Fitting anxious emotion-focused intervention into the ecology of schools: results from a test anxiety program evaluation.

Emotion-focused prevention and intervention efforts in schools have been promoted as a significant developmental and public health priority. This paper reports the results of a longitudinal study testing central premises of a school-based prevention model aimed at promoting positive emotional development through targeting test anxiety. Test anxiety interventions may be a practical strategy for conducting emotion-focused prevention and intervention efforts because of a natural fit within the ecology of the school setting. At-risk youth (n = 1,048) from urban public schools were screened and 325 with elevated test anxiety were offered the intervention in one of two waves (immediate intervention vs. waitlist). The intervention was associated with decreases in test anxiety, anxiety disorder, and depression symptoms. Critically, results suggest high participant satisfaction and growth curve analysis of follow-up assessments (end of the year, the next school year, and a subsequent school year) demonstrated positive developmental trajectories consistent with predictions (e.g., initial change in test anxiety predicted change in other symptoms). Findings provide evidence for the ecological validity of targeting test anxiety in school-based, emotion-focused prevention efforts.

Pre- and Perinatal Risk Factors for Youth with Autism Spectrum Disorder Versus Youth with Other Mental Health Disorders.

Research has linked pre- and perinatal complications (PPCs) with increased risk for autism spectrum disorder (ASD). However, PPCs are also known risk factors for other mental health disorders. This study explored which PPCs are specific risk factors for ASD, as opposed to other forms of psychopathology, among a large sample of clinically-referred youth. Archival data were used from 1177 youth who were evaluated at a hospital-based autism clinic. Results from logistic regressions indicated that use of tobacco, alcohol, or drugs, or experiencing amniocentesis predicted inclusion in the non-ASD group, while physical difficulties with delivery predicted inclusion in the ASD group. Possible explanations and implications for these findings are discussed.

IQ, parent- and self-reports of child anxiety and salivary cortisol in a sample of children with autism spectrum disorder.

This study examined the relation between IQ, parent-reported child anxiety, and salivary cortisol levels in youth with autism spectrum disorder (ASD) with a wide range of intellectual abilities using a prospective design. Results showed that IQ at time 1 (T1) positively predicted parent-reports of child anxiety at time 2 (T2); however, IQ at T1 negatively predicted cortisol levels from saliva samples taken at a research laboratory at T2. Parent reports of child anxiety at T1 and T2 were not associated with cortisol levels at T2. Implications for the assessment of anxiety in youth with ASD are discussed.

Exploring the association between cognitive functioning and anxiety in children with autism spectrum disorders: the role of social understanding and aggression.

This study examined relations between anxiety, aggression, social understanding, IQ, and diagnosis in a sample of 231 children (ages 2-9) diagnosed with Autism Spectrum Disorders (ASDs; Autistic Disorder, Asperger's Disorder, Pervasive Developmental Disorder Not Otherwise Specified) in a hospital setting. Children were administered tests of IQ, and parents completed measures of remaining variables. ASD diagnosis was associated with level of anxiety, and level of IQ explained this relation. IQ was significantly and positively associated with anxiety. Tests of a developmental model to explain the relation between IQ and anxiety showed that social understanding and aggression mediated the relation for toddlers. For preschool- and early elementary school-aged children, respectively, three-way interactions between IQ, social understanding, and aggression predicted anxiety, and graphs of the interactions suggest that the association between IQ and anxiety is increasingly driven by either aggression or social understanding over the course of childhood.

Correlates of long-term posttraumatic stress symptoms in children following Hurricane Katrina.

The present study examined the roles of loss and disruption, major life events, and social support in the relationship between exposure and PTSD symptoms in a group of children 33 months after Hurricane Katrina. One hundred fifty-six 4th, 5th, and 6th graders were surveyed in the New Orleans area. Results indicated that 46% of the children reported moderate to very severe levels of PTSD symptoms. Lower levels of classmate support and more negative life events after the hurricane were uniquely related to PTSD symptoms. Analyses did not reveal any moderating relationships among the variables. The results of this study have implications for the prevention and treatment of PTSD symptoms long after exposure to trauma.

Age Differences in Expression of Generalized and Social Anxiety Among Youth with Autism Spectrum Disorder.

This study examined differences in generalized and social anxiety symptoms across two age groups of children with autism spectrum disorder (ASD) while accounting for overall anxiety level, gender, and intellectual functioning. Older children (12-18 years) expressed more overall and social anxiety symptoms than younger children (6-11 years), and social anxiety symptoms were predominant in the older group. Younger children expressed more generalized anxiety symptoms than the older youth, and there was a trend for generalized anxiety symptoms to be more dominant in the younger group. Findings are consistent with theory of differential expression of specific anxiety symptoms across different ages seen with typically developing children, yet social evaluative concerns may be even stronger for adolescents with ASD.

PTSD symptoms and somatic complaints following Hurricane Katrina: the roles of trait anxiety and anxiety sensitivity.

This study examined the relationships between trait anxiety and anxiety sensitivity and the outcome variables posttraumatic stress disorder (PTSD) symptoms and somatic complaints following a major hurricane. Sixth and seventh graders in the New Orleans area (N = 302) were surveyed 5 to 8 months following Hurricane Katrina. As expected, hurricane exposure was a significant predictor of PTSD symptoms and somatic symptoms. Also as hypothesized, certain factors of anxiety sensitivity interacted with trait anxiety to predict PTSD symptoms and somatic symptoms. Clinical implications of potential linkages among trait anxiety, dimensions of anxiety sensitivity and PTSD, and somatic symptoms are discussed.

Parenting practices and childhood anxiety reporting in Mexican, Mexican American, and European American families.

Parenting practices reflecting over-control and lack of warmth and acceptance are associated with childhood anxiety in white non-Latino populations. In this study, we examined whether these parenting practices were related to childhood anxiety in Mexican-descent children. Mexican (M: n=46), Mexican American (MA: n=48), and European American (EA: n=47) families discussed three ambiguous, potentially anxiety provoking situations. Transcribed discussions were coded for parenting practices reflecting control and lack of warmth and acceptance. Controlling practices were associated with more anxiety for the M and EA groups and with less anxiety for the MA group. The MA parents generated more verbalizations indicative of control than the M parents and more verbalizations indicative of lack of warmth and acceptance than the EA parents. Implications for our understanding of anxiety development in Latino children are discussed.

A Pilot Study Examining the Effectiveness of the PEERS Program on Social Skills and Anxiety in Adolescents with Autism Spectrum Disorder.

The Program for the Evaluation of the Enrichment of Relational Skills (PEERS), a social skills intervention for high functioning adolescents with autism spectrum disorder (ASD), has been proven efficacious in randomized control trials. However, the effectiveness of the PEERS program in community settings has not been studied. The present small-scale pilot study examined the effectiveness of the PEERS program in a community setting. Five adolescents and their caregivers participated in the PEERS intervention. Results indicated that the adolescents showed significant improvement in their social engagement, social cognition, social communication, social motivation, and knowledge of PEERS skills and concepts from pre- to post-intervention. Furthermore, adolescents showed significant reductions in their internalizing and autistic symptoms from pre- to post-intervention. The findings from this small-scale pilot study support the effectiveness of the PEERS program in community-based settings.

Parenting style of Mexican, Mexican American, and Caucasian-non-Hispanic families: social context and cultural influences.

To begin accounting for cultural and contextual factors related to child rearing in Mexican-descent (MD; Mexican American and Mexican immigrant) families in the United States, the current study examined parenting practices in 2-parent families of Mexican, MD, and Caucasian-non-Hispanic (CNH) parents. Parents in all groups reported using authoritative practices more often than authoritarian strategies. MD parents reported greater use of authoritarian practices than Mexican and CNH parents. Results suggest that previously found cultural variations in parenting between MD parents and CNH parents may be more related to the ecological context of MD families than to an affiliation with Mexican culture. Clinicians should explore the positive qualities of authoritative parenting in MD families along with the potential motivations for using authoritarian strategies.

Parenting practices, interpretive biases, and anxiety in Latino children.

A number of factors are believed to confer risk for anxiety development in children; however, cultural variation of purported risk factors remains unclear. We examined relations between controlling and rejecting parenting styles, parental modeling of anxious behaviors, child interpretive biases, and child anxiety in a mixed clinically anxious (n=27) and non-clinical (n=20) sample of Latino children and at least one of their parents. Families completed discussion-based tasks and questionnaires in a lab setting. Results indicated that child anxiety was: linked with parental control and child interpretative biases, associated with parental modeling of anxious behaviors at a trend level, and not associated with low parental acceptance. Findings that controlling parenting and child interpretive biases were associated with anxiety extend current theories of anxiety development to the Latino population. We speculate that strong family ties may buffer Latino children from detrimental effects of perceived low parental acceptance.

Mother-child disagreement in reports of child anxiety: effects of child age and maternal anxiety.

The present study examined effects of maternal anxiety, child age, and their interaction on mother-child anxiety reporting disagreement while taking into account the direction of each informant's report relative to the other. Participants were 41 dyads of mothers and clinically anxious children aged 7-13. A hierarchical regression revealed a significant interaction between maternal anxiety and child age (ß = .30, p < .05). A graph of this interaction indicated that when maternal anxiety is high and the child is older, maternal report of anxiety is relatively higher, and when maternal anxiety is high and the child is younger, child report of anxiety is relatively higher. When maternal anxiety is low, the reporting discrepancy is relatively stable across age. Results may help explain previous mixed findings regarding effects of age and maternal anxiety on reporting discrepancies. Possible explanations for these results are discussed.

Predictors of metabolic control in children with Type 1 diabetes: the impact of Hurricane Katrina in a prospective study.

AIMS: To prospectively examine the effects of fear of hypoglycemia (FH), adherence to blood glucose testing, and anxiety on metabolic control in youth with Type 1 diabetes. To examine the relationships among these variables in the context of a hurricane. METHODS: Participants included 158 children completing measures at two times, with 58 participants completing measures pre- and post-Hurricane Katrina. Hierarchical regressions were run predicting indices of metabolic control. RESULTS: HbA1c was a unique predictor of subsequent HbA1c although a significant interaction between children's FH and hurricane group was found for HbA1c. Percent of low blood glucose (BG) was the only unique predictor of subsequent low BG. Percent of high BG and demographic variables were predictors of subsequent high BG. There was also a significant interaction between children's FH and hurricane group for high BG. CONCLUSIONS: Prior metabolic control is a strong predictor of subsequent metabolic control. Youth who exhibit FH are at risk for poor metabolic control, specifically demonstrating high BG levels and HbA1c if they have experienced a major stressor such as a natural disaster.

Maternal control, cognitive style, and childhood anxiety: a test of a theoretical model in a multi-ethnic sample.

This study tested a theoretical model of the interrelations among controlling parenting, negative cognitive styles, children's anxiety, and race/ethnicity. The model suggests that, in general, cognitive style mediates the relation between maternal control and child anxiety but that the set of associations may differ as a function of ethnicity. African American (n = 235), Latin American (n = 56), and European American (n = 136) children completed measures of their anxiety, cognitive schemas reflecting impaired autonomy/performance and disconnection/rejection domains, and maternal control. Results indicated that a disconnection/rejection negative cognitive style mediated the effect of perceived maternal control on childhood anxiety only for the European American group. Maternal control was associated with the impaired autonomy/performance cognitive style for each of the three ethnic groups and with a disconnection/rejection cognitive style only for the European American and Latin American groups. Maternal control had an indirect effect on anxiety through the disconnection/rejection cognitive style for the Latin American group. The results are discussed in terms of how the model presented extends current theories of anxiety problems to African American and Latin American children by noting that significant cultural variations may exist in how parenting practices and cognitive styles relate to children's anxiety levels.

The influence of culture on anxiety in Latino youth: a review.

This article reviews the literature on how culture influences anxiety in Latino youth. First, a review of cross-cultural variations in prevalence and measurement is presented. Then, the article focuses on how culture impacts the meaning and expression of anxiety. Specifically, we discuss the meaning and expression of anxiety, the impact of culture on anxiety at a societal level and through its effect on family and cognitive processes, and the influence of immigration and acculturation on anxiety. Finally, we propose recommendations on how to advance the literature in this area building on existing knowledge.

Parenting strategies and socio-cultural influences in childhood anxiety: Mexican, Latin American descent, and European American families.

This study examined the relationship between anxiety in Latin American children and Latino cultural schemas, parenting strategies, being an ethnic minority, and assimilation. Latin American (n=72; LA) and white European-American (n=46; EA) children living in the U.S., Mexican children living in Mexico (n=99; M), and at least one parent per family (n=283) were administered measures assessing anxiety, parenting strategies, collectivism, family cohesion, simpatia, parent-child communication, and assimilation. M and LA children expressed more anxiety symptoms than EA children. More mother control and less father acceptance were associated with childhood anxiety across all three groups. However, father control was associated with more anxiety for the EA group but not the MA group, and mother acceptance was associated with more anxiety for the EA and MA groups but with less anxiety for the M group. Family cohesion was negatively associated with children's anxiety independent of ethnic group. Finally, differing from parents in assimilation did not influence LA children's anxiety.

Development of a new fear of hypoglycemia scale: preliminary results.

OBJECTIVE: To provide preliminary psychometric data on the Children's Hypoglycemia Index (CHI), a new scale was designed to measure fear of hypoglycemia (FH) in children. METHODS: One hundred and nine children with type 1 diabetes attending a diabetes summer camp completed the CHI, and 57 of these children completed the CHI 2 weeks later. All participants also completed the Children's Hypoglycemia Fear Survey (CHFS), the Revised Children's Manifest Anxiety Scale (RCMAS), and a Hypoglycemia History Form. Parents of the children also completed a Hypoglycemia History Form. RESULTS: The CHI demonstrated good factor structure, internal consistency, test-retest reliability, and criterion-related validity with established measures. Frequency of severe hypoglycemic episodes since diabetes diagnosis also predicted scores on the Situation- and General-Fear subscales of the CHI. CONCLUSIONS: The CHI demonstrated reliability and validity as a measurement of children's FH. The use of this measure offers important clinical and research implications.

Anxiety reporting and culturally associated interpretation biases and cognitive schemas: a comparison of Mexican, Mexican American, and European American families.

This study examined whether Mexican (n = 53), Mexican American (n = 50), and European American (n = 51) children differed in their reporting of anxiety symptoms and whether parental influence and specific cognitive schemas associated with Mexican culture were related to differences in anxiety reporting. As expected, Mexican and Mexican American children reported significantly more physiological and worry symptoms than the European American children. Mexican and Mexican American children endorsed collectivism as a cultural value more strongly than European American children, and the Mexican children evidenced greatest use of social strategies reflecting simpatia. In family discussions of ambiguous, potentially anxiety-arousing situations, Mexican and Mexican American parents verbalized a greater percentage of somatic interpretations than the European American parents. Results indicate potential linkages between cultural values, socialization practices, and anxiety reporting.