Screening for anxiety disorders in children

Anxiety disorders are highly prevalent and have negative consequences on individual and societal level. This study examined the usefulness of screening for anxiety disorders in primary school children. More specifically, the value of the screening method to discriminate between and to predict anxiety disorders was studied. Children and their parents were selected if the children had self-reported scores on the screening questionnaire Screen for Child Anxiety Related Emotional Disorders-71 (SCARED-71) within the top-15% (High-anxious) or from two points below to two points above the median (Median-anxious). Of the selected children, 183 high-anxious children and their parents, and 80 median-anxious children and their parents took part in a diagnostic interview, the Anxiety Disorder Interview Schedule (ADIS). Of the high-anxious children, 60% had an anxiety disorder versus 23% of the median-anxious children, whereas groups did not differ on rates of dysthymia/depression and attention deficit hyperactivity disorder. The diagnoses separation anxiety disorder, social phobia and specific phobia were specifically predicted by the corresponding subscales of the screening questionnaire, while the diagnosis generalised anxiety disorder was not predicted by any of the subscales. The screening method has proven its utility for discriminating between children with and without anxiety disorders when applying the top-15% cut-off. Moreover, separation anxiety disorder, social phobia, and specific phobia, all known to be prevalent and debilitating childhood anxiety disorders, can be predicted by the corresponding subscale of the screening instrument

The influence of rumination and distraction on depressed and anxious mood: a prospective examination of the response styles theory in children and adolescents

The present study sought to test predictions of the response styles theory in a sample of children and adolescents. More specifically, a ratio approach to response styles was utilized to examine the effects on residual change scores in depression and anxiety. Participants completed a battery of questionnaires including measures of rumination, distraction, depression, and anxiety at baseline (Time 1) and 8–10 weeks follow-up (Time 2). Results showed that the ratio score of rumination and distraction was significantly associated with depressed and anxious symptoms over time. More specifically, individuals who have a greater tendency to ruminate compared to distracting themselves have increases in depression and anxiety scores over time, whereas those who have a greater tendency to engage in distraction compared to rumination have decreases in depression and anxiety symptoms over time. These findings indicate that a ratio approach can be used to examine the relation between response styles and symptoms of depression and anxiety in non-clinical children and adolescents. Implications of the results may be that engaging in distractive activities should be promoted and that ruminative thinking should be targeted in juvenile depression treatment

Bidirectional Associations Between Coparenting Relations and Family Member Anxiety: A Review and Conceptual Model

Research into anxiety has largely ignored the dynamics of family systems in anxiety development. Coparenting refers to the quality of coordination between individuals responsible for the upbringing of children and links different subsystems within the family, such as the child, the marital relationship, and the parents. This review discusses the potential mechanisms and empirical findings regarding the bidirectional relations of parent and child anxiety with coparenting. The majority of studies point to bidirectional associations between greater coparenting difficulties and higher levels of anxiety. For example, the few available studies suggest that paternal and perhaps maternal anxiety is linked to lower coparental support. Also, research supports the existence of inverse links between coparenting quality and child anxiety. A child’s reactive temperament appears to have adverse effects on particularly coparenting of fathers. A conceptual model is proposed that integrates the role of parental and child anxiety, parenting, and coparenting, to guide future research and the development of clinical interventions. Future research should distinguish between fathers’ and mothers’ coparenting behaviors, include parental anxiety, and investigate the coparental relationship longitudinally. Clinicians should be aware of the reciprocal relations between child anxiety and coparenting quality, and families presenting for treatment who report child (or parent) anxiety should be assessed for difficulties in coparenting. Clinical approaches to bolster coparenting quality are called for.FSW – Publicaties zonder aanstelling Universiteit Leide

The Effectiveness of Mindfulness Training on Behavioral Problems and Attentional Functioning in Adolescents with ADHD

The effectiveness of an 8-week mindfulness training for adolescents aged 11–15 years with ADHD and parallel Mindful Parenting training for their parents was evaluated, using questionnaires as well as computerized attention tests. Adolescents (N = 10), their parents (N = 19) and tutors (N = 7) completed measurements before, immediately after, 8 weeks after and 16 weeks after training. Adolescents reported on their attention and behavioral problems and mindful awareness, and were administered two computerized sustained attention tasks. Parents as well as tutors reported on adolescents’ attention and behavioral problems and executive functioning. Parents further reported on their own parenting, parenting stress and mindful awareness. Both the mindfulness training for the adolescents and their parents was delivered in group format. First, after mindfulness training, adolescents’ attention and behavior problems reduced, while their executive functioning improved, as indicated by self-report measures as well as by father and teacher report. Second, improvements in adolescent’ actual performance on attention tests were found after mindfulness training. Moreover, fathers, but not mothers, reported reduced parenting stress. Mothers reported reduced overreactive parenting, whereas fathers reported an increase. No effect on mindful awareness of adolescents or parents was found. Effects of mindfulness training became stronger at 8-week follow-up, but waned at 16-week follow-up. Our study adds to the emerging body of evidence indicating that mindfulness training for adolescents with ADHD (and their parents) is an effective approach, but maintenance strategies need to be developed in order for this approach to be effective in the longer term

The Mindful Attention Awareness Scale for Adolescents (MAAS-A): Psychometric Properties in a Dutch Sample

The factor structure and psychometric properties of the Dutch version of the Mindful Attention Awareness Scale for Adolescents (MAAS-A) was studied in a sample of adolescents (n = 717; age range, 11–17 years) of the general population. The MAAS-A and other questionnaires measuring other constructs were administered in high schools across the Netherlands. A one-factor structure was demonstrated using principal component analysis and was further confirmed using confirmatory factor analysis. The MAAS-A was shown to have high internal consistency. Expected negative correlations between mindfulness and self-reported stress and emotion regulation strategies such as rumination and catastrophizing were found. Further, mindfulness was positively correlated with happiness, healthy self-regulation, and with another recently developed measure of mindfulness in children and adolescents, the Child and Adolescent Mindfulness Measure. Mindfulness as measured by the MAAS-A correlated positively with quality of life, but an expected positive relationship with acceptance was not found. Interestingly, adolescents without meditation experience scored higher on the MAAS-A than adolescents without this experience. Further, adolescents with chronic disorders scored lower on the MAAS-A than adolescents without these disorders. Overall, this study has shown evidence of the first valid and reliable Dutch measure of mindfulness for adolescents. The factor structure, internal consistency, and convergent and divergent validity as well as their relationship to quality of life are comparable to the original MAAS-A

Evaluating Mindful With Your Baby/Toddler: Observational Changes in Maternal Sensitivity, Acceptance, Mind-Mindedness, and Dyadic Synchrony

Studies on the effectiveness of mindful parenting interventions predominantly focused on self-report measures of parenting, whereas observational assessments of change are lacking. The present study examined whether the Mindful with your baby/toddler training leads to observed changes in maternal behavior and mother–child interaction quality. Mindful with your baby/toddler is a 8- or 9-week mindful parenting training for clinically referred mothers of young children (aged 0–48 months), who experience parental stress, mother–child interaction problems, and/or whose children experience regulation problems. The study involved a quasi-experimental non-random design including a sample of 50 mothers who were diagnosed with a mood disorder (n = 21, 42%), an anxiety disorder (n = 7, 14%), post-traumatic stress disorder (n = 6, 12%), or other disorder (n = 7, 14%). Mothers completed a parental stress questionnaire and participated in home observations with their babies (n = 36) or toddlers (n = 14) during a waitlist, pretest, and posttest assessment. Maternal sensitivity, acceptance, and mind-mindedness were coded from free-play interactions and dyadic synchrony was coded from face-to-face interactions. Sensitivity and acceptance were coded with the Ainsworth’s maternal sensitivity scales. Mind-mindedness was assessed by calculating frequency and proportions of appropriate and nonattuned mind-related comments. Dyadic synchrony was operationalized by co-occurrences of gazes and positive facial expressions and maternal and child responsiveness in vocal interaction within the dyad. Coders were blind to the measurement moment. From waitlist to pretest, no significant improvements were observed. At posttest, mothers reported less parenting stress, and were observed to show more accepting behavior and make less nonattuned comments than at pretest, and children showed higher levels of responsiveness. The outcomes suggest that the Mindful with your baby/toddler training affects not only maternal stress, but also maternal behavior, particularly (over)reactive parenting behaviors, which resulted in more acceptance, better attunement to child’s mental world, and more “space” for children to respond to their mothers during interactions. Mindful with your baby/toddler may be a suitable intervention for mothers of young children with (a combination of) maternal psychopathology, parental stress, and problems in the parent–child interaction and child regulation problems

An online mindful parenting training for mothers raising toddlers:Assessment of acceptability, effectiveness, and personal goals

Objectives Mindful parenting (MP) interventions show promising results, but they mostly target parents (of children) with mental health problems. This study examined an online MP intervention for mothers with toddlers in a population-based sample. Aims were to assess acceptability and effectiveness of the intervention for mothers with and without parental stress, and examine their predetermined personal goals. Methods The study included 157 mothers with toddlers from the general population of whom 73 reported parental stress. The mothers participated in an 8-week online MP training. Questionnaires were completed at waitlist, pretest, posttest, and follow-up. Results Mothers rated the training positively, although only 23.1% completed the training. Personal goals were analyzed qualitatively, establishing four different themes: attention, well-being, patience, and balance. Significant improvements in personal goals posttest and follow-up were found (large and very large effect size, respectively). We found no significant improvements from waitlist to pretest for all outcome variables, except personal goals (medium effect size). Mixed-linear model analyses showed significant improvements posttest and follow-up as compared to pretest regarding Self-compassion, Parental over-reactivity and Symptoms of anxiety and depression (small to medium effect sizes). There was an effect at posttest for Parenting problems, and for Parental role restriction at follow-up (small effect sizes). Levels of parental stress and theme of personal goal did not influence the effectiveness of the intervention. Conclusions The current study provides initial evidence that an online MP training could be an easily accessible, inexpensive, and valuable intervention for parents without an indication for a therapist-assisted intervention. Trial Registration Dutch Trial Register (NTR7401

Modular CBT for Childhood Anxiety Disorders: Evaluating Clinical Outcomes and its Predictors

This study examined clinical outcomes of a modular individual CBT for children with anxiety disorders (AD), and predictors of outcomes, in usual clinical practice. Participants were 106 children with ADs (7–17 years), and parents. Assessments were pre-, mid-, post-test, and 10 weeks after CBT (follow-up). Predictors (measured pre-treatment) were child characteristics (gender, age, type of AD, comorbid disorders), fathers’ and mothers’ anxious/depressive symptoms, and parental involvement (based on parents’ presence during treatment sessions and the use of a parent module in treatment). At follow-up, 59% (intent-to-treat analyses) to 70% (completer analysis) of the children were free from their primary anxiety disorder. A significant decrease in anxiety symptoms was found. Higher parental involvement was related to lower child anxiety at follow-up, but only for children with comorbid disorders. Findings suggest that it is beneficial to treat anxiety with modular CBT. Future steps involve comparisons of modularized CBT with control conditions

Unique Roles of Mothering and Fathering in Child Anxiety; Moderation by Child’s Age and Gender

We examined the associations between the parenting dimensions autonomy granting, over control, and rejection and children’s anxiety, in relation to parent and child gender and child age. Elementary school-aged children (n = 179, Mage = 10.27, SD = 1.30), adolescents (n = 127, Mage = 15.02, SD = 1.54) and both their parents completed questionnaires on parenting and children’s anxiety. Parenting was more strongly related to child anxiety in elementary school children than in adolescents. Maternal over control was uniquely related to elementary school-aged children’s anxiety whereas paternal over control was more important during adolescence. Opposite to our expectations, we found higher levels of parental autonomy granting to be related to higher levels of anxiety for younger elementary school-aged children (age < 10). For adolescents, the association between paternal over control and anxiety was stronger for older adolescents (age > 15), with higher levels of over control related to higher levels of anxiety. For both elementary school-aged children and adolescents, the associations between parenting and child anxiety did not differ as a function of the child’s gender. If we are to understand the associations between parenting and children’s anxiety, it is important to distinguish parental autonomy granting from parental over control and to consider the role of parent gender and the age of the child