Understanding the Comorbidity of Asthma and Anxiety in Childhood: Characteristics, Vulnerabilities, and Treatment Implications

Introduction: Given the high incidence of asthma and anxiety comorbidity, clinicians should be informed of the unique presentation of these clients in clinical practice. Although much is known about the development and characteristics of childhood anxiety, less is known about children with anxiety and comorbid asthma. Methods: This study, using archival data, examined the potential differences in children with comorbid asthma and anxiety compared to children with anxiety from a random controlled trial. These two groups were compared on negative self-talk, number of physical symptoms, parent anxiety, content of their worries, and presence of panic, generalized anxiety, and separation anxiety disorder. Both groups were compared on their responsiveness to traditional Cognitive Behavioral Treatment for Childhood Anxiety. Discussion: Findings will contribute to more effective ways of addressing asthma in psychotherapy

Sleep, Communicative Ability, and Dietary Intervention as Predictors of Aggression in Children with Autism Spectrum Disorder

Aggression is a common behavioral issue in children with Autism Spectrum Disorder (ASD). Aggression is often treated with evidence-based behavioral treatments such as applied behavioral analysis and functional communication training. One form of intervention that has grown in popularity is to alter the child’s diet. The most popular dietary intervention, the Autism Diet, has been utilized as a form of behavior management by parents and guardians for children diagnosed with ASD to address aggressive behavior, however its use has not been strongly supported by research. We propose that a more beneficial way of understanding aggression in ASD is to understand aggression through the lens of the frustration-aggression hypothesis. According to the frustration-aggression hypothesis, aggressive acts can stem from aggression-activating affect caused by factors such as physical pain, irritation, and psychological discomfort. It is proposed that children with ASD turn to aggressive behavior when experiencing these irritants due to the communicative challenges they face as a part of ASD. This study examined the use of the Autism Diet, sleep disturbance, and communicative ability as predictors of aggression in children diagnosed with ASD. Use of the diet and lower communicative ability were significantly and positively correlated with aggressive episodes while sleep disturbance was not. These findings did not find support for use of the Autism Diet in reducing aggression; however, they should be interpreted with caution due to the retrospective nature of the data

Trauma as a predictor of exposure and response prevention (Ex/RP) treatment outcomes for patients with obsessive-compulsive disorder (OCD) in a clinical setting

Background: Trauma has been found to be highly prevalent among individuals diagnosed with obsessive-compulsive disorder (OCD) and to impact the onset, maintenance, and severity of OCD symptoms. Little is known, however, about how trauma might affect outcomes for individuals engaging in exposure and response prevention (Ex/RP). Despite Ex/RP being the most widely implemented treatment for OCD, lack of consideration for psychosocial factors, like experienced trauma, has been cited as a possible limitation of the treatment. Furthermore, intolerance of uncertainty (IU), anxiety sensitivity (AS), and emotion regulation (ER) are transdiagnostic variables most commonly associated with the presence of posttraumatic stress and OCD treatment success, respectively, however, no research to date has identified whether such variables might be implicated in the relationship between trauma and Ex/RP treatment outcomes. Objective: The primary aim of this study is to investigate how trauma might predict Ex/RP treatment outcomes for patients with OCD. The questions this study seeks to answer are: (1) Do OCD patients with trauma experience more severe OCD symptoms, IU, AS, and ER at pretreatment, compared to those without trauma? (2) Do the variables (i.e., IU, AS, and ER) mediate the relationship between trauma and Ex/RP treatment outcomes? Methods: Analyses of archival data will be performed on pretreatment and posttreatment measures of treatment-seeking patients with a primary OCD at a specialty anxiety clinic. Based on patient self-report on the Posttraumatic Diagnostic Scale for the DSM-5 (PDS-5; Foa, 2013) OCD patients will be separated into two groups: (1) those reporting no trauma experiences (OCD group), and (2) those reporting at least one trauma experience (OCDT group). A MANOVA will be used to assess whether the OCDT group report more severe OCD symptoms, IU, AS, and ER at pretreatment, compared to the OCD group. Second, based on those findings, a mediation analysis will be used to assess whether the variable found to differ most significantly between the groups (IU, AS, & ER) mediate the relationship between trauma and Ex/RP outcomes (severity change scores) at posttreatment. Discussion: Findings from this study have the potential to inform clinical practice around the assessment of OCD symptom presentation and the need to consider the impact of trauma and related transdiagnostic variables in the implementation of Ex/RP treatment to provide greater opportunity for successful treatment outcomes

Clinical assessment of DSM-IV anxiety disorders in fragile X syndrome: prevalence and characterization

Fragile X syndrome (FXS) is the most common form of inherited intellectual disability (ID). Anxiety and social withdrawal are considered core features of the FXS phenotype, yet there is limited diagnostic evidence of the prevalence of formal anxiety disorders in FXS. This study assessed the prevalence of anxiety disorders in a sample of 58 males and 39 females with FXS (ages 5.0–33.3 years). Participants’ parents completed the Anxiety Disorders Interview Schedule (ADIS-IV), a clinical interview based on DSM-IV criteria, and the Anxiety Depression and Mood Scale (ADAMS), a psychiatric disorders screening instrument normed in ID. We conducted cognitive (IQ) and autism (AUT) assessments and surveyed medication use. Despite a high rate of psychopharmacological treatment, 86.2% of males and 76.9% of females met criteria for an anxiety disorder, with social phobia and specific phobia the most commonly diagnosed. Proband status, gender, and IQ were not significantly related to any anxiety disorders, however significantly higher rates of a few anxiety disorders were found in older age and AUT groups. Significant correlations between ADIS diagnoses and ADAMS scores provided cross-validation of instruments, indicating that the ADIS is suitable for use in FXS. A greater percentage of our sample met criteria for most anxiety disorders than has been reported in other ID groups or the general population. The rate of anxiety compared to general ID suggests that the FMR1 full mutation confers an especially high risk for these disorders, regardless of factors commonly associated with FXS clinical involvement. A thorough clinical assessment and treatment of anxiety should be included in the FXS standard of care

Treating a Child With Anxiety and Attention-Deficit/Hyperactivity Disorder? Don\u27t Rule Out Cognitive-Behavioral Therapy.

Anxiety disorders (ADs) and attention-deficit/hyperactivity disorder (ADHD) are two of the most common psychiatric disorders in youth and approximately 25% of those with an AD have comorbid ADHD.Children with AD and ADHD evidence greater impairment than those with either disorder alone, making them a particularly vulnerable population in need of effective treatment.Although a strong evidence base supports the efficacy of cognitive-behavioral therapy (CBT) for treating anxiety in children,there is little information to guide practitioners on how to best treat those dually diagnosed with an AD and ADHD. Questions have arisen as to whether the cognitive, attentional, and behavioral impairments associated with ADHD interfere with the ability of these children to benefit from CBT for anxiety.Does the distractibility and overactivity characteristic of ADHD inhibit, perhaps differentially, the ability of these children to effectively engage in CBT for anxiety (eg, psychoeducation, cognitive restructuring, therapeutic exposure)

Antón Arrufat’s Los Siete Contra Tebas: Political Allegory and Anthropological Concepts As Vehicles to Portray Theatrical and Social Conflict

This thesis (i) presents a critical analysis of the political allegory and dramatic elements employed by Antón Arrufat in Los siete contra Tebas in order to comment upon the conflict in Cuban society during and immediately after the Cuban revolution; and (ii) further analyzes that conflict using an anthropological approach in order to establish partial reintegration as an additional final phase in the rites of passage journey

Clinical case presentation: The case of Sandra

Presents the case of Sandra, a composite of several individuals who have presented with anxiety problems. The contributors to this volume discuss their therapeutic orientation, their specific treatment model, and the clinical skills and attributes that are most essential to their therapeutic approach. Then, they address issues in Sandra\u27s case from their perspective: assessment, conceptualization, therapeutic relationship, and treatment implementation and outcome. (PsycINFO Database Record (c) 2012 APA, all rights reserved). (chapter

Comparison of treatment approaches

Presents an overview comparing the treatment approaches to anxiety disorder in the case of Sandra as described in this volume (see record 200304404-000). The defining characteristics of each of the psychotherapy models are presented, including the following: cognitive-behavioral therapy, problem-solving therapy, acceptance and commitment therapy, contextual family therapy, Adlerian therapy, context-centered therapy, interpersonal psychotherapy, person-centered therapy, supportive-expressive therapy, psychodynamic psychotherapy, and psychopharmacological treatments. (PsycINFO Database Record (c) 2012 APA, all rights reserved). (chapter

Comparative treatments for anxiety disorders

Anxiety disorders are costly, common and debilitating, and often present challenging problems to the caseloads of practicing clinicians. This volume compares and contrasts various models of and treatment approaches to anxiety disorders. Each contributor, an experienced clinician, analyzes the same case and presents a thorough description of the model. Detailed descriptions of therapists\u27 skills and attributes, assessment plans, treatment goals, intervention strategies, common pitfalls and mechanisms of change are included. (PsycINFO Database Record (c) 2012 APA, all rights reserved). (cover

Anxiety disorders: An overview

Presents an overview of the characteristics of anxiety and anxiety disorders. In the first section, the authors describe the basic characteristics of anxiety and discuss several issues in distinguishing between anxiety as a normal response and anxiety as a disordered response. The second section presents a brief review of the DSM-IV classification scheme for anxiety disorders. These include panic disorder, panic disorder with agoraphobia, specific phobia, social phobia, generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress disorder, acute stress disorder, and anxiety disorder not otherwise specified. The final section addresses mental and physical substrate factors, triggering factors, and maintenance factors in anxiety. (PsycINFO Database Record (c) 2012 APA, all rights reserved). (chapter