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This paper describes the development and psychometric evaluation of a brief self‐report measure (BEACON) to inform universal mental health screening in schools. Items assess symptoms and impairment associated with anxiety and attention/hyperactivity problems (grades 4–11) as well as depression and eating difficulties (grades 6–11), with optional items for suicidality and self‐harm (grades 7–11). Initial item examination based on Item Response Theory (IRT) and classical test theory involved 3844 students in grades 4 through 11 (Study 1) and identified 18 items for grades 4–5 and 31 items for grades 6–11 that fulfilled pre‐set criteria. Study 2 extended testing with 10,479 students in grades 4–11 and added an additional four items assessing impairment associated with eating difficulties for older students (grades 6–11) creating a total of 35 items for grades 6–11. All items, for both grade‐level versions, met the pre‐set criteria for IRT and classical test theory analysis supporting their strength in the measurement of the dimensions of concern. The measure showed good reliability (subscale alphas.87 to.95). Validity was also demonstrated against standard symptom measures, school grades, school absenteeism, and help‐seeking. The BEACON appears to be a psychometrically sound measure to use in the first stage of school‐based screening for mental health problems. [ABSTRACT FROM AUTHOR]

Background: Screening young people for risk of mental health difficulties in schools is an effective method to facilitate monitoring and early intervention. This study is a preliminary report on the adaptation of the Youth RADAR screening instrument for primary school children. Specifically designed to be used in schools, the Child RADAR assesses a child's balance of risk and protective factors known to be associated with the development of mental health problems. Method: Three hundred and thirty‐nine children drawn from six primary schools across NSW, Australia, completed the alpha version of the Child RADAR in addition to an assessment of depression and anxiety symptoms and subjective well‐being. Results: Confirmatory factor analysis revealed the Child RADAR to have an acceptable factor structure. Reliability for the Total Child RADAR was satisfactory based on both internal consistency (α = .86) and test–retest reliability (r = .85). Convergent validity was demonstrated through significant associations with symptoms of anxiety and depression. Conclusions: The Child RADAR shows preliminary promise as a school‐based screener of mental health risk. Further evaluation is required to demonstrate the generalizability of the instrument across different populations. [ABSTRACT FROM AUTHOR]

Background Children from developing countries are more vulnerable to traumatic experiences and more likely to suffer a range of psychological problems than children from developed countries. Method The current paper describes a survey of 1360 children and adolescents from Bangladesh who were selected either from the general community or through a range of social service organizations. Children completed a checklist of traumatic events and questionnaires to assess symptoms of PTSD, anxiety and depression. Results Children from both samples reported high levels of exposure to traumatic events, both via direct experience and indirectly. Direct experiences with intentional, man-made events were more frequently reported by children from support services while trauma from natural disasters was more common among community children. Psychological symptoms were significantly higher within children from social support services. The strongest predictors of psychological symptoms were age, gender, sample source and exposure to man-made direct traumas. Conclusion The results point to the common occurrence of traumatic events and their emotional consequences among children and adolescents from Bangladesh and indicate the need to develop effective and accessible mental health services for Bangladeshi children and adolescents. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to compare treatment outcomes following a group family-based cognitive behavioural therapy for children with different anxiety disorders (social anxiety disorder, separation anxiety disorder, generalised anxiety disorder, specific phobia and obsessive compulsive disorder). Method This study utilised a clinical sample of 842 children and adolescents (aged between 6 and 18 years) and assessed outcome using diagnostic interview, parent-report and child-report. Results Based on diagnostic data and parent-reported symptoms, results revealed that children with a diagnosis of social anxiety disorder experienced a slower rate of change and poorer diagnostic outcomes at post treatment and follow-up than children with other anxiety disorders. Children with GAD showed better response to this broad-based intervention and children with OCD showed better response on one measure. Conclusions This study provides evidence for differential response to broad-based CBT for children, based on type of anxiety diagnoses. [ABSTRACT FROM AUTHOR]

Objectives In order to assist mental health services in developing countries, a key issue is the availability of psychometrically sound, brief, and cost-effective measures that have been tested within the relevant context. The present study was designed to evaluate within a young Bangladeshi population, the psychometric properties of two widely used Western measures of internalizing distress in young people: the short form of the Spence Children's Anxiety Scale and the Short Moods and Feelings Questionnaire. Method The sample included 1,360 children and adolescents aged 9-17 years ( M = 12.3 years, SD = 2.12) recruited from six districts of Bangladesh, including both community and emotionally at-risk participants. A total of 179 children were re-tested on the measures within 3-4 weeks. Results Confirmatory factor analyses showed single-factor structures for both scales in the total sample and in both community and at-risk participants separately. Multiple group analyses across gender and age-group within the at-risk and community samples showed that the single-factor structure was suitable regardless of subgroup. Analyses also indicated acceptable internal consistency, test-retest reliability and construct validity for both scales. Conclusion The two measures show promise as brief, reliable, and valid instruments for the assessment of internalizing distress among young people from Bangla-speaking communities. Practitioner points Positive clinical implications These two measures of internalizing distress in young people showed solid psychometric properties within samples collected from various parts of Bangladesh. The measures can therefore be used to assess anxiety and depression in Bangla-speaking youth., These measures should be of value in both clinical settings and at a community level to assess the need for services., Cautions and limitations Resource limitations did not allow comparison against diagnostic criteria and therefore cut-off scores to indicate clinical status among Bangladeshi youth will require further research. [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]

The objectives of this study are to assess the association between childhood bullying and preference-based health-related quality of life (QoL) in Australian school children and their parents and estimate quality-adjusted life years (QALYs) associated with bullying chronicity. Children aged 8–10 years completed the child health utilities (CHU-9D), while parents completed the Australian quality of life (AQoL-8D). Children were grouped into four categories of bullying involvement (no bullying, victim, perpetrator, or both perpetrator and victim) based on the Revised Olweus Bully/Victim Questionnaire. Parental data were compared across two bullying involvement groups (bullying vs. no bullying). QALYs were calculated for children over two years and comparisons made based on the number of assessments where bullying was reported (baseline, 1- and 2-year follow up). Children who were involved in bullying (victims and/or perpetrators) reported statistically significantly lower mean utility scores compared to children who were not involved in bullying. Parents whose child was involved in bullying had significantly lower mean utility scores compared to parents of children not involved with bullying. There appeared to be a dose–response relationship, with higher QALY losses associated with increasing frequency of reported bullying. Bullying among Australian school children was associated with significantly lower preference-based QoL for themselves and their parents. This study also confirmed the significant burden of disease for bullying among children measured by an incremental decrease in QALY with an increasing chronicity of bullying over time. [ABSTRACT FROM AUTHOR]

Objective: The current study determined the viability of using the telephone to facilitate assessment of children using the Anxiety Disorders Interview Schedule for children for DSM-IV (ADIS-C-IV). Method: Diagnoses established during telephone administration of the ADIS-C-l V-Parent version were compared with diagnoses obtained during standard administration of the AD1S-C-IV using both Child and Parent versions. Seventy-three children and their parents participated in counterbalanced, repeated assessments. Results: The level of agreement between telephone and standard administration for principal diagnosis (K = 0.86), individual anxiety disorders (K = 0.63-0.86), and other disorders (K = 0.79-0.91) were in the good to excellent range. Additionally, agreement on overall suitability for an anxiety treatment program was excellent (K = 0.97). Conclusions: The data indicate that telephone administration of the ADIS-C-IV is a valid way to differentiate children who have anxiety disorders from those who have no disorder or other disorders, providing a less resource- demanding alternative to face-to-face assessment. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the nature and organization of a range of negative self-statements in children and adolescents, using a structural equations/confirmatory factor-analytic approach. A community sample of 978 children aged 7-16 years completed a questionnaire about the frequency with which they experienced a broad range of negative automatic thoughts. The outcome of comparative modeling provided strongest support for a model in which 4 distinct cognitive factors were all related to a single higher order factor. The 4 lower order factors related to cognitions on social threat, physical threat, personal failure, and hostility. The pattern of results was consistent across age and gender. Results were consistent with assumptions of cognitive specificity models of psychopathology, on the latent structure of automatic thoughts in children and adolescents. [ABSTRACT FROM AUTHOR]

Cognitive theories of anxiety suggest that anxious children interpret negatively only those materials specifically related to the content of their anxiety. So far, there are only a few studies available that report on this postulated content-specificity of interpretation processes across different anxiety disorders in children, and most of them focused on social anxiety. Therefore, we examined interpretation bias and its content-specificity in a group of clinically anxious children between the ages of 6–12 years with various anxiety disorders, using an "ambiguous scenarios" task. Children were asked to finish scenarios that were related to either social threat, general threat, or separation threat. In total, 105 clinically anxious children, 21 control children and their mothers were assessed with the ADIS-C/P and the Spence Children's Anxiety Scale. As expected, clinically anxious children provided significantly more negative endings to the scenarios than control children. Within the clinically anxious group, specific interpretation biases were found: Interpretation of scenarios related to social threat, general threat, and separation threat were only predicted by the children's self-reported levels of social anxiety, generalized anxiety, and separation anxiety, respectively. These findings support the content-specificity hypothesis that clinically anxious children display interpretation biases that are specific to fear-relevant stimuli. • Anxious children provided more negative endings to ambiguous scenarios than non-anxious peers. • Anxious children display interpretation biases that are specific to fear-relevant stimuli. • Interpretation related to social threat was only predicted by social anxiety. • Interpretation related to general threat was only predicted by generalized anxiety. • Interpretation related to separation threat was only predicted by separation anxiety. [ABSTRACT FROM AUTHOR]

This paper explores the concept that reducing general psychopathology early in the life course provides unprecedented opportunities to prevent the development of all forms of psychopathology later in life. We review empirical evidence for the existence of the general factor of psychopathology and theories regarding the psychological nature of the factor. We then highlight specific examples of environmental risk factors for general psychopathology and discuss translational implications for the transdiagnostic prevention of psychopathology beginning in early childhood. Ultimately, we propose a developmentally informed and transdiagnostic stepped care approach to intervention in which reduction of general psychopathology in early childhood represents the foundational step for prevention and intervention of subsequent psychopathology. This model heralds three key benefits over the current treatment zeitgeist: (1) Reducing the burden and confusion in healthcare and education systems by providing a coherent and systematic structure for early intervention across a child's development, (2) maximising the breadth of the impact of intervention by focusing on common shared risks across psychopathology, and (3) increasing the efficiency of intervention by corresponding with the development of psychopathology and leveraging the emergence of general psychopathology in early childhood. • There is evidence for a general factor of psychopathology. • This factor captures the shared features common to all mental disorders. • It also highlights opportunities for transdiagnostic prevention of mental illness. • We propose a developmentally informed and stepped care approach to prevention. • In early childhood, the most efficient focus is on targeting the general factor. [ABSTRACT FROM AUTHOR]

This study assessed the psychometric properties of the Italian version of the Preschool Anxiety Scale-Revised (PAS-R), a parent-reported measure of their preschool child's anxiety symptoms. The participants were mothers of 279 Italian preschoolers (age 2–7 years, M = 4.5 years). According to information criteria derived from a confirmatory factor analysis, the four originally identified factors (generalized anxiety, social anxiety, separation anxiety, specific fears) provided the best fit to the data. Reliability was excellent for the total score and acceptable for the subscales. PAS-R total score showed moderate correlation with internalizing subscales of the Strengths and Difficulties Questionnaire (SDQ) and of the Child Behavior Checklist and weak correlation with the externalizing subscale of the SDQ, demonstrating convergent and concurrent validity, respectively. Test–retest reliability of the PAS-R was good after 1 month. The results suggest good psychometric properties of the Italian PAS-R, although its factor structure needs further investigation with different samples. [ABSTRACT FROM AUTHOR]

Background: The Online Assessment of Preschool Anxiety (OAPA) is a newly developed measure that assesses anxiety disorders in preschool children aged 3–6 years. This study aimed to explore the OAPA's initial psychometric properties with a particular focus on examining its construct validity, both convergent and discriminant. Method: The OAPA was completed online by a community sample of 319 Australian parents of temperamentally inhibited preschool children (M: 5.3 years). Preliminary diagnoses were automatically generated before assessment reports were reviewed by a psychologist. Construct validity was examined by assessing the degree of agreement between the OAPA and existing valid questionnaire measures that were simultaneously administered online. Results: Nearly half of participants met criteria for a child anxiety disorder according to the OAPA, most commonly social phobia. Findings supported convergent validity with the Revised Preschool Anxiety Scale (an anxiety symptom measure), the Children's Anxiety Life Interference Scale – Preschool Version (a measure of life interference from anxiety), the Emotional Symptoms scale of the Strengths and Difficulties Questionnaire‐Parent Version (a measure of broader internalizing symptoms), as well as an over‐involved/protective parenting scale. Findings also supported initial discriminant validity with the Conduct Problems scale of the Strengths and Difficulties Questionnaire‐Parent Version. Conclusions: Results of this study provide evidence for the OAPA's preliminary construct validity. With further research into the OAPA's reliability (test–retest and interrater) and confirming construct validity, the OAPA may be a useful instrument for use in research settings and clinical practice. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Anxiety disorders are the most prevalent mental disorder in children and young people. Developing effective therapy for these children is critical to reduce mental disorders across the lifespan. The study aimed to evaluate the efficacy of combining cognitive behavioural therapy (CBT) and sertraline (SERT) in the treatment of anxiety in youth, using a double-blind randomised control trial design. Methods: Ninety-nine youth (ages 7–15 years) with an anxiety disorder were randomly allocated to either individual (CBT) and SERT or individual CBT and pill placebo and assessed again immediately and 6 months after treatment. Results: There were no significant differences between conditions in remission of primary anxiety disorder or all anxiety disorders. Furthermore, there were no significant differences in rates of change in diagnostic severity, parent-reported anxiety symptoms, child-reported anxiety symptoms or life interference due to anxiety. Conclusions: The efficacy of CBT for children and adolescents with anxiety disorders is not significantly enhanced by combination with a short-term course of anti-depressants over and above the combined effects of pill placebo. [ABSTRACT FROM AUTHOR]

Cognitive Behavioural Therapy (CBT) programs adapted to children with Autism Spectrum Disorder (ASD) effectively reduce anxiety when run in university clinics. Forty-nine children aged 8–14 years participated in a waitlist controlled study in a general child psychiatric hospital setting. Post-treatment 30% of the children were free of their primary anxiety diagnoses and 5% were free of all anxiety diagnoses. No statistically significant difference between the two trial conditions were found on primary outcomes. However, statistically significant differences were found on secondary outcomes indicating clinically meaningful treatment responses. Together with high program satisfaction this study shows the CBT program to be feasible and potentially efficacious in treating anxiety in children with ASD in a general child psychiatric hospital setting. [ABSTRACT FROM AUTHOR]

Shy/inhibited young children are at risk for internalising difficulties; however, for many, this temperamental style does not result in mental health problems. This study followed a population-based sample of temperamentally inhibited preschool children into mid childhood to explore the aetiology of clinical-level anxious and depressive problems. Amongst inhibited preschool children, we aimed to predict each of clinical child anxiety and depressive problems in mid childhood from a broad range of potential risks (demographics, traumatic events and broader recent stressors, parents' well-being, and parenting practices). This study is based on data from a wider population trial of Cool Little Kids that recruited a representative sample of inhibited preschool children enrolled in their year before starting school. In 2011–2012, an inhibition screen was universally distributed to parents of children in their year before school (age 4 years) across eight diverse government areas in Melbourne, Australia. Participants were 545 parents of inhibited preschoolers (78% uptake, 545/703) who were followed to mid childhood (three annual waves 2015–2017, age 7–10 years) with 84% retention (456/545). Parents completed questionnaires spanning child ages 4–10 years, along with diagnostic interviews for child anxiety. Children also completed questionnaires in mid childhood. The questionnaires encompassed a variety of potential risks including sociodemographics, traumatic events, recent life stressors, parent wellbeing and parenting practices. In mid childhood, 57% (246/430) of inhibited preschoolers had a clinical level of anxiety problems while 22% (95/432) had depressive problems (by one or more sources). The aetiology analyses highlighted parent distress and parenting practices (overinvolved/protective, harsh discipline) as key predictors of inhibited preschoolers' internalising problems by mid childhood. Some high-risk families may not have participated. Child depression was not assessed with a diagnostic interview. The measures did not include every possible risk factor. The findings lend support to parenting programs for shy/inhibited young children that aim to prevent the development of anxiety and depression as they grow. [ABSTRACT FROM AUTHOR]

A substantial empirical base supports the use of psychotherapy to alleviate anxiety symptoms and diagnoses in children and adolescents. However, focusing only on symptom or diagnostic reduction provides an incomplete picture of clinically meaningful efficacy given that anxiety disorders in this age group are integrally associated with problems in functioning. A systematic review and meta-analysis (N studies = 40, N participants = 3094) evaluating the impacts of psychotherapy for anxiety was conducted on the following outcomes: global functioning, social functioning, academic functioning, and school attendance. Randomised controlled trials with a passive control condition, a child and/or adolescent sample (7–17 years) with a primary anxiety diagnosis, and receiving anxiety-focused psychotherapy were eligible for inclusion if they reported suitable outcome data. Results from the meta-analysis indicated that from pre- to post-treatment, psychotherapy led to significant improvements in global functioning according to clinician (d = 1.55), parent (d = 0.67), and child (d = 0.31) reports and on social functioning according to parent (d = 0.51), but not child (d = 0.31) reports. The qualitative review provided preliminary support psychotherapy's efficacy in increasing family functioning and school attendance, but not so much in enhancing academic performance. These results indicate that psychotherapy improves daily functioning in anxious children and adolescents. The study also highlighted the limited attention paid to measures of functioning in the empirical literature on treatment of childhood anxiety. Trial Registry: This study is registered with PROSPERO under the identification number CRD42021246565. [ABSTRACT FROM AUTHOR]

Background Prevention and early intervention for anxiety disorders has lagged behind many other forms of mental disorder. Recent research has demonstrated the efficacy of a parent-focussed psycho-educational programme. The programme is directed at parents of inhibited preschool children and has been shown to reduce anxiety disorders at 1 and 3 years following intervention. The current study assesses the cost-effectiveness of this intervention to determine whether it could provide value-for-money across a population. Method A cost-utility economic framework, using Disability-Adjusted-Life-Years ( DALYs) as the outcome, was adopted. Economic modelling techniques were used to assess the incremental cost-effectiveness ratio ( ICER) of the intervention within the Australian population context, which was modelled as add-on to current practice. The perspective was the health sector. Uncertainty was measured using multivariate probabilistic testing and key assumptions were tested using univariate sensitivity analysis. Results The median ICER for the intervention was AUD$8,000 per DALY averted with 99.8% of the uncertainty iterations falling below the threshold value-for-money criterion of AUD$50,000 per DALY averted. The results were robust to sensitivity testing. Conclusions Screening young children in a preschool setting for an inhibited temperament and providing a brief intervention to the parents of children with high levels of inhibition appears to provide very good value-for-money and worth considering in any package of preventive care. Further evaluation of this intervention under routine health service conditions will strengthen conclusions. Acceptability issues associated with this intervention, particularly to preschool staff and parents, need to be considered before wide-scale adoption is undertaken. [ABSTRACT FROM AUTHOR]

Anxiety disorders are common, emerge during childhood, and pose a significant burden to society and individuals. Research evaluating the impact of anxiety on functional impairment and quality of life (QoL) is increasing; however, there is yet to be a systematic review and meta-analysis of these relationships in pediatric samples. This systematic review and meta-analysis were conducted to determine the extent of impairments in functioning and QoL that young people with anxiety disorders experience relative to their healthy peers, as well as sociodemographic and clinical moderators of these relationships. Studies were included when they compared young people (mean age range within studies 7–17 years) with a primary clinical anxiety disorder to a healthy comparison group and measured impairment and/or QoL via a validated instrument. A total of 12 studies met criteria for this review (N = 3,129 participants). A majority of studies (K = 9) assessed impairment as an outcome measure, and three assessed QoL outcomes. Meta-analysis of nine studies (N = 1,457 children) showed large relationships between clinical anxiety and life impairment (g = 3.23) with the strongest effects seen for clinician report (g = 5.00), followed by caregiver (g = 2.15) and child (g = 1.58) report. The small number of studies and diversity in methodology prevented quantitative investigation of moderating factors. In the systematic review of QoL outcomes, all three studies reported significantly poorer QoL for youth with anxiety disorders relative to unaffected peers. Findings support the importance of measuring functioning and QoL as outcomes in clinical research and practice among anxious young people.This study is registered with PROSPERO under the identification number CRD42023439040. [ABSTRACT FROM AUTHOR]

Background: Identifying and supporting young children who are at risk of developing anxiety disorders would benefit children, families, and wider society. Elevated anxiety symptoms, inhibited temperament, and high parental anxiety are established risk factors for later anxiety disorders, but it remains unclear who is most likely to benefit from prevention and early intervention programmes. Delivering an online intervention through schools to parents of young children who have one or more of these risks could maximise reach. The primary aim of this trial is to evaluate the effectiveness and cost-effectiveness of delivering an online parent-led intervention, compared with usual school provision only, for children (aged 4-7) identified as at risk for anxiety disorders on the basis of at least one risk factor. We also aim to identify the characteristics of children who do and do not benefit from intervention and mechanisms of change from the intervention.Methods: The design will be a parallel group, superiority cluster randomised controlled trial, with schools (clusters) randomised to intervention or usual school practice arms in a 1:1 ratio stratified according to level of deprivation within the school. The study will recruit and randomise at least 60 primary/infant schools in England, and on the basis of recruiting 60 schools, we will recruit 1080 trial participants (540 per arm). Parents of all children (aged 4-7) in sampled Reception, Year 1, and Year 2 classes will be invited to complete screening questionnaires. Children who screen positive on the basis of anxiety symptoms, and/or behavioural inhibition, and/or parent anxiety symptoms will be eligible for the trial. Parents/carers of children in schools allocated to the intervention arm will be offered a brief online intervention; schools in both arms will continue to provide any usual support for children and parents throughout the trial. Assessments will be completed at screening, baseline (before randomisation), 6 weeks, 12 weeks, and 12 months post-randomisation. The primary outcome will be the absence/presence of an anxiety disorder diagnosis at 12 months.Discussion: The trial will determine if delivering an online intervention for parents of young children at risk of anxiety disorders identified through screening in schools is effective and cost-effective.Trial Registration: ISRCTN 82398107 . Prospectively registered on Jan. 14, 2021. [ABSTRACT FROM AUTHOR]

Background: Public health advocates have highlighted internalising problems as a leading cause of global burden of disease. Internalising problems (anxiety/depression) affect up to 20% of school‐age children and can impact peer relations, school engagement and later employment and mortality. This translational trial aimed to determine whether a selective/indicated parenting group programme to prevent internalising distress in shy/inhibited preschool children had sustained effects in middle childhood. Translational design aspects were a brief parent‐report screening tool for child inhibition offered universally across the population via preschools in the year before school, followed by an invitation to parents of all inhibited children to attend the parenting programme at venues in their local community. Methods: Design of the study was a randomised controlled trial. The setting was 307 preschool services across eight socioeconomically diverse government areas in Melbourne, Australia. Participants were 545 parents of inhibited four‐year‐old children of which 456 (84%) were retained during middle childhood (age of seven to 10 years). Early intervention was the Cool Little Kids parenting group programme, and control was 'usual care' access to available support services in the community. Primary outcomes were child anxiety and depression symptoms (parent and child report) and DSM‐IV anxiety disorders (assessor masked). Secondary outcomes were parenting practices and parent mental health. Results: There was no significant difference in anxiety disorders between the intervention and control group during the three annual follow‐ups of the cohort in middle childhood (2015 43% vs. 41%, 2016 40% vs. 36%, 2017 27% vs. 30%, respectively; p's >.05). There were also no significant differences in child anxiety or depression symptoms (by child or parent report), parenting practices or parent mental health, between the intervention and control group during middle childhood. However, a priori interaction tests suggested that for children with anxious parents, early intervention attenuated risk for middle childhood internalising problems. Conclusions: An issue for population translation is low levels of parent engagement in preventive interventions. Initial effects of the Cool Little Kids parenting group programme in reducing shy/inhibited preschool children's internalising distress at school entry dissipated over time, perhaps due to low engagement. Future translational research on early prevention of internalising problems could benefit from screening preschool children in the population at higher risk (combining temperamental inhibition and parent distress) and incorporating motivational techniques to facilitate family engagement. Trial registration ISRCTN30996662 http://www.isrctn.com/ISRCTN30996662. [ABSTRACT FROM AUTHOR]

Abstract: Cognitive distortions refer to cognitive processes that are biased and therefore yield dysfunctional and maladaptive products (e.g., interpretation bias). Automatic aspects of information processing need to be considered and investigating these aspects requires forms of assessment other than self-report. Studies focussing on the specificity of cognitive biases across different types of anxiety disorders in childhood are rare. Thus, a forced choice reaction time paradigm with picture stimuli was used to assess the interpretation bias in anxious children online. The study investigated disorder-specific interpretation bias in 71 children with separation anxiety disorder (SAD), 31 children with social phobia, and 42 children without mental disorders, aged 5–13 years. Results indicated that children with SAD rated ambiguous separation pictures as significantly more unpleasant and more arousing than nonanxious children. However, no support was found that children with SAD and social phobia interpret ambiguous separation or social pictures in a more negative way than nonanxious children. Furthermore, no group differences were found in reaction times to all picture categories. [Copyright &y& Elsevier]

Abstract: Interpretation biases towards threat play a prominent role in cognitive theories of anxiety, and have been identified amongst highly anxious adults and children. Little is known, however, about the development of these cognitive biases although family processes have been implicated. The current study investigated the nature of threat interpretation of anxious children and their mothers through (i) comparison of a clinic and non-clinic population, (ii) analysis of individual differences; and (iii) pre- and post-treatment comparisons. Participants were 27 children with a primary anxiety disorder and 33 children from a non-clinic population and their mothers. Children and mothers completed self-report measures of anxiety and indicated their most likely interpretation of ambiguous scenarios. Clinic and non-clinical groups differed significantly on measures of threat interpretation. Furthermore, mothers’ and children''s threat interpretation correlated significantly. Following treatment for child anxiety, both children and their mothers reported a reduction in threat interpretation. [Copyright &y& Elsevier]

This study examined the psychometric properties of the parent version of the Spence Children’s Anxiety Scale (SCAS-P); 484 parents of anxiety disordered children and 261 parents in a normal control group participated in the study. Results of confirmatory factor analysis provided support for six intercorrelated factors, that corresponded with the child self-report as well as with the classification of anxiety disorders by DSM-IV (namely separation anxiety, generalized anxiety, social phobia, panic/agoraphobia, obsessive–compulsive disorder, and fear of physical injuries). A post-hoc model in which generalized anxiety functioned as the higher order factor for the other five factors described the data equally well. The reliability of the subscales was satisfactory to excellent. Evidence was found for both convergent and divergent validity: the measure correlated well with the parent report for internalizing symptoms, and lower with externalizing symptoms. Parent–child agreement ranged from 0.41 to 0.66 in the anxiety-disordered group, and from 0.23 to 0.60 in the control group. The measure differentiated significantly between anxiety-disordered children versus controls, and also between the different anxiety disorders except GAD. The SCAS-P is recommended as a screening instrument for normal children and as a diagnostic instrument in clinical settings. [Copyright &y& Elsevier]

This study investigated the role of control beliefs in childhood anxiety disorders. The sample comprised 117 youth aged 9–17 years (86 met diagnostic criteria for an anxiety disorder and the remaining 31 were nonreferred comparison participants). Participants' anxiety levels and their perceptions of control over anxiety-related events (e.g., “things that might be harmful,” “feeling shaky or nervous”) were assessed. Findings indicated that perceived control over anxiety-related events was significantly negatively correlated with self-reported anxiety levels. Moreover, youth with anxiety disorders reported significantly lower perceived control about anxiety than the nonreferred participants. Findings were consistent with theory and suggest that anxiety disorders in youth are associated with beliefs that anxiety is uncontrollable. [ABSTRACT FROM AUTHOR]

Background: Anxiety disorders in children and young people are common and bring significant personal and societal costs. Over the last two decades, there has been a substantial increase in research evaluating psychological and pharmacological treatments for anxiety disorders in children and young people and exciting and novel research has continued as the field strives to improve efficacy and effectiveness, and accessibility of interventions. This increase in research brings potential to draw together data across studies to compare treatment approaches and advance understanding of what works, how, and for whom. There are challenges to these efforts due largely to variation in studies' outcome measures and variation in the way study characteristics are reported, making it difficult to compare and/or combine studies, and this is likely to lead to faulty conclusions. Studies particularly vary in their reliance on child, parent, and/or assessor‐based ratings across a range of outcomes, including remission of anxiety diagnosis, symptom reduction, and other domains of functioning (e.g., family relationships, peer relationships). Methods: To address these challenges, we convened a series of international activities that brought together the views of key stakeholders (i.e., researchers, mental health professionals, young people, parents/caregivers) to develop recommendations for outcome measurement to be used in treatment trials for anxiety disorders in children and young people. Results and Conclusions: This article reports the results of these activities and offers recommendations for selection and reporting of outcome measures to (a) guide future research and (b) improve communication of what has been measured and reported. We offer these recommendations to promote international consistency in trial reporting and to enable the field to take full advantage of the great opportunities that come from data sharing going forward. [ABSTRACT FROM AUTHOR]

A growing body of evidence points to a strong overlap between selective mutism (SM) and social anxiety disorder in children, specifically with regard to characteristics such as social reticence and anxiety. Yet few studies have directly compared these populations, especially with young children. This study compared 25 children (aged 3–7 years) with a primary diagnosis of SM, 17 children with a primary diagnosis of social anxiety disorder and 15 non-clinical controls using interviews and questionnaires on expressions of social anxiety and behavioural inhibition. Results showed that children with SM or social anxiety disorder were more anxious than non-clinical controls and did not significantly differ from each other on either non-verbal social anxiety or non-social forms of anxiety. Both children with SM and social anxiety disorder had fewer friends and experienced greater difficulties forming friendships than non-clinical controls. However, children with SM scored higher than children with social anxiety disorder and non-clinical controls on a few measures of inhibition (both verbal and nonverbal). The results support assertions of strong similarities between SM and social anxiety disorder, but suggest that children with SM may show even greater severity in certain symptoms at a young age. These findings point to the need for treatment to include both cognitive behavioural skills to manage social anxiety and structured practice of social skills in order to improve treatment efficacy for children with SM. • SM and SAD children show similar anxiety in both social and non-social situations. • SM children are more inhibited than SAD children. • Children with SM and SAD both have similar disruptions to friendships. • SM and SAD in young children have more similarities than differences. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore how some temperamentally inhibited young children and not others in the general population develop anxiety disorders and broader clinical-level internalizing (anxious/depressive) problems, with a focus on the family. A brief screening tool for inhibition was universally distributed to parents of children in their year before starting school across eight socioeconomically diverse government areas in Melbourne, Australia (307 preschool services). Screening identified 11% of all children as inhibited. We invited all parents of inhibited children to participate in a longitudinal prevention study. Participants were 545 parents of inhibited pre-schoolers (78% uptake) of whom 498 (91%) completed assessment one year later and 469 (86%) two years later. Parents completed questionnaires to assess parenting practices, parent wellbeing, and child internalizing problems. Parents also engaged in structured diagnostic interviews to assess child anxiety disorders. During the follow up period close to half of the inhibited young children had anxiety disorders and one in seven had clinical-level internalizing problems, with girls perhaps at higher risk. The family variables significantly predicted inhibited children's anxiety disorders and broader internalizing problems. For child anxiety disorders, overinvolved/protective parenting was particularly important for girls and boys, and poorer parent wellbeing contributed. For child anxious/depressive problems, harsh discipline was a consistent predictor for girls and boys, and poorer parent wellbeing again contributed. These etiological findings support early intervention for temperamentally inhibited young children that focuses on the family environment to prevent the development of mental health problems. [ABSTRACT FROM AUTHOR]

Purpose: Autism spectrum disorder (ASD) includes core symptoms that affect general and social development. High risk of developing comorbid disorders such as anxiety is prominent. Up to 60% of children with ASD suffer from anxiety disorders which can negatively influence educational, social and general development together with quality of life. This study is the first to investigate the feasibility of the manualised cognitive behavioural therapy (CBT) group programme 'Cool Kids ASD' for anxiety adapted for children with ASD in a general hospital setting. Methods: Nine children, aged 9–13 years, with ASD and anxiety recruited from a public child psychiatric health clinic were enrolled in the study. Outcome measures were collected from both child and parent pre- and post-treatment and at 3-month follow-up and included scores from a semi-structured anxiety interview, together with questionnaires on anxiety symptoms, life interference, children's automatic thoughts and satisfaction with the programme. Results: Eight out of nine families found the programme useful and would recommend it to other families in a similar situation. Six families attended all 12 sessions in the programme, two missed one session and one family only managed to attend eight sessions. At follow-up, five children were free of all anxiety diagnoses and a further two out of the nine children no longer met the criteria for their primary anxiety diagnosis. Conclusions: This study suggests that the transition of the group programme 'Cool Kids ASD' from University Clinics to standard child psychiatric clinical settings is feasible. Further randomised studies are needed to confirm the efficacy of the programme in a larger sample. [ABSTRACT FROM AUTHOR]

We investigated the role of self-reports and behavioral measures of interpretation biases and their content-specificity in children with varying levels of spider fear and/or social anxiety. In total, 141 selected children from a community sample completed an interpretation bias task with scenarios that were related to either spider threat or social threat. Specific interpretation biases were found; only spider-related interpretation bias and self-reported spider fear predicted unique variance in avoidance behavior on the Behavior Avoidance Task for spiders. Likewise, only social-threat related interpretation bias and self-reported social anxiety predicted anxiety during the Social Speech Task. These findings support the hypothesis that fearful children display cognitive biases that are specific to particular fear-relevant stimuli. Clinically, this insight might be used to improve treatments for anxious children by targeting content-specific interpretation biases related to individual disorders. [ABSTRACT FROM AUTHOR]

Background: Informant discrepancies between mother and child have challenged the assessment, classification, and treatment of childhood anxiety. Despite numerous studies on this matter, the implications and consequences for research and clinical practice remain unclear.Objective: The present study aimed to obtain meaningful clinical information about informant discrepancies by examining mother-child agreement for anxiety subtypes, and by exploring mother-child discrepancies in relation to independent observer ratings of behavioral anxiety.Method: The screen for child anxiety related emotional disorders was administered to 79 mothers and clinically referred anxious children aged 7-13 years. Mother-child dyads were observed during an anxiety-provoking task and independent observers rated children’s observed anxiety.Results: The findings indicated a high level of mother-child disagreement on reports of anxiety. There was variability in levels of agreement between subtypes of anxiety, with significantly stronger mother-child agreement for separation compared to other forms of anxiety. Observed proximity between the mother and child was positively associated with child-reported separation anxiety and children’s observed anxious voice was negatively associated with child-reported panic disorder.Conclusions: The results highlight the need to incorporate a multi-informant assessment of childhood anxiety in clinical practice and research, in particular for subtypes of anxiety problems that are characterized by less observable and more internally experienced components. [ABSTRACT FROM AUTHOR]

Recent research has started to examine the applicability of influential adult models of the maintenance of social anxiety disorder (SAD) to youth. This research is limited by the lack of psychometrically validated measures of underlying constructs that are developmentally appropriate for youth. One key construct in adult models of SAD is maladaptive social-evaluative beliefs. The current study aimed to develop and validate a measure of these beliefs in youth, known as the Report of Youth Social Cognitions (RYSC). The RYSC was developed with a clinical sample of youth with anxiety disorders (N = 180) and cross-validated in a community sample of youth (N = 305). In the clinical sample, the RYSC exhibited a 3-factor structure (negative evaluation, revealing self, and positive impression factors), good internal consistency, and construct validity. In the community sample, the 3-factor structure and the internal consistency of the RYSC were replicated, but the test of construct validity showed that the RYSC had similarly strong associations with social anxiety and depressed affect. The RYSC had good test-retest reliability overall, although the revealing self subscale showed lower temporal stability which improved when only older participants were considered (age ≥9 years). The RYSC in general was also shown to discriminate between youth with and without SAD although the revealing self subscale again performed suboptimally but improved when only older participants were considered. These findings provide psychometric support for the RYSC and justifies its use with youth in research and clinical settings requiring the assessment of maladaptive social-evaluative beliefs. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Background: Autism spectrum disorder (ASD) is found in approximately 1% of the population and includes core symptoms that affect general and social development. Beside these core symptoms, it is suggested that up to 60% of children with ASD suffer from comorbid anxiety disorders which may further affect educational, social and general development as well as quality of life. The main goal of this study is to examine the effectiveness of a manualized cognitive behavioral therapy (CBT) anxiety program adapted for children with ASD.Methods: This study is a randomized controlled trial (RCT). Fifty children with ASD and anxiety, aged 7 to 13 years, will be randomly assigned to group CBT or a wait-list control (WL) condition. The design will follow a two (CBT and WL) by two (pre-post assessment) mixed between-within design. The control group will receive intervention after the waitlist period of 13 weeks. Primary outcomes are diagnostic status and severity of the anxiety disorders, measured with The Anxiety Disorder Interview Schedule for DSM-IV, Parent and Child Versions. Secondary outcomes are parent and child ratings on questionnaires on the child's level of anxiety and impact on everyday life. Additional outcomes entail information gathered from parents, child and teachers on the child's behavior and negative self-statements, together with social and adaptive skills. Follow-up data will be collected 3 months after intervention.Discussion: This study aims to evaluate the effectiveness of a manualized CBT program in Danish children with ASD and anxiety within a mental health clinic setting. The hypothesis is that training anxiety reduction skills will decrease anxiety in children, as well as ensure better psychosocial development for the child in general.Trial Registration: https://ClinicalTrials.gov ( NCT02908321 ). Registered 19th of September 2016. [ABSTRACT FROM AUTHOR]

Temperamental inhibition has been identified as a key risk factor for childhood anxiety and internalizing problems. An efficacious early prevention programme for shy/inhibited children has been developed; however, accurate, efficient and acceptable screening is needed to support wider implementation. We explore community screening options in the context of a trial implementing the Cool Little Kids prevention programme for anxiety disorders. In comparison to the Australian Temperament Project's inhibition scale, we examine the Strengths and Difficulties Questionnaire's (SDQ) ability to screen for inhibited preschool children. Parents of 6307 children aged 3 to 6 years enrolled in preschool programmes from eight socio-economically diverse districts in Melbourne, Australia, first completed the measures of inhibition and SDQ. Parents with inhibited children then enrolled in the Cool Little Kids randomized trial ( n = 545). Of these, 88% provided feedback about inhibition screening. Parents allocated to the intervention also provided feedback on the Cool Little Kids parenting programme. Results demonstrated that parents of preschool children (i) find inhibition screening acceptable, (ii) take up this parenting programme and (iii) report favourable feedback. The SDQ emotional symptoms subscale demonstrated acceptable sensitivity but insufficient specificity to identify inhibited preschool children. Presenting parents with a brief, validated inhibition scale could be a low-cost option for identifying inhibited preschool children in the community to offer early anxiety prevention. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Within a therapeutic gene by environment (G × E) framework, we recently demonstrated that variation in the Serotonin Transporter Promoter Polymorphism; 5 HTTLPR and marker rs6330 in Nerve Growth Factor gene; NGF is associated with poorer outcomes following cognitive behaviour therapy ( CBT) for child anxiety disorders. The aim of this study was to explore one potential means of extending the translational reach of G × E data in a way that may be clinically informative. We describe a 'risk-index' approach combining genetic, demographic and clinical data and test its ability to predict diagnostic outcome following CBT in anxious children. Method DNA and clinical data were collected from 384 children with a primary anxiety disorder undergoing CBT. We tested our risk model in five cross-validation training sets. Results In predicting treatment outcome, six variables had a minimum mean beta value of 0.5:5 HTTLPR, NGF rs6330, gender, primary anxiety severity, comorbid mood disorder and comorbid externalising disorder. A risk index (range 0-8) constructed from these variables had moderate a predictive ability ( AUC = .62-.69) in this study. Children scoring high on this index (5-8) were approximately three times as likely to retain their primary anxiety disorder at follow-up as compared with those children scoring 2 or less. Conclusion Significant genetic, demographic and clinical predictors of outcome following CBT for anxiety-disordered children were identified. Combining these predictors within a risk index could be used to identify which children are less likely to be diagnosis-free following CBT alone and require longer or enhanced treatment. The 'risk-index' approach represents one means of harnessing the translational potential of G × E data. [ABSTRACT FROM AUTHOR]