Faculty Bibliography

OBJECTIVE: To examine the relationship between self-reported social anxiety and asthma in a non-clinical sample of adolescents. STUDY DESIGN: High school students (n = 765) completed the Social Anxiety Scale for Adolescents (SAS-A), the Social Phobia and Anxiety Inventory for Children (SPAI-C), and questions on asthma diagnosis, asthma symptoms, and asthma-related limitations and medical care. Relationships were examined between social anxiety symptoms and asthma, including history of diagnosis, diagnosis plus current symptoms, and severity. RESULTS: Compared with students without an asthma diagnosis and no symptoms, students with a diagnosis and current symptoms reported heightened social anxiety symptoms related to fear of negative evaluations and generalized discomfort in social settings as measured by the SAS-A. Additionally, a greater proportion of students with an asthma diagnosis and current symptoms were in the clinical range of social anxiety on the SAS-A. Differences on the SAS-A by history of asthma diagnosis and by severity were not supported. No differences were found on the SPAI-C for history of asthma diagnosis, diagnosis plus current symptoms or severity. CONCLUSIONS: Students with current asthma symptoms were more likely to report social anxiety, perhaps related to concerns about exhibiting symptoms or taking medication in front of peers. These findings may suggest advantages for medical providers to identify and treat social anxiety in patients with asthma

OBJECTIVE: Research on child and adolescent anxiety disorders has seen a surge in investigations of parenting factors potentially associated with their etiology. However, many of the well-established parenting measures are limited by over-reliance on self-report or lengthy behavioral observation procedures. Such measures may not assess factors most salient to anxiety etiology, since most family functioning measures were not originally developed for this purpose. The Family Assessment Clinician Interview (FACI) was developed as a clinician-administered interview of parent and family factors associated with child and adolescent anxiety. The present study is the first to investigate the psychometric properties of the FACI. METHOD: Using a clinical sample of 65 children with various anxiety disorders, and their parents, inter-rater reliability, convergent validity and associations with child-reported and clinician-evaluated anxiety severity were examined. RESULTS: suggest that the FACI has good to excellent inter-rater reliability with kappas ranging from 0.79 to 1.0 across FACI scales and subscales. Some evidence of convergent validity with relevant portions of the Family Environment Scale was observed, although the latter findings varied by respondent (mother versus father). The Family Warmth/Closeness subscale of the FACI was consistently associated with increased child anxiety symptoms. Contrary to expectations, higher levels of parental expectations were associated with lower levels of child anxiety. CONCLUSION: Results suggest that the FACI is a promising measure of family anxiety constructs that may be useful in both research and clinical settings.

OBJECTIVE: To examine the initial feasibility and potential efficacy of a cognitive-behavioral intervention for youth with anxiety disorders and non-medical somatic symptoms. BACKGROUND: Based on a strong relationship between somatic complaints and anxiety disorders, screening youngsters seeking medical care due to physical symptoms with no organic basis may enhance the recognition of anxiety disorders and facilitate access to appropriate services. METHOD: Seven boys and girls, ages 8 through 15, with medically unexplained gastrointestinal complaints and anxiety disorders received a 12-session cognitive-behavioral intervention targeting anxiety and physical symptoms. Assessments were conducted at baseline and following treatment. RESULTS: All participants were classified as treatment responders. Three of the seven participants no longer met diagnostic criteria for their principal anxiety disorder. Children's physical discomfort decreased from a moderate to minimal level based on self- and parent-reports. CONCLUSIONS: Our modified cognitive-behavioral approach has promise for reducing anxiety and somatic symptoms in children seeking medical care

Anxiety disorders are among the most common disorders affecting children and adolescents. Most pediatric anxiety treatment trials have been conducted in specialized research clinics and have targeted mixed samples of anxious children. In addition, the majority have focused on children ages 7 through 14 years, and used waiting-list controls which provide limited documentation of the specific contribution of CBT. Another issue is that despite the efficacy demonstrated for existing cognitive-behavioral treatments, the majority of affected children in the community do not receive mental health services. Future research is needed examining the effectiveness of interventions: (a) compared to other treatments, (b) tailored to specific disorders, and (c) for younger children below age 9 as well as adolescents. An additional critical direction will be to evaluate the efficacy of interventions in less controlled and innovative settings, and to adapt our existing treatments to be feasible for delivery by less specialized clinicians and more applicable to children with anxiety disorders who present in community settings. This special series in Cognitive and Behavioral Practice aims to expand the research agenda on interventions for pediatric anxiety disorders to address these unmet needs of anxious children and adolescents.

Anxiety disorders in children and adolescents are largely undetected and the majority of youth do not receive services. Given the deleterious consequences of anxiety disorders, early identification and intervention have public health implications. In order to increase identification and treatment of anxious youth, expansion to nonpsychiatric settings (i.e., pediatric medical settings, schools) is necessary. Pediatric medical offices represent ideal settings for detection and intervention for several reasons: (1) access to large numbers of children, (2) high prevalence of unrecognized anxiety disorders in medical settings, and (3) an association between anxiety disorders and medically unexplained somatic symptoms. This paper describes a cognitive-behavioral intervention for youth who present to pediatric medical settings with nonmedical somatic symptoms and undiagnosed anxiety disorders. We explain the rationale for and focus of our treatment approach, present two case studies illustrating the treatment process, and conclude with a discussion of implementation considerations.

BACKGROUND: Anxiety disorders are often undetected and untreated in adolescents. This study evaluates the relative efficacy of a school-based, cognitive-behavioral intervention compared to an educational-supportive treatment for adolescents with social anxiety disorder. METHODS: Thirty-six students (30 females), ages 14 to 16, were randomized to a 12-week specific intervention, Skills for Social and Academic Success (SASS), or a credible attention control matched for structure and contact, conducted in school. RESULTS: Independent evaluations and adolescent self-reports indicated significant reduction in social anxiety for SASS compared to the control group. Parent reports of their children's social anxiety did not discriminate between treatments. In the specific intervention, 59%, compared to 0% in the control, no longer met criteria for social anxiety disorder following treatment. Superiority of the SASS intervention was maintained 6 months after treatment cessation. CONCLUSIONS: The study provides evidence that intervention for social anxiety disorder that emphasizes exposure and social skills is efficacious. Results indicate that clinical improvement is sustained for at least 6 months, and that, overall, adolescents with social anxiety disorder do not respond to non-specific treatment. This investigation has public health implications by demonstrating that effective interventions can be transported to nonclinical settings

In this Special Issue, we bring together leaders in the field to discuss more general issues in the transporting of evidence-based programs to children and the status of some of the more promising programs targeting specific populations. The Special Issue also provides in-depth coverage of SMH programs targeting specific populations. Populations covered represent the full spectrum of developmental levels and syndrome types. Two papers address the treatment of anxiety disorders. Externalizing syndromes are also covered. Despite the promise of early intervention in the prevention of conduct problems, there is little empirical data to justify or guide such efforts. The Issue closes with a paper focusing on students experiencing a wide range of difficulties who are classified in educational settings as having an emotional disturbance (ED), one of the 12 disability categories defined in the Individuals with Disabilities Education Act (IDEA).