Does the Vigilance-Avoidance Gazing Behavior of Children with Separation Anxiety Disorder Change after Cognitive-Behavioral Therapy?

Cognitive biases are of interest in understanding the development of anxiety disorders. They also play a significant role during psychotherapy, where cognitive biases are modified in order to break the vicious cycle responsible for maintaining anxiety disorders. In a previous study, the vigilance-avoidance pattern was shown in children with separation anxiety disorder (In-Albon et al. Journal of Abnormal Child Psychology 38:225-235, 2010). The exhibited avoidance pattern may be essential for the maintenance of the anxiety disorder. Therefore, in the present study we used eye tracking methodology presenting disorder specific pictures to examine possible changes in the vigilance-avoidance pattern in 18 children with separation anxiety disorder after cognitive-behavioral treatment (CBT) and 13 healthy controls. Results indicated that following treatment, the vigilance pattern of children with separation anxiety disorder reduced significantly. Thus, the vigilance-avoidance pattern can be modified by CB

Vigilance and Avoidance of Threat in the Eye Movements of Children with Separation Anxiety Disorder

The vigilance-avoidance attention pattern is found in anxious adults, who initially gaze more at threatening pictures than nonanxious adults (vigilance), but subsequently gaze less at them than nonanxious adults (avoidance). The present research, using eye tracking methodology, tested whether anxious children show the same pattern. Children with separation anxiety disorder or no mental disorder viewed pairs of pictures, while the direction of their gaze was tracked. Each picture pair showed one picture of a woman separating from a child, the other picture of a woman reuniting with a child. The results supported the vigilance-avoidance model in children. Although the two groups' gaze direction did not differ during the first second of viewing, anxious children gazed significantly more at separating (threatening) pictures than nonanxious children after a period of 1s. But after 3s the pattern reversed: anxious children gazed significantly less at the separating pictures than nonanxious childre

Mental disorders in the Pediatric Setting- Results of a Swiss Survey

Theoretical background: Mental disorders emerge in childhood and adolescence and are important risk factors for mental disorders in adolescents and adulthood. Since pediatricians typically are the first to see children with psychological problems, the aim of this study was to obtain a survey of mental disorders of children in pediatric settings. Methods: 250 pediatricians completed a questionnaire especially developed for this study, which asked for the estimated frequency and type of mental disorders in their patients, assurance in identifying mental disorders, used diagnostic and treatment strategies for these disorders and requests for training.Results: Pediatricians estimated that 15% percent of children in their pediatric setting reported psychological difficulties. The most frequent mental disorders indicated by the pediatricians were attention-deficit hyperactivity disorder (ADHD), anxiety disorders, depression, and aggressive disorders. Comfort in assigning diagnoses for anxiety disorders and depression was lower than for externalizing disorders. Counseling was the treatment approach most often reported in treating mental disorders, followed by psychopharmacological medication, psychotherapy however being reported very rarely. Their wish for continuing education included diagnostics and screening instruments for psychological problems in childhood. Conclusions: Estimated prevalence rates reported by pediatricians are comparable with rates in epidemiological studies. Because pediatricians are often confronted with psychological problems, they have the important role in recognizing early signs of mental problems

Kinder-DIPS:

Mit dem Kinder-DIPS Open Access: Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter liegt das etablierte diagnostische Interview in seiner dritten Auflage vor und steht nun für Praxis und Forschung frei zur Verfügung. Mithilfe des Kinder-DIPS Open Access können Diagnosen psychischer Störungen des Kindes- und Jugendalters nach DSM-5 und ICD-10 zuverlässig gestellt werden. Zudem können wichtige Informationen für die Planung und Durchführung psychotherapeutischer Interventionen strukturiert ermittelt werden.Die Interviewleitfäden (Eltern- und Kindversion) des Kinder-DIPS Open Access leiten Interviewerinnen und Interviewer durch die diagnostischen Gespräche mit Eltern und Kind. Im Anschluss an die Interviews bietet das Kinder-DIPS Open Access die Möglichkeit einer umfassenden Dokumentation der allgemeinen Anamnese sowie der sozialen Beurteilung. Die ebenfalls enthaltenen Protokollbögen erlauben schließlich die übersichtliche Dokumentation der erhobenen Symptomatik sowie eine detaillierte Zuordnung zu DSM-5-Kriterien. Schlagworte: Strukturiertes, klinisches Interview; Kinder-DIPS; Diagnostik; Psychische Störungen des Kindes- und Jugendalters; DSM-5; ICD-10 Bitte zitieren Sie für das Verfahren die beiden folgenden Angaben: Margraf, Cwik, Pflug &Schneider (2017). Structured clinical interviews for mental disorders across the lifespan: Psychometric quality and further developments of the DIPS Open Access interviews. [Strukturierte klinische Interviews zur Erfassung psychischer Störungen über die Lebensspanne: Gütekriterien und Weiterentwicklungen der DIPS-Verfahren.] Zeitschrift für Klinische Psychologie und Psychotherapie, 46(3). Schneider, S., Pflug, V., In-Albon, T. & Margraf, J. (2017). Kinder-DIPS Open Access: Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter. Bochum: Forschungs- und Behandlungszentrum für psychische Gesundheit, Ruhr-Universität Bochum. Doi: 10.13154/rub.101.90 Kinder-DIPS Open Access: Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter von Schneider, S., Pflug, V., In-Albon, T., & Margraf, J. ist lizenziert unter einer Creative Commons Namensnennung - Nicht kommerziell - Keine Bearbeitungen 4.0 International Lizenz. Tina In-Albon und Laura Kraus haben an Universität Koblenz-Landau ein Zusatzmodul zum Kinder-DIPS entwickelt. Diese Fragen erfassen Nichtsuizidale Selbstverletzungen (NSSV; DSM 5, Sektion 3: Klinische Erscheinungsbilder mit weiterem Forschungsbedarf). Das Modul liegt ausschließlich in der Kinderversion vor. Das Zusatzmodul zum Kinder-DIPS ist ebenfalls lizenziert unter einer Creative Commons Namensnennung - Nicht kommerziell - Keine Bearbeitungen 4.0 International Lizenz

Psychopathologie und elterlicher Stress bei 3- bis 6-jährigen Kindern mit Ausscheidungsstörungen

Objective: Incontinence and functional gastrointestinal disorders are common in young children and are associated with higher rates of psychological symptoms and mental disorders. This article focuses on the mutual association between incontinence and related toilet refusal syndrome, parental stress, and children’s psychopathology especially in young children. Methods: Children’s psychological symptoms, mental disorders, and parental stress levels were assessed in 38 parent-child dyads involving children with incontinence and 42 dyads of typically developing (TD) children. Results: Compared to TD children, patients had higher internalizing and externalizing CBCL scores and higher rates of clinically relevant externalizing problems. However, the rates of clinically relevant internalizing problems and mental disorders did not differ. The parents of children with incontinence reported signifi cantly higher stress levels regarding child-related stress factors (PSI-CD) than did parents of TD children. However, there were no clinically relevant parental stress scores on a group level, which remained below the clinical range (T-value < 60). When simultaneously analyzed, children’s (comorbid) mental disorders but not incontinence had a major impact on parental stress. Conclusions: Despite moderate stress levels, incontinence symptoms, urinary and fecal incontinence are highly prevalent in young children. However, stress among parents of young children was mainly elicited by any (comorbid) mental disorder.Fragestellung: Ausscheidungsstörungen (AS) wie funktionelle Harn- und Stuhlinkontinenz sind sehr häufi ge Störungen im Vorschulalter und sind mit einer erhöhten Prävalenz von psychopathologischen Symptomen und psychischen Störungen bei den betroffenen Kindern assoziiert. Innerhalb der vorliegenden Arbeit wird der wechselseitige Zusammenhang von funktioneller Harn- und Stuhlinkontinenz sowie dem damit in Verbindung stehenden Toilettenverweigerungssyndrom auf die kindliche Psychopathologie und das elterliche Stresserleben speziell bei jungen Kindern untersucht. Methode: Psychopathologische Symptome, psychische Störungen und elterliche Stressbelastung wurden in 38 Eltern-Kind-Dyaden bei Kindern mit vorhandener AS und in 42 Dyaden bei Kindern ohne AS untersucht. Ergebnisse: Kinder mit AS wiesen höhere Werte von internalisierendem und externalisierendem Problemverhalten auf und waren häufi ger von klinisch relevanter externalisierender Symptomatik betroffen. Nichtsdestotrotz war die Prävalenz psychischer Störungen vergleichbar. Eltern von Kindern mit AS berichteten signifi kant höhere kindbezogene Stresslevel. Dennoch zeigte sich auf Gruppenebene kein klinisch bedeutsamer elterlicher Stress und die mittleren Stresslevel lagen unterhalb des Bereichs der klinischen Auffälligkeit (T-Wert < 60). Bei gleichzeitiger Betrachtung des Einfl usses von AS und psychischen Störungen zeigten sich letztere als ausschlaggebend für den elterlichen Stress. Schlussfolgerungen: Trotz moderater Stresslevel konnte eine generell hohe Prävalenz von AS Symptomen bei 3–6-Jährigen aufgezeigt werden. Elterlicher Stress war jedoch bedeutsamer mit einer (komorbiden) psychischen Erkrankung assoziiert

Measurement of Panic Interpretation Bias Using the Anxiety Interpretation Questionnaire for Children

The purpose of the present study is to investigate the development of a reliable and valid measure for the assessment of panic-relevant interpretations in children. The resulting measure, the Anxiety Interpretation Questionnaire for Children (AIQ-C), presents descriptions of panic-relevant and panic-irrelevant ambiguous scenarios along with several possible interpretations of these scenarios. Child participants are also asked to rate their agreement with various strategies for coping. First, we investigated content validity of this measure by asking a group of experts to rate the relevance of the scenario interpretations. In a second step, reliability and validity of this measure was investigated utilizing a sample of 143 children. In this investigation, the AIQ-C demonstrated good construct, convergent, and discriminate validity as well as adequate internal consistency. The results of this study indicate that the AIQ-C appears to be a reliable and valid measure for the assessment of bodily sensation interpretations associated with panic in children

START adolescents: study protocol of a randomised controlled trial to investigate the efficacy of a low-threshold group treatment programme in traumatised adolescent refugees

Introduction No evaluated therapeutic approaches, that can efficiently be established in routine mental healthcare, are currently available for traumatised adolescent refugees in Germany. This study evaluates the efficacy of the Stress-Traumasymptoms-Arousal-Regulation-Treatment (START) programme to reduce trauma-related symptoms and psychological distress in traumatised adolescent refugees based in Germany. Methods and analysis This randomised, waiting-list-controlled, multicentre trial with a 12-week follow-up will include 174 refugee minors with partial or full post-traumatic stress disorder who are fluent in either Arabic, Dari, English, German or Somali. Eligible refugee minors will be randomised to the START or waiting-list control groups. The manualised 8-week START programme is based on techniques of dialectical behaviour therapy (DBT), fosters adaptive coping with emotional distress and traumatic symptoms and comprises eight therapy modules and a booster session. Study assessments are planned at baseline, post-treatment (ie, after programme participation or waiting time), booster session at week 12 or 12-week waiting time, and at the 12-week follow-up. Primary and coprimary outcomes are changes in psychological distress and traumatic symptoms at post-treatment and will be analysed as response variables in linear mixed regression models. Secondary outcomes are changes in further trauma-related and other psychopathological symptoms, emotion regulation and intermediate effects of the programme at follow-up. We will also assess effects of the programme with ecological momentary assessments and on neuroendocrine stress parameters using hair cortisol. Ethics and dissemination This study has been approved by the lead ethics committee of Rhineland-Palatinate and the ethics committees of participating sites. The study results will be disseminated through peer-reviewed publications and scientific conferences

Self-injury: Treatment, Assessment, Recovery (STAR): online intervention for adolescent non-suicidal self-injury - study protocol for a randomized controlled trial

Background: Non-suicidal self-injury (NSSI) is a clinically significant behavior affecting approximately 18% of adolescents and young adults worldwide. The importance of NSSI is supported by its association with a broad spectrum of mental disorders. Despite its high relevance, evidence-based, specific, time-, and cost-effective treatment approaches are scarce. Cognitive behavioral therapy (CBT) seems effective in reducing the frequency of NSSI in adolescents and young adults. However, young people are often reluctant to seek professional help and effective interventions adressing NSSI are not sufficiently available across all regions of Germany. Research indicates that the majority of youth with risk behavior (including NSSI) prefer technology-based interventions. To date, effective interventions for adolescents and young adults with NSSI that are deliverd online are not available. Methods: The present project aims to develop and evaluate an online intervention for adolescents and young adults with NSSI based on the content of a recently evaluated face-to-face short-term program that includes elements of CBT and dialectical behavior therapy (DBT): “The Cutting Down Programme” (CDP). The efficacy of the new online CDP intervention will be tested in a randomized controlled trial (RCT) in which n = 700 youths engaging in repetitive NSSI will participate in either an online psychoeducation (n = 350) or online CDP (n = 350). Within a postline assessment four months after baseline (end of treatment; T1), and follow-up evaluations 12 and 18 months after baseline (follow-ups; T2 and T3), NSSI and comorbid symptoms as well as quality of life will be assessed. It is hypothesized that participants receiving online CDP report a greater reduction in the frequency of NSSI within the last three months at T2 (primary endpoint) compared to those receiving online psychoeducation. Exploratory analyses will focus on predictors of treatment outcome. Discussion: We report on the development and evaluation of an online intervention for adolescents and young adults engaging in NSSI based on the CDP. If supported by empirical evidence, an online-based intervention for NSSI might help to overcome the limited availability of adequate interventions for youth. Trial registration: German Clinical Trials Register, DRKS00014623. Registered on 22 May 2018

Patterns of sub‐optimal change following CBT for childhood anxiety

Background: Children and adolescents demonstrate diverse patterns of symptom change and disorder remission following cognitive behavioural therapy (CBT) for anxiety disorders. To better understand children who respond sub‐optimally to CBT, this study investigated youths (N = 1,483) who continued to meet criteria for one or more clinical anxiety diagnosis immediately following treatment or at any point during the 12 months following treatment. Methods: Data were collected from 10 clinical sites with assessments at pre‐and post‐treatment and at least once more at 3, 6 or 12‐month follow‐up. Participants were assigned to one of three groups based on diagnostic status for youths who: (a) retained an anxiety diagnosis from post to end point (minimal responders); (b) remitted anxiety diagnoses at post but relapsed by end point (relapsed responders); and (c) retained a diagnosis at post but remitted to be diagnosis free at end point (delayed responders). Growth curve models assessed patterns of change over time for the three groups and examined predictors associated with these patterns including demographic, clinical and parental factors, as well as treatment factors. Results: Higher primary disorder severity, being older, having a greater number of anxiety disorders, having social anxiety disorder, as well as higher maternal psychopathology differentiated the minimal responders from the delayed and relapsed responders at the baseline. Results from the growth curve models showed that severity of the primary disorder and treatment modality differentiated patterns of linear change only. Higher severity was associated with significantly less improvement over time for the minimal and relapsed response groups, as was receiving group CBT, when compared to the delayed response group. Conclusions: Sub‐optimal response patterns can be partially differentiated using variables assessed at pre‐treatment. Increased understanding of different patterns of change following treatment may provide direction for clinical decision‐making and for tailoring treatments to specific groups of clinically anxious youth. Future research may benefit from assessing progress during treatment to detect emerging response patterns earlier

The impact of treatment delivery format on response to Cognitive Behaviour Therapy for pre-adolescent children with anxiety disorders

Background. Several delivery formats of Cognitive Behaviour Therapy (CBT) for child anxiety have been proposed, however there is little consensus on the optimal delivery format. The primary goal of this study was to investigate the impact of the child’s primary anxiety diagnosis on changes in clinical severity (of the primary problem) during individual CBT, group CBT, and guided parent-led CBT. The secondary goal was to investigate the impact of the child’s primary anxiety diagnosis on rates of remission for the three treatment formats. Methods. A sample of 1253 children (5 – 12 years; Mage = 9.3, SD = 1.7) was pooled from CBT trials carried out at 10 sites. Children had a primary diagnosis of Generalised Anxiety Disorder (GAD), Social Anxiety Disorder (SoAD), Specific Phobia (SP) or Separation Anxiety Disorder (SAD). Children and parents completed a semi-structured clinical interview to assess the presence and severity of DSM-IV psychiatric disorders at pre intervention, post intervention and follow-up. Linear mixture modelling was used to evaluate the primary research question and logistic modelling was used to investigate the secondary research question. Results. Children with a primary diagnosis of GAD, SoAD and SAD demonstrated comparable improvements in clinical severity to all three CBT treatment formats. However, children with primary SP showed significantly larger reductions in clinical severity following individual CBT compared to group CBT and guided parent-led CBT. The results were mirrored in the analysis of remission responses with the exception that individual CBT was no longer superior to group CBT for children with a primary SP. Furthermore, the difference between individual and group was not significant when the follow-up data was examined separately. Conclusions. The data show that there may be greater clinical benefit by allocating children with a primary SP to individual CBT, although future research on cost-effectiveness is needed to determine whether the additional clinical benefits justify the additional resources required