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"Lebowitz, Eli R"
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Family Accommodation in Autism Spectrum Disorder
Family accommodation occurs frequently among families of children with OCD and anxiety disorders, with higher levels of accommodation repeatedly associated with greater symptom severity, lower functioning, and poorer treatment outcomes for children. This is the first examination of family accommodation of restricted and repetitive behaviors (RRBs) in children with autism spectrum disorder (ASD). Parents of children with ASD (N = 86) completed questionnaires assessing their children’s RRBs and parental accommodation of these symptoms. Most participants (80%) reported engaging in accommodation at least once a month and family accommodation was significantly positively correlated with RRB severity. These results suggest accommodation of RRBs follows a pattern similar to that reported in obsessive compulsive and anxiety disorders, and highlight avenues for potential parent-based interventions.
Journal Article
Family accommodation in obsessive-compulsive disorder
Family accommodation refers to ways in which family members take part in the performance of rituals, avoidance of anxiety-provoking situations or modification of daily routines to assist a relative with obsessive-compulsive disorder (OCD). Our goal is to review the available data on the role of family accommodation in both children and adults with OCD. A search of available peer-reviewed English language papers was conducted through PubMed and PsycINFO cross-referencing the keyword OCD with accommodation, family relations and parents. The resulting 641 papers were individually evaluated for relevance to the scope of the review. It was found that accommodation is common in OCD and is strongly and consistently correlated with OCD symptom severity. Family accommodation also appears to be increased when the proband has cleaning contamination symptoms and increased internalizing or externalizing problems. Family accommodation is associated with increased parental OCD and anxiety symptoms. Levels of accommodation are associated with treatment outcomes for both behavioral and pharmacological treatment. Significant improvement of OCD symptoms with treatment is associated with reductions in family accommodation. Family accommodation represents important clinical data that is worth measuring, monitoring and tracking in clinical care. Therapies targeting family accommodation may be successful in improving treatment outcomes in OCD.
Journal Article
Response to the COVID-19 Outbreak in Urban Settings in China
The COVID-19 outbreak in China was devastating and spread throughout the country before being contained. Stringent physical distancing recommendations and shelter-in-place were first introduced in the hardest-hit provinces, and by March, these recommendations were uniform throughout the country. In the presence of an evolving and deadly pandemic, we sought to investigate the impact of this pandemic on individual well-being and prevention practices among Chinese urban residents. From March 2–11, 2020, 4607 individuals were recruited from 11 provinces with varying numbers of COVID-19 cases using the social networking app WeChat to complete a brief, anonymous, online survey. The analytical sample was restricted to 2551 urban residents. Standardized scales measured generalized anxiety disorder (GAD), the primary outcome. Multiple logistic regression was conducted to identify correlates of GAD alongside assessment of community practices in response to the COVID-19 pandemic. We found that during the COVID-19 pandemic, the recommended public health practices significantly (p < 0.001) increased, including wearing facial mask, practicing physical distancing, handwashing, decreased public spitting, and going outside in urban communities. Overall, 40.3% of participants met screening criteria for GAD and 49.3%, 62.6%, and 55.4% reported that their work, social life, and family life were interrupted by anxious feelings, respectively. Independent correlates of having anxiety symptoms included being a healthcare provider (aOR = 1.58, p < 0.01), living in regions with a higher density of COVID-19 cases (aOR = 2.13, p < 0.01), having completed college (aOR = 1.38, p = 0.03), meeting screening criteria for depression (aOR = 6.03, p < 0.01), and poorer perceived health status (aOR = 1.54, p < 0.01). COVID-19 had a profound impact on the health of urban dwellers throughout China. Not only did they markedly increase their self- and community-protective behaviors, but they also experienced high levels of anxiety associated with a heightened vulnerability like depression, having poor perceived health, and the potential of increased exposure to COVID-19 such as living closer to the epicenter of the pandemic.
Journal Article
A computational network perspective on pediatric anxiety symptoms
While taxonomy segregates anxiety symptoms into diagnoses, patients typically present with multiple diagnoses; this poses major challenges, particularly for youth, where mixed presentation is particularly common. Anxiety comorbidity could reflect multivariate, cross-domain interactions insufficiently emphasized in current taxonomy. We utilize network analytic approaches that model these interactions by characterizing pediatric anxiety as involving distinct, inter-connected, symptom domains. Quantifying this network structure could inform views of pediatric anxiety that shape clinical practice and research.
Participants were 4964 youths (ages 5-17 years) from seven international sites. Participants completed standard symptom inventory assessing severity along distinct domains that follow pediatric anxiety diagnostic categories. We first applied network analytic tools to quantify the anxiety domain network structure. We then examined whether variation in the network structure related to age (3-year longitudinal assessments) and sex, key moderators of pediatric anxiety expression.
The anxiety network featured a highly inter-connected structure; all domains correlated positively but to varying degrees. Anxiety patients and healthy youth differed in severity but demonstrated a comparable network structure. We noted specific sex differences in the network structure; longitudinal data indicated additional structural changes during childhood. Generalized-anxiety and panic symptoms consistently emerged as central domains.
Pediatric anxiety manifests along multiple, inter-connected symptom domains. By quantifying cross-domain associations and related moderation effects, the current study might shape views on the diagnosis, treatment, and study of pediatric anxiety.
Journal Article
Assessing Behavioral Threat Avoidance in Pediatric Anxiety With Naturalistic Games
Behavioral avoidance exacerbates anxiety symptoms. Capturing and identifying maladaptive avoidance patterns holds clinical utility. However, effective assessment tools which provide unique information on behavior beyond self‐report are needed. Here, we assess the replicability of an interactive game to distinguish between clinically anxious and healthy youth's behavioral avoidance. One hundred and fifteen youth (8–17 years old) completed the Yale Interactive Kinect Environment Software (YIKES) paradigm, whereby behavioral avoidance of aversive and non‐aversive faces is captured. Our primary, preregistered analyses used mixed ANOVA models to test differences in behavioral avoidance by diagnostic status, clinician‐reported avoidance, and self‐reported social anxiety symptoms. Secondary, non‐preregistered analyses pooled data across two published studies (n = 189 youth). Primary analyses found no association between clinician‐rated anxiety symptoms and avoidance (ps > 0.296). A secondary, pooled analysis with additional data indicated a positive association between self‐reported social anxiety symptom severity and avoidance of aversive faces (r = 0.25, p < 0.001). A positive association also emerged between overall self‐reported anxiety symptoms and avoidance of aversive faces (r = 0.18, p = 0.014). Here, we provide evidence that a naturalistic interactive game is effective for capturing avoidance patterns. While no associations with clinician‐rated measures emerged, behavioral avoidance was correlated with self‐reported anxiety. This appeared stronger for social anxiety compared to overall anxiety symptom severity. Our results suggest that self‐report may be more sensitive to capturing behavioral patterns of avoidance than clinician‐report, although replication and further work building on this paradigm is warranted.
Journal Article
Developmental psychopathology: an introduction
Specifically designed for readability and utilizing a concise format, Developmental Psychopathology: An Introduction offers an authoritative, approachable overview of mental developmental disorders and problems faced by children and adolescents. Noted researcher and author Dr. Fred R. Volkmar leads a team of experts from the Child Study Center at Yale University School of Medicine in presenting essential, introductory information ideal for fellows and physicians in child and adolescent psychiatry, as well as psychiatry residents and other health care professionals working in this complex field.
eBook
Sex and age as moderators in the expression of internalizing and externalizing behaviors: insights from the Child Behavior Checklist (CBCL)
Background
Children referred for anxiety disorders frequently show both internalizing and externalizing problems, but the role of sex and age in shaping these behavioral expressions remains unclear. Prior research suggests sex differences may shift across development, yet findings have been inconsistent.
Methods
We analyzed data from 600 children (ages 6–17; 53.2% male) referred to a pediatric anxiety specialty clinic in the Northeastern United States between 2013 and 2021. Parents completed the Child Behavior Checklist (CBCL/6–18). Ordinary least squares regression models with an interaction term (sex × age) were estimated using Hayes’ PROCESS macro (Model 1). The Johnson–Neyman technique was applied to identify developmental periods where sex differences were significant.
Results
Sex significantly moderated the association between age and CBCL scores. Boys displayed higher externalizing scores than girls between ages 6 and 9.7 years, whereas girls showed higher internalizing scores from age 10.4 years onward. Effect sizes for the interactions were modest (ΔR2 range = .03–.05).
Conclusions
Findings indicate that the expression of behavioral problems among anxiety-referred youth differs by both sex and developmental stage. Early externalizing difficulties in boys and later-emerging internalizing difficulties in girls suggest that findings may inform age- and sex-sensitive approaches to assessment and intervention to age- and sex-specific trajectories in pediatric anxiety populations.
Journal Article
Transactional associations of child irritability and anxiety with parent psychological control in Taiwanese school‐aged children
Background Child irritability and anxiety are associated with parent psychological control; yet their transactional relations over time are not well‐characterized at the within‐person level. Research addressing generalizability of past Western‐based literature in non‐Western, collectivist community samples is lacking. Methods Sample comprised 285 children aged 8.8–11.4 years (145 girls; Mage = 9.9 years, SD = 0.6) in Northern Taiwan. Participants were assessed at baseline (T1), 6‐month (T2), and 12‐month (T3) follow‐ups. Child irritability and anxiety symptoms were assessed using parent‐rated Child Behavior Checklist. Parent psychological control was assessed using the parent‐ and child‐rated Psychological Control Scale. Within‐person processes were specified using the random‐intercept cross‐lagged panel models. Results Models showed that psychological control predicted increased child irritability when analyzing parenting data from parents and children. However, the lagged effect from psychological control to child anxiety was only seen in parent‐rated parenting data. We found limited evidence for a back‐and‐forth transactional pathway among constructs. Child irritability predicted increased child anxiety in all models. Conclusions Directional effects from psychological control to child irritability and anxiety support parent‐involved interventions that prioritize collaborative parenting and positive reinforcement techniques. Future validations in combined clinical and typically developing samples and direct cross‐cultural comparisons are warranted.
Journal Article
Chronotherapeutic intervention targeting emotion regulation brain circuitry, symptoms, and suicide risk in adolescents and young adults with bipolar disorder: a pilot randomised trial
BackgroundMood episodes and high suicide risk of bipolar disorder (BD) are thought to derive from amygdala–ventral prefrontal cortex emotion regulation brain circuitry dysfunction and resulting emotion dysregulation, making these potential intervention targets.ObjectiveTo assess feasibility, acceptability, and preliminary efficacy in engaging the emotion regulation targets of two Brain Emotion Circuitry-targeted Self-Monitoring and Regulation Therapy (BE-SMART) variations in adolescents and young adults with BD (BDAYA): BE-SMART-ER, which directly targets emotion regulation, and BE-SMART-DR, a social rhythm therapy (SRT)-based chronotherapeutic intervention designed to reduce daily rhythm (DR) irregularities.MethodsIn a single-blind, parallel, pilot-randomised trial, 60 BDAYA (aged 16–29 years) were randomised to 12 weekly sessions (9 telehealth) of BE-SMART-DR or BE-SMART-ER. Nineteen BE-SMART-DR and 16 BE-SMART-ER participants completed the intervention, with 11 and 13, respectively, having pre-intervention and post-intervention functional MRI data.FindingsIn addition to demonstrating feasibility, only BE-SMART-DR showed pre-treatment to post-treatment improvements in DR regularity (Cohen’s d=0.55; 95% CI [0.06, 1.03]), associated with reductions in left amygdala responses to emotional face stimuli (pFWE (family-wise error)-SVC (small volume correction)<0.05), difficulties in emotion regulation (d=0.75; 95% CI [0.23, 1.25]) and suicide risk (d=0.65; 95% CI [0.15, 1.14]). Significant correlations were observed among these changes (p<0.05). Both interventions showed high acceptability and improvements in depression and mania symptoms. No intervention-related adverse events were observed.ConclusionsRegularising DRs may enhance emotion regulation brain circuitry functioning, emotion regulation, and reduce suicide risk in BDAYA.Clinical implicationsChronotherapeutic interventions regularising DRs, such as SRT, should be studied further as potential treatment strategies for BDAYA.Trial registration numberNCT03183388.
Journal Article