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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]

AbstractBackgroundMethodsResultsConclusionAutism includes core symptoms affecting general and social development. Up to 60% of autistic adolescents experience co-occurring anxiety disorders negatively influencing educational, social, and general development together with quality of life. A manualised cognitive behavioural therapy (CBT) program ‘Cool Kids - Autism Spectrum Adaptation (ASA)’ has previously demonstrated efficacy in reducing anxiety in children with co-occurring autism. The current study investigates the feasibility of adapting this program for adolescents.Fifteen autistic adolescents, aged 14–17 years, with co-occurring anxiety disorders were enrolled in the study. Outcome measures collected from both adolescents and parents pre-, post-treatment and at 3-month follow-up included participant evaluation of the program, scores from a semi-structured anxiety interview, and questionnaires on anxiety symptoms, life interference, and quality of life.92% of the families who completed the program found it useful and would recommend it to other families in a similar situation. At follow-up, 55% no longer met the criteria for their primary anxiety diagnosis and 34% of adolescents were free of all anxiety diagnoses. Of the five adolescents who did not attend school before treatment three (60%) had returned to school after treatment.This study suggests that the adaptation of the program ‘Cool Kids - ASA’ into an adolescent version is feasible and has the potential to show good effects thus enhancing the possibility of education, development and independence in future life for this group. Larger RCTs studies are, however, needed to examine the efficacy of the adolescent version. [ABSTRACT FROM AUTHOR]

This feasibility study explored suitability of a preventive intervention for internalising problems in young children for culturally and linguistically diverse families in Australia. A subsample of 62 families whose main language at home was other than English was selected from a population-based randomised trial of the Cool Little Kids parenting program. The population trial recruited 545 inhibited preschool children. Measures included family demographics, feedback post-intervention and child internalising problems at longitudinal follow-up. Parents of children whose main language at home was not English gave feedback that Cool Little Kids was helpful for managing their inhibited child's emotional distress. Significantly fewer intervention than control children whose main language at home was not English had separation anxiety symptoms after 2 years (M (SD) = 3.00 (3.15) versus 5.95 (3.98), p = 0.041). Further work to expand accessibility of Cool Little Kids to recent immigrant parents who do not speak English could be worthwhile. [ABSTRACT FROM AUTHOR]

Initial research suggests stepped-care approaches to therapy for youth anxiety is associated with reduced therapy time with similar therapeutic outcomes to treatment-as-usual in real-world settings. Research on the acceptability and feasibility of stepped-care approaches in routine practice is very limited. In a secondary analysis of a pilot randomised controlled trial that compared stepped-care to treatment-as-usual in adolescent mental health services, we examine acceptability and feasibility from consumer and clinician perspectives. Fifteen adolescents and ten clinicians provided brief quantitative and qualitative feedback. Some benefits were noted and these related to improved access to treatment; however, major barriers were also noted. Concerns related to the lack of consumer and clinician choice and flexibility in delivery of stepped interventions, challenges engaging adolescents with internet interventions and associated guided telephone calls, and workplace issues. Systemic changes to facilitate consumer preferences, clinician flexibility and staffing are needed for stepped-care to be feasible in routine care. [ABSTRACT FROM AUTHOR]

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

This study examined whether distorted cognition changes during cognitive behavioural therapy (CBT) in children (N = 61; aged 7–12) with social anxiety disorder (SAD) and whether changes in distorted cognition from pre- to post-treatment predict SAD at 6-month follow-up. Baseline distorted cognition was also examined as a predictor of post-treatment outcome. Multiple informant SAD-measures were obtained pre-treatment, post-treatment and at 6-month follow-up. Children reported on interpretation bias and dysfunctional beliefs. A decrease in interpretation bias and dysfunctional beliefs was prospectively related to greater SAD change between post-treatment and 6-month follow-up. Child-reported SAD-change at post-treatment predicted greater change in dysfunctional beliefs at 6-month follow-up. Higher baseline interpretation bias predicted greater change in SAD-severity at post-treatment. Children with greater distorted cognition reductions during treatment, showed greater treatment gains at 6-month follow-up. Children who do not show this reduction may require additional efforts focused on distorted cognition to maximally benefit from treatment. [ABSTRACT FROM AUTHOR]

Objective: Safety behaviors have been found to undermine successful exposure in the treatment of anxiety disorders for both adults and children. Although reliable measures of safety behaviors have been developed for use with adults, no such measure has been developed specifically for pediatric populations. In light of this limitation, the current study aimed to develop and validate a measure of the use of safety behaviors suitable for children: The Subtle Avoidance Measure for Youth (SAMY). Methods: Clinical (n = 174) and community (n = 138) young people, aged 7–13 years, provided data. Results: Both exploratory and confirmatory factor analyses supported a three-factor solution of the SAMY, which reflected checking behaviors, behaviors related to image management, and behaviors related to physical protection. The SAMY and its subscales demonstrated strong internal consistency, test-retest reliability, construct validity, and the ability to discriminate between clinical and community participants. Conclusions: Given its solid psychometric properties, the SAMY will prove useful for both research and clinical work with anxious young people. [ABSTRACT FROM AUTHOR]

Many young people with mental disorders are not identified until some years after the first onset of symptoms and then frequently do not receive professional intervention. One promising strategy to better identify these young people is mental health screening in schools. Despite a growing literature on the benefits of school-based screening, it remains a relatively uncommon practice and little is known about the practices of those schools that do screen. Moreover, the barriers that prevent schools from screening are not well understood. This study reports on the perceptions of school psychologists about universal mental health screening in schools regarding the prevalence of screening; the practices within schools that do screen; and the perceived barriers to implementing screening. Results indicated that screening remains uncommon, with only 14.8% of school psychologists working in schools that screened in the previous 12 months. The most significant barriers to screening related to being adequately resourced to implement programs, and particularly concerns about how to follow-up students identified as being at-risk. Despite this, school psychologists endorse the potential benefit of screening and report being likely to run screening programs if perceived barriers could be reduced. Impact and Implications statement Universal mental health screening in schools remains uncommon. The main perceived barriers relate to adequate resources – partly in terms of available time - and to management of at-risk students. Despite these barriers, school psychologists see school-based screening as useful for student wellbeing. [ABSTRACT FROM AUTHOR]

Background: Current models of loneliness emphasise the role of maladaptive cognitions in causing and/or maintaining loneliness. However, standardised paradigms to experimentally examine the role of maladaptive cognition in loneliness are lacking, making it difficult to establish causality. This paper tested a mock online chat paradigm designed to induce changes in negative affect (loneliness, depression, and anxiety), and strength of belief in lonely thoughts, by manipulating comparative and normative fit.Participants (N = 59) were randomised into either the loneliness arm (i.e., loneliness induction chat followed by a social connectedness induction chat), or the social connectedness arm (i.e., two separate social connectedness induction chats), and subsequently completed outcome measures.The experimental paradigm significantly and specifically increased lonely affect; however, this was associated with non-significant changes in strength of belief in lonely thoughts. The social connectedness induction chat led to significant reductions in broad negative affect for both groups, with these effects accruing across chats for participants in the social connectedness arm.Experimentally manipulating comparative and normative fit to either emphasise differences or similarities between an individual and group members is an effective paradigm for increasing lonely affect or decreasing general negative affect, respectively.Methods: Current models of loneliness emphasise the role of maladaptive cognitions in causing and/or maintaining loneliness. However, standardised paradigms to experimentally examine the role of maladaptive cognition in loneliness are lacking, making it difficult to establish causality. This paper tested a mock online chat paradigm designed to induce changes in negative affect (loneliness, depression, and anxiety), and strength of belief in lonely thoughts, by manipulating comparative and normative fit.Participants (N = 59) were randomised into either the loneliness arm (i.e., loneliness induction chat followed by a social connectedness induction chat), or the social connectedness arm (i.e., two separate social connectedness induction chats), and subsequently completed outcome measures.The experimental paradigm significantly and specifically increased lonely affect; however, this was associated with non-significant changes in strength of belief in lonely thoughts. The social connectedness induction chat led to significant reductions in broad negative affect for both groups, with these effects accruing across chats for participants in the social connectedness arm.Experimentally manipulating comparative and normative fit to either emphasise differences or similarities between an individual and group members is an effective paradigm for increasing lonely affect or decreasing general negative affect, respectively.Results: Current models of loneliness emphasise the role of maladaptive cognitions in causing and/or maintaining loneliness. However, standardised paradigms to experimentally examine the role of maladaptive cognition in loneliness are lacking, making it difficult to establish causality. This paper tested a mock online chat paradigm designed to induce changes in negative affect (loneliness, depression, and anxiety), and strength of belief in lonely thoughts, by manipulating comparative and normative fit.Participants (N = 59) were randomised into either the loneliness arm (i.e., loneliness induction chat followed by a social connectedness induction chat), or the social connectedness arm (i.e., two separate social connectedness induction chats), and subsequently completed outcome measures.The experimental paradigm significantly and specifically increased lonely affect; however, this was associated with non-significant changes in strength of belief in lonely thoughts. The social connectedness induction chat led to significant reductions in broad negative affect for both groups, with these effects accruing across chats for participants in the social connectedness arm.Experimentally manipulating comparative and normative fit to either emphasise differences or similarities between an individual and group members is an effective paradigm for increasing lonely affect or decreasing general negative affect, respectively.Conclusion: Current models of loneliness emphasise the role of maladaptive cognitions in causing and/or maintaining loneliness. However, standardised paradigms to experimentally examine the role of maladaptive cognition in loneliness are lacking, making it difficult to establish causality. This paper tested a mock online chat paradigm designed to induce changes in negative affect (loneliness, depression, and anxiety), and strength of belief in lonely thoughts, by manipulating comparative and normative fit.Participants (N = 59) were randomised into either the loneliness arm (i.e., loneliness induction chat followed by a social connectedness induction chat), or the social connectedness arm (i.e., two separate social connectedness induction chats), and subsequently completed outcome measures.The experimental paradigm significantly and specifically increased lonely affect; however, this was associated with non-significant changes in strength of belief in lonely thoughts. The social connectedness induction chat led to significant reductions in broad negative affect for both groups, with these effects accruing across chats for participants in the social connectedness arm.Experimentally manipulating comparative and normative fit to either emphasise differences or similarities between an individual and group members is an effective paradigm for increasing lonely affect or decreasing general negative affect, respectively. [ABSTRACT FROM AUTHOR]

The Metacognitions Questionnaire – Short Form (MCQ-30) was designed as a parsimonious measure of the metacognitive beliefs and processes implicated in the maintenance of Generalized Anxiety Disorder (GAD). The present study sought to examine the psychometric properties and clinical utility of the MCQ-30 among people with GAD. One hundred and thirty-nine adults diagnosed with GAD and 76 non-clinical controls completed the MCQ-30 and self-report measures of worry, fear of anxiety, attempted thought suppression, distress, GAD symptoms, and interference. A five-factor structure was evaluated using confirmatory factor analysis (CFA). Among the clinical sample, CFA supported the construct validity of the scale, although the relationship between the factors differed from community samples. Evidence was found for the internal consistency, test-retest reliability, and concurrent, convergent and criterion validity of the MCQ-30 in people with GAD. The treatment sensitivity and clinical responsiveness of the scale were also demonstrated, with the Uncontrollability and Danger Beliefs subscale identified as the most accurate predictor of clinical status. This subscale also exhibited the strongest correlations with most symptom measures, highlighting the cardinal role played by negative beliefs about worry in maintaining clinical levels of GAD. This study provides the first evidence of the reliability, validity and clinical utility of the MCQ-30 with people diagnosed with GAD. [ABSTRACT FROM AUTHOR]

Background: Evidence about empathy in people high in social anxiety has produced mixed outcomes. The current study aimed to compare cognitive and emotional forms of empathy among university women who were high or low in social anxiety. Methods: Empathy was assessed using both self-report and a directly observable social interaction task. Sixty adult women with either high or low levels of social anxiety completed a self-report measure of empathy and also engaged with a female confederate online. The interpersonal exchange included disclosure of a recent stressful experience by the confederate and participants' responses were coded for indicators of cognitive and emotional empathy. Results were analysed with depression both controlled and not controlled. Results: When depression was statistically controlled, participants who were high in social anxiety demonstrated more robust indicators of empathy on both self-report and the interpersonal exchange for both cognitive and emotional measures of empathy. Results were very similar when depression was not statistically controlled, however the groups no longer differed significantly on the self-report measure of cognitive empathy. Conclusions: The implications for these findings on the interpersonal functioning of socially anxious individuals are discussed. [ABSTRACT FROM AUTHOR]

Methods to deliver empirically validated treatments for anxious youth that require fewer therapist resources (low intensity) are beginning to emerge. However, the relative efficacy of low-intensity treatment for youth anxiety against standard face-to-face delivery has not been comprehensively evaluated. Young people aged 6–16 years with a primary anxiety disorder (N = 281) were randomly allocated to treatment delivered either face-to-face or in a low-intensity format. Face-to-face treatment comprised ten, 60-min sessions delivered by a qualified therapist. Low intensity comprised information delivered in either printed (to parents of children under 13) or electronic (to adolescents aged 13 +) format and was supported by up to four telephone sessions with a minimally qualified therapist. Youth receiving face-to-face treatment were significantly more likely to remit from all anxiety disorders (66%) than youth receiving low intensity (49%). This difference was reflected in parents' (but not child) reports of child's anxiety symptoms and life interference. No significant moderators were identified. Low intensity delivery utilised significantly less total therapist time (175 min) than face-to-face delivery (897 min) and this was reflected in a large mean difference in therapy costs ($A735). Standard, face-to-face treatment for anxious youth is associated with significantly better outcomes than delivery of similar content using low-intensity methods. However, the size of this difference was relatively small. In contrast, low-intensity delivery requires markedly less time from therapists and subsequently lower treatment cost. Data provide valuable information for youth anxiety services. Clinical trial registration information: A randomised controlled trial of standard care versus stepped care for children and adolescents with anxiety disorders; https://anzctr.org.au/; ACTRN12612000351819. [ABSTRACT FROM AUTHOR]

Social anxiety is a common mental disorder with an average age of onset in early adolescence. Current theories focus largely on risk factors that are present from early in life, but reasons for onset of the disorder as youth move into adolescence are rarely discussed. We recently proposed a model of the onset of certain mental disorders during the adolescent years based on characteristics of adolescent development. While this model will require longitudinal testing, the current article establishes concurrent associations between relevant variables in a cohort of 528 preadolescents (M age = 11.2 years) at baseline. Youth with social anxiety disorder differed significantly from other youth on measures of social comparison (including physical appearance comparisons, self-rated attractiveness, and negative peer comparisons on social media) as well as positive peer connections (including self-reported school belonging, number of friends, victimization, and peer affiliation). A structural equation model showed that symptom levels of social anxiety were directly related to social comparisons and peer connections, as well as indirectly associated with pubertal development and social comparisons. This pattern was not moderated by sex of youth. [ABSTRACT FROM AUTHOR]

This study examined the long-term durability of cognitive behaviour therapy (CBT) for older adults with comorbid anxiety and depression 10 years after treatment, in comparison to an active control group. Participants from a randomised controlled trial for older adults with comorbid anxiety and depression (Wuthrich et al., 2016) were re-contacted. Participants had received either group CBT or an active control treatment (Discussion Group). The final sample (N = 54; Aged 70–84, M age = 76.07, SD = 3.83; 59 % of the eligible original sample) completed a diagnostic interview, cognitive assessment and self-report measures of symptoms and quality of life. CBT was associated with significantly improved long-term (10-year) efficacy for reducing anxiety and depression in older adults compared to the Discussion group. Effects included higher rates of remission (58 % remission of all diagnoses vs 27 %, 88 % of all depressive diagnoses vs 54 %, 63 % of all anxiety diagnoses vs 35 %, 67 % of primary diagnosis vs 42 %), lower rates of relapse (25–31 % vs 50–78 %) and lower rates of chronic treatment-resistance (8 % primary disorder vs 39 %, 21 % any disorder vs 58 %). Participants who showed an acute treatment response at post-treatment were 7–9 times more likely to be in remission after 10 years than those with residual symptoms. Results may not generalise to those who do not complete CBT, and the time trajectory of symptom change is unclear. Long-term improvements in symptoms are specific to CBT. Results provide compelling evidence for CBT as an effective and durable treatment for late-life anxiety and depression. • Assessed the durability of CBT among older adults 10 years after treatment • Compared effects to an active control group • CBT was associated with higher remission, lower relapse and chronic non-response. • CBT has long-lasting benefits for anxiety and depression in older adults. [ABSTRACT FROM AUTHOR]

Despite the extensive evaluation of school-based interventions for bullying, victimization remains a significant problem in schools. Bullying victimization is significantly predicted by contextual (school-related) factors. As a consequence whole-school programs have been commonly used to prevent and reduce bullying victimization. Evidence also points to individual risk factors (such as emotional distress) in predicting victimization, yet programs to prevent bullying victimization by changing these individual risks are far less developed. Few studies have approximated "real-world" implementation conditions in their trials. The current effectiveness trial evaluated the combination of a whole-school program designed to prevent bullying perpetration and victimization together with a targeted intervention for at-risk students, teaching them individual and dyadic strategies to reduce their anxiety and manage victimization, allowing schools some latitude to implement programs as they typically would. Students from Grades 3 and 4 (N = 8,732) across 135 schools were randomly assigned to one of four conditions: combined intervention; whole-school intervention only; individual intervention only; and care as usual. Victimization decreased significantly and similarly across all four conditions at 12 and 24 months following baseline. Similar reductions and failure to discriminate conditions were found on other key constructs: anxiety; bullying perpetration; and depression. Possible reasons for the failure to demonstrate victimization prevention differences and lessons learned from this large, effectiveness trial are considered. [ABSTRACT FROM AUTHOR]

Repetitive negative thinking (RNT) is a key risk and maintenance factor for many psychological disorders and is considered a transdiagnostic process. However, there are few disorder-neutral measures that assess RNT in adults, only 1 of moderate length considered suitable for children, and none that are validated for both children and adults. This study aimed to address this gap by developing a brief measure of RNT that can be used with both children and adults and can be quickly administered in research and clinical contexts. In Study 1, we administered the new 5-item Persistent and Intrusive Negative Thoughts Scale (PINTS) to 527 children (50.3% boys; Mage = 11.2). A 1-factor model fit well and was invariant for boys and girls. The scale showed high internal consistency and good stability across a 2-week interval. The PINTS was significantly associated with measures of depression, anxiety, and disordered eating and was weakly associated with adaptive forms of coping, demonstrating good divergent validity. In Study 2, there were 419 adults (38.9% men; Mage = 31.7) who completed the PINTS. The results replicated and extended the results of Study 1 by demonstrating that the PINTS had good construct, convergent, and criterion validity as well as good internal consistency and stability over time and was invariant across gender and age. It was concluded that the PINTS is a brief, valid, and useful tool for investigating RNT as a transdiagnostic process in the etiology and maintenance of psychological disorders in both children and adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Background: Stepped care has been promoted for the management of mental disorders; however, there is no empirical evidence to support the cost-effectiveness of this approach for the treatment of anxiety disorders in youth. Method: This economic evaluation was conducted within a randomised controlled trial comparing stepped care to a validated, manualised treatment in 281 young people, aged 7–17, with a diagnosed anxiety disorder. Intervention costs were determined from therapist records. Administrative data on medication and medical service use were used to determine additional health care costs during the study period. Parents also completed a resource use questionnaire to collect medications, services not captured in administrative data and parental lost productivity. Outcomes included participant-completed quality of life, Child Health Utility – nine-dimension and parent-completed Assessment of Quality of Life – eight-dimension to calculate quality-adjusted life years. Mean costs and quality-adjusted life years were compared between groups at 12-month follow-up. Results: Intervention delivery costs were significantly less for stepped care from the societal perspective (mean difference −$198, 95% confidence interval −$353 to −$19). Total combined costs were less for stepped care from both societal (−$1334, 95% confidence interval −$2386 to $510) and health sector (−$563, 95% confidence interval −$1353 to $643) perspectives but did not differ significantly from the manualised treatment. Youth and parental quality-adjusted life years were not significantly different between groups. Sensitivity analysis indicated that the results were robust. Conclusion: For youth with anxiety, this three-step model provided comparable outcomes and total health sector costs to a validated face-to-face programme. However, it was less costly to deliver from a societal perspective, making it an attractive option for some parents. Future economic evaluations comparing various models of stepped care to treatment as usual are recommended. [ABSTRACT FROM AUTHOR]

Objectives: To determine the feasibility, acceptability and initial efficacy of telephone-delivered cognitive behavioral therapy (CBT) for the treatment of anxiety and depressive symptoms in people with Parkinson's disease. Methods: A small randomized controlled trial compared telephone-based CBT to waitlist control. Eleven participants aged >50 years with Parkinson's disease and anxiety and/or depressive symptoms above recommended clinical cut-offs, were randomized to one of two conditions. Participants completed self-report measures of symptom severity and quality of life. Their carers were invited to participate and completed self-reported measures of symptoms and carer burden. At the end of the 10-week intervention period, participants and carers were reassessed on baseline measures, and again one month later. Results: The CBT program was associated with significantly reduced depressive symptoms (Cohen's d =.90) at post-treatment with gains maintained at one-month follow-up. Anxiety symptom decreases (Cohen's d = 0.36) were not statistically different. Waitlist was associated with significantly worsened anxiety. Carer symptoms also reduced with CBT. No changes on quality of life were found. Good acceptability and feedback was received. Conclusions: Telephone-based CBT reduced symptoms of depression in participants with Parkinson's disease but not anxiety. Clinical Implications: Telephone-based CBT is a promising treatment option. [ABSTRACT FROM AUTHOR]

This three-wave panel study examined the prospective and bidirectional relationships between parental control of social media use, and parents' and adolescents' perceived time spent on social media over a 2-year period. Adolescents (52% males, T1: M age = 12.19, SD = 0.52) and one of their parents (96% mothers, T1: M age = 45.26, SD = 4.28) completed annual surveys (T1: N = 498, T2: N = 477 and T3: N = 440). Data were analysed using cross-lagged panel models. More adolescent time spent on social media predicted small decreases in parental control 1 year later, but parental control did not predict adolescent time on social media. More parental time spent on social media predicted small increases in adolescent time spent on social media 1 year later, but adolescent use did not predict parent use. Examining factors related to parental use, rather than restriction, may be more effective to reduce adolescents' social media use. [ABSTRACT FROM AUTHOR]

Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances. • Anxiety disorders are the most common form of paediatric mental disorder. • Both distal and proximal risk factors predict the onset of paediatric anxiety disorders. • Extensive research demonstrates strong outcomes from CBT treatments. • A smaller evidence base also shows good efficacy from pharmacological treatments. • The potential for early intervention can reduce the lifelong impact of these disorders. [ABSTRACT FROM AUTHOR]

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

Highlights • Developed a measure of parental reactions to adolescent depression. • Parental responses were overprotection, criticism, distress and support. • Depressed parents reported more negative attitudes and responses. • Parents of depressed youth reported more negative responses. • Parent depression literacy and depression stigma impacted parental responses. Abstract Background This study aimed to: (1) validate a measure of parental reactions, attitudes and understanding of adolescent depressive symptoms (PRAUD) and (2) examine the impact of adolescent and parent depressive symptoms, parental knowledge about adolescent depression (depression literacy), and parental depression stigma on parental responses to adolescent depression. Method Parents (N = 440) of adolescents aged 13–17 years completed an anonymous online questionnaire. Results Factor analysis suggested four patterns of parental responses to adolescent depressive symptoms: overprotection, criticism, distress and support. Internal consistency was good for all PRAUD subscales (α = 0.80–0.88). Higher parent and adolescent depressive symptoms, greater depression stigma and lower depression literacy were associated with more negative parental responses. Higher adolescent depressive symptoms and poorer parent depression literacy predicted overprotective responses, and depression stigma moderated the effect of parent depressive symptoms. Depression literacy moderated the effect of parent depression on supportive parental responses, and stigma moderated the effect of adolescent depression. Higher levels of depression stigma and parent depression predicted critical responses, and depression literacy moderated the effect of adolescent depressive symptoms. Distress responses were predicted by higher stigma, and depression literacy moderated the effect of parent and adolescent depressive symptoms. Limitations Differences between the two sample recruitment sites. Conclusions There was evidence of more negative parental attitudes and responses among depressed parents and parents of depressed youth. Improving parental depression literacy and reducing depression stigma during treatment of adolescent depression may facilitate parental responsiveness, and in some circumstances, may help buffer against the negative impact of parental depression. [ABSTRACT FROM AUTHOR]

Background: This study aimed to: (1) validate a measure of parental reactions, attitudes and understanding of adolescent depressive symptoms (PRAUD) and (2) examine the impact of adolescent and parent depressive symptoms, parental knowledge about adolescent depression (depression literacy), and parental depression stigma on parental responses to adolescent depression.Method: Parents (N = 440) of adolescents aged 13-17 years completed an anonymous online questionnaire.Results: Factor analysis suggested four patterns of parental responses to adolescent depressive symptoms: overprotection, criticism, distress and support. Internal consistency was good for all PRAUD subscales (α = 0.80-0.88). Higher parent and adolescent depressive symptoms, greater depression stigma and lower depression literacy were associated with more negative parental responses. Higher adolescent depressive symptoms and poorer parent depression literacy predicted overprotective responses, and depression stigma moderated the effect of parent depressive symptoms. Depression literacy moderated the effect of parent depression on supportive parental responses, and stigma moderated the effect of adolescent depression. Higher levels of depression stigma and parent depression predicted critical responses, and depression literacy moderated the effect of adolescent depressive symptoms. Distress responses were predicted by higher stigma, and depression literacy moderated the effect of parent and adolescent depressive symptoms.Limitations: Differences between the two sample recruitment sites.Conclusions: There was evidence of more negative parental attitudes and responses among depressed parents and parents of depressed youth. Improving parental depression literacy and reducing depression stigma during treatment of adolescent depression may facilitate parental responsiveness, and in some circumstances, may help buffer against the negative impact of parental depression. [ABSTRACT FROM AUTHOR]

Pre- and post-event rumination have been proposed to be key processes involved in the maintenance of social anxiety disorder. While the importance of addressing rumination in treatment is becoming increasingly clear, factors that mediate the relationship between changes in social anxiety and changes in rumination have yet to be investigated. Individuals with social anxiety disorder (N = 82) completed measures that assessed key cognitive and attentional processes of social anxiety, including pre- and post-event rumination, before and after cognitive behavioural treatment. Following treatment there were significant reductions in pre- and post-event rumination in addition to other cognitive and attentional aspects of social anxiety. Mediation analyses revealed that changes in state anxiety and performance and threat appraisals mediated the relationship between changes in social anxiety and pre-event rumination, while only changes in threat appraisals mediated the relationship between changes in social anxiety and post-event rumination. It appears that key cognitive and attentional processes have differing importance when anticipating feared social situations and when reflecting on it afterwards. This suggests that treatment that aims to reduce the role of pre-event rumination needs to consider multiple factors, while threat appraisals particularly need to be addressed when addressing post-event rumination. [ABSTRACT FROM AUTHOR]

Negative rumination in social anxiety disorder (SAD) occurs in anticipation of a social event (pre-event rumination) and in its aftermath (post-event rumination). Both are proposed to be key maintaining factors of the vicious cycle of social anxiety. Despite this, there is a dearth of research investigating the processes that mediate the relationship between social anxiety and pre-event rumination and uncertainty regarding the cognitive and attentional processes that mediate the relationship between social anxiety and post-event rumination. To investigate this further, the current study utilised a clinical sample of participants with SAD to determine the hypothesised mediators of a social anxiety and pre-event model (N = 239) and a social anxiety and post-event rumination model (N = 216). Results from path analyses were broadly consistent with cognitive models of SAD that posit several interrelated processes mediate the relationship between social anxiety and pre- and post-event rumination. Results also indicated slightly different processes showed stronger prediction of pre-event rumination (i.e., biased performance appraisals) and post-event rumination (i.e., negative attentional focus). Treatment recommendations that aim to address the maladaptive role of negative rumination in social anxiety are made in keeping with the inter-connected and dynamic role played by cognitive and attentional processes in heightening social anxiety. [ABSTRACT FROM AUTHOR]

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

Research suggests that mothers may influence the development of body image concerns and eating disturbances in their daughters by modeling negative body image beliefs and unhealthy eating behaviors. However, the causal nature of that mode of influence is yet to be established. This study implemented an experimental design to examine the impact of mothers' modeling of negative comments about their own appearance and diet on their daughters' body image concerns and eating behaviors. Participants were 8–12 year old girls and their mothers ( N = 50). While viewing thin-ideal magazine advertisements with their daughter, mothers were instructed to make either negative comments about their own weight, shape, and diet or to make no appearance or diet related comments. Daughters' levels of body esteem, body satisfaction, and eating attitudes were assessed pre- and post-manipulation, and their actual eating habits were measured post-manipulation. Girls whose mothers had made self-critical comments about their own appearance and diet reported lower body esteem, lower body satisfaction, more problematic eating attitudes, and ate significantly fewer sweets than girls whose mothers had not made self-critical comments. These results have implications for disordered eating prevention programs, suggesting that greater emphasis be placed on discouraging negative modeling behaviors among mothers. [ABSTRACT FROM AUTHOR]

Background Previous studies have demonstrated the efficacy of early intervention for anxiety in preschoolers through parent-education. The current study evaluated a six-session early intervention program for preschoolers at high risk of anxiety disorders in which a standard educational program for parents was supplemented by direct training of social skills to the children. Methods Seventy-two children aged 3–5 years were selected based on high behavioural inhibition levels and concurrently having a parent with high emotional distress. Families were randomly assigned to either the intervention group, which consisted of six parent-education group sessions and six child social skills training sessions, or waitlist. After six months, families on waitlist were offered treatment consisting of parent-education only. Results Relative to waitlist, children in the combined condition showed significantly fewer clinician-rated anxiety disorders and diagnostic severity and maternal (but not paternal) reported anxiety symptoms and life interference at six months. Mothers also reported less overprotection. These gains were maintained at 12-month follow-up. Parent only education following waitlist produced similar improvements among children. Quasi-experimental comparison between combined and parent-only interventions indicated greater reductions from combined intervention according to clinician reports, but no significant differences on maternal reports. Conclusions Results suggest that this brief early intervention program for preschoolers with both parent and child components significantly reduces risk and disorder in vulnerable children. The inclusion of a child component might have the potential to increase effects over parent-only intervention. However, future support for this conclusion through long-term, randomised controlled trials is needed. [ABSTRACT FROM AUTHOR]

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

The current study examined the associations between perceived actual-ideal discrepancies in facial and bodily attributes and adolescent girls' appearance satisfaction and whether these relationships were moderated by the importance associated with the attributes and/or the country of the participants. A multilingual survey was completed by 900 girls aged 12–18 years old living in Australia, China, India, and Iran. Girls in India and Iran were most satisfied with their appearance followed by girls in China and Australia. Iranian girls had the highest perceived actual-ideal discrepancies in facial and bodily attributes. Chinese and Indian girls perceived their facial attributes to be more important to their overall sense of appearance than their bodily attributes, whereas Australian and Iranian girls valued them equally. Higher perceived actual-ideal facial discrepancies were related to lower appearance satisfaction only for Iranian girls and higher perceived bodily discrepancies were linked to lower appearance satisfaction only for Australian girls. The importance associated with physical attributes and/or the country of participants did not moderate the relationship between perceived discrepancies and appearance satisfaction for facial or bodily attributes. Findings underscore the critical role of cultural nuances in understanding body image among adolescent girls and determinants of appearance satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: Stuttering is a speech disorder frequently accompanied by anxiety in social-evaluative situations. A growing body of research has confirmed a significant rate of social anxiety disorder among adults who stutter. Social anxiety disorder is a chronic and disabling anxiety disorder associated with substantial life impairment. Several influential models have described cognitive-behavioral factors that contribute to the maintenance of social anxiety in nonstuttering populations. The purpose of the present article is to apply these leading models to the experience of social anxiety for people who stutter. Method: Components from existing models were applied to stuttering in order to determine cognitive-behavioral processes that occur before, during, and after social-evaluative situations, which may increase the likelihood of stutteringrelated social fears persisting. Results: Maintenance of social anxiety in stuttering may be influenced by a host of interrelated factors, including fear of negative evaluation, negative social-evaluative cognitions, attentional biases, self-focused attention, safety behaviors, and anticipatory and postevent processing. Conclusion: Given the chronic nature of social anxiety disorder, identifying factors that contribute to the persistence of stuttering-related social fears has the potential to inform clinical practice and the development of psychological treatment programs to address the speech and psychological needs of people who stutter with social anxiety. [ABSTRACT FROM AUTHOR]

This study examined factors influencing parent willingness to use D-Cycloserine (DCS) for treating child anxiety. N = 222 parents were given information about using DCS to treat anxiety. They were then asked to rate their willingness to allow their child to take DCS/antibiotics for mild anxiety, severe anxiety, or an infection. The associations between willingness to use DCS and parental trait anxiety, demographics, as well as specific concerns regarding the medication, were examined. Parents could also provide written responses regarding their attitudes to DCS, which were analysed for themes. Parents reported concerns regarding potential side-effects from DCS. More severe anxiety was associated with more willingness to consent; however, parents were more willing to use antibiotics to treat an infection than DCS to treat their child's anxiety. The degree of perceived benefit from DCS was most strongly associated with parents’ willingness to use it. Overall, parents expressed mixed views, reporting they would consider using DCS to treat their child; however, they had significant concerns about it. Results suggest providing parents with information explaining how DCS works, its risks and potential benefits may increase its acceptability. [ABSTRACT FROM PUBLISHER]

Use of the partial NMDA receptor agonist d-Cycloserine (DCS) to increase extinction to feared cues among anxious adults has shown mixed, although overall positive effects. Few studies have extended this effect to youth and none have addressed young people with broad-based anxiety such as separation anxiety, social anxiety, or generalised anxiety. In the current trial 51 children and adolescents with diagnosed anxiety disorders, aged 7–14 years received four sessions of graduated, experimenter-led, in vivo exposure to a hierarchy of feared cues relevant to their primary fear. They were randomly allocated to receive either 50 mg of DCS or a matched placebo capsule in a fully double-blind design. Both groups showed large reductions across sessions in their primary fear according to both parent and child report, but there were no significant differences between conditions at any session. The results are consistent with most studies to date of DCS-augmented exposure in young people. [ABSTRACT FROM AUTHOR]

The current paper presents an update to the model of social anxiety disorder (social phobia) published by Rapee and Spence (2004). It evaluates the research over the intervening 11 years and advances the original model in response to the empirical evidence. We review the recent literature regarding the impact of genetic and biological influences, temperament, cognitive factors, peer relationships, parenting, adverse life events and cultural variables upon the development of SAD. The paper draws together recent literature demonstrating the complex interplay between these variables, and highlights the many etiological pathways. While acknowledging the considerable progress in the empirical literature, the significant gaps in knowledge are noted, particularly the need for further longitudinal research to clarify causal pathways, and moderating and mediating effects. The resulting model will be valuable in informing the design of more effective treatment and preventive interventions for SAD and will provide a useful platform to guide future research directions. [ABSTRACT FROM AUTHOR]

Epidemiological studies indicate that as many as 1 in 5 young people will develop a mental health problem in any given year. Early detection and intervention are needed to reduce the impact that these conditions have-both for the young person and for the communities in which they live. This study reports the development of a new instrument aimed at helping identify students at risk of developing mental health difficulties. Rather than asking about the presence of symptoms of mental health conditions, the RADAR screening tool assesses a student's balance of risk and protective factors associated with the development of mental health problems. The RADAR was evaluated with a sample of 838 participants in high school Years 7-12. A robust internal factor structure was revealed using exploratory and confirmatory factor analysis. Internal consistency was satisfactory for each subscale, ranging from .73 to .90 while the reliability for the total scale was .91. Retest stability, measured over a 12 month period, was found to be strong (r = .72). Convergent validity was demonstrated with reference to standard measures of depression and behavioral problems. It is concluded that the RADAR is a promising measure for helping mental health professionals and educators decide which students may be at risk of developing mental health problems. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Background: Within maintenance models of social anxiety disorder (SAD), a number of cognitive and behavioural factors that drive the persistence of SAD have been proposed. However, these maintenance models do not address how SAD develops, or the origins of the proposed maintaining factors. There are also models of the development of SAD that have been proposed independently from maintenance models. These models highlight multiple factors that contribute risk to the onset of SAD, but do not address how these aetiological factors may lead to the development of the maintaining factors associated with SAD.Methods: A systematic review of the literature was conducted to identify aetiological and maintenance models of SAD. We then united key factors identified in these models and formulated an integrated aetiological and maintenance (IAM) model of SAD. A systematic review of the literature was then conducted on the components of the IAM model.Results: A number of aetiological and maintaining factors were identified in models of SAD. These factors could be drawn together into the IAM model. On balance, there is empirical evidence for the association of each of the factors in the IAM model with social anxiety or SAD, providing preliminary support for the model.Limitations: There are relationships between components of the IAM model that require empirical attention. Future research will need to continue to test the IAM model.Conclusions: The IAM model provides a framework for future investigations into the development and persistence of SAD. [ABSTRACT FROM AUTHOR]

The aims of this study were to determine the impact of adolescent-relevant risk factors on changes in social anxiety symptoms from pre-to early-adolescence. From 2016 to 2018, 528 youth (51% boys) were tested in three annual waves across grades 6, 7, and 8 (M ages 11.2, 12.7, 13.7 years). Through online surveys youth reported on peer relationships that were combined into two latent factors: 1) appearance comparisons, comprising youth reports of appearance comparisons relative to others in general and while using social media, along with perceived attractiveness; and 2) positive peer connections, comprising youth reports of group affiliation, school belonging, and peer victimisation. Youth and their parents also reported on the youth's level of pubertal development as well as the youth's level of social anxiety using previously validated questionnaires. Social anxiety was also assessed with structured diagnostic interview. Separate cross-lagged panel models were used to model longitudinal associations between all risk factors and youth, parent, and interviewer-reported measures of social anxiety. Of the associations tested, only appearance comparisons directly predicted increases in social anxiety symptoms 12 months later across all models. More advanced pubertal development was associated with increased appearance comparisons the following year. On the other hand, higher levels of social anxiety predicted subsequent reductions in positive peer connections in parent and interviewer models. These results highlight the important and interconnected impact of pubertal development and appearance comparisons on both the development of social anxiety symptoms during early adolescence, as well as the social consequences of social anxiety. • Social anxiety disorder commonly begins during early adolescence. • Comparing one's appearance against others predicted social anxiety the following year. • More advanced pubertal development indirectly predicted social anxiety. • Poor peer connections did not predict future social anxiety. • However, higher levels of social anxiety predicted poorer peer connections. [ABSTRACT FROM AUTHOR]

This study examined the harm beliefs of dog fearful children and the effect of exposure therapy on harm beliefs. The harm beliefs of 27 dog fearful children were examined before and after exposure therapy to a dog. Children were shown a live dog and asked to rate the extent to which they believed the dog would harm them (for example, the dog would bite or attack). The children were asked to complete Behaviour Approach Tests (BATs) to the dog before and after the exposure therapy. The children partially endorsed all harm beliefs regarding the dog prior to exposure. Harm beliefs predicted distress during a BAT before exposure therapy and avoidance after exposure. There was a significant reduction in all harm beliefs after exposure therapy with large effect sizes. Results also indicate the effectiveness of a single session of exposure in reducing a child's harm beliefs. [ABSTRACT FROM AUTHOR]

The present study was designed to examine the effects of training in positive interpretations in clinically anxious children. A total of 87 children between 7 and 12 years of age were randomly assigned to either a positive cognitive bias modification training for interpretation (CMB-I) or a neutral training. Training included 15 sessions in a two-week period. Children with an interpretation bias prior to training in the positive training group showed a significant reduction in interpretation bias on the social threat scenarios after training, but not children in the neutral training group. No effects on interpretation biases were found for the general threat scenarios or the non-threat scenarios. Furthermore, children in the positive training did not self-report lower anxiety than children in the neutral training group. However, mothers and fathers reported a significant reduction in social anxiety in their children after positive training, but not after neutral training. This study demonstrated that clinically anxious children with a prior interpretation bias can be trained away from negative social interpretation biases and there is some evidence that this corresponds to reductions in social anxiety. This study also highlights the importance of using specific training stimuli. [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]

This study described the psychometric properties of a self-report measure of functional impairment related to anxiety and depression in adolescents, the Adolescent Life Interference Scale for Internalizing symptoms (ALIS-I). A clinical sample of 266 adolescents and a community sample of 63 adolescents, aged 11 to 18 years (Mean = 14.7, SD = 1.71) completed the ALIS-I and additional measures assessing internalizing problems. Exploratory factor analyses indicated four distinct but correlated factors of life interference related to personal withdrawal/avoidance, peer problems, problems with study/work, and somatic symptoms. Reliability and retest reliability (8–12 weeks) of the total score were high and psychometric properties of the subscales were acceptable. The ALIS-I effectively discriminated between clinical and community control groups, and expected correlations were shown between ALIS-I subscales and other related symptom measures. The ALIS-I is a promising instrument for the assessment of functional impairment related to internalizing disorders in youth. [ABSTRACT FROM AUTHOR]

Background For exposure therapy to be successful, it is essential that fear extinction learning extends beyond the treatment setting. d-Cycloserine (DCS) may facilitate treatment gains by increasing generalization of extinction learning, however, its effects have not been tested in children. We examined whether DCS enhanced generalization of fear extinction learning across different stimuli and contexts among children with specific phobias. Methods The study was a double-blind placebo-controlled randomized controlled trial among dog or spider phobic children aged 6-14. Participants ingested either 50 mg of DCS ( n = 18) or placebo ( n = 17) before receiving a single prolonged exposure session to their feared stimulus. Return of fear was examined 1 week later to a different stimulus (a different dog or spider), presented in both the original treatment context and an alternate context. Avoidance and fear were measured with Behavior Approach Tests (BATs), where the child was asked to increase proximity to the stimulus while reporting their fear level. Results There were no differences in BAT performance between groups during the exposure session or when a new stimulus was later presented in the treatment context. However, when the new stimulus was presented in a different context, relative to placebo, the DCS group showed less avoidance ( P = .03) and less increase in fear ( P = .04) with moderate effect sizes. Conclusions DCS enabled children to better retain their fear extinction learning. This new learning generalized to different stimuli and contexts. [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]

Support from social networks is generally considered to protect against mental disorder but in some circumstances support for negative behaviours (such as avoidance) may be counterproductive. Given the critical interplay between social anxiety disorder and social interactions, it is surprising that the relationship of support from significant others to this disorder has received so little attention. The current study evaluated the reciprocal relationships between perceived social support and perceived partner support for avoidance behaviours (avoidance support) among a sample of 131 participants with social anxiety disorder who were assessed three times within the context of a treatment outcome study. A new measure of partner support for avoidance behaviours was developed, called the Avoidance Support Measure, and showed adequate internal consistency and construct validity. Correlations at baseline showed significant negative relationships between perceived social support and social anxiety and significant positive relationships between avoidance support and social anxiety. Path analysis showed that perceived social support at Times 1 and 2 negatively predicted future social anxiety at Times 2 and 3. On the other hand, only a single predictive relationship involving avoidance support was significant and showed that social anxiety at Time 1 positively predicted avoidance support at Time 2. These early results point to the different ways that support from significant others might relate to social anxiety and suggest that further work in this area may be fruitful. [ABSTRACT FROM AUTHOR]

Anxiety disorders affect around 5% of the paediatric population at any given time and are associated with high social and personal impact. These disorders typically begin early in life, and children with anxiety disorders are at increased risk for a variety of later difficulties across the life-span. Although causes of anxiety in childhood are not fully understood, there is a strong heritable component. Additional risk factors include temperament, parent psychopathology, parent handling and peer interactions. Psychological treatments have demonstrated good efficacy with around 60% of anxious youth being in diagnostic remission immediately following treatment and a further 10% remitting over the following months. Because young people with anxiety disorders are among the least likely to seek appropriate help, paediatricians are in a unique position to identify anxious young people, educate families and recommend appropriate intervention. [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]

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