Nicholas D. Mian

Patterns of anxiety symptoms in toddlers and preschool-age children: evidence of early differentiation.

The degree to which young childrens anxiety symptoms differentiate according to diagnostic groupings is under-studied, especially in children below the age of 4 years. Theoretical (confirmatory factor analysis, CFA) and statistical (exploratory factor analysis, EFA) analytical methods were employed to test the hypothesis that anxiety symptoms among 2-3-year-old children from a non-clinical, representative sample would differentiate in a manner consistent with current diagnostic nosology. Anxiety symptom items were selected from two norm-referenced parent-report scales of child behavior. CFA and EFA results suggested that anxiety symptoms aggregate in a manner consistent with generalized anxiety, obsessive-compulsive symptoms, separation anxiety, and social phobia. Multi-dimensional models achieved good model fit and fit the data significantly better than undifferentiated models. Results from EFA and CFA methods were predominantly consistent and supported the grouping of early childhood anxiety symptoms into differentiated, diagnostic-specific categories.

Lost Toy? Monsters Under the Bed? Contributions of Temperament and Family Factors to Early Internalizing Problems in Boys and Girls

This study was designed to examine the contribution of multiple risk factors to early internalizing problems and to investigate whether family and ecological context moderated the association between child temperament and internalizing outcomes. A sample of 1,202 mothers of 2- and 3-year-old children completed a survey of child social-emotional functioning, family environment, and violence exposure. Child temperament, maternal affective symptoms, and family expressiveness were associated with child anxiety and depression problems. Violence exposure was related only to child anxiety. When maternal affective symptoms were elevated, inhibited girls but not boys were rated as more anxious and youngsters with heightened negative emotionality were rated as more depressed. Family expressiveness moderated the association between inhibited temperament and anxiety symptoms.

Development of a novel observational measure for anxiety in young children: The Anxiety Dimensional Observation Scale.

BACKGROUND Identifying anxiety disorders in preschool-age children represents an important clinical challenge. Observation is essential to clinical assessment and can help differentiate normative variation from clinically significant anxiety. Yet, most anxiety assessment methods for young children rely on parent-reports. The goal of this article is to present and preliminarily test the reliability and validity of a novel observational paradigm for assessing a range of fearful and anxious behaviors in young children, the Anxiety Dimensional Observation Schedule (Anx-DOS). METHODS A diverse sample of 403 children, aged 3 to 6 years, and their mothers was studied. Reliability and validity in relation to parent reports (Preschool Age Psychiatric Assessment) and known risk factors, including indicators of behavioral inhibition (latency to touch novel objects) and attention bias to threat (in the dot-probe task) were investigated. RESULTS The Anx-DOS demonstrated good inter-rater reliability and internal consistency. Evidence for convergent validity was demonstrated relative to mother-reported separation anxiety, social anxiety, phobic avoidance, trauma symptoms, and past service use. Finally, fearfulness was associated with observed latency and attention bias toward threat. CONCLUSIONS Findings support the Anx-DOS as a method for capturing early manifestations of fearfulness and anxiety in young children. Multimethod assessments incorporating standardized methods for assessing discrete, observable manifestations of anxiety may be beneficial for early identification and clinical intervention efforts.

Little Children with Big Worries: Addressing the Needs of Young, Anxious Children and the Problem of Parent Engagement

Anxiety disorders in preschool-age children represent an important clinical problem due to high prevalence, substantial impairment, persistence, and associated risk for later emotional problems. Early intervention may mitigate these problems by capitalizing on a strategic developmental period. Elevated neuroplasticity, availability of screening tools, and the potential to modify parenting practices position anxiety as a good candidate for early intervention and preventive efforts. While some novel interventions show promise, the broad success of such programs will largely depend on parent engagement. Since parents are less likely to identify and seek help for anxiety problems compared to other childhood behavior problems, especially in a preventive manner, methods for understanding parents’ decisions to participate and enhancing levels of engagement are central to the success of early childhood anxiety prevention and intervention. Understanding these processes is particularly important for families characterized by sociodemographic adversity, which have been underrepresented in anxiety treatment research. This review summarizes the developmental phenomenology of early emerging anxiety symptoms, the rationale for early intervention, and the current state of research on interventions for young, anxious children. The roles of parent engagement and help-seeking processes are emphasized, especially among economically disadvantaged and ethnic minority communities who are acutely at risk. Evidence-based strategies to enhance parent engagement to facilitate the development and dissemination of efficacious programs are offered.

Using Research-Informed Pedagogical Practices to Maximize Learning in Youth Cognitive Behavioral Therapy

ABSTRACT Cognitive-behavioral therapy (CBT) for youth is an evidence-based treatment that typically starts with some form of psychoeducation, during which the patient is taught in a didactic manner about their presenting problems and strategies to ameliorate their symptoms. The learning process continues over the course of treatment as patients consolidate and attempt to utilize their aqcuired knowledge in their daily life. Manuals provide helpful structure and strategies to facilitate this learning process (e.g., using metaphors, personalized coping cards); however, there is variability across patients in terms of what presented content they will be able to access and understand, how they can most effectively transfer what they learn into their everyday life, and why they will become engaged in this learning process. The purpose of this article is to connect CBT and pedagogy by outlining the research-informed pedagogical framework known as Universal Design for Learning (UDL) as it relates to the teaching and learning that takes place in CBT. First, we describe UDL as a lens through which clinicians can conceptualize evidence-based pedagogical principles that undergird common CBT teaching practices. Second, we recommend that clinicians use UDL as a guiding framework when they are faced with barriers to learning due to the variability that exists in how patients engage in, access and understand, and utilize the material. We posit that UDL can help clinicians ensure that more patients are able to successfully access and benefit from CBT.

The Relationship Between Worry and Dimensions of Anxiety Symptoms in Children and Adolescents.

BACKGROUND Worry is a common feature across many anxiety disorders. It is important to understand how and when worry presents from childhood to adolescence to prevent long-term negative outcomes. However, most of the existing studies that examine the relationship between worry and anxiety disorders utilize adult samples. AIMS The present study aimed to assess the level of worry in children and adolescents and how relationships between worry and symptoms of separation anxiety disorder (SAD) and social anxiety disorder (Soc) may present differently at different ages. METHOD 127 children (age 8-12 years) and adolescents (age 13-18 years), diagnosed with any anxiety disorder, presenting at a child anxiety out-patient clinic, completed measures of worry, anxiety and depression. RESULTS Worry scores did not differ by age group. Soc symptoms were significantly correlated with worry in both age groups; however, SAD symptoms were only significantly correlated with worry in younger participants. After the inclusion of covariates, SAD symptoms but not Soc symptoms remained significant in the regression model with younger children, and Soc symptoms remained significant in the regression model with older children. CONCLUSIONS The finding that worry was comparable in both groups lends support for worry as a stable construct associated with anxiety disorders throughout late childhood and early adolescence.

Early identification of anxiety disorders: The role of the pediatrician in primary care

ABSTRACT Anxiety disorders are the most common psychiatric disorder of childhood, and are associated with high risk for development of future psychopathology. Yet, pediatric anxiety disorders continue to be under diagnosed in primary care, leaving many children untreated. Pediatricians in primary care settings are in a unique position to detect child anxiety within the context of well-child visits. While important efforts are currently under way, such as increased behavioral screening, one of the most important challenges is that pediatricians do not receive an adequate level of training in the evaluation, management, and treatment of anxiety disorders. We review recent assessment initiatives in this area and call for increased efforts to promote early detection in primary care and reduce potential barriers for pediatricians, consistent with the movement toward integrated behavioral health models. Finally, we describe a current initiative that utilizes collaboration between psychologists and pediatric faculty to train pediatric residents to detect, diagnose, counsel, and refer young children with anxiety.