, developmental factors and gender. This study documents the clinical presentation of AD among adolescents in India, and explores the symptom clusters among the different age groups as well as gender.

METHODS

Five hundred adolescents aged between 11 and 19 y from Pattanakad ICDS block, of Allapuzha district in Kerala were recruited and assessed using the self-rated Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire to identify symptom clusters of anxiety and this was followed by confirmation of the diagnosis using DSM-IV TR within a week. Anxiety symptom clusters and severity (obtained from continuous SCARED scores) were compared between early, middle and late adolescence subgroups as well as between sexes.

RESULTS

The most predominant anxiety symptoms across the subtypes were the anxious mood, which was noted in 12.60% followed by cognitive symptoms in 9.94% of the cases and finally physical symptoms in 9.22% of the study sample. The symptom clusters varied among the subtypes with anxious mood being commoner in Panic Disorder (PD), cognitive symptoms in Generalised Anxiety Disorder (GAD) and physical symptoms were prominent among Separation Anxiety (SeAD) and Social Anxiety Disorders (SoAD). The severity of anxiety disorder in general and its various subtypes were mostly of mild intensity although significant proportion had a severe form of the disease(s). The severity of the AD among girls was statistically significantly higher than boys (P = 0.02). There was no significant difference on symptom frequency or anxiety severity with regard to age.

CONCLUSIONS

Understanding of age appropriate presentation of anxiety symptoms may help in streamlining the treatment guidelines and yield a better estimate of the disease process.

ADad 5: the co-morbidity in Anxiety Disorders among adolescents in a rural community population in India

OBJECTIVE

Anxiety Disorders (AD) have been known to have high prevalence of intra-AD and extra-AD co-morbidities. This study documents the prevalence and profile of intra and extra-AD co-morbidities, the effect of the presence and number of co-morbidities on the severity of anxiety symptoms and the influence of age as well as gender on the co-morbidity.

METHODS

In a prospective community survey of 500 adolescents, independent raters administered the Screen for Child Anxiety Related Emotional Disorders (SCARED) and Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL) to collect the required data. Descriptive statistics, independent t tests, one-way ANOVA and Chi-square tests were done to evaluate the prevalence and profile of co-morbidity presentation, compare the effect of co-morbidity on severity of anxiety symptoms as well as analyse the influence of age groups and gender on intra-AD co-morbidities.

RESULTS

Among those with AD, 14.2% had a DSM-IV-TR intra-AD co-morbidity and 70% had SCARED based intra-AD co-morbidity. Adolescents with Separation Anxiety Disorder and Generalised Anxiety Disorder had the highest SCARED and DSM-IV-TR prevalence of intra-AD co-morbidity respectively. Also, 23.7% had overlapping extra-AD co-morbidity. Presence and number of intra-AD co-morbidity was significantly associated with severity of total anxiety score and subscale scores (all with P = 0.001). Age and gender of adolescents were not related to the co-morbidity.

CONCLUSIONS

Intra and extra-AD co-morbidities are quite prevalent among adolescents with Anxiety Disorders in India. As such, co-morbidities increase the severity of anxiety symptoms, they should be identified and appropriate management should be established.

Assessing separation anxiety in Italian youth: preliminary psychometric properties of the Separation Anxiety Assessment Scale

This study examined the internal consistency and construct validity of the Separation Anxiety Assessment Scale for Children in a non-clinical Italian sample of 358 children ages 6 to 10 years. Statistically significant differences were examined by sex and age. Two exploratory factor analyses were carried out: (a) on the symptom sub-dimensions which led to three interpretable factors of Fear of Abandonment and of Physical Illness, Fear of Calamitous Events, Fear of Being Alone and (b) on all Separation Anxiety Assessment Scale for Children items, which led to three interpretable factors: Fear of Abandonment and Safety Signals, Fear of Calamitous Events, and Fear of Being Alone and Left Alone. Preliminary findings for validity were described with the Separation Anxiety Symptoms Inventory for Children and the Italian Fear Schedule for Children (convergent validity). Implications regarding the clinical utility of the Separation Anxiety Assessment Scale for Children are discussed.

Early evidence for factorial structure of the separation anxiety symptom inventory in Italian children

The aim of this study was to explore the internal consistency and confirm the factor structure of the separation anxiety symptom inventory for children (SASI-C) in a community sample of 329 Italian children, ages 6 to 10 years. A confirmatory factor analysis yielded two interpretable factors. Correlations between scores for the SASI-C and the Italian Fear Survey Schedule for Children were calculated to estimate convergent validity; medium effect sizes are hypothesized. Implications regarding the clinical utility of the SASI-C are discussed.

Cognitive behavior therapy for the anxiety triad

This article presents an overview of the existing, as well as newly developed, cognitive behavior therapy methods for treating the child anxiety triad (separation anxiety disorder, generalized anxiety disorder, and social phobia). For each disorder of the triad, the authors review diagnostic criteria, clinical presentation, disorder-specific treatment methods and innovations, and future directions for research.

Cross-ethnic measurement equivalence of the SCARED in an outpatient sample of African American and non-Hispanic White youths and parents

The present study evaluated the measurement equivalence of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in a clinical sample of non-Hispanic White (NHW) and African American (AA) youths and parents. In addition, we explored the concurrent criterion validity of parent report on the SCARED to a parent diagnostic interview. Cross-ethnic measurement equivalence was examined in both youth self-report (ages 11-18; N = 374) and parent report (youth ages 5-18; N = 808) using multiple group analysis. Sensitivity, specificity, positive predictive value, and negative predictive value of the SCARED parent report were also examined. The original five-factor structure of the SCARED was replicated using confirmatory factor analysis for both groups using parent and youth report, although factor loadings were not equivalent across groups. Sensitivity and specificity of the SCARED-P clinical cutoff score (Total ≥25) to anxiety diagnoses were acceptable in both ethnic groups. Although evidence for the cross-ethnic equivalence of SCARED was limited, results suggest a similar structure of anxiety symptoms across NHW and AA youths while demonstrating sensitivity in symptom-level differences in anxiety expression. Overall, results provide preliminary evidence for the SCARED as an acceptable screening tool for anxiety symptoms in NHW and AA youths.

Love hurts (in more ways than one): specificity of psychological symptoms as predictors and consequences of romantic activity among early adolescent girls

OBJECTIVE

Research has linked adolescent romantic and sexual activities to depressive symptoms. The current study examines whether such activities are uniquely linked to depressive symptoms versus symptoms of other disorders (including anxiety, externalizing, and eating disorders), and whether co-occurring symptoms more precisely account for the association between depressive symptoms and romantic involvement.

METHOD

Early adolescent girls (N = 83; mean age = 13.45) participated in baseline and 1-year follow up data collection.

RESULTS

Romantic (i.e., dating and sexual) activities were longitudinally related to numerous types of symptoms. The association between depressive symptoms and romantic variables remained when considering co-occurring symptoms. Girls with more comorbid disorders reported more romantic activities.

CONCLUSIONS

Results suggest that the maladaptive consequences and precipitants of adolescent romantic activities extend beyond depression, but also imply that this association is not secondary to comorbid symptoms. Future work should clarify causal pathways.

Separation anxiety disorder in OCD

BACKGROUND

A history of separation anxiety disorder (SAD) is frequently reported by patients with obsessive-compulsive disorder (OCD). The purpose of this study was to determine if there are clinical differences between OCD-affected individuals with, versus without, a history of SAD.

METHODS

Using data collected during the OCD Collaborative Genetic Study, we studied 470 adult OCD participants; 80 had a history of SAD, whereas 390 did not. These two groups were compared as to onset and severity of OCD, lifetime prevalence of Axis I disorders, and number of personality disorder traits.

RESULTS

OCD participants with a history of SAD were significantly younger than the non-SAD group (mean, 34.2 versus 42.2 years; P<.001). They had an earlier age of onset of OCD symptoms (mean, 8.0 versus 10.5 years; P<.003) and more severe OCD, as measured by the Yale-Brown Obsessive Compulsive Scale (mean, 27.5 versus 25.0; P<.005). In addition, those with a history of SAD had a significantly greater lifetime prevalence of agoraphobia (odds ratio (OR) = 2.52, 95% confidence interval (CI) = 1.4-4.6, P<.003), panic disorder (OR = 1.84, CI = 1.03-3.3 P<.04), social phobia (OR = 1.69, CI 1.01-2.8, P<.048), after adjusting for age at interview, age at onset of OCD, and OCD severity in logistic regression models. There was a strong relationship between the number of dependent personality disorder traits and SAD (adjusted OR = 1.42, CI = 1.2-1.6, P<.001).

CONCLUSIONS

A history of SAD is associated with anxiety disorders and dependent personality disorder traits in individuals with OCD.

It’s About Time

Accurate identification of emotional expressions is important to social interaction. We examined the relations among shyness, sociability, and the accuracy of categorization of facial expression of emotions in a sample of 127 undergraduates. Individual differences in sociability, but not shyness, were significantly related to categorization accuracy under conditions of limited presentation time, but not under circumstances of unlimited stimulus presentation time. Adults self-rated as low to moderate in sociability were significantly less accurate in categorizing facial expressions of emotion, albeit only under conditions of rapid stimulus presentation. These results suggest that individual differences in sociability and social exposure may influence the ability to categorize facial expressions of emotions.

Racial differences in symptoms of anxiety and depression among three cohorts of students in the southern United States

The present study aimed to extend the literature on mental health disparities in underserved areas by investigating racial differences in symptoms of anxiety and depression in three cohorts of school children in the Southern United States. White and African American students attending elementary, middle, and high school (n = 3,146) were administered a multi-dimensional measure of anxiety and depression. Racial differences were examined using categorical, dimensional, and latent-variable analytic methods. Although effect sizes were small across all levels of analysis, the categorical and dimensional approaches produced different patterns of significant anxiety-related findings. Additionally, confirmatory factor analysis indicated that the dimensional findings were not due to racial differences in the measurement of anxiety. The results of the current investigation suggest that, among school children, race has modest effects on symptoms of anxiety, but not depression. Further, the differential findings observed across analytic approaches reinforce the importance of measurement and methodology when studying psychopathology in children and adolescents.

Sex variations in youth anxiety symptoms: effects of pubertal development and gender role orientation

This study evaluated whether pubertal development and gender role orientation (i.e., masculinity and femininity) can partially explain sex variations in youth anxiety symptoms among clinic-referred anxious youth (N = 175; ages 9-13 years; 74% Hispanic; 48% female). Using youth and parent ratings of youth anxiety symptoms, structural equation modeling results indicated that youth who reported being more advanced in their pubertal development reported high levels of femininity and anxiety symptoms. Youth who reported high levels of masculinity had low levels of anxiety symptoms as reported by both youths and parents. The estimated effects of pubertal development, femininity, and masculinity on youth and parent ratings of youth anxiety symptoms were not significantly moderated by biological sex. Pubertal development and gender role orientation appear to be important in explaining levels of youth anxiety symptoms among clinic-referred anxious youth.

DSM-IV criteria for childhood separation anxiety disorder: informant, age, and sex differences

BACKGROUND

The present study examines frequency of DSM-IV symptom and diagnostic criteria for separation anxiety disorder (SAD) by informant, age, and sex.

METHODS

Children aged 4-15 years with a primary DSM-IV diagnosis of SAD (N=106) were assessed using structured diagnostic interviews (Kinder-DIPS; DSM-IV-TR Version). Frequency of DSM-IV symptom and diagnostic criteria were examined as a function of informant and child characteristics, along with impairment and distress ratings.

RESULTS

The most frequently reported symptoms were separation-related distress, avoidance of being alone/without an adult and sleeping away from caregivers or from home, with nightmares the least frequently endorsed criterion. Child report did not yield any significant sex or age differences. However, parent report revealed greater reluctance or avoidance of school attendance for girls than boys, and for younger children (<8 years). Parent report indicated greater symptom-related impairment than child report, and the number of symptoms was correlated with impairment based on parent report, and with distress based on child report.

CONCLUSIONS

The primary indicators of SAD appear to be separation distress, avoidance of being alone, and sleeping away from caregivers. Findings suggest that parents may be best placed to determine impairment, while children may be the most accurate reporters of more covert internal distress. Implications for clinicians are that reports from multiple informants should be used to gain the most comprehensive information about childhood SAD.

Cultural aspects in social anxiety and social anxiety disorder

To examine cultural aspects in social anxiety and social anxiety disorder (SAD), we reviewed the literature on the prevalence rates, expressions, and treatments of social anxiety/SAD as they relate to culture, race, and ethnicity. We further reviewed factors that contribute to the differences in social anxiety/SAD between different cultures, including individualism/collectivism, perception of social norms, self-construal, gender roles, and gender role identification. Our review suggests that the prevalence and expression of social anxiety/SAD depends on the particular culture. Asian cultures typically show the lowest rates, whereas Russian and US samples show the highest rates, of SAD. Taijin kyofusho is discussed as a possible culture-specific expression of social anxiety, although the empirical evidence concerning the validity of this syndrome has been mixed. It is concluded that the individual's social concerns need to be examined in the context of the person's cultural, racial, and ethnic background in order to adequately assess the degree and expression of social anxiety and SAD. This has direct relevance for the upcoming DSM-V.

The Separation Anxiety Daily Diary: child version: feasibility and psychometric properties

This report describes the feasibility and psychometric properties of the child version of the Separation Anxiety Daily Diary (SADD-C) in 125 children (ages 7-14 years) from German-speaking areas of Switzerland. Children with separation anxiety disorder (SAD; n = 58), "other" anxiety disorders (n = 36), and healthy controls (n = 31) recorded the frequency of parent-child separations, along with associated anxiety, thoughts, reactions and subsequent parental responses. Compliance rates were modest, consistent with past research on self-report diaries with anxious children. The SADD-C was better at discriminating children with SAD from controls than "other anxious" children. The SADD-C demonstrated good convergent validity with maternal and child self-reported anxiety (Revised Child Manifest Anxiety Scale, Separation Anxiety Inventory) and perceived quality of life (Inventory for Quality of Life in Children and Adolescents). Results provide support for the SADD-C as an acceptable and valid method of assessing child symptoms and parent behavior on separation. Findings are discussed with regard to the clinical utility of the SADD-C and strategies to improve compliance.

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

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

Nervousness and performance characteristics as predictors of peer behavior towards socially anxious adolescents

Social anxiety in adolescents has frequently been linked to negative outcomes from social interactions. The present study investigated whether socially anxious adolescents are treated negatively by their classmates and which characteristics of socially anxious adolescents could explain negative social responses. Classroom observations of class behavior were made during oral presentations of 94 students (60% females) in the ages of 13-18 years. Speakers' social performance, speech quality, and nervousness during the presentation were also rated. Findings showed that the social performance of socially anxious students was a predictor of class behavior, whereas their overt nervousness was not. Surprisingly, the quality of their speech was negatively related to class behavior. Implications of these findings for the treatment of socially anxious adolescents are discussed.

Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in the general Italian adolescent population: a validation and a comparison between Italy and The Netherlands

In this study examination is given to the psychometric properties of the Italian version of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in a large community sample of adolescents. Additionally, a comparison was made between the anxiety scores of this Italian adolescent cohort (N=1975) and a comparative Dutch adolescent cohort (N=1115). Findings revealed that a five-factor structure of the SCARED applied not only to the Italian adolescents from the general community, but also to boys and girls, and to early and middle adolescents. Moreover, sex and age differences on anxiety scores within the Italian sample were found to be consistent with previous studies of adolescent anxiety disorders. Finally, Italian adolescents reported higher anxiety scores than their Dutch peers. Findings of this study highlight that the SCARED is a valid screening instrument to rate anxiety symptoms of Italian adolescents.

Differentiating interpersonal correlates of depressive symptoms and social anxiety in adolescence: implications for models of comorbidity

Research on psychosocial correlates of depression and social anxiety often has not accounted for their comorbidity. Differentiating correlates of depression and social anxiety may inform the development of comorbidity models. Building on research linking both disorders to interpersonal dysfunction, this study examined interpersonal correlates of depressive symptoms and social anxiety in nonreferred early adolescent (M age = 13.46) girls (n = 83), controlling for comorbid symptoms. Although both showed significant bivariate correlations with peer and family variables, partial correlations revealed that social anxiety (controlling for depressive symptoms) was more strongly related to peer variables (e.g., social competence and trust and communication in friendships), whereas depressive symptoms (controlling for social anxiety) were more strongly related to family variables (e.g., lower trust and greater alienation and conflict). Comorbid girls showed heightened peer and family alienation compared to purely dysphoric or anxious girls. Implications for casual models of comorbidity and for understanding poorer outcomes associated with comorbidity and discussed.

Reliability and validity of the screen for child anxiety related emotional disorders (SCARED) in Chinese children

The present study examined the psychometric properties of the screen for child anxiety related emotional disorders (SCARED) in a large community sample of Chinese children. The 41-item version of the SCARED was administered to 1559 primary and junior high school students (774 boys and 785 girls, mean age 11.8+/-2.11) in 12 Chinese cities. The SCARED demonstrated moderate to high internal consistency (alpha=0.43-0.89) and test-retest reliability (intraclass correlation coefficients=0.46-0.77 over 2 weeks and 0.24-0.67 over 12 weeks), moderate parent-child correlation (r=0.49-0.59) and good discriminant validity (between anxiety and non-anxiety disorders). The SCARED total score was significantly correlated with the internalizing factor of the child behavior checklist (0.41). Factor analyses revealed the same five-factor structure as the original SCARED. These findings support that the SCARED is a reliable and valid anxiety screening instrument in Chinese children.

Characterizing non-OCD anxiety disorders in psychiatrically referred children and adolescents

BACKGROUND

To characterize childhood and adolescent anxiety disorders in a psychiatric clinic.

METHODS

Subjects were 1375 youth referred to a pediatric psychopharmacology program at a major academic center from 1991-2002. DSM-III-R diagnoses were obtained by Schedule for Affective Disorders and Schizophrenia for School-Age Children.

RESULTS

Of 1375 referred youth, 794 had at least one non-obsessive-compulsive anxiety disorder, and 581 psychiatric comparison subjects had at least one disruptive behavior disorder and no anxiety disorders. There were 367 (46%) youth with one anxiety disorder, 224 (28%) with two disorders. Most prevalent were separation anxiety (49%), and overanxious disorder (47%). Mean ages of onset ranged from simple phobia (4.1) to panic disorder (8.5). Risk analyses revealed anxiety disorders significantly increased risk for anxiety and mood disorders.

CONCLUSIONS

The full complement of anxiety disorders occurs in youth.

Homotypic versus heterotypic continuity of anxiety symptoms in young adolescents: evidence for distinctions between DSM-IV subtypes

Objective: to investigate homotypic and heterotypic longitudinal patterns of symptoms of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), social phobia (SoPh), panic disorder (PD), and obsessive compulsive disorder (OCD) in young adolescents from the Dutch general population.

Method: 2,067 individuals (51.4% girls) from a Dutch community sample, who were assessed for the first time when they were aged 10 to 12 years, were followed up across a period of two years. At both assessments, anxiety symptoms were assessed with the RCADS, a self-report questionnaire.

Results: Regression analyses indicated that homotypic continuity was relatively high for SAD, GAD, and SoPh symptoms, and for PD in girls.

Conclusions: In many studies, anxiety disorders are treated as one group of disorders, and some widely used assessment instruments, such as the Child Behavior Checklist, do not even contain scales that tap different anxiety dimensions. In the present study, evidence for homotypic continuity was found, especially for symptoms of separation, social, and generalized anxiety, and for symptoms of panic disorder in girls, underscoring the usefulness of making distinctions between different anxiety constructs.

Teacher awareness of anxiety symptoms in children

The present study aimed to determine which anxiety symptoms in children are associated with teacher awareness and whether teacher awareness differs according to student age and gender. The Multidimensional Anxiety Scale for Children (MASC) was completed by 453 second through fifth grade students and teachers nominated the three most anxious students in their classrooms. A multivariate analysis of variance was conducted with MASC scale scores as the dependent variables. Children identified by teachers as anxious had significantly higher levels of overall anxiety, physiological anxiety, social anxiety, and separation anxiety. Overall, teacher awareness did not differ based on student age or gender.

Distinctions between separation anxiety and social anxiety in children and adolescents

Separation anxiety and social phobia are intertwined to a considerable degree, and high comorbidity rates have been reported. The present study used latent class analysis (LCA) to investigate if classes of children and adolescents with-simultaneously-high rates of separation anxiety and low rates of social anxiety symptoms, or vice versa, could be identified. Eight- to 18-year-olds from a large general population (n=1000) and referred sample (n=735) were assessed with the Multidimensional Anxiety Scale for Children (MASC). With LCA, a separate class of referred 8-11-year-old children with high separation anxiety scores, and simultaneously lower social anxiety scores was identified, next to a class of children with high scores on separation anxiety and social anxiety. In the other groups (referred 12-18-year-olds and children and adolescents from the general population), a class with individuals who specifically scored high on separation anxiety could not be revealed. The results indicated that separation anxiety represents a different construct than social anxiety in referred children (but not in referred adolescents or in the general population). It can be concluded that, in referred children, research regarding etiology and treatment outcome of anxiety symptoms should be aimed specifically at separation anxiety and social anxiety, instead of just investigating a broader anxiety dimension.

Vulnerability factors for anxiety disorders in children and adolescents

With the maturation of community studies of adults in the past decade, there has been growing awareness of the importance of the magnitude and impact of anxiety disorders in the general population. The convergence of findings from adult and child epidemiology reveals that the onset of anxiety disorders occurs in childhood, and a substantial proportion of youth with anxiety continues to manifest lifelong problems with anxiety and other mental disorders. In this article, the major risk factors for the development of anxiety disorders in childhood and adolescence are reviewed.