Cyd C. Strauss

Comorbidity among childhood anxiety disorders.

This paper reports on 73 consecutive admissions to an outpatient anxiety disorder clinic for children and adolescents. Patients were evaluated with a structured diagnostic interview for primary and secondary disorders with DSM-III criteria in order to examine patterns of comorbidity. The most common primary diagnoses for the sample included separation anxiety disorder (33%), overanxious disorder (15%), social phobia of school (15%), and major depression (15%). Children with a primary diagnosis of separation anxiety disorders were most likely to receive a concurrent diagnosis of overanxious disorder. Alternatively, children with a primary diagnosis of overanxious disorder were most likely to receive an additional diagnosis indicative of a social anxiety problem, either social phobia or avoidant disorder. Children with a primary major depression most often exhibited social phobia and/ or overanxious disorder. No clear-cut pattern of comorbidity emerged for the social phobic (school) group. These findings are discussed in terms of their comparability with results recently obtained from an adult anxiety clinic population.

Association between anxiety and depression in children and adolescents with anxiety disorders

The relationship between anxiety and depression was examined in a sample of 106 children and adolescents referred to an outpatient anxiety disorder clinic for children. Twenty-eight percent of patients with DSM-III diagnoses of anxiety disorders displayed a concurrent major depression. Children with anxiety disorders plus major depression were found (1) to be older, (2) to demonstrate more severe anxiety symptomatology, and (3) to be diagnosed with different rates of certain anxiety-disorder subtypes, when compared to anxious patients without major depression. Nondepressed anxious children and adolescents did not differ from a psychopathological control group in severity of either anxiety or depression symptoms.

Comparison of DSM-III Separation Anxiety and Overanxious Disorders: Demographic Characteristics and Patterns of Comorbidity

Abstract In an initial empirical evaluation of the DSM-III diagnostic categories of separation anxiety disorder (SAD) and overanxious disorder (OAD), the demographic characteristics and patterns of comorbidity associated with the two anxiety diagnoses were examined and compared in a clinical sample of 69 children and adolescents. The two anxiety disorders differed on several dimensions: age, social class, and presence of a coexisting anxiety disorder. Children with SAD were younger and from families of lower socioeconomic status than children with OAD. Children with OAD were much more likely than children with SAD to present with an additional concurrent anxiety disorder, usually simple phobia or panic disorder. Results from this study support the DSM-III distinction between SAD and OAD.

Are Attention Deficit Disorders with and without Hyperactivity Similar or Dissimilar Disorders

From a population of 625 children in grades 2–5, 10 children were identified as those with attention deficit disorder with hyperactivity (ADD/H) and 20 children were identified as those with attention deficit disorder without hyperactivity (ADD/WO). When compared with matched normal control children on a battery of teacher ratings, peer ratings, and self-report measures, markedly different patterns of characteristics were found for the two ADD groups. ADD/H children exhibited aggressive conduct disorders, bizarre behavior, were guiltless, very unpopular, and performed poorly in school. In contrast, ADD/WO children were found to be anxious, shy, socially withdrawn, moderately unpopular, and poor in sports and school performance. Both groups exhibited depression and poor self-concepts, but differed in the specific areas of low self-esteem. These different patterns suggest that ADD/ H and ADD/WO are dissimilar syndromes and perhaps should not be considered to be subtypes of the same disorder.

Correlates of depressed mood in normal children

Two instruments which have been proposed as measures of clinical depression in children and an ad hoc teacher rating were given to a group of 109 normal children. The Childrens Depression Inventory (CDI), the Peer Nomination Inventory for Depression (PNID), and a teacher rating of depression were given along with the Conner s Teacher Rating Scale (TRS), teacher ratings of somatic complaints, peer popularity, and absenteeism, and peer ratings of popularity to examine the behavioral correlates of depressed mood in normal children. While few sex differences were found on mean depression scores, different patterns of correlations were found for the two sexes. For males, there were no significant correlations among the three depression measures, but all three depression measures were correlated with unpopularity and conduct problem ratings on the TRS. For females, the three depression measures were adequately intercorrelated. The teacher rating of depression was correlated with general deviance as measured by the TRS, but the CDI and PNID were correlated with TRS ratings of conduct problems, with peer ratings of unpopularity, and with teacher ratings of somatic complaints. Implications for the issue of the possible existence of a clinical syndrome of depression in children were discussed.

Overanxious Disorder: An Examination of Developmental Differences.

Differences between a clinical sample of younger (ages 5 to 11) and older (ages 12 to 19) children meeting DSM-III criteria for overanxious disorder (OAD) were examined. Younger and older children were compared in terms of (1) the rates of OAD diagnoses occurring in the two age groups, (2) sociodemographic characteristics, (3) symptom expression, (4) association with other forms of maladjustment, and (5) self-reported anxiety and depression. The prevalence of OAD diagnoses and sociodemographic characteristics did not differ. Although younger and older OAD children showed similar rates of most specific DSM-III OAD symptoms, older children presented with a higher total number of overanxious symptoms than younger children. Older children more frequently exhibited a concurrent major depression or simple phobia, whereas younger OAD children more commonly had coexisting separation anxiety or attention deficit disorders. Older OAD children reported significantly higher levels of anxiety and depression on self-report measures. Findings indicated that the expression of OAD varies by developmental level.

Characteristics of children with extreme scores on the children's depression inventory

The concurrent validity of the Childrens Depression Inventory (CDI) was examined by assessing the relationship between this instrument and other measures of psychological and social functioning with which it would be expected to correlate. From a sample of 252 second through fifth graders, 15 children were identified who obtained extreme scores on the CDI (score 19 or greater). A matched comparison group of 15 children who received low scores on the CDI (scores of 5 or below) was also formed. A battery of self‐report, peer, and teacher measures was administered to assess anxiety, self‐esteem, academic status, teacher ratings of child behavior, sociometric status, social functioning, and other child characteristics. Findings suggested that children with extreme scores on the CDI displayed many of the characteristics critical in the diagnosis of depression and features believed to be associated with depression in children and adults. These included low self‐esteem, anxiety, unassertiveness, social withdraw...

Teacher Ratings of Attention Problems in Children Experimentally Classified as Exhibiting Attention Deficit Disorder with and without Hyperactivity

From a total of 625 children, 30 children in grades 2–5 were experimentally classified as having Attention Deficit Disorder with Hyperactivity (ADD/H: N = 10) or Attention Deficit without Hyperactivity (ADD/WO: N = 20) using teacher ratings of behavior on the Revised Behavior Problem Checklist (RBPC). These groups were compared to normal control children ( N = 20) on each of the items that comprise the Attention Problem-Immaturity (API) factor of the RBPC. Both ADD groups were rated by teachers as exhibiting significantly greater attention problems than controls on 12 of the 16 items on the factor. However, the ADD/H children were rated as more irresponsible, sloppy, distractible, impulsive, less sluggish, more likely to answer without thinking, and faster in finishing assignments than the ADD/WO children. In addition, only the ADD/H group differed significantly from controls on ratings of impulsivity and anwering without thinking, and only the ADD/WO group differed from controls on ratings of sluggishness and drowsiness. A stepwise discriminant analysis showed that the two ADD groups could be accurately discriminated (average canonical r 2 = 0.83) by a combination of ratings of impulsivity, sluggishness, immaturity, sloppiness, slowness, and need for supervision. These results suggest that ADD/H and ADD/WO may exhibit dissimilar types of attention deficits. Journal of the American Academy of Child Psychiatry , 24, 5:613–616, 1985.

Parent's accuracy in estimating child weight status

Mothers of 107 preschool children estimated their childs weight status, and the accuracy of these estimates was examined. The majority of mothers (72%) were accurate. Of those who were inaccurate, 83% had underestimated the childs weight status, whereas only 17% had overestimated. Mothers of heavier children were more likely to underestimate their childs weight status.

Expression of separation anxiety disorder: the roles of age and gender.

The purpose of this study was to examine the roles of age and gender in the symptom expression of separation anxiety disorder. Forty-five males and females of varying ages served as subjects. The nine symptoms included in the DSM-III diagnostic criteria for separation anxiety disorder were used as dependent variables. No gender differences were found on any of the symptoms. However, interesting age differences were discovered for specific symptoms and for the total number of clinically significant symptoms.