Worry and problem-solving skills and beliefs in primary school children

Objective. To examine the association between worry and problem-solving skills and beliefs (confidence and perceived control) in primary school children. Method. Children (8–11 years) were screened using the Penn State Worry Questionnaire for Children. High (N ¼ 27) and low (N ¼ 30) scorers completed measures of anxiety, problem-solving skills (generating alternative solutions to problems, planfulness, and effectiveness of solutions) and problem-solving beliefs(confidence and perceived control). Results. High and low worry groups differed significantly on measures of anxiety and problem-solving beliefs (confidence and control) but not on problem-solving skills. Conclusions. Consistent with findings with adults, worry in children was associated with cognitive distortions, not skills deficits. Interventions for worried children may benefit froma focus on increasing positive problem-solving beliefs

The impact of maternal control on children’s anxious cognitions, behaviours and affect: an experimental study

Controlling parenting is associated with child anxiety however the direction of effects remains unclear. The present study implemented a Latin-square experimental design to assess the impact of parental control on children’s anxious affect, cognitions and behaviour. A non-clinical sample of 24 mothers of children aged 4-5 years were trained to engage in (a) controlling and (b) autonomy-granting behaviours in interaction with their child during the preparation of a speech. When mothers engaged in controlling parenting behaviours, children made more negative predictions about their performance prior to delivering their speech and reported feeling less happy about the task, and this was moderated by child trait anxiety. In addition, children with higher trait anxiety displayed a significant increase in observed child anxiety in the controlling condition. The pattern of results was maintained when differences in mothers’ levels of negativity and habitual levels of control were accounted for. These findings are consistent with theories that suggest that controlling parenting is a risk factor in the development of childhood anxiety

A clinician's quick guide of evidence based approaches: childhood anxiety disorders

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Autonomic arousal in childhood anxiety disorders: associations with state anxiety and social anxiety disorder

Background Psychophysiological theories suggest that individuals with anxiety disorders may evidence inflexibility in their autonomic activity at rest and when responding to stressors. In addition, theories of social anxiety disorder, in particular, highlight the importance of physical symptoms. Research on autonomic activity in childhood (social) anxiety disorders, however, is scarce and has produced inconsistent findings, possibly because of methodological limitations. Method The present study aimed to account for limitations of previous studies and measured respiratory sinus arrhythmia (RSA) and heart rate (HR) using Actiheart heart rate monitors and software (Version 4) during rest and in response to a social and a non-social stressor in 60 anxious (30 socially anxious and 30 ‘other’ anxious), and 30 nonanxious sex-and age-matched 7–12 year olds. In addition, the effect of state anxiety during the tasks was explored. Results No group differences at rest or in response to stress were found. Importantly, however, with increases in state anxiety, all children, regardless of their anxiety diagnoses showed less autonomic responding (i.e., less change in HR and RSA from baseline in response to task) and took longer to recover once the stressor had passed. Limitations This study focused primarily on parasympathetic arousal and lacked measures of sympathetic arousal. Conclusion The findings suggest that childhood anxiety disorders may not be characterized by inflexible autonomic responding, and that previous findings to the contrary may have been the result of differences in subjective anxiety between anxious and nonanxious groups during the tasks, rather than a function of chronic autonomic dysregulation

Measurement invariance of the higher-order model of Preschool Anxiety Scale (PAS) across child age, gender, parental anxiety, and pandemic period in England

The Preschool Anxiety Scale (PAS) is a parent-report scale measuring young children’s anxiety symptoms involving five specific anxiety symptoms (separation anxiety, physical injury fears, social phobia, obsessive-compulsive disorder, generalised anxiety) that load on a higher-order factor representing general anxiety shared by all specific anxiety symptom subtypes. Although the PAS has been widely used to assess anxiety symptoms in young children, few studies have tested its measurement invariance for group comparisons. Using data from a sample of 2,221 children and their parents/carers in England, this study investigated the measurement invariance of the higher-order model of the PAS across child age (4-6 years vs. 6-7 years), gender (girls vs. boys), parental anxiety (low vs. high level), and children’s living circumstances (before vs. after the removal of COVID-19 restrictions). Our findings demonstrated the good factor structure, internal consistency, and convergent validity of the higher-order model of the PAS in all subgroups and supported its configural, metric, scalar invariance across these subgroups. Therefore, the findings suggest that the PAS is a reliable and valid instrument for assessing specific anxiety symptoms and general anxiety among young children in England, and that comparisons can be made between the subgroups under examination. Keywords: Anxiety symptoms, Preschool anxiety scale, Measurement invariance, Group comparisons, Early childhoo

Cognitive, affective and behavioural characteristics of mothers with anxiety disorders in the context of child anxiety disorder

Parental emotional distress, particularly high maternal anxiety, is one of the most consistent predictors of child anxiety treatment outcome. In order to identify the cognitive, affective and behavioural parenting characteristics of mothers of children with anxiety disorders who themselves have an anxiety disorder, we assessed the expectations and appraisals of 88 mothers of anxious children (44 not anxious (NONANX) and 44 with a current anxiety disorder (ANX)) before and after interacting with their 7-12 year old children. There were no observed differences in anxiety and avoidance among children of ANX and NONANX mothers, but, compared to NONANX mothers, ANX mothers held more negative expectations and differed on observations of intrusiveness, expressed anxiety, warmth and the quality of the relationship. Associations were moderated by the degree to which children expressed anxiety during the tasks. Maternal reported negative emotions during the task significantly mediated the association between maternal anxiety status and the observed quality of the relationship. These findings suggest that maternal anxiety disorder is associated with reduced tolerance of children’s negative emotions. This may interfere with the maintenance of a positive, supportive mother-child interaction under conditions of stress, and as such impede optimum treatment outcomes. The findings identify potential cognitive, affective and behavioural targets to improve treatment outcomes for children with anxiety disorders in the context of a current maternal anxiety disorder

Development and usability testing of OSI: Online Support and Intervention for child anxiety

Background: Online treatments for child anxiety may help increase access to evidence-based therapies, however user engagement, uptake and adherence within routine clinical practice remains a challenge. Involving the intended end users in the development process through co-design and usability testing is argued to be crucial for maximising user engagement and adoption of online treatments, but so far this has been lacking for online treatments for child anxiety. Objective: To develop an online treatment for child anxiety through a process of co-design (Phase 1) and usability testing (Phase 2), based on an existing evidence-based face-to-face therapist-supported, parent-led CBT intervention. It was intended that the online version of this treatment would consist of a parent website, case management system for clinicians and mobile game application for children. Methods: Parents, children and clinicians who were familiar with the face-to-face version of the treatment were recruited from 2 NHS clinics. In Phase 1, participants took part in 3 workshops to gain feedback on the overall concept, explore their wants and needs for the websites/game, generate ideas on how the treatment may look and gain feedback on initial mock-ups of the websites/game. In Phase 2, participants attended 3 individual usability testing sessions where they were presented with working prototypes of the websites/game and asked to carry out a series of tasks on the website (parents/clinicians) or play the game (children). The frequency and detail of usability errors was recorded. Participants were asked for their feedback on the website/game using a standardised usability questionnaire and semi-structured interviews. The websites/game were iterated after each round of usability testing in response to this feedback. Results: In Phase 1, participants approved the general concept and rated the initial mock-ups of the website/game positively. In Phase 2, working prototypes were rated positively and usability errors declined across the iterations and were mainly cosmetic or minor issues relating to aesthetic preference, with few issues regarding ability to navigate the website or technical issues affecting functionality. Feedback from the semi-structured interviews further supported the positive response of participants to the website/game and helped identify areas for improvement during the iteration process. The final iteration of the website/game is presented. Conclusions: Taking an iterative approach to development through co-design and usability testing has resulted in an online treatment for child anxiety (OSI: Online Support and Intervention for child anxiety) that appears to meet the needs and expectations of the intended users (parents, children and clinicians), and is easy and enjoyable to use