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1.  Anxiety-Promoting Parenting Behaviors: A Comparison of Anxious Parents with and without Social Anxiety Disorder 
While parenting behaviors among anxious parents have been implicated in the familial transmission of anxiety, little is known about whether these parenting behaviors are unique to specific parental anxiety disorders. The current study examined differences in the use of five specific parenting behaviors (i.e., warmth/positive affect, criticism, doubts of child competency, over-control, and granting of autonomy) in anxious parents with (n = 21) and without (n = 45) social anxiety disorder (SAD) during a five-minute task with their non-anxious child (aged 7-12 years, M = 9.14). Parents with SAD demonstrated less warmth/positive affect and more criticism and doubts of child competency than did those without SAD. There were no group differences in over-control or granting of autonomy. Findings help clarify inconsistent results in the literature, inform models of familial transmission, and suggest intervention targets for parents with SAD.
PMCID: PMC3546134  PMID: 23053617
social anxiety disorder; parenting behaviors; etiology
2.  Classes of Psychotic Experiences in Kenyan Children and Adolescents 
Psychotic-like experiences (PLEs) have been observed worldwide in both adults and children outside the context of a clinical disorder. In the current study, we investigate the prevalence and patterns of PLEs among children and adolescents in Kenya. Among 1,971 students from primary and secondary schools around Nairobi (aged 8–19), 22.1 % reported a lifetime history of a psychotic experience, and 16.3 % reported this unrelated to sleep or drugs. Psychotic experiences were more common in males compared to females. LCA resulted in a three-class model comprised of a normative class (83.3 %), a predominately hallucinatory class (Type 1 psychosis: 9.6 %), and a pan-psychotic class (Type 2 psychosis: 7.2 %). These results indicate that PLEs are prevalent in children and adolescents, and the distributions of symptom clusters are similar to that found in adulthood. The relationship of specific PLEs to the future development of psychotic disorder, functional impairment or distress will require further study.
PMCID: PMC3568190  PMID: 23065300
Psychosis; Children; Adolescents; Kenya; Africa; LCA
3.  A Randomized Controlled Trial of the Child Anxiety Multi-Day Program (CAMP) for Separation Anxiety Disorder 
While the efficacy of cognitive behavior therapy for childhood anxiety disorders, including separation anxiety disorder (SAD), has been established, tailoring such treatments to particular interests and needs may enhance uptake of evidence-based interventions. The current investigation evaluates the feasibility and preliminary efficacy of an intensive, cognitive-behavioral intervention for girls with SAD provided within the novel context of a one-week camp-like setting, the Child Anxiety Multi-Day Program (CAMP). Twenty-nine female children aged 7 to 12 with a principal diagnosis of SAD were randomized to immediate CAMP treatment (n = 15) or waitlist (i.e., delayed treatment; n = 14) condition during the course of this randomized controlled trial. Children in the immediate treatment group evidenced significant reductions in SAD severity, functional impairment, and parent report of child anxiety symptoms relative to the waitlist condition. The intervention’s positive therapeutic response suggests one possible delivery model for surmounting difficulties faced in the dissemination of weekly treatments for SAD.
PMCID: PMC3582853  PMID: 23053618
cognitive behavioral therapy; child anxiety; separation anxiety disorder; intensive treatment; summer camp
4.  Symptoms of Anxiety and Associated Risk and Protective Factors in Young Asian American Children 
Anxiety is one of the most prevalent mental health problems in young children but there has been a dearth of studies focusing on Asian American children. This study examines the patterns and the predictors of childhood anxiety and related symptoms in young children in a diverse Asian American (ASA) sample (n = 101). Findings indicate that ASA children are at higher risk for anxiety, somatization, and depressive problems than their peers. Parents’ level of acculturation (i.e., American identity, English competence), parental negative emotion socialization, conflicted parent–child relationship, child emotional knowledge and adaptive skills, as well as teachers’ ethnic background and school class types were all associated with ASA children’s anxiety. A combination of cultural, family, and school factors explained from 17 to 39 % of the variance in anxiety symptoms. Findings inform prevention services for young ASA children.
PMCID: PMC4009686  PMID: 22410755
Asian American; Anxiety; Somatization; Acculturation; Parenting; Risk factor
5.  Maternal Distress Influences Young Children's Family Representations Through Maternal View of Child Behavior and Parent-Child Interactions 
Distress of a parent is a key influence on the quality of the child's experience in the family. We hypothesized that maternal distress would spill over into more negative views of their children's behaviors and less emotional availability in their relationships. Further, we investigated whether these cumulative experiences contributed to children's emerging narratives about mothers and family life.
In this longitudinal study, mothers of young twin children reported their distress on three occasions in relation to: self, the marital relationship, and the family climate. Mothers also reported on their children's externalizing behavior problems. Mother-child interaction was observed focusing on maternal sensitivity and child responsivity. Children responded to story stem beginnings about challenging situations in the family and their narratives were scored for family conflict and cohesion themes. APIM methods of dyadic data analysis accounted for the inclusion of both twins in the analysis.
Results from structural equation models supported the hypothesized cumulative experience of maternal distress on children's family life representations for both family conflict and family cohesion.
A family environment in which children are exposed to persistent maternal distress early in life may have cumulative effects, influencing how mothers interact with and view their children's behavior at later developmental stages. Moreover, exposure to repeated distress for longer periods of time may contribute to an intergenerational continuity of distress for the child that may become rooted in negative affective bias in their own view of family relationships.
PMCID: PMC3992274  PMID: 23568672
maternal distress; behavioral problems; interaction quality; child narratives; Structural Equation Model
6.  The Role of Parental Language Acculturation in the Formation of Social Capital: Differential Effects on High-risk Children 
This person-centered study examines the extent to which parents’ language dominance influences the effects of an after school, multi-family group intervention, FAST, on low-income children’s emotional and behavioral outcomes via parents’ relations with other parents and with school staff. Social capital resides in relationships of trust and shared expectations, which are highly dependent on whether parents share the language of other parents and teachers. This study is based on a community epidemiologically-defined sample of Latino families (N = 3,091) in San Antonio, Texas and Phoenix, Arizona. Latent profile analyses revealed three language profiles of parents across the two cities: English-dominant, Spanish-dominant, and bilingual. Path models revealed that FAST did not have a direct or indirect effect on children’s emotional and behavior functioning, although FAST increased parent-parent and parent-school social capital among Spanish-dominant parents in Arizona and these parent-parent relations were associated with better child outcomes. Implications for interventions are discussed.
PMCID: PMC3530652  PMID: 22903786
acculturation; language; social capital; behavior problems; FAST
7.  Relationship of Ferritin to Symptom Ratings Children with Attention Deficit Hyperactivity Disorder: Effect of Comorbidity 
Child psychiatry and human development  2007;39(3):10.1007/s10578-007-0095-0.
Our aim was to investigate the relation between behavioral symptoms and hematological variables which are related with iron deficiency and anemia, ferritin, hemoglobin, mean corpuscular volume (MCV), and reticulosite distribution width (RDW) in children and adolescents with pure Attention Deficit Hyperactivity Disorder (ADHD) or ADHD comorbid with other psychiatric disorders. The sample consisted of 151 subjects with ADHD, 45 of these subjects had other comorbid conditions. Conners Parent (CPRS) and Teacher Rating Scales (CTRS) were obtained. Comorbid ADHD subjects had lower mean hemoglogin and MCV. In the ADHD group in general, CPRS and CTRS Total scores were significantly negatively correlated with ferritin level. When only pure ADHD subjects were taken into account, the correlations did not reach statistical signifance. Overall, these results suggested that lower ferritin level was associated with higher behavioral problems reported by both parents and teachers. Presence of comorbid conditions might increase the effect of lower iron stores on behavioral measures.
PMCID: PMC3884682  PMID: 18165896
Attention Deficit Hyperactivity Disorder; Ferritin; Comorbidity
8.  Psychopathic Traits and Reactive-Proactive Aggression in a Large Community Sample of Polish Adolescents 
This paper presents results of the only large-scale study carried-out in Poland to date on the prevalence of psychopathic traits and their relationship with aggressive behaviour in mainstream adolescents. The sample consists of 9,415 students (4,808 boys, 4,607 girls) in the first to third grades at 142 public secondary schools. Psychopathic traits were measured by teacher-report ratings with the antisocial process screening device (APSD), while aggressive behaviours were assessed using the Reactive-Proactive Aggression Questionnaire. Analysis of results revealed that boys scored much higher than girls in total APSD scale measuring psychopathic traits. Only 2.68 % of assessed adolescents scored above the cut-off of 25 points. Results also showed significant correlations between psychopathic traits and both proactive and reactive aggression. The authors concluded that screening a large sample to identify children and youths with psychopathic traits has some important advantages but, on the other hand, it is a sensitive undertaking because of the label ‘psychopath’ can have negative consequences for the subjects.
PMCID: PMC4065651  PMID: 24374497
Adolescents; Psychopathic traits; Reactive-proactive aggression; Assessment
9.  Perceived Child Behavior Problems, Parenting Stress, and Maternal Depressive Symptoms Among Prenatal Methamphetamine Users 
The present study was designed to examine parenting stress, maternal depressive symptoms, and perceived child behavior problems among mothers who used methamphetamine (MA) during pregnancy. Participants were a subsample (n = 212; 75 exposed, 137 comparison) of biological mothers who had continuous custody of their child from birth to 36 months. The subsample was drawn from a larger, ongoing longitudinal study on the effects of prenatal methamphetamine exposure (n = 412; 204 exposed, 208 comparison) (Arria et al in Matern Child Health J 10:293–302 2006). Mothers who used MA during pregnancy reported more parenting stress and more depressive symptoms than a matched comparison group. There were no differences between groups on perceived child behavior problems. In a hierarchical linear model, depressive symptoms, and perceived child behavior problems, but not MA exposure, were statistically significant predictors of parenting stress. Screening for potential parenting problems among mothers with a history of substance abuse is warranted. Parenting interventions targeting depressive symptoms, parenting stress, and child behavior problems are needed for this population.
PMCID: PMC3717339  PMID: 22552952
Parenting stress; Prenatal drug exposure; Methamphetamine; Child behavior problems; Maternal depression
10.  Preventive Intervention for Anxious Preschoolers and Their Parents: Strengthening Early Emotional Development 
The high prevalence and early onset of anxiety disorders have inspired innovative prevention efforts targeting young at-risk children. With parent–child prevention models showing success for older children and adolescents, the goal of this study was to evaluate a parent–child indicated preventive intervention for preschoolers with mild to moderate anxiety symptoms. Sixteen children (ages 3–5) and at least one of their parents participated in Strengthening Early Emotional Development (SEED), a new 10-week intervention with concurrent groups for parents and children. Outcome measures included clinician-rated and parent-rated assessments of anxiety symptoms, as well as measures of emotion knowledge, parent anxiety, and parental attitudes about children’s anxiety. Participation in SEED was associated with reduced child anxiety symptoms and improved emotion understanding skills. Parents reported decreases in their own anxiety, along with attitudes reflecting enhanced confidence in their children’s ability to cope with anxiety. Reductions in child and parent anxiety were maintained at 3-month follow-up. Findings suggest that a parent–child cognitive-behavioral preventive intervention may hold promise for young children with mild to moderate anxiety. Improvements in parent anxiety and parental attitudes may support the utility of intervening with parents. Fostering increased willingness to encourage their children to engage in new and anxiety-provoking situations may help promote continued mastery of new skills and successful coping with anxiety.
PMCID: PMC3759969  PMID: 22331442
Child anxiety; Parent anxiety; Indicated prevention
11.  Factor Structure of Measures of Anxiety and Depression Symptoms in African American Youth 
Previous research has suggested that the factor structure of anxiety measures is different in African American samples compared to majority population samples. However, these findings may be due to misuse of analytic methods rather than meaningful differences in the underlying presentation of anxiety. To address this, we examined the factor structure of two measures of child anxiety: the Revised Children’s Anxiety and Depression Scale (RCADS) and the Multidimensional Anxiety Scale for Children (MASC) in a sample of 229 African American youth. Contrary to previous research, confirmatory factor analyses yielded good fit for the original factor structures of both measures. These results suggest that the underlying factor structure of these measures may not be significantly different for African American and majority population youth as previously thought. The effect of data analytic procedures on subsequent conclusions and theory is discussed and recommendations are made.
PMCID: PMC3737595  PMID: 23224837
child anxiety; child depression; factor analysis; African American children; assessment
12.  Temperamental Profiles of Dysregulated Children 
It is crucial to characterize self-regulation in children. We compared the temperamental profiles of children with the Child Behavior Checklist (CBCL) Dysregulation Profile (CBCL-DP) to profiles associated with other CBCL-derived syndromes. 382 children (204 boys; aged 5–18) from a large family study were examined. Temperamental profiles were based on the Juvenile Temperament and Character Inventory (JTCI). . Children with the CBCL-DP had a temperamental profile characterized by high Novelty Seeking (NS), high Harm Avoidance (HA), low Reward Dependence (RD) and low Persistence (P). Linear mixed models and regression-based models demonstrated that the CBCL-DP was associated with a “disengaged” temperamental profile. This profile is similar to the profile seen in adult disorders of self-regulation, including cluster B personality disorders. These results support the hypothesis that the CBCL-DP measures poor self-regulation.
PMCID: PMC3374895  PMID: 22271225
juvenile bipolar disorder; ADHD; CBCL; temperament; JTCI
13.  Modifying Adolescent Interpretation Biases Through Cognitive Training: Effects on Negative Affect and Stress Appraisals 
Adolescent anxiety is common, impairing and costly. Given the scale of adolescent anxiety and its impact, fresh innovations for therapy are in demand. Cognitive Bias Modification of Interpretations (CBM-I) studies of adults show that by training individuals to endorse benign interpretations of ambiguous situations can improve anxious mood-states particularly in response towards stress. While, these investigations have been partially extended to adolescents with success, inconsistent training effects on anxious mood-states have been found. The present study investigated whether positive versus negative CBM-I training influenced appraisals of stress, in forty-nine adolescents, aged 15–18. Data supported the plasticity of interpretational styles, with positively-trained adolescents selecting more benign resolutions of new ambiguous situations, than negatively-trained adolescents. Positively-trained adolescents also rated recent stressors as having less impact on their lives than negatively-trained adolescents. Thus, while negative styles may increase negative responses towards stress, positive styles may boost resilience.
PMCID: PMC3764320  PMID: 23722473
Cognitive bias modification; Interpretational style; Adolescence; Anxiety; Stress reactivity
14.  Identifying Patterns of Early Risk for Mental Health and Academic Problems in Adolescence: A Longitudinal Study of Urban Youth 
This investigation examined profiles of individual, academic, and social risks in elementary school, and their association with mental health and academic difficulties in adolescence. Latent profile analyses of data from 574 urban youth revealed three risk classes. Children with the “well-adjusted” class had assets in the academic and social domains, low aggressive behavior, and low depressive symptoms in elementary school, and low rates of academic and mental health problems in adolescence. Children in the “behavior-academic-peer risk” class, characterized by high aggressive behavior, low academic achievement, and low peer acceptance, had conduct problems, academic difficulties, and increased mental health service use in adolescence. Children with the “academic-peer risk” class also had academic and peer problems but they were less aggressive and had higher depressive symptoms than the “behavior-academic-peer risk” class in the first grade; the “academic-peer risk” class had depression, conduct problems, academic difficulties, and increased mental health service use during adolescence. No differences were found between the risk classes with respect to adolescent outcomes.
PMCID: PMC3651024  PMID: 21538121
childhood risk; adolescent adjustment; person-centered approach
15.  [No title available] 
PMCID: PMC3637687  PMID: 22080366
16.  Understanding the Relation of Low Income to HPA-Axis Functioning in Preschool Children: Cumulative Family Risk and Parenting As Pathways to Disruptions in Cortisol 
This study examined the relation of low income and poverty to cortisol levels, and tested potential pathways from low income to disruptions in cortisol through cumulative family risk and parenting. The sample of 306 mothers and their preschool children included 29 % families at or near poverty, 27 % families below the median income, and the remaining families at middle and upper income. Lower income was related to lower morning cortisol levels, and cumulative risk predicted a flatter diurnal slope, with a significant indirect effect through maternal negativity, suggesting that parenting practices might mediate an allostatic effect on stress physiology.
PMCID: PMC3621874  PMID: 22528032
Low income; Cumulative risk; Parenting practices; Cortisol; Children
17.  Children with Generalized Anxiety Disorder Do Not Have Peer Problems, Just Fewer Friends 
A common assumption is that all youth with anxiety disorders (AD) experience impaired peer relationships relative to healthy control children. Social impairments have been identified among youth with certain AD (e.g., social anxiety disorder; SAD), but less is known about the peer relationships of children with generalized anxiety disorder (GAD). We therefore compared the interpersonal functioning of youth with GAD, SAD, and controls (6 to 13 years). Despite having relatively fewer friends overall, children with GAD did not differ from controls in terms of the likelihood of having a best friend, participation in groups/clubs, and parent ratings of social competence. In comparison, youth with SAD were less socially competent, had fewer friends and difficulty making new friends compared to controls. Findings suggest that peer difficulties are not a universal feature of all childhood AD and highlight a need to better understand the social experiences and functioning of children with GAD.
PMCID: PMC3213291  PMID: 21739298
generalized anxiety disorder; peer relations; social competence; social anxiety disorder
18.  Emotional and Behavioral Functioning of Offspring of African American Mothers with Depression 
Extensive research demonstrates the negative impact of maternal depression on their offspring. Unfortunately, few studies have been explored in African American families. This study examined emotional and behavioral functioning among children of African American mothers with depression. African American mothers (n = 63), with a past year diagnosis of a depressive disorder, and one of their children (ages 7–14) completed behavioral rating scales in a cross-sectional design. Results showed that 6.5% and 15% scored within the clinical range for depression and anxiety symptoms, respectively. Approximately a third of the offspring reported suicidal ideation. Based on mothers’ report, 25.4% and 20.6% of the offspring exhibited internalizing and externalizing symptoms in the clinical range, respectively. Offspring whose mothers were in treatment exhibited higher levels of self-reported anxiety symptoms Offspring of African American mothers with depression were exhibiting socioemotional problems in ways that are similar to offspring of European American mothers with depression.
PMCID: PMC3177021  PMID: 21671005
Depression; Anxiety; Mothers; Offspring; African American
19.  Still Struggling: Characteristics of Youth With OCD Who are Partial Responders to Medication Treatment 
The primary aim of this paper is to examine the characteristics of a large sample of youth with OCD who are partial responders (i.e., still have clinically significant symptoms) to serotonin reuptake inhibitor (SRI) medication. The sample will be described with regard to: demographics, treatment history, OCD symptoms/severity, family history and parental psychopathology, comorbidity, and global and family functioning. The sample includes 124 youth with OCD ranging in age from 7 to 17 with a primary diagnosis of OCD and a partial response to an SRI medication. The youth are a predominantly older (age 12 and over), Caucasian, middle to upper income group who had received significant past treatment. Key findings include moderate to severe OCD symptoms, high ratings of global impairment, and significant comorbidity, despite partial response to an adequate medication trial. Considerations regarding generalizability of the sample and limitations of the study are discussed.
PMCID: PMC3134148  PMID: 21484416
Pediatric obsessive compulsive disorder (OCD); Serotonin reuptake inhibitor (SRI); Partial responder; Phenomenology
20.  Social and Non-Social Behavioral Inhibition in Preschool-Age Children: Differential Associations with Parent-Reports of Temperament and Anxiety 
Behavioral inhibition (BI) has generally been treated as a unitary construct and assessed by combining ratings of fear, vigilance, and avoidance to both novel social and non-social stimuli. However, there is evidence suggesting that BI in social contexts is not correlated with BI in non-social contexts. The present study examined the distinction between social and non-social BI in a community sample of 559 preschool-age children using a laboratory assessment of child temperament, a diagnostic interview, and parent-completed questionnaires. Social and non-social BI were not significantly correlated and exhibited distinct patterns of associations with parent reports of temperament and anxiety symptoms. This study suggests that BI is heterogeneous, and that distinguishing between different forms of BI may help account for the variation in trajectories and outcomes exhibited by high BI children.
PMCID: PMC3356158  PMID: 21479511
21.  Effects of Zinc and Ferritin Levels on Parent and Teacher Reported Symptom Scores in Attention Deficit Hyperactivity Disorder 
It has been suggested that both low iron and zinc levels might be associated with Attention Deficit Hyperactivity Disorder (ADHD) symptoms. However, the association of zinc and iron levels with ADHD symptoms has not been investigated at the same time in a single sample.
118 subjects with ADHD (age = 7–14 years, mean = 9.8, median = 10) were included in the study. The relationship between age, gender, ferritin, zinc, hemoglobin, mean corpuscular volume and reticulosite distribution width and behavioral symptoms of children and adolescents with ADHD were investigated with multiple linear regression analysis.
Results showed that subjects with lower zinc level had higher Conners Parent Rating Scale (CPRS) Total, Conduct Problems and Anxiety scores, indicating more severe problems. CPRS Hyperactivity score was associated both with zinc and ferritin levels. Conners Teacher Rating Scale (CTRS) scores were not significantly associated with zinc or ferritin levels.
Results indicated that both low zinc and ferritin levels were associated with higher hyperactivity symptoms. Zinc level was also associated with anxiety and conduct problems. Since both zinc and iron are associated with dopamine metabolism, it can be speculated that low zinc and iron levels might be associated with more significant impairment in dopaminergic transmission in subjects with ADHD.
PMCID: PMC3399584  PMID: 20238159
ADHD; Zinc; Ferritin; Behavioral ratings
22.  Characterization and Factors Associated with Sleep Quality in Adolescents with Bipolar I Disorder 
Sleep disturbance is an early marker for bipolar disorder (BD) onset in youth. We characterized sleep quality in adolescents experiencing mania within the last 6–12 months. We examined the association between mood and sleep in 27 adolescents with BD and 24 matched healthy controls (HC). Subjects were assessed by parent and teen report of sleep, a semi-structured clinical interview, the Young Mania Rating Scale (YMRS), and the Childhood Depression Rating Scale (CDRS-R). Average BD youth YMRS (mean 20.3 ± 7.3) and CDRS-R (mean 42.4 ± 14.1) scores indicated they were still ill at time of assessment. Compared to HCs, adolescents with BD have distinct patterns of prolonged sleep onset latency, frequent nighttime awakenings, and increased total time awake. Mood symptoms, specifically excessive guilt, self-injurious behavior, and worsening evening mood, interfered with sleep. Further studies are needed to determine whether early regulation of sleep would improve long-term outcome in BD youth.
PMCID: PMC3379876  PMID: 21701911
Bipolar disorder; Adolescents; Sleep; Mood; Parent–child report
23.  Childhood Predictors of Anxiety Symptoms: A Longitudinal Study 
The present study examined the concurrent and prospective relation between a select number of potential predictors and symptoms of anxiety among a high-risk community sample of 149 predominately African American children. Parent and child reports of anxiety were assessed in the first and seventh grade. Six domains of childhood risk factors (i.e., Loss-Death, Loss-Separation, Social Adversity, Negative Family Environment, Academic Difficulties, and Peer Rejection) were assessed using multiple informants in the first grade. Results indicated that children who experienced a more negative family environment, had a greater number of losses and deaths, and experienced academic failures in the first grade exhibited higher levels of anxiety (concurrently and/or at the six year follow-up). Findings provide empirical support to etiological models that posit both parental/familial and environmental factors contribute to the development of heightened anxiety in children.
PMCID: PMC3374847  PMID: 16228143
risk factors; child anxiety; African American
24.  Parent Psychopathology and Youth Internalizing Symptoms in an Urban Community: A Latent Growth Model Analysis 
The present study examined the developmental trajectories of youth depression and anxiety symptoms from 6th through 12th grade in a low-income, urban sample (N = 141; mean age = 11.75 years; 88.7% African American). The study also tested the independent contribution of parent mood disorders, anxiety disorders, and substance use disorders assessed in early childhood to initial levels and rate of change in depression and anxiety symptoms from 6th through 12th grade. Possible gender differences in symptom course and strength of parent psychopathology predictors were examined using multiple-group analysis. Results indicated that depression symptoms declined over time for males, whereas depression symptoms initially declined, but then increased for females. In contrast, male and female adolescents each showed a decline in anxiety symptoms throughout adolescence. Findings also indicated that parent mood disorders were the only predictor of youth depression and anxiety symptoms for male and female adolescents in 6th grade. Parent anxiety disorders uniquely predicted the rate of change in depression symptoms among male adolescents. These results underscore the importance of targeting parents with mood and anxiety disorders in urban families in order to reduce the risk for internalizing difficulties in their adolescent youth.
PMCID: PMC3373962  PMID: 19669407
Parent psychopathology; Youth depression; Youth anxiety; African American
25.  Maternal and Child Expressed Emotion as Predictors of Treatment Response in Pediatric Obsessive–Compulsive Disorder 
Expressed emotion (EE) is associated with symptoms and treatment outcome in various disorders. Few studies have examined EE in pediatric OCD and none of these has assessed the child’s perspective. This study examined the relationship among maternal and child EE, child OCD severity, and OCD-related functioning pre- and post-treatment. At pre-treatment, mothers completed speech samples about the child with OCD and an unaffected sibling. Children with OCD completed speech samples about parents. There were low rates of high maternal EE (child with OCD: 16.1%; sibling: 2.6%) and high child EE about parents (mothers: 11.9%; fathers: 10.2%). High EE was primarily characterized by high criticism, not high overinvolvement. High maternal EE and child EE regarding fathers were associated with pre-treatment child OCD severity but not post-treatment severity. High child and maternal EE were predictive of post-treatment OCD-related functioning. EE may be an important child and maternal trait associated with pre-treatment OCD severity and generalization of treatment gains.
PMCID: PMC3337147  PMID: 22090186
Expressed emotion; Obsessive–compulsive disorder; OCD; Family; Treatment

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