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.
generalized anxiety disorder; peer relations; social competence; social anxiety disorder
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.
Depression; Anxiety; Mothers; Offspring; African American
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.
Pediatric obsessive compulsive disorder (OCD); Serotonin reuptake inhibitor (SRI); Partial responder; Phenomenology
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.
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.
ADHD; Zinc; Ferritin; Behavioral ratings
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.
Bipolar disorder; Adolescents; Sleep; Mood; Parent–child report
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.
risk factors; child anxiety; African American
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.
Parent psychopathology; Youth depression; Youth anxiety; African American
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.
Expressed emotion; Obsessive–compulsive disorder; OCD; Family; Treatment
The present study examined competing models of the bi-directional influences of anxiety and reading achievement. Participants were 153 ethnically-diverse children (84 male, 69 female) from general education classes evaluated in the winter and spring of their first-grade academic year. Children completed standardized measures of reading achievement involving decoding and fluency along with an anxiety rating scale. Hierarchical linear regression analyses revealed that separation anxiety symptoms were negatively predicted by fluency performance and harm avoidance symptoms were positively predicted by decoding performance. Fluency performance was positively predicted by harm avoidance and total anxiety (for girls only) symptoms, while decoding was not predicted by any anxiety subscale.
Anxiety; Reading; Achievement; Learning
The aim of the current study was to extend etiological models of social anxiety in youth by examining the relative importance of parental (i.e., parental anxiety, rejection, and overcontrol) and peer factors (i.e., social acceptance, social support, and friendship quality). Sixty-three youth (ages 7–12; 52% male) and their parents participated in the study. Using multiple informants of these factors, results generally indicated that higher levels of parental anxiety, rejection, and overcontrol were related to higher levels of social anxiety. Higher levels of social support, acceptance, and validation were associated with lower levels social anxiety. The strongest predictors of social anxiety symptoms (as rated by an independent evaluator) were parental anxiety and friendship quality (i.e., validation from a peer). The strongest predictors of child rated social anxiety symptoms were parental overcontrol and perceived social acceptance. Findings are discussed in the context of current etiological models and suggest that interventions aimed at lowering social anxiety in youth address both parental anxiety and peer relationships.
Social anxiety; Children; Parental anxiety; Parenting style; Peer relationships
This study examined the associations between maternal anxiety, behaviors, and expectations and children’s self-evaluations of distress, coping, and performance during a stressful performance evaluation task. Seventy-five mothers (38 clinically anxious and 37 nonanxious) along with one of their children aged 6–14 (52.0% female; 78.7% Caucasian) were videotaped while preparing the child to deliver a speech about themselves. Child and parent assessments were obtained before and after the speech, and independent coders rated maternal behavior during the speech preparation. Maternal anxiety and behaviors accounted for a greater proportion of variance in children’s self-evaluations than did maternal expectations, such that children of mothers who reported higher task anxiety and demonstrated more overcontrol and anxious behavior during the task evaluated themselves more negatively. These findings extend the literature by providing information about the relative associations between maternal factors and children’s self-evaluations within the context of an in vivo stressful situation.
Child anxiety; Maternal anxiety; Expectations; Overcontrol; Anxious behavior
Previous research has shown that maternal overcontrol is related to higher levels of child anxiety. It has been theorized, though not empirically tested, that maternal overcontrol decreases child perceived competence and mastery, which increases child anxiety. The present study investigated this theory using a sample of 89 mother–child dyads (children aged 6–13, 84.3% Caucasian, 6.7% African American, and 51.7% male). After statistically controlling for maternal anxiety level, child perceived competence was shown to partially mediate the relationship between maternal overcontrol and child anxiety. Though current findings are based on cross sectional data, they suggest multiple pathways through which maternal overcontrol impacts child anxiety. One pathway, described in theoretical models, posits that greater levels of parental control reduce children's opportunities to acquire appropriate developmental skills, lowering their perceived competence, and thus increasing their anxiety. Implications of these findings and directions for future research are discussed.
Parenting; Anxiety; Overcontrol; Perceived competence; Child anxiety
This study examined the relations between behavioral inhibition, Big Five personality traits, and anxiety disorder symptoms in non-clinical children (n = 147) and clinically anxious children (n = 45) aged 6–13 years. Parents completed the Behavioral Inhibition Questionnaire-Short Form, the Big Five Questionnaire for Children, and the Screen for Child Anxiety Related Emotional Disorders-Revised. Results indicated that, compared to parents of non-clinical children, parents of clinically anxious children rated their offspring higher on neuroticism and behavioral inhibition, but lower on extraversion, conscientiousness, and intellect/openness. Further, extraversion emerged as the strongest correlate of an inhibited temperament, and this appeared true for the clinically anxious as well as the non-clinical children. Finally, in both the clinical and non-clinical samples, higher levels of behavioral inhibition and neuroticism were unique and significant predictors of anxiety disorders symptoms.
Behavioral inhibition; Anxiety disorder symptoms; Neuroticism; Extraversion
In this study, we explored informant characteristics as determinants of parent–teacher disagreement on preschoolers’ psychosocial problems. Teacher characteristics were included in the analyses, in addition to child and parent factors. Psychosocial problems of 732 4-year olds from a Norwegian community sample were assessed by parents and teachers (CBCL-TRF). Furthermore, teachers reported on their education, experience and relationship to the child. Parental stress and psychopathology were also measured. Teachers rated children considerably lower than their parents did, especially on internalizing problems. When teachers rated more child problems, this was strongly associated with conflict in the teacher–child relationship, which predicted disagreement more than other factors. The highest agreement was on boys’ externalizing problems. Girls’ behavior was rated much lower by teachers than boys’ behavior compared to parents’ ratings. Possible teacher perception biases are discussed, such as teacher–child conflict, non-identification of internalizing problems, and same-gender child preference.
Informant; Discrepancy; Disagreement; Psychopathology; Child; Preschool; Psychology; Psychiatry; Child and School Psychology
Previous studies of the long-term effects of maternal postpartum depression (PPD) on child development have mostly focused on a limited set of outcomes, and have often not controlled for risk factors associated with maternal depression. The present study compared children of postpartum depressed mothers (n = 29) with children from a community sample (n = 113) in terms of a broad range of developmental outcomes in the early school period. Controlling for risk factors associated with maternal depression, we found that children of postpartum depressed mothers had lower ego-resiliency, lower peer social competence, and lower school adjustment than the community sample children. In addition, girls of postpartum depressed mothers showed lower verbal intelligence, and, unexpectedly, showed fewer externalizing problems than their counterparts in the community sample. Results show that children’s capacities to deal with stress and interact with peers in the early school period may be particularly affected by their mothers’ PPD.
Maternal depression; Postpartum depression; Early school age; Child development
There is rising interest in identifying precursors to bipolar disorder symptoms, including thought disorder. Thought disorder is identified in adults through self-report and in school-aged children through parent report and child story-telling. This study is an exploration to determine if preschoolers with mood dysregulation have evidence of disordered thoughts using a story-stem completion method.
Participants included two groups of 3.5–6 year-old children: 20 with mood dysregulation including manic symptoms and 11 typically-developing comparison children. Children were administered story completion narratives including one story where the child character accidentally cuts him/herself while pretending to cook. The children were asked to complete the stories and their responses were analyzed for atypical themes consistent with disordered thoughts such as violence or bizarreness outside of the story or props coming to life.
35% of symptomatic preschoolers versus 0% of typically-developing preschoolers ascribed independent actions to inanimate props (p=0.03). 80% of symptomatic preschoolers versus 9% of typically-developing preschoolers utilized props in a violent or bizarre manner outside the central story (p<0.001).
Preschool children with symptoms of dysregulated mood express themes related to the unusual use of story props which may indicate disordered thoughts. This preschool expression of dysregulated mood appears similar to and possibly continuous with school-age and adult versions of bipolar disorder.
preschool; dysregulated mood; disordered thought; mania; story completion; bipolar disorder; thought disorder
The need to assess Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) disorders in children younger than 7 years of age has intensified as clinical efforts to diagnose and treat this population have increased, and clinical research on psychopathology has advanced. A new diagnostic instrument for young children was created, the Diagnostic Infant Preschool Assessment (DIPA), and was tested for test–retest reliability and concurrent criterion validity. The caregivers of 50 outpatients aged 1–6 years were interviewed twice by trained interviewers, once by a clinician and once by a research assistant, about eight disorders. The median test–retest intraclass correlation was 0.69, mean 0.61, and values ranged from 0.24 to 0.87. The median test–retest kappa was 0.53, mean 0.52, and values ranged from 0.38 to 0.66. There were no differences by duration between interviews. Concurrent criterion validity show good agreement between the instrument and DSM-based Child Behavior Checklist scales when the DSM-based scales were matched well to the disorder (attention-deficit/hyperactivity inattentive and hyperactive and oppositional disorders). Preliminary data support the DIPA as a reliable and valid measure of symptoms in research and clinical work with very young children. This measure adds a tool that is flexible in covering both DSM-IV syndromes and empirically-validated developmental modifications that can help increase confidence in assessing young children, ensuring coverage of symptoms, and improve access to care.
Test–retest reliability; Criterion validity; Preschool children; Diagnostic interview
To explore whether punitive parenting styles contribute to early-acquired emotion knowledge deficits observable in neglected children, we observed 42 preschool children’s emotion knowledge, expression recognition time, and IQ. The children’s mothers completed the Parent–Child Conflict Tactics Scales to assess the recent use of three types of discipline strategies (nonviolent, physically punitive, and psychological aggression), as well as neglectful parenting. Fifteen of the children were identified as neglected by Child Protective Services (CPS) reports; 27 children had no record of CPS involvement and served as the comparison group. There were no differences between the neglect and comparison groups in the demographic factors of gender, age, home language, minority status, or public assistance, nor on IQ. Hierarchical multiple regression modeling showed that neglect significantly predicted emotion knowledge. The addition of IQ contributed a significant amount of additional variance to the model and maintained the fit. Adding parental punitiveness in the final stage contributed little additional variance and did not significantly improve the fit. Thus, deficits in children’s emotion knowledge may be due primarily to lower IQ or neglect. IQ was unrelated to speed of emotion recognition. Punitiveness did not directly contribute to emotion knowledge deficits but appeared in exploratory analysis to be related to speed of emotion recognition.
Neglect; Maltreatment; Punitive parenting; Emotion knowledge; Emotion recognition
Angry, agitated outbursts (AAOs) are a common precipitant of children’s psychiatric hospitalization. In the hospital, AAOs present both management and diagnostic challenges, e.g., while they have recently been described as manic “rages”, older studies suggest that they may be exacerbated temper tantrums. Factor analyses of 109 AAOs had by 46 hospitalized 4 to 12 year olds yielded 3 subsets of behaviors expressing different intensities of anger and 2 subsets expressing different intensities of distress (sadness). Cluster analysis of behavior time course supported the anger-distress distinction; the former behaviors are most probable at AAO onset and then decline while the latter are more evenly distributed across the outburst. Age trends, factor structure, and temporal organization of AAOs all indicate that they are exacerbated tantrums. The AAOs of children with anxiety or PDD diagnoses showed significantly more distress relative to anger. AAOs have clinical implications; their particular characteristics may have diagnostic significance.
anger; anxiety; disruptive behavior; emotion dysregulation; sadness
Adult mood disturbances are highly correlated with obesity, although little is known about the developmental relationship between mood disorders and weight. This study investigated the relationship between childhood psychopathology and weight over the course of 3 years. Body Mass Index (BMI) percentiles and demographic data of children (ages 8–18) with depression (n = 143) or anxiety (n = 43) were compared to healthy controls (n = 99). Both childhood depression (χ2 = 4.6, p = 0.03) and anxiety (χ2 = 6.0, p = 0.01) were associated with increased BMI percentiles. Compared to controls, BMI percentiles of depressed females over the course of the study differed profoundly (χ2 = 7.0, p = 0.01) and BMI percentiles of anxious females approached significance (χ2 = 3.7, p = 0.06). Males with anxiety showed a greater trend towards overweight (χ2 = 3.3, p = 0.07) in comparison to controls. The major finding that depression and anxiety are associated with increased BMI percentiles in a non-obese sample suggests that childhood psychopathology is an important factor that should be carefully monitored.
Weight; Depression; Anxiety; Adolescent; Body mass index
In the current study, sleep actigraphy and parent-report measures were used to investigate differences in sleeping behavior among four groups of 3- to 7-year-olds (N = 79): children in regular foster care (n = 15); children receiving a therapeutic intervention in foster care (n = 17); low income community children (n = 18); and upper middle income community children (n = 29). The children in therapeutic foster care exhibited longer sleep latency and increased variability of sleep duration than the upper middle income community children. In addition, there was indication of a treatment effect: the therapeutic foster care children slept longer than the regular foster care and low income community children and had earlier bedtimes, fell asleep earlier, and spent more time in bed than the regular foster care children. The results are discussed in terms of the effectiveness of early intervention for enhancing sleep in foster children.
sleep actigraphy; foster care; early intervention
The present study examines the construct validity of separation anxiety disorder (SAD), social phobia (SoP), panic disorder (PD), and generalized anxiety disorder (GAD) in a clinical sample of children. Participants were 174 children, 6 to 17 years old (94 boys) who had undergone a diagnostic evaluation at a university hospital based clinic. Parent and child ratings of symptom severity were assessed using the Multidimensional Anxiety Scale for Children (MASC). Diagnostician ratings were obtained from the Anxiety Disorders Interview Schedule for Children and Parents (ADIS: C/P). Discriminant and convergent validity were assessed using confirmatory factor analytic techniques to test a multitrait–multimethod model. Confirmatory factor analyses supported the current classification of these child anxiety disorders. The disorders demonstrated statistical independence from each other (discriminant validity of traits), the model fit better when the anxiety syndromes were specified than when no specific syndromes were specified (convergent validity), and the methods of assessment yielded distinguishable, unique types of information about child anxiety (discriminant validity of methods). Using a multi-informant approach, these findings support the distinctions between childhood anxiety disorders as delineated in the current classification system, suggesting that disagreement between informants in psychometric studies of child anxiety measures is not due to poor construct validity of these anxiety syndromes.
Anxiety; Parent–child agreement; Construct validity
The present study examined age-related patterns in children’s anxiety-related interpretations and internal attributions of physical symptoms. A large sample of 388 children aged between 4 and 13 years completed a vignette paradigm during which they had to explain the emotional response of the main character who experienced anxiety-related physical symptoms in a variety of daily situations. In addition, children completed measures of cognitive development and anxiety sensitivity. Results demonstrated that age, cognitive development, and anxiety sensitivity were all positively related to children’s ability to perceive physical symptoms as a signal of anxiety and making internal attributions. Further, while a substantial proportion of the younger children (i.e., <7 years) were able to make a valid anxiety-related interpretation of a physical symptom, very few were capable of making an internal attribution, which means that children of this age lack the developmental prerequisites for applying physical symptoms-based theories of childhood anxiety.
Anxiety-related physical symptoms; Internal/external attributions; Anxiety sensitivity; Children
To examine the relationship between early parenting stress and later child behavior in a high risk sample and measure the effect of drug exposure on the relationship between parenting stress and child behavior.
A subset of child-caregiver dyads (n = 607) were selected from the Maternal Lifestyle Study, which is a large sample of children (n = 1388) with prenatal cocaine exposure and a comparison sample unexposed to cocaine. Of the 607 dyads, 221 were prenatally exposed to cocaine and 386 were unexposed to cocaine. Selection was based on the presence of a stable caregiver at 4 and 36 months with no evidence of change in caregiver between those time points.
Parenting stress at 4 months significantly predicted child externalizing behavior at 36 months. These relations were unaffected by cocaine exposure suggesting the relationship between parenting stress and behavioral outcome exists for high-risk children regardless of drug exposure history.
These results extend the findings of the relationship between parenting stress and child behavior to a sample of high-risk children with prenatal drug exposure. Implications for outcome and treatment are discussed.
disruptive behavior; parenting stress; high-risk children; prenatal drug exposure; cocaine