Psychologische Inflexibiliteit bij Kinderen: Invloed op de Relatie tussen en de Samenhang met Gepest worden en (Sociale) Angst

Pesten komt voor op alle scholen en kan psychosociale gevolgen hebben zoals (sociale) angst klachten. Op cognitieve gedragstherapie gebaseerde interventies hebben dikwijls de voorkeur bij behandeling van de klachten. De cognitieve vaardigheden van kinderen van 8 tot 11 jaar schieten echter soms tekort om optimaal te kunnen profiteren van cognitieve therapie. Acceptance and Commitment Therapy (ACT) zet in op het vergroten van de psychologische flexibiliteit en is mogelijk een geschikte alternatieve therapie voor kinderen. In de huidige studie werd onderzocht of psychologische inflexibiliteit een onderliggend probleem vormt bij kinderen die angsten hebben of dat gepest worden de kwetsbaarheid voor psychologische inflexibiliteit vergroot. Er werd een positieve samenhang tussen de variabelen psychologische inflexibiliteit, (sociale) angst en gepest worden verwacht. Tevens werd verwacht dat de positieve samenhang tussen gepest worden en (sociale) angst wordt gemodereerd door psychologische inflexibiliteit. Aan 126 kinderen, 66 jongens en 60 meisjes in de leeftijd van 8 tot 11 jaar, afkomstig van basisscholen in Zuid-Nederland werd door de ouders toestemming verleend voor deelname. Eenmalig werden een drietal zelfrapportage vragenlijsten klassikaal aan de kinderen voorgelegd. (Sociale) angst werd gemeten met de Screen for Child Anxiety Related Emotional Disorders-71 (SCARED-71), gepest worden werd gemeten met de Personal Experience Checklist-32 (PECK-32) en psychologische inflexibiliteit werd gemeten met de Avoidance and Fusion Questionnaire for Youth (AFQ-Y). Er werd een positieve samenhang gevonden tussen psychologische inflexibiliteit, (sociale) angst en gepest worden. Een moderatie effect van psychologische inflexibiliteit op de relatie tussen gepest worden en (sociale) angstklachten werd niet gevonden. De huidige studie bevestigt dat psychologische inflexibiliteit een onderliggend probleem vormt voor kinderen met angsten of kinderen die gepest worden. De gevonden verbanden bleken sterker voor angst als algemene trek dan voor sociale angst. Geslacht werd ter controle meegenomen in de analyses, maar verschillen tussen jongens en meisjes werden niet gevonden. ACT vermindert de psychologische inflexibiliteit door het versterken van de psychologische flexibiliteit. De verwachting dat de inzet van ACT de angstklachten en de gevolgen van het gepest worden bij kinderen kan verminderen wordt middels deze studie ondersteund. Verklaringen, beperkingen en relevantie worden besproken evenals suggesties voor verder onderzoek.

Effectiviteit van Preventieve Interventies op het Gezinsfunctioneren bij hoogangstige Kinderen

Het doel van dit onderzoek is inzicht geven in het effect van preventieve angstinterventies op verschillende stijlen (algeheel, functioneel, disfunctioneel) van het gezinsfunctioneren bij hoogangstige kinderen en hun ouders. De proefpersonen (N = 2494) werden gerekruteerd op basisscholen. Uiteindelijk bleven 150 respondenten over. Deze respondenten bestaan uit 70 (46.7%) jongens en 80 (53.3%) meisjes. De respondenten zijn kinderen van 8 tot 13 jaar. De gemiddelde leeftijd van de respondenten is 9.83 jaar (SD = 1.14), de jongste is 8 en de oudste is 13 jaar. De screeningsprocedure is uitgevoerd met de kindversie van de zelfrapportage vragenlijst Screen for Child Anxiety Related Emotional Disorders. Na screening werden de hoogangstige kinderen en hun ouders gerandomiseerd over de drie onderzoekscondities. Daarnaast werd aan de deelnemers gevraagd de Family Functioning Scale in te vullen. Maximaal 3 maanden na de screening vond de voormeting plaats bij kinderen en ouders, hierna vond na maximaal 6 weken de interventie plaats. Na de voormeting volgden de follow-up metingen na respectievelijk 1 en 2 jaar. Om de variabele angst te meten is gebruik gemaakt van de Screen for Child Anxiety Related Emotional Disorder (SCARED-71; Bodden, Bögels, & Muris, 2009). Om de variabele gezinsfunctioneren te meten is gebruik gemaakt van de Family Functioning Scale (FFS; Bloom, 1985). De resultaten lieten zien dat het gezinsfunctioneren bij hoogangstige kinderen en hun ouders niet verbetert na het volgen van een interventie of geen interventie. Daarnaast is geen verschil in effectiviteit gevonden tussen de kind- of oudergerichte interventie op de verschillende aspecten van het gezinsfunctioneren.

A ansiedade infantil : vulnerabilidades da criança e influência dos pais

Tese de Doutoramento em Psicologia na área de especialidade Psicologia Clínica

Évaluation de l’anxiété, de la détresse et de la douleur provoquée par l’examen anogénital chez les enfants soupçonnés d’avoir été victime d’agression sexuelle

Essai doctoral présenté à la Faculté des études supérieures en vue de l’obtention du grade de Docteur en psychologie (D.Psy.), option clinique

Évaluation de l’anxiété, de la détresse et de la douleur provoquée par l’examen anogénital chez les enfants soupçonnés d’avoir été victime d’agression sexuelle

Essai doctoral présenté à la Faculté des études supérieures en vue de l’obtention du grade de Docteur en psychologie (D.Psy.), option clinique

Parent and child perspectives on the nature of anxiety in children and young people with Autism Spectrum Disorders: a focus group study

Anxiety disorders are common among children and young people with Autism Spectrum Disorders (ASD). Despite growing knowledge about the prevalence, phenomenology and treatment of anxiety disorders, relatively little is understood about the nature and impact of anxiety in this group and little is known about autism-specific factors that may play a role in the increased prevalence of anxiety disorders. In this exploratory study, we report on a series of 5 focus groups with 17 parents of children and adolescents with ASD and anxiety. Across groups, parents gave strikingly similar descriptions of the triggers and behavioural signs associated with anxiety. Another consistent finding was that many parents reported that their children had great difficulty expressing their worries verbally and most showed their anxiety through changes in their behaviour. The impact of anxiety was reported to often be more substantial than the impact of ASD itself. The implications of the focus group findings are discussed in relation to existing literature.

Doll Play narratives about starting school in children of socially anxious mothers, and their relation to subsequent child school-based anxiety

Background: Child social anxiety is common, and predicts later emotional and academic impairment. Offspring of socially anxious mothers are at increased risk. It is important to establish whether individual vulnerability to disorder can be identified in young children. Method: The responses of 4.5 year-old children of mothers with social phobia (N = 62) and non-anxious mothers (N = 60) were compared, two months before school entry, using a Doll Play (DP) procedure focused on the social challenge of starting school. DP responses were examined in relation to teacher reports of anxious-depressed symptoms and social worries at the end of the child’s first school term. The role of earlier child behavioral inhibition and attachment, assessed at 14 months, was also considered. Results: Compared to children of non-anxious mothers, children of mothers with social phobia were significantly more likely to give anxiously negative responses in their school DP (OR = 2.57). In turn, negative DP predicted teacher reported anxious-depressed and social worry problems. There were no effects of infant behavioral inhibition or attachment. Conclusion: Vulnerability in young children at risk of anxiety can be identified using Doll Play narratives.

Parent-child interactions and adolescent anxiety: a systematic review

Parental behaviours have been implicated in the development and maintenance of anxiety in children and young people; however the degree to which findings apply to adolescents specifically remains unclear. We conducted a systematic review of studies examining the evidence for an association between parental behaviours and adolescent anxiety. Twenty two studies were identified. The results of this systematic review provide fairly consistent preliminary evidence for an association between anxiety and perceived parental control and anxious rearing in adolescence. The findings relating to an association between adolescent anxiety and perceived parental rejection and lack of warmth are somewhat less consistent. Methodological shortcomings in the studies mean that these results should be interpreted with caution. Future research should be conducted using observational and experimental design with adolescents from referred, clinical populations to help identify the critical parental processes and clarify the direction of effects.

Early life stress and child temperament style as predictors of childhood anxiety and depressive symptoms : findings from the longitudinal study of Australian children

Objective. The purpose of this study was to determine whether the relationship between stressful infant environments and later childhood anxiety and depressive symptoms varies as a function of individual differences in temperament style.

Methods. Data was drawn fromthe Longitudinal Study of Australian Children (LSAC). This study examined 3425 infants assessed at three time points, at 1-year, at 2/3 years and at 4/5 years. Temperament was measured using a 12-item version of Toddler Temperament Scale (TTS) and was scored for reactive, avoidant, and impulsive dimensions. Logistic regression was used to model direct relationships and additive interactions between early life stress, temperament, and emotional symptoms at 4 years of age. Analyses were adjusted for socioeconomic status, parental education, andmarital status.

Results. Stressful family environments experienced in the infant’s first year of life (high versus low) and high reactive, avoidant, and impulsive temperament styles directly and independently predicted anxiety and depressive problems in children at 4 years of age. There was no evidence of interaction between temperament and family stress exposure.

Conclusions. Both infant temperament and stress exposures are independent and notable predictors of later anxiety and depressive problems in childhood. The risk relationship between stress exposure in infancy and childhood emotion problems did not vary as a function of infant temperament. Implications for preventive intervention and future research directions are discussed.

Parent-child agreement using the Spence Children's Anxiety Scale and a thermometer in children with autism spectrum disorder

Children with Autism Spectrum Disorder (ASD) experience high anxiety which often prompts clinical referral and requires intervention. This study aimed to compare parent and child reports on the Spence Children's Anxiety Scale (SCAS) and a child-reported "worry thermometer" in 88 children aged 8-13 years, 44 with ASD and 44 age, gender, and perceptual IQ matched typically developing children. There were no gender differences in child report on the SCAS and worry thermometers. Results indicated generally good correlations between parent and child self-reported SCAS symptoms for typically developing children but poor agreement in parent-child ASD dyads. The worry thermometer child-report did not reflect child or parent reports on the SCAS. Findings suggest 8-13-year-old children with ASD may have difficulties accurately reporting their anxiety levels. The clinical implications were discussed.

The impact of maternal smoking during pregnancy on depressive and anxiety behaviors in children: the Norwegian Mother and Child Cohort Study.

BACKGROUND: Maternal smoking during pregnancy (MSDP) is associated with multiple adverse childhood outcomes including externalizing behaviors. However, the association between MSDP and internalizing (anxiety and depressive) behaviors in offspring has received less investigation. We aimed to assess the association between MSDP and childhood internalizing (anxiety and depressive) behaviors in a very large, well-characterized cohort study. METHODS: We assessed the association between MSDP and internalizing behaviors in offspring utilizing information drawn from 90,040 mother-child pairs enrolled in the Norwegian Mother and Child Cohort Study. Mothers reported smoking information, including status and frequency of smoking, twice during pregnancy. Mothers also reported their child's internalizing behaviors at 18 months, 36 months, and 5 years. Associations between MSDP and childhood internalizing behaviors, including dose-response and timing of smoking in pregnancy, were assessed at each time point. RESULTS: MSDP was associated with increased internalizing behaviors when offspring were aged 18 months (B = 0.11, P <0.001) and 36 months (B = 0.06, P <0.01), adjusting for numerous potential confounders. Higher rates of smoking (e.g., >20 cigarettes per day) were associated with higher levels of internalizing behaviors. Maternal smoking during early pregnancy appeared to be the critical period for exposure. CONCLUSIONS: We found evidence supporting a potential role for MSDP in increasing internalizing (anxiety and depressive) behaviors in offspring. We also found evidence supportive of a possible causal relationship, including dose-dependency and support for a predominant role of early pregnancy exposure. Further investigation utilizing genetically informed designs are warranted to assess this association.

The impact of a child's unexpected hospitalization upon Taiwanese parents' situational anxiety

Background. The parents of a sick child likely experience situational anxiety due to their young child being unexpectedly hospitalized. The emotional upheaval may be great enough that their anxiety inhibits them in providing positive support to their hospitalized child. Because anxiety affects psychological distress as well as behavioral distress, identifying parental distress helps parents improving their coping mechanisms. ^ Purpose. The study compared situational anxiety levels between Taiwanese fathers and mothers and focused on differences between parental anxiety levels at the beginning of the child's unplanned hospitalization and at time of discharge. The study also identified factors related to the parents' distress and use of coping mechanisms. ^ Methods. A descriptive, comparative research design was used to determine the difference between the anxiety levels of 62 Taiwanese father-mother dyads during the situational crisis of their child's unexpected hospitalization. The Mandarin version (M) of Visual Analog Scale (VAS-M), State-Trait Anxiety Inventory (STAI-M), and the Index of Parent Participation/Hospitalized Child (IPP/HC-M) were used to differentiate maternal and paternal anxiety levels and identify factors related to the parents' distress. Questionnaires were completed by parents within 24-36 hours of the child's hospital admission and within 24 hours prior to discharge. A paired t-test, two sample t-test, and linear mixed regression model were used to test and support the study hypothesis. ^ Results. The findings reveal that the mothers' anxiety levels did not significantly differ from the fathers' anxiety level when their child had a sudden admission to the hospital. In particular, parental state anxiety levels did not decrease during the child's hospital stay and subsequent discharge. Moreover, anxiety levels did not differ between parents regardless of whether the child's disease was acute or chronic. The most effective factor related to parental situational anxiety was parental perception of the severity of the child's illness. ^ Conclusions. Parental anxiety was found to be significantly related to changes in their perception of the severity of their child's illness. However, the study was not able to illustrate how parental involvement in the child's hospital care was related to parental perception of the severity of their child's illness. Future studies, using a qualitative approach to gamer more information as to what variables influence parental anxiety during a situational crisis, may provide a richer database from which to modify key variables as well as the instruments used to improve the quality of the data obtained. ^

A Young Child's Anxiety and Math Performance: Enhancing Cognitive Behavioral Intervention with Conjoint Behavioral Consultation

Partnering with families, school personnel, and community resources is an important step to supporting the child and family, especially when children might suffer from debilitating anxiety concerns. However, little research examines the impact of anxiety on math performance for young children participating in school-based interventions enhanced by family components. The following research questions were addressed in the study: 1a) Will a young child with elevated levels of anxiety show a decrease in anxiety symptoms with a Cognitive Behavioral framework intervention program for children? 1b) Will anxiety be reduced with the addition of a Conjoint Behavioral Consultation with the family and teacher? 2a) Will a young child show an increase in math performance after participation in a Cognitive Behavioral framework intervention program for children? 2b) Will math performance be increased with the addition of a Conjoint Behavioral Consultation with the family and teacher? A single-subject staggered baseline across situations intervention study addressed whether the Coping Cat, an evidenced-based child-focused intervention now widely used in schools and clinics to treat childhood anxiety, combined with family and school consultation will decrease elevated anxiety levels and improve math performance in an elementary-aged student. The objective was to support mental health development and math performance with an eight-year-old, female elementary student through a collaborative effort of stakeholders in the student's life. Baseline data was collected with repeated measures of anxiety and math performance, and was compared to two intervention phases: first, a child-focused intervention and second, a family and school consultation. The study tested the theory that the Cognitive Behavioral intervention and Conjoint Behavioral Consultation intervention will influence, positively, the anxiety levels and math performance for an elementary-aged student. Results indicate that the child participant with elevated levels of anxiety showed a reduction in symptoms with the introduction of a Cognitive Behavioral framework intervention when compared to her baseline data. The participant showed further reduction in symptoms across the school and home settings with the implementation of Conjoint Behavioral Consultation when compared to baseline and the first intervention phase. Math performance began to increase with the introduction of the Cognitive Behavioral intervention, and continued to improve with the implementation of the Conjoint Behavioral Consultation. Findings suggest that consultation should begin immediately when an intervention is implemented in order to enhance outcomes.

Evaluation of a brief child-focused group-based intervention for anxiety-disordered children

This paper presents a pilot study of a brief, group-based, cognitive-behavioural intervention for anxiety-disordered children. Five children (aged 7 to 13 years) diagnosed with a clinically significant anxiety disorder were treated with a recently developed 6-session, child-focused, cognitive-behavioural intervention that was evaluated using multiple measures (including structured diagnostic interview, self-report questionnaires and behaviour rating scales completed by parents) over four follow-up occasions (posttreatment, 3-month follow-up, 6-month follow-up and 12-month follow-up). This trial aimed to (a) evaluate the conclusion suggested by the research of Cobham, Dadds, and Spence (1998) that anxious children with non-anxious parents require a child-focused intervention only in order to demonstrate sustained clinical gains; and (b) to evaluate a new and more cost-effective child-focused cognitive-behavioural intervention. Unfortunately, the return rate of the questionnaires was poor, rendering this data source of questionable value. However, diagnostic interviews (traditionally the gold standard in terms of outcome in this research area) were completed for all children at all follow-up points. Changes in diagnostic status indicated that meaningful treatment-related gains had been achieved and were maintained over the full follow-up period. The results would thus seem to support the principle of participant-intervention matching proposed by Cobham et al. (1998), as well as the utility of the more brief intervention evaluated.