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A Post-Treatment Evaluation of the Combined Effects of Imipramine Pharmacotherapy and Brief Psychotherapy in the Treatment of Childhood Anxiety DisordersPorter, Daniel B. III 04 May 1998 (has links)
This study evaluated a treatment program for anxiety disordered children, ages five to twelve years, utilizing both qualitative and quantitative methodologies. The treatment program integrated Imipramine pharmacotherapy and brief psychotherapy. The participants' nuclear and extended family histories were examined in terms of the occurrence of psychopathology and endemic transactional patterns. The examination of family patterns utilized Murray Bowen's Generational Model, as well as the T-F-A model of Hutchins and Cole, as a means of explaining the transmission of anxiety in the family. Ten children suspected of experiencing anxiety disorders were referred by pediatric physicians for treatment. Following an initial diagnostic assessment, children were placed on 25 milligrams of Imipramine per day for four to six weeks, while participating in weekly conjoint psychotherapy with their mothers for a six to eight-week period.
A post-treatment evaluation was conducted by selecting ten prototypic participants. Selection was based upon age, diagnosis of overanxious disorder or separation anxiety disorder in childhood, and a time interval of no more than one year or less than one week following treatment. Semi-structured interviews were conducted with mother-child pairs separately to evaluate participants' perceptions of pre- and post-treatment symptom levels and family dynamics. DSM-III diagnostic criteria, Bowenian and T-F-A models served as the frameworks for organizing and evaluating qualitative data. All child participants experienced a dramatic and lasting resolution of both OAD and SAD symptomology. A quantitative analysis was performed utilizing the Wilcoxon sign rank to compare pre- and post-treatment symptom levels, with a significant effect by treatment occurring at the .005 level of significance. Cross-validation of treatment outcome was achieved through review of medical records, original psychotherapy notes, and videotapes of the interviews. Qualitative data regarding transgenerational medical and psychological disorders and family dynamics was generated. The data supported the Unitary model of generational family pathology. Six of seven Bowenian constructs were confirmed in this sample. The T-F-A model was used to demonstrate a cyclical pattern of reassurance, anxiety reduction, and child dependency between anxious children and their mothers. These results were discussed to provide a better understanding of the etiology and treatment of childhood anxiety disorders (OAD and SAD). The term "anxogenic family" was suggested to convey the interaction of genetics and generational learning in the families of anxiety disordered children. Implications for future research and modification of the DSM-IV regarding childhood anxiety disorders were discussed. / Ph. D.
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Effects of Anxious Mood on Play ProcessesChristian, Kelly M. January 2009 (has links)
No description available.
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Maternal Socialization of Emotion Regulation: Promoting Social Engagement Among Inhibited ToddlersPenela, Elizabeth Carmen 01 January 2009 (has links)
The ability to regulate emotions is thought to influence the development of positive peer relations in early childhood. By effectively regulating fear and anger in peer settings, social interactions tend to unfold in a smooth and successful manner, leading children to become socially competent over time. Fear regulation, however, is especially difficult for children who were highly reactive and frequently expressed negative affect as infants. These children, often referred to as having an inhibited temperament, are likely to become distressed by novel stimuli and show a high degree of vigilance and anxious behaviors as toddlers. After toddlerhood, research has shown that some of these children handle novel, social situations in a competent manner, whereas others continue along the pathway of inhibition and become socially reticent. Socially reticent children often engage in hovering behavior and stay on the outskirts of the peer group, which can have negative consequences for the development of positive peer relations. One factor that influences inhibited toddlers to follow one pathway versus another seems to be whether they have learned to effectively regulate emotions. The acquisition of emotion regulation strategies is a complex process, but parents usually have the most proximal influence during early childhood. Therefore, in order to learn more about promoting socially competent behavior, it is important to understand how parents are socializing emotion regulation in toddlerhood. Using data from a larger longitudinal study, the current study examined how the socialization of emotion regulation at age three influenced social engagement at age four among behaviorally inhibited toddlers. It was hypothesized that sensitive maternal socialization of emotion regulation strategies would predict higher levels of engagement in future peer social interactions.
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Changes in the Neural Bases of Emotion Regulation Associated with Clinical Improvement in Children with Anxiety DisordersHum, Kathryn 13 December 2012 (has links)
Background: The present study was designed to examine prefrontal cortical processes in anxious children that mediate cognitive regulation in response to emotion-eliciting stimuli, and the changes that occur after anxious children participate in a cognitive behavioral therapy treatment program.
Methods: Electroencephalographic activity was recorded from clinically anxious children and typically developing children at pre- and post-treatment sessions. Event-related potential components were recorded while children performed a go/no-go task using facial stimuli depicting angry, calm, and happy expressions.
Results: At pre-treatment, anxious children had significantly greater posterior P1 and frontal N2 amplitudes than typically developing children, components associated with attention/arousal and cognitive control, respectively. For the anxious group only, there were no differences in neural activation between face (emotion) types or trial (Go vs. No-go) types. Anxious children who did not improve with treatment showed increased cortical activation within the time window of the P1 at pre-treatment relative to comparison and improver children. From pre- to post-treatment, only anxious children who improved with treatment showed increased cortical activation within the time window of the N2.
Conclusions: At pre-treatment, anxious children appeared to show increased cortical activation regardless of the emotional content of the stimuli. Anxious children also showed greater medial-frontal activity regardless of task demands and response accuracy. These findings suggest indiscriminate cortical processes that may underlie the hypervigilant regulatory style seen in clinically anxious individuals. Neural activation patterns following treatment suggest that heightened perceptual vigilance, as represented by increased P1 amplitudes for non-improvers, may have prevented these anxious children from learning the treatment strategies, leading to poorer outcomes. Increased cognitive control, as represented by increased N2 amplitudes for improvers, may have enabled these anxious children to implement treatment strategies more effectively, leading to improved treatment outcomes. Hence, P1 activation may serve as a predictor of treatment outcome, while N2 activation may serve as an indicator of treatment-related outcome. These findings point to the cortical processes that maintain maladaptive functioning versus the cortical processes that underlie successful intervention in clinically anxious children.
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Changes in the Neural Bases of Emotion Regulation Associated with Clinical Improvement in Children with Anxiety DisordersHum, Kathryn 13 December 2012 (has links)
Background: The present study was designed to examine prefrontal cortical processes in anxious children that mediate cognitive regulation in response to emotion-eliciting stimuli, and the changes that occur after anxious children participate in a cognitive behavioral therapy treatment program.
Methods: Electroencephalographic activity was recorded from clinically anxious children and typically developing children at pre- and post-treatment sessions. Event-related potential components were recorded while children performed a go/no-go task using facial stimuli depicting angry, calm, and happy expressions.
Results: At pre-treatment, anxious children had significantly greater posterior P1 and frontal N2 amplitudes than typically developing children, components associated with attention/arousal and cognitive control, respectively. For the anxious group only, there were no differences in neural activation between face (emotion) types or trial (Go vs. No-go) types. Anxious children who did not improve with treatment showed increased cortical activation within the time window of the P1 at pre-treatment relative to comparison and improver children. From pre- to post-treatment, only anxious children who improved with treatment showed increased cortical activation within the time window of the N2.
Conclusions: At pre-treatment, anxious children appeared to show increased cortical activation regardless of the emotional content of the stimuli. Anxious children also showed greater medial-frontal activity regardless of task demands and response accuracy. These findings suggest indiscriminate cortical processes that may underlie the hypervigilant regulatory style seen in clinically anxious individuals. Neural activation patterns following treatment suggest that heightened perceptual vigilance, as represented by increased P1 amplitudes for non-improvers, may have prevented these anxious children from learning the treatment strategies, leading to poorer outcomes. Increased cognitive control, as represented by increased N2 amplitudes for improvers, may have enabled these anxious children to implement treatment strategies more effectively, leading to improved treatment outcomes. Hence, P1 activation may serve as a predictor of treatment outcome, while N2 activation may serve as an indicator of treatment-related outcome. These findings point to the cortical processes that maintain maladaptive functioning versus the cortical processes that underlie successful intervention in clinically anxious children.
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A randomized-controlled trial of a one-week summer treatment program for childhood separation anxiety disorderSantucci, Lauren C. January 2012 (has links)
Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Separation anxiety disorder (SAD) is the most common and impairing childhood anxiety disorder. Left untreated, SAD is associated with heightened risk for the development of additional internalizing disorders as well as impairments in educational attainment and social functioning. Numerous clinical trials have demonstrated the efficacy of cognitive-behavior therapy (CBT) for the treatment of childhood anxiety disorders, including SAD. However, additional research is needed to enhance the compatibility (e.g., fit of the treatment to the patient population) and ultimate uptake of evidence-based interventions for anxious youth. The current research evaluates the feasibility and preliminary efficacy of an intensive, cognitive-behavioral intervention for school-aged girls with SAD provided within the novel context of a one-week camp-like setting. This alternative treatment format was predicated on evidence supporting the need for treatments that allow for creative and developmentally-sensitive applications of intervention components, incorporate a child's social context, target relevant parenting variables, and provide additional models for treatment delivery. Twenty-nine female children aged 7 to 12 with a principal or co-principal diagnosis of SAD were randomized to an immediate treatment (n = 15) or waitlist (i.e., delayed treatment; n = 14) condition during the course of this randomized-controlled trial. Measures were administered at pretreatment/ pre-waitlist, post-treatment/post-waitlist, and six weeks following treatment to assess changes in symptom reports, functional outcomes, and overall program satisfaction. Analyses of covariance were conducted to assess effects of treatment condition and repeated measures analyses of variance were conducted to evaluate change over the three data collection time points. Relative to waitlist, children in the immediate treatment group evidenced significant reductions in SAD severity by clinician report on a diagnostic interview measure. Moreover, treatment gains strengthened over time. Contrary to hypotheses, children receiving the intervention did not display significantly greater improvements relative to waitlist on parent-rated fear and avoidance scores or on parent or child self-report measures. Potential explanations for non-significant findings are discussed. Overall, the intervention's positive therapeutic response on SAD diagnostic status and severity suggests one possible delivery model for surmounting difficulties faced in the dissemination of standard, weekly treatments for this condition. / 2031-01-02
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Wearable Sensors Outperform Behavioral Coding as Valid Marker of Childhood Anxiety and DepressionMcGinnis, Ellen, McGinnis, Ryan, Hruschak, Jessica, Bilek, Emily, Ip, Ka, Morelen, Diana, Lawler, Jamie, Fitzgerald, Kate, Rosenblum, Katherine, Musik, Maria 25 April 2018 (has links) (PDF)
There is a significant need to develop objective measures for identifying children under the age of 8 who have anxiety and depression. If left untreated, early internalizing symptoms can lead to adolescent and adult internalizing disorders as well as comorbidity which can yield significant health problems later in life including increased risk for suicide. To this end, we propose the use of an instrumented fear induction task for identifying children with internalizing disorders, and demonstrate its efficacy in a sample of 63 children between the ages of 3 and 7. In so doing, we extract objective measures that capture the full six degree-of-freedom movement of a child using data from a belt-worn inertial measurement unit (IMU) and relate them to behavioral fear codes, parent-reported child symptoms and clinician-rated child internalizing diagnoses. We find that IMU motion data, but not behavioral codes, are associated with parent-reported child symptoms and clinician-reported child internalizing diagnosis in this sample. These results demonstrate that IMU motion data are sensitive to behaviors indicative of child psychopathology. Moreover, the proposed IMU-based approach has increased feasibility of collection and processing compared to behavioral codes, and therefore should be explored further in future studies.
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CHARACTERIZATION OF CHILDREN AT-RISK FOR DEVELOPING ANXIETY DISORDERS: FINDINGS FROM CLINICAL ASSESSMENTS, BEHAVIOURAL DATA AND FUNCTIONAL MAGNETIC RESONANCE IMAGINGSenaratne, Rhandi 04 1900 (has links)
<p>The aim of this research study was to examine the clinical, behavioural and neurobiological characteristics of children who are considered to be at increased risk for developing anxiety disorders. The study population included high-risk children who have at least one parent with social phobia and normal-risk control subjects. The first objective of the study was to examine the prevalence of anxiety disorders in high-risk children. We determined the proportion of high-risk children who met criteria for a psychiatric disorder using structured clinical interviews and assessed symptom severity using measures of anxiety and depression. We found the prevalence of anxiety disorders to be elevated in high-risk children with 77% meeting criteria for a lifetime psychiatric disorder. High-risk subjects also had significantly higher levels of anxiety symptoms relative to normal-risk subjects. The second objective of the study was to examine threat-related attention processing in high-risk and normal-risk children using the dot-probe attention orienting task. We compared probe detection reaction times of high-risk children and normal-risk control children when they were exposed to emotional facial stimuli. We did not find any significant within-group or between-group differences in reaction times in our high-risk and normal-risk subjects. However, we did observe a trend towards longer reaction times in high-risk subjects for all trial types relative to normal-risk subjects, which could indicate general processing deficits in the high-risk group. The third objective of this study was to examine the activity of emotion processing brain regions using functional magnetic resonance imaging (<em>f</em>MRI) in children who are at increased risk for developing anxiety disorders. We compared the blood oxygenation level dependant (BOLD) response while high-risk and normal-risk subjects were engaged in the dot probe attention orienting task. Using <em>f</em>MRI, the BOLD response was measured while subjects were exposed to masked emotional (angry, happy or neutral) facial stimuli. We found increased activation of several frontal, temporal and limbic regions in high-risk subjects relative to normal-risk subjects during the presentation of emotional facial stimuli. These regions included the prefrontal cortex, anterior cingulate, hippocampus, insula, basal ganglia and temporal regions. To our knowledge this is the first study to characterize a sample of children at-risk for anxiety disorders using clinical, behavioural and neuroimaging data. The findings from this study demonstrate that high-risk children experience heightened anxiety symptoms and that they also present with functional abnormalities of brain regions involved in emotion processing. These results highlight the need for early identification and intervention for children at-risk for anxiety disorders. Future studies should aim for longitudinal study designs combined with neuroimaging techniques to examine changes in anxiety symptoms over time and to study the effects of treatment on the function of limbic and prefrontal structures in children at-risk for anxiety disorders.</p> / Doctor of Philosophy (PhD)
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Ansiedade na infância e adolescência e bullying escolar em uma amostra comunitária de crianças e adolescentesIsolan, Luciano Rassier January 2012 (has links)
Os transtornos de ansiedade representam uma das formas mais comuns de psicopatologia em crianças e adolescentes e estão associados com prejuízos no funcionamento acadêmico, social e familiar. Porém, permanecem frequentemente subdiagnosticados e subtratados. O bullying escolar é muito comum e está associado com um amplo espectro de problemas psiquiátricos, incluindo sintomas de ansiedade. O principal objetivo desta tese foi examinar a prevalência de bullying em uma grande amostra comunitária de crianças e adolescentes brasileiros e investigar a associação entre bullying e sintomatologia ansiosa de acordo com o DSM-IV. Esse estudo transversal consistiu no preenchimento de um questionário sobre bullying e de sua frequência e de um instrumento auto-aplicativo de triagem para transtornos de ansiedade que é a Screen for Child Anxiety Related Emotional Disorders (SCARED) por 2.353 estudantes entre 9 e 18 anos provenientes de seis escolas pertencentes à área de captação da Unidade Básica de Saúde do Hospital de Clínicas de Porto Alegre. Um total de 22,9% da amostra relatou envolvimento com bullying frequente, como agressor (7,6%), como vítima (5,7%) ou como agressor-vítima (9,6%). Em geral, meninos foram mais envolvidos como agressores e como agressores-vítimas e meninas como vítimas. Nossos achados demonstraram que estudantes envolvidos com bullying, como vítimas ou agressores-vítimas, apresentavam maiores escores na SCARED total e em suas subescalas do que agressores ou do que os estudantes sem envolvimento com bullying. A prevalência do bullying encontrada no nosso estudo está na média quando comparada com estudos prévios na literatura. Vítimas e agressores-vítimas, mas não agressores, são grupos associados com uma sintomatologia ansiosa mais alta. Embora no Brasil as taxas para as prevalências dos transtornos de ansiedade na infância e adolescência sejam substanciais, há uma carência de instrumentos para avaliar os sintomas de ansiedade e constructos relacionados à ansiedade em crianças e adolescentes. Adicionalmente, essa tese avaliou as propriedades psicométricas de duas escalas que são utilizadas na avaliação da ansiedade em crianças e adolescentes. A SCARED é um instrumento auto-aplicativo que foi originalmente desenvolvido como uma ferramenta de triagem para avaliar os transtornos de ansiedade na infância e adolescência de acordo com o DSM-IV. Os resultados encontrados em nosso estudo evidenciam que a SCARED apresenta propriedades psicométricas apropriadas e é um instrumento válido e confiável para avaliar sintomas de ansiedade em jovens no Brasil. O Childhood Anxiety Sensitivity Index (CASI) é o principal instrumento utilizado para avaliar sensibilidade à ansiedade em crianças e adolescentes. A sensibilidade à ansiedade é um constructo temperamental que pode ser conceitualizado como o medo de que sintomas de ansiedade possam ter graves consequências físicas, psicológicas ou sociais para o indivíduo. A sensibilidade à ansiedade está associada com outras medidas de ansiedade, principalmente àquelas que avaliam sintomas relacionados ao transtorno do pânico, e pode ser considerada um fator de risco para o desenvolvimento de sintomas de ansiedade e de transtornos de ansiedade em jovens. Nossos achados demonstraram uma confiabilidade apropriada e evidência de validade convergente entre a CASI e a SCARED em uma subamostra do nosso estudo, sugerindo que a CASI possa ser uma ferramenta útil na avaliação da sensibilidade à ansiedade nessa população. Tendo em vista os limitados recursos em relação à saúde mental e a pouca atenção clínica aos transtornos de ansiedade, acredita-se que tais instrumentos possam 11 se tornar ferramentas úteis na triagem de crianças e adolescentes com sintomas de ansiedade e que poderão necessitar de avaliações adicionais e de tratamento. / Anxiety disorders are one of the most common forms of psychopathology among children and adolescents and are associated with impairments in academic, social, and family functioning. Although very prevalent, the anxiety disorders are often undetected or untreated. School bullying is common and is associated with a broad spectrum of psychiatric problems, including anxiety symptomatology. The main objective of this study was to examine the prevalence of bullying behaviors in a large communitarian sample of Brazilian children and adolescents and to investigate the association between bullying behaviors and DSM-IV anxiety symptomatology. This cross-sectional study involved completion of a self-report questionnaire about bullying behaviors and their frequency and the Screen for Child Anxiety Related Emotional Disorders (SCARED) that is also a self-report screening tool for childhood anxiety disorders by 2353 students aged 9-18 years from 6 schools located in the catchment area of the Primary Care Unit from the Hospital de Clínicas de Porto Alegre. A total of 22.9% of the sample reported frequent involvement in bullying, as a bully (7.4%), as a victim (5.7%), or as a bully-victim (9.5%). In general, boys were more likely to be involved as bully and as bully-victim, and girls were more likely to be involved as victims. Our findings showed that students involved in bullying behaviors, as victims or bully-victims, were more likely to have higher total scores in SCARED scale, as well as in its subscales than bullies and than uninvolved students. The prevalence of bullying behaviors found in our sample is about average when compared with previous studies described in the literature. Victims and bully-victims, but no bullies, are groups associated with higher anxiety symptomatology. Although prevalence rates of anxiety disorders in Brazilian youth are significant, there is a lack of validated instruments to assess anxiety symptoms and related constructs in children and adolescents. In addition, this study verified the psychometrics properties of two scales that are frequently used in the assessment of anxiety in children and adolescents. The SCARED is a self-report instrument that was originally developed as a screening tool for DSM-IV childhood anxiety disorders. Our study suggested that the SCARED has appropriate psychometric properties and is a useful and reliable instrument to assess anxiety symptoms in Brazilian youth. The Childhood Anxiety Sensitivity Index (CASI) is the principal instrument used to assess anxiety sensitivity in children and adolescents. Anxiety Sensitivity refers to the tendency to fear anxiety-related sensations and is thought to arise from beliefs about their harmful physical, cognitive, or social consequences. Anxiety sensitivity is associated with other anxiety measurements, mainly those evaluating panic symptoms. It is also considered a risk factor for the development of anxious symptomatology and anxiety disorders in youth. Our findings demonstrated an appropriate reliability and evidence of convergent validity in the CASI with the SCARED in a subsample of our study, suggesting that the CASI could be a suitable tool for evaluating anxiety sensitivity in this population. Given the limited mental health resources and the paucity of clinical attention to childhood anxiety disorders in Brazil, these instruments may be a valuable tool for screening Brazilian children and adolescents with anxiety symptoms who may need further assessment and treatment.
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Ansiedade na infância e adolescência e bullying escolar em uma amostra comunitária de crianças e adolescentesIsolan, Luciano Rassier January 2012 (has links)
Os transtornos de ansiedade representam uma das formas mais comuns de psicopatologia em crianças e adolescentes e estão associados com prejuízos no funcionamento acadêmico, social e familiar. Porém, permanecem frequentemente subdiagnosticados e subtratados. O bullying escolar é muito comum e está associado com um amplo espectro de problemas psiquiátricos, incluindo sintomas de ansiedade. O principal objetivo desta tese foi examinar a prevalência de bullying em uma grande amostra comunitária de crianças e adolescentes brasileiros e investigar a associação entre bullying e sintomatologia ansiosa de acordo com o DSM-IV. Esse estudo transversal consistiu no preenchimento de um questionário sobre bullying e de sua frequência e de um instrumento auto-aplicativo de triagem para transtornos de ansiedade que é a Screen for Child Anxiety Related Emotional Disorders (SCARED) por 2.353 estudantes entre 9 e 18 anos provenientes de seis escolas pertencentes à área de captação da Unidade Básica de Saúde do Hospital de Clínicas de Porto Alegre. Um total de 22,9% da amostra relatou envolvimento com bullying frequente, como agressor (7,6%), como vítima (5,7%) ou como agressor-vítima (9,6%). Em geral, meninos foram mais envolvidos como agressores e como agressores-vítimas e meninas como vítimas. Nossos achados demonstraram que estudantes envolvidos com bullying, como vítimas ou agressores-vítimas, apresentavam maiores escores na SCARED total e em suas subescalas do que agressores ou do que os estudantes sem envolvimento com bullying. A prevalência do bullying encontrada no nosso estudo está na média quando comparada com estudos prévios na literatura. Vítimas e agressores-vítimas, mas não agressores, são grupos associados com uma sintomatologia ansiosa mais alta. Embora no Brasil as taxas para as prevalências dos transtornos de ansiedade na infância e adolescência sejam substanciais, há uma carência de instrumentos para avaliar os sintomas de ansiedade e constructos relacionados à ansiedade em crianças e adolescentes. Adicionalmente, essa tese avaliou as propriedades psicométricas de duas escalas que são utilizadas na avaliação da ansiedade em crianças e adolescentes. A SCARED é um instrumento auto-aplicativo que foi originalmente desenvolvido como uma ferramenta de triagem para avaliar os transtornos de ansiedade na infância e adolescência de acordo com o DSM-IV. Os resultados encontrados em nosso estudo evidenciam que a SCARED apresenta propriedades psicométricas apropriadas e é um instrumento válido e confiável para avaliar sintomas de ansiedade em jovens no Brasil. O Childhood Anxiety Sensitivity Index (CASI) é o principal instrumento utilizado para avaliar sensibilidade à ansiedade em crianças e adolescentes. A sensibilidade à ansiedade é um constructo temperamental que pode ser conceitualizado como o medo de que sintomas de ansiedade possam ter graves consequências físicas, psicológicas ou sociais para o indivíduo. A sensibilidade à ansiedade está associada com outras medidas de ansiedade, principalmente àquelas que avaliam sintomas relacionados ao transtorno do pânico, e pode ser considerada um fator de risco para o desenvolvimento de sintomas de ansiedade e de transtornos de ansiedade em jovens. Nossos achados demonstraram uma confiabilidade apropriada e evidência de validade convergente entre a CASI e a SCARED em uma subamostra do nosso estudo, sugerindo que a CASI possa ser uma ferramenta útil na avaliação da sensibilidade à ansiedade nessa população. Tendo em vista os limitados recursos em relação à saúde mental e a pouca atenção clínica aos transtornos de ansiedade, acredita-se que tais instrumentos possam 11 se tornar ferramentas úteis na triagem de crianças e adolescentes com sintomas de ansiedade e que poderão necessitar de avaliações adicionais e de tratamento. / Anxiety disorders are one of the most common forms of psychopathology among children and adolescents and are associated with impairments in academic, social, and family functioning. Although very prevalent, the anxiety disorders are often undetected or untreated. School bullying is common and is associated with a broad spectrum of psychiatric problems, including anxiety symptomatology. The main objective of this study was to examine the prevalence of bullying behaviors in a large communitarian sample of Brazilian children and adolescents and to investigate the association between bullying behaviors and DSM-IV anxiety symptomatology. This cross-sectional study involved completion of a self-report questionnaire about bullying behaviors and their frequency and the Screen for Child Anxiety Related Emotional Disorders (SCARED) that is also a self-report screening tool for childhood anxiety disorders by 2353 students aged 9-18 years from 6 schools located in the catchment area of the Primary Care Unit from the Hospital de Clínicas de Porto Alegre. A total of 22.9% of the sample reported frequent involvement in bullying, as a bully (7.4%), as a victim (5.7%), or as a bully-victim (9.5%). In general, boys were more likely to be involved as bully and as bully-victim, and girls were more likely to be involved as victims. Our findings showed that students involved in bullying behaviors, as victims or bully-victims, were more likely to have higher total scores in SCARED scale, as well as in its subscales than bullies and than uninvolved students. The prevalence of bullying behaviors found in our sample is about average when compared with previous studies described in the literature. Victims and bully-victims, but no bullies, are groups associated with higher anxiety symptomatology. Although prevalence rates of anxiety disorders in Brazilian youth are significant, there is a lack of validated instruments to assess anxiety symptoms and related constructs in children and adolescents. In addition, this study verified the psychometrics properties of two scales that are frequently used in the assessment of anxiety in children and adolescents. The SCARED is a self-report instrument that was originally developed as a screening tool for DSM-IV childhood anxiety disorders. Our study suggested that the SCARED has appropriate psychometric properties and is a useful and reliable instrument to assess anxiety symptoms in Brazilian youth. The Childhood Anxiety Sensitivity Index (CASI) is the principal instrument used to assess anxiety sensitivity in children and adolescents. Anxiety Sensitivity refers to the tendency to fear anxiety-related sensations and is thought to arise from beliefs about their harmful physical, cognitive, or social consequences. Anxiety sensitivity is associated with other anxiety measurements, mainly those evaluating panic symptoms. It is also considered a risk factor for the development of anxious symptomatology and anxiety disorders in youth. Our findings demonstrated an appropriate reliability and evidence of convergent validity in the CASI with the SCARED in a subsample of our study, suggesting that the CASI could be a suitable tool for evaluating anxiety sensitivity in this population. Given the limited mental health resources and the paucity of clinical attention to childhood anxiety disorders in Brazil, these instruments may be a valuable tool for screening Brazilian children and adolescents with anxiety symptoms who may need further assessment and treatment.
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