Sara E. Whiting

Evidence-based treatment of anxiety and phobia in children and adolescents: current status and effects on the emotional response.

Research on treatments for childhood anxiety disorders has increased greatly in recent decades. As a result, it has become increasingly necessary to synthesize the findings of these treatment studies into reviews in order to draw wider conclusions on the efficacy of treatments for childhood anxiety. Previous reviews of this literature have used varying criteria to determine the evidence base. For the current review, stricter criteria consistent with the original Task Force (1995) guidelines were used to select and evaluate studies. Studies were divided by anxiety disorder; however, many studies combine various anxiety disorders in their samples. As a result, these were included in a combined anxiety disorder group. Using more traditional guidelines, studies were assigned a status of well-established, probably efficacious, or experimental based on the available literature and the quality of the studies. While some treatments do meet the criteria for well-established status, it is clear from this examination that gaps remain and replication is necessary to establish many of these treatments as efficacious. In addition, there still appears to be a lack of research on the effects of treatment on the physiological and cognitive aspects of fear and anxiety.

The Role of Intolerance of Uncertainty in Social Anxiety Subtypes

OBJECTIVES Intolerance of uncertainty (IU) is thought to underlie several internalizing disorders; however, it has only begun to be explored within social anxiety (SA). This study extends previous findings by examining IUs relation to performance and interaction SA subtypes and by accounting for obsessive-compulsive symptoms. METHODS A total of 472 undergraduates completed measures of IU, SA, perfectionism, worry, obsessions/compulsions, and fear of negative evaluation (FNE). RESULTS IU and obsessions/compulsions predicted performance SA beyond FNE. IU predicted interaction SA beyond FNE. Inhibitory anxiety IU contributed to both SA types but contributed more to performance SA. Prospective anxiety IU was negatively related to performance SA and unrelated to interaction SA, though a trend emerged. Contrasts between those high in one SA type, both, or neither revealed IU was highest when both types were present. CONCLUSIONS Inhibitory IU plays a significant role in both SA subtypes and may play a slightly greater role in performance SA.

Examination and validation of a measure of anxiety specific to children with autism spectrum disorders

Objective: Investigated the use of a combined scale (Worry/Depressed and Avoidant scales) from the Autism Spectrum Disorders-Comorbidity for Children (ASD-CC) as a measure of anxiety. Alternative methods of measuring anxiety were examined using the ASD-CC in an ASD population. Methods: Participants included 147 children, age 2–16 years, evincing a mixture of behavior problems. Comparisons between scores on the ASD-CC and Behavior Assessment System for Children, Second Edition (BASC-2) were examined to determine the most efficacious method of measuring anxiety and to establish convergent and discriminant validity. Results: The worry/depressed subscale was the most effective subscale of the ASD-CC to measure anxiety with proven incremental validity over the combined scale. Conclusion: The worry/depressed subscale is the best measure of anxiety utilizing the ASD-CC in children with an ASD. Additionally, convergent and discriminant validity was demonstrated by comparing the scale with similar and dissimilar scales of the BASC-2.

The behavioral avoidance task using imaginal exposure (BATIE): a paper-and-pencil version of traditional in vivo behavioral avoidance tasks.

Behavioral avoidance tasks (BATs) have been used for decades in the assessment of specific phobias, but they also involve a number of prohibitive difficulties. This study investigated a new imaginal/self-report instrument, the Behavioral Avoidance Task Using Imaginal Exposure (BATIE), and evaluated whether it was an efficient paper-and-pencil alternative. Forty-nine adults diagnosed with specific phobias were matched to 49 participants without those particular phobias who served as control participants. The participants were 89.8% female and 79.6% Caucasian and had a mean age of 20.81 years (SD = 3.62). Diagnosis was determined using the Anxiety Disorders Interview Schedule (Brown, DiNardo, & Barlow, 1994). Participants completed a BAT following a BATIE. Results indicated BATIE ratings significantly correlated with BAT performance and ratings. Significant differences were also found between the phobic and control groups on all BATIE ratings (all differences indicated poorer performance or more fear in those with specific phobias). Also, the BATIE scores demonstrated good evidence of convergent and discriminant validity compared to other self-reports, significantly predicted BAT performance even when controlling for those measures of fear and anxiety, and significantly predicted diagnostic severity ratings. Overall, results indicated that the BATIE may be a reasonable alternative to in vivo BATs in certain situations (e.g., clinical practice, unavailability of BAT stimuli).

Somatic symptoms in those with performance and interaction anxiety

This study (n = 304) examined the relationship between somatic symptoms and social anxiety. Significant differences in the experience of somatic symptoms were found among four groups (i.e. performance anxious, interaction anxious, generalized socially anxious, and controls). Post hoc analyses revealed that those who exceeded the clinical cutoff for generalized social anxiety exhibited more somatic symptoms than those who exceeded the clinical cutoff in the other two social anxiety domains or controls. Individuals in each group exhibited more somatic symptoms than controls, but subtypes did not differ in the amount of somatic symptoms experienced. Additionally, regression analyses revealed that type of somatic symptoms experienced varied depending on subtype.

Repetitive/restricted behaviours and interests in children with cerebral palsy and autism spectrum disorder

Objective: To inspect the presence and severity of deficits in restricted and/or repetitive behaviours and interests (RRBIs) in children with cerebral palsy (CP) and autism spectrum disorders (ASDs). Methods: Children studied (18–35 months of age) belonged to one of three diagnostic groups: children with CP and autism (n = 11), children with CP and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS; n = 10) and children with a sole diagnosis of CP (n = 15). A one-way, between subjects ANOVA was conducted on the Repetitive Behaviour/Restricted Interests domain of the Baby and Infant Screen for aUtIsm Traits-Part 1 (BISCUIT-Part 1) and followed up with post-hoc tests. Percentage endorsements were also calculated for each item of this domain. Results: Children with CP + autism had significantly greater impairment. No significant differences were found between the CP + PDD-NOS and the CP alone groups. Conclusion: The implications of these findings are discussed.

Exposure Therapy for Anxiety Disorders in Children

Unfortunately, childhood anxiety disorders are prevalent and cause a great deal of difficulty and interference in the lives of those children affected. The following chapter provides a brief overview of the outcome of almost two decades of research into the development and dissemination of efficacious treatments to alleviate the symptoms of these anxiety disorders. Behavioral and cognitive-behavioral interventions have been found to be particularly efficacious, administered either individually or in groups depending on the disorder. Even so, a great deal more research is required to further refine these treatments, determine how they work (i.e., mediators), determine for whom they work (i.e., moderators), and improve the effects of treatment for those children with refractory anxiety disorders.

Differentiating among singular and comorbid obsessive-compulsive disorder and social phobia symptomology.

Social phobia is a frequent co-occurring diagnosis with obsessive–compulsive disorder (OCD); however, co-occurring OCD in those with social phobia is less common. Genetic, environmental, and cognitive traits are common risk factors for anxiety disorders broadly. It is plausible that shared variables related to OCD and/or social phobia could provide insight into the co-occurrence of these two disorders. The current study explored differences in fear of negative evaluation (FNE) and perfectionism among four groups: those with (1) elevated social phobia symptoms, (2) elevated OCD symptoms, (3) elevated symptoms of OCD and social phobia, and those who were (4) asymptomatic as a control group. A non-clinical sample of 196 participants completed several online questionnaires about social phobia and OCD symptomology. Results identified three cognitive variables (i.e., FNE, total perfectionism, and concern over mistakes) as differential variables in comorbid symptom presentation of OCD and social phobia. A fourth variable (i.e., doubts about actions) was identified as a potential dual risk factor, and four subsequent variables (i.e., parental criticism, personal standards, parental expectations, and organization) were not implicated in differential symptom presentation. Given the different rates of OCD and social phobia co-occurrence, identification of differentiating variables could aid in better understanding of potential risk factors, which may enhance preventative and therapeutic techniques. Study implications, limitations, and future recommendations are discussed.