Identification of Early Behavioral Markers of Anxiety and Social Withdrawal in Preschool Children

This study examined an observational method for identifying specific behaviors to indicate social anxiety and social withdrawal in preschool children. During an interaction task with a novel adult, 28 children (ages 4 and 5) were observed for specific verbal and non-verbal behaviors (i.e., total utterances, commands, questions, unsolicited conversation, direct responses, eye gaze aversion, non-verbal response, physical distancing, freezing, smiling ) and global behaviors (i.e., shyness, volume or speech, and postural rigidity), theoretically relevant to early childhood social anxiety. Behaviors observed during the interaction task were examined in relation to the parent-reported Spence Preschool Anxiety Scale\u27s social anxiety subscale (Spence, Rapee, Edwards, & Ingram, 2001) and the percentage of solitary behavior observed during unstructured play at preschool (Morris, Messer, & Gross, 1995). Four years later, participants were re-contacted and 15 parents and children completed the Social Phobia and Anxiety Inventory for Children, Parent Report (P-SPAIC; Beidel, Turner, Hamlin, & Morris, 2000), the Child Behavior Checklist Social Competence Subscale (CBCL, Social Competence; Achenbach, 1991), and the Social Phobia and Anxiety Inventory for Children, Item 10 self-report (SPAIC-10, T. Morris, personal communication). Preliminary analyses revealed that the specific verbal and non-verbal behaviors (with the exception of physical distancing and commands) were significantly correlated with the global behaviors. The global behaviors did not predict a significant amount of variance in solitary behavior during unstructured play. None of the specific verbal or non-verbal behaviors were significantly related to solitary behavior during unstructured play or the Spence Preschool Anxiety Scale\u27s social anxiety subscale. Although solitary behavior during unstructured play and the Spence Preschool Anxiety Scale\u27s social anxiety subscale were significantly related, neither one was significantly differentially related to any of the specific verbal or non-verbal behaviors observed during the interaction task. Unsolicited conversation and direct responses were significantly related to CBCL Social Competence at follow-up. Although a significant difference was not detected, a large effect was seen for total utterances, commands, and non-verbal responses to direct questions for those children who were elevated on one or more of the follow-up measures compared to children who were not elevated on any follow-up measure. Although limited by a lack of adequate statistical power and a restricted range of social anxiety at baseline, the study has important implications for the identification of specific behaviors in preschool that may be risk-factors for social anxiety childhood

Social anxiety and facial affect recognition in preschool children

Previous research relating anxiety and facial affect recognition, focusing mostly on school-aged children and adults, has yielded mixed results. The current study sought to demonstrate an association among behavioral inhibition and parent-reported social anxiety, shyness, social withdrawal and facial affect recognition performance using the Diagnostic Analysis of Nonverbal Accuracy Scale in 30 preschool children, ages 4 years to 5 years 8 months. Results indicated that social anxiety, social withdrawal, shyness, and behavioral inhibition together account for 25% of the variance in facial affect recognition performance, although this proportion was not statistically significant r2 = .25, F(4,24) = 1.95, p = .13. A limit of the investigation was the relatively small sample size. Further studies with larger samples are required to better understand the possible association

The Revised Child Anxiety and Depression Scale-Short Version: Scale reduction via exploratory bifactor modeling of the broad anxiety factor.

Using a school-based (N = 1,060) and clinic-referred (N = 303) youth sample, the authors developed a 25-item shortened version of the Revised Child Anxiety and Depression Scale (RCADS) using Schmid-Leiman exploratory bifactor analysis to reduce client burden and administration time and thus improve the transportability characteristics of this youth anxiety and depression measure. Results revealed that all anxiety items primarily reflected a single “broad anxiety” dimension, which informed the development of a reduced 15-item Anxiety Total scale. Although specific DSM-oriented anxiety subscales were not included in this version, the items comprising the Anxiety Total scale were evenly pulled from the 5 anxiety-related content domains from the original RCADS. The resultant 15-item Anxiety Total scale evidenced significant correspondence with anxiety diagnostic groups based on structured clinical interviews. The scores from the 10-item Depression Total scale (retained from the original version) were also associated with acceptable reliability in the clinic-referred and school-based samples (α = .80 and .79, respectively); this is in contrast to the alternate 5-item shortened RCADS Depression Total scale previously developed by Muris, Meesters, and Schouten (2002), which evidenced depression scores of unacceptable reliability (α = .63). The shortened RCADS developed in the present study thus balances efficiency, breadth, and scale score reliability in a way that is potentially useful for repeated measurement in clinical settings as well as wide-scale screenings that assess anxiety and depressive problems. These future applications are discussed, as are recommendations for continued use of exploratory bifactor modeling in scale development.Psycholog

Safety and immunogenicity of the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen in infants: a phase 2, randomised, double-blind, active-controlled trial in Guinea and Sierra Leone.

BACKGROUND: This study assessed the safety and immunogenicity of the Ad26.ZEBOV and MVA-BN-Filo Ebola virus (EBOV) vaccine regimen in infants aged 4-11 months in Guinea and Sierra Leone. METHODS: In this phase 2, randomised, double-blind, active-controlled trial, we randomly assigned healthy infants (1:1 in a sentinel cohort, 5:2 for the remaining infants via an interactive web response system) to receive Ad26.ZEBOV followed by MVA-BN-Filo (Ebola vaccine group) or two doses of meningococcal quadrivalent conjugate vaccine (control group) administered 56 days apart. Infants were recruited at two sites in west Africa: Conakry, Guinea, and Kambia, Sierra Leone. All infants received the meningococcal vaccine 8 months after being randomly assigned. The primary objective was safety. The secondary objective was immunogenicity, measured as EBOV glycoprotein-binding antibody concentration 21 days post-dose 2, using the Filovirus Animal Non-Clinical Group ELISA. This study is registered with ClinicalTrials.gov (NCT03929757) and the Pan African Clinical Trials Registry (PACTR201905827924069). FINDINGS: From Aug 20 to Nov 29, 2019, 142 infants were screened and 108 were randomly assigned (Ebola vaccine n=75; control n=33). The most common solicited local adverse event was injection-site pain (Ebola vaccine 15 [20%] of 75; control four [12%] of 33). The most common solicited systemic adverse events with the Ebola vaccine were irritability (26 [35%] of 75), decreased appetite (18 [24%] of 75), pyrexia (16 [21%] of 75), and decreased activity (15 [20%] of 75). In the control group, ten (30%) of 33 had irritability, seven (21%) of 33 had decreased appetite, three (9%) of 33 had pyrexia, and five (15%) of 33 had decreased activity. The frequency of unsolicited adverse events was 83% (62 of 75 infants) in the Ebola vaccine group and 85% (28 of 33 infants) in the control group. No serious adverse events were vaccine-related. In the Ebola vaccine group, EBOV glycoprotein-binding antibody geometric mean concentrations (GMCs) at 21 days post-dose 2 were 27 700 ELISA units (EU)/mL (95% CI 20 477-37 470) in infants aged 4-8 months and 20 481 EU/mL (15 325-27 372) in infants aged 9-11 months. The responder rate was 100% (74 of 74 responded). In the control group, GMCs for both age groups were less than the lower limit of quantification and the responder rate was 3% (one of 33 responded). INTERPRETATION: Ad26.ZEBOV and MVA-BN-Filo was well tolerated and induced strong humoral responses in infants younger than 1 year. There were no safety concerns related to vaccination. FUNDING: Janssen Vaccines & Prevention and Innovative Medicines Initiative 2 Joint Undertaking. TRANSLATION: For the French translation of the abstract see Supplementary Materials section

Atrial fibrillation genetic risk differentiates cardioembolic stroke from other stroke subtypes

AbstractObjectiveWe sought to assess whether genetic risk factors for atrial fibrillation can explain cardioembolic stroke risk.MethodsWe evaluated genetic correlations between a prior genetic study of AF and AF in the presence of cardioembolic stroke using genome-wide genotypes from the Stroke Genetics Network (N = 3,190 AF cases, 3,000 cardioembolic stroke cases, and 28,026 referents). We tested whether a previously-validated AF polygenic risk score (PRS) associated with cardioembolic and other stroke subtypes after accounting for AF clinical risk factors.ResultsWe observed strong correlation between previously reported genetic risk for AF, AF in the presence of stroke, and cardioembolic stroke (Pearson’s r=0.77 and 0.76, respectively, across SNPs with p &lt; 4.4 × 10−4 in the prior AF meta-analysis). An AF PRS, adjusted for clinical AF risk factors, was associated with cardioembolic stroke (odds ratio (OR) per standard deviation (sd) = 1.40, p = 1.45×10−48), explaining ∼20% of the heritable component of cardioembolic stroke risk. The AF PRS was also associated with stroke of undetermined cause (OR per sd = 1.07, p = 0.004), but no other primary stroke subtypes (all p &gt; 0.1).ConclusionsGenetic risk for AF is associated with cardioembolic stroke, independent of clinical risk factors. Studies are warranted to determine whether AF genetic risk can serve as a biomarker for strokes caused by AF.</jats:sec

A naturalistic observation of social behaviors during preschool drop-off

The present study utilised naturalistic observation to assess the impact of parental departure during daily drop-off at preschool on children\u27s settling into daily preschool routines. Forty-six 3–5-year-old children and their parents/caregivers were observed during morning drop-off at preschool. Longer latencies of parent/caregiver leaving were associated with less child–peer engagement, solitary active play, and onlooking and were associated with more child–caregiver proximity-seeking, hugging and kissing, and picking up and holding. Mothers and other female caregivers were slightly more likely to pick up and hold their children during drop-off than fathers and other male caregivers. Findings suggest that continued parental involvement may initially hinder children\u27s daily settling into the preschool classroom environment through facilitation of escape or avoidance. Additional research is needed to better understand individual differences that may serve as protective factors or vulnerabilities affecting children\u27s daily adaptation to the preschool environment

A Baseline Controlled Examination of a 5-Day Intensive Treatment for Pediatric Obsessive-Compulsive Disorder

This study extends support for a 5-day intensive exposure and response prevention (ERP) treatment protocol for pediatric obsessive compulsive disorder (OCD). Twenty-two children with OCD received ERP treatment twice daily for 5 days. The treatment also emphasized teaching children and parents how to conduct ERP independently after they returned home. Symptoms were assessed at four time-points: Baseline, 4 weeks later at pre-treatment, one week after the intensive treatment 5-day treatment, and at 3 month follow-up. Changes on the primary outcome measure, clinician severity ratings on the Anxiety Disorders Interview Schedule for Children, and secondary measures, indicated that OCD symptoms remained stable from the evaluation to baseline and improved significantly from baseline to follow-up. Moreover, parental accommodation of OCD decreased significantly from baseline to post-treatment and from post-treatment to follow-up. These data suggest that the 5-day intervention demonstrates efficacy in reducing OCD symptoms and may initiate change in parent accommodation that continues to improve after the family returns home

A Measurement Invariance Examination of the Revised Child Anxiety and Depression Scale in a Southern Sample: Differential Item Functioning Between African American and Caucasian Youth

This study examined the psychometric properties of the Revised Child Anxiety and Depression Scale in a large sample of youth from the Southern United States. The authors aimed to determine (a) if the established six-factor Revised Child Anxiety and Depression Scale structure could be replicated in this Southern sample and (b) if scores were associated with measurement invariance across African American and Caucasian youth representative of youth from this region of the United States. The established six-factor model evidenced the best fit in comparison to one-, two-, and five-factor models in the total sample (N = 12,695), as well as in the African American (n = 4,906) and Caucasian (n = 6,667) subsamples. Multigroup confirmatory factor analysis also supported measurement invariance across African American and Caucasian youth at the levels of equal factor structure and equal factor loadings. Noninvariant item intercepts were identified, however, indicating differential functioning for a subset of items. Clinical and measurement implications of these findings are discussed and new norms are presented