Dissertations / Theses on the topic 'Anxiety disorders in children'

Worry is the hallmark feature of the anxiety disorders in children and adolescents. Little information, however, is available on childhood worry, and when worry may lead to functional impairment. The number, frequency, intensity, and areas of worry were examined in a clinic sample of children with anxiety disorders (n=59) using a structured data gathering procedure. Findings revealed that number of worry increased with age; severity decreased with age. An interaction between age and gender was also found. No differences were found for frequency or intensity. The most common areas of worry were School, Health, and Personal Harm. A link between worry and anxiety was also established as children with Overanxious Disorder (which is characterized by excessive worry) scored higher on all worry parameters relative to children with other types of anxiety disorders. The theoretical and clinical implication of these finding are discussed.

Despite a considerable progress in developing and testing psychosocial treatments to reduce youth anxiety disorders, much remains to learn about the relation between anxiety symptom reduction and change in youth functional impairment. The specific aims of this dissertation thus were to examine: (1) the relation between different levels of anxiety and youth functional impairment ratings; (2) incremental validity of the Children Global Assessment Scale (CGAS); (3) the mediating role of anxiety symptom reduction on youth functional impairment ratings; (4) the directionality of change between anxiety symptom reduction and youth functional impairment; (5) the moderating effects of youth age, sex, and ethnicity on the mediated relation between youth anxiety symptom reduction and change in functional impairment; and (6) an agreement (or lack thereof) between youths and their parents in their views of change in youth functional impairment vis-à-vis anxiety symptom reduction. The results were analyzed using archival data set acquired from 183 youths and their mothers. Research questions were tested using SPSS and structural equation modeling techniques in Mplus. The results supported the efficacy of psychosocial treatments to reduce the severity of youth anxiety symptoms and its associated functional impairment. Moreover, the results revealed that at posttreatment, youths who scored either low or medium on anxiety levels scored significantly lower on impairment, than youths who scored high on anxiety levels. Incremental validity of the CGAS was also revealed across all assessment points and informants in my sample. In addition, the results indicated the mediating role of anxiety symptom reduction with respect to change in youth functional impairment at posttest, regardless of the youth’s age, sex, and ethnicity. No significant findings were observed with regard to the bidirectionality and an informant disagreement vis-à-vis the relation between anxiety symptom reduction and change in functional impairment. The study’s main contributions and potential implications on theoretical, empirical, and clinical levels are further discussed. The emphasis is on the need to enhance existing evidence-based treatments and develop innovative treatment models that will not only reduce youth’s symptoms (such anxiety) but also evoke genuine and palpable improvements in lives of youths and their families.

Although up to 40% of children with autism spectrum disorder (ASD) have a comorbid anxiety disorder, little is known about the origins and trajectory of change in anxiety symptoms in ASD. Characteristics specific to ASD such as social impairments and alexithymia may alter the experience of anxiety in this population. Consequently, anxiety may differ in the ASD population and merits focused study. This dissertation consists of two related studies that used data from the longitudinal Pathways in ASD study. The psychometric properties of the Spence Children’s Anxiety Scale – Parent Form (SCAS-P) in 238 children who were seen annually from ages 7.5 to 11 were examined in Study 1. While the original six-factor structure was not a good fit in this sample, four subscales reflecting Generalized, Separation Anxiety, Panic and Agoraphobia symptoms were identified. In Study 2, parent ratings of Generalized, Separation Anxiety, Panic and Agoraphobia symptoms were captured at snapshots in middle childhood, as well as changing over time in 262 children who were seen annually between ages 7.5 to 11. The proportion of children whose parents rated them as experiencing Elevated Generalized Anxiety was comparable to past reports, though rates of Elevated Separation Anxiety symptoms were higher than past reports. Parent-rated Generalized Anxiety, Separation Anxiety, Panic and Agoraphobia symptoms were stable over the middle childhood years, and there was little variance in the trajectories of all except the Separation Anxiety domain. Children with age-typical language abilities were rated as experiencing higher levels of Generalized and Separation Anxiety in middle childhood. Parent-rated anxiety in early childhood significantly predicted higher Generalized and Separation anxiety across middle childhood, while parental internalizing symptoms in early childhood were predictive of Generalized, but not Separation Anxiety symptoms. There were no differences in Generalized or Separation Anxiety levels across ages 7-11 between boys and girls. The results of this research offer a deeper understanding of the psychometric properties of one widely used anxiety rating scale, as well as its predictors, incidence and development over middle childhood. In turn, this understanding can support efforts aimed at preventing and treating anxiety disorders in ASD.
Education, Faculty of
Educational and Counselling Psychology, and Special Education (ECPS), Department of
Graduate

The relationship between DSM-IV anxiety disorders and their clinical characteristics in mothers and anxiety in offspring was examined in 933 mother-child pairs from a longitudinal community study. Offspring of mothers with an anxiety disorder had an elevated risk of developing any anxiety disorder, compared with offspring of mothers with no anxiety disorder. Increased risk of anxiety in the offspring was especially associated with maternal social phobia and generalised anxiety disorder, and with maternal diagnoses of early onset, greater number and more severe impairment. These results suggest that the type of maternal anxiety disorder and its severity of manifestation contribute to mother-offspring aggregation of anxiety.

The relationship between DSM-IV anxiety disorders and their clinical characteristics in mothers and anxiety in offspring was examined in 933 mother-child pairs from a longitudinal community study. Offspring of mothers with an anxiety disorder had an elevated risk of developing any anxiety disorder, compared with offspring of mothers with no anxiety disorder. Increased risk of anxiety in the offspring was especially associated with maternal social phobia and generalised anxiety disorder, and with maternal diagnoses of early onset, greater number and more severe impairment. These results suggest that the type of maternal anxiety disorder and its severity of manifestation contribute to mother-offspring aggregation of anxiety.

Childhood anxiety disorders are highly prevalent, cause significant distress and functional impairment, are risk factors for depression, suicidal ideation and attempts, substance abuse and smoking, yet often go unrecognized and untreated. As a result, effective prevention and early intervention have become policy and research priorities. This study evaluated the effectiveness of a universal school-based cognitive behavioural intervention in decreasing anxiety symptoms experienced by early adolescents during the transition from elementary to middle or secondary school. The role of gender, coping style, geographic location, and timing of the intervention were also assessed. Participants were 722 grade 7 and 8 students (11 – 14 years) from 41 classrooms in 20 randomly selected public schools in British Columbia. Schools were randomly assigned to either the FRIENDS for Youth program provided within regular classrooms, one hour weekly for 10 weeks or to a waitlist control group. Self-reported anxiety, depression and coping, and parent and teacher assessed difficulties were assessed at pre-, post, and six month follow-up. Results were examined universally and for children who scored above the clinical cut-off for anxiety at pre-test. Results indicate students, including those “at risk”, who participated in the FRIENDS for Youth program had lower anxiety than those in the control group at 6-month follow-up. Gender differences in self-reported anxiety as well as in response to the intervention were found, with girls, including those “at risk” reporting higher anxiety scores than boys, and intervention group girls reporting significantly lower anxiety scores at post-intervention and at 6-month follow-up compared to the control group. Teachers assessed girls as having lower difficulties scores than boys, and intervention group girls reporting significantly lower difficulties scores at post-intervention than the control group. Grade 7 elementary students had significantly lower anxiety scores than middle school students and grade 7 students in the intervention group had significantly lower anxiety scores at post-intervention than the control group. Overall, intervention effects on anxiety were small. For “at risk” participants and for girls, however, the intervention was effective. Results demonstrated a prevention effect with significantly fewer “at risk” students at 6-month follow-up in the intervention group than the control group.

Psychology
Ph.D.
There is a paucity of research that has examined co-occurring oppositional defiant disorder and generalized anxiety disorder (ODD+GAD) symptoms and oppositional defiant disorder and separation anxiety disorder (ODD+SAD) symptoms among children. To address this gap, I investigated multiple explanations for the co-occurrence of ODD+GAD and ODD+SAD. Specifically, I investigated whether (a) GAD symptoms prospectively predicted ODD symptoms and SAD symptoms prospectively predicted ODD symptoms (Explanation 1), (b) ODD symptoms prospectively predicted GAD symptoms and ODD symptoms prospectively predicted SAD symptoms (Explanation 2), and (c) shared risk processes accounted for the co-occurrence of ODD+GAD and ODD+SAD (Explanation 3). Participants were an ethnic minority, inner-city sample of first through fourth grade children (N = 88, 51% male) and their primary caregivers. I used data collected at the baseline and 1-year follow-up assessments of the Child Health and Behavior Study, a longitudinal survey of families residing in North Philadelphia. Findings provided support for Explanation 2 and Explanation 3 in the development of co-occurring ODD+GAD symptoms and support for Explanation 3 in the development of co-occurring ODD+SAD symptoms. This study contributes to the extant literature by providing the first empirical examination of these multiple explanations in an ethnic minority, inner city sample of children.
Temple University--Theses

The proposed study examined the relationship between parental anxiety, measured both subjectively (via self-report questionnaires) and objectively (via salivary cortisol) and the child's feeding progress. Children diagnosed with a feeding disorder were recruited with their parents at Our Children's House at Baylor (n=19; 11 females, 8 males). The patients and their parents were housed in the clinic for an eight-week intensive multidisciplinary pediatric feeding disorder treatment program. Calorie intake was recorded daily as outcome measures of treatment progression. Parental anxiety was measured by the Pediatric Inventory for Parents (PIP), state anxiety on the State Trait Anxiety Inventory (STAI), and by salivary cortisol at three different time points. The present study attempted to examine whether parental feeding (phase three of treatment program) would continue to cause a decrease in the child's caloric intake. In averaging ten meals prior to parental feeding in comparison to the average of ten meals following parental feeding, there was no significant difference as measured by a t-test. Paired t-tests examined parental anxiety from time one to time two and found that salivary cortisol increased significantly t(15) = -6.07, p = .000 from Time 1 (M = 2.30, SD = 1.64) to Time 2 (M = 5.24, SD = 2.58). This demonstrated that while parental anxiety increased as measured by salivary cortisol, the children continued to make improvements. This may be the result of the multidisciplinary feeding program which encompassed a strong behavioral component and parent training. Even though the current results did not demonstrate a direct relationship between parental stress and caloric intake, parental stress as measured by salivary cortisol did increase.

In the literature, a well-known effective program in reducing children’s anxiety symptoms is the ‘Coping Cat’ program (Kendall, 1994). However, effectiveness studies of parental education program have been relatively limited. Parenting factors are important as the risk for anxiety disorders appears particularly high in the offspring of anxious parents (McClure, Brennan, Hammen, & Le Brocque, 2001). Further parenting styles such as over-involvement and criticism was found to play a significant role in the development and maintenance of childhood anxiety (Gar, & Hudson, 2008). Therefore, this study adopted the ‘Coping Cat’ treatment program and delivered exclusively to parents of 14 children with anxiety symptoms of ages 6-11. The intervention group consisted of 6 2-hours group sessions of 4 to 7 parents. Psychological questionnaires were administered to parents during pre and post treatment. The outcome measures were compared with another 14 parents who did not receive the parental education program. Self-reported questionnaires were administered, including Parenting Stress Scale (PSS), Alabama Parenting Questionnaire (APQ), Coping Self-Efficacy Scale (CSE 13), Brief COPE and Screen for Child Anxiety Related Disorders (SCARED), to assess parental stress, parental styles, parental stress-coping styles and indirect effect on children’s anxiety symptoms. Repeated-measures ANOVA and paired sample t-tests was computed to evaluate the effects of the parental program. Results suggested that the intervention group showed significantly reduction in parents and children’s levels of stress and anxiety symptoms. It also demonstrated significant decrease of child’s separation anxiety symptoms and school avoidance behaviours after intervention. Moreover, significant reduced level of negative parental practices and increased practices of positive stress-coping strategies were found at post-treatment. Furthermore, perceived efficacy in stopping unpleasant emotions and thoughts as well as getting support from friends and family had improved. Additionally, the reduced stress symptoms among participants in the intervention group were negatively correlated with the increased use of humour coping strategies. Likewise, the reduced level of anxiety symptoms at post-treatment was positively correlated with the reduced practices of negative and ineffective discipline.
published_or_final_version
Clinical Psychology
Master
Master of Social Sciences

The current study examined whether variables that have been found to influence treatment outcome serve as mediators of a child and adolescent cognitive behavioral treatment (CBT) anxiety program at multiple time points throughout the intervention. The study also examined mediating variables measured at multiple time points during treatment to determine the time lags necessary for changes in the mediator variable to translate into changes on treatment gains. Participants were 168 youth (ages 6 to 16 years; 54% males) and their mothers who presented to the Child Anxiety and Phobia Program (CAPP) at Florida International University (FIU). Overall, results indicate that the mediators at multiple time points influenced youth anxiety in a fluctuating manner, such that a decrease in skills at one given session caused changes in youth anxiety at a later session. This dynamic between the mediator and outcome may be reflective of the process of therapeutic change and suggests that skills gained from session to session took time to exert their effect on youth anxiety. The methodology employed helps to elucidate how variables mediate treatment outcome in youth anxiety disorders.

Anxiety can influence an individual's decision-making process; however, researchers have yet to establish whether anxiety has an impact on the healthcare utilization practices of mothers of children with a mental health diagnosis. The purpose of this study was to assess whether trait anxiety, coping styles, and self-efficacy in mothers of children with a mental health diagnosis affected their healthcare utilization decisions. The transactional model of stress and coping was used to analyze the impact of children with mental health disorders on their caretakers. For this study, a quantitative, cross-sectional research design was employed. The 4 survey tools, administered through SurveyMonkey.com as well as in paper form, included the Brief COPE, State-Trait Anxiety Inventory for Adults (STAID-AD), Health Self-Efficacy Measure, and Healthcare Utilization Questionnaire. Study participants (N = 152) were mothers primarily ages 30-49 years (90.8%), Caucasian (57.9%), and high school graduates (63.2%) who were residents of Lawrence County, Pennsylvania. Mothers reported their children were primarily ages 3-6 years (34.2%), Caucasian (49.3%), had a mental health diagnosis, were living in the home, and were currently in mental health treatment. The outcomes of a binary logistic regression found that trait anxiety did not have a significant impact on healthcare utilization. A Sobel test of mediation indicated that coping styles and self-efficacy were not mediating variables between trait anxiety and healthcare utilization. The implications for positive social change as a result of this research may lead to the training of healthcare providers on the specific characteristics of mothers of children with a mental health diagnosis and the development of social policies concerning healthcare utilization.

Social anxiety disorder (SAD) is defined by persistent, irrational anxiety in social situations while generalized anxiety disorder (GAD) is characterized by excessive worry unrelated to any specific situation. These two disorders share some features and are frequently comorbid in children and adults. The current study sought to examine this comorbidity and compare the disorders on a number of dimensions in a clinical sample of children and adolescents. It was hypothesized that SAD would be accompanied by higher levels of social anxiety and behavioral inhibition and lower levels of family expressiveness and social functioning than GAD. GAD was hypothesized to be accompanied by higher levels of worry, physiological symptoms, and anxiety sensitivity and lower levels of school functioning as compared to SAD. Youth with both disorders were hypothesized to function more poorly on all dimensions as compared to either disorder alone. Participants were drawn from a sample of 397 (137 female) youth who underwent psychoeducational assessment. A series of analyses of variance, discriminant function analyses, and factor analyses were performed using the entire sample, and repeated by gender and age group. Results indicated youth with GAD had higher levels of harm avoidance as compared to youth with social anxiety disorder. However, the diagnostic groups did not differ on other features. Moreover, results of factor and discriminant function analyses did not distinguish between the two groups. The pattern of results was similar when examined for gender and age, although some differences emerged. Overall, results suggest SAD and GAD overlap significantly in children, with less overlap in adolescents. This raises questions regarding the validity of current child anxiety taxonomies. Future research should further examine this phenomenon, including longitudinal samples and a wider range of diagnoses.
Ph. D.

The purpose of the present dissertation was to evaluate the internal validity of symptoms of four common anxiety disorders included in the Diagnostic and Statistical Manual of Mental Disorders fourth edition (text revision) (DSM-IV-TR; American Psychiatric Association, 2000), namely, separation anxiety disorder (SAD), social phobia (SOP), specific phobia (SP), and generalized anxiety disorder (GAD), in a sample of 625 youth (ages 6 to 17 years) referred to an anxiety disorders clinic and 479 parents. Confirmatory factor analyses (CFAs) were conducted on the dichotomous items of the SAD, SOP, SP, and GAD sections of the youth and parent versions of the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV: C/P; Silverman & Albano, 1996) to test and compare a number of factor models including a factor model based on the DSM. Contrary to predictions, findings from CFAs showed that a correlated model with five factors of SAD, SOP, SP, GAD worry, and GAD somatic distress, provided the best fit of the youth data as well as the parent data. Multiple group CFAs supported the metric invariance of the correlated five factor model across boys and girls. Thus, the present study’s finding supports the internal validity of DSM-IV SAD, SOP, and SP, but raises doubt regarding the internal validity of GAD.

Children with Social Anxiety Disorder (SAD) characterized by persistent shyness and anxiety in social or performance situation, exhibit social skills deficits. These deficits include difficulty initiating conversations, maintaining eye contact, and taking turns when speaking, which in turn leads to impairments in their daily interactions and development of peer relationships (Greco, 2005; Miers, 2010). Although there are many subjective assessments for treatment outcomes for children with SAD, in order to become more thorough and effective when assessing treatment outcomes, more objective measures of actual behaviors are needed. This study uses digital vocal analysis to examine vocal parameters associated with anxiety such as pitch and volume in children with SAD pre and post treatment. Measuring vocal parameters during role-play behavioral assessment tasks allowed us to examine whether the software was capable of detecting differences in vocal characteristics that are consistent with the clinical presentation of the disorder. Children with SAD showed differences in vocal characteristics pre to post treatment, in regards to pitch, pitch variability, volume, and volume variability. There were significant changes in volume pre to post treatment, however the changes in pitch, pitch variability, and volume variability were not significant. These results suggest that post SET-C treatment, certain vocal characteristics, (one of the social skills deficits exhibited by children with SAD) improved. Implications of the findings are discussed.
B.S.
Bachelors
Sciences
Psychology

Emotional disorders of anxiety and depression have been recognized as the most prevalent mental disorders in children and adolescents. High rates of co-morbidity between anxiety and depression have been reported in both adults and youths. Clark and Watson (1991) proposed a tripartite model to explain both the overlap and distinctiveness of anxiety and depression. In that model, negative affectivity (NA) is experienced in both anxiety and depression; lack of positive affectivity (PA) is specific to depression; and high physiological hyperarousal (PH) is unique to anxiety. Two decades of research among adults have supported the utility of the tripartite model. However, its applicability to children and adolescents has been studied less, and the results have been controversial. This controversy could be caused by two main issues. First, early youth research on the tripartite components has had to borrow adult measures to represent the tripartite constructs. Second, even after child-specific measures for the tripartite constructs were developed, relatively few studies have examined all three tripartite components together. In particular, PH has received less attention than NA and PA. The present study addresses these issues. First, this study assesses all three components of the tripartite model among Chinese children and adolescents in Hong Kong schools. A deliberate attempt is made to use measures of the tripartite constructs that are specific to children in order to improve the construct validity of the measurements. Finally, special attention is paid to the differential utility of the PH construct. Results partially supported the Clark and Watson’s tripartite model (1991). NA is a common component to both anxiety and depression. However, both PA and PH are also common components to both anxiety and depression. In addition, high correlations were found among anxiety, depression, and PH. These results tend to suggest more intricate relationships among anxiety, depression, and somatic symptoms. To conclude, this study suggests an alternative transdiagnostic approach to the tripartite model, which emphasizes clustering of anxiety, depression, and somatic symptoms.
published_or_final_version
Clinical Psychology
Doctoral
Doctor of Psychology

Previous research had demonstrated cognitive biases towards threatening stimuli in anxious individuals, such as in attention, interpretation and memory. The present study aimed to examine the differences in memory-related information processing between anxious and nonanxious children and the effectiveness of a Cognitive-Bias Modification (CBM) based positive training in altering these differences. The study adopted a directed forgetting paradigm, where children with anxiety disorders (N=12) and healthy controls (N=12) were asked to either forget or remember word lists comprised of words of negative or positive valence, and were later asked to recall and recognize target words. The CBM training was subsequently administered, in which subjects were trained to endorse positive interpretations to ambiguous situations, followed by a similar directed forgetting task for post-training assessment. Results revealed that the CBM training was effective in reducing the hypervigilance towards negative words in anxious children, as well as reducing recall of negative words in all subjects. Clinical implications and limitations of the study were discussed.
published_or_final_version
Clinical Psychology
Master
Master of Social Sciences

Anxiety disorders are the most common mental health disorder among children (Merikangas et al., 2010). If left untreated, anxiety disorders can cause significant impairment in functioning and persist into adolescence and adulthood (Ehrenreich & Santucci, 2009; Öst & Treffers, 2001). Although anxiety disorders are often responsive to psychological intervention and the literature suggests that they can be preventable with early detection and intervention (Hirshfeld-Becker et al., 2010), they often remain undetected and untreated. In order to contribute to early intervention efforts, it is important to understand risk factors associated with childhood anxiety disorders. Current theoretical models of childhood anxiety underscore the importance of reciprocal interactions between parents, their children, and environmental stressors. Specific factors, such as marital discord and parental anxiety, have been hypothesized to influence the development of anxiety disorders in children (Ginsburg, Siqueland, Masia-Warner, & Hedtke, 2004), and may highlight the association between family environment, parenting, and child anxiety disorders. Parental and family factors account for the intergenerational transmission of anxiety. Maternal stress has been indicated as a predictor of both internalizing and externalizing problems in children (Bayer, Hiscock, Ukoumunne, Price, & Wake, 2008). A significant body of research links children’s externalizing behaviour problems and parenting stress. Research has not focused as much attention on the connection between parenting stress and children’s internalizing problems, specifically anxiety disorders. This study proposes to explore the relationship between parenting stress and anxiety disorders in young children through a secondary analysis of data collected from a larger study.

Research shows that anxiety disorders are common and problematic in children. Treatment studies demonstrate that cognitive-behavioural interventions for children can successfully minimise these problems. Further, when implemented as early intervention or prevention programs, these interventions can prevent the onset of anxiety problems in 7 to 14 year olds and reduce existing levels of anxiety. This type of preventive approach has enormous potential for improving community mental health in a low cost model of service delivery. Yet, to develop this as a viable service model, these programs need to be evaluated under 'real world' conditions as opposed to specialist university clinical teams. In this research, the long-term effectiveness of an ecological model of the prevention of anxiety disorders for children was conducted. In the first study, teachers (N = 17) were trained intensively in the principles of anxiety and the FRIENDS anxiety prevention program (Barrett, Lowry-Webster & Holmes, 1999). Measures were taken of the PROXIMAL effects of training on the knowledge and self-efficacy of participating teachers at two points in time. Compared to teachers in a control group (N= 17) and a group comprised of psychologists regarded as experts in the FRIENDS anxiety program (N= 22), trained teachers demonstrated significant increases in the levels of knowledge and self-efficacy at time two. These increases approached levels exhibited by experts in terms of knowledge, and were not significantly different from experts in their levels of self-efficacy to implement the FRIENDS program following training. This study also explored the quality or fidelity of program implementation by these trained teachers (INTERMEDIATE EFFECTS). Results demonstrated that trained teachers implemented the program with high levels of integrity in accordance with the FRIENDS intervention manual. The second study sought to investigate the outcomes for participating children in terms of actually preventing and reducing existing levels of anxiety. Also of interest was the impact this intervention had on levels of depression. Participants were 594 children aged 10-13 years from 7 schools in Brisbane Australia. Children, and parents reported on children's social, emotional and behavioural characteristics at three-assessment points over 12 months. Results were examined universally (for all children) and for children who scored above the clinical cut-off for anxiety at pre-test. Results revealed that children in the FRIENDS intervention group reported fewer anxiety symptoms regardless of their risk status at posttest. In terms of reported levels of depression, only the high anxiety group who completed the FRIENDS intervention evidenced significant improvements at posttest. The results indicated that intervention gains were maintained over a period of 12 months, as measured by self-reports and diagnostic interviews. Moreover, evidence of a prevention effect was also demonstrated, with a significantly greater percentage of children in the control group progressed to "at risk" or "remained at risk" compared to children in the intervention group. Additionally, 85% of children in the intervention group who were scoring above the clinical cut-off for anxiety and depression were diagnosis free in the intervention condition at 12-month follow-up, compared to only 31.2% of children in the control group. Implications of these findings are examined, alongside limitations of the study and directions for future research.

Research shows that anxiety disorders are common and problematic in children. Treatment studies demonstrate that cognitive-behavioural interventions for children can successfully minimise these problems. Further, when implemented as early intervention or prevention programs, these interventions can prevent the onset of anxiety problems in 7 to 14 year olds and reduce existing levels of anxiety. This type of preventive approach has enormous potential for improving community mental health in a low cost model of service delivery. Yet, to develop this as a viable service model, these programs need to be evaluated under 'real world' conditions as opposed to specialist university clinical teams. In this research, the long-term effectiveness of an ecological model of the prevention of anxiety disorders for children was conducted. In the first study, teachers (N = 17) were trained intensively in the principles of anxiety and the FRIENDS anxiety prevention program (Barrett, Lowry-Webster & Holmes, 1999). Measures were taken of the PROXIMAL effects of training on the knowledge and self-efficacy of participating teachers at two points in time. Compared to teachers in a control group (N= 17) and a group comprised of psychologists regarded as experts in the FRIENDS anxiety program (N= 22), trained teachers demonstrated significant increases in the levels of knowledge and self-efficacy at time two. These increases approached levels exhibited by experts in terms of knowledge, and were not significantly different from experts in their levels of self-efficacy to implement the FRIENDS program following training. This study also explored the quality or fidelity of program implementation by these trained teachers (INTERMEDIATE EFFECTS). Results demonstrated that trained teachers implemented the program with high levels of integrity in accordance with the FRIENDS intervention manual. The second study sought to investigate the outcomes for participating children in terms of actually preventing and reducing existing levels of anxiety. Also of interest was the impact this intervention had on levels of depression. Participants were 594 children aged 10-13 years from 7 schools in Brisbane Australia. Children, and parents reported on children's social, emotional and behavioural characteristics at three-assessment points over 12 months. Results were examined universally (for all children) and for children who scored above the clinical cut-off for anxiety at pre-test. Results revealed that children in the FRIENDS intervention group reported fewer anxiety symptoms regardless of their risk status at posttest. In terms of reported levels of depression, only the high anxiety group who completed the FRIENDS intervention evidenced significant improvements at posttest. The results indicated that intervention gains were maintained over a period of 12 months, as measured by self-reports and diagnostic interviews. Moreover, evidence of a prevention effect was also demonstrated, with a significantly greater percentage of children in the control group progressed to "at risk" or "remained at risk" compared to children in the intervention group. Additionally, 85% of children in the intervention group who were scoring above the clinical cut-off for anxiety and depression were diagnosis free in the intervention condition at 12-month follow-up, compared to only 31.2% of children in the control group. Implications of these findings are examined, alongside limitations of the study and directions for future research.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Applied Psychology
Full Text

The studies presented in this thesis sought to investigate a number of developmental factors that influence the efficacy of preventive intervention for child anxiety disorders. Preventive intervention has emerged as a vital step forward in clinical research following data indicating anxiety disorders are among the most common forms of psychopathology in youngsters (Kashani & Orvaschel, 1990; Mattison, 1992). Several risk and protective factors associated with childhood anxiety disorders have been identified, along with effective treatment protocols (Kendall, 1994; Howard & Kendall, 1996; Barrett, 1998, 1999; Silverman et al., 1999a, 1999b), as prerequisites to the development of preventive programs for child anxiety problems (Spence, 2001). The first objective of this research was to add to the literature on risk and protective factors by investigating the role of peer interaction in the development of child anxiety problems. Study one examined developmental differences in the influence of peer interaction on children's anxiety-related cognition and behaviour. One hundred and sixty two children enrolled in grade 6 (n = 96) aged between 9 and 10 years, and grade 9 (n = 66) aged between 14 and 16 years participated in the study. Participants were stratified into either an at risk group or to a healthy group, based on their anxiety scores on the Spence Child Anxiety Scale (SCAS; Spence, 1997), and further allocated to a peer group comprising of 3 'healthy' (non-anxious) and 3 'at risk' (high anxious) children. Prior to and following a peer discussion, participants completed a standardised self-report measure of threat interpretation and response plans to two ambiguous vignettes (Barrett, Rapee, Dadds, & Ryan, 1996; Dadds, Barrett, Rapee, & Ryan, 1996). Results showed all participants evidenced changes in threat interpretation and response plans following the discussion with peers (p < .001). Overall, findings highlight the potential importance of peer interaction in the development of anxiety-related cognition and behaviour. The findings of study one have important implications for the future development of school-based intervention programs; specifically those conducted in the classroom. Study two sought to advance the current research on preventive intervention for child anxiety by establishing the age at which youngsters benefit the most from the FRIENDS program as a classroom-based universal intervention. Study two presents the results of a longitudinal study evaluating the effects of a universal school-based intervention for child anxiety at two developmental stages. The study involved a cohort of 733 children enrolled in grade 6 (n = 336, 45.6%) aged between 9 and 10 years, and grade 9 (n = 401, 54.4%) aged between 14 and 16 years, Participants were allocated to either a school-based cognitive behavioural intervention or to a monitoring group. Participants completed standardised measures of anxiety, depression and coping style. Participants identified as 'at risk' of an anxiety disorder were assessed for a clinical diagnosis with a structured diagnostic interview. Results indicated the universal intervention effective in significantly reducing anxiety (p < .001), depression (p < .001) and behaviour avoidance in children at post- intervention and 12-month follow-up intervals. Grade 6 children reported significantly higher anxiety at pre-intervention and greater reductions in anxiety at post intervention compared with the grade 9 (p < .001), although both primary and secondary school participants showed equal reductions in anxiety at 12-month follow up. Overall, findings suggest universal intervention potentially successful in reducing symptoms of anxiety and increasing coping skills in children. Primary school children reported the greatest changes in anxiety symptoms, suggesting earlier preventive intervention potentially more advantageous than later intervention. Developmental differences in anxiety, depression and coping strategies are discussed in addition to the implications and limitations of this study and directions for future research.

The studies presented in this thesis sought to investigate a number of developmental factors that influence the efficacy of preventive intervention for child anxiety disorders. Preventive intervention has emerged as a vital step forward in clinical research following data indicating anxiety disorders are among the most common forms of psychopathology in youngsters (Kashani & Orvaschel, 1990; Mattison, 1992). Several risk and protective factors associated with childhood anxiety disorders have been identified, along with effective treatment protocols (Kendall, 1994; Howard & Kendall, 1996; Barrett, 1998, 1999; Silverman et al., 1999a, 1999b), as prerequisites to the development of preventive programs for child anxiety problems (Spence, 2001). The first objective of this research was to add to the literature on risk and protective factors by investigating the role of peer interaction in the development of child anxiety problems. Study one examined developmental differences in the influence of peer interaction on children's anxiety-related cognition and behaviour. One hundred and sixty two children enrolled in grade 6 (n = 96) aged between 9 and 10 years, and grade 9 (n = 66) aged between 14 and 16 years participated in the study. Participants were stratified into either an at risk group or to a healthy group, based on their anxiety scores on the Spence Child Anxiety Scale (SCAS; Spence, 1997), and further allocated to a peer group comprising of 3 'healthy' (non-anxious) and 3 'at risk' (high anxious) children. Prior to and following a peer discussion, participants completed a standardised self-report measure of threat interpretation and response plans to two ambiguous vignettes (Barrett, Rapee, Dadds, & Ryan, 1996; Dadds, Barrett, Rapee, & Ryan, 1996). Results showed all participants evidenced changes in threat interpretation and response plans following the discussion with peers (p < .001). Overall, findings highlight the potential importance of peer interaction in the development of anxiety-related cognition and behaviour. The findings of study one have important implications for the future development of school-based intervention programs; specifically those conducted in the classroom. Study two sought to advance the current research on preventive intervention for child anxiety by establishing the age at which youngsters benefit the most from the FRIENDS program as a classroom-based universal intervention. Study two presents the results of a longitudinal study evaluating the effects of a universal school-based intervention for child anxiety at two developmental stages. The study involved a cohort of 733 children enrolled in grade 6 (n = 336, 45.6%) aged between 9 and 10 years, and grade 9 (n = 401, 54.4%) aged between 14 and 16 years, Participants were allocated to either a school-based cognitive behavioural intervention or to a monitoring group. Participants completed standardised measures of anxiety, depression and coping style. Participants identified as 'at risk' of an anxiety disorder were assessed for a clinical diagnosis with a structured diagnostic interview. Results indicated the universal intervention effective in significantly reducing anxiety (p < .001), depression (p < .001) and behaviour avoidance in children at post- intervention and 12-month follow-up intervals. Grade 6 children reported significantly higher anxiety at pre-intervention and greater reductions in anxiety at post intervention compared with the grade 9 (p < .001), although both primary and secondary school participants showed equal reductions in anxiety at 12-month follow up. Overall, findings suggest universal intervention potentially successful in reducing symptoms of anxiety and increasing coping skills in children. Primary school children reported the greatest changes in anxiety symptoms, suggesting earlier preventive intervention potentially more advantageous than later intervention. Developmental differences in anxiety, depression and coping strategies are discussed in addition to the implications and limitations of this study and directions for future research.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Applied Psychology (Health)
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Thesis (Ph.D.)--Boston University
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Separation anxiety disorder (SAD) is the most common and impairing childhood anxiety disorder. Left untreated, SAD is associated with heightened risk for the development of additional internalizing disorders as well as impairments in educational attainment and social functioning. Numerous clinical trials have demonstrated the efficacy of cognitive-behavior therapy (CBT) for the treatment of childhood anxiety disorders, including SAD. However, additional research is needed to enhance the compatibility (e.g., fit of the treatment to the patient population) and ultimate uptake of evidence-based interventions for anxious youth. The current research evaluates the feasibility and preliminary efficacy of an intensive, cognitive-behavioral intervention for school-aged girls with SAD provided within the novel context of a one-week camp-like setting. This alternative treatment format was predicated on evidence supporting the need for treatments that allow for creative and developmentally-sensitive applications of intervention components, incorporate a child's social context, target relevant parenting variables, and provide additional models for treatment delivery. Twenty-nine female children aged 7 to 12 with a principal or co-principal diagnosis of SAD were randomized to an immediate treatment (n = 15) or waitlist (i.e., delayed treatment; n = 14) condition during the course of this randomized-controlled trial. Measures were administered at pretreatment/ pre-waitlist, post-treatment/post-waitlist, and six weeks following treatment to assess changes in symptom reports, functional outcomes, and overall program satisfaction. Analyses of covariance were conducted to assess effects of treatment condition and repeated measures analyses of variance were conducted to evaluate change over the three data collection time points. Relative to waitlist, children in the immediate treatment group evidenced significant reductions in SAD severity by clinician report on a diagnostic interview measure. Moreover, treatment gains strengthened over time. Contrary to hypotheses, children receiving the intervention did not display significantly greater improvements relative to waitlist on parent-rated fear and avoidance scores or on parent or child self-report measures. Potential explanations for non-significant findings are discussed. Overall, the intervention's positive therapeutic response on SAD diagnostic status and severity suggests one possible delivery model for surmounting difficulties faced in the dissemination of standard, weekly treatments for this condition.
2031-01-02

Objective: Attention Bias Modification Training (ABMT) for anxiety aims to train attention away from threatening stimuli and toward neutral stimuli. Although ABMT shows promising anxiety reduction effects in children and adolescents, no study has examined its influence on neural indicators of attention measured using event-related potentials (ERPs) in children or adolescents (i.e., youths). The present study examined the influence of ABMT on the P1, N170, P2 and P3 ERP components during completion of the emotional faces dot probe task in youths with anxiety disorders who failed to respond to cognitive behavioral therapy. Method: Thirty youths (M age = 11.97, SD = 2.89) with primary DSM-IV-TR anxiety disorders completed the dot probe task while undergoing electroencephalogram (EEG) to obtain ERPs before, immediately after, and eight weeks after eight sessions of either ABMT (n = 14) or a control task regimen (CT), (n = 16). Results: At post-treatment, statistically significant effects were found for P1 and P3 mean amplitudes: P1 was significantly higher during trials showing neutral-neutral (NN) face pairs in the ABMT arm than in the CT arm; P3 was significantly higher during trials showing NN face pairs than during trials showing neutral-threat (NT) face pairs in the ABMT arm, but not the CT arm. At eight-week follow-up, participants in both arms showed significantly higher (more negative) N170 responses for NN trials than for NT trials. Conclusions: Attention Bias Modification Treatment led to increases in neural processing of neutral stimuli in early and late stage attentional processing, as measured by the P1 and P3 components, respectively. These components during the dot probe task are promising neural markers of ABMT’s effects on attentional processing in youth with anxiety disorders.

Introduction: This study was designed to validate the Screen for Child Anxiety Related Emotional Disorder-Revised (SCARED-R) for use in the local context. Furthermore, different components of anxiety-related attentional bias were studied with emotional spatial cueing task (ESCT). This study also attempted to investigate the relationship among attentional bias, temperamental traits of Negative Affectivity (NA) and Effortful Control (EC), and anxiety. Method: Subjects were recruited from P.4 to F.3 students of mainstream Chinese speaking schools. The SCARED-R and self-report measures of NA and EC were administered. 508 child/adolescent subjects (mean age=11.7 years, SD=1.80; 327 boys and 181 girls) and 312 of their parents (child’s mean age=11.50; SD=1.77; 196 boys and 116 girls) were included in the analysis. In Stage 2 of the study, subjects were recruited from those with SCARED-R scores at 85th percentile or above and 50th percentile or below. 34 pairs of child/adolescent and parent subjects (mean age=11.89 years; SD=1.90) were assessed with the Chinese version of the Diagnostic Interview for Children-Version 4, with which the Anxiety group (n=14) and Control group (n=20) were identified. All subjects completed the SCARED-R and Spence Children’s Anxiety Scale (SCAS). The child/adolescent subjects did ESCT, which presented Angry, happy and neutral faces for 17 ms, 500 ms and 1250 ms. Results: The mean total SCARED-R scores were 31.94 (SD=19.51) and 22.96 (SD=15.35) for child/adolescent and parent subjects. Internal consistencies (Cronbach’s α=.95 and .94) and one-month test-retest reliability (Spearman’s rho=.72 and .79, both at p<.001) for child and parent total SCARED-R scores were satisfactory. Total SCARED-R scores correlated significantly with total SCAS scores, and were significantly different between the Anxiety and Control groups. These provided support for SCARED-R’s convergent validity. Results of exploratory and confirmatory factor analyses suggested that SCARED-R was multi-dimensional. Facilitated attentional bias and disengagement difficulties were not related as predicted. Angry cues induced greater disengagement difficulties than happy cues. Compared with Control group, Anxiety group showed greater disengagement difficulties when Angry cues were presented at cue duration of 1250 ms. A direct and significant relationship existed between anxiety with NA, and between anxiety and EC. NA and EC played their own unique roles in affecting anxiety but the variance accounted by EC in addition to NA was small. EC did not moderate the relationship between NA and anxiety, though a very small mediating effect between NA and anxiety was noted. Conclusion: This study provides support for the satisfactory psychometric properties of the SCARED-R for local use, showing its good potential of being used as a screening instrument for anxiety disorders. Despite the small sample size, anxious children/adolescents were found to have disengagement difficulties from threat cue at cue duration of 1250 ms, and this could be a parameter to consider in future design of attentional bias modification training. The major limitation of this study is its convenience sampling of subjects from community and the low participation/consent rate. This limits generalizability of the results, impedes an investigation of the sensitivity and specificity of the scale, and poses great constraints on statistical power.
published_or_final_version
Psychiatry
Doctoral
Doctor of Philosophy

The current study was designed to examine the relationship between childhood anxiety and depression and children's rate of medical care utilization. Additionally, the model examined considered family and parental factors (family conflict, parental anxiety, parental depression, and parental somatization) as well as children's level of negative affectivity and demographic variables (ageand sex). A hierarchical regression analysis was used to examine the effects of each of these variables on rate of physician utilization and to control for the effects of demographic factors, parent/family variables and negative affectivity while examining childhood anxiety and depression. Results revealed that parental anxiety and depression and family conflict contribute significantly to the explanation of children's health care utilization. Additionally, child anxiety also explained number of physician visits but only when considered in the absence of child depression.
Master of Science

Despite its rewards, parenting is a challenging role, frequently associated with heightened stress. Parents of children with mental health conditions, such as childhood anxiety disorders (ADs), commonly report even higher levels of parenting stress and increased problems with their own mental health. These parents may also experience greater emotion dysregulation (ED) and may engage in more “negative” parenting behaviours (e.g., criticism, rejection); all of which are in turn associated with greater child anxiety symptoms and poorer child anxiety-focused therapy outcomes. In contrast, several “positive” parenting behaviours (e.g., warmth, responsiveness) have been shown to be associated with better long-term outcomes for clinically anxious children and appear to play an important protective role among families. Recently, it has been suggested that parent’s capacity for mindfulness and mindful parenting is related to parents adopting more positive parenting practices that may result in more favourable parent and child outcomes. This may be particularly relevant for parents of young children with ADs given the important role parents play for their emotional and behavioural adjustment during early childhood years. Yet, there is a paucity of research examining these parent factors (including ED, parenting stress, parenting behaviours, and mindful parenting) among parents of young clinically anxious children. Given the challenges that many parents face in parenting a clinically anxious child, there is a need for interventions that aim to provide greater support to parents in hopes to improve therapeutic outcomes for both parents and children with ADs. Indeed, mindful parenting interventions (MPIs) have been proposed as one such support for parents. A key aim of MPIs is to address parenting stress through teaching mindfulness and mindful parenting techniques. Although the evidence-base has increased, much is yet to be learned about the theoretical assumptions underlying mindful parenting interventions. Moreover, little is known about the extent to which MPIs are feasible among specific populations, and who may benefit most from these types of interventions. Therefore, the main objective of this doctoral research project was to advance knowledge of the MPI literature for parents of young clinically anxious children. Firstly, Study 1 examined theoretical mechanisms of mindful parenting and parenting stress among a sample of 83 parents of young clinically anxious children (aged 3- to 7 years) utilising a cross-sectional study design. Child diagnostic status was determined with diagnostic interviews with parents. Key variables of interest were parent factors that appear to be associated with the development and/or maintenance of anxiety in children, including parental ED, parenting stress, and parenting behaviours, which were measured using commonly used self-report questionnaires. Specifically, this study evaluated the relationships between parental ED and parenting behaviours (including warmth, rejection) within an integrative model with mindful parenting and parenting stress as sequential mediators to determine independent and combined mediation effects. It was hypothesised that mindful parenting would be positively associated with parental warmth, and negatively associated with ED, parenting stress, and parental rejection, while it was expected to find inverse associations of these variables with parenting stress. Secondly, it was expected that mindful parenting and parenting stress would emerge as significant independent mediators in respective simple mediation models. Finally, we hypothesise that mindful parenting and parenting stress sequentially mediate the links between ED and parenting behaviours. Overall, results of this study largely supported hypotheses, showing associations in expected directions and single mediation effects of parental rejection and warmth. Results of sequential mediation revealed the links between ED and warmth and rejection, respectively, were sequentially mediated via mindful parenting and parenting stress; and that mindful parenting also had direct unique associations with rejection (and to a lesser extent, warmth). Findings of this study suggest that ED affects parenting behaviours via mindful parenting and parenting stress. Moreover, in the sequential mediation models mindful parenting showed unique direct effects on parental rejection, and to a somewhat lesser extent, parental warmth. This demonstrates the potentially protective role of greater parental capacity for mindful parenting and provides evidence in support of theory. This study concludes that mindful parenting and parenting stress may serve as potential targets for intervention among parents of young clinically anxious children. Thus, trialling MPIs among this population is warranted. Study 2 examines and compares the feasibility of an in-person versus online delivered group MPI among 83 parents of clinically anxious children (aged 3- to 7-years) and explored associations between baseline parent and child characteristics with adherence to the MPI. Feasibility was defined as adherence (indicated by facilitator-rated parental session attendance and self-reported home-practice compliance), acceptability (weekly session acceptability, overall program satisfaction, and program component evaluations), and limited effectiveness on key outcomes (self-reported parenting stress and parent-reported child anxiety severity). The study showed that there was no difference in indices of feasibility between the in-person and online modalities, except for online participants rating the session content on average as more useful. Outcomes provide evidence for effectiveness across modalities with reductions in parenting stress and child anxiety severity from baseline to post-intervention and short-term follow-up. However, dropout and non-adherence (46%) to both programs were high among parents. Further, adherence (as indexed by an average of 53% session attendance across parents and home-practice compliance estimated as low) to the MPIs was found to be average to low compared to prior MPI trials. Anecdotally reported barriers to engagement are discussed. Parents who were deemed adherers to the MPIs were found to be more distressed and less mindful at baseline relative to parents who were deemed non-adherers to the MPI, and their children tended to have fewer comorbid or externalising disorders. Finally, Study 3 examined predictors of response among 45 mothers who completed the MPIs by comparing parents who achieved reliable change on measures of self-reported parenting stress (i.e., responders) relative to parents who did not demonstrate reliable change following the MPI (i.e., non-responders). Secondary to this aim, this study investigated whether mother’s response would be associated with reliable change in parent-reported child anxiety severity, and whether changes in parenting stress would predict reductions in child anxiety at short-term follow-up. It was found that overall, approximately 50% of mothers experienced reliable improvements in their parenting stress following the MPI. Moreover, mothers’ positive response to the MPI was associated with reliable improvements in child anxiety severity. Relative to non-responders, mothers who had a positive response to the MPI were less overprotective in their parenting; and their child had higher comorbidity and more externalising disorders at baseline. Although no baseline predictors of parental response emerged, it was found that reductions in parenting stress from baseline to post-intervention were associated with decreased child anxiety severity at short-term follow-up. Moreover, the study showed that change in parents’ negative attitudes about the child being “difficult” to take care of predicted reduced child anxiety. Taken together, the findings presented in these three empirical studies inform the utility of addressing parent factors commonly associated with child anxiety and provide evidence for the importance of including parenting stress and mindful parenting in explanatory models. Indeed, findings offer support for theoretical notions of mindful parenting and support the potential utility of MPIs to improve the wellbeing of both parents and their young clinically anxious children. Both MPIs appeared to be acceptable and effective for parents of young anxious children; however, adherence rates were not optimal. Therefore, barriers to adherence need to be considered prior to recommending MPIs. Parents of clinically anxious children with more co-occurring disorders and externalising disorders, who were experiencing heightened distress themselves were more likely to adhere to the MPIs. However, this thesis also demonstrated that of those who adhered, parents who have children with more co-occurring disorders including externalising disorders, may be more likely to benefit from MPIs. Given that adherers were also found to be characterised by lower dispositional mindfulness and mindful parenting, it could be speculated that parents may be more likely to adhere well to MPIs for the right reasons: to improve their own levels of distress and mindfulness. However, more research is needed to confirm this interpretation. Taken together, the results from studies of this doctoral research project are promising; thus, larger clinical trial studies are warranted to replicate findings and to overcome limitations of the present studies. Overall, it has been concluded that more research is needed to advance the larger child anxiety and parenting literature. Parenting behaviours associated with child anxiety have long been accepted as explanatory factors in models of child anxiety; however, other parent factors such as parenting stress have been largely neglected in basic and applied intervention research. This doctoral thesis showed that mindful parenting and parenting stress seem to be relevant to the explanation of how parental ED affects parenting behaviours among parents of clinically anxious children, all of which may contribute to the explanation of intergenerational transmission of anxiety. Hence, more research in this field is warranted. Indeed, helping parents of young clinically anxious children to better manage their own wellbeing is important for future intervention efforts. However, problems with feasibility of parent-focused interventions at large, including MPIs, have been demonstrated. Therefore, more research and work need to be done to address these problems to be better able to reach and support these stressed parents of young anxious children. In fact, finding better ways to support these families is of importance given that parent factors, such as heightened parenting stress, not only exacerbate child anxiety but directly interfere with the success of child anxiety-focused therapies (e.g., dropout, attenuated response). MPIs appear to be acceptable to parents of young children with ADs. Therefore, offering MPIs as an adjunct or modifying traditional child-focused anxiety therapies to include MPI components may be beneficial. However, the problems of feasibility need to be addressed. Novel approaches to target parenting stress via MPIs in brief formats, or with multi-modes (e.g., more intensive workshop days combined with therapist assisted app support) might result in greater adherence, more access for parents and better child outcomes.
Thesis (Professional Doctorate)
Doctor of Philosophy (PhD)
School of Applied Psychology
Griffith Health
Full Text

The present study examined inter-rater agreement on the Anxiety Disorder Interview Schedule DSM-IV Child and Parent Interview (ADIS-IV-C/P) in youth with autism spectrum disorder and if age and ASD diagnosis moderated agreement. Diagnoses established for 70 7-16-year-old youth with ASD during a live administration of the ADIS-IV-C/P were compared to diagnoses identified by a second rater after listening to audiotaped recordings of the interviews. Inter-rater agreement on parent and child reports was excellent (k=1.00). Inter-rater agreement on principal diagnoses (k=0.91), individual anxiety diagnoses (k=0.85-0.97), and other comorbid diagnoses (i.e., major depressive disorder, dysthymia, oppositional defiant disorder, attention deficit hyperactivity disorder-Inattention/Hyperactivity/Combined Type) (0.89-1.00) were excellent; agreement did not differ as a function of ASD diagnosis or age. Results suggest that the anxiety disorders and comorbid disorders assessed by the ADIS-IV-C/P can be diagnosed by pairs of clinicians with good reliability.

Significant symptoms of anxiety in individuals with autism spectrum disorder (ASD) may arise due to impaired emotion recognition. In light of reports showing ASD-specific developmental changes in amygdala volumes, we expanded a previous study of recognition of music-evoked emotions in ASD versus typical controls (CON). We explicitly compared both behavioral and psychophysiological response to music-evoked emotions of children (ages 8-11) and older adolescents (ages 16-18). A total of 91 participants (42 ASD) listened to segments of instrumental music that had been previously validated to evoke happy, sad, or scary emotional valence. We measured accuracy and reaction time while also collecting skin conductance response. The ASD group demonstrated reduced skin conductance response to the emotional music stimuli overall, compared to controls. The younger child groups, regardless of diagnosis showed greater physiological reactivity to scary stimuli than to the other emotions. Analysis of behavioral data demonstrated an interaction of age group and diagnostic group: for scary music, the older control group was more accurate than the younger control group while the opposite pattern was observed for the ASD group. These data suggest disrupted developmental trajectories for integrating physiological and cognitive cues in ASD. This lack of integration may underlie increased feelings of uncertainty and anxiety that are associated with more difficult and less adaptive decision making in ASD.

This thesis examines the perceptions of interpersonal adequacy held by preadolescent behaviour disordered boys through comparisons with perceptions held of them by putative significant others and normative comparison with their peers. The sample, selected according to behavioural status, comprised 70 boys drawn from 22 regular primary schools in south west Sydney, Australia. Thirty five boys, identified as behaviour disordered, were matched with boys whose behaviour was perceived to be appropriate in the school setting. An overview of the results would suggest that the influence of selected putative significant others on the multidimensional self concepts of preadolescent boys is not universal and varies according to behavioural classification
Doctor of Philosophy (PhD)

Psychology
Ph.D.
Research from the information processing and temperament literatures has proposed dysfunction within systems of attention, including early attentional orientation (bottom-up) and later executive control of attention (top-down), in contribution toward the development of anxiety disorders. This study investigated the moderating role of attentional control on the relationship between threat-related attention bias and youth anxiety severity. Participants were 107 treatment-seeking youth (7-17 years, Mage = 11.17 years, SD = 3.06; 41.4% male) who met diagnostic criteria for an anxiety disorder. Multimodal assessment (behavioral, youth-, and parent-report) of attention control, threat-related attention bias, and anxiety severity was conducted. Hierarchical regression analyses provided little support for attention control as a moderator of the relationship between threat-related attention bias and anxiety severity. However, attention control was identified as a more salient predictor of anxiety severity than threat-related attention bias. Measures of attention were identified as distinct from parent-reported symptoms of attention-deficit/hyperactivity disorder (ADHD) and depression for youth. Similarly, measures of attention and anxiety severity for youth were not related to parenting behavior or parental attention control but were influenced by parents’ self-reported symptoms of anxiety and depression. Implications for future research and clinical work are discussed.
Temple University--Theses

Thesis (Ph.D.)--University of Western Sydney, Nepean, 1995.
"The sample, selected according to behavioural status, comprised 70 boys drawn from 22 regular primary schools in south west Sydney, Australia" -- Abstract. Bibliography: leaves 249-267.