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Dimensional Diagnosis of Anxiety in Youth

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Handbook of Child and Adolescent Anxiety Disorders

Abstract

The diagnosis of anxiety disorders in children and adolescents is associated with several problems including high comorbidity and low clinical utility of diagnostic categories. This chapter will begin by outlining the weaknesses of the current categorical diagnostic system and reviewing the history and evidence for taking a dimensional approach to the diagnosis of anxiety disorders in children and adolescents. The problem of the high comorbidity of anxiety and depression in youth will be discussed, followed by a review of several quantitative structural models which have been proposed to differentiate between the shared and specific components of anxiety and depression. Based on the research indicating that anxiety disorders are best classified as highly correlated symptom clusters comprising internalizing syndromes, approaches to assessment and diagnosis will be covered in the last section of this chapter. Tools that have been validated to measure anxiety and depression dimensionally in youth will be presented, as well as measurement of narrow traits that have been found to put children and adolescents at risk for the development of pathological anxiety. Finally, we will discuss the need to move toward a system of classification that corresponds more directly to effective interventions for anxiety disorders in youth.

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References

  • Achenbach, T. M. (1991). Manual for the child behavior checklist 4–18 and 1991 profile. Burlington: Department of Psychiatry, University of Vermont.

    Google Scholar 

  • Achenbach, T. M., Demenci, L., & Rescorla, L. A. (2003). DSM-oriented and empirically based approaches to constructing scales from the same item pools. Journal of Clinical Child and Adolescent Psychology, 32, 328–340.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders (2nd ed.). Washington: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: American Psychiatric Association.

    Google Scholar 

  • Anderson, E. R., & Hope, D. A. (2008). A review of the tripartite model for understanding the link between anxiety and depression in youth. Clinical Psychology Review, 28, 275–287.

    Article  PubMed  Google Scholar 

  • Barlow, D. H. (1991). The nature of anxiety: Anxiety, depression, and emotional disorders. In R. M. Rapee & D. H. Barlow (Eds.), Chronic anxiety, generalized anxiety disorder, and mixed-anxiety depression (pp. 1–28). New York: Guilford.

    Google Scholar 

  • Barlow, D. H., & Campbell, L. A. (2000). Mixed anxiety-depression and its implications for models of mood and anxiety disorders. Comprehensive Psychiatry, 41(Suppl 1), 55–60.

    Article  PubMed  Google Scholar 

  • Barlow, D. H., Chorpita, B. F., & Turovsky, J. (1996). Fear, panic, anxiety and disorders of emotion. Nebraska Symposium of Motivation, 432, 251–328.

    Google Scholar 

  • Beidel, D. C., & Turner, S. M. (2005). Childhood anxiety disorders: A guide to treatment and research. New York: Routledge.

    Google Scholar 

  • Bernstein, A., Zvolensky, M. J., Stewart, S., & Comeau, N. (2007). Taxometric and factor analytic models of anxiety sensitivity among youth: Exploring the latent structure of anxiety psychopathology vulnerability. Behavior Therapy, 38, 269–283.

    Article  PubMed  Google Scholar 

  • Biederman, J., Hirshfeld-Becker, D. R., Rosenbaum, J. F., Herot, C., Friedman, D., Snidman, N., et al. (2001). Further evidence of association between behavioral inhibition and social anxiety in children. American Journal of Psychiatry, 158, 1673–1679.

    Article  PubMed  Google Scholar 

  • Bishop, G., Spence, S. H., & McDonald, C. (2003). Can parents and teachers provide a reliable and valid report of behavioral inhibition? Child Development, 74, 1899–1917.

    Article  PubMed  Google Scholar 

  • Blashfield, R. K., Keely, J. W., & Burgess, D. R. (2009). Classification. In P. Blaney & T. Millon (Eds.), Oxford textbook of psychopathology (2nd ed., pp. 35–57). New York: Oxford University Press.

    Google Scholar 

  • Brady, E. U., & Kendall, P. C. (1992). Comorbidity of anxiety and depression in children and adolescents. Psychological Bulletin, 111, 244–255.

    Article  PubMed  Google Scholar 

  • Broman-Fulks, J. J., Deacon, B. J., Olatunji, B. O., Bondy, C. L., Abramowitz, J. S., & Tolin, D. F. (2010). Categorical or dimensional: A reanalysis of the anxiety sensitivity construct. Behavior Therapy, 41, 154–171.

    Article  PubMed  Google Scholar 

  • Brown, T. A., Chorpita, B. F., & Barlow, D. H. (1998). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. Journal of Abnormal Psychology, 107, 179–192.

    Article  PubMed  Google Scholar 

  • Buckby, J. A., Yung, A. R., Cosgrave, E. M., & Killackey, E. J. (2007). Clinical utility of the Mood and Anxiety Symptom Questionnaire (MASQ) in a sample of young help-seekers. BioMed Central Psychiatry, 7, 50.

    PubMed  Google Scholar 

  • Caron, C., & Rutter, M. (1991). Comorbidity in child psychopathology: concepts, issues and research strategies. Journal of Child Psychology and Psychiatry, 32, 1063–1080.

    Article  PubMed  Google Scholar 

  • Carson, R. C. (1991). Dilemmas in the pathway of the DSM-IV. Journal of Abnormal Psychology, 100, 302–307.

    Article  PubMed  Google Scholar 

  • Chorpita, B. F., Daleiden, E. L., Moffitt, C., Yim, L., & Umemento, L. A. (2000). Assessment of tripartite factors of emotion in children and adolescents I: Structural validity and normative data of an affect and arousal scale. Journal of Psychopathology and Behavioral Assessment, 22, 141–160.

    Article  Google Scholar 

  • Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316–336.

    Article  PubMed  Google Scholar 

  • Clark, L. A., Watson, D., & Mineka, S. (1994). Temperament, personality, and the mood and anxiety disorders. Journal of Abnormal Psychology, 103, 103–116.

    Article  PubMed  Google Scholar 

  • Clark, L. A., & Watson, D. (2006). Distress and fear disorders: An alternative empirically based taxonomy of the “mood” and “anxiety” disorders. British Journal of Psychiatry, 189, 481–483.

    Article  PubMed  Google Scholar 

  • Cole, D. A., Truglio, R., & Peeke, L. (1997). Relation between symptoms of anxiety and depression in children: A multitrait-multimethod-multigroup assessment. Journal of Consulting and Clinical Psychology, 65, 110–119.

    Article  PubMed  Google Scholar 

  • Crook, K., Beaver, B. R., & Bell, M. (1998). Anxiety and depression in children: A preliminary examination of the utility of the PANAS-C. Journal of Psychopathology and Behavioral Assessment, 20, 333–350.

    Article  Google Scholar 

  • DiLalla, L. F. (2004). Behavior genetics principles: Perspectives in development, personality, and psychopathology. Washington: American Psychological Press.

    Book  Google Scholar 

  • Frances, A. J., First, M. B., Widiger, T. A., Miele, G. M., Tilly, S. M., Davis, W. W., et al. (1991). An A to Z guide to DSM-IV conundrums. Journal of Abnormal Psychology, 100, 407–412.

    Article  PubMed  Google Scholar 

  • Goldberg, D. (2000). Plato versus Aristotle: Categorical and dimensional models for common mental disorders. Comprehensive Psychiatry, 41(Suppl 1), 8–13.

    Article  PubMed  Google Scholar 

  • Goodman, M., Weiss, D. S., Mitropoulou, V., New, A., Koenigsburg, H., Silverman, J. M., et al. (2003). The relationship between pathological dissociation, self-injury, and childhood trauma in patients with personality disorders using taxometric analysis. Journal of Trauma and Dissociation, 4, 65–88.

    Article  Google Scholar 

  • Haslam, N., Williams, B. A., Kyrios, M., McKay, D., & Taylor, S. (2005). Subtyping obsessive-compulsive disorder: A taxometric analysis. Behavior Therapy, 36, 381–391.

    Article  Google Scholar 

  • Hayward, C., Killen, J. D., Kraemer, H. C., Blair-Greiner, A., Strachowski, D., Cunning, D., et al. (1997). Assessment and phenomenology of nonclinical panic attacks in adolescent girls. Journal of Anxiety Disorders, 11, 17–32.

    Article  PubMed  Google Scholar 

  • Hettema, J. M., Neale, M. C., & Kendler, K. S. (2001). A review and meta-analysis of the genetic epidemiology of anxiety disorders. American Journal of Psychiatry, 158, 1568–1578.

    Article  PubMed  Google Scholar 

  • Hirshfeld-Becker, D. R., Micco, J., Henin, A., Bloomfield, A., Biederman, J. and Rosenbaum, J. (2008). Behavioral inhibition. Depression and Anxiety, 25, 357–367.

    Article  PubMed  Google Scholar 

  • Hughes, A. A., & Kendall, P. C. (2009). Psychometric properties of the positive and negative affect scale for children (PANAS-C) in children with anxiety disorders. Child Psychiatry and Human Development, 40, 343–352.

    Article  PubMed  Google Scholar 

  • Jacques, H. A. K., & Mash, E. J. (2004). A test of the tripartite model of anxiety and depression in elementary and high school boys and girls. Journal of Abnormal Child Psychology, 32, 13–25.

    Article  PubMed  Google Scholar 

  • Joiner, T. E., & Lonigan, C. J. (2000). Tripartite model of depression and anxiety in youth psychiatric inpatients: Relations with diagnostic status and future symptoms. Journal of Clinical Child and Adolescent Psychology, 29, 372–382.

    Article  Google Scholar 

  • Kagan, J., Reznick, J. S., & Snidman, N. (1988). Biological bases of childhood shyness. Science, 240, 167–171.

    Article  PubMed  Google Scholar 

  • Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62, 100–110.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., Puliafico, A. C., Barmish, A. J., Choudhury, M. S., Henin, A., & Treadwell, K. S. (2007). Assessing anxiety with the child behavior checklist and the teacher report form. Journal of Anxiety Disorders, 21, 104–1015.

    Article  Google Scholar 

  • Kendler, K. S. (2006). Reflections on the relationship between psychiatric genetics and psychiatric nosology. American Journal of Psychiatry, 163, 1138–1146.

    Article  PubMed  Google Scholar 

  • Kiernan, G., Laurent, J., Joiner, T. E., Catanzaro, S. J., & MacLachlan, M. (2001). Cross-cultural examination of the tripartite model with children: Data from the Barretstown studies. Journal of Personality Assessment, 77, 359–379.

    Article  PubMed  Google Scholar 

  • Krueger, R. F. (1999). The structure of common mental disorders. Archives of General Psychiatry, 56, 921–926.

    Article  PubMed  Google Scholar 

  • Krueger, R. F., & Markon, T. M. (2006). Understanding psychopathology: Melding behavior genetics, personality, and quantitative psychology to develop an empirically based model. Current Directions in Psychological Science, 15, 113–117.

    Article  PubMed  Google Scholar 

  • Krueger, R. F., & Piasecki, T. M. (2002). Toward a dimensional approach and psychometrically-informed approach to conceptualizing psychopathology. Behaviour Research and Therapy, 40, 485–500.

    Article  PubMed  Google Scholar 

  • Laurent, J., Catanzaro, S. J., Joiner, T. E., Rudolph, K. D., Potter, K. I., Lambert, S., et al. (1999). A measure of positive and negative affect for children: Scale development and preliminary validation. Psychological Assessment, 11, 326–338.

    Article  Google Scholar 

  • Lerner, J., Safren, S. A., Henin, A., Warman, M., Heimberg, R. G. & Kendall, P. C. (1999). Differen­tiating Anxious and Depressive Selfstatements in Youth: Factor Structure of the Negative Affect Self-statement Questionnaire Among Youth Referred to an Anxiety Disorders Clinic. Journal of Clinical Child & Adolescent Psychology, 28, 82–93.

    Article  PubMed  Google Scholar 

  • Marin, C. E., Rey, Y., Nichol-Lopez, K., & Silverman, W. K. (2008). The relations between anxiety sensitivity and anxiety control in the prediction of anxiety symptoms among children and adolescents. Behavioural and Cognitive Psychotherapy, 36, 391–402.

    Article  Google Scholar 

  • McNally, R. (1990). Psychological approaches to panic disorder: A review. Psychological Bulletin, 108, 403–419.

    Article  PubMed  Google Scholar 

  • Mineka, S., Watson, D., & Clark, L. A. (1998). Comorbidity of anxiety and unipolar mood disorders. Annual Review of Psychology, 49, 377–412.

    Article  PubMed  Google Scholar 

  • Muris, P., Merckelbach, H., Wessel, I., & van de Ven, M. (1999). Psychopathological correlates of self-reported behavioural inhibition in normal children. Behaviour Research and Therapy, 37, 575–584.

    Article  PubMed  Google Scholar 

  • Olatunji, B. O., Broman-Fulks, J. J., Bergman, S. M., Green, B. A., & Zlomke, K. R. (2010). A taxometric investigation into the latent structure of worry: Dimensionality and association with depression, anxiety, and stress. Behavior Therapy, 41, 212–228.

    Article  PubMed  Google Scholar 

  • Rachman, S. J. (1991). A psychological approach to the study of comorbidity. Clinical Psychology Review, 11, 461–464.

    Article  Google Scholar 

  • Rapee, R. M., & Barlow, D. H. (1991). Chronic anxiety: Generalized anxiety disorder and mixed anxiety-depression. New York: Guilford.

    Google Scholar 

  • Rapee, R. M., Craske, M. G., Brown, T. A., & Barlow, D. H. (1996). Measurement of perceived control over anxiety related events. Behavior Therapy, 27, 279–293.

    Article  Google Scholar 

  • Rapee, R. M., Kennedy, S., Ingram, M., Edwards, S., & Sweeney, L. (2005). Prevention and early intervention of anxiety disorders in inhibited preschool children. Journal of Consulting and Clinical Psychology, 73, 488–497.

    Article  PubMed  Google Scholar 

  • Reiss, S. (1991). Expectancy model of fear, anxiety, and panic. Clinical Psychology Review, 11, 141–153.

    Article  Google Scholar 

  • Reiss, S. S., Peterson, R. A., & Gursky, D. M. (1988). Anxiety sensitivity, injury sensitivity, and individual differences in fearfulness. Behaviour Research and Therapy, 26, 341–345.

    Article  PubMed  Google Scholar 

  • Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the predictions of fearfulness. Behaviour Research and Therapy, 24, 1–8.

    Article  PubMed  Google Scholar 

  • Ruscio, A. M., Ruscio, J., & Keane, T. M. (2002). The latent structure of posttraumatic stress disorder: A taxometric investigation of reactions to extreme stress. Journal of Abnormal Psychology, 111, 290–301.

    Article  PubMed  Google Scholar 

  • Silverman, W. K., Fleisig, W., Rabian, B., & Peterson, R. A. (1991). Childhood anxiety sensitivity index. Journal of Clinical Child Psychology, 20, 162–168.

    Article  Google Scholar 

  • Spence, S. H. (1997). Structure of anxiety symptoms among children: A confirmatory factor-analytic study. Journal of Abnormal Psychology, 106, 280–297.

    Article  PubMed  Google Scholar 

  • Stark, K. D., & Laurent, J. (2001). Joint factor analysis of the children’s depression inventory and the revised children’s manifest anxiety scale. Journal of Clinical Child Psychology, 30, 552–567.

    Article  PubMed  Google Scholar 

  • Taylor, S. (1999). Anxiety sensitivity. Mahwah: Erlbaum.

    Google Scholar 

  • Taylor, S., Abramowitz, J. S., McKay, D., & Asmundson, G. J. G. (2010). Anxious traits and temperaments. In D. Stein, E. Hollander, & B. O. Rothbaum (Eds.), American psychiatric publishing textbook of anxiety disorders (2nd ed., pp. 81–96). Washington: American Psychiatric Press.

    Google Scholar 

  • Tellegen, A. (1985). Structures of mood and personality and their relevance to assessing anxiety, with an emphasis on self-report. In A. H. Tuma & J. D. Maser (Eds.), Anxiety and the anxiety disorders (pp. 681–706). Hillsdale, NJ: Erlbaum.

    Article  PubMed  Google Scholar 

  • Turner, C. M., & Barrett, P. M. (2003). Does age play a role in the structure of anxiety and depression in youth? An investigation of the tripartite model in three age cohorts. Journal of Consulting and Clinical Psychology, 71, 826–833.

    Article  PubMed  Google Scholar 

  • Turner, S. M., Beidel, D. C., & Roberson-Nay, R. (2005). Offspring of anxious parents: Reactivity, habituation, and anxiety-proneness. Behaviour Research and Therapy, 43, 1263–1279.

    Article  PubMed  Google Scholar 

  • Waller, N.G., & Meehl, P. E. (1998). Multivariate taxometric procedures: Distinguishing types from continua. Thousand Oaks, CA : Sage Publications.

    Article  Google Scholar 

  • Waller, N., Putnam, F. W., & Carlson, E. B. (1996). Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences. Psychological Methods, 1, 300–321.

    Article  Google Scholar 

  • Watson, D. (2005). Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology, 114, 522–536.

    Article  PubMed  Google Scholar 

  • Watson, D., Clark, L. A., & Carey, G. (1988). Positive and negative affectivity and their relation to anxiety and depressive disorders. Journal of Abnormal Psychology, 97, 346–353.

    Article  PubMed  Google Scholar 

  • Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070.

    Article  PubMed  Google Scholar 

  • Watson, D., Clark, L. A., Weber, K., Assenheimer, J. S., Strauss, M. E., & McCormick, R. A. (1995a). Testing a tripartite model: I. Evaluating the convergent and discriminant validity of anxiety and depression symptom scales. Journal of Abnormal Psychology, 104, 3–14.

    Article  PubMed  Google Scholar 

  • Watson, D., Clark, L. A., Weber, K., Assenheimer, J. S., Strauss, M. E., & McCormick, R. A. (1995b). Testing a tripartite model: II. Exploring the symptom structure of anxiety and depression in student, adult, and patient samples. Journal of Abnormal Psychology, 104, 15–25.

    Article  PubMed  Google Scholar 

  • Weems, C. F., Hayward, C., Killen, J., & Taylor, C. B. (2002). A longitudinal investigation of anxiety sensitivity in adolescence. Journal of Abnormal Psychology, 111, 471–477.

    Article  PubMed  Google Scholar 

  • Weems, C. F., Silverman, W. K., Rapee, R. M., & Pina, A. A. (2003). The role of control in childhood anxiety disorders. Cognitive Therapy and Research, 27, 557–568.

    Article  Google Scholar 

  • Zinbarg, R. E., & Barlow, D. H. (1996). Structure of anxiety and the anxiety disorders: A hierarchical model. Journal of Abnormal Psychology, 105, 181–193.

    Article  PubMed  Google Scholar 

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Correspondence to Melanie W. Moretz .

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Moretz, M.W., McKay, D. (2011). Dimensional Diagnosis of Anxiety in Youth. In: McKay, D., Storch, E. (eds) Handbook of Child and Adolescent Anxiety Disorders. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7784-7_8

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