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The metacognitive model and therapy has proven to be a promising theory and intervention for emotional disorders in adults. The model has also received empirical support in normal and clinical child samples. The purpose of the present study was to adapt metacognitive therapy to children (MCT-c) with generalised anxiety disorder (GAD) and create suggestions for an adapted manual. The adaptation was based on the structure and techniques used in MCT for adults with GAD. However, the developmental limitations of children were taken into account. For instance, therapy was aided with worksheets, practical exercises and delivered in a group format. Overall, the intervention relied heavily on practising MCT techniques in vivo with therapist assistance. A detailed description of how the manual was adapted for this age group is given, and examples from a group of four children are presented in a case series. Findings indicate that the adapted version of the metacognitive techniques and manual for children is feasible. [ABSTRACT FROM AUTHOR]

A few studies have examined the relative contribution of insecure attachment and negative parental rearing behaviors on childhood anxiety, but none have examined if insecure attachment mediates the association between negative parental rearing behavior and anxiety. The present study investigated the direct, as well as the indirect, relation between attachment to parents, parental rearing behaviors and anxiety symptoms in a sample of 1134 normal developing children and adolescent. Attachment relation was measured by the Security Scale (SEC), negative parental rearing behavior was measured by the Rearing Behavior Questionnaire (RBQ), and anxiety was assessed using the Screen for Anxiety Related Emotional Disorders-Revised (SCARED-R). We found, in accordance with previous research, that insecure attachment, maternal rejection and overprotection, each accounted for a significant proportion of the variance of anxiety symptoms. Another result was that insecure attachment was found to mediate the relationship between maternal psychological control and rejection, and anxiety symptoms. Findings are discussed with respect to future directions. [ABSTRACT FROM AUTHOR]

Theoretical views and empirical findings suggest interrelations among attachment security, emotion dysregulation and anxiety in childhood and adolescence. However, the associations among the three constructs have rarely been investigated in children, and no study has yet addressed these associations in adolescence. The aim of the present study was to test a model of the interrelations among the three factors on a sample of 673 youths (age 9–16), using structural equation modelling. In accordance with theoretical conceptualisations, it was hypothesised that attachment security would relate to anxiety and that emotion dysregulation would help explain the association between attachment security and anxiety. Results showed that more securely attached youths reported less emotion dysregulation and that youths who had fewer emotion regulation difficulties experienced less anxiety. The association between attachment security and anxiety was mediated by emotion dysregulation. The model was confirmed for both children and adolescents. Findings are discussed with respect to theoretical implications, as well as future directions. [ABSTRACT FROM AUTHOR]

Background: Little is known about the effect of case-formulation based cognitive behaviour therapy (CBT) for anxious children. Aim: The present study explores the feasibility of case-formulation driven CBT for anxious children. Parents were involved in treatment as either co-facilitators (involved only as the child's assistants, treatment being primarily directed at the child), or as co-clients (parents received therapy targeting theoretically established maintaining mechanisms; children received half of the sessions, parents the other half). Method: Feasibility of the case-formulation driven CBT was established by comparing the completion rate and the percentage of children free of anxiety after treatment, with manualized treatments reported in existing meta-analyses. Children aged 7–12 years and their parents participated (n = 54). Families were assessed at pre- and posttreatment and at 6-month follow-up. Results: All families completed treatment and the percentage of recovery in the case-formulation driven approach was comparable to results obtained in manualized treatments. Conclusion: The findings from this stage I study supports the notion that a case-formulation driven approach to CBT may be a feasible option when selecting treatment for anxious children; however, further studies must be conducted before firm conclusions can be drawn. [ABSTRACT FROM AUTHOR]

Objective Specific parental behaviors and cognitions are associated with child anxiety. Studies informing us of the directionality of the associations are lacking. We investigated the effect of parental involvement in children's anxiety treatment on parental behaviors and cognitions. Method Children ( N = 54, 7–12 years) and parents were randomly allocated to different treatment groups (involved, not involved). Observed behavior, self-reported behavior and cognitions were assessed separately for mothers and fathers at pre-, posttreatment and follow-up. Results There were no differences over time for self-reported parental efficacy and observed negativity, but self-reported autonomy granting increased for both groups over time. Differential effects were found between groups for observed paternal over-involvement (fathers involved in treatment showed a more rapid decrease) and self-reported maternal autonomy-granting (non-involved mothers showed a greater increase). Conclusion Our findings suggest that child anxiety significantly influences parental behaviors and cognitions. Child therapy may successfully change the family system. [ABSTRACT FROM AUTHOR]

Theoretical models of anxiety have been developed in adult populations. The applicability of these models in child samples has been assessed using downward extensions of the questionnaires developed to assess the proposed theoretical mechanisms. This poses a challenge, as children are still in the process of developing the skills that are being assessed. Psychometrically sound assessment tools are therefore needed for this developing population, in order to ensure the early detection of mechanisms leading to anxiety disorders in children. This study examined if metacognitions, which play a key role in generalized anxiety disorder (GAD) in adults, can also be reliably assessed in childhood. The study investigated the psychometric properties of the 30-item Metacognitions Questionnaire for Children (MCQ-C30; Gerlach, Adam, Marschke, & Melfsen, 2008) in a national sample of 974 children and adolescents (538 girls) ages 9-17 years. Confirmatory factor analysis supported the 5-factor subscale structure and a 2nd-order total scale factor, which corresponds with previous versions of the scale. MCQ-C30 expectedly correlated significantly with anxiety symptoms and worry. Structural equation modeling revealed that both obsessive-compulsive disorder and generalized anxiety disorder symptoms regressed significantly onto the MCQ-C30. We fitted separate models for children and adolescents, and no noticeable differences are suggested between the models. Female gender was, expectedly, associated with increased levels of general metacognitions. This gender effect was mediated by level of anxiety. Overall, the MCQ-C30 exhibited acceptable psychometric properties in our community sample of children ages 9-17 years. Future studies should investigate the psychometric properties of the instrument in clinical samples and samples of younger children. [ABSTRACT FROM AUTHOR]

Early identification of anxiety among youth is required to prevent them from going unrecognised and untreated by mental health professionals. A precise identification of the young person's primary difficulty is also required to guide treatment programs. Availability of a valid and easily administrable assessment tool is crucial for identifying youth suffering from anxiety disorders. The purpose of the present study was therefore to examine the psychometric properties of the Danish version of the Revised Children's Anxiety and Depression Scale (RCADS). A total of 667 youth from community schools (4th through 9th grade) across Denmark participated in the study. The psychometric properties of the RCADS-DAN resembled those reported in US and Europe. Within scale reliability was excellent with Chronbach's alpha of.96. All subscales also showed good to excellent internal reliability. The study provides convincing evidence that the RCADS-DAN is a valid assessment tool for screening anxiety in Danish youth. [ABSTRACT FROM AUTHOR]

Abstract: Anxiety affects 10% of all children and disrupts educational, socio-emotional development and overall functioning of the child and family. Research has shown that parenting factors (i.e. intrusiveness, negativity, distorted cognitions) contribute to the development and maintenance of childhood anxiety. Recent studies have therefore investigated if the treatment effect of traditional cognitive behavioural therapy may be enhanced by adding a parental component. However, randomised controlled trials have not shown unequivocal support for this assumption. The results are inconsistent and ambiguous. This article investigates possible reasons for this inconsistency and in particular differences in methodology and the theoretical relevance of the applied parental components are highlighted as possible contributory factors. Another factor is that treatment effect is mainly measured by change in the child''s diagnostic status rather than changes in parental or family functioning. [Copyright &y& Elsevier]

The aim of this study was to specify the latent construct structure of the Friends and Family Interview (FFI: Steele & Steele, 2005) based on its dimensional scale coding protocol. The FFI is a semi‐structured interview measuring attachment in middle childhood. We analyzed data from 341 FFI interviews with children aged 7–12 years, recruited in the Scandinavian Öresund Region. Exploratory Factor Analysis revealed a three‐component model as best fitting the data. The first component, denoting attachment security, gathered all dimensional scales for evidence of secure base/safe haven regarding mother/father and coherence in the child's narrative style, along with scales regarding reflective functioning, self‐perception, and social functioning. The second component comprised preoccupying feelings of anger, but also derogation. The third component gathered all scales coding idealization. Inter‐relations among the components were consistent with attachment theory, and respondents' scores for all three components differed significantly across the four categorical attachment classifications. Affect regulation of negative emotion through anger and through derogation co‐occurred, and was distinct from regulation through maintaining a belief that things are better than they appear (idealization). These two affect regulation strategies appeared commonly when reflective functioning, and an organized self‐perception, and positive peer relations were less in evidence. The multi‐dimensional FFI coding system appears to measure successfully these diverse features of the child's narrative provided in response to the interview. Overall, our findings support the construct validity of the FFI and provide further evidence of its usefulness for assessing attachment in middle childhood and early adolescence. [ABSTRACT FROM AUTHOR]

Objectives: Our study investigated the association between parental behaviour and anxiety in children and adolescents in a longitudinal 3-year follow-up design. Our study supplements widely used self-reports on parental behaviour with observations of the parent-child interactions. Methods: A community sample of 101 children and their mothers were included in the study. We hypothesized that anxiety symptoms in the child and mother at intake would influence levels of anxiety in the child at three-year follow-up. We also hypothesized that negative maternal behaviour both self-reported and observed would provide a unique variance in predicting increased levels of anxiety symptoms in the child after three years above and beyond child and maternal levels of anxiety symptoms at intake. Results: We found that children's anxiety symptom levels at intake, as well as female gender were significant and the most important contributors to the development of higher levels of anxiety symptoms at follow-up. Furthermore, observed maternal tension at intake significantly predicted child's anxiety levels at follow-up. Conclusion: Although maternal tension also significantly predicted higher levels of anxiety symptoms, the maternal variables were of less importance than child anxiety level at intake and female gender in predicting anxiety levels at follow-up. [ABSTRACT FROM AUTHOR]

Although cognitive behavioral therapy (CBT) is effective for childhood anxiety disorders, approximately 40% of youth remain anxious after treatment. Metacognitive therapy (MCT-c) for children with generalized anxiety disorder (GAD) has shown promising effects. The present study aimed to examine if CBT and MCT-c show differential effects in children with primary GAD based on baseline characteristics, in a quasi-experimental design. To investigate which treatment is most beneficial for whom, three potential moderators: age, symptom severity, and comorbid social anxiety were examined. Sixty-three children aged 7-14 completed CBT or MCT-c. Participants were assessed before and after treatment. Both CBT and MCT-c were highly effective in treatment of childhood GAD. None of the selected variables significantly moderated treatment outcomes. Subgroups of children with high symptom severity and social anxiety comorbidity showed trends of responding better to CBT. Methodologically stronger studies are needed to facilitate a better adaptation of treatment for children with GAD. [ABSTRACT FROM AUTHOR]

Background: Research suggests that the metacognitive model is applicable to clinical child populations. However, few measures related to the model are available for younger age groups. A key concept of the model is the cognitive attentional syndrome (CAS), which encompasses the individual's worry and rumination, maladaptive coping strategies, and metacognitive beliefs. While the CAS has been successfully measured in adults, this has not yet been attempted in children. Aims: The aim of this study was to adapt a measure of the CAS for use with children and investigate the measure's associations with anxiety, worry, depression and metacognitions. Methods: Our study included 127 children with anxiety disorders aged 7–13 years. The adult measure of CAS was adapted for use with children and administered at pre- and post-treatment. We examined the correlations between variables and the ability of the CAS measure to explain variance in anxious symptomatology, as well as the measure's sensitivity to treatment change. Results: The adapted measure, CAS-1C, displayed strong associations with overall anxiety, depression, worry and metacognitions. The CAS-1C explained an additional small amount of variance in anxiety and worry symptoms after accounting for metacognitions, which may be due to the measure also assessing thinking styles and coping strategies. Furthermore, the measure displayed sensitivity to treatment change. Conclusions: The child measure of the CAS is a brief tool for collecting information on metacognitive beliefs and strategies that maintain psychopathology according to the metacognitive model, and it can be used to monitor treatment changes in these components. [ABSTRACT FROM AUTHOR]

Theory and preliminary evidence suggests that parental beliefs and cognitions may be transmitted to their offspring. Transmission of maladaptive cognitions may play a role in the development of anxiety disorders in childhood. However, few studies have investigated such transmission using longitudinal designs. The objective of this study was to investigate the interaction between maternal and child metacognitions and their role in the development of childhood anxiety. We used a longitudinal design with self-report measures of maternal and child anxiety symptoms and metacognitions. Participants were 107 mothers and their children who were assessed when the children were between 7 and 12 years old and again 3 years later. Child metacognitions at baseline did not predict later child anxiety symptoms. Baseline maternal metacognitions approached significance in predicting anxiety symptoms in children at the follow-up, when controlling for known risk factors, including female gender and higher levels of anxiety in mother and child at baseline. Mediation analyses revealed that child metacognitions at baseline, as well as at follow-up fully mediated the relationship between maternal baseline metacognitions and child anxiety 3 years later. Examinations of how child and maternal metacognitions affect child anxiety levels after three years revealed that current levels of child metacognitions play a greater role in predicting child anxiety than child and maternal metacognitions at baseline. [ABSTRACT FROM AUTHOR]

The aim of the present review was to provide an updated investigation of literature from the past ten years that examined the effects of comorbid problems on treatment outcomes, and/or explored if cognitive behavioral treatments (CBT) targeting anxiety disorders also affected comorbid disorders. A search of the literature resulted in a total of 33 publications, based on 28 randomized controlled trials that met predefined inclusion criteria. An analysis of studies that examined whether comorbidity affects treatment outcome yielded mixed results for different types of comorbidities. The inconsistent results were largely due to methodological heterogeneity in the identified studies. Support for negative effects of comorbidity on treatment outcomes was usually found in studies that investigated comorbidity as a categorical diagnosis, rather than symptom levels, and those that analyzed specific comorbid diagnoses, rather than grouping them together. Overall, our findings suggest that comorbid disorders may have a more negative impact on treatment outcomes than proposed in previous reviews, particularly in the cases of comorbid social anxiety and mood disorders. Furthermore, CBT for anxiety disorders in children was found to ameliorate comorbid problems. [ABSTRACT FROM AUTHOR]

We aimed to bring a developmental perspective to metacognitive theory. The metacognitive model (MCM) was originally developed for adults. However, an increasing number of studies demonstrate the MCM is relevant to child anxiety. Therefore, it is important to understand the origins of anxiety-specific metacognitions. Given the role experiences of controlling parenting play in maintaining and perhaps forming anxious cognitions or a cognitive vulnerability we focused on maternal behavioral and psychological control. Using a cross-sectional design, Danish school children (9-17 years old; N = 1062) rated their levels of anxiety and anxiety-specific metacognitions, and their mothers' controlling behavior. Child-perceived maternal psychological control was positively correlated with each anxiety specific metacognition (positive and negative worry beliefs, cognitive confidence, need to control, and cognitive self-consciousness). Child-perceived autonomy-granting was negatively correlated with all metacognitions except cognitive self-consciousness. Child perceived maternal psychological control was indirectly associated with anxiety via total metacognitions. Child-perceived autonomy-granting, but not psychological control, was directly related to anxiety. Given the differential findings for psychological control and autonomy-granting, we suggest that specific types of parenting behavior may be related to specific elements of (meta-) cognitive vulnerability. Our findings are theoretically important because they propose maternal psychological control is an environmental factor that may play a role in the development of a metacognitive vulnerability related to anxiety. A potential clinical implication of our findings is that metacognitive therapy for children should include a parental component. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate reductions in negative automatic thoughts and metacognitive beliefs as predictors of treatment gains in CBT for childhood anxiety disorders. A sample of 44 clinically anxious children between 7 and 12 years of age, who underwent CBT, completed questionnaires assessing negative thinking, metacognitive beliefs and processes, and anxiety symptoms before, after, and 6 months following treatment. Results indicated that negative thoughts and metacognitions decreased equally during the treatment period. Furthermore, metacognitions continued to decrease during the posttreatment period. Negative thinking and metacognitions were both significant predictors of reductions in child-reported anxiety from pre- to posttreatment. For long-term anxiety changes, only decreases in negative thoughts were related to anxiety reduction. Mediation analysis showed that metacognitions partially mediated the relation between negative thinking and anxiety. The study supports negative automatic thoughts and metacognitive beliefs and processes as putative mediators of CBT. [ABSTRACT FROM AUTHOR]

This study investigated attention control and attentional bias for emotional stimuli in children with anxiety disorders, compared with disorder-free children. Furthermore, it examined the effect of individual cognitive behavioral therapy on these attentional variables in anxious children. Participants included 22 anxious and 20 control children (aged 7-12 years; 50 % female). Attention control was measured using a partial report-by-color task based on the theory of visual attention, which assesses ability to focus on task-relevant information and resist distraction by non-emotional task-irrelevant information. Attentional bias for emotional faces was assessed using a visual probe task with angry, happy, and neutral faces. Anxious and control children were assessed at baseline (pre-treatment) and, in addition, anxious children were re-assessed post-treatment and at 6 months following treatment. Before treatment, children with clinical anxiety showed poorer attention control and greater attentional bias for emotional faces in comparison to control children. Following treatment, anxious children showed a significant reduction in attentional bias for emotional faces, and a trend for improvement in attention control. There was no significant change in attentional bias or attention control between post-treatment and 6-months follow-up assessments. Findings contribute to prior research by showing that clinically anxious children exhibit both increased attention to emotional information and impaired attention control, and that following treatment their attentional bias and attention control are comparable with those of control children. Further research is required to clarify the extent to which changes in attentional functioning relate to the maintenance of anxiety disorders and responsiveness to treatment. [ABSTRACT FROM AUTHOR]

Aim: We investigated the associations between motor performance and IQ at 5 years of age and school difficulties and grade point averages (GPAs) at 18 years of age. Additionally, the accuracy of preschool IQ in predicting school difficulties was examined., Methods: A nationwide follow-up study of children born in 1994-1995 who were <28 weeks of gestation or had a birthweight <1000 g. The Danish personal identification number was used to merge data from a national cohort study with population-based registries. Logistic regression analyses examined the associations between motor performance/IQ and school difficulties. Linear regression analyses and the area under the receiver operator curve (AUC) were used to examine the relationship between IQ and GPAs., Results: The study population comprised 248 children, 37% were classified with school difficulties. Motor performance and IQ were associated with school difficulties. The odds of having school difficulties increased as IQ decreased, and the same pattern was observed for GPAs. IQ predicted school difficulties, with an AUC of 0.80 (confidence interval: 0.74-0.86)., Conclusion: Preschool motor performance and IQ were associated with school difficulties. Additionally, IQ was linked to GPAs. As a screening tool, the predictive ability of preschool IQ for academic difficulties was moderate/high in this cohort., (© 2024 The Author(s). Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Background: Social anxiety disorder (SAD) is common in youths. However, our understanding of SAD in children is inferior to that of SAD in adolescents or adults, and it is unclear if known adult SAD maintenance mechanisms may also operate in children with SAD., Aim: The paper sets out to investigate the specificity of positive automatic thoughts, social threat negative automatic thoughts, repetitive negative thinking, positive and negative metacognitions in predicting SAD symptoms and diagnoses in clinically anxious children., Method: We enrolled 122 clinically anxious children aged 7-13 years; of these, 33 had an SAD diagnosis., Results: SAD symptoms correlated positively with social threat negative automatic thoughts, repetitive negative thinking, and negative metacognitions, and negatively with positive automatic thoughts. Linear regression indicated that, of these variables, only social threat negative automatic thoughts predicted social anxiety symptoms. Logistic regression indicated that social threat negative automatic thoughts, a higher number of diagnoses and negative metacognitive beliefs specifically predicted the presence of SAD diagnosis., Conclusions: Our findings suggest that content-specific social threat negative automatic thoughts was the only variable that specifically distinguished both higher levels of social anxiety symptoms and diagnoses.

Objective: The objective of this study was to explore how anxiety-disordered children attempt to regulate their worry., Design: An experimental manipulation was applied, followed by a qualitative interview., Methods: Thirty children aged 7-13 were enrolled in this study. Each child was presented with a black mystery box, was told that shortly he/she would have to feel what was inside the box, and was then left alone for 4 min, prior to commencing the task. The purpose of the experimental manipulation was to induce slight levels of worry in the child, so that he/she could better report on worry regulation strategies. Afterwards, an interview about how the child had regulated worry during the experimental manipulation and in everyday life was undertaken. The interviews were coded using thematic analysis., Results: Five main themes were uncovered. These were (1) internal regulation of worry, for example, thinking about something else and self-reassurance talk, (2) external regulation of worry, for example, behavioural avoidance and distraction, (3) perceived effect of strategies, (4) shifting between strategies, and (5) absence of a strategy., Conclusions: Our results demonstrate that anxious children use a variety of behavioural and cognitive strategies to regulate worry. They use these strategies in combination, they generally perceive them as ineffective, and they sometimes do not report any strategy for attempting to regulate their worry. These results indicate that clinicians should be curious about which strategies anxious children use to regulate their worry, how these strategies interact with each other, and how they are implemented by the child., Practitioner Points: Using an experimental manipulation followed by an interview, this study sought to investigate how anxious children seek to regulate their worries. Anxious children attempt to regulate their worry with use of behavioural regulation strategies, such as avoidance and distraction, and with use of cognitive regulation strategies, including thinking about something else, self-reassurance talk, and thought suppression. Sometimes, however, anxious children are not able to report a regulation strategy for a specific worry episode, suggesting that they may not always have a strategy or that they lack the introspective ability to report what they did. Clinicians should be aware that anxious children may use internal (cognitive) regulation strategies while at the same time using behavioural regulation strategies, such as avoidance., (© 2018 The British Psychological Society.)

The ability to regulate one's emotions is crucial to engaging successfully in social contexts. Difficulties in emotion regulation are seen in multiple psychiatric disorders, prompting an increased interest in the concept. Suitable methods for assessing emotion regulation, however, are lacking. In this study, we investigated the interrater and intrarater reliability, construct validity, and content validity of a new observational method for evaluating children's emotion regulation abilities (a complex puzzle task) in a sample of 62 children without psychiatric disorders and 23 children with attention-deficit/hyperactivity disorder (ADHD) aged 7-12, using intra-class correlation coefficients for the reliability analyses and Spearman's rank-order correlations for analyses of convergent and discriminant validity. A panel of experts examined the content validity of the test, and Mann-Whitney U -tests were used to investigate the ability of the test to differentiate the non-clinical group from the ADHD group. Results showed a high level of interrater and intrarater reliability of the test. There was mixed evidence for convergent and discriminant validity as expected due to the novelty and experimental nature of the test, making it difficult to compare with questionnaire-based measures. Content validity analysis was satisfactory, and the group comparison showed that the test differentiated the groups on the primary outcome measure. Overall, the measure demonstrated high feasibility and satisfactory psychometric properties. The generic nature of the test makes it suitable for use across psychiatric disorders and age groups with potential relevance in both research and clinical settings., (Copyright © 2019 Hagstrøm, Spang, Christiansen, Maigaard, Vangkilde, Esbjørn, Jepsen and Plessen.)

Cognitive Behavior Therapy (CBT) is an effective treatment for child anxiety. However, access to treatment is limited. It has been suggested that low-intensity formats of parent-delivered CBT may improve access to treatment. Our aim was to develop and pilot-test the acceptability and effect of a low-intensity therapist-guided parent-delivered group program for anxious children (age 7-12 years) adjusted to the Scandinavian culture. The program required 1.5 hours of therapist-time per family. Mothers, fathers and children reported on revised child anxiety and depression scale (RCADS) at referral, pre- and post-treatment. Mothers and fathers also gave a qualitative account of their experiences. Thirty-one families were enrolled and only one family dropped out. Mean age of the children was 9 years. Intent-to-treat analyses revealed significant reductions in anxiety and depressive symptoms from pre- to post-treatment for all informants. Large effect sizes were found for child anxiety symptoms as reported by mothers and fathers, and for child depressive symptoms as reported by mothers. Medium to large effect sizes was found for the self-reported anxiety symptoms by the children, and for depressive symptoms reported by both children and fathers. More than 93% of the parents would recommend the program. Results suggest that our program may provide a new approach to improve access to treatment for anxious children in Scandinavia; however, further research must be conducted before firm conclusions can be drawn., (© 2019 Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

In the metacognitive model, attentional control and metacognitive beliefs are key transdiagnostic mechanisms contributing to psychological disorder. The aim of the current study was to investigate the relative contribution of these mechanisms to symptoms of anxiety and depression in children with anxiety disorders and in non-clinical controls. In a cross-sectional design, 351 children (169 children diagnosed with a primary anxiety disorder and 182 community children) between 7 and 14 years of age completed self-report measures of symptoms, attention control and metacognitive beliefs. Clinically anxious children reported significantly higher levels of anxiety, lower levels of attention control and higher levels of maladaptive metacognitive beliefs than controls. Across groups, lower attention control and higher levels of maladaptive metacognitive beliefs were associated with stronger symptoms, and metacognitions were negatively associated with attention control. Domains of attention control and metacognitions explained unique variance in symptoms when these were entered in the same model within groups, and an interaction effect between metacognitions and attention control was found in the community group that explained additional variance in symptoms. In conclusion, the findings are consistent with predictions of the metacognitive model; metacognitive beliefs and individual differences in self-report attention control both contributed to psychological dysfunction in children and metacognitive beliefs appeared to be the strongest factor.

Background: The treatment options for fetal chylothorax include thoracocentesis, thoracoamniotic shunting, and pleurodesis using OK-432. Knowledge on the long-term outcomes after treatment with OK-432 is limited., Objective: The aim of this study was to assess the long-term outcomes of children treated in utero with OK-432., Methods: We performed follow-up on pregnancies and children treated in utero with OK-432 between 2003 and 2009 at Copenhagen University Hospital Rigshospitalet for pleural effusions at gestational age (GA) 16+0-21+6 weeks. Anamnestic information, physical examination, pulmonary function test, neuropediatric examination, and intelligence testing using the Wechsler Intelligence Scale were used for evaluation., Results: Fourteen cases, all chylothorax, were treated with OK-432. None had preterm premature rupture of membranes (PPROM), and the median GA at delivery was 38+5 (24+4-41+5) weeks. Twelve children were eligible for follow-up. The median age at follow-up was 11.4 (7.8-13.8) years. Pulmonary function was normal in all children and the mean full-scale IQ did not differ from that of normal children. Four children had a diagnosed medical condition, attention deficit disorder, or genetic syndrome. The remaining children had normal follow-up., Conclusion: Children treated with OK-432 have comparable survival rates and long-term neurodevelopmental outcomes to those treated with thoracoamniotic shunts. There seems to be a lower risk of procedure-related PPROM., (© 2018 S. Karger AG, Basel.)

Metacognitive therapy is an effective treatment for anxiety disorders in adults. Studies have demonstrated that the underlying theoretical model is also supported in children. It has therefore been suggested that metacognitive therapy for children may be effective. Our study is an open trial of metacognitive therapy for children with generalized anxiety as their primary disorder. Therapy was provided in groups. Families were interviewed with the Anxiety Disorders Interview Schedule - child/parent versions. They reported on the child's anxiety levels using the Revised Childrens Anxiety and Depression Scale - child/parent versions. Children reported on metacognitive beliefs using the Metacognitions Questionnaire for Children - 30 item version. Fourty-four children aged 7-13 years (50% girls) were enrolled, and one family dropped out during treatment. Fifty percent of the children had received counseling or psychological treatment for their anxiety disorder previously. Following treatment, 86.4% of the children were free of their primary disorder and 72.7% were free of all anxiety disorders, the corresponding figures were 75% and 65.9% at 6-months follow-up. The effect sizes were large for all measures and clinically significant improvements were obtained for 70% of the children at posttest and 77% at follow-up. Our study suggests that metacognitive therapy for children with generalized anxiety disorder may be a highly promising treatment approach., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Parental factors have been linked to childhood anxiety, hence, parental involvement in cognitive behavioral therapy (CBT) for anxious children has been examined. However, findings do not consistently show added effects of parent-enhanced CBT, longitudinal investigations are scarce and long-term effects unclear. In the present study, 40 out of 54 families who, 3 years previously, completed one of two types of CBT treatment: with limited or active parental involvement, were assessed using semi-structured diagnostic interviews. Diagnostic status at 3-years follow-up was compared between groups. Changes in diagnostic status across assessment points: posttreatment, 6-month and 3-year follow-up were analyzed within groups. Diagnostic change from 6-month to 3-year follow-up was compared between groups. Intent-to-treat analyses revealed no significant difference in diagnostic status between groups at 3-year follow-up. Nonetheless, children whose parents actively participated in treatment showed significantly more remission from 6-month to 3-year follow-up than children with limited parental participation.

Introduction: During the 1990s, knowledge on the psychosocial consequences of extremely preterm birth was requested. The Danish Paediatric Society therefore launched a prospective longitudinal study of all children born in Denmark in 1994-95 with a gestational age of <28 weeks and/or a bodyweight of <1000 g (ETFOL)., Material and Methods: Surviving children and a group of children born at term were assessed at 5 years of age and the parents filled in a questionnaire. Quantitative data were analysed, qualitative data and impressions received through conversations with the parents were considered on the basis of a psychological understanding of loss and grief., Results: During the first year of life, index children were more ill and were cared for in the home for a longer time than were reference children. From the 3rd year of life, differences in illness were minimal. Index parents received more support from professionals than did reference parents. Differences in family structure or social network did not explain this. Despite this, 28% of index vs. 4% of reference parents felt that they did not receive enough support., Conclusion: Index children were more vulnerable than reference children. After discharge, index parents had an increased need of support that could not be fulfilled by family/friends. An understanding hereof may be found in the vulnerability of the children and in a psychological understanding of loss and grief. The parents lacked contact and dialogue with other parents and professionals with knowledge of their situation. We therefore need to consider the appropriateness of today's follow-up procedures for prematurely born children and their parents.