Treating child and adolescent anxiety effectively: Overview of systematic reviews.

We conducted an overview of systematic reviews about child and adolescent anxiety treatment options (psychosocial; medication; combination; web/computer-based treatment) to support evidence informed decision-making. Three questions were addressed: (i) Is the treatment more effective than passive controls? (ii) Is there evidence that the treatment is superior to or non-inferior to (i.e., as good as) active controls? (iii) What is the quality of evidence for the treatment? Pre-specified inclusion criteria identified high quality systematic reviews (2000-2015) reporting treatment effects on anxiety diagnosis and symptom severity. Evidence quality (EQ) was rated using Oxford evidence levels [EQ1 (highest); EQ5 (lowest)]. Twenty-two of 39 eligible reviews were high quality (AMSTAR score≥3/5). CBT (individual or group, with or without parents) was more effective than passive controls (EQ1). CBT effects compared to active controls were mixed (EQ1). SSRI/SNRI were more effective than placebo (EQ1) but comparative effectiveness remains uncertain. EQ for combination therapy could not be determined. RCTs of web/computer-based interventions showed mixed results (EQ1). CBM/ABM was not more efficacious than active controls (EQ1). No other interventions could be rated. High quality RCTs support treatment with CBT and medication. Findings for combination and web/computer-based treatment are encouraging but further RCTs are required. Head-to-head comparisons of active treatment options are needed.

The use of medication in selective mutism: a systematic review.

Despite limited evidence, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are used to reduce symptoms of selective mutism (SM) in children unresponsive to psychosocial interventions. We review existing evidence for the efficacy of these medications, limitations of the literature, and resulting treatment considerations. Bibliographic searches were conducted in Medline, Embase, PsycInfo, Web of Science and Cochrane up to June 2015. Two reviewers independently sought studies of children with SM as primary psychiatric diagnosis, which reported response to medication treatment. Abstracts were limited to those reporting original data. Two reviewers independently assessed the ten papers reporting on >2 subjects regarding study design, key results, and limitations. Heterogeneity of designs mandated a descriptive summary. Symptomatic improvement was found for 66/79 children treated with SSRIs and 4/4 children treated with phenelzine. Only 3/10 studies had unmedicated comparison groups and only two were double-blinded. This review may be affected by publication bias, missed studies, and variability of outcome measures in included studies. Although there is some evidence for symptomatic improvement in SM with medication, especially SSRIs, it is limited by small numbers, lack of comparative trials, lack of consistent measures, and lack of consistent reporting on tolerability. The clinician must weigh this paucity of evidence against the highly debilitating nature of SM, and its adverse effects on the development of those children whose progress with psychosocial interventions is limited or very slow. Studies of optimal dosage and timing of medications in relation to psychosocial treatments are also needed.

Translating Anxiety-Focused CBT for Youth in a First Nations Context in Northwestern Ontario.

OBJECTIVE: We sought to evaluate a translation of anxiety-focused cognitive behavioral therapy (CBT) to a First Nations children's mental health provider in rural Ontario and to enhance our understanding of CBT challenges and adaptations unique to the First Nations context. METHODS: The study was conceptualized as a mixed methods sequential explanatory approach using a quasi-experimental (before and after) design with quantitative and qualitative components. Data were produced in two ways: questionnaires completed by therapists, parents and clients pre- and post-training, and through a focus group with therapists working with First Nations clients. Participants of this study were a subset of a larger knowledge translation study involving ten agencies, and comprised nine therapists (two males and seven females), and seven children (six males and one female) from a single First Nations agency. The mean age of children was 11.8 years (±2.71), comparable to children in other agencies. RESULTS: First Nations therapists' scores on a child CBT knowledge questionnaire post-training did not differ from those of therapists in other agencies when controlling for initial values, suggesting comparable training benefit. Children did not differ between groups on any key measures, and all key measures showed improvement from pre- to post-training. Four key themes emerged from therapist focus groups: client challenges, value of supervision, practice challenges, and Northern/rural/remote challenges. CONCLUSIONS: The study highlights the importance of delivering a culturally appropriate CBT program to First Nations populations in Northern Ontario, and provides preliminary evidence of its effectiveness.

OBJECTIF: Nous avons cherché à évaluer une adaptation de la thérapie cognitivo-comportementale (TCC) axée sur l'anxiété pour un prestataire de soins de santé mentale aux enfants des Premières nations en région rurale de l'Ontario, et à accroître notre compréhension des problèmes et des adaptations de la TCC propres au contexte des Premières nations. MÉTHODES: L'étude a été conceptualisée comme une approche de méthodes mixtes séquentielles explicatives à l'aide d'un devis quasi-expérimental (avant et après) avec des composantes quantitatives et qualitatives. Les données ont été produites de deux manières: des questionnaires remplis par les thérapeutes, les parents et les clients avant et après la formation, et à l'aide d'un groupe de discussion formé des thérapeutes travaillant avec les clients des Première nations. Les participants à cette étude étaient un sous-ensemble d'une étude plus vaste du transfert des connaissances comportant dix organismes et composée de neuf thérapeutes (deux masculins et sept féminins), et sept enfants (six garçons et une fille) d'un seul organisme des Premières nations. L'âge moyen des enfants était de 11,8 ans (±2,71), comparable aux enfants d'autres organismes. RÉSULTATS: Les scores des thérapeutes des Premières nations à un questionnaire sur les connaissances de la TCC après la formation ne différaient pas de ceux des thérapeutes d'autres organismes, après contrôle des valeurs initiales, ce qui suggère des avantages comparables de la formation. Les enfants ne différaient pas entre les groupes à aucune des mesures clés, et toutes les mesures clés montraient une amélioration entre avant et après la formation. Quatre thèmes principaux se sont dégagés des groupes de discussion des thérapeutes: les problèmes des clients, la valeur de la supervision, les problèmes organisationnels, et les problèmes des régions nordiques/rurales/ éloignées. CONCLUSIONS: L'étude souligne l'importance d'exécuter un programme de TCC culturellement adapté aux populations des Premières nations du nord de l'Ontario, et fournit des données probantes préliminaires de son efficacité.

PREVENTING CHILD AND ADOLESCENT ANXIETY DISORDERS: OVERVIEW OF SYSTEMATIC REVIEWS.

Overviews of systematic reviews (OSRs) provide rapid access to high quality, consolidated research evidence about prevention intervention options, supporting evidence-informed decision-making, and the identification of fruitful areas of new research. This OSR addressed three questions about prevention strategies for child and adolescent anxiety: (1) Does the intervention prevent anxiety diagnosis and/or reduce anxiety symptoms compared to passive controls? (2) Is the intervention equal to or more effective than active controls? (3) What is the evidence quality (EQ) for the intervention? Prespecified inclusion criteria identified systematic reviews and meta-analyses (2000-2014) with an AMSTAR quality score ≥ 3/5. EQ was rated using Oxford evidence levels EQ1 (highest) to EQ5 (lowest). Three reviews met inclusion criteria. One narrative systematic review concluded school-based interventions reduce anxiety symptoms. One meta-analysis pooled 65 randomized controlled trials (RCTs; any intervention) and reported a small, statistically significant reduction in anxiety symptoms and diagnosis incidence. Neither review provided pooled effect size estimates for specific intervention options defined by type (i.e., universal/selective/indicated), intervention content, or comparison group (i.e., passive/active control), thus precluding EQ ratings. One meta-analysis pooled trials of vigorous exercise and reported small, nonstatistically significant reductions in anxiety symptoms for comparisons against passive and active controls (EQ1). Better use of primary studies in meta-analyses, including program-specific pooled effect size estimates and network meta-analysis is needed to guide evidence-informed anxiety prevention program choices. RCTs of innovative community/primary care based interventions and web-based strategies can fill knowledge gaps.

A Youth Suicide Prevention Plan for Canada: A Systematic Review of Reviews.

OBJECTIVE: We conducted an expedited knowledge synthesis (EKS) to facilitate evidence-informed decision making concerning youth suicide prevention, specifically school-based strategies and nonschool-based interventions designed to prevent repeat attempts. METHODS: Systematic review of review methods were applied. Inclusion criteria were as follows: systematic review or meta-analysis; prevention in youth 0 to 24 years; peer-reviewed English literature. Review quality was determined with AMSTAR (a measurement tool to assess systematic reviews). Nominal group methods quantified consensus on recommendations derived from the findings. RESULTS: No included review addressing school-based prevention (n = 7) reported decreased suicide death rates based on randomized controlled trials (RCTs) or controlled cohort studies (CCSs), but reduced suicide attempts, suicidal ideation, and proxy measures of suicide risk were reported (based on RCTs and CCSs). Included reviews addressing prevention of repeat suicide attempts (n = 14) found the following: emergency department transition programs may reduce suicide deaths, hospitalizations, and treatment nonadherence (based on RCTs and CCSs); training primary care providers in depression treatment may reduce repeated attempts (based on one RCT); antidepressants may increase short-term suicide risk in some patients (based on RCTs and meta-analyses); this increase is offset by overall population-based reductions in suicide associated with antidepressant treatment of youth depression (based on observational studies); and prevention with psychosocial interventions requires further evaluation. No review addressed sex or gender differences systematically, Aboriginal youth as a special population, harm, or cost-effectiveness. Consensus on 6 recommendations ranged from 73% to 100%. CONCLUSIONS: Our EKS facilitates decision maker access to what is known about effective youth suicide prevention interventions. A national research-to-practice network that links researchers and decision makers is recommended to implement and evaluate promising interventions; to eliminate the use of ineffective or harmful interventions; and to clarify prevention intervention effects on death by suicide, suicide attempts, and suicidal ideation. Such a network could position Canada as a leader in youth suicide prevention.

Translating Cognitive Behavioral Therapy for Anxious Youth to Rural-Community Settings via Tele-Psychiatry.

This study aimed to determine the feasibility of translating cognitive behavioral therapy for anxious youth to rural-community settings via tele-psychiatry training. A 20-week group-supervision training program was delivered to ten different groups from different agencies within Northern Ontario. Each group consisted of four to nine clinicians with child therapy background not specific to CBT (n = 78, 51% social workers, 49% other mental health disciplines). Clinicians were each required to treat an anxious youth under supervision. Changes in clinician knowledge and youth internalizing symptoms were measured. Northern Ontario clinicians showed significant gains on a child CBT-related knowledge test (t (1, 52) = -4.6, p < .001). Although youth treated by these clinicians showed a significant decrease in anxiety symptoms, possible response bias and the lack of a comparison group mandate further studies before generalizing our findings. Nevertheless, training local therapists in anxiety-focused CBT for children via a group supervision based tele-psychiatry model appears to be a feasible and well-received approach to knowledge translation to rural settings.

Eight years later: outcomes of CBT-treated versus untreated anxious children.

BACKGROUND: Anxiety disorders are the most common psychiatric disorders of childhood, generate significant distress, are considered precursors to diverse psychiatric disorders, and lead to poor social and employment outcomes in adulthood. Although childhood anxiety has a significant impact on a child's developmental trajectory, only a handful of studies examined the long-term impact of treatment and none included a control group. The aim of this study was to conduct a long-term follow-up (LTFU) of anxious children who were treated with Cognitive-Behavioral Therapy (CBT) compared to a matched group of children who were not. METHODS: Subjects comprised 120 children: a treatment group which included the first 60 consecutive consenting children who were diagnosed with an anxiety disorder and treated with CBT between the years 1997 and 2003 and a control group, 60 matched children who were assessed but not treated with CBT. An "ex-post-facto" design was used to compare the two groups. RESULTS: Children showed lower rates of anxiety diagnosis (about 50% for both groups) and significantly improved functioning at LTFU (time effect P < 0.0001; no group difference). Anxiety levels were significantly lower in the nontreatment group at LTFU as compared to initial assessment (P = 0.02), but not in the treatment group, and a significant between-group difference was found (P = 0.01) according to child. An inverse relationship was found between self-efficacy/self-esteem and anxiety outcome ([P = 0.0008] and [P = 0.04], respectively). CONCLUSIONS: This study supports the assumption that childhood anxiety disorders may improve without treatment and highlights self-efficacy/self-esteem as potential factors in recovery.

Types of parental involvement in CBT with anxious youth: a preliminary meta-analysis.

OBJECTIVE: Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CBT) for anxious children is therapeutically beneficial. There is also great heterogeneity in the type of parental involvement included. We investigated parental involvement focused on contingency management (CM) and transfer of control (TC) as a potential outcome moderator using a meta-analysis with individual patient data. METHOD: Investigators of randomized controlled trials (RCTs) of CBT for anxious children, identified systematically, were invited to submit their data. Conditions in each RCT were coded based on type of parental involvement in CBT (i.e., low involvement, active involvement without emphasis on CM or TC, active involvement with emphasis on CM or TC). Treatment outcomes were compared using a 1-stage meta-analysis. RESULTS: All cases involved in active treatment (894 of 1,618) were included for subgroup analyses. Across all CBT groups, means of clinical severity, anxiety, and internalizing symptoms significantly decreased posttreatment and were comparable across groups. The group without emphasis on CM or TC showed a higher proportion with posttreatment anxiety diagnoses than the low-involvement group. Between posttreatment and 1-year follow-up, the proportion with anxiety diagnoses significantly decreased in CBT with active parental involvement with emphasis on CM or TC, whereas treatment gains were merely maintained in the other 2 groups. CONCLUSIONS: CBT for anxious children is an effective treatment with or without active parental involvement. However, CBT with active parental involvement emphasizing CM or TC may support long-term maintenance of treatment gains. RESULTS should be replicated as additional RCTs are published.

Do anxious boys and girls differ in emotion recognition accuracy?

INTRODUCTION: Difficulty recognizing emotions may contribute to childhood anxiety and anxiety-related social difficulties. METHODS: We examined the relationship between gender and emotion recognition accuracy in children with and without anxiety disorders. RESULTS: Gender did not predict emotion recognition accuracy except for disgust. DISCUSSION: Disgust recognition was significantly less accurate in clinically anxious girls than in clinically anxious boys. There was also a trend towards anxious girls being less accurate than non-anxious girls in recognizing disgust.

INTRODUCTION: La difficulté à reconnaître les émotions peut contribuer à l'anxiété pédiatrique et aux difficultés sociales liées à l'anxiété. MÉTHODES: Nous avons examiné la relation entre les sexes et l'exactitude de la reconnaissance des émotions chez des enfants souffrant ou non de troubles anxieux. RÉSULTATS: Le sexe ne prédisait pas l'exactitude de la reconnaissance des émotions excepté pour le dégoût. DISCUSSION: La reconnaissance du dégoût était significativement moins exacte chez les filles cliniquement anxieuses que chez les garçons cliniquement anxieux. Les filles anxieuses avaient aussi tendance à reconnaître moins exactement le dégoût que les filles non anxieuses.

Effects of age and subtype on emotional recognition in children with anxiety disorders: implications for cognitive-behavioural therapy.

OBJECTIVE: It remains unclear whether an anxiety diagnosis is associated with children's emotional recognition. We considered children's age and types of primary anxiety diagnosis, which have been neglected, to elucidate this relationship. METHODS: Sixty-three referred children with anxiety disorder(s) and 59 volunteer children without anxiety disorder(s), aged between 6 and 11 years, were presented with animated characters, displaying a range of simple and complex emotions, for identification. Statistical analyses examined identification accuracy based on presence or absence of anxiety disorder, age, and types of primary diagnoses. RESULTS: Children with anxiety disorder(s) as a group performed comparably to children without anxiety disorder(s) in identifying emotions (z = -0.72, P = 0.47). In both groups, accuracy for disgust increased significantly each year of age ([anxiety group] OR 2.6; 95% CI 1.6 to 4.3, P < 0.001, [control group] OR 2.1; 95% CI 1.3 to 3.3, P = 0.002). When primary anxiety types were considered, while controlling for age, children with separation anxiety disorder (SAD) showed deficits in overall emotional recognition, compared with children with other subtypes or without anxiety (P = 0.004). Further regression analyses showed that children with generalized anxiety disorder (GAD) presented significantly lower accuracy than children without anxiety disorder(s) at a young age, but the deficit disappeared with increased age. CONCLUSION: Children with anxiety disorder(s) as a group may not appear to be impaired in emotional recognition. However, when age and subtypes are considered, children with SAD and young children with GAD appear to have difficulty, compared with children without anxiety disorder(s).

Objectif : Il n'est pas encore déterminé si un diagnostic d'anxiété est associé à la reconnaissance émotionnelle des enfants. Nous avons pris en compte l'âge des enfants et les types des diagnostics d'anxiété primaires, qui ont été négligés pour éclaircir cette relation. Méthodes : Soixante-trois enfants référés souffrant de trouble(s) anxieux et 59 enfants volontaires sans trouble(s) anxieux, âgés entre 6 et 11 ans, se sont fait présenter des personnages animés, qui affichaient une gradation d'émotions simples et complexes, aux fins d'identification. Des analyses statistiques ont examiné l'exactitude de l'identification d'après la présence ou l'absence de trouble anxieux, l'âge, et les types des diagnostics primaires. Résultats : Comme groupe, les enfants souffrant de trouble(s) anxieux ont eu un rendement comparable à celui des enfants sans trouble(s) anxieux pour identifier les émotions (z = ­0,72; P = 0,47). Dans les deux groupes, l'exactitude de l'identification du dégoût augmentait significativement à chaque âge ([groupe anxieux] RC 2,6; IC à 95 % 1,6 à 4,3; P < 0,001, [groupe témoin] RC 2,1; IC à 95 % 1,3 à 3,3; P = 0,002). Lorsque les types d'anxiété primaires étaient examinés, en contrôlant l'âge, les enfants souffrant du trouble d'anxiété de séparation (TAS) présentaient des déficits de reconnaissance émotionnelle générale, comparativement aux enfants souffrant d'autres sous-types ou sans anxiété (P = 0,004). Des analyses de régression ont indiqué, les enfants souffrant du trouble d'anxiété généralisée (TAG) présentaient une exactitude significativement plus faible que les enfants sans trouble(s) anxieux à un jeune âge, mais le déficit s'estompait avec l'âge. Conclusion : Comme groupe, les enfants souffrant de trouble(s) anxieux peuvent ne pas sembler être déficients en matière de reconnaissance émotionnelle. Cependant, lorsque l'âge et les sous-types sont pris en compte, les enfants souffrant de TAS et les jeunes enfants souffrant de TAG semblent éprouver des difficultés, comparativement aux enfants sans trouble(s) anxieux.

Cognitive behavioral therapy age effects in child and adolescent anxiety: an individual patient data metaanalysis.

BACKGROUND: Investigations of age effects on youth anxiety outcomes in randomized trials (RCTs) of cognitive behavior therapy (CBT) have failed to yield a clear result due to inadequate statistical power and methodologic weaknesses. We conducted an individual patient data metaanalysis to address this gap. QUESTION: Does age moderate CBT effect size, measured by a clinically and statistically significant interaction between age and CBT exposure? METHODS: All English language RCTs of CBT for anxiety in 6-19 year olds were identified using systematic review methods. Investigators of eligible trials were invited to submit their individual patient data. The anxiety disorder interview schedule (ADIS) primary diagnosis severity score was the primary outcome. Age effects were investigated using multilevel modeling to account for study level data clustering and random effects. RESULTS: Data from 17 of 23 eligible trials were obtained (74%); 16 studies and 1,171 (78%) cases were available for the analysis. No interaction between age and CBT exposure was found in a model containing age, sex, ADIS baseline severity score, and comorbid depression diagnosis (power ≥ 80%). Sensitivity analyses, including modeling age as both a categorical and continuous variable, revealed this result was robust. CONCLUSIONS: Adolescents who receive CBT in efficacy research studies show benefits comparable to younger children. However, CBT protocol modifications routinely carried out by expert trial therapists may explain these findings. Adolescent CBT protocols are needed to facilitate the transportability of efficacy research effects to usual care settings where therapists may have less opportunity for CBT training and expertise development.

Neurophysiological markers that predict and track treatment outcomes in childhood anxiety.

The present study examined the cortical processes that mediate cognitive regulation in response to emotion-eliciting stimuli, before and after anxious children participated in a cognitive behavioral therapy program. Electroencephalographic activity was recorded from anxious children (n = 24, 8 males) and comparison children (n = 16, 7 males) at pre-and post-treatment sessions. The change in anxiety T-scores from pre- to post-treatment was used to signify clinical improvement among anxious children (Improvers: n = 11 vs. Non-improvers: n = 13). Event-related potential components were recorded while children performed a Go/No-go task using emotional facial expressions. For the P1 component, believed to reflect attention and/or arousal processes, Non-improvers had greater activation levels relative to Improver and comparison groups at both sessions. Greater P1 amplitudes at pre-treatment predicted non-improvement following treatment. For the frontal N2 component, thought to reflect cognitive control processing, Improvers recruited greater activation from pre- to post-treatment, a change in activation that was predictive of treatment outcome. Non-improvers showed increased cortical activation within the time window of the P1, whether at pre- or post-treatment. These data suggest that heightened perceptual vigilance may have led to poorer outcomes. Improvers showed increased prefrontal activation within the time window of the N2 from pre- to post-treatment. These data suggest that increased cognitive control may have led to improved treatment outcomes. In sum, P1 activation may serve as a predictor of treatment outcome, while N2 activation may serve as an indicator of treatment response.

Neural mechanisms of emotion regulation in childhood anxiety.

BACKGROUND: The present study was designed to examine the cortical processes that mediate cognitive regulation in response to emotion-eliciting stimuli in anxious children. METHODS: Electroencephalographic (EEG) activity was recorded from clinically anxious children (n = 29) and typically developing children (n = 34). Event-related potential components were recorded while children performed a go/no-go task using facial stimuli depicting angry, calm, and happy expressions. RESULTS: Anxious children had significantly greater posterior P1 and frontal N2 amplitudes, components associated with attention/arousal and cognitive control, respectively, than typically developing children. Anxious children also had significantly greater error-related negativities and correct-response negativities relative to typically developing children. For the anxious group only, there were no differences in neural activation between face (emotion) types or trial (Go vs. No-go) types. A regression analysis revealed that No-go N2 amplitudes for calm faces predicted self-reported anxiety levels. CONCLUSIONS: Anxious children appeared to show increased cortical activation regardless of the emotional content of the stimuli. Anxious children also showed greater medial-frontal activity regardless of task demands and response accuracy. Taken together, these findings suggest indiscriminate cortical processes that may underlie the hypervigilant regulatory style seen in clinically anxious individuals.

Generalized anxiety disorder in the classroom.

Interventions for students with generalized anxiety disorder require attention to contextual factors both within and outside the classroom. They often are based on the principles of increasing environmental predictability and increasing the student's sense of self-efficacy. Good judgment is sometimes needed to determine which strategies constitute reasonable accommodations to the student's anxiety and which constitute an excessive deviation from usual school expectations. The latter can single out students unnecessarily or limit their academic progress. Working closely with parents and mental health professionals involved in the student's care is most likely to ensure a consistently helpful approach.

Managing anxiety related to anaphylaxis in childhood: a systematic review.

Objectives. This paper reviews the relationship between anxiety and anaphylaxis in children and youth, and principles for managing anxiety in the anaphylactic child and his or her parents. Methods. A review of the medical literature (Medline) was done using the keywords "anxiety," "anaphylaxis," and "allergy," limited to children and adolescents. Findings were organized into categories used in the treatment of childhood anxiety disorders, then applied to managing anxiety in the anaphylactic child. Results. Twenty-four relevant papers were identified. These varied widely in methodology. Findings emphasized included the need to distinguish anxiety-related and organic symptoms, ameliorate the anxiety-related impact of anaphylaxis on quality of life, and address parental anxiety about the child. Conclusion. Children with anaphylaxis can function well despite anxiety, but the physical, cognitive, and behavioral aspects of anxiety associated with anaphylactic risk must be addressed, and parents must be involved in care in constructive ways.

Symptomatology and family functioning in children and adolescents with comorbid anxiety and depression.

OBJECTIVE: Previous studies suggest that comorbid anxiety and depressive disorders in youth are associated with more severe symptomatology and family dysfunction than either disorder alone. Our aim was to replicate and extend past findings by expanding the definition of comorbidity to include comorbid subthreshold symptoms (i.e., symptoms fall below the diagnostic criteria cut-off of a disorder). METHOD: A clinic-based sample of 193 youth (aged 4-18) and maternal caregivers completed measures assessing the youth's internalizing symptoms and family functioning. RESULTS: Comorbid youth endorsed more severe anxiety symptoms and family dysfunction than anxiety-only youth. By contrast, comorbid youth did not endorse more severe depression symptoms or family dysfunction compared to youth with depression only. Similar results were found for maternal reports of internalizing symptoms, but maternal reports of family functioning yielded no group differences. CONCLUSIONS: This study replicates past findings that the presence of comorbid depression in anxious youth is associated with severe anxiety and family dysfunction. Our findings also suggest that subthreshold depressive symptoms in anxious youth relate to the severity of symptomatology and family dysfunction reported, but subthreshold anxiety symptoms in depressed youth do not. Longitudinal studies are needed to further clarify the etiology and developmental course of this comorbidity.

Self-perceptions in relation to self-reported depressive symptoms in boys and girls.

BACKGROUND: Low self-esteem is associated with depressive symptoms in children. However, the association between domains of self-esteem (e.g., self perceptions) and depressive symptoms may vary by gender. AIMS: This study evaluated self-perceptions in relation to self-reported depressive symptoms in boys and girls. METHODS: School children in grades 3 to 6 (n = 140; 54% boys; 46% girls) completed the Children's Depression Inventory (CDI) and The Self-Perception Profile for Children (SPPC) as part of a school-based intervention targeting anxious and depressive symptoms. The CDI was re-administered about 1 month later. Pearson correlations between the subscales of the SPPC and the average CDI T-scores were determined. Significant correlations were entered in stepwise regressions to predict depressive symptoms for the whole sample and then separately for boys and girls. RESULTS: Self-perceived scholastic competence, physical appearance, and behavioral conduct accounted for 19.8% of the variance in self-reported depressive symptoms overall. Behavioral conduct was a more salient predictor in boys (adjusted R(2) =0.146) whereas scholastic competence and physical appearance were more salient in girls (adjusted R(2) =0.203). CONCLUSION: Although replication is needed, boys and girls appear to have different self-perceptions in relation to depressive symptoms. Understanding these differences may help to inform clinical interventions.