Effective reduction of anxiety in hospitalised children through bibliotherapy.

AIM: The process of being admitted to a hospital is widely recognised as a distressing encounter for children, frequently resulting in notable levels of anxiety. The main aim was to assess the effectiveness of bibliotherapy in reducing anxiety and to associate anxiety levels with demographic and clinical variables. METHODS: This study was conducted at a paediatric ward in a tertiary care hospital located in Tamil Nadu, India, for 3 months from 1 August 2023-30 October 2023. In this study, a one-group pre-test and post-test design was employed. A sample of 60 children, aged between 5 and 12 years, was recruited using a convenience sampling method. Spence Children Anxiety Scale was used for assessing anxiety levels. RESULTS: The mean age of the participants was 8.46 ± 1.91 years, and the majority, comprising 57%, were male. Following bibliotherapy, 72% of children showed mild anxiety, 28% showed moderate anxiety and no individual had considerable anxiety. Anxiety scores dropped 27%. Significant associations were found between anxiety reduction and variables such as age, educational status, and type of family. CONCLUSION: Bibliotherapy was notably effective in substantially reducing anxiety levels among children aged 5-12 years who were admitted to hospitals.

Do maternal anxiety and depressive symptoms predict anxiety in children with and without ADHD at 8 years?

Maternal anxiety and depression during pregnancy and early childhood have been associated with child anxiety and attention-deficit/hyperactivity disorder (ADHD). However, previous studies are limited by their short follow-up, few assessments of maternal symptoms, and by not including maternal and child ADHD. The present study aimed to fill these gaps by investigating whether maternal anxiety and depressive symptoms from pregnancy to child age 5 years increase the risk of child anxiety disorders at age 8 years. This study is part of the population-based Norwegian Mother, Father, and Child Cohort Study. Maternal anxiety and depressive symptoms were assessed by the Hopkins Symptom Checklist (SCL) six times from pregnancy through early childhood, and ADHD symptoms by the Adult Self-Report Scale (ASRS). At age 8 years (n = 781), symptoms of anxiety disorders and ADHD were assessed, and disorders classified by the Child Symptom Inventory-4. Logistic regression models estimated the risk of child anxiety depending on maternal symptoms. The mothers of children classified with an anxiety disorder (n = 91) scored significantly higher on the SCL (at all time points) and ASRS compared with the other mothers. In univariable analyses, maternal anxiety and/or depression and ADHD were associated with increased risk of child anxiety (odds ratios = 2.99 and 3.64, respectively), remaining significant in the multivariable analysis adjusted for covariates. Our findings link maternal anxiety, depression, and ADHD during pregnancy and early childhood to child anxiety at age 8 years.

Parental Overprotection and Locus of Control as the Mechanisms Explaining the Relationship Between Parent and Child Anxiety: A Multiple Mediation Model.

The study probes the role played by parenting control practices and parental locus of control in the relationship between parent and child anxiety. The study particularly aims at probing these matters in light of the parental gender-specific role, striving to improve our understanding of the differential etiological contribution of mothers' and fathers' anxiety and parental practices to child's anxiety. The study consisted of 316 parents (159 mothers and 157 fathers) who reported their own and their child's anxiety using valid instruments. The general path model used in the study exhibited an adequate fit to the data, generally confirming our theory regarding the direct and indirect associations between parent-child anxiety. Using SEM multiple group analysis for parental gender, a strong-direct unique association was found between parent and child anxiety. For mothers, this association was partially mediated by maternal overprotection. Finally, maternal external locus of control was positively associated with child anxiety, after accounting for the effects of all other maternal variables. The study's findings and limitations are profoundly discussed in light of parental gender differences.

Anxiety in the family: A five-wave random-intercept cross-lagged panel analysis of dynamic reciprocal associations between father, mother, and child anxiety.

This five-wave longitudinal study examined the between- and within-family dynamic associations between father, mother, and child anxiety and the moderating effects of child gender in Chinese culture. Five hundred and twenty-two father-mother dyads of children (59% boys; Mage T1 = 8.34 years) completed measures of father, mother, and child anxiety at five time points, 6 months apart. Between-family associations suggested that children whose parents had more anxiety symptoms showed higher anxiety levels, and mothers or fathers whose partners had more anxiety symptoms showed higher anxiety levels. At the within-family level, after periods with higher child anxiety symptoms, mothers reported higher anxiety symptoms and vice versa. However, no reciprocal associations were found between father and child anxiety and between father and mother anxiety. Finally, the associations between father, mother, and child anxiety did not differ across boys and girls. Our findings highlight the importance of distinguishing among between-family and within-family associations and help to develop effective programs to prevent anxiety disorders in families.

Combining CBT and sertraline does not enhance outcomes for anxious youth: a double-blind randomised controlled trial.

BACKGROUND: Anxiety disorders are the most prevalent mental disorder in children and young people. Developing effective therapy for these children is critical to reduce mental disorders across the lifespan. The study aimed to evaluate the efficacy of combining cognitive behavioural therapy (CBT) and sertraline (SERT) in the treatment of anxiety in youth, using a double-blind randomised control trial design. METHODS: Ninety-nine youth (ages 7-15 years) with an anxiety disorder were randomly allocated to either individual (CBT) and SERT or individual CBT and pill placebo and assessed again immediately and 6 months after treatment. RESULTS: There were no significant differences between conditions in remission of primary anxiety disorder or all anxiety disorders. Furthermore, there were no significant differences in rates of change in diagnostic severity, parent-reported anxiety symptoms, child-reported anxiety symptoms or life interference due to anxiety. CONCLUSIONS: The efficacy of CBT for children and adolescents with anxiety disorders is not significantly enhanced by combination with a short-term course of anti-depressants over and above the combined effects of pill placebo.

Diagnosing selective mutism: a critical review of measures for clinical practice and research.

Selective mutism (SM) is an anxiety disorder (prevalence 1-2%), characterized by the consistent absence of speaking in specific situations (e.g., in school), while adequately speaking in other situations (e.g., at home). SM can have a debilitating impact on the psychosocial and academic functioning in childhood. The use of psychometrically sound and cross-culturally valid instruments is urgently needed.The aim of this paper is to identify and review the available assessment instruments for screening or diagnosing the core SM symptomatology. We conducted a systematic search in 6 databases. We identified 1469 studies from the last decade and investigated the measures having been used in a diagnostic assessment of SM. Studies were included if original data on the assessment or treatment of SM were reported. It was found that 38% of published studies on SM reporting original data did not report the use of any standardized or objective measure to investigate the core symptomatology. The results showed that many different questionnaires, interviews and observational instruments were used, many of these only once. The Selective Mutism Questionnaire (SMQ), Anxiety Disorders Interview Schedule (ADIS) and School Speech Questionnaire (SSQ) were used most often. Psychometric data on these instruments are emerging. Beyond these commonly used instruments, more recent developed instruments, such as the Frankfurt Scale of SM (FSSM) and the Teacher Telephone Interview for SM (TTI-SM), are described, as well as several interesting observational measures. The strengths and weaknesses of the instruments are discussed and recommendations are made for their use in clinical practice and research.

An Updated Characterization of Childhood Selective Mutism: Exploring Clinical Features, Treatment Utilization, and School Services.

Selective mutism (SM) is a severe but understudied childhood anxiety disorder. Most epidemiological research on SM was conducted decades ago and is limited by small sample sizes. This study analyzes parent-reported clinical data from 230 children with diagnosed and suspected SM to provide current information about the presentation of this disorder. Overall, anxiety and social anxiety symptoms were elevated. Gender ratio, comorbidities and family history of psychopathology were generally aligned with previous research. However, age of onset and diagnosis were both earlier than previously reported, with an average delay of 2 years between onset and diagnosis. The majority of children received therapy and school accommodations for their SM, yet there was large variability in types of interventions. This is the largest survey of children with SM conducted primarily within the US and it constitutes the first systematic inquiry into interventions and accommodations received within clinical and school settings.

Associations Between Parents' Cognitions About Child Anxiety and Emotion Dysregulation in Clinically Anxious Children: The Unique Contribution of Fathers.

This study examined the influence of parental cognition, including attitudes, beliefs, and understanding of anxiety, on emotion dysregulation in children with anxiety disorder. A total of 47 clinically anxious children (6-17 years old) and their parents were involved in the current study. The mothers and fathers separately completed a self-reported questionnaire assessing their attitudes, beliefs, and understanding of their children's anxiety, while the children completed a self-report questionnaire assessing emotion dysregulation. Pearson correlation and hierarchical regression analyses were used for data analysis. The results indicated that only fathers' higher levels of unhelpful attitudes, beliefs, and understanding of anxiety were positively and significantly associated with greater emotion regulation (ER) difficulties in anxious children. Furthermore, fathers' unhelpful cognitions regarding anxiety uniquely predicted their children's emotion regulation difficulties. These findings highlight the importance of including fathers in preventive and therapeutic interventions in promoting ER abilities in children with anxiety disorder.

Guided parent-delivered cognitive behavioural therapy for Japanese children and parents: a single-arm uncontrolled study.

BACKGROUND: Guided parent-delivered cognitive behavioural therapy (GPD-CBT) is an effective low-intensity treatment for childhood anxiety disorder in Western countries and can increase access to evidence-based psychological therapies. AIM: This study aimed to examine its feasibility in a Japanese sample. METHOD: Twelve children with anxiety disorders and their parents participated in the study, and ten children and parents completed the program. Participants were assessed at pre-, post- and one-month follow-up using a diagnostic interview for anxiety disorders, self- and parent-report measures for anxiety, depression, parental behaviour, and parental anxiety. RESULTS: Four children (40% of completers) were free from their primary diagnoses immediately following the brief treatment, and seven children (70%) at the one-month follow-up. Changes in disorder severity, child and parent reported anxiety symptoms, and child reported depression symptoms were consistent with those found in Western trials of GPD-CBT and of Japanese trials of more intensive CBT for child anxiety disorders that involves both the child and the parent. Moderate increases were also found in child reported parental autonomy behaviours; however, there were only small changes in parent self-reported anxiety. CONCLUSION: These results support the potential of GPD-CBT to increase access to evidence-based treatments for anxiety disorders in Japanese children.

On return to school: disorder symptoms, stress at home and evaluations of school COVID-19 measures.

Background: Social restrictions during the COVID-19 pandemic had a major impact on the mental health of children. Yet, analyses on the mental health of younger children in the later course of the pandemic are scarce. The present study assessed 8- to 11-year-olds' internalising disorder symptoms during the last three weeks, from the third week of February through to the first week of March, of the 2021 national lockdown.Method: One hundred and forty-five pupils, including a subset of keyworkers' children who had face-toface schooling, completed the validated Revised Child Anxiety and Depression scales, items on COVID-related stress at home, and evaluations of home-learning and school's measures for reopening.Results: Symptoms increased with age in months and/or number of siblings. Girls reported more symptoms and home stress than boys did. Pupils who had face-to-face schooling were more satisfied with school measures and less satisfied with home learning compared with those who only had home learning. Hierarchical regression analyses corroborated the contributions of sociodemographic characteristics and found that home stress and school measures evaluations were associated most with major depression, generalised anxiety, and social phobia.Conclusion: Findings can contribute to mental health practice by promoting school communications and family and educator awareness of stressors, vulnerabilities and symptoms to boost pupils' readiness for school returns.

Psychometric properties of the Screen for Child Anxiety Related Disorders Thai version.

BACKGROUND: Anxiety disorders are the most common psychiatric disorders among children. Because of their internalizing nature, anxiety disorders are underdiagnosed and untreated. Therefore, self-report screening tools play an important role in the early identification of these cases. This study aimed to examine the psychometric properties of the Screen for Child Anxiety Related Disorders (SCARED)-Thai version in a clinical population. METHODS: One hundred and eight participants were enrolled from patients aged 9-16 years with any psychiatric diagnosis and their parents who visited a child and adolescent psychiatric clinic in Thailand. All the parent-child pairs completed the SCARED and the Strengths and Difficulties Questionnaire (SDQ)-emotional subscale. Clinical diagnosis of an anxiety disorder was endorsed through a standard clinical interview by certified child and adolescent psychiatrists blinded to the results of the SCARED and SDQ. Internal consistency, predictive validity, and convergent validity of the screens were assessed. RESULTS: This study found that the SCARED-Thai version had very good reliability, with internal consistency (Cronbach's alpha) of 0.913 for the SCARED-Child form and 0.925 for the SCARED-Parent form. With an optimal cut-off point of 23, the SCARED-Child version significantly distinguished anxious from non-anxious young people in clinical settings with a sensitivity of 0.74 and a specificity of 0.50, while the SCARED-Parent version had a sensitivity of 0.74 and a specificity of 0.67 at the same threshold. The convergent validity between the SCARED-Thai (total) and SDQ (emotional subscale) was at a highly suitable range (r = 0.81). CONCLUSION: The SCARED-Thai version exhibited good psychometric quality for identifying young people with comorbid anxiety disorders when used in clinical settings.

The association of different parenting styles among depressed parents and their offspring's depression and anxiety: a cross-sectional study.

BACKGROUND: Parenting styles play a critical role in children's development, especially for those in families with a depressed parent. To date, no study has explored whether youth perceptions of parenting style are heterogeneous in families with a depressed parent or whether heterogeneous parenting styles are associated with children's internalizing symptoms. METHODS: Participants were children aged 8-16 years who had a parent with major depressive disorder; they were enrolled through their parents, who were outpatients at two hospitals in Ningxia. Parenting styles were measured using the Parental Bonding Instrument. Youth depression and anxiety were measured using the Depression Self-Rating Scale for Children and the Screen for Child Anxiety-Related Emotional Disorders, respectively. We applied latent profile analysis to identify the subtypes of parenting styles with similar patterns. Differences between subtypes in relation to demographic variables and parenting style scores were calculated using one-way ANOVAs, Wilcoxon rank sum tests, and chi-squared tests. Bivariate logistic analyses were conducted to examine the associations between parental bonding subtypes and children's depression and anxiety. RESULTS: Four parenting styles were identified through latent profile analysis: care-autonomy, overprotection-indifference, indifference, and undifferentiated parenting. Youth with care-autonomy parents had a lower risk of depression (OR: 0.16; 95% CI: 0.06-0.41) and anxiety (OR: 0.22; 95% CI: 0.10-0.48), while indifference parenting increased children's risk of depression (OR: 5.29; 95% CI: 1.30-21.54) more than undifferentiated parenting. CONCLUSIONS: Children with a depressed parent had heterogeneous perceptions of parenting styles. Mothers' and fathers' parenting styles were largely congruent. Care-autonomy parenting (high care and high autonomy) may decrease children's risk of depression, whereas indifference parenting (low care and autonomy) may increase their risk of depression.

Mothers' and children's metacognitions and the development of childhood anxiety: a longitudinal investigation of transmission.

Theory and preliminary evidence suggests that parental beliefs and cognitions may be transmitted to their offspring. Transmission of maladaptive cognitions may play a role in the development of anxiety disorders in childhood. However, few studies have investigated such transmission using longitudinal designs. The objective of this study was to investigate the interaction between maternal and child metacognitions and their role in the development of childhood anxiety. We used a longitudinal design with self-report measures of maternal and child anxiety symptoms and metacognitions. Participants were 107 mothers and their children who were assessed when the children were between 7 and 12 years old and again 3 years later. Child metacognitions at baseline did not predict later child anxiety symptoms. Baseline maternal metacognitions approached significance in predicting anxiety symptoms in children at the follow-up, when controlling for known risk factors, including female gender and higher levels of anxiety in mother and child at baseline. Mediation analyses revealed that child metacognitions at baseline, as well as at follow-up fully mediated the relationship between maternal baseline metacognitions and child anxiety 3 years later. Examinations of how child and maternal metacognitions affect child anxiety levels after three years revealed that current levels of child metacognitions play a greater role in predicting child anxiety than child and maternal metacognitions at baseline.

Low intensity treatment for clinically anxious youth: a randomised controlled comparison against face-to-face intervention.

Methods to deliver empirically validated treatments for anxious youth that require fewer therapist resources (low intensity) are beginning to emerge. However, the relative efficacy of low-intensity treatment for youth anxiety against standard face-to-face delivery has not been comprehensively evaluated. Young people aged 6-16 years with a primary anxiety disorder (N = 281) were randomly allocated to treatment delivered either face-to-face or in a low-intensity format. Face-to-face treatment comprised ten, 60-min sessions delivered by a qualified therapist. Low intensity comprised information delivered in either printed (to parents of children under 13) or electronic (to adolescents aged 13 +) format and was supported by up to four telephone sessions with a minimally qualified therapist. Youth receiving face-to-face treatment were significantly more likely to remit from all anxiety disorders (66%) than youth receiving low intensity (49%). This difference was reflected in parents' (but not child) reports of child's anxiety symptoms and life interference. No significant moderators were identified. Low intensity delivery utilised significantly less total therapist time (175 min) than face-to-face delivery (897 min) and this was reflected in a large mean difference in therapy costs ($A735). Standard, face-to-face treatment for anxious youth is associated with significantly better outcomes than delivery of similar content using low-intensity methods. However, the size of this difference was relatively small. In contrast, low-intensity delivery requires markedly less time from therapists and subsequently lower treatment cost. Data provide valuable information for youth anxiety services.Clinical trial registration information: A randomised controlled trial of standard care versus stepped care for children and adolescents with anxiety disorders; https://anzctr.org.au/ ; ACTRN12612000351819.

Efficacy of psychological interventions for selective mutism in children: A meta-analysis of randomized controlled trials.

BACKGROUND: Selective mutism is a rare childhood anxiety disorder characterized by a consistent failure to speak in certain social situations where speech is expected, despite fluent speech in other situations. The purpose of this meta-analysis was to investigate the efficacy of psychological interventions for selective mutism in randomized controlled trials (RCTs). METHODS: Five RCTs with a total of 233 participants were analysed using a random-effects model. A quality assessment of the included studies revealed that psychometrically sound measures and treatment manuals were used across all studies. RESULTS: The results of the analyses showed psychological interventions to be more effective than no treatment, with the overall weighted effect size of g = 0.87, indicating a large mean treatment effect. This effect did not significantly differ with whether only selective mutism specific or nonselective mutism specific measures were included in the analysis. CONCLUSIONS: These findings provide support for the efficacy of psychological treatment for selective mutism. Future research could examine the effects of the successful treatments identified in this meta-analysis when compared with a psychological placebo or another bona fide treatment.

COVID-related fear maintains controlling parenting behaviors during the pandemic.

The direct threat posed by the 2019 novel coronavirus (COVID-19), uncertainty surrounding best safety practices, and secondary consequences of the virus have led to widespread stress and declining mental health across communities and individuals. These stresses may impact parenting behaviors, potentially leading to negative consequences for children. Controlling parenting behaviors increase in the face of perceived environmental threat and are associated with adverse mental health outcomes for children; however, determinants of parenting behaviors have not been investigated during the COVID-19 pandemic. The current study prospectively evaluated parenting behaviors during the pandemic (N=87). Results indicated that all negative affect emotions investigated were positively associated with controlling parenting behaviors. However, only COVID-related fear predicted changes in controlling parenting behaviors across timepoints. Specifically, although controlling parenting behaviors decreased in the overall sample from time 1 to time 2, higher COVID-related fear scores at time 1 predicted maintenance of high levels of controlling parenting behaviors at time 2. Additionally, this effect was specific to controlling, as opposed to more adaptive, parenting behaviors. Future studies should investigate the association between parents' COVID-related fear, controlling parenting behaviors, and adverse mental health outcomes for children in the context of the COVID-19 pandemic.

Do Maternal Parenting Behaviors Indirectly Link Toddler Dysregulated Fear and Child Anxiety Symptoms?

Dysregulated fear (DF), display of high-fear in low-threat contexts, has been shown to predict child anxiety development. Maternal protective, comforting, and intrusive behaviors have also been linked to child anxiety development and may be candidate mechanisms linking DF to anxiety. First, the relation between DF (age 2) and child separation anxiety (age 4) as indirectly linked by maternal protective, comforting, and intrusive behaviors was investigated. Second, the relation between DF and social anxiety (age 4) through parenting behaviors was investigated. Results suggested DF significantly predicted child separation anxiety through maternal intrusive behaviors, above and beyond protective and comforting behaviors. Neither protective nor comforting parenting behavior served as indirect effects between DF and separation anxiety. No parenting behaviors were found to indirectly link the relation between DF and social anxiety. Results suggest that multiple parenting behaviors are involved as environmental mechanisms by which DF predicts separation anxiety.

The Pediatric Autism Spectrum Therapy Observation System: Development, Psychometric Properties, and Sensitivity to Treatment.

An observational coding system was developed to track clinical change in children with autism spectrum disorder (ASD) during psychotherapy. The Pediatric Autism Spectrum Therapy Observation System (PASTOS) consists of 23 items divided into 5 subscales and is used to rate child behaviors in individual psychotherapy sessions. Manual-based cognitive behavioral therapy session transcripts of 22 children diagnosed with ASD (IQ > 70) and a concurrent anxiety disorder (M = 9.41 years, SD = 1.56 years) enrolled in a randomized, controlled trial were coded. Results suggested that the PASTOS exhibited promising interrater reliability, internal consistency, convergent validity at post-treatment, and treatment sensitivity. The PASTOS may be a useful tool for studying process and outcome in psychotherapy research on children with ASD.

Assessment of the cognitive attentional syndrome in children: an adaptation of the CAS-1.

BACKGROUND: Research suggests that the metacognitive model is applicable to clinical child populations. However, few measures related to the model are available for younger age groups. A key concept of the model is the cognitive attentional syndrome (CAS), which encompasses the individual's worry and rumination, maladaptive coping strategies, and metacognitive beliefs. While the CAS has been successfully measured in adults, this has not yet been attempted in children. AIMS: The aim of this study was to adapt a measure of the CAS for use with children and investigate the measure's associations with anxiety, worry, depression and metacognitions. METHODS: Our study included 127 children with anxiety disorders aged 7-13 years. The adult measure of CAS was adapted for use with children and administered at pre- and post-treatment. We examined the correlations between variables and the ability of the CAS measure to explain variance in anxious symptomatology, as well as the measure's sensitivity to treatment change. RESULTS: The adapted measure, CAS-1C, displayed strong associations with overall anxiety, depression, worry and metacognitions. The CAS-1C explained an additional small amount of variance in anxiety and worry symptoms after accounting for metacognitions, which may be due to the measure also assessing thinking styles and coping strategies. Furthermore, the measure displayed sensitivity to treatment change. CONCLUSIONS: The child measure of the CAS is a brief tool for collecting information on metacognitive beliefs and strategies that maintain psychopathology according to the metacognitive model, and it can be used to monitor treatment changes in these components.

Parental and Child Anxiety Perioperatively: Relationship, Repercussions, and Recommendations.

PURPOSE: Elective surgical procedures predictably cause stress and anxiety for children and their parents. This can have a negative effect on the child's short-term and long-term psychological and physiological outcomes. This narrative review examines perioperative child anxiety and existing interventions to reduce child and parent perioperative anxiety. The aim was to identify a need and gaps in knowledge for future study. DESIGN: Peer-reviewed articles were examined to identify themes in the literature on interventions in place to reduce child and parent perioperative anxiety and to identify any gaps in knowledge for future study. METHODS: A narrative review of 62 peer-reviewed articles was conducted. FINDINGS: Evidence of themes aimed at lowering perioperative child anxiety using medication, cognitive educational, and play therapy approaches emerged through the literature search. A relationship between parental anxiety and the effect on the child's anxiety was supported, yet interventions that target the parent were limited cognitive education interventions and were found to be implemented only in a small number of hospitals. CONCLUSIONS: A clear gap is the lack of research on the effects of parental interventions on the short-term and long-term negative behavioral and physiological outcomes of child perioperative anxiety. Research is needed to further explore the effect of a preoperative psychotherapeutic intervention to allow parents to express anxieties and discuss them with a trained professional in the absence of children. A systematic review or further research would help determine if a psychotherapeutic intervention for the parents would lower child anxiety perioperatively.