Attenuation of frontal asymmetry in pediatric posttraumatic stress disorder.

BACKGROUND: Volumetric imaging research has shown abnormal brain morphology in adults with posttraumatic stress disorder (PTSD) when compared with matched control subjects. In this article, we present brain imaging findings from a study of children with PTSD symptoms. METHODS: Twenty-four children between the ages of 7 and 14 with a history of trauma and PTSD symptoms were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). The sample underwent magnetic resonance imaging in a 1.5 T scanner. Brain images were analyzed by raters blind to diagnostic status using well-standardized methods, and images were compared with age- and gender-matched healthy control subjects. RESULTS: The clinical group demonstrated attenuation of frontal lobe asymmetry and smaller total brain and cerebral volumes when compared with the control group. There were no statistically significant differences in hippocampal volume between clinical and control subjects. CONCLUSIONS: Frontal lobe abnormalities may occur as a result of PTSD in children or, alternatively, be a risk factor for the development of the syndrome in this age group. The implications of the findings and their consistency with previous research are discussed.

An analysis of the RCMAS Lie scale in a clinic sample of anxious children.

Examined Revised Children's Manifest Anxiety Scale (RCMAS) Lie scores in a sample of 284 anxious children. Lie scores were examined in relation to children's age, ethnicity/race, and gender, and in relation to Total Anxiety scores. The utility of Lie scores also was examined in terms of whether they were predictive of children's anxiety levels as rated by children themselves, parents, and clinicians. Between-group differences in children's Lie scores were examined as well. Results indicated that younger children had significantly higher Lie scores than older children, and Hispanic American children had significantly higher Lie scores than European American children. There were no significant gender differences in Lie scores, and no significant relation was found between RCMAS Lie scores and Total Anxiety scores for the total sample. Subgroup analyses indicated that Lie scores were predictive of children's anxiety levels. Results also indicated that Lie scores were significantly different between children who presented with anxiety disorders and children who presented with anxiety and externalizing disorders. Findings are discussed in terms of the usefulness of RCMAS Lie scores.

What do youth referred for anxiety problems worry about? Worry and its relation to anxiety and anxiety disorders in children and adolescents.

This study examined worry and the parameters of worry that may be associated with clinical anxiety in a sample of 119 children and adolescents referred to a childhood anxiety disorders specialty clinic. Using an interviewing procedure, results indicated that the types of worries reported by the children were similar to those reported in previous studies of nonreferred community children. Also similar to previous community studies were findings showing moderate but significant correlations between different indices of worry (i.e., number, intensity, and frequency of the worries) and children's scores on self-rating scales of anxiety. Results further indicated that worry contributed additional variance beyond that of anxiety in predicting fear. In addition, intensity differentiated clinic children's worries from nonreferred children's. Intensity and number of worries differentiated subsamples of children within the clinic-referred sample (i.e., children with overanxious disorder or generalized anxiety disorder and children with simple phobia). The importance of examining children's worries to further understand anxiety and its disorders in youth is discussed.

Treating anxiety disorders in children with group cognitive-behaviorial therapy: a randomized clinical trial.

A randomized clinical trial evaluated the therapeutic efficacy of group cognitive-behavioral therapy (GCBT) versus a wait-list control (WLC) condition to treat anxiety disorders in children. Results indicated that GCBT, with concurrent parent sessions, was highly efficacious in producing and maintaining treatment gains. Children in GCBT showed substantial improvement on all the main outcome measures, and these gains were maintained at 3-, 6-, and 12-month follow-ups. Children in the WLC condition did not show improvements from the pre- to the postwait assessment point. These findings are discussed in terms of the need to continue to advance the development of practical, as well as conceptual, knowledge of efficacious treatment for anxiety disorders in children.

The discrimination of children's phobias using the Revised Fear Survey Schedule for children.

The discriminant validity of children's and parents' ratings of the child's fear on the Revised Fear Survey Schedule for Children (FSSC-R; Ollendick, 1983) was examined using a clinic sample of children who met DSM criteria for phobic disorders (N = 120). Discriminant function analyses and item analyses were conducted to determine if children meeting diagnostic criteria for a primary disorder of social phobia, simple phobia of the dark/sleeping alone, simple phobia of animals, or a simple phobia of shots/doctors could be differentiated on the basis of FSSC-R subscale scores and items. Results of the discriminant function analyses indicated that the child-completed as well as the parent-completed FSSC-Rs were similarly useful in differentiating the specific types of phobias. Results of the item analyses indicated that child-completed FSSC-R items could discriminate among the different simple phobias but not social phobia and that parent-completed FSSC-R items could discriminate not only the different simple phobias but also social phobia. Results are discussed in terms of the utility of the FSSC-R in the assessment of clinically significant fears in children with phobic disorders and the relative utility of child and parent ratings in the assessment of childhood fears.

Contingency management, self-control, and education support in the treatment of childhood phobic disorders: a randomized clinical trial.

This study evaluated the relative efficacy of an exposure-based contingency management (CM) treatment condition and an exposure-based cognitive self-control (SC) treatment condition relative to an education support (ES) control condition for treating children with phobic disorders. Eighty-one children and their parents completed a 10-week treatment program in which children and parents were seen in separate treatment sessions with the therapist, followed by a brief conjoint meeting. Children in both the CM and SC conditions showed substantial improvement on all of the outcome measures. These gains were maintained at 3-, 6-, and 12-month follow-ups. Interestingly, children in the ES condition also showed comparable improvements at posttreatment and at 3-, 6-, and 12-month follow-ups. Implications of the findings are discussed with respect to knowledge development and clinical practice.

The evaluation of heart rate biofeedback using a multi-element design.

This experiment used the integration of a multi-element design with a second baseline to isolate the effect of biofeedback on the control of a target response, heart rate. The results of the experiment indicate that contingent visual heart rate feedback was instrumental in specifically facilitating the control of heart rate and that control was not mediated by the effects of changes in overall arousal level as measured by skin conductance. These results encourage the experimental analysis of biofeedback using single case designs. Further, the design presented herein offers a clinically and experimentally useful methodology for biofeedback research.

Testing the utility of the anxiety sensitivity construct in children and adolescents referred for anxiety disorders.

Tested the utility of assessing anxiety sensitivity in children by investigating the incremental validity of the Childhood Anxiety Sensitivity Index (CASI) in a sample of clinic-referred children and adolescents ages 6 to 17 (N = 280). In the first test we examined whether the CASI would predict variance in trait anxiety beyond that predicted by measures of manifest anxiety and fear in children ages 6 to 11 (n = 202) and adolescents ages 12 to 17 (n = 78). In the next test, we examined whether the CASI would predict variance in fear beyond that predicted by a measure of trait anxiety for both age groups. In addition, age was tested as a continuous moderator of the CASI's incremental validity. No evidence was found to suggest that age systematically influences the CASI's incremental validity in the age ranges for which the CASI was designed. We discuss the results in terms of the utility of the CASI with younger and older age groups of children and the importance of such a measure for investigating the development of anxiety disorders in children.

The relation between anxiety sensitivity and depression in children and adolescents referred for anxiety.

Research conducted with adult samples suggests that anxiety sensitivity is positively related to depression (Otto et al., 1995, Journal of Anxiety Disorders, 10, 117-123). The Childhood Anxiety Sensitivity Index (CASI, Silverman et al., 1991, Journal of Clinical Child Psychology, 20 162-168) was used in this study to provide an examination of the relation between anxiety, anxiety sensitivity, and depression in a sample of children and adolescents (N = 234) referred for anxiety disorders. A significant correlation between depression and anxiety sensitivity was found. This relation remained statistically significant when controlling for other aspects of anxiety (i.e. worry, physiological anxiety, and concentration). The similarities between these findings and findings obtained with adults are discussed, as well as suggestions for future research.