Anxiety disorders in children with Williams syndrome, their mothers, and their siblings : implications for the etiology of anxiety disorders.

Genetic factors play an important role in the etiology of anxiety disorders. Williams syndrome (WS), a genetic disorder caused by a deletion on chromosome 7q11.23 and associated with increased prevalence of anxiety disorders relative to the general population and other genetic disorders associated with intellectual disability, can be used in the search for susceptibility genes for anxiety disorders. This study examines the prevalence of anxiety disorders in children with WS, their mothers, and their siblings as well as predictors of anxiety in these groups, in order to facilitate the use of WS in studies of genetics of anxiety disorders. Anxiety disorders were assessed in 109 children with WS ages 4-16 years, 106 mothers, and 72 siblings in the same age range. Prevalence was compared to that in the general population. Children with WS had a significantly higher prevalence of specific phobia, generalized anxiety disorder (GAD), and separation anxiety in comparison to children in the general population. The mothers had a significantly higher prevalence of GAD than women in the general population, but the prevalence rate for GAD in this group prior to the birth of the child with WS was comparable to that for women in the general population. The siblings had a significantly higher prevalence of specific phobia in comparison to children in the general population, but it was similar to the rates reported in other studies of specific phobia in typically developing children. The odds of a child with WS having an anxiety disorder increased with age and the severity of maternal anxiety. The odds of mothers having an anxiety disorder increased if the mother was not employed outside of home and if the child with WS was a male. The elevated prevalence rates of anxiety disorders in children with WS suggest a connection between the deletion found in WS and anxiety disorders. Given the increased prevalence of anxiety disorders in children with WS, genetic studies examining possible links between particular gene(s) deleted in WS and anxiety are warranted. It would also be worthwhile to investigate relations between genes deleted in WS and genes previously implicated in anxiety disorders

Intensive cognitive-behavioral therapy for anxiety disorders in adolescents: a case study

Anxiety disorders are one of the most common psychiatric conditions in youth and can contribute to impairment in social, academic, and family functioning. Cognitive-behavioral therapy (CBT) has been shown to be efficacious in treating youth anxiety disorders; however, for a multitude of reasons, fewer than 20% of adolescents with anxiety disorders receive services for anxiety-related problems. Intensive treatments, which rely on the same traditional components of CBT but are delivered over a shorter period of time or in a fewer number of sessions, may be particularly helpful for anxiety disorders and can offer a number of advantages over standard CBT. Despite emerging evidence supporting the advantages of the intensive approach, there are few established intensive treatment programs for youth with anxiety disorders. Further, no treatment to date has comprehensively targeted the entire spectrum of comorbid adolescent anxiety disorders in a combined intensive and transdiagnostic format, even though non-intensive (i.e., weekly delivered) CBT has been tested using a transdiagnostic approach. We developed an intensive, six-session intervention based on Angelosante and colleagues’ 2009 The Adolescent Panic Control Treatment with In-Vivo Exposures (Angelosante et al., 2009) and other empirically-supported treatments for youth to target all anxiety disorders in adolescents. We present a case study on an adolescent with multiple comorbid anxiety and related disorders who received intensive CBT treatment as a way to illustrate the clinical benefit and utility of an intensive, transdiagnostic approach. Findings support the acceptability and feasibility of transdiagnostic treatment of youth anxiety.First author draf

Predictors of treatment satisfaction among adolescents following an intensive cognitive-behavioral intervention for panic disorder

No studies to date examine predictors of treatment satisfaction following intensive cognitive-behavioral therapy interventions among adolescents. Given the challenges to treatment adherence among adolescents, and the promise intensive interventions hold for providing rapid symptom relief and increasing access to care, data examining adolescents' satisfaction with intensive programs are needed. Twenty-four adolescents (ages 12-17) with panic disorder received an eight-day intensive cognitive-behavioral therapy intervention. Pre-treatment characteristics and clinical outcome variables were examined as predictors of satisfaction at post-treatment and three-months follow-up. Multiple regression analyses revealed that higher levels of overall symptom interference at baseline and greater reductions in agoraphobic fear during treatment predicted greater treatment satisfaction at post-treatment. Only satisfaction at post-treatment significantly predicted treatment satisfaction at follow-up, highlighting the potential influence of treatment satisfaction on long-term perceptions of treatment. Considerations for fostering treatment satisfaction in the context of intensive interventions are discussed.19050 - Brain and Behavior Research FoundationAccepted manuscrip

Anxiety disorders in children with Williams syndrome, their mothers, and their siblings: Implications for the etiology of anxiety disorders

This study examines the prevalence of anxiety disorders in children with Williams syndrome (WS), their sibling closest in age, and their mothers as well as the predictors of anxiety in these groups. The prevalence of anxiety disorders was assessed and compared to that in the general population. Children with WS had a significantly higher prevalence of specific phobia, generalized anxiety disorder (GAD), and separation anxiety in comparison to children in the general population. While mothers had a higher prevalence of GAD than population controls, the excess was accounted for by mothers who had onset after the birth of their WS child. The siblings had rates similar to the general population. This pattern of findings suggests the presence of a gene in the WS region whose deletion predisposes to anxiety disorders. It is also worthwhile to investigate relations between genes deleted in WS and genes previously implicated in anxiety disorders

Overlap between autism and specific language impairment: Comparison of autism diagnostic interview and autism diagnostic observation schedule scores.

Autism and specific language impairment (SLI) are developmental disorders that, although distinct by definition, have in common some features of both language and social behavior. The goal of this study was to further explore the extent to which specific clinical features of autism are seen in SLI. The children with the two disorders, matched for non-verbal IQ, were compared on the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS). In the SLI group, 41% met autism or autism spectrum cut-offs for social or communication domains either on the ADI or ADOS or both. No relationship was found between the language deficits exhibited by the children with SLI and their scores on the ADI and ADOS. These findings contribute to evidence that there is some overlap in social and communicative deficits between autism and SLI, supporting the view that autism and SLI share etiologic factors. This continuum of pathology between SLI and autism appears to range from structural language abnormalities as seen in individuals with SLI to individuals with SLI with both structural and social abnormalities to individuals with autism with pragmatic impairment and language abnormalities