Assessment and management of anxiety disorders in children and adolescents

Anxiety disorders in childhood and adolescence are extremely common and are often associated with lifelong psychiatric disturbance. Consistent with DSM-5 and the extant literature, this review concerns the assessment and treatment of specific phobias, separation anxiety disorder, generalised anxiety disorder, social anxiety disorder, panic disorder and agoraphobia. Evidence-based psychological treatments (cognitive behaviour therapy; CBT) for these disorders have been developed and investigated, and in recent years promising low-intensity versions of CBT interventions have been proposed that offer a means to increase access to evidence-based treatments. There is some evidence of effectiveness of pharmacological treatments for anxiety disorders in children and young people, however, routine prescription is not recommended due to concerns about potential harm.

Emotional and behavioural problems in children with language impairments and children with autism spectrum disorders

Background: Although it is well-established that children with language impairment (LI) and children with autism spectrum disorders (ASD) both show elevated levels of emotional and behavioural problems, the level and types of difficulties across the two groups have not previously been directly compared. Aims: To compare levels of emotional and behavioural problems in children with LI and children with ASD recruited from the same mainstream schools. Methods & Procedures: We measured teacher-reported emotional and behavioural problems using the Strengths and Difficulties Questionnaire (SDQ) in a sample of 5-to-13-year old children with LI (N=62) and children with ASD (N=42) attending mainstream school but with identified special educational needs. Outcomes & Results: Both groups showed similarly elevated levels of emotional, conduct and hyperactivity problems. The only differences between the LI and ASD groups were on subscales assessing peer problems (which were higher in the ASD group) and prosocial behaviours (which were higher in the LI group). Overall, there were few associations between emotional and behavioural problems and child characteristics, reflecting the pervasive nature of these difficulties in children with LI and children with ASD, although levels of problems were higher in children with ASD with lower language ability. However, in the ASD group only, a measure of family social economic status was associated with language ability and attenuated the association between language ability and emotional and behavioural problems. Conclusions & Implications: Children with LI and children with ASD in mainstream school show similarly elevated levels of emotional and behavioural problems, which require monitoring and may benefit from intervention. Further work is required to identify the child, family and situational factors that place children with LI and children with ASD at risk of emotional and behavioural problems, and whether these differ between the two groups. This work can then guide the application of evidence-based interventions to these children.

Serotonin transporter [corrected] methylation and response to cognitive behaviour therapy in children with anxiety disorders

Anxiety disorders that are the most commonly occurring psychiatric disorders in childhood, are associated with a range of social and educational impairments and often continue into adulthood. Cognitive behaviour therapy (CBT) is an effective treatment option for the majority of cases, although up to 35-45% of children do not achieve remission. Recent research suggests that some genetic variants may be associated with a more beneficial response to psychological therapy. Epigenetic mechanisms such as DNA methylation work at the interface between genetic and environmental influences. Furthermore, epigenetic alterations at the serotonin transporter (SERT) promoter region have been associated with environmental influences such as stressful life experiences. In this study, we measured DNA methylation upstream of SERT in 116 children with an anxiety disorder, before and after receiving CBT. Change during treatment in percentage DNA methylation was significantly different in treatment responders vs nonresponders. This effect was driven by one CpG site in particular, at which responders increased in methylation, whereas nonresponders showed a decrease in DNA methylation. This is the first study to demonstrate differences in SERT methylation change in association with response to a purely psychological therapy. These findings confirm that biological changes occur alongside changes in symptomatology following a psychological therapy such as CBT.

Maternal antenatal anxiety, postnatal stroking and emotional problems in children: outcomes predicted from pre and postnatal programming hypotheses

Background Mothers' self-reported stroking of their infants over the first weeks of life modifies the association between prenatal depression and physiological and emotional reactivity at 7 months, consistent with animal studies of the effects of tactile stimulation. We now investigate whether the effects of maternal stroking persist to 2.5 years. Given animal and human evidence for sex differences in the effects of prenatal stress we compare associations in boys and girls. Method From a general population sample of 1233 first-time mothers recruited at 20 weeks gestation we drew a random sample of 316 for assessment at 32 weeks, stratified by reported inter-partner psychological abuse, a risk indicator for child development. Of these mothers, 243 reported at 5 and 9 weeks how often they stroked their infants, and completed the Child Behavior Checklist (CBCL) at 2.5 years post-delivery. Results There was a significant interaction between prenatal anxiety and maternal stroking in the prediction of CBCL internalizing (p = 0.001) and anxious/depressed scores (p < 0.001). The effects were stronger in females than males, and the three-way interaction prenatal anxiety × maternal stroking × sex of infant was significant for internalizing symptoms (p = 0.003). The interactions arose from an association between prenatal anxiety and internalizing symptoms only in the presence of low maternal stroking. Conclusions The findings are consistent with stable epigenetic effects, many sex specific, reported in animal studies. While epigenetic mechanisms may be underlying the associations, it remains to be established whether stroking affects gene expression in humans.

Beneath a learning management system: understanding the human information interaction in information systems

Studies on learning management systems have largely been technical in nature with an emphasis on the evaluation of the human computer interaction (HCI) processes in using the LMS. This paper reports a study that evaluates the information interaction processes on an eLearning course used in teaching an applied Statistics course. The eLearning course is used as a synonym for information systems. The study explores issues of missing context in stored information in information systems. Using the semiotic framework as a guide, the researchers evaluated an existing eLearning course with the view to proposing a model for designing improved eLearning courses for future eLearning programmes. In this exploratory study, a survey questionnaire is used to collect data from 160 participants on an eLearning course in Statistics in Applied Climatology. The views of the participants are analysed with a focus on only the human information interaction issues. Using the semiotic framework as a guide, syntactic, semantic, pragmatic and social context gaps or problems were identified. The information interactions problems identified include ambiguous instructions, inadequate information, lack of sound, interface design problems among others. These problems affected the quality of new knowledge created by the participants. The researchers thus highlighted the challenges of missing information context when data is stored in an information system. The study concludes by proposing a human information interaction model for improving the information interaction quality issues in the design of eLearning course on learning management platforms and those other information systems.

Family language policy in the Chinese community in Singapore: a question of balance?

This paper focuses on the language shift phenomenon in Singapore as a consequence of the top-town policies. By looking at bilingual family language policies it examines the characteristics of Singapore’s multilingual nature and cultural diversity. Specifically, it looks at what languages are practiced and how family language policies are enacted in Singaporean English-Chinese bilingual families, and to what extend macro language policies – i.e. national and educational language policies influence and interact with family language policies. Involving 545 families and including parents and grandparents as participants, the study traces the trajectory of the policy history. Data sources include 2 parts: 1) a prescribed linguistic practices survey; and 2) participant observation of actual negotiation of FLP in face-to-face social interaction in bilingual English-Chinese families. The data provides valuable information on how family language policy is enacted and language practices are negotiated, and what linguistic practices have been changed and abandoned against the background of the Speaking Mandarin Campaign and the current bilingual policy implemented in the 1970s. Importantly, the detailed face-to-face interactions and linguistics practices are able to enhance our understanding of the subtleties and processes of language (dis)continuity in relation to policy interventions. The study also discusses the reality of language management measures in contrast to the government’s ‘separate bilingualism’ (Creese & Blackledge, 2011) expectations with regard to ‘striking a balance’ between Asian and Western culture (Curdt-Christiansen & Silver 2013; Shepherd, 2005) and between English and mother tongue languages (Curdt-Christiansen, 2014). Demonstrating how parents and children negotiate their family language policy through translanguaging or heteroglossia practices (Canagarajah, 2013; Garcia & Li Wei, 2014), this paper argues that ‘striking a balance’ as a political ideology places emphasis on discrete and separate notions of cultural and linguistic categorization and thus downplays the significant influences from historical, political and sociolinguistic contexts in which people find themselves. This simplistic view of culture and linguistic code will inevitably constrain individuals’ language expression as it regards code switching and translanguaging as delimited and incompetent language behaviour.