Maths performance of adults with and without developmental coordination disorder (DCD): The role of working memory and maths anxiety.

Previous studies have shown that children with Developmental Coordination Disorder (DCD)/Dyspraxia have poorer maths performance compared to their neurotypical (NT) counterparts. However, no studies have explored the cognitive and emotional factors affecting the maths performance of adults with DCD. This study, therefore, investigated the role of working memory (WM), maths anxiety (MAS), and maths self-efficacy on the maths performance of adults with DCD. We found that adults with DCD had lower WM and maths performance and were more maths anxious than their NT peers. However, there were no significant differences in maths self-efficacy. When looking at the predictors of maths performance, we found a positive relationship between WM resources and the DCD maths performance, possibly indicating that they relied more on WM resources to perform simple mental arithmetic tasks than NTs. On the other hand, MAS had an inverse relationship with the NT maths performance but not with the DCD performance. The reasons and implications of these findings will be discussed.

Number sense-arithmetic link in Grade 1 and Grade 2: A case of fluency.

BACKGROUND: Recent research suggested fluent processing as an explanation on why number sense contributes to simple arithmetic tasks-'Fluency hypothesis'. AIMS: The current study investigates whether number sense contributes to such arithmetic tasks when other cognitive factors are controlled for (including those that mediate the link); and whether this contribution varies as a function of participants' individual maths fluency levels. SAMPLE: Four hundred and thirty-seven Chinese schoolchildren (186 females; Mage = 83.49 months) completed a range of cognitive measures in Grade 1 (no previous classroom training) and in Grade 2 (a year later). METHODS: Number sense, arithmetic (addition and subtraction), spatial ability, visuo-spatial working memory, perception, reaction time, character reading and general intelligence were measured. RESULTS: Our data showed that the link between number sense and arithmetic was weaker in Grade 1 (Beta = .15 for addition and .06 (ns) for subtraction) compared to Grade 2 (.23-.28), but still persisted in children with no previous maths training. Further, math's performance in Grade 1 did not affect the link between number sense and maths performance in Grade 2. CONCLUSION: Our data extended previous findings by showing that number sense is linked with simple maths task performance even after controlling for multiple cognitive factors. Our results brought some evidence that number sense-arithmetic link is somewhat sensitive to previous formal maths education. Further research is needed, as the differences in effects between grades were quite small, and arithmetic in Grade 1 did not moderate the link at question in Grade 2.

Exploring the link between perceived physical literacy and academic performance outcomes: insights from the EHDLA study.

Objective: The aim of this study was to verify the relationship between perceived physical literacy (PPL) and academic performance outcomes among Spanish adolescents aged 12-17 years. Methods: This cross-sectional study is a secondary examination utilizing data derived from the Eating Healthy and Daily Life Activities (EHDLA) project. The Spanish Perceived Physical Literacy Instrument for Adolescents (S-PPLI) was used to evaluate the PPL of the participants. To determine academic performance, the numerical grades for each subject were added together and then divided by the total number of subjects. Results: Overall, a positive trend in the association between S-PPLI scores and academic performance was observed. We identified two significant ranges within the S-PPLI scores. First, there was a significant range between 9 and 33 points on the S-PPLI, indicating an inverse association with academic performance. Second, another significant range was observed at scores of 34 points or higher on the S-PPLI, suggesting a positive association with academic performance. Participants with low PPL had the lowest academic performance (mean = 6.4; bias-corrected and accelerated (BCa) bootstrapped 95% confidence interval (CI): 6.2-6.6). Conversely, those adolescents with high PPL had the highest academic performance (mean = 6.9; BCa bootstrapped 95% CI: 6.6-7.1). Significant differences were found between low PPL and medium PPL (p-adjusted = 0.031) and between low PPL and high PPL (p-adjusted = 0.031). Conclusions: Increased physical literacy could be a relevant factor for achieving greater academic performance in adolescents. This study has potential implications for physical education instructors, school leaders, and healthcare practitioners.

Maths anxiety and subjective perception of control, value and success expectancy in mathematics.

Mathematics anxiety (MA) is an academic anxiety related to doing, learning and testing mathematics. MA can negatively affect mathematics performance, motivation and maths-heavy science and technology-related career choices. Previous data suggest that subjective perceptions and interpretations of students are key in the genesis of MA. Here, based on expectancy-value and control-value theory, we aimed to identify potential, theoretically based subjective factors probably key to understanding MA. We analysed data from 151 745 fifteen-year-old children from 65 'countries and economies' from the Programme for International Student Assessment (PISA) 2012 dataset. Subjective self-perceptions had a stronger relationship with MA than maths achievement. We found that higher MA was associated with lower perceived control over maths activities and lower subjective expectation of success. Surprisingly, children with higher subjective valuation of maths had higher MA for similar levels of subjective control and success expectancy in maths. Results offer an improved understanding of potential antecedents of MA and suggest that effective interventions could be based on gradual confidence building in maths. These could primarily draw on a deeper understanding of the subject improving subjective success expectancy and feeling of control over maths activities. Cultural variation in findings is discussed.

Direct and indirect links between children's socio-economic status and education: pathways via mental health, attitude, and cognition.

A child's socio-economic environment can profoundly affect their development. While existing literature focusses on simplified metrics and pair-wise relations between few variables, we aimed to capture complex interrelationships between several relevant domains using a broad assessment of 519 children aged 7-9 years. Our analyses comprised three multivariate techniques that complimented each other, and worked at different levels of granularity. First, an exploratory factor analysis (principal component analysis followed by varimax rotation) revealed that our sample varied along continuous dimensions of cognition, attitude and mental health (from parallel analysis); with potentially emerging dimensions speed and socio-economic status (passed Kaiser's criterion). Second, k-means cluster analysis showed that children did not group into discrete phenotypes. Third, a network analysis on the basis of bootstrapped partial correlations (confirmed by both cross-validated LASSO and multiple comparisons correction of binarised connection probabilities) uncovered how our developmental measures interconnected: educational outcomes (reading and maths fluency) were directly related to cognition (short-term memory, number sense, processing speed, inhibition). By contrast, mental health (anxiety and depression symptoms) and attitudes (conscientiousness, grit, growth mindset) showed indirect relationships with educational outcomes via cognition. Finally, socio-economic factors (neighbourhood deprivation, family affluence) related directly to educational outcomes, cognition, mental health, and even grit. In sum, cognition is a central cog through which mental health and attitude relate to educational outcomes. However, through direct relations with all components of developmental outcomes, socio-economic status acts as a great 'unequaliser'. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-021-02232-2.

Number sense at 12 months predicts 4-year-olds' maths skills.

Preverbal infants spontaneously represent the number of objects in collections. Is this 'sense of number' (also referred to as Approximate Number System, ANS) part of the cognitive foundations of mathematical skills? Multiple studies reported a correlation between the ANS and mathematical achievement in children. However, some have suggested that such correlation might be mediated by general-purpose inhibitory skills. We addressed the question using a longitudinal approach: we tested the ANS of 60 12 months old infants and, when they were 4 years old (final N = 40), their symbolic math achievement as well as general intelligence and inhibitory skills. Results showed that the ANS at 12 months is a specific predictor of later maths skills independent from general intelligence or inhibitory skills. The correlation between ANS and maths persists when both abilities are measured at four years. These results confirm that the ANS has an early, specific and longstanding relation with mathematical abilities in childhood. RESEARCH HIGHLIGHTS: In the literature there is a lively debate about the correlation between the ANS and maths skills. We longitudinally tested a sample of 60 preverbal infants at 12 months and rested them at 4 years (final sample of 40 infants). The ANS tested at 12 months predicted later symbolic mathematical skills at 4 years, even when controlling for inhibition, general intelligence and perceptual skills. The ANS tested at 4 years remained linked with symbolic maths skills, confirming this early and longstanding relation in childhood.

Effect of an Integrated Active Lessons Programme through Playful Maths Games on Self-Concept, Self-Esteem and Social Skills in Preschool Children.

The aim of this study was to analyse the effects of an integrated active lessons programme based on playful math games, of 10 weeks' duration (30 min/day × 2 days/week), on self-concept, self-esteem and social skills in preschool children. One hundred and ninety-four preschool children (53.6% girls) aged 53.36 ± 11.82 months were split into a control group (CG) and an experimental group (EG). The EG improved significantly in self-concept compared to the CG in boys and girls (6.8% and 7.1%, respectively). Personal and academic self-esteem levels increased significantly (8.1% and 5.5%, respectively, only in girls). Although the EG obtained significant improvements in social self-esteem and social skills compared to the beginning of the study, these results were not found in comparison with the CG. The introduction of active lessons based on playful maths games within the classroom is recommended as support for the improvement in self-concept, self-esteem and social skills in early childhood education.

Cognition and maths in children with Attention-Deficit/Hyperactivity disorder with and without co-occurring movement difficulties.

BACKGROUND: Movement difficulties are common in ADHD, however, the implications of their co-occurrences on cognitive and maths performance is unknown. AIMS: This study set out to examine whether cognitive and maths performance of children with high ADHD symptoms differs depending on the co-occurrence of movement difficulties given evidence that weaker visuospatial processing, known to be important for maths performance, differentiates ADHD and DCD. We also aimed to examine whether relationships between cognition and maths in ADHD differs depending on co-occurring movement difficulties. METHODS: Participants were 43 drug naïve children between 6 and 12 years old (M = 101.53 months SD = 19.58). The ADHD-only group (n = 18) included children with high ADHD scores, and those in the ADHD+DCD group (n = 25) concurrently had high movement difficulty scores. All completed executive function and memory, including 2 visuo-spatial memory tasks from the CANTAB battery and Mathematics Problem Solving, Numeracy, and Maths Fluency tasks from the WIAT-III and specific factual, conceptual, and procedural maths component tasks. RESULTS: Children in the ADHD+DCD group scored significantly lower on visuospatial working memory (WM) capacity, than those in the ADHD-only group. Both groups were comparable on all other cognitive assessments of executive functions, memory, and processing speed. The groups did not differ in their maths attainment scores, nor on more specific maths skills. Comparison of the correlations between cognitive processes and maths revealed that the association between visuospatial WM updating and procedural skill efficiency was stronger for the ADHD-only group. Moreover, associations between visuospatial WM and maths problem solving attainment were stronger in the ADHD+DCD group. CONCLUSIONS: Despite similarities in maths performance, children with ADHD+DCD could be distinguished by lower visuospatial WM. Differential associations with some of the maths domain implicate recruitment of different cognitive processes for some aspects of maths. This distinction can be particularly useful for conceptualising cognitive characteristics of different clinical groups and understanding cognitive pathways of maths difficulties. Implications for interventions are discussed.

The effects of active classroom breaks on moderate to vigorous physical activity, behaviour and performance in a Northern NSW primary school: A quasi-experimental study.

ISSUE ADDRESSED: Approximately 77% of NSW children aged 5 to 15 years do not meet physical activity guidelines and many spend a considerable amount of time sitting. Active breaks at primary school are feasible, may increase daily moderate to vigorous physical activity (MVPA) and decrease off-task behaviour without adversely affecting cognitive function and learning. METHODS: In this quasi-experimental study, 101 primary school children in six intervention classrooms participated in three 10-minute active breaks per day for six-weeks during class time, while five control classrooms were run as usual (n = 89). Physical activity levels were measured using wrist-worn Actigraph wGT3X-BT accelerometers and analysed using a random forest model. Students' off-task behaviour, wellbeing, cognitive function and maths performance were also measured. School staff completed a brief feedback survey. RESULTS: Children in the intervention group engaged in 15.4 and 10.9 minutes more MVPA per day at 3 and 6 weeks respectively (P < .001). Participation significantly increased the proportion of children who met the Australian 24-Hour Movement Guidelines (P < .001). At pre, middle and end of intervention, 44.4%, 60.8% and 55.1% of intervention children and 46.5%, 45.9% and 45.8% of controls met the guidelines. Significantly fewer students engaged in off-task behaviour in the intervention classes at mid and final weeks of intervention (-1.4 students, P = .003). No significant intervention effects were found for wellbeing, cognitive and maths performance. CONCLUSIONS: Active classroom breaks are an effective way to increase physical activity among primary school children while reducing off-task classroom behaviour. SO WHAT?: Primary school students' health would benefit from active breaks with no detrimental effects on wellbeing, maths and cognitive performance.

Association of basic vaccination with cognitive and learning ability among children: insights from the India Human Development Survey, 2004-05 and 2011-12.

Basic vaccination is important to protect children from infectious diseases and illnesses. Adequate levels of vaccination coverage reduce the morbidity and mortality burden among children and promote their physical and mental development. This study aimed to assess the association between basic childhood vaccination and the cognitive and learning ability of school children in India. Nationally representative follow-up data on 6183 children from the Indian Human Development Surveys conducted in 2004-05 and 2011-12 (IHDS I & II) were analysed. Children aged 8-10 years who had received all basic vaccines by the age 12 months performed better in a maths test than partially vaccinated or unvaccinated children (OR: 1.87, 95% CI: 1.48, 2.35). Similarly, fully vaccinated children performed better in writing tasks than partially vaccinated or unvaccinated children (OR: 1.77, 95% CI: 1.44, 2.18). Likewise, fully vaccinated children had better reading skills than fully unvaccinated children (OR: 1.60, 95% CI: 1.23, 2.09). The results suggest that enhancing child vaccination coverage can have significant benefits beyond health and can potentially improve the long-term educational outcomes of children.

Ability to Consolidate Instances as a Proxy for the Association Among Reading, Spelling, and Math Learning Skill.

Learning skills (as well as disorders) tend to be associated; however, cognitive models typically focus either on reading, spelling or maths providing no clear basis for interpreting this phenomenon. A recent new model of learning cognitive skills proposes that the association among learning skills (and potentially the comorbidity of learning disorders) depends in part from the individual ability to consolidate instances (taken as a measure of rate of learning). We examined the performance of typically developing fifth graders over the acquisition of a novel paper-and-pencil task that could be solved based on an algorithm or, with practice, with reference to specific instances. Our aim was to establish a measure of individual rate of learning using parameters envisaged by the instance theory of automatization by Logan and correlate it to tasks requiring knowledge of individual items (e.g., spelling words with an ambiguous transcription) or tasks requiring the application of a rule or an algorithm (e.g., spelling non-words). The paper-and-pencil procedure yielded acquisition curves consistent with the predictions of the instance theory of automatization (i.e., they followed a power function fit) both at a group and an individual level. Performance in tasks requiring knowledge of individual items (such as doing tables or the retrieval of lexical representations) but not in tasks requiring the application of rules or algorithms (such as judging numerosity or spelling through sublexical mapping) was significantly predicted by the learning parameters of the individual power fits. The results support the hypothesis that an individual dimension of "ability to consolidate instances" contributes to learning skills such as reading, spelling, and maths, providing an interesting heuristic for understanding the comorbidity across learning disorders.

A Network Analysis of the Relationship among Reading, Spelling and Maths Skills.

Background. Skill learning (e.g., reading, spelling and maths) has been predominantly treated separately in the neuropsychological literature. However, skills (as well as their corresponding deficits), tend to partially overlap. We recently proposed a multi-level model of learning skills (based on the distinction among competence, performance, and acquisition) as a framework to provide a unitary account of these learning skills. In the present study, we examined the performance of an unselected group of third- to fifth-grade children on standard reading, spelling, and maths tasks, and tested the relationships among these skills with a network analysis, i.e., a method particularly suited to analysing relations among different domains. Methods. We administered a battery of reading, spelling, and maths tests to 185 third-, fourth-, and fifth-grade children (103 M, 82 F). Results. The network analysis indicated that the different measures of the same ability (i.e., reading, spelling, and maths) formed separate clusters, in keeping with the idea that they are based on different competences. However, these clusters were also related to each other, so that three nodes were more central in connecting them. In keeping with the multi-level model of learning skills, two of these tests (arithmetic facts subtest and spelling words with ambiguous transcription) relied heavily on the ability to recall specific instances, a factor hypothesised to underlie the co-variation among learning skills. Conclusions. The network analysis indicated both elements of association and of partial independence among learning skills. Interestingly, the study was based on standard clinical instruments, indicating that the multi-level model of learning skills might provide a framework for the clinical analysis of these learning skills.

Cognitive Dimensions of Learning in Children With Problems in Attention, Learning, and Memory.

A data-driven, transdiagnostic approach was used to identify the cognitive dimensions linked with learning in a mixed group of 805 children aged 5 to 18 years recognised as having problems in attention, learning and memory by a health or education practitioner. Assessments included phonological processing, information processing speed, short-term and working memory, and executive functions, and attainments in word reading, spelling, and maths. Data reduction methods identified three dimensions of phonological processing, processing speed and executive function for the sample as a whole. This model was comparable for children with and without ADHD. The severity of learning difficulties in literacy was linked with phonological processing skills, and in maths with executive control. Associations between cognition and learning were similar across younger and older children and individuals with and without ADHD, although stronger links between learning-related problems and both executive skills and processing speed were observed in children with ADHD. The results establish clear domain-specific cognitive pathways to learning that distinguish individuals in the heterogeneous population of children struggling to learn.

Testing the Specificity of Predictors of Reading, Spelling and Maths: A New Model of the Association Among Learning Skills Based on Competence, Performance and Acquisition.

In a previous study (Zoccolotti et al., 2020) we examined reading, spelling, and maths skills in an unselected group of 129 Italian children attending fifth grade by testing various cognitive predictors; results showed a high degree of predictors' selectivity for each of these three behaviors. In the present study, we focused on the specificity of the predictors by performing cross-analyses on the same dataset; i.e., we predicted spelling and maths skills based on reading predictors, reading based on maths predictors and so on. Results indicated that some predictors, such as the Orthographic Decision and the Arithmetic Facts tests, predicted reading, spelling and maths skills in similar ways, while others predicted different behaviors but only for a specific parameter, such as fluency but not accuracy (as in the case of RAN), and still others were specific for a single behavior (e.g., Visual-auditory Pseudo-word Matching test predicted only spelling skills). To interpret these results, we propose a novel model of learning skills separately considering factors in terms of competence, performance and acquisition (automatization). Reading, spelling and calculation skills would depend on the development of discrete and different abstract competences (accounting for the partial dissociations among learning disorders reported in the literature). By contrast, overlap among behaviors would be accounted for by defective acquisition in automatized responses to individual "instances"; this latter skill is item specific but domain independent. Finally, performance factors implied in task's characteristics (such as time pressure) may contribute to the partial association among learning skills. It is proposed that this new model may provide a useful base for interpreting the diffuse presence of comorbidities among learning disorders.

Maths attitudes, school affect and teacher characteristics as predictors of maths attainment trajectories in primary and secondary education.

Maths attainment is essential for a wide range of outcomes relating to further education, careers, health and the wider economy. Research suggests a significant proportion of adults and adolescents are underachieving in maths within the UK, making this a key area for research. This study investigates the role of children's perceptions of the school climate (children's affect towards school and student-teacher relationships), their attitudes towards maths and teacher characteristics as predictors of maths attainment trajectories, taking the transition from primary to secondary education into consideration. Two growth models were fit using secondary data analysis of the Avon Longitudinal Study of Parents and Children (ALSPAC). The first model, which looked at predictors of maths attainment in primary education, found significant associations only between positive maths attitudes and increased maths attainment. The second model, which looked at predictors of maths attainment in secondary education, found significant associations between increased maths attainment and positive maths attitudes, decreased school belonging, positive student-teacher relationships and increased teacher fairness. The findings suggest that the secondary education school environment is particularly important for maths attainment.

Predictors of mathematical attainment trajectories across the primary-to-secondary education transition: parental factors and the home environment.

A 'maths crisis' has been identified in the UK, with many adults and adolescents underachieving in maths and numeracy. This poor performance is likely to develop from deficits in maths already present in childhood. Potential predictors of maths attainment trajectories throughout childhood and adolescence relate to the home environment and aspects of parenting including parent-child relationships, parental mental health, school involvement, home teaching, parental education and gendered play at home. This study examined the aforementioned factors as predictors of children's maths attainment trajectories (age 7-16) across the challenging transition to secondary education. A secondary longitudinal analysis of the Avon Longitudinal Study of Parents and Children found support for parental education qualifications, a harmonious parent-child relationship and school involvement at age 11 as substantial predictors of maths attainment trajectories across the transition to secondary education. These findings highlight the importance of parental involvement for maths attainment throughout primary and secondary education.

Profiles of academic achievement and attention in children with and without Autism Spectrum Disorder.

BACKGROUND: Academic outcomes for autistic individuals are heterogeneous, but the reasons for this are unknown. Attention is known to predict learning in typical development, but there is less evidence about this relationship in Autism Spectrum Disorders (ASD), even though attention is reported as atypical in this group. AIMS: To investigate reading and maths achievement profiles for children with and without an ASD, focusing on the role of attention in these profiles and to enable a better understanding of individual differences. METHODS: Reading, maths and attention abilities of 22 autistic children (6-16 years) and 59 TD children (6-11 years) were measured using standardised assessments. RESULTS: A hierarchical cluster analysis that included all children (N = 81) revealed three distinct transdiagnostic subgroups, characterised by children with good, average, and poorer divided attention and academic achievement respectively. Children with poorer attention and achievement displayed relative weaknesses in maths, while children with average or above-average attention and achievement showed no such weakness. CONCLUSIONS: The findings provide a novel insight into the relationship between attention and achievement and understanding individual differences in ASD and typical development.

Internalizing symptoms and working memory as predictors of mathematical attainment trajectories across the primary-secondary education transition.

The transition from primary to secondary education is a critical period in early adolescence which is related to increased anxiety and stress, increased prevalence of mental health issues, and decreased maths performance, suggesting it is an important period to investigate maths attainment. Previous research has focused on anxiety and working memory as predictors of maths, without investigating any long-term effects around the education transition. This study examined working memory and internalizing symptoms as predictors of children's maths attainment trajectories (age 7-16) across the transition to secondary education using secondary longitudinal analysis of the Avon Longitudinal Study of Parents and Children (ALSPAC). This study found statistically significant, but very weak evidence for the effect of internalizing symptoms and working memory on maths attainment. Greater parental education was the strongest predictor, suggesting that children of parents with a degree (compared with those with a CSE) gain the equivalent of almost a year's schooling in maths. However, due to methodological limitations, the effects of working memory and internalizing symptoms on attainment cannot be fully understood with the current study. Additional research is needed to further uncover this relationship, using more time-appropriate measures.

Inhibition and cognitive load in fractions and decimals.

BACKGROUND: Prior research with adults and children suggests that inhibitory control may have a role to play in learning counterintuitive fractions and decimals that are inconsistent with whole number knowledge. However, there is little research to date with primary school-aged children at the early stages of fraction and decimal instruction that addresses this relationship. Understanding this association has the potential to inform instructional practices concerning the learning of counterintuitive maths concepts. AIM: This study examined the relationship between inhibitory control and counterintuitive fractions and decimals in the presence of varying cognitive load in 8- to 10-year-old children. METHODS: Children aged 8-10 years (N = 95) completed a fraction and decimal magnitude comparison task with pairs that were either consistent (controls) or inconsistent (counterintuitive) with whole number magnitudes. Cognitive load was manipulated by presenting trials with simple integrated text (no additional load), with integrated text accompanied by supportive illustrations (low load), or with illustrations containing information that needed to be integrated to arrive at an answer (high load). Participants also completed measures of response and semantic inhibition. RESULTS: Inhibitory control uniquely contributed to performance in counterintuitive fractions and decimals only under conditions of high cognitive load, where low semantic inhibition predicted longer response times. CONCLUSION: Our results indicate a more nuanced relation between inhibitory control and counterintuitive fractions and decimals than presumed by previous research. They suggest that the role of inhibitory control when reasoning about counterintuitive fractions and decimals is not constant, and it is only drawn on at high levels of cognitive load.

Predicting maths anxiety from mathematical achievement across the transition from primary to secondary education.

The primary- to secondary-education transition is a substantive life event for many children. The transition can be associated with changes in the developmental trajectories of both emotional health and academic achievement. The current study looked at whether the trajectory of mathematical attainment and emotional health (anxiety) across this transition predicted later maths anxiety. A secondary analysis of data from the Twin Early Development Study (TEDS) was performed. The statistical models were fit on the 753 participants (one from each twin pair) for which there were measures of mathematical performance across the primary- to secondary-education transition and maths anxiety at age 18. Two multi-level growth models were fit predicting mathematical attainment and anxiety over the primary- to secondary-education transition. The intercepts and slopes for each child were extracted from these models and used as predictors of subsequent maths anxiety at age 18. These effects were adjusted for biological sex, socio-economic status, verbal cognitive ability and general anxiety. Maths anxiety at age 18 was significantly predicted by both pre-transition levels of anxiety and mathematical attainment and their rate of change across the primary- to secondary-education transition. However, the effects were small, suggesting that theories of maths anxiety may have overplayed the role of prior mathematical attainment and general anxiety.