Anxiety Disorders in Children and Adolescents, 2nd Edition

Anxiety Disorders in Children and Adolescents provides readers, both in the research as well as clinical arenas, with a thorough and comprehensive overview of the understanding of the underlying processes for anxiety disorders in both children and adolescents. In the second edition, the authors have added extensive up-to-date research findings that were not available at the time of the first edition as well as suggestions for future investigations. The book is divided into four sections, focusing on historical and conceptual issues, the biology of child and adolescent anxiety, environmental influences on child and adolescent anxiety, and prevention and treatment of child and adolescent anxiety. Section 1 focuses on historical and conceptual issues. Starting with chapter 1, this book presents a wealth of information on historical perspectives, compiling narratives of descriptions of anxiety from Hippocrates through the middle ages, when anxiety was seen as the work of the devil. Early definitions of obsessivecompulsive disorder as well as the origins of anxiety are described. The factors identified in the later half of the 19th century including illnesses in parents, illnesses in mothers during pregnancy, and the role of parenting, among others, are discussed. Chapter 2 deals with clinical phenomenology and both the categorical and dimensional approaches to defining anxiety. Assessment methods using unstructured, semistructured, and structured interviews are presented as well as self-report measures that provide quick and cost-efficient ways of assessing a child’s anxiety. A thorough discussion of the prevalence and the epidemiology is covered in chapter 3, including the results of a thorough meta-analysis of 55 data sets. This chapter covers the prevalence rates for each age group as well as the lifetime associations between anxiety disorders and other illnesses such as depression, attention deficit hyperactivity disorder, oppositional defiant disorder, and substance use disorders. The findings that panic disorders were more likely to occur in adolescents than in young children as well as the fact that children with separation anxiety are more likely than other children to begin drinking earlier are important findings for prevention efforts and for clinical practice. Chapter 4 provides several explanations for the evolution of cognitive processes in children’s development and for the change in the nature of children’s fears (loud noises, loss of physical support, etc.). The effects of sex, culture, and socioeconomic variables on the development of fear are discussed. Ethnic minority children display higher levels of fear and anxiety than the majority culture does. The chapter includes discussion of vulnerability factors such as biological sensitivities and cognitive distortions that contribute to turning normal fears to more pathological states of anxiety. The studies on social anxiety reviewed in chapter 5 point to the importance of distinguishing among the different aspects of social anxiety such as public speaking and performance anxiety including the different ages of onset for these different aspects. The authors point out that the normal increase in social evaluation makes adolescents specifically sensitive to negative evaluation by peers, especially when feedback from peers is negative. The extensive research presented in chapter 6 supports the notion that both clinically and nonYclinically anxious children demonstrate information processing biases for threat. Clinically anxious children and adolescents increasingly interpret ambiguous situations in a threatening way. Chapter 7 focuses on the adult models of anxiety. Even though research in this area is in its early stages, the models developed for social phobia, generalized anxiety disorders, and obsessivecompulsive disorders have applicability for younger populations. Section 2 of the book presents the biology of child and adolescent anxiety. Starting with the genetic basis of anxiety in chapter 8, the authors review how age, sex, or rater differences influence the heritability estimates of anxiety. Twin studies have been helpful in highlighting the role of nonshared environment in genetic risk. An exhaustive review of the existing literature of genetic studies is offered, pointing to contributions by serotonergic genes, genes associated to catechol-O-methyl transferase, dopamine receptor genes, as well as genes for gamma-aminobutyric acid, corticotropin-releasing factor, and brain derived neurotrophic factor systems. This chapter also includes discussions of endophenotypes aswell as epigenetic changes mediated through changes in DNA methylation, with cited examples such as the research studies done of maternal grooming of rat pups influencing stress resilience. In chapter 9, Pine has written a comprehensive chapter that provides a framework for conceptualizing the influences of genes and the environment on the brain. These influences, in turn, shape information processing that mediates individual differences in behavior. It reviews existing mechanisms for processes involved in anxiety states such as threat appraisal, fear conditioning, and reward processing. Chapter 10 focuses on the construct that temperament, personality, and psychopathology fit together in a hierarchical model, with direct and indirect bidirectional effects between constructs. Behavioral inhibition, parenting styles, and higher-order temperamental dimensions of negative affectivity/neuroticism and effortful control and their relationship to anxiety are examined thoroughly. Section 3 focuses on several environmental factors that influence anxiety disorders. Chapter 11 is a detailed review of the role of learning in the development of anxiety disorders via different pathways that involve verbal threat information, vicarious experience, and direct conditioning. Schematic models of fear acquisition are presented and discussed. Chapter 12 focuses on the clinical and diagnostic features of posttraumatic stress reactions as well as frequency, risk of exposure, and developmental and cultural issues implicated in the reaction to trauma. Chapter 13 is an extensive, comprehensive, and detailed chapter on attachment theory and its link to anxiety. The authors review empirical methods to test attachment in both children and adolescents and adults. The studies that examine the link between insecure attachment and anxiety disorders arewell described as are themechanisms involved in the development and maintenance of anxiety disorders in children. This chapter offers key practice guidelines for both the assessment as well as the therapy of children with anxiety disorders that will be extremely valuable to clinicians. In chapter 14, the authors explore the evidence of the role of parenting, learning processes of modeling, and information transfer in the development of anxiety disorders as well as the role of parental control and the cognitive way by which it influences anxiety. They conclude that ‘‘increased parental control can lead to increased anxiety’’ (p. 307). Some of the parenting practices and behaviors may respond to interventions and may bring benefit to anxious children. Chapter 15 presents the aspects of peer processes that are associated with anxiety symptoms and the evidence that supports the concept that aversive peer processes like peer victimization and rejection contribute directly to anxiety, especially social anxiety. In addition to highlighting the measures used for assessing peer variables, the authors review cognitive behavioral therapy interventions for the socially anxious youth. Section 4 of the book focuses on the prevention and treatment of child and adolescent anxiety. In addition to an extremely detailed and comprehensive chapter that focuses on psychotherapy and cognitive behavioral therapy, this section contains a chapter dedicated to exploring universal prevention programs as well as selective programs for preschool children with high behavioral inhibition, for children whose parents have an anxiety disorder, and for those who are exposed to stressful events. The authors highlight barriers to the implementation of prevention programs such as issues of consent and engagement. A new addition to the second edition of the book is BOOK REVIEWS