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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.

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 cognit

School absenteeism is an understudied field, and little is known about youths’ and parents’ perceptions of the problem. We examined the experiences of three youths with anxiety-related school absenteeism and their parents using a qualitative phenomenological approach. Results highlight the overarching domains consisting of the contribution of individual, school, and parental factors. Underlying main themes were also identified. These included: ambivalence towards school attendance, school at the organisational level, school at the student-teacher level, school at the student-peer level, parental responsibility, and limited understanding and knowledge concerning school absenteeism. Furthermore, subthemes were identified. Findings are discussed and practice implications are outlined, including the need for developing a common policy and procedure concerning anxiety-related school absenteeism in Danish schools.

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 oresund 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.

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.

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.

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, neuro-pediatric 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 neuro-developmental outcomes to those treated with thoracoamniotic shunts. There seems to be a lower risk of procedure-related PPROM. (C) 2018 S. Karger AG, Basel

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.

Background: Theoretically, insecure attachment and negative parental behaviors are risk factors for childhood anxiety. However, few empirical studies have examined their relative contribution including differences between mothers and fathers. To date, only one study has examined a mediational model including these factors, albeit in a nonclinical sample. Method: This study ameliorates this limitation by investigating direct and indirect relations between maternal and paternal attachment and behaviors, and clinical anxiety in children (mean age 9.6 years). The study recruited 54 families. Anxiety symptoms were measured by the Spielberger State-trait Inventory for Children, attachment relationships by the Security Scale, and parental behaviors using the Rearing Behavior Questionnaire. Results: Neither insecure attachment relationship with mother nor maternal negative behavior was a significant predictor of anxiety in children. However, insecure attachment to father accounted for a significant proportion of variance in anxiety, and also fully mediated the relationship between paternal rejection and anxiety. Conclusions: Our findings highlight the importance of assessing the relative contribution of risk factors and the importance of including fathers when investigating the development and maintenance of childhood anxiety.

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.

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.

Formålet med artiklen er at invitere til dialog mellem børneklinisk, almen udviklingspsykologisk og almen pædagogisk praksis med henblik på forebyggelse af angst hos børn. Artiklen forsøger at begrebsliggøre og videreudvikle kvaliteter ved den almene pædagogiske praksis i relation til børneklinisk viden. Udgangspunktet for dialogen er anerkendelse de to praksissers forskellige kvaliteter og bidrag og et ønske om at skabe komplementære indsatser i forhold til reduktion af angst i børnelivet. Vi håber med denne artikels diskussion at komme nærmere en afklaring af hvordan en tidlig almen pædagogisk indsats kan virke angstforebyggende.