Query: child anxiety

title: Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety
abstract: Anxiety disorders are the most common mental health disorder among children and adolescents. We examined 111 treatment outcome studies testing 204 treatment conditions for child and adolescent anxiety published between 1967 and mid 2013. Studies were selected for inclusion in this review using the PracticeWise Evidence Based Services database. Using guidelines identified by this journal (Southam Gerow Prinstein, 2014) studies were included if they were conducted with children and/or adolescents (ages 1 19) with anxiety and/or avoidance problems. In addition to reviewing the strength of the evidence, the review also examined indicators of effectiveness, common practices across treatment families, and mediators and moderators of treatment outcome. Six treatments reached well established status for child and adolescent anxiety, 8 were identified as probably efficacious, 2 were identified as possibly efficacious, 6 treatments were deemed experimental, and 8 treatments of questionable efficacy emerged. Findings from this review suggest substantial support for cognitive behavioral therapy (CBT) as an effective and appropriate first line treatment for youth with anxiety disorders. Several other treatment approaches emerged as probably efficacious that are not primarily CBT based, suggesting that there are alternative evidence based treatments that practitioners can turn to for children and adolescents who do not respond well to CBT. The review concludes with a discussion of treatments that improve functioning in addition to reducing symptoms, common practices derived from evidence based treatments, mediators and moderators of treatment outcomes, recommendations for best practice, and suggestions for future research.

title: A Genome Wide Test of the Differential Susceptibility Hypothesis Reveals a Genetic Predictor of Differential Response to Psychological Treatments for Child Anxiety Disorders
abstract: The differential susceptibly hypothesis suggests that certain genetic variants moderate the effects of both negative and positive environments on mental health and may therefore be important predictors of response to psychological treatments. Nevertheless, the identification of such variants has so far been limited to preselected candidate genes. In this study we extended the differential susceptibility hypothesis from a candidate gene to a genome wide approach to test whether a polygenic score of environmental sensitivity predicted response to cognitive behavioural therapy (CBT) in children with anxiety disorders.  We identified variants associated with environmental sensitivity using a novel method in which within pair variability in emotional problems in 1,026 monozygotic twin pairs was examined as a function of the pairs' genotype. We created a polygenic score of environmental sensitivity based on the whole genome findings and tested the score as a moderator of parenting on emotional problems in 1,406 children and response to individual, group and brief parent led CBT in 973 children with anxiety disorders.  The polygenic score significantly moderated the effects of parenting on emotional problems and the effects of treatment. Individuals with a high score responded significantly better to individual CBT than group CBT or brief parent led CBT (remission rates: 70.9, 55.5 and 41.6% respectively)  Pending successful replication, our results should be considered exploratory. Nevertheless, if replicated, they suggest that individuals with the greatest environmental sensitivity may be more likely to develop emotional problems in adverse environments but also benefit more from the most intensive types of treatment.

title: Maternal Postnatal Depression and Anxiety and Their Association With Child Emotional Negativity and Behavior Problems at Two Years
abstract: Postnatal maternal depression is associated with poorer child emotional and behavioral functioning, but it is unclear whether this occurs following brief episodes or only with persistent depression. Little research has examined the relation between postnatal anxiety and child outcomes. The present study examined the role of postnatal major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptom chronicity on children's emotional and behavioral functioning at 24 months. Following postnatal screening mothers (n 296) were identified as having MDD, GAD, MDD and GAD, or no disorder at 3 months postnatal; the average age was 32.3 (SD 5.0) 91.9% self identified as Caucasian, and 62.2% were married. Maternal disorder symptom severity was assessed by questionnaires and structured interview at 3, 6, 10, 14, and 24 months postpartum. At 24 months, child emotional negativity and behavior were assessed using questionnaires and by direct observation. Latent trait state occasion modeling was used to represent maternal disorder symptom chronicity; both stable trait and time specific occasion portions of maternal symptomatology were examined in relation to child outcomes. Only the stable trait portion of maternal MDD and GAD symptom severity were related to maternal report of child behavior problems and higher levels of emotional negativity. Persistent maternal MDD, but not GAD, symptom severity was related to higher levels of child emotional negativity as measured observationally. These data suggest that children's behavior problems and emotional negativity are adversely affected by persistent maternal depression, and possibly anxiety. This has implications for interventions to prevent negative effects of postnatal psychopathology on children.

title: Dental anxiety: An understudied problem in youth.
abstract: Dental anxiety and dental phobia typically emerge during childhood; the associated avoidance of dental care can result in oral health problems and is associated with lower quality of life. In this review, we discuss the definition of dental phobia and dental anxiety and issues related to their differentiation. We then review the literature on dental anxiety and dental phobia, including its prevalence, assessment, and sequalae. Moreover, we provide a synthesis of findings on the etiology and maintenance of dental phobia and propose a comprehensive cognitive behavioral model to guide further study. We also present a systematic qualitative and a quantitative review of the treatment literature, concluding that although we have made strides in learning how to prevent dental anxiety in youth, the methods effective in preventing anxiety may not be equally effective in treating youth with dental phobia. We propose a multidisciplinary approach, including those with expertise in pediatric anxiety as well as pediatric dentistry, is likely required to move forward.

title: A Meta Analysis of Maternal Prenatal Depression and Anxiety on Child Socioemotional Development.
abstract: Observed associations between maternal prenatal stress and children's socioemotional development have varied widely in the literature. The objective of the current study was to provide a synthesis of studies examining maternal prenatal anxiety and depression and the socioemotional development of their children.  Eligible studies through to February 2018 were identified using a comprehensive search strategy. Included studies examined the association between maternal prenatal depression or anxiety and the future development of their children's socioemotional development (eg, difficult temperament, behavioral dysregulation) up to 18 years later. Two independent coders extracted all relevant data. Random effects meta analyses were used to derive mean effect sizes and test for potential moderators.  A total of 71 studies met full inclusion criteria for data analysis. The weighted average effect size for the association between prenatal stress and child socioemotional problems was as follows: odds ratio (OR) 1.66 (95% CI 1.54 1.79) Effect sizes were stronger for depression (OR 1.79; 95% CI 1.61 1.99) compared to anxiety (OR 1.50; 95% CI 1.36 1.64) Moderator analyses indicated that effect sizes were stronger when depression was more severe and when socio demographic risk was heightened.  Findings suggest that maternal prenatal stress is associated with offspring socioemotional development, with the effect size for prenatal depression being more robust than for anxiety. Mitigating stress and mental health difficulties in mothers during pregnancy may be an effective strategy for reducing offspring behavioral difficulties, especially in groups with social disadvantage and greater severity of mental health difficulties.

title: Anxiety
abstract: Anxiety disorders (separation anxiety disorder, selective mutism, specific phobias, social anxiety disorder, panic disorder, agoraphobia, and generalised anxiety disorder) are common and disabling conditions that mostly begin during childhood, adolescence, and early adulthood. They differ from developmentally normative or stress induced transient anxiety by being marked (ie, out of proportion to the actual threat present) and persistent, and by impairing daily functioning. Most anxiety disorders affect almost twice as many women as men. They often co occur with major depression, alcohol and other substance use disorders, and personality disorders. Differential diagnosis from physical conditions including thyroid, cardiac, and respiratory disorders, and substance intoxication and withdrawal is imperative. If untreated, anxiety disorders tend to recur chronically. Psychological treatments, particularly cognitive behavioural therapy, and pharmacological treatments, particularly selective serotonin reuptake inhibitors and serotonin noradrenaline reuptake inhibitors, are effective, and their combination could be more effective than is treatment with either individually. More research is needed to increase access to and to develop personalised treatments.

title: Child STEPs in California: A Cluster Randomized Effectiveness Trial Comparing Modular Treatment With Community Implemented Treatment for Youth With Anxiety, Depression, Conduct Problems, or Traumatic Stress
abstract: This study reports outcomes from a randomized effectiveness trial testing modular treatment versus multiple community implemented evidence based treatments for youth.  An ethnoracially diverse sample of 138 youth ages 5 to 15 (62 girls, 76 boys) whose primary clinical concerns involved diagnoses or clinical elevations related to anxiety, depression, disruptive behavior, and/or traumatic stress were treated by community therapists randomly assigned to 1 of 2 conditions: (a) modular treatment, which involved a single modular protocol (i.e. modular approach to therapy for children; MATCH) that allowed flexible selection and sequencing of procedures to fit the chosen treatment focus in the context of measurement feedback, and (b) community implemented treatment (CIT) which was a county supported implementation of multiple evidence based practices for youth.  Youth treated with MATCH showed significantly faster rates of improvement over time on clinical and functional outcomes relative to youth in the CIT condition and required significantly fewer sessions delivered over significantly fewer days. Caregiver reported clinical improvement rates were significantly greater for MATCH (60% versus CIT (36.7% Further, youth in the CIT condition were significantly more likely to receive additional psychosocial treatment services and were significantly more likely to use a variety of psychotropic medications during the active treatment phase.  These results extend prior findings, supporting the effectiveness and efficiency of a modular, multifocus approach that incorporates monitoring and feedback relative to community implementation of evidence based treatments.

title: The etiology of social anxiety disorder: An evidence based model.
abstract: The current paper presents an update to the model of social anxiety disorder (social phobia) published by Rapee and Spence (2004) It evaluates the research over the intervening 11 years and advances the original model in response to the empirical evidence. We review the recent literature regarding the impact of genetic and biological influences, temperament, cognitive factors, peer relationships, parenting, adverse life events and cultural variables upon the development of SAD. The paper draws together recent literature demonstrating the complex interplay between these variables, and highlights the many etiological pathways. While acknowledging the considerable progress in the empirical literature, the significant gaps in knowledge are noted, particularly the need for further longitudinal research to clarify causal pathways, and moderating and mediating effects. The resulting model will be valuable in informing the design of more effective treatment and preventive interventions for SAD and will provide a useful platform to guide future research directions.

title: Cognitive behavioural therapy for anxiety disorders in children and adolescents.
abstract: A previous Cochrane review (James 2005) showed that cognitive behavioural therapy (CBT) was effective in treating childhood anxiety disorders; however, questions remain regarding (1) the relative efficacy of CBT versus non CBT active treatments; (2) the relative efficacy of CBT versus medication and the combination of CBT and medication versus placebo; and (3) the long term effects of CBT.  To examine (1) whether CBT is an effective treatment for childhood and adolescent anxiety disorders in comparison with (a) wait list controls; (b) active non CBT treatments (i.e. psychological placebo, bibliotherapy and treatment as usual (TAU) and (c) medication and the combination of medication and CBT versus placebo; and (2) the long term effects of CBT. SEARCH METHODS Searches for this review included the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Depression, Anxiety and Neurosis Group Register, which consists of relevant randomised controlled trials from the bibliographic databases The Cochrane Library (1970 to July 2012) EMBASE, (1970 to July 2012) MEDLINE (1970 to July 2012) and PsycINFO (1970 to July 2012) SELECTION CRITERIA All randomised controlled trials (RCTs) of CBT versus waiting list, active control conditions, TAU or medication were reviewed. All participants must have met the criteria of the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD) for an anxiety diagnosis, excluding simple phobia, obsessive compulsive disorder, post traumatic stress disorder and elective mutism.  The methodological quality of included trials was assessed by three reviewers independently. For the dichotomous outcome of remission of anxiety diagnosis, the odds ratio (OR) with 95% confidence interval (CI) based on the random effects model, with pooling of data via the inverse variance method of weighting, was used. Significance was set at P 0.05. Continuous data on each child's anxiety symptoms were pooled using the standardised mean difference (SMD) MAIN RESULTS Forty one studies consisting of 1806 participants were included in the analyses. The studies involved children and adolescents with anxiety of mild to moderate severity in university and community clinics and school settings. For the primary outcome of remission of any anxiety diagnosis for CBT versus waiting list controls, intention to treat (ITT) analyses with 26 studies and 1350 participants showed an OR of 7.85 (95% CI 5.31 to 11.60, Z 10.26, P 0.0001) but with evidence of moderate heterogeneity (P 0.04, I2 33% The number needed to treat (NNT) was 6.0 (95% CI 7.5 to 4.6) No difference in outcome was noted between individual, group and family/parental formats. ITT analyses revealed that CBT was no more effective than non CBT active control treatments (six studies, 426 participants) or TAU in reducing anxiety diagnoses (two studies, 88 participants) The few controlled follow up studies (n 4) indicate that treatment gains in the remission of anxiety diagnosis are not statistically significant.  Cognitive behavioural therapy is an effective treatment for childhood and adolescent anxiety disorders; however, the evidence suggesting that CBT is more effective than active controls or TAU or medication at follow up, is limited and inconclusive.

title: Annual Research Review: An expanded account of information processing mechanisms in risk for child and adolescent anxiety and depression
abstract: Anxiety and depression occurring during childhood and adolescence are common and costly. While early emerging anxiety and depression can arise through a complex interplay of 'distal' factors such as genetic and environmental influences, temperamental characteristics and brain circuitry, the more proximal mechanisms that transfer risks on symptoms are poorly delineated. Information processing biases, which differentiate youth with and without anxiety and/or depression, could act as proximal mechanisms that mediate more distal risks on symptoms. This article reviews the literature on information processing biases, their associations with anxiety and depression symptoms in youth and with other distal risk factors, to provide direction for further research.  Based on strategic searches of the literature, we consider how youth with and without anxiety and/or depression vary in how they deploy attention to social affective stimuli, discriminate between threat and safety cues, retain memories of negative events and appraise ambiguous information. We discuss how these information processing biases are similarly or differentially expressed on anxiety and depression and whether these biases are linked to genetic and environmental factors, temperamental characteristics and patterns of brain circuitry functioning implicated in anxiety and depression.  Biases in attention and appraisal characterise both youth anxiety and depression but with some differences in how these are expressed for each symptom type. Difficulties in threat safety cue discrimination characterise anxiety and are understudied in depression, while biases in the retrieval of negative and overgeneral memories have been observed in depression but are understudied in anxiety. Information processing biases have been studied in relation to some distal factors but not systematically, so relationships remain inconclusive.  Biases in attention, threat safety cue discrimination, memory and appraisal may characterise anxiety and/or depression risk. We discuss future research directions that can more systematically test whether these biases act as proximal mechanisms that mediate other distal risk factors.