Comorbidity in youth with specific phobias: Impact of comorbidity on treatment outcome and the impact of treatment on comorbid disorders.

The purpose of the present study was twofold. In an analysis of data from an existing randomized control trial of brief cognitive behavioral treatment on specific phobias (One-Session Treatment, OST; Ollendick et al., 2009), we examined 1) the effect of comorbid specific phobias and other anxiety disorders on treatment outcomes, and 2) the effect of treatment of the specific phobia on these co-occurring disorders. These relations were explored in 100 youth presenting with animal, natural environment, situational, and "other" types of phobia. Youth were reliably diagnosed with the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent versions (Silverman & Albano, 1996). Clinician severity ratings at post-treatment and 6-month follow-up were examined as were parent and child treatment outcome satisfaction measures. Results indicated that the presence of comorbid phobias or anxiety disorders did not affect treatment outcomes; moreover, treatment of the targeted specific phobias led to significant reductions in the clinical severity of other co-occurring specific phobias and related anxiety disorders. These findings speak to the generalization of the effects of this time-limited treatment approach. Implications for treatment of principal and comorbid disorders are discussed, and possible mechanisms for these effects are commented upon.

Gestantes colonizadas pelo Streptococcus do grupo B e seus recém-nascidos: análise crítica da conduta adotada no Instituto Fernandes Figueira, Fundação Oswaldo Cruz / Beta-hemolytic streptococcus in pregnant women and their newborn infants: a critical analysis of the protocol used at Fernandes Figueira Institute, Oswaldo Cruz Foundation, in Brazil

OBJETIVO: Avaliar a aplicação do protocolo do Centers of Disease Control (CDC, 2002) quanto à profilaxia da sepse neonatal precoce por Streptococcus do grupo B (SGB). MÉTODOS: Estudo retrospectivo com revisão de prontuários de 125 gestantes colonizadas pelo SGB e 133 recém-nascidos, no período de janeiro/2003 a dezembro/2006. A conduta intraparto foi considerada correta quando a gestante recebia antibioticoprofilaxia pelo menos quatro horas antes do parto, ou quando não recebia, mas era submetida a parto cesáreo eletivo. A conduta intraparto foi considerada incorreta quando a gestante recebia antibioticoprofilaxia menos de quatro horas antes do parto, a prescrição antibiótica estava incorreta ou quando não havia profilaxia prescrita. RESULTADOS: A prevalência de colonização materna pelo SGB foi de 4,7 por cento. A época de coleta do swab vaginal/retal variou entre 14 e 40 semanas de gestação, com média de 32 semanas. Das gestantes colonizadas, 54 (43 por cento) receberam conduta intraparto correta. Dos 133 recém-nascidos estudados, 95 (71 por cento) receberam avaliação diagnóstica corretamente, 17 (13 por cento) evoluíram com sepse clínica e um (0,75 por cento) apresentou sepse comprovada. A incidência de sepse foi maior em recém-nascidos cujas mães não receberam profilaxia intraparto corretamente, porém esta associação não apresentou diferença estatística significativa (18 versus 7 por cento, p>0,05). CONCLUSÕES: Apesar de o protocolo para prevenção de sepse precoce pelo SGB estar implementado na instituição, ainda é possível observar falhas na profilaxia intraparto materna. Essas falhas representam oportunidades perdidas na prevenção da sepse precoce pelo SGB.

OBJECTIVE: To evaluate the use of the guidelines of the Centers of Disease Control (CDC, 2002) regarding the prophylaxes of group B Streptococcus (GBS) early onset neonatal sepsis. METHODS: We conducted a retrospective study by chart review of 125 pregnant women colonized by GBS and 133 neonates born at a 3rd level maternity hospital, from January/2003 to December/2006. The intrapartum management was deemed correct when pregnant women were given prophylactic antibiotic at least four hours before delivery or when they did not receive medication but were submitted to elective cesarean section. The intrapartum management was considered incorrect when the pregnant woman was given antibiotic prophylaxis less than four hours before delivery, when the antibiotic prescription was inadequate or no prophylaxis had been prescribed. RESULTS: The prevalence of maternal colonization by GBS was 4.7 percent. The time when the vaginal/rectal swab was collected ranged between 14-40 (mean 32) weeks of gestation. Among the colonized mothers, 54 (43 percent) received correct intrapartum management. Among 133 studied infants, 95 (71 percent) received a correct diagnosis; 17 (13 percent) developed clinical sepsis and one (0.75 percent) had proven bacterial sepsis. The incidence of sepsis was higher in infants whose mothers did not receive a correct intrapartum prophylaxis, but this difference was not significant (18 versus 7 percent, p>0.05). CONCLUSIONS: Although the guidelines to prevent perinatal GBS disease are in place, there are flaws in the intrapartum prophylaxis and in infants' evaluation. These flaws represent missed opportunities to prevent early onset GBS sepsis.

An examination of treatment completers and non-completers at a child and adolescent community mental health clinic.

This study examined sociodemographic and clinical characteristics of treatment completers (N = 114) and non-completers (N = 136) at a child and adolescent community mental health clinic. Results indicated that children who completed treatment significantly differ from those who prematurely drop out of treatment. Non-completers presented with considerably more impairment in functioning and psychiatric symptoms, and their caregiver reported experiencing significantly more parenting stress and depressive symptoms. Results suggest that mental health treatment is not readily provided to the most difficult to reach and most at-risk youth and their families.

Hurricane Katrina and youth anxiety: the role of perceived attachment beliefs and parenting behaviors.

This study sought to examine the role of attachment beliefs and parenting behaviors on youth's anxious response to disaster by testing a theoretical model which posits youths' perceptions of attachment beliefs and parenting behaviors as moderators of the relation between pre and post disaster anxiety symptoms. Seventy-four youth (ages 6-17 years) and their parents exposed to Hurricane Katrina participated in pre and post disaster assessments. Results indicated that both youths' pre disaster perceived attachment beliefs (i.e., trust and communication) and perceptions of parenting behaviors (i.e., acceptance and firm control) moderated the relation between pre and post Katrina anxiety symptoms. Exploratory analyses demonstrated no age, gender, or ethnicity differences in post Katrina anxiety symptoms. Findings are discussed in terms of how parents may influence youths' pre and post disaster anxiety symptoms in the face of natural disasters and the implications for intervention.

One-session treatment of specific phobias in youth: a randomized clinical trial in the United States and Sweden.

One hundred and ninety-six youth, ages 7-16, who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for various specific phobias were randomized to a one-session exposure treatment, education support treatment, or a wait list control group. After the waiting period, the wait list participants were offered treatment and, if interested, rerandomized to 1 of the 2 active treatments. The phobias were assessed with semistructured diagnostic interviews, clinician severity ratings, and behavioral avoidance tests, whereas fears, general anxiety, depression, and behavior problems were assessed with self- and parent report measures. Assessments were completed pretreatment, posttreatment, and at 6 months following treatment. Results showed that both treatment conditions were superior to the wait list control condition and that 1-session exposure treatment was superior to education support treatment on clinician ratings of phobic severity, percentage of participants who were diagnosis free, child ratings of anxiety during the behavioral avoidance test, and treatment satisfaction as reported by the youth and their parents. There were no differences on self-report measures. Treatment effects were maintained at follow-up. Implications of these findings are discussed.

Sleep problems and their relation to cognitive factors, anxiety, and depressive symptoms in children and adolescents.

BACKGROUND: Existing research indicates sleep problems to be prevalent in youth with internalizing disorders. However, childhood sleep problems are common in the general population and few data are available examining unique relationships between sleep, specific types of anxiety and depressive symptoms among non-clinical samples of children and adolescents. METHODS: The presence of sleep problems was examined among a community sample of children and adolescents (N=175) in association with anxiety and depressive symptoms, age, and gender. Based on emerging findings from the adult literature we also examined associations between cognitive biases and sleep problems. RESULTS: Overall findings revealed significant associations between sleep problems and both anxiety and depressive symptoms, though results varied by age. Depressive symptoms showed a greater association with sleep problems among adolescents, while anxiety symptoms were generally associated with sleep problems in all youth. Cognitive factors (cognitive errors and control beliefs) linked with anxiety and depression also were associated with sleep problems among adolescents, though these correlations were no longer significant after controlling for internalizing symptoms. CONCLUSIONS: Results are discussed in terms of their implications for research and treatment of sleep and internalizing disorders in youth.

Social support, discrimination, and coping as predictors of posttraumatic stress reactions in youth survivors of Hurricane Katrina.

This study examined the influence of aspects of the post-Hurricane Katrina recovery environment (i.e., discrimination, social support) and coping behaviors on children's posttraumatic stress reactions (symptoms of posttraumatic stress disorder [PTSD], anxiety, and depression). Data corresponding to 46 youth (M = 11.43 years; 39% girls; 33% African American, 67% European American) revealed that greater helpfulness from extrafamilial sources of social support predicted lower levels of child-rated symptoms of PTSD, anxiety, and depression. A positive predictive relation was found between helpfulness from professional support sources and PTSD, perhaps suggesting that parents whose children were experiencing higher PTSD symptom levels sought professional support and reported it to be helpful. Youths' avoidant coping behaviors predicted both PTSD and anxiety symptoms. Discrimination, active coping, and familial support did not predict any of the posttraumatic stress reactions assessed in this study.

The psychosocial impact of Hurricane Katrina: contextual differences in psychological symptoms, social support, and discrimination.

This study tested a contextual model of disaster reaction by examining regional differences in the psychosocial impact of Hurricane Katrina. A total of 386 individuals participated in this study. All were recruited in the primary areas affected by Hurricane Katrina and included residents of metropolitan New Orleans (Orleans Parish, Louisiana), Greater New Orleans (i.e., Metairie, Kenner, Gretna), and the Mississippi Gulf Coast (i.e., cities along the coast from Waveland to Ocean Springs, Mississippi). Participants were assessed for posttraumatic stress disorder (PTSD) symptoms, other psychological symptoms, perceptions of discrimination, perceptions of social support, evacuation distance, and the extent to which they experienced hurricane-related stressful events. Results were consistent with previous research on the impact of disasters on mental health symptoms. Findings extended research on individual differences in the response to trauma and indicated that regional context predicted unique variance in the experience of discrimination, social support, and emotional symptoms consistent with the theoretical model presented.

Predisaster trait anxiety and negative affect predict posttraumatic stress in youths after hurricane Katrina.

On the basis of theory and previous research, it was hypothesized that predisaster child trait anxiety would predict disaster-related posttraumatic stress symptoms and generalized anxiety disorder symptoms, even after controlling for the number of hurricane exposure events. Results support this hypothesis and further indicate that predisaster negative affect predicted disaster-related posttraumatic stress symptoms and generalized anxiety disorder symptoms. Also, Katrina-related posttraumatic stress disorder symptoms were predicted by the number of hurricane exposure events and sex (being female). Predisaster generalized anxiety disorder symptoms predicted postdisaster generalized anxiety disorder symptoms, and predisaster trait anxiety predicted postdisaster depressive symptoms. Findings are discussed in terms of their relevance for developing interventions to mitigate the impact of disasters in youths.

Cognitive errors, anxiety sensitivity, and anxiety control beliefs: their unique and specific associations with childhood anxiety symptoms.

This study examined the interrelations among negative cognitive errors, anxiety sensitivity, and anxiety control beliefs and explored their unique and specific associations with anxiety symptoms in a community sample of youth. Existing research has suggested that these constructs are related to childhood anxiety disorder symptoms; however, additional research is needed to test the interrelations among negative cognitive errors, anxiety sensitivity, and anxiety control beliefs and to determine if they show unique and specific associations with anxiety symptoms. The results of this study indicated that negative cognitive errors, anxiety sensitivity, and anxiety control beliefs were associated with each other and that they demonstrated unique concurrent associations with childhood anxiety disorder symptoms. Moreover, certain cognitive biases showed specificity in their association with anxiety symptoms versus depressive symptoms.

Gestantes colonizadas pelo estreptococos do grupo B e seus recém-nascidos: análise crítica da conduta adotada no Instituto Fernandes Figueira / Pregnant women colonized with group B streptococci and their newborns: a critical analysis of the approach adopted in the Fernandes Figueira Institute

Streptococcus do grupo B (SGB) é a causa mais comum de sepse neonatal e é responsável por significatica mortalidade e morbidade....A prevalência de colonização materna pelo SGB em nossa amostra foi de 5,1%. A época de coleta do swab vaginal/retal variou entre 14 e 40 semanas de gestação, sendo a média de 32,2 semanas. Cinquenta e quatro (43,2%) gestantes colonizadas receberam conduta intraparto correta. Setenta e uma (56,8%) gestantes não receberam profilaxia intraparto corretamente, pois em 26 gestantes o antibiótico não havia sido prescrito, em 7 gestantes a prescrição estava incorreta e em 38 o parto ocorreu antes de 4 horas do antibiótico. Dos 133 recém nascidos estudados, noventa e cinco (71,4%) receberam avaliação diagnóstica corretamente, 17 (12,8%) evoluiram com sepse clínica suspeira e 1 (0,75%) apresentou sepse comprovada com hemocultura positiva para SGB. A maioria dos recém nascidos que desenvolveram sepse eram prematuros. A incidência de sepse foi maior em recém nascidos cujas mães não receberam profilaxia intraparto corretamente, porém esta associação não apresentou diferença estatística significativa (18% vc 7,2%. p > 0,05). Apesar do protocolo para prevenção de sepse precoce pelo SGB estar implementado no IFF, ainda podemos detectar falhas na profilaxia intraparto materna e na avaliação do recém nascido. Estas falhas na aderência ao protocolo representam oportunidades perdidas na prevenção da sepse precoce pelo SGB.

Physiological response and childhood anxiety: association with symptoms of anxiety disorders and cognitive bias.

This study examined the physiological response (skin conductance and heart rate [HR]) of youth exposed to a mildly phobic stimulus (video of a large dog) and its relation to child- and parent-reported anxiety symptoms and cognitive bias in a community-recruited sample of youth (n = 49). The results of this study indicated that HR and skin-conductance response were associated with youth report but not parent report of their child's symptoms of anxiety disorders and that HR response was more strongly associated with anxiety symptoms than skin-conductance response. Physiological response was uniquely associated with youth-reported symptoms of anxiety rather than youth-reported depression. Finally, HR response interacted with cognitive bias in predicting childhood anxiety disorder symptoms in a manner consistent with theories of the etiology of anxiety disorders.

Developmental differences in the expression of childhood anxiety symptoms and fears.

OBJECTIVE: To examine age differences in the expression of childhood fears and anxiety symptoms. METHOD: A cross-sectional design was used to test recently formulated developmental hypotheses regarding the differential expression of childhood anxiety symptoms and fears in a community sample of youths (N = 145). Three groups of youths were compared: children aged 6-9 years (n = 47), preteens aged 10-13 years (n = 52), and adolescents aged 14-17 years (n = 46). Symptoms of separation anxiety, generalized anxiety, and social anxiety were assessed using a dimensional approach by both parent and child report. Fears were assessed by child report. RESULTS: The results indicated that there are systematic age differences in the expression of childhood fears and anxiety symptoms. Results also point toward specific symptoms predominant at certain ages (i.e., separation anxiety symptoms in youths aged 6-9 years, death and danger fears in youths aged 10-13 years, and social anxiety symptoms as well as failure and criticism fears in youths aged 14-17 years) in partial support of predictions. CONCLUSIONS: Models of the etiology of childhood anxiety disorders tracing continuity and change over time should consider differences in the developmental expression of childhood fears and anxiety symptoms. Attention to developmental issues concerning symptom expression may be important in the clinical understanding of childhood anxiety.

A cross-sectional evaluation of the factorial invariance of anxiety sensitivity in adolescents and young adults.

This study examined the cross-sectional factorial invariance of anxiety sensitivity in an ethnically diverse sample of adolescents (n = 173; mean age 15.5 years) and young adults (n = 291; mean age 20.1 years). Research in adult and youth samples suggests that anxiety sensitivity is best understood as a hierarchical construct with several lower-order factors. Factor models based on previous research using both adult and youth samples were compared and a hierarchical model with three lower-order factors provided the best fit to the data. Results supported the hypothesis that the factor structure of the Anxiety Sensitivity Index was invariant across age and gender. The factor scores also demonstrated differential correlations with symptoms of anxiety and depression. Results are discussed with regard to construct validation and understanding the structure of anxiety sensitivity in youth.