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A large proportion of children experience subclinical levels of anxiety and cognitive-behavioral therapy (CBT) aimed at preventing anxiety disorders is moderately effective. However, most at-risk children do not seek help or drop out of programs prematurely because of stigma, lack of motivation, and accessibility barriers. Applied games have received increased attention as viable alternatives and have shown promising results, but direct comparisons between applied games and the gold-standard CBT are lacking. Our aim was to investigate whether the applied game MindLight is as effective as CBT (i.e., Coping Cat) within an indicated prevention context. We conducted a randomized controlled non-inferiority trial with a sample of 174 children (7- to 12-year olds) with elevated levels of anxiety, comparing MindLight to CBT. Anxiety was assessed with self- and parent-reports at pre- and post-program, and at 3- and 6-month follow-ups. Intention-to-treat and completers-only confidence interval approach and latent growth curve modeling showed an overall significant quadratic decrease in child- and parent-reported anxiety symptoms over time and, as predicted, the magnitude of improvement was the same for MindLight and CBT. The within-group effect sizes were small to medium at post-test (- 0.32 to - 0.63), and medium to large (- 0.60 to - 1.07) at 3- and 6-month follow-ups. Furthermore, MindLight and CBT were rated equally anxiety inducing, difficult, and appealing; CBT was rated as more relevant to daily life than MindLight. The current study adds to the growing research on applied games for mental health and shows that these games hold potential as alternative delivery models for evidence-based therapeutic techniques. [ABSTRACT FROM AUTHOR]

Childhood anxiety is a problem not only because of its negative consequences on the well-being of children but also because of its adverse effects on society and its role in mental disorders later in life. Adequate prevention might be the key in tackling this problem. The effectiveness of Coping Cat, as an indicated CBT-based prevention program in Dutch primary school children, was assessed by means of a randomized controlled trial. In total, 141 children aged 7-13 with elevated levels of anxiety and their mothers were included and randomly assigned to an intervention group and a waiting list control group. After screening, all participants completed baseline, post-intervention, and 3-month follow-up assessments. The results showed that Coping Cat, as an indicated prevention program, reduces children's self-reported anxiety symptoms, with Cohen's effect size d of 0.66 at the 3-month follow-up. A moderating effect was found for baseline anxiety level; specifically, children with high levels of baseline anxiety who received the Coping Cat program had lower anxiety levels at follow-up compared to children with high levels of anxiety in the control condition. No moderating effects of gender or age were found. An unexpected decline in anxiety levels from screening to pre-assessment was found in both groups, and this decline was stronger in the experimental group. These promising results warrant the implementation of Coping Cat as an indicated prevention program. [ABSTRACT FROM AUTHOR]

Children use signals from others to guide their behavior when confronted with potentially dangerous situations, so called social referencing. Due to evolutionary based different expertise of fathers and mothers, parents might be different social references for their children. The present study tested the influence of paternal and maternal social referencing signals on child anxiety. We expected that (1) children would show different social reference processing towards fathers' and mothers' signals; (2) in male-specific situations children would be more influenced by paternal signals, and in female-specific situations by maternal signals; (3) boys would respond with more anxiety to female-specific situations, and girls to male-specific situations; (4) high anxious children would be more susceptible to parental, and specifically paternal, social referencing signals than low anxious children. Children aged 8-13 read scripts of ambiguous situations in which the mother/father signaled anxious/confident behavior, and indicated how anxious they would feel. Experiment 1 ( n = 129) concerned non-social situations, and Experiment 2 ( n = 124) social situations. As expected, children responded with more anxiety to scripts in which their parent acted anxious than to scripts in which their parent acted confident. Children, also high-anxious children, were not differently affected by signals of fathers and mothers. Girls responded with more anxiety than boys in male-typical non-social situations. Congruence between the parent signaling and his/her evolutionary expertise did in general not affect social referencing. In conclusion, independent from parental evolutionary based expertise or from children's level of anxiety, fathers' signals have as much influence on their children's anxiety as mothers'. [ABSTRACT FROM AUTHOR]

The present study examined the relationship between worry and threat-related confirmation bias in children. Forty non-clinical children aged 10-12 years completed the child version of the Penn State Worry Questionnaire as a cognitive index of anxiety proneness, and then were administered a modified version of the Wason Selection Task to assess verifying and falsifying reasoning strategies in response to conditional danger rules. Results demonstrated that children with high levels of worry displayed a stronger tendency towards verification and a weaker inclination towards falsification than children with low levels of worry. This finding indicates that confirmation bias occurs in individuals with a general vulnerability to anxiety, and fits well with current theoretical models in which cognitive distortions are viewed as risk factors predisposing to the development of fear and anxiety problems. [ABSTRACT FROM AUTHOR]

Anxiety in children is highly frequent and causes severe dysfunction. Various studies have used screening procedures to identify high-anxious children and offer them indicated prevention, but the cost-effectiveness of these screening procedures in combination with a preventive intervention has never been examined. This study compared four potential strategies in relation to the prevention of child anxiety: (1) a one-time school-based screening which offers a child-focused intervention, (2) the screening and offering of a parent-focused intervention, (3) the screening and differentially offering a child- or parent-focused intervention, depending on whether or not the parents are anxious themselves, and (4) or doing nothing. An economic evaluation from a societal perspective (i.e. including direct healthcare costs, direct non-healthcare costs, indirect costs, and out-of-pocket costs), using a decision-analytic model. The model was based on the real-world 2-year participation rates of screening and intervention, and real-world costs and effects of high- and median-anxious children (aged 8-12) from regular primary schools. Incremental cost-effectiveness ratios were calculated, and several secondary and one-way sensitivity analyses were performed. The strategy of doing nothing and the strategy of screening and differentially offering the child- or parent-focused intervention, depending on parental anxiety levels were both worthwhile, with the latter strategy costing relatively little extra money compared to doing nothing. In conclusion, some evidence for the cost-effectiveness of screening and intervening was found. Screening and offering a parent-focused intervention to children of anxious parents, and a child-focused intervention to children of non-anxious parents, were found to be the most cost-effective approach. [ABSTRACT FROM AUTHOR]

Abstract: Individuals reporting Childhood Abuse (CA) (i.e., emotional neglect, emotional-, physical- and sexual-abuse) are marked by increased explicit (i.e. self-reported) negative self-associations, and an increased risk to develop depression or anxiety disorders. Automatic self-associations might play an important role in the development and maintenance of affective disorders after exposure to CA, since automatic associations are assumed to be involved in uncontrolled (spontaneous) affective behavior. This study examined whether individuals reporting a history of CA show stronger automatic (and explicit) self-depression and/or self-anxiety associations than individuals who report no CA in a large cohort study (Netherlands Study of Depression and Anxiety (NESDA), n = 2981). The Implicit Association Test (IAT) was utilized to assess automatic self-depression and self-anxiety associations. We found that CA was associated with enhanced automatic (and explicit) self-depression and self-anxiety associations. Additionally, when compared to physical- and sexual-abuse, Childhood Emotional Maltreatment (CEM; emotional abuse and emotional neglect) had the strongest link with enhanced automatic (and explicit) self-depression and self-anxiety associations. In addition, automatic and explicit negative self-associations partially mediated the association between CEM and depressive or anxious symptomatology. Implications regarding the importance of CA, and CEM in particular will be discussed. [Copyright &y& Elsevier]

The number of children displaying childhood disorders in the Netherlands is estimated through a questionnaire referencing DSM-IV symptoms filled out by the parents of 2,563 4- 18-year-old Dutch children randomly taken from the general Dutch Youth population in 2004. The number of impaired children was estimated by applying the DSM-IV criteria for impairment by symptoms. It was found that 14% of all Dutch children display developmental difficulties, with 8% at risk of moderate behavioral and emotional difficulties and 6% at risk of a childhood psychiatric disorder. These prevalence figures based upon parental observations of DSM-IV symptoms in children are in agreement with the findings of other studies estimating psychiatric disorders in childhood in Western countries. [ABSTRACT FROM AUTHOR]

We examined to what extent children in The Netherlands are affected by the threat of terrorism. For this purpose, a sample of school children living in Rotterdam or adjacent satellites ( N = 216) completed a fear survey that included a number of terrorism-related items, and were confronted with ambiguous vignettes to measure threat-related interpretation bias. The results demonstrated that although a number of terrorism-related items (i.e., bombing attacks, explosions in a bus or subway) listed high in a ranking of most intense childhood fears, very few children made terrorist-related interpretations of ambiguous situations. [ABSTRACT FROM AUTHOR]

Objective: The societal changes experienced by Western societies in recent decades have raised concerns about increases in the level of children's mental health problems. Although studies of secular changes in the prevalence of psychiatric diagnoses have indeed shown increases, their results may have been influenced by methodological problems, such as changing diagnostic criteria. Although repeated population studies using identical measures have not indicated such a clear increase in mental health problems, these studies have been limited to school-age children. We therefore investigated changes in Dutch parents' reports of very young children's emotional and behavioral problems over a 14-year period.Method: We compared Child Behavior Checklist scores across two Dutch general population samples of 2- and 3-year-olds, one sample assessed in 1989 and one in 2003.Results: Results revealed only a few changes over time, indicating small decreases in parent-reported problems. Between 1989 and 2003, there were decreases in the mean scores and in the proportions of children with deviant scores on the Anxious/Depressed, Total Problems, Internalizing, and DSM-oriented attention-deficit/hyperactivity problems scales.Conclusions: Despite indications of increasing problems among school-age children and adolescents, parent-reported problem levels of very young Dutch children have not increased. Our findings even showed some small improvements in parents' reports of very young children's functioning between 1989 and 2003. [ABSTRACT FROM AUTHOR]

Examined the reliability, validity, and factor structure of the Childhood Anxiety Sensitivity Index ( CASI; Silverman, Fleisig, Rabian, & Peterson, 1991) in a Dutch sample. Five hundred forty-four Dutch schoolchildren between 8 and 16 years of age completed Dutch translations of the CASI; the State-Trait Anxiety Inventory for Children (Spielberger, Edwards, Lushene, Montuori, & Platzek, 1973); and the Fear Survey Schedule for Children-Revised (Ollendick, 1983). The Dutch CASI was found to have adequate internal consistency for use with children as well as adolescents. Results reveal that the CASI predicted fear beyond a measure of trait anxiety in this Dutch sample. Both exploratory and confirmatory factor analyses comparing different models were undertaken. The model with 3 first-order factors found in previous studies showed an acceptable fit in this cross-validation sample. Loadings on the 3 factors (Physical Concerns, Mental Concerns, and Publicly Observable Concerns) did not differ between children and adolescents. Results are compared with previous research on the CASI. Directions for future research are discussed. [ABSTRACT FROM AUTHOR]