Fears in American, Australian, Chinese, and Nigerian children and adolescents: a cross-cultural study

Self-reported fears and mental health in elementary school children across Europe

Fears are common in the general population and particularly among children. The number of fear subtypes (animals, natural environment, situational, blood-injection-injury or other type) has been shown to be associated with psychopathology. Furthermore, there is evidence suggesting that some subtypes may be more often associated with mental disorders than others. The present study uses data from a large cross sectional survey, the School Children Mental Health in Europe (SCMHE) study, conducted in eight European countries on children ages 6 through 13-years-old attending elementary school (n = 9613). Fear subtypes and self-reported mental health were assessed using the Dominic Interactive (DI), a self-administered computerized image-based questionnaire. The findings show that the number of fear subtypes is strongly associated with self-reported internalizing and externalizing problems. In addition, adjusting for the number of subtypes, fear of animals was less likely than other fears to be associated with psychopathology. The findings support the notion that children who report excessive and generalized fear should be targeted for prevention, consistent with research identifying childhood onset generalized specific phobia as a probable precursor to subsequent psychopathology.

Association between developmental dyslexia and anxiety/depressive symptoms among children in China: The chain mediating of time spent on homework and stress

BACKGROUND

The relationship between dyslexia and anxiety/depressive symptoms among children in China is unclear. Besides, the pathways to explain the risks are also undefined.

METHODS

3993 primary school students from grade 2 to 6 were recruited in this study. The Dyslexia Checklist for Chinese Children and the Pupil Rating Scale-Revised Screening for Learning Disabilities were used to filter the dyslexic children. The Chinese perceived stress scale, the Screen for Child Anxiety Related Emotional Disorders, and the Children's Depression Inventory-Short Form were used separately to assess stress, anxiety symptoms, and depressive symptoms of the children. Time spent on homework was obtained by asking their parents: "How long does it take the children to complete the homework every day?". The chain mediation models were examined using SPSS PROCESS macro 3.3 software.

RESULTS

Dyslexic children spend more time on homework (2.61±1.15), and have higher scores for depression (4.75±3.60) and stress (26.55±7.40) compared to normal children (1.87±0.77, 3.25±3.32, and 23.20±8.43, respectively). The differences are statistically significant (all P<0.01). There is no direct association between dyslexia and anxiety symptoms, while dyslexia has a direct link with depressive symptoms. Dyslexia could affect anxiety/depressive symptoms via the independent mediating effect of stress and the chain mediating effect of time spent on homework and stress. The total indirect effect is 0.21 and 0.25, respectively.

LIMITATIONS

The data used in our study is self-reported and this is a cross-sectional study.

CONCLUSIONS

Time spent on homework and stress could mediate the association between dyslexia and anxiety/depressive symptoms.

Something Scary is Out There II: the Interplay of Childhood Experiences, Relict Sexual Dinichism, and Cross-cultural Differences in Spatial Fears

Children’s nighttime fear is hypothesized as a cognitive relict reflecting a long history of natural selection for anticipating the direction of nighttime predatory attacks on the presumed human ancestor, Australopithecus afarensis, whose small-bodied females nesting in trees would have anticipated predatory attacks from below. Heavier males nesting on the ground would have anticipated nighttime predatory attacks from their sides. Previous research on preschool children and adults supports this cognitive-relict hypothesis by showing developmental consistencies in their remembrances of the location of a “scary thing” relative to their beds. The current study expands this research by investigating whether nighttime fear in childhood, including the effect of parental threats to behave, influenced adult spatial fears in different biotic and abiotic situations. A 25-item questionnaire employing ordinal scales was given to 474 foreign-born Vietnamese and ethnic Chinese adults living in the USA. Univariate analyses of adult remembrances of childhood indicated that females were more fearful of something scary below their beds than males. To examine the influence of childhood nighttime fear on adult fears, exploratory factor analyses supported three factors: (1) indeterminate agents, indicated something scary under the bed, the difficulty locating unspecific threats, and the brief appearances of large apparitions; (2) environmental uncertainty, indicated by potential encounters with unseen animate threats; (3) predictable animals, as the relative comfort of viewing animals in zoo exhibits. Using structural equation modeling, the results suggest that childhood nighttime fear influenced only the latent variable, indeterminate agents, in both groups via the mediating variable, parental threats.

Fear and Anxiety Pathways Associated with Root Canal Treatments Amongst a Population of East Asian Origin

Objective

This study aimed to identify and compare the pathways of endodontic fear and anxiety amongst East Asian origin patients attending Griffith University's Dental Clinics, Gold Coast, Australia.

Methods

East Asian patients who attended the Griffith University dental clinics were included in this study. The "My Endodontic Fear" survey was used. The pathways involved in self-perception of dental fear and anxiety were assessed through 5 different questions. Chi-square test was for statistical analysis and the level of significance was set at P<0.05.

Results

One hundred and forty six participants (n=146) (ages 18-62 years) of East Asian descent met the criteria to participate. 58.2% were females, and 41.8% males. The ethnicities were split into Chinese origin and non-Chinese origin (Korean, Phillipino, Japanese, Vietnamese). Results indicate multiple pathways affect the origin of fear, regardless of ethnicity. The Cognitive Conditioning pathway was the primary pathway selected by the Chinese and non-Chinese sub groups (51.4%, 43.6%) followed by the Informative (38.3%, 38.5%), then Vicarious (27.1%, 33.3%) and Parental (18.7%, 33.3%) pathways respectively.The Verbal Threat pathway was the least selected pathway for both groups, however the non- Chinese group selected this pathway significantly more often than the Chinese group (P<0.001).

Conclusion

This study demonstrates that the Cognitive Conditioning pathway was the primary fear and anxiety pathway utilized by both East Asian sub-groups. Understanding how patients develop fear and anxiety can help treating dentists discuss triggering factors for patients and alleviate undue anxiety prior to treatment.

Depression, anxiety, and post-traumatic stress disorder among youth in low and middle income countries: A review of prevalence and treatment interventions

BACKGROUND

Low and middle income countries (LMICs) not only have the majority of the world's population but also the largest proportion of youth. Poverty, civil conflict and environmental stressors tend to be endemic in these countries and contribute to significant psychiatric morbidity, including depression, anxiety and post-traumatic stress disorder (PTSD). However, mental health data from LMICs is scarce, particularly data on youth. Evaluation of such information is crucial for planning services and reducing the burden of disability. This paper reviews the published data on the prevalence and randomized trials of interventions for depression, anxiety and PTSD in youth in LMICs.

METHODS

PubMed and Google Scholar were searched for articles published in English up to January 2017, using the keywords: Low/middle income country, depression, anxiety, post-traumatic stress disorder, child, youth, adolescent, prevalence, treatment, intervention, and outcomes.

RESULTS

The few prevalence studies in LMICs reported rates of up to 28% for significant symptoms of depression or anxiety among youth, and up to 87% for symptoms of PTSD among youth exposed to traumatic experienences, though these rates varied widely depending on several factors, including the assessments tools used. Most rigorous interventions employed some form or variation of CBT, with mixed results. Studies using other forms of psychosocial interventions appear to be heterogeneous and less rigorous.

CONCLUSIONS

The mental health burden due to depression and anxiety disorders in youth is substantial in LMICs, with high needs but inadequate services. Youth specific services for early detection and cost-effective interventions are needed.

The association between car accident fatalities and children's fears: A study in seven EU countries

Children's fear of a car accident occurring to parents or themselves has been used as a concrete example to illustrate one of the symptoms of anxiety disorders such as separation anxiety and generalized anxiety. However, its usage across countries may be questionable where the prevalence of this specific type of injury differs. This cross-sectional study compares samples from seven diverse European countries (Bulgaria, Germany, Italy, Lithuania, Netherlands, Romania, Turkey) to see if an environmental exposure, car accident death rate per 100,000 people (country-wide from WHO data), is associated with children's self-report of car accident fears. In this study, 6-11 year-old children were surveyed by a diagnostic instrument (Dominic Interactive) about several situations and asked if they believed they were similar to a fictional child depicted in said situations. Mothers were surveyed for additional sociodemographic information. Multivariable logistic regression was used to adjust for covariates including mother's age, mother's education, single parenting, and mother's professional inactivity. We report a monotonic relationship between higher car accident death rates and the prevalence of children reporting fear of parent's or own accident. Relative to a reference of 3.9 deaths per 100,000 people, children's odds of reporting fear of parent's accident ranged from 1.99 (95% CI 1.51-2.61) times to 4.84 (95% CI 3.68-6.37) times as the risk of death by car accident increased across countries. A similar result arose from fear of child's own accident, with significant ORs ranging from 1.91 (95% CI 1.53-2.40) to 2.68 (95% CI 2.07-3.47) alongside increased death rates. Given that reporting of these fears accompanies correspondingly high accident death rates, the pertinence of using fear of car accidents as an illustration for some diagnostic item for mental disorders cross-nationally appears to be an issue.

Cross-cultural measurement invariance of the Revised Child Anxiety and Depression Scale across 11 world-wide societies

BACKGROUND

In order to compare estimates by one assessment scale across various cultures/ethnic groups, an important aspect that needs to be demonstrated is that its construct across these groups is invariant when measured using a similar and simultaneous approach (i.e., demonstrated cross-cultural measurement invariance). One of the methods for evaluating measurement invariance is testing for differential item functioning (DIF), which assesses whether different groups respond differently to particular items. The aim of this study was to evaluate the cross-cultural measurement invariance of the Revised Child Anxiety and Depression Scale (RCADS) in societies with different socioeconomic, cultural, and religious backgrounds.

METHODS

The study was organised by the International Child Mental Health Study Group. Self-reported data were collected from adolescents residing in 11 countries: Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, Palestinian Territories, the Philippines, Portugal, Romania and Serbia. The multiple-indicators multiple-causes model was used to test the RCADS items for DIF across the countries.

RESULTS

Ten items exhibited DIF considering all cross-country comparisons. Only one or two items were flagged with DIF in the head-to-head comparisons, while there were three to five items flagged with DIF, when one country was compared with the others. Even with all cross-culturally non-invariant items removed from nine language versions tested, the original factor model representing six anxiety and depressive symptoms subscales was not significantly violated.

CONCLUSIONS

There is clear evidence that relatively small number of the RCADS items is non-invariant, especially when comparing two different cultural/ethnic groups, which indicates on its sound cross-cultural validity and suitability for cross-cultural comparisons in adolescent anxiety and depressive symptoms.

Towards a comprehensive test specification for normative adolescent fears: a conservation of resources perspective

OBJECTIVE

This study assessed the extent to which the primary tenets of Conservation of Resources theory provide an adequate basis for categorising and conceptualising normative adolescent fears.

METHOD

Initial descriptive research, using data obtained from a sample of South African adolescents (n = 163), used systematic emergent content analysis to develop a test specification (i.e., content domains and manifestations of content domains) relevant to measures of normative adolescent fears, with subsequent a priori content analyses being used to explore the content validity of the test specification with respect to the item-content of selected normative childhood and adolescent fear schedules.

RESULTS

Analyses suggest that content domains proposed by Conservation of Resources theory provide an adequate (exhaustive and mutually exclusive) basis for reliably conceptualising and categorising normative adolescent fears and for predicting the valence of specific adolescent fears.

CONCLUSIONS

A Conservation of Resources perspective was found to be of heuristic value in exploring content domains relevant to normative adolescent fears, and would appear to hold promise as a useful conceptual framework for future research in the field.

Child-Parent Agreement in the Assessment of Young Children's Fears

Finnish and Estonian parents' assessments of their 5- to 6-year-old children's fears (selected items of the Ollendick Fear Survey Schedule) were compared with children's self-reported fears in a semistructured interview that included a picture-aided section. Representative samples from Finland and Estonia consisted of 330 child-parent pairs. The level of agreement between the informants'assessmentswas lowin both countries. Children reported more fears than did their parents in comparable items. Parents in both countries seem to underestimate children's fears. These findings suggest that children should be primary informants of their fears. In addition, the same types of differences in children's fears were revealed between the countries irrespective of the informant. Finnish children expressed more fears related to issues of mental overexcitation; the fears of Estonian children more often concerned concrete people's behavior.

An exploratory study of fears among adolescent students from an urban cohort in India

BACKGROUND

Normal fear is an adaptive response to a real or imagined threat. Fears occur in children and adolescents at varying levels while they negotiate different developmental phases.

OBJECTIVE

The present study aimed at assessing the types of fears in children and adolescents between the ages of 11 and 19 years. Age and gender based differences in these fears were also studied.

MATERIALS AND METHODS

The study sample consisted of 2010 adolescents from an urban setting between the ages of 11 and 19 who filled in a proforma questionnaire for socio-demographic details and also filled in the Fear Survey Schedule for Children-Revised (FSSC-R). Statistical analysis of the data was done along with the use of descriptive statistics.

RESULTS

The prevalence of fears among adolescents was found to be 85.17% in the total sample. Girls reported a significantly greater number of fears (p<0.0001) and greater levels of fear (p<0.0001) than boys. Age however, did not affect the number of fears reported. Girls scored significantly higher on all the subscales of the FSSC-R. 'Failing a test' emerged as the most common fear expressed by the sample. Girls expressed a greater fear for snakes and earthquakes than boys.

CONCLUSION

Girls expressed fears to a greater extent than boys and adolescents demonstrated a high level of fears in general. There is a need for further studies in this direction to elucidate the nature of fears in this population.

Psychometric Properties of Farsi Version of the Revised Fear Survey Schedule for Children

This study examined the psychometric properties of the Farsi version of the Revised Fear Survey Schedule for Children (Ollendick, 1983), namely the FSSC-FA, in a sample of Iranian children and adolescents (N = 394, 206 girls) aged 9-11:11 years. The internal consistency coefficient was found to range from .79 to .96 for total and subscale scores. The authors used exploratory and confirmatory factor analyses to determine the factor structure of the FSSC-FA. The results showed that a 71-item, six-factor model provided a satisfactory fit for the structure of the FSSC-FA (RMSEA = .07, 90% CIs [.068, .072], CFI = .94, NNFI = .94, χ2/df = 2.94). With regard to gender and age differences in fears of the present sample, girls typically reported more fears than boys (Cohen's d = .28, 95% CIs [.08, .48], p < .001), but differences between older and younger participants were modest. The study also reported most common fears in the sample which were very similar to those reported by other studies except one item being specific to the Iranian population. Bearing in mind the limitations discussed, the results generally show that the FSSC-FA scores are valid and reliable to assess fears in Iranian youth.

Psychometric properties of the RCMAS-2 in pediatric cancer patients

PURPOSE OF THE RESEARCH

The Revised Children's Manifest Anxiety Scale, second edition (RCMAS-2) is widely used internationally to assess anxiety. However, there is little data regarding its validity for pediatric cancer patients. This study evaluated the psychometric properties of the RCMAS-2 in pediatric cancer patients.

METHODS AND SAMPLE

This cross-sectional study included 370 pediatric cancer patients (aged 6-19 years) that were recruited from three medical centers between August 2008 and March 2011 in Taiwan. Reliability was evaluated by internal consistency. Confirmatory factor analysis was performed to examine the factor structure. Construct validity was examined by known-groups analyses.

KEY RESULTS

The internal consistency of the full scale was good (α = 0.90) but the scores of Physiological Anxiety subscale was low (α = 0.65). Using known-groups validity, significant differences in anxiety were observed between genders and between patients that were on and off treatment. The hypothesized three-factor model did not adequately fit (χ(2)/d.f = 2.4; p < 0.01, GFI = 0.80, CFI = 0.71, RMSEA = 0.06, SRMR = 0.01).

CONCLUSIONS

The RCMAS-2 demonstrated reliability and validity for use with pediatric cancer patients aged 6 and 19 years. Further structure evaluation of the RCMAS-2 in pediatric oncology population is needed, and the scores of the Physiological Anxiety subscale should be interpreted with caution.

Self-reported depression and anxiety symptoms in school-aged Singaporean children

INTRODUCTION

Few studies have examined anxiety and depression experiences of primary (middle) school-aged children from ethnically diverse backgrounds, and most have relied on parents or others as informants. The present study aimed to investigate self-reported anxiety and depression symptoms in Singaporean primary school-aged children. Age, gender, and ethnic differences and interactions were explored as well as similarities and differences between Singaporean children and US norms.

METHODS

A large representative community sample of 1655 8- to 12-year-old Singaporean children (Chinese, Malay, and Indian) completed the Multidimensional Anxiety Scale for Children (MASC) and the Children's Depression Inventory (CDI) as part of a larger epidemiological study of mental health in Singaporean children.

RESULTS

Rates of clinically elevated symptoms of anxiety and depression were 9.3% and 16.9% on the MASC and the CDI, respectively. Separation and social anxieties were most common. Evidence of a gender difference in levels of emotional symptoms was most evident in Indian children, with girls reporting more symptoms than boys. The relationship between age and internalizing problems was weak.

DISCUSSION

A substantial minority of primary school-aged Singaporean children reported elevated anxious and depressive symptoms. Better understanding of the factors that contribute to the development and maintenance of these problems can help the development of culture-specific interventions and facilitate the planning of community-tailored services and initiatives.

The short form of the fear survey schedule for children-revised (FSSC-R-SF): an efficient, reliable, and valid scale for measuring fear in children and adolescents

The present study examined the psychometric properties of the Short Form of the Fear Survey Schedule for Children-Revised (FSSC-R-SF) in non-clinical and clinically referred children and adolescents from the Netherlands and the United States. Exploratory as well as confirmatory factor analyses of the FSSC-R-SF yielded support for the hypothesized five-factor structure representing fears in the domains of (1) failure and criticism, (2) the unknown, (3) animals, (4) danger and death, and (5) medical affairs. The FSSC-R-SF showed satisfactory reliability and was capable of assessing gender and age differences in youths' fears and fearfulness that have been documented in previous research. Further, the convergent validity of the scale was good as shown by substantial and meaningful correlations with the full-length FSSC-R and alternative childhood anxiety measures. Finally, support was found for the discriminant validity of the scale. That is, clinically referred children and adolescents exhibited higher scores on the FSSC-R-SF total scale and most subscales as compared to their non-clinical counterparts. Moreover, within the clinical sample, children and adolescents with a major anxiety disorder generally displayed higher FSSC-R-SF scores than youths without such a diagnosis. Altogether, these findings indicate that the FSSC-R-SF is a brief, reliable, and valid scale for assessing fear sensitivities in children and adolescents.

Childhood anxiety trajectories and adolescent disordered eating: findings from the NICHD Study of Early Child Care and Youth Development

OBJECTIVE

The goal of the present article was to examine whether childhood anxiety trajectories predict eating psychopathology. We predicted that girls with trajectories of increasing anxiety across childhood would have significantly greater risk of disordered eating in adolescence in comparison to girls with stable or decreasing trajectories of anxiety over childhood.

METHOD

Data were collected as part of the prospective longitudinal NICHD Study of Early Child Care and Youth Development (N = 450 girls). Childhood anxiety was assessed yearly (54 months through 6th grade) via maternal report on the Child Behavior Checklist. Disordered eating behaviors were assessed at age 15 via adolescent self-report on the Eating Attitudes Test (EAT-26). We conducted latent growth mixture modeling to define girls' childhood anxiety trajectories. Maternal sensitivity, maternal postpartum depression, maternal anxiety, and child temperament were included as predictors of trajectory membership.

RESULTS

The best fitting model included three trajectories of childhood anxiety, the low-decreasing class (22.9% of girls), the high-increasing class (35.4%), and the high-decreasing class (41.6%). Mothers with more symptoms of depression and separation anxiety had girls who were significantly more likely to belong to the high-increasing anxiety trajectory. There were no significant differences in adolescent disordered eating for girls across the three childhood anxiety trajectories.

DISCUSSION

Childhood anxiety, as captured by maternal report, may not be the most robust predictor of adolescent disordered eating and may be of limited utility for prevention programs that aim to identify children in the community at greatest risk for disordered eating.

Assessment Practices and Issues with School-refusing Children

School refusal is a complex and heterogeneously determined and experienced behaviour problem. Due to its complexity and heterogeneity, a multimethod and multisource approach to assessment is required. The approach is described as a hypothesis-testing approach which uses developmentally sensitive and empirically validated procedures. Clinical-behavioural interviews, structured diagnostic interviews, self-reports, reports of significant others, self-monitoring, and behavioural observations are recommended. Issues associated with these procedures are reviewed.

Child anxiety and parenting in England and Italy: the moderating role of maternal warmth

BACKGROUND

Parenting factors have been implicated in the aetiology and maintenance of child anxiety. Most research has been correlational with little experimental or longitudinal work. Cross-cultural comparison could be illuminating. A comparison of Italian and British children and their mothers was conducted.

METHODS

A sample of 8- to 10-year old children, 60 Italian and 49 English, completed the Spence Child Anxiety Scale. Mothers also completed two questionnaires of parenting: the Skills of Daily Living Checklist (assessing maternal autonomy granting) and the Parent-Child Interaction Questionnaire (assessing maternal intrusiveness). Parenting was assessed in two video-recorded blindly rated mother-child interaction tasks, the 'belt-buckling tasks and the 'etch-a-sketch', providing objective indices of overcontrol, warmth, lack of autonomy granting, and overprotection.

RESULTS

There were no differences between the children in overall anxiety and specific forms of anxiety. Parenting, however, was markedly different for the two countries. Compared to English mothers, on the two questionnaires, Italian mothers were significantly less autonomy granting and more intrusive; and in terms of the observed indices, a significantly greater proportion of the Italian mothers displayed a high level of both overprotection and overcontrol, and a low level of autonomy granting. Notably, Italian mothers evidenced significantly more warmth than English mothers; and maternal warmth was found to moderate the impact of self-reported maternal intrusiveness on the level of both overall child anxiety and the level of child separation anxiety; and it also moderated the relationship between both observed maternal intrusiveness and overall child anxiety and observed maternal overprotectiveness and child separation anxiety.

CONCLUSIONS

Although, compared to the British mothers, the Italian mothers were more likely to evidence high levels of parenting behaviours previously found to be anxiogenic, the high levels of warmth displayed by these mothers to their children appears to have neutralised the adverse impact of these behaviours.

Prevalence, correlates, and comorbidities of four DSM-IV specific phobia subtypes: results from the Korean Epidemiological Catchment Area study

Although several studies have detected differences in clinical features among specific phobias, there is a shortage of detailed national data on the on the DSM-IV SP subtypes, particularly in the Asian population. To examine the prevalence, demographic and other correlates, and co-morbidities of DSM-IV SP subtypes in a nationwide sample of Korean adults. We recruited 6510 participants aged 18-64 years for this study. Lay interviewers used the Composite International Diagnostic Interview to assess participants. We analyzed socio-demographics, health-related correlates and frequencies of comorbid mental disorders among participants with SP and each subtypes compared to unaffected adults. The prevalence of lifetime DSM-IV SP was 3.8%, and animal phobias were the most prevalent type of SP. Blood-injection-injury phobia was negatively associated with education, whereas situational phobia was positively associated with education. The strongest mental disorder comorbidity was associated with situational phobia; there is a higher probability of comorbid mood (OR=5.73, 95% CI=2.09-15.73), anxiety (OR=7.54, 95% CI=2.34-24.28), and somatoform disorders (OR=7.61, 95% CI=1.64-35.22) with this subtype. Blood-injection-injury phobia was highly associated with alcohol dependence (OR=9.02, 95% CI=3.54-23.02). Specific phobias are heterogeneous with respect to socio-demographic characteristics and comorbidity pattern. Implications of the usefulness of current subtype categories should continue to be investigated.

Examining the cultural validity of fear survey schedule for children: the contemporary fears of Turkish children and adolescents

The authors examined the cultural validity of Fear Survey Schedule for Children (FSSC-AM) developed by J. J. Burnham (2005) with Turkish children. The relationships between demographic variables and the level of fear were also tested. Three independent data sets were used. The first data set comprised 676 participants (321 women and 355 men) and was used for examining factor structure and internal reliability of FSSC. The second data set comprised 639 participants (321 women and 318 men) and was used for testing internal reliability and to confirm the factor structure of FSCC. The third data set comprised 355 participants (173 women and 182 men) and used for analyses of test-retest reliability, inter-item reliability, and convergent validity for the scores of FSSC. The sum of the first and second samples (1,315 participants; 642 women and 673 men) was used for testing the relationships between demographic variables and the level of fear. Results indicated that FSSC is a valid and reliable instrument to examine Turkish children's and adolescents' fears between the ages of 8 and 18 years. The younger, female, children of low-income parents reported a higher level of fear. The findings are discussed in light of the existing literature.

Psychometric properties of the social phobia and anxiety inventory-child version in a Swedish clinical sample

The social phobia and anxiety inventory for children (SPAI-C) is a 26 item, empirically derived self-report instrument developed for assessing social phobic fears in children. Evidence for satisfactory psychometric properties of the SPAI-C has been found in multiple community studies. Since its development, however, no study has presented an extensive psychometric evaluation of SPAI-C in a sample of carefully diagnosed children with social phobia. The present study sought to replicate and expand previous studies by administrating the SPAI-C to a sample of 59 children that fulfilled DSM-IV criteria for social phobia, and 49 children with no social phobia diagnosis. An exploratory factor analysis resulted in a three factor solution reflecting: (1) fear of social interactions, (2) fear of public performance situations, and (3) physical and cognitive symptoms connected with social phobia. These factors appear to parallel domains of social phobia also evident in adults. The SPAI-C total scale and each factor was found to possess good internal consistency, good test-retest reliability and was generally strongly correlated with both self-report and clinician measures of anxiety and fears. The discriminative properties of the total scale were satisfactory.

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.

The structure of anxiety symptoms among adolescents in Iran: a confirmatory factor analytic study of the Spence Children's Anxiety Scale

The present study examined the psychometric properties of the Iranian translation of the Spence Children's Anxiety Scale (SCAS) in a large community sample of adolescents (N = 1984), aged 12-17 years, in Ahvaz City, Iran. In addition to the SCAS, all participants completed the Strengths and Difficulties Questionnaire (SDQ), and the Centre for Epidemiological Studies Depression Scale for Children (CES-DC). The internal consistency (Cronbach Alpha = .92) and the validity of the Iranian translation of the SCAS was excellent. The SCAS total scores correlated significantly with the CES-DC, as well as with the emotional, conduct problems, hyperactivity-inattention, and peer problems subscales of the SDQ. However, Steiger's Z test demonstrated that correlations between the SCAS scores and the SDQ conduct problems or hyperactivity-inattention subscales were significantly lower than the correlations between the SCAS scores and the SDQ emotional symptoms subscale. Confirmatory factor analyses revealed the same 6-factor structure as the original SCAS. The SCAS proved to be a reliable and valid measure of anxiety symptoms among adolescents in Iran.

Construction and validation of the South African version of the Fear Survey Schedule for Children: an exploratory factor analysis

The Fear Survey Schedule for Children-Revised (Ollendick, 1983) is an 80-item self-report instrument that has been used internationally to asses the number of fears and general level of fearfulness among children. Despite its widespread use, this instrument has not been adapted to the South African context. The present study addressed this gap by means of a 2-phase investigation aimed at developing a South African version of the instrument. In Phase 1, semistructured interviews were conducted with 40 children (7 to 13 years of age). Qualitative data obtained from these interviews were used to construct additional items for inclusion in the South African Fear Survey Schedule for Children-Revised. The modified scale, consisting of 97 items, was then administered to a sample of 646 children between the ages of 7 and 13 years. Further psychometric considerations resulted in the final version of the scale consisting of 74 items with high internal consistency (α=.97). The factor structure was explored by means of principal component analysis with varimax rotation and a 5-factor solution was found to provide the best conceptual fit. The factors identified were as follows: Fear of Death and Danger; Fear of the Unknown; Fear of Small Animals and Minor Threats to Self; Large Animal Fears; and Situational Fears. Differences between the South African version and the original Fear Survey Schedule for Children-Revised are noted and implications for the study of fear in South Africa and other countries are discussed.

Assessment of Child and Adolescent Migrants to Australia: A Crosscultural Comparison

This study examines whether young migrants, differentiated by cultural background, (a) vary in their experience of cultural adjustment, emotional distress, levels of self-esteem, and coping ability, and (b) how they compare with Australian students on measures of self-esteem and coping ability. One hundred and seventy-three students differentiated by cultural origin (former-Yugoslavian, Chinese, Mixed-culture, and Australian) and school level (primary and high school) were recruited at random from public schools in South East Queensland. Students completed measures of cultural adjustment (Bicultural Involvement Questionnaire), anxiety and trauma (Revised Children's Manifest Anxiety Scale, Trauma Symptom Checklist), self-esteem (Coopersmith Self-Esteem Inventory, Rosenberg Self-Esteem Scale), and coping ability (Coping Scale for Children and Adolescents). The main findings from this study indicate that culturally diverse groups residing in Australia vary in their experience of cultural adaptation, level of self-esteem, and symptoms of emotional distress, illustrating culture-specific strengths and weaknesses among young non-English speaking (NESB) students. This study reveals information on how culturally diverse migrants acculturate, the type and severity of symptoms they experience, and their capacity to cope in stressful situations. The need for culture-specific early intervention and prevention programs is discussed.

Fears and Fearfulness in South-African Children

The present study examined common childhood fears in 9- to 13-year-old South-African children (N = 404) from white, coloured, and black cultural groups. Fears were assessed by means of two methods — the fear list method and the Fear Survey Schedule for Children-Revised (FSSC-R). Results showed that fear rank orders as obtained with the fear list method were quite different from those derived from the FSSC-R. Furthermore, clear differences in fear levels were found among the three cultural groups. More specifically, coloured and black South-African children displayed significantly higher fear levels than white children. Finally, differences were also found as to the content of prevalent fears in the three cultural groups. For example, common fears in coloured and black children were more frequently related to violence than in white children.

Evaluation of an Anxiety-prevention and Positive-coping Program (FRIENDS) for Children and Adolescents of Non-English-speaking Background

This study aimed to (a) appraise the efficacy of a well validated Anglo-Australian anxiety-prevention and stress-resiliency program (FRIENDS) for use with culturally diverse migrant groups residing in Australia, (b) examine the social validity of FRIENDS, and (c) obtain information from both participants and facilitators regarding how the program can best be modified for specific use with non-English-speaking background (NESB) clients. To test the efficacy of the intervention, pre- and post-intervention evaluation of internalising symptoms and coping ability were compared with waiting-list control groups (matched according to ethnic group, gender, and school level). One hundred and six primary and ninety-eight high school students differentiated by cultural origin (former-Yugoslavian, Chinese, and mixed-ethnic) and school level (primary and high school), completed standardised measures of internalising symptoms and were allocated to either an intervention (n = 121) or a waiting-list (n = 83) condition. Both groups were readministered the assessment package for comparison following a 10-week treatment or waiting period. Consistent with a recent pilot study, pre/post-assessment indicated that participants in the intervention condition exhibited lower anxiety and a more positive future outlook than waiting-list participants. Participating students reported to be highly satisfied with the intervention. Despite the overall success of FRIENDS, the program may be enhanced by culturally sensitive supplements so that the program is more applicable for use with NESB participants. Suggestions for treatment program modifications of FRIENDS are discussed.

Childhood Anxiety in Ethnic Families: Current Status and Future Directions

Australia is a culturally diverse country with many migrant families in need of support and assistance from clinical psychologists. Yet, surveys indicate that migrants do not feel comfortable in accessing community mental health services, due to the lack of cultural sensitivity and understanding of our current practices. Despite this finding, there remains a paucity of research on migrant families, their different values and needs, and how they adjust to the Australian culture. The present article reviews research on migrant children, their characteristics, and the factors that help or hinder healthy adjustment to a new culture. This review focuses particularly on anxiety, which is not only the most common form of childhood psychopathology, but also frequently coincides with stressful life events such as migration. Our review concludes with recommendations for the development of assessment and intervention protocols, and areas of future research.

Test-anxious Children and Adolescents: Psychopathology, Cognition, and Psychophysiological Reactivity

Test anxiety in children has long been recognised to be a significant and challenging educational problem. Recent advances in diagnostic interviewing, cognitive assessment, and physiological recording have facilitated a considerable amount of research on test-anxious youth. This research has yielded important clinical insights about test-anxious children and adolescents of interest to teachers and psychologists. We describe and evaluate the findings of these investigations. Finally, we discuss the implications of the research findings for intervention in school settings. Cognitive-behavioural strategies are tentatively recommended for the treatment of test-anxious children and adolescents.

Cross-cultural variations in the prevalence and presentation of anxiety disorders

Considerable cross-cultural variation exists in the prevalence and presentation of the anxiety disorders as defined by the fourth edition of the Diagnostic and Statistical Manual. Researchers debate whether this variation represents cultural differences in the phenomenology of universal disorders or the existence of unique culturally constructed disorders. This article reviews recent literature on the prevalence and presentation of five anxiety disorders: generalized anxiety disorder, social anxiety disorder, panic disorder, specific phobia and post-traumatic stress disorder, both across countries and within the USA. This article indicates that certain anxiety disorders (e.g., generalized anxiety disorder and panic disorder) may vary greatly in rate across cultural groups. It indicates that the clinical presentation of anxiety disorders, with respect to symptom presentation and the interpretation of symptoms, varies across cultures. A difference in catastrophic cognitions about anxiety symptoms across cultures is hypothesized to be a key aspect of cross-cultural variation in the anxiety disorders. Future research directions are suggested.

Anxiety symptoms among adolescents in Japan and England: their relationship with self-construals and social support

BACKGROUND

Most of our knowledge about anxiety in adolescents has come from studies conducted in Western countries. Little is known about the extent to which these results can be generalized to those who live in other cultures. The main aim of this study was to compare the frequency and correlates of anxiety symptoms among adolescents in Japan and England.

METHOD

A total of 689 adolescents (338 from England and 351 from Japan), aged 12-17 years, took part in this research. They completed a set of questionnaires which were used to measure DSM-IV anxiety disorder symptoms, general difficulties and positive attributes, self-construals, and social support.

RESULTS

Adolescents in England reported significantly higher levels of anxiety symptoms than adolescents in Japan. In both countries, independent self-construal was negatively associated with anxiety symptoms, while interdependent self-construal was positively associated with anxiety. However, the magnitude of this relationship was stronger for independent self-construal than the interdependent self-construal. Path analysis showed that the effect of interdependent self-construal seemed to be weaker in Japan than in England.

CONCLUSION

Future studies need to explore the effects of cultural context and environmental experiences such as the role of parenting styles that account for the higher levels of anxiety in English compared with Japanese adolescents.

The Fear Survey Schedule for Children-Revised: Normative Developmental Data in Italy

The aim of the study was to explore children's fear content. Using the Italian Fear Survey Schedule for Children, an Italian-language version of Ollendick's Fear Survey Schedule for Children–Revised (1983), the study assessed the reliability of the survey and reported intensity, prevalence, and content of fears in children aged six to 10 years, using this questionnaire. 1,845 school children (931 girls, 914 boys; M age = 8.3 yr., SD = 1.4) were asked to complete the survey, indicating what they thought were their fears, and the intensity of those fears. Sex and age differences were also examined. Girls endorsed significantly higher fearfulness than did boys. Few age differences were found, with seven-year-olds appearing more fearful than 10- to 11-year-old children. Results were interpreted in relation to developmental changes. Cross-national comparisons were discussed.

Culture and the anxiety disorders: recommendations for DSM-V

BACKGROUND

The anxiety disorders specified in the fourth edition, text revision, of The Diagnostic and Statistical Manual (DSM-IV-TR) are identified universally in human societies, and also show substantial cultural particularities in prevalence and symptomatology. Possible explanations for the observed epidemiological variability include lack of measurement equivalence, true differences in prevalence, and limited validity or precision of diagnostic criteria. One central question is whether, through inadvertent "over-specification" of disorders, the post-DSM-III nosology has missed related but somewhat different presentations of the same disorder because they do not exactly fit specified criteria sets. This review canvases the mental health literature for evidence of cross-cultural limitations in DSM-IV-TR anxiety disorder criteria.

METHODS

Searches were conducted of the mental health literature, particularly since 1994, regarding cultural or race/ethnicity-related factors that might limit the universal applicability of the diagnostic criteria for six anxiety disorders.

RESULTS

Possible mismatches between the DSM criteria and the local phenomenology of the disorder in specific cultural contexts were found for three anxiety disorders in particular. These involve the unexpectedness and 10-minute crescendo criteria in Panic Disorder; the definition of social anxiety and social reference group in Social Anxiety Disorder; and the priority given to psychological symptoms of worry in Generalized Anxiety Disorder. Limited evidence was found throughout, particularly in terms of neurobiological markers, genetic risk factors, treatment response, and other DSM-V validators that could help clarify the cross-cultural applicability of criteria.

CONCLUSIONS

On the basis of the available data, options and preliminary recommendations for DSM-V are put forth that should be further evaluated and tested.

Children's specific fears

BACKGROUND

Most children experience some degree of fear during their development. Specific fears are considered as an appropriate response provided that they are proportionate to the intensity of the perceived threat. Our aim is to present the prevalence of specific fears among children in the Great Britain, their socio-demographic correlates, in particular their association with ethnicity.

METHODS

Data on the child's experience of specific fears were obtained from parents of a national representative sample of 5- to 16-year-olds using the Development and Well-Being Assessment. Biographic, socio-demographic and socioeconomic characteristics of the child and the family were included in the questionnaire.

RESULTS

About one-third of children were assessed by their parents as having at least one of 12 specific fears. The most commonly reported fears were animals (11.6%), blood/injections (10.8%) and the dark (6.3%). Just less than 1% of all children were assessed according to International Classification of Diseases research diagnostic criteria as having a specific phobia. Biographic, socio-demographic and socioeconomic factors were independently associated with a greater likelihood of a child having particular fears. The most marked associations were fears of the dark, loud noises, imagined supernatural beings in younger children and fear of animals among girls and all non-white groups.

CONCLUSIONS

Although fears are only labelled as phobias when they impair functioning and interfere with life, they can cause personal distress to children and also can interfere with their daily activities. Children's fears differ in nature across different ethnic groups. Culturally mediated beliefs, values and traditions may play a role in their expression.

Children's fears: a survey of Italian children ages 6 to 10 years

The aim of this study was to explore children's fears. The article reports on average factor scores of a study carried out in Italy using the Fear Survey Schedule for Children (here, the "Fear Survey"; Ollendick, 1983) with normal 6- to 10-yr.-old children (931 girls, 914 boys). Participants were 1,845 children, recruited in mainstream classrooms. Respondents were asked to complete the schedule indicating their fears and the intensity of such fears. A principal components analysis yielded a four-factor structure (1: Death and Danger, 2: Injury and Animals, 3: Failure and Criticism, 4: Fear of the Unknown). Average factor scores showed significant differences across the factors and according to sex and age. Girls reported significantly higher fearfulness than boys. Age differences were found on some factors.

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.

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

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

Anxiety symptoms in Chinese and German adolescents: their relationship with early learning experiences, perfectionism, and learning motivation

The main aim of this study was to compare the frequency and correlates of DSM-IV anxiety disorder symptoms among non-referred adolescents in Germany and in Hong Kong. A total of 1,022 adolescents (594 from Germany and 428 from Hong Kong) between the ages of 12 and 17 years were investigated. Results showed that adolescents in Hong Kong reported significantly higher levels of anxiety symptoms than adolescents in Germany. Anxiety symptoms showed different correlates in different cultures. Specifically, academic motivational goals to compete to get good grades and to be rewarded for their performance correlated significantly with anxiety symptoms in Hong Kong. In Germany, anxiety symptoms correlated significantly with reinforcement received for anxiety-related problems (i.e., instrumental learning) and with parental verbal transmission about the danger of anxiety (i.e., informational learning). The findings underscore the importance of cultural factors on adolescent's anxiety.

Challenges in developing novel treatments for childhood disorders: lessons from research on anxiety

Alterations in brain development may contribute to chronic mental disorders. Novel treatments targeted toward the early-childhood manifestations of such chronic disorders may provide unique therapeutic opportunities. However, attempts to develop and deliver novel treatments face many challenges. Work on pediatric anxiety disorders illustrates both the inherent challenges as well as the unusual opportunities for therapeutic advances. The present review summarizes three aspects of translational research on pediatric anxiety disorders as the work informs efforts to develop novel interventions. First, the review summarizes data on developmental conceptualizations of anxiety from both basic neuroscience and clinical perspectives. This summary is integrated with a discussion of the two best-established treatments, cognitive behavioral therapy and selective serotonin reuptake inhibitors. Second, the review summarizes work on attention bias to threat, considering implications for both novel treatments and translational research on neural circuitry functional development. This illustrates the manner in which clinical findings inform basic systems neuroscience research. Finally, the review summarizes work in basic science on fear learning, as studied in fear conditioning, consolidation, and extinction paradigms. This summary ends by describing potential novel treatments, illustrating the manner in which basic neuroscience informs therapeutics.

Origins of common fears in South African children

The present study examined the origins of common childhood fears within a South African context. Six-hundred-and-fifty-five 10- to 14-year-old children were given a brief fear list that helped them to identify their most intense fear and then completed a brief questionnaire for assessing the origins of fears that was based on Rachman's [Rachman, S. (1977). The conditioning theory of fear acquisition: A critical examination. Behaviour Research and Therapy, 15, 375-387; Rachman, S. (1991). Neoconditioning and the classical theory of fear acquisition. Clinical Psychology Review, 17, 47-67] three-pathways theory. More precisely, children were asked to report whether they had experienced conditioning, modeling, and negative information experiences in relation to their most feared stimulus or situation, and also had to indicate to what extent such experiences had actually played a role in the onset and/or intensification of their fears. Results showed that children most frequently reported indirect learning experiences (i.e., modeling and negative information) in relation to their fears, whereas conditioning was clearly less often mentioned. The majority of the children had no precise idea of how their fear had actually begun, but a substantial proportion of them reported various learning experiences in relation to the onset and intensification of fears. Significant cultural differences were not only observed in the prevalence of common fears, but also in the pathways reported for the origins of fears. The results are briefly discussed in terms of the living conditions of South African children from various cultural backgrounds.

Anxieties in Mainland Chinese and Singapore Chinese adolescents in comparison with the American norm

There is a growing literature base on child and adolescent anxiety. Cross-cultural research on child and adolescent anxiety, however, has been relatively limited. This study examined whether there were similarities and differences in the self reported anxieties in Mainland Chinese and Singapore Chinese adolescents (12-17 years of age), and whether these similarities or differences were related to gender and/or grade. This study also compared anxiety levels of Mainland Chinese and Singapore Chinese adolescents with the American normative sample (12-17 years of age). The results indicate that the levels of anxieties did not differ based on country (China and Singapore). Gender differences were evident. Gender and grade interaction effects were found on the anxiety scales. Mixed results were found when comparing Mainland Chinese and Singapore Chinese with the American normative sample on the different anxiety scales.

Avoidance Ratings and Fears of Chinese Adults by Age, Ethnic Group, Sex, and Residency

Few studies among the Chinese population concerning avoidance out of fear have been reported. Existing studies are limited to school and collegiate samples while overlooking ethnic minorities, of which China has more than 50. In this study, a general population sample in China indicated the level at which they would avoid certain situations. The data were analyzed relative to age, ethnicity, sex, and the amount of time living in urban or rural areas. Three samples (urban Han, n = 144; rural Han, n = 144; Urban Huí, n = 72) were selected using stratified quota sampling. Respondents identified that they avoided social situations the most and agoraphobic situations the least. Overall, women expressed significantly greater fear. This sex difference was less marked in the urban sample where the Chinese tradition of male dominance has been diluted due to urbanization and modernization. There were few age-related differences, although some fears among the elderly were explained by age-related vulnerabilities and folklore. The Hui minority group had significantly lower overall scores than the Han group; this was attributed to the role of their Islamic beliefs.

Reliability and validity of the Chinese version of the Social Anxiety Scale for Adolescents

This study evaluated the psychometric properties of the Chinese version of the Social Anxiety Scale for Adolescents (SAS-A) in a sample of 296 adolescents (49% boys) in Grades 7, 8, 9, 10, and 12 with a mean age of 15.52 years. Confirmatory factor analysis replicated the three-factor structure of the SAS-A in the Chinese sample: Fear of Negative Evaluation (FNE), Social Avoidance and Distress in New Situations (SAD-New), and Social Avoidance and Distress-General (SAD-General). Internal consistency and test-retest reliability were appropriate. The results also revealed a clear and predictable pattern of relationships between the SAS-A and the Questionnaire about Interpersonal Difficulties for Adolescents and the International Personality Item Pool. Chinese boys reported greater SAD-General than Chinese girls, and this difference increased with grade. The SAS-A scores were compared to previously collected data from the USA and Spain, revealing that Chinese adolescents scored significantly higher in social anxiety than American and Spanish adolescents.

Developmental trajectories of adolescent anxiety disorder symptoms: a 5-year prospective community study

OBJECTIVE

This study prospectively examined the developmental trajectories of anxiety disorder symptoms in a large sample of adolescents from the general population.

METHOD

Two cohorts of early and middle adolescents (1,318 junior high and high school students) completed the Screen for Child Anxiety Related Emotional Disorders during 5 consecutive years. The Screen for Child Anxiety Related Emotional Disorders is a questionnaire that measures self-rated child and adolescent anxiety symptoms that map onto DSM-IV-TR anxiety disorders. At the first wave of measurement, the early and middle adolescent cohorts were an average of 12 and 16 years of age, respectively. Age and sex differences in the developmental trajectories of adolescent anxiety disorder symptoms over time were examined by means of latent growth modeling.

RESULTS

Over the course of 5 years, there was a slight decrease in the panic disorder, school anxiety, and separation anxiety disorder symptoms for all of the adolescents, with the exception of social phobia symptoms, which remained fairly stable over time. Adolescent girls showed a slight increase of generalized anxiety disorder symptoms over time, whereas these symptoms decreased among adolescent boys.

CONCLUSIONS

This study replicates and extends earlier findings on the developmental trajectories of anxiety symptoms during adolescence. By using individually focused, trajectory-based analyses rather than group score differences, this study extends earlier findings and advances our understanding of age and sex differences in the development of adolescent anxiety symptoms.