Jennifer L. Hudson

Anxiety Disorders During Childhood and Adolescence: Origins and Treatment

The present review summarizes our current knowledge of the development and management of anxiety in children and adolescents. Consideration is given to limitations of this knowledge and directions for future research. The review begins with coverage of the development and demographic correlates of anxiety in young people and then moves to systematic discussion of some of the key etiological factors, including genetics, temperament, parenting, and individual experiences. The second part of the review describes current treatment strategies and efficacy as well as factors thought to influence treatment outcome, including treatment features, child factors, and parent factors. The review concludes with brief coverage of some more recent developments in treatment including alternative models of delivery and prevention strategies.

Parent-child interactions and anxiety disorders: an observational study.

Past research has indicated a potential link between anxiety and parenting styles that are characterised by control and rejection. However, few studies have utilised observational methods to support these findings. In the current study, mother-child interactions were observed while the child completed two difficult cognitive tasks. The sample consisted of clinically anxious children (n=43), oppositional defiant children (n=20) and non-clinical children (n=32). After adjusting for the age and sex of the child, mothers of anxious children and mothers of oppositional children displayed greater and more intrusive involvement than mothers of non-clinical children. Mothers of anxious children were also more negative during the interactions than mothers of non-clinical children. The differences between anxious and non-clinical interactions were equivalent across three separate age groups. The results support the relationship between an overinvolved parenting style and anxiety but question the specificity of this relationship.

Cognitive-behavioral therapy for anxiety disordered youth: a randomized clinical trial evaluating child and family modalities.

This randomized clinical trial compared the relative efficacy of individual (child) cognitive-behavioral therapy (ICBT), family cognitive-behavioral therapy (FCBT), and a family-based education/support/ attention (FESA) active control for treating anxiety disordered youth ages 7-14 years (M = 10.27). Youth (N = 161; 44% female; 85% Caucasian, 9% African American, 3% Hispanic, 3% other/mixed) with a principal diagnosis of separation anxiety disorder, social phobia, or generalized anxiety disorder and their parents participated. Outcome analyses were conducted using hierarchical linear models on the intent-to-treat sample at posttreatment and 1-year follow-up using diagnostic severity, child self-reports, parent reports, and teacher reports. Chi-square analyses were also conducted on diagnostic status at post and 1-year follow-up. Children evidenced treatment gains in all conditions, although FCBT and ICBT were superior to FESA in reducing the presence and principality of the principal anxiety disorder, and ICBT outperformed FCBT and FESA on teacher reports of child anxiety. Treatment gains, when found, were maintained at 1-year follow-up. FCBT outperformed ICBT when both parents had an anxiety disorder. Implications for treatment and suggestions for research are discussed.

Issues in the diagnosis and assessment of anxiety disorders in children and adolescents

Accurate diagnosis and assessment of anxiety disorders in children and adolescents is important for both treatment and research. In this paper, we review research related to the discriminant validity of the childhood anxiety disorders, and outline methods of assessment for children, including diagnostic interviews, self-report instruments, and behavioural, cognitive, and psychophysiological measures. Particular attention is given to psychometric and developmental issues, and their influence on assessment. The evidence provides support for the validity of the anxiety disorders as a whole, but only partial support for differentiation between specific anxiety disorders in children. Similarly, assessment methods used with anxious children provide reasonably accurate information on anxious symptoms, however are limited by poor discriminant validity and lack of sensitivity to developmental levels.

Anxiety in Adolescents with Asperger Syndrome: Negative Thoughts, Behavioral Problems, and Life Interference.

This study examined anxiety symptoms in 29 adolescents With Asperger syndrome (AS) aged 12 to 16 years, compared to 30 nonclinical (NC) adolescents and 34 adolescents With anxiety disorders (AD). Comorbidity betWeen anxiety symptoms and negative thoughts, behavioral problems, and life interference Was also examined. Self- and parental reports revealed significantly higher levels of anxiety in both the AS group and the AD group than in the NC group. Negative thoughts, behavioral problems, and life interference Were significantly higher for the AS group than for the tWo comparison groups.

Parent-Child Interactions in Clinically Anxious Children and Their Siblings

The Emotion Expression Scale for Children (EESC) is a new self-report scale designed to examine 2 aspects of deficient emotion expression: lack of emotion awareness and lack of motivation to express negative emotion. Validity was assessed using self-report measures of emotion regulation and self- and peer-report of internalizing and externalizing symptoms. Using a community sample of 208 fourth- and fifth-grade children, reliability analyses revealed high internal consistency and moderate test-retest reliability of the EESC. The results provide initial support for concurrent validity for the EESC factors evidenced by relations with measures of emotion management. Associations were found between the EESC and measures of internalizing symptoms.

Therapygenetics: the 5HTTLPR and response to psychological therapy

Whilst pharmacogenetic research thrives 1 , genetic determinants of response to purely psychotherapeutic treatments remain unexplored. In a sample of children undergoing Cognitive Behavior Therapy (CBT) for an anxiety disorder, we tested whether treatment response is associated with the serotonin transporter gene promoter region (5HTTLPR), previously shown to moderate environmental influences on depression. Children with the short-short genotype were significantly more likely to respond to CBT than those carrying a long allele.

Cognitive-behavioral treatment versus an active control for children and adolescents with anxiety disorders: a randomized trial.

OBJECTIVE The current trial examined whether a specific cognitive-behavioral treatment package was more efficacious in treating childhood anxiety disorders than a nonspecific support package. METHOD One hundred twelve children (aged 7-16 years) with a principal anxiety disorder were randomly allocated to either a group cognitive-behavioral treatment (CBT) program or a control condition (group support and attention [GSA]). RESULTS Overall, results showed that CBT was significantly more efficacious compared with the GSA condition: 68.6% of children in the CBT condition did not meet diagnostic criteria for their principal anxiety diagnosis at 6-month follow-up compared with 45.5% of the children in the GSA condition. The results of the child- and parent-completed measures indicated that, although mothers of CBT children reported significantly greater treatment gains than mothers of GSA children, children reported similar improvements across conditions. CONCLUSIONS Specific delivery of cognitive-behavioral skills is more efficacious in the treatment of childhood anxiety than a treatment that includes only nonspecific therapy factors.

Parental Responses to Positive and Negative Emotions in Anxious and Nonanxious Children

This study examined the role of multiple childrens emotions and parental anxiety during parent–child interactions of anxiety disordered (AD) and nonanxious (NA) children ages 7 to 13 years. Families (mother, father, child) each discussed three recent and real separate situations in which the child experienced anxiety, anger, and happiness. Results revealed significant differences in behavior between parents of AD and NA children. Maternal behavior, but not paternal behavior, was related to the emotion the child was experiencing. Mothers of AD children displayed greater intrusive involvement than mothers of NA children in those situations in which the child was experiencing negative affect. A significant interaction was evident between maternal anxiety disorder and emotion, whereby anxious mothers were more intrusive in situations involving anxiety and anger (compared to positive emotion situations), whereas nonanxious mothers were more intrusive only during situations involving anger.

The Pain Course: A randomised controlled trial of a clinician-guided Internet-delivered cognitive behaviour therapy program for managing chronic pain and emotional well-being

&NA; Examination of a clinician‐guided Internet‐delivered cognitive behaviour therapy program for chronic pain found significant improvements in disability, anxiety, depression, and average pain ratings. &NA; The present study evaluated the efficacy of a clinician‐guided Internet‐delivered cognitive behaviour therapy (iCBT) program, the Pain Course, to reduce disability, anxiety, and depression associated with chronic pain. Sixty‐three adults with chronic pain were randomised to either a Treatment Group or waitlist Control Group. Treatment consisted of 5 iCBT‐based lessons, homework tasks, additional resources, weekly e‐mail or telephone contact from a Clinical Psychologist, and automated e‐mails. Twenty‐nine of 31 Treatment Group participants completed the 5 lessons during the 8‐week program, and posttreatment and 3‐month follow‐up data were collected from 30/31 and 29/31 participants, respectively. Treatment Group participants obtained significantly greater improvements than Control Group participants in levels of disability, anxiety, depression, and average pain levels at posttreatment. These improvements corresponded to small to large between‐groups effect sizes (Cohen’s d) at posttreatment for disability (d = .88), anxiety (d = .38), depression (d = .66), and average pain (d = .64), respectively. These outcomes were sustained at follow‐up and participants rated the program as highly acceptable. Overall, the clinician spent a total mean time of 81.54 minutes (SD 30.91 minutes) contacting participants during the program. The results appear better than those reported in iCBT studies to date and provide support for the potential of clinician‐guided iCBT in the treatment of disability, anxiety, and depression for people with chronic pain.