Julia D. McQuade

Cognitive Behavioral Therapy for 4- to 7-Year-Old Children with Anxiety Disorders: A Randomized Clinical Trial.

OBJECTIVE To examine the efficacy of a developmentally appropriate parent-child cognitive behavioral therapy (CBT) protocol for anxiety disorders in children ages 4-7 years. METHOD DESIGN Randomized wait-list controlled trial. Conduct: Sixty-four children (53% female, mean age 5.4 years, 80% European American) with anxiety disorders were randomized to a parent-child CBT intervention (n = 34) or a 6-month wait-list condition (n = 30). Children were assessed by interviewers blind to treatment assignment, using structured diagnostic interviews with parents, laboratory assessments of behavioral inhibition, and parent questionnaires. ANALYSIS Chi-square analyses of outcome rates and linear and ordinal regression of repeated measures, examining time by intervention interactions. RESULTS The response rate (much or very much improved on the Clinical Global Impression Scale for Anxiety) among 57 completers was 69% versus 32% (CBT vs. controls), p < .01; intent-to-treat: 59% vs. 30%, p = .016. Treated children showed a significantly greater decrease in anxiety disorders (effect size [ES] = .55) and increase in parent-rated coping (ES = .69) than controls, as well as significantly better CGI improvement on social phobia/avoidant disorder (ES = .95), separation anxiety disorder (ES = .82), and specific phobia (ES = .78), but not on generalized anxiety disorder. Results on the Child Behavior Checklist Internalizing scale were not significant and were limited by low return rates. Treatment response was unrelated to age or parental anxiety but was negatively predicted by behavioral inhibition. Gains were maintained at 1-year follow-up. CONCLUSIONS Results suggest that developmentally modified parent-child CBT may show promise in 4- to 7-year-old children.

Peer Problems in Attention Deficit Hyperactivity Disorder: Current Status and Future Directions.

This article extends previous reviews regarding the peer problems of children with Attention Deficit Hyperactivity Disorder (ADHD) in several ways. In addition to summarizing past and current literature regarding the social behaviors of children with ADHD, these behaviors are discussed in terms of subtype and gender differences and treatment implications. Given limited effectiveness of treatment options, whether it be medication, behavioral modification, or social skills training, there is a need to examine additional factors that may contribute to the social impairment of children with ADHD. Therefore, this review focuses on potential neuropsychological deficits, biased perceptions of social ability, and deficits in encoding and processing social information that may contribute to the social impairment of children with ADHD. These topics are discussed both in terms of their contribution to our understanding of the peer problems of children with ADHD and as potential avenues for future research.

Pilot Physical Activity Intervention Reduces Severity of ADHD Symptoms in Young Children

Objective: Physical activity associates with mental health and neurocognitive function, showing potential for addressing ADHD symptoms. As a preliminary assessment of this potential, the authors piloted a before-school physical activity intervention for young children. Method: Seventeen children (Grades K-3) exhibiting four or more hyperactivity/impulsivity symptoms on the Disruptive Behavior Disorders Rating Scale (Pelham, 2002) completed about 26 min of continuous moderate-to-vigorous physical activity daily over eight school weeks. The authors administered cognitive, motor, social, and behavioral functioning measures at pre- and postprogram, assessed response inhibition weekly, and coded negative behaviors daily. Results: Several measures showed significant or marginally significant change over time (effect size = 0.35-0.96) with additional measures showing meaningful effect size values (≥ 0.20). Response inhibition effects were most consistent. Most participants (64% to 71%) exhibited overall improvement according to postprogram parent, teacher, and program staff ratings. Conclusion: Physical activity shows promise for addressing ADHD symptoms in young children.

Developmental trajectories of anxiety disorders in offspring at high risk for panic disorder and major depression

The objective of this study was to evaluate the longitudinal course of psychiatric disorders in children of parents with and without panic disorder and major depression as they transition through the period of risk from early to late childhood. Over a 5-year follow-up, we compared the course of psychiatric disorders in offspring of parents with panic disorder, major depression, or neither disorder. Subjects consisted of 233 offspring (from 151 families) with baseline and follow-up assessments. Subjects were comprehensively assessed with structured diagnostic interviews. Anxiety disorders at baseline were used to predict anxiety disorders and major depression at follow-up using stepwise logistic regression. Separation anxiety disorder significantly increased the risk for the subsequent development of specific phobia, agoraphobia, panic disorder, and major depression, even after parental panic and depression were covaried. Agoraphobia significantly increased the risk for subsequent generalized anxiety disorder. These findings suggest that separation anxiety disorder is a major antecedent disorder for the development of panic disorder and a wide range of other psychopathological outcomes, and that it increases the risk for subsequent psychopathology even among children already at high familial risk for anxiety or mood disorder.

Working memory and social functioning in children.

This study extends previous research and examines whether working memory (WM) is associated with multiple measures of concurrent social functioning (peer rejection, overall social competence, relational aggression, physical aggression, and conflict resolutions skills) in typically developing fourth- and fifth-grade children (N=116). Poor central executive WM was associated with both broad social impairments (peer rejection and poor overall social competence) and specific social impairments (physical aggression, relational aggression, and impaired conflict resolution skills); poor verbal storage was associated only with greater peer rejection, and spatial storage was not associated with any measures of social impairment. Analyses also examined whether specific impairments in aggressive behavior and conflict resolution skills mediated the association between central executive and broad measures of social functioning. Greater physical aggression and impaired conflict resolution skills were both significant mediators; relational aggression was not. Implications for theory and future research are discussed.

Perceived Social Acceptance and Peer Status Differentially Predict Adjustment in Youth With and Without ADHD

Objective: This study extends previous research and examined if the longitudinal relation between self-perceived social acceptance and changes in adjustment was moderated by peer status and ADHD diagnosis. Method: A sample of children with ADHD and a normative comparison group (age 8-13 years) were assessed at baseline and one-year follow-up. Self-perceived social acceptance, peer status, and three areas of adjustment (depression symptoms, aggression/conduct problems, and social skills) were measured. Results: Moderation was found when predicting depression symptoms and aggression/conduct problems. Specifically, in children with ADHD only, higher perceived social acceptance protected against increases in depression symptoms for those with lower peer preference, but predicted greater aggression/conduct problems for those with higher peer preference. There was not evidence of significant moderation for predicting social skills; instead non-ADHD status, greater peer preference, and greater self-perceived social acceptance were each predictive of greater social skills. Conclusion: Results highlight the complex association between positive social self-perceptions and adjustment for children with ADHD and caution against a universal assumption that high self-perceptions are adaptive.

Does childhood positive self-perceptual bias mediate adolescent risky behavior in youth from the MTA study?

OBJECTIVE This studys primary aim was to examine whether the positive self-perceptual bias present in many youth with attention-deficit/hyperactivity disorder (ADHD; Hoza et al., 2004; Hoza, Pelham, Dobbs, Owens, & Pillow, 2002) mediates the relation of childhood ADHD status to later risky behaviors. METHOD Using a subset of children with ADHD and comparison children (n = 645) from the Multimodal Treatment Study of Children With ADHD, we predicted that a positive bias in childhood would partially or fully mediate the relation between having ADHD and risky driving and sexual behaviors 8 years later. RESULTS Results strongly supported this hypothesis for risky driving behavior but only provided limited support for risky sexual behavior. CONCLUSIONS Taken together, findings suggest that future research should explore whether self-perceptual bias may be a useful target of intervention for children with ADHD.

Peer victimization and changes in physical and relational aggression: The moderating role of executive functioning abilities

This study is the first to examine whether executive functioning (EF) abilities moderate longitudinal associations between peer victimization and engagement in physically and relationally aggressive behavior. Participants were 61 children (9-13 years, M = 10.68, SD = 1.28; 48% male) drawn from a partially clinical sample who were assessed at two time points, approximately 12 months apart. At time 1, children were administered a battery of EF tests; adult reports of childrens relational and physical victimization and use of relational and physical aggression were collected. At time 2, adult-reported aggression was re-collected. Regression analyses tested whether EF ability moderated the association between peer victimization and increased engagement in aggression. Form-specific (e.g., physical victimization predicting physical aggression) and cross-form (e.g., physical victimization predicting relational aggression) models were tested. EF moderated the association between physical victimization and increases in physical aggression over time and between relational victimization and increases in relational aggression over time. Physical victimization predicted increases in physical aggression only among children with poor EF. However, relational victimization predicted increases in relational aggression for children with good EF skills but decreases in relational aggression for children with poor EF skills. Interaction effects for cross-form models were not significant. Results suggest that there are distinct risk factors implicated in childrens engagement in physical and relational aggression. Established cognitive vulnerability models for engagement in physical aggression should not be assumed to apply to engagement in relational aggression.

Social Costs for Wannabes: Moderating Effects of Popularity and Gender on the Links between Popularity Goals and Negative Peer Experiences

Youth in early adolescence are highly concerned with being popular in the peer group, but the desire to be popular can have maladaptive consequences for individuals. In fact, qualitative work suggests that youth with high popularity goals who are nonetheless unpopular have negative experiences with their peers. However, little quantitative work has examined this possibility. The purpose of the current study was to examine if popularity goals were linked with physical (e.g., being hit) and relational (e.g., being excluded) victimization and peer rejection, particularly for individuals who strived for popularity but were viewed by their peers as unpopular. Late elementary and early middle school participants (N = 205; 54% female) completed self-reports of popularity goals and peer nominations of popularity and peer rejection. Teachers reported on students’ experiences of relational and physical victimization. Peer nominated popularity and gender were moderators of the association between popularity goals and negative peer experiences. Consistent with hypotheses, girls who were unpopular but wanted to be popular were more likely to experience peer rejection and relational victimization. Unexpectedly, boys who were unpopular but did not desire to be popular were more likely to be rejected and relationally victimized. The findings suggest that intervention and prevention programs may benefit from addressing the social status goals of low status youth in a gender-specific manner.

Borderline Personality Features Mediate the Association Between ADHD, ODD, and Relational and Physical Aggression in Girls

Objective: This study investigates borderline personality features (BPF) as a mediator of the association between ADHD and ODD symptoms and aggression in girls. Method: Parents of 118 girls (Mage = 11.40 years old) with and without ADHD completed ratings of ADHD and ODD severity, and parents and youth provided ratings of physical and relational aggression. Results: ADHD, ODD, and their subfactors were significantly correlated with BPF, and these variables were associated with aggression measures. BPF fully mediated the association between total ODD symptom severity and relational and physical aggression by parent and youth report. At the subfactor level, BPF fully mediated the association between hyperactivity/impulsivity and oppositional behavior and physical and relational aggression. Conclusion: These findings add to a growing literature showing the relevance of BPF as a risk factor for poor social functioning in youth and point to the importance of continued work examining BPF among girls with ADHD and ODD.