Eli R. Lebowitz

Mother and Child Ratings of Child Anxiety: Associations With Behavioral Avoidance and the Role of Family Accommodation

SYNOPSIS Objective. This study compared mother and child ratings of child anxiety to each other and to an objective measure of the child’s avoidant behavior, using a novel motion-tracking paradigm. The study also examined the moderating role of family accommodation for the link between mother ratings of child anxiety and child behavioral avoidance. Design. Participants were 98 children (7- to 14-years-old) and their mothers. Children met criteria for a primary anxiety disorder. Measures included parent and child versions of the Multi-Dimensional Anxiety Scale for Children and the Screen for Child Anxiety Related Emotional Disorders. Children also completed the Spider Phobia Questionnaire for children and the Family Accommodation Scale for Anxiety—Child Report. The Yale Interactive Kinect Environment Software platform was used to measure children’s behavioral avoidance of spider images. Results. Mother and child ratings of child anxiety were moderately correlated. Only child ratings of child anxiety were associated with child behavioral avoidance. Child-rated family accommodation moderated the association between parent ratings and child avoidance. When accommodation was low parent ratings correlated with child avoidance, but not when accommodation was high. Conclusions. The findings contribute to understanding commonly reported discrepancies between mother and child ratings of child anxiety symptoms.

Parenting a Child with ASD: Comparison of Parenting Style Between ASD, Anxiety, and Typical Development

Parenting children with ASD has a complex history. Given parents’ increasingly pivotal role in children’s treatment, it is critical to consider parental style and behaviours. This study (1) compares parenting style of parents of children with ASD, parents of children with anxiety disorders, and parents of typically developing (TD) children and (2) investigates contributors to parenting style within and between groups. Parents of children with anxiety had a distinct parenting style compared to ASD and TD parents. Unique relationships between child symptoms and parenting behaviours emerged across the three groups. Understanding factors that impact parenting between and within clinical groups can guide the development of interventions better tailored to support the needs of parents, particularly parents of children with ASD.

Linking volitional preferences for emotional information to social difficulties: A game approach using the microsoft kinect

Emotional intelligence has been positively associated with social competence. In addition, attentional responses to emotional information have been associated with psychological characteristics related to mental health. In this study, we used the Microsoft Kinect platform as a tool to examine relationships between responses to emotional information in a gameplay environment and psychological factors. 45 typically developing individuals participated in the study, which involved 1) the Kinect game, requiring participants to engage in unprompted volitional whole-body responses to emotional stimuli, and 2) psychosocial assessments such as the Broader Autism Phenotype Questionnaire (BAPQ) and the Brief Symptom Inventory (BSI). Principal component analysis revealed patterns of gameplay that were associated with psychological characteristics of individuals. Preference for emotional content in general was associated with fewer social difficulties. The present work offers preliminary support for utilizing Kinect video games to understand emotion orienting and social capabilities, and shows that implicit patterns of preference identified during gameplay may relate to psychological and psychiatric phenomena. While the issues are complex and further research is needed, this work may inform the development of novel approaches to diagnostic and therapeutic tools.

Using Motion Tracking to Measure Avoidance in Children and Adults: Psychometric Properties, Associations With Clinical Characteristics, and Treatment-Related Change

Avoidance is implicated in many areas of psychopathology, particularly anxiety and its disorders. Accurate, reliable, valid, and objective measurement of avoidance behavior poses methodological challenges. Two key technological advances, increased computing power and the advent of motion-tracking technology, offer novel solutions to these challenges. We describe a series of three studies using a novel motion-tracking system to measure avoidance in children and adults. The first study examined behavioral avoidance of spider stimuli in large samples of children and adults (N = 200 each; the adults were the mothers of the children). Behavioral avoidance was associated with self-rated fear of spiders and increased state anxiety from before to after the task. The second study examined avoidance of threat faces in children and adults (N = 35 each; the adults were the mothers of the children) and test-retest reliability in the adults. Avoidance of threat faces was associated with broadband anxiety symptom severity. Test-retest correlations in behavioral avoidance measured 6 weeks apart was high and significant. The third study examined behavioral avoidance of spiders in clinically anxious children (N = 25) before and after cognitive-behavioral therapy for childhood anxiety disorders. Behavioral avoidance was significantly reduced following cognitive-behavioral therapy and reduction in behavioral avoidance correlated significantly with improvement in child-rated anxiety symptoms. Taken together, these studies provide strong support for the promise of motion-tracking technology to enable a new phase of behavioral avoidance research with sensitive, valid, reliable, and cost- and time-effective measurement of behavioral avoidance across the lifespan.

Treatment of Extreme Family Accommodation in a Youth with Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) in youth is typically characterized by high degrees of family accommodation or changes to parent behavior aimed at aiding the youth in avoiding or alleviating distress caused by the disorder. Coercive-disruptive behaviors are also prevalent among youth with OCD and describe forceful attempts to impose family accommodation on parents and siblings. High degrees of family accommodation are associated with greater symptom severity and with poorer response to treatment. Parent-based interventions offer an alternative or enhancement to therapy with the youth. Supportive Parenting for Anxious Childhood Emotions (SPACE) is a parent-based treatment for pediatric OCD and anxiety disorders. SPACE works to systematically reduce family accommodation and provides parents with practical tools for coping with the youth’s responses, including coercive-disruptive behaviors. This chapter presents an overview of SPACE and illustrative case example. Alyssa was a 14-year-old girl with severe OCD whose parents reported severe coercive-disruptive behaviors and extreme family accommodation. Over treatment, parents systematically charted their accommodation and implemented plans to reduce it. The therapist guided the parents in applying SPACE modules to cope with Alyssa’s anger and distress and to improve their ability to work collaboratively with each other. Following treatment, Alyssa showed significant improvement in obsessive-compulsive symptoms, and parents reported greatly reduced family accommodation and coercive-disruptive behaviors. A discussion of complicating factors is included.

Addressing Family Accommodation in Childhood Obsessive-Compulsive Disorder

Abstract Parents of children with OCD modify their own behavior to help their child avoid or alleviate distress related to their OCD symptoms, a process termed family accommodation. Family accommodation can help a child to feel better in the short term but is associated with more severe symptoms in the longer term and places considerable burden on parents and other family members. High levels of family accommodation also predict poorer treatment outcomes for the child. It is important to assess the frequency and nature of family accommodation when evaluating childhood OCD and reducing family accommodation should be integrated into treatment planning. This chapter reviews the theoretical and empirical knowledge relating to family accommodation of childhood OCD, describes the phenomenology of family accommodation, presents measures for assessing family accommodation, and provides strategies for addressing family accommodation through parent-based treatment.

Bernardo J. Carducci and Lisa Kaiser: Shyness: The Ultimate Teen Guide

Shyness: The Ultimate Teen Guide was written by Dr. Bernardo Carducci, a professor of psychology at Indiana University Southeast and his colleague, Lisa Kaiser. It is part of an edited book series that focuses on various illnesses, psychological concepts, and lifestyle choices relevant to adolescents and young adults. The book provides information about shyness and self-help strategies to become ‘‘successfully shy,’’ that is, effective management of shyness so it does not impede one’s goals. It was primarily written for shy teenagers, but also for people who are close to a shy teenager (e.g., friends and caregivers) and researchers. The book is comprised of three parts. Part I: Getting to Know Shy Teens normalizes shyness, describes the heterogeneity of people who are shy, and discusses the etiology of shyness. It explains that there is nothing wrong with feeling shy and that shyness is just one small part of an individual’s identity. Part II: What it Feels Like to Be Shy describes the phenomenology of shyness including the physiological manifestations of anxiety, destructive thought patterns typical of shy adolescents, and how shyness can adversely impact one’s self-worth. Readers are taught how to change their reactions to interpersonal situations so they are not hindered by them. Part III: Becoming a Successfully Shy Teen provides practical guidance for making friends, dating, navigating school and college, using social media, and reducing bullying. Overall, the book provides a compassionate and accessible integration of theoretically and empirically informed approaches to managing shyness. The book appears to be designed for typically developing teens as there is no mention of individuals with autism or other developmental disorders. However, the information and skills provided are widely applicable. Readers may become more self-aware and empowered to ‘‘take control of shyness’’ by building on their strengths and interests. Although the book provides a healthy dose of encouragement to shy teens, it balances this appropriately with realistic expectations. The text is enhanced with pictures, self-assessment inventories, reflective questions, structured exercises, and personal accounts of shyness. We like the structure the author provides for skills like small talk, problem-solving, and expanding one’s comfort zone. For shy teenagers, and for individuals with developmental disorders in particular, breaking down complex interpersonal situations into steps can be invaluable. Because individuals with a higher severity of shyness, otherwise known as social anxiety (American Psychiatric Association 2013), are more likely to buy and read the book, it is important for the readership to know of the availability and efficacy of mental health treatment targeting this concern. Psychotherapy can help teenagers implement the strategies outlined in the book, many of which are based on cognitive–behavioral approaches such as gradual exposure and the importance of practice (Lebowitz and Omer 2013; Walkup et al. 2008). The authors mention the use of medication to treat anxiety but downplay its significance in favor of self-awareness and behavioral strategies. We agree with this sentiment for individuals with low to moderate levels of shyness; however, this statement implies to us that the author may be underestimating the severity of social anxiety and its clinical correlates (e.g., depression and suicidality) in the & Eli R. Lebowitz eli.lebowitz@yale.edu