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Anxiety and Depression During Childhood and Adolescence: Testing Theoretical Models of Continuity and Discontinuity

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The present study sought to clarify the trajectory (i.e., continuous vs. discontinuous) and expression (i.e., homotypic vs. heterotypic) of anxiety and depressive symptoms across childhood and adolescence. We utilized a state-of-the-science analytic approach to simultaneously test theoretical models that describe the development of internalizing symptoms in youth. In a sample of 636 children (53% female; M age = 7.04; SD age = 0.35) self-report measures of anxiety and depression were completed annually by youth through their freshman year of high school. For both anxiety and depression, a piecewise growth curve model provided the best fit for the data, with symptoms decreasing until age 12 (the “developmental knot”) and then increasing into early adolescence. The trajectory of anxiety symptoms was best described by a discontinuous homotypic pattern in which childhood anxiety predicted adolescent anxiety. For depression, two distinct pathways were discovered: A discontinuous homotypic pathway in which childhood depression predicted adolescent depression and a discontinuous heterotypic pathway in which childhood anxiety predicted adolescent depression. Analytical, methodological, and clinical implications of these findings are discussed.

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  1. We note the terms heterotypic and homotypic continuity have been used to describe both manifest behaviors and latent internalizing processes over time (Cicchetti et al. 1994; Lahey et al. 2014). As a major aim of our study was the translational importance of distinguishing between continuous and discontinuous models of psychopathology for assessment purposes, we focus our discussion of heterotypic and homotypic continuity on symptom manifestations.

  2. Grade-based models for both anxiety and depression suggested that piecewise models provided the best fit, with the knot being placed at grades 6 or 7 (when the majority of participants would be age 12). Specifically, for anxiety models, the knot fit equally well in 6th and 7th grade (ΔCFI < 0.01, Δχ2/df = 0.20, ΔRMSEA < 0.01, ΔSRMR = 0.01). For depression models, the knot fit best when placed at grades 6 or 7, with slightly better fit for grade 7 (ΔCFI = 0.02, Δχ2/df = 1.12, ΔRMSEA = 0.01, ΔSRMR < 0.01).

  3. The secondary intercept can be removed in alternate arrangements for piecewise growth functions. We selected this arrangement with a second intercept because of our interest in predicting average symptoms at the beginning of the second growth period, adolescence. Alternate piecewise growth functions with a single intercept per symptom were also examined. Both single-intercept models also fit well and produced similar findings.

  4. Specific manifestations of anxiety (e.g., panic disorder), however, may have different trajectories during adolescence (Nelemans et al. 2014). This issue is discussed further in the limitations section.


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We would like to thank the families and schools who participated in this study. We are grateful to Jamie Abaied, Monica Agoston, Hannah Banagale, Megan Flynn, Ellie Hessel, Nicole Llewellyn, Michelle Miernicki, Jo Pauly, Jennifer Monti, and Niwako Sugimura for their assistance in data collection and management. This research was funded by a University of Illinois Arnold O. Beckman Award and National Institute of Mental Health Grant MH68444 awarded to Karen D. Rudolph.

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Correspondence to Joseph R. Cohen.

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Cohen, J.R., Andrews, A.R., Davis, M.M. et al. Anxiety and Depression During Childhood and Adolescence: Testing Theoretical Models of Continuity and Discontinuity. J Abnorm Child Psychol 46, 1295–1308 (2018).

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