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Biomedical subjects

Wendy K Silverman

Publications and source records attributed to Wendy K Silverman.

16 recordsLinked to original sources
PubMed2006

External validation of comorbid patterns of anxiety disorders in children and adolescents.

To evaluate the external validity of comorbid patterns of anxiety disorders among youth who presented to an anxiety disorders clinic, comorbid cases were compared to "pure" anxiety disorder cases. Children and adolescents (N=329; mean age=10.04 years) and parents were administered structured interviews and four groups were formed, Pure Anxiety, Anxiety+Anxiety, Anxiety+Externalizing, and Anxiety+Depressive, and compared along with four external validation criteria: sociodemographics, clinical phenomenology, psychosocial, and family factors. All comorbid groups were more severe than the pure anxiety group on clinical phenomenology and psychosocial factors. The Anxiety+Depressive Disorders group was most severe on all criteria except sociodemographics. Results provide evidence for the external validity of comorbid diagnostic presentations among anxiety disorders, as there was differential meaningfulness in the diagnostic presentation of a pure anxiety disorder versus anxiety disorder comorbid with other disorders. Assessment and future research implications are discussed.

Adolescent↗
PubMed2006

An integrative model of control: implications for understanding emotion regulation and dysregulation in childhood anxiety.

Theorists and investigators have emphasized an important role for control in emotional problems such as anxiety and anxiety disorders in youth. However, the term "control" is subject to theoretical ambiguities because of the broad conceptual bases for the term. In this article, we examine the concepts of locus of control, learned helplessness/attributional style, self-efficacy, and perceived control to develop an integrative model of control based on research and theory. The review emphasizes each of the theories distinguishing features in order to show how these distinctive features relate to real versus perceived control and how they may be differentially associated with childhood anxiety. We attempt to clarify the various definitions of control and the implications of these various definitions with respect to childhood anxiety, its disorders and their treatment and present a model of control that is integrative but also addresses the complexities of the different definitions of control (i.e., is multifaceted). The model developed from our review of the literature postulates that individuals differ in the extent to which they actually have control and differ, also on a continuum, in their perceptions of control. The need for this integrative model is highlighted by methodological, developmental, and clinical considerations. In particular, research has operationalized control and related constructs such as emotion regulation in ways that may be confounding actual control and perceived control. The need for an integrative but also multifaceted conceptualization of the role of control in childhood anxiety is also highlighted by clinical and developmental considerations. For instance, different facets of control may have differential relevance to clinical anxiety and at different points in childhood.

Affect↗
PubMed2006

Client similarities and differences in two childhood anxiety disorders research clinics.

Some evidence suggests that research and service clinics differ on treatment-relevant dimensions, but no study has examined whether research clinics (RCs) themselves differ. We compared 2 samples of children and adolescents (ages 7 to 17 years) with anxiety disorders treated in 2 different university-based child anxiety RCs, one in Philadelphia (n = 184) and one in Miami (n = 64), on child symptom and diagnostic measures, family characteristics (e.g., income), and level of maternal depression. The samples were not significantly different on any youth symptom and diagnostic measures except 1 (parent-reported diagnoses); further, the 2 samples were statistically equivalent on 3 of 6 youth symptom measures. Although the Miami sample had significantly more parent-reported diagnoses than the Philadelphia sample, the effect size was small (Cohen's d = .44). Statistically significant differences between the samples in ethnic background and family income were observed, though the former was not significant after controlling for population differences. Findings are discussed in terms of the implications of homogeneity of RCs for treatments tested there.

Adolescent↗
PubMed2005

Multisample cross-validation of a model of childhood posttraumatic stress disorder symptomatology.

This study is the latest advancement of our research aimed at best characterizing children's posttraumatic stress reactions. In a previous study, we compared existing nosologic and empirical models of PTSD dimensionality and determined the superior model was a hierarchical one with three symptom clusters (Intrusion/Active Avoidance, Numbing/Passive Avoidance, and Arousal; Anthony, Lonigan, & Hecht, 1999). In this study, we cross-validate this model in two populations. Participants were 396 fifth graders who were exposed to either Hurricane Andrew or Hurricane Hugo. Multisample confirmatory factor analysis demonstrated the model's factorial invariance across populations who experienced traumatic events that differed in severity. These results show the model's robustness to characterize children's posttraumatic stress reactions. Implications for diagnosis, classification criteria, and an empirically supported theory of PTSD are discussed.

Adolescent↗
PubMed2005

Specific phobia.

This article describes specific phobia of childhood and its clinical presentation, discusses issues related to the differential diagnosis of specific phobia, considers the issue of comorbidity among phobic and anxiety disorders and developmental trends in the manifestation of fears, summarizes the epidemiology, causes, and course of specific phobia, and presents assessment and treatment issues. Finally, a case study is offered that serves to illuminate the major topics outlined in the article.

Anxiety Disorders↗
PubMed2005

Evidence-based assessment of anxiety and its disorders in children and adolescents.

We provide an overview of where the field currently stands when it comes to having evidence-based methods and instruments available for use in assessing anxiety and its disorders in children and adolescents. Methods covered include diagnostic interview schedules, rating scales, observations, and self-monitoring forms. We also discuss the main purposes or goals of assessment and indicate which methods and instruments have the most evidence for accomplishing these goals. We also focus on several specific issues that need continued research attention for the field to move forward toward an evidence-based assessment approach. Finally, tentative recommendations are made for conducting an evidence-based assessment for anxiety and its disorders in children and adolescents. Directions for future research also are discussed.

Adolescent↗
PubMed2004

Clinical phenomenology, somatic symptoms, and distress in Hispanic/Latino and European American youths with anxiety disorders.

This study compared clinic-anxious Hispanic/Latino and European American youths (ages 6 to 17 years old) along sociodemographic and clinical variables. Groups were relatively similar, although significant differences emerged as a function of ethnocultural and language choice (English, Spanish) used during the assessment. Within the English language choice group, Cuban American (CA) youths reported somatic symptoms as less distressing than non-Cuban American Hispanic/Latino (non-CA/HL) youths. Conversely, within the Spanish language choice group, CA youths reported somatic symptoms as more distressing than non-CA/HL youths. Also, parents in the European American and CA groups reported their youths as having less somatic symptoms than parents in the non-CA/HL group. Implications of findings are discussed, particularly regarding possible cultural significance of somatic symptoms.

Adolescent↗
PubMed2003

The facets of anxiety sensitivity represented in the childhood anxiety sensitivity index: confirmatory analyses of factor models from past studies.

Results of past factor analytic studies of the Childhood Anxiety Sensitivity Index and Anxiety Sensitivity Index were used to formulate hypotheses about factor models of anxiety sensitivity. Using a nonclinical sample of 767 children and adolescents and confirmatory factor analysis, hypothesized models with 2, 3, and 4 lower order factors (facets) were tested. Goodness-of-fit criteria indicated that a model with 4 facets fits these data well. Support was found for factorial invariance of the 4 facets across age and gender, using nonclinical and clinical samples. Results support a hierarchical factor model in that there was a strong general factor, explaining 71% of the variance. Findings are discussed in the context of anxiety sensitivity theory and research with children and adolescents.

Adolescent↗
PubMed2003

A comparison of completers and noncompleters of exposure-based cognitive and behavioral treatment for phobic and anxiety disorders in youth.

This article examined sociodemographic and clinical characteristics of child treatment completers and noncompleters who received exposure-based cognitive-behavioral treatment. A total of 137 children (46% girls) and their parents (predominantly Euro-American and Hispanic/Latino) participated in this study (106 completers, 31 noncompleters). The majority of noncompleters received an average of 5 sessions. Findings were generally consistent with past research in terms of lack of differences between completers and noncompleters. Results are discussed in the context of previous child attrition research and directions for future research.

Adolescent↗
PubMed2003

Exposure-based cognitive-behavioral treatment for phobic and anxiety disorders: treatment effects and maintenance for Hispanic/Latino relative to European-American youths.

OBJECTIVE: To examine treatment response and maintenance to exposure-based cognitive-behavioral therapy (CBT) for Hispanic/Latino relative to European-American youths with phobic and anxiety disorders. METHOD: A total of 131 Hispanic/Latino and European-American youths (aged 6-16 years) who participated in two previous clinical trials for phobic and anxiety disorders were compared along diagnostic recovery rates, clinically significant improvement, and youth- and parent-completed questionnaire scores using traditional hypothesis tests, including effect sizes, and statistical equivalence tests. RESULTS: After treatment, Hispanic/Latino and European-American youths responded similarly to exposure-based CBT in their diagnostic recovery rates and questionnaires. Effect sizes for questionnaire data were also more similar than different across the two groups. With regard to treatment maintenance, Hispanic/Latino and European-American youths also responded more similarly than differently, albeit with some variations within specific assessment points in questionnaire data. CONCLUSIONS: Exposure-based CBT for phobic and anxiety disorders produced positive treatment gains and maintenance for Hispanic/Latino youths who participated in the trials. The treatment response that can be expected is generally similar (i.e., favorable) and equivalent to that found with European-American youths based on all the available indices of change.

Adolescent↗
PubMed2003

Clinical distinctions between selective mutism and social phobia: an investigation of childhood psychopathology.

OBJECTIVE: To investigate the hypothesis that children with selective mutism are more socially anxious than children with social anxiety disorder but who are not selectively mute. METHOD: Twenty-three children with comorbid selective mutism and social phobia and 23 age-matched controls with social phobia alone and their parents participated in a comprehensive assessment of social anxiety and related aspects of psychopathology. RESULTS: The results do not uniformly support previous suggestions that children with selective mutism refuse speech because they are "frozen with fear." Although clinician and observer ratings for children with selective mutism revealed higher ratings of social distress than for children with social phobia alone, self-report data do not support this conclusion. Furthermore, although there were no group differences on measures of trait anxiety, general fears, or scores on the Child Behavior Checklist broadband Internalizing or Externalizing scales, children with selective mutism scored higher than children with social phobia alone on the Child Behavior Checklist Delinquency subscale, suggesting the presence of a broader clinical syndrome. CONCLUSION: It remains unclear whether children with selective mutism have extreme levels of social anxiety. Potential areas that might shed further light on this interesting disorder are discussed.

Case-Control Studies↗
PubMed2003

Childhood behavioral and emotional disorders.

We reviewed the literature on family treatment for childhood behavioral and emotional disorders and found an increase in the number of studies since 1995; however there was significant variation by disorder and therapy model. There is substantially more research on externalizing disorders (i.e., conduct disorder, attention deficit hyperactivity disorder, oppositional defiant disorder) then internalizing disorders, depression and anxiety disorders. The data support the conclusion that family-based interventions produce results comparable to individually oriented interventions, and in some cases family-based interventions are superior to individual treatments. To date, cognitive behavioral family therapy and parent management have been the two models studied, almost exclusively. Implications for family therapy and future research are considered.

Anxiety Disorders↗
PubMed2003

Research on information-processing factors in child and adolescent psychopathology: a critical commentary.

Provides a critical commentary on the state-of-the-art of research on information-processing (I-P) factors in clinical child and adolescent psychology. The articles in this special section amply demonstrate the value of the I-P paradigm as a heuristic framework for conceptualizing and studying the role(s) of cognitive factors in the etiology and maintenance of child and adolescent psychopathology. However, the current status of such research also reflects a number of limitations that warrant consideration if the potential value of the I-P paradigm is to be fully realized. Specifically, understanding the role(s) played by such factors is impeded by a variety of insufficiently addressed methodological and psychometric issues, as well as by insufficiently articulated theories regarding such factors. These issues are particularly challenging for child and adolescent psychopathology researchers because of the complexities added by development. The value of I-P theories of childhood and adolescent psychopathology will be considerably enhanced if these issues are more fully considered in future research.

Adolescent↗
PubMed2002

Case study: disgust and a specific phobia of buttons.

The role of disgust in childhood phobias has received limited attention in the psychiatric literature. Available studies suggest that attention to the emotion of disgust is optimal for reduction of phobic symptoms given that the interaction between fear and disgust has been found to maintain and even exacerbate phobias. Disgust was targeted via imagery exposures as part of an exposure-based cognitive-behavioral intervention for a 9-year-old Hispanic American boy who presented with a specific phobia of buttons. Posttreatment, 6-month, and 12-month follow-up assessment results demonstrated maintenance of treatment gains. The role of disgust in treating specific phobias in children is discussed.

Attitude↗
PubMed2002

Diagnostic efficiency of symptoms in the diagnosis of DSM-IV: generalized anxiety disorder in youth.

BACKGROUND: Evaluated five probability indices, including odds ratios, to determine relative contribution of Uncontrollable Excessive Worry (DSM-IV criterion A and criterion B) and Physiological Symptoms associated with uncontrollable excessive worry (DSM-IV criterion C) for diagnosing DSM-IV generalized anxiety disorder in youth. METHOD: One hundred eleven youths (6 to 17 years old) and their parents who presented to a childhood anxiety disorders specialty clinic were administered a semi-structured diagnostic interview schedule. Separate evaluations were conducted for children and adolescents. RESULTS: Results showed that symptoms comprising DSM-IV's generalized anxiety disorder diagnosis vary relative to one another in the degree to which they contribute to the diagnosis, with certain symptoms having relatively higher diagnostic value than other symptoms. The relative value of symptoms also appeared to vary with children's and adolescents' reports, and parents' reports about their children and adolescents. CONCLUSIONS: Despite variations in symptoms' values, with only a few exceptions, almost all symptoms were still quite useful for diagnosis, whether reported by children, adolescents, or their parents.

Adolescent↗