olcl university of ubrary - … · vlll anxiety disorders interview schedule for dsm-iv,child and...

UNIVERSITY OF UBRARY

')(i II}

~·~(olcl

A PSYCHOMETRIC EVALUATION OF THE PARENTAL BEHAVIORS AND

BELIEFS ABOUT ANXIETY QUESTIONNAIRE AMONG A CHILD CLINICAL

POPULATION

A DISSERTATION SUBMITTED TO THE GRADUATE DIVISION OF THEUNIVERSITY OF HAWAI'I IN PARTIAL FULFILLMENT OF THE

REQUIREMENTS FOR THE DEGREE OF

DOCTOR OF PHILOSOPHY

IN

PSYCHOLOGY

AUGUST 2005

BySarah E. Francis

Dissertation Committee:

Bruce F. Chorpita, ChairpersonDaniel D. BlaineElaine M. Heiby

Kelly M. VitousekJean Johnson

IV

This dissertation is dedicated to myparents,

William Joseph Francis

Eileen Ruth Crocker Francis Johnston

Gerald Leamon Johnston

Thank you for your genes, your love, your nurturance, andyour support; for

teaching me to love books, to try my best, and to take a minute and think about it. For the

education you have given me, I am eternally grateful.

vACKNOWLEDGMENTS

My sincerest thanks and appreciation are extended to the members of my committee for

their time, dedication, and patience throughout the design, development, and execution of

this project. I also wish to extend my boundless gratitude to my colleagues, whose time

and attention to the details of data entry and management made the completion of this

dissertation possible.

I also wish to thank four ofmy most favorite people in this world, without whom my

endeavors would not have much meaning at all:

To Carrie - always a source ofperspective, levity, and constructive criticism. Thank you.

To Peter - constantly challenging me to challenge myself, to examine my beliefs, and to

be mindful. Thank you.

To Jerry - teaching me moderation, balance, scientific thinking, and the limitations of

precision. Thank you.

To my mother-the unwavering calm and source of strength in my world, and the

behaviorist who first instilled in me an appreciation ofall things psychological. Thank

you.

VI

ABSTRACT

Heritability studies have consistently demonstrated an increased risk for anxiety among

the offspring of anxious parents (e.g., D. C. Beidel & S. M. Turner, 1997). Moreover,

nume~ous parental styles, practices, behaviors, and beliefs have been linked to childhood

anxiety (e.g., M. R. Dadds & P. M. Barrett, 1996; R. M. Rapee, 1997). However, the role

parenting behaviors and beliefs playas mediators in the relationship between parental and

child anxiety has yet to be systematically examined. This investigation describes the

development ofan objective parent-report instrument designed to assess 3 parental

factors hypothesized to mediate the relationship between parental and child anxiety:

overinvolvement with the child, parental beliefs about anxiety, and stimulus regulation.

Only parental beliefs about the child's anxiety significantly mediated the relationship

between parent and child anxiety, suggesting that it is not parental anxiety per se that

predicts child anxiety, but rather the parent's beliefs about the extent to which anxiety is

harmful for their child.

Vll

TABLE OF CONTENTS

Acknowledgments vAbstract viList of Tables xL · fF' ..1st 0 Igures Xlll

Introduction 1Triple vulnerability model. 2

Generalized biological vulnerability 2Generalized psychological vulnerability .4Specific psychological vulnerability .4

Parental beliefs and behaviors specifically associated with childhood anxiety 7A transactional approach 7Parental cognitive biases and child anxiety 8Parental overprotection 10Overinvolvement with the child 12

Other parental factors associated with childhood anxiety .14Summary 16

Hypothesized relationships among parental behaviors, parental beliefs aboutanxiety, and child anxiety 16

Present investigation 18Study 1 19

Method 19Overview 19Participants 19Procedure 20

Scale development, content, and scope .20Item pool creation 21Item selection 22Item classification 22

Results 23Study 2 24

Method 24Overview 24Participants 24Procedure 24

Item construct validity .24Results 25

Construct validity ratings .25Study 3 26

Method 26Overview 26Participants 26Measures 28

Vlll

Anxiety Disorders Interview Schedule for DSM-IV, Child andParent versions (ADIS-IV-C/P) .28

Procedure 28Results 30

Qualitative interview results 30Questions that were difficult to understand , 30Unclear words, phrases, and items 31Potentially objectionable items .32Questions that should be worded differently 32Favored questions 33Response options 33General impressions 34

Quantitative findings 35Study 4 38

Method 39Overview 39Participants 39Materials 42

Parent self-report measures .42Depression, Anxiety, and Stress Scales-21 (DASS-21 ) .42Positive Affect and Negative Affect Scales (PANAS) 44

Parent-report measure of child behavior .45Child Behavior Checklist for ages 6-18 (CBCL/6-18) .45

Clinician-administered measures for parent and child 46Anxiety Disorders Interview Schedule for DSM-IV, Child

and Parent Versions (ADIS-IV-C/P) 46Dimensional Ratings of Clinical Severity (DRs) .47

Child self-report measures .48Revised Child Anxiety and Depression Scale (RCADS)..48Positive and Negative Affect Schedule for Children

(PANAS-C) 50Affect and Arousal Scale (AFARS) .51

Procedure 51Aims of the present investigation .52

Results 56Demographic differences 56Psychometric properties ofmeasures employed 57Parent and child anxiety 60Initial psychometric evaluation of the PBBA-Q 64

Analysis of item distributions on the PBBA-Q 64Tests of internal consistency and homogeneity 64Interrater convergence 65

Convergent validity of the PBBA-Q 67Parent-reported anxiety, negative affectivity, and the PBBA-Q 67Child anxiety diagnoses and scores on the PBBA-Q 69

IX

Parent reports ofchild anxiety and scores on the PBBA-Q 70

Child-reported anxiety and affectivity and parent scores on thePBBA-Q 72

Discriminant validity of the PBBA-Q 75Evaluating hypothesized relationships between parental and child

anxiety 76Parent and child anxiety 77Mediators ofchild anxiety 78Evaluating moderators of parental anxiety and parent beliefs and

behaviors 82Discussion 82

Overview 82Parent and child anxiety 84Moderating influences ofparental behaviors and beliefs about anxiety 92Limitations 92Future directions 97Conclusion 101

Tables 102Appendix A:PBBA-Q Items Retained, Deleted, Revised, and Added Following Study 1

.............................................................................................................................. 149Appendix B:PBBA-Q Items Retained and Deleted Following Study 2 158Appendix C:PBBA-Q Items Retained and Deleted Following Study 3 163Appendix D:PBBA-Q 169Appendix E:DASS-21 173Appendix F:PANAS 175Appendix G:Dimensional Rating Sheet. 177Appendix H:CIDLD BERAVIOR CHECKLIST FOR AGES 6-18 178Appendix I:RCADS 181Appendix J:Fee1ings and Emotions (Positive Affect and Negative Affect Scale-Child

Version) 185Appendix K:AFARS 186Appendix L:Supplementary Tables 188References '" 193

xLIST OF TABLES

I. DSM-IV-TR Consensus Diagnoses Assigned to Child Participants, Basedon both Child and Parent Reports 102

2. Demographic Characteristics ofParticipants and their Families 104

3. Correlations Among each of the Three Scales Comprising the PBBA-Qand all other Child- and Parent-Report Measures Administered 106

4. Between Groups Differences for Child Gender on each of the ThreePBBA-Q Scales 108

5. Between Groups Differences for Parental Marital Status on each of theThree PBBA-Q Scales 109

6. Estimates of Internal Consistency and Average Interitem Correlations foreach of the Scales Comprising the DASS and PANAS, as Completed byParent in the Present Sample 111

7. Estimates of Internal Consistency and Average Interitem Correlationsfor each ofthe Scales Comprising the RCADS, PANAS-C, and AFARSas Completed by Child Respondents in the Present Sample .l12

8. Correlations Among the Stress, Anxiety, and Depression Scales of theParent-Report DASS-21 and the Positive Affect and Negative AffectScales of the Parent-Report PANAS I 13

9. Correlations Among the Anxiety Scales ofthe Child-Report RCADS andthe Affective Scales of the Child-Report PANAS-C and AFARS 114

10. Correlations Among Parent-Reported Anxiety, Stress, Depression, PositiveAffectivity, and Negative Affectivity on the DASS-21 Anxiety, Stress, andDepression Scales and the PANAS, respectively, and Child-ReportedAnxiety, Depression, Positive Affectivity, and Negative Affectivity on theRCADS and PANAS-C, respectively I 16

II. Between Group Analyses ofParent-Reported Anxiety, Stress, and Depressionon the DASS-21 Anxiety, Stress, and Depression Scales Among Parents of

Anxious and Non-Anxious Children, as Indicated by Diagnostic Status I 17

xi12. Between Group Analyses of Parent-Reported Negative Affect and Positive

Affect on the PANAS Among Parents ofAnxious and Non-AnxiousChildren, as Indicated by Diagnostic Status .l18

13. Correlations Among Parent-Reported Anxiety, Stress, Depression on theDASS-21 Anxiety, Stress, and Depression Scales and Dimensional RatingsofClinical Severity Yielded via Child and Parent Reports on the ADIS-IV-CIP 119

14. Correlations Among Child-Reported Anxiety and Depression on the Subscalesof the RCADS and Dimensional Ratings ofClinical Severity Yielded via Childand Parent Reports on the ADIS-IV-CIP 120

15. Response distributions for each ofthe 51 items comprising the PBBA-Q.......... 121

16. Estimates of Internal Consistency and Average Interitem Correlations foreach of the Scales Comprising the PBBA-Q, as Completed by Parent in thePresent Sample 130

17. Convergence Between Parent 1 and Parent 2 Reports on the OIC, PB, andSR scales of the PBBA-Q, and on Parent Self-Report Dimensions ofDepression, Anxiety, and Stress on the Scales of the DASS-21, and Negativeand Positive Affect on the Scales of the PANAS Among a Subsample(n=25) ofParticipants for whom Two Parents Completed the Parent-Report Measures Administered 131

18. Interrater Reliability Between Parent 1 and Parent 2 Reports on the ProblemScales of the CBCL Among a Subsample (n=25) ofParticipants for whomTwo Parents Completed the Parent-Report Measures Administered 132

19. Correlations Among Each of the three PBBA-Q scales and the Anxiety,Stress, and Depression scales of the Parent-Completed DASS-21.. 133

20. Correlations Among Each ofthe three PBBA-Q scales and the Anxiety,Stress, and Depression scales ofthe Parent-Completed. DASS-21.. .l34

21. Between Groups Differences for Child Anxiety Diagnostic Status on eachof the Three PBBA-Q Scales 135

22. Correlations Among Each of the Three PBBA-Q Scales the Broad-BandInternalizing Scale of the CBCL, and the Narrow-Band Anxious/Depress,Withdrawn/Depressed, and Somatic Complaints Scales ofthe Parent-ReportCBCL 136

xii

23. Correlations Among Each of the Three PBBA-Q Scales and the TotalAnxiety Dimensional Rating Score Obtained From Parent and ChildReport on the ADIS-IV-C/P 137

24. Correlations Among Each of the Three Parent-Reported PBBA-Q Scales,Each Anxiety Scale of the RCADS, and the RCADS Total Anxiety Score 138

25. Correlations Among Each ofthe Three Parent-Reported PBBA-Q Scales,the NA and PA Scales of the Child-Report PANAS-C, and the NA, PH,and PA scales of the Child-Report AFARS 139

26. Correlations Among Parent Report on each of the Three Scales ofthePBBA-Q, Child and Parent Externalizing Dimensional Ratings as derivedfrom the Opposition, Delinquency, Inattention, and Hyperactivity portionsof the ADIS-IV, and Parent Report on the Externalizing Subscale Composite ofthe Child Behavior Checklist. 140

27. Regression Analyses for Parent-Reported Anxiety and Stress on theDASS-21 Anxiety and Stress Scales When Entered as Predictors of theRCADS Total Anxiety Scores and as Predictors of the Composite AnxietyDR based on Child Report on the ADIS-IV-C. 141

28. Regression Analyses for Parent-Reported Anxiety on the DASS-21Anxiety Scale When Entered as Predictors of the OIC, PB, and SRscales ofthe PBBA-Q 142

29. Regression Analyses for the Anxiety Scale of the DASS-21 scale WhenEntered as a Predictor of the Child Composite Anxiety DR Rating (Modell)and When Entered with the PB Scale of the PBBA-Q (Model 2) as Predictorsof the Child Composite Anxiety DR Rating as Derived from the ADIS-IV-C...143

30. Regression Analyses for Parent-Reported Stress on the DASS-21 StressScale When Entered as Predictors of the OIC, PB, and SR scales of thePBBA-Q 144

31. Regression Analyses for the Stress Scale of the DASS-21 Scale WhenEntered as a Predictor of the Child Composite Anxiety DR Rating (Modell)and When Entered with the PB Scale of the PBBA-Q (Model 2) as Predictorsof the Child Composite Anxiety DR Rating as Derived from the ADIS-IV-C...l45

X111

LIST OF FIGURES

1. Hypothesized mediational and moderational relationships among parentanxiety, parental behaviors and beliefs about anxiety, and child anxiety .l46

2. Unstandardized beta coefficients (and standard error estimates) for themediational relationship between parental anxiety, parental beliefs aboutanxiety, and child anxiety 147

3. Unstandardized beta coefficients (and standard error estimates) for themediational relationship between parental stress, parental beliefs aboutanxiety, and child anxiety 148

1

INTRODUCTION

Anxiety disorders are the most prevalent form of psychopathology among

children and adolescents (Costello & Angold, 1995; Bell-Dolan & Brazeal, 1993;

Bernstein & Borchardt, 1991; Orvaschel & Weissman, 1986), with between 10% and

20% ofthis population meeting diagnostic criteria for an anxiety disorder at some point

during youth (Verhulst, van der Ende, Ferdinand, & Kasius, 1997; Achenbach, Howell,

McConaughy, & Stanger, 1995; Pine, 1994). Symptoms associated with anxiety

significantly impair a child's ability to function adaptively across domains (Albano &

Detweiler, 2001; Last, Hanson, & Franco, 1997), and, in the absence of treatment, these

disorders tend to persist over time (Dadds, Holland, Laurens, Mullins, Barrett, & Spence,

1999; Spence, 2001).

Anxiety disorders also represent a form ofpsychopathology with a high

concordance rate among family members. Specifically, anxious parents are more likely to

have anxious children (Beidel & Turner, 1997; Turner, Beidel, & Costello, 1987),

particularly when the mother also has been diagnosed with an anxiety disorder (McClure,

Brennan, Hammen, & Le Brocque, 2001); anxious children are more likely to have

anxious parents (Last, Hersen, Kazdin, Orvaschel, & Perrin, 1991); and higher rates of

anxiety disorders are found among siblings ofyouth diagnosed with anxiety (Rende,

Warner, Wickramaratne, & Weissman, 1999). Despite the numerous studies

demonstrating significant concordance rates for anxiety disorders among family

members, particularly with respect to parents and children, the mechanisms facilitating

the transmission ofanxiety from parent to child remain less clear (McClure et aI., 2001).

2

Triple Vulnerability Model

Most recently, Barlow's ''triple vulnerability" model (Barlow, 2000; 2002) has

been used as a framework within which to conceptualize the development of anxiety and

anxiety disorders. The triple vulnerability model posits that three interacting dispositions

place an individual at increased risk ofdeveloping anxiety, namely a generalized

biological (heritable) vulnerability, a generalized psychological vulnerability, and a

specific psychological vulnerability.

Generalized biological vulnerability. Specific genes have not been found to

responsible for the transmission of specific anxiety disorders (Eley, 2001). However,

genetic factors do appear to be implicated in the transmission of risk for anxiety (Barlow,

2002) and anxiety disorders (Kendler, Neale, Kessler, Heath, & Eaves, 1992; Torgersen,

1983). For example, findings indicating that children of anxious parents have a

significantly increased risk of being diagnosed with an anxiety disorder (Turner et aI.,

1987) suggest support for a shared familial risk factor for anxiety (Albano, Chorpita, &

Barlow, 2003).

The generalized biological vulnerability component of the triple vulnerability

model has been linked to child temperament, or those potentially heritable emotional and

behavioral components comprising personality (Albano et aI., 2003; Lonigan & Philips,

2001). More specifically, Kagan (1997) identified a specific temperamental style, termed

behavioral inhibition, which is detectible in early childhood. Behavioral inhibition is

typified by a low threshold for distress and developing fear in the face of unfamiliar

situations, people, and events, and is often characterized by behaviors such as restriction

3

of speech, infrequent smiling, few spontaneous conversational comments, and a high

level of motoric arousal (Kagan, 1997). The behaviorally inhibited temperament during

early childhood has been significantly associated with the parental diagnosis of panic

disorder with agoraphobia, as well as with the diagnosis ofan anxiety disorder later in

childhood (Biederman, Rosenbaum, Bolduc, Faraone, & Hirshfeld, 1991; Biederman et

al., 1993). Such findings suggest that the temperamental variable of behavioral inhibition

represents a general familial vulnerability to anxiety and anxiety disorders (Biederman et

aI., 1991; Biederman et aI., 1993). Another temperamental variable that has been linked

to anxiety is negative affectivity. More specifically, Clark and Watson's tripartite theory

ofemotion (Clark & Watson, 1991), suggests that negative affectivity (NA) serves as a

general risk factor for the development of anxiety and depression, whereas physiological

hyperarousal (PH) and low positive affectivity (PA) are specific risk factors for anxiety

and depression, respectively. Investigations ofthe applicability of this model among child

and adolescent populations have yielded support for a similar tripartite model (e.g.,

Chorpita, Albano, & Barlow, 1998; Joiner, Catanzaro, & Laurent, 1996), although more

recent examinations of the model among adult and child populations have suggested that

PH is uniquely related to panic, but not to other anxiety dimensions (Brown, Chorpita, &

Barlow, 1998; Chorpita, 2002). In sum, multiple lines of research among child and

adolescent populations, including investigations of genetics, behavioral inhibition, and

the temperamental variables ofNA and PA, have converged to suggest that a common,

potentially heritable, temperamental risk factor underlies negative emotions such as

anxiety (Albano et aI., 2003).

4

Generalizedpsychological vulnerability. The generalized psychological

vulnerability component ofthe triple vulnerability model refers to early experience with a

sense of diminished personal control over one's surrounding environment (Barlow,

2000). Chorpita and Barlow (1998) suggest that early experiences with low perceived

control stem from two broad parenting practices, namely (l) a noncontingent style of

responding to the child, and (2) intrusive and protective behaviors which preclude

autonomous exploration of the environment. During early development, perceived

control is hypothesized to act as a mediator of negative life events and the subsequent

development ofNA, or the general risk factor for the development of anxiety (Chorpita &

Barlow, 1998). More specifically, negative or stressful life events during early childhood

will not predict later anxiety disorders so much as will the child's level of perceived

control over his environment. During later childhood, a history of low perceived control

moderates the relationship between stressful life events and the development ofNA, such

that the generalized vulnerability (diminished control) exacerbates the negative effects of

stressful life events (Chorpita, 2002).

SpecifiC psychological vulnerability. The third component of the triple

vulnerability model refers to instances in which the individual is exposed to an event or

set ofevents, relevant to a specific anxiety disorder, in which anxious apprehension is

activated (Barlow, 2000). Each anxiety disorder is associated with a set of specific

psychological vulnerabilities, but all generally involve the individual experiencing,

through vicarious learning or modeling, that anxiety is harmful or is associated with

negative consequences (e.g., in the context ofpanic disorder learning that physiological

5

symptoms are dangerous and could predict illness and death). Although a single instance

of vicarious learning is itselfinsufficient to result in an anxiety disorder, in the context of

generalized biological and psychological vulnerabilities, such experiences can contribute

to the development of clinically significant symptoms ofanxiety (Barlow, 2000). For

children, the family environment, and parenting practices in particular, represent a

specific psychological vulnerability for anxiety (Albano et aI., 2003). For example,

family environments characterized by high levels ofparental control have been

associated with child anxiety disorders (McClure et aI., 2001; Chorpita, Brown, &

Barlow, 1998; Rapee, 1997; Silove, Parker, Hadzi-Pavlovic, Manicavasagar, &

Blaszczynski, 1991; Solyom, Silberfeld, & Solyom, 1976). Moreover, parents of anxious

children have been observed to frame ambiguous situations in a threatening light with

their children, thereby modeling the misinterpretation ofambiguous environmental cues

and fostering the child's selection of avoidant responses (Barrett, Rapee, Dadds, & Ryan,

1996).

Evidence from numerous sources has suggested that parents and families playa

considerable role with respect to creating for the child a specific psychological

vulnerability for the development ofanxiety (Barrett, Rapee et aI., 1996; Cobham, Dadds,

& Spence, 1999; Dadds, Barrett, Rapee, & Ryan, 1996; Kohlmann, Schumacher, &

Streit, 1988; Krohne & Hock, 1991; Messer & Beidel, 1994). For example, parents of

anxious children have been found to be different from parents of nonanxious children

along several key dimensions (Cobham et aI., 1999). Specifically, parents of anxious

children are presumed to hold specific (negative) beliefs about anxiety and its

6

consequences for their child (Barrett, Rapee et a!., 1996; Cobham, 1998), to model

anxious and avoidant responding for the child (Krohne & Hock, 1991), and to reinforce

their child's selection and execution of anxious and avoidant modes of responding in

ambiguous situations (Cobham, 1998; Dadds et a!., 1996).

In sum, the triple vulnerability model suggests that children can inherit a

temperamental style (e.g., behavioral inhibition) that places them at increased risk for

anxiety. The environment in which they are raised, from very early on, can present

general psychological risk factors, such as parents who respond noncontingently to their

needs (e.g., soothing, feeding) and create an overall diminished sense of personal control.

Finally, through vicarious learning or modeling, children can associate anxiety with

negative or harmful consequences (e.g., watching parents respond to ambiguous stimuli).

As the triple vulnerability model suggests, parenting practices alone are not sufficient for

the development ofan anxiety disorder of childhood. However, in the context of general

genetic and psychological vulnerabilities, parent and family characteristics can exert

considerable influence over the maintenance and perpetuation of childhood anxiety. The

present investigation posits that the parenting practices associated with parent and child

anxiety are a key factor in clarifying current conceptions of the specific vulnerabilities

that operate in the development ofchildhood anxiety disorders. More specifically, a

greater knowledge of the factors that underlie the link between parent and child anxiety

will contribute to an enhanced understanding of the specific psychosocial factors that

playa role in the dynamic process that characterizes the development and maintenance of

anxiety among children. As such, this investigation will evaluate a newly developed

7

parent-report measure designed to examine the role that three parental beliefs and

behaviors associated with child anxiety play in mediating the relationship between parent

and child anxiety.

Parental Beliefs and Behaviors Specifically Associated with Childhood Anxiety

A transactional approach. Children with anxiety disorders often have parents

with anxiety, as has been indicated by investigations of both the children of anxious

parents (Beidel & Turner, 1997; Turner et al., 1987), and the parents of anxious children

(Last et aI., 1991). However, such findings need not imply a causal relationship between

parental and child anxiety (Dadds & Roth, 2001). Rather, childhood anxiety disorders

appear to result from multiple pathways that reflect repeated transactions between the

child and his or her environment (Hirshfeld, Biederman, Brody, Faraone, & Rosenbaum,

1997b; Vasey & Dadds, 2001). Employing a transactional model to explain the

development and maintenance ofchildhood anxiety disorders suggests that particular

parental beliefs and behaviors may be associated with childhood anxiety, but cannot be

said to cause these disorders in children (Dadds et aI., 1996). Among those unique

pathways through which interactions between parents and children may contribute to the

development ofchildhood anxiety are (1) parental modeling ofanxious behaviors, (2)

parental overprotection and overcontrol ofthe child, and (3) parental reinforcement for

and encouragement of anxious behaviors and avoidance by the child (Spence, 1996;

Vasey & Dadds, 2001). The specific parental beliefs and behaviors suggested to comprise

these pathways will be briefly reviewed below.

8

Parental cognitive biases and child anxiety. Individuals can vary widely in their

degree of "anxiety sensitivity," or the extent to which they believe that anxiety is harmful

(Reiss, 1991). Underlying anxiety sensitivity are expectations about what might occur if

the feared situation is experienced, and sensitivities, or the reasons underlying the

person's fears (Reiss, 1991). The expectation ofdanger is hypothesized to underlie

anxiety (Butler & Mathews, 1983), such that highly anxious individuals are more likely

to anticipate danger in ambiguous situations, and to perceive such situations as

threatening. Anxious individuals also attend more closely to threatening environmental

cues and perceive themselves as being particularly at risk of experiencing harmful events

(Butler & Mathews, 1983).

Although the potential effects of anxiety sensitivity on childrearing activities or

parent-child interactions have not been explicitly researched, it is hypothesized that

elevated levels ofparental cognitive biases toward threatening cues from the environment

might mediate the relationship between parental and child anxiety. Specifically, if parents

(a) interpret ambiguous situations or events as threatening, and (b) perceive anxiety and

its effects as harmful for themselves, they might also (a) convey to their child that

uncertain situations are threatening, and (b) believe that experiencing symptoms of

anxiety is harmful for their child. Conveying to their child a heightened awareness of

threat might contribute to not only heightened levels ofchild anxiety, but may also

increase the child's own sensitivity to situations or symptoms associated with anxiety.

In an empirical investigation of this hypothesis, Krohne and Hock (1991)

observed that children with high levels of anxiety also tend to receive more negative

9

feedback from parents and experience high levels of parental restriction with respect to

their behaviors. These findings suggested that as a result of such parental behaviors,

anxious children (a) expect negative consequences to result from their actions, and (b)

exhibit increasingly fearful and avoidant behaviors (Krohne & Hock, 1991).

Parents of anxious children also appear to playa significant role in not only

modeling avoidance responses for their children (Barrett, Rapee et aI., 1996), but also in

actively guiding their children in the selection of avoidant strategies in response to

potentially threatening situations (Dadds et aI., 1996). Specifically, significant

associations have been found between child and parent interpretations ofambiguous

stimuli, such that anxious children and their parents are significantly more likely than

nonclinic control groups to interpret ambiguous situations as threatening (Barrett, Rapee

et al., 1996). Moreover, parents ofanxious children have been found to not only expect

their child to choose an avoidant solution to an ambiguous situation (Cobham et aI.,

1999), but to also play an active role in influencing their child's choice of response to an

ambiguous situation. Specifically, parents ofanxious children respond selectively to

avoidant suggestions from the child, and are less likely to attend to or reinforce prosocial

suggestions (Dadds et al., 1996). As children are reinforced for their selection ofavoidant

strategies in particular situations, avoidance may become a more salient component of the

child's response repertoire, thus leading to subsequent increases in avoidant behaviors

(Dadds et at, 1996).

It is thus suggested that parental misinterpretations ofambiguous situations as

threatening and parental beliefs about the effects ofanxiety for their child mediate the

10

relationship between parent and child anxiety. These cognitive rnisattributions and

anxious beliefs are hypothesized to represent one pathway through which parents

influence the development and maintenance of anxiety in children.

Parental overprotection. The extent to which parents are overprotective with their

child, or limit their child's ability to engage in activities that the parent perceives as

potentially threatening, is also associated with childhood anxiety (Dadds & Barrett, 1996;

Krohne & Hock, 1991; LaFreniere & Dumas, 1992; Messer & Beidel, 1994; Rapee,

1997; Silove, Parker, Hadzi-Pavlovic, Manicavasagar, & Blaszczynski, 1991).

Specifically, overprotective mothers may perceive their child as vulnerable to threat

(Siqueland, Kendall, & Steinberg, 1996), leading them to actively attempt to keep their

child away from potentially dangerous situations and to maintain continuous supervision

over their child (Solyom et aI., 1976). High levels of parental restriction may also prevent

the child from developing or exercising independent methods ofproblem solving (Dadds

& Barrett, 1996; Krohne & Hock, 1991), ultimately limiting the child's ability to develop

a sense of control over himself and his environment, thus increasing the risk of later

anxiety (Chorpita & Barlow, 1998; Solyom et aI., 1976).

Inherent to the construct ofoverprotection are parental control and restriction.

Multiple empirical investigations have found mothers ofanxious children and anxious

parent-child dyads to demonstrate higher levels of parental control and restriction

(Dumas, Lafreniere, & Serketich, 1995; Krohne & Hock, 1991; Solyom et aI., 1976) than

do parents ofnon-anxious children. Dadds and Roth (2001) hypothesized that children

who experience heightened levels ofparental control and restriction become highly

11

sensitive to threat and are more likely to interpret ambiguous stimuli as threatening and

dangerous. Such sensitivities in turn increase the likelihood that the child will engage in

more avoidant, rather than approach, behaviors (Dadds, Bovbjerg, Redd, & Cutmore,

1997; Davey, 1992). More specifically, the avoidant behaviors of children with

overprotective, high control parents are negatively reinforced by the removal of the

distressing stimuli (e.g., the child does not have to participate in the potentially

threatening interaction or event) and positively reinforced by the parents themselves (e.g.,

praise, confirmation of the avoidant response). Ultimately, overprotective parental

behaviors teach the child to interpret ambiguous situations as threatening and to avoid,

rather than engage in, these situations (Hirshfeld, Biederman, Brody, Faraone, &

Rosenbaum, 1997a; Hirshfeld et aI., 1997b).

Such parental regulation of the child's environment represents an additional

pathway through which parental anxiety can affect child anxiety. Specifically, parents

who prevent their child from participating in novel or challenging situations may not

allow the child to learn that such situations are not threatening, given that the child is

unable to ascertain for him or herself the outcomes associated with these events. For

children who might experience feelings of nervousness associated with unfamiliar

activities, the process of being shielded from participation in such activities and being

allowed to escape from such situations might maintain feelings ofanxiety, given that the

child is unable to become accustomed, or habituate, to such activities. It is suggested that

parental overprotection (and, accordingly, high levels of parental control) precludes the

child's development of a sense ofautonomy and ofcontrol over his or her environment.

12

Developmentally, perceptions of low control over the environment have been linked to

helpless response styles (Chorpita & Barlow, 1998), pessimistic and unrealistic

perceptions of the world (Rapee, 1997), and compromised problem-solving and coping

skills (Krohne & Hock, 1993; LaFreniere & Capuano, 1997). It is thus hypothesized that

patental overprotection mediates the relationship between parent and child anxiety and

represents a second pathway through which parents influence the development and

maintenance of anxiety in children.

Overinvolvement with the child Emotional overinvolvement (Stubbe, Zahner,

Goldstein, & Leckman, 1993), or the extent to which parents have an enmeshed

relationship with their child (i.e., a relationship characterized by an inappropriate level of

involvement in the child's life, unclear distinctions between parent and child roles and

concerns, poorly defmed domains of parent concerns and child concerns, or a sense of

closeness that obscures the distinction between the parent and child), has also been

implicated in the development and maintenance of anxiety among children (Bloom &

Naar, 1994; Hirshfeld et al., 1997a; Rapee, 1997; Stubbe et aI., 1993). Mothers of

anxious children have been found to engage in actions that promote their child's

dependency on them (Messer & Beidel, 1994; Siqueland et aI., 1996); reward the child

for choosing avoidant solutions to challenges; and comfort the child when he or she has

acted in accordance with the parent's advice, yet forfeited the opportunity to participate

in activities with others (Dadds et aI., 1996). Moreover, when engaged in problem

solving tasks with their anxious children, mothers provide greater amounts ofunsolicited

assistance and engage in more intrusive behaviors than do mothers ofnon-anxious

13

children (Hudson & Rapee, 2000; LaFreniere & Dumas, 1992). Such overinvolved

parental behaviors have been associated with lower social competence and increased

withdrawal behaviors among anxious youth (Lafreniere & Capuano, 1997). These

parental behaviors might actively encourage the child to rely on the parent to such an

extent that the child is prevented from developing a well-established sense ofautonomy

(Siqueland et al., 1996).

It is hypothesized that an enmeshed parent-child relationship represents an

additional pathway through which parental anxiety affects child anxiety. Poorly defined

distinctions between the parent and the child roles might result in the parent

communicating many of their own difficulties to the child. The child is then more aware

of the parents' own feelings ofanxiety, or is perhaps provided with an inappropriate

burden in the parent-child relationship. Similarly, if parents are overinvolved with their

child, their beliefs about anxiety might lead them to be more restrictive of their child's

activities, and to take steps to protect their child from environmental events that may

expose the child to corrective information about situations that often produce anxiety

(i.e., presentations at school, participation in a group or club). Finally, being raised in the

context of an enmeshed family system with an anxious parent also increases the amount

ofexposure the child has to perceptions ofambiguous stimuli as threatening and avoidant

response styles (Dadds, Davey, & Field, 2001). It is thus hypothesized that parental

overinvolvement mediates the relationship between parent and child anxiety and

represents a third pathway through which parents influence the development and

maintenance ofanxiety in children.

14

Other Parental Factors Associated with Childhood Anxiety

Although factors such as parental warmth, punishment and reward use,

consistency, and the nature of the family environment have been associated with the

development and maintenance of childhood anxiety, these factors are not uniquely

associated with an increased risk ofchild anxiety (e.g., these factors are associated with a

broad range ofchild psychopathology). As such, their hypothesized roles in the

development and maintenance of childhood anxiety will be briefly reviewed here, but

their association with childhood anxiety will not be examined in the study presented

below.

Parental warmth, one of the two dimensions proposed to comprise parenting style

(Baumrind, 1967), has been found to be associated with lower levels ofchild anxiety

(Moos & Moos, 1983), whereas unsupportive parenting styles have been found to be

broadly associated with the presence ofnegative affectivity among children (Rapee,

1997). Specifically, parents of anxious children have been reported to be more rejecting

of their children (Rapee, 1997), more domineering (Dadds & Barrett, 1996), less caring

(SHove et al., 1991), and to respond to their children with higher levels of aversive

communication and hostility, creating a parent-child interactional pattern characterized

by low parental warmth (Cowan, Cohn, Cowan, & Pearson, 1996; Dadds & Barrett,

1996; Messer & Beidel, 1994).

Parent discipline styles have also been associated with anxiety among children

(Dadds, Heard, & Rapee, 1991). Specifically, mothers ofchildren displaying high levels

of performance competence have been found to praise their child for his or her efforts,

15

and to avoid expressions ofdisapproval or aversive affect (Dumas & LaFreniere, 1993).

Conversely, mothers who are punitive, placing strict limits on the child, tend to have

children displaying heightened levels ofanxiety (Dumas et aI., 1995). Mothers ofanxious

children have also been observed to use coercive means to control their child's behavior,

tending to accompany such actions with aversive behaviors or affect (Dumas et aI.,

1995). Moreover, parental consistency has also been associated with trait anxiety among

children (Dadds & Barrett, 1996; Dadds et aI., 1991; Kohlmann et aI., 1988; Rapee,

1997), such that children ofparents who are inconsistent in their application of reward or

punishment may fail to develop a sense ofcontrol over their environment (Kohlmann et

aI., 1988), perhaps placing them at risk for the development and subsequent maintenance

ofanxiety (Chorpita, Brown, & Barlow, 1998; Chorpita & Barlow, 1998).

Finally, the family environment within which a child develops has also been

found to be a key contributing factor to the development ofchildhood anxiety (Dadds et

aI., 1991; Silove et aI., 1991). The family environments ofchildren experiencing anxiety

have been characterized by low levels of familial cohesion and organization, higher

levels of conflict, and more control over family members and their respective activities,

resulting in the development of lower levels of independence among children in the

family (Crawford & Manassis, 2001; Messer & Heidel, 1994; Moos & Moos, 1983;

Siqueland et aI., 1996). Within such family contexts, greater family control has been

correlated with not only child trait anxiety, but with temperamental rigidity and lower

self-competence as well (Messer & Heidel, 1994).

16

Summary. Research from numerous sources has consistently demonstrated an

increased risk of anxiety among the offspring ofparents with anxiety disorders (e.g.,

Beidel & Turner, 1997; Last et al., 1991). Moreover, several parental beliefs and

behaviors have been found to be associated with child anxiety (e.g., Dadds & Barrett,

1996; Rapee, 1997). However, many of these beliefs and behaviors have been examined

only as simple correlates ofchildhood anxiety, such that the manner in which these

parenting practices might mediate the relationship between parental and child anxiety has

been largely overlooked. The present investigation describes the development ofa parent

report measure designed to assess parental beliefs and behaviors that are associated with

childhood anxiety and that potentially mediate the effects ofparental anxiety on

childhood anxiety. Moreover, this study examines preliminary evidence with respect to

the utility ofa parent-report measure designed to identify mediators of parental and child

anxiety within a clinical context.

Hypothesized Relationships Among Parental Behaviors, Parental Beliefs About Anxiety,

and Child Anxiety

It was hypothesized that, in the present investigation, parental anxiety would

serve as a predictor ofchild anxiety. However, three factors were hypothesized to act as

mechanisms through which parental anxiety affects child anxiety, or to mediate the

relationship between parental and child anxiety. These factors were conceptualized as

parental beliefs about anxiety, stimulus regulation, and overinvolvement with the child

(see Figure 1). Specifically, it was suggested that parents who reported high levels of

anxiety would hold particular beliefs about anxiety (i.e., that anxiety is harmful for the

17

child, that ambiguous situations are threatening for their child), which in tum would be

associated with the child's own espousal of anxious cognitions and heightened levels of

anxiety. It was further hypothesized that parents who reported heightened levels of

anxiety would take steps to regulate or control their child's environment, such that the

child's exposure to anxiety-provoking stimuli (Le., class speeches, meeting new people)

would be reduced. Preventing the child from participating in new or potentially

challenging situations was, in turn, hypothesized to be related to feelings of anxiety in the

child regarding his or her ability to engage in these activities successfully. Additionally,

parents expressing heightened levels ofanxiety were also predicted to be overinvolved

with their child, such that they would report identifying closely with their child's

concerns and overvalue the bond between themselves and their child. Such an

overinvolved, or enmeshed, relationship was expected to also lead to heightened levels of

anxiety in the child, such that the child would be dependent on the parent and unable to

develop a sense ofautonomy and self-efficacy in the environment. Moreover,

inappropriate amounts of infonnation about the parent and his or her own difficulties

might be communicated to the child within the context of an enmeshed relationship,

potentially placing an undue burden on the child with respect to his or her role within the

parent-child relationship.

In addition to their roles as mediators of the relationship between parental and

child anxiety, however, these variables were also predicted to be related to one another. It

was predicted that the parent's overinvolvement with their child would moderate the

relationship between parental anxiety and stimulus regulation, such that as the parent

18

becomes more overinvolved with the child, the effects of parental anxiety on stimulus

regulation should increase. Specifically, parents who are anxious may take certain steps

to insure that their child does not experience unnecessary anxiety; however, ifparents are

overinvolved with the child, it was suggested that the degree to which they regulate the

child's activities, do difficult things for their child, and protect the child from ambiguous

situations would be markedly increased. Further, parental beliefs about anxiety were also

predicted to moderate the relationship between parental anxiety and stimulus regulation,

such that as parental beliefs about anxiety become more negative, the effects ofparental

anxiety on stimulus regulation should increase. More specifically, parents who were more

fearful of anxiety and its potential effects on their child would impose higher levels of

restriction on their child's activities.

Present Investigation

Research from numerous sources has suggested that multiple pathways exist

through which parents can affect their child's anxious thoughts and avoidant behaviors,

thus creating a specific vulnerability for the development ofanxiety. It was the intent of

the present investigation to evaluate the psychometric properties of a newly developed

questionnaire designed to identify those specific parental beliefs and behaviors

hypothesized to be most proximally related to child anxiety. More specifically, the

present investigation describes the development ofparent-self report measure, as well as

the initial examinations of this instrument's construct, convergent, and discriminant

validity.

19

STUDY 1

METHOD

Overview

Study 1 focused on the development of the Parental Behaviors and Beliefs about

Anxiety Questionnaire (PBBA-Q), a parent-report instrument designed to elicit parents'

perceptions of the behaviors they employ in the parenting of their child as well as their

beliefsconceming anxiety and how anxiety may affect their child. Although a reliance on

"perceptions" of childrearing behavior may present methodological limitations with

respect to identifying the actual behaviors exhibited by the parent in the context of

parent-child interactions, it is contended herein that perceptions ofchildrearing practices

or beliefs, rather than a measure ofactual parenting behaviors, is the target variable of

interest. Specifically, one intent ofthis investigation was to develop a parent-report

measure th;lt could be efficiently administered (with respect to time and monetary cost)

that assessed parenting practices and beliefs proposed to contribute to the child anxiety.

Study 1 focused on initial item-pool creation for the PBBA-Q, as well as on an

investigation of the face validity of the items comprising this measure.

Participants

Participants for Study 1 included five graduate students in clinical psychology.

Each participant had at least one year ofexperience working with children in a clinical

setting (range = 1 to 9 years), and was involved in the provision ofassessments and

20

treatment to children and their families in an outpatient clinical setting at the time of this

investigation.

Procedure

Scale development, content, and scope. The PBBA-Q was intended to provide a

measure of those parental behaviors and beliefs hypothesized to mediate the relationship

between parental and child anxiety. On the basis ofprevious research, three classes of

parental behaviors and beliefs were identified that have been significantly associated with

anxiety among children. From each of these three domains a scale was developed,

comprised of items intended to reflect the specific behaviors and beliefs thought to

underlie each area as broadly defined in the literature.

The three scales comprising the PBBA-Q are: (1) Parental Beliefs about Anxiety

(PB), intended to reflect the parent's level of anxiety sensitivity with respect to their

child, as well as the extent to which the parent makes cognitive misattributions in their

evaluation of ambiguous stimuli that are related to their child; (2) Stimulus Regulation

(SR), intended to reflect the extent to which parents attempt to control, restrict, or

regulate their child's engagement in activities, as well as the degree to which the parent is

willing to allow the child to experience potential or perceived discomfort or emotional

distress; and (3) Overinvolvement with the Child (OIC), designed to reflect parental

perceptions that their child is similar to them, feelings on the part of the parent that they

have a unique relationship with their child, and the degree to which the parent has an

inappropriate and excessive level of involvement in the child's life.

21

Although parental warmth, punishment/reward use, consistency, and familial

interactions are hypothesized to be mediating variables of parental and child anxiety,

these factors were not represented on the PBBA-Q because existing measures of each of

these constructs are available (i.e., the Family Environment Scale, Moos & Moos, 1983).

Thus, despite the fact that parental factors related nonspecifically to the development and

maintenance ofchild anxiety are considered to be variables critical to understanding the

relationship between parent and child anxiety, these factors will not be examined in the

present investigation.

Item pool creation. The items selected and written by the primary investigator for

the PBBA-Q were derived using the theoretical-rational method of scale development

(Loevinger, 1957), such that items were written to reflect the primary content areas

hypothesized to comprise the domain of interest.

The items comprising this instrument were written to be simple and

straightforward with respect to sentence construction, such that they could be understood

by individuals from a broad range ofeducational backgrounds. Items, on average,

consisted of 13.6 words, with 3.9 characters per word. The items were written at

approximately a fifth grade reading level (Flesch-Kincaid Grade Level, 4.7; Flesch,

1994), and the scale as a whole yielded as Flesch Reading Ease score of 85.4 (on a scale

of0 to 100, with higher scores indicating a greater ease of readability; Flesch, 1994).

Although most items were subsequently re-written by the primary investigator, many of

the items comprising the PBBA-Q were drawn from other scales measuring parenting

behaviors. The scales from which items were originally drawn include the: (1) Parental

22

Nurturance Scale (PNS; Boo, 1989); (2) Parent Affect Test (PAT; Linehan, Paul, &

Egan, 1983); (3) Parental Locus ofControl Scale (PLOC; Campis, Lyman, & Prentice

Dunn, 1986); (4) Parent's Report (PR; Dibble & Cohen, 1974); (5) Parental Bonding

Instrument (PBI; Parker, Tupling, & Brown, 1979); (6) Parenting Scale (Arnold,

O'Leary, Wolff, & Acker, 1993); (7) MaternallPaternal Sensitization Questionnaire

(Bennet & Stirling, 1998); (8) Child Rearing Practices Report (CRPR; Block, 1965); and

(9) Parent Protection Scale (Thomasgard, 1998).

Item selection. The 170 items originally comprising the PBBA-Q were initially

derived from several existing measures ofparenting behavior, although the majority of

these items were rewritten to be in the present tense to assess current, rather than past,

styles ofchildrearing. Because mothers have been found to employ very different

patterns of interaction with their own child, relative to other children (Dumas &

LaFreniere, 1993), as well as to have different interactional styles with each of their

children, all questions were written to be specific to the parent and one child being

assessed.

Item classification. Each of the five raters in Study 1 was asked to classify each

item, on the basis of item content, as representing one of the three dimensions

hypothesized to comprise parenting beliefs and behaviors that underlie the relationship

between parent and child anxiety. Specifically, each rater was provided with a detailed

description ofthe theoretical construct underlying each of the domains to be assessed by

the PBBA-Q. Accompanying each construct description were two example items (which

were not actual PBBA-Q items). Raters were also provided with a list of 170 items,

23

arranged in random order. In a space to the right of each item, each rater was asked to

indicate the subscale most representative of the item's content. All rating of items was

done independently, and neither consultation with one another nor with the principal

investigator, who compiled the scale, was permitted.

RESULTS

The decision to retain items in Study 1 was based on majority consensus among

the five raters (i.e., agreement among four of the five raters). Thus, items for which three

or fewer raters agreed with respect to classification were eliminated from the scale.

Agreement among four of the five raters was chosen as the criterion to retain items given

that perfect agreement was thought to impose too stringent a constraint on item retention,

whereas agreement among only three raters might have resulted in the retention of items

that did not most accurately reflect their respective constructs. Following this procedure,

101 items were retained.

Eight of the remaining 101 items were subsequently rewritten, based on

suggestions provided by the raters, to more clearly reflect the dimension they were

intended to assess. Eleven new items were added to the PB scale to more

comprehensively assess parents' beliefs that anxiety is harmful for their child. More

specifically, these 11 new items were re-written directly from the Anxiety Sensitivity

Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986). Specifically, 11 of the 16 items

comprising this instrument were re-written for "my child" rather than for "I"; the content

of the remaining 5 items of the ASI was found to be represented on items previously

written for the PB scale. One hundred twelve items remained on the PBBA-Q,

24

comprising the PB (42 items), SR (22 items), and Ole (48 items) scales (see Appendix

A).

STUDY 2

METHOD

Overview

Given that 101 items on the PBBA-Q were reliably classified into each ofthree

scales in Study 1, as well as that eleven new items were added to the instrument, Study 2

sought to examine the validity ofthese item classifications. Specifically, raters in Study 1

were asked to indicate that scale to which the content ofeach item was best matched.

Study 2 instead asked raters to determine the extent to which each item reflected the

underlying theoretical construct of the scale to which it had been classified in Study 1.

Participants

Participants for Study 2 included five graduate students in clinical psychology

(each ofwhom served as a rater for Study 1) who specialized in the study of childhood

anxiety. Each participant had at least one year of experience working with children in a

clinical setting (range::::: 1 to 9 years), and was involved in the provision of assessments

and treatment to children and their families in an outpatient clinical setting at the time of

this investigation.

Procedure

Item construct validity. Each rater was provided with a detailed description of the

theoretical construct underlying each of the domains to be assessed by the PBBA-Q.

Accompanying each construct description were two example items. Following each

25

detailed scale description, raters were presented with the items assigned to that scale in

Study 1. Specifically, each rater received three separate lists of items (Parental Beliefs

About Anxiety, Overinvolvement with Child, and Stimulus Regulation), each of which

was preceded by a detailed description of the construct intended to underlie that scale.

Items on each list were arranged in random order. In a space to the right of each item,

each rater was asked to rate the extent to which each item reflected the content of the

scale to which it had been classified in Study 1. More specifically, raters were asked to

indicate, on a Likert scale ranging from 1 (fits not at all) to 4 (fits very well), the extent to

which they believed that each item reflected the construct represented by the scale the

item was purported to measure. All rating of items was done independently, and neither

consultation with one another nor with the principal investigator, who compiled the scale,

was permitted.

RESULTS

Construct validity ratings. An item was deemed representative of its intended

scale if four out of five raters assigned the item a rating of '3' (fits some) or above. Items

for which two or more raters assigned the item a rating of '2' (fits a little) or less were

eliminated from the scale. Agreement among four ofthe five raters was chosen as the

criterion to retain items given that perfect agreement was thought to impose too stringent

a constraint on item retention, whereas agreement among only three raters might have

resulted in the retention of items that did not most accurately reflect their respective

constructs. Following this procedure, 33 items were removed from the scale as a whole

(20 items from the PB scale, 3 items from the SR scale, and 10 items from the OIC

26

scale). Of the 79 items remaining on the revised PBBA-Q, 22 items comprised the PB

scale, 19 items comprised the SR scale, and 38 items comprised the OIC scale (see

Appendix B). Moreover, the remaining items comprising each scale were judged by at

least four out of five raters to at least "fit some" with the construct assessed by their

respective scales.

STUDY 3

METHOD

Overview

To examine the item content and construct validity of the PBBA-Q among a

clinical sample ofparents ofchildren presenting for a mental health evaluation, this

instrument, as constructed in Study 2, was administered to a small group of parents, a

subset of whom had a child diagnosed with an anxiety disorder. Qualitative responses

were elicited from parents with respect to their reactions to the questionnaire, and the

extent to which individual items distinguished between parents of anxious and non

anxious children was examined.

Participants

Participants for Study 3 included an ethnically diverse, diagnostically

heterogeneous sample of 35 parents and their children presenting for a mental health

evaluation at the Child and Adolescent Stress and Anxiety Program (CASAP) at the

Center for Cognitive Behavior Therapy (CCBT) at the University ofHawai'i at Manoa.

The majority of these children and their families were referred by school personnel,

whereas other families approached the clinic privately. Based on the information obtained

27

during the administration ofa structured diagnostic interview, 62.9% (n=22) of the child

participants received DSM-IV-TR (American Psychiatric Association, 2000) diagnoses

on Axis I. Ofthose youth receiving an Axis I diagnosis, 31.4% (n=ll) received a

principal or an additional diagnosis of an anxiety disorder (i.e., Separation Anxiety

Disorder, Social Phobia, Specific Phobia, Obsessive Compulsive Disorder, Panic

Disorder, Agoraphobia, Generalized Anxiety Disorder, Acute Stress Disorder, Anxiety

Disorder Not Otherwise Specified, or Adjustment Disorder with Anxiety); the remainder

of the sample did not receive a diagnosis ofan anxiety disorder anywhere in their

diagnostic profile. Of the 24 child participants who did not receive a diagnosis ofan

anxiety disorder, 13 received no Axis I diagnosis, 3 were diagnosed with a mood disorder

(e.g., Major Depressive Disorder, Dsythymic Disorder), 2 were diagnosed with

attentional problems, and 6 received diagnoses ofdisruptive behavior disorders. Of the

total child sample, 68.6% were boys (n=24), 31.4% were girls (n=II), and 25.7% (n=9)

were between the ages of 5 and 12, with 2.9% (n=l) of the present sample younger than

age 7. The mean age ofparent respondents was 42.97 years (SD=8.57); the mean age of

child respondents was 13.89 years (SD=3.18). The median annual family income was

$32,500 (SD=$34,735). Ofthe present child sample, 8.6% identified primarily with an

Asian ethnicity (i.e., Filipino, Japanese), 17.1% with Pacific Islander (Le., Hawaiian and

Samoan), 14.3% with Caucasian, 51.4% with a mixed ethnic background, and 5.7%

reported identifying most with an other ethnic background. For the purposes of the

present investigation, a "parent" included the child's (a) biological mother, or (b)

biological father. In the event that neither of these individuals lived with or cared for the

28

child, the "parent" was defined as that adult who had the primary responsibility of

providing for the child's social, emotional, and material needs. The "parent" need not

have been a biological relative of the child or a legal custodian of the child.

Measures

Anxiety Disorders Interview Schedule for DSM-IV, Child and Parent Versions

(ADIS-IV-C/P). The ADIS-N-CIP (Silverman & Albano, 1996), a revision of the ADIS

CIP (Silverman & Nelles, 1988), which was a downward extension of the adult ADIS

(DiNardo, O'Brien, Barlow, Waddell, & Blanchard, 1983), is a semistructured diagnostic

interview, designed for the assessment ofDSM-IV diagnoses ofchildhood anxiety,

mood, behavioral, and attentional disturbances. This interview schedule, which is

intended for use with youth between the ages of 7 and 17, presents questions worded to

assess current functioning. Ratings from both the parent and child are obtained for both

symptom severity and symptom interference. Excellent interrater reliability has been

suggested for the ADIS-IV-CIP (1(=.77; Chorpita, Plummer, & Moffitt, 2000).

Procedure

All participants and their primary caregiver(s) were administered the ADIS-IV

CIP by doctoral students in clinical psychology who were trained to reliability using this

structured interview (training involves matching an experienced interviewer exactly in

three out ofa series of five cases). On the basis of all information obtained during the

assessment process, the diagnostic profile ofeach child was determined, and Axis I

diagnoses were assigned as indicated.

29

For the purposes of initial scale evaluation, the 79 items comprising the revised

PBBA-Q subsequent to Study 1 and Study 2 were administered to 35 parents, 11 of

whom were parents of anxious children (i.e., children receiving a primary or additional

Axis I diagnosis ofan anxiety disorder, as determined by the procedures described above)

and 24 ofwhom were parents ofnon-anxious children (Le., children who did not receive

an Axis I diagnosis ofanxiety anywhere in their diagnostic profile, as determined by the

procedures described above). Following the administration of the PBBA.Q, 11 of the

parents who completed the PBBA·Q (five of whom were parents of children who

received principal or additional diagnoses of an anxiety disorder) were met with

individually for a brief interview about the questionnaire. During this interview, each

parent was asked for comments about and impressions of the PBBA-Q. Specifically,

parents were asked to identify items they found unclear, difficult to understand, or

challenging to answer. Suggestions with respect to how to more clearly or more

effectively word particular items were also solicited. Further, parents were asked if they

objected to any particular items, and, if so, for what reasons. It was determined that those

items that were deemed unclear or too difficult to understand or answer would be

eliminated, as would those items to which parents objected. It was decided that decisions

regarding the elimination of particular items would be made on the basis of both the

magnitude of the concern with the item, and the number of individuals who expressed

concern with the item. For example, if one parent expressed a particularly strong concern

regarding one item, that item would be dropped from the scale; alternatively, if several

parents expressed mild concerns with an item, that item would also dropped.

30

In addition to feedback solicited with respect to the items comprising the PBBA

Q, parents were also asked to indicate their level of satisfaction with the response scale

anchors accompanying the items. Specifically, parents were asked to indicate the ease

with which they were able to respond to items using anchors indicating degrees of

agreement (e.g., "strongly agree," "agree," "disagree," "strongly disagree").

Following this qualitative interview, the responses ofparents in the anxious group

on each item were compared to the corresponding responses ofparents in the non

anxious group, with the intent ofeliminating from the scale those items which did not

discriminate meaningfully (e.g., no apparent difference in mean responses between parent

groups, or differences in the opposite direction of those predicted) between parents of

anxious children and parents of non-anxious children.

RESULTS

Qualitative interview results.

Questions that were diffiCult to understand With respect to items that the parents

interviewed found unclear, difficult to understand, or challenging to answer, parents of

both anxious and non-anxious children reported that they found questions that seemed

redundant (i.e., a very similar item had appeared earlier on the questionnaire) difficult to

answer, given that they were concerned about the degree to which their two answers

corresponded. Parents also indicated that they had difficulty answering questions with

two clauses (i.e., I enjoy having separate interests from my child because then we always

have something to talk about), given that they might have agreed with one portion of the

question, but disagreed with the other portion of the question. Some parents of anxious

31

children also indicated that they had difficulty answering questions that included the

word "sometimes," as they were uncertain ofprecisely how often "sometimes" implied.

Although some parents indicated that some questions were too general and that their

responses would vary depending on the situation (i.e., "I attend to my own needs before 1

attend to my child's needs"), other parents reported that some questions were too

situation-specific, making it difficult for them to choose an answer that "best" applied to

them (i.e., "When 1feel worried that my child is not safe, it is important for me to trust

those feelings no matter what anyone else says," "I do not like it when other people see•

my child is afraid"). Finally, parents of older children suggested that some questions did

not apply to them or their child, given that the situations appeared to refer to those more

likely to be encountered by parents of younger children (i.e., "My child comes to me first

when he/she has a problem").

Unclear words, phrases, and items. When asked if there were any words in

particular items that they found unclear, parents ofanxious children reported that they

were uncertain as to whether physical sensations (i.e., "short of breath," "heart beats")

were intended to reflect physical exertion, or whether these sensations were intended to

refer to "panic" or "physical problems." Parents of anxious children also reported

vacillating between response choices, and made statements such as "Some part ofme

thinks yes, but does it mean [that] ... maybe [my answer] should be ...." Similarly,

other parents ofanxious children indicated that they would have chosen a particular

answer, but decided not to because of one specific word that they did not like. Parents of

anxious children again indicated that some questions were unclear to them because of the

32

situational specificity, or lack thereof, inherent in some items. For example, some parents

reported that for questions such as, 'Ifmy child will probably be rejected from a group of

peers, I try to warn my child to avoid that situation,' they might not always try to warn

their child, thus leading them to be confused about how to respond. In contrast to parents

ofanxious children, parents of non-anxious children did not report finding any words on

the questionnaire that did not make sense.

Potentially objectionable items. When asked about questions to which they might

have objected, parents of anxious children indicated that in general some ofthe items

made them feel "self-conscious" and as though they might be a "bad parent"; others

indicated feeling uncomfortable with what they perceived as judgments with respect to

"good parents versus bad parents" underlying all items on the questionnaire. One parent

ofa non-anxious child reported thinking that some of the questions were "trick

questions," and also indicated that some of the questions seemed "silly." Some parents of

non-anxious children reported that everyone gets uncomfortable and that they had some

difficulty choosing a response, given that they viewed some of the situations listed as

very common to all children. Overall the parents ofnon-anxious children did not indicate

finding any particular questions objectionable.

Questions that should be worded differently. When asked if they would prefer a

different wording ofany of the questions on the instrument, parents.of non-anxious

children generally responded that they did not have any problems with the current

wording ofitems. However, one parent of a non-anxious child indicated that they would

have preferred a phrase other than "heart beating rapidly" in the item, "When my child

33

tells me that hislher heart is beating rapidly, 1worry that he/she might have a heart

attack," given that they could imagine several situations that might lead to a rapidly

beating heart. Some parents ofanxious children reported that they were "embarrassed" to

respond to some of the items that indicated they put the needs of their child ahead of

others, such as spouses and friends. One parent ofan anxious child also reported feeling

that the words "mentally ill" in the item, "When my child is nervous, 1worry that he/she

might be mentally ill," were "too strong."

Favored questions. Parents were also asked whether there were items that they

particularly liked or thought were good questions that would lead a clinician to have a

better understanding of them and their child. Overall, parents in both groups agreed that

the questions were well-written and clear. Some parents ofanxious children indicated

that the questions appeared somewhat more applicable to parents of younger children.

Parents also indicated preferring questions with only one clause (i.e., preferring "1 am the

only one who really understands how my child is feeling" rather than "1 know, more than

anyone else, how my child feels about things"). Parents in both groups also reported that

these questions prompted them to think about how they themselves behaved as parents,

such as whether they were "good parents," whether they were too protective of their

child, and how they themselves thought about challenging situations that their child

might face. One parent of a non-anxious child indicated that the questions on the PBBA·

Q were actually the easiest to answer out of the entire assessment battery administered.

Response options. When asked for their opinion about the response options

(ranging from "Strongly Agree" to "Strongly Disagree"), all parents of anxious children

34

reported liking the response options and finding that they went well with the items.

Several parents of non~anxiouschildren reported wanting more options on the scale,

wanting a middle response point, and wanting a "don't know" option included. One

parent also indicated that the response options were difficult to use on questions that

included negatives, such as "I do not try to restrict my child's activities, decisions, or

desires."

General impressions. Parents were also asked for their general impressions of the

questionnaire. Several parents from both groups reported that the PBBA-Q was different

from other questionnaires they had completed about their child; some parents reported

that the questionnaire asked much more than typical about them as a parent and that it

asked about common situations from a different angle (i.e., focusing on how the parent

would perceive or handle these situation).

Although the majority of the parents did not feel that the 79-item questionnaire

was too long or tedious to complete, some parents in each group reported that it was a

long questionnaire. Only two parents reported that the questions on this instrument

required too much thought and were excessively difficult to answer. None ofthe parents

in this sample found the questionnaire intrusive or unpleasant, and all reported that they

thought the questionnaire would be a good part of the assessment they had completed.

Two parents additionally indicated that they thought the questionnaire was good given

that it made them think about things they had not thought about before with respect to

parenting their child. All but one parent reported finding the questionnaire easy to

35

understand. All but one parent in each group reported that the questionnaire asked about

feelings and situations relevant to their relationship with their child.

Finally, parents were asked whether they perceived this questionnaire as a

valuable component of their child's overall assessment. All parents responded to this

question affirmatively, and many provided additional comments as well. Parents of

anxious children reported: "It's a pretty good device to get information fast and covers

lots ofareas really well," "You would need to find out, maybe, if the mother is

overprotective, or if the parents are sad him or herself," "a good questionnaire ... it takes

some thought, but its good all around ... I'd recommend that you keep all of the

questions because you do not think about this kind of stuff all of the time, so it is like a

wake up call- I asked myself, 'do I usually do this or that?''' Parents ofnon~anxious

children reported: "Felt like it was trying to push me to say that 'I live for my child';

made me realize that I really am my own person," "It's important to know how a parent

feels about their child; important feelings were asked about. The parent's perspective on

these things is important," "Different points of view are solicited ... I think it added

information," "It made me think about some situations, what would I do if that

happened?"

Quantitative findings.

The primary purpose of Study 3 was to identify any items that, when administered

among a small clinical sample, were problematic, failed to discriminate between parents

of anxious children and parents ofnon~anxiouschildren, or were difficult to understand

and respond to. Multiple factors were taken into consideration when evaluating each item

36

for retention on the subsequent version of the scale. Given that the scales each included

different numbers of items, one goal of this stage of the scale development was to

construct three scales of approximately an equal number of items. Those items that

parents had indicated were unclear or difficult to answer were also examined. The

centrality ofeach item to the theory underlying its respective scale was also reviewed.

Finally, attempts were made to identify those items that did and did not meaningfully

discriminate between parents ofanxious children and parents of non-anxious children.

The mean response for each item was computed for parents in each group. The two

means for each item were then compared, and a difference score was computed for each

pair. Positive differences indicated that the parents of anxious children, as a group, scored

higher on a particular item than parents of non-anxious children; negative differences

indicated that the non-anxious parents, as a group, scored higher on the item. The

converse was true for items that were written to be reverse-scored.

Several factors were considered before deleting an item from the scale.

Specifically, given that the PB and SR scales had far fewer items than the Ole scale at

the commencement of Study 3, it was decided that fewer items should be deleted from

these scales. Thus, even if an item on one of these two scales did not discriminate

meaningfully between parent groups, it might have been retained in order to maintain

commensurate item numbers across scales. Moreover, although some items that parents

had identified as unclear or difficult to answer were deleted, others were not if they were

thought to be particularly central to the theory underlying the scale, or if they were found

to discriminate particularly well between parent groups. Finally, although some items

37

were deleted if the mean among parents ofnon-anxious children was higher in raw value

than the mean among parents of anxious children (e.g., the difference score was in the

unintended direction), other items for which this was true were retained if they were

thought to be central to the theory underlying the scale, or if they could not be deleted

given the intent to create scales of a certain length.

Twenty-eight of the 79 items comprising the PBBA-Q were deleted following

these evaluations. Twelve items were deleted because they had been identified by parents

as being unclear, difficult to understand, or challenging to answer. The majority of these

12 items contained two parts, which multiple parents had identified as difficult to respond

to, given that they might agree with one part of the item, but disagree with the other part

(i.e., "I enjoy having separate interests from my child because then we always have

something to talk about"). Other items were deleted because they contained words or

phrases that parents had identified as confusing or difficult to understand (i.e., "It scares

me when my child tells me that he/she has unusual body sensations"). Seven items were

deleted because very low differences were found in the means of each parent group, and

9 items were deleted because the mean ofthe parents of non-anxious children was higher

than that among parents ofanxious children. Moreover, each of these sixteen items

deleted for quantitative reasons was also identified as secondary to the theory underlying

its respective scale. When examined by scale, 7 items from the ole scale were deleted

because ofparental feedback, as were 3 from the PB scale, and 2 from the SR scale. For

demonstrating low discriminability between groups, 6 items were deleted from the ole

38

scale and 1 from the PB scale. For demonstrating mean differences in the opposite

direction, 8 items were deleted from the OIC scale and 1 from the PB scale.

Following Study 3,51 items were retained, with 17 items comprising each of the

three scales (see Appendix C). The mean group differences for these 51 items ranged

from -0.46 to 0.55. For the OIC items, the differences ranged from -0.43 to 0.45, for the

PB scale differences ranged from -0.46 to 0.44, and for the SR scale differences ranged

from -0.27 to 0.55. Although some ofthe items retained discriminated less well between

parent groups, these items were judged to be central to the theory underlying the scale.

Moreover, with respect to the PB and SR scales, some items were retained in an effort to

3 attain scales of commensurate length.

STUDY 4

It was suggested that because parental perceptions of their child and of their

interactions with their child appear to play such a large role in the perpetuation ofanxiety

among children, parents' perceptions oftheir childrearing behaviors might play an

equally significant role in the maintenance ofchildhood anxiety. In order to evaluate the

psychometric integrity of the PBBA-Q, the degree to which its respective scales

correlated with related constructs (Le., parent and child anxiety~ parent and child negative

affect) and discriminated from constructs hypothesized to be distinct (Le., family income,

child inattentive, oppositional, or delinquent behaviors) was evaluated. The experimental

hypotheses initially posited were then tested, such that the role ofeach of the three scales

of the PBBA-Q in mediating the relationship between parent and child anxiety was

examined.

39

METHOD

Overview

In order to empirically evaluate the construct validity of the 51-item version

PBBA-Q (see Appendix D) in a larger clinical sample, the scores ofparents ofchildren

with anxiety disorders were compared to the scores of parents ofchildren who did not

receive principal or additional diagnoses ofanxiety. It was predicted that the parents of

children with anxiety disorders would receive higher scores on the subscales of the

PBBA-Q than would parents ofchildren who did not have an anxiety disorder present in

their diagnostic profile. Given that the initial evaluation of this instrument was intended

to determine the boundaries of the target construct, parents' scores on this instrument

were correlated with scores on a battery of standardized assessment instruments

measuring related constructs ofanxiety, depression, and affectivity. The PBBA-Q was

thus evaluated among a sample of parents of clinically-referred children given that the

target construct ofmediators of parental and child anxiety was hypothesized to possess

unique properties among a clinic population.

Participants

Participants for this study included an ethnically diverse, diagnostically

heterogeneous sample of 103 parents and their children presenting for a mental health

evaluation at the Child and Adolescent Stress and Anxiety Program (CASAP) at the

Center for Cognitive Behavior Therapy (CCBT) at the University ofHawai'i at Manoa.

Participants for Study 4 were referred to the CCBT via the same methods described in

Study 3. A sample size ofapproximately 100 participants was sought given guidelines

40

(Cohen, 1992) suggesting that a minimum of26 participants per group are needed in

order to identify large effect sizes (ES) when a = .05 for Analyses of Variance

(ANOVAs; ES=.40), and that a total sample size of between 76 and 85 participants is

needed in order to identify medium effect sizes when a = .05 for multiple regression

analyses (ES=.15) and correlational analyses (ES=.30; Cohen, 1992). Participant

recruitment continued until a minimum of 100 total participants, and a minimum of26 of

those participants receiving a diagnosis of anxiety, were recruited. The ratio of26

anxious to 74 nonanxious participants reflects the natural balance of children presenting

to the university-based clinic from which participants were recruited in the present

investigation, such that historical referral rates (spanning the 4 years from 1998 to 2002)

for this clinic indicated that between one quarter and one third ofall intake assessments

conducted through the CASAP at the CCBT yielded diagnoses indicating an anxiety

disorder. The instrument evaluated in the present investigation was designed for use

among a clinical population. As such, using a stratified sample (i.e., comprised of an

equal number ofparents ofanxious and parents of nonanxious children, or a ratio of

parents ofanxious to non-anxious children not representative of the distribution of this

variable in the general population) in the analyses might not have provided an accurate

indication of its psychometric properties. More specifically, such a sample would not

reflect the diagnostic distribution ofchildren and families in a '"real world" clinical

setting.

Diagnostic status was determined on the basis of the child's composite diagnosis

(i.e., the diagnosis yielded from the child and parent interviews, child- and parent-report

41

paper-and-pencil measures, and teacher interview). Based on the information obtained

during the assessment process, 78.6% (n=81) of the child participants received DSM-IV

TR (American Psychiatric Association, 2000) diagnoses on Axis I. Of those youth

receiving an Axis I diagnosis, 29.1% (n=30) received a principal or an additional

diagnosis of an anxiety disorder (i.e., Separation Anxiety Disorder, Social Phobia,

Specific Phobia, Obsessive Compulsive pisorder, Panic Disorder, Agoraphobia,

Generalized Anxiety Disorder, Post-Traumatic Stress Disorder, Acute Stress Disorder,

Anxiety Disorder Not Otherwise Specified, or Adjustment Disorder with Anxiety); the

remainder of the child sample did not receive a diagnosis ofan anxiety disorder anywhere

in their diagnostic profile (see Table 1). Of the total child sample, 66.0% were boys

(n=68), 34.0% were girls (n=35), and 36.9% (n=38) were between the ages of6 and 12,

with 2.0% (n=2) of the present sample younger than age 7. The mean age ofchild

participants in this study was 12.78 years (SD=2.93); mean parent age was 40.67 years

(SD=6.89). The median annual family income was $35,000 (SD=$54,728). Ofthe present

child sample, 13.0% identified primarily with an Asian ethnicity (i.e., Chinese, Filipino,

Japanese, and Korean), 2.2% with Southeast Asian, 4.3% with Pacific Islander (i.e.,

Hawaiian and Samoan), 1.9% with African American, 1.1% with Portuguese, 1.1% with

Latino, 15.1% with Caucasian, 57.0% with mixed ethnic background, and 4.3% reported

identifying with an "other" ethnic identity. Data on parent ethnicity was not available.

For the purposes of the present investigation, a "parent" included the child's (a)

biological mother, or (b) biological father. In the event that neither of these individuals

lived with or cared for the child, the "parent" was defined as that adult who had the

42

primary responsibility of providing for the child's social, emotional, and material needs.

The "parent" need not have been a biological relative of the child or a legal custodian of

the child. Among those parents participating in the present investigation, 48.4% were

married, 3.2% were separated, 25.8% were divorced, 1.1% were widowed, and 19.4%

were single at the time of assessment (see Table 2). Among parent participants in the

present investigation, 89.3% (n=92) were mothers and 10.7% (n=11) were fathers.

Materials

Parent self-report measures.

Depression, Anxiety, and Stress Scales-21 (DASS-21; Antony, Beiling, Cox, Enns,

& Swinson, 1998). The DASS~21 (see Appendix E) is a shortened version of the original

42~item DASS (Lovibond & Lovibond, 1995). The DASS~21 is a self-report measure

designed to assess symptoms associated with anxiety, depression, and general stress in

adults. Factor analytic studies of the DASS~21 have supported a three factor scale

structure, comprising separate scales for anxiety, depression, and stress, each consisting

of seven items (Antony et al., 1998). The DASS-Depression scale is significantly

correlated with low positive affect, hopelessness, low self~esteem,and lack of incentive;

items on the DASS-Anxiety scale correspond to measures of autonomic arousal and

fearfulness; and the DASS-Stress scale is comprised of items assessing persistent tension,

irritability, and low thresholds for frustration (Brown, Chorpita, Korotitsch, & Barlow,

1997). Strong estimates ofreliability and concurrent validity have also been reported for

the DASS~21 (Antonyet aI., 1998). Estimates of internal consistency reported for the

DASS-21 are generally high (a = 0.94,0.87, and 0.91 for depression, anxiety, and stress

43

respectively; Antony et aI., 1998). Examinations ofconcurrent validity have indicated

that the DASS-Depression scale correlates most strongly with other measures of

depression, that the DASS-Anxiety scale correlates most highly with other indicators of

anxiety, and that the DASS-Stress scale is moderately highly correlated with other

indicators of anxiety and depression (Antony et aI., 1998), suggesting that the DASS

Depression and DASS-Anxiety subscales are criterion valid measures ofthe respective

constructs ofdepression and anxiety, and that the DASS-Stress scale assesses a more

general factor related to both constructs. Comparisons of the DASS-21 to the original

DASS have suggested that the DASS-21 performs almost identically to the original

DASS with respect to tests ofintemal consistency, concurrent validity, and between

groups distinctions ofa clinically depressed and anxious population and a nonclinic

control group (Antony et aI., 1998; Clara, Cox, & Enns, 2001). Further, the DASS-21

provides a more parsimonious measure ofdepression, anxiety, and stress, while also

yielding a more easily interpretable factor structure, and lower correlations among the

three factors (Antony et aI., 1998; Clara et aI., 2001) than does the original DASS. Given

that the DASS~Stress scale has been found to correlate more highly with the DASS·

Anxiety than with the DASS-Depression scale, as well as that those items comprising the

Stress scale assess for arousal, tension, and a low tolerance for frustration, both the

Anxiety and Stress scales appear to measure key components of anxiety (Lovibond &

Lovibond, 1995). As such, both scales were used as indicators ofparental anxiety in the

present investigation. The items comprising the DASS-21 are written at approximately a

sixth grade reading level (Flesch-Kincaid Grade Level, 6.1; Flesch, 1994), and the scale

44

as a whole yields as Flesch Reading Ease score of75.7 (on a scale of0 to 100, with

higher scores indicating a greater ease of readability; Flesch, 1994).

Positive Affect and Negative Affect Scales (PANAS; Watson, Clark, & Tellegen,

1988). The PANAS (see Appendix F) consists of two lO-item scales designed to tap the

mood dimensions ofpositive and negative affect. For each mood adjective, participants

are asked to rate, on a 5-point scale ("very slightly or not at all," "a little," "moderately,"

"quite a bit," and "very much"), the extent to which they have experienced that specific

mood state during a specified amount of time, typically the past two weeks (Watson et

ai., 1988). The positive and negative adjectives comprising the scale are arranged

randomly. High alpha reliabilities have been obtained for the NA (.84 to .87) and PA (.86

to .90) scales, and the two scales have been found to be weakly and negatively correlated

with one another, suggesting that they share little common variance. The PANAS has

also demonstrated good test-retest reliability, with stability estimates increasing as the

rated time frame (i.e., ''the past few days" versus "the past year") decreases (Watson et

aI., 1988). The PANAS has also been found to display good convergent and discriminant

validity with corresponding measures of anxiety and depression. More specifically, the

NA scale of the PANAS and the Beck Depression Inventory (BDI; Beck, Wald,

Mendelson, Mock, & Erbaugh, 1961) are positively correlated (r=.58), whereas the PA

scale is negatively correlated with the BDI (r=-.36). Similarly, the A-State scale of the

State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, & Lushene, 1970) is

positively correlated with the NA scale (r=.51) and negatively correlated with the PA

scale (r=-.35; Watson et aI., 1988). The items comprising the PANAS are written at a

45

seventh grade reading level (Flesch~Kincaid Grade Level, 7.0; Flesch, 1994), and the

scale as a whole yields as Flesch Reading Ease score of69.1 (on a scale of 0 to 100, with

higher scores indicating a greater ease of readability; Flesch, 1994).

Parent-report measure 0/child behavior.

Child Behavior Checklist/or ages 6-18 (CBCL/6-18). The CBCL (Achenbach &

Rescorla, 2001; see Appendix H) is a parent~report questionnaire consisting of 113

behavioral symptom items related to a variety ofproblems among children between the

ages of six and eighteen. Although this instrument should not be solely for the purposes

ofdiagnosis, it can provide corroborating diagnostic information, as well as an indication

ofa child position on a continuum of problematic behaviors (Mash & Terdal, 1997).

Behavioral symptom items are rated on a 3~point scale, ranging from O=not true, to

1=somewhat or sometimes true, to 2=very true or often true. Scores can be summed to

yield composite scores for each ofeight "narrow~band" subscales (anxious/depressed,

withdrawn/depressed, somatic complaints, social problems, thought problems, attention

problems, rule-breaking behavior, and aggressive behavior) that have been empirically

validated within groupings by age and sex. Scores can also be summed to yield

composite scores for each of six "clinical" subscales (affective problems, anxiety

problems, somatic problems, attention deficit/hyperactivity problems, oppositional

defiant problems, and conduct problems), corresponding to DSM-IV diagnostic

categories (Achenbach & Rescorla, 2001). Raw scores for each of the eight narrow-band

subscales, the six clinical subscales, and the two broad-band scales of Internalizing and

Externalizing problems can also be transformed into T scores (M=50, SD=10). The scale

46

scores comprising the CBCL were derived from factor analyses of parents' ratings of

4,994 clinically-referred youth; norms were derived from a sample of 1,753 youth aged 6

to 18 (Achenbach & Rescorla, 2001). The items comprising the CBCL are written at

approximately a sixth grade reading level (Flesch-Kincaid Grade Level, 6.1; Flesch,

1994), and the scale as a whole yields as Flesch Reading Ease score of77.2 (on a scale of

oto 100, with higher scores indicating a greater ease ofreadability; Flesch, 1994).

Clinician-administered measures for parent and child.

Anxiety Disorders Interview Schedule for DSM-IV, Child and Parent Versions

(ADIS-IV-C/P). The ADIS-IV-CIP (Silverman & Albano, 1996), a revision of the ADIS

CIP (Silverman & Nelles, 1988), which was a downward extension of the adult ADIS

(DiNardo et al., 1983), is a semistructured diagnostic interview, designed for the

assessment of DSM-IV diagnoses ofchildhood anxiety, mood, behavioral, and attentional

disturbances. This interview schedule, which is intended for use with youth between the

ages of 7 and 17, presents questions worded to assess current functioning. Ratings from

both the parent and child are obtained for both symptom severity and symptom

interference. Excellent interrater reliability has been suggested for the ADIS-IV-CIP

(1\.=.77; Chorpita, Plummer et aI., 2000). The ADIS-IV-CIP is designed to yield diagnoses

based on child report only, parent report only, and a combined consensus report. More

specifically, child and parent diagnoses are assigned on the basis of the information

gathered only during the course of the child or parent interview, respectively. Consensus

diagnoses are assigned based on child report obtained during the interview, parent report

obtained during the interview, child self-report measures, parent-report measures of child

47

behavioral and emotional functioning, and information obtained from relevant collateral

sources (Le., teachers). For the purposes of the present investigation, "diagnosis" will

refer to the consensus diagnosis, based on all of the information available to the clinician

at the time of the assessment.

Dimensional Ratings ofClinical Severity (DRs). Dimensional Ratings of Clinical

Severity (DRs; see Appendix G) represent an attempt to extend upon the earlier work of

Silverman and Nelles (1988) and Silverman and Albano (1996) by quantifying the

presence and severity ofa symptom constellation that need not meet diagnostic criteria

(e.g., social fears, separation anxieties). These clinician-derived ratings are based on the

interference rating scale developed previously for the ADIS-C/P (Silverman & Nelles,

1988), such that ratings of 0 to 8, with larger numbers indicating greater degrees of

distress and impairment, are provided for each diagnostic area on the basis of information

obtained during each the child and parent interview. DRs differ from the original

interference ratings such that a numerical rating is assigned for each symptom area

regardless ofwhether or not diagnostic criteria for that area was met by the individual's

(or parent's) symptom endorsement.

In the present investigation, subsequent to the administration ofthe ADIS-IV-C/P,

a DR was assigned by the clinician to each individual for each diagnostic area (Le.,

separation anxiety, social anxiety, specific fear/phobia, generalized anxiety, panic,

agoraphobia, obsessions/compulsions, posttraumatic stress, depression/dysthymic

disorder, oppositional, delinquent, hyperactive, and inattentive), using information

obtained in the parent and child interviews separately. From these ratings for each

48

diagnostic area, a composite Anxiety DR score was also created, comprised ofDRs for

separation anxiety, social anxiety, specific fear/phobia, generalized anxiety, panic,

agoraphobia, obsessions/compulsions, and posttraumatic stress. For the purposes of the

present investigation, a composite Anxiety DR score was created on the basis ofchild

and parent report separately. Similarly, a composite Externalizing DR was also created,

comprised ofDRs for oppositional, delinquent, hyperactivity, and inattention domains.

For each participant, two composite Externalizing DRs were created, one on the basis of

child report only and one on the basis ofparent report only.

Child se(freport measures.

Revised Child Anxiety and Depression Scale (RCADS; Chorpita, Yim, Moffitt,

Umemoto, & Francis, 2000). The RCADS (see Appendix I) is a 47-item revision of the

Spence Children's Anxiety Scale (SCAS; Spence, 1998), designed to correspond more

closely to DSM-IV anxiety disorders and incorporating a subscale for major depression.

On this instrument, children are asked to rate the extent to which each item is true of

them, by indicating their responses on a 0 to 3 scale, corresponding to anchors of"never,"

"sometimes," "often," and "always." A large-scale school-based study of the RCADS

yielded factor analytic results suggesting the following subscales: Separation Anxiety

Disorder, Social Phobia, Generalized Anxiety Disorder, Obsessive-Compulsive Disorder,

Panic Disorder, and Major Depressive Disorder (Chorpita, Yim et aI., 2000). This factor

structure was subsequently confirmed among a large clinical sample (Chorpita, Moffitt,

& Gray, in press). The subscales have demonstrated good factorial validity, internal

consistency, one-week test-retest reliability, and good convergent and discriminant

49

validity in both normal and clinical samples (Chorpita et al., in press; Chorpita, Vim et

aI., 2000). Subscale internal consistencies have been reported to range from .71 to .81

among a school-based sample (Chorpita, Vim et aI., 2000) and from .78 to .88 among a

clinical sample ofyouth. The results of several investigations have provided support for

the RCADS as a measure of internal distress. Specifically, convergent validity

correlations with the Revised Children's Manifest Anxiety Scale (Reynolds & Richmond,

1978) total scores range from .63 to .74 among a normal sample, and from .59 to .72

among a clinical sample; discriminant validity coefficients of anxiety subscales with the

Children's Depression Inventory (CDI; Kovacs, 1980/1981) range from .18 to .45 among

non-clinical youth and from .47 to .59 (Chorpita et aI., in press; Chorpita, Vim et aI.,

2000). Additionally, the RCADS Major Depression subscale was highly correlated with

the CDI (r = .70) among both clinical and non-clinical samples. Moreover, both parent

and child reports on a structured diagnostic interview assessing for the presence of

symptoms ofanxiety and depression have been reported to correlate positively and

significantly with respective scales of the RCADS (Chorpita et aI., in press). The items

comprising the RCADS are written at approximately a third grade reading level (Flesch

Kincaid Grade Level, 3.5; Flesch, 1994), and the scale as a whole yields as Flesch

Reading Ease score of87.8 (on a scale of 0 to 100, with higher scores indicating a greater

ease of readability; Flesch, 1994). For the purposes of the present investigation, each

child's scores on the five anxiety subscales of the RCADS was summed to yield an

anxiety subscale total.

50

Positive and Negative Affect Schedule for Children (PANAS~C; Joiner et al.,

1996). The PANAS-C (see Appendix 1) is a downward extension of the adult PANAS

(Watson et aI., 1988). The child version of this scale is a 27-item, self-report instrument,

consisting of two scales, Positive Affect (PA) and Negative Affect (NA). The PA scale of

the PANAS-C contains 12 and the NA scale contains 15 mood adjectives, which are rated

by the respondent in terms of the frequency with which each emotion has been

experienced during the past week. Respondents are asked to rate the extent to which they

have experienced each emotion adjective during the past two weeks on a 5~point Likert

scale, ranging from "very slightly or not at all" to "extremely." The items comprising the

PANAS-C are written at a seventh grade reading level (Flesch-Kincaid Grade Level, 7.0;

Flesch, 1994), and the scale as a whole yields as Flesch Reading Ease score of 69.1 (on a

scale of 0 to 100, with higher scores indicating a greater ease ofreadability; Flesch,

1994). However, reports exist in the literature indicating that this instrument has been

employed successfully with children as young as eight years ofage (Laurent et aI., 1999),

or in the fourth grade (Joiner et aI., 1996). Both the PA and NA scales of the PANAS-C

have demonstrated good levels of internal consistency (.84 and .80, respectively; Joiner et

aI., 1996). This scale has demonstrated good construct validity, as the NA scale has been

found to be significantly related to the CDI (r=.53,p<.001) and to the RCMAS (r=.65,

p<.OOI). Similarly, examinations of the construct validity of the PA scale have yielded

significant, negative correlations with both the CDI and RCMAS (r=~.45, and r=-.28,

respectively; Joiner et aI., 1996). Support for the validity of the two factors ofthe

PANAS-C as representative of two separate dimensions in child populations has been

51

suggested by minimal and negative correlations between the NA and PA scales (r=-.20,

p>.05; Joiner et al., 1996).

Affect and Arousal Scale (AFARS; Chorpita, Daleiden, Moffitt, Yim, & Umemoto,

2000). The AFARS (see Appendix K) is a 27-item self-report questionnaire designed to

measure the temperamental variables ofpositive affect (PA), negative affect (NA), and

physiological hyperarousal (PH). This instrument was designed for use among child and

adolescent populations. The AFARS asks individuals to indicate how true each statement

is of them on a 4-point Likert scale, ranging from 0 (never true) to 3 (always true). In a

large school-based sample of the AFARS (Chorpita, Daleiden et al., 2000), estimates of

internal consistency were.77 for the PAscale, .80 for the NA scale, and .81 for the PH

scale. A subsequent investigation of the concurrent validity ofthe AFARS (Daleiden,

Chorpita, & Wu, 2000) among a large school-based sample revealed significant positive

correlations of both the NA and PH scales with other measures ofworry, arousal, and

anxiety. The PA scale was unrelated to measures ofworry, arousal, and anxiety, but was

significantly negatively correlated with a measure of child depression, as the tripartite

theory would predict.

Procedure

All participants and their primary caregiver(s) were administered the ADIS-IV

C/P by a doctoral student in clinical psychology who had been trained to reliability using

this structured interview (training involves matching an experienced interviewer exactly

in three out of series of five cases). For those participants under the age of seven, as well

as for youth who experienced difficulty understanding questions presented on the ADIS-

52

IV, interview questions were re-worded to facilitate the child's understanding of the

questions posited. Based only on the information provided in each child and parent

interview, each intake assessor assigned DRs to each participant for each diagnostic area

for both the parent and child interviews. Thus, the child and parent DRs assigned to each

participant reflected only that information that was obtained during the course of the

child or parent interview, respectively. Following the clinical interview, each participant

completed a standardized battery of assessment instruments which included the RCADS,

AFARS, and PANAS-C. For those participants who were below the age of seven or who

experienced difficulty reading any items comprising these measures, individual assistance

was provided by the intake clinician or a trained clinical staff member. During their

child's clinical interview, each parent completed a standardized battery ofparent-report

instruments, including the DASS-21, the PANAS, and the CBCL. As part of each child's

assessment, information was typically obtained via phone interview and teacher-report

measures from each child's school teacher and/or counselor as a means ofascertaining

the child's current symptom profile.

Aims ofthe Present Investigation

The primary aim ofthe present investigation was to develop a parent-report

measure designed to assess three parental beliefs and behaviors hypothesized to mediate

the relationship between parent and child anxiety. It was first hypothesized, however, that

all of the measures employed in the present investigation would demonstrate good

internal consistency (as measured by a and the average interitem correlation of the scale),

and that the measures employed with correlate with one another in a manner predicted by

53

theory (e.g., measures of anxiety were predicted to correlate significantly and positively

with measures of negative affectivity). Multiple specific hypotheses about the

relationship between parent and child anxiety were also posited. More specifically, the

present investigation hypothesized that (a) parent self-reports of anxiety (as measured by

the Anxiety and Stress scales of the DASS-21) would be significantly and positively

correlated with child self-reports of anxiety (as measured by the anxiety scales of the

RCADS), (b) parent self-reports of negative affectivity (as measured by the NA scale of

the PANAS) would be significantly and positively correlated with child self-reports of

negative affectivity (as measured by the NA scales of the PANAS-C and AFARS), (c)

children diagnosed with an anxiety disorder (as measured by the ADIS-IV-C/P composite

diagnosis) would have parents reporting significantly more anxiety and stress on the

corresponding scales of the DASS-21 than would children who were not diagnosed with

an anxiety disorder on the ADIS-IV-C/P, (d) parent self-reported anxiety (as measured by

the Anxiety and Stress scales of the DASS-21) would be significantly and positively

correlated with clinician-assigned ratings ofchild anxiety yielded via both parent and

child report on the ADIS-IV-C/P (as measured by DRs), (e) child self-reported anxiety

(as measured by the anxiety scales of the RCADS) would be significantly and positively

correlated with clinician-assigned ratings ofchild anxiety yielded via both parent and

child report on the ADIS-IV-C/P (as measured by DRs), (f) parent self-reported negative

affectivity (as measured by the NA scale of the PANAS) would be significantly and

positively correlated with clinician-assigned ratings ofchild anxiety yielded via both

parent and child report on the ADIS-IV-C/P (as measured by DRs), and (g) child self-

54

reported negative affectivity (as measured by the NA scales ofthe PANAS-C and the

AFARS) would be significantly and positively correlated with clinician-assigned ratings

ofchild anxiety yielded via both parent and child report on the ADIS-IV-C/P (as

measured by DRs). With respect to the PBBA-Q, it was hypothesized that (a) the OIC,

PB, and SR scales of the PBBA-Q would not be significantly associated with the

demographic variables of child age, child gender, parent age, parent marital status, and

family income, (b) the OIC, PB, and SR scales of the PBBA-Q would not be significantly

correlated with parent reports ofchild externalizing behaviors (as measured by the Child

Behavior Checklist Externalizing Scale composite score), (c) the OIC, PB, and SR scales

of the PBBA-Q would not be significantly correlated with parent or child reports of child

externalizing behaviors (as measured by clinician assigned DRs for the externalizing

portions of the ADIS-IV-CIP), (d) each of the three scales of the PBBA-Q would

demonstrate sound internal consistency, (e) children diagnosed with an anxiety disorder

would have parents who scored significantly higher on the OIC, PB, and SR scales of the

PBBA-Q than children who did not receive a diagnosis ofan anxiety disorder, (f) parent

reported anxiety, stress, and negative affectivity (as measured by the Anxiety and Stress

scales of the DASS-21 and the NA scale of the PANAS, respectively) would be

significantly and positively correlated with parent reports on the OIC, PB, and SR scales

of the PBBA-Q, (g) child-reported anxiety and negative affectivity (as measured by the

anxiety scales of the RCADS and the NA scales ofthe PANAS-C and the AFARS,

respectively) would be significantly and positively correlated with parent reports on the

OIC, PB, and SR scales of the PBBA-Q, (h) parent reports ofchild internalizing

55

symptoms ofdistress (as measured by the Internalizing Composite, the

Anxious/Depressed, the WithdrawnlDepressed, and the Somatic Complaints scales of the

CBCL) would be positively and significantly correlated with parent-reports on the OIC,

PB, and SR scales of the PBBA-Q, (i) parent reports of child anxiety on a diagnostic

interview (as measured by clinician-assigned DRs on the ADIS-IV-P) would be

positively and significantly correlated with parent reports on the OIC, PB, and SR scales

ofthe PBBA-Q, and (j) child reports ofchild anxiety on a diagnostic interview (as

measured by clinician-assigned DRs on the ADIS-IV-C) would be positively and

significantly correlated with parent reports on the OIC, PB, and SR scales ofthe PBBA-

Q.

Additionally, this study sought to determine the extent to which parental beliefs

about anxiety (PB), stimulus regulation (SR), and overinvolvement with the child (OIC)

(see Figure 1) act as mechanisms through which parental anxiety (as measured by the

DASS-21 Anxiety and Stress scales) affects child anxiety (as measured by the RCADS

anxiety scales and by child report on the ADIS-IV-C).1t was hypothesized that parental

anxiety (as measured by the Anxiety and Stress scales of the DASS-21) would influence

the particular beliefs about anxiety (as measured by the PB scale of the PBBA-Q)

endorsed by parents, which in tum would affect the child's endorsement ofanxious

cognitions and behaviors (as measured by the anxiety scales of the RCADS and child

reported anxiety on the ADIS-IV-C).1t was also predicted that parental anxiety (as

measured by the Anxiety and Stress scales ofthe DASS-21) would affect the extent to

which parents attempted to regulate their child's environment (as measured by the SR

56

scale of the PBBA-Q), which, in tum, would influence the child's feelings ofanxiety (as

measured by the anxiety scales of the RCADS and child-reported anxiety on the ADIS

IV-C). Finally, parental anxiety (as measured by the Anxiety and Stress scales of the

DASS-21) was hypothesized to be related to parental reports ofoverinvolvement with

their child (as measured by the OIC scale of the PBBA-Q), which would contribute to the

child's self-reported anxiety (as measured by the anxiety scales of the RCADS and child

reported anxiety on the ADIS-IV-C).

This investigation also sought to identify moderators of the relationship between

parental anxiety and parental beliefs and behaviors associated with anxiety. It was

predicted that the level of the parent's overinvolvement with their child (as measured by

the OIC scale of the PBBA-Q) would moderate the relationship between parental anxiety

(as measured by the Anxiety and Stress scales of the DASS-21) and stimulus regulation

(as measured by the SR scale of the PBBA-Q). Moreover, parental beliefs about anxiety

(as measured by the PB scale of the PBBA-Q) were predicted to moderate the

relationship between parental anxiety (as measured by the Anxiety and Stress scales of

the DASS-21) and stimulus regulation (as measured by the SR scale of the PBBA-Q).

RESULTS

Demographic Differences

In order to determine whether demographic differences were related to parents'

profiles on the PBBA-Q, several variables were correlated with parents' scores on each of

the three PBBA-Q scales. Specifically, correlational analyses were conducted between

parents' scores on the PBBA-Q OIC, PB, and SR scales and (a) their child's age, (b) their

57

own (parent's) age, and (c) the income ofthe family. Neither child age nor parental age

was significantly correlated with the OIC, SR, or PB scales of the PBBA-Q. Family

income, however, was weakly, but significantly and negatively, correlated with the OIC

scale of this instrument (see Table 3). However, controlling for family income in all

subsequent analyses involving the PBBA-Q OIC scale yielded no significant changes in

results observed using this scale; as such, family income was not used as a covariate in

any analyses reported (see Appendix L for results ofall analyses involving the OIC scale

controlling for family income).

One-way analyses of variance (ANOVAs) were then performed to ascertain

whether significant between groups differences existed dependent on the child's gender

(male versus female), or the parent's marital status (single, separated, divorced, married).

No significant child gender differences were observed on any ofthe three PBBA-Q scales

(see Table 4); nor were' any significant between-group differences found with respect to

parental marital status on any of the three PBBA-Q scales (see Table 5). These findings

indicated that any differences observed in PBBA-Q scale scores in subsequent analyses

would be independent ofchild gender, child age, parent age, family income, and parental

marital status; as such, these groups were collapsed in all subsequent analyses. Further

examination of the correlations among the variables studied in this investigation (see

Table 3) indicated no significant relationships between child age, parental age, or family

income and any other relevant variables of interest (Le., parent-reported anxiety, child

reported anxiety, parent-reports ofchild anxiety, child behavior problems).

58

Psychometric Properties ofMeasures Employed

Prior to conducting any of the proposed analyses in this investigation, the

psychometric properties of the measures employed were first examined. Specifically,

estimates of internal consistency, including coefficient alpha and average interitem

correlations, were calculated for each self- and parent-report measure, and the

correlations between measures of related constructs were examined. Estimates of internal

consistency for the respective scales of each parent-report measure were in the ideal

range for clinical assessment tools (Nunnally, 1967), ranging from u=.89 (the Anxiety

scale of the DASS-21) to u=.94 (the Depression scale of the DASS-21; see Table 6).

Although slightly lower, estimates of internal consistency for child self-report measures

were well within the good to acceptable range for clinical assessment tools, particularly

given that alpha levels tend to be lower for scales comprised of fewer than 20 items (as

are the scales of the RCADS, which are comprised of between 6 and 9 items each;

Dekovic, Janssens, & Gems, 1991; Holden, Fekken, & Cotton, 1991). Alpha coefficients

for child-report scales ranged from .74 (the SAD scale of the RCADS) to .91 (the PA

scale of the PANAS; see Table 7).

In order to examine whether the items comprising each instrument administered

were intercorrelated by using a more straightforward estimate ofintemal consistency,

average interitem correlations were calculated. Given that the average interitem

correlations should range from .15 to .50 (Clark & Watson, 1995), those observed for

parent-report measures, ranging from r=.50 (for the PA scale of the PANAS) to r=.68

59

(for the Depression scale of the DASS-21), were slightly high, suggesting some

redundancy of item content (see Table 6). However, average interitem correlations

calculated for the scales of the child-report measures employed were all within the

acceptable range, varying from r-=.29 (for the SAD scale of the RCADS) to r=.46 (for the

PA scale ofthe PANAS; see Table 7).

Finally, the correlations between scales representing theoretically related

constructs were examined for the parent- and child-report measures. As the tripartite

theory ofanxiety and depression would predict (e.g., Antony et aI., 1998; Clark &

Watson, 1991), correlations among parent reports ofanxiety, stress, and depression, as

measured by the DASS-21 Anxiety, Stress, and Depression scales, were significantly and

positively correlated with parent-reported negative affectivity, as measured by the NA

scale of the PANAS (see Table 8). However, tripartite theory also predicts that positive

affectivity will be significantly and negatively correlated with self-reported depression;

although a negative correlation among parent reporters was observed between these two

constructs in the present sample (r=- .17, ns), the association was not statistically

significant. However, consistent with the tripartite theory, a significant correlation was

not observed between positive and negative affect, indicating that among the present

sample, the PANAS was measuring two distinct constructs ofpositive and negative

affectivity (see Table 8). Correlations among child-report measures of anxiety, negative

affect, physiological arousal, and positive affect were all in anticipated directions (Joiner

et aI., 1996; Chorpita et aI., 1998; Chorpita & Daleiden, 2002; Lonigan, Phillips, & Hooe,

2003). Specifically, each anxiety scale of the RCADS was correlated significantly and

60

positively with the NA scales ofboth the PANAS-C and the AFARS, as well as with the

PH scale of the AFARS (see Table 9). Similar to findings observed among the parent

report measures, the PA scales of the PANAS and AFARS were not significantly

correlated with any measure ofanxiety; nor did the PA scales correlate significantly with

scales measuring NA and PH, suggesting that the PA scales were measuring the distinct

temperamental construct ofpositive affectivity. These patterns of inter-instrument

correlations, observed among both parent- and child-report measures, suggested that each

of the child- and parent-report scales administered in the present investigation was

measuring its purported underlying construct in a manner consistent with that suggested

by the respective scale developers.

In sum, the child- and parent-report measures employed in this investigation were

found to be internally consistent and to correlate with theoretically related constructs in a

manner consistent with theories underlying anxiety, depression, and the temperamental

constructs of negative and positive affectivity. These results suggest that among this

sample, the child- and parent-report measures employed were psychometrically sound,

reducing the likelihood that the results that follow are attributable to measurement error.

Parent and Child Anxiety

To examine whether there was a significant relationship between parent and child

anxiety among participants in the present sample, parent scores on the DASS-Anxiety

and DASS-Stress scales were correlated with child scores on the anxiety scales of the

RCADS. Previous findings have suggested significant correlations between parent and

child anxiety (e.g., Krain & Kendall, 2000; Last et aI., 1991), whereas parental stress has

61

been posited as a general risk factor in the development ofnegative emotions, such as

anxiety, anger, or depression (Barlow, 2002; Hammen, Burge, & Stansbury, 1990;

Hammen, Adrian, Gordon, Burge, Jaenicke, & Hiroto, 1987). Contrary to predictions, no

significant correlations between parent reports ofanxiety and stress and child-reported

anxiety were observed, suggesting a lack of correspondence between self-reported

symptoms of anxiety between parents and their children in this sample (see Table 10). To

examine whether a relationship might exist between parent-reported depression and

child-reported anxiety (i.e., whether there might be a relationship between a common

underlying negative affect factor, rather than specific anxiety symptom reports),

correlations between the DASS-Depression scale and the anxiety scales ofthe RCADS

were examined. Consistent with findings for parent-reported anxiety and stress, no

significant correlations were observed between parent-reported depression and child

reported anxiety (see Table 10). However, significant positive correlations were observed

between child-reported depression, as measured by the MDD scale of the RCADS, and

parent-reported depression (r=.25,p=.05) and stress (r=.26,p=.01), as measured by the

Depression and Stress scales, respectively, of the DASS-21. Moreover, child-reported

NA was correlated significantly and positively with parent-reported depression (r=.21,

p<.05), and parent-reported NA was correlated positively and significantly with child

reported depression (r=.21,p<.05). Significant correlations were not observed between

parent- and child-reported NA (r=.13, ns), or between child-reported NA and parent

reported anxiety (r=.16, ns) or stress (r=.18, ns). These findings suggest that, among the

present sample, a stronger association existed between parent and child reports of

62

depression than of anxiety, as well as that a specific association existed between child

and parent negative affectivity and depression that was not observed for child and parent

NA and anxiety.

Children were then grouped according to the presence of an anxiety disorder

anywhere in their diagnostic profile (Le., a primary or an additional diagnosis ofan

anxiety disorder, based upon the consensus diagnosis; see Study 4 Method section for a

definition ofconsensus diagnosis), and parent scores on the DASS-Anxiety and DASS

Stress scales were compared between the two child diagnostic groups (anxiety diagnosis

vs. no anxiety diagnosis). Although parents ofanxious children comprised a smaller

number ofparticipants than the group of parents of non-anxious children, comparing

groups of unequal size does not preclude the use of Analysis of Variance (ANOVA).

Specifically, if the relative frequencies in each parent group correspond to the likelihood

of membership in each group in the corresponding populations, the F test may still be

robust to heterogeneity ofvariance (Hays, 1994). Thus, for this, and for all subsequent

between groups analyses, this rationale for using the Ftest will follow. Contrary to

predictions,children who received a diagnosis of an anxiety disorder did not have parents

who attained significantly higher scores on the DASS-Anxiety and DASS-Stress scales

than did parents who had a child who did not receive an anxiety disorder diagnosis (see

Table 11). Similarly, children who received a diagnosis ofan anxiety disorder did not

have parents who reported significantly higher levels of depression on the DASS

Depression scale than did children who did not receive a diagnosis ofan anxiety disorder.

Parent scores on the NA scale of the PANAS were also compared between children with

63

and without a diagnosis of anxiety in their diagnostic profile. Inconsistent with

predictions, parents of children receiving a diagnosis of anxiety did not obtain

significantly higher scores on the PANAS NA scale than did parents of children who did

not receive a diagnosis ofanxiety (see Table 12).

Neither parental anxiety, stress, depression, nor negative affectivity, as measured

by the DASS-21 and the PANAS, respectively, was found to correlate significantly with

child self-reported anxiety or to be significantly different between child diagnostic

groups. However, parent reports ofanxiety, stress, and depression were found to correlate

significantly and positively with child composite and parent composite dimensional

ratings of anxiety assigned by the clinician for both child and parent reports on the ADIS

IV-C/P (see Study 4 Method section for a definition ofdimensional ratings of clinical

severity, DRs). Specifically, parents' reports on all three scales ofthe DASS-21 were

significantly and positively correlated with the extent to which their child reported

experiencing symptoms of anxiety during the course of a structured diagnostic interview.

Similarly, parents' reports on the DASS-21 were also significantly and positively

correlated with the extent to which they themselves reported that their child was

experiencing symptoms of anxiety on the parent version of the same structured diagnostic

interview (see Table 13). Similar findings were observed for child self-reports ofanxiety

on the RCADS, such that significant and positive correlations were yielded for each of

the subscales ofthe RCADS, including the depression scale, with both child and parent

reports of anxiety symptom experience on the ADIS-IV-C/P (see Table 14). These results

suggest that when examining anxiety symptoms continuously via dimensional ratings of

64

anxiety, rather than dichotomously via diagnoses ofanxiety disorders, parent and child

reports ofanxiety and stress were significantly correlated with child-experienced anxiety

symptoms, as reported from both the child's and parent's perspective during the course of

a structured diagnostic interview designed to assess the child's experience of symptoms

ofanxiety.

Initial Psychometric Evaluation ofthe PBBA-Q

Analysis ofitem distributions on the PBBA-Q. The response distribution for each

item on the PBBA-Q was examined in order to identify those items that yielded skewed

or unbalanced distributions (i.e., those items to which nearly all respondents reported the

same answer), given that items demonstrating a skewed or unbalanced distribution may

be oflow informational value, may correlate weakly with other scale items, or may result

in biased correlational results (Clark & Watson, 1995). Using a liberal criterion of75% or

more of the sample endorsing the same response to an item, none of the items of the

PBBA-Q displayed a skewed response distribution. However, two items were identified

for which 72% ofrespondents endorsed the same response option (items 24 and 28). All

other items demonstrated relatively balanced response profiles with no more than 68% of

respondents endorsing any single response option for each item (see Table 15).

Tests ofinternal consistency and homogeneity. Two tests of internal consistency

were conducted for each of the three subscales comprising the PBBA-Q. First, coefficient

alpha estimates were calculated for each of the three PBBA-Q scales in order to

determine the extent to which each scale was internally consistent. Nunnally (1967) has

recommended that alphas in the range of .50 to .60 are acceptable for instruments in the

65

early stages ofdevelopment, suggesting further that alphas in the range of .80 are

acceptable for basic research tools, and those in the range of .90 are acceptable for

clinical tools. Others have indicated that coefficient alphas in the .60 to .70 range are

acceptable (Dekovic, Janssens, & Gems, 1991; Holden, Fekken, & Cotton, 1991). Using

these guidelines to determine acceptable levels of internal consistency, each of the

PBBA~Q scales yielded estimates ofcoefficient alpha within these ranges, with the OIC

and PB scales yielding slightly higher alphas (u=.80 and u=.81, respectively) than the SR

scale (u=.60). In order to determine the extent to which items on each scale tapped a

unitary or homogeneous underlying construct, interitem correlations for each scale were

calculated. Clark and Watson (1995) have suggested that average interitem correlations

ranging from .15 to .50 are indicative of scales measuring a single underlying dimension

(Clark & Watson, 1995). Consistent with coefficient alpha estimates observed for each

scale, the average interitem correlations for the OIC and PB scales were within the range

suggested by Clark and Watson as appropriate for narrow constructs (r=.19 and r=.20,

respectively); however, the average interitem correlation for the SR scale was somewhat

lower (r=.08). These findings suggest that the OIC and PB scales were comprised of

intercorrelated items measuring relatively narrow constructs, whereas the SR scale

appeared to be comprised of items which were not responded to by participants as a

cohesive set (see Table 16).

Interrater convergence. To further evaluate the psychometric properties of the

PBBA-Q scales, the extent ofconvergence between two parents with respect to their

beliefs and behaviors relative to the same child was examined for each scale.

66

Specifically, a subsample of participants was identified for whom two parents had

completed the standardized battery ofparent-report instruments administered in this

investigation (n==25). A strong degree ofconvergence was found between parent reports

on the OIC scale of the PBBA·Q (r=.78,p<.OI). Moderate degrees ofcorrespondence

were observed between parent raters on the PB (r=.44,p<.05) and SR (r=,47,p<.05)

PBBA·Q scales (see Table 17). This pattern ofcorrelation suggests a relatively consistent

degree of association between parents with respect to their ratings of their parenting

behaviors and beliefs about anxiety regarding their child. Moreover, the interrater

correlations observed for the PBBA·Q scales were consistent with overall degree of

interrater agreement observed on the parent·report measures of child behavioral and

emotional functioning administered in this investigation (e.g., the Child Behavior

Checklist; see Table 18). Interestingly, a high degree ofcorrespondence was also

observed between parents with respect to their reports of their own anxiety, stress,

depression, and negative affectivity, as all of these correlations were in the moderate to

strong range. These findings suggest that among this small subset ofparents, a high

degree ofcorrespondence was observed with respect to not only their parenting behaviors

and beliefs associated with their child's anxiety, but also with respect to their ratings of

their child's current emotional and behavioral functioning.

In sum, these results suggest that in this validation sample, the PB and OIC scales

of the PBBA·Q demonstrated good reliability initially. Across all items comprising these

scales, a normal response distribution was observed, such that there were no items for

which the majority ofrespondents (defined by more than 75% of the sample) responded

67

identically to a particular item. Moreover, the PB and OIC scales demonstrated

acceptable levels of internal consistency, as measured by both coefficient alpha and

average interitem correlations. Although the estimated coefficient alpha of the SR scale

was slightly lower, it was in the acceptable range; however, examining the internal

consistency of this scale using a more straightforward estimate of internal consistency

(e.g., average interitem correlation) suggested that the SR items were not meaningfully

intercorrelated. Finally, among a subsample ofparents, good rates of interrater

convergence were observed for all scales of the PBBA-Q, suggesting that parents of the

same child held very similar views of their own parenting behaviors and beliefs. The

reliability of the PB and OIC scales ofthe PBBA-Q appeared sufficiently adequate to

allow for the examination of the experimental hyPOtheses posed in this investigation.

Although the internal consistency of the SR scale was found to be lower than that of the

PBand ole scales, the alpha reliability estimate yielded was in the acceptable range

(Nunnally, 1967). As such, results pertaining to the SR scale in subsequent analyses were

evaluated with caution and in light of the somewhat limited reliability demonstrated by

this scale.

Convergent Validity ofthe PBBA-Q

Parent-reported anxiety, negative affectivity, and the PBBA-Q. Parents' scores on

each subscale of the PBBA-Q were fIrst correlated with their scores on each of the three

DASS-21 subscales. It was predicted that the PBBA-Q scales would correlate positively,

strongly, and signifIcantly with the Anxiety and Stress subscales of the DASS-21, and

positively, moderately, and signifIcantly with the Depression scale of the DASS-21. It

68

was also predicted that the strongest positive correlations observed between the DASS-21

and the PBBA-Q would be those between the PB scale and the DASS-Anxiety and

DASS-Stress scales. Inconsistent with predictions, positive, strong, and significant

correlations were not observed between the PBBA-Q OIC and SR scales and the DASS

21 Anxiety and Stress scales. However, partially consistent with predictions, moderate,

significant, and positive correlations were observed between the PBBA-Q PB scale and

the DASS-21 Anxiety and Stress scales. Moreover, a similarly moderate, significant, and

positive correlation was observed between the PBBA-Q PB scale and the Depression

scale ofthe DASS-21 (Welkowitz, Ewen, & Cohen, 1988; Evans, 1996). The DASS-21

Depression scale was not observed to be significantly correlated with either the OIC or

SR scales of the PBBA-Q (see Table 19). Correlational analyses were also conducted for

parents' scores on the NA scale of the PANAS and scale scores of the PBBA-Q. It was

predicted that moderate, positive, significant correlations would be found between the

PANAS NA scale and each of the three PBBA-Q scales. The PB scale of the PBBA-Q

was predicted to correlate most strongly with the PANAS NA scale, given that parents'

anxiety about their child's experience of nervousness and fear was hypothesized to be

associated with high NA and anxiety in parents. In partial support of these predictions,

the PB scale was found to correlate weakly, significantly, and positively with the NA

scale of the PANAS. However, neither the OIC nor the SR scales of the PBBA-Q

correlated significantly with the NA scale of the PANAS. None of the three PBBA-Q

scales correlated significantly with the PA scale of the PANAS (see Table 20). These

findings suggested that the only scale of the PBBA-Q that was significantly associated

69

with parents' own reports ofanxiety, stress, depression, and negative affectivity was the

PB scale, indicating a moderate degree ofcorrespondence, in the present sample, between

parental beliefs about their child's anxiety and their own experience of symptoms related

to negative affectivity, including anxiety, stress, and depression.

Child anxiety diagnoses and scores on the PBBA-Q. Parents were next compared

on the basis of the presence ofan anxiety disorder anywhere in their child's diagnostic

profile (i.e., a primary or an additional consensus diagnosis of an anxiety disorder). It was

predicted that parents of anxious children would attain significantly higher scores on each

of the three scales of the PBBA-Q than would parents ofnon-anxious children. Contrary

to predictions, parents of anxious children did not attain significantly higher scores on the

OIC or SR scales ofthe PBBA-Q than did parents of non-anxious children. Although

parents of anxious children (M=27.93, SD=6.23) did receive higher scores than parents of

non-anxious children (M=25.58, SD=5.93) on the OIC scale, the difference between

diagnostic groups only approached significance [F(l,102)=3.27,p=.07, 112=.03].

Consistent with predictions, significant between group differences were observed for the

PB scale ofthe PBBA-Q [F(l,102)=3.96,p=.05, 112=.04]. Specifically, parents of

anxious children (M=27.23, SD=5.76) attained significantly higher scores on the PB

scale of the PBBA-Q than did their counterparts of non-anxious children (M=24.52,

SD=7.49). Although parents' scores on the PB scale ofthe PBBA-Q accounted for only a

very small portion of the variance in child diagnostic status (4%), this finding suggests

that parents ofanxious children hold beliefs about their child's experience ofanxiety that

differ significantly than those beliefs about their child's anxiety held by parents of non-

70

anxious children. More specifically, parents of anxious children, in the present sample,

reported believing that anxiety is hannful for their child and will result in undesirable

consequences for their child, more so than did parents ofnon·anxious children (see Table

21).

Parent reports ofchild anxiety and scores on the PBBA-Q. In order to examine

the extent to which Parent reports of their child's experience of internalizing symptoms of

distress correlated with their ratings oftheir own parenting behaviors and beliefs

associated with anxiety, total internalizing raw scores on the CBCL were correlated with

parental scores on each scale ofthe PBBA-Q. It was predicted that the parent-reported

child scores on the Internalizing scales of the CBCL (i.e., Withdrawn,

Anxious/Depressed, and Somatic Complaints) would correlate positively and

significantly with the PB, SR, and OIC scale scores of the PBBA-Q. This prediction was

supported only by the PB scale of the PBBA-Q scale, which correlated weakly, but

significantly and positively, with the Internalizing Scale of the CBCL, as well as with

each of the three narrow band scales comprising the broad-band Internalizing CBCL

scale (see Table 22). This pattern ofcorrelations suggested that parents holding more

negative beliefs about the nature ofanxiety for their child also reported their child as

experiencing a greater number ofbehaviors associated with internalizing distress.

Additionally, correlational analyses were conducted for parent-reported DRs for

the anxiety sections ofthe ADIS-IV-P and parent reports on each subscale of the PBBA

Q. These correlations were conducted to examine the extent to which parents' reports

about their child's experience of symptoms related to anxiety were associated with their

71

reports of their own behaviors and beliefs about with their child's anxiety. An Anxiety

DR composite score was calculated for each child on the basis ofchild and parent report,

separately. The composite Anxiety DR calculated for each reporter (parent, child)

consisted of the total ofeach DR for the Separation Anxiety, Social Phobia, Specific

Phobia, Panic, Agoraphobia, Generalized Anxiety, Obsessive Compulsive, and

Posttraumatic Stress portions of the ADIS-IV. It was predicted that the parent-reported

composite Anxiety DR would correlate positively and significantly with the PB, SR, and

OIC scale scores of the PBBA-Q. Given the small sample size used in the current

investigation and the anticipated low number ofchildren displaying elevations on

individual anxiety scales, correlational analyses were not conducted for individual DRs

(i.e., using just the Separation Anxiety or Panic DR). In partial support ofpredictions, the

PB scale of the PBBA-Q was found to correlate weakly, significantly, and positively with

composite Anxiety DRs obtained from parent (r=.25,p<.05) report on the ADIS-IV-P.

However, neither the OIC nor SR scales of the PBBA-Q were found to be significantly

correlated with parent-reported composite Anxiety DRs as derived from the ADIS-IV-P

(see Table 23). These findings suggest that parents' beliefs about their child's anxiety

were significantly associated with their reports on the ADIS-IV-P of their child's

experience of anxiety symptoms. Specifically, the more negative beliefs about their

child's anxiety endorsed by parents in the present sample, or the more harmful they

believed their child's anxiety was, the more symptoms ofanxiety the parents endorsed

during the course ofa diagnostic interview assessing their child's experience of

symptoms associated with anxiety disorders.

72

Overall, parent reports about their own symptoms of anxiety and stress, as well as

about their child's experience of symptoms ofanxiety (on both a parent-report paper and

pencil measure and a diagnostic interview designed to assess for the presence of

symptoms related to anxiety disorders) correlated positively and significantly with the PB

scale of the PBBA-Q (designed to assess the extent to which parents perceive their

child's anxiety as negative and potentially harmful) but were not correlated with either

the OIC or SR scales of the PBBA-Q.

Child-reported anxiety and affectivity andparent scores on the PBBA-Q. To

explore the degree ofcorrespondence between parents' reports of their behaviors and

beliefs associated with their child's anxiety and their child's self-reported levels of

anxiety, children's scores on the RCADS were correlated with their parents' scores on

each of the PBBA-Q scales. It was predicted that children's scores on the anxiety

subscales of the RCADS would be moderately positively correlated with their parents'

scores on each of the three scales of the PBBA-Q. The strongest correlation between the

anxiety scales of the RCADS and PBBA-Q scales was predicted to be observed between

the PB scale of the PBBA-Q and the RCADS anxiety subscales. Results partially

supported these predictions, as child-reported anxiety on the ReADS was correlated

weakly, but significantly and positively, with only the PB scale ofthe PBBA-Q; no

significant correlations were observed between child-reported anxiety on any of the

RCADS scales and the OIC or SR scales of the PBBA-Q (see Table 24). These findings

suggest that, among the present sample, parents' beliefs about their child's anxiety were

significantly associated with their children's self-reported symptoms ofanxiety, such that

73

more negative parental beliefs about their child's anxiety were associated with a greater

number ofchild-reported anxious symptoms.

Correlational analyses were also conducted to examine the relationship between

children's scores on the NA scales of the PANAS-C and AFARS and parent scores on

the three scales comprising the PBBA-Q; a significant positive relationship between

scores on each of the PBBA-Q scales and the NA scales was predicted. However, a weak,

significant, positive correlation was observed only between the NA scale of the PANAS

C and the PB scale of the PBBA-Q (r=.24,p<.05); no other significant correlations were

observed between either NA scale and the PBBA-Q scales, nor between the PH scale of

the AFARS and the PBBA-Q scales (see Table 25). Although the PA scale of the AFARS

was not significantly correlated with any of the three PBBA-Q scales, the PA scale of the

PANAS-C was positively and significantly correlated with the OIC scale of the PBBA-Q.

This finding suggested that although in general child-reported PA was not related to

parent reports of their own beliefs about their child's anxiety or the extent to which they

regulated their child's environment, higher levels ofchild-reported PA were weakly

associated with higher levels of parent-reported overinvolvement with their child (see

Table 25).

Finally, child-reported DRs for the anxiety sections of the ADIS-IV-C were

correlated with parent reports on the subscales of the PBBA-Q in order to assess the

degree to which child-reported symptoms ofanxiety on a structured diagnostic interview

were associated with parent-reported behaviors and beliefs associated with their child's

anxiety. Specifically, it was predicted that the child-report-derived composite Anxiety

74

DR would correlate positively and significantly with the PB, SR, and OIC scale scores of

the PBBA-Q. In partial support of predictions, the PB scale of the PBBA-Q was found to

correlate weakly, significantly, and positively (r=.31,p<.Ol) with the composite Anxiety

DR obtained from child report on the ADIS-IV-C. However, neither the OIC nor SR

scales of the PBBA-Q were found to be significantly correlated with child-report-derived

composite Anxiety DR from the ADIS-IV-C (see Table 23). These fmdings suggested

that parents' beliefs about their child's anxiety were significantly associated with their

child's reports oftheir own experience ofanxiety symptoms on the ADIS-IV-C.

Specifically, the more negative beliefs about their child's anxiety endorsed by parents in

the present sample, the more symptoms ofself-experienced anxiety children endorsed

during the course ofa diagnostic interview.

Overall, child reports of anxious symptoms on both a self-report measure of

anxiety and an interview designed to elicit symptoms associated with various anxiety

disorders correlated positively and significantly with the PB scale of the PBBA-Q,

measuring the degree to which parents perceive their child's anxiety as negative and

potentially harmful. However, similar associations were not observed between child self

reported anxiety and parent reports on either the SR or OIC scales of the PBBA-Q. This

finding parallels finding using parent-report measures ofchild anxiety, such that the PB

scale is the only scale of the PBBA-Q to correlate significantly with parent ratings of

their child's anxiety.

75 .

Discriminant Validity ofthe PBBA~Q

Following an examination of the concurrent and construct validity of the PBBA

Q, the discriminant validity of the newly developed scale was examined among the

present sample ofparents. Specifically, scores ofparents on the PBBA-Q were predicted

to be unrelated to measures of (a) family income, and (b) parental marital status (i.e.,

married, divorced, separated). Consistent with predictions, parent report on the OIC, PB,

and SR scales of the PBBA-Q was unrelated to parents' marital status (see Table 5).

However, although family income was unrelated to parent report on the PB and SR scales

of the PBBA-Q, it was weakly, but significantly and negatively, correlated with parent

report on the OIC scale of the PBBA-Q (see Table 3). Yet, controlling for family income

in all subsequent analyses involving the PBBA-Q OIC scale yielded no significant

changes in results observed using this scale; as such, family income was not used as a

covariate in any analyses reported (see Appendix L for results ofOIC analyses

controlling for family income).

Scores on the PBBA-Q were also predicted to be nonsignificantly correlated with

parent and child externalizing DRs, as obtained from the ADIS-IV-C/P for (a)

Opposition, (b) Delinquency, (c) Inattention, and (d) Hyperactivity, as well as with parent

report on the Externalizing subscale composite score of the CBCL (a sum ofthe Rule

Breaking and Aggression subscales). A composite Externalizing DR score was calculated

for each child on the basis ofchild and parent report, separately. The composite

Externalizing DR calculated for each reporter (parent, child) consisted of the total ofeach

76

DR for the Opposition, Delinquency, Inattention, and Hyperactivity portions ofthe

ADIS-IV-C/P. Given the small sample size used in the current investigation and the low

number ofchildren displaying elevations on individual externalizing scales, correlational

analyses were not conducted for individual DRs (i.e., using just the Oppositional or

Hyperactivity DR). Consistent with predictions, Externalizing DRs derived from child

and parent report on the Opposition, Delinquency, Inattention, and Hyperactivity portions

of the ADIS-IV·C were not significantly correlated with parent report on any of the three

scales of the PBBA-Q (see Table 26). Similarly, and consistent with predictions, parent

report on the Externalizing subscale composite of the CBCL was not significantly

correlated with parent report on any of three scales of the PBBA-Q (see Table 26). These

findings suggest that overall parent report on each of the three scales comprising the

PBBA-Q demonstrated good discriminant validity, such that they were not correlated

with theoretically distinct constructs. As such, the scales of the PBBA-Q did not appear

to be significantly associated with externalizing child behaviors or specific demographic

characteristics (i.e., family income).

Evaluating Hypothesized Relationships Between Parental and Child Anxiety

Subsequent to evaluating the psychometric qualities and the construct, concurrent,

" and discriminant validity of the PBBA-Q among a validation sample, the relationship of

the constructs measured by the scales of the PBBA-Q to parent and child anxiety was

then explored. Specifically, regression analyses were employed to evaluate the extent to

which each of the three scales of the PBBA-Q mediated the relationship proposed to exist

between parent and child anxiety (see Figure 1). The predictive value of parental anxiety

77

on child anxiety was first investigated, followed by an exploration of the unique effects

of parental beliefs about anxiety, stimulus regulation, and overinvolvement with the child

in predicting children's self-reported anxiety, as measured by their scores on the RCADS

and on the composite Anxiety DR.

Parent and child anxiety. The correlations observed between measures ofparent

and child anxiety were reported in a previous section of this paper (see section "Parent

and child anxiety," page 55, Tables 10 and 13). The analyses that follow are intended

explore the relationship between these variables in the context ofa mediational model.

First, the direct effect of parental anxiety on child anxiety was tested using simple

regression. Specifically, the Anxiety and Stress scales ofthe DASS-21 were used as

predictors ofchild scores on the RCADS anxiety subscale total and on the composite

child Anxiety DR. It was predicted that DASS-Anxiety and DASS-Stress scores would

account for a significant proportion of the variance in child scores on the RCADS anxiety

scales and the composite child Anxiety DR.

Neither parent-reported anxiety or stress, as measured by the DASS-21 Anxiety

and Stress scales, was a significant predictor ofchild anxiety when measured by child

self-report on the anxiety scales comprising the RCADS. However, both parent-report

measures ofanxiety and stress were significant predictors ofchild anxiety as measured

by the child composite Anxiety DR obtained from child report ADIS-IV-C (see Table

27). Specifically, parental anxiety and stress, as measured by the Anxiety [F(1,102)=7.93,

p=.Ol; R2=.07] and Stress [F(l,102)=6.93,p=.Ol; R2=.06] subscales ofthe DASS-21,

accounted for a significant proportion of the variance in the extent to which symptoms of

78

anxiety were reported during the course ofthe child interview using the ADIS-IV-C.

Given that neither parental anxiety nor stress was found to be a significant predictor of

child anxiety as measured by the RCADS, the anxiety total score ofthe RCADS was not

used as a dependent variable in any subsequent regression analyses. Moreover, given that

both parental anxiety and stress were significant predictors ofchild anxiety (as measured

by the composite child Anxiety DR), both the Anxiety and Stress scales of the DASS-21

were used, separately, in the subsequent mediational tests.

Mediators ofchild anxiety. In order to provide a test ofa mediational model, three

regression equations must be tested, and three conditions must be satisfied (Baron &

Kenny, 1986). The series ofregression analyses to be tested to evaluate a mediational

model includes a series of tests in which (1) the mediator is regressed on the independent

variable (IV); (2) the dependent variable (DV) is regressed on the IV; and (3) the DV is

regressed on both the IV and the mediator in the same analysis (Baron & Kenny, 1986).

Further, those conditions that must be satisfied in order to assume a mediational model

include, (1) the effect of the IV on the mediator must be significant, (2) the effect of the

IV on the DV must be significant, (3) the effect ofthe mediator on the DV must be

significant when the IV is also present in the model, and (4) the effect of the IV on the

DV must be diminished with the addition ofthe mediator to the regression equation

(Baron & Kenny, 1986).

Given that parental anxiety, as measured by the Anxiety scale of the DASS-21,

was found to be a significant predictor ofchild anxiety, as measured by the composite

Anxiety DR yielded from child reports on the ADIS-IV-C, a series ofmultiple regression

79

analyses was calculated (this same series ofequations was then conducted using the

Stress scale of the DASS-21 as a predictor). Specifically, in addition to predicting child

anxiety from parental anxiety, three potential mediators of the relationship between

parent and child anxiety were tested (see Figure 1), including parental beliefs about

anxiety (PB), stimulus regulation (SR), and overinvolvement with the child (OIC).

Specifically, parents' DASS-Anxiety scores were first entered as a predictor of parent

report on the SR, PB, and OIC scales of the PBBA-Q; it was predicted that parental

anxiety would account for a significant proportion of the variance in each of the three

parenting variables. Contrary to predictions, parental anxiety only accounted for a

significant proportion of the variance ofparental beliefs about anxiety [F(l, 102)=19.40,

p=.00, R2=.16]; parental anxiety was not a significant predictor ofeither stimulus

regulation or parental overinvolvement (see Table 28). As such, parental beliefs about

anxiety was the only potential mediator of the relationship between parent and child

anxiety that was tested in subsequent analyses.

. Next, in testing the mediational model described above, the DASS-Anxiety scores

were entered as a predictor of the child composite Anxiety DR rating; it was predicted

that parental anxiety would be a significant predictor ofchild anxiety. Consistent with

predictions, parental anxiety did significantly predict child anxiety [F(l,101)=7.93,

p=.OI; R2=.07] (see Table 27). Finally, the DASS-Anxiety score and the PB scale score

were entered as predictors ofchild scores on the composite Anxiety DR rating; a

significant effect ofparental beliefs about anxiety on child anxiety was predicted.

Consistent with predictions, parental beliefs about anxiety was found to be a significant

80

predictor of child anxiety, such that when the PB scale of the PBBA-Q and the Anxiety

scale of the DASS-21 were entered together in the subsequent block ofpredictors, a

significant proportion of the variance in child anxiety was accounted for by parental

beliefs about anxiety [Fchange(1,100);::;:5.71 , p;::;:.02; R2change=.05]. Given that one additional

criterion for a variable to meet in order to be considered a mediator is that the initial

effect of the IV on the DV be diminished when the mediator is entered into the regression

equation, it was further predicted that the proportion ofvariance in child anxiety

accounted for by parental anxiety alone would be decreased once the PB scale of the

PBBA-Q was entered into the regression equation. Specifically, it was hypothesized that

a significant proportion ofthe variance in child anxiety due to parental anxiety would be

accounted for instead by parental beliefs about anxiety. This prediction was also

supported, given that once parental beliefs about anxiety was entered into the regression

equation with parental anxiety, parental anxiety no longer significantly predicted child

anxiety (see Table 29). Moreover, the Goodman (I) version of the Sobel test (Baron &

Kenny, 1986; MacKinnon & Dwyer, 1993; MacKinnon, Warsi, & Dwyer, 1995)

indicated that the indirect effect ofparental anxiety (the IV) on child anxiety (the DV)

through parental beliefs about anxiety (the mediator) was significantly different from

zero (z-value==2.08, p=.04). These results indicate support for a full mediational model,

such that the effects ofparental anxiety on child anxiety are fully mediated by parental

beliefs about the child's anxiety. Specifically, these results suggest that it is not parental

anxiety per se that predicts child anxiety, but rather the parent's beliefs about the extent

to which anxiety is harmful for their child that predicts subsequent child anxiety, as

81

measured by dimensional ratings ofclinical severity assigned based on information about

the child's anxiety obtained during the course ofa clinical interview (see Figure 2).

1bis same series ofregression equations was then conducted using parent

reported stress, as measured by the Stress scale of the DASS-21 as a predictor ofchild

anxiety, as measured by the child composite Anxiety DR yielded from the ADIS-IV-C.

Similar to results obtained using the DASS-21 Anxiety scale, parental stress only

accounted for a significant proportion of the variance ofparental beliefs about anxiety

[F(1,102)=23.84,p=.OO, R2=.19]; parental stress was not a significant predictor of either

stimulus regulation or parental overinvolvement (see Table 30). As such, parental beliefs

about anxiety was the only potential mediator of the relationship between parent stress

and child anxiety that was tested in subsequent analyses. Consistent with predictions and

findings when using parental anxiety as a predictor, parental stress did significantly

predict child anxiety [F(1,10l)=6.93,p=.01; R2=.06] (see Table 27). Parental beliefs

about anxiety was again found to be a significant predictor ofchild anxiety, such that

when the PB scale of the PBBA-Q and the Stress scale of the DASS-21 were entered

together in the subsequent block ofpredictors, a significant proportion of the variance in

child anxiety was accounted for by parental beliefs about anxiety [Fchange(1,100)=5.73,

p=.02; R2change=.05]. Also parallel to findings When using parental anxiety as a predictor,

and consistent with predictions, once parental beliefs about anxiety was entered into the

regression equation with parental stress, parental stress no longer significantly predicted

child anxiety (see Table 31; see Figure 3). Results of the Goodman (I) version of the

Sobel test (Baron & Kenny, 1986; MacKinnon & Dwyer, 1993; MacKinnon et aI., 1995)

82

again indicated that the indirect effect ofparental stress on child anxiety through parental

beliefs about anxiety was significantly different from zero (z-value=2.18, p=.03). These

results indicate support for a full mediational model, such that the effects of parental

stress on child anxiety are fully mediated by parental beliefs about the child's anxiety.

Specifically, these results suggest that it is not parental stress per se that predicts child

anxiety, but rather the parent's beliefs about the extent to which anxiety is harmful for

their child that predicts subsequent child anxiety.

Evaluating moderators ofparental anxiety andparent beliefs and behaviors. In

speculating about the structure of the relationships among parent and child anxiety and

the variables that might mediate the link between these two variables, two hypotheses

were made with respect to variables that might act as moderators in this model (see

Figure 1). Specifically, it was hypothesized that (a) parental beliefs about anxiety would

act as a moderator of the relationship between parental anxiety and stimulus regulation,

and (b) overinvolvement with the child would act as a moderator of the relationship

between parental anxiety and stimulus regulation. However, given the lack ofmain

effects observed between parental anxiety and stimulus regulation and between parental

anxiety and overinvolvement with the child, the hypothesized moderational relationships

involving these variables were not tested.

DISCUSSION

Overview

Two primary objectives prompted the present research, namely to (l) develop a

psychometrically sound assessment instrument to assess three specific parental behaviors

83

and beliefs (overinvolvement with the child, parental beliefs about anxiety, and stimulus

regulation) hypothesized to mediate the previously identified relationship between parent

and child anxiety, and (2) subsequently use this new assessment tool to examine the role

each of these three factors play in mediating the relationship between parental and child

anxiety in a clinically referred sample.

With respect to this first objective, the Parental Behaviors and Beliefs About

Anxiety Questionnaire (PBBA-Q), as developed in Studies 1,2, and 3, was constructed to

be comprised of items that were rated as representative of their corresponding theoretical

domains. Study 4 revealed that two of the three PBBA-Q scales (the OIC and PB scales)

yielded good estimates of internal consistency and normal item response distribution

patterns. Across two methods ofassessing internal consistency in the final phase of this

investigation, the SR scale performed poorly, suggesting that the items comprising this

scale were not strongly intercorrelated. Moreover, only the PB scale correlated with

theoretically relevant constructs (Le., parental anxiety and stress), whereas the OIC and

SR scales did not. Similarly, only the PB scale of the PBBA-Q distinguished between

youth with and without an anxiety disorder and was meaningfully related to the severity

ofchild anxiety symptoms, as reported by both parents and youth.

With respect to the second objective of this investigation, Study 4, consistent with

previous findings (e.g., Krain & Kendall, 2000; Last et al., 1991), reported a significant

relationship between parental anxiety (assessed via parent self-report) and child anxiety

(as measured by dimensional ratings of-clinical severity assigned based on information

about the child's anxiety obtained during the course ofa clinical interview). However, of

84

the three factors posited to underlie this relationship, only parental beliefs about anxiety

(PB) was found to significantly mediate the link between parent and child anxiety. The

present results suggested that it is not parental anxiety, per se, that predicts child anxiety,

but rather the beliefs that the parent holds about the child's experience ofanxiety.

However, it must be noted that the significant correlational relationship reported between

parental and child anxiety in the present investigation was observed only when child

anxiety was measured using dimensional ratings ofclinical severity which were assigned

by a clinician and derived from the child's report about his or her symptoms ofanxiety

during the course ofa semi-structured clinical interview.

The present investigation thus yielded support for previous theories suggesting

that parents' beliefs about anxiety contribute to the presence of anxious symptoms

exhibited by their child (Barrett, Rapee et aI., 1996; Cobham et aI., 1999; Dadds et aI.,

1996), while also providing initial support for a newly developed scale (the PB scale)

designed to assess such parental beliefs.

Parent and Child Anxiety

One of the two primary objectives of the present investigation was to develop a

method by which to measure the variables that were hypothesized to mediate the

relationship between child and parental anxiety. It was suggested that being able to

measure such variables in a psychometrically sound manner would allow for an enhanced

understanding of the specific vulnerabilities that operate in the development and

perpetuation of childhood anxiety disorders. It was thus necessary to first establish a link

between parent and child anxiety among the present sample. However, parents' self-

85

reported symptoms of stress and anxiety were not significantly related to child self·

reports ofanxiety symptoms. Moreover, parent-reported stress and anxiety also failed to

distinguish those youth with and without a diagnosis of an anxiety disorder. Similarly,

neither parental stress nor parental anxiety served as a significant predictor ofeither child

self-reported anxiety or child diagnostic status.

Parents' self·reports of their own anxiety were, however, significant predictors of

the severity of their child's symptoms of anxiety, as reported to and rated by a clinician

during the course ofa diagnostic interview. More specifically, clinicians' ratings of the

severity of the child's symptoms ofanxiety were significantly predicted by and related to

parents' reports of their own symptoms of anxiety. These same clinician-derived severity

ratings were also significantly correlated with child self-reports ofanxious symptoms. In

sum, although a significant direct correlation between parent and child self-reports of

anxiety was not observed, both parent- and child-reports of the child's anxious symptoms

were significantly related to clinician-derived severity ratings.

These anomalous findings were attributed in part to the self- and parent-report

measurement strategies employed in this study. More specifically, children were asked to

report on their experience of symptoms associated with anxiety on a questionnaire

comprised of items corresponding directly to DSM-IV criteria for each offive anxiety

disorders. Conversely, parents completed a questionnaire asking about their general

experience of the negative emotional state underlying anxiety (e.g., autonomic arousal,

skeletal muscle effects, situational anxiety, subjective experience of anxious affect). For

example, a typical question on the child self-report measure was "I feel afraid of being on

86

my own at home," (asking about a specific symptom of SeparationAnxiety Disorder),

whereas a question typical of the anxiety scale of the parent-report measure was "I

experienced difficulty breathing" (asking about a symptom ofthe anxious response that

might underlie any of the anxiety disorders). It is suggested that the slight dissimilarity in

foci between the respective self-report measures employed might account for the very

low correlations observed between parent and child measures of anxiety in this sample.

Unfortunately, many previous studies demonstrating a correlation between parent and

child anxiety incorporated diagnostic evaluations of both reporters, rather than attempting

to establish a cross-generational link via self-report measures.

It is possible that the presence ofany clinically elevated symptom constellation on

the part of the child (e.g., a disruptive behavior disorder, attention-deficit/hyperactivity

disorder) might be associated with elevated levels of stress and anxiety in the parent, thus

precluding the detection ofa unique relationship between self-reported parent anxiety and

child-reported anxiety. In support of this hypothesis, significant correlations were

observed between parent-reported anxiety and parent reports ofchild externalizing

behavior on the Child Behavior Checklist (r=.34, p<.O1), as well as between parent

reported anxiety and the parent Externalizing Dimensional Rating (DR) composite score

(r=.21,p<.05). The child composite Externalizing DR was not significantly correlated

with parental anxiety. Such findings tentatively suggest that parents might report elevated

levels ofanxiety when their child is exhibiting heightened symptoms ofeither

internalizing (e.g., anxiety, depression) or externalizing (oppositional defiance) disorders.

However, this investigation precludes unequivocally determining whether the present

87

findings are unique to the present sample, an artifact of the measurement methodology, or

attributable to another unmeasured variable.

When considered in the context of the triple vulnerability model (Barlow, 2000;

2002), these fmdings lend support to the notion that particular parental beliefs and

cognitions create a specific vulnerability with respect to childhood anxiety. Although

tests ofdirectionality or causation were beyond the scope of this investigation, the

observed findings appear to lend support for the idea that a parental style characterized by

holding negative beliefs about the child's anxiety, is predictive of the child's display of

anxious symptoms.

This parental style of thinking about anxiety appears to be itself associated with

parental anxiety. More specifically, among the present sample, parents reporting high

trait anxiety also reported holding more beliefs about the harmful nature ofanxiety for

their child. Such "anxiety is harmful" beliefs in parents were in turn related to more

severe expressions of anxiety in their children. However, mere association does not imply

causation. It remains entirely plausible that the experience of parenting a behaviorally

inhibited child is an anxiety-provoking practice for the parent, such that the child's

anxiety increases the extent to which the parent believes that anxiety is harmful, in turn

increasing the parent's own experience of anxious symptomatology. When viewed in the

context of the triple vulnerability model, it would appear that anxious parents pass on to

their child a general biological vulnerability to experience anxiety while simultaneously

"setting the stage" for the development ofanxiety by parenting the child within the

context of an anxious family (e.g., high negative affectivity, high levels of parental

88

control, providing limited opportunities for the child to develop a sense of autonomy with

respect to the environment). At that point, either particular parenting practices could

create a specific vulnerability for the development ofchild anxiety, or certain child

behaviors (e.g., those consistent with a behaviorally inhibited temperament) could

increase the parent's tendency to conceptualize anxiety as a harmful emotion for their

child. In either scenario, what appears most important is the interaction between the

parent and child and the reciprocal effects of the actions ofeach individual on the other.

More specifically, regardless ofdirectionality, the present findings lend support to the

notion that specific interactional patterns between parents and children playa role in the

child's experience ofanxiety.

The findings reported here also lend additional support to theories ofanxiety

sensitivity (e.g., Reiss, 1991; Butler & Matthews, 1983) that suggest that individuals who

are highly anxious are also more likely to anticipate danger in ambiguous situations and

to perceive such situations as threatening. More specifically, findings observed in the

present study extend the theory ofanxiety sensitivity by suggesting that anxious parents

anticipate danger for their children in ambiguous situations and perceive such situations

as threatening for their children. It is these beliefs about the harmful nature ofanxiety for

their children that presumably affect parents' behaviors in observational studies (e.g.,

Dadds et aI., 1996, Barrett, Rapee et aI., 1996, Cobham et aI., 1999). For example,

parents who guide their children in the selection of avoidant strategies in response to

potentially threatening situations might simultaneously interpret ambiguous situations as

89

threatening for their child, thus prompting them to coach their child in the execution of

avoidant behaviors.

Although the present study suggests that parents' harmful beliefs about their

child's anxiety are related to their child's expression ofanxious symptoms, causative

explanations of this relationship remain purely speculative. One well.-established finding

is that the relationship between early fearful behavior and later internalizing disorders is

mediated by multiple factors, one ofwhich involves parenting and family variables

(Goodwin, Fergusson, & Horwood, 2004). Looking specifically at parenting variables,

Moos and colleagues (Moos, Steerneman, Merckelbach, & Meesters, 1996) found that

mothers endorsing high levels of trait anxiety also reported expressing a greater amount

of fearfulness in front of their children than non-anxious mothers. Moreover, these

mothers' reports of fearfulness behaviors were significant predictors of the child's level

of fearfulness in similar situations (Moos et aI., 1996). Such findings can be explained by

the triple vulnerability model, such that children born to an anxious parent (general

biological vulnerability) and parented by an anxious individual (general psychological

vulnerability) will have more opportunities to learn to be fearful and to engage in

avoidant behaviors (specific psychological vulnerability), such as by witnessing their

mothers display heightened levels of fearfulness, as was reported by Moos and

colleagues (Muris et al., 1996). In the context of such a model, it is possible that parents

holding certain beliefs about anxiety (e.g., that anxiety is harmful for their child) will

teach their child, either through modeling or direct verbal communication, to avoid

fearful stimuli, thus increasing the child's overall level of trait anxiety. Longitudinal

90

studies, employing both self-report and observational methodology, are needed to provide

further insight with respect to the means through which parents' beliefs about anxiety

result in the expression ofanxious symptomatology in the child. For example, certain

parental behaviors not yet measured might be highly correlated with parental beliefs

about their child's anxiety. These behaviors might be responsible for the significant

association between parental beliefs and the child's display of anxious symptoms.

Alternatively, parental beliefs about child anxiety might be specifically associated with a

subset ofanxious behaviors observed in the child. Further study can potentially elucidate

the processes of transmission underlying the associations observed here.

Despite support yielded for the PB scale as a mediator of the relationship between

parent and child anxiety, similar support was not observed for the OIC or SR scales.

Mor~ specifically, the present investigation failed to create a meaningful measurement

tool to assess overinvolved parental behaviors and behaviors that closely regulate the

child's environment. Previous investigations have also failed to yield evidence supporting

a relationship between the extent to which parents control and regulate their child's

environment and the child's subsequent display ofanxious symptoms when measuring

control as a component of parental style via paper-and-pencil measures (Wood, McLeod,

Sigman, Hwang, & Chu, 2003). However, such findings suggest not that these variables

are unimportant in the maintenance and exacerbation of childhood anxiety, but rather that

a meaningful measurement strategy has yet to be constructed to accurately assess these

behaviors.

91

Several factors might explain the absence of the hypothesized significant

correlations between parental overinvolvement and overcontrol and parent and child

anxiety. The SR scale in particular yielded low estimates of internal consistency,

evaluated via two different methods, suggesting that its reliability among the present

sample was poor. As such, this scale's failure to correlate with other theoretically related

constructs might be attributable solely to its questionable reliability.

With respect to the ole scale, however, it is possible that overinvolved parenting

behaviors are best assessed via behavioral observation methods. Perhaps Pa£Cnts are poor

reporters of such behaviors, not necessarily because of social desirability demands, but

because of lack of awareness. For example, a parent who relies extensively on their child

as a confidante might have done so for such a long period oftime that such behaviors no

longer stand out to the parent as something they do "often" or to a large degree.

Moreover, ifthe parent has only their own parenting behaviors to serve as a reference, he

or she might not be able to accurately report on the extent to which such parenting

behaviors occur. Alternatively, the Ole scale examined in this study might assess

behaviors that are common to parents ofall children, regardless of whether or not they

have an anxiety disorder, thus making this scale an insensitive indicator of its respective

construct. For example, it is the role ofparents to spend time with their child and to know

where their child is and with whom he or she is associating. As such, it is possible that

the items comprising the Ole scale were not sensitive enough to capture the difference

between responsible parents and parents who are overinvolved.

92

Thus, based on solely the findings of this investigation, it can only be ascertained

that the Ole and SR scales of the PBBA-Q administered to this sample failed to

distinguish parents ofanxious children from those of non-anxious youth. However, these

results provide little definitive insight with respect to the specific reasons underlying the

poor performance of the ole and SR scales. Future investigations ofoverinvolved and

restrictive parenting behaviors concurrently employing observational and paper-and

pencil assessment methods might identify specific behaviors that are amenable to

objective assessment methodologies, or might suggest correlates of these variables that

are more easily assessed via paper-and-pencil measures.

Moderating Influences ofParental Behaviors and Beliefs About Anxiety

Multiple moderational models were hypothesized to exist between parent and

child anxiety and the variables hypothesized to mediate this relationship. However, these

tests of moderation were ultimately not conducted given the lack ofmain effects

observed between parental anxiety and stimulus regulation and between parental anxiety

and overinvolvement with the child. Future studies utilizing alternative means of

assessing overcontrol and overprotection, however, might yield data that can be used to

examine the moderational models proposed here.

Limitations

One of the most obvious limitations to the present investigation is the inclusion of

only a single measure of parental beliefs and behaviors associated with anxiety. Although

this shortcoming could not be avoided, given the lack ofany other known paper-and

pencil measure of these constructs, these [mdings are limited by the fact that the actual

93

criterion validity of the PBBA-Q cannot be ascertained from the present investigation. To

provide criterion validation for this instrument, it is suggested that future investigations

might employ behavior ratings in a setting in which it is feasible to conduct behavioral

observations and analog assessments. For example, utilizing behavioral tasks such as

those employed by Barrett and colleagues (Barrett, Rapee et aI., 1996) and Dadds and

colleagues (Dadds et aI., 1996) could demonstrate correspondence between parental

reports on the PBBA-Q and actual behaviors parents display when interacting with their

child. In addition to providing further support for the validity of the PBBA-Q, such

observational paradigms might also suggest additional behaviors and beliefs about

anxiety displayed by parents that could be assessed via questionnaire measures. However,

a deliberate intention of the present investigation was to assess parental perceptions of

their beliefs and behaviors associated with anxiety rather than their actual behaviors. It is

suggested that in this area of study, parental perceptions of their parenting behaviors are

the key variable of interest, rather than the specific parenting behaviors in which they

engage.

One area of inquiry that this investigation failed to address was the factor

structure underlying the PBBA-Q. Given that this study focused on the development of a

new questionnaire designed to assess the constructs of parental overinvolvement, parental

overcontrol, and parental beliefs about anxiety, it was beyond the realm of this study to

investigate the factor structure underlying the set of items created to measure these

constructs. As such, only raters' classifications of the PBBA-Q items were employed to

create instrument "factors." Similarly, rather than employing factor analytic techniques to

94

eliminate noncritical items, a series ofquantitative and qualitative decision-rules were

instead implemented. For a more rigorous test of the psychometric qualities of this

instrument, a large sample and factor analytic techniques will be required.

Moreover, although this investigation allowed for the examination of the

contribution ofeach of three parental factors to child anxiety, the role of these factors

relative to other parental variables was not examined. For example, ifparental warmth,

discipline style, and the family environment had also been measured in this study, their

contribution to child anxiety relative to parental beliefs and behaviors associated with

child anxiety could have been examined. Although parental beliefs about their child's

anxiety contributed significantly to the child's symptoms ofanxiety, this variable might

offer little incremental validity relative to that ofanother parent construct for which an

assessment measure has already been developed (e.g., family environment). Future

investigations might examine the relative predictive value of the PB scale in comparison

to a measure such as the Family Environment Scale (FES; Moos & Moos, 1983) with

respect to predicting the severity ofchildren's symptoms ofanxiety, particularly given

that the family environments of anxious children have been described as differing from

families ofnon-anxious children on several key dimensions (e.g., conflict, control,

support, cohesion; Whaley, Pinto, & Sigman, 1999).

The present investigation was also limited by the relatively small number of

parent and child participants. With respect to future psychometric evaluations of the

PBBA·Q, it is suggested that a factor analytic investigation of this instrument, among a

much larger and more heterogeneous sample of parents, would yield highly informative

95

data with respect to its underlying factor structure, critical items, and optimal length.

Additionally, evaluating the PBBA-Q among a larger sample would allow for

comparisons across parents ofchildren presenting with a range of different anxiety

disorders. For example, the parental beliefs about anxiety assessed in the present

investigation might be more strongly correlated with certain child anxiety disorders (e.g.,

panic disorder, generalized anxiety disorder) than with others (e.g., obsessive-compulsive

disorder, specific phobia). Conversely, demonstrating that parental beliefs about anxiety

significantly mediate the relationship between parent and child anxiety across the entire

spectrum ofanxiety disorders would lend support to the notion that believing anxiety and

its consequences are harmful for their child creates a generalized specific vulnerability

for child anxiety, rather than perpetuating only a discrete set ofanxiety-related

sYmptoms.

Utilizing a larger sample ofparticipants would also allow for the evaluation of the

PBBA-Q across different child age groups. For example, parenting is not perceived as a

static behavioral construct across the developmental trajectory ofa child. Given that

parents exhibit different parenting behaviors with their 5 year olds than with their

teenagers, one might hypothesize that their beliefs about their child's anxiety might also

change as their child ages. A larger sample with children at various stages of

development would allow for a test of this hypothesis, as well as an examination of the

dynamic processes potentially underlying parental beliefs about child anxiety.

Administering this instrument to a larger sample ofparents and youth would also allow

for comparisons ofparents of anxious children with parents ofdepressed children. More

96

specifically, one might question whether parental beliefs about the harmful nature of

anxiety are discretely related to child anxiety, or whether such beliefs also create a

vulnerability for general negative affectivity which might also be manifested as a

depressive or mood disorder. Finally, a larger sample, with multiple predictors for each

variable, would allow for the use of structural equation modeling procedures, such that all

of the links in the hypothesized model presented here could be evaluated simultaneously.

Such analysis would provide a more comprehensive test of the constructs, and their

interactions, discussed in this study.

An additional limitation of the present investigation pertains to the evaluation of

the PBBA-Q among a strictly clinical sample, with the exclusion ofa normal comparison

group. A clinical sample was selected to evaluate the PBBA-Q, given that this instrument

was designed for use among a clinical population. More specifically, the instrument

evaluated herein was designed to identify a set of clinically meaningfully beliefs and

behaviors evidenced by parents of children with anxiety, with the ultimate intent of

augmenting current notions of the ways in which anxiety disorders are transmitted to and

maintained among youth. This instrument was not developed with the intent of furthering

knowledge about the pathogenesis ofanxiety or anxious affect. Rather it was designed to

inform clinicians of the presence of specific parental beliefs and behaviors that are related

to the child's current anxious symptomatology. Given the intended clinical focus of this

instrument, a clinical sample was deemed most appropriate for an initial investigation of

the PBBA-Q. However, without administering this instrument to a normal comparison

group of parents, no conclusions can be drawn about the nature of the constructs

97

evaluated in this study (e.g., parental beliefs about anxiety, stimulus regulation,

overinvolvement with the child) among the general population. As such, the conclusions

reported in this study currently lack generalizability to non-clinical groups.

A potential confound of the present investigation pertains to the fact that the

parents queried in this study were fully aware that their child was being evaluated in a

clinical setting specializing in the treatment ofchildhood anxiety disorders. Similarly, it

was obvious to parents that they were simultaneously being asked about their own

symptoms ofanxiety, stress, and depression. The parents' knowledge of this information

could have potentially influenced their responses on the questionnaires administered

(e.g., parents might have wished to minimize their own symptoms ofanxiety or feelings

of anxiety related to their child in hopes ofattaining treatment for their child; conversely

parents might have wished to accentuate such reports to illustrate to the clinician that

their case was quite serious). In either case, however, it is suggested that any potential

dIects of the open nature ofthis investigation were balanced across respondents and do

not contribute in a systematic way to confounding the findings of this investigation.

Future Directions

Data yielded from this study suggested that the link between parental and child

anxiety might be a relationship mediated by other variables, rather than a direct link.

Moreover, although relationships were observed in this data between parent and child

anxiety and between parental beliefs about their child's anxiety and child anxiety

severity, the method used to assess these constructs was a paper-and-pencil instrument

that asked parents to evaluate their own global style ofparenting over a non-specific time

98

period (no restrictions on time period were mentioned in the instructions). As such, the

PBBA-Q is most reflective ofa measure ofparenting style (Wood et aI., 2003), and might

be only minimally reflective ofactual parenting practices and behaviors. However, in

order to assess parental factors that might impact child anxiety in a cost-effective and

time-efficient manner, the use ofquestionnaires might be best suited to such purposes. As

such, a highly salient area of future investigation is the degree of association between

paper-and-pencil measures ofparenting style and behavioral manifestations ofsuch

characteristics. More specifically, using behavioral observation data to validate the

construct underlying the PB scale [by engaging parents in tasks similar to those employed

by Barrett and colleagues (Barrett, Rapee et aI., 1996) and Dadds and colleagues (Dadds

et al., 1996)] would allow for an examination ofwhether parents are exhibiting behaviors

in a manner that corresponds to their self-reports on the scale. Such findings would allow

researchers to ascertain whether parent reports of specific behaviors on a questionnaire

are reliable and valid indicators of parental behaviors observed in analog settings.

One key area of future investigation might be to determine the incremental

validity ofthe PB scale of the PBBA-Q, or the extent to which it provides unique and

valuable information beyond that offered by existing adult self-report measures. For

example, the present study appears to have identified a construct akin to "anxiety

sensitivity by proxy," whereby anxious parents endorsed symptoms of anxiety sensitivity

with respect to their child. Given that the items comprising the PB scale are largely

similar to those comprising the adult version of the Anxiety Sensitivity Index (with the

modification that they are worded to refer to "my child" rather than to "I"), one might

99

wonder whether assessing parents' own anxiety sensitivity would yield results similar to

those observed when using the PB scale of the PBBA-Q. As such, a potentially

interesting area of future investigation might involve examining the correlations among

(a) parents' self-reports ofanxiety sensitivity on the Anxiety Sensitivity Index (ASI;

Reiss et aI., 1986), (b) parents' reports of anxiety sensitivity for their children (i.e., on the

PB scale of the PBBA-Q), and (c) children's self-reports ofanxiety sensitivity on the

Child Anxiety Sensitivity Index (CASI; Silverman, Fleisig, Rabian, & Peterson, 1991).

Such methodology would allow clinical researchers to determine whether parent report

on the ASI is correlated to such an extent with parent report on the PB scale that the two

measures are essentially redundant. Moreover, such a future study could also examine

whether the ASI and the PB scale are equally efficient in predicting child anxiety and in

mediating the relationship between parental and child anxiety symptoms.

As previously noted, the present investigation failed to create a meaningful

measurement strategy to assess overinvolved parental behaviors and behaviors that

closely regulate the child's environment. Although the reasons underlying the failure of

these scales to perform as anticipated in this study can only be speculated upon (see

above), future research efforts in the area ofparent and child anxiety might be directed

toward developing efficient and effective means ofmeasuring these constructs. For

example, more useful operational definitions ofparental overinvolvement and

overcontrol might be formulated, thus allowing for the development of a more

comprehensive and sensitive item pool for a paper and pencil measure. Additionally,

observational methods might be employed with an objective parent-report measure to

100

validate these constructs. Alternatively, more easily measured correlates of each of these

factors might be identified, such that the role ofparental overinvolvement and

overcontrol in child anxiety could be evaluated by examining parental characteristics that

are closely related to such parental behaviors.

Finally, an additional area of future study might be to examine the utility ofthe

PB scale of the PBBA-Q in the context of treatment for childhood anxiety. Multiple

investigations have examined the effects of involving parents in the child's receipt of

Cognitive Behavioral Therapy (CBT) for anxiety (e.g., Howard and Kendall, 1996;

Barrett, Dadds, and Rapee, 1996; Cobham, Dadds, & Spence, 1998). Overall, these

clinical trials have suggested superior child treatment outcome effects when parents of

anxious children also receive cognitive behavioral treatment components to address their

own anxious feelings, cognitions, and behaviors. The benefits conferred upon the child of

parental involvement in the child's treatment become even more pronounced when the

parent is also anxious (Cobham et al., 1998). One area of future study, with respect to the

PB scale, might be to determine whether existing parent treatment components (e.g.,

Cobham et al., 1998) result in measurable changes in the parent's beliefs about their

child's anxiety (as measured by the PB scale). For example, administering the PB scale at

pre- and post-treatment assessment points could assess whether psychoeducation about

child anxiety and cognitive techniques to address the parent's thoughts about their child's

anxiety impact the parent's thoughts associated with their child's anxiety. Moreover,

future research might also examine whether parental beliefs about child anxiety change

during the course ofthe child's treatment for anxiety (as the child's own cognitions about

101

anxiety are also changing). Such initial examinations of the PB scale in the context of

treatment might provide valuable information about the usefulness of this scale in

identifying parents appropriate for a parental cognitive behavioral treatment component

that is provided parallel to their child's treatment. However, future studies exploring the

extent to which the PB scale is correlated with observable parent-child interactions and

other meaningful treatment variables (e.g., parent participation in the child's treatment)

must first be pursued before the clinical utility of this scale can be meaningfully

examined.

Conclusion

In conclusion, the present investigation sought to develop a parent-report measure

designed to objectively assess parental behaviors and beliefs about their child's anxiety

that were hypothesized to mediate the relationship between parent and child anxiety. This

study revealed that, of the three domains originally posited to underlie the relationship

between parent and child anxiety, only one domain, parental beliefs about their child's

anxiety (PB), reliably served as a mediator of this relationship. More specifically,

findings from this investigation suggested that parental beliefs about the harmful nature

of their child's anxiety contribute to the link between parental and child anxiety and

significantly predict the severity ofthe child's anxiety-related symptoms. As such, this

study provides initial empirical support for the theoretical notion that particular parenting

behaviors and beliefs constitute a specific vulnerability contributing to the child's

experience of anxiety.

102

Table 1.

DSM-IV-TR Consensus Diagnoses Assigned to Child Participants, Based on both Child

and Parent Reports

Diagnosis

No Diagnosis

Anxiety Disorder Diagnoses

22

percentb

21.36

Separation Anxiety Disorder

Social Phobia

Specific Phobia

Obsessive Compulsive Disorder

Generalized Anxiety Disorder

Panic Disorder

Post-Traumatic Stress Disorder

Anxiety Disorder Not Otherwise Specified

Acute Stress Disorder

Adjustment Disorder With Anxiety

Adjustment Disorder With Mixed Anxiety And Depressed Mood

Non-Anxiety Disorder Diagnoses

3 2.91

13 12.62

13 12.58

6 5.83

4 3.88

1 0.97

3 2.91

2 1.94

1 0.97

1 0.97

2 1.94

Major Depressive Disorder, Single Episode 3 2.91

Major Depressive Disorder, Recurrent 3 2.91

Dysthymic Disorder 3 2.91

Depressive Disorder Not Otherwise Specified 1 0.97

Bipolar I Disorder 1 0.97

103

Table 1.

(Continued) DSM-IV-TR Consensus Diagnoses Assigned to Child Participants, Based on

both Child and Parent Reports

Adjustment Disorder With Disturbance Of Conduct

Adjustment Disorder, Unspecified

Attention-DeficitlHyperactivity Disorder, Combined Type

Attention-DeficitIHyperactivity Disorder, PredominantlyInattentive Type

Attention-DeficitlHyperactivity Disorder, PredominantlyHyperactive-Impulsive Type

Attention-DeficitlHyperactivity Disorder, Not Otherwise Specified

Oppositional Defiant Disorder

Conduct Disorder

Disruptive Behavior Disorder, Not Otherwise Specified

Substance Abuse

Encopresis

Enuresis

Eating Disorder, Not Otherwise Specified

Other

1 0.97

1 0.97

12 11.65

12 11.65

1 0.97

1 0.97

21 20.42

19 18.45

8 7.77

5 4.85

1 0.97

2 1.94

1 0.97

6 5.83

a The number ofparticipants receiving each diagnosis does not add up to the total number ofstudy

participants given that co-morbid diagnoses are tabUlated here allowing each participant to be assigned up

to six diagnoses.

b The percentage ofparticipants in each diagnostic category does not add up to 100 given that co-morbid

diagnoses are tabulated here allowing each participant to be assigned up to six diagnoses.

Table 2.

Demographic Characteristics ofParticipants and their Families

104

Child gender

Child age

Female

Male

6.0 - 11.9 years

12.0-17.8 years

n

35

68

38

65

percent

34.0

66.0

36.9

73.1

Ethnicity African American 2 2.2

Caucasian 14 15.1

Chinese 1 1.1

Filipino 6 6.5

Hawaiian 3 3.2

Latino 1 1.1

Japanese 4 4.3

Korean 1 1.1

Portuguese 1 1.1

Samoan 1 1.1

Southeast Asian 2 2.2

Other 4 4.3

Multiethnic 53 57.0

Parental marital status Married 45 48.4

Separated 3 3.2

Divorced 24 25.8

Widowed 1 1.1

Table 2.

(Continued) Demographic Characteristics ofParticipants and their Families

105

Single 28 19.4

106

Table 3.

Correlations Among each o/the Three Scales Comprising the PBBA-Q and all other Child- and Parent-Report Measures Administered

Child Parent Incom OIC PB SR DASSAge age e S<:ale Scale Scale Dep

Parent Age .36"

DASSSlress

DASSAnx

PANASPA

PANASNA

ChildAnxDR

ParentAnxDR

RCADS

SAD

RCAOS

GAD

RCADS

MOD

RCAOSPD

RCADS

SOC

RCADS

OCO

RCADS

TotalAnx

PANAS..c

PA

PANAS-C

NA

AFARSPA

AFARSNA

Income

OICscal.

PBscal.

SRscale

DASSDep

DASS Streos

DASSAnx

PANASPA

PANASNA

ChildAnxDR

Parent AnxDR

RCADSSAD

RCADSGAD

RCADSMOD

RCADSPD

RCADSSOC

RCADSoeD

RCADSTo<aIAnx

PANAS-CPA

PANAS-CNil

AFARSPA

AFARSNA

.00

.04

.10

-.02

.13

.09

.07

-.14

.09

.07

.09

-.30··

.01

-.02

-.02

.05

-.11

-.07

-,25**

-.02

-.06

.17

.17

-.17

-.16

-.09

-.05

-.13

-.03

-.15

-.09

.01

-.01

-.21

-.05

-.05

-.01

.01

-.12

-.06

-.01

.01

.08

-.10

-.29'

-.17

-.18

-.09

-.03

-.22

.08

-.07

.01

-.04

.00

.02

.19

.04

.04

-.00

.03

-.06

-.00

.04

.07

.56**

.67··

.09

.03

.12

-.10

.05

.14

.09

.08

.11

-.09

.04

.11

.19

.12

.23'

.17

-.08

.03

.55**

.40....

44**

.40**

-.15

.27··

.31**

.25**

.28··

.27**

.25*

.20*

.21*

.36**

.29··

.02

.24'

-.09

.14

.13

.04

.15

-.15

.10

.03

-.07

.08

.06

-.09

-.04

.04

.10

.os

.16

.10

-.06

-.08

.89**

.79**

-.17

.61'*

.26"'*

.34*'"

.05

.13

.25*

.10

.15

.12

.13

-.10

.21*

-.14

,26*·

.76""

-.13

.63**

.25'*

.35"

.07

.IS

.26"""

.08

.15

.13

.14

-.09

.18

-.06

.30·*

-.Q7

.51**

.27··

.28**

.09

.05

.16

.10

.12

.16

.12

-.05

.16

-.02

,21"'·

.04

-.04

.02

-.09

-.16

-.10

-.03

-.17

-.03

-12

-.01

-.09

.10

-.02

.16

.29**

.11

.09

.21*

.11

.03

.12

.10

-.10

.13

-.18

.19

.58**

.54**

,56**

.52··

.46**

.65**

AS··

.62**

-.08

.45'*

-.10

.32**

.35"

.29**

.28'*

.20*

.34**

.23··

.33 ....

-.16

.24*

-.26**

.25*

.66**

.73··

.72**

.67**

.69*·

.8S"

.02

.59**

-.08

.34**

.70"

.68**

.74··

.69-·

,86**

.00

.63"'·

.02

,47··

.76**

.70··

.67**

.81**

-.13

,53**

-,08

.49**

.70··

.73**

.8S··

-.04

.56**

-.05

.42··

.68**

.90**

-.01

.64**

•.02

.42**

.87**

.04

.59**

.03

Al"

.00

.70**

-.03

.47**

.08

.60"

.03

.02

.44*· .24*

107

Table 3.

(Continued) Correlations Among each o/the Three Scales Comprising the PBBA-Q and all other Child- and Parent-Report Measures

Administered

AFARSPH -.02 -.03 .00 .f}7 .13 -.11 .11 .13 .12 -.13 .15 .32" .15 .41·· .49** .54** .64** .51** .52-* .59"· -.04 .54*'" .06 .54"

Note. OIC=Overinvolvement with Child. PB=Parental Beliefs about Anxiety. SR=Stimulus Regulation. DASS Dep= Depression, Anxiety, and Stress Scales, 2 I-item version

Depression scale. DASS Stress= Depression, Anxiety, and Stress Scales, 2 I-item version Stress scale. DASS Anx= Depression, Anxiety, and Stress Scales, 2l·item version

Anxiety scale. PANAS PA=Positive Affect and Negative Affect Scales Positive Affect scale. PANAS NA= Positive Affect and Negative Affect Scales Negative Affect scale.

Child Anx DR=Chiid Anxiety Dimensional Rating Composite Score. Parent Anx DR=Parent Anxiety Dimensional Rating Composite Score. RCADS SAD=Revised Child Anxiety

and Depression Scale Separation Anxiety Scale. RCADS GAD= Revised Child Anxiety and Depression Scale Generalized Anxiety Scale. RCADS MDD= Revised Child Anxiety

and Depression Scale Depression Scale. RCADS PD= Revised Child Anxiety and Depression Scale Panic Scale. RCADS SOC= Revised Child Anxiety and Depression Scale

Social Anxiety Scale. RCADS OCD= Revised Child Anxiety and Depression Scale Obsessive Compulsive Scale. RCADS Total= Revised Child Anxiety and Depression Scale

Total score. PANAS-C PA=Positive and Negative Affect Schedule for Children Positive Affect scale. PANAS-C NA= Positive and Negative Affect Schedule for Children

Negative Affect scale. AFARS PA=Affect and Arousal Scale Positive Affect Scale. AFARS NA= Affect and Arousal Scale Negative Affect Scale. AFARS PH= Affect and

Arousal Scale Physiological Hyperarousal Scale.

108

Table 4.

Between Groups Differences for Child Gender on each ofthe Three PBBA-Q Scales

StandardSignificance Eta SquaredGroup Mean Deviation F-ratio

PBBA·QOIC Male 26.07 6.24 0.19 .66 .00scale

Female 26.63 5.84

Total 26.26 6.08

PBBA-QPB Male 24.63 6.65 2.29 .13 .02scale

Female 26.63 5.67

Total 25.31 6.38

PBBA-QSR Male 22.54 4.36 0.35 .55 .00scale

Female 23.06 3.71

Total 22.72 4.14

Note. OIC=Overinvolvement with Child. PB=ParentaI Beliefs about Anxiety. SR=Stimulus Regulation.

109

Table 5.

Between Groups Differences/or Parental Marital Status on each o/the Three PBBA-Q

Scales

StandardSignificance Eta SquaredGroup Mean Deviation F-ratio

PBBA-QOIC Married 25.53 6.43 0.95 .44 .04scale

Separated 24.33 7.02

Divorced 26.67 3.63

Widoweda 36.00

Single 26.56 6.85

Total 26.28 5.98

PBBA-QPB Married 25.02 6.38 0.48 .75 .02scale


Divorced 24.13 4.52

Widoweda 32.00

Single 25.39 7.55

Total 25.15 6.27

PBBA-QSR Married 22.40 4.47 1.11 .36 .05scale


Divorced 21.25 2.94

Widoweda 25.00

Table 5.

(Continued) Between Groups Differences/or Parental Marital Status on each o/the

Three PBBA-Q Scales

Single 22.57 4.23

Total 22.57 4.23

110

Note. OIC=Overinvolvement with Child. PB=Parental Beliefs about Anxiety. SR=Stimulus Regulation.

a Only I widowed parent is represented in this sample; thus the standard deviation for this group is not

calculable.

111

Table 6.

Estimates ofInternal Consistency and Average Interitem Correlations for each ofthe

Scales Comprising the DASS and PANAS, as Completed by Parent in the Present Sample

Measure ScaleNumber of

itemsa average r

DASS-21 Anxiety 7 .89 .54

Stress 7 .91 .61

Depression 7 .94 .68

PANAS PA 10 .91 .50

NA 10 .92 .54Note. DASS-21=Depression, Anxiety, and Stress Scales, 21-item version. PANAS= Positive Affect and

Negative Affect Scales.

Table 7.


Scales Comprising the RCADS, PANAS-C, and AFARS as Completed by Child

Respondents in the Present Sample

112

Measure ScaleNumber of

itemsa average r

RCADS Separation Anxiety 7 .74 .29

Generalized Anxiety 6 .80 040

Panic 9 .83 .36

Social Phobia 9 .86 Al

Obsessive Compulsive 6 .77 .36

PANAS-C PA 12 .91 046

NA 15 .90 .38

AFARS PH 9 .82 .33

PA 10 .89 044

NA 8 .86 .42

Note. RCADS=Revised Child Anxiety and Depression Scale. PANAS-C=Positive and Negative Affect

Schedule for Children. AFARS=Affect and Arousal Scale.

113

Table 8.

Correlations Among the Stress, Anxiety, and Depression Scales ofthe Parent-Report

DASS-21 and the Positive Affect andNegative Affect &ales ofthe Parent-Report PANAS

DASSDASS Stress DASS Anxiety PANASPA

Depression

DASS Stress .89**

DASS Anxiety .79** .76**

PANASPA -.17 -.13 -.06

PANASNA .61** .63** .51** .04

Note. DASS Depression'O: Depression, Anxiety, and Stress Scales, 2I-item version Depression scale. DASS

Stress'O: Depression, Anxiety, and Stress Scales, 2I-item version Stress scale. DASS Anx= Depression,

Anxiety, and Stress Scales, 2I-item version Anxiety scale. PANAS PA=Positive Affect and Negative

Affect Scales Positive Affect scale. PANAS NA= Positive Affect and Negative Affect Scales Negative

Affect scale.

** Correlation is significant at the 0.01 level (2-tailed).

114

Table 9.

Correlations Among the Anxiety Scales o/the Child-Report RCADS and the Affective Scales o/the Child-Report PANAS-C and

AFARS

PANAS.C PANAS-CAFARS

AFARSSeparation Generalized

Depression PanicSocial Obsessive Positive Negative

PbysiologiPositiveAnxiety Anxiety Pbobia Compulsive

Affect Affectcal

AffectArousal

Generalized Anxiety .66"''''

Depression .73"'''' .70*'"

Panic .72** .68** .76"''''

Social Phobia .67** .74"'''' .70"'''' .70**

Obsessive Compulsive .69** .69.... .67** .73** .68*'"

PANAS-C Positive .02 .00 -.13 -.04 .00 .04Affect

PANAS-C Negative .59** .63*'" .53"'''' .56** .64"'* .59"'* .08Affect

AFARS Physiological 040** 049** .54"'''' .64** .51** .52** -.03 .54"'*Arousal

AFARS Positive Affect -.08 .02 -.08 -.05 -.02 .03 .60"'''' .02 .06

AFARS Negative .34*'" 047"'* .49*'" .41** 042** AI ** .03 .44"'''' .54** .24*Affect

115

Table 9.

(Continued) Correlations Among the Anxiety Scales a/the Child-Report RCADS and the Affective Scales a/the Child-Report PANAS

CandAFARS

Note. RCADS=Revised Child Anxiety and Depression Scale. PANAS-C=Positive and Negative Affect Schedule for Children. AFARS=Affect and Arousal

Scale.

** Correlation is significant at the O.ol level (2-tailed).

* Correlation is significant at the 0.05 level (2-taiIed).

116

Table 10.

Correlations Among Parent-Reported Anxiety, Stress, Depression, Positive Affectivity,

and Negative Affectivity on the DASS-21 Anxiety, Stress, and Depression Scales and the

PANAS, respectively, and Child-Reported Anxiety, Depression, Positive Affectivity, and

Negative Affectivity on the RCADS and PANAS-C, respectively

RCADS Scale DASS DASS DASS PANASNA PANASPAAnxiety Stress Depression

Separation.05 .07 .05 .11 -.09

AnxietyGeneralized .13 .15 .13 .09 -.16

Anxiety

Panic .10 .08 .10 .11 -.03

Social Phobia .15 .15 .15 .03 -.17

Obsessive.12 .13 .12 .12 -.03

Compulsive

Depression .16 .26** .25* .21 * -.10

Total Anxiety .13 .14 .16 .13 -.12

PANAS-CNA .16 .18 .21* .13 -.09

PANAS-CPA -.05 -.09 -.20 -.10 -.01

Note. DASS Anxiety= Depression, Anxiety, and Stress Scales, 2 I-item version Anxiety scale. DASS

Stress= Depression, Anxiety, and Stress Scales, 2 I-item version Stress scale. DASS Depression=

Depression, Anxiety, and Stress Scales, 2 I-item version Depression scale. PANAS NA= Positive Affect

and Negative Affect Scales Negative Affect scale. PANAS PA=Positive Affect and Negative Affect Scales

Positive Affect scale. RCADS=Revised Child Anxiety and Depression Scale. PANAS-C NA=Positive and

Negative Affect Schedule for Children Negative Affect Scale. PANAS-C PA=Positive and Negative Affect

Schedule for Children Positive Affect Scale.

** Correlation is significant at the O.oI level (2-tailed).

* Correlation is significant at the 0.05 level (2-tailed).

Table 11.

Between Group Analyses ofParent-Reported Anxiety, Stress, and Depression on the

DASS-2I Anxiety, Stress, and Depression Scales Among Parents ofAnxious and Non-

Anxious Children, as Indicated by Diagnostic Status

Standard SignificanceEta

Group Mean Deviation F-ratio Squared

DASSAnxious 2.77 4.61 0.00 .99 .00Anxiety

scale

Non-2.75 4.25

Anxious

Total 2.76 4.49

DASS Anxious 4.93 4.70 0.05 .82 .00Stress scale

Non-5.19 5.47

Anxious

Total 5.12 5.24

DASSDepression Anxious 3.93 4.81 0.02 .88 .00

scale

Non-3.77 5.30

Anxious

Total 3.82 5.14

Note. DASS=Depression, Anxiety, and Stress Scale, 2 I-item version.

117

118

Table 12.

Between Group Analyses ofParent-Reported Negative Affect and Positive Affect on the

PANAS Among Parents ofAnxious and Non-Anxious Children, as Indicated by

Diagnostic Status

Standard SignificanceEta

Group Mean Deviation F-ratio Squared

PANASNA Anxious 18.97 9.02 0.04 .85 .00scale

Non-18.63 8.00

Anxious

Total 18.73 8.27

PANASPA Anxious 31.80 10.04 0.01 .94 .00scale

Non-31.95 8.03

Anxious

Total 31.90 8.61

Note. PANAS NA=Positive Affect and Negative Affect Scales Negative Affect scale. PANAS pA=

Positive Affect and Negative Affect Scales Positive Affect scale.

119

Table 13.

Correlations Among Parent-Reported Anxiety, Stress, Depression on the DASS-21

Anxiety, Stress, and Depression Scales and Dimensional Ratings ofClinical Severity

Yielded via Child and Parent Reports on the ADIS-IV-C/P

Dimensional Rating DASS Anxiety DASS Stress DASS Depression

Child Composite Anxiety DR .27** .25** .26**

Parent Composite Anxiety DR .28** .35** .34**Note. DR=Dimensional Rating. DASS=Depression, Anxiety, and Stress Scales, 2I-item version.


120

Table 14.

Correlations Among Child-Reported Anxiety and Depression on the Subscales ofthe

RCADS and Dimensional Ratings ofClinical Severity Yielded via Child and Parent

Reports on the ADIS-IV-C/P

RCADS Subscales

Dimensional Rating SAD GAD PD SOC OCD MDDAnxiety

Total

Child Composite .54** .56** .46** .65** .45** .52** .62**Anxiety DR

Parent Composite .35** .29** .20* .34** .23* .28** .33**Anxiety DR

Note. DR=Dimensional Rating. RCADS=Revised Child Anxiety and Depression Scale. SAD=Separation

Anxiety. GAD=Generalized Anxiety. PD=Panic. SOC=Social Anxiety. OCD=Obsessive Compulsive.

MDD=Depression.


*Correlation is significant at the 0.05 level (2-tailed).

Table 15.

Response distributions/or each o/the 51 items comprising the PBBA~Q

Item Response n Percentage

PBBA-Q item 1

strongly disagree 5 4.9

disagree 27 26.5

agree 58 56.9

strongly agree 12 11.8

PBBA-Q item 2


disagree 33 32.4

agree 54 52.9


PBBA-Q item 3


disagree 17 17.5

agree 38 39.2


PBBA-Q item 4


disagree 56 54.4

agree 23 22.3


PBBA-Q item 5


disagree 15 14.7

agree 62 60.8


PBBA-Q item 6


disagree 17 16.5

agree 61 59.2

121

Table 15.

(Continued) Response distributions for each ofthe 51 items comprising the PBEA-Q


PBBA-Q item 7


disagree 60 60.0

agree 29 29.0


PBBA-Q item 8


disagree 55 54.5

agree 29 28.7


PBBA-Q item 9


disagree 15 14.9

agree 54 53.5


PBBA-Q item 10


disagree 23 23.5

agree 66 67.3


PBBA-Q item 11


disagree 50 49.0

agree 39 38.2


PBBA-Q item 12


disagree 55 54.5

agree 19 18.8

122

Table 15.

(Continued) Response distributionsfor each ofthe 51 items comprising the PBBA-Q


PBBA-Q item 13


disagree 44 43.6

agree 45 44.6


PBBA-Q item 14


disagree 21 20.4

agree 71 68.9


PBBA-Q item 15


disagree 12 11.9

agree 49 48.5


PBBA-Q item 16


disagree 41 39.8

agree 51 49.5


PBBA-Q item 17


disagree 29 28.2

agree 66 64.1


PBBA-Q item 18


disagree 14 13.7

agree 69 67.6

123

Table 15.

(Continued) Response distributions for each ofthe 51 items comprising the PEEA-Q


PBBA-Q item 19


disagree 39 38.6

agree 49 48.5


PBBA-Q item 20


disagree 64 62.7

agree 12 11.8


PBBA-Q item 21


disagree 66 64.7

agree 22 21.6


PBBA-Q item 22


disagree 52 52.5

agree 33 33.3


PBBA-Q item 23


disagree 31 30.7

agree 41 40.6


PBBA-Q item 24


disagree 74 71.8

agree 16 15.5

124

Table 15.

(Continued) Response distributions for each ofthe 51 items comprising the PRRA-Q


PBBA-Q item 25


disagree 64 63.4

agree 19 18.8


PBBA~Q item 26


disagree 69 67.0

agree 20 19.4


PBBA-Q item 27


disagree 48 47.5

agree 40 39.6


PBBA~Q item 28


disagree 16 15.7

agree 73 71.6


PBBA~Q item 29


disagree 17 16.5

agree 62 60.2


PBBA~Q item 30


disagree 42 42.4

agree 39 39.4

125

Table 15.

(Continued) Response distributions for each ofthe 51 items comprising the PBBA-Q


PBBA-Q item 31


disagree 4 3.9

agree 69 67.0


PBBA-Q item 32


disagree 59 57.8

agree 32 31.4


PBBA-Q item 33


disagree 51 50.0

agree 40 39.2


PBBA-Q item 34


disagree 40 39.2

agree 50 49.0


PBBA-Q item 35


disagree 35 34.3

agree 59 57.8


PBBA-Q item 36


disagree 42 42.4

agree 48 48.5

126

Table 15.

(Continued) Response distributions/or each o/the 51 items comprising the PBBA-Q


PBBA-Q item 37


disagree 38 38.0

agree 51 51.0


PBBA-Q item 38


disagree 39 40.2

agree 44 45.4


PBBA-Q item 39


disagree 55 55.6

agree 36 36.4


PBBA.-Q item 40


disagree 15 15.0

agree 57 57.0


PBBA-Q item 41


disagree 48 48.0

agree 35 35.0


PBBA-Q item 42


disagree 48 48.0

agree 42 42.0

127

Table 15.

(Continued) Response distributions for each ofthe 51 items comprising the PBBA~Q


PBBA-Q item 43


disagree 26 26.5

agree 56 57.1


PBBA-Q item 44


disagree 45 44.1

agree 45 44.1


PBBA-Q item 45


disagree 52 52.5

agree 38 38.4


PBBA-Q item 46


disagree 66 65.3

agree 21 20.8


PBBA-Q item 47


disagree 48 49.5

agree 42 43.3


PBBA-Q item 48


disagree 39 39.8

agree 45 45.9

128

Table 15.

(Continued) Response distributions for each ofthe 51 items comprising the PBBA-Q


PBBA-Q item 49


disagree 66 66.7

agree 22 22.2


PBBA-Q item 50


disagree 32 32.0

agree 59 59.0


PBBA-Q item 51


disagree 17 16.7

agree 60 58.8

strongly agree 24 23.5Note. PBBA-Q=Parental Behaviors and Beliefs About Anxiety Questionnaire.

129

130

Table 16.


Scales Comprising the PBBA-Q, as Completed by Parent in the Present Sample

Measure Scale a average r

PBBA-Q ole .80 .19

PB .81 .20

SR .60 .08

Note. PBBA-Q=Parental Behaviors and Beliefs About Anxiety Questionnaire. OIC=Overinvolvement with

Child. PB=Parental Beliefs About Anxiety. SR=Stimulus Regulation.

131

Table 17.

Convergence Between Parent 1 and Parent 2 Reports on the OIC, PB, and SR scales of

the PBBA-Q, and on Parent Self-Report Dimensions ofDepression, Anxiety, and Stress

on the Scales ofthe DASS-21, and Negative and Positive Affect on the Scales ofthe

PANAS Among a Subsample (n~25) ofParticipants for whom Two Parents Completed

the Parent-Report Measures Administered

Measure r

PBBA-QOIC .78**

PBBA-QPB .44*

PBBA-QSR .47*

DASS 21 Depression .59**

DASS 21 Anxiety .76**

DASS 21 Stress .79**

PANASNA .49*

PANASPA .34Note. PBBA-Q=Parental Behaviors and Beliefs About Anxiety Questionnaire. OIC=Overinvolvement with

Child. PB=Parental Beliefs about Anxiety. SR=Stimulus Regulation. DASS 21 Depression=Depression,

Anxiety, and Stress Scales, 21·item version Depression scale. DASS 21 Anxiety=Depression, Anxiety, and

Stress Scales, 2I-item version Anxiety scale. DASS 21 Stress=Depression, Anxiety, and Stress Scales, 21

item version Stress scale. PANAS NA= Positive Affect and Negative Affect Scales Negative Affect scale.

PANAS PA=Positive Affect and Negative Affect Scales Positive Affect scale.

132

Table 18.

Interrater Reliability Between Parent 1 and Parent 2 Reports on the Problem Scales of

the CBCL Among a Subsample (n=25) ofParticipants for whom Two Parents Completed

the Parent-Report Measures Administered

Measure

CBCL AnxiouslDepressed

CBCL Aggressive

CBCL Attention Problems

CBCL Rule Breaking Behavior

CBCL Somatic Complaints

CBCL Social Problems

CBCL Thought Problems

CBCL WithdrawnlDepressed

CBCL Other ProblemsNote. CBCL=Child Behavior Checklist.


r

.86**

.85**

.87**

.90**

.78**

.86**

.84**

.85**

.82**

133

Table 19.

Correlations Among Each ofthe three PBBA-Q scales and the Anxiety, Stress, and

Depression scales ofthe Parent-Completed DASS-21

DASS Anxiety DASS Stress DASS Depression

PBBA-Q ole scale .12 .03 .09

PBBA-Q PB scale .40** .44** .40**

PBBA-Q SR scale.15 .04 .13Note. PBBA-Q=Parental Behaviors and Beliefs About Anxiety Questionnaire. OIC""Overinvolvement with

Child. PB=Parental Beliefs About Anxiety. SR=Stimulus Regulation. DASS=Depression, Stress, and

Anxiety Scales, 21-item version.


134

Table 20.

Correlations Among Each ofthe three PBBA-Q scales and the Anxiety, Stress, and

Depression scales ofthe Parent-Completed DASS-21

PANASNA PANASPA

PBBA-Q ole scale .05 -.10

PBBA-Q PB scale .27** -.15

PBBA-Q SR scale.lO -.15Note. PBBA-Q=Parental Behaviors and Beliefs About Anxiety Questionnaire. OIC=Overinvolvement with

Child. PB=Parental Beliefs About Anxiety. SR=Stimulus Regulation. PANAS NA=Positive Affect and

Negative Affect Scales Negative Affect Scale. PANAS PA=Positive Affect and Negative Affect Scales

Positive Affect Scale.

** Correlation is significant at the O.Qllevel (2-tailed).

Table 21.

135

Between Groups Differences for Child Anxiety Diagnostic Status on each ofthe Three

PBBA-Q Scales

PBBA-Q StandardSignificance

EtaScale Group Mean Deviation F-ratio Squared

ole Anxious 27.93 6.23 3.27 .07 .03

Non-Anxious 25.58 5.93

Total 26.26 6.08

PB Anxious 27.23 5.76 3.96 ;05 .04


Total 25.31 6.38

SR Anxious 22.63 3.89 0.02 .89 .00


Total 22.72 4.14



136

Table 22.

Correlations Among Each ofthe Three PBBA-Q Scales the Broad-Band Internalizing

Scale ofthe CBCL, and the Narrow-Band Anxious/Depress, Withdrawn/Depressed, and

Somatic Complaints Scales ofthe Parent-Report CBCL

Internalizing Anxious/ Withdrawn! SomaticScale Depressed Depressed Complaints

PBBA-Q OIC scale .10 .07 .06 .16

PBBA-Q PB scale .33** .29** .32** .25*

PBBA-Q SR scale -.01 -.03 -.00 .03





137

Table 23.

Correlations Among Each ofthe Three PBBA-Q Scales and the Total Anxiety

Dimensional Rating Score Obtained From Parent and Child Report on the ADIS·IV-C/P

Parent·ADIS-IV AnxietyDimensional Rating Total

PBBA·Q ole scale .09

PBBA-Q PB scale .25*

PBBA-Q SR scale -.07

Child·ADIS-IV AnxietyDimensional Rating Total

.14

.31 **

.03


Child. PB=Parental Beliefs About Anxiety. SR=Stimulus Regulation. ADIS-IV=Anxiety Disorders

Interview Schedule for DSM-IV.



138

Table 24.

Correlations Among Each ofthe Three Parent-Reported PBBA-Q Scales, Each Anxiety

Scale ofthe RCADS, and the RCADS Total Anxiety Score

RCADS ScalePBBA-QOIC PBBA-QPB PBBA-QSR

scale scale scale

Separation Anxiety .08 .28** .08

Generalized Anxiety .11 .27** .06

Depression -.09 .25* -.09

Panic .04 .20* -.04

Social Phobia .11 .21 * .04

Obsessive Compulsive .19 .36** .10

Total Anxiety .12 .29** .05

Note. RCADS=Revised Child Anxiety and Depression Scale. PBBA-Q=Parental Behaviors and Beliefs

About Anxiety Questionnaire. OIC=Overinvolvement with Child. PB=Parental Beliefs About Anxiety.

SR=Stimulus Regulation.



139

Table 25.

Correlations Among Each a/the Three Parent-Reported PBBA-Q Scales, the NA and PA

Scales a/the Child-Report PANAS-C, and the NA, PH, and PA scales a/the Child-Report

AFARS

Child-Report Scale PBBA-QOIC PBBA-QPB PBBA-QSRscale scale scale

PANAS-CNA .17 .24* -.10

PANAS-CPA .23* .02 .16

AFARSNA .03 .14 -.08

AFARSPH .07 .13 -.11

AFARSPA -.08 -.09 -.06

Note. PBBA-Q==Parental Behaviors and Beliefs About Anxiety. OIC==Overinvolvement with Child.

PB==Parental Beliefs about Anxiety. SR==Stimulus Regulation. PANAS-C NA== Positive and Negative

Affect Schedule for Children Negative Affect scale. PANAS-C PA=Positive and Negative Affect Schedule

for Children Positive Affect scale. AFARS PA=Affect and Arousal Scale Positive Affect Scale. AFARS

NA== Affect and Arousal Scale Negative Affect Scale. AFARS PH= Affect and Arousal Scale

Physiological Hyperarousal Scale


*Correlation is significant at the 0.05 level (2-tailed).

140

Table 26.

Correlations Among Parent Report on each ofthe Three Scales ofthe PBBA-Q, Child

and Parent Externalizing Dimensional Ratings as derived from the Opposition,

Delinquency, Inattention, and Hyperactivity portions ofthe ADIS-IV, and Parent Report

on the Externalizing Subscale Composite ofthe Child Behavior Checklist

Parent-ADIS-IV Externalizing DimensionalRating Total

Child-ADIS-IV Externalizing DimensionalRating Total

Child Behavior Checklist Externalizing ScaleComposite Score

PBBA-QOICScale

.03

-.01

.05

PBBA-QPB Scale

.19

.15

.18

PBBA-QSRScaie

.03

.06

.00

Note. PBBA-Q=Parental Behaviors and Beliefs About Anxiety. OIC=Overinvolvement with Child.

PB=Parental Beliefs about Anxiety. SR=Stimulus Regulation. ADIS-IV=Anxiety Disorders Interview

Schedule for DSM-IV.

141

Table 27.

Regression Analyses for Parent-Reported Anxiety and Stress on the DASS-21 Anxiety and

Stress Scales When Entered as Predictors ofthe RCADS Total Anxiety Scores and as

Predictors ofthe Composite Anxiety DR based on Child Report on the ADIS-IV-C

Dependent Variables Predictors p SE t P

RCADS Total Anxiety DASS Anxiety .49 .41 1.20 .23

DASS Stress .48 .35 1.38 .17

Composite Anxiety DR DASS Anxiety .45 .16 2.82 .01

DASS Stress .37 .14 2.63 .01

Note. RCADS=Revised Child Anxiety and Depression Scale. DASS=Depression, Anxiety, and Stress

Scales 21-item version. DR=Dimensional Ratings.

142

Table 28.

Regression Analyses for Parent-Reported Anxiety on the DASS-21 Anxiety Scale When

Entered as Predictors ofthe OIC, PB, and SR scales ofthe PBBA-Q

Dependent Variables Predictors

PBBA-Q OIC DASS Anxiety

PBBA-Q PB DASS Anxiety

PBBA-Q SR DASS Anxiety

.16

.57

.14

SE

.13

.13

.09

t

1.22

4.41

1.53

p

.23

.00

.13


Child. PB=Parental Beliefs About Anxiety. SR=Stimulus Regulation. DASS=Depression, Anxiety, and

Stress Scales 2 I-item version.

143

Table 29.

Regression Analyses for the Anxiety Scale 0/the DASS-21 scale When Entered as a

Predictor a/the Child Composite Anxiety DR Rating (Modell) and When Entered with

the PB Scale a/the PBBA-Q (Model 2) as Predictors a/the Child Composite Anxiety DR

Rating as Derivedfrom the ADIS-IV-C

Model Dependent Variables Predictors p SE t P

Model IComposite Child DASS

.45 .16 2.82 .01Anxiety DR Anxiety

Model 2Composite Child DASS

.29 .17 1.68 .10Anxiety DR Anxiety

PBBA-Q.29 .12 2.38 .02

PB

Note. DR=Dimensional Rating. DASS=Depression, Anxiety, and Stress Scales 21-item versions. PBBA-

Q=Parental Behaviors and Beliefs About Anxiety Questionnaire. PB=Parental Beliefs About Anxiety.

144

Table 30.

Regression Analysesfor Parent-Reported Stress on the DASS-21 Stress Scale When

Entered as Predictors ofthe OIC, PB, and SR scales ofthe PBBA-Q

Dependent Variables

PBBA-QOIC

PBBA-QPB

PBBA-QSR

Predictors

DASS Stress

DASS Stress

DASS Stress

.04

.53

.03

SE

.12

.11

.08

t

0.32

4.88

0.40

p

.75

.00

.69


Child. PB=Parental Beliefs About Anxiety. SR=Stimulus Regulation. DASS=Depression, Anxiety, and

Stress Scales, 2 I-item version.

145

Table 31.

Regression Analyses for the Stress Scale ofthe DASS-21 Scale When Entered as a

Predictor ofthe Child Composite Anxiety DR Rating (Modell) and When Entered with

the PB Scale o/the PBBA-Q (Model 2) as Predictors ofthe Child Composite Anxiety DR

Rating as Derivedfrom the ADIS-IV-C

Model Dependent Variables Predictors p SE t P

ModellComposite Child DASS

.37 .14 2.63 .01Anxiety DR Stress

Model 2Composite Child DASS

.21 .15 1.38 .17Anxiety DR Stress

PBBA-Q.30 .12 2.39 .02

PB

Note. DR=Dimensional Rating. DASS=Depression, Anxiety, and Stress Scales 21-item version. PBBA-

Q=Parental Behaviors and Beliefs About Anxiety Questionnaire. PB=Parental Beliefs About Anxiety.

146

/

~

Overinvolvementwith the

Child

Parental BeliefsAbout

Anxiety

//

Figure 1.

Hypothesized mediational and moderational relationships among parent anxiety, parental behaviors and beliefs about anxiety, and

child anxiety.

147

..

~(.I=--

ChildAnxiety

.45 (.16)*


Anxiety.57/--

.29 (.17) ns

Figure 2.

Unstandardized beta coefficients (and standard error estimates) for the mediational relationship between parental anxiety, parental

beliefs about anxiety, and child anxiety. Significant coefficients indicated with an *.

148

•

~O(.12)'

.37 (.14)*


Anxiety.53/

.21 (.15) ns

Figure 3.

Unstandardized beta coefficients (and standard error estimates)for the mediational relationship between parental stress,

parental belieft about anxiety, and child anxiety. Significant coefficients indicated with an *.

Appendix APBBA-Q Items Retained, Deleted, Revised, and Added Following Study I

ItemMy child comes to me ftrst when he/she has a problem.I know, more than anyone else, what my child thinks about.I know, more than anyone else, how my child feels about things.I try to spend as much time with my child as I can.

I understand what my child goes through better than anyone elsedoes.

I try to cut down on my work or social schedule when my childneeds more time from me.

If my child is not feeling well, I will stop all ofmy other activitiesto spend time with hirnlher.

If my child wants to be near me, I make sure to give hirn/her a lotof extra attention.

In many ways, my child is my best friend.My child is perfect in many respects.My child's fears and worries are just like mine.I am very close to my child.My child is the center of the household.My child often tells me that he/she wants to be with me.Even though I try to keep everyone's interests in mind whenmaking decisions at home, I usually just need to do what is best formy child.My child and I enjoy many of the same activities.I attend to my own needs before I attend to my child's needs.I have thought about quitting my job (or giving up some activities)to spend more time with my child.

149

There are certain aspects of my life (Le., [mances, romanticrelationships, work-related concerns) which I don't think my childneeds to really know about.

I try to be involved in all of the same activities that my child is.I enjoy having separate interests from my child because then wealways have something to talk about.

No matter who is right, I always stand up for my child in anargument.My child really needs me.I understand my child completely.I would like my child to stay in control ofhis!her feelings.

If my child gets too nervous, it could be really harmful.It is better ifmy child does nothing than if he/she something thathe/she is not sure of.

Other children notice when my child is afraid.It bothers me to think that my child might mess up.I do not like it when other people see my child is afraid.It scares me when my child throws up.

When my child says he/she feels upset, I worry that there might besomething wrong with himlher.

When my child cannot concentrate on schoolwork, I worry thatsomething might really be wrong.

When I worry about my child, I feel like I am being a good parent.I feel like I am a bad parent if my child becomes stressed out.My child would become insecure if I did not respond to himlherwhen he/she is crying.

It makes me upset to see my child scared or nervous.

I do not get uncomfortable when my child is upset about

retained OICretained OlC

retained OlC

retained OlCretained OlCretained OlC

retained PBretained PB

retained PBretained PBretained PBretained PB

retained PB

retained PB

retained PBretained PBretained PB

retained PB


151

It is important to me that my child stayrewritten in control ofhislher emotions.

It scares me when my child isrewritten nauseous.

When my child cannot keep his/hermind on a task, I worry that he/she

rewritten might be going crazy.

rewritten It scares me when my child is nervous.

something.I react strongly with my child is worrying.When my child is upset, it makes me very anxious.My child will grow out ofhislher fears.I get very anxious when my child is ill.My child should learn that other people's opinion ofhimlher is veryimportant.

When I feel worried that my child is not safe, it is important for meto trust those feelings no matter what anyone else says.

I always trust my instincts when I feel that my child is not safe.If! feel that my child is in danger, it is a sure sign that somethingbad is about to happen.

It is important that my child never feel nervous or scared.

My child is not able to handle anxiety.My child should not have to feel afraid.If things have been going well for my child, I know that just meansthat bad times are just around the comer.

In general, my child seems like he/she is not as healthy as mostchildren.

When there is a "bug" going around, my child usually ends upcatching it.

I often am concerned that my child does not look as healthy ashe/she should.

My child seems to get a lot more colds than most children I know.I get concerned about the circles under my child's eyes.I try not to restrict my child's activities, decisions, or desires.I let my child decide what to do without giving too much advice.My child needs to make his/her own mistakes to learn.I keep my child home from school when he/she has a headache orstomachache.

152

retained PBretained PBretained PBretained PB

retained PB


retained PBIt is important to me that my child not

retained PB rewritten appear nervous.retained PBretained PB

retained PB

retained PB

retained PB

retained PBretained PBretained PBretained SRretained SRretained SR

retained SR

I would change my child's school if problems came up there.I try to protect my child from looking foolish in front of others.It is OK for my child to play rough activities and sports.I am proud when my child makes his/her own decisions.

When I feel that my child is in danger, all of my attention isimmediately directed toward trying to prevent a bad thing fromhappening.

My child is the best person to decide when he/she is ready toconfront things that make him/her uncomfortable.

I help my child whenever he/she needs assistance with something.I think it is important for my child to play with a group ofotherchildren his/her own age.

My child cannot decide things for him/herself.Friends are such an important choice for a child, so I usuallychoose my child's friends for him/her.

Before my child tries anything new, we sit down together andreview all of the things that might go wrong so that he/she knowswhat to look out for.

My child can handle challenging situations on his/her own.I don't let Illy child participate in social situations where he/shemay become embarrassed or feel ashamed.

Ifmy child will probably be rejected from a group ofpeers, I try towarn my child to avoid that situation.

When my child is not feeling well, it is best ifhe/she stays homefrom school so that I can take care ofhim/her.

I try to encourage my child to try new and exciting things.My child does many things on his/her own.When my child has something difficult to do, I try to do it for them.I am not responsible for directing or guiding my child's behavior.

retainedretainedretained

retained

retained

retainedretained

retainedretained

retained

retainedretained

retained

retained

retainedretainedretainedretaineddeleted

SRSRSR

SR

SR

SRSR

SRSR

SR

SRSR

SR

SR

SRSRSRSROle

153

It is good for my child to make his/herrewritten own decisions.

154

I often need to speak to my child's teachers about my child'sproblems in school. deleted OICI try to help my child as much as I can with his/her problems. deleted OICI make sure that I know where my child is at all times. deleted OICI try to coor~inate the behaviors, activities, and desires of my childwith those ofother family members deleted OICWhen my child has displeased me, I avoid talking to him/herafterward. deleted OICIf my child is in trouble, I talk to hislher friends. deleted OICI never find fault with my child. deleted OICMy child needs my help to overcome hislher fears. deleted OICI try to make sure that my child is never unhappy. deleted OICI often talk about school-related problems with my child. deleted OICIf my child does not do what I've asked him/her to do, I usually justdo it myself to get it done. deleted OICWhen something is wrong between me and my child, I feel I can donothing to make it better. deleted OICI try to do everything possible to help my child overcome his/herfears and worries. deleted OICI wish I had more influence over the direction that my child's life istaking. deleted OICMy child is very sensitive. deleted OICI feel I have had a lot of influence over the decisions that my childhas made. deleted OICI feel in control when it comes to my child. deleted OICI feel that my child is in control when it comes to our relationship. deleted OICMy child decides when we do things together as a family. deleted OICIf my child wants something, it is important that I not let him/herdown. deleted OICMy child is not able to do things for him/herselfunless I am thereto help him/her. deleted OIC

155

My child does not need privacy. deleted OICMy child comes to me for comfort when he/she is sad. deleted OlCWorrying about my child takes up all ofmy energy. deleted OlCWhenever my child cries, I try to comfort himlher immediately. deleted OlCMy child's behavior often leaves me feeling like, "Is this the thanksyou give me for having done so much for you?". deleted OlCIn disagreements between my child and another child, I try to takethe side of whomever is right. deleted OlCIf my child is clingy, I know that means he/she needs some extraattention. deleted OlCI always know exactly what my child is doing. deleted OlCWhen I am unhappy, it is usually because my child has donesomething to upset me. deleted OlCI keep a close eye on my child so that I am always the first to knowwhen he/she has misbehaved. deleted OlCMy child needs a lot of rest. deleted PBI encourage my child to face hislher fears. deleted PBWhen my child does not succeed at something he/she does, I getupset. deleted PBI cannot stand to think of my child failing at something. deleted PBWhen my child is sick, I take himlher to the doctor immediately. deleted PBI feel like a good parent when I am concerned for the well-being ofmy child. deleted PBMy child would not do things to make me worry ifhe/she reallycared about me. deleted PBI often think that I should call the doctor about my child. deleted PBMy child often has to stay indoors because of health concerns. deleted PBI often check on my child during the night to make sure that he/sheis okay. deleted PBI worry about my child so much because I care. deleted PBIt is my job to protect my child from all possible dangers. deleted PB

156

My friends and family tell me that I worry too much about mychild. deleted PBI think my child should be free to make up hislher own mind anddo what he/she wants to do, even if! do not think it is right. deleted SRI want my child to form his/her own opinions about family matters. deleted SRIt is usually my child's teacher's fault if problems come up at schoolfor my child. deleted SRI do everything I can to make sure that my child has friends. deleted SRIf my child is feeling scared, I let them stay near me for as long asthey need to. deleted SRMy child should be more assertive. deleted SRI think my child is better off if he/she is kept busy with activities allof the time. deleted SRI teach my child to solve hislher own problems deleted SRMy child's teachers do not understand my child. deleted SRMy child cannot handle chores like other kids can. deleted SRIt is not OK for my child to sleep in my bedroom when he/she isscared. deleted SRMy child has as much freedom as he/she wants. deleted SRI know it is best not to push my child too hard. deleted SRIt is important that my child have his/her own ideas about how theworld works. deleted SROthers tell me that I am an overprotective mother, but I think I carefor my child like a mother should. deleted SRIf! do not like my child's friends, I make sure he/she knows that. deleted SRI trust my child when he/she is own hislher own. deleted SRI encourage my child make his/her own decisions about things. deleted SRI don't really trust anyone to care for my child appropriately if I amnot there. deleted SRI help my child achieve things he/she wants to achieve, but I don'tjust give him/her whatever he/she wants. deleted SR

When my child has something difficult to do, I try to supporthimJher the best I can. deleted SRMy child does not really need "free time." deleted SRI try to teach my child how to act in situations that he/she findsherself in. deleted SRMy child will figure out on hislher own how to behave. deleted SRMy child might make the wrong decision ifhe/she did it on hislherown. deleted SROther people notice when my child feels shaky. new PBIt scares me when my child is unable to keep hislher mind on a

new PBtask.When my child's stomach is upset, I worry that he/she might be

new PBseriously ill.When my child is nervous, I worry that he/she might be mentally

new PBill.It scares me when my child tells me that he/she has unusual body

new PBsensations.

It scares me when I notice that my child is short of breath. new PBIt embarrasses me when my child's stomach growls. new PBIt scares me when my child gets shaky or trembles. new PBIt scares me when my child's heart beats rapidly. new PBWhen my child tells me that hislher heart is beating rapidly, I worry

new PBthat he/she might have a heart attack.It scares me when my child says he/she feels faint. new PB

157

Appendix BPBBA-Q Items Retained and Deleted Following Study 2

158

ItemMy child is always my ftrst priority.I know, more than anyone else, how my child feels about things.I understand what my child goes through better than anyone else does.I know, more than anyone else, what my child thinks about.I tell my child everything.I am the only one who really understands how my child is feeling.It is difficult for my child and I to be apart from one another.I am always the one who understands what my child needs.My child is the center of the household.I am the only one who can help my child when he/she is nervous.Even though I try to keep everyone's interests in mind when making decisions at home, I usually justneed to do what is best for my child.

My child has the biggest influence over the things that happen in my life.I understand my child completely.I feel closer to my child sometimes than to my spouse/partner.There are certain aspects ofmy life (Le., fmances, romantic relationships, work-related concerns)which I don't think my child needs to really know about.

I am quite conftdent that all of my child's opinions about things are the same as my own.

In many ways, my child is my best friend.No matter how old my child gets, he/she will always be my baby.I try to be involved in everything that my child does.I attend to my own needs before I attend to my child's needs.I try to spend as much time with my child as I possibly can.I know how my child will feel about something new.

Scale RetainedlDeletedOlC retainedOlC retainedOlC retainedOlC retainedOlC retainedOlC retainedOlC retainedOlC retainedOlC retainedOlC retained

OlC retainedOlC retainedOle retainedOlC retained

OIC retained

OlC retainedOlC retainedOlC retainedOIC retainedOlC retainedOlC retainedOlC retained

I enjoy having separate interests from my child because then we always have something to talk about.

It is so difficult to know what my child is thinking and feeling.Before I make any plans, I try to think about my child's own needs.My child's fears and worries are just like mine.My child does not control my life.I try to be involved in all of the same activities that my child is.When I have a hard time making up my mind about something, my child can often help me.

My child really needs me.My child affects the number of friendships that I can have.I try to cut down on my work or social schedule when my child needs more time from me.

My child and I enjoy many of the same activities.When my child comes home, I make sure that I find out everything that helshe has been doing.

Ifmy child is not feeling well, I will stop all ofmy other activities to spend time with himlher.

I know how my child will behave in certain situations.My child knows that helshe can always depend on me more than on anyone else.

My child comes to me first when helshe has a problem.When I worry about my child, I feel like I am being a good parent.Ifmy child gets too nervous, it could be really harmful.It scares me when my child is nervous.When my child is nervous, I worry that helshe might be mentally ill.When my child's stomach is upset, I worry that helshe might be seriously ill.It scares me when my child says helshe feels faint.It scares me when my child gets shaky or trembles.I do not get uncomfortable when my child is upset about something.It scares me when I notice that my child is short ofbreath.

OIC retainedOIC retainedOIC retainedOIC retainedOIC retainedOIC retained

OIC retainedOIC retainedOIC retained

OIC retainedOIC retained

OIC retained

OIC retainedOIC retained

OIC retainedOIC retainedPB retainedPB retainedPB retainedPB retainedPB retainedPB retainedPB retainedPB retainedPB retained

159

When my child tells me that hislher heart is beating rapidly, I worry that he/she might have a heartattack.

It scares me when my child is nauseous.I feel like I am a bad parent ifmy child becomes stressed out.It scares me when my child's heart beats rapidly.My child will grow out of his/her fears.I get very anxious when my child is ill.When I feel worried that my child is not safe, it is important for me to trust those feelings no matterwhat anyone else says.

It scares me when my child tells me that he/she has unusual body sensations.

When my child is upset, it makes me very anxious.It is important to me that my child not appear nervous.I do not like it when other people see my child is afraid.If I feel that my child is in danger, it is a sure sign that something bad is about to happen.

My child should not have to feel afraid.I try not to restrict my child's activities, decisions, or desires.Friends are such an important choice for a child, so I usually choose my child's friends for him/her.

I let my child decide what to do without giving too much advice.I don't let my child participate in social situations where he/she may become embarrassed or feelashamed.

I try to protect my child from looking foolish in front of others.When my child has something difficult to do, I try to do it for them.Ifmy child will probably be rejected from a group ofpeers, I try to warn my child to avoid thatsituation.

I try to encourage my child to try new and exciting things.My child needs to make his/her own mistakes to learn.My child can handle challenging situations on his/her own.

PB retainedPB retainedPB retainedPB retainedPB retainedPB retained

PB retained

PB retainedPB retainedPB retainedPB retained

PB retainedPB retainedSR retained

SR retainedSR retained

SR retainedSR retainedSR retained

SR retainedSR retainedSR retainedSR retained

160

I keep my child home from school when he/she has a headache or stomachache.

My child is the best person to decide when he/she is ready to confront things that make himlheruncomfortable.

My child cannot decide things for himlherself.It is good for my child to make hislher own decisions.It is OK for my child to play rough activities and sports.When I feel that my child is in danger, all of my attention is immediately directed toward trying toprevent a bad thing from happening.

Before my child tries anything new, we sit down together and review all of the things that might gowrong so that he/she knows what to look out for.

I would change my child's school if problems came up there.When my child is not feeling well, it is best ifhe/she stays home from school so that I can take care ofhimlher.

No matter who is right, I always stand up for my child in an argument.I am very close to my child.I do not want my child to grow up.I have thought about quitting my job (or giving up some activities) to spend more time with my child.

If! want things to work out for me, I have to make sure that my child is kept happy.

My child often tells me that he/she wants to be with me.My child prefers for me to always know where he/she is.If my child wants to be near me, I always make sure to give himlher a lot ofextra attention.

My child is perfect in many respects.No one else should ever criticize my child.My child would become insecure if I did not respond to himlher when he/she is crying.

When my child says he/she feels upset, I worry that there might be something wrong with himlher.

SR retained

SR retainedSR retainedSR retainedSR retained

SR retained

SR retainedSR retained

SR retainedOIC deletedOIC deletedOIC deleted

OIC deleted

OIC deletedOIC deletedOIC deleted

OIC deletedOIC deletedOIC deleted

PB deleted

PB deleted

161

My child is not able to handle anxiety.It scares me when my child is unable to keep hislher mind on a task.When my child cannot keep hislher mind on a task, I worry that he/she might be going crazy.

I get concerned about the circles under my child's eyes.I always trust my instincts when I feel that my child is not safe.It bothers me to think that my child might mess up.It is important to me that my child stay in control ofhislher emotions.It is better if my child does nothing than if he/she something that he/she is not sure of.

I react strongly with my child is worrying.I often am concerned that my child does not look as healthy as he/she should.

Other children notice when my child is afraid.It embarrasses me when my child's stomach growls.If things have been going well for my child, I know that just means that bad times are just around thecomer.

In general, my child seems like he/she is not as healthy as most children.Other people notice when my child feels shaky.My child should learn that other people's opinion ofhirnlher is very important.

When there is a "bug" going around, my child usually ends up catching it.My child seems to get a lot more colds than most children I know.My child does many things on his/her own.I help my child whenever he/she needs assistance with something.I think it is important for my child to play with a group of other children hislherown age.

162

PB deletedPB deleted

PB deletedPB deletedPB deletedPB deletedPB deleted

PB deletedPB deleted

PB deletedPB deletedPB deleted

PB deletedPB deletedPB deleted

PB deletedPB deletedPB deletedSR deletedSR deleted

SR deleted

163

Appendix CPBBA-Q Items Retained and Deleted Following Study 3

Non-Item Anxious Anxious Reason

Scale Number Mean Mean Difference Item Deleted Excluded Explanationtwo part question,

My child knows that he/she can always depend on me "more than anyoneOlC PBBAQ25 2.33 2.09 -0.24 more than on anyone else. parent feedback else"

I am always the one who understands what my child redundant withOlC PBBAQ35 1.74 1.55 -0.19 needs. parent feedback item 72

overly specific,OlC PBBAQ78 1.96 1.82 -0.14 My child comes to me first when he/she has a problem. parent feedback "me first"

I know, more than anyone else, what my child thinksOlC PBBAQ30 1.38 1.55 0.17 about. parent feedback two clauses

I enjoy having separate interests from my childOlC PBBAQll 1.92 2.09 0.17 because then we always have something to talk about. parent feedback two clauses

There are certain aspects of my life (Le., finances,romantic relationships, work-related concerns) which I difficult to

OlC PBBAQ60 1.96 2.18 0.22 don't think my child needs to really know about. parent feedback understandI attend to my own needs before I attend to my child's too general to

OIC PBBAQ75 1.13 1.36 0.23 needs. parent feedback understandIt is difficult for my child and I to be apart from one low

OlC PBBAQ33 1.13 1 -o.l3 another. discrimination

When my child comes home, I make sure that I find lowOlC PBBAQ43 1.52 1.45 -0.07 out everything that he/she has been doing. discrimination

I understand what my child goes through better than lowOlC PBBAQ23 1.87 1.82 -0.05 anyone else does. discrimination

lowOIC PBBAQ5 2.25 2.27 0.02 I know how my child will behave in certain situations. discrimination

Before I make any plans, I try to think about my lowOIC PBBAQ26 2.21 2.27 0.06 child's own needs. discrimination

164

I am quite confident that all of my child's opinions lowOIC PBBAQ40 0.79 0.91 0.12 about things are the same as my own. discrimination

oppositeOIC PBBAQ47 1.67 1.27 ·0.4 In many ways, my child is my best friend. direction

oppositeOIC PBBAQ39 1.46 1.09 -().37 My child is the center of the household. direction

I try to be involved in all ofthe same activities that my oppositeOIC PBBAQ74 1.54 1.18 -0.36 child is. direction

oppositeOIC PBBAQ16 1.75 1.4 -0.35 My child and I enjoy many of the same activities. direction

oppositeOIC PBBAQ66 1.87 1.55 -0.32 I try to be involved in everything that my child does. direction

oppositeOIC PBBAQ65 2.35 2.09 -0.26 My child really needs me. direction

It is so difficult to know what my child is thinking and oppositeOIC PBBAQl9 1.79 1.55 -0.24 feeling. direction

Even though I try to keep everyone's interests in mindwhen making decisions at home, I usually just need to opposite

OIC PBBAQ44 1.96 1.78 -0.18 do what is best for my child. directiondifficult to

When my child tells me that hislher heart is beating understand "heartPB PBBAQ9 1.46 1.27 -0.19 rapidly, I worry that he/she might have a heart attack. parent feedback beating rapidly"

difficult tounderstand "heart

PB PBBAQ42 1.5 1.55 0.05 It scares me when my child's heart beats rapidly. parent feedback beating rapidly"difficult tounderstand

It scares me when my child tells me that he/she has "unusual bodilyPB PBBAQ69 1.43 1.64 0.21 unusual body sensations. parent feedback sensations"

lowPB PBBAQ63 1.83 1.73 -0.1 It scares me when my child gets shaky or trembles. discrimination

If I feel that my child is in danger, it is a sure sign that oppositePB PBBAQ68 1.46 1.2 -0.26 something bad is about to happen. direction

When I feel that my child is in danger, all of myattention is immediately directed toward trying to

SR PBBAQ21 2.52 2.36 -0.16 prevent a bad thing from happening. parent feedback two clauses

Friends are such an important choice for a child, so ISR PBBAQ24 0.92 1.1 0.18 usually choose my child's friends for him/he~ ~arent feedback two clauses

165

166

Appendix CPBBA-Q Items Retained and Deleted Following Study 3

Non-Item Anxious Anxious

Scale Number Mean Mean Difference Item Retained

PB PBBAQ8 2.26 1.8 -0.46 It scares me when I notice that my child is short ofbreath.PB PBBAQIO 1.75 1.3 -0.45 It scares me when my child is nauseous.

OIC PBBAQ46 1.61 1.18 -0.43 My child has the biggest influence over the things that happen in my life.PB PBBAQ27 1.75 1.36 -0.39 When I worry about my child, I feel like I am being a good parent.PB PBBAQ4 I.65 1.27 -0.38 It scares me when my child is nervOus.PB PBBAQ22 1.78 1.4 -0.38 I get very anxious when my child is ill.

OIC PBBAQ49 1.83 1.45 -0.38 No matter how old my child gets, he/she will always be my baby.PB PBBAQ13 1.63 1.27 -0.36 When my child's stomach is upset, I worry that he/she might be seriously ill.

When I feel worried that my child is not safe, it is important for me to trust those feelings noPB PBBAQ48 2.25 1.91 -0.34 matter what anyone else says.

OIC PBBAQ55 1.7 1.4 -0.3 I feel closer to my child sometimes than to my spouse/partner.

My child is the best person to decide when he/she is ready to confront things that make him/herSR PBBAQ50 2 1.73 -0.27 uncomfortable.PB PBBAQ45 1.91 1.64 -0.27 My child will grow out ofhislher fears.

When my child is not feeling well, it is best ifhe/she stays home from school so that I can takeSR PBBAQ70 1.61 1.36 -0.25 care ofhim/her.

Before my child tries anything new, we sit down together and review all of the things that mightSR PBBAQ53 1.42 1.2 -0.22 go wrong so that he/she knows what to look out for.PB PBBAQ61 1.82 1.64 -0.18 It scares me when my child says he/she feels faint.

If my child will probably be rejected from a group ofpeers, I try to warn my child to avoid thatSR PBBAQ32 1.58 1.45 -0.13 situation.PB PBBAQ29 1.3 U8 -0.12 I feel like I am a bad parent if my child becomes stressed out.SR PBBAQ38 2.29 2.18 -0.11 I try to encourage my child to try new and exciting things.

OIC PBBAQl4 1.74 1.64 -0.1 When I have a hard time making up my mind about something, my child can often help me.

167

SR PBBAQ67 1.65 155 -0.1 My child can handle challenging situations on his/her own.

PB PBBAQ18 2.09 2 -0.09 My child should not have to feel afraid.SR PBBAQ31 1.25 1.18 -0.07 When my child has something difficult to do, I try to do it for them.

SR PBBAQ36 1.43 1.36 -0.07 I keep my child home from school when he/she has a headache or stomachache.

SR PBBAQ15 1.88 1.82 -0.06 I try to protect my child from looking foolish in front ofothers.

SR PBBAQ56 2.13 2.09 -0.04 My child needs to make his/her own mistakes to learn.SR PBBAQ59 1.67 1.64 -0.03 I would change my child's school if problems came up there.

OIC PBBAQ52 1.21 1.18 -0.03 I understand my child completely.SR PBBAQ7 1.92 1.91 -O.oI I try not to restrict my child's activities, decisions, or desires.

OIC PBBAQ79 1.92 1.91 -0.01 I try to cut down on my work or social schedule when my child needs more time from me.PB PBBAQ17 1.7 1.73 0.03 When my child is upset, it makes me very anxious.PB PBBAQ37 1.22 1.27 0.05 It is important to me that my child not appear nervous.SR PBBAQ58 2.09 2.18 0.09 It is good for my child to make his/her own decisions.PB PBBAQ76 1.33 1.45 0.12 If my child gets too nervous, it could be really harmfu1.

OIC PBBAQ34 0.96 1.09 0.13 I tell my child everything.OIC PBBAQI 2.13 2.27 0.14 I try to spend as much time with my child as Ipossibly can.PB PBBAQ2 1.58 1.73 0.15 I do not get uncomfortable when my child is upset about something.

OIC PBBAQ72 1.08 1.27 0.19 I am the only one who really understands how my child is feeling.

OIC PBBAQl2 2.25 2.45 0.2 My child is always my ftrst priority.

OIC PBBAQ20 1.798 2 0.202 I know, more than anyone else, how my child feels about things.OIC PBBAQ71 0.88 1.09 0.21 My child affects the number of friendships that I can have.OIC PBBAQ41 1.13 1.36 0.23 I am the only one who can help my child when he/she is nervous.PB PBBAQ54 0.83 1.09 0.26 When my child is nervous, I worry that he/she might be mentally ill.SR PBBAQ28 1.54 1.82 0.28 I let my child decide what to do without giving too much advice.SR PBBAQ51 1.08 1.36 0.28 My child cannot decide things for him/herself.SR PBBAQ73 1.79 2.1 0.31 It is OK for my child to play rough activities and sports.

OIC PBBAQ6 1.96 2.27 0.31 I know how my child will feel about something new.

OIC PBBAQ77 1.38 1.73 0.35 Ifmy child is not feeling well, I will stop all of my other activities to spend time with him/her.OIC PBBAQ64 2.08 2.45 0.37 My child does not control my life.

PB PBBAQ57Ole PBBAQ62

SR PBBAQ3

1.261

1.65

1.71.45

2.2

0.440.45

0.55

168

I do not like it when other people see my child is afraid.My child's fears and worries are just like mine.

I don't let my child participate in social situations where he/she may become embarrassed or feelashamed.

169

AppendixDPBBA-Q

Child's Name: Date: _

Relationship to child: Mother Father Other: _

Listed below are some statements about how you might get along with your child.Please read each statement carefully and circle the answer which indicates how much youagree with each statement/or you and your child. There are no right or wrong answers.Do not spend too much time on any statement.

Remember, we would like to know what your relationship with your child seemslike to you. So do not try to figure out how other people might see your relationship withyour child, but do give us your impression of your relationship with your one child whosename is listed above, for each statement.

1 My child is the best person to decide when he/she is ready to Strongly Stronglyconfront things that make himlher uncomfortable. Agree

Agree Disagree Disagree

2 When my child is upset, it makes me very anxious. Strongly StronglyAgree

Agree DisagreeDisagree

3 It scares me when I notice that my child is short ofbreath. Strongly StronglyAgree


4 I feel like I am a bad parent if my child becomes stressedStrongly Strongly

out. AgreeAgree Disagree Disagree

5 Ifmy child is not feeling well, I will stop all of my otherStrongly Strongly

activities to spend time with himlher. AgreeAgree Disagree Disagree

6 My child does not control my life. Strongly Agree DisagreeStrongly

Agree Disagree

7 I am the only one who can help my child when he/she is Strongly Stronglynervous. Agree


8 If my child gets too nervous, it could be really harmful. Strongly StronglyAgree


9 My child should not have to feel afraid. Strongly StronglyAgree


10 My child will grow out of his/her fears. StronglyAgree Disagree

StronglyAgree Disagree

11 I understand my child completely. Strongly StronglyAgree


12 When my child is nervous, I worry that he/she might beStrongly Strongly

mentally ill. AgreeAgree Disagree

Disagree

170

13 I get very anxious when my child is ill. Strongly Agree DisagreeStrongly

Agree Disagree

14 I try not to restrict my child's activities, decisions, or Strongly Agree DisagreeStrongly

desires. Agree Disagree

15 My child is always my ftrst priority. Strongly Agree Disagree StronglyAgree Disagree

16 When I have a hard time making up my mind aboutStrongly Strongly

something, my child can often help me. Agree Agree Disagree Disagree

17 It is OK for my child to play rough activities and sports. Strongly Agree Disagree StronglyAgree Disagree

18 It is good for my child to make his/her own decisions. Strongly Agree Disagree StronglyAgree Disagree

19 I would change my child's school ifproblems came up Strongly Agree Disagree Stronglythere. Agree Disagree

20 My child affects the number of friendships that I can have. Strongly Agree Disagree StronglyAgree Disagree

21 My child's fears and worries are just like mine. Strongly Agree Disagree StronglyAgree Disagree

22 I do not like it when other people see my child is afraid. Strongly Agree DisagreeStrongly

Agree Disagree

23 No matter how old my child gets, he/she will always be my Strongly Agree Disagree Stronglybaby. Agree Disagree

24 My child cannot decide things for himlherself. Strongly Agree Disagree StronglyAgree Disagree

25 I tell my child everything. Strongly Agree Disagree StronglyAgree Disagree

26 When my child's stomach is upset, I worry that he/she might Strongly Agree Disagree Stronglybe seriously ill. Agree Disagree

27 I keep my child home from school when he/she has a Strongly Agree Disagree Stronglyheadache or stomachache. Agree Disagree

28 My child needs to make hislher own mistakes to learn. Strongly Agree Disagree StronglyAgree Disagree

29 I try to cut down on my work or social schedule when my Strongly Agree Disagree Stronglychild needs more time from me. Agree Disagree

30 My child has the biggest influence over the things that Strongly Agree Disagree Stronglyhappen in my life. Agree Disagree

31 I try to encourage my child to try new and exciting things. Strongly Agree Disagree StronglyAgree Disagree

32 When my child has something difficult to do, I try to do it Strongly Agree Disagree Stronglyfor them. Agree Disagree

171

33 When I worry about my child, I feel like I am being a good StronglyAgree Disagree

Stronglyparent. Agree Disagree

34 Before my child tries anything new, we sit down togetherand review all ofthe things that might go wrong so that Strongly

Agree DisagreeStrongly

he/she knows what to look out for. Agree Disagree

35 My child can handle challenging situations on his/her own. StronglyAgree Disagree


36 I know how my child will feel about something new. StronglyAgree Disagree


37 When my child is not feeling well, it is best if he/she staysStrongly Strongly

home frOI,11 school so that I can take care ofhim/her. AgreeAgree Disagree

Disagree

38 I try to protect my child from looking foolish in front of StronglyAgree Disagree

Stronglyothers. Agree Disagree

39 It scares me when my child is nervous. StronglyAgree Disagree


40 When I feel worried that my child is not safe, it is importantfor me to trust those feelings no matter what anyone else Strongly

Agree DisagreeStrongly

says. Agree Disagree

41 I know, more than anyone else, how my child feels about StronglyAgree Disagree

Stronglythings. Agree Disagree

42 I do not get uncomfortable when my child is upset aboutStrongly Strongly

something. AgreeAgree Disagree

Disagree

43 It scares me when my child says he/she feels faint. StronglyAgree Disagree


44 It scares me when my child is nauseous. StronglyAgree Disagree


45 It is important to me that my child not appear nervous. StronglyAgree Disagree


46 I don't let my child participate in social situations where StronglyAgree Disagree

Stronglyhe/she may become embarrassed or feel ashamed. Agree Disagree

47 If my child will probably be rejected from a group ofpeers,Strongly Strongly

I try to warn my child to avoid that situation. AgreeAgree Disagree

Disagree

48 I feel closer to my child sometimes than to my StronglyAgree Disagree

Stronglyspouse/partner. Agree Disagree

49 I am the only one who really understands how my child is StronglyAgree Disagree

Stronglyfeeling. Agree Disagree

50 I let my child decide what to do without giving too much StronglyAgree Disagree

Stronglyadvice. Agree Disagree

51 I try to spend as much time with my child as I possibly can. StronglyAgree

Agree Disagree

172

StronglyDisagree

173

Appendix E

DASS21 Name: Date:

Please read each statement and circle a number 0, 1, 2 or 3 that indicates how much thestatement applied to you over the past week. There are no right or wrong answers. Donot spend too much time on any statement.

The rating scale is as follows:

o Did not apply to me at all1 Applied to me to some degree, or some of the time2 Applied to me to a considerable degree, or a good part of time3 Applied to me very much, or most of the time

1 I found it hard to wind down 0 1 2 3

2 I was aware of dryness of my mouth 0 1 2 3

3 I couldn't seem to experience any positive feeling at all 0 1 2 3

4 I experienced breathing difficulty (eg, excessively rapid 0 1 2 3breathing,breathlessness in the absence of physical exertion)

5 I found it difficult to work up the initiative to do things 0 1 2 3

6 I tended to over-react to situations 0 1 2 3

7 I experienced trembling (eg, in the hands) 0 1 2 3

8 I felt that I was using a lot of nervous energy 0 1 2 3

9 I was worried about situations in which I might panic and make 0 1 2 3a fool of myself

10 I felt that I had nothing to look forward to 0 1 2 3

11 I found myself getting agitated 0 1 2 3

12 I found it difficult to relax 0 1 2 3

13 I felt down-hearted and blue 0 1 2 3

14 I was intolerant of anything that kept me from getting on with 0 1 2 3what I was doing

15 I felt I was close to panic 0 1 2 3

16 I was unable to become enthusiastic about anything 0 1 2 3

17 I felt I wasn't worth much as a person 0 1 2 3

174

18 I felt that I was rather touchy 0 1 2 3

19 I was aware of the action of my heart in the absence of 0 1 2 3physicalexertion (eg, sense of heart rate increase, heart missing abeat)

20 I felt scared without any good reason 0 1 2 3

21 I felt that life was meaningless 0 1 2 3

175

Appendix FPANAS

This scale consists of a number of words that describe different feelings and emotions.Read each item and then circle the appropriate answer next to that word.Indicate to what extent you have felt this way during the past few weeks.

Very slightlyA little Moderately Quite a bit Extremely

or not at all

1. Interested 1 2 3 4 5

2. Distressed 1 2 3 4 5

3. Excited 1 2 3 4 5

4. Upset 1 2 3 4 5

5. Strong 1 2 3 4 5

6. Guilty 1 2 3 4 5

7. Scared 1 2 3 4 5

8. Hostile 1 2 3 4 5

9. Enthusiastic 1 2 3 4 5

10. Proud 1 2 3 4 5

11. Irritable 1 2 3 4 5

12. Alert 1 2 3 4 5

13. Ashamed 1 2 3 4 5

14. Inspired 1 2 3 4 5

15. Nervous 1 2 3 4 5

16. Determined 1 2 3 4 5

17. Attentive 1 2 3 4 5

18. Jittery 1 2 3 4 5

19. Active 1 2 3 4 5

20. Afraid 1 2 3 4 5

176

177

AppendixGChild's Number Rater Date -------:--

Dimensional Rating SheetBased on the child and parent portion of the assessments, please assign a dimensional rating (DR) from 0 to 8 for the featuresof each disorder, whether or not criteria are met for that disorder. In order to make the measures sensitive, be sure to assign azero (0) rating only when there is no trace or feature of that disorder. Ifmultiple disorders or areas are present within one ratingscale (e.g., multiple specific phobias), please indicate this by assigning an appropriately increased DR for that scale.

Child VersionSeparation Anxiety

Generalized Anxiety

Social Anxiety

Obsessions/Compulsions

Panic

Agoraphobia

Posttraumatic Stress

Specific Fear/Phobia

Depression/Dysthymic Disorder

Oppositional

Delinquent

Hyperactive

Inattentive

Parent VersionSeparation Anxiety

Generalized Anxiety

Social Anxiety

Obsessions/Compulsions

Panic

Agoraphobia

Posttraumatic Stress

Specific Fear/Phobia

Depression/Dysthymic Disorder

Oppositional

Delinquent

Hyperactive

Inattentive

178AppendixH

CHILD BEHAVIOR CHECKLIST FOR AGES 6-18

Below is a list of items that describe children and youths. For each item that describesyour child now or within the past 6 months, please circle the 2 if the item is very trueor often true of your child. Circle the 1 if the item is somewhat or sometimes true ofyour child. If the item is not true ofyour child, circle the O. Please answer all items aswell as you can, even if some do not seem to apply to your child.

1. Acts too young for hislher age2. Drinks alcohol without parents' approval (describe):~ _3. Argues a lot4. Fails to finish things helshe starts5. There is very little helshe enjoys6. Bowel movements outside toilet7. Bragging, boasting8. Can't concentrate, can't pay attention for long9. Can't get his/her mind off certain thoughts; obsessions (describe): _10. Can't sit still, restless, or hyperactive11. Clings to adults or too dependent12. Complains of loneliness13. Confused or seems to be in a fog14. Cries a lot15. Cruel to animals16. Cruelty, bullying, or meanness to others17. Daydreams or gets lost in his/her thoughts18. Deliberately harms selfor attempts suicide19. Demands a lot ofattention20. Destroys hislher own things21. Destroys things belonging to hislher family or others22. Disobedient at home23. Disobedient at school24. Doesn't eat well25. Doesn't get along with other kids26. Doesn't seem to feel guilty after misbehaving27. Easily jealous28. Breaks rules at home, school, or elsewhere29. Fears certain animals, situations, or places, other than school (describe): _30. Fears going to school31. Fears helshe might think or do something bad32. Feels helshe has to be perfect33. Feels or complains that no one loves him/her34. Feels others are out to get him/her35. Feels worthless or inferior36. Gets hurt a lot, accident-prone

37. Gets in many'fights38. Gets teased a lot39. Hangs around with others who get in trouble40. Hears sound or voices that aren't there (describe): _41. Impulsive or acts without thinking42. Would rather be alone than with others43. Lying or cheating44. Bites fingernails45. Nervous, high-strung, or tense46. Nervous movements or twitching (describe): _47. Nightmares48. Not liked by other kids49. Constipated, doesn't move bowels50. Too fearful or anxious51. Feels dizzy or lightheaded52. Feels too guilty53. Overeating54. Overtired without good reason55. Overweight56. Physical problems without known medical cause:a. Aches or pains ( not stomach or headaches)b. Headachesc. Nausea, feels sickd. Problems with eyes (not if corrected by glasses) (describe): _e. Rashes or other skin problemsf. Stomachachesg. Vomiting, throwing uph. Other (describe): ---57. Physically attacks people58. Picks nose, skin, or other parts of body (describe): _59. Plays with own sex parts in public60. Plays with own sex parts too much61. Poor school work62. Poorly coordinated or clumsy63. Prefers being with older kids64. Prefers being with younger kids65. Refuses to talk66. Repeats certain acts over and over; compulsions (describe): __- _67. Runs away from home68. Screams a lot69. Secretive, keeps things to self70. Sees things that aren't there (describe): ~

71. Self-conscious or easily embarrassed72. Sets fires73. Sexual problems (describe): _

179

18074. Showing off or clowning75. Too shy or timid76. Sleeps less than most kids77. Sleeps more than most kids during day and/or night (describe):~_~_~_78. Inattentive or easily distracted79. Speech problem (describe): _80. Stares blankly81. Steals at home82. Steals outside the home83. Stores up too many things he/she doesn't need (describe): ~_~_

84. Strange behavior (describe): _85. Strange ideas (describe): _86. Stubborn, sullen, or irritable87. Sudden changes in mood or feelings88. Sulks a lot89. Suspicious90. Swearing or obscene language91. Talks about killing self92. Talks or walks in sleep (describe): _. - _93. Talks too much94. Teases a lot95. Temper tantrums or hot temper96. Thinks about sex too much97. Threatens people98. Thumb-sucking99. Smokes, chews, or sniffs tobacco100. Trouble sleeping (describe): _101. Truancy, skips school102. Underactive, slow moving, or lacks energy103. Unhappy, sad, or depressed104. Unusually loud105. Uses drugs for nonmedical purposes (don't include alcohol or tobacco) (describe):106. Vandalism107. Wets selfduring the day108. Wets the bed109. Whining110. Wishes to be ofopposite sex111. Withdrawn, doesn't get involved with others112. Worries113. Please write in any problems your child has that were not listed above:

181Appendix I

ReADSPlease put a circle around the word that shows how often each of these things happen toyou. There are no right or wrong answers.

1. I worry about things. Never Sometimes Often Always

2. I feel sad or empty. Never Sometimes Often Always

3. When I have a problem, I get a funny Never Sometimes Often Alwaysfeeling in my stomach.

4. I worry when I think I have done Never Sometimes Often Alwayspoorly at something.

5. I would feel afraid of being on my Never Sometimes Often Alwaysown at home.

6. Nothing is much fun anymore. Never Sometimes Often Always

7. I feel scared when I have to take a Never Sometimes Often Alwaystest.

8. I feel worried when I think someone Never Sometimes Often Alwaysis angry with me.

9. I worry about being away from my Never Sometimes Often Alwaysparents.

10. I get bothered by bad or silly thoughts Never Sometimes Often Alwaysor pictures in my mind.

11. I have trouble sleeping. Never Sometimes Often Always

12. I worry that I will do badly at my Never Sometimes Often Alwaysschool work.

13. I worry that something awful will Never Sometimes Often Alwayshappen to someone in my family.

14. I suddenly feel as if I can't breathe Never Sometimes Often Alwayswhen there is no reason for this.

15. I have problems with my appetite. Never Sometimes Often Always

182

16. I have to keep checking that I have Never Sometimes Often Alwaysdone things right (like the switch isoff, or the door is locked)

17. I feel scared if I have to sleep on my Never Sometimes Often Alwaysown.

18. I have trouble going to school in the Never Sometimes Often Alwaysmornings because I feel nervous orafraid.

19. I have no energy for things. Never Sometimes Often Always

20. I worry I might look foolish. Never Sometimes Often Always

21. I am tired a lot. Never Sometimes Often Always

22. I worry that bad things will happen.to Never Sometimes Often Alwaysme.

23. I can't seem to get bad or silly Never Sometimes Often Alwaysthoughts out ofmy head.

24. When I have a problem, my heart Never Sometimes Often Alwaysbeats really fast.

25. I cannot think clearly. Never Sometimes Often Always

26. I suddenly start to tremble or shake Never Sometimes Often Alwayswhen there is no reason for this.

27. I worry that something bad will Never Sometimes Often Alwayshappen to me.

28. When I have a problem, I feel shaky. Never Sometimes Often Always

29. I feel worthless. Never Sometimes Often Always

30. I worry about making mistakes. Never Sometimes Often Always

31. I have to think of special thoughts Never Sometimes Often Always(like numbers or words) to stop badthings from happening.

183

32. I worry what other people think of Never Sometimes Often Alwaysme.

33. I am afraid of being in crowded Never Sometimes Often Alwaysplaces (like shopping centers, themovies, buses, busy playgrounds).

34. All ofa sudden, I feel really sacred Never Sometimes Often Alwaysfor no reason at all.

35. I worry about what is going to Never Sometimes Often Alwayshappen.

36. I suddenly become dizzy or faint Never Sometimes Often Alwayswhen there is no reason for this.

37. I think about death. Never Sometimes Often Always

38. I feel afraid if I have to talk in front of Never Sometimes Often Alwaysmy class.

39. My heart suddenly starts to beat too Never Sometimes Often Alwaysquickly for no reason.

40. I feel like I don't want to move. Never Sometimes Often Always

41. I worry that I will suddenly get a Never Sometimes Often Alwaysscared feeling when there is nothingto be afraid of.

42. I have to do some things over and Never Sometimes Often Alwaysover again (like washing my hands,cleaning or putting things in a certainorder).

43. I feel afraid that I will make a fool of Never Sometimes Often Alwaysmyself in front of people.

44. I have to do some things in just the Never Sometimes Often Alwaysright way to stop bad things fromhappening.

45. I worry when I go to bed at night. Never Sometimes Often Always

46. I would feel scared if I had to stayaway from home overnight.

47. I feel restless.

Never Sometimes Often

Never Sometimes Often

184Always

Always

185AppendixJ

Feelings and Emotions (Positive Affect and Negative Affect Scale-Child Version)This scale consists ofa number of words that describe different feelings and emotions.Read each item and then circle the appropriate answer next to that word.Indicate to what extent you have felt this way during the past few weeks.

Very A little Moderately Quite a bit Extremelyslightly ornot at all

Interested I 2 3 4 5

Sad I 2 3 4 5

Frightened I 2 3 4 5

Excited I 2 3 4 5

Ashamed I 2 3 4 5

Upset I 2 3 4 5

Happy 1 2 3 4 5

Strong I 2 3 4 5

Nervous 1 2 3 4 5

Guilty I 2 3 4 5

Energetic I 2 3 4 5

Scared I 2 3 4 5

Calm I 2 3 4 5

Miserable I 2 3 4 5

Jittery I 2 3 4 5

Cheerful I 2 3 4 5

Active I 2 3 4 5

Proud I 2 3 4 5

Afraid I 2 3 4 5

Joyful I 2 3 4 5

Lonely 1 2 3 4 5

Mad I 2 3 4 5

Disgusted I 2 3 4 5

Delighted I 2 3 4 5

Blue I 2 3 4 5Gloomy I 2 3 4 5

Lively I 2 3 4 5

186AppendixK

AFARS

Directions: This form is about how your feel. For each sentence that you read, circle theanswer that best tells how true that sentence is about how you usually feel. Remember,there are no right or wrong answers, just circle what you think describes you best.

1.When I'm doing well at something, never sometimes most times alwaysI really feel good. true true true true

2. Other people upset me.never sometimes most times alwaystrue true true true

3.Often I have trouble getting my never sometimes most times alwaysbreath. true true true true

4. I get upset easily.never sometimes most times alwaystrue true true true

5. My mouth gets dry.never sometimes most times alwaystrue true true true

6. I have fun at school.never sometimes most times alwaystrue true true true

7. My heart beats too fast.never sometimes most times alwaystrue true true true

8. Little things bother me.never sometimes most times alwaystrue true true true

9I will try something new if I think it never sometimes most times alwayswill be fun. true true true true

10. My hands get shaky.never sometimes most times alwaystrue true true true

11.When I get something I want, I feel never sometimes most times alwaysexcited. true true true true

12. lover-react to things.never sometimes most times alwaystrue true true true

13. I have trouble swallowing.never sometimes most times alwaystrue true true true

14. I love going to new places.never sometimes most times alwaystrue true true true

15. I get upset by little things.never sometimes most times alwaystrue true true true

16. I feel shaky.never sometimes most times alwaystrue true true true

17. I would love to win a contest.never sometimes most times alwaystrue true true true

18. I don't like to wait for things.never sometimes most times alwaystrue true true true

19. I like being with people. never sometimes most times always

187true true true true

20. I have trouble breathing.never sometimes most times alwaystrue true true true

21.When I see a chance for fun, I take never sometimes most times alwaysit. true true true true

22. I get upset.never sometimes most times alwaystrue true true true

23.When good things happen to me, I never sometimes most times alwaysfeel full of energy. true true true true

24. I have plenty of friends. never sometimes most times alwaystrue true true true

25. I sometimes feel faint.never sometimes most times alwaystrue true true true

26. I can't calm down once I'm upset.never sometimes most times alwaystrue true true true

27. Often I feel sick in my stomach.never sometimes most times alwaystrue true true true

188AppendixL

Table 4.1

Analysis ofCovariance ofthe OIC Scale ofthe PBBA-Q with Family Income Acijustedand the Child's Gender (n=59)

Source

CorrectedModel

Intercept

FamilyIncome

Gender

Error

Total

CorrectedTotal

Type ill Sum ofdf Mean Square

Squares

243.00 2 121.499

18775.74 1 18775.74

219.36 1 219.36

75.87 1 75.87

1744.93 56 31.16

38763.00 59

1987.93 58

F

3.90

602.57

7.04

2.44

p

.03

.00

.01

.12

189

Table 5.1

Analysis o/Covariance o/the OIC Scale o/the PBBA-Q with Family Income A4justedand the Parent Marital Status (n=59)

Source

CorrectedModel

Intercept

FamilyIncome

ParentMaritalStatus

Error

Total

CorrectedTotal

Table 19.1

Type III Sum ofSquares

207.58

20872.94

139.18

40.45

1780.35

38763.00

1987.93

df

3

1

1

2

55

59

58

Mean Square

69.19

20872.94

139.18

20.23

32.37

F

2.14

644.823

4.30

.63

p

.11

.00

.04

.54

Partial Correlations Among the OIC Scale o/the PBBA-Q scale and the Anxiety, Stress,and Depression scales o/the Parent-Completed DASS-21, Controlling/or Family Income

PBBA.Q ole scale

DASS Anxiety

.13

DASS Stress

.11

DASS Depression

.15

190

Table 20.1

Partial Correlations Among the OIC Scale ofthe PBBA-Q scale and the Negative Affectand Positive Affect scales ofthe Parent-Completed PANAS, Controllingfor FamilyIncome

PBBA-Q ole scale

Table 21.1

PANASNA

.11

PANASPA

-.07

Analysis ofCovariance ofthe OIC Scale ofthe PBBA-Q with Family Income Adjustedand the Child's Anxiety Diagnostic Status (n=59)

Source

CorrectedModel

Intercept

FamilyIncome

AnxietyDiagnostic

Status

Error

Total

CorrectedTotal

Type ill Sum ofSquares

267.55

20113.58

168.765

100.42

1720.38

38763.00

1987.93

df

2

1

1

1

56

59

58

Mean Square

133.78

20113.58

168.77

100.42

30.72

F

4.36

654.72

5.49

3.27

p

.02

.00

.02

.08

191Table 22.1

Partial Correlations Among the OIC Scale ofthe PBBA-Q, the Broad-Band InternalizingScale ofthe CBCL, and the Narrow-Band Anxious/Depress, Withdrawn/Depressed, andSomatic Complaints Scales ofthe Parent-Report CBCL, Controllingfor Family Income

InternalizingScale

PBBA~Q OIC scale .02

Table 23.1

AnxiouslDepressed

-.00

Withdrawn!Depressed

-.09

SomaticComplaints

.20

Partial Correlations Among the OIC Scale ofthe PBBA-Q and the Total AnxietyDimensional Rating Score Obtained From Parent and Child Report on the ADIS-IV-C/P,Controllingfor Family Income

Parent-ADIS-IV AnxietyDimensional Rating Total

PBBA-Q OIC scale .06

Table 24.1

Child-ADIS-IV AnxietyDimensional Rating Total

.19

Partial Correlations Among the Ole Parent-Reported PBBA-Q Scale, Each AnxietyScale ofthe RCADS, and the RCADS Total Anxiety Score, Controllingfor Family Income

RCADSScale PBBA-Q OIC scale

Separation Anxiety .03

Generalized Anxiety .14

Depression -.05

Panic .04

Social Phobia .21

Obsessive Compulsive .15

Total Anxiety .15

192Table 25.1

Partial Correlations Among the OIC Parent-Reported PBBA-Q Scale, the NA and PAScales ofthe Child-Report PANAS-C, and the NA, PH, and PA scales ofthe Child-ReportAFARS, Controllingfor Family Income

Table 26.1

Child-Report Scale

PANASNA

PANASPA

AFARSNA

AFARSPH

AFARSPA

PBBA-Q OIC scale

.16

.23

.05

.11

.10

Partial Correlations Among Parent Report on the Ole Scale ofthe PBBA-Q, Child andParent Externalizing Dimensional Ratings as derived from the Opposition, Delinquency,Inattention, and Hyperactivity portions ofthe ADIS-IV, and Parent Report on theExternalizing Subscale Composite ofthe Child Behavior Checklist, ControllingforFamily Income

PBBA-Q OIC Scale

Parent-ADIS-IV Externalizing DimensionalRating Total

Child-ADIS-IV Externalizing DimensionalRating Total

Child Behavior Checklist Externalizing ScaleComposite Score

-.16

-.11

-.08

193References

Achenbach, T. M., Howell, C. T., McConaughy, S. H., & Stanger, C. (1995). Six year

predictors ofproblems in a national sample ofchildren and youth: 1. Cross

informant syndromes. Journal ofthe American Academy ofChild and Adolescent

Psychiatry, 34, 336-347.

Achenbach, T. M., & Rescorla, L. A. (2001). Manualfor ASEBA school-age/orms &

profiles. Burlington, VT: University of Vermont, Research Center for Children,

Youth, & Families.

Albano, A. M., Chorpita, B. F., & Barlow, D. H. (2003). Childhood anxiety disorders. In

E. J. Mash & R. A. Barkley (Eds.), Child Psychopathology (20d ed.). New York:

Guilford.

Albano, A.. M., & Detweiler, M. F. (2001). The developmental and clinical impact of

social anxiety and social phobia in children and adolescents. In S. G. Hoffman &

P. M. DiBartolo (Eds.), Social phobia and social anxiety: An integration (pp. 162

178). New York: Plenum.

American Psychiatric Association. (2000). Diagnostic and statistical manual ofmental

disorders, text revised (4th ed.). Washington, DC: Author.

Antony, M. M., Beiling, P. J., Cox, B. J., Bnns, M. W., & Swinson, R. P. (1998).

Psychometric properties of the 42-item and 21-item versions of the Depression

Anxiety Stress Scales in clinical groups and a community sample. Psychological

Assessment, 10, 176-181.

194Arnold, D. S., O'Leary, S. G., Wolff, L. S., & Acker, M. M. (1993). The Parenting Scale:

A measure ofdysfunctional parenting in discipline situations. Psychological

Assessment, 5, 137-144.

Barlow, D. H. (2000). Unraveling the mysteries of anxiety and its disorders from the

perspective ofemotion theory. American Psychologist, 55, 1245-1263.

Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment ofanxiety and

panic (2nd ed.). New York: Guilford.

Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in

social psychological research: Conceptual, strategic, and statistical considerations.

Journal ofPersonality and Social Psychology, 51, 1173-1182.

Barrett, P. M., Dadds, M. R., & Rapee, R. M. (1996). Family treatment ofchildhood

anxiety: A controlled trial. Journal ofConsulting & Clinical Psychology, 64, 333-

342.

Barrett, P. M., Rapee, R. M., Dadds, M. R., & Ryan, S. M (1996). Family enhancement

ofcognitive style in anxious and aggressive children. Journal ofAbnormal Child

Psychology, 24, 187-203.

Baumrind, D. (1967). Child care practices anteceding three patterns of preschool

behavior. Genetic Psychology Monographs, 75,43-88.

Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory

for measuring depression. Archives ofGeneral Psychiatry, 4, 561-571.

Beidel, D. C., & Turner, S. M. (1997). At risk for anxiety: I. Psychopathology in the

offspring ofanxious parents. Journal ofthe American Academy ofChild &

Adolescent Psychiatry, 36, 9~8-924.

195Bell-Dolan, D., & Brazeal, T. J. (1993). Separation anxiety disorder, overanxious

disorder, and school refusal. Child and Adolescent Psychiatric Clinics ofNorth

America, 2, 563-580.

Bennet, A., & Stirling, J. (1998). Vulnerability factors in the anxiety disorders. British

Journal ofMedical Psychology, 71, 311-321.

Bernstein, G. A., & Borchardt, C. M. (1991). Anxiety disorders ofchildhood and

adolescence: A critical review. Journal ofthe American Academy ofChild and

Adolescent Psychiatry, 30, 519-532.

Biedennan, J. Rosenbaum, J. F., Bolduc-Murphy, E. A., Faraone, S. V., Chaloff, J,

Hirshfeld, D. R., et al. (1993). A three year follow-up ofchildren with and

without behavioral inhibition. Journal ofthe American Academy ofChild and


Biedennan, J. Rosenbaum, J. F., Bolduc, E. A, Faraone, S. V., & Hirshfeld, D. R.

(1991). A high risk study ofyoung children ofparents with panic disorder and

agoraphobia with and without comorbid major depression. Psychiatry Research,

37, 333-348.

Block, J. H. (1965). Child rearingpractices report: A set ofitems for the description of

parental socialization and values. Berkeley, CA: University of California.

Bloom, B. L., & Naar, S. (1994). Self-report measures of family functioning: Extensions

of a factorial analysis. Family Process, 33, 203-216.

196Brown, 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 ofAbnormal


Brown, T. A., Chorpita, B. F., Korotitsch, W., & Barlow, D. H. (1997). Psychometric

properties of the Depression Anxiety Stress Scales (DASS) in clinical samples.

Behaviour Research and Therapy, 35, 79-89.

Burl, J. R. (1989). Self-esteem and appraisals of parental behavior. Journal ofAdolescent

Behavior, 4, 33-49.

Butler, G., & Mathews, A. (1983). Cognitive processes in anxiety. Advancements in

Behavior Research and Therapy, 5, 51-62.

Campis, L. K., Lyman, R. D., & Prentice-Dunn, S. (1986). The Parental Locus of Control

Scale: Development and validation. Journal ofClinical Child Psychiatry, 15, 260-

267.

Chorpita, B. F. (2002). The tripartite model and dimensions ofanxiety and depression:

An examination of structure in a large school sample. Journal ofAbnormal Child


Chorpita, B. F., Albano, A. M., & Barlow, D. H. (1998). The structure ofnegative

emotions in a clinical sample ofchildren and adolescents. Journal ofAbnormal


Chorpita, B. F., & Barlow, D. H. (1998). The development ofanxiety: The role ofcontrol

in the early environment. Psychological Bulletin, 124, 3-21.

197Chorpita, B. F., Brown, T. A., & Barlow, D. H. (1998). Perceived control as a mediator

of family environment in etiological models of childhood anxiety. Behavior

Therapy, 29, 457-476.

Chorpita, B. F., & Daleiden, E. L. (2002). Tripartite dimensions of emotion in a child

clinical sample: Measurement strategies and implications for clinical utility.

Journal ofConsulting and Clinical Psychology, 70, 1150-1160.

Chorpita, B. F., Daleiden, E. L., Moffitt, C., Yim, L., & Umemoto, L. A. (2000).

Assessment of tripartite factors ofemotion 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.

Chorpita, B. F., Moffitt, C. E., & Gray, J. (in press). Psychometric properties of the

Revised Child Anxiety and Depression Scale in a clinical sample. Behavior

Research and Therapy.

Chorpita, B. F., Plummer, M., & Moffitt, C. E. (2000). Relations of tripartite dimensions

ofemotion to childhood anxiety and mood disorders. Journal ofAbnormal Child


Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000).

Assessment of symptoms of DSM-IV anxiety and depression in children: A

revised child anxiety and depression scale. Behaviour Research and Therapy, 38,

835-855.

Clara, I. P., Cox, B. 1., & Enns, M. W. (2001). Confirmatory factor analysis of the

Depression-Anxiety-Stress Scales in depressed and anxious patients. Journal of

Psychopathology and Behavioral Assessment, 23, 61-67.

198Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression:

Psychometric evidence and taxonomic implications. Journal ofAbnormal


Clark, L. A., & Watson, D. (1995). Constructing validity: Basic issues in objective scale

development. Psychological Assessment, 7,309-319.

Cobham, V. E. (1998). The case for involving the family in the treatment of childhood

anxiety. Behaviour Change, 15, 203-212.

Cobham, V. E., Dadds, M. R., & Spence, S. H. (1998). The role ofparental anxiety in

the treatment ofchildhood anxiety. Journal ofConsulting and Clinical


Cobham, V. E., Dadds, M. R., & Spence, S. H. (1999). Anxious children and their

parents: What do they expect? Journal ofClinical Child Psychology, 28, 220

231.

Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155-159.

Costello, E. J., & Angold, A. (1995). Epidemiology in anxiety disorders in children and

adolescents. In J. S. March (Ed.), Anxiety disorders in children and adolescents

(pp. 109-124). New York: Guilford.

Cowan, P.A., Cohn, D. A., Cowan, C. P., & Pearson, J. L. (1996). Parents' attachment

histories and children's externalizing and internalizing behaviors: Exploring

family systems models of linkage. Journal ofConsulting and Clinical


199Crawford, A. M., & Manassis, K. (2001). Familial predictors of treatment outcome in

childhood anxiety disorders. Journal of the American Academy of Child and


Dadds, M. R, & Barrett, P. M. (1996). Family processes in child and adolescent anxiety

and depression. Behaviour Change, 13,231-239.

Dadds, M. R, Barrett, P. M., Rapee, R M., & Ryan, S. (1996). Family process and child

anxiety and aggression: An observational analysis. Journal ofAbnormal Child


Dadds, M. R., Bovbjerg, D., Rood, W. H., & Cutmore, T. H. (1997). Imagery and human

classical conditioning. Psychological Bulletin, 122, 89-103.

Dadds, M. R., Davey, G. C. L., & Field, A. P. (2001). Developmental aspects of

conditioning processes in anxiety disorders. In M. W. Vasey & M. R Dadds

(Eds.), The Developmental Psychopathology ofAnxiety (pp.205-230). Oxford:

Oxford University Press.

Dadds, M. R, Heard, P. M., & Rapee, R M. (1991). Anxiety disorders in children.

International Review ofPsychiatry, 3, 231-241.

Dadds, M. R, Holland, D. E., Laurens, K. R, Mullins, M., Barrett, P. M., & Spence, S.

H. (1999). Early intervention and prevention of anxiety disorders in children:

Results at 2-year follow-up. Journal ofConsulting and Clinical Psychology, 67,

145-150.

Dadds, M. R, & Roth, J. H. (2001). Family processes in the development of anxiety

problems. In M. W. Vasey & M. R Dadds (Eds.), The Developmental

Psychopathology ofAnxiety (pp. 278-303). Oxford: Oxford University Press.

200Daleiden, E., Chorpita, B. F., Lu, W. (2000). Assessment of tripartite factors of emotion

in children and adolescents II: Concurrent validity of the Affect and Arousal

Scales for Children. Journal ofPsychopathology and Behavioral Assessment, 22,

161-182.

Davey, G. C. L. (1992). Classical conditioning and the acquisition of human fears and .

phobias: A review and synthesis of the literature. Advances in Behaviour

Research and Therapy, 14, 29-66.

Dekovic, M., Janssens, J. M. A. M., & Gerris, 1. R. M. (1991). Factor structure and

construct validity of the Block Child Rearing Practices Report (CRPR).

Psychological Assessment, 3, 182-187.

Dibble, E., & Cohen, D. J. (1974). Comparison instruments for measuring children's

competence and parental style. Archives ofGeneral Psychiatry, 30, 805-815.

DiNardo, P. A., O'Brien, G. T., Barlow, D. H., Waddell, M. T., & Blanchard, E. B.

(1983). Reliability of DSM-III anxiety disorders using a new structured interview.

Archives ofGeneral Psychiatry, 22, 1070-1078.

Dumas, J. E., & Lafreniere, P. 1. (1993). Mother-child relationships as sources of support

or stress: A comparison of competent, average, aggressive, and anxious dyads.

Child Development, 64, 1732-1754.

Dumas, J. E., Lafreniere, P. J., & Serketich, W. J. (1995). "Balance ofpower": A

transactional analysis of control in mother-child dyads involving socially

competent, aggressive, and anxious children. Journal ofAbnormal Psychology,

104, 104-113.

201Eley, T. C. (2001). Contributions of behavioral genetics research: Quantifying genetic,

shared environmental and nonshared environmental influences. In M. W. Vasey

& M. R. Dadds (Eds.), The developmental psychopathology ofanxiety (pp. 45·

59). New York: Oxford University.

Evans, J. D. (1996). Straightforward statistics for the behavioral sciences. Belmont, CA:

Brooks/Cole.

Flesch, R. (1994). Art o/readable writing. New York: Wiley.

Goodwin, R. D., Fergusson, D. M., & Horwood, J. (2004). Early anxious/withdrawn

behaviors predict later intemalising disorders. Journal ofChild Psychology and

Psychiatry, 45, 874-883.

Hammen, C., Adrian, C., Gordon, D., Burge, D., Jaenicke, C., & Hiroto, D. (1987).

Children ofdepressed mothers: Maternal strain and symptom predictors of

dysfunction. Journal ofAbnormal Psychology, 96, 190-198.

Hammen, C., Burge, D., & Stansbury, K. (1990). Relationship ofmother and child

variables to child outcomes in a high-risk sample: A causal modeling analysis.

Developmental Psychopathology, 26, 24-30.

Hays, W. L. (1994). Statistics (5th ed.). Fort Worth: Harcourt Brace College.

Hirshfeld, D. R., Biederman, J., Brody, L., Faraone, S. V., & Rosenbaum, J. F. (1997a).

Associations between expressed emotion and child behavioral inhibition and

psychopathology: A pilot study. Journal ofthe American Academy ofChild and

Adolescent Psychiatry, 36, 205·213.

202Hirshfeld, D. R., Biederman, J., Brody, L., Faraone, S. V., & Rosenbaum, J. F. (1997b).

Expressed emotion toward children with behavioral inhibition: Associations with

maternal anxiety disorder. Journal ofthe American Academy ofChild and


Holden, R. R., Fekken, G. C., & Cotton, D. H. G. (1991). Assessing psychopathology

using structured test-item response latencies. Psychological Assessment, 3, 111-

118.

Howard, B. L., & Kendall, P. C. (1996). Cognitive-behavioral family therapy for anxiety-

disordered children: A multiple-baseline evaluation. Cognitive Therapy and

Research, 20, 423-443.

Hudson, 1. L., & Rapee, R. M. (2001). Parent-child interactions and anxiety disorders: An

observational study. Behaviour Research and Therapy, 39, 1411-1427.

Joiner, T. E., Catanzaro, S. 1., & Laurent, J. (1996). Tripartite structure of positive and

negative affect, depression, and anxiety in child and adolescent psychiatric

patients. Journal ofAbnormal Psychology, 105, 401-409.

Kagan., J. (1997). Temperament and the reactions to unfamiliarity. Child Development,

68, 139-143.

Kazdin, A. E., & Wassell, G. (1999). Barriers to treatment participation and therapeutic

change among children referred for conduct disorder. Journal ofClinical Child


Kendler, K. S., Neale, M. C., Kessler, R. C., Heath, A. C., & Eaves, L. J. (1992). Major

depression and generalized anxiety disorders: Same genes, (partly) different

environments? Archives ofGeneral Psychiatry, 49, 716-622.

203Kohlmann, C. W., Schumacher, A., & Streit, R. (1988). Trait anxiety and parental child-

rearing behavior: Support as a moderator variable? Anxiety Research, 1, 53-64.

Kovacs, M. (1980/1981). Rating scales to assess depression in preschool children. Acta

Paedopsychiatry, 5, 125-138.

Krain, A. L., & Kendall, P. C. (2000). The role of parental emotional distress in parent

report ofchild anxiety. Journal ofClinical Child Psychology, 29, 328-335.

Krohne, H. W., & Hock, M. (1991). Relationships between restrictive mother-child

interactions and anxiety of the child. Anxiety Research, 4, 109-124.

Krohne, H. W., & Hock, M. (1993). Coping dispositions, actual anxiety, and the

incidental learning ofsUCcess- and failure-related stimuli. Personality and

Individual Differences, 15, 33-41.

LaFreniere, P. J., & Capuano, F. (1997). Preventive intervention as a means ofclarifying

direction ofeffects in socialization: Anxious-withdrawn preschooler's case.

Development and Psychopathology, 9, 551-564.

LaFreniere, P. J., & Dumas, J. E. (1992). A transactional analysis ofearly childhood

anxiety and social withdrawal. Developmental and Psychopathology, 4, 385-402.

Last, C. G., Hanson, C., & Franco, N. (1997). Anxious children in adulthood: A

prospective study of adjustment. Journal ofthe American Academy ofChild and


Last, C. G., Hersen, M., Kazdin, A., Orvaschel, H., & Perrin, S. (1991). Anxiety

disorders in children and their families. Archives ofGeneral Psychiatry, 48, 928-

934.

204Laurent, 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 ofchildren: Scale development

and preliminary validation. Psychological Assessment, 11, 326-338.

Linehan, M. M., Paul, E., & Egan, K. J. (1983). The Parent Affect Test: Development,

validity and reliability. Journal ofClinical Child Psychology, 12, 161-166.

Loevinger, J. (1957). Objective tests as instruments ofpsychological theory.

Psychological Reports, 3, 635-694.

Lonigan, C. J., & Phillips, B. M. (2001). Temperamental influences on the development

ofanxiety disorders. In M. W. Vasey & M. R. Dadds (Eds.), The developmental

psychopathology ofanxiety (pp. 60-91). New York: Oxford University.

Lonigan, C. 1., Phillips, B. M.; & Hooe, E. S. (2003). Relations of positive and negative

affectivity to anxiety and depression in children: Evidence from a latent variable

longitudinal study. Journal ofConsulting and Clinical Psychology, 71, 465-481.

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states:

Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck

Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335-

343.

MacKinnon, D. P.; & Dwyer, J. H. (1993). Estimating mediated effects in prevention

studies. Evaluation Review, 17, 144-158.

MacKinnon, D. P., Warsi, G., & Dwyer, J. H. (1995). A simulation study of mediated

effect measures. Multivariate Behavioral Research, 30(1), 41-62.

205Mash, E. J. & Terdal, L. G. (1997). Assessment of child and family disturbance: A

behavioral-systems approach. In E. J. Mash & L. G. Terdal (Eds.), Assessment of

childhood disorders (pp. 3-68). New York: Guilford.

McClure, E. B., Brennan, P. A., Hammen, C., & Le Brocque, R. M. (2001). Parental

anxiety disorders, child anxiety disorders, and the perceived parent-child

relationship in an Australian high-risk sample. Journal ofAbnormal Child


Messer, S. C., & Beidel, D. C. (1994). Psychosocial correlates of childhood anxiety

disorders. Journal ofthe Academy ofChild and Adolescent Psychiatry, 33, 975

983.

Moos, R. H., & Moos, B. S. (1983). Adaptation and the quality of life in work and family

settings. Journal ofCommunity Psychology, 11, 158-170.

Moos, P., Steememan, P., Merckelbach, H., & Meesters, C. (1996). The role of parental

fearfulness and modeling in children's fear. Behaviour Research & Therapy, 34,

265-268.

Nunnally, J. C. (1967). Psychometric theory. New York: McGraw-Hill.

Orvaschel, H., & Weissman, M. M. (1986). Epidemiology ofanxiety disorders in

children: A review. In R. Gittelman (Ed.), Anxiety disorders ofchildhood (pp. 58

72). New York: Guilford.

Parker, G., Tupling, H., & Brown, L. B. (1979). A Parental Bonding Instrument. British

Journal ofMedical Psychology, 52, 1-10.

Pine, D. S. (1994). Child-adult anxiety disorders. Journal ofthe American Academy of

Child and Adolescent Psychiatry, 33, 280-281.

206Rapee, R. M. (1997). Potential role ofchildrearing practices in the development of

anxiety and depression. Clinical Psychology Review, 17,47-67.

Reiss, S. (1991). Expectancy model of fear, anxiety, and panic. Clinical Psychology

Review, 11, 141-153.

Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity,

anxiety frequency and the predictions of fearfulness. Behaviour Research &

Therapy, 24, 1-8.

Rende, R., Warner, V., Wickramarante, P., & Weissman, M. M. (1999). Sibling

aggregation for psychiatric disorders in offspring at high and low risk for

depression: 10-year followup. Psychological Medicine, 29, 1291-1298.

Reynolds, C. R., & Richmond, B. O. (1978). What I think and feel: A revised measure of

children's manifest anxiety. Journal 0/Abnormal Child Psychology, 6, 271-280.

Silove, D., Parker, G., Hadzi-Pavlovic, D., Manicavasagar, V., & Blaszczynski, A.

(1991). British Journal o/Psychiatry, 159, 835-841.

Silvennan, W. K., & Albano, A. M. (1996). Anxiety Disorders Interview Schedule/or

DSM-IV, Child and Parent Versions. San Antonio, TX: Psychological

Corporation.

Silverman, W. K., Fleisig, W., Rabian, B., & Peterson, R. A. (1991). Child Anxiety

Sensitivity Index. Journal o/Clinical Child Psychology, 20, 162-168.

Silverman, W. K., & Nelles, W. B. (1988). The Anxiety Disorders Interview Schedule for

Children. Journal a/the American Academy a/Child & Adolescent Psychiatry,

27, 772-778.

207Siqueland, L., Kendall, P. C., & Steinberg, L. (1996). Anxiety in children: Perceived

family environments and observed family interaction. Journal o/Clinical Child

Psychology, 25, 225~237.

Solyom, L., Silberfeld, M., & Solyom, C. (1976). Maternal overprotection in the etiology

of agoraphobia. Canadian Psychiatric Association Journal, 21, 1976.

Spence, S. H. (1996). The prevention of anxiety disorders in childhood. In P. Cotton & H.

Jackson (Eds.), Early Intervention and Preventative Applications o/Clinical

Psychology (pp. 87-108). Melbourne: Australian Academic.

Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour

Research and Therapy, 36, 545~566.

Spence, S. H. (2001). Prevention strategies. In M. W. Vasey & M. R. Dadds (Eds.), The

Developmental Psychopathology 0/Anxiety (pp. 325~351). Oxford: Oxford

University Press.

Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). Manual/or the State-Trait

Anxiety Inventory. Palo Alto, CA: Consulting Psychologists.

Stubbe, D. E., Zahner, G. E. P., Goldstein, M. J., & Leclanan, J. F. (1993). Diagnostic

specificity ofa briefmeasure of expressed emotion: A community study of

children. Journal 0/Child Psychology and Psychiatry, 34, 139-154.

Thomasgard, M. (1998). Parental perceptions ofchild vulnerability, overprotection, and

parental psychological characteristics. Child Psychiatry and Human Development,

28,223.,240.

Torgersen, S. (1983). Genetic factors in anxiety disorders. Archives o/General

Psychiatry, 40, 1085~1089.

208Turner, S. M., Beidel, D. C., & Costello, A (1987). Psychopathology in the offspring of

anxiety disorders patients. Journal a/Consulting and Clinical Psychology, 55,

229-235.

Vasey, M. W., & Dadds, M. R. (2001). An introduction to the developmental

psychopathology ofanxiety. In M. W. Vasey & M. R. Dadds (Eds.), The

Developmental Psychopathology ofAnxiety (pp. 3-26). Oxford: Oxford University

Press.

Verhulst, F. C., van der Ende, J., Ferdinand, R. F., & Kasius, M. C. (1997). The

prevalence ofDSM-III-R diagnoses in a national sample ofDutch adolescents.

Archives ofGeneral Psychiatry, 54, 329-336.

Watson, D., Clark, L. A, & Tellegen, A. (1988). Development and validation of brief

measures ofpositive and negative affect: The PANAS scales. Journal of

Personality and Social Psychology, 54, 1063-1070.

Welkowitz, J., Ewen, R. B., & Cohen, J. (1988). Introductory statistics/or the behavioral

sciences; Alternative Jrd ed. New York: Harcourt Brace Jovanovich.

Whaley, S. E., Pinto, A, & Sigman, M. (1999). Characterizing interactions between

anxious mothers and their children. Journal ofConsulting and Clinical


Wood, J. J., McLeod, B. D., Sigman, M., Hwang, W. c., & Chu, B. C. (2003). Parenting

and childhood anxiety: Theory, empirical findings, and future directions. Journal

ofChild Psychology & Psychiatry, 44, 134-151.

olcl university of ubrary - … · vlll anxiety disorders interview schedule for dsm-iv,child and...

Documents