Neglecting the impact of childhood neglect: A scoping review of the relation between child neglect and emotion regulation in adulthood.

BACKGROUND: Childhood neglect, a prevalent form of child abuse, has significant short-term and long-term consequences on mental health. OBJECTIVE: This scoping review aimed to provide an overview of existing evidence on childhood neglect in relation to emotion regulation in adulthood. PARTICIPANTS AND SETTING: Participants were not individually evaluated but we provided future directions for research based on the overview of studies. METHODS: A systematic search strategy was conducted, resulting in the analysis of 25 selected articles. We performed an inventory of existing evidence to identify knowledge gaps. RESULTS: The review identified the need for future research to differentiate neglect from other forms of child abuse. Longitudinal studies tracking individuals from childhood to adulthood are recommended to understand developmental trajectories and continuity. Diverse samples, with various ages, genders, and (socio-economic) backgrounds, should be included for enhanced generalizability. Geographical representation should be expanded to capture cultural variations in the association between neglect and adult emotion regulation. Furthermore, investigating other psychopathologies beyond depression in relation to neglect and emotion regulation is suggested. CONCLUSIONS: Overall, this scoping review highlights the limited knowledge regarding the link between childhood neglect and adult emotion regulation and provides valuable recommendations for advancing research in this field.

An imagery rescripting based intervention in children and adolescents who endured a negative life event: A pilot study, satisfaction and feasibility survey.

BACKGROUND AND OBJECTIVES: ImRs, a technique targeting distressing mental images, has shown promise in adult psychiatric treatment. Initial research indicates positive outcomes in children, with potential for reducing mental health care burden. This pilot study examined the use of Imagery Rescripting (ImRs) as an intervention for children who have experienced negative life events. We aimed to assess short-term emotional changes, participant satisfaction, and the feasibility of a larger-scale ImRs intervention for children. METHODS: We employed a pre-posttest within-group design, and included 35 children (ages 5-18) who experienced negative life events, as well as 12 coaches. ImRs targeted distressing images related to negative events. Measurement tools included Visual Analogue Scales for distress and emotions, along with satisfaction surveys for both children and coaches. The feasibility of a larger-scale study was also explored through a coach questionnaire. RESULTS: We found significant short-term improvements for all emotional states, with large effects for anxiety, sadness, and happiness, and a moderate effect for anger. Children reported fair levels of satisfaction with the intervention's acceptability and complexity. Coaches expressed high levels of satisfaction with the intervention as a whole and with its characteristics. Coaches were also strongly motivation for future, more in-depth research. An important limitation of this pilot study was the lack of a control group. In light of the promising results, more extensive studies with diagnostic information, multiple measures, and follow-up assessments are warranted. CONCLUSION: Altogether, imagery rescripting based interventions seem a promising venue for children who experienced negative events.

Psychometric Properties of the Dutch Child Avoidance Measure.

Avoidance is considered a hallmark feature of child anxiety, but convenient measures are scarce. This study examined the psychometric properties of the Child Avoidance Measure (CAM) in a Dutch population, focusing mainly on the child-version. We included children 8 to 13 years old from a community sample (n = 63, longitudinal design) and a sample of high-anxious children (n = 92, cross-sectional design). Regarding the child-version, the internal consistencies were acceptable to good with moderate test-retest reliability. The validity analyses showed encouraging results. High-anxious children had higher avoidance scores than children from a community sample. Regarding the parent-version, both the internal consistency and test-retest validity were excellent. Overall, this study confirmed the sound psychometric properties and usefulness of the CAM. Future studies should focus on the psychometric properties of the Dutch CAM in a clinical sample, assess its ecological validity more extensively, and examine more psychometric features of the parent-version.

Cumulative Risk Exposure and Social Isolation as Correlates of Carer and Child Mental Health During the COVID-19 Pandemic: An Online Study with Families from Various Europeans Countries.

This study adopted a cumulative risk approach to examine the relations between various domains of risk factors (i.e., social isolation and home confinement, other pandemic-related risk factors, and pre-existing psychosocial risk factors) and carers' and children's mental health during the first wave of the COVID-19 pandemic in Europe. The sample consisted of 1475 carers of 6- to 16-year-old children and adolescents residing in five European countries (Portugal, United Kingdom, Romania, Spain, and The Netherlands) who completed an online survey. The results showed that each of the three domains of adversity accounted for unique variation in carers' and children's mental health outcomes. Also, the results indicated that pre-existing psychosocial risk factors moderated the relationship between pandemic-related risk factors and children and carers' anxiety and between social isolation and confinement and carers' well-being. Simple slopes analysis suggested a stronger relationship between these domains of adversities and mental health outcomes in already more vulnerable families. It is important to consider the implications of social isolation measures and confinement for families' mental health, paying special attention to families with pre-existing psychosocial vulnerabilities.

Validity and Reliability of Youth Anxiety Measure for DSM-5 in Iranian Non-Clinical Children and Adolescents.

The present study aimed to explore the validity and reliability of the Persian version of the Youth Anxiety Measure for DSM-5 (YAM-5). Two groups of non-clinical children and adolescents were recruited. The first group (n = 520) was recruited via 4 schools of Tehran, Iran, and only completed the YAM-5. The second group (n = 557) was recruited via 4 schools of Tabriz, Iran. In addition to the YAM-5, they completed another anxiety scale and a depression scale. The exploratory factor analysis of data of the first group revealed a five factor model similar to the original model of the scale. The confimatory factor analysis showed that the five factor model fit with the data of second group. Also, the convergent validity was supported. The current findings, thus, provide support for validity and reliability of Persian version of the YAM-5 in a nonclinical sample of children and adolescents in Iran.

Development of 'learn to dare!': An online assessment and intervention platform for anxious children.

BACKGROUND: Many children and adolescents suffer from problematic levels of anxiety, but the multitude of these children do not receive an intervention. It is of importance to increase the accessibility and availability of child anxiety interventions, as to identify and treat anxious children early and successfully. Online platforms that include information, assessments and intervention can contribute to this goal. Interventions for child anxiety are frequently based on Cognitive Behavioral Therapy, because of its strong theoretical and empirical basis. However, the working mechanisms of Cognitive Behavioral Therapy in children are poorly studied. To our knowledge, mediation studies on child anxiety are non-existent regarding online Cognitive Behavioral Therapy. METHODS: We will aim at children aged 8-13 years with problematic anxiety. We recruit these children via the community setting, and refer them to our online platform 'Learn to Dare!' (in Dutch: 'Leer te Durven!'), https://leertedurven.ou.nl, where information about child anxiety and our research is freely accessible. After an active informed consent procedure, the participants can access the screening procedure, which will select the children with problematic anxiety levels. Thereafter, these children will be randomized to an online intervention based on Cognitive Behavioral Therapy (n = 120) or to a waitlist control (WL, n = 120). The intervention consists of 8 sessions with minimal therapist support and contains psycho-education, exposure (based on inhibitory learning), cognitive restructuring and relapse prevention. Child anxiety symptoms and diagnoses, cognitions, avoidance behavior and level of abstract reasoning are measured. Assessments are the same for both groups and are performed before and after the proposed working mechanisms are offered during the intervention. A follow-up assessment takes place 3 months after the final session, after which children in the waitlist control group are offered to take part in the intervention. DISCUSSION: This protocol paper describes the development of the online platform 'Learn to Dare!', which includes information about child anxiety, the screening procedure, anxiety assessments, and the online intervention. We describe the development of the online intervention. Offering easy accessible interventions and providing insight into the working mechanisms of Cognitive Behavioral Therapy contributes to optimizing Cognitive Behavioral Therapy for anxious youth.

Challenging anxious cognitions or accepting them? Exploring the efficacy of the cognitive elements of cognitive behaviour therapy and acceptance and commitment therapy in the reduction of children's fear of the dark.

Anxiety is highly prevalent in pre-adolescent children. Distorted cognitions are characteristic for dysfunctional levels of anxiety. However, applying cognitive elements in pre-adolescent children cannot be fully ascertained, as it is not until adolescence before children can apply logical and abstract reasoning in a sophisticated manner. Cognitive behaviour therapy (CBT) and acceptance and commitment therapy (ACT) both target distorted cognitions. Whereas CBT encourages children to change the content of negative cognitions by applying cognitive restructuring, ACT stimulates youth to have a more accepting attitude towards these thoughts by applying cognitive defusion. The current study examined the efficacy of applying cognitive elements and compared the cognitive elements of CBT and ACT in pre-adolescent children. We included no behavioural elements to specifically study the developmental appropriateness of the cognitive elements in this age group. Highly anxious children, aged 8-12 years were randomised to a 30-minute cognitive restructuring (n = 21) or cognitive defusion intervention (n = 22). Subjective fear of the dark levels, behavioural darkness toleration, and comprehension and fun associated with the interventions were assessed. Both interventions had a significantly positive impact on children's fear of the dark. Cognitive restructuring led to more favourable results on subjective fear than cognitive defusion, no differences were found for darkness toleration.

The Youth Anxiety Measure for DSM-5 (YAM-5): Development and First Psychometric Evidence of a New Scale for Assessing Anxiety Disorders Symptoms of Children and Adolescents.

The Youth Anxiety Measure for DSM-5 (YAM-5) is a new self- and parent-report questionnaire to assess anxiety disorder symptoms in children and adolescents in terms of the contemporary classification system. International panels of childhood anxiety researchers and clinicians were used to construct a scale consisting of two parts: part one consists of 28 items and measures the major anxiety disorders including separation anxiety disorder, selective mutism, social anxiety disorder, panic disorder, and generalized anxiety disorder, whereas part two contains 22 items that focus on specific phobias and (given its overlap with situational phobias) agoraphobia. In general, the face validity of the new scale was good; most of its items were successfully linked to the intended anxiety disorders. Notable exceptions were the selective mutism items, which were frequently considered as symptoms of social anxiety disorder, and some specific phobia items especially of the natural environment, situational and other type, that were regularly assigned to an incorrect category. A preliminary investigation of the YAM-5 in non-clinical (N = 132) and clinically referred (N = 64) children and adolescents indicated that the measure was easy to complete by youngsters. In addition, support was found for the psychometric qualities of the measure: that is, the internal consistency was good for both parts, as well as for most of the subscales, the parent-child agreement appeared satisfactory, and there was also evidence for the validity of the scale. The YAM-5 holds promise as a tool for assessing anxiety disorder symptoms in children and adolescents.

Psychological Inflexibility and Child Anxiety.

Psychological flexibility is the main outcome of acceptance commitment therapy. Insight into the usefulness of measuring psychological flexibility is an important step to enable studies on the effectiveness of acceptance commitment therapy in middle-aged children (8-10 years). For this purpose, we examined the factor structure, the construct validity and the reliability of the Avoidance and Fusion Questionnaire for Youth. The Avoidance and Fusion Questionnaire for Youth taps psychological inflexibility (the opposite of psychological flexibility) in children and adolescents. Although the questionnaire has been extensively validated in older children, this is not the case for middle-aged children. The Avoidance and Fusion Questionnaire for Youth contains 17 items and is constituted of the subscales cognitive fusion, experiential avoidance and behavioral ineffectiveness. A shortened 8-item version also exists, the Avoidance and Fusion Questionnaire for Youth-8, which does not distinguish between these subscales. We performed a confirmatory factor analysis. Additionally, we assessed the relationship between psychological flexibility and child anxiety. Children, aged 8-10 years, were recruited via regular primary schools. Of the 459 approached children, 267 (58 %) parents signed informed consents for their children (Age: M = 9.18; SD = .79; Sex: nboys = 137, 51 %). Children completed the questionnaires during regular classes. In this sample, the 17-item version of the Avoidance and Fusion Questionnaire for Youth was less appropriate for measuring psychological inflexibility than the 8-item version. Furthermore, we found a significant positive relationship between psychological inflexibility and child anxiety. We argue that acceptance commitment therapy would be an interesting candidate for intervening early on in dysfunctional child anxiety, as acceptance commitment therapy's cognitive elements require cognitive skills that children are likely to master early on.

Factors associated with the referral of anxious children to mental health care: the influence of family functioning, parenting, parental anxiety and child impairment.

This study aims to identify factors that predict the mental health care referral of anxious children. In total, 249 children and families, aged 8-13 years, participated: 73 children were referred with anxiety disorders to mental health care [mean (M) age = 10.28, standard deviation (SD) = 1.35], 176 non-referred anxious children recruited in primary schools (M age = 9.94, SD = 1.22). Child anxiety and other disorders were assessed with semi-structured interviews. Child anxiety symptoms, behavioural problems, parental anxiety, the parenting styles overprotection, autonomy encouragement, rejection, and the family functioning dimensions control and relational functioning, were assessed with child, father and mother report on questionnaires. The summed interference rating of children's anxiety disorders was a predictor of referral, consistent over child and parent reports, but not comorbidity. Most family and parenting variables did not predict referral, nor differed between the referred and non-referred sample. Contrary to our hypothesis, maternal self-reported anxiety decreased the odds of referral and child reported parental autonomy granting increased, while child reported overprotection decreased the odds of referral. The impairment for the child due to the number and severity of their anxiety disorder(s) is, based on child, mother and father report associated with referral. This indicates that those who need it most, receive clinical treatment.

An explorative cost-effectiveness analysis of school-based screening for child anxiety using a decision analytic model.

Anxiety in children is highly frequent and causes severe dysfunction. Various studies have used screening procedures to identify high-anxious children and offer them indicated prevention, but the cost-effectiveness of these screening procedures in combination with a preventive intervention has never been examined. This study compared four potential strategies in relation to the prevention of child anxiety: (1) a one-time school-based screening which offers a child-focused intervention, (2) the screening and offering of a parent-focused intervention, (3) the screening and differentially offering a child- or parent-focused intervention, depending on whether or not the parents are anxious themselves, and (4) or doing nothing. An economic evaluation from a societal perspective (i.e. including direct healthcare costs, direct non-healthcare costs, indirect costs, and out-of-pocket costs), using a decision-analytic model. The model was based on the real-world 2-year participation rates of screening and intervention, and real-world costs and effects of high- and median-anxious children (aged 8-12) from regular primary schools. Incremental cost-effectiveness ratios were calculated, and several secondary and one-way sensitivity analyses were performed. The strategy of doing nothing and the strategy of screening and differentially offering the child- or parent-focused intervention, depending on parental anxiety levels were both worthwhile, with the latter strategy costing relatively little extra money compared to doing nothing. In conclusion, some evidence for the cost-effectiveness of screening and intervening was found. Screening and offering a parent-focused intervention to children of anxious parents, and a child-focused intervention to children of non-anxious parents, were found to be the most cost-effective approach.

Cost-effectiveness of child-focused and parent-focused interventions in a child anxiety prevention program.

In this study, the cost-effectiveness of three indicated anxiety prevention strategies was examined from a societal perspective. Children (aged 8-12) were recruited via primary schools, selecting children scoring as high-anxious on an anxiety screening questionnaire. Participating children and their parents were randomized to a child--a parent-focused, or non-intervention group. All groups completed a diagnostic interview and standardized cost-diaries at pretest, and 1- and 2-year follow-up. Incremental cost-effectiveness ratios per 'ADIS improved' child (based on diagnostic information) were calculated and cost-effectiveness acceptability curves and frontiers were plotted. The base-case and most secondary analyses showed it would be cost-effective to offer high-anxious children an intervention, and the parent-focused intervention to be the optimal strategy at lower monetary threshold values than the child-focused intervention and when parents were anxious. The child-focused intervention was dominant when analyses were performed from a healthcare perspective, for boys, and for children of grades 7-8 of primary school.

Efficacy of child-focused and parent-focused interventions in a child anxiety prevention study.

This study examined anxiety development in median- (n = 74) and high-anxious children (n = 183) aged 8-13, the effect of parent- and child-focused preventive interventions on child/parental anxiety, and the effect of parental anxiety on child anxiety. High-anxious children were randomized into a parent-focused (n = 69), child-focused (n = 58) or non-intervention (n = 56) group. Families completed a pretest and 1- and 2-year follow-ups. Children selected as high-anxious or at risk were found to remain more susceptible to having anxiety problems and developing anxiety disorders than median-anxious children. Both intervention types showed favorable outcomes compared to no intervention on the number of "ADIS improved" children. These findings underline the need for effective preventive interventions for child anxiety. General improvements over time were found for symptoms of child and parental anxiety, however, and parental anxiety did not predict improvement in child anxiety after controlling for intervention. Therefore, it may not be necessary to focus on parental anxiety in interventions aimed at preventing child anxiety.

Risk factors occurring during pregnancy and birth in relation to brain functioning and child's anxiety.

OBJECTIVE: This study examined whether the most objective risk factors during pregnancy (prenatal) and delivery (perinatal) precede child's anxiety, and whether these factors exerted their influence via child's non-specific cerebral functioning. METHOD: Median-anxious (n=82) and high-anxious (n=188) children (8-12), enrolled via the use of an anxiety screening questionnaire. Mothers were interviewed on pre-/perinatal risk factors, and children completed a visuospatial copying task. RESULTS: High-anxious children were exposed to more prenatal (not perinatal) risk factors and deviated more on the visuospatial copying task. Prenatal risk factors, deviation on visuospatial copying, and their interaction were significant predictors of anxiety, accounting for 13.5% of the variance of anxiety. CONCLUSIONS: This percentage is impressive, given the fact that anxiety emerges from various combinations of risk factors and nature-nurture interactions. This study underlined the importance of considering risk factors occurring during pregnancy in relation to child anxiety and brain functioning.

Screening for anxiety disorders in children.

Anxiety disorders are highly prevalent and have negative consequences on individual and societal level. This study examined the usefulness of screening for anxiety disorders in primary school children. More specifically, the value of the screening method to discriminate between and to predict anxiety disorders was studied. Children and their parents were selected if the children had self-reported scores on the screening questionnaire Screen for Child Anxiety Related Emotional Disorders-71 (SCARED-71) within the top-15% (High-anxious) or from two points below to two points above the median (Median-anxious). Of the selected children, 183 high-anxious children and their parents, and 80 median-anxious children and their parents took part in a diagnostic interview, the Anxiety Disorder Interview Schedule (ADIS). Of the high-anxious children, 60% had an anxiety disorder versus 23% of the median-anxious children, whereas groups did not differ on rates of dysthymia/depression and attention deficit hyperactivity disorder. The diagnoses separation anxiety disorder, social phobia and specific phobia were specifically predicted by the corresponding subscales of the screening questionnaire, while the diagnosis generalised anxiety disorder was not predicted by any of the subscales. The screening method has proven its utility for discriminating between children with and without anxiety disorders when applying the top-15% cut-off. Moreover, separation anxiety disorder, social phobia, and specific phobia, all known to be prevalent and debilitating childhood anxiety disorders, can be predicted by the corresponding subscale of the screening instrument.