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Assessment of anxiety in children with autism spectrum disorder (ASD) most commonly includes parent questionnaires. However, due to the nature of the questions and verbal limitations often present in children with ASD, caregivers may have difficulty completing such measures. Caregivers of 144 children with ASD ages 6 to 12 completed the Child and Adolescent Symptom Inventory-4 ASD Anxiety Scale and rated their level of confidence in responding to each item. Results indicated that parents had a moderate to high level of confidence in rating their children's anxiety symptoms. Parent confidence was not influenced by their child's age, expressive language ability, or intellectual functioning, but was related to their child's anxiety symptom count and ASD severity., Author(s): Marian E. Williams [sup.1] [sup.4] , Leah I. Stein Duker [sup.2] , Cheryl L. P. Vigen [sup.2] , Chelsey Wylde [sup.3] [sup.5] , Sharon A. Cermak [sup.2] Author Affiliations: [...]

The aim of this study was to explore the associations between temperamental reactivity and regulation and the emergence of anxiety traits in a longitudinal sample of infants enriched for later ASD. Parents of 143 infants who were at high- and low-risk for ASD rated their child's temperament traits when they were 9, 15 and 24 months old; they rated anxiety and ASD traits when they were 36 months old. The findings suggest that behavioural inhibition may be an early predictor of later anxiety in children with and without ASD and that lower levels of effortful control in children who later develop ASD may contribute to the higher expression of anxiety within this population., Author(s): Mutluhan Ersoy [sup.1] , Tony Charman [sup.1] , Greg Pasco [sup.1] , Ewan Carr [sup.2] , Mark H. Johnson [sup.3] [sup.4] , Emily J. H. Jones [sup.3] , Anna [...]

Shared difficulties with cognitive control may play a role in co-occurring mental health problems frequently observed in autistic children. We investigated how different cognitive control processes (inhibitory control, conflict resolution, cognitive flexibility) associated with traits of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) and anxiety in 7-year-old children at elevated (n = 44) and typical (n = 37) familial likelihood for ASD. Poor inhibitory control was associated with higher ADHD traits. Better inhibitory control and poorer cognitive flexibility predicted higher anxiety traits. Cognitive control processes were not associated dimensionally with autistic traits, though better conflict resolution predicted greater likelihood of meeting diagnostic criteria for ASD in categorical analysis. These findings suggest that different cognitive control alterations are associated with ASD, ADHD and anxiety., Author(s): Priscilla B. G. Godoy [sup.1] , Elizabeth Shephard [sup.1] [sup.2] [sup.5] , Bosiljka Milosavljevic [sup.2] [sup.3] [sup.6] , Mark H. Johnson [sup.3] [sup.4] , Tony Charman [sup.2] , Simon [...]

Background: An increased neural response to making errors has emerged as a biomarker of anxiety. Error negativity (Ne) or error-related negativity (ERN) is an event-related potential generated when people commit errors; the Ne/ERN is greater among people with anxiety and predicts increases in anxiety. However, no previous study has examined whether the Ne/ERN can be used as a prognostic indicator among people with current anxiety. The present study addressed this gap by examining whether the Ne/ERN prospectively predicts increases in anxiety symptoms in clinically anxious children and adolescents. Methods: The sample included 34 female participants between the ages of 8 and 14 years who met the criteria for a clinical anxiety disorder based on clinical interview. The Ne/ERN was measured using a flanker task. Results: Increased Ne/ERN at baseline predicted increases in total anxiety symptoms 2 years later, even when accounting for baseline symptoms. The Ne/ERN predicted increases in the symptom domains of generalized anxiety, social anxiety and harm avoidance/perfectionism, but not panic, separation anxiety, school avoidance or physical symptoms. Limitations: The sample size was small, which may have inflated the false discovery rate. To mitigate this possibility, we used multiple self-report measures, and the results for the 2 measures (as well as their symptom domains) converged. Conclusion: These data suggest that the Ne/ERN can delineate specific risk trajectories, even among those who already meet the criteria for a clinical anxiety disorder. Considering the need for prognostic markers among people with clinical anxiety, the current findings are an important and novel extension of previous work., Introduction Anxiety disorders are the most prevalent form of mental illness and often cause significant distress and impairment across the lifespan. (1) Although anxiety affects adults and children, it most [...]

Children on the autism spectrum experience high rates of anxiety but little is known about the impact of anxiety on child or parent quality of life (QoL). This study aimed to investigate the relationship between anxiety, autism characteristics, and QoL in children and their parents. Sixty-four parents of children on the spectrum completed questionnaires on their child's autism characteristics, anxiety symptomatology, and both child (PedsQL) and parent QoL (WHOQoL-BREF). Parents of children with elevated anxiety reported lower child and parent QoL. Regression models highlight specific anxiety subscales as predictive of PedsQL school and emotional functioning but not of parent QoL. Anxiety symptomatology may be a significant factor contributing to specific aspects of QoL for children on the spectrum., Author(s): Dawn Adams [sup.1] [sup.2] , Megan Clark [sup.1] [sup.2] , Kate Simpson [sup.1] [sup.2] Author Affiliations: (1) grid.1022.1, 0000 0004 0437 5432, Autism Centre of Excellence, School of Education [...]

Analysis of the data from a sample of Dutch twins aged 12, 14, and 16 years reveals no difference between heritability estimates in boys and girls. Findings agree with previous studies on the age-specific effects of genes and shared environment on anxiety, depression, and withdrawn behavior in childhood and adolescence.

This study used data from 340 mother--child dyads to examine characteristics of children with co-occurring diagnoses of anxiety and externalizing disorders and compared them with children with a sole diagnosis or no diagnosis. Comparisons were made using 4 child-diagnostic groups: anxiety-only, externalizing-only, co-occurrence, and no-problem groups. Most mothers were characterized by low income and histories of psychiatric diagnoses during the child's lifetime. Analyses using multinomial logistic regressions found the incidence of co-occurring childhood disorders to be significantly linked with maternal affective/anxiety disorders during the child's lifetime. In exploring implications for developmental competence, we found the co-occurrence group to have the lowest level of adaptive functioning among the 4 groups, faring significantly worse than the no-problem group on both academic achievement and intelligence as assessed by standardized tests. Findings underscore the importance of considering co-occurring behavior problems as a distinct phenomenon when examining children's developmental outcomes. Keywords: co-occurring psychiatric disorders, anxiety disorders, externalizing disorders DOI: 10.1037/a0017848

Learning-based models of anxiety disorders emphasize the role of aversive conditioning and retarded extinction in the etiology and maintenance of anxiety disorders. Yet few studies have examined these underlying processes in children, despite that some anxiety disorders typically onset during childhood. The authors examined the acquisition and extinction of conditioned responses in 17 anxious children and 18 nonanxious control children between 8 and 12 years old using a discriminative Pavlovian conditioning procedure. One geometric shape conditional stimulus was paired with an unpleasant loud tone unconditional stimulus (CS+) whereas another geometric shape was presented alone (CS-). In the context of similar levels of discriminative conditioning in both groups, anxious children showed larger skin conductance responses to the CS+ and the CS- during acquisition and evaluated the CS+ as more arousing than the CS- compared with control children. They also showed greater resistance to extinction in skin conductance responses but not in arousal ratings to the CS+ vs. the CS- relative to control children. Results suggest that deficits in response inhibition to safety cues and retarded extinction may underlie learning processes involved in the pathogenesis of childhood anxiety disorders. Keywords: conditioning, anxiety disorders, children

This study examined the developmental trajectory of anxiety symptoms among 290 boys and evaluated the association of trajectory groups with child and family risk factors and children's internalizing disorders. Anxiety symptoms were measured using maternal reports from the Child Behavior Check-list (T. M. Achenbach, 1991, 1992) for boys between the ages of 2 and 10. A group-based trajectory analysis revealed 4 distinct trajectories in the development of anxiety symptoms: low, low increasing, high declining, and high-increasing trajectories. Child shy temperament tended to differentiate between initial high and low groups, whereas maternal negative control and maternal depression were associated with increasing trajectories and elevated anxiety symptoms in middle childhood. Follow-up analyses to diagnoses of preadolescent depression and/or anxiety disorders revealed different patterns on the basis of trajectory group membership. The results are discussed in terms of the mechanisms of risk factors and implications for early identification and prevention. Keywords: childhood anxiety, temperament, emotion regulation, parent-child interaction, maternal depression

The authors examined genetic and environmental influences, including the contributions of 2 measured aspects of the shared environment of twins (paternal absence, socioeconomic disadvantage) on the development of mother-reported separation anxiety disorder (SAD) history in a sample of 1,887 female twin pairs. Four different symptom categories of SAD were considered. Results revealed that all 4 SAD symptom categories were significantly heritable, whereas the contribution of shared environmental influences to the variation in risk was significant for only 2 of the 4 SAD categories. Paternal absence was found to have an important influence in vulnerability for SAD, whereas the effect of socioeconomic disadvantage was less robust. Evidence for race differences in the etiology of SAD was not found.

Procedural conscious sedation and analgesia in the ED * Diagnostic and therapeutic procedures in the emergency department (ED) can evoke pain and anxiety in pediatric patients. Reassurance and local analgesia, [...]