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Oval Hall - Bulgarian Red Cross

Children and Young People

Ana Pereira, Jens Högström, Lynn Mobach, Samantha Pearcey, Johan Kleberg / Cathy Creswell (Chair) Speaker

Chair: Cathy Creswell, University of Reading

16:00 Parental cognitions and motivation to change as predictors of parents’ engagement in
            psychological interventions: A systematic review
           Ana Pereira, L.Barros, University of Lisbon

16:15 Social attention in youth with social anxiety disorder and the impact of cognitive
            behavioral therapy
           Jens Högström, Eva Serlachius, Karolinska Institutet & Stockholm County Council
           Johan Lundin-Kleberg,Uppsala University
           Miriam Larson Lindal, Ebba Taylor,Karolinska Institutet
           Terje Falck-Ytter,Uppsala University & Karolinska Institutet

16:30 Content-specificity of Interpretation Bias in Childhood Anxiety and the Role of Gender
            and Age
           Lynn Mobach,Radboud University & Macquarie University
           AnkeKlein, TessaLansu,Eni S. Becker, Mike Rinck, Radboud University
           Jennifer L. Hudson,Macquarie University

16:45 The relationship between social anxiety and social communication: A Systematic
            Review and Meta-analysis
           Samantha Pearcey, Cathy Creswell, Bhismadev Chakrabarti,University of Reading

17:00 Pupil dilation to emotional faces distinguishes adolescent social anxiety from autism,
            and responders from non-responders in a CBT treatment
           Johan Kleberg, Uppsala University
           Terje Falck-Ytter, Sven Bölte, Uppsala University & Karolinska Institutet
           Eva Serlachius, Jens Högström, Karolinska Institutet & Stockholm County Council

17:15 Discussion

 

Abstracts:

1) Parental cognitions and motivation to change as predictors of parents’ engagement in psychological interventions: A systematic review
Pereira, A. I. Faculty of Psychology, University of Lisbon; Barros, L., Faculty of Psychology, University of Lisbon

This work reviews the available research on the predictors of parental engagement in preventive and therapeutic psychological interventions to promote mental health in children. We examine seven predictors concerning the perceived need of intervention (perceived child problems, perceived parenting) and possibility of change (attributions of problems, self-efficacy, perceived benefits and expectations of treatment, perceived obstacles) and more global readiness to change. PRISMA guidelines for systematic review were used to search for papers published between 1990 and 2017. Thirty-seven studies were included in the review. These longitudinal studies evaluated parental cognitions at the beginning of the intervention and examined them as predictors of parental engagement during a psychological intervention. Most studies focused on the parents’ perception of the child’s problems and of parenting with fewer studies examining the role of the other putative parental cognitive predictors. The results suggest that studies that focus their evaluation on the psychological dimensions, proposed in motivational models, of parent change and engagement in interventions may have an important role in understanding parental engagement (e.g. parents’ attributions of problems and parents’ readiness to change).

 

2) Social attention in youth with social anxiety disorder and the impact of cognitive behavioral therapy.
Jens Högström,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm County Council, Stockholm, Sweden;Johan Lundin-Kleberg, Uppsala Child and Baby Lab, Department of Psychology, Uppsala University, Sweden;Miriam Larson Lindal, Ebba Taylor,Department of Clinical Neuroscience, Division of Psychology, Psychology program, Karolinska Institutet, Stockholm, Sweden;Terje Falck-Ytter, Uppsala Child and Baby Lab, Department of Psychology, Uppsala University, Sweden &Department of Women’s and Children’s Health, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden;Eva Serlachius, Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm County Council, Stockholm, Sweden

Introduction:
To successfully navigate the social world we have to attend to complex and quickly shifting information such as facial expressions and emotional display. Work in psychology and neuroscience has demonstrated that typically developing children are remarkably apt at doing this. However, many children with social anxiety have a difficulty directing their attention flexibly and adaptively to social events, typically manifested as avoidance of eye contact or hyper-vigilance towards potential social threat (e.g., someone looking angry). This atypical social attention has been suggested to be involved in the etiology as well as in the maintenance of social anxiety disorder (SAD) but there is a lack of knowledge about these attentional mechanisms in youth and if they can be affected by psychological treatment. In this study, we tested the specificity of some fundamental social attention mechanisms that have been linked to SAD and their relationship to the outcome of cognitive behavioral therapy (CBT) for adolescents with SAD.
Method:
Participants (N=24) were adolescents with SAD who were matched on sex and age with (N=22) non-anxious controls. In the SAD group, social attention was measured with a corneal reflection eye-tracker before and after the participants went through 12 weeks of CBT. The non-anxious control participants were recruited through a random selection of youths from the Swedish population register.The SAD diagnosis was established with the M.I.N.I-kid interview and social anxiety was measured using the Social Phobia and Anxiety Inventory - Child version (SPAI-C).
Results:
Adolescents with SAD were found to be more vigilant to threatening social stimuli, compared to when they were confronted with neutral or positive stimuli. I.e. they were faster to shift their gaze towards peripheral threat stimuli. However, this attention bias was also found in the non-anxious control group. Similarly, participants in the SAD group were found to be quicker to shift their gaze away (avoidance) from threatening social stimuli, once a fixation had occurred. This effect was however also seen for the non-anxious controls. Furthermore, analyses showed that level of vigilance to threat at baseline did not predict the outcome from CBT, and there was no effect of CBT on vigilance after treatment.
Discussion:
Although an elevated vigilance toward threat was found in the SAD group, this attention bias was also seen in the non-anxious group, indicating that for adolescents this form of atypical attention does not distinguish SAD from the normal population. This is in line with some previous findings showing that this difference between SAD and non-anxious individuals does not become noticable until adulthood. Furthermore, attention bias did not predict the outcome from CBT indicating that CBT is a treatment that works well notwithstanding the degree of vigilance that particpiants present with. Nor did the level of vigilance change over the course of CBT treatment, pointing in the direction that attention bias has more of a trait like character, that may be difficult to change.
Conclusions:
Youths attend to threatening social stimuli differently than to neutral and positive stimuli and this seem to be the case whether or not they have SAD. Futher studies with larger samples are needed to confirm these results.  

 

3)Content-specificity of Interpretation Bias in Childhood Anxiety and the Role of Gender and Age
Lynn Mobach, Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands & Centre for Emotional Health, Macquarie University, Sydney, Australia;Anke M. Klein; Tessa A. M. Lansu, Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Jennifer L. Hudson, Centre for Emotional Health, Macquarie University, Sydney, Australia; Eni S. Becker; Mike Rinck,Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.

Introduction:
Recent studies found ample evidence for the existence of cognitive biases in socially anxious children. Specifically, interpretation biases - the phenomenon that fearful individuals have the tendency to interpret ambiguous situations as threatening – have been studied quite intensively with regard to childhood social anxiety. Cognitive biases are believed to be content-specific; only stimuli associated with the specific anxiety are biased. There are numerous studies that found interpretation biases in socially anxious children, and several studies also found evidence for the content-specificity of these interpretation biases. Recent studies found age and content of the scenarios (i.e., content-specificity) to be moderators of the association between anxiety and negative interpretation. However, most studies have focused on social anxiety and other anxieties have been neglected. Furthermore, there are very little studies assessing the moderating role of age and gender. Therefore, the current study aimed to (1) study the content-specificity of social anxiety-, separation anxiety-, and spider phobia-related interpretation bias, and (2) to study the moderating role of age and gender. It was hypothesized that there would be content-specificity of interpretation bias for the different anxieties and that gender and age would moderate this association.
Method:
School-aged children (N=600) between the ages of 7 and 13 were recruited from six regular elementary schools. Children had to complete an ambiguous scenario task consisting of 15 multiple-choice scenarios (5 social threat scenarios, 5 separation threat scenarios, 5 spider threat scenarios). Children had to choose from four answer options (positive/neutral/neutral-negative/negative) to indicate which ending would fit them best. Children also filled out questionnaires on social anxiety, separation anxiety and spider phobia. Data were analysed with hierarchical regression analyses.
Results:
Results showed that only social anxiety-related threat score was predictive of social anxiety. For spider phobia, only spider-related threat score was predictive of spider fear. However, for separation anxiety all threat scores were significant predictors. Although age and gender were significant predictors for almost all anxieties (age was not a significant predictor for spider fear), moderation analyses showed that age and gender did not significantly moderate the relation between negative interpretations and each of the anxieties.
Discussion:
These results indicate that content-specificity of interpretation bias might be present only for social anxiety and spider phobia. A strength of the current study is that a large sample was included and therefore had sufficient power to assess a possible moderating role for gender and age. However, the current study included a community sample and results should be replicated in a clinical sample. Future research should include other anxieties such as generalized anxiety disorder, which is also highly prevalent in children.
Conclusion:
The current study partially replicates earlier studies on content-specificity in childhood anxiety. Results confirmed content-specificity of interpretation bias in social anxiety and spider phobia, but not for separation anxiety. Interestingly, gender and age did not moderate the relation between negative interpretation and any of the anxieties. These results suggest that at least for social anxiety and spider phobia, it may be beneficial for treatment to specifically target interpretations related to the specific anxiety disorder.  

 

4) The relationship between social anxiety and social communication:  A Systematic Review and Meta-analysis.
      Samantha Pearcey;Cathy Creswell;Bhismadev Chakrabarti,University of Reading

Introduction:
Social anxiety disorder (SAD) is one of the most common mental health disorders, with approximately 13% of the population meeting diagnostic criteria for SAD during their life. Individuals typically present for treatment for SAD in early adolescence (median 13 years) and the most extensively evaluated treatment for childhood SAD is cognitive behaviour therapy (CBT). However, outcomes tend to be poorer for children with SAD than for those with other anxiety disorders when using generic CBT (i.e. not anxiety disorder specific). Diagnostic specific psychological treatments, that typically involve training social skills, are more efficacious than generic CBT for childhood SAD. However, it is not clear whether this is a direct result of improvements to social skills. Indeed, the nature of social skills deficits in childhood SAD remain unclear. For example, some studies have found that children with SAD have fewer social skills than those with other anxiety disorders or non-disordered children. However, others suggest that this is a reflection of their inhibited behaviour in social situations and overly negative perceptions of their own social skills, rather than reflecting social skills ‘deficits’. Additionally, children with disorders conceptualised by social communication difficulties (i.e. Autism spectrum conditions, ASC) are known to be at greater risk of developing SAD (40-50%) than children without these conditions (28%).
Aims:
There is clearly some evidence for a relationship between social anxiety and social communication difficulties, but this evidence is mixed and the strength and nature of this relationship is particularly unclear. Therefore, the current review and meta-analysis aims to (a) examine the association between social anxiety and social skills in children and adolescents and (b) examine which populations experience which aspects of social anxiety and social communication. As such variation in (a) social skills among children with varying levels of social anxiety, and (b) social anxiety among children with varying levels of social skills will be examined. This will build on previous reviews which have focused either on anxiety symptoms in general in ASD populations, or on social skills deficits in socially anxious populations. Method and results: Searches were run in 5 databases, yielding over 14,000 abstracts published between 1980 and 2017. Over 1,000 full texts were coded and 150 papers included in the final meta-analysis. Analyses establish an overall effect size for the relationship between social anxiety and social communication, as well as the moderating effects of child age, sample (e.g. clinical (ASD/SAD), community or mixed), type of measure (e.g. questionnaire, experimental task or observation) and reporter (e.g. self, parent, independent observer) on the strength of this relationship. The results will establish whether a relationship exists between social anxiety and social communication and how this varies across different populations; as well as giving a better understanding of which demographic, clinical and methodological aspects affect this relationship. Clarification of this relationship will be important in order to put together more effective and efficient treatments for childhood social anxiety as well as for children with difficulties characterised by social communication difficulties.

 

5) Pupil dilation to emotional faces distinguishes adolescent social anxiety from autism, and responders from non-responders in a CBT treatment
Johan Lundin Kleberg, Uppsala Child and Baby Lab, Department of Psychology, Uppsala University, Sweden; Terje Falck-Ytter, Sven Bölte, Uppsala Child and Baby Lab, Department of Psychology, Uppsala University &Department of Women’s and Children’s Health, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden; Eva Serlachius, Jens Högström, Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm County Council, Sweden

Introduction:
Social anxiety disorder (SAD) is associated with atypical attention to potential social threats such as emotional faces. More knowledge is needed about the mechanisms underlying this form of atypical attention, and how it relates to treatment outcome. There is also a lack of knowledge about the overlap between SAD and autism spectrum disorder in terms of social attention. Pupil dilation is a reliable index of activity in the locus coeruleus-norephinephrine (LC-NE) system, which mediates attention to emotionally and motivationally salient stimuli. We studied pupil dilation during face perception in individuals with SAD, a nonclinical control group, and a group of individuals with autism spectrum disorder (ASD). Our aim was to characterize social attention in adolescents with SAD and examine potential biomarkers for treatment outcome.
Methods:
Adolescents with SAD (N=25) were matched on sex and age with a group of non-anxious controls (N=23), and matched on age with a group of adolescents with ASD (N = 10). Individuals with SAD took part in a cognitive behavioral treatment (CBT), and completed diagnostic assessments after treatment and at a six months follow-up visit. In total, 20 participants had valid pupil data and clinical assessment from the follow up assessment. Of these, 11 were categorized as being in remission. Participants viewed still images of angry, happy, and neutral faces.  Pupil dilation was measured during 2000-4000 milliseconds after trial onset with a corneal reflection eye tracker. We studied the amplitude and the slope (i.e. the change over the course of the trial) of the pupil dilation.
Results:
The SAD group had smaller slope values (i.e. faster recovery of the pupillary response) than the control (p <.05) and the ASD (p <.0001) group. The ASD group was also slower to recover than the typical group (p <.05).These results were found for fearful and happy, but not neutral faces. The groups did not differ in pupil dilation amplitude to emotional or neutral faces, but across groups, the level of autistic traits were negatively related to pupil dilation amplitude.  We also compared pupil dilation during the baseline measurement in SAD participants in remission at post and follow up (N = 12) and participants who still had a SAD diagnosis (N = 8).Participants in remission had pupil dilations of larger amplitude at baseline when viewing happy faces (p<.05), but did not differ in slope.
Discussion:
Adolescent SAD is characterized by atypical LC-NE mediated attention to emotional faces. Specifically, SAD was associated with quicker recovery of pupil dilations, potentially reflecting top-down modulation and avoidance. Individuals with SAD who responded to CBT treatment had elevated pupil dilation amplitude to happy faces at baseline, suggesting that enhanced attention bias to threat may be associated with better outcome.
Conclusion:
Pupil dilation to emotional faces is a feasible index of atypical social attention in adolescent SAD, and may be a useful biomarker for predicting treatment response.