The role of parenting in childhood anxiety: Etiological factors and treatment implications

New insights into recalled parental behavior in social anxiety disorder: A cluster analytic approach

BACKGROUND

Social Anxiety Disorder (SAD) is a highly heterogeneous disorder. To enlighten its heterogeneity, this study focused on recalled parental behavior and aimed to empirically identify if there are subgroups of SAD based on recalled parental behavior by means of cluster analysis. Further, the study investigated whether those subgroups differed on clinical, trauma, and personality variables.

METHODS

This study included 505 individuals diagnosed with SAD and 98 adult controls who were asked to fill out the Parental Bonding Instrument (PBI), the Adverse Childhood Experiences Questionnaire (ACE), and the Temperament and Character Inventory (TCI). Cluster analysis determined whether there are meaningful SAD subgroups based on PBI. The clusters obtained were compared with each other and with the control group with regard to clinical, ACE, and TCI variables.

RESULTS

The cluster analysis revealed two SAD clusters based on recalled parental behavior. SAD individuals in the first cluster (49.3 %) perceived their parents as intermediately caring, but not as overcontrolling. SAD individuals in the second cluster (50.7 %) perceived their parents as less caring and overcontrolling, reported more severe clinical symptoms and trauma, and had lower values in Self-Directedness and Cooperativeness.

LIMITATIONS

The present study is cross-sectional, therefore unable to confirm causal interpretations.

CONCLUSION

Parenting is meaningful to enlighten the heterogeneity of SAD symptomatology and to specify treatment approaches as there are two meaningful subgroups in individuals with SAD corresponding to differences in clinical presentation, trauma, and personality.

Study protocol for a randomized controlled trial testing the efficacy of Emotion Detectives In-Out: a blended version of the unified protocol for transdiagnostic treatment of emotional disorders in Portuguese children

BACKGROUND

Childhood emotional disorders (EDs; i.e., anxiety and depressive disorders) are currently a public health concern. Their high prevalence, long-term effects, and profound influence on the lives of children and families highlight the need to identify and treat these disorders as early and effectively as possible. This clinical trial will examine the efficacy of a blended version (i.e., combining face-to-face and online sessions into one treatment protocol) of the Unified Protocol for Children (the "Emotion Detectives In-Out" program). This program is a manualized cognitive-behavioral therapy for the transdiagnostic treatment of EDs in children aged 7 to 12 years that aims to reduce the intensity and frequency of strong and aversive emotional experiences by helping children learn how to confront those emotions and respond to them in more adaptive ways.

METHODS

This study is designed as a multicenter equivalence randomized controlled parallel-group two-arm trial comparing the Emotion Detectives In-Out program with an evidenced-based group intervention for children with anxiety disorders (the Coping Cat program). Participants will be children aged between 7 and 12 years with an anxiety disorder or with clinically significant anxiety symptoms as well as one of their parents or a legal representative. A minimum sample size of 138 children (69 per group) is needed to test whether the efficacy of the proposed intervention is equivalent to that of the well-established Coping Cat intervention.

DISCUSSION

We expect Emotion Detectives In-Out to be a feasible and efficacious alternative intervention for treating children's EDs by allowing for a greater increase in children's access to care. A blended format is expected to overcome common barriers to treatment (e.g., parents´ lack of time to attend regular sessions) and make the intervention more accessible to families.

TRIAL REGISTRATION

The clinical trial is registered at ClinicalTrials.gov (Identifier: NCT05747131, date assigned February 28, 2023).

Preschoolers and anxiety: The effect of parental characteristics

PROBLEM

Anxiety is a common phenomenon among children that can lead to adverse developmental outcomes. A challenging parent-child relationship and its characteristics may negatively impact the development of a child's internalizing problems. However, theoretical models on children's anxiety have not fully emphasized the contribution of parenting and environmental factors. Therefore, the aim of this study is to explore the possible correlations between parenting styles and other parental characteristics with children's anxiety.

METHODS

The sample consisted of 443 parents of preschool children who completed the Parenting Styles and Dimension Questionnaire and the Child Behavior Checklist 1.5-5. The univariate analysis included differences between demographic groups, assessed with independent sample t-tests. Associations between demographic evidence and child anxiety were estimated using χ2 tests. Binomial logistic regression analysis assessed the most important parenting characteristics contributing to a child's anxiety.

FINDINGS

A total of 24.6% of the children had borderline or clinical symptoms of anxiety. Parents whose children were anxious were more permissive than parents of nonanxious children (p < 0.001). Mothers were more authoritative compared to fathers. In addition, permissive parenting style increased the probability of a child's anxiety and maternal permissive style emerged as a significant predictor of anxiety in preschoolers (p < 0.003).

CONCLUSIONS

This study revealed that the permissive parenting style is associated with anxiety in preschool children. Furthermore, the maternal permissive style was identified as a predictor of anxiety. Future research may address its causal effect on anxiety and other behavioral problems, focusing on multiple perspective relationships and cultural dimensions.

Clinician Maladaptive Anxious Avoidance in the Context of Implementation of Evidence-Based Interventions: A Commentary

This paper posits that a clinician's own anxious reaction to delivering specific evidence-based interventions (EBIs) should be better accounted for within implementation science frameworks. A key next step for implementation science is to delineate the causal processes most likely to influence successful implementation of evidence-based interventions (EBIs). This is critical for being able to develop tailored implementation strategies that specifically target mechanisms by which implementation succeeds or fails. First, we review the literature on specific EBIs that may act as negatively valenced stimuli for clinicians, leading to a process of clinician maladaptive anxious avoidance that can negatively impact EBI delivery. In the following sections, we argue that there are certain EBIs that can cause emotional distress or discomfort in a clinician, related to either: (1) a clinicians' fear of the real or predicted short-term distress the EBI can cause patients, or (2) fears that the clinician will inadvertently cause the patient harm and/or face liability. This distress experienced by the clinician can perpetuate a cycle of maladaptive anxious avoidance by the clinician, contributing to lack of or suboptimal EBI implementation. We illustrate how this cycle of maladaptive anxious avoidance can influence implementation by providing several examples from leading EBIs in the psychosocial literature. To conclude, we discuss how leveraging decades of treatment literature aimed at mitigating maladaptive anxious avoidance can inform the design of more tailored and effective implementation strategies for EBIs that are negatively valenced.

From mothers to children and back: Bidirectional processes in the cross-generational transmission of anxiety from early childhood to early adolescence

BACKGROUND

Maternal psychopathology and caregiving behavior are linked with child anxiety and these associations may be particularly salient when families face mass trauma together and members influence each other's symptomatology and resilience. Despite the well-known mother-to-child effects, less research addressed the longitudinal bidirectional effects of maternal and child's anxiety symptoms on each other.

METHODS

Mothers and children exposed to chronic war-related trauma from Sderot, Israel, and comparison group were followed at three time-points; Early childhood (T1:N = 232, M_Age  = 2.76 years), late childhood (T3:N = 176, M_Age  = 9.3 years), and early adolescence (T4:N = 110, M_Age  = 11.66 years). At each time-point maternal and child's anxiety symptoms were evaluated via questionnaires and maternal sensitivity was coded from videotaped observations of parent-child interactions. Bidirectional associations were examined using traditional cross-lagged panel model (CLPM) and CLPM with random intercepts (RI-CLPM).

RESULTS

Trauma-exposed mothers and children exhibited more anxiety symptoms and lower maternal sensitivity. Cross-lagged panel models revealed cross-time bidirectional associations between maternal anxiety and child anxiety from early to late childhood. Child anxiety at each time-point predicted maternal anxiety and maternal sensitivity at the next stage; however, maternal sensitivity did not show longitudinal associations with child anxiety, highlighting children's role in shaping caregiving.

CONCLUSIONS

Findings demonstrate bidirectional cross-generational influences of mother and child on each other's anxiety in contexts of trauma and pinpoint early childhood as a sensitive period for such mutual influences. Children's increased anxiety following trauma appears to be further exacerbated via its impact on increasing maternal anxiety and compromising sensitive caregiving, underscoring the potential benefits of parental and mother-child interventions for trauma-exposed populations.

Maternal Anxiety and Separation Anxiety in Children Aged Between 3 and 6 Years: The Mediating Role of Parenting Style

OBJECTIVE

Maternal anxiety is known to be associated with childhood separation anxiety. However, there is little research on the mediating factors of this relationship, despite the possible consequences separation anxiety might have for children's development and autonomy. The objective of this study was to analyze the possible mediating effects of 4 parenting styles (overprotective, assertive, punitive, and inhibited) on the relationship between maternal anxiety and child separation anxiety.

METHODS

Participants were 235 mothers with children aged 3 to 6 years, recruited from 6 preschools in the southeast of Spain. Maternal trait anxiety, maternal parenting style, and child separation anxiety were evaluated.

RESULTS

A parallel multiple-mediation analysis revealed that the overprotective parenting style was a significant mediator of the relationship between maternal trait anxiety and child separation anxiety. In addition, mothers with higher trait anxiety scores exhibited a greater likelihood of using an overprotective, punitive, or less assertive parenting style. Younger mothers were more likely to use an overprotective parenting style, and compared with girls, boys were more exposed to the assertive style.

CONCLUSION

This study provides initial evidence that parenting style acts as a mediator of the relationship between maternal anxiety and child separation anxiety.

The mediating role of parenting behaviors in the relationship between early and late adolescent levels of anxiety: Specificity and informant effects

INTRODUCTION

The role of parenting behavior is often highlighted in the development of anxiety in youth. However, previous reports are limited in terms of the specificity of relationships between different types of anxiety and parenting behaviors, informant effects on these relationships, and direction of effects.

METHODS

This study investigates these questions using longitudinal data from 1350 Swedish adolescents and their parents. Adolescents' self-reports of six dimensions of anxiety and adolescents' and parents' reports of six dimensions of parenting behaviors were used in the analyses. Parallel multiple mediation models were employed to analyze specificity and informant effects within a reciprocal effects model.

RESULTS

Overall, and irrespective of informant, this study found little support for a mediating role of parenting behaviors in the relationship between early and late adolescent levels of anxiety. Evidence for specificity within the parenting-anxiety relationship was scarce with specific mediating effects observed only for panic/agoraphobia and total anxiety through the parenting dimension of rejection.

CONCLUSIONS

The findings of this study concern the un-conditional mediating role of parenting. Parenting behaviors may be more influential among some adolescents, depending on individual differences in other factors related to the development and course of adolescent anxiety. Thus, further research on moderating factors of the influence of parenting on adolescent anxiety is warranted.

The Parenting Anxious Kids Ratings Scale-Parent Report (PAKRS-PR): Initial Scale Development and Psychometric Properties

Developmental models of pediatric anxiety posit multiple, maladaptive parenting behaviors as potential risk factors. Despite this, a standardized means of assessing multiple of these practices (i.e., anxiogenic parenting) in a comprehensive and efficient manner are lacking. In Study 1531 parents of children 7-17 years old completed an online survey via Amazon Mechanical Turk. In Study 2, a separate community sample (N = 109; 9-17 years old) was recruited and completed a comprehensive assessment battery as part of a larger study. All parents (Study 1 and 2 samples) completed the Parenting Anxious Kids Ratings Scale-Parent Report (PAKRS-PR), a measurement tool designed to assess anxiogenic parenting. Factor analysis conducted as part of Study 1 revealed a 32-item scale consisting of five factors: conflict, overinvolvement, accommodation/beliefs, modeling, and emotional warmth/support. Four of these factors were significantly correlated with parent-report of anxiety severity. Within Study 2, the parents of children diagnosed with an anxiety or related disorder reported significantly higher levels of anxiogenic parenting practices as compared to the parents of healthy controls. The PAKRS-PR and respective subscales demonstrated acceptable reliability and validity in both the internet (Study 1) and community (Study 2) samples. The PAKRS-PR may be a beneficial multidimensional parenting scale for use among anxious youths.

Involvement in Child Rearing and Firm Control Parenting by Male Cohabiting Partners in Black Low-Income Stepfamilies: Forecasting Adolescent Problem Behaviors

Cohabitation is a family structure that is rapidly increasing in the United States. The current longitudinal study examined the interplay of involvement in a youth's daily activities and firm control parenting by male cohabiting partners (MCPs) on change in adolescents' internalizing and externalizing problems. In a sample of 111 inner-city African American families, adolescents reported on involvement and parenting by MCPs at Wave 1 and biological mothers reported on adolescent problem behaviors at Waves 1 and 2. A significant interaction indicated that low involvement and low firm control by MCPs at Wave 1 were associated with the highest level of internalizing problems at Wave 2. An interaction did not emerge when externalizing problems served as the outcome. The findings indicate that male partners play an important role in parenting adolescents in cohabiting families and should be considered potential participants in prevention and intervention programs.

Parent Emotion Socialization Practices and Child Self-regulation as Predictors of Child Anxiety: The Mediating Role of Cardiac Variability

The importance of the parent-child relationship in emotional development is well supported. The parental role of facilitating a child's self-regulation may provide a more focused approach for examining the role of parenting in child anxiety. The current study hypothesized that parent emotion socialization practices would predict a child's abilities in self-regulation. Given that physiological arousal has been implicated in emotional development, this was hypothesized to mediate the relationship between parental emotion socialization and child emotion regulation to predict child anxiety. Eighty-five parent and child dyads participated in the study. Parents reporting higher degrees of unsupportive emotion socialization were more likely to have children with fewer abilities in emotion regulation. Cardiac responsiveness mediated the relationship between unsupportive emotion socialization and child emotion regulation. The model of cardiac responsiveness mediating the relationship between unsupportive emotion socialization and child emotion regulation failed to reach statistical significance in predicting child anxiety symptoms.

Interpretation bias modification for youth and their parents: a novel treatment for early adolescent social anxiety

Social anxiety is the most prevalent anxiety disorder of late adolescence, yet current treatments reach only a minority of youth with the disorder. Effective and easy-to-disseminate treatments are needed. This study pilot tested the efficacy of a novel, online cognitive bias modification for interpretation (CBM-I) intervention for socially anxious youth and their parents. The CBM-I intervention targeted cognitive biases associated with early adolescents' maladaptive beliefs regarding social situations, and with parents' intrusive behavior, both of which have been theoretically linked with the maintenance of social anxiety in youth. To investigate the efficacy of intervening with parents and/or children, clinically diagnosed early adolescents (ages 10-15; N=18) and their mothers were randomly assigned to one of three conditions: the first targeted early adolescents' cognitive biases related to social anxiety (Child-only condition); the second targeted parents' biases associated with intrusive behavior (Parent-only condition); and the third targeted both youth and parents' biases in tandem (Combo condition). The use of a multiple baseline design allowed for the efficient assessment of causal links between the intervention and reduction in social anxiety symptoms in youth. Results provided converging evidence indicating modest support for the efficacy of CBM-I, with no reliable differences across conditions. Taken together, results suggest that online CBM-I with anxious youth and/or their parents holds promise as an effective and easily administered component of treatment for child social anxiety that deserves further evaluation in a larger trial.