Twenty-five Years of Research on Childhood Anxiety Disorders: Publication Trends Between 1982 and 2006 and a Selective Review of the Literature

We examined trends in publications on childhood anxiety disorders over the past 25 years. A PsycINFO search was carried out to find relevant research articles published between 1982 and 2006. Results indicated a gradual and significant rise in the frequency of publications on childhood anxiety disorders during the past 25 years, and this increase was particularly strong for post-traumatic stress disorder, obsessive–compulsive disorder, social phobia, and multiple anxiety disorders. Most studies concerned the phenomenology of childhood anxiety disorders (i.e., >50%). Considerable less research has been conducted on the etiology, intervention, and assessment of these disorders in youths. Nevertheless, the conclusion seems warranted that the research on childhood anxiety disorders has made significant advancements during the past decades. This notion is supported by a selective review of the literature, which highlights important developments in this field of study

A Psychometric Evaluation of the Behavioral Inhibition Questionnaire in a Non-Clinical Sample of Dutch Children and Adolescents

The Behavioral Inhibition Questionnaire (BIQ) is a parent-rating scale for measuring temperamental characteristics referring to shyness, fearfulness, and withdrawal in young, preschool children. The present study evaluated the psychometric properties of the BIQ in a Dutch community sample of children with a broad age range. For this purpose, the reliability and validity of the BIQ was evaluated in three age groups: 4–7-year-olds, 8–11-year-olds, and 12–15-year-olds. The results indicated that the internal consistency of most BIQ scales was satisfactory in all three age groups. Principal component analysis of the BIQ yielded a six-factor model that was largely in keeping with the hypothesized structure consisting of the social and non-social components of behavioral inhibition. Confirmatory factor analysis indicated that this model provided a reasonable fit for the data. Further, support for the validity of the measure was obtained in all age groups. That is, BIQ scores were positively correlated with a wide range of anxiety symptoms, although the most substantial links were found for symptoms of social anxiety. Finally, a self-report version of the BIQ, which was administered to children aged 9 years and above, was found to possess good internal consistency and adequate parent–child agreement. Altogether, the results of this study indicate that suggests that the BIQ might be a reliable and valid measure for assessing behavioral inhibition not only in preschoolers but also in older children and adolescents

Anxiety in Non‐Clinical Children: Developmental Course and Vulnerability Factors

Some children are afraid of the dark, spiders, ghosts, or imaginary creatures, others are apprehensive of something bad happening to their parents or themselves, or worry about doing something stupid in front of others. Nevertheless, fear and anxiety are a normal part of childhood development and can be seen as an adaptive response to stimuli and situations that are potentially threatening or dangerous (Marks, 1987). Normal fear and anxiety in youths shows a clear developmental pattern (Gullone, 2000). Marks (1987) has described this pattern as the “ontogenetic parade”, which refers to the rise and disappearance of certain fears in a predictable sequence during children’s development. That is, in their preschool years, children’s fears are focused on imaginary creatures (e.g., ghosts, witches), animals, strangers, and their natural environment (e.g., the dark, thunderstorms). In middle childhood, fears of physical danger, bodily injury, and school performance become more prominent, whereas during adolescence, youths more often report fears about social evaluations and interactions, death, and illness (Bauer, 1976; Muris, Merckelbach, Gadet, & Moulaert, 2000). Fear and anxiety are thought to come up and disappear following this predictive pattern because they are linked to different developmental stages and the specific dangers that children encounter during these stages (Marks, 1987). For example, fear of strangers and separation anxiety become manifest around the time that infants have learned to differentiate between familiar and unfamiliar faces, whereas fear of heights usually develops around the time infants start crawling. When children have acquired these cognitive and/or physical skills, they encounter potential dangers (e.g., strangers, heights) for which they do not already have developed sufficient cognitive capacity to understand. Therefore, children develop fears to protect them from these potential dangers by triggering the appropriate safety responses (e.g., avoiding strangers or avoiding heights). When children acquire the cognitive abilities to understand the potential dangers of these situations and learn how to deal with them, their fear or anxiety for these stimuli or situations usually abates. Thus, it seems that children’s fears and anxiety are closely linked to their cognitive and physical development

Do you think I should be scared? The effect of peer discussion on children's fears

This study investigated whether close friends affect each other’s fear responses (fear beliefs and avoidance) when they discuss fear-related issues together. Children (N = 242) aged 7 to 10 years were first presented with ambiguous and threatening information about two novel animals respectively, after which their fear responses towards each animal were assessed (T1). Next, dyads of close friends had a discussion about their feelings regarding the animals, and their fear responses were measured again (T2). Results showed that children influenced each other’s cognitions following the discussion; from T1 to T2 their fear responses became more similar and close friends’ fear responses at T1 significantly predicted children’s fear responses at T2. Gender pair type predicted change in children’s fear responses over time. Children in boy-boy pairs showed a significant increase in fear responses following the discussion; their fear level became more in line with that of other gender pairs at T2, while those in girl-girl pairs showed a significant decrease in their fear beliefs, at least when threatening information was given. Differences in anxiety level between close friends did not affect change in fear responses over time. Altogether, the results indicate that children may affect each other’s fears

Longitudinal investigation of the role of temperament and stressful life events in childhood anxiety

The current study investigated the longitudinal relationships between BI, life events, and anxiety in a sample of 102 behaviourally inhibited (BI) and 100 uninhibited (BUI) children aged 3 to 4 years. Children’s parents completed questionnaires on BI, stressful life events, and anxiety symptoms, and were administered a diagnostic interview three times in a 5-year period. In line with our hypotheses, negative life events, and negative behaviour- dependent life events (i.e. life events that are related to the children’s own behaviours) in particular, and the impact of negative life events, were predictive of increases in subsequent anxiety symptoms, the likelihood of having an anxiety disorder, and increased number of anxiety diagnoses over the five year follow-up period. Experiencing more positive, behaviour-independent life events decreased the risk of being diagnosed with an anxiety disorder. Furthermore, differences were found in life events between BI and BUI children. That is, BI children experienced fewer positive and specifically positive behaviour-dependent life events, and the impact of these positive life events was also lower in BI children than in BUI children. However, BI did not interact with life events in the prediction of anxiety problems as hypothesized. Therefore, this study seems to indicate that BI and life events act as additive risk factors in the development of anxiety problems

Associations between parent-adolescent attachment relationship quality, negative life events and mental health

Purpose: The aim of this study was to examine the association of negative life events and parent-adolescent attachment relationship quality with mental health problems and to explore an interaction between the parent-adolescent attachment relationship and one or multiple negative life events on the mental health of adolescents. Methods: A two-year longitudinal study was conducted among first-year secondary school students (N = 3181). The occurrence of life events and the quality of parent-adolescent attachment were assessed at baseline and mental health status at two-year follow-up by means of self-report questionnaires. Binary logistic regression analyses were conducted to assess associations between life events, parent-adolescent attachment and mental health problems. Relative Excess Risk due to Interaction techniques were used to determine the interaction effects on the additive scale. Results: Life events were related to mental health status, as was parent-adolescent attachment. The combined effect of an unfavourable parent-adolescent attachment with life events on mental health was larger than the sum of the two individual effects. Among adolescents with one life event or multiple life events, an unfavourable parent-adolescent attachment increased the risk of mental health problems at follow-up compared to the group without life events. Conclusion: Results supported an interaction effect between parent-adolescent attachment and negative life events on mental health. Especially adolescents with one or multiple life events and an unfavourable parent-adolescent attachment seems to be a vulnerable group for mental health problems. Implications for further research are discussed

Depressive symptoms and clustering of risk behaviours among adolescents and young adults attending vocational education: a cross-sectional study

BACKGROUND: Depressive symptoms and risk behaviours often do not occur in isolation among adolescents and young adults. In order to improve intervention programmes, more research is needed to elucidate the clustering of risk behaviours, the association with depressive symptoms, and demographic variables. Therefore, this study examined the clustering of risk behaviours, the association with depressive symptoms, and demographic variables among adolescents and young adults in vocational education. Furthermore, the prevalence of depressive symptoms and risk behaviours was examined.METHODS: This study included 584 students (mean age 18.3 years) attending vocational education in the Netherlands. Depressive symptoms and risk behaviours (binge drinking, cannabis use, smoking, delinquency and incurring debts) were assessed with self-report questionnaires. Truancy was monitored via the school registration system. Principal Components Analysis (PCA) was conducted to assess the factor structure of the risk behaviours (i.e. clustering). Linear regression analyses with a bootstrapping method were performed to assess the associations.RESULTS: Binge drinking was reported by 50.5% and cannabis use by 14.2% of the students (both in the past 4 weeks), whereas 37.7% reported currently being a smoker. More than 10% reported having been questioned at a police station in the past year. Furthermore, 82.2% had been truanting in the first two months of education, 21.0% reported having debts and 29.2% reported clinically-relevant depressive symptoms. The PCA indicated two clusters. The 'substance use' cluster consisted of the risk behaviours: binge drinking, cannabis use and smoking. The 'problem behaviours' cluster consisted of the risk behaviours: delinquency, truancy and incurring debts. Both clusters were associated with depressive symptoms. Various demographic variables were associated with both clusters.CONCLUSIONS: Risk behaviours formed two clusters, both of which were associated with depressive symptoms. These findings underscore the importance of screening adolescents and young adults at lower educational levels for multiple risk behaviours and depressive symptoms and of focusing on multiple risk behaviours in interventions simultaneously

A longitudinal study of children's outside play using family environment and perceived physical environment as predictors

Background: A natural and cheap way of increasing children's physical activity is stimulating unstructured outside play.Purpose: This study examined whether characteristics of the family and perceived physical environment were associated with the duration of children's outside play.Methods: Parents participating in the " Be Active, Eat Right" cluster RCT control group (N = 2007) provided information on potential predictors of outside play (i.e. family and perceived physical environment) of their 5-year-old child by questionnaire. Child outside play was assessed by parental reports both at five and seven years. Linear regression analyses, adjusted for seasonality, were performed to evaluate associations between potential predictors and child outside play. Linear mixed models were fitted to evaluate the relationship between potential predictors and the development of outside play over two years, with season entered as a random factor.Results: Family environment was the strongest construct predicting child outside play, while parent perceived physical environment had no significant association with child outside play. Parental habit strength and the presence of rules were the strongest predictors of increased outside play. Parent perceived difficulty in improving child outside play was the strongest predictor of decreased outside play.Conclusion: Family environment predicted child outside play and not perceived physical environment. Parental rules and habit strength regarding improving outside play were associated with an improvement of child's engagement in outside play

Cyber and traditional bullying victimization as a risk factor for mental health problems and suicidal ideation in adolescents

Purpose: To examine whether traditional and cyber bullying victimization were associated with adolescent's mental health problems and suicidal ideation at two-year follow-up. Gender differences were explored to determine whether bullying affects boys and girls differently. Methods: A two-year longitudinal study was conducted among first-year secondary school students (N = 3181). Traditional and cyber bullying victimization were assessed at baseline, whereas mental health status and suicidal ideation were assessed at baseline and follow-up by means of self-report questionnaires. Logistic regression analyses were conducted to assess associations between these variables while controlling for baseline problems. Additionally, we tested whether gender differences in mental health and suicidal ideation were present for the two types of bullying. Results: There was a significant interaction between gender and traditional bullying victimization and between gender and cyber bullying victimization on mental health problems. Among boys, traditional and cyber bullying victimization were not related to mental health problems after controlling for baseline mental health. Among girls, both traditional and cyber bullying victimization were associated with mental health problems after controlling for baseline mental health. No significant interaction between gender and traditional or cyber bullying victimization on suicidal ideation was found. Traditional bullying victimization was associated with suicidal ideation, whereas cyber bullying victimization was not associated with suicidal ideation after controlling for baseline suicidal ideation. Conclusions: Traditional bullying victimization is associated with an increased risk of suicidal ideation, whereas traditional, as well as cyber bullying victimization is associated with an increased risk of mental health problems among girls. These findings stress the importance of programs aimed at reducing bullying behavior, especially because early-onset mental health problems may pose a risk for the development of psychiatric disorders in adulthood

Design of a controlled trial to evaluate the effectiveness of Supportive Parenting ('Stevig Ouderschap'): An intervention to empower parents at increased risk of parenting problems by providing early home visits

__Background:__ In the Netherlands, 15 % of all families with children under the age of 13 years deal with significant parenting problems. Severe parenting problems may lead to adverse physical, cognitive, and psychosocial outcomes for children, both in the short and long run. The intervention Supportive Parenting (in Dutch: "Stevig Ouderschap") is a preventive program, which aims to reduce the risk of (developing) parenting problems among parents at risk of these problems. The intervention consists of six additional home visits by a Youth Health Care nurse during the first 18 months after childbirth and is focusing on the following elements of parental empowerment: activating social networks, increasing parenting skills and supporting parent(s)/caregiver(s) in getting grip on their own life. __Methods and design:__ A controlled trial is performed in two regions in the Netherlands. An intervention group receives the intervention Supportive Parenting, and a control group receives 'care-as-usual'. Parents in both the intervention and control group fill out three questionnaires focusing on various elements of empowerment (social support, parenting skills, self-sufficiency and resilience), behavioral and emotional problems of the child. The effects of the intervention will be evaluated at child age 1-3 months (baseline) and child age 18 months by comparing the outcomes between the intervention group and the control group on the primary outcomes. Additionally, interviews and focus group interviews will be held to identify factors, which hinder or stimulate a wider implementation of the intervention Supportive Parenting. __Discussion:__ It is hypothesized that parents at increased risk of parenting problems who receive the intervention Supportive Parenting during the first 18 months after childbirth, will have enhanced their social support networks and parenting skills, increased their self-sufficiency and strengthened resilience compared to at risk parents receiving care-as-usual. Additionally children of parents from the intervention group will display less parent-reported behavioral and emotional problems