The current study was designed to examine the relationship between childhood anxiety and depression and children's rate of medical care utilization. Additionally, the model examined considered family and parental factors (family conflict, parental anxiety, parental depression, and parental somatization) as well as children's level of negative affectivity and demographic variables (age and sex). A hierarchical regression analysis was used to examine the effects of each of these variables on rate of physician utilization and to control for the effects of demographic factors, parent/family variables and negative affectivity while examining childhood anxiety and depression. Results revealed that parental anxiety and depression and family conflict contribute significantly to the explanation of children's health care utilization. Additionally, child anxiety also explained number of physician visits but only when considered in the absence of child depression. / Master of Science

Many children and their families who seek assistance for childhood behaviour disorders experience comorbid disorders, namely the presence of two or more disorders. Although comorbid disorders are recognized as a frequent clinical complication, minimal direction exists within the literature about the risk factors for comorbid conditions and how best to provide intervention services. In this study an ecological framework was used to compare the individual, family, and community environmental contexts of young girls who presented at intake at a children’s mental health centre with comorbid externalizing and internalizing disorders, and girls who presented at intake with externalizing disorders only. The treatment response to a cognitive-behavioural intervention for externalizing behaviour disorders was examined, by comparing externalizing scores over time between girls with comorbid externalizing and internalizing disorders and girls with externalizing disorders only. Additionally, internalizing scores over time for girls with comorbid disorders were examined. Results indicated that a history of abuse and a cluster of individual characteristics placed girls at higher risk to present with comorbid conditions. The results also indicated that girls with comorbid disorders experienced a reduction of both externalizing and internalizing symptoms. Only 1 in 7.4 girls, however, scored below the clinical range for both externalizing and internalizing disorders at the end of the treatment phase, in comparison to 1 in 5 girls scoring below the clinical range for externalizing disorders in the noncomorbid group.

Many children and their families who seek assistance for childhood behaviour disorders experience comorbid disorders, namely the presence of two or more disorders. Although comorbid disorders are recognized as a frequent clinical complication, minimal direction exists within the literature about the risk factors for comorbid conditions and how best to provide intervention services. In this study an ecological framework was used to compare the individual, family, and community environmental contexts of young girls who presented at intake at a children’s mental health centre with comorbid externalizing and internalizing disorders, and girls who presented at intake with externalizing disorders only. The treatment response to a cognitive-behavioural intervention for externalizing behaviour disorders was examined, by comparing externalizing scores over time between girls with comorbid externalizing and internalizing disorders and girls with externalizing disorders only. Additionally, internalizing scores over time for girls with comorbid disorders were examined. Results indicated that a history of abuse and a cluster of individual characteristics placed girls at higher risk to present with comorbid conditions. The results also indicated that girls with comorbid disorders experienced a reduction of both externalizing and internalizing symptoms. Only 1 in 7.4 girls, however, scored below the clinical range for both externalizing and internalizing disorders at the end of the treatment phase, in comparison to 1 in 5 girls scoring below the clinical range for externalizing disorders in the noncomorbid group.

No description available.

The primary purpose of this research was to examine the long-term relations between peer victimization and internalizing symptoms (anxiety and depression) in middle school children. Furthermore, this study intended to determine the potential roles of self-worth, self-acceptance, and social supports in moderating or mediating these proposed relations. At time one, 280 sixth grade students participated and at follow up, 77 eighth grade children were participants. All children were from the same public middle school and completed self-report measures representing the constructs previously described. Reported levels of peer victimization were found to be similar to those reported in previous studies. Significant concurrent correlations were found between the sixth grade predictor variables (victimization, self-worth, social acceptance, social supports). Sixth grade reported peer victimization was also significantly associated with eighth grade depression for boys and eighth grade social anxiety for girls. Tests of mediation supported the role of global self-worth for boys and social acceptance for girls. Teacher support served a significant moderating role for boys' peer victimization-internalizing symptom (depression and social anxiety) relation. In both cases, boys reported fewer internalizing symptoms when peer victimization was low and teacher support was high. Findings are integrated into the literature regarding peer victimization and internalizing difficulties. / Ph. D.

Die Arbeit untersucht die physiologische und psychologische Stressreaktion von Kindern und Jugendlichen mit internalisierenden Störungen im Vergleich zu gesunden Kontrollkindern (n = 55 pro Gruppe, Alter 8-14 J). Es wurde ein standardisierter Stressor, der Trier Social Stress Test for Children (TSST-C; Buske-Kirschbaum et al., 1997) eingesetzt und die Stressreaktion der Probanden mehrdimensional erfasst. So wurde vor und nach Stresstest insgesamt zu 9 Messzeitpunkten die physiologische Stressreaktion anhand des Stresshormons Cortisol gemessen sowie die aktuelle subjektive Aufregung erfragt. Die kognitive Stressreaktion wurde unmittelbar nach dem Stresstest anhand einer subjektiven Leistungseinschätzung sowie eine Stunde nach dem Stressor anhand eines Fragebogens zu negativen Kognitionen erfasst. Es zeigte sich, dass die Kinder der internalisierenden Gruppe eine signifikant geringere physiologische (blunted reaction) sowie eine signifikant höhere kognitive Stressreaktion aufweisen als die Kinder der Kontrollgruppe. Darüber hinaus zeigte sich eine Unterschied in den subjektiven Aufregungswerten nach dem Stresstest, mit einer höheren und länger andauernden Aufregung in der internalisierenden Gruppe. Im Rahmen von mehreren explorativen Fragestellungen wurde der Zusammenhang zwischen den verschiedenen Aspekten der Stressreaktion untersucht. Stärken und Schwächen der Arbeit sowie klinische Implikationen der gefundenen Ergebnisse werden diskutiert.

This study examined interpersonal predictors of early therapeutic alliance in a cognitive-behavioral treatment study for adolescents with anxiety and/or depressive disorders. Client, therapist, and observer rated measures of alliance were obtained from the third session of treatment in a sample of twenty-seven adolescents. Results indicate that alliance ratings across the three perspectives are significantly associated with one another, but that pretreatment interpersonal variables were differentially associated with varying informant perspectives. Adolescents’ perceptions of their relationships to their caregivers positively related to their perceptions of the therapeutic alliance, such that adolescents with more positive representations of relationships with their attachment figures were more likely to endorse stronger working alliances early in treatment. Adolescent-reported symptom severity at pretreatment predicted observer ratings of alliance, such that adolescents who indicated greater symptoms at pretreatment were rated as having stronger early alliances with their therapists by independent observers. Adolescent perceptions of social support also predicted observer ratings of alliance. Therapists perceived having weaker alliances with adolescents showing clinically significant depression, as compared to adolescents diagnosed with anxiety disorders alone. Future research is needed to examine whether identification of relevant interpersonal factors can help improve therapeutic engagement and outcomes for the psychosocial treatment of adolescents with anxiety and depressive disorders.

No description available.

No description available.

Research investigating aggressive behavior among youth is plentiful; however, the field contains mixed findings in terms of risk factors, correlates, sequelae, and treatment response, suggesting that individuals who exhibit aggressive behaviors are heterogeneous. The current project utilized a person-centered perspective to characterize youth who differ in frequency and quality of aggressive behaviors and a variable-centered approach to validate these classes. Specifically, the aims of the current study were (a) to use latent class analysis (LCA) to identify classes of youth that are characterized by qualitatively and quantitatively different types of aggressive behaviors, and (b) to examine the external validity of the identified aggression classes in a large, prospective sample. Participants included 648 children (M = 11.42 + .92 years; 76% Caucasian) assessed at five time points between the ages of 10 and 25 as part of a longitudinal project conducted through the Center for Education and Drug Abuse Research at the University of Pittsburgh. Analyses suggest five distinct aggression profiles in the sample; individuals exhibiting (1) primarily reactive aggression, (2) primarily proactive aggression (3) mixed reactive and proactive aggression, (4) loss of control (endorsement of a subset of reactive aggression items), and (5) low reactive and proactive aggression. Classes differed in their levels of executive functioning, peer processes, lack of guilt, internalizing symptoms, and provocation to aggression. Specifically, individuals who engaged in primarily proactive, primarily reactive, or mixed aggression exhibited significantly lower ECF than individuals in the low aggression class. Individuals who engaged in mixed aggression experienced greater peer rejection, associations with deviant peers, internalizing symptoms, and lack of guilt than individuals who exhibited low aggression at specific time points. Of note, individuals who engaged in primarily proactive aggression were more likely to experience internalizing symptoms than individuals who engaged in reactive or low aggression in late childhood and early adolescence and were more likely to report lack of guilt after misbehaving than members of other aggression classes across late childhood and early adulthood. Differences among classes in terms of these variables better characterize and validate the subgroups of aggressive youth identified in the latent class analysis. The study fills gaps in the literature by identifying concurrent and prospective correlates of aggression classes and decreasing the heterogeneity found in aggression-related research by considering the qualitative and quantitative ways in which individuals differ on aggression using a dimensional approach. These findings enhance understanding of risk processes related to aggression and inform interventions that focus specifically on ameliorating deficits displayed by youth with different aggression profiles. / Psychology