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Background Previous studies have demonstrated the efficacy of early intervention for anxiety in preschoolers through parent-education. The current study evaluated a six-session early intervention program for preschoolers at high risk of anxiety disorders in which a standard educational program for parents was supplemented by direct training of social skills to the children. Methods Seventy-two children aged 3–5 years were selected based on high behavioural inhibition levels and concurrently having a parent with high emotional distress. Families were randomly assigned to either the intervention group, which consisted of six parent-education group sessions and six child social skills training sessions, or waitlist. After six months, families on waitlist were offered treatment consisting of parent-education only. Results Relative to waitlist, children in the combined condition showed significantly fewer clinician-rated anxiety disorders and diagnostic severity and maternal (but not paternal) reported anxiety symptoms and life interference at six months. Mothers also reported less overprotection. These gains were maintained at 12-month follow-up. Parent only education following waitlist produced similar improvements among children. Quasi-experimental comparison between combined and parent-only interventions indicated greater reductions from combined intervention according to clinician reports, but no significant differences on maternal reports. Conclusions Results suggest that this brief early intervention program for preschoolers with both parent and child components significantly reduces risk and disorder in vulnerable children. The inclusion of a child component might have the potential to increase effects over parent-only intervention. However, future support for this conclusion through long-term, randomised controlled trials is needed. [ABSTRACT FROM AUTHOR]

Reliable, valid, and brief measures are important for identifying young people in community contexts who experience mental health problems. This paper reports the development and preliminary validation of the Brief Emotional Distress Scale for Youth (BEDSY), a measure based on anxiety and depression symptoms that load strongly upon the general construct of emotional distress. Participants, aged 11–17 years, included 2663 from a community population and 281 referred anxious youth. From a pool of 20 items, eight were selected for the final scale using methods from classical test theory, followed by item response theory (IRT). The final eight items met the pre-specified criteria for skewness and kurtosis, item-total correlations, IRT characteristics, and discrimination between referred vs. community samples. Exploratory structural equation modeling for a bi-factor model indicated that 81% of total variance was explained by the general emotional distress factor. The 8-item BEDSY showed strong internal consistency, good construct validity, and acceptable sensitivity and specificity in discriminating between a community sample vs anxious youth, and between youth with and without high levels of depressive symptoms. As such the scale has strong potential as a brief screen for identifying emotionally distressed young people in community contexts. • The BEDSY is a new, brief, self-report scale of emotional distress in young people. • It has promise as a brief screen for identifying emotionally distressed youth in community contexts. • It aims to identify youth who are likely to benefit from early intervention. • The scale has strong internal consistency, good construct validity, and discriminant validity. [ABSTRACT FROM AUTHOR]

Abstract: A variety of cognitive and attentional factors are hypothesised to be associated with post-event rumination, a key construct that has been proposed to contribute to the maintenance of social anxiety disorder (SAD). The present study aimed to explore factors contributing to post-event rumination following delivery of a speech in a clinical population. 121 participants with SAD completed measures of trait social anxiety a week before they undertook a speech task. After the speech, participants answered several questionnaires assessing their state anxiety, self-evaluation of performance, perceived focus of attention and probability and cost of expected negative evaluation. One-week later, participants completed measures of negative rumination experienced over the week. Results showed two pathways leading to post-event rumination: (1) a direct path from trait social anxiety to post-event rumination and (2) indirect paths from trait social anxiety to post-event rumination via its relationships with inappropriate attentional focus and self-evaluation of performance. The results suggest that post event rumination is at least partly predicted by the extent to which socially anxious individuals negatively perceive their own performance and their allocation of attentional resources to this negative self-image. Current findings support the key relationships among cognitive processes proposed by cognitive models. [Copyright &y& Elsevier]

Abstract: According to cognitive theories, safety-seeking behaviors are crucial in both the maintenance and management of social anxiety. In order to facilitate assessment of these behaviors the Subtle Avoidance Frequency Examination (SAFE) was developed. Three factors emerged from the SAFE, which appeared to reflect active “safety” behaviors, subtle restriction of behavior, and behaviors aimed at avoiding or concealing physical symptoms. The SAFE demonstrated strong internal consistency, good construct validity and the ability to discriminate between clinical and non-clinical participants. In addition, the SAFE was responsive to the effects of treatment. Given its excellent psychometric properties, the SAFE may be useful to further investigate the role of safety strategies in social anxiety and to assess treatment outcomes. [Copyright &y& Elsevier]

Abstract: This study examined the time-course of attentional bias in anxious and non-anxious children and adolescents aged 7–17 years using eye movement as an index of selective attention. Participants completed two eye-tracking tasks in which they viewed happy-neutral and negative-neutral face pairs for 3000 and 500ms, respectively. When face pairs were presented for 3000ms eye movement data showed no evidence of an attentional bias at any stage of attentional processing. When face pairs were presented for 500ms a bias in initial orienting occurred; anxious adolescents directed their first fixation away from negative faces and anxious children directed their first fixation away from happy faces. Results suggest that childhood anxiety is characterized by a bias in initial orienting, with no bias in sustained attention, although only for briefly presented faces. [Copyright &y& Elsevier]

Abstract: Many studies have reported that anxious children experience more negative life events than controls. However, studies have not yet addressed the possibility that this difference may be due to comorbidity with non-anxiety disorders. Furthermore, presence of psychopathology may also lead children to act in ways that increases frequency of negative life events and decreases the frequency of positive life events. Mother and child-report versions of a questionnaire measure of life events (CASE) assessed life events in the past 12 months in anxiety-disordered children (n =198), and controls (n =88). Mother reports indicated that anxious children experienced more negative and fewer positive behavior-dependent events than control children. Child reports showed a similar pattern, however significant differences were only present between anxious and control groups on the number of negative behavior-dependent events. Results indicated that anxious-control differences remain irrespective of comorbidity with non-anxiety disorders. However, the highest rates of negative life events were present in children with a comorbid disorder. [Copyright &y& Elsevier]

• First study to assess the factor structure of the SARQ in a clinical SAD sample. • One factor solutions demonstrated for the SARQ: Pre-event and SARQ: Post-event. • The SARQ demonstrated good validity and reliability. • The SARQ showed responsivity to treatment and clinical utility. • SARQ assesses rumination in relation to a range of social threat tasks in SAD. Cognitive models have consistently recognised pre-event and post-event rumination as maintaining factors in Social Anxiety Disorder (SAD). This study aimed to investigate the psychometric properties of a state-based measure of pre-event and post-event rumination in SAD: The Socially Anxious Rumination Questionnaire (SARQ), which was formerly known as the Thoughts Questionnaire. In particular, we examined the factor structure, internal consistency, test-retest reliability, construct validity, sensitivity to treatment response, clinical cut-off scores (relative to non-clinical participants), and associated test performance indicators of the SARQ. The sample comprised 505 adults with a principal diagnosis of SAD and 130 non-clinical controls. Pre-event and post-event rumination were assessed in relation to a three-minute impromptu speech. Results indicated single factors for the SARQ: Pre-event and SARQ: Post-event scales, along with excellent internal consistency, good test-retest reliability, sound sensitivity to cognitive-behavioural treatment response, and a clear ability to discriminate between individuals with a principal diagnosis of SAD and non-clinical controls. The findings justify the SARQ's use as a robust and reliable measure of state rumination for individuals with SAD that can be used both before and after encountering a social threat. [ABSTRACT FROM AUTHOR]

Two studies were conducted in order to examine biases in the interpretation of negative social events among socially anxious individuals. Results showed that social anxiety was associated with the tendency to believe that negative social events: would result in negative evaluation by other people; were actually indicative of negative personal characteristics; and would have adverse consequences in the long-term future. Although other types of anxiety were not independently associated with such beliefs, comorbid depression among individuals with social phobia was associated with further increases in these interpretative biases. The findings are consistent with theories suggesting that maladaptive interpretations of negative social events represent central cognitive biases in social phobia, but suggest that these interpretations are also associated with depression. [Copyright &y& Elsevier]

Despite growing recognition of childhood anxiety as a common and often debilitating clinical concern, we have limited knowledge of the particular ways in which anxiety interferes with daily life for young children who have not yet entered formal schooling. The present study evaluated the psychometric properties of the Child Anxiety Life Interference Scale – Preschool Version (CALIS-PV). The CALIS-PV is a brief (18 item) parent-report measure of the impacts of a young child’s anxiety on their own life and that of her or his parent. Participants were 784 parents of a child aged 3–7 years, who completed the CALIS-PV as a part of the follow-up assessment battery for two anxiety prevention trials targeted at preschool children with temperamental inhibition. Confirmatory factor analysis supported three CALIS-PV factors reflecting anxiety-related life interference at home, outside home and on parent life. The three factors showed good internal consistency and good convergent and divergent validity, and successfully differentiated children with and without an anxiety diagnosis. Findings provide initial support for the CALIS-PV as a reliable and valid measure of the daily life impacts of childhood anxiety for preschool-aged children and their parents. [ABSTRACT FROM AUTHOR]

Cognitive models of social anxiety propose that overestimation of the probability and cost of negative evaluation plays a central role in maintaining the disorder. However, there are currently no self-report state-based measures of probability and cost appraisals. The current paper examines the psychometric properties of the Probability and Consequences Questionnaire for social anxiety (PCQ-SA), which measures probability and consequence appraisals both in anticipation of, and in response to, an impromptu speech task. A total of 532 participants were recruited for the present study, consisting of 409 participants with a principal diagnosis of Social Anxiety Disorder (SAD), and 123 non-clinical controls. Results of exploratory and confirmatory factor analyses supported a two-factor solution for the PCQ-SA. The PCQ-SA demonstrated excellent internal consistency, excellent test-retest reliability, good convergent validity at both time points (i.e., pre and post speech task), and sensitivity to treatment. Finally, using Receiver Operating Characteristic Curve Analysis, clinical cut-off scores were calculated for probability and consequences at both time points, with the PCQ-SA scales showing good sensitivity, specificity, and positive and negative predictive values. Overall, the results provide evidence that the PCQ-SA possesses excellent psychometric properties. The PCQ-SA is suitable for use in clinical and research settings to assess key cognitive maintaining factors for SAD. • First study to assess the psychometric properties of the PCQ-SA in a SAD sample. • A two-factor solution for the PCQ-SA was supported by the results • The PCQ-SA demonstrated good validity, reliability, and clinical utility. • PCQ-SA demonstrates excellent psychometric properties. [ABSTRACT FROM AUTHOR]

Online treatment delivery has the potential to increase access to evidence-based mental health care for children with anxiety disorders. Using a randomized controlled trial design, we evaluated the efficacy of Cool Kids Online, a family-based and therapist supported internet-delivered cognitive behavioral treatment (CBT) designed to target anxiety disorders in children. Ninety-five children aged 7–12 years with a DSM-5 anxiety disorder were randomly allocated to Cool Kids Online or a waitlist control. Children were assessed at baseline, week 11, and 6-months following treatment. Children in waitlist received treatment after week 11 and also completed assessments immediately and six months after treatment, allowing treatment maintenance to be evaluated for all children. Compared to waitlist, Cool Kids Online led to significantly greater remission of anxiety disorders (primary and all anxiety diagnoses) and greater reduction of caregiver-reported anxiety symptoms and interference at week 11. Child-reported anxiety symptoms and interference and child- and caregiver-reported depressive or externalizing symptoms did not differ significantly between conditions. Medium to large within-treatment effects were observed for all children from pre to post treatment with post treatment effects maintained until follow-up. Overall, the findings provide support for the efficacy of the program in treating anxiety. Cool Kids Online compared to waitlist for the remission of anxiety disorders in clinically anxious children; anzctr.org.au ; ACTRN12615000947505. • Online family-based cognitive behaviour therapy reduces child anxiety disorders. • Therapist support during online child anxiety programs may be important for change. • Cool Kids Online is a promising method to improve access to child anxiety treatment. [ABSTRACT FROM AUTHOR]

• Adolescent males are often reluctant to seek help for symptoms of anxiety disorders. • Mental health literacy is associated with help-seeking attitudes in adolescent males. • Alignment with norms of hegemonic masculinity moderated this relationship. • Mental health initiatives may benefit from incorporating themes of masculinity. Poor mental health literacy and greater alignment with norms of hegemonic masculinity are established barriers to mental health help-seeking in men. However, little is known about how these variables influence adolescent male help-seeking and in particular, help-seeking for anxiety disorders. This study investigated the relationship between i) anxiety mental health literacy, ii) alignment with traditional masculinity norms and iii) help-seeking attitudes, intentions and behaviour in a sample of adolescent males. 1732 adolescent males (aged 12–18 years) participated online whilst at school. Participant attitudes towards formal help-seeking, intentions to seek help from a family member and from an online source were found to predict professional help-seeking behaviour by the adolescent and/or by their parents on the adolescents' behalf. In adolescents with a low or average personal alignment with norms of hegemonic masculinity, greater anxiety mental health literacy was positively associated with more favourable attitudes towards formal and informal help-seeking. However, this relationship was not found in adolescent males with a greater alignment with norms of hegemonic masculinity. The study had a correlational research design and used self-report measures. Mental health initiatives which consider the impact of masculinity and gender stereotypes have the potential to significantly improve help-seeking in this population. [ABSTRACT FROM AUTHOR]

• Examined factor structure of four social-evaluative cognitive process measures. • In a sample with social anxiety disorder (SAD), a bifactor model best fit the data. • A general factor represented social-evaluative threat detection. • Two group factors represented anticipatory processing and post-event processing. • Processes can be unified as facets of a social-evaluative threat detection process. The integrated aetiological and maintenance (IAM) model of social anxiety disorder (SAD) conceptualises four social-evaluative cognitive processes (anticipatory processing, attention to the self, attention to threat in the environment, and post-event processing) as facets of a social-evaluative threat detection construct. The current study tested this by examining potential factor structures underlying the four social-evaluative cognitive processes. Baseline data from two randomised controlled trials, consisting of 306 participants with SAD who completed measures of the four social-evaluative cognitive processes in relation to a speech task, were subjected to confirmatory factor analysis. Model fit indices and bifactor model indices showed that the optimal factor structure was a bifactor model with a Social-evaluative Threat Detection General Factor and two group factors corresponding to anticipatory processing and post-event processing. Analyses also indicated that the Social-evaluative Threat Detection General Factor had moderate to large associations with other constructs in the IAM model, whereas the two group factors only had small associations with these constructs. These findings suggest that the four social-evaluative cognitive processes can be unified as facets of a social-evaluative threat detection process, consistent with the IAM model, although group factors for anticipatory processing and post-event processing need to be taken into account. [ABSTRACT FROM AUTHOR]

Social anxiety and depressive symptoms increase markedly during adolescence. Most research examining the emergence of these symptoms has used a variable-centered approach providing little information about how these symptoms group together in individuals over time. A person-centered approach utilizing latent profile and latent transitional analyses was applied to a large adolescent sample (N = 2742, M age =13.65; SD =0.63; 47.9% girls). Subgroups differing in their expressions of social anxiety and depressive symptoms at each of four annual time points were identified and then change in membership of these groups was evaluated. Four subgroups were identified: 1. Low Distress, 2. Socially Anxious, 3. Dysphoric, and 4. Comorbid. The low distress group was the largest and most stable, followed by the socially anxious group, who most commonly transitioned into the comorbid group. In contrast, the dysphoric group were most likely to remit and move to the low distress group. The comorbid group was the smallest and least stable, although once in this group, three quarters of adolescents remained in this group over time. Early intervention is particularly imperative for socially anxious adolescents with or without comorbid depressive symptoms as they are the least likely to improve across the adolescent years. • Four subgroups with varying profiles of social anxiety and depressive symptoms were identified. • For the comorbid group, social anxiety was more likely to precede depression than vice versa. • Transitions between subgroups were driven more by changes in depression than social anxiety. • Those high in social anxiety were the least likely to experience a remission in symptoms over time. [ABSTRACT FROM AUTHOR]

Highlights: [•] Investigated the psychometric properties of the Child Anxiety Life Interference Scale (CALIS). [•] The CALIS measures impairment and interference on child and parent life. [•] Results indicated that the CALIS has good reliability and validity. [•] The CALIS is sensitive to treatment change. [Copyright &y& Elsevier]

Highlights: [•] Examined cross-sectional and prospective relations between behavioral inhibition and overprotective parenting and childhood anxiety symptoms in preschool children. [•] Behavioral inhibition emerged as a clear predictor of anxiety disorder symptoms, especially social anxiety. [•] Stable high inhibited children ran the greatest risk for developing an anxiety disorder. [•] The contribution of overprotective parenting to children's anxiety symptoms was less consistent. [•] Differences between native and non-native Dutch children were found with regard to temperament, parenting, and anxious symptoms. [Copyright &y& Elsevier]

Abstract: This paper describes the development and psychometric evaluation of a teacher report scale of anxiety in children. After initial pilot, the School Anxiety Scale—Teacher Report (SAS-TR) was reduced to 16 items which were answered on a 4-point scale. Psychometric evaluation was conducted on 240 community and 140 anxiety disordered children aged 5–12 years. Factor analysis identified two subscales reflecting social and generalized anxiety. The SAS-TR was found to have acceptable internal consistency, appropriate relationships with other teacher report scales, and was positively correlated with parent report of child anxiety. Gender and age effects on total and subscale scores were not evident. Clinical utility was evident with the scale discriminating between the community and clinical groups, correctly classifying a large proportion of anxiety disordered children and showing sensitivity to changes in anxiety with treatment. The SAS-TR complements existing measures and can be used within a multi-informant approach to the assessment of child anxiety. [Copyright &y& Elsevier]

• First study to assess the factor structure of the IUS-12 in a sample with GAD. • Bifactor type (two-factor testlet) model demonstrated best fit for the IUS-12. • Only the IUS-12 total score should be interpreted. • The IUS-12 demonstrated good validity and reliability. • The IUS-12 showed responsivity to treatment and clinical utility. Intolerance of uncertainty is a psychological vulnerability implicated in the development and maintenance of generalized anxiety disorder (GAD). The Intolerance of Uncertainty Scale-12 (IUS-12) is a widely used measure, however no studies have thoroughly tested the psychometric properties in a clinically diagnosed GAD sample. This study aimed to evaluate the factor structure, measurement properties and clinical utility of the IUS-12 in clinical and non-clinical samples. Participants were screened using the Anxiety Disorders Interview Schedule for DSM-IV to ascertain clinical (n = 136: principal diagnosis of GAD) or non-clinical status (n = 76). Confirmatory factor analysis determined that the bifactor type (two-factor testlet) model demonstrated significantly better fit in comparison to the unidimensional model for the clinical sample. The IUS-12 exhibited limited multidimensionality indicating that only the total score provides meaningful interpretation. The IUS-12 demonstrated good construct validity (with DASS-21, MCQ-30, and PSWQ), good internal consistency, as well as good test-retest reliability over 12-weeks. The IUS-12 demonstrated responsivity to treatment following cognitive behavioral therapy and mindfulness based psychological interventions. Receiver operating characteristic curve analysis indicated an optimal cut-off score of 28 for distinguishing individuals with GAD from non-clinical cases. Overall, the IUS-12 is a valid, reliable and clinically useful instrument for individuals with GAD. [ABSTRACT FROM AUTHOR]

• Parent education prevented symptoms of anxiety and depression in shy children. • Costs to the health care system were higher for children in the parenting group. • Costs to society were not higher for children in the parenting group. • Parent education is likely cost-effective for preventing anxiety and depression in children. A translational trial evaluated the effectiveness of screening for inhibited childhood temperament, followed by a preventive parenting program - Cool Little Kids. This study determined the cost-effectiveness from societal and health sector perspectives using trial data. Resources to deliver the screening and parenting sessions were determined from study records. Parents completed a questionnaire reporting resources used at one-year follow-up. Standard Australian unit costs were applied. Clinical outcomes for children and parental quality adjusted life-years (QALYs) were used to calculate incremental cost-effectiveness ratios (ICERs). Total societal costs were lower, but non-significant for the intervention compared to the control group (mean difference -$500 p = 0.937). Total health sector costs were significantly greater (mean difference $1,956; p = 0.015). The intervention led to significantly fewer internalising symptoms (Strengths and Difficulties Questionnaire (SDQ)-emotional difficulties adjusted mean difference −0.5; p = 0.006), fewer children with SDQ-emotional symptoms in the abnormal range (24.2 % vs. 33.0 % p =.014) and fewer with diagnosed anxiety (44.2 % vs. 50.2 % p = 0.427). From the societal perspective, the intervention would likely be cost-effective. Health sector ICERs were $1,171/SDQ-emotional symptom decrease, $51/abnormal SDQ avoided and $77/anxiety case avoided. This economic analysis alongside an implementation study provides an early indication that Cool Little Kids may be cost-effective. [ABSTRACT FROM AUTHOR]