A Systematic Review and Meta-Analysis of Impairment and Quality of Life in Children and Adolescents with Anxiety Disorders.

Anxiety disorders are common, emerge during childhood, and pose a significant burden to society and individuals. Research evaluating the impact of anxiety on functional impairment and quality of life (QoL) is increasing; however, there is yet to be a systematic review and meta-analysis of these relationships in pediatric samples. This systematic review and meta-analysis were conducted to determine the extent of impairments in functioning and QoL that young people with anxiety disorders experience relative to their healthy peers, as well as sociodemographic and clinical moderators of these relationships. Studies were included when they compared young people (mean age range within studies 7-17 years) with a primary clinical anxiety disorder to a healthy comparison group and measured impairment and/or QoL via a validated instrument. A total of 12 studies met criteria for this review (N = 3,129 participants). A majority of studies (K = 9) assessed impairment as an outcome measure, and three assessed QoL outcomes. Meta-analysis of nine studies (N = 1,457 children) showed large relationships between clinical anxiety and life impairment (g = 3.23) with the strongest effects seen for clinician report (g = 5.00), followed by caregiver (g = 2.15) and child (g = 1.58) report. The small number of studies and diversity in methodology prevented quantitative investigation of moderating factors. In the systematic review of QoL outcomes, all three studies reported significantly poorer QoL for youth with anxiety disorders relative to unaffected peers. Findings support the importance of measuring functioning and QoL as outcomes in clinical research and practice among anxious young people.This study is registered with PROSPERO under the identification number CRD42023439040.

The meditating role of sleep in the longitudinal associations between peer victimization and internalizing symptoms: A cross-lagged panel analysis.

Adolescence is a time of heightened vulnerability for both peer victimization (PV) and internalizing symptoms. While the positive association between them is well established, there is little understanding of the mechanisms underpinning this relationship. To address this gap, the current study aimed to investigate sleep hygiene and school night sleep duration as individual and sequential mediators of the relationship between PV and both depressive and social anxiety symptoms during pre- to mid-adolescence. The study drew upon a community sample of 528 Australian youth aged 10-12 years at baseline (M age = 11.19, SD = .55; 51.1% boys) and data were collected over five annual measurement occasions. Direct and indirect longitudinal and bidirectional associations were examined using cross-lagged panel analysis. There was no evidence of sequential mediation through both sleep hygiene and sleep duration to depression and social anxiety. Instead, the findings show that sleep hygiene mediated the prospective association between PV and both depressive and social anxiety symptoms, and between PV and sleep duration. Overall, sleep hygiene represents a modifiable transdiagnostic factor that can be targeted to break the cycle of PV, inadequate sleep, and internalizing symptoms.

Examining the Prospective Bidirectional Associations between Subjective and Objective Attractiveness and Adolescent Internalizing Symptoms and Life Satisfaction.

Research has consistently shown that more physically attractive individuals are perceived by others to be happier and better psychologically adjusted than those perceived as less attractive. However, due to the lack of longitudinal research in adolescents, it is still unclear whether poor mental health predicts or is predicted by either objective or subjective attractiveness during this critical developmental period. The purpose of the current study was to examine prospective bidirectional associations between both subjective and objective ratings of attractiveness, life satisfaction and symptoms of social anxiety, depression and eating disorders (i.e., internalizing symptoms) from early to mid-adolescence. Participants (T1: N = 528, 49.9% girls; Mage = 11.19; SD = 0.55) were followed annually over four time points. The cross-lagged panel model results revealed evidence of prospective associations between both forms of attractiveness and life satisfaction and internalizing symptoms, which were driven more by changes in the mental health outcomes than by changes in the subjective and objective attractiveness ratings. The results also indicated that the pattern, strength, and direction of the associations tested were robust across boys and girls, and white and non-white ethnic groups. Overall, the findings suggest that it is important to find effective ways of educating adolescents who are unhappy with their appearance that making changes to improve their mental health, rather than focusing on their physical appearance, will have benefits not only for how they perceive themselves but also for how they are perceived by others.

A longitudinal investigation of sleep hygiene as a mediator linking parental warmth with adolescent sleep.

STUDY OBJECTIVES: Parental warmth in adolescence protects sleep in early adulthood, yet the nature, directions, and mechanisms of this association across adolescence are unknown. This study examined parental warmth, adolescent sleep hygiene and sleep outcomes (morning/eveningness, school night sleep duration, and daytime sleepiness) across five annual waves, spanning four years, using a cross-lagged panel design. METHODS: Adolescents and one primary caregiver (96% mothers) completed questionnaires assessing parental warmth (child- and parent-report) and adolescent sleep hygiene and sleep (child-report), across five annual waves: Wave 1 (N = 531, Mage = 11.18, SD = 0.56, 51% male), Wave 2 (N = 504, Mage = 12.19, SD = 0.53, 52% male), Wave 3 (N = 478, Mage = 13.19, SD = 0.53, 52% male), Wave 4 (N = 440, Mage = 14.76, SD = 0.47, 51% male), and Wave 5 (N = 422, Mage = 15.75, SD = 0.49, 51% male). RESULTS: Greater child-reported parental warmth was indirectly associated with better adolescent sleep (greater morningness, longer school night sleep duration, less sleepiness) through healthier sleep hygiene. The inverse was also often observed. Warmth had a direct relationship with sleep duration and sleepiness, independent of sleep hygiene. Parent-reported parental warmth did not predict, nor was predicted by child-reported adolescent sleep. CONCLUSIONS: Parental warmth may protect against developmental changes in adolescent sleep, partially by improving sleep hygiene practices. Similarly, inadequate adolescent sleep may negatively impact parental warmth via deteriorating sleep hygiene. Sleep hygiene emerged as a key mechanism for protecting adolescent sleep and parent-child relationships.

Risk for social anxiety in early adolescence: Longitudinal impact of pubertal development, appearance comparisons, and peer connections.

OBJECTIVES: The aims of this study were to determine the impact of adolescent-relevant risk factors on changes in social anxiety symptoms from pre-to early-adolescence. METHODS: From 2016 to 2018, 528 youth (51% boys) were tested in three annual waves across grades 6, 7, and 8 (M ages 11.2, 12.7, 13.7 years). Through online surveys youth reported on peer relationships that were combined into two latent factors: 1) appearance comparisons, comprising youth reports of appearance comparisons relative to others in general and while using social media, along with perceived attractiveness; and 2) positive peer connections, comprising youth reports of group affiliation, school belonging, and peer victimisation. Youth and their parents also reported on the youth's level of pubertal development as well as the youth's level of social anxiety using previously validated questionnaires. Social anxiety was also assessed with structured diagnostic interview. RESULTS: Separate cross-lagged panel models were used to model longitudinal associations between all risk factors and youth, parent, and interviewer-reported measures of social anxiety. Of the associations tested, only appearance comparisons directly predicted increases in social anxiety symptoms 12 months later across all models. More advanced pubertal development was associated with increased appearance comparisons the following year. On the other hand, higher levels of social anxiety predicted subsequent reductions in positive peer connections in parent and interviewer models. CONCLUSIONS: These results highlight the important and interconnected impact of pubertal development and appearance comparisons on both the development of social anxiety symptoms during early adolescence, as well as the social consequences of social anxiety.

Eye-tracking to assess anxiety-related attentional biases among a large sample of preadolescent children.

A considerable body of research in adults has demonstrated that anxiety disorders are characterised by attentional biases to threat. Findings in children have been inconsistent. The present study examined anxiety-related attention biases using eye tracking methodology in 463 preadolescents between 10 and 12 years of age, of whom 92 met criteria for a DSM-5 anxiety disorder and 371 did not. Preadolescent's gaze was recorded while they viewed adolescent face pairs depicting angry-neutral and happy-neutral expressions with each face pair presented for 5000 ms. No group differences were observed across any eye tracking indices including probability of first fixation direction, latency to first fixation, first fixation duration and dwell time. The sample overall showed faster initial attention towards threat cues, followed by a later broadening of attention away from threat. There is a need to identify the types of threats and the developmental period during which visual attention patterns of anxious and non-anxious youth diverge to inform more developmentally sensitive treatments.

The causes and consequences of shame in obsessive-compulsive disorder.

Research into the aetiology, maintenance, and treatment of obsessive-compulsive disorder (OCD) has largely been informed by models of anxiety. However, non-experimental research suggests that some individuals may engage in compulsions to neutralise shame, with repugnant obsessions associated with more shame than other obsessions. Violent and sexual obsessions and shame have been linked with poorer treatment outcomes, and thus, treatment modifications are needed. This experimental study aimed to examine if and how shame fits into a cognitive behavioural model of OCD. Fifty-five individuals experiencing subclinical (n = 9) to clinical (n = 46) OCD symptoms were randomly administered four different obsession induction paradigms focused on harm, sexual, contamination, and symmetry obsessions. After each induction, participants reported on their emotional states, gave appraisal ratings regarding their urges to engage in compulsions and avoidant behaviour, and completed manipulation checks. Harm and sexual inductions elicited greater shame and anxiety and were considered more immoral than contamination and symmetry inductions. Shame responses were also independently associated with compulsion and avoidance behaviours in repugnant obsessions, controlling for anxiety. Theoretical models and treatment for OCD should be adapted to address shame.

The role of parenting behaviors in the bidirectional and intergenerational transmission of depression and anxiety between parents and early adolescent youth.

BACKGROUND: Parenting is a modifiable factor proposed to underpin the transmission of anxiety and depression from parents to children. This study examined the role of parenting in the intergenerational transmission of anxiety and depression across pre- and early adolescence. METHOD: Participants were 531 youth (Mage = 11.18, SD = 0.56; 50.85% boys) and their parent. Child and parent anxiety and depression, and parental rejection, warmth and overprotection were assessed annually over 3 years. Bidirectional relationships between parent and child anxiety and depression, and the mediating role of parenting behaviors, were examined using cross-lagged panel models. RESULTS: Results suggest bidirectional associations over time between parent and child depression, and parental rejection and child depression. Parental rejection and low warmth were associated with increases in child depression, but did not mediate depression transmission. Parental anxiety was associated with increases in child anxiety and depression, but there was no bidirectional association from child psychopathology to parental anxiety. There was little evidence that parenting predicted changes in child anxiety over time. Child anxiety and depression were associated with subsequent increases in parental depression. CONCLUSION: Parental depression, rejection and low warmth are independent risk factors for child depression. Parental rejection may also be a consequence of parenting a depressed youth. Parenting did not account for the apparent transmission of parental anxiety to increased child anxiety and depression. Child psychopathology increases risk of parental depression. Parental rejection may be an important modifiable risk factor for youth depression in early adolescence, and may also reduce later risk of parent depression.

Risk and Protective Factors for Prospective Changes in Adolescent Mental Health during the COVID-19 Pandemic.

The restrictions put in place to contain the COVID-19 virus have led to widespread social isolation, impacting mental health worldwide. These restrictions may be particularly difficult for adolescents, who rely heavily on their peer connections for emotional support. However, there has been no longitudinal research examining the psychological impact of the COVID-19 pandemic among adolescents. This study addresses this gap by investigating the impact of the COVID-19 pandemic on adolescents' mental health, and moderators of change, as well as assessing the factors perceived as causing the most distress. Two hundred and forty eight adolescents (Mage = 14.4; 51% girls; 81.8% Caucasian) were surveyed over two time points; in the 12 months leading up to the COVID-19 outbreak (T1), and again two months following the implementation of government restrictions and online learning (T2). Online surveys assessed depressive symptoms, anxiety, and life satisfaction at T1 and T2, and participants' schooling, peer and family relationships, social connection, media exposure, COVID-19 related stress, and adherence to government stay-at-home directives at T2 only. In line with predictions, adolescents experienced significant increases in depressive symptoms and anxiety, and a significant decrease in life satisfaction from T1 to T2, which was particularly pronounced among girls. Moderation analyses revealed that COVID-19 related worries, online learning difficulties, and increased conflict with parents predicted increases in mental health problems from T1 to T2, whereas adherence to stay-at-home orders and feeling socially connected during the COVID-19 lockdown protected against poor mental health. This study provides initial longitudinal evidence for the decline of adolescent's mental health during the COVID-19 pandemic. The results suggest that adolescents are more concerned about the government restrictions designed to contain the spread of the virus, than the virus itself, and that those concerns are associated with increased anxiety and depressive symptoms, and decreased life satisfaction.

Longitudinal Associations between Coping Strategies and Psychopathology in Pre-adolescence.

Much of the literature investigating the association between coping and psychopathology is cross-sectional, or associations have been investigated in a unidirectional manner; hence, bidirectionality between coping and psychopathology remains largely untested. To address this gap, this study investigated bidirectional relations between coping and psychopathology during pre-adolescence. Participants (N = 532, 51% male) and their primary caregiver both completed questionnaires assessing pre-adolescents' coping (i.e., avoidant, problem solving, social support seeking) and symptoms of psychopathology (i.e., generalized anxiety, social anxiety, depression, eating pathology) in Wave 1 (Mage = 11.18 years, SD = 0.56, range = 10-12) and Wave 2 (Mage = 12.18 years, SD = 0.53, range = 11-13, 52% male), one year later. Cross-lagged panel models showed child-reported avoidant coping predicted increases in symptoms of generalized and social anxiety, and eating pathology. In separate child and parent models, symptoms of depression predicted increases in avoidant coping. Greater parent-reported child depressive symptoms also predicted decreases in problem solving coping. Taken together, results suggest unique longitudinal associations between coping and psychopathology in pre-adolescence, with avoidant coping preceding increases in symptoms of anxiety and eating pathology, and depressive symptoms predicting later increases in maladaptive coping.

The use of social media by Australian preadolescents and its links with mental health.

OBJECTIVES: Preadolescent social media use is normative and could influence mental health. This study investigated: (a) Differences between preadolescent users and non-users of various social media platforms on mental health, (b) unique links between time spent on those platforms, appearance-based activities on social media, and mental health, and (c) the moderating role of biological sex on those relationships. METHOD: Preadolescent youth (N = 528; 50.9% male) completed online surveys. RESULTS: Users of YouTube, Instagram, and Snapchat reported more body image concerns and eating pathology than non-users, but did not differ on depressive symptoms or social anxiety. Appearance investment uniquely predicted depressive symptoms. Appearance comparisons uniquely predicted all aspects of mental health, with some associations stronger for females than males. CONCLUSIONS: Preadolescents could be encouraged to reduce their opportunities to make appearance comparisons and to invest less in their appearance on social media. Preadolescents may benefit from social media intervention programs.

Adolescent development and risk for the onset of social-emotional disorders: A review and conceptual model.

The adolescent developmental stage appears to be a sensitive period for the onset of several particular forms of mental disorder that are characterised by heightened emotionality and social sensitivity and are more common in females than males. We refer to these disorders (social anxiety disorder, generalised anxiety disorder, eating disorders, major depression) collectively as the social-emotional disorders. The aim of this paper is to address an important question in the understanding of social-emotional disorders - why do these disorders commonly begin during adolescence? We present a conceptual model that describes some of the key changes that occur during adolescence and that addresses some hypothesised ways in which these changes might increase risk for the development of social-emotional disorders. An overview of the extant empirical literature and some possible directions for future research are suggested. The model points to interesting links between psycho-social risk factors that should highlight potentially fruitful directions for both psychopathology research and early intervention programs.

Measuring repetitive negative thinking: Development and validation of the Persistent and Intrusive Negative Thoughts Scale (PINTS).

Repetitive negative thinking (RNT) is a key risk and maintenance factor for many psychological disorders and is considered a transdiagnostic process. However, there are few disorder-neutral measures that assess RNT in adults, only 1 of moderate length considered suitable for children, and none that are validated for both children and adults. This study aimed to address this gap by developing a brief measure of RNT that can be used with both children and adults and can be quickly administered in research and clinical contexts. In Study 1, we administered the new 5-item Persistent and Intrusive Negative Thoughts Scale (PINTS) to 527 children (50.3% boys; Mage = 11.2). A 1-factor model fit well and was invariant for boys and girls. The scale showed high internal consistency and good stability across a 2-week interval. The PINTS was significantly associated with measures of depression, anxiety, and disordered eating and was weakly associated with adaptive forms of coping, demonstrating good divergent validity. In Study 2, there were 419 adults (38.9% men; Mage = 31.7) who completed the PINTS. The results replicated and extended the results of Study 1 by demonstrating that the PINTS had good construct, convergent, and criterion validity as well as good internal consistency and stability over time and was invariant across gender and age. It was concluded that the PINTS is a brief, valid, and useful tool for investigating RNT as a transdiagnostic process in the etiology and maintenance of psychological disorders in both children and adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Preteen Perfectionist: An Evaluation of the Perfectionism Social Disconnection Model.

This research investigated associations between socially prescribed and self-orientated perfectionism, and the social functioning of 510 preteens (Mage = 11.2). The study focused on predictions from the Perfectionism Social Disconnection Model (PSDM) by determining whether rejection sensitivity and social isolation, in that sequence, mediated the associations between both perfectionism types and mental health outcomes. Employing both survey and experimental methods, findings indicated that both types of perfectionism in preadolescence were associated with increased interpersonal difficulty, rejection sensitivity and feelings of social isolation, as well as higher levels of eating disorder symptoms, depression, and anxiety. Results from serial mediation analyses found general support for the theoretical predictions of the PSDM for socially prescribed perfectionism, and extending upon previous research, for self-orientated perfectionism. The age of the sample suggests that both forms of perfectionism may be important targets in programs to prevent the development of mental health problems.

D-cycloserine-augmented one-session treatment of specific phobias in children and adolescents.

BACKGROUND: D-Cycloserine has potential to enhance exposure therapy outcomes. The current study presents a preliminary randomized, placebo-controlled double-blind pilot trial of DCS-augmented one-session treatment (OST) for youth (7-14 years) with specific phobia. A secondary aim of this pilot study was to explore the effects of youth age and within-session fear reduction as potential moderators of DCS outcomes in order to generate hypotheses for a larger trial. It was hypothesized that DCS would be associated with greater improvements than placebo, that children (7-10 years) would have greater benefits than adolescents (11-14 years), and that DCS effects would be stronger for participants with the greater within-session fear reduction during the OST. METHODS: Thirty-five children and adolescents were randomized to either OST combined with DCS (n = 17), or OST combined with placebo (PBO; n = 18) and assessed at 1 week, 1 month, and 3 month following treatment. RESULTS: There were no significant pre- to post-treatment or follow-up benefits of DCS relative to placebo. Secondary analyses of age indicated that relative to PBO, DCS was associated with greater improvements for children (but not adolescents) on measures of severity at 1-month follow-up. Children in the DCS condition also showed significantly greater improvement to 1 month on global functioning relative to other groups. Conversely, adolescents had significant post-treatment benefits in the PBO condition on symptom severity measures relative to DCS, and adolescents in the DCS condition had significantly poorer functioning at 3 months relative to all other groups. Finally, there was a trend for within-session fear reduction to be associated with moderating effects of DCS, whereby greater reduction in fear was associated with greater functioning at one-month follow-up for children who received DCS, relative to PBO. LIMITATIONS: The study sample was small and therefore conclusions are tentative and require replication. CONCLUSIONS: Age and within-session fear reduction may be important moderators of DCS-augmented one-session exposure therapy, which requires testing in a fully powered randomized controlled trial.

Parental Control of the Time Preadolescents Spend on Social Media: Links with Preadolescents' Social Media Appearance Comparisons and Mental Health.

Time spent on social media and making online comparisons with others may influence users' mental health. This study examined links between parental control over the time their child spends on social media, preadolescents' time spent browsing social media, preadolescents' appearance comparisons on social media, and preadolescents' appearance satisfaction, depressive symptoms, and life satisfaction. Preadolescent social media users (N = 284, 49.1% female; aged 10-12) and one of their parents completed online surveys. Preadolescents, whose parents reported greater control over their child's time on social media, reported better mental health. This relationship was mediated by preadolescents spending less time browsing and making fewer appearance comparisons on social media. Parental control over time spent on social media may be associated with benefits for mental health among preadolescents.

Cognitive Behavioral Therapy for Anxiety and Depression in Children and Adolescents.

Anxiety and depression are highly prevalent disorders in youth. Assessments for these disorders in young people typically include clinician-administered instruments such as diagnostic interviews and parent- and youth-report questionnaires. Cognitive behavioral therapy is considered a well-established treatment for both anxiety and depression. Latest research in the field is exploring innovative methods to enhance treatment outcome and improve access to evidence-based treatments.

Adapting Cognitive Behavioral Therapy for Anxious Children and Adolescents.

This article discusses considerations for adapting cognitive behavioral therapy (CBT) techniques and processes with anxious children and adolescents. To successfully deliver CBT with this population, the therapist must take into consideration the child's developmental level and other contextual factors that may affect treatment outcome. Suggested adaptions to CBT include the use of rewards, technology, and interactive activities to increase child motivation and engagement. Moreover, dependent on the child's or adolescent's cognitive capacity, cognitive techniques will need to be simplified and concrete examples provided to increase children's understanding. It may be beneficial to have parents and/or schools involved in children's treatment to assist them to implement CBT strategies outside of the therapy setting. A case example is presented to illustrate the implementation of CBT with a child.

One session treatment for specific phobias in children: Comorbid anxiety disorders and treatment outcome.

BACKGROUND AND OBJECTIVES: One-Session Treatment (OST) for specific phobias has been shown to be effective in reducing phobia severity; however, the effect of different types of co-occurring anxiety disorders on OST outcomes is unknown. The present study examined (1) the effects of co-occurring generalized anxiety disorder (GAD), social anxiety disorder (SAD), or another non-targeted specific phobia (OSP) on the efficacy of OST for specific phobias, and (2) the effects of OST on these co-occurring disorders following treatment. METHODS: Three groups of 18 youth (7-15 years) with a specific phobia and comorbid GAD, SAD, or OSP were matched on age, gender, and phobia type. Outcome measures included diagnostic status and severity, and clinician rated improvement. RESULTS: All groups demonstrated an improvement in their specific phobia following treatment. Treatment was equally effective regardless of co-occurring anxiety disorder. In addition, comorbid anxiety disorders improved following OST; however, this effect was not equal across groups. The SAD group showed poorer improvement in their comorbid disorder than the GAD group post-treatment. However, the SAD group continued to improve and this differential effect was not evident six-months following treatment. LIMITATIONS: The current study sample was small, with insufficient power to detect small and medium effect sizes. Further, the sample only included a portion of individuals with primary GAD or SAD, which may have attenuated the findings. CONCLUSIONS: The current study demonstrated that co-occurring anxiety disorders did not interfere with phobia treatment. OST, despite targeting a single specific phobia type, significantly reduced comorbid symptomatology across multiple anxiety disorders.

Brief intensive CBT for pediatric OCD with E-therapy maintenance.

Cognitive behaviour therapy (CBT), incorporating exposure and response prevention (ERP), has received strong empirical support for the treatment of paediatric OCD, and moreover, is considered the first line treatment of choice (Geller & March, 2012). However, despite the availability of effective treatments for this chronic and debilitating disorder, only a small proportion of youth receive these evidence-based approaches. The present study aimed to examine the effectiveness of an intensive ERP-based treatment for youth OCD, using a multiple baseline controlled design. Children and youth (N=10; aged 11-16 years) with a primary diagnosis of OCD were randomly assigned to a 1- or 2-week baseline monitoring condition followed by the intervention. The efficacy of the intensive treatment, involving 1 session psychoeducation, 2-sessions ERP plus e-therapy maintenance was examined across parent- child- and clinician-rated measures at post-treatment and 6-month follow-up. Overall, there were significant reductions across time on almost all measures (except self-report anxiety), and moreover, the majority of the sample (80%) were considered reliably improved, and meeting clinically significant change. At post-treatment, 60% were in remission of symptoms, and at 6-month follow-up this increased to 70%. These findings provide strong support for intensive, time-limited approaches to ERP-based CBT for children and youth with OCD.