Personalized Assessment of Anxiety and Avoidance in Children and Their Parents—Development and Evaluation of the Anxiety and Avoidance Scale for Children

In treating childhood anxiety disorders, therapists use highly individualized anxiety hierarchies to assess anxiety-eliciting situations and to personalize treatment. In contrast, psychometric assessment of anxiety symptoms in children usually consists of standardized questionnaires, assessing either total anxiety or disorder-specific symptom scores, prioritizing comparability over individual information. To account for interindividual differences, the Anxiety and Avoidance Scale for Children (AVAC) was developed, following a precise, personalized, assessment approach. In responding to the questionnaire, children and parents identify the most anxiety-eliciting situations before starting treatment, and rate them for anxiety and avoidance. Ratings are repeated over the course of treatment. The aim of this study is to introduce the new questionnaire and present first data on psychometric properties. The AVAC was administered to 389 children with separation anxiety disorder (N = 148), social anxiety disorder (N = 110) or specific phobia (N = 131) aged 8 to 16 and their parents, along with other measures of anxiety and psychopathology before and after cognitive behavioral treatment. Results showed adequate to good test-retest reliability. The AVAC items correlated significantly with established anxiety questionnaires, indicating convergent construct validity. Regarding divergent construct validity, the AVAC showed only small correlations with externalizing symptoms, demonstrating its precision in measuring anxiety and avoidance. The questionnaire was also sensitive to change after treatment, with medium to large effects in the reduction of anxiety and avoidance. The present analyses suggest that the new personalized assessment approach with the AVAC is a reliable and valid assessment of individualized anxiety and avoidance, as well as change in those constructs over the course of CBT treatment.

A Review on Pediatric Social Phobia and Selective Mutism

Selective mutism (SM) is a psychological disease that affects children and is defined by a complete lack of speech in certain social contexts while speech production appears normal in others. Separation anxiety disorder, social anxiety disorder (previously known as social phobia), agoraphobia, and panic disorder, as well as shyness and anxiety, can all be associated with selective mutism. SM is a rather uncommon condition. Estimates of its point prevalence have been found in clinic or school samples in a variety of countries, and typically range between 0.03 percent and 1.9 percent depending on the setting. To properly establish the disorder's diagnosis, clinicians can use the SM module of the Anxiety Disorders Interview Schedule for Children and Parents (ADIS-C/P) or the Schedule for Affective Disorders and Schizophrenia for Children (Kiddie- or K-SADS). Nonmedication and medication-based therapies are the two basic types of treatment for selective mutism. Psychodynamic therapy, behavioural therapy, and family therapy are among the most common nonmedication-based or psychotherapy treatments. Selective seratonin reuptake inhibitors (SSRIs) (fluoxetine in particular) have been demonstrated to improve mutism and anxiety when used as a treatment option. The study aims to evaluate and treat selective silence and social phobia in children.

Association Between Family Structure and Anxiety Disorder Among Pre-schoolers: A Cross-Sectional Study in Urban Chongqing, China

Objective: This study explores the current situation of anxiety disorder of pre-schoolers and assesses the association between family structure and anxiety disorder (AD) among pre-schoolers in Chongqing, China.Methods: This is a cross-sectional study of 499 main fosterers of children aged 3–6 years who completed the 28-item Chinese version of the Spence Pre-school Anxiety Scale (PAS). Multinomial logistic regression with three models was used to assess the association of the family structure with the different AD.Results: The prevalence of AD was 31.46%, whose score of PAS were more than 48. Among the five different PAS sub-scales, the prevalence of obsessive-compulsive disorder (OCD) was the highest (50.10%), followed by separation anxiety disorder (SAD, 39.28%), fear of physical harm (FPH, 37.68%), generalized anxiety disorder (GAD, 33.47%), and social phobia (SP, 25.85%). Pre-schoolers from inter-generational families were more probably have AD than those from nuclear families (OR = 3.73, p < 0.05). The participants from inter-generational families were more likely to have SAD (OR = 3.39, p < 0.05), FPM (OR = 2.80, p < 0.05), or OCD (OR = 2.40, p < 0.05), in comparison with participants from other family structures.Conclusion: Anxiety disorder among pre-schoolers aged 3–6 in Chongqing is widespread. Pre-schoolers from inter-generational families were more probably have AD, SAD, FPM, and OR and pre-schoolers from stem families may be less likely to have SAD compared with those from nuclear families. Relieving the anxiety of pre-schoolers may be possible with additional interventional efforts in inter-generational families.

Comparing of the Effectiveness of Child-Centered Play Therapy and Child-Parent Relationship Therapy (CPRT) on the Affective Style in Children with Separation Anxiety Disorder

Aims: The purpose of this study was to compare the effectiveness of child-centered play therapy and (CPRT) on the affective styles in children suffering from separation anxiety disorder. Method: The research method was semi-experimental with pre-test and post-test and control groups. The statistical population of this study consisted of all female students with separation anxiety in the fifth and sixth grades of primary schools in city of Babol, of whom 45 of these students were selected via random sampling, and were randomly divided into three groups: experimental group-1, experimental group-2 and control group. The first experimental group received child-centered play therapy with Axline approach in sixteen 45-minute sessions, and the second experimental group were taught (CPRT) ten 2-hour sessions. The research instruments were questionnaire (form d) of the children Symptoms Inventory (Sprafkin, Lani & Gadow, 1994) and the Affective Style Questionnaire (Hofmann & Kashdan, 2010) . Covariance was used to analyze the data. Findings: The results showed that both interventions play an effective role in improving the affective styles in children with separation anxiety disorder. Moreover, there was a significant difference between the effectiveness of (CPRT) and child-centered play therapy and the (CPRT) was more effective in improving the affective styles there (p< 0/05). Conclusions: CPRT training can be considered as a more suitable alternative in improving the affective styles as well as in improving the psycho-cognitive symptoms of children with separation anxiety disorder.

KNOWLEDGE OF PARENTS TOWARDS SEPARATION ANXIETY DISORDER IN SAUDI ARABIA

Background:Anxiety is a common condition among young children that can be detected in the early years of life. Separation anxiety is a subtype of anxiety that can affect young children and negatively inuence their physical and intellectual development. Hence, the knowledge of parents about separation anxiety is crucial to reduce its incidence among children, Objective: This survey analysis aims to investigate the knowledge of parents living in Saudi Arabia towards separation anxiety, its causes, risk factors diagnosis, and treatment. Design and Setting:Aself-administered structured survey was sent to the public online targeting parents. The survey included questions to collect data on parents' demographics, their children, their knowledge about separation anxiety, and any children with separation anxiety. Data analysis was excuted through SPSS program version 26. Results: 1090 parents responded to this online survey, with 27.9% of them were in the age group between 36 to 45 years old, and 29.4% had two children aged less than 18 years old. As for the knowledge of patients regarding separation anxiety, 23.6% knew about the disease. 29.4% of parents strongly agreed that separation anxiety is a medical condition; 21.6% strongly agreed that these children are anxious and avoid going to school. As for parents who have children with separation anxiety, 7.6% of the parents had children with separation anxiety, and 7.3% had children with an age onset of the disease at less than four years old. As for treatment, 42.4% of the responders strongly agreed that separation anxiety should be treated as soon as possible to prevent mental health problems, and 73.2% of parents agreed that it could be achieved through family therapy, while only 4.2% of parents thought that there is no treatment for separation anxiety. The parents' average knowledge score was 4.6±3.6, with a minimum score of zero and a maximum score of 27. Factors that can signicantly inuence knowledge towards separation anxiety are gender, age group, nationality, marital status, educational level, employment status, place of residence, and having children less than 18 years old at p-value <0.001. Conclusion: The knowledge of parents towards childhood separation anxiety is considered unsatisfactory and requires improvement. Awareness campaigns in public areas should be held for this purpose.

PSYCHIATRIC DISORDERS IN CHILDREN: PATTERN AND CORRELATES AMONG THOSE REPORTING TO A TERTIARY CARE HOSPITAL

Objective: To determine the pattern of psychiatric disorders among children reporting to the Psychiatry department Pakistan Naval Ship Shifa Hospital, Karachi. Study Design: Comparative cross sectional study. Place and Duration of Study: Psychiatry department Pakistan Naval Ship Shifa Hospital, Karachi, from Feb to Aug 2018. Methodolgy: A total of 100 children, aged between 6-12 years of age, both male and female, meeting the selection criteria of the study, presenting to the Psychiatry department at Pakistan Naval Ship Shifa Hospital, were enrolled for this study. Informed consent was taken from the parents. The consultant psychiatrist interviewed the patients and diagnosed any psychiatric disorders based on international classification of diseases version 10. The data was recorded on the study proforma. Results: Out of a total of 100 children, 66 (66%) were male, while 34 (34%) were female. The mean age of the participating children was 8.66 + 1.97 years. The most common psychiatric disorder was attention deficit hyperactivity disorder 44 (44%), followed by depression 30 (30%). Other diagnoses included oppositional defiant disorder 12 (12%), conduct disorder 9 (9%) and separation anxiety disorder 5 (5%). Conclusion: Attention deficit hyperactivity disorder and depression are amongst the quite prevalent psychiatric disorders, than that was considered earlier.