Anxiety Disorders: Manassis K

Manassis K. · University of Toronto, Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada. · Expert Rev Neurother. · Pubmed #17678493 No free full text.

Abstract: Anxiety disorders (ANX) and attention-deficit/hyperactivity disorder (ADHD) commonly co-occur; this comorbidity is associated with a high degree of impairment and a poor long-term prognosis. In this review, the nature of this comorbidity and its treatment will be described, and an approach to treating children with ANX + ADHD will be presented. The etiology of ANX + ADHD is controversial, with biological, developmental, environmental and cognitive factors examined in various studies. There is increasing evidence that ANX + ADHD may be distinct from each separate disorder, and may represent a neuropsychiatric condition that involves dysregulation in both anxiety and ADHD domains. Treatment usually requires a combination of medication and psychotherapeutic intervention. Stimulant medications have been found most helpful so far compared with other medications, although atomoxetine is also being studied. There is limited evidence for selective serotonin reuptake inhibitors, and their potential for behavioral activation may be problematic in these children. Intensive behavior modification was shown to be beneficial in conjunction with medication for ANX + ADHD in a multimodal treatment study of children with ADHD. Cognitive-behavioral therapy has been used to address anxiety symptoms, but may need to be individualized in ANX + ADHD as cognitive limitations and ADHD behaviors may otherwise interfere. Parental anxious or ADHD traits and the child's developmental level must also be considered to optimize treatment.

Adler-Nevo G, Manassis K. · Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. · Depress Anxiety. · Pubmed #16180209 No free full text.

Abstract: Despite the prevalence of childhood trauma, studies regarding psychotherapy for children suffering from posttraumatic stress disorder (PTSD) are scarce, especially regarding the treatment for pediatric PTSD following single-incident trauma. Treatment practices for this population rely mainly on the paradigms of therapy for adult PTSD and pediatric PTSD following sexual abuse. This review outlines the studies published in the last 10 years pertaining to the treatment of pediatric PTSD following single-incident trauma. This is done in the context of available literature on the paradigms mentioned above. Of 742 articles dealing with treatment of pediatric trauma, 10 were found relevant to the treatment of pediatric PTSD following single-incident trauma. The modalities of treatment most frequently reported in this context were cognitive-behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and play therapy. As a whole, CBT studies were methodologically more rigorous, used manualized, reproducible treatment, and were group, school-based therapies. EMDR treatments were usually short and individual. Most studies showed statistically significant improvement but were still methodologically lacking. We conclude that research on the subject of treatment for pediatric PTSD following single-incident trauma constitutes a neglected part of the study of pediatric PTSD. This stands in contrast to the obvious prevalence of this type of trauma. We encourage future research that will address issues such as clarifying the role of pharmacotherapy, comparing different modes of treatment, dismantling treatment "packages," researching developmentally sensitive treatments, conducting long-term follow-up, and comparing different PTSD populations.

Manassis K. · Department of Psychiatry, Hospital for Sick Children, Toronto, Ont. · Can Fam Physician. · Pubmed #15318675 links to  free full text

Abstract: OBJECTIVE: To present an approach to intervention in childhood anxiety disorders. SOURCES OF INFORMATION: This paper is based on selected findings from a MEDLINE search for recent literature on childhood anxiety disorders and on my experience as a child psychiatrist and researcher in a specialized anxiety disorders clinic. MAIN MESSAGE: Children with symptoms of high sympathetic arousal; persistent worries or intrusive thoughts; and extreme clinging, avoidance, or repetitive behaviours that interfere with daily functioning should be investigated for anxiety disorders. Counseling parents, relaxation techniques, and incentives for "brave" behaviour can often return children with mild disorders to age-appropriate functioning. Children who are severely impaired or fail to respond to these simple interventions might require medication or referral for cognitive-behavioural therapy. CONCLUSION: Family physicians can play an important role in recognizing and intervening early in childhood anxiety disorders.

Manassis K. · Anxiety Disorders Program, Hospital for Sick Children, Toronto, Ontario. · Can J Psychiatry. · Pubmed #11086555 No free full text.

Abstract: Studies of childhood anxiety disorders have increased in recent years, but the clinical implications of the work are sometimes difficult to discern. This paper reviews salient findings (related to the assessment and management of anxious children) published in the last 5 years. The high comorbidity among disorders, the occurrence of different disorders in the same child over time, recent changes in diagnostic categories, the availability of new anxiety measures, and poor correspondence between parent and child reports of symptoms all underscore the need for thorough assessment. Increasing evidence supports cognitive-behavioural treatments for anxiety disorders, alone or in combination with pharmacotherapy. Other important aspects of management suggested by developmental studies of anxious children include psychoeducation about constitutional factors in the development of anxiety, interventions to address parental anxiety, parenting advice regarding behaviour management and reduction of family conflict, and treatment of child impairment to decrease the risk of depression. Questions requiring further research are identified.

Manassis K, Mendlowitz SL, Scapillato D, Avery D, Fiksenbaum L, Freire M, Monga S, Owens M. · Department of Psychiatry, Hospital for Sick Children, Toronto, Canada. · J Am Acad Child Adolesc Psychiatry. · Pubmed #12447028 No free full text.

Abstract: OBJECTIVE: To compare the efficacy of group and individual cognitive-behavioral therapy (CBT) in children with Axis I anxiety disorders. It was hypothesized that certain subgroups would respond preferentially to one modality. METHOD: Seventy-eight children aged 8-12 years with diagnosed anxiety disorders were randomly assigned to a 12-week, manual-based program of group or individual CBT, both with parental involvement. Outcomes included child anxiety (child and parent report) and global functioning as estimated by clinicians. Repeated-measures analyses of variance (ANOVAs) were done. The sample was then dichotomized by self-reported social anxiety (high/low) and parent-reported hyperactivity (high/low) using median splits, and diagnostically by generalized anxiety disorder versus phobic disorders. ANOVAs were repeated. RESULTS: Children and parents reported significantly decreased anxiety and clinicians reported significantly improved global functioning regardless of treatment modality. Children reporting high social anxiety reported greater gains in individual treatment than in group treatment (p <.01). Parent reports of hyperactivity and diagnostic differences were not associated with differential treatment response by modality. CONCLUSIONS: Children with anxiety disorders appear to improve with CBT, whether administered in a group or individual format. A subgroup of children reporting high social anxiety may respond preferentially to individual treatment. Replication of these findings is indicated.

Mendlowitz SL, Manassis K, Bradley S, Scapillato D, Miezitis S, Shaw BF. · Hospital for Sick Children, Toronto, Ontario, Canada. · J Am Acad Child Adolesc Psychiatry. · Pubmed #10517054 No free full text.

Abstract: OBJECTIVES: This study examined (1) the effect of a cognitive-behavioral group intervention on anxiety, depression, and coping strategies in school-age children (aged 7-12 years) with Axis I anxiety disorders; and (2) the effect of parental involvement on treatment outcomes. METHOD: Parents and children (N = 62) were randomly assigned to one of three 12-week treatment conditions: parent and child intervention, child-only intervention, and parent-only intervention. Child anxiety, depression, and coping strategies were assessed before and after treatment. RESULTS: All treatment groups reported fewer symptoms of anxiety and depression posttreatment and changes in their use of coping strategies. Children in the parent and child intervention used more active coping strategies posttreatment compared with children in the other 2 treatment conditions. Parents in this treatment condition reported a significantly greater improvement in their children's emotional well-being than parents in the other treatment conditions. CONCLUSIONS: Cognitive-behavioral group interventions reduced symptoms of anxiety and depression in school-age children with anxiety disorders. Concurrent parental involvement enhanced the effect on coping strategies. Further investigation is needed to corroborate the effectiveness of such short-term interventions and the maintenance of treatment effects.

Nevo GA, Manassis K. · Department of Psychiatry, Sunnybrook Health Sciences Centre, Ontario, Canada. · Depress Anxiety. · Pubmed #19496175 No free full text.

Abstract: BACKGROUND: Anxiety disorders are the most common psychiatric disorders of childhood, generating significant distress in the individual and an economic burden to society. They are precursors to diverse psychiatric illnesses and have an impact on development. Childhood anxiety's reach into the future accentuates the importance of studying the long-term effect of treatment. The purpose of this paper is to examine existing Long-Term-Follow-Up (LTFU) studies' capacity to inform us on the impact of anxiety treatment on development. METHOD: Medline, PsycInfo, SciSearch, SocScisearch, Cinhal, Embase, and the Cochrane library were searched. Bibliographies of relevant book chapters and review articles and information from colleagues with expertise in anxiety were also a source of information. The search produced more than a thousand citations. Only eight studies met inclusion criteria: follow-up of a cohort of treated anxious youth for more than 2 years. RESULTS: follow-up ranged from 2 to 7.4 years. The studies were methodologically rigorous and, in general, showed maintenance of or improvement in acute treatment gains. The studies reviewed could not outline course of recovery or control for pivotal confounding variables such as maturation. Seven of the eight studies employed a Cognitive Behavioral intervention and one employed a manualized, time-limited, psychodynamic intervention. No LTFU trial for medication was found. CONCLUSION: ample evidence exists for the short-term benefit of pediatric anxiety treatment, but evidence is still lacking for the understanding of treatment's role in the facilitation of healthy development into adulthood. Recommendations for future research are proposed.

Manassis K, Tannock R, Monga S. · Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario. · J Can Acad Child Adolesc Psychiatry. · Pubmed #19495430 links to  free full text

Abstract: INTRODUCTION: Assessing childhood anxiety is complicated by differences between informants, particularly parents and children. We examined factors associated with mother- and child-report, to understand how children identified by each might differ. METHOD: Eighty-five children with anxiety disorders diagnosed by semi-structured interview, and 45 children without such disorders and their mothers completed a standardized anxiety questionnaire. Predictors of questionnaire scores by mother- and child-report were examined, and a comparison of children high- and low- on self- report was done. RESULTS: Child anxiety self-reports were best predicted by depressive symptoms, maternal psychopathology (self-report), and a support-seeking coping style (adjusted R(2) = .299). Maternal reports were best predicted by child functioning (clinician-rated) and maternal psychopathology (self-report) (adjusted R(2) = .305). Children high on self-report showed higher depressive symptoms (p = .001) and reported higher use of avoidant (p < .05) and support-seeking (p < .01) coping strategies than low self-reporters. Diagnosis was more significantly linked to maternal- than child-report (chi-square = 49.99, p <.001 for mother; 4.27, p<.05 for child). CONCLUSION: Depressive symptoms and coping style appear to predict children's self-reported anxiety, but clinicians may place greater emphasis on maternal report in assigning diagnoses, potentially missing some children with significant anxiety.

Manassis K, Mendlowitz S, Kreindler D, Lumsden C, Sharpe J, Simon MD, Woolridge N, Monga S, Adler-Nevo G. · Department of Psychiatry, University of Toronto, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. · J Clin Child Adolesc Psychol. · Pubmed #19437298 No free full text.

Abstract: We evaluated a novel, computerized feelings assessment instrument (MAAC) in 54 children with anxiety disorders and 35 nonanxious children ages 5 to 11. They rated their feelings relative to 16 feeling animations. Ratings of feelings, order of feeling selection, and correlations with standardized anxiety measures were examined. Positive emotions were rated more highly and visited earlier by nonanxious children. Children with anxiety disorders explored fewer emotions. MAAC ratings on several positive emotions showed inverse correlations with state anxiety. Although needing further evaluation, MAAC may facilitate feelings assessment in young children and may distinguish children with anxiety disorders from nonanxious children.

Wood H, Manassis K, Owens M, Garland EJ. · University of Toronto, Canada. · Clin Child Psychol Psychiatry. · Pubmed #19103707 No free full text.

Abstract: This exploratory study sought to characterize anxious children displaying an Obsessive Difficult Temperament (ODT), and examined features that may differentiate them from anxiety disordered, non ODT children. Participants comprised 67 children, aged 4 to 7 years, consecutively referred to an anxiety disorders clinic at an urban children's hospital. Retrospective categorization of the participants' temperament profile was undertaken, with 21 children appearing to display ODT. Groups were compared on the bases of child functioning (parent and clinician rated), the presence of comorbid disorders (based on structured interview), and parental stress and symptomatology. Participants with ODT were found to display a specific profile of temperament traits. Compared to non ODT participants, they showed a significantly poorer social functioning, more comorbid externalizing disorders, elevated levels of maternal stress, and increased maternal psychiatric symptoms. To conclude, anxious children expressing ODT present with significant impairments in functioning and require further investigation. Associated parental stress and impaired maternal psychosocial functioning are evident.

Manassis K, Tannock R. · Hospital for Sick Children, Toronto, Ontario. · Can J Psychiatry. · Pubmed #18940039 No free full text.

Abstract: OBJECTIVE: To examine the outcome within 6 to 8 months of medical and nonmedical intervention for children with severe selective mutism (SM). METHOD: Children with SM (n = 17) and their mothers, seen in a previous study, attended follow-up appointments with a clinician. Obtained by maternal report were: treatment received, current diagnosis (based on semi-structured interview), speech in various environments, and global improvement. An independent clinician also rated global functioning. RESULTS: The diagnosis of SM persisted in 16 children, but significant symptomatic improvement was evident in the sample. All children had received school consultations. Children who had been treated with selective serotonin reuptake inhibitors (SSRI) (n = 10) showed greater global improvement, improvement in functioning, and improvement in speech outside the family than children who were unmedicated (n = 7). No differences were evident for children receiving and not receiving additional nonmedical intervention. CONCLUSIONS: The findings suggest the potential benefit of SSRI treatment in severe SM, but randomized comparative treatment studies are indicated.

Manassis K, Tannock R, Garland EJ, Minde K, McInnes A, Clark S. · The Hospital for Sick Children and the University of Toronto, 555 University Avenue, Toronto, Ontario, Canada. · J Am Acad Child Adolesc Psychiatry. · Pubmed #17712242 No free full text.

Abstract: OBJECTIVES: To determine whether oral language, working memory, and social anxiety differentiate children with selective mutism (SM), children with anxiety disorders (ANX), and normal controls (NCs) and explore predictors of mutism severity. METHOD: Children ages 6 to 10 years with SM (n = 44) were compared with children with ANX (n = 28) and NCs (n = 19) of similar age on standardized measures of language, nonverbal working memory, and social anxiety. Variables correlating with mutism severity were entered in stepwise regressions to determine predictors of mute behavior in SM. RESULTS: Children with SM scored significantly lower on standardized language measures than children with ANX and NCs and showed greater visual memory deficits and social anxiety relative to these two groups. Age and receptive grammar ability predicted less severe mutism, whereas social anxiety predicted more severe mutism. These factors accounted for 38% of the variance in mutism severity. CONCLUSIONS: Social anxiety and language deficits are evident in SM, may predict mutism severity, and should be evaluated in clinical assessment. Replication is indicated, as are further studies of cognition and of intervention in SM, using large, diverse samples.

Manassis K, Tannock R, Young A, Francis-John S. · Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. · Behav Brain Funct. · Pubmed #17224054 links to  free full text

Abstract: BACKGROUND: Cognition in children with anxiety disorders (ANX) and comorbid Attention Deficit Disorder (ADHD) has received little attention, potentially impacting clinical and academic interventions in this highly disabled group. This study examined several cognitive features relative to children with either pure condition and to normal controls. METHODS: One hundred and eight children ages 8-12 and parents were diagnosed by semi-structured parent interview and teacher report as having: ANX (any anxiety disorder except OCD or PTSD; n = 52), ADHD (n = 21), or ANX + ADHD (n = 35). All completed measures of academic ability, emotional perception, and working memory. Clinical subjects were compared to 35 normal controls from local schools. RESULTS: Groups did not differ significantly on age, gender, or estimated IQ. On analyses of variance, groups differed on academic functioning (Wide Range Achievement Test, p < .001), perception of emotion (auditory perception of anger, p < .05), and working memory (backwards digits, p < .01; backwards finger windows, p < .05; Chipasat task, p < .001). ANX + ADHD and children with ADHD did poorly relative to controls on all differentiating measures except auditory perception of anger, where ANX + ADHD showed less sensitivity than children with ANX or with ADHD. CONCLUSION: Though requiring replication, findings suggest that ANX + ADHD relates to greater cognitive and academic vulnerability than ANX, but may relate to reduced perception of anger.

Korenblum CB, Chen SX, Manassis K, Schachar RJ. · Brain and Behaviour Programme, Research Institute, and Department of Psychiatry, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada. · Depress Anxiety. · Pubmed #17004236 No free full text.

Abstract: Anxiety disorder (ANX) is characterized by heightened arousal, psychosocial and academic difficulties, and comorbidity with other disorders, in particular, attention-deficit/hyperactivity disorder (ADHD). The heightened arousal contributes to cognitive impairment by adversely affecting executive control of cognition. The nature of the effect on executive control is poorly understood. Research in this area could inform intervention, diagnostic, and etiological research. Our objective was to characterize children with ANX on measures of executive functioning, while controlling for comorbid ADHD. We compared children ages 6-14 with ANX (N=21), ADHD (N=78), ANX+ADHD (N=38), and normal controls (NC; N=40) on the stop task, a measure of performance monitoring and response inhibition. No difference was observed between NC and ANX groups in performance monitoring. Compared to the NC group, the three clinical groups showed inhibition deficits, and both ADHD and ANX+ADHD groups monitored less after responses. ANX was not associated with performance monitoring or inhibition deficits once comorbid ADHD was considered. This emphasizes the importance of controlling for comorbid ADHD in studies of cognition and anxiety.

Monga S, Manassis K. · Anxiety and Mood Disorders Program, Division of Child Psychiatry, Department of Psychiatry, University of Toronto, Ontario, Canada. · J Am Acad Child Adolesc Psychiatry. · Pubmed #16865044 No free full text.

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Papneja T, Manassis K. · University of Toronto, Ontario. · Can J Psychiatry. · Pubmed #16786822 No free full text.

Abstract: OBJECTIVES: To compare children with Axis I anxiety disorders and asthma with a matched group of anxious children without asthma on questionnaire measures and response to cognitive-behavioural treatment (CBT) for anxiety. METHOD: A sample of 36 children with comorbid anxiety and asthma, aged 8 to 12 years, were matched for age, sex, and specific anxiety disorder with 36 children with an Axis I anxiety disorder but no asthma. Parents and children completed standardized questionnaires. RESULTS: Children with comorbid anxiety and asthma had significantly more perinatal complications (P = 0.001), and higher total (P = 0.000) and psychological stressors (P = 0.02), especially parent-child problems (P = 0.01), but lower levels of depression (P = 0.03) and anxiety (P = 0.05), compared with anxious, nonasthmatic children. All children reported decreased anxiety (P = 0.001) and depression (P = 0.000) posttreatment, with a trend toward less improvement in anxiety in anxious children with asthma. CONCLUSIONS: Although replication is needed, addressing psychosocial stress and parent-child problems may increase CBT efficacy in children with comorbid anxiety and asthma.

McInnes A, Manassis K. · Department of Psychiatry Research, Hospital for Sick Children, Toronto, Ontario, Canada. · Semin Speech Lang. · Pubmed #16155858 No free full text.

Abstract: Selective mutism (SM) is a rare disorder that is associated with both anxiety and communication impairments. Preliminary evidence suggests that educational attainment and development of social skills and self-esteem may be affected by SM in a significant proportion of cases. There is a critical need for cross-disciplinary research from the fields of speech-language pathology, psychiatry, and clinical psychology to develop protocols for assessing language and cognitive functioning in children with SM and developing interventions that address psychiatric, communicative, and social aspects of this disorder.

Manassis K. · University of Toronto, Toronto, Canada. · Evid Based Ment Health. · Pubmed #16043619 links to  free full text

This publication has no abstract.

McInnes A, Fung D, Manassis K, Fiksenbaum L, Tannock R. · The Hospital for Sick Children, Toronto, Ontario, Canada. · Am J Speech Lang Pathol. · Pubmed #15719897 No free full text.

Abstract: Selective mutism (SM) is a rare and complex disorder associated with anxiety symptoms and speech-language deficits; however, the nature of these language deficits has not been studied systematically. A novel cross-disciplinary assessment protocol was used to assess anxiety and nonverbal cognitive, receptive language, and expressive narrative abilities in 7 children with SM and a comparison group of 7 children with social phobia (SP). The children with SM produced significantly shorter narratives than children with SP, despite showing normal nonverbal cognitive and receptive language abilities. The findings suggest that SM may involve subtle expressive language deficits that may influence academic performance and raise additional questions for further research. The assessment procedure developed for this study may be potentially useful for language clinicians.

Manassis K, Avery D, Butalia S, Mendlowitz S. · Department of Psychiatry, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada. · Depress Anxiety. · Pubmed #15274169 No free full text.

Abstract: We examined anxiety symptoms, anxiety-related impairment, and further treatment in adolescents who received cognitive behavioral therapy (CBT) for childhood anxiety disorders 6-7 years previously. Forty-three adolescents and their parents (14 boys, 29 girls; mean age 16.7 years) participated in structured telephone interviews. Participants (68% of initial sample of 63) did not differ in age, diagnostic profile, socioeconomic status, or initial severity from nonparticipants but more girls than boys participated. Indices based on child- and parent-reported symptoms and impairment were calculated, and within-sample comparisons by age, gender, diagnosis, and initial severity were done using t tests. Predictors of symptoms and impairment were also examined. On average, adolescents reported modest levels of anxiety-related impairment. Further treatment for anxiety had occurred in 30% (13 of 43) of patients. Stepwise regressions found female gender and diagnosis other than generalized anxiety disorder predictive of increased symptoms by parent report, and initial severity predicted adolescent-reported impairment. Adolescents showed limited internalizing symptomatology and impairment but almost one third had required further treatment. Studies comparing treated and untreated samples are needed to clarify whether CBT alters the natural history of childhood anxiety disorders and to replicate our findings regarding predictors of symptomatology and impairment.

Liashko V, Manassis K. · Hospital for Sick Children, Toronto, Ontario. · Can J Psychiatry. · Pubmed #14733455 No free full text.

Abstract: OBJECTIVE: To determine whether individual and family characteristics of children with anxiety disorders who take psychotropic medications differ from those that are unmedicated and whether there is a differential response to cognitive-behavioural therapy (CBT). METHOD: Children ages 8 to 12 years (n = 102: 18 medicated, 84 unmedicated) were recruited in a specialized outpatient clinic over a 3-year period. All had a primary diagnosis of an anxiety disorder. Comparisons were done using t-tests for continuous measures and chi-square tests for discrete measures. Treatment-related changes were assessed using repeated measures analyses of variance. RESULTS: Medicated and unmedicated groups did not differ by age, sex, socioeconomic status, or diagnostic profile. Initial ratings of anxiety symptoms, depressive symptoms, and global functioning were comparable. Greater family dysfunction and family frustration were reported in medicated children. With treatment, both groups improved symptomatically and showed improved family functioning. Families of medicated children showed a greater reduction in frustration than families of unmedicated children, whereas unmedicated children showed greater gains in global functioning. CONCLUSIONS: Initial family functioning of medicated children seems to show more disturbances. Both medicated and unmedicated children can benefit from CBT. Further studies of differential treatment effects for medicated and unmedicated children are indicated.

Manassis K, Fung D, Tannock R, Sloman L, Fiksenbaum L, McInnes A. · Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada. · Depress Anxiety. · Pubmed #14625881 No free full text.

Abstract: Selective mutism (SM) occurs when a child persistently lacks speech in some social situations but not in others, despite the ability to use and comprehend language. While considered to be related to anxiety, SM is poorly understood and studies of SM children are often based on parent reports. This study developed a unique, non-verbally based assessment protocol for SM children in order to better characterize their clinical profile, language abilities, and learning abilities. A comparison was done with a group of children of similar age, with social phobia (SP) but no SM, to search for characteristics that might distinguish SM from other anxiety disorders. Twenty-three children participated in the study (14 SM and 9 SP). The assessment protocol included standardized anxiety rating scales, cognitive and academic tests, and a speech and language assessment. SM and SP groups showed similar levels of anxiety and academic ability, but the SM group showed some language impairments relative to the SP group. Though requiring replication with a larger sample and nonclinical comparison group, the results suggest that SM children can be assessed by non-verbal means and that their disorder is characterized by anxiety and subtle language impairments.

Scapillato D, Manassis K. · Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada. · J Am Acad Child Adolesc Psychiatry. · Pubmed #12049449 No free full text.

This publication has no abstract.

Barbosa J, Tannock R, Manassis K. · Hospital for Sick Children, Toronto, University of Toronto, Toronto, Canada. · Depress Anxiety. · Pubmed #11891994 No free full text.

Abstract: This study examines parent-child reporting differences for childhood anxiety in normal controls (n = 16) and in children with diagnosed anxiety disorders (ANX; n = 15), attention-deficit hyperactivity disorder (ADHD; n = 15), and comorbid ANX and ADHD (n = 16). Correspondence between child reports of anxiety on two self-report inventories and diagnosis based on structured parent interview was assessed for all four groups. Parent-child agreement did not appear to be measurement dependent but did differ by diagnostic group, with poorer agreement for clinical groups. Though needing replication, these findings suggest that it is inadvisable to rely exclusively on self-report measures when assessing childhood anxiety, especially in clinical populations. Such measures can be useful in monitoring clinical progress, however, provided parent and child reports are examined separately.

Crawford AM, Manassis K. · Department of Human Development and Applied Psychology, Ontario Institute for Studies in Education, Toronto, Canada. · J Am Acad Child Adolesc Psychiatry. · Pubmed #11589531 No free full text.

Abstract: OBJECTIVE: To determine whether family factors are predictive of outcome in children with anxiety disorders who are receiving cognitive-behavioral treatment. METHOD: Participants were 61 children aged 8 to 12 years (mean = 10.0, SD = 1.4) with Axis I anxiety disorders who had been referred to a large Toronto children's hospital. Parents and children completed measures assessing family functioning, parenting stress, parental frustration, and parental psychopathology before and after treatment. Outcome measures included clinician-rated functioning (Children's Global Assessment Scale) and self- and parent-rated anxiety (Revised Children's Manifest Anxiety Scale). RESULTS: Child ratings of family dysfunction and frustration predicted clinician-rated improvement (total R2 = 0.28, p < .001). Mother and father reports of family dysfunction, and maternal parenting stress, predicted mother-rated child improvement (total R2 = 0.18, p < .01). Father-rated somatization and child reports of family dysfunction and frustration predicted child-rated improvement (total R2 = 0.25, p < .001). Several family factors improved with treatment. CONCLUSION: Family dysfunction appears to be related to less favorable treatment outcome in children with anxiety disorders.