An Integrative Model of Youth Anxiety: Cognitive-Affective Processes and Parenting in Developmental Context.

Multiple theoretical frameworks have been proposed to provide a more comprehensive picture of the risk factors that influence anxiety-related developmental trajectories. Nonetheless, there remains a need for an integrative model that outlines: (1) which risk factors may be most pertinent at different points in development, and (2) how parenting may maintain, exacerbate, or attenuate an affective style that is characterized by high negative emotional reactivity to unfamiliar, uncertain, and threatening situations. A developmentally informed, integrative model has the potential to guide treatment development and delivery, which is critical to reducing the public health burden associated with these disorders. This paper outlines a model integrating research on many well-established risk mechanisms for anxiety disorders, focusing on (1) the developmental progression from emotional reactivity constructs early in life to those involving higher-level cognitive processes later in youth, and (2) potential pathways by which parenting may impact the stability of youth's cognitive-affective responses to threat-relevant information across development.

The late positive potential during affective picture processing: Associations with daily life emotional functioning among adolescents with anxiety disorders.

Pediatric anxiety disorders are characterized by potentiated threat responses and maladaptive emotion regulation (ER). The Late Positive Potential (LPP) is a neural index of heightened attention to emotional stimuli. Anxious individuals typically exhibit a larger LPP to unpleasant stimuli, but the LPP may also be blunted to unpleasant and pleasant stimuli for those with co-morbid depression. While a larger LPP is thought to reflect greater emotional reactivity, it is unknown to what extent variation in the LPP to laboratory stimuli corresponds to daily emotional functioning. We assessed the LPP in the laboratory in response to unpleasant, pleasant, and neutral images in combination with ecological momentary assessment of emotional reactivity and regulation in daily life among youth (9-14 years old; 55 % female) with anxiety disorders (ANX, N = 130) and no psychiatric diagnoses (ND, N = 47). We tested whether LPP amplitudes to unpleasant and pleasant stimuli (vs. neutral) are greater in ANX (vs. ND) youth and whether LPP amplitudes inversely correlate with co-morbid depression symptoms. We also examined associations between the LPP and daily life emotional functioning among ANX and ND youth. We found no group-by-valence effects on LPP amplitudes. Within ANX youth, higher depression symptoms were associated with smaller LPP amplitudes to unpleasant, but not pleasant, stimuli relative to neutral stimuli. Larger LPP amplitudes to emotional (relative to neutral) stimuli were correlated with use of specific ER strategies among ANX and ND youth but not emotional reactivity. While the LPP may reflect initial emotional reactivity to laboratory stimuli, it is associated with ER behaviors, and not emotional reactivity, in daily life.

Neural indices of performance monitoring are associated with daily emotional functioning in youth with anxiety disorders: An ERP and EMA study.

Excessive monitoring of one's performance is a characteristic of anxiety disorders that has been linked to alterations in implicit emotion regulation (ER), including elevations in neural measures of performance monitoring (i.e., error- and correct-related negativity; ERN and CRN). Elevations in ERN and CRN amplitudes have been reported consistently in anxiety disorders, suggesting that an overactive performance monitoring system is linked to ER difficulties in anxiety. Yet, the relevance of these lab-based neural measures for day-to-day emotional functioning remains poorly understood. This study examined the degree to which ERN and CRN amplitudes are associated with measures of daily ER difficulties in youth with anxiety disorders. Youth (N = 100, Mage = 11.14, SDage = 1.46) completed a computerized flanker task assessing the ERN and CRN. They then completed a 5-day ecological momentary assessment (EMA) protocol assessing their daily ER (i.e., intensity of momentary and peak negative affect, intensity of worry, reliance on maladaptive ER strategies). Results showed that more negative mean CRN amplitudes were associated with higher levels of negative emotional reactivity and more intense worries. There were no significant associations between ERN amplitude and EMA measures. Furthermore, elevations in CRN were linked to more frequent use of maladaptive ER strategies (i.e., rumination, physiological reactivity, avoidance). Together, results indicate that among youth with anxiety, individual differences in CRN, but not ERN, amplitudes are related to daily ER difficulties. Findings highlight the clinical utility of a lab-based neural measure of ER, suggesting that the CRN, rather than the ERN, reflects individual ER differences in the context of daily life among youth with pediatric anxiety disorders. As such, the CRN might serve as an important dimensional index of a treatment target that can be tracked with a validated, multi-method measure.

Introduction to the Special Issue: Interplay of Family Factors and Cognitive-Affective Processes in Youth.

Substantial research suggests that caregivers and families are powerful socialization agents when it comes to how youth process and regulate cognitive-affective information, which in turn can be a risk or resilience factor for various forms of developmental psychopathology. To this end, Clinical Child and Family Psychology Review features this special journal issue on the "Interplay of Family Factors & Cognitive-Affective Processes in Youth." Featured articles review a wide array of methodologies and highlight numerous forms of cognitive-affective processing and family contextual factors. Multiple themes emerged across the twelve articles, emphasizing the need to examine (1) complex pathways within families, (2) the quality of cognitive-affective processes across individuals, (3) neurodevelopmental pathways linking socialization and cognitive-affective processes, (4) nuanced methods to assess "in-the-moment" cognitive-affective processes, (5) the impact of cultural background on how family factors intersect with youth cognitive-affective processes, and (6) the socialization of positive emotion. These papers showcase the applicability of this significant area of research for future efforts in prevention and intervention with youth at risk for, or already experiencing, some form of psychopathology.

Countermeasures for Health Care Disruptions During Lockdowns.

Many countries did not have alternative healthcare arrangements during their initial coronavirus disease (COVID-19) lockdowns. This is surprising as partial and full lockdowns have been previously used to manage terrorism and the severe acute respiratory syndrome (SARS) outbreak of 2002-2003. This paper examines how lockdowns disrupt normal health care services and discusses countermeasures that can be used during lockdowns regardless of the emergency that engendered them. Solutions for consultations and pharmacy operations are discussed pragmatically with frontline clinicians, health care managers, and policy-makers in mind. Mental health services are used as a case in point with generalizable lessons for other healthcare specialties.

Cultural Values Influence Relations Between Parent Emotion Socialization and Adolescents' Neural Responses to Peer Rejection.

Adolescents' responses to negative social experiences can be influenced by parenting behaviors. This includes how parents react to their child's expression of emotions, an aspect of parenting referred to as emotion socialization. Emotion socialization may intersect with cultural values, particularly collectivism, a socially-relevant attitude that emphasizes the importance of interpersonal relationships. Examination of a neural measure called the feedback-related negativity (FRN), thought to reflect the degree to which feedback is experienced as aversive, could help elucidate neural contributions to and consequences of the role of collectivism in such family dynamics. Thus, this study examined whether adolescents' endorsement of collectivism moderated the association of parents' dismissive emotion socialization responses (called override responses) and FRN following peer rejection. A community sample of 83 Latinx (n = 32), Asian American (n = 20), and non-Latinx White (n = 31) adolescents ages 13-17 completed a computerized peer feedback task while continuous electroencephalogram was recorded. Their parents completed a battery of self-report questionnaires. Regression analyses demonstrated that adolescents' endorsement of collectivism moderated the association of override responses and FRN following peer rejection, such that FRN was enhanced as override responses increased for adolescents endorsing low and moderate levels of collectivism. Results suggest that there is cultural variation in the association of the emotion socialization strategy of override and adolescents' neural responses to socially-salient events. Findings have implications for parenting interventions designed to enhance adolescents' emotion regulation abilities.

Cultural group differences in the association of neural sensitivity to social feedback and social anxiety among diverse adolescents.

Social anxiety disproportionately impacts individuals from certain cultural and developmental groups, namely those from Latinx and Asian American cultures and adolescents. Neural sensitivity to social feedback has been shown to vary across individuals and could contribute to this disparity by further exacerbating differences; thus, this could be an important phenomenon for understanding, preventing, and treating social anxiety. The goal of the present study was to examine the association of social anxiety with a neural correlate of feedback processing, the feedback-related negativity (FRN), and determine if there was a moderating effect of racial/ethnic group. A community sample of 104 Latinx (n = 41), Asian American (n = 24), and non-Latinx White (NLW; n = 39) adolescents (ages 13-17) completed a computerized peer feedback task while continuous electroencephalogram was recorded. Social anxiety and FRN measures were differentially associated as a function of race/ethnicity. NLW adolescents demonstrated greater FRN responses to acceptance feedback as social anxiety increased, whereas FRN responses to both rejection and acceptance feedback were related to greater social anxiety for Asian American adolescents. Notably, the Latinx group showed the greatest FRN responses yet endorsed the least amount of social anxiety, with no relation between social anxiety and FRN detected. Results highlight cultural variation in the relation between neural correlates of self-regulatory processes and social anxiety. This information could guide culturally-informed models of social anxiety that adopt a multiple units of analysis framework.

The ERN as a neural index of changes in performance monitoring following attention training in pediatric obsessive-compulsive disorder.

Evidence of associations between obsessive compulsive disorder (OCD) and alterations in neural indices of performance monitoring, i.e., elevated neural activity following errors, have accelerated interest in the error-related negativity (ERN) as a biomarker for pediatric OCD. The study investigates the degree to which attention bias training is linked to changes in neural measures of performance monitoring (ERN, correct response negativity or CRN) and whether pre-to-post training changes in these neural indices are associated with symptom changes in youth with OCD. The sample included 36 youth (8-17 years) diagnosed with OCD who completed a 12-session attention training program and pre- and post-training EEG assessment of performance monitoring using cognitive and emotional flanker tasks. The emotional flanker task was individualized to each participant's negative ratings of stimuli at pre-treatment to enhance salience of threat-related stimuli across youth. Results indicated that unlike participants who received attentional control protocol (CON), those who received attentional bias modification protocol (ABM) showed significant attenuations in neural activity following erroneous and correct responses in the emotional flanker task. The ERN amplitude during the cognitive flanker task was unchanged in both ABM and CON groups. Attenuations in the ERN were also linked to decreases in social anxiety and depressive symptoms. Findings highlight the relevance of including emotionally-salient tasks when investigating potential neural mechanisms of treatments and suggest that alterations in neural processes underlying performance monitoring can be targeted via attention training programs in pediatric OCD.

Collectivism is associated with enhanced neural response to socially salient errors among adolescents.

The perceived salience of errors can be influenced by individual-level motivational factors. Specifically, those who endorse a high degree of collectivism, a cultural value that emphasizes prioritization of interpersonal relationships, may find errors occurring in a social context to be more aversive than individuals who endorse collectivism to a lesser degree, resulting in upregulation of a neural correlate of error-monitoring, the error-related negativity (ERN). This study aimed to identify cultural variation in neural response to errors occurring in a social context in a sample of diverse adolescents. It was predicted that greater collectivism would be associated with enhanced neural response to errors occurring as part of a team. Participants were 95 Latinx (n = 35), Asian American (n = 20) and non-Latinx White (n = 40) adolescents (ages 13-17) who completed a go/no-go task while continuous electroencephalogram was recorded. The task included social (team) and non-social (individual) conditions. ERN was quantified using mean amplitude measures. Regression models demonstrated that collectivism modulated neural response to errors occurring in a social context, an effect that was most robust for Latinx adolescents. Understanding cultural variation in neural sensitivity to social context could inform understanding of both normative and maladaptive processes associated with self-regulation.

Associations among response inhibition, motivational beliefs, and task persistence in early elementary school.

Task persistence is an important learning-related behavior associated with academic success. Although persistence has been related to motivational beliefs and cognitive skills, these constructs are typically studied independently, limiting our understanding of relations among them. The current investigation was designed to understand how these concepts are related in early elementary school, a developmental period characterized by high motivational beliefs, growth in cognitive control, and the transition to school. Interest, perceived competence, and response inhibition were evaluated as predictors of children's (N = 73, Mage = 6.91 years) likelihood to demonstrate high persistence on a challenging puzzle task. Results provided evidence that motivational constructs are not sufficient for understanding differences in persistent behavior during this developmental period. Specifically, relations between interest and perceived competence and task persistence were present only for children with moderate to high response inhibition skills. Moreover, gender differences in task persistence emerged, indicating that although interest and perceived competence motivated all students to exhibit persistence, girls were still more likely to demonstrate task persistence than boys. Overall, findings suggest that task persistence in elementary school is a complex behavior that requires both cognitive control skills to support engagement and the motivation to continue engaging as task difficulty increases.

Principle ERP reduction and analysis: Estimating and using principle ERP waveforms underlying ERPs across tasks, subjects and electrodes.

Event-related potentials (ERP) waveforms are the summation of many overlapping signals. Changes in the peak or mean amplitude of a waveform over a given time period, therefore, cannot reliably be attributed to a particular ERP component of ex ante interest, as is the standard approach to ERP analysis. Though this problem is widely recognized, it is not well addressed in practice. Our approach begins by presuming that any observed ERP waveform - at any electrode, for any trial type, and for any participant - is approximately a weighted combination of signals from an underlying set of what we refer to as principle ERPs, or pERPs. We propose an accessible approach to analyzing complete ERP waveforms in terms of their underlying pERPs. First, we propose the principle ERP reduction (pERP-RED) algorithm for investigators to estimate a suitable set of pERPs from their data, which may span multiple tasks. Next, we provide tools and illustrations of pERP-space analysis, whereby observed ERPs are decomposed into the amplitudes of the contributing pERPs, which can be contrasted across conditions or groups to reveal which pERPs differ (substantively and/or significantly) between conditions/groups. Differences on all pERPs can be reported together rather than selectively, providing complete information on all components in the waveform, thereby avoiding selective reporting or user discretion regarding the choice of which components or windows to use. The scalp distribution of each pERP can also be plotted for any group/condition. We demonstrate this suite of tools through simulations and on real data collected from multiple experiments on participants diagnosed with Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder. Software for conducting these analyses is provided in the pERPred package for R.

A review of associations between parental emotion socialization behaviors and the neural substrates of emotional reactivity and regulation in youth.

As highlighted by Eisenberg, Cumberland, and Spinrad (1998), parents play a critical role in children's socioemotional development, in part, by shaping how children and adolescents process, respond to, and regulate their emotions (i.e., emotional reactivity/regulation). Although evidence for associations between parenting behavior and youth's emotional processing has relied primarily on behavioral measures of emotion, researchers have begun to examine how parenting is related to the neural substrates of youth's reactivity and regulation. This article reviews a growing literature linking parental behavior with structural brain development as well as functional activity and connectivity in neural regions supporting emotional reactivity/regulation during infancy, childhood, and adolescence. By focusing on normative parental behaviors, we evaluate the evidence for associations between typical variations in caregiving and neural processes thought to support youth's emotional reactivity/regulation. The purpose of this review is to (1) extend the model put forth by Eisenberg and colleagues to consider the ways that parenting behaviors are related to neural substrates of youth's emotional reactivity and regulation; (2) review the empirical evidence for associations between parenting, particularly parental "emotion-related socialization behaviors" (ERSBs), and neural substrates of youth's emotional reactivity/regulation; and (3) recommend future directions for this emerging area of research. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Family functioning in pediatric trichotillomania, obsessive compulsive disorder, and healthy comparison youth.

Pediatric trichotillomania (TTM) is an understudied condition that can be highly impairing; little is known about family environmental features that shape its development and course. We examined family functioning among age and gender-matched groups of youth with primary TTM (n = 30; mean age = 12.87), obsessive compulsive disorder (OCD; n = 30; mean age = 12.70), and no psychiatric history (healthy controls; HC; n = 30; mean age = 12.46). An additional group of n = 25 TTM cases was employed to examine relationships between TTM severity and family functioning. All youth completed standardized diagnostic assessment, including the Family Environment Scale (FES) and Children's Report of Parenting Behavior Inventory (CRPBI). Family functioning was more impaired among both TTM and OCD cases relative to controls, as evidenced by higher levels of child-reported FES conflict and lower cohesion, expressiveness, and organization. Less consistent findings emerged on parent report, with cohesion, but not conflict, distinguishing the HC and clinical groups. In keeping with prior research, parents of TTM-affected youth also reported lower expressiveness and cohesion than parents in the OCD group. There was limited evidence for links between hair-pulling severity and family impairment and no links to parenting behavior. Findings are discussed in terms of implications for family focused treatment.

Symptom Dimension Response in Children and Adolescents with Obsessive-Compulsive Disorder.

This report examined the nature of obsessive-compulsive disorder (OCD) symptoms nominated for treatment and investigate improvement in OCD symptom dimensions. Youth with OCD (N = 71) participated in a clinical trial that compared exposure-based cognitive behavior therapy (CBT) to psychoeducation plus relaxation training (PRT). Participants completed a baseline assessment to characterize OCD severity. Next, parents and youth collaboratively developed an OCD symptom treatment hierarchy. Afterward, these symptoms were independently reassessed at each session by youth and parents. After 12 sessions, a posttreatment assessment was completed by independent evaluators. A greater incidence of baseline aggressive/checking symptoms predicted a positive CBT treatment response. For parent ratings of youth distress, CBT outperformed PRT across symptom dimensions, but hoarding symptoms exhibited a slower rate of improvement relative to other dimensions across treatments. For youth distress ratings, CBT outperformed PRT across most symptom dimensions. Although symmetry/ordering symptoms exhibited a slower rate of improvement relative to other dimensions across treatments, post hoc tests found no difference in the average distress rating for symmetry/ordering symptoms between treatment groups. Finally, across symptom dimensions, parents reported a linear reduction in youth distress, whereas youth experienced a nonlinear reduction in distress that diminished over treatment. Exposure-based CBT is beneficial for OCD symptoms and remains the principle treatment for pediatric OCD. However, as symmetry/ordering symptoms exhibited improvement from CBT and PRT, there is some shared treatment mechanisms that improves these symptoms. Finally, as youth perceive diminishing distress reduction over time, clinicians are encouraged to employ appropriate reinforcement strategies in treatment.

Onabotulinum Toxin A Injections Into the Salivary Glands for Spinal Muscle Atrophy Type I: A Prospective Case Series of 4 Patients.

OBJECTIVE: The aim of the study was to investigate the safety and efficacy of onabotulinum toxin A injection to the salivary glands under ultrasound guidance for the treatment of sialorrhea in patients with spinal muscular atrophy type I. DESIGN: Prospective case series with four patients with spinal muscular atrophy type I who received onabotulinum toxin A injection to parotid and submandibular glands for sialorrhea as part of clinical care. All four patients received validated surveys for measuring drooling, including objective measures of number of bib changes, and number of mouth wipes before injection and 4-6 wks after injection. Research was limited to survey completion. Scales included the Drooling Severity and Frequency Scale and the Drooling Impact Scale as well as a new scale used in our clinic, the Posterior Drooling Scales looking at coughing/choking and number of aspiration pneumonias. RESULTS: There were no adverse events. All four patients showed clinically significant improvements. The improvement in drooling using the Drooling Impact Scale was statistically significant (paired t test, t = 3.243, P = 0.048). All patients improved with number of mouth wipes. CONCLUSION: Ultrasound-guided onabotulinum toxin A injections to the salivary glands may be a safe and effective method of decreasing drooling in patients with spinal muscular atrophy type I.

Changes in Sleep Problems Across Attention-Deficit/Hyperactivity Disorder Treatment: Findings from the Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder Study.

Objective: Stimulant medication and behavior therapy are efficacious for youth with attention-deficit/hyperactivity disorder (ADHD). However, research suggests that stimulants may start and/or worsen sleep problems for youth. Further, the impact of behavior therapy for ADHD on sleep is unknown. This study examined the frequency of sleep problems and effects of stimulant medication, behavior therapy, and their combination on sleep problems in youth with ADHD. This study also explored the influence of dimensional baseline ratings of ADHD symptom subtype and psychiatric comorbidity on sleep outcomes. Methods: Participants were 576 children (aged 7-9 years) with ADHD-Combined type from the Multimodal Treatment of ADHD study that compared methylphenidate, behavior therapy, and their combination to community care. Before treatment, parents completed the Child Behavior Checklist used to derive a total sleep problems score. Parents also completed ratings of oppositionality and ADHD symptom severity, whereas youth completed ratings of depression and anxiety. These ratings were readministered after treatment. Results: General linear mixed-effects models were used to assess change in total sleep problems across treatment. The combined group exhibited a statistically significant reduction in total sleep problems (z = -5.81, p < 0.001). Reductions in total sleep problems in methylphenidate (z = -3.11, p = 0.05), behavior therapy (z = -2.99, p = 0.08), or community care (z = -1.59, p > 0.99) did not reach statistical significance. Change in psychiatric symptoms did not significantly moderate change in total sleep problems by treatment assignment. Greater baseline oppositional defiant disorder severity predicted less reduction in total sleep problems, χ2(1) = 3.86, p < 0.05. Conclusions: Findings suggest that combination of methylphenidate and behavior therapy is efficacious for reducing parent-reported sleep problems in young children with ADHD-Combined type relative to community care. However, potential ameliorative effects of monotherapy treatments (i.e., methylphenidate, behavior therapy) should be examined. Future replication is needed to confirm findings.

Age-Related Developmental and Individual Differences in the Influence of Social and Non-social Distractors on Cognitive Performance.

This study sought to examine age-related differences in the influences of social (neutral, emotional faces) and non-social/non-emotional (shapes) distractor stimuli in children, adolescents, and adults. To assess the degree to which distractor, or task-irrelevant, stimuli of varying social and emotional salience interfere with cognitive performance, children (N = 12; 8-12y), adolescents (N = 17; 13-17y), and adults (N = 17; 18-52y) completed the Emotional Identification and Dynamic Faces (EIDF) task. This task included three types of dynamically-changing distractors: (1) neutral-social (neutral face changing into another face); (2) emotional-social (face changing from 0% emotional to 100% emotional); and (3) non-social/non-emotional (shapes changing from small to large) to index the influence of task-irrelevant social and emotional information on cognition. Results yielded no age-related differences in accuracy but showed an age-related linear reduction in correct reaction times across distractor conditions. An age-related effect in interference was observed, such that children and adults showed slower response times on correct trials with socially-salient distractors; whereas adolescents exhibited faster responses on trials with distractors that included faces rather than shapes. A secondary study goal was to explore individual differences in cognitive interference. Results suggested that regardless of age, low trait anxiety and high effortful control were associated with interference to angry faces. Implications for developmental differences in affective processing, notably the importance of considering the contexts in which purportedly irrelevant social and emotional information might impair, vs. improve cognitive control, are discussed.

Error-related brain activity in pediatric anxiety disorders remains elevated following individual therapy: a randomized clinical trial.

BACKGROUND: Anxiety disorders are associated with an overactive action monitoring system as indexed by a larger error-related negativity (ERN). This study tests whether ERN magnitude changes following treatment, predicts response to treatment, and varies by treatment type. METHODS: The sample included 130 youth (9-14 years): youth with an anxiety disorder (ANX; n = 100) and healthy control (HC; n = 30) youth with no lifetime DSM-IV disorders. ANX youth were randomized to either a manualized cognitive-behavior therapy (CBT) or a comparison child-centered therapy (CCT). The ERN was assessed before and after 16 sessions of treatment and within a comparable interval for HC. Subjective ratings about making errors on the task were obtained following each testing session. The ClinicalTrials.gov identifier is NCT00774150. RESULTS: The ERN was larger in ANX than HC youth but ERN magnitude did not significantly change following treatment in the ANX youth, regardless of treatment type, and baseline ERN did not predict treatment response. Post-task ratings revealed that ANX youth worried more about task performance feedback than HC. Like the ERN, mean ratings did not significantly change following treatment. However, these ratings were not correlated with ERN amplitude. CONCLUSIONS: Findings of greater ERN in pediatric anxiety disorders are replicated in a larger sample. More importantly, findings from this randomized control trial show that a larger ERN and feeling worried about performance feedback remain unchanged following treatment and are unrelated to treatment response. Such findings suggest that action monitoring systems remain overactive in anxious youth treated with psychotherapy, suggesting the need for future investigation of whether novel complimentary cognitive and emotional training programs can modify these systems would be warranted.

A Randomized Clinical Trial Comparing Individual Cognitive Behavioral Therapy and Child-Centered Therapy for Child Anxiety Disorders.

This study compared individual cognitive behavioral therapy (CBT) and a supportive child-centered therapy (CCT) for child anxiety disorders on rates of treatment response and recovery at posttreatment and 1-year follow-up, as well as on real-world measures of emotional functioning. Youth (N = 133; ages 9-14) with anxiety disorders (generalized, separation, and/or social anxiety) were randomized using a 2:1 ratio to CBT (n = 90) or CCT (n = 43), which served as an active comparison. Treatment response and recovery at posttreatment and 1-year follow-up were assessed by Independent Evaluators, and youth completed ecological momentary assessment of daily emotions throughout treatment. The majority of youth in both CBT and CCT were classified as treatment responders (71.1% for CBT, 55.8% for CCT), but youth treated with CBT were significantly more likely to fully recover, no longer meeting diagnostic criteria for any of the targeted anxiety disorders and no longer showing residual symptoms (66.7% for CBT vs. 46.5% for CCT). Youth treated with CBT also reported significantly lower negative emotions associated with recent negative events experienced in daily life during the latter stages of treatment relative to youth treated with CCT. Furthermore, a significantly higher percentage of youth treated with CBT compared to CCT were in recovery at 1-year follow-up (82.2% for CBT vs. 65.1% for CCT). These findings indicate potential benefits of CBT above and beyond supportive therapy on the breadth, generalizability, and durability of treatment-related gains.

Child language and parenting antecedents and externalizing outcomes of emotion regulation pathways across early childhood: A person-centered approach.

Decreases in children's anger reactivity because of the onset of their autonomous use of strategies characterizes the prevailing model of the development of emotion regulation in early childhood (Kopp, 1989). There is, however, limited evidence of the varied pathways that mark this development and their proposed antecedents and consequences. This study used a person-centered approach to identify such pathways, antecedents, and outcomes. A sample of 120 children from economically strained rural and semirural households were observed while waiting to open a gift at ages 24, 36, and 48 months. Multitrajectory modeling of children's anger expressions and strategy use yielded three subgroups. As they aged, typically developing children's strategy use (calm bids and focused distraction) increased while anger expressions decreased. Later developing children, though initially elevated in anger expression and low in strategy use, demonstrated marked growth across indicators and did not differ from typically developing children at 48 months. At-risk children, despite developing calm bidding skills, did not display longitudinal self-distraction increases or anger expression declines. Some predicted antecedents (12-24 month child language skills and language-capitalizing parenting practices) and outcomes (age 5 years externalizing behavior) differentiated pathways. Findings illustrate how indicator-specific departures from typical pathways signal risk for behavior problems and point to pathway-specific intervention opportunities.