Nissa R. Towe-Goodman

Preschool Anxiety Disorders in Pediatric Primary Care: Prevalence and Comorbidity

OBJECTIVE We sought to establish prevalence rates and detail patterns of comorbidity for generalized anxiety disorder, separation anxiety disorder, and social phobia in preschool-aged children. METHOD The Duke Preschool Anxiety Study, a screen-stratified, cross-sectional study, drew from pediatric primary care and oversampled for children at risk for anxiety. A total of 917 parents of preschool children (aged 2-5 years) completed the Preschool Age Psychiatric Assessment. RESULTS Generalized anxiety disorder, separation anxiety disorder, and social phobia are common in preschool-aged children attending pediatric primary care. Three-fourths of preschoolers with an anxiety disorder only had a single anxiety disorder. Generalized anxiety disorder displayed the greatest degree of comorbidity: with separation anxiety disorder (odds ratio [OR] = 4.1, 95% CI = 2.0-8.5), social phobia (OR = 6.4, 95% CI = 3.1-13.4), disruptive behavior disorders (OR = 5.1, 95% CI = 1.6-15.8), and depression (OR = 3.7, 95% CI = 1.1-12.4). CONCLUSIONS The weakness of association between generalized anxiety disorder and depression stands in contrast to substantial associations between these 2 disorders reported in older individuals. Attenuated associations in preschool-aged children could translate into clinical opportunities for targeted early interventions, aimed at modifying the developmental trajectory of anxiety disorders.

Power assertive discipline, maternal emotional involvement, and child adjustment.

Despite long-standing research, the relations between power assertive discipline and child adjustment continue to be debated. Disentangling disciplinary practices from the parent-child emotional climate may aid understanding of how such parenting practices impact child adjustment. This study explored longitudinal relations between maternal emotional involvement, power assertive discipline, and child adjustment in a sample of 35 mothers of infant, toddler, and preschool-age children. Results indicate that power assertive discipline may differentially impact child adjustment, depending on levels of maternal emotional involvement.

Interparental aggression and infant patterns of adrenocortical and behavioral stress responses

Drawing on emotional security theory, this study examined linkages between interparental aggression, infant self-regulatory behaviors, and patterns of physiological and behavioral stress responses in a diverse sample of 735 infants residing in predominately low-income, non-metropolitan communities. Latent profile analysis revealed four classes of adrenocortical and behavioral stress-response patterns at 7 months of age, using assessments of behavioral and cortisol reactivity to an emotion eliciting challenge, as well as global ratings of the childs negative affect and basal cortisol levels. The addition of covariates within the latent profile model suggested that children with more violence in the home and children who used less caregiver-oriented regulation strategies were more likely to exhibit a pattern of high cortisol reactivity with moderate signs of distress rather than the average stress response, suggesting possible patterns of adaptation in violent households.

Interparental aggression, attention skills, and early childhood behavior problems

The current study explored longitudinal associations between interparental aggression, the development of child attention skills, and early childhood behavior problems in a diverse sample of 636 families living in predominately low-income, nonmetropolitan communities. The results of latent-variable, cross-lagged longitudinal models revealed that maternal-reported interparental aggression in infancy predicted reduced observed attention skills in toddlerhood; no association was observed, however, between attention in infancy and interparental aggression during the toddler years. Further, reduced toddler attention and high interparental aggression were both associated with increased risk for attention-deficit/hyperactivity disorder symptoms and conduct problems at 3 years of age. Processes largely operated in similar ways regardless of child gender or low-income status, although a few differences were observed. Overall, the results suggest that interparental aggression undermines attention development, putting childrens early behavioral adjustment at risk.

Family Violence and Children’s Behavior Problems: Independent Contributions of Intimate Partner and Child-Directed Physical Aggression

Using data from a diverse sample of 581 families living in predominantly low-income, rural communities, the current study sought to investigate the longitudinal associations among father-perpetrated intimate partner violence (IPV) and child-directed physical aggression perpetrated by the mother. The unique contributions of each of these types of family violence on children’s behavioral problems at school entry were also examined. Results confirm bidirectional associations between father-perpetrated IPV and maternal physical aggression directed toward the child, and indicate that both types of physical aggression contribute to child behavior problems at school entry.

Maternal Depression, Mothering and Child Development

Depression is a highly prevalent disorder of affect characterized by persistent sadness or anhedonia (an inability to experience pleasure), typically accompanied by additional symptoms such as negative cognitions (selfperceptions of failure, feelings of guilt, and/or suicidal thoughts), somatic dysfunction (fatigue, loss of appetite, fatigue, disturbances in sleep), and impairment in daily functioning (e.g., indecisiveness) (Gelfand & Teti, 1990). When such a symptom pattern persists for at least two consecutive weeks and is not accompanied by period manic swings, the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV-TR; American Psychiatric Association, 2000) identifies it as a major depressive episode (MDD). A formal DSM-IV-TR diagnosis of MDD can be given for a single major depressive episode, or for multiple, recurring episodes over time, which is common. Other depressive disorders identified in DSM-IV-TR include dysthymic disorder, and adjustment disorder with depressed mood.