ABSTRACT
The relationship between improvements in child anxiety and changes in parent factors (e.g., parental anxiety, parenting behaviors) is poorly understood. The present study investigated the directionality of change for child anxiety and parent factors among youth treated for anxiety disorders. Structural equation modeling examined these relationships pre- to posttreatment and at 1-year follow-up for 111 youth aged 7 to 14 (57% male, 84% Caucasian). Child anxiety was measured using the Anxiety Disorders Interview Schedule for Children and the Child Behavior Checklist. The State-Trait Anxiety Inventory, Children's Report of Parental Behavior Inventory, and Family Assessment Device were used to measure maternal anxiety, psychological control, behavior control, and family affective involvement. Findings suggest that decreases in mother-reported child anxiety led to decreases in maternal anxiety. Decreases in maternal psychological control and family affective involvement preceded decreases in clinician-rated child anxiety. Youth who showed the most reductions in anxiety over the course of treatment were those who tended to have lower family affective involvement, behavior control, and maternal anxiety at pretreatment. Stability of the parent factors and child anxiety over time suggest that stability was greater for behavior control and maternal anxiety relative to affective involvement and psychological control. The findings are consistent with previous research indicating the importance of these parent factors as they relate to anxiety in youth. Furthermore, results indicate that changes in child anxiety may precede changes in parent factors and suggest that parental psychological control and affective involvement are important treatment targets for youth with anxiety disorders.
Subject(s)
Adolescent Behavior/psychology , Anxiety Disorders/therapy , Child Behavior/psychology , Cognitive Behavioral Therapy/methods , Parent-Child Relations , Parenting/psychology , Adolescent , Anxiety Disorders/psychology , Child , Female , Humans , Male , Maternal Behavior/psychology , Severity of Illness Index , Treatment OutcomeABSTRACT
Evidence is mixed regarding an independent association between anxiety and suicidality in youth. Study 1 examined suicidal ideation in treatment-referred, anxiety-disordered youth (N = 312, aged 7-17). Forty-one percent of anxiety-disordered youth endorsed suicidal ideation. Anxiety disorder severity, global impairment, and current depressive symptoms predicted suicidal ideation in a multivariate model. Study 2 compared youth (N = 216, aged 7-14) with and without anxiety disorders. Higher rates of suicidal ideation were associated with anxiety diagnosis, and levels of anxiety predicted suicidal ideation after controlling for comorbid depressive disorders, current depressive symptoms, and global impairment. Results support an association between anxiety disorders and suicidal ideation in treatment-referred youth and recommend routine screening for suicidal ideation in this population.
Subject(s)
Anxiety Disorders/psychology , Association , Suicidal Ideation , Adolescent , Child , Female , Humans , Logistic Models , MaleABSTRACT
This review examines the empirical literature on the relationship between internalizing disorders and substance use disorders (SUDs) in youth in terms of (a) comorbidity rates, (b) risk relationships, (c) temporal sequencing, and (d) implications for intervention. Findings from community and clinical samples suggest that comorbidity rates range from 9.0 to 47.9%. The majority of the evidence supports the temporal precedence of internalizing disorders before substance use disorders and a unidirectional risk model in which internalizing disorders increase risk for later substance use disorders. Implications of this relationship for interventions are considered, both in terms of treatment outcome for principal disorders and in terms of the potential "secondary benefit" of treating one disorder for preventing or reducing risk of the other. Finally, recommendations for future research on the relationship between internalizing disorders and SUDs in youth are discussed.
Subject(s)
Anxiety Disorders/epidemiology , Depressive Disorder/epidemiology , Substance-Related Disorders/epidemiology , Adolescent , Anxiety Disorders/psychology , Child , Comorbidity , Depressive Disorder/psychology , Humans , Risk , Substance-Related Disorders/psychology , Young AdultABSTRACT
BACKGROUND: Subjective Units of Distress Scale (SUDS) ratings are commonly used during exposure tasks in cognitive behavioral treatment (CBT) for anxiety. AIMS: The present study examined patterns and predictors of SUDS in a sample of anxiety-disordered youth. METHOD: Youth (N = 99) aged 7 to 14 (M = 10.4, SD = 1.8) were treated with CBT for social phobia (SP), generalized anxiety disorder (GAD), and/or separation anxiety disorder (SAD). Analyses were conducted using hierarchical linear modeling. RESULTS: Child's peak SUDS and magnitude of change in SUDS significantly increased between sessions. Higher child self-reported pretreatment total Multidimensional Anxiety Scale for Children (MASC) score predicted greater change in SUDS within the first exposure session. Primary GAD diagnosis predicted less increase in change in SUDS between sessions. CONCLUSIONS: Results suggest that higher pretreatment total MASC scores are associated with increased first exposure within-session habituation. Additionally, youth with a principal diagnosis of GAD experienced less between-session habituation, perhaps because they may have required more imaginal than in-vivo exposures.
Subject(s)
Anxiety Disorders/psychology , Anxiety Disorders/therapy , Anxiety, Separation/psychology , Anxiety, Separation/therapy , Arousal , Cognitive Behavioral Therapy/methods , Depressive Disorder/psychology , Depressive Disorder/therapy , Family Therapy/methods , Fear , Implosive Therapy/methods , Pain Measurement , Personality Inventory/statistics & numerical data , Phobic Disorders/psychology , Phobic Disorders/therapy , Adolescent , Anxiety Disorders/diagnosis , Anxiety, Separation/diagnosis , Child , Depressive Disorder/diagnosis , Female , Habituation, Psychophysiologic , Humans , Imagination , Linear Models , Male , Patient Education as Topic , Personality Assessment/statistics & numerical data , Phobic Disorders/diagnosis , Psychometrics , Social SupportABSTRACT
Research indicates that depression and anxiety are highly comorbid in youth. Little is known, however, about the clinical and family characteristics of youth with principal anxiety disorders and comorbid depressive diagnoses. The present study examined the demographic, clinical, and family characteristics of 200 anxiety-disordered children and adolescents (aged 7-17) with and without comorbid depressive disorders (major depressive disorder or dysthymic disorder), seeking treatment at a university-based anxiety clinic. All participants met DSM-IV diagnostic criteria for a principal anxiety disorder (generalized anxiety disorder, separation anxiety disorder, or social phobia). Of these, twelve percent (n = 24) also met criteria for a comorbid depressive disorder. Results suggest that anxiety-disordered youth with comorbid depressive disorders (AD-DD) were older at intake, had more severe anxious and depressive symptomatology, and were more impaired than anxiety-disordered youth without comorbid depressive disorders (AD-NDD). AD-DD youth also reported significantly more family dysfunction than AD-NDD youth. Future research should examine how this diagnostic and family profile may impact treatment for AD-DD youth.
