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.

N-methyl-D-aspartate Partial Agonist Enhanced Intensive Cognitive-Behavioral Therapy of Panic Disorder in Adolescents.

Panic disorder (PD) can result in significant functional impairment. Studies of cognitive behavioral therapy (CBT) for PD have demonstrated response rates ranging between 38 and 65%. D-cycloserine (DCS), a partial NMDA agonist, may enhance the effects of exposure-based therapy for PD in adults; however, no studies have examined its effect in adolescents with PD. This study examined the feasibility and acceptability of the use of DCS to augment intensive CBT for PD in adolescents. Twenty-four adolescents (ages 12-17) participated in this randomized, double-blinded, placebo-controlled trial, to compare CBT + DCS to CBT + placebo. The results demonstrated the feasibility and acceptability of the treatment to participants. No significant differences were found between the two groups, but both groups showed significant improvement. This is the first investigation of DCS in the treatment of PD in adolescents and it provides initial support for a more extensive study of DCS augmentation of CBT among adolescents with PD.

Development of a scale to evaluate young children's responses to uncertainty and low environmental structure.

Intolerance of Uncertainty (IU), defined as the dispositional interpretation of uncertain or ambiguous events as stressful and problematic, has been linked to excessive worry and other anxiety-related problems in adults and youth. IU has been conceptualized as a vulnerability factor for excessive worry and anxiety, but the historical absence of a supported measure of IU in young children has hampered longitudinal research needed to evaluate temporal relationships between IU and anxiety and the differential developmental pathways of IU leading to different anxiety disorders and depression. The present study evaluated the psychometric properties of a newly developed 17-item parent-report measure of younger children's Responses to Uncertainty and Low Environmental Structure (i.e., the RULES questionnaire). We examined the preliminary structure, reliability, and validity of the RULES within a treatment-seeking sample of children aged 3-10 (N=160) with anxiety. Findings from an exploratory factor analysis supported a one-factor model that retained all 17 items. The RULES demonstrated strong internal consistency, and predictive, convergent, and divergent validity. In this early childhood sample, the RULES also showed stronger associations with anxiety than did a previously supported measure of IU developed for older youth, and showed preliminary sensitivity to treatment-related change. Findings provide preliminary psychometric support for the RULES as a parent-report measure of children's responses to uncertainty and low environmental structure that may inform etiologic models of anxiety.

Patterns and predictors of comorbidity of DSM-IV anxiety disorders in a clinical sample of children and adolescents.

This study examined the comorbidity of anxiety disorders and its predictors in a large, clinically referred sample of children and adolescents. Participants were 608 youth aged 4-18 years presenting at a large anxiety clinic for assessment and treatment of anxiety or mood related problems. The diagnoses were determined using the Anxiety Disorder Interview Schedule, Child/Parent versions. Sixty three percent of the participants had an additional diagnosis of an anxiety or depressive disorder. Comorbidity patterns differed based on the principal diagnostic category. Older children and females with anxiety were more likely to have a comorbid anxiety disorder. The presence of a medical condition increased the odds of having a comorbid anxiety disorder as well. This is the largest clinical sample of children and adolescents in which comorbidity of emotional disorders has been examined. Understanding the common patterns of comorbidity has important implications for future classification and treatment planning of childhood anxiety disorders.

Factor structure of the Children's Behavior Questionnaire in children with Williams syndrome.

To examine the factor structure of temperament in 5-10-year-olds with Williams syndrome, an exploratory factor analysis was conducted on the responses of parents of 192 children on the children's behavior questionnaire. Four factors were identified. Two corresponded to factors reported for typically developing children: effortful control and extraversion/surgency and two corresponded to the temperament constructs of withdrawal/inhibition and irritability/frustration and activity, observed in typically developing infants. Parents of 109 of the 192 participants also completed the anxiety disorders interview schedule, parent version. Children with an anxiety disorder other than specific phobia differed significantly from children without an anxiety disorder on all factors except extraversion/surgency. Children with attention deficit hyperactivity disorder (ADHD) differed significantly from children without ADHD on effortful control and extraversion/surgency.

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

PURPOSE: To determine the prevalence of anxiety disorders in children with Williams syndrome (WS), their sibling closest in age, and their mothers and to examine the predictors of anxiety in these groups. METHODS: The prevalence of anxiety disorders was assessed and compared to that in the general population. RESULTS: 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. CONCLUSIONS: 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.

Parental control in the etiology of anxiety.

Anxiety disorders are among the most prevalent forms of adult and childhood psychiatric disorders, and they are highly familial. However, the mechanisms of transmission remain unclear. One familial characteristic that may promote the development of anxiety is the construct of parental control. This paper provides a conceptual overview of the construct of control in the parenting and anxiety literatures, reviews existing literature on control in anxious families, and reviews current conceptual models of and developmental approaches to anxiety. Based on the current empirical literature, an elaborated model that takes child developmental level into consideration is proposed in order to provide a better understanding of the role of parental control in the development of anxiety.

Comorbid psychiatric disorders in children with autism: interview development and rates of disorders.

The Kiddie Schedule for Affective Disorders and Schizophrenia was modified for use in children and adolescents with autism by developing additional screening questions and coding options that reflect the presentation of psychiatric disorders in autism spectrum disorders. The modified instrument, the Autism Comorbidity Interview-Present and Lifetime Version (ACI-PL), was piloted and frequently diagnosed disorders, depression, ADHD, and OCD, were tested for reliability and validity. The ACI-PL provides reliable DSM diagnoses that are valid based on clinical psychiatric diagnosis and treatment history. The sample demonstrated a high prevalence of specific phobia, obsessive compulsive disorder, and ADHD. The rates of psychiatric disorder in autism are high and are associated with functional impairment.

Prevalence of psychiatric disorders in 4 to 16-year-olds with Williams syndrome.

The prevalence of a range of DSM-IV psychiatric disorders in a sample of 119 4-16-year-old children with Williams syndrome (WS) was assessed using a structured diagnostic interview with their parents. Most children (80.7%) met criteria for at least one DSM-IV diagnosis. The most prevalent diagnoses were Attention Deficit/Hyperactivity Disorder (ADHD; 64.7%) and Specific Phobia (53.8%). There was a significant shift in Predominant Type of ADHD as a function of CA, from Combined for the youngest group (ages 4-6 years) to Inattentive for the oldest group (ages 11-16 years). The prevalence of Generalized Anxiety Disorder (GAD) increased significantly with age. These findings are another step toward defining the behavioral phenotype of WS.

Examination of the utility of the Beck Anxiety Inventory and its factors as a screener for anxiety disorders.

The Beck Anxiety Inventory (BAI) and the Anxiety Disorders Interview Schedule (ADIS-IV) were administered to 193 adults at a major Midwestern university recruited from an anxiety research and treatment center. The BAI and its four factor scores were compared from individuals with a primary diagnosis of generalized anxiety disorder (GAD), specific or social phobia, panic disorder with or without agoraphobia, obsessive-compulsive disorder (OCD), and no psychiatric diagnosis. The cut scores on the BAI and its factors, their sensitivity, specificity, as well as positive and negative predictive values were calculated for each group. The results of this study support previous findings that the strongest quality of the BAI is its ability to assess panic symptomatology. The present study also expands on this notion by establishing that the BAI can be used as an efficient screening tool for distinguishing between individuals with and without panic disorder.

Exploratory subsetting of autism families based on savant skills improves evidence of genetic linkage to 15q11-q13.

OBJECTIVE: Autism displays a remarkably high heritability but a complex genetic etiology. One approach to identifying susceptibility loci under these conditions is to define more homogeneous subsets of families on the basis of genetically relevant phenotypic or biological characteristics that vary from case to case. METHOD: The authors performed a principal components analysis, using items from the Autism Diagnostic Interview, which resulted in six clusters of variables, five of which showed significant sib-sib correlation. The utility of these phenotypic subsets was tested in an exploratory genetic analysis of the autism candidate region on chromosome 15q11-q13. RESULTS: When the Collaborative Linkage Study of Autism sample was divided, on the basis of mean proband score for the "savant skills" cluster, the heterogeneity logarithm of the odds under a recessive model at D15S511, within the GABRB3 gene, increased from 0.6 to 2.6 in the subset of families in which probands had greater savant skills. CONCLUSIONS: These data are consistent with the genetic contribution of a 15q locus to autism susceptibility in a subset of affected individuals exhibiting savant skills. Similar types of skills have been noted in individuals with Prader-Willi syndrome, which results from deletions of this chromosomal region.

A principal components analysis of the Autism Diagnostic Interview-Revised.

OBJECTIVE: To develop factors based on the Autism Diagnostic Interview-Revised (ADI-R) that index separate components of the autism phenotype that are genetically relevant and validated against standard measures of the constructs. METHOD: ADIs and ADI-Rs of 292 individuals with autism were subjected to a principal components analysis using VARCLUS. The resulting variable clusters were validated against standard measures. RESULTS: Six clusters of variables emerged: spoken language, social intent, compulsions, developmental milestones, savant skills and sensory aversions. Five of the factors were significantly correlated with the validating measures and had good internal consistency, face validity, and discriminant and construct validity. Most intraclass correlations between siblings were adequate for use in genetic studies. CONCLUSION: The ADI-R contains correlated clusters of variables that are valid, genetically relevant, and that can be used in a variety of studies.