Anxiety Disorders: Ehrenreich JT

Danielson CK, de Arellano MA, Ehrenreich JT, Suárez LM, Bennett SM, Cheron DM, Goldstein CR, Jakle KR, Landon TM, Trosper SE. · National crime Victims Research & treatment Center, Medical University of South Carolina, Charleston, SC 29403, USA. · J Psychiatr Pract. · Pubmed #17122697 No free full text.

Abstract: An adolescent's possible response to being the victim of interpersonal violence is not limited to posttraumatic stress disorder and depression but may also involve a host of developmental effects, including the occurrence of high-risk behaviors that may have a significant and negative impact on the adolescent's psychological and physical health. Identifying such high-risk behaviors, understanding their possible link to a previous victimization incident, and implementing interventions that have been demonstrated to reduce such behaviors may help decrease potential reciprocal interactions between these areas. Clinicians in psychiatric practice may be in a unique position to make these connections, since parents of adolescents may perceive a greater need for mental health services for youth engaging in problematic externalizing behaviors than for those displaying internalizing symptoms. In this article, the authors first describe high-risk behaviors, including substance use, delinquent behavior, risky sexual behaviors, and self-injurious behaviors, that have been linked with experiencing interpersonal violence. They then review empirically based treatments that have been indicated to treat these deleterious behaviors in order to help clinicians select appropriate psychosocial interventions for this population. Recommendations for future research on the treatment of high-risk behaviors in adolescents are also presented.

Ehrenreich JT, Gross AM. · University of Mississippi, Psychology, PO Box 1848, University of Mississippi, University, MS 38677, USA. · Clin Psychol Rev. · Pubmed #12238250 No free full text.

Abstract: This review examines the state of current theory and research regarding a relatively new area of study in childhood anxiety: the examination of attentional biases associated with the processing of threatening environmental stimuli. In particular, this paper focuses upon current attempts to extend an information processing framework traditionally associated with childhood psychopathology (i.e., Crick & Dodge [Psychol Bull 115 (1994) 74]) and anxiety-related attentional bias research previously conducted only with adults, to populations of anxious children. First, a thorough discussion of Crick and Dodge's model and its applicability to current theories of anxiety is presented. Although each stage of Crick and Dodge's model is shown to possess correlates with current conceptualizations of anxiety, the research investigations reviewed here focus upon the multiple approaches that have been undertaken to better comprehend anxious children's attentional biases in encoding and subsequent task performance decrements. Specifically, recent investigations of anxious children's attentional performance utilizing Stroop tasks, probe detection tasks, and the relatively new probe localization task are reviewed. A discussion of the disparate findings associated with recent studies of each of these tasks is given, with an eye toward the need to specify the developmental, theoretical, demographic, and clinically relevant characteristics associated with the biased attentional behavior observed among highly anxious children.

Bacow TL, Pincus DB, Ehrenreich JT, Brody LR. · Boston University, Center for Anxiety and Related Disorders, 648 Beacon Street, 6th Floor, Boston, MA 02215, United States. · J Anxiety Disord. · Pubmed #19362445 No free full text.

Abstract: A self-report measure of metacognition for both children and adolescents (ages 7-17) (Metacognitions Questionnaire for Children; MCQ-C) was adapted from a previous measure, the MCQ-A (Metacognitions Questionnaire for Adolescents) and was administered to a sample of 78 children and adolescents with clinical anxiety disorders and 20 non-clinical youth. The metacognitive processes included were (1) positive beliefs about worry (positive meta-worry); (2) negative beliefs about worry (negative meta-worry); (3) superstitious, punishment and responsibility beliefs (SPR beliefs) and (4) cognitive monitoring (awareness of one's own thoughts). The MCQ-C demonstrated good internal-consistency reliability, as well as concurrent and criterion validity, and four valid factors. In line with predictions, negative meta-worry was significantly associated with self-reports of internalizing symptoms (excessive worry and depression). Age-based differences on the MCQ-C were found for only one subscale, with adolescents reporting greater awareness of their thoughts than children. Adolescent girls scored higher on the total index of metacognitive processes than adolescent boys. Overall, these results provide preliminary support for the use of the MCQ-C with a broader age range as well as an association between metacognitive processes and anxiety symptomatology in both children and adolescents, with implications for cognitive behavioral interventions with anxious youth.

Cheron DM, Ehrenreich JT, Pincus DB. · Boston University Center for Anxiety and Related Disorders, Boston, MA 02215, USA. · Child Psychiatry Hum Dev. · Pubmed #19280337 No free full text.

Abstract: This investigation seeks to establish the psychometric properties of an adapted measure of experiential avoidance (EA) in the parenting context by assessing its relation to other parenting constructs and psychosocial correlates of child anxiety in a clinical sample. Participants were 154 children (90 female, 64 male) diagnosed with anxiety disorders and their parents (148 mothers, 119 fathers). The newly developed Parental Acceptance and Action Questionnaire (PAAQ) was administered to parents along with self-report measures of adult experiential avoidance, parental psychopathology, affective expression, and parental control behaviors. A subsample of participants, n = 35, were re-administered the PAAQ to assess temporal stability. Factor analysis of the PAAQ yielded a two-factor solution with factors labeled Inaction and Unwillingness. Temporal stability of the PAAQ was found to be moderate, r = .68-.74. Internal consistency was fair across subscales of the PAAQ, alpha = .64-.65. Correlational analysis of the PAAQ and parent-report measures support the criterion validity of the PAAQ, suggesting that the PAAQ correlates with parent-report measures of parental locus of control, affective expression, and controlling parental behaviors as well as child psychopathology symptoms. Finally, the clinical applicability of the PAAQ is indicated by the PAAQ's ability to predict a significant amount of variance in parent- and clinician-rated levels of child anxiety and related psychopathology.

Ehrenreich JT, Micco JA, Fisher PH, Masia Warner C. · Department of Psychology, University of Miami, Coral Gables, FL 33124, USA. · Child Psychiatry Hum Dev. · Pubmed #19165591 No free full text.

Abstract: OBJECTIVE: Research on child and adolescent anxiety disorders has seen a surge in investigations of parenting factors potentially associated with their etiology. However, many of the well-established parenting measures are limited by over-reliance on self-report or lengthy behavioral observation procedures. Such measures may not assess factors most salient to anxiety etiology, since most family functioning measures were not originally developed for this purpose. The Family Assessment Clinician Interview (FACI) was developed as a clinician-administered interview of parent and family factors associated with child and adolescent anxiety. The present study is the first to investigate the psychometric properties of the FACI. METHOD: Using a clinical sample of 65 children with various anxiety disorders, and their parents, inter-rater reliability, convergent validity and associations with child-reported and clinician-evaluated anxiety severity were examined. RESULTS: suggest that the FACI has good to excellent inter-rater reliability with kappas ranging from 0.79 to 1.0 across FACI scales and subscales. Some evidence of convergent validity with relevant portions of the Family Environment Scale was observed, although the latter findings varied by respondent (mother versus father). The Family Warmth/Closeness subscale of the FACI was consistently associated with increased child anxiety symptoms. Contrary to expectations, higher levels of parental expectations were associated with lower levels of child anxiety. CONCLUSION: Results suggest that the FACI is a promising measure of family anxiety constructs that may be useful in both research and clinical settings.

Micco JA, Ehrenreich JT. · Center for Anxiety and Related Disorders at Boston University, Boston, MA, United States. · J Anxiety Disord. · Pubmed #17434288 No free full text.

Abstract: This study examined the effect of situation salience on interpretation and avoidant response biases in clinically anxious and non-clinical children. The relationship between mothers' threat perception and expectations of their children's coping, and children's threat perception and coping expectations was also assessed. Forty clinically anxious and 40 non-clinical children (ages 7-14) participated with their mothers. In response to hypothetical situations, children described their likely thoughts and actions; mothers listed a typical child's thoughts and what their child would do. Consistent with information processing theories of anxiety, anxious children displayed amplified cognitive biases in response to personally salient situations, compared to non-clinical children. Mothers of anxious children had lower expectations for their children's coping than mothers of non-anxious children, mirroring differences between the groups of children. Mothers' expectations of their children's coping predicted children's coping expectations in non-salient and salient situations and threat perception in salient situations. Implications of findings are discussed.

Landon TM, Ehrenreich JT, Pincus DB. · Department of Psychology, Boston University, 648 Beacon Street, 6th Floor, Boston, MA 02215, USA. · Child Psychiatry Hum Dev. · Pubmed #17131178 No free full text.

Abstract: Although diminished self-efficacy has been linked to childhood psychopathology, including depression, it has only recently been studied in relation to childhood anxiety disorders. This study examines the relationship between self-efficacy and self-reported anxiety in children who have been referred for an assessment and possible treatment of anxiety symptoms as well as a comparison group of non-referred children. A self-efficacy questionnaire for children and a childhood anxiety measure were administered to a group of children referred for assessment and treatment of a clinical anxiety disorder (n = 50) and a non-referred control group (n = 50). Results indicate that the two samples differed significantly on measures of emotional self-efficacy, but not in terms of self-reported anxiety or other self-efficacy domains. Potential explanations for observed findings are discussed, including the possibility that self-reports of emotional self-efficacy in children may vary by clinical or referral status, amongst those reporting higher levels of anxiety overall.

Meuret AE, Ehrenreich JT, Pincus DB, Ritz T. · Department of Psychology, Southern Methodist University, 6424 Hilltop Lane, Dallas, TX 75205, USA. · Depress Anxiety. · Pubmed #16841339 No free full text.

Abstract: Our objective was to determine the prevalence rate of parent-reported asthma in children with internalizing disorders seeking psychological treatment, and to study the level of internalizing and externalizing problems in these patients compared to patients without asthma. Participants were 367 children (ages 5-18 years) with internalizing disorders seeking psychological treatment. Children's psychiatric diagnosis was established with the Anxiety Disorders Interview Schedule for DSM-IV-Child and Parent versions. Parents reported on their child's asthma diagnosis, medical history, and medication usage. Child psychopathology was assessed with the Child Behavior Checklist and by child self-report with the Multidimensional Anxiety Scale for Children and the Children's Depression Inventory. We assessed internalizing psychopathology of the mothers with the Depression Anxiety and Stress Scale. An additional diagnosis of parent-reported asthma was established for 15% of the children diagnosed with an Axis I internalizing disorder, a prevalence rate markedly higher than reported for current parent-reported childhood asthma in the U.S. population. Patients with asthma showed higher levels of internalizing problems than their nonasthmatic counterparts. Internalizing psychopathology was not higher for mothers of patients with asthma. Asthma is a significant problem within the population of patients with childhood internalizing disorders. It can be accompanied by a greater severity of internalizing problems and may require specific precautions in the treatment protocol. Though parent report of asthma diagnosis is commonly used in surveys of childhood asthma, our findings have to be viewed in the light of its limitations.