Pediatric anxiety disorders are highly prevalent and while pharmacological intervention seems to be an effective treatment, the validity of reported adverse side effects remains unclear. <br/><br/>Objective: To analyze the nature of evidence regarding adverse side effects in the pharmacological treatment of pediatric anxiety disorders. <br/><br/>Approach: A search using Google Scholar, PubMed, and PsychInfo was conducted for meta-analyses of pharmacological treatment of pediatric anxiety disorders as well as randomized controlled trials. The focus was on adverse events.<br/><br/>Results and Conclusion: Reportings of a limited number of adverse events were found among resources available to clinician and patient informed sources to inform pharmacological treatment of pediatric anxiety disorders. Only a small fraction of adverse side effects were found in the research literature. This finding raises concerns about making informed decisions to treat pediatric anxiety disorders with pharmacotherapy.

The thesis project merges interdisciplinary research to develop a self-directed creative intervention for immigrant youth, allowing them to make sense of their social and cultural identities. It takes research on self-awareness, multicultural identification, perceived belonging, and bibliotherapy to create a guided journal titled "Unearth," filled with art and writing prompts that are age-appropriate for adolescents and that serve as avenues for self-exploration. The project ultimately engages a focus group discussion to understand the usability and accessibility of the intervention.

The thesis project merges interdisciplinary research to develop a self-directed creative intervention for immigrant youth, allowing them to make sense of their social and cultural identities. It takes research on self-awareness, multicultural identification, perceived belonging, and bibliotherapy to create a guided journal titled "Unearth," filled with art and writing prompts that are age-appropriate for adolescents and that serve as avenues for self-exploration. The project ultimately engages a focus group discussion to understand the usability and accessibility of the intervention.

It is possible that voluntary studies on the effects of divorce fail to capture the perspectives of offspring who may be deterred from volunteering by their negative experiences of the divorce of their parents. This issue of non-response bias would cause researchers to gather unrepresentative samples that ultimately create an unrepresentative picture on the effects of divorce. The problem of non-response bias may also be a possible explanation for why research shows that small differences in psychological problems exist between children of divorce and children from intact families. This study sought to identify if non-response bias compromises the external validity of a sample of college students of divorce. To answer this question we conducted this study through the use of the introductory psychology pre screening study that is administered every semester to introductory psychology students at Arizona State University. We surveyed undergraduate introductory psychology students, all of whom completed a required prescreen survey for research credit. The students who indicated they were from divorced families, or whose parents were “never married and not still together”, were invited to participate in a follow up study to “to understand young adults’ perspectives on their parents’ divorce”. The students who responded to our invitation were compared to the students who did not volunteer in terms of their prescreen data. Volunteers did not differ from non-volunteers on seven out of the ten dependent measures. Volunteers differed from non-volunteers in terms of their closeness to their fathers, in terms of the parents conflict they experienced during the two years before and the two years after their parents permanently separated. Volunteers were more likely to be closer to their fathers and more likely to have experienced more parent conflict than non-volunteers. We are unaware of any studies on the subject of divorce that have had a similar opportunity to address the issue of non-response bias and its effects on the external validity of a college sample of divorce. This study should be replicated to determine the reliability of the results.

Mobile health (mHealth) applications (apps) hold tremendous potential for addressing chronic health conditions. Smartphones are now the most popular form of computing, and the ubiquitous “always with us, always on” nature of mobile technology makes them amenable to interventions aimed and managing chronic disease. Several challenges exist, however, such as the difficulty in determining mHealth effects due to the rapidly changing nature of the technology and the challenges presented to existing methods of evaluation, and the ability to ensure end users consistently use the technology in order to achieve the desired effects. The latter challenge is in adherence, defined as the extent to which a patient conducts the activities defined in a clinical protocol (i.e. an intervention plan). Further, higher levels of adherence should lead to greater effects of the intervention (the greater fidelity to the protocol, the more benefit one should receive from the protocol). mHealth has limitations in these areas; the ability to have patients sustainably adhere to a protocol, and the ability to drive intervention effect sizes. My research considers personalized interventions, a new approach of study in the mHealth community, as a potential remedy to these limitations. Specifically, in the context of a pediatric preventative anxiety protocol, I introduce algorithms to drive greater levels of adherence and greater effect sizes by incorporating per-patient (personalized) information. These algorithms have been implemented within an existing mHealth app for middle school that has been successfully deployed in a school in the Phoenix Arizona metropolitan area. The number of users is small (n=3) so a case-by-case analysis of app usage is presented. In addition simulated user behaviors based on models of adherence and effects sizes over time are presented as a means to demonstrate the potential impact of personalized deployments on a larger scale.

Frequent flyers are students who make repeated, unplanned visits to the school nurse, mostly presenting with somatic symptoms like headaches, stomachaches, and musculoskeletal pain. Somatic symptoms are characteristic of pediatric anxiety symptoms and disorders, but the relation between anxiety symptoms and frequent flyer status never has been systematically examined. This study employs data corresponding to 209 students in the 4th and 5th grade (Mage = 9.51, 43.5% girls, 50.9% 51.2% Caucasian, 23.9% Hispanic/Latino) to examine the relation between students' visits to the school nurse (frequent flyer status) and anxiety, including possible variations by children's socio-demographic characteristics, including sex and race/ethnicity. Findings showed statistically significant relations between anxiety and an increased number of nurse visits. A relation between anxiety and sex leading to increased nurse visits was not statistically significant. The statistical model testing race/ethnicity and anxiety in relation to increased nurse visits was found to be significant but driven solely by anxiety. Implications for this study include reframing how frequent flyers are viewed by teachers and addressing possible anxiety in these students.

This study examined whether changes in intervention related gains from the REACH for Personal and Academic Success program, an indicated anxiety prevention school-based protocol, vary as a function of participant youth's exposure to overprotective parenting. This study also examined if ethnicity/race (Caucasian vs. Hispanic/Latino) interacts with overprotective parenting to predict program response. A total of 98 children (M age = 9.70, SD = .07; 77.60% girls; 60.20% Hispanic/Latino) received 1 of 2 protocols (REACH or academic support) and responses were measured at post-treatment and 1-year follow-up. Findings showed that child self-regulation skills improved in the school program (REACH) for children of parents with low levels of overprotection, and child self-regulation skills improved in the control program (academic support) for children of parents with high levels of overprotection. These findings were significant in the Hispanic/Latino subsample, but not in Caucasian youth.

The purpose of this study was to examine if certain child demographics and risk modifiers of the child (i.e., anxiety sensitivity, depressive symptoms, anxiety control, and social competence) predict program response to a Child Anxiety Indicated Prevention and Early Intervention protocol (Pina, Zerr, Villalta, & Gonzales, 2012). This anxiety protocol focused on cognitive behavioral techniques (e.g., systematic and gradual exposure) that used culturally responsive implementation strategies (Pina, Villalta, & Zerr, 2009). The current study aims to investigate specific predictors of program response to this anxiety protocol. First, it was of interest to determine if child demographics and risk modifiers of the child at baseline would predict program response to the early anxiety intervention protocol. Second, it was of interest to see if an interaction with one of the four risk modifiers at baseline and sex or protocol condition would predict program response to the early anxiety intervention protocol. This study included 88 youth (59.14% Hispanic/Latino and 40.9% Caucasian) who were recruited through referrals from public schools and randomized to one of two protocol conditions (i.e., child-only or the child-plus-parent protocol), which had varying levels of mothers’ participation within the Child Anxiety Indicated Prevention and Early Intervention protocol (Pina et al., 2012). Participants ranged from 6 to 17 years of age (M = 10.36, SD = 2.73), and 48.9% were boys. The four risk modifiers were assessed using the Childhood Anxiety Sensitivity Index (CASI; Silverman, Fleisig, Rabian, & Peterson, 1991), Children's Depression Inventory (CDI; Kovacs, 1981), Anxiety Control Questionnaire for Children-Short Form (ACQ-C-S; Weems, 2005), and Social Competence scale from the Child Behavior Checklist (CBCL; Achenbach & Resorla, 2001). Program response was measured by pre-to-posttest changes in anxiety outcomes. Regarding the first aim, each of the four risk modifiers was related to pre-to-posttest changes in program response outcomes. Regarding the second aim for interactions between each of the four focal predictors, sex and protocol condition emerged as moderators. These results have potential implications for clinicians and researchers interested in understanding why some children might experience more or less change when participating in an early intervention protocol for anxiety.

Anxiety is one of the most common psychiatric disorders among children yet characterized by lower use of mental health services. Preventive efforts have demonstrated promise in the ability to reduce anxiety symptoms. However, as evidence-based interventions move into real-world settings, there is a need to systematically examine potential implementation factors that may affect program outcomes. The current study investigates the relations between different aspects of implementation and their effect on outcomes of a school-based preventive intervention targeting anxiety symptoms. Specifically, the study examines: (1) the measurement of quality of delivery, (2) specific relations among implementation components, (3) relations between these facets and anxiety program outcomes. Implementation data were collected from nine school-based mental health staff and observer ratings. Program outcomes (pretest and immediate posttest) were measured from 59 participants and their parents (mostly mothers) in the intervention condition. Implementation components included adherence, quality of delivery, time spent, participant responsiveness, and perceived usefulness of program materials. Program outcomes included child-reported emotional expressivity, physiological hyperarousal, negative cognitions, social skills, self-efficacy, and child and parent reported levels of child anxiety. Study findings indicated that quality of delivery was best captured as two facets: skillful presentation and positive engagement. Adherence and quality of delivery were associated with greater participant responsiveness, although time spent was not. Significant relations were found between some implementation components and some program outcomes. Further efforts can be used to optimize the translation of evidence-based programs into real-world settings.