Faculty Bibliography

Taken together, anxiety disorders are the most common mental health disorders, and typically onset in childhood or early adolescence. Left untreated, anxiety disorders in youth can lead to additional psychopathology and decreased overall functioning in adulthood. This article provides a review of recent findings regarding best practices in the psychosocial treatment of anxiety disorders in children and adolescents. Special topics, such as obsessive-compulsive disorder, parenting, technological advances, and psychopharmacology are also covered.

Abstract Objective: In light of the current controversy about whether severe temper outbursts are diagnostic of mania in young children, we conducted a study to characterize such children, focusing on mania and other mood disorders, emotion regulation, and parental psychiatric history. Methods: Study participants included 51 5-9-year-old children with frequent, impairing outbursts (probands) and 24 non-referred controls without outbursts. Parents completed a lifetime clinical interview about their child, and rated their child's current mood and behavior. Teachers completed a behavior rating scale. To assess emotion regulation, children were administered the Balloons Game, which assesses emotion expressivity in response to frustration, under demands of high and low regulation. Parental lifetime diagnoses were ascertained in blind clinical interviews. Results: No child had bipolar disorder, bipolar disorder not otherwise specified (NOS), or major depression (MDD). The most prevalent disorder was oppositional defiant disorder (88.2%), followed by attention-deficit/hyperactivity disorder (74.5%), anxiety disorders (49.0%), and non-MDD depressive disorders (33.3%). Eleven probands (21.6%) met criteria for severe mood dysregulation. During the Balloons Game, when there were no demands for self-regulation, children with severe outbursts showed reduced positive expressivity, and also showed significant deficits in controlling negative facial expressions when asked to do so. Anxiety disorders were the only diagnoses significantly elevated in probands' mothers. Conclusions: Overall, young children with severe temper outbursts do not present with bipolar disorder. Rather, disruptive behavior disorders with anxiety and depressive mood are common. In children with severe outbursts, deficits in regulating emotional facial expressions may reflect deficits controlling negative affect. This work represents a first step towards elucidating mechanisms underlying severe outbursts in young children.

New and innovative ways of implementing cognitive-behavioral therapy (CBT) are required to address the varied needs of youth with anxiety disorders. Brief treatment formats may be useful in assisting teens to return to healthy functioning quickly and can make treatment more accessible for those who may not have local access to providers of CBT. This paper provides information about the implementation of an intensive, 8-day treatment program for panic disorder (with or without agoraphobia) in adolescents. The treatment protocol is described, as are the various areas to consider when implementing an intensive format. Two case examples are provided to detail how the treatment specifically addresses the wide array of symptoms that can present as part of panic disorder with agoraphobia. Within these case descriptions, treatment challenges are highlighted as well as ideas for handling them. Finally, areas for future research are discussed.

This study evaluated the relationship between expressed emotion (EE) and treatment outcome in the families of anxious youth. Expressed emotion was measured via the Five-Minute Speech Sample (FMSS). Treatment outcome was operationalized by change scores both from pretreatment to posttreatment and from pretreatment to one-year follow-up, measured in three ways: (a) severity of child anxiety (clinician severity rating on ADIS-IV-C/P), (b) presence of anxiety disorder (ADIS-IV-C/P), and (c) global functioning (CGAS). Participants were 98 children (ages 8-13) with a primary diagnosis of generalized anxiety disorder, separation anxiety disorder, or social phobia and their families. The children and their families were randomized to one of three treatment conditions: family cognitive-behavioral therapy (FCBT), individual cognitive-behavioral therapy (ICBT), and an education/support/attention (ESA) condition. The relative contributions of EE and its two components, criticism and emotional overinvolvement (EOI), on the three treatment outcome measures were evaluated separately for mothers and fathers. Mother's classification as high in overall EE at pretreatment predicted the presence of an anxiety-disorder diagnosis in the child one year after treatment. The relationship between the three treatment conditions and parents' EE status across time was also evaluated. Parents' level of overall EE, criticism, and EOI improved significantly from pretreatment to one-year follow-up, but only for those in FCBT. Additional analyses examined the relationship between EE and measures of family functioning and parenting. Maternal criticism was significantly related to less acceptance, worse family adjustment, and worse overall family functioning. Finally, exploratory work focused on evaluating new coding systems for emotional over-involvement and warmth from the FMSS. New coding systems did not improve the utility of the FMSS in this sample. Study limitations and suggestions for avenues of future research are discussed. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

This study investigated the utility of several scales of the Child Behavior Checklist (CBCL) when diagnosing anxiety disorders in youth. Participants were the mothers and fathers of 130 children (ages 7 to 14; M = 9.61 years, SD = 1.74; 69 boys, 61 girls) who were evaluated at a specialty mental health clinic (100 were referred for treatment; 30 were nonanxious volunteers). For both mothers' and fathers' reports, the highest correlations were found between the Anxious/Depressed subscale and the severity of generalized anxiety disorder (GAD); the second highest relations were between the Withdrawn subscale and the severity of social phobia (SP). Using either mothers' reports or fathers' reports, receiver operating characteristics (ROC) analyses identified cutoff scores that were useful in ruling in the presence of an anxiety disorder in general but did not identify cutoff scores to rule in the presence of principal GAD or principal SP. For mothers' reports only, receiver operating characteristics analyses identified a useful cutoff score to rule out the presence of an anxiety disorder, as well as a cutoff score to rule out the presence of principal GAD. Finally, discriminant function analyses determined the most useful subscales for ruling in and ruling out an anxiety disorder in general, as well as principal GAD and principal SP. Findings are discussed with regard to diagnosis of child anxiety and the clinical utility of the CBCL with anxious youth

The present study evaluated treatment outcome differences in anxiety-disordered youth who differed in their disclosure of internal distress as measured in a structured diagnostic interview. One hundred and seventy-one clinic-referred, anxiety-disordered children served as participants. Participants' primary diagnoses were one of three anxiety disorders: separation anxiety, generalized anxiety/overanxious, or social phobia/avoidance. At a pretreatment assessment, children and their parents were interviewed separately using the Anxiety Disorders Interview Schedule (ADIS) to determine the child's diagnosis. The child's status as a discloser of high distress or discloser of low distress was determined by the parents' endorsement of an anxiety disorder and the child's endorsement or lack of endorsement of an anxiety disorder, respectively. Parents, teachers, and children also completed measures assessing the child's psychopathology (e.g., Revised Children's Manifest Anxiety Scale, Child Behavior Checklist). In general, findings indicated that the level of distress reported by the children moderated treatment outcome. Although both groups benefited from treatment, the children disclosing high distress experienced greater treatment gains than the children disclosing low distress