Ellin Simon

Screening for anxiety disorders in children

Anxiety disorders are highly prevalent and have negative consequences on individual and societal level. This study examined the usefulness of screening for anxiety disorders in primary school children. More specifically, the value of the screening method to discriminate between and to predict anxiety disorders was studied. Children and their parents were selected if the children had self-reported scores on the screening questionnaire Screen for Child Anxiety Related Emotional Disorders-71 (SCARED-71) within the top-15% (High-anxious) or from two points below to two points above the median (Median-anxious). Of the selected children, 183 high-anxious children and their parents, and 80 median-anxious children and their parents took part in a diagnostic interview, the Anxiety Disorder Interview Schedule (ADIS). Of the high-anxious children, 60% had an anxiety disorder versus 23% of the median-anxious children, whereas groups did not differ on rates of dysthymia/depression and attention deficit hyperactivity disorder. The diagnoses separation anxiety disorder, social phobia and specific phobia were specifically predicted by the corresponding subscales of the screening questionnaire, while the diagnosis generalised anxiety disorder was not predicted by any of the subscales. The screening method has proven its utility for discriminating between children with and without anxiety disorders when applying the top-15% cut-off. Moreover, separation anxiety disorder, social phobia, and specific phobia, all known to be prevalent and debilitating childhood anxiety disorders, can be predicted by the corresponding subscale of the screening instrument.

Efficacy of Child-Focused and Parent-Focused Interventions in a Child Anxiety Prevention Study.

This study examined anxiety development in median- (n = 74) and high-anxious children (n = 183) aged 8–13, the effect of parent- and child-focused preventive interventions on child/parental anxiety, and the effect of parental anxiety on child anxiety. High-anxious children were randomized into a parent-focused (n = 69), child-focused (n = 58) or non-intervention (n = 56) group. Families completed a pretest and 1- and 2-year follow-ups. Children selected as high-anxious or at risk were found to remain more susceptible to having anxiety problems and developing anxiety disorders than median-anxious children. Both intervention types showed favorable outcomes compared to no intervention on the number of “ADIS improved” children. These findings underline the need for effective preventive interventions for child anxiety. General improvements over time were found for symptoms of child and parental anxiety, however, and parental anxiety did not predict improvement in child anxiety after controlling for intervention. Therefore, it may not be necessary to focus on parental anxiety in interventions aimed at preventing child anxiety.

An explorative cost-effectiveness analysis of school-based screening for child anxiety using a decision analytic model

Anxiety in children is highly frequent and causes severe dysfunction. Various studies have used screening procedures to identify high-anxious children and offer them indicated prevention, but the cost-effectiveness of these screening procedures in combination with a preventive intervention has never been examined. This study compared four potential strategies in relation to the prevention of child anxiety: (1) a one-time school-based screening which offers a child-focused intervention, (2) the screening and offering of a parent-focused intervention, (3) the screening and differentially offering a child- or parent-focused intervention, depending on whether or not the parents are anxious themselves, and (4) or doing nothing. An economic evaluation from a societal perspective (i.e. including direct healthcare costs, direct non-healthcare costs, indirect costs, and out-of-pocket costs), using a decision-analytic model. The model was based on the real-world 2-year participation rates of screening and intervention, and real-world costs and effects of high- and median-anxious children (aged 8–12) from regular primary schools. Incremental cost-effectiveness ratios were calculated, and several secondary and one-way sensitivity analyses were performed. The strategy of doing nothing and the strategy of screening and differentially offering the child- or parent-focused intervention, depending on parental anxiety levels were both worthwhile, with the latter strategy costing relatively little extra money compared to doing nothing. In conclusion, some evidence for the cost-effectiveness of screening and intervening was found. Screening and offering a parent-focused intervention to children of anxious parents, and a child-focused intervention to children of non-anxious parents, were found to be the most cost-effective approach.

Factors associated with the referral of anxious children to mental health care: the influence of family functioning, parenting, parental anxiety and child impairment.

This study aims to identify factors that predict the mental health care referral of anxious children. In total, 249 children and families, aged 8–13 years, participated: 73 children were referred with anxiety disorders to mental health care [mean (M) age =10.28, standard deviation (SD) =1.35], 176 non‐referred anxious children recruited in primary schools (M age =9.94, SD =1.22). Child anxiety and other disorders were assessed with semi‐structured interviews. Child anxiety symptoms, behavioural problems, parental anxiety, the parenting styles overprotection, autonomy encouragement, rejection, and the family functioning dimensions control and relational functioning, were assessed with child, father and mother report on questionnaires. The summed interference rating of childrens anxiety disorders was a predictor of referral, consistent over child and parent reports, but not comorbidity. Most family and parenting variables did not predict referral, nor differed between the referred and non‐referred sample. Contrary to our hypothesis, maternal self‐reported anxiety decreased the odds of referral and child reported parental autonomy granting increased, while child reported overprotection decreased the odds of referral. The impairment for the child due to the number and severity of their anxiety disorder(s) is, based on child, mother and father report associated with referral. This indicates that those who need it most, receive clinical treatment. Copyright

Anxiety in preadolescent children: what happens if we don’t treat it, and what happens if we do?

In this paper, we review the area of anxiety in children under the age of 11 years. We explore the literature examining the continuity of anxiety symptoms and behavioral inhibition when they appear in children of this age, and show that when these are present, there is a high likelihood of significant anxiety in later childhood, adolescence, and beyond. We then focus on the growing area of treatment research. We show that there are a number of promising new avenues for managing anxiety disorders in this young age group. Many of these interventions involve a key role for parents in the treatment process, but others have demonstrated success employing modified cognitive behavior therapy directed at the child. Limitations to the conclusions, caused by the limited amounts research, small sample sizes and significant methodological difficulties, are discussed.

Psychological Inflexibility and Child Anxiety

Psychological flexibility is the main outcome of acceptance commitment therapy. Insight into the usefulness of measuring psychological flexibility is an important step to enable studies on the effectiveness of acceptance commitment therapy in middle-aged children (8–10 years). For this purpose, we examined the factor structure, the construct validity and the reliability of the Avoidance and Fusion Questionnaire for Youth. The Avoidance and Fusion Questionnaire for Youth taps psychological inflexibility (the opposite of psychological flexibility) in children and adolescents. Although the questionnaire has been extensively validated in older children, this is not the case for middle-aged children. The Avoidance and Fusion Questionnaire for Youth contains 17 items and is constituted of the subscales cognitive fusion, experiential avoidance and behavioral ineffectiveness. A shortened 8-item version also exists, the Avoidance and Fusion Questionnaire for Youth-8, which does not distinguish between these subscales. We performed a confirmatory factor analysis. Additionally, we assessed the relationship between psychological flexibility and child anxiety. Children, aged 8–10 years, were recruited via regular primary schools. Of the 459 approached children, 267 (58 %) parents signed informed consents for their children (Age: M = 9.18; SD = .79; Sex: nboys = 137, 51 %). Children completed the questionnaires during regular classes. In this sample, the 17-item version of the Avoidance and Fusion Questionnaire for Youth was less appropriate for measuring psychological inflexibility than the 8-item version. Furthermore, we found a significant positive relationship between psychological inflexibility and child anxiety. We argue that acceptance commitment therapy would be an interesting candidate for intervening early on in dysfunctional child anxiety, as acceptance commitment therapy’s cognitive elements require cognitive skills that children are likely to master early on.

Risk factors occurring during pregnancy and birth in relation to brain functioning and child's anxiety.

OBJECTIVE This study examined whether the most objective risk factors during pregnancy (prenatal) and delivery (perinatal) precede childs anxiety, and whether these factors exerted their influence via childs non-specific cerebral functioning. METHOD Median-anxious (n=82) and high-anxious (n=188) children (8-12), enrolled via the use of an anxiety screening questionnaire. Mothers were interviewed on pre-/perinatal risk factors, and children completed a visuospatial copying task. RESULTS High-anxious children were exposed to more prenatal (not perinatal) risk factors and deviated more on the visuospatial copying task. Prenatal risk factors, deviation on visuospatial copying, and their interaction were significant predictors of anxiety, accounting for 13.5% of the variance of anxiety. CONCLUSIONS This percentage is impressive, given the fact that anxiety emerges from various combinations of risk factors and nature-nurture interactions. This study underlined the importance of considering risk factors occurring during pregnancy in relation to child anxiety and brain functioning.