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Background and Objectives: It has been proposed that negative mental imagery plays an important role in the persistence of social fears. Experiencing vivid and distressing 'flashforward' images of a potential social catastrophe appears to be of relevance in speech anxiety. To clarify the role of these images, the current experimental study tested if reducing the vividness and distressing properties of recurring negative flashforward images subsequently reduces anxiety and avoidance tendencies regarding a speech., Methods: Participants were female undergraduates high in speech anxiety (N = 134) who joined our study online. In the experimental condition, we used a visuospatial dual-task to reduce the vividness and distress of flashforward imagery. Primary outcomes were participants' self-reported anxiety and avoidance ratings in anticipation of and during an actual speech. As a secondary outcome, we used observer ratings of participants' anxiety during the speech., Results: Participants reported moderate to high frequency and interference of their vivid and distressing flashforward images in daily life. The dual-task resulted in reductions in image vividness and distress. However, we found no differences between conditions in anxiety and avoidance ratings before and during the speech., Limitations: The imagery manipulation effect was moderate to small. Moreover, we included a subclinical sample., Conclusions: Reducing negative flashforward imagery vividness and distress with a visuospatial dual-task did not directly lead to less anxiety and avoidance tendencies related to a later speech. Thus, findings provided no support for the hypothesis that experiencing highly vivid and distressing flashforward images causally contributes to social fears., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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., Competing Interests: Declaration of Competing Interest Dr McLellan is an author of the Cool Kids Online program but does not receive any personal payments. Dr Woon reports no biomedical financial interests or potential conflicts of interest. Professor Hudson is a co-author of the Cool Kids programs but does not receive any royalties. Professor Hudson has also co-authored a book and several book chapters for clinicians on the treatment of anxiety disorders in children and adolescents of which she has received one-off payments or royalties. Dr Lyneham is an author of the Cool Kids programs but does not receive any personal payments. Dr Lyneham is also an author on a commercial book for parents about child anxiety from which she received royalties. Dr Karin reports no biomedical financial interests or potential conflicts of interest. Professor Rapee is an author of the Cool Kids programs but does not receive any personal payments. Professor Rapee is also an author on a commercial book for parents about child anxiety from which she received royalties., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The aim of this study was to evaluate the tripartite influence model of body image and disordered eating among 12-18-year-old girls (N = 900) living in Australia (n = 184), China (n = 293), India (n = 223), and Iran (n = 200). Participants completed measures about appearance pressures from family, peers, and media, thin-ideal internalization, appearance comparisons, appearance satisfaction, and disordered eating. Results indicated that media- pressures were most salient in Australia, whereas Iranians perceived family pressures to be the strongest. Indians felt the most pressure to look attractive from their family and peers, whereas Chinese felt similar levels of pressure from family, peers, and media. Path analyses suggested direct associations from one or more sociocultural factors to appearance satisfaction or disordered eating, with indirect paths via thin-ideal internalization and appearance comparisons emerging in all countries. Certain sociocultural factors contributed more strongly to the internalization of ideals and appearance comparisons within some countries. Multigroup path analyses demonstrated some cross-cultural variations in the strength of the pathways. Findings extend cross-cultural support for a modified tripartite influence model emphasizing culture-based specificities that can further guide preventative efforts to improve body image and eating attitudes among young girls in these four countries., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Pediatric social anxiety disorder consistently shows the poorest treatment response of all anxiety disorders. The current study compared a generic cognitive-behavioral therapy (CBT) treatment for pediatric anxiety against a modified (social anxiety) treatment that incorporated specific components to target theoretically important maintaining processes., Method: A total of 200 children and adolescents (mean age = 9.5 years, SD = 2.2 years; 47% boys) diagnosed with social anxiety disorder as either their principal or additional disorder were randomly allocated to either the generic or the modified treatment. Both treatments were based on a manualized, empirically validated program (Cool Kids) and comprised 10 sessions over 12 weeks. Assessments comprised structured diagnostic interview and parent and youth reports, and covered diagnoses, symptoms, life impairment, and assessment of maintaining processes at posttreatment and 6-month follow-up., Results: The treatments did not differ significantly on the primary outcome (remission of social anxiety disorder) at either posttreatment (remission in generic = 41%; modified = 44%) or follow-up (remission in generic = 51%; modified = 69%), although the latter approached significance (p = .08). They also did not differ at either time point on most secondary measures of outcome. The only maintaining process that changed more under modified treatment was attention to the current task., Conclusion: Despite some positive hints in the data, there was little evidence that the modified intervention significantly improved treatment of pediatric social anxiety disorder, despite incorporating strategies to address putative maintaining mechanisms. The similar improvement between treatments on most maintaining processes suggests that new and innovative strategies may be needed to better target these processes., Clinical Trial Registration Information: Efficacy of Cognitive Behavioural Treatment for Socially Anxious Youth; https://www.anzctr.org.au/; 12616001065482., (Copyright © 2022 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

There is tremendous need for brief and supported, non-commercial youth- and caregiver-report questionnaires of youth anxiety. The pediatric and parent proxy short forms of the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety scale (8a v2.0) are free, brief, publicly accessible measures of youth- and caregiver-reported anxiety in children and adolescents. Despite increased use of the PROMIS, no study has evaluated performance of its anxiety scales in a sample of treatment-engaged anxious youth. Analyses were conducted on baseline data from the first 265 families (child M Age =11.14 years, 70% racial/ethnic minoritized youth) to enroll in the Kids FACE FEARS trial, a multisite comparative effectiveness trial of therapist-led vs. self-administered treatment for elevated youth anxiety. Confirmatory factor analysis (CFA) examined factor structure; omega coefficients and regression models examined internal consistency, convergent validity, and cross-informant reliability. CFA supported adjusted single-factor solutions across youth and caregiver reports, and internal consistency was high. Convergent validity was supported by medium-to-large associations with anxiety-related impairment and severity. Moderate cross-informant reliability between reports was found. Results showcase the first psychometric study of the PROMIS Anxiety scale short forms among treatment-engaged youth with elevated anxiety. Findings highlight the PROMIS Anxiety scale's utility in typical care settings for youth anxiety., (Published by Elsevier Ltd.)

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., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: 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., Method: 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., Results: 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., Conclusion: 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., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

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., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

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., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: With expected increases in the number of older adults worldwide, the delivery of stepped psychological care for depression and anxiety in older populations may improve both treatment and allocative efficiency for individual patients and the health system., Design: A multisite pragmatic randomised controlled trial evaluating the clinical and cost-effectiveness of a stepped care model of care for treating depression and anxiety among older adults compared to treatment as usual (TAU) will be conducted. Eligible participants (n = 666) with clinically interfering anxiety and/or depression symptoms will be recruited from and treated within six Australian mental health services. The intervention group will complete a low intensity cognitive behavioural therapy (CBT) program: Internet-delivered or using a work-at-home book with brief therapist calls (STEP 1). Following STEP 1 a higher intensity face-to-face CBT (STEP 2) will then be offered if needed. Intention-to-treat analyses will be used to examine changes in primary outcomes (e.g. clinician-rated symptom severity changes) and secondary outcomes (e.g. self-reported symptoms severity, health related quality of life and service utilisation costs). An economic evaluation will be conducted using a cost-utility analysis to derive the incremental cost-effectiveness ratio for the stepped care intervention., Discussion: This study will demonstrate the relative clinical and economic benefits of stepped care model of psychological care for older adults experiencing anxiety and/or depression compared to TAU. The evaluation of the intervention within existing mental health services means that results will have significant implications for the translation of evidence-based interventions in older adult services across urban and rural settings., Trail Registration: Prospectively registered on anzctr.org.au (ACTRN12619000219189) and isrctn.com (ISRCTN37503850)., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: 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., Methods: 1732 adolescent males (aged 12-18 years) participated online whilst at school., Results: 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., Limitations: The study had a correlational research design and used self-report measures., Conclusions: Mental health initiatives which consider the impact of masculinity and gender stereotypes have the potential to significantly improve help-seeking in this population., (Copyright © 2020. Published by Elsevier Ltd.)

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., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

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., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: We examined the effectiveness of targeted school-based cognitive-behavioral therapy (CBT) for adolescents (12-16 years of age) with anxiety, and tested whether brief CBT was noninferior to standard duration CBT., Method: A randomized controlled study of 313 adolescents (mean 14.0 years, SD = 0.84, 84% girls) were recruited through school health services to 10 weeks CBT group interventions. Groups of 5 to 8 adolescents were randomly allocated to brief (5 sessions, comprising 5.5 hours) or standard CBT (10 sessions, comprising 15 hours), or 10 weeks waitlist (WL). Self-reported and parent-reported youth anxiety symptoms, impairment from anxiety, depressive symptoms,and clinical severity were assessed pre- and postintervention, after WL, and at 1-year follow-up., Results: Targeted school based CBT significantly reduced adolescents' anxiety symptoms with small to moderate effect sizes compared to WL (Cohen d = 0.34 for youth report and d = 0.53 for parent report). According to the parents, also adolescents' impairment from anxiety was significantly reduced compared to WL (d = 0.51). Pre to post changes in anxiety symptoms were small to moderate (within-group effect sizes between d = 0.41 and d = 0.67). Although no significant differences in effects were found between brief and standard CBT, brief CBT was not noninferior to standard CBT. Outcomes from both interventions were sustained at 1-year follow-up., Conclusion: Targeted school-based CBT interventions reduced anxiety, impairment, and depressive symptoms in adolescents. Both brief and standard CBT demonstrated efficacy, but brief CBT was not noninferior to standard CBT. By administering school-based CBT to youths with anxiety symptoms, we may reach young people with effective interventions at an earlier phase in their lives., Clinical Trial Registration Information: School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/; NCT02279251., (Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.)

Objective: 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., Method: 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)., Results: 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., Conclusions: This economic analysis alongside an implementation study provides an early indication that Cool Little Kids may be cost-effective., Competing Interests: Declaration of Competing Interest Rapee developed and distributes the Cool Little Kids program, but receives no financial benefit. There are no other conflicts of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Existing literature suggests that anticipatory processing and post-event processing-two repetitive thinking processes linked to social anxiety disorder (SAD)-might be better conceptualized as facets of an underlying unidimensional repetitive thinking construct. The current study tested this by examining potential factor structures underlying anticipatory processing and post-event processing. Baseline data from two randomized controlled trials, consisting of 306 participants with SAD who completed anticipatory processing and post-event processing measures in relation to a speech task, were subjected to confirmatory factor analysis. A bifactor model with a General Repetitive Thinking factor and two group factors corresponding to anticipatory processing and post-event processing best fit with the data. Further analyses indicated an optimal model would include only the General Repetitive Thinking factor (reflecting anticipatory processing and a specific aspect of post-event processing) and Post-event Processing group factor (reflecting another specific aspect of post-event processing that is separable), providing evidence against a unidimensional account of repetitive thinking in SAD. Analyses also indicated that the General Repetitive Thinking factor had moderately large associations with social anxiety and life interference (rs = .43 to .47), suggesting its maladaptive nature. The separable Post-event Processing group factor only had small associations with social anxiety (rs = .16 to .27) and was not related to life interference (r = .11), suggesting it may not, in itself, be a maladaptive process. Future research that further characterises the bifactor model components and tests their utility has the potential to improve the conceptualisation and assessment of repetitive thinking in SAD., (Copyright © 2018. Published by Elsevier Ltd.)

Viewing idealized images of attractive women on social media can negatively impact women's body image and mood. Although women tend to post idealized images on social media, some also post natural no-makeup images. This study examined the impact of viewing both made up and no-makeup selfies on young women's body image and mood. Female undergraduate students (N = 175) viewed either images of a woman wearing no makeup interspersed among idealized made up images of that woman (no-makeup condition), only idealized made up images of a woman (makeup only condition), or appearance-neutral travel images (control condition). Participants rated their state appearance satisfaction and mood pre- and post-exposure to the study images and rated their desire to change aspects of the face, hair, and skin post-exposure to the study images. Participants in the makeup only condition were less satisfied with their facial appearance and were more motivated to change aspects of their face, hair, and skin after exposure to the study images. Viewing the study images had no impact on the body image or mood of participants in the no-makeup condition. These results suggest that no-makeup selfies may reduce any negative impact of idealized made up images on women's facial concerns., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background and Objectives: Cognitive theories of fear suggest that biases in interpretation are content-specific: Fearful children should only interpret materials negatively if they are specifically related to the content of their fear. So far, there are only a few studies available that report on this postulated content-specificity of interpretation processes in childhood fear. The goal of this study was to examine interpretation bias and its content-specificity in children with varying levels of Generalized Anxiety Disorder (GAD) symptoms., Methods: In an Auditory Interpretation Task (AIT), two words that differ by one phoneme are acoustically blended so that one can hear only one of the words. In the current AIT, we included GAD-related blends, negatively-valenced fear-related blends and positive blends. Multiple-choice (n = 371) or open-ended (n = 295) responses were collected from 666 nonclinical children between 7 and 13 years of age., Results: Children with higher levels of self-reported GAD showed significantly more negative interpretations of ambiguous GAD-related blends in the multiple-choice version than children with lower levels of GAD. There were no differences when interpreting the other ambiguous blends. This result was not found with the open-ended version., Limitations: Effects were relatively small, some GAD-stimuli were sub-optimal, and the task was administered in a classroom setting. Even though we ensured that all children were able to hear all words clearly, this may have impacted the results., Conclusions: The findings only partly support the idea that fearful children display cognitive biases specific for fear-relevant stimuli, and more research is needed to replicate the results and test the usability of the AIT., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Previous research has identified factors related to outcome in child anxiety treatment and parent training programs for child behavior problems. However, it is unclear what factors predict outcomes in interventions delivered online to parents of young children at risk of anxiety. This study investigated predictors of child anxiety outcomes among 433 families with young children (3-6 years) who participated in a randomized controlled trial of Cool Little Kids Online, an eight-module early intervention program for child anxiety based on cognitive-behavioral therapy (CBT). Potential predictors included baseline demographic factors, child and parent mental health factors, and indicators of program use, including number of online modules completed and frequency of homework practice. Results showed that only access to a printer moderated intervention effectiveness. Printer access predicted lower child anxiety in the Cool Little Kids Online group, but had no effect on outcomes in the wait-list group. In both groups, higher levels of child anxiety symptoms, child-inhibited temperament, and poorer parent mental health at baseline predicted higher levels of child anxiety symptoms at 6-month follow-up. The amount of online program use was not related to improvements in child anxiety symptoms. However, parents who reported practicing the program skills more frequently showed greater reductions in child anxiety, and access to a printer was related to frequency of program skills practice. These findings provide empirical support for the important role of skills practice in online CBT interventions, and suggest that practicing program skills may be more important than completing the online modules., (Copyright © 2017. Published by Elsevier Ltd.)

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., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

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., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: Stepped care is embraced as an ideal model of service delivery but is minimally evaluated. The aim of this study was to evaluate the efficacy of cognitive-behavioral therapy (CBT) for child anxiety delivered via a stepped-care framework compared against a single, empirically validated program., Method: A total of 281 youth with anxiety disorders (6-17 years of age) were randomly allocated to receive either empirically validated treatment or stepped care involving the following: (1) low intensity; (2) standard CBT; and (3) individually tailored treatment. Therapist qualifications increased at each step., Results: Interventions did not differ significantly on any outcome measures. Total therapist time per child was significantly shorter to deliver stepped care (774 minutes) compared with best practice (897 minutes). Within stepped care, the first 2 steps returned the strongest treatment gains., Conclusion: Stepped care and a single empirically validated program for youth with anxiety produced similar efficacy, but stepped care required slightly less therapist time. Restricting stepped care to only steps 1 and 2 would have led to considerable time saving with modest loss in efficacy. Clinical trial registration information-A Randomised Controlled Trial of Standard Care Versus Stepped Care for Children and Adolescents With Anxiety Disorders; http://anzctr.org.au/; ACTRN12612000351819., (Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Cognitive behavior group therapy (CBGT) is effective for social anxiety disorder (SAD), but a substantial proportion of patients do not typically achieve normative functioning. Cognitive behavioral models of SAD emphasize negative self-imagery as an important maintaining factor, and evidence suggests that imagery is a powerful cognitive mode for facilitating affective change. This study will compare two group CBGT interventions, one that predominantly uses verbally-based strategies (VB-CBGT) and another that predominantly uses imagery-enhanced strategies (IE-CBGT), in terms of (a) efficacy, (b) mechanisms of change, and (c) cost-effectiveness. This study is a parallel groups (two-arm) single-blind randomized controlled trial. A minimum of 96 patients with SAD will be recruited within a public outpatient community mental health clinic in Perth, Australia. The primary outcomes will be self-reported symptom severity, caseness (SAD present: yes/no) based on a structured diagnostic interview, and clinician-rated severity and life impact. Secondary outcomes and mechanism measures include blind observer-rated use of safety behaviors, physiological activity (heart rate variability and skin conductance level) during a standardized speech task, negative self-beliefs, imagery suppression, fear of negative and positive evaluation, repetitive negative thinking, anxiety, depression, self-consciousness, use of safety behaviors, and the EQ-5D-5L and TiC-P for the health economic analysis. Homework completion, group cohesion, and working alliance will also be monitored. The outcomes of this trial will inform clinicians as to whether integrating imagery-based strategies in cognitive behavior therapy for SAD is likely to improve outcomes. Common and distinct mechanisms of change might be identified, along with relative cost-effectiveness of each intervention., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Anticipatory processing, maladaptive attentional focus, and postevent processing are key cognitive constructs implicated in the maintenance of social anxiety disorder (SAD). The current study examined how treatment for SAD concurrently affects these three cognitive maintaining processes and how these processes are associated with each other as well as with symptom change from pre- to posttreatment. The sample consisted of 116 participants with SAD receiving group cognitive behavioral therapy. All three cognitive maintaining processes were measured relative to a speech task and again relative to a conversation task. Across both tasks, the three cognitive process variables demonstrated decreases from pre- to posttreatment. Within the same task, a slower rate of decrease in a specific cognitive process variable from pre- to posttreatment was predicted from higher pretreatment levels of either one or both of the other cognitive process variables. Additionally, higher levels of pretreatment conversation-related anticipatory processing and maladaptive attentional focus predicted a slower rate of decrease in social anxiety symptoms from pre- to posttreatment. Results are consistent with cognitive models of SAD and have important implications for enhancing existing treatments., (Copyright © 2017. Published by Elsevier Ltd.)

Objective: The Cool Little Kids parenting group program is an effective intervention for preventing anxiety disorders in young children who are at risk because of inhibited temperament. The program has six group sessions delivered by trained psychologists to parents of 3- to 6-year-old children. An online adaptation (Cool Little Kids Online) has been developed to overcome barriers to its wide dissemination in the community. This study tested the efficacy of Cool Little Kids Online in a randomized controlled trial., Method: A total of 433 parents of a child aged 3 to 6 years with an inhibited temperament were randomized to the online parenting program or to a 24-week waitlist. The online program has 8 interactive modules providing strategies that parents can implement with their child to manage their child's avoidant coping, reduce parental overprotection, and encourage child independence. Parents were provided telephone consultation support with a psychologist when requested. Parents completed self-report questionnaires at baseline and at 12 and 24 weeks after baseline., Results: The intervention group showed significantly greater improvement over time in child anxiety symptoms compared to the control group (d = 0.38). The intervention group also showed greater reductions in anxiety life interference (ds = 0.33-0.35) and lower rates of anxiety disorders than the control group (40% versus 54%), but there were minimal effects on broader internalizing symptoms or overprotective parenting., Conclusion: Results provide empirical support for the efficacy of online delivery of the Cool Little Kids program. Online dissemination may improve access to an evidence-based prevention program for child anxiety disorders. Clinical trial registration information-Randomised Controlled Trial of Cool Little Kids Online: A Parenting Program to Prevent Anxiety Problems in Young Children; http://www.anzctr.org.au/; 12615000217505., (Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: Cognitive theories suggest that cognitive biases may be related and together influence the anxiety response. However, little is known about the interrelations of cognitive bias tasks and whether they allow for an improved prediction of fear-related behavior in addition to self-reports. This study simultaneously addressed several types of cognitive biases in children, to investigate attention bias, interpretation bias, memory bias and fear-related associations, their interrelations and the prediction of behavior., Methods: Eighty-one children varying in their levels of spider fear completed the Spider Anxiety and Disgust Screening for Children and performed two Emotional Stroop tasks, a Free Recall task, an interpretation task including size and distance indication, an Affective Priming Task, and a Behavioral Assessment Test., Results: We found an attention bias, interpretation bias, and fear-related associations, but no evidence for a memory bias. The biases showed little overlap. Attention bias, interpretation bias, and fear-related associations predicted unique variance in avoidance of spiders. Interpretation bias and fear-related associations remained significant predictors, even when self-reported fear was included as a predictor., Limitations: Children were not seeking help for their spider fear and were not tested on clinical levels of spider phobia., Conclusions: This is the first study to find evidence that different cognitive biases each predict unique variance in avoidance behavior. Furthermore, it is also the first study in which we found evidence for a relation between fear of spiders and size and distance indication. We showed that this bias is distinct from other cognitive biases., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Purpose: Stuttering during adulthood is associated with a heightened rate of anxiety disorders, especially social anxiety disorder. Given the early onset of both anxiety and stuttering, this comorbidity could be present among stuttering children., Method: Participants were 75 stuttering children 7-12 years and 150 matched non-stuttering control children. Multinomial and binary logistic regression models were used to estimate odds ratios for anxiety disorders, and two-sample t-tests compared scores on measures of anxiety and psycho-social difficulties., Results: Compared to non-stuttering controls, the stuttering group had six-fold increased odds for social anxiety disorder, seven-fold increased odds for subclinical generalized anxiety disorder, and four-fold increased odds for any anxiety disorder., Conclusion: These results show that, as is the case during adulthood, stuttering during childhood is associated with a significantly heightened rate of anxiety disorders. Future research is needed to determine the impact of those disorders on speech treatment outcomes., (Copyright © 2016. Published by Elsevier Inc.)

Objective: The Genes for Treatment study is an international, multisite collaboration exploring the role of genetic, demographic, and clinical predictors in response to cognitive-behavioral therapy (CBT) in pediatric anxiety disorders. The current article, the first from the study, examined demographic and clinical predictors of response to CBT. We hypothesized that the child's gender, type of anxiety disorder, initial severity and comorbidity, and parents' psychopathology would significantly predict outcome., Method: A sample of 1,519 children 5 to 18 years of age with a primary anxiety diagnosis received CBT across 11 sites. Outcome was defined as response (change in diagnostic severity) and remission (absence of the primary diagnosis) at each time point (posttreatment, 3-, 6-, and/or 12-month follow-up) and analyzed using linear and logistic mixed models. Separate analyses were conducted using data from posttreatment and follow-up assessments to explore the relative importance of predictors at these time points., Results: Individuals with social anxiety disorder (SoAD) had significantly poorer outcomes (poorer response and lower rates of remission) than those with generalized anxiety disorder (GAD). Although individuals with specific phobia (SP) also had poorer outcomes than those with GAD at posttreatment, these differences were not maintained at follow-up. Both comorbid mood and externalizing disorders significantly predicted poorer outcomes at posttreatment and follow-up, whereas self-reported parental psychopathology had little effect on posttreatment outcomes but significantly predicted response (although not remission) at follow-up., Conclusion: SoAD, nonanxiety comorbidity, and parental psychopathology were associated with poorer outcomes after CBT. The results highlight the need for enhanced treatments for children at risk for poorer outcomes., (Copyright © 2015 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Unlabelled: Anxiety is one of the most widely observed and extensively studied psychological concomitants of stuttering. Research conducted prior to the turn of the century produced evidence of heightened anxiety in people who stutter, yet findings were inconsistent and ambiguous. Failure to detect a clear and systematic relationship between anxiety and stuttering was attributed to methodological flaws, including use of small sample sizes and unidimensional measures of anxiety. More recent research, however, has generated far less equivocal findings when using social anxiety questionnaires and psychiatric diagnostic assessments in larger samples of people who stutter. In particular, a growing body of research has demonstrated an alarmingly high rate of social anxiety disorder among adults who stutter. Social anxiety disorder is a prevalent and chronic anxiety disorder characterised by significant fear of humiliation, embarrassment, and negative evaluation in social or performance-based situations. In light of the debilitating nature of social anxiety disorder, and the impact of stuttering on quality of life and personal functioning, collaboration between speech pathologists and psychologists is required to develop and implement comprehensive assessment and treatment programmes for social anxiety among people who stutter. This comprehensive approach has the potential to improve quality of life and engagement in everyday activities for people who stutter. Determining the prevalence of social anxiety disorder among children and adolescents who stutter is a critical line of future research. Further studies are also required to confirm the efficacy of Cognitive Behaviour Therapy in treating social anxiety disorder in stuttering., Educational Objectives: The reader will be able to: (a) describe the nature and course of social anxiety disorder; (b) outline previous research regarding anxiety and stuttering, including features of social anxiety disorder; (c) summarise research findings regarding the diagnostic assessment of social anxiety disorder among people who stutter; (d) describe approaches for the assessment and treatment of social anxiety in stuttering, including the efficacy of Cognitive Behaviour Therapy; and (e) outline clinical implications and future directions associated with heightened social anxiety in stuttering., (Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Of the few risk factors identified for the development of anxiety disorders, behavioral inhibition has received the strongest support. However, studies examining prediction of anxiety disorder from inhibition over time have not been extensive, and very few have assessed the impact of inhibition assessed early in life on anxiety in adolescence., Method: The current study assessed 3 risk factors among 91 children when they were approximately 4 years of age, and determined anxiety diagnoses when the children were in midadolescence (mean age, 15 years). Children were included in the study at preschool age if they scored high (n = 57) or low (n = 34) on behavioral inhibition. Maternal anxiousness and maternal attitudes toward the child were assessed at the same time. Diagnoses at age 15 years were categorized as social anxiety disorder or other anxiety disorders., Results: Social anxiety disorder at age 15 years was predicted by both inhibition and maternal anxiousness at age 4 years, whereas other anxiety disorders were predicted only by maternal anxiousness. Almost 37% of inhibited preschool-aged children demonstrated social anxiety disorder at age 15, compared with 15% of uninhibited children., Conclusions: The results support a growing body of research pointing to the importance of behavioral inhibition as a risk for social anxiety well into adolescence, and also highlight maternal anxiousness as a more general risk across anxiety disorders., (Copyright © 2014 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

This paper describes the development and psychometric evaluation of a parent and child report measure of life interference and impairment associated with childhood anxiety, the Child Anxiety Life Interference Scale (CALIS). The CALIS is designed to measure life interference and impairment experienced by the child from the child (9 items) and parent (16 items) point of view and also the interference experienced by the parent in their own life. A total of 622 children between 6 and 17 years of age, and their parents, completed the CALIS. Results indicated that the CALIS has good internal consistency, moderate-to-high test re-test reliability, significant inter rater reliability, good convergent and divergent validity and is sensitive to treatment change. The CALIS is a reliable and valid tool for the assessment of life interference and impairment associated with anxiety disorders in childhood., (Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.)

This study examined behavioral inhibition and overprotective parenting as correlates and predictors of anxiety disorder symptoms in preschoolers with a multi-cultural background (N=168). Parents of 3- to 6-year-old children completed a set of questionnaires twice, 12 months apart. Parents were also interviewed with the Anxiety Disorders Interview Schedule for DSM-IV at the 12-month point to assess the clinical severity of children's anxiety symptoms. Behavioral inhibition consistently emerged as a significant concurrent correlate of anxiety symptoms and this was particularly true for social anxiety symptoms. Overprotective parenting also emerged as a significant correlate of anxiety, but only in the case of non-social anxiety symptoms and mainly in non-native Dutch children. Prospective analyses revealed that behavioral inhibition was a significant predictor of social anxiety symptoms, while overprotective parenting did not explain significant variance in the development of children's anxiety over time. The support for an interactive effect of behavioral inhibition and overprotective parenting was unconvincing. Finally, it was found that children who exhibited stable high levels of behavioral inhibition throughout the study ran the greatest risk for developing an anxiety disorder., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: The purpose of the present study was to evaluate the influence of comorbid disorders on the degree of change and the endpoint of cognitive-behavioral treatment in anxious young people., Method: Data on 750 children 6 to 18 years old were compiled from different samples within one clinic. All children had a primary anxiety disorder and were engaged in a manual-based, 10-session, cognitive-behavioral treatment program. Outcome was determined according to diagnostic status and continuous symptom measurements. Analyses compared results among four groups: no comorbidity, comorbid anxiety disorders, comorbid externalizing disorders, comorbid mood disorders. All analyses were intent-to-treat analyses., Results: Children with comorbid depression were the least likely to be free of their primary anxiety diagnosis at the end of treatment and follow-up. According to child and maternal reports, symptoms of anxiety decreased similarly over time in all groups, but children with comorbid mood disorders scored significantly highest at all time points. Examining the effects of anxiety treatment on comorbid disorders showed that comorbid mood disorders, but not externalizing disorders, decreased significantly over time., Conclusions: The existence of comorbid disorders does not appear to affect the rate or extent of response to cognitive-behavioral treatment for child anxiety. However, comorbidity has a marked influence on the endpoint of treatment. Children with nonanxiety comorbidity and especially with comorbid mood disorders exhibit greater severity at the outset and remain worse after treatment. On the positive side, treatment for anxiety disorders appears to decrease comorbid mood disorders, although it has less effect on comorbid externalizing disorders., (Copyright © 2013 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

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 © 2012 Elsevier Ltd. All rights reserved.)

Objective: Computerized cognitive behavioral interventions for anxiety disorders in adults have been shown to be efficacious, but limited data are available on the use of computerized interventions with young persons. Adolescents in particular are difficult to engage in treatment and may be especially suited to computerized technologies. This paper describes the results of a small randomized controlled trial of the Cool Teens program for adolescent anxiety, and examines potential barriers to treatment and user preferences of computerized technology in this population., Method: Forty-three adolescents with a primary diagnosis of anxiety were randomly allocated to the Cool Teens program, a 12-week computerized cognitive-behavioral therapy program for anxiety management, or a 12-week wait list. Effects on symptoms, negative thoughts, and life interference were assessed at post-treatment and 3-month follow-up, based on diagnosis as well as self and maternal report., Results: Using mixed-model analyses, at post-treatment and follow-up assessments, adolescents in the Cool Teens condition, compared with those on the wait list, were found to have significant reductions in the total number of anxiety disorders, the severity of the primary anxiety disorder, and the average severity for all disorders. These results were matched by significant reductions in mother and child questionnaire reports of anxiety, internalizing symptoms, automatic thoughts, and life interference. Further few barriers to treatment were found, and user preferences indicated that the computerized treatment was well suited to adolescents with anxiety., Conclusions: The Cool Teens program is efficacious for treatment of adolescent anxiety. Clinical trial registration information-A randomized controlled trial of the Cool Teens computerized program for anxious adolescents compared with waist list; http://www.anzctr.org.au; ACTRN12611000508976., (Copyright © 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

The current study compared the predicted social and career impact of socially withdrawn and reticent behaviors among participants from Western and East Asian countries. Three hundred sixty-one college students from 5 Western countries and 455 students from 3 East Asian countries read hypothetical vignettes describing socially withdrawn and shy behaviors versus socially outgoing and confident behaviors. Participants then answered questions following each vignette indicating the extent to which they would expect the subject of the vignette to be socially liked and to succeed in their career. Participants also completed measures of their own social anxiety and quality of life. The results indicated significant vignette-by-country interactions in that the difference in perceived social and career impact between shy and outgoing vignettes was smaller among participants from East Asian countries than from Western countries. In addition, significant negative correlations were shown between personal level of shyness and experienced quality of life for participants from both groups of countries, but the size of this relationship was greater for participants from Western than East Asian countries. The results point to the more negative impact of withdrawn and socially reticent behaviors for people from Western countries relative to those from East Asia., (Copyright © 2011. Published by Elsevier Ltd.)

This study investigated the time-course of attentional bias in socially phobic (SP) and non-phobic (NP) adults. Participants viewed angry and happy faces paired with neutral faces (i.e., face-face pairs) and angry, happy and neutral faces paired with household objects (i.e., face-object pairs) for 5000ms. Eye movement (EM) was measured throughout to assess biases in early and sustained attention. Attentional bias occurred only for face-face pairs. SP adults were vigilant for angry faces relative to neutral faces in the first 500ms of the 5000ms exposure, relative to NP adults. SP adults were also vigilant for happy faces over 500ms, although there were no group-based differences in attention to happy-neutral face pairs. There were no group differences in attention to faces throughout the remainder of the exposure. Results suggest that social phobia is characterised by early vigilance for social cues with no bias in subsequent processing.

The present study aimed to examine how video feedback can affect perceived performance and anticipatory anxiety in various naturalistic social anxiety-provoking situations among clinical patients diagnosed with social anxiety disorder (SAD) and to examine predictors that might influence response to video feedback. Participants were 52 consecutive patients with DSM-IV SAD who participated in a group-based CBT program. Our results demonstrated that video feedback was associated with a decrease in the underestimation of own performance as well as the perception of feared outcomes. Moreover, anticipatory anxiety decreased after video feedback combined with peer feedback. Male sex, comorbidity with other anxiety disorders, and benzodiazepine prn, as well as patients' initial anxiety and avoidance were negative predictors of the effect of video feedback.

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.

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 500 ms, respectively. When face pairs were presented for 3000 ms eye movement data showed no evidence of an attentional bias at any stage of attentional processing. When face pairs were presented for 500 ms 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.

Objective: The current study evaluated the efficacy of early intervention for preschool-aged children selected on the basis of risk who also met diagnostic criteria for anxiety disorders., Method: Seventy-one 3- to 4-year-old children were selected based on demonstrating high levels of inhibition and having a parent with a current anxiety disorder. They were randomly allocated to an eight-session parent intervention or waitlist., Results: At baseline, all of the children met criteria for one or more anxiety disorders. At 6-month follow-up, the intervention group showed a significantly greater reduction in anxiety disorders and less interference from their anxiety than the waitlist. In addition, children in the intervention condition showed greater reductions in parent and laboratory observed measures of behavioral inhibition., Conclusions: The results suggest that a brief early intervention delivered through parents can reduce current anxiety and associated risk and may have the potential to alter the developmental trajectory of anxiety in a high-risk group of young children.

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.

Objective: The current trial examined whether a specific cognitive-behavioral treatment package was more efficacious in treating childhood anxiety disorders than a nonspecific support package., Method: One hundred twelve children (aged 7-16 years) with a principal anxiety disorder were randomly allocated to either a group cognitive-behavioral treatment (CBT) program or a control condition (group support and attention [GSA])., Results: Overall, results showed that CBT was significantly more efficacious compared with the GSA condition: 68.6% of children in the CBT condition did not meet diagnostic criteria for their principal anxiety diagnosis at 6-month follow-up compared with 45.5% of the children in the GSA condition. The results of the child- and parent-completed measures indicated that, although mothers of CBT children reported significantly greater treatment gains than mothers of GSA children, children reported similar improvements across conditions., Conclusions: Specific delivery of cognitive-behavioral skills is more efficacious in the treatment of childhood anxiety than a treatment that includes only nonspecific therapy factors.