Amie E. Grills-Taquechel

Comorbidity as a predictor and moderator of treatment outcome in youth with anxiety, affective, attention deficit/hyperactivity disorder, and oppositional/conduct disorders.

In the present review, we examine one of the critical issues that have been raised about evidence-based treatments and their portability to real-world clinical settings: namely, the presence of comorbidity in the participants who have been treated in these studies and whether the presence of comorbidity predicts or moderates treatment outcomes. In doing so, we examine treatment outcomes for the four most commonly occurring childhood psychiatric disorders: Anxiety disorders, affective disorders, attention deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD)/conduct disorder (CD). For each of these disorders, we first review briefly the prevalence of comorbidity in epidemiological and clinical samples and then highlight the evidence-based treatments for these disorders. We next determine the effects of comorbidity on treatment outcomes for these disorders. For the most part, comorbidity in the treated samples is the rule, not the exception. However, the majority of studies have not explored whether comorbidity predicts or moderates treatment outcomes. For the not insignificant number of studies that have examined this issue, comorbidity has not been found to affect treatment outcomes. Notable exceptions are highlighted and recommendations for future research are presented.

Impaired and incapacitated rape victims: assault characteristics and post-assault experiences

Alcohol is the most common “rape drug,” with up to two-thirds of victims consuming alcohol prior to the assault. Surprisingly, little research has examined the assault and postassault experiences of victims who were impaired or incapacitated as a result of substance use, including alcohol, during a rape. Thus, the current study evaluated the assault and postassault experiences of a sample of 340 nonimpaired, impaired, and incapacitated college rape victims. Results supported that these three groups differed in several assault characteristics, including threats by the assailant, resistance by the victim, and relationship with the assailant. In addition, impairment and incapacitation were associated with several postassault factors, including self-blame, stigma, and problematic alcohol use. Results also highlighted similarities in victims’ experiences, including levels of postassault distress. Implications of the findings for future research investigating impaired and incapacitated sexual assault victims are discussed.

SEXUAL ASSAULT VICTIMS' ACKNOWLEDGMENT STATUS AND REVICTIMIZATION RISK

How a victim of rape characterizes her assault has potential implications for her postassault experiences and revictimization risk. Prior research has identified several potential benefits to not conceptualizing ones experience as a form of victimization. The current study sought to identify whether there are costs to not acknowledging rape as well, specifically whether unacknowledged victims are at elevated risk of revictimization. The revictimization risk behaviors of 334 acknowledged and unacknowledged female college rape victims were compared. Unacknowledged victims reported more hazardous alcohol use and were more likely to report that they continued a relationship with the assailant after the assault. A subsample of 105 victims completed a 6-month follow-up survey regarding sexual victimization during the follow-up period. Unacknowledged victims were nearly twice as likely to report having experienced an attempted rape during the 6-month follow-up period. Implications of the results for future work evaluating rape acknowledgment, rape recovery, and revictimization are discussed.

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

Abstract 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.

Social support, world assumptions, and exposure as predictors of anxiety and quality of life following a mass trauma

This study examined the influence of a mass trauma (the Virginia Tech campus shootings) on anxiety symptoms and quality of life, as well as the potential vulnerability/protective roles of world assumptions and social support. Pre-trauma adjustment data, collected in the six months prior to the shooting, was examined along with two-month post-shooting data in a sample of 298 female students enrolled at the university at the time of the shootings. Linear regression analyses revealed consistent predictive roles for world assumptions pertaining to control and self-worth as well as family support. In addition, for those more severely exposed to the shooting, greater belief in a lack of control over outcomes appeared to increase vulnerability for post-trauma physiological and emotional anxiety symptoms. Implications of the results for research and intervention following mass trauma are discussed.

Reexamination of the MASC factor structure and discriminant ability in a mixed clinical outpatient sample.

Anxiety problems in youth are common, suggesting the need for developmentally appropriate and psychometrically sound measures in this area. The Multidimensional Anxiety Scale for Children (MASC) was created with this goal in mind, but has yet to be examined with samples representative of youth typically seen in clinical settings. Two hundred and sixty‐two outpatient youth with mixed clinical presentations completed the MASC, a measure that includes a total anxiety score, as well as subscale scores for social anxiety, harm avoidance, separation anxiety/panic, and physical symptoms of anxiety. Internal consistency, means, and factor structure were comparable to that reported previously. Model invariance was supported across gender, diagnosis, and age. The MASC total score significantly differentiated children who received anxiety disorder diagnoses from those who did not. The social anxiety subscale significantly predicted social phobia and the harm avoidance subscale significantly predicted generalized anxiety disorder. Further support was found for the MASC. However, caution should be exercised given mixed discriminant ability findings. That is, the MASC seems best suited as a screening instrument for anxiety and when used in conjunction with a multiple method/informant assessment approach. Depression and Anxiety, 2008.

Anxiety and Reading Difficulties in Early Elementary School: Evidence for Unidirectional- or Bi-Directional Relations?

The epidemiology of anxiety traits was examined in a large sample of Italian preadolescent children, and 3,479 Italian nine-year-old subjects were enrolled. Anxious traits were observed in 10.5% of children. No significant gender differences were found, but children of separated couples presented a relative risk for anxious traits that was 50% higher, than children of cohabiting or married parents. Moreover, large families (more than 4 members) with a stay-at-home mother were also associated with anxiety in the offspring. Currently, this is the first study carried out in a large sample of preadolescent children, all of the same age.The present study examined competing models of the bi-directional influences of anxiety and reading achievement. Participants were 153 ethnically-diverse children (84 male, 69 female) from general education classes evaluated in the winter and spring of their first-grade academic year. Children completed standardized measures of reading achievement involving decoding and fluency along with an anxiety rating scale. Hierarchical linear regression analyses revealed that separation anxiety symptoms were negatively predicted by fluency performance and harm avoidance symptoms were positively predicted by decoding performance. Fluency performance was positively predicted by harm avoidance and total anxiety (for girls only) symptoms, while decoding was not predicted by any anxiety subscale.

Longitudinal evaluation of the relationship between maladaptive trauma coping and distress: examination following the mass shooting at Virginia Tech

Abstract Growing evidence supports that the coping strategies that individuals utilize are a key predictor of distress following trauma. However, there is limited longitudinal research examining the relationship between psychological distress and coping over time, and even less research examining the possibility of reciprocal relationships between distress and coping, despite the fact that prior theoretical work posits such a relationship. The current study modeled the relationship between distress (PTSD and general distress) and maladaptive coping over time in a sample of 368 college women exposed to the mass shooting at Virginia Tech (VT). Participants completed web surveys regarding their distress, shooting-related coping, and shooting-related PTSD 2 months, 6 months, and 1 year following the shooting. They also completed measures of their psychological distress prior to the shooting as part of an unrelated study. A structural cross-lagged model with latent variables supported a reciprocal relationship between maladaptive coping and general psychological distress over time. In contrast, the cross-lagged model evaluating the relationship between PTSD and maladaptive coping supported that PTSD symptoms predicted coping over time, but there was no reciprocal relationship between coping and PTSD. Implications of the findings for future work examining adjustment following traumatic events are discussed.

Resource loss as a predictor of posttrauma symptoms among college women following the mass shooting at Virginia Tech.

We examined risk factors for posttrauma symptomatology, 2 and 6 months following the April 2007 mass shooting at Virginia Tech. Using a conservation of resources framework and a Web-based survey methodology, we prospectively evaluated the relations among preshooting distress, social support, resource loss, and posttrauma symptomatology in a sample of 293 female students enrolled at the university at the time of the shootings. Structural equation modeling supported that preshooting social support and distress predicted resource loss postshooting. Resource loss predicted symptomatology 2 months and 6 months after the shooting. Implications of the results for research and intervention following mass trauma are discussed.

Health Risk Behavior and Sexual Assault Among Ethnically Diverse Women

Sexual assault is associated with a number of health risk behaviors in women. It has been hypothesized that these risk behaviors, such as hazardous drinking, may represent women’s attempts to cope with psychological distress, such as symptoms of depression and anxiety. However, extant research has failed to evaluate these relationships among ethnic minority samples or identify the mechanisms responsible for this association. The current study examined sexual assault history and two health risk behaviors (hazardous drinking and engaging in sexual behavior to regulate negative affect) in a diverse sample of 1,620 college women. Depression and anxiety were examined as mediators of the relationship between sexual assault and health risk behaviors. There was evidence of moderated mediation, such that for European American women, but not for ethnic minority women, both forms of psychological distress were significant mediators of the sexual assault/hazardous drinking relationship. In contrast, among all ethnic groups, the relationship between sexual assault and both forms of psychological distress was mediated by the use of sexual behavior as an affect regulation strategy. Results support a need to evaluate the assault experiences of ethnically diverse women, as well as the impact of the assault on their postassault experiences including health risk behaviors and psychological adjustment. Additionally, results suggest that practitioners should carefully assess health risk behaviors among victims of sexual assault and be aware that there may be differences in the risk factors and motives for these behaviors among women of various ethnic backgrounds.