Andrea M. Victor

Comparison of clinical characteristics of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and childhood obsessive-compulsive disorder.

OBJECTIVE The objectives of this study were to identify unique clinical characteristics of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) compared with a control group of children with non-PANDAS obsessive-compulsive disorder (OCD) with respect to ancillary symptoms, types of obsessions and compulsions, symptom severity, and co-morbid DSM-IV diagnoses. METHOD Classification of PANDAS was based on review of pediatric and psychiatric records using the criteria developed by Swedo and colleagues. Children aged 6-14 with PANDAS (n = 21) and non-PANDAS OCD (n = 18) were assessed by blind independent evaluators using the PANDAS Questionnaire, Childrens Yale-Brown Obsessive Compulsive Scale, Yale Global Tic Severity Scale, and Anxiety Disorders Interview Schedule for DSM-IV. RESULTS PANDAS children were significantly more likely to present with separation anxiety, urinary urgency, hyperactivity, impulsivity, deterioration in handwriting, and decline in school performance during their initial episode of neuropsychiatric illness compared with children with OCD. Total tics and vocal tics were more severe in PANDAS children. Separation anxiety disorder and social phobia were more prevalent in non-PANDAS OCD children. Children with non-PANDAS OCD were significantly more likely to include others in their rituals. There were no significant differences between groups on demographics or severity of OCD. CONCLUSIONS Distinguishing clinical characteristics in PANDAS, which included urinary urgency, hyperactivity, impulsivity, and deterioration in handwriting, are linked to basal ganglia functions. These clinical characteristics will aid in the differentiation of PANDAS children for research and clinical purposes and ultimately advance our understanding and treatment of this disorder.

Generalized anxiety disorder in a nonclinical sample of children: Symptom presentation and predictors of impairment

Presentation of generalized anxiety disorder (GAD) in a nonclinical sample of children (7-11 years old) and factors that predict overall impairment were examined. Symptom presentation was compared in children with GAD (n=49) and anxious children without GAD (n=42). Children with GAD endorsed significantly more worries, greater intensity of worries, and more DSM-IV associated symptoms than anxious children without GAD. Eighty-six percent of children with GAD had a comorbid diagnosis with 4% having a depressive disorder. Number of associated symptoms was most predictive of GAD impairment based on child perspective and intensity of worry was most predictive based on clinician perspective. Overall, findings from the current study are consistent with reports based on clinical samples. The DSM-IV-TR criteria for GAD were supported, with the exception that children with GAD typically present with several associated symptoms, rather than only one.

Environmental Correlates of Cognition and Behavior in Children with Fetal Alcohol Spectrum Disorders

ABSTRACT The physical, cognitive, and behavioral correlates of Fetal Alcohol Spectrum Disorders (FASD) have been well-researched. However, there is minimal investigation of the non-biological correlates of cognition and behavior in this population. The association between foster care placement history and cognitive and behavioral functioning was explored using archival data from 136 children with FASD. Significant cognitive and behavioral abnormalities were found in the overall sample. Children with one foster care placement performed significantly better on measures of verbal intelligence, mathematics achievement, and impulse control and endorsed fewer symptoms of internalizing disorders compared to children who were never removed from their biological home. Children with multiple foster home placements generally fell between the other two groups on assessment measures. It may be important to consider placement history of children with FASD when attempting to understand their cognitive and behavioral abnormalities.

Anxiety Disorders and Posttraumatic Stress Disorder Update

Anxiety disorders are one of the most common categories of psychopathology in children and adolescents. This article provides an overview of several anxiety disorders that are diagnosed often during childhood and adolescence, including separation anxiety disorder, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder. Although anxiety disorders commonly show similar clinical characteristics during childhood and adulthood, this article highlights some of the differences that may present across the life span.

Videoconferencing at psychology internships: Interns' perceptions of interactive television experiences and prospects

This article reviews the use and perceptions of videoconferencing in psychology internship training from the perspective of interns. Videoconferencing offers a means of expanding training beyond conventional on-site models. Psychology interns completed an online survey about their experiences with videoconferencing and perspectives of its impact on training. Most participants encountered it in their didactics. Some used it for supervision or other purposes. Interns’ perspectives were complex, with videoconferencing seen as supporting learning similar to conventional training in some ways, yet as less desirable overall. Direct comparisons between videoconferencing and on-site training revealed interns perceived videoconferencing as somewhat less effective, and as deleteriously affecting learning dynamics. Challenges and potential benefits of incorporating videoconferencing into psychology internship training were identified. Potential benefits include augmenting available internship training and increasing rural sites’ access to training.

Childhood Anxiety Disorders and Obsessive-Compulsive Disorder

Anxiety disorders is one of the most prevalent diagnostic categories identified in children and adolescents. This chapter provides an overview of the epidemiology of childhood anxiety disorders and presents several pathways of etiology, specifically genetics, parent–child attachment, and neurobiology. Separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and panic disorder are reviewed. Cognitive-behavioral therapy and psychopharmacology are summarized as effective treatment approaches for childhood anxiety disorders.

Childhood anxiety disorders

Anxiety disorders is one of the most prevalent diagnostic categories identified in children and adolescents. This chapter provides an overview of the epidemiology of childhood anxiety disorders. Several pathways of etiology are presented, specifically genetics, parent–child attachment, parental anxiety and parenting style, and life experiences. Six of the common childhood anxiety disorders, separation anxiety disorder, specific phobia, social phobia, generalized anxiety disorder, obsessive–compulsive disorder, and panic disorder, are reviewed. Cognitive–behavioral therapy and psychopharmacology are summarized as effective treatment approaches for childhood anxiety disorders.

Treatment of pediatric anxiety disorders

Anxiety disorders are prevalent among children and adolescents. Youth with anxiety disorders are at risk for developing academic, social and family difficulties. Therefore, early identification and effective treatment of anxiety disorders in youth are critical. Cognitive–behavioral therapy (CBT) and selective serotonin-reuptake inhibitors (SSRIs) are shown to be effective treatments of childhood anxiety disorders. It is important to consider CBT, SSRIs and a combination of CBT and SSRIs when considering treatment options for children and adolescents with anxiety disorders. Despite the black box warning associated with antidepressants, there is evidence that the benefits of the use of SSRIs in the treatment of children and adolescents with anxiety disorders outweigh the potential risks when the medication is carefully monitored.