This article was downloaded by: [McGill University Library]

On: 21 April 2013, At: 06:38

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,
37-41 Mortimer Street, London W1T 3JH, UK

Journal of Clinical Child Psychology

Publication details, including instructions for authors and subscription information:
http://www.tandfonline.com/loi/hcap19

Anxiety in children: Perceived family environments and

observed family interaction
Lynne Siqueland , Philip C. Kendall & Laurence Steinberg
Version of record first published: 07 Jun 2010.

To cite this article: Lynne Siqueland , Philip C. Kendall & Laurence Steinberg (1996): Anxiety in children: Perceived family
environments and observed family interaction, Journal of Clinical Child Psychology, 25:2, 225-237
To link to this article: http://dx.doi.org/10.1207/s15374424jccp2502_12

PLEASE SCROLL DOWN FOR ARTICLE

Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions
This article may be used for research, teaching, and private study purposes. Any substantial or systematic
reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to
anyone is expressly forbidden.
The publisher does not give any warranty express or implied or make any representation that the contents
will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should
be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims,
proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in
connection with or arising out of the use of this material.

Copyright O 1996 by
Lawrence Erlbaum Associates, Inc.

Journal of Clinical Child Psychology

1996, Vol. 25, NO.2,225-237

Anxiety in Children: Perceived Family Environments and

Observed Family Interaction
Lynne Siqueland
University of Pennsylvania Medical School

Philip C. Kendall and Laurence Steinberg

Downloaded by [McGill University Library] at 06:38 21 April 2013

Temple University
Assessed differences between families with a child diagnosed with anxiety disorder
and controlfamilies on self-report measures ofparenting and independent observers'
ratings of jizmily interaction. Children rated their parents, and parents rated themselves on the parental variables of warrnthlacceptancct and psychological autonomy/control. Similar constructs were rated by independent observers offamily interaction generated via a revealed difSerences discussion task. Parents of children with
anxiety disorders were rated by observers as less granting of psychological autonomy
than controls. In addition, children with anxiety disorders rated both their mothers
and fathers as less accepting than control children rated their parents. Results are
discussed in terms of sociali~atian,familysystems, and attachment theories regarding
the tolerance and acceptance of different and/or negative emotions within fmilies.
The possible relation of dfamilyinteraction styles to the internalizing disorders in
childhood is explored.

Given the powerful and substantial role families play

in children's lives, it is not surprising that researchers
and clinicians have been interested in understanding the
influence that family interaction styles may have in the
etiology ancllor maintenance of child psyc,hopathology.
Most research to date has focused on general family risk
factors and their relation to overall pathology (for reviews, see Hetherington & Martin, 1986; Jacob, 1987).
Interest has turned to an attempt to study the "mechanisms of effect" of family factors-potentially leading
to both a clearer understanding of family members'
mutual influences on each other aqd more direct intervention designs (Fauber & Long, 1991). Although such
a literature is mounting, it has centered largely on the
relation of parentinglfamily interaction styles and the
externqlizing disorders (e.g., Barkley, 1981; Forehand
& McMahon, 1981; Patterson, 1982).
In oontrast, little is known about familial influences
on internalizing disorders. Contrary to previous belief,
there is now some evidence that anxiety disorders are
quite common among children (Costello, 1989;
This study is based on Lynne Siqueland's doctoral dissertation for
Temple University.
Lynne Siqueland thanks all the staff at the Child and Adolescent
Anxiety Disordlers Clinic at Temple University for their help-partitularly Martha Kane, Bonnie Howard, and Elizabeth Goesch for
their support, ~~deas,
and encouragement. She also thanks Robert
Fauber for his input on the development of this project.
Requests for reprints should be sent to Lynne Siqueland,Medical
School, University of Pennsylvania, 3600 Market Street, Room 705,
Philadelphia, PA 19104.

Kashani & Orvaschel, 1988) and are not simply transitory; they often persist over time (Cantwell dz Baker,
1989; Keller et al., 1992). Children with anxiety disordqrs often suffer from physical problems such as headaches, stomachaches, and irritable bowel sjrndrome
(Livingston, Taylor, & Crawford, 1988),as well as low
self-esteem, social isolation, inadequate s ~ ~ i iskills,
il
and problems in social adjustment and in academic
work (Dweck & Wortman, 1982; Klein & Last, 1989;
Strauss, Lease, Kazdin, Dulcan, & Last, 1989). Howeyer, because these anxious children are often well-behi+ved,they are typically less disruptive to their parents
and teachers than children with externalizing disorders
and, therefore, have been less often studied.
The relation between pqrenting practices and children's adjustment and competence has long been a
focus of developmental research. In general, this research has suggested that optimal child adjustment
develops within highly warm and supportive families,
family settings with consistent and clear behavioral
expectations and consequences, and families thiit accept
individuality and psychological autonomy (e.g., Baumrind, 1971, 1989; Becker, 1964; Maccoby & Martin,
1983;Schaefer, 1959,1965).The dimension of psychological autonomy has been the least thoroughly researched of the thee constructs, but empirical work has
s~ggestedits importance as both an independlent and
mediating factor in chidren's psychological adjustment
(Fauber, Forehand, Thomas, & Wierson, 1990; Steinbarg 1990; Steinberg, Elmen, & Mounts, 19819). The
importance of psychological autonomy is noted in a

Downloaded by [McGill University Library] at 06:38 21 April 2013

SIQUELAND, KENDALL, & STEINBERG

number of studies that have found that the sharing, or

even competitive challenging, of different viewpoints
within families, when combined with a low levels of
rejection or distortion of the differences between family
members, is associated with the highest levels of autonomy development among adolescents (Hauser et al.,
1984; Powers, Hauser, Schwartz, Noam, & Jacobson,
1983). Studies of internalizing problems in non-clinic
samples has found that overcontrolled behavior among
children is associated with high parental control and
low warmth or support (Baumrind, 1989; Block &
Block, 1979; Kagan & Moss, 1962).
Family theorists also have been interested in the
concept of psychological control and its relation to
family functioning, but they have used different terms
to describe these interactional constructs. These theorists also associate extremes of interconnectedness or
limitations of autonomy with general psychopathology
or dysfunction (e.g,, Bowen's, 1960, undifferentiated
ego mass; Minuchin's, 1974, enmeshment; Reiss's,
1981, consensus-sensitive families; and Wynne's,
1984, concept of pseudomutuality). Extreme scores on
dimensions of family cohesion have been found to be
associated with general child psychopathology (Smets
& Hartup, 1988). Empirical applications of the family
therapy model rarely have focused on anxiety disorders
per se but nevertheless have examined family interaction within a likely related group of children with
psychosonlatic illness. Researchers have found psychosomatic illness to be associated with marital dysfunction, triangulation and a combination of enmeshment,
overprptectiom, rigidity, and conflict avoidance
(Minuchin, Rosmw, & Bak~r,1978; Wood, 1985;
Wood et al., 1989). However, these studies and early
case reports sre limited methodologically by their lack
of adequate control groups and absence of clear operational definitions.
Although the relation of parenting practices to the
expes~ilanof internalizing symptoms within a normal
population has been studied, diagnosable anxiety disorders in children per se have only somewhat recently
gained the attention of clinicians and researchers (e.g.,
Kendall et al,, 1992). Early case reports, clinical records, and retrospective reports described the parents of
children with neurotic or anxiety disorders as overinvalved and invasive of their child's physical and psycHologli~dprivacy-in other words, they limit their
child's autonomy (e.g., Levy, 1943; Parker, 1983;
Waldron, Slqier* Stone, & Tobin, 1975). However,
these clinical studies are limited by their descriptive
name and labk of control groups.
There is more research od the relation of family
facthrs to depressive disorders in children (for review,
see Butbah & Borduin, 1986). A lack of warmth,
suppod, and Cceptarice af the child seems to be most
prevalreht in diepressed chilclreps' report of their family
interactions. Depressed children perceive their families

as more rejecting and witholding (Asarnow, Carlson, &

Guthrie, 1987; Kaslow, Rehm, & Seigel, 1984;
Lefkowitz & Tesiny, 1985) and less trustworthy and
dependable (Armsden, McCauley, Greenberg, &
Burke, 1987) than nondepressed children. In addition,
high levels of parental criticism and hostility (expressed
emotion) have been found to be related to recovery and
relapse in children with depressive disorders, as has
been documented within adult populations (Asarnow,
Goldstein, Tompson, & Guthrie, 1993). Jaenicke et al.
(1987) reported high correlations between mother's
criticism of their child and the child's self-criticism in
a depressed sample.
In one of the few studies involving interviews with
the mothers of depressed children, Puig-Antich et al.
(1985a) found that mothers reported limited communication and time spent with their children, and the
affective tone of the mother-child relationship was
characterized as cold, hostile, tense, and, at times,
rejecting. In additiofl, after the depression had remitted
for 4 months, the family relationships improved only
partially with problems in communication and conflict
still evident, suggesting that the nature of the parent-child interac~onsare not simply due to the difficulty in parenting a depressed child (Puig-Antichet al.,
198Sb). Children of parents with anxiety or depressive
disorders rated their families on measures of family
functioning as more controlled, more conflicted, less
cohesive, and less independent than controls (Silverman, Cerny, & Mslles, 1988; Sylvester, Hyde, &
Reichler, 1987).
The high concordance of anxiety and depressive
disorder$,as well as the overlap between the two symptom presentations, has led some researchers to question
whether these disoidm can and should be distinguished
(for review, sea Btady & Kendall, 1992). Stark, Rouse,
and Livingst04 (1991) proposed a model for the development of dlepressive disorders, based in a cognitive-behavioral framework, suggesting that the core
schema chat asglanizr: children's information processing ar'e formed throu$h early learning experiences and
communigatim with the family. This communication
is chiiractelized by negative messages about the children themselves, tbe world, and the future. In one of the
few studies to. look at the family perceptions of children
with diagnlosed.smxie$yand depressivedisorders, Stark,
Humpkef, Crook, and Lewis (1990) found that both
children with anxiety and depressive disorders described their families as being more conflictual and
more enmeshed as well as less supportive, cohesive,
open to expression, and demociatic in their decision
making than children withiolut anxiety or dtspressive
disorders. Mothers generally corroborated their bhildreh's repotttts. The bnly significant differ~ncesamong
the three ;psyclli@@cgr~lipswere between the depressed and t-+nxi~asgroup (most distressed group) and
the anxious-only group (least distressed), Stark, Hum-

Downloaded by [McGill University Library] at 06:38 21 April 2013

ANXIETY IN CHILDREN

phrey, Laurent, Livingston, and Christopher (1993)

tried to differentiate between anxiety and depressive
disorders in childhood on cognitive, behavioral, and
family environment variables. Depressed and 6anxious
children could be discriminated on the basis of their
cognitions-the depressed children reported more
negative views about themselves, the world, and the
future-but also on the basis of family v;iriables--de
pressed chikhn received m e negative messages tom
their father about themselves, the world, and the future.
What may differentiate the interactions of families
with a depressed versus anxious child is the tolerancefor
the expression of certain negative emotions or differing
viewpoints within families of children with anxiety disorders. Rubin and Mills (1990) reported that mothers of
withdrawn-internalizing children were more angry, disappointed, embarrassed, and guilty about displays of
withdrawal ;ad aggression by their children than were
mothers of average children. Again, these negative feelings expressed by parents suggest that the overinvolvement attributed to these families may also have angry
underc~~~enrts.
Rubin and Mills (1991) proposed one
pathway by which internalizing disorders develop in
childhood. They suggested that thase difficulties arise
iom an interaction among the temperamental dispositions in the child, socialization experiences with the
parents, and certain setting conditions (e.g., poverty and
family stress). Rubin and Mills postulated that temperamental warir~essin infancy may lead to less sensitive and
responsive parenting due to the difficulty in comforting
and soothing these infants. An insecure attachment relationship develops, which may then lead to limited exploration of the environmentby the child, espially in
novel situations. Rubin and Mills suggested that parents
who sensethair child's diff~cultiesand helplessnessmay
try to interveme in a highly directivck manrler or to even
take over fo~rthe child. However%this overcontrol and
overinvolvement by pwents further exacerbates the
child's sense of her;l_pllessiness
and incompetence.
Although empirical studies of depressed children
are beginning to appear in the lite~ature,the research
to date on family factars associated with childhood
anxiety disorders is (a) descriptive only, (b) lacking in
proper controls, (c) rarely deals with diagnosed cases,
and (d) relies on self-report only (rather than on observation). In ddition, although the developmental and
clinical literature suggest that high parental control
(both psychological and behavioral) and low warmth
and support are general risk factors for internalizing
disorders, there has been difficulty in differentiating
between family interaction styles associated with children with de,pressionor anxiety disorders (Silverman
et al., 1988; Stark et al., 1990; Sylvester, Hyde, &
Reichler, 19187).
Our study addresses some of these deficits by comparing a clinical group of children with anxiety disorders with noaanxious controlson both paper-and-pencil

measures and independent observers' ratings of the

parental psychological autonomy granting and
warmthlacceptance. It is the only such study we know
of that includes an anxiety disordered sample assessed
with a multimethod approach. Given the lack of'empirical work in this area, this study serves as a beginning
effort to investigate family interaction patterns in children with anxiety disorders.
We hypothesized that the parents of children with
anxiety disorders would receive lower scores on both
the granting d psychological autonomly and
warmth/acceptance than the parents of controls. These
between-group differences were expected on both the
paper-and-pencil measures and independent observer
ratings, but it was predicted that these differences would
be stronger on the ratings of videotaped family interaction. This latter hypothesis was based on the ifindings
of anxious children's tendency to minimize their distress on self-report measures, and the clinical impression that their parents may also minimize family difficulties (Stark et al., 1990; Straws, Last, Hersen, &
Kazdin, 1988). Ailthough not the primary focus of this
study, there is a growing literature on the relation
among parental psychopathology (e.g., Last, Hersen,
Kazdin, Frimcis, & Grubb, 1987; Turner, Beidel, &
Costello, 1987) and marital conflict (fqr review, see
Curnrnings & Davies, 1994) and internalizin,g disorders; therefore, differences between the clinical and
control groups on parental reports of anxiety and depression and marital conflict were also assessed to
examine their relation to the particular interactional
style being investigated.

Method
Participants
The clinical sampleincluded 17families with a child
that had a diagniosed anxiety disorder who had been
referred to the Child and Adolescent Anxiety Disorders
Clinic (CAADC) at Temple University. Referrals to the
CAADC came from contacts established by the
CAADC with treatment clinics, pediatricians, school
systems, and school psychologists in the area and
through newspaper articles and advertisementstlescribing the clinical services availablle. All families needed
to initiate contact with the clinic independently in order
to be evaluated, even though the referral often came
from an agency. Fourteen of the children were diagnosed with primary overanxious disorder (OAD) and 3
with primary separation anxiety disorder (SAD). One
of the children with SAD had secondary diagnoses of
both OAD and avoidant disorder. Eight of the 17 children had additional anxiety diagnoses, all simplle phobia except for the OADIavoidant disorder sec~ondary
diagnosis just mentioned. None of the anxiety disor-

Downloaded by [McGill University Library] at 06:38 21 April 2013

)ALL,& STEINBERG

dered children in this sample had a concurrent depressive disorder or externalizing disorder diagnosis, although all children were screened for these diagnoses
by structured interview. All the clinic children had had
difficulties with anxiety for at least 6 months, and the
majority for at least 2 to 3 years. All children received
a rating of 3 or 4 on the Anxiety Disorders Interview
Schedule (ADIS; Silverman, 1987; Silverman 8
Nelles, 1988) severity rating scale, reflecting significant impairment in social or academic functioning and
avoidance of activities and tasks that were either required (school) or desired (ability to attend a party).
Fifteen of the clinical sample families were two-parent families, and 2 were single-parent families. The
clinic sample consisted of 13 boys and 4 girls with a
mean age of 10 years, 9 months (ages ranged from 9
years, 0 months to 12 years, 6 months). There were 27
familiesincluded in the nonclinic or cotrtrol sample-19
two-parent families and 8 single-parent families. The
control sample ~ongistedbf 17 boys and 10 girls with a
mean age of 11 years, 2 months (ages ranged from 9
years, 11 months to 12 years, 10 manths). All families
in both the clihical and control group were Caucasian.
The control smple was reowited through two methods: flyers sent home with children from a variety of
public and private schaols, and advertisements in a
number of local papers. Children from the nonclinic
sample who showed dlirlical levels of anxiety andor
depression on se1Cne;paxt;measures and whose parents
and teachers reported an intmnalizing T score on the
Child Bieth~viarCherjlqlist (CBCL;Achenbach, 1991;
see Measures section) within the clinical range were
excluded from the control sample.
A preliminary one-way analysis of variance indicated that there were no significant between-group
differences in children'sages, %e mean ages for fathers
of children with anxiety disorders and the control children were 39.0 and 40.47 years, respectively; for mothers, the ntew ulges l m 37.4 and 39.61 years, respectively. mere w m no significant between-group
difforaces. A chi-square an;llysis on sex revealed no
sigoificant hhmn-#mu# di@*nces, although in both
groups thexe %eremarebayl6 than girls (consistent with
soma r e p m of typi~al~ f m d
patterns to anxiety
disorder cXIxlias for thf: cilini~alsample; Last, Hersen,
Kmdin, Firrk~lsdn,L Gmurss, 1987). A chi-square
andpsis on Pmilly income Uing the Four Factor Index
of Social #ttus (IiI~lXEtigs&#,
1975) also revealed no
sigtriflcmt betwednqpv~#$f&@nces,with the majority crf f d ! y inh~mmsllf&lfa&within the $30,000 to
$40,000rage.

Structured Clinical Interview

All children and parents in the clinical group were
interviewed using the ADIS (Silverman & Nelles,
1988).This structured interview (which is based on the

Diagnostic and Statistical Manual of Mental Disorders

[3rd ed., rev.]; American Psychiatric Association,
1987) was chosen because it contains an expanded
anxiety section not found in other available instruments, and it allows the assessor to screen for other
disorders. The instrument screens for and has the ability
to diagnose all anxiety disorders (adult and child),
affective disorders, attention deficit disorder, oppositional disorder, conduct disorder, and psychosis. Data
on reliability and validity of the interview can be found
in Silverman and Nelles (1988), and an illustration of
its reliability and validity with a clinical sample can be
found in Kendall(1994).
Both children and parents were interviewed separately by the same interviewer-the parent(s) interviewed f i t and then the child. For younger children
( 4 2 yeas), diagnosis was based on parental report.
Discrepanciesin symptom reports were discussed with
both the child and parents present following the conclusion of the interviews. For older children, the child had
to c o n f i i
pwental diagnosis. Six of thle, youngBr
children did not provide enough information to receive
an OAD or SAD diagnosis; they did, howevar, endorse
concans relevant to the symptom oat ego ti^ of OAD
and SAD, and all children received at least a phobia
diagnosis by their own report,

Clinical Interviewers
%agnostic interviews were administered by four
doctoral students who were trained through the use of
videotapes and supervision; they reached a criterion of
greater than 85% agreement across diagnoses (kappa;
Cohen, 1977).All interviews were videotaped, and one
fourth of these videotapes were randomly selected and
reviewed as a reliability check and to monitor observer
drift. Reliability wqs based on rerating the videotaped
interviews. Analyses of ongoing diagnostic reliabilities
demonstrated that, on the basis of six random interviews
for four pairs of diagnosticians, there was 100% agreement based an Cahea's kappa for all diagnosesfor three
of the f m pairs of raters. For the fowth pair, there was
83% agearnent for simple phobia and 100% agreemant
for all other diagnoses.

Procedure
The families were recruited using the procedures
described in the subjects section. After the family contacted the research office, an appointmentwas arranged.
Each family was greeted in the waiting room by a
member of the research staff and was briefed about the
nature of the study. Consent forms were signed by both
parents and the child. The parents were led to a room
and asked to seat themselves at opposite ends of a long
table. The parents were asked to complete their ques-

Downloaded by [McGill University Library] at 06:38 21 April 2013

ANXIETY IN CHILDREN

tionnaires without discussing their answers with each

other until the task was finished. For children, every
item of the child's questionnaires was read aloud by a
research assistant while the child marked his or her
answer on a corresponding form.
For the families referred from the clinic, the child
self-report measures of anxiety and depression and the
parent and teacher CBCL had been completed at the
time of intalce to the clinic. The parenting measures and
interaction tasks were scheduled as soon as possible
after the intake and never later than 2 weeks after the
intake. This procedure was established because completing all ]measures and structured interviews at the
same meeting would have required over 6 hr-too
heavy a burden for the first visit to a clinic where
families were seeking treatment. The families completed the interaction task following the completion of
the self-report forms. Approximately 2 hr were required
for the families to complete the study protocol just
described. Both clinical and control families were paid
$30 for theiir participation in the study at the completion
of the videattape task.

Observed I~amilyInteraction Task

Each family participated in four 6-min revealed-differences tasks that were videotaped. Following a practice task (e,j;.r deciding which television show to watch
together), the families participated in thee additional
discussions in the following order: mother-child, father-child, and mother-father-child. The parent who
was not participating in the particular interaction waited
in a chair outside the video room. Single-parentfamilies
participated in only two interactions following the practice task, both involving the mother-child dyad. The
issues to be discussed were culled from the issues
checklist (described in the Measures section).
For the mother-child dyad, the mother's "hottest"
topic (topic rated as most prevalent and contentious)
was used; for the father-child dyad, the father's hottest
topic was used; and for the triad, the mother's second
hottest topic was chosen. The family was asked to read
the topic printed ion a card placed on a table in front of
them and to discuss that topic for 6 min. If the family
did not disciuss the topic far a full 6 min, the discussion
was stopped1 follgwing 30 sec of silence. Videotapes of
the parents'behavior in the interaction were then rated
using global subjective ratings of the granting of psychological autonomy and warmth.

Trraining of observers. Two graduate students

rated the videotapes on the two dimensions. The primary rater's ratings were used in this study; the other's
ratings served a$ ilreliability check on 50% of the tapes.
The raters were trained on the definitions of therelevant
parenting ccmstructs using a combination of written

descriptions, group discussion, and observation of videotape examples. Each rater practiced rating lhe construct from training tapes until a minimum interrater
reliability criterion of .80 (using kappa) was achieved.
The observers viewed the videotaped interactions
and independentlyrated the garent(s) at 2-min iintervals.
All raters were blind to the family's group membership.
For rating purposes, the identified parent was the
mother in the mother-child interaction, the father in the
father-child interaction, and the parental couple in the
triadic interaction. Observers rated each parerit on the
relevant dimension using a 3-point Likert scale ranging
from 1 (low a u n t of the variable) to 3 (high amount
of the variable; operationalized next). The interrater
reliabilities (Cohen's kappa) were .91 for psych~ological
autonomy panting and .85 for warmth.

Measures
The measures of the parenting variables of psychological control and warmthlacceptance in both the paper-and-pencil and observationalformats are reviewed,
followed by the self-reports of anxiety, depression, and
conflict.

Parenting mleasures. The Children's Report of

&
Parenting Rehavior Inventory (ICRPBI;Schlud~erman
Schluderman, 1970)is a 30-itern, widely used qluestionnaire designed to assess children's perceptions of their
parents' behavior toward them along three subscales:
Psychological Control (PC), Acceptance (A.C), and
Firm Control (FC). According to Schwartz, BartonHenry, and Pruzinsky (1985), the internal con~sistency
of the subscales ranges from .65 to .74. The children
completed separate CRPBI inventories about. mother
and father. Each parent respoinded to the same items
used in the child version, which were reworded to allow
the parent to rate his or her own parenting. Aldequate
internal consistency was found in this samplr: for the
major factors of the AC and PC subscales, arrd lower
consistency was found for the FC subscale. The FC
subscalewas not used in the ;analysesbecause ofthelow
consistency scores and the lack of specific hypotheses
about this subscale. The internad consistency alpha levels for this sample were as follows for the AC and PC
subscales: for mother's report of herself, .68 and .70;
for father's report of himself, .76 and .65; for child's
report of mother, .66 and .69; and for child's report of
father, .72 and .80.
Psychological Autonomy Gmnting in Family Interaction was defined as the: degree to which dh~eparent
constrains or encourages the child's individuality
through the use of inductive disciplinary teclmiques.
This is in contrast to psychologically coercive forms of
control, such as guilt induction, love withdrawal, and
power assertion. Raters coded ]parentbehavior using a

Downloaded by [McGill University Library] at 06:38 21 April 2013

SIQUELAND, KENDALL, & STEINBERG

3-point scale (1 =discouragespsychologicalautonomy,

2 = neither encourages nor discouragespsychological
autonomy, and 3 = encourages psychological autonomy) based on the following behavioral indices: (a)
solicits child's opinion, not simply a reaffirmation of
parents' opinion; (b) tolerates differences of opinion;
(c) acknowledges and demonstrates respect for child's
views; (d) avoidsjudgmental or dismissive reactions to
child's views; (e) encourages child to think independently; and ( f ) uses explanation and other inductive
techniques.
Warmth in Family Interaction was defined as the
affective or emotional qualities of the parent-child
relationship. Raters coded the parents' behavior using
a 3-point scale (1 = cold, distant, lacking expressions of
warmth; 2 = moderate expressions of warmth; and 3 =
frequent and consistent expressions of warmth) based
on the following behavioral indices: (a) expresses affection; (b) shows positive regard for child; (c) has a
mutual expression or recognition of feelings (parental
disclosure); (d) laughs, smiles, or touches; (e) appears
responsive and engaged in discussion with child; ( f )
shows ability to talk with child in child's language; and
(g) is physically oriented toward child.
In each intaaction, the level of psychological autonomy and warmth was rated at Zmin intervals (three
ratings per interaction) across the three interaction
tasks, for a troltal of nine possible rating scores per
family. These ratings were averaged across the interactions to yield a mean score an each variable for each
family, The amount of t h e the family spent discussing
the topic within thler Bmin period was also recorded to
discovm if the anxiety disordered families might "shut
down" sooner and stop th& discussion of topics of
potential conflict.

Self-reports of anxiety and depression. The

children rated their level of anxiety on two self-report
measures: the Revised Children's Manifest Anxiety
Scale (RCMAS; Reynolds & Richmond, 1978), which
consists of 37 true-false items (28 Anxiety and 9 Lie
subscale items) that assess a variety of anxiety symptoms; and the State-Trait Anxiety Inventory for Children-Trait version (STAIC-T; Spielberger, 1973),
which is a 20-item measurc of trait anxiety (enduring
tendencies to experience anxiety). For both the
RCMAS; and STAIC-T, raw scores are converted to T
scores based on the child's age and sex. Adequate
reliability, validity, and nonnative data have been reported for both measures (Kendall & Ronan, 1990;
Reynolds & Paget, 1981;Reynolds & Richmond, 1978;
Spielbmger, 1973).The RCMAS cdkl differentiate children with anxiety disorders and psychiatric controls
(Mattigo&,Bagmito, & Birubaker, 191B8),and bat. measures have b e ~ nshown ta diffirentiate children with
anxiety dkordets from nonanxious controls (Bell-Dolan, Last, & Strauss, 1990).

The children rated their level of depression on the

Children's Depression Inventory (CDI; Kovacs, 1979,
1981), a 27-item scale that allows the child to select
among alternatives on a 3-point scale ranging from 1
(low number of particular depressive symptoms) to 3
(high number of depressive symptoms; total scores
range from 0 to 54). Adequate reliability and validity
have been reported (Kazdin, 1981; Saylor, Finch,
Spirito, & Bennett, 1484).
Children's internalizing and externalizing symptoms were rated by both parents and teachers on the
Child Behavior Checklist-Parent and Teacher versions
(CBCG-P and CBCGT; Achenbach, 1991;Achenbach
& Edelbrock, 1981). The CBCL-P and the CBCGT
assess an array of behavioral problems on a 2-point
scale, ranging from 0 (a lot) to 2 (not at all). The
checklists provide scores on several specificbehavioral
problems as well as an overall internalizing and externalizing score. The specific factors vary with child's
age and sex and are, therefore, reported as T scares to
allow for comparison, The CBCL-P and the C B a - T
are widely used because of their reliability, validity, and
established norms for both normal and clinical populations (Achenbach, 1991; Achenbach & Edelbrock,
1981).
Parents rated their own level of anxiety and depression on the State-Trait Anxiety Inventory-Trait Version (STAI-T; Spielberger, Gorsuch, & Lushene,
1970), a 20-item scale used to assess trait anxiety; and
the Beck Depression Inventory (BCII; B&k, 1967), a
21-item instrument in which the respondent is asked to
choose one of four statements refl~ctingincreasing
levels of depressive symptmatology. Adequate internal consistency, test-retest reliability, and validity have
been reported for bath measures (Becrk, Stmr, & Garbin, 1988;Kendall, Finch, Auerbaah,Hoaka, & Mikula,
1976; Kendall, Hallon, Beck, Hamman, & Ingram,
1987; Spielberger et al., 1970).

Parent-child and marital conflict The Issues

Checklist (IC; Robin & Weiss, 1980) requires parents
and adolescents to recall disagreements about 44 specific issues such tis ('cleaning up the bedroom" and
"doing homework" during the past 2 we&. Each issue
is rated on whethier and how often the issue had been
discussed within the family and how calm or angry the
discussion was. Each family member was asked to
number in order the 3 issues from the list that were of
most concern to them cmently. The issue was selected
based on this list of 3 issues. The IC yislds three scores
for each family member: (a) quantity of issues discussed, (b) proportion of angry disaussions, and (c)
proportion of calm disaussions (Rdbln & Weiss, 1980).
The O'Leary-Porter Scale-Reviston (OPS-R; Porter & O'Leary, 1980) E)sa 1Q-itemseal$ developed to
assess the frequency of o h r t paralltal cionfliet that
~
by
occurs in front of the ohild. The 10 itms a r rated

ANXIETY IN CHILDREN

parents along a 5-point scale ranging from 1 (vely ofen)

to 5 (never) In our study, the parents were also asked
to rate each item on the same 5-point scale to determine
whether there was covert conflict and arguments in
private. Total OPS-R scores can range from O to 40.
Porter and CI'Leary (1980)reported a2-week test-retest
reliability of .96 and validity based on responses to
other maritall conflict measures (e.g., a correlationof .63
with the Marital Adjustment Inventory).
Results

Downloaded by [McGill University Library] at 06:38 21 April 2013

Analyses describing the sample are provided first

and are foll~owedby tests of the specific hypotheses.
Group Differences on Internalizing
Symptoms
A multivariate analysis of variance (MANOVA)
was used to assess differences between children with
anxiety disorders and the controls on the t h e measures
of internalizing symptoms: STAIC-T, RCMAS, and
the CDI. The result yielded a significant omnibus F(l,
43) = 2.87, p = .05, using the Pillais's Vstatistic. Univariate tests revealed significant differences between
the two groups on the CDI, with children with anxiety
disordersreceiving higher total scores than controls, but
nonsignific,mt differences on the STAIC-T and
RCMAS (see Table 1). Five children in the anxiety
disordered group received T scores below 50 on the
RCMAS, but three of these five children received T
scores on the Lie scale of the RCMAS that were in the
clinically significant range. No differences were found
between the anxiety disordered and control groups on
either mothers' or fathers' self-reports of anxiety on the
STAI-T or of depression on the BDI.
Though not included in the analyses, CBCL-P T
scores on the internalizing symptoms corroborated dif-

Table 1. SelfReports of Anxiety and Depressive

Symptoms of Children With Anxiety Disorders, Control Children, and Parents

Anxiety and
Depression Measure
CDI
STAIC
RCMAJ
BDI-Mother
BDI-Father
STAI-T-Mother
STAI-T-Father
an

= 17. bn = 27.

Anxiousa
M

SD

14.47
50.12
9.88
5.57
40.94
38.54

11.84
7.68
4.36
11.71
8.89

controlsb

SD

7-57

2.96

44p68
50.58
5.46
5.32
38.50
33.53

8.38
8.02
5.51
6.55
7.86
9.30

.02
2.41
.004
.58
2.32

ferences between the anxiety disordered andl control

groups, with mother's internalizing T scores for anxiety
disordered children (M = 72.93, SD = 4.35) being
significantly higher than those for control children (M
= 56.79, SD = 8.8). These differences were allso conf m e d in the teacher reports, with children with anxiety
disorders receiving significantly higher scores (M =
66.43, SD = 14.62) than controls (M = 51.619,SD =
6.88). The CBCL-P has a mean of 50 and a standard
deviation of 10, with children with anxiety disorders
scoring on average 1 to 2 standard deviations above the
norm and in the clinical range. (CBCL-T scores were
not included in the analyses of internalizing symptoms
because they were only available on a limited number
of children. Some of the data were collected in the
summer, when teacher reports were not available.)
Differences Between the Clinical and
Control Groups on Parental
Psychological AutonomylCorntrol and
WarmthlAcceptance
MANOVAs were used to assess differencesbetween
families of children with anxiety disorders and the
control group on psychological autonomy/control and
warmWacceptance using the mother's self-report of
parenting (CRPBI-PC and AC: factors), child's report
of parenting (CRPBI-PC and AC factors), and the
observers' mean ratings of the family on the Warmth
The
and Psychological Autonomy Granting fact~~rs.
first MANOVA utilized all 44 cases (single- imd twoparent families) and yielded a significant overall omnibus F(1, 43) = 2.44, p = .O4, using the Pilllais V's
statistic. Because we had a limited number of a priori
orthogonal unidirectional hypotheses, we chose to test
the comparisons with a one+tailedtest with alpha set at
.05, given the exploratory nature of this project. Univariate tesls revealed significant differences between
the clinical and control groups in the predicted direction
on observeirs' ratings of psychological autononiy granting and child's report of acceptance by motlher. The
families of children with anxiety disorders were rated
as less granting of autonomy (M= 1.75, SD = .38) than
controls (Mr=1.96, SD = 32). In addition, childlrenwith
anxiety disorders rated their mothers as less accepting
(M = 22.38, SD = 1.93) than control children who rated
their mothers (&I = 25.21, SD = 2.75). The univariate
Fs were converted to correlations as a measure of effect
size to aid in interpretation of between-group differences, yielding moderate effect sixes of .29 for observer
ratings of psychological autonomy granting and A4 for
child's report of acceptance by mother.
There were no significant differences between the
two groups on child's report of PC by mother on the
CRPBI, mother's report of PC or AC on the CRPBI, or
observers' mean ratings of the Warmth factor (see Table

SIQUELAND, KENDALL, & STEINBERG

Table 2. Observers' Ratings and Child and Parent CRPBI Reports of Main Constructs of Psychological
AutonomylControl and WarmthlAcceptance

Measures of Psychological
Autonomy and Warmth
Observer Rating
Psychological Autonomy Granting
Warmtht'Acceptance
CRPBI
PC-CRMC
PC-MR~
AC-CRMe

AC-MR'

1.75
1.93

.38
.23

18.06
16.81
22.38
26.88

5.43
2.29
3.72
1.93

Downloaded by [McGill University Library] at 06:38 21 April 2013

Note. N = 44.
an = 17. bn = 27. CChild's report of parenting on CRPBI-PC factor about mother. d ~ o t h e r ' sself-report of parenting on CRPBI-PC factor.
eChild's report of parenting on CRPBI-AC factor about mother. o other's self-report of parenting on CRPBFAC factor.
* p < .05, one-tailed. **p < .01, one-tailed.

A second MANOVA, using the six variables just

described plus 4 additional variables (father's report of
PC and AC on the CRPBI, and child's report of PC and
AC by father on the CRPBI) was run separately on an
exploratory basis for the 34 families for which data on
the fathers were available. The univariate test for child
self-reportof acceptanceby father was significant,F(1,
33) = 9.04, p = .01, though the omnibus F for the
MANOVA was not. The fathers' CRPBI AC scores for
children with anxiety disorders were lower (M = 21.79,
SD = 3.72) than the scores for control children (M =
24.55, SD = 2.87). There were no significant betweengroup differences on child's report of PC by father on
the CRPBI, father's report of PC or AC on the CRPBI,
or observers' mean ratings of the Warmth factor. Group
differences would have been difficult to obtain on observers' ratings of the Wanmth factor given the limited
variability in the ratings of this factor.
These differential findings for child's report of parental acceptanceand parents' report of their acceptance
suggests that the children are only perceiving their
parents as less accepting. However, the child's report
of parental acceptancewas significantlycorrelated with
observers' ratings of warmth (r = .41, p = .O1 for
self-report of acceptanceby mother, and r = .52, p < .O1
for self-report of acceptance by father), whereas parents' reports of their acceptance were not significantly
correlated with observers' ratings.

Group Differences on Measures of

Conflict
The parents of the anxious and control children
reported no significant differences on their level of
covert or overt marital conflict on the subscales of the
OPS-R. There were also nonsignificant differences
between children with anxiety disorders and the control
group on the amount of time spent in the interaction.

Discussion
In family interactions involving the discussion of
relevant issues of disagreement within families, the
parents of children with anxiety disorders were rated by
independentobservers as less granting of psychological
autonomy than the parents of control children. In addition, the children with anxiety disorders rated their
mothers and fathers as significantly less accepting than
did control children. The parents of the children with
anxiety disorders, however, did not rate themselves
differently than the parents of controls on either psychological control or acceptance. Contrary to our hypothesis, there were no significant differences between
the clinical and control groups on ratings of warmth
obtained in the observation task; however, the warmth
code on the videotaped interactions developed for our
study resulted in a very limited range of scores, with
almost all families judged to be moderately warm. In
contrast to other studies, there were no significant differences between the clinical and control groups on
either marital conflict or level of parental psychopathology (anxiety or depression).
These findings may suggest that children with anxiety disorders only perceive their parents as less accepting. However, the children's perceptions of their parents' behavior are corroborated by the independent
observers' ratings for warmth, giving some credence to
the children's views. These data are consistent with
Stark et al.'s (1990) impression that parents in families
with children with anxiety disorders may minimize
their own or their family's difficulties. Our results are
in keeping with the literature on family interactions of
depressed children whose families are described as
more rejecting and withholding (Kaslow et al., 1984;
Lefkowitz & Tesiny, 1985). In addition, in clinical
studies and case reviews, the combination of high overprotection and low caring was associated with anxiety
disorders in adulthood (Parker, 1983) and school pho-

Downloaded by [McGill University Library] at 06:38 21 April 2013

ANXIETY IN CHILDREN

bia in childhood (Waldron et al., 1975), as well as with

overcontrollled behavior in normal populations (e.g.,
Block & Block, 1979). Most studies to date have had
difficulty finding significant differences between responses by children who are anxious and those who are
depressed on measures of family interactional style
(Silverman et al., 1988; Stark et al., 1990; Stark et al.,
1993). These findings from a sample with anxiety disorders seem to corroborate the work of the researchers
just cited and those cited in the introduction, which
shows that both families with children who are d e
pressed and anxious view their families as lwking in
support and cohesiveness.
Families of children with depression versus those of
children with anxiety disorders may differ on psychological control, a variable that has not been well operationalized in many previous studies. The constructs of
overinvo1ve:mentand overprotection belileved to be associated with anxiety may have more to do with intrusion into the child's privacy or limitation of the child's
activitiesand emotional expressionby parents than with
excessive warmth or care expressed to the child. Some
behaviars n~otedin the videotapes of the family interactions collected for this study that appeared to b related
to psychological control but were not captured on the
observational rating system include (a) a 10-year-old
boy who began to disagree with his mother about
whether it was important to clean his room everyday
but then ncrXjiced a look of distress on her face and
proceeded to put his thumb in his mouth and lay his
head in her lap saying "never mind"; or (b) a mother
saying to her daughter "you would be happier if you
cleaned your room,'>tating clearly what would make
mother happy without ever asking h p daughter how she
felt about it.
In our study, a difference between families of children with anxiety disorders and nonclinical families
was found in observers' ratings on psychological control using a1 rather simple three-level rating scale. A
mare eqpanlded L i b r t scale or an elaborate system like
Benjamin's (1974) Structural Analysis of Social Behavior may be better able to describe the complexity of
these interactions and provide more information on
whether the involvement that often accomparnies psychological control is mixed with anger, as proposed by
some theorists. We also chose to combine mother's and
father's ratiings for simplicity; however, nt is clear that
at times mothers and fathers interacted differently with
their child with anxiety disorders when they were oneon-one with1 the ohild than when the parents were together. These differences betwmn pNents themselves
and in i~teractignsralone. or with the family as a whole
are areas in need of further exploration.
We suggest that the combination of the child's expe&ience of a lack of acceptance or tolerance of the
expression of his or her own views and feelings within
the family and the confusion inherent in trying to make

sense of the discrepancies between one's own and one's

parents' views and feelings has a role in the etiology
andlor maintenance of anxiety disorders. Perhaps as
Minuchin et al. (1978) suggested, in these families
"loyalty is valued over autonomy and approval is valued over competence" (p. 56). It may be that independence and differentiation is limited bazause it
threatens the stability of the family organization; therefore; conflict and disagreement are to be avoided. It is
not clear from the studies thus far whether famillieswith
children who are depressed score high on psychological
control; the picture thus far is more one of disengagement and distance.
In his writings on attachment, Bowlby (1973) stated
that children's anxious behavior is related to the child's
perception and experience of the "availability and accessibility (ofthe caretaker ... in the role of comforter
and protector'' (pp. 202-203). Children develop "internal working models" of relationships with significant
others through early interactions with parental figures.
Bowlby suggested that children who are anxious are
fearful because of actual experiencesin which they have
been threatened with abandonment, ranging from parents actually leaving children to milder forms of abandonment, such as the suggestion that children make the
parents ill or upset, or parental withdrawal of love.
Bowlby (1973) also proposed that a child1 who is
anxious may come to deny or not express his or her own
views or feelings because of these threats of abandonment. Bowlby stated that two of the possible outcomes
of the child's awareness of discrepancies between his
or her views and experiences and those of his or her
parents is (a) to comply with the parents' view of the
child and the family at the cost of disowning his or her
own view, or (b) to form an uneasy compromise by
giving credence to both views and oscillating ibetween
the two @. 318). Bowlby suggested that the confusion
inherent in and the nature of this compromise leads to
anxiety and a n p . The family interaction st:yles just
described appear similar to the styles of families who
rate high in psycJholagica1 control. Due to aver,involvenlent and a~verprotection,children with amiet,y disorders may also begin to form a woqking modd cpf themselves as incomp~tentand fragile,
However, the Rubin and Mills (1991) mode11for the
developmeint of internalizing disorders (described in the
introductio~n)reverses the d i t i o n of causality proposed here,, suggesting that an inhibited tempprament
leads to psychological control by parents. Kagan,
Reznick, and Snidrnan (1987) demonstrated that a temperamental style of hip4 ai~tonlamic
arousal, blelbavioral
inhibition, ,and passivity is evident in Some children in
infancy, and it shows at l m t moderate stabi1it.y across
the first decade of life. Th~ereis no d ~ u b tha most
parents who bring their childrw for treatment for anxiety disorders describe them as having always been
cautious and easily distressed often from birth,. Rubin

Downloaded by [McGill University Library] at 06:38 21 April 2013

SIQUELAND, KENDALL, & STEINBERG

and Mills (1991) suggested this model as one of the

possible developmental pathways to internalizing disorders, but they also stated that temperamental wariness
is not a prerequisite to internalizing disorders and that
the parenting style they described could lead a child
with a calmer temperament to develop internalizing
difficulties. Future research should be better able to
capture the systemic nature of these interactions-what
the child is doing prior to the parents' actions of trying
to encourage psychological autonomy, and how the
child reacts to parents' attempts to encourage independence. Some children may be asserting their own
independence, such that encouragement by the parent
is not necessary. However, one would almost expect to
see higher levels of parental autonomy granting in the
sample of children with anxiety disorders because one
of the most helpful interventionsparents can make with
an inhibited or withdrawn child may be to encourage,
model, and reward independence and competence because functioningindependently is particularly difficult
for these children. Instead parents often attempt to
reassure, calm and help their child to minimize their
child's distress often without success.
Reseamhers may be able to more carefully delineate
the direction of causalily by examining the interaction
between the parents of dldldreal with anxiety disorders
and the nonsymptarnatic siblings af those children to
see if t h y interact diffedntly with their children with
anxiety disorder$than with their dthes children. Parents
could also ba asked to report what they may do in
response tb taped segments of ohilwn in various situations to see how they may respond to children other
than their own, because t h y may perceive their own
children as particulmly Vulnerable or fkagile.
The lack of between-group differences the self-report measures of mxiety was aamewhat surprising.
However, Strziuss, bast, @ al, (1988) reported that at
times olinic-refamd childran with anxiety disorders
were ri& diff~mntth& glhicd control children on
self-reports of anxiety and that, in general, younger
children with anxiety @~lisdrdasmport lower levels of
symptoms than older GhilQdn (Strw$s, Lease, Last, &
Francis, 1988). In additbn, the mtm anxiety scores on
the selfhreportsof the cl$iidrenwith ahaiety disorders in
this study are quite sinirldar to tbe swple treated in the
clinical trial of ~ ~ i g n 4 d $ r b h v i rtreatment
al
versus
wait liSt r e p o w by k@ihdell(19Q4)and in other samples of cbildmd lddh ranki@t$disordersreported in the
literature [Perrin &iWt, 1992; Sbavss, Last, et al.,
1988: Strauauss, L@a$e,at all, 1988). This finding is
cormbortit@dby our o&fl dipi$;r/ experience working
with the;s"e fmilias. BGth childran, with anxiety disorders arid thab pments asp v&ty oariopr~edwith presenting wall, add Sit seems vet+$ hard for them to admit that
theta are diBioulkieswi&in the fmE.'ty or that the child's
anxiety omsee p61blieMs for the fimily. Our research
staff has crodsi~tdhtlyotrsb~v&d
the children with anxiety

disorders erasing and changing responses on the selfreports or agonizing over a question about difficulty in
making decisions only to conclude that they have no
problems in this area, This phenomenon is especially
evident in younger children and is corroborated by the
high Lie (Social Desirability) scale scores on the
RCMAS reported by most of the children with the
below-clinical-level scores. Children with anxiety disorders are more able to admit to difficultieswith skillful
questioning during the structured interview.
Our study may be limited in its ability to comment
on parenting practices of children with "pure" anxiety
disorders, given that 33% of the children who reported
clinical levels of anxiety also reported clinical levels of
depressive symptoms on the CDI. None of the children
received a diagaosis of depressive disorder. However,
comorbidity rates for depressive and anxiety diagnoses
vary from 15% to 60% and are even higher with selfreport measuras (see review by Brady & Kendall, 1992;
Kendall, Cantwell, & Kazdin, 1989). The strass of
coping with an anxiety disorder for a number of years
and the lack of engagement, especially in recreational
and sooial activities ofken prevalent with anxiety disarders, can leave these children with feelings af loneliness, isolation, incompetence, low self-resteem, hopelessnms, and helplessness---all important coqoflents
of the depression self-report measures. In addition,
Kovacs, Oatsonis, Padaukas, and Richad$ (1989)
found that, in a sample ef dllildren with dlagniosa
depressive disorders, many afi tha ohildreti Also had
conourrent anxiety disorder^ &at almsst alvays preceded the d@pressionand oftPjn did not remit: with
treatment af the depression, The chronicity af tha mxiety disorder may piut children at risk for a l a ~depresr
sive disorder, or it may be that low levels of ddpre~sion
occur regullarly in the pres@nceuf an anxiety disorder.
Similar findings have been noted in addt pdpulatioas
(Ktmdall tWlltstm, 1989).
Our 8Qdy is a bqjhnillg &fort to investigqte family
interaction patterns, %I children with anxiety disorders,
but it is only a first s t q . It is the fast study that we know
of that assessee c h i l ~ r mdiqndsed with anxiety disorders wibh both selfayo&s and inddpendenti observer
ratings of family intW&~tions.Howbver, the study is
limited by the laok of inalpding amtha psychiatric
control group, whi~hWy3uld b$ rmqbired in lqter:studies
to clarify whethm my $#dings were dug to diffefenoes
bemmn ti olinic~lhtl naf#u4il sample, rath~rthan rel a t d to anxiety or inwnalidrkg diswdefs in pwti~ulbr.
It is importtint, for eaampJe, to test for differ~n~es
betwepn a p u p of oMId#mnwithqxiety &solders b d
a group of children with e~tdrnalizingdiscifdiere as @ell
as to assess diffefenom kiatqlt4en chJil&~with a n d ~ ~ t y
and depressive di$occd&$, tJ$fi.lriffe~t:*1131bk @e work of
Stark aad his qr~lfeagua
[lD?gQ,lg93) into d w t obsbvation of intotracbonb. I%
@%plwatory
$
naWb of & b e
analyses r e q h h neplikatioti With I&~IE~x:
6$1.nple8 before

ANXIETY IN CHILDREN

we can have: confidence in the results, and these results

should be iinterpreted with caution. In fbture studies,
more sophisticated rating systems that can address the
complexity and subtlety of psychological control are
needed. The findings of this study are also constrained
by their cross-sectionalnature. Subsequentlongitudinal
and experimental studies are needed to test if overcontrolled parenting precedes anxiety in children or if the
causal sequence is reversed when having a reactive and
cautious chi~ldleads to parental overinvolvement and
control.If these studies provide further confurnation for
the link of parents' level of psychological control and
acceptance with anxiety disorders in their children,
these results would have many implications for the
design of therapeutic interventions.

Downloaded by [McGill University Library] at 06:38 21 April 2013

References
American Psychiatric Assocation. (1987). Diagnostic and statistical
manual ofmental disorders (3rd ed., Rev.). Washington, DC:
Author.
Achenbach,T. (1991). Manualfor the Chi/dBehaviorChecklistl4-18
and 1991 Projle. Burlington: University of Vermont, Department of Psychiatry.
Achenbach, T., & Edelbrock, C. (1981). Behavioral problems and
competenicies reported by parents of normal and disturbed children aged four through sixteen. Monographs of the Society for
Research in Child Development, 46(1, Serial No. 188).
Armsden, G. C., McCauley, E., menberg, H. T., & Burke, P. M.
(199Q). Paret and pear attachtnept in early adolescent depression. Jounlrla @Abnormal ChiM PqychoEogy, 18, 683697.
Asarnow, J. R., Carlson, G. A., & Guthrie, D. (1987). Coping strategies, self-]perceptions,hopelessness, and perceived family envirorumnts hdepmssd and suicidal c w r e n . Journal of Consulting qnd Clinical Psychology, 55,361-366,
Asarno~V,J. R., Goldstein, M. J., Tompsm, M., & Guthrie, D. (1993).
One yew outcomes of depmsive disorders in child psychiatric
of a brief measure
inpatients: Evaluation of tbe pr~gnos~cpower
of expressed emotion. Journal of Child Psychology and Psychiatry, 34 129-137.
Barkley, R, (1g181).Hyperactive children: A handbookfor diagnosis
and treatnwnt. New York: Guilford.
Bau-d,
D. (1971). Current patterns ofiparental authority. Developmental Psychology, 4(1, Pt.2), 1-103.
Baumrind, D. (1989). Rearing competent children. In W. Damon
(lkl.),Child development today and tomorrow. San Francisco:
Jossey-Bass.
Beck, A. T. (1967). Depression: Causes and treatment. Philadelphia:
Unjversitjc of Pennsylvania Pness.
Beck, A. T., Steer, R A,, & Garbibin, M. 0. (1988). Psychometric
properties ofthe Beck Depression Inventary: Twenty-five years
later. Clin~icalPsychology Review, 8, 77-100.
Becker, W, C. (1964). Consequences d Clifferent kinds of parental
discipline. In M. L, Hoffman & L. W. Hoffman (Eds.), Review
qfchdlddevelopmenfresearch (V01.1, pp. 169-208). New York:
Russell Sage Foundation.
Bell-Dolan, D. I., Lash G. G., & Strauss, C. C. (1990). Symptoms of
anxiety didilsorders in normal children. Journql of the American
Academy of Child and Adolescent Psychiatry, 29,759-765.
Benjamin, L. (1974). Smctural analysis of social behavior. Psychologicd ~eview,81,392425.
Block J. H.,& Block, J. (1979). The role of ego-control and ego-resilieincy in the organization of behavior. In W.A. Collins (Ed.),
Minnesota symposia on childpsychology: Vol. Y 3. Development

of cognition, @ect and social relations (pp. 39-101). Hillsdale,

NJ: Lawrence Eklbaum Associates, Inc.
Bowen, M. (1960). The family as the unit of study and treatment.
American Joumal of Orthopsychiatry,31,4046.
Bowlby, D. (1973). Attachment and loss: Vol. 2. Separation New
York: Basic Books.
Brady, E.U., & Kendall, P. C. (1992). Comorbidity of anxiety and
depression in children and adolescents. Psychological Bulletin,
111,244-255.
Burbach, D.J., & Barduin, C. M. (1986). Parent-child relations and
the etiology of idepression: A review of methods ant1 findings.
Clinical Psychology Review, 6, 133-153.
Cantwell, D. P., & Baker, L. (1989). Stability and natural history of
DSM-111 childhood diagnoses. Annual Progress in Child Psychiatry and Child Development, 28,311-322.
Cohen, J. (1977). Staristical power analysis for the behavioral sciences. S m Diego: Academic.
Costello, E. J. (1989). Child psychiatric disorders and their ~correlates:
A primary care pediatric sample. Journal of the American
Academy of Child & Adolescent Psychiatry, 28, 851--855.
Cummings, N[.E., & Davies, P. (1994). Children and rmzrital conflict: % impact of family dispute and resolution. New York:
Guilford.
Dweck, C., & Wortman, C. (1983). Learned helplessness, anxiety and
stress
achievement. In H. Krone &L.Laux @kls.),Achievem~ent,
andanxiety (pp. 93-125). New York: Hemisphere.
Fauber, R. L., Forehand, R., Thomas, A. M., & Wierson, M.(1990).
A mediational model of the impact of marital conflict on adolescent adjustmRnt in intact and 0ivorced families: ?'he role of
disrupted parenting. ChildDevelopment, 61, 1112-1 123.
Fauber, R. L., & Long, N. (1991). Children in context: The role of
the family in child psychotherapy. Journal of Consiulting nnd
Clinical ,Psychology,59, 813-820.
Forehand, R., & MclLlahon, R. J. (1981). Helping the noncompliant
child: A Aclinician's guide to parent training. New York: Guilford.
Hauser, S. T., Powers, S. I., Noam, G. G., Jacobson, A. Id., Weiss,
B., & Follansbee, D. J. (1984). Familial contexts of adolescent
ego development. Child Development, 55,195-213.
Hetherington, E.M., & Martin, B. (1986). Family factors and psychopathology in children. In H. C. Quay & J. S. We:rry (Eds.)
Pqxhopathological disorders of childhood (3rd ed., pp.
332-390). New York: Wiley.
Hollingshead, A. (1975). Four Factor Index of Social Statuls. Unpublished manuscript, Yale University, Department of ZSociology,
New Haven, CT.
Jacob, T. (Ed.). (1987). Family interaction and psychqrathology:
Theories, methods, andfuture directions. New York: Plenum.
Jaenicke, C., I - I m n , C., Zupan, B., Airoto, D., Gordon, I).,Adrian,
C., & Burge, D. (1987). Cognitive vulnerability in children at
y,
risk for depression. Journal of Abnormal child ~ s ~ c h o l o g15,
559-572.
Kagan, J., & Moss, H. A. (1962). Birth to rnuturity: A sfudy in
psychological development.New York: Wiley.
Kagan, J., Reznick, S., & Snidtrm, N. (1987). The physilology and
psychology of behavioral inhibition in children. Child'Development, 58, 1459-1473.
Kashani, J. H., & Orvaschel, H. (1988). Anxiety disordeirs in midadolescence: A community sample. American Journal of Psychiatry, 145,960-964.
Kaslow, N . J., Rehm, L.P., & Seigel, A. W. (1984). Social-cognitive
and cognitive correlates of depression in children. Journal of
Abnorma,l Child Psychology, 12, 605-620.
Kazdin, A. E. (1981). Assessment lechniques for childhoo~ddepression: A critical appraisal. Journal of the American Academy of
Child Psychiiaty, 20, 358-375.
Keller,M. B.,I.avori, P. W., Wunder, J., Beardsless, W. R., !3chwartz,
C. E., & Roth, J. (1992). Chronic course of anxiety disorders in

Downloaded by [McGill University Library] at 06:38 21 April 2013

Downloaded by [McGill University Library] at 06:38 21 April 2013

ANXIETY IN CHILDREN
Spielberger, C. (1973).Manualfor the State-Trait Anxiety Inventory
for Child~ren.Palo Alto, CA: Consulting Psychologists Press.
Spielberger, C., Gorsuch, R., & Lushene, R. (1970). State-Trait
Anxiety Inventory manual. Palo Alto, CA: Consulting Psychologists Press.
Stark, K. D., Humphrey, L. L., Crook, K., & Lewis, K. (1990).
Perceivedl family environments of depressed and anxious children: Chid's and maternal figure's perspectives. J o u m l of
A b n o m l Child Psychology, 18,527-547.
Stark, K. D., Humphrey, L. L., Laurent, J., Livingston, R., & Christopher, J. (1993). Cognitive, behavioral, and family factors in
the differentiation of depressive and anxiety disorders during
childhood. Journal of Consulting and Clinical Psychology, 61,
878-886.
Stark, IS. D., Rouse, L., & Livingston, R. (1991). Treatment of
depression during childhood and adolescence: Cognitivsbehavioral procedures for the individual and family. In P. C.
Kendall (Ed.), Child and adolescent thempy: Cognitive-behavioralprocedures(pp. 165-208). New York: Guilford.
Steinberg, L. ((1990).Autonomy, conflict, and harmony in family
relationship. In S. S. Feldrnan & G. R. Elliot (Eds.), At the
threshold: The developing adolescent (pp. 255-276). Cambridge, M A : Harvard University Press.
Steinberg, L., Elmen, J. D., & Mounts, N. S. (1989). Authoritative
parenting, psychosocial maturity, and academic success among
adolescents. Child Development, 60, 1424-1436.
Strauss, C. C., Last, C. G., Hersen, M., & Kazdin, A. E. (1988).
Associati~~n
between anxiety and depression in children and
adolescen~tswith anxiety disorders. Journal of A b n o m l Child
Psychology, 16,5748.
Straws, C. C., Lease, C. A., Kazdin, A. E., Dulcan, M., &Last, C.
(1989). Multi-method assessment of the social competence of

anxiety disordered children. J o u m l of Consultingand Clinical

Psychology, 18,184-190.
Strauss, C. C., Lease, C. A., Last C. G., & Francis, IG. (1988).
Overanxious disorder: An examination of developmental differences. Journal of Abnormal Child Psychology, 16,433443.
Sylvester, C., Hyde, T. S., & Reichler, R. J. (1987). The diagnostic
interview for children in studies at risk for anxiety disorders or
depression. Jownal of the American Academy of Child and
Adolescent Psychiatry, 26, 668-4175.
Turner, S. M.., Beidel, D. C., & Costello, A. (1987).Psychopathology
in the offspringof anxiety disorder patients. Journal of Consulting and clinical Psychology, 95, 168-172.
Waldron, S., Shrier, D. K., Stone, B., & Tobin, E (1975). School
phobia m d other childhood neuroses: A systematic study of
children and their families. American Journal of 13sychiatty,
132,802-808.
Wood, B. (1985). Proximity and hier'mhy: Orthogonal dlimensions
of family interconnectedness. Family Process, 24, 4137-507.
Wood, B., Watkins, J. B., Boyle, J. T., Nogueira, J., Zimand, E., &
Carroll, L. (1989). The "psychosomatic family" model: An
empirical and theoretical analysis. Family Process, 28,
399-417.
Wynne, L. C. (1984).The epigenesis of relational systems: A model
for uncbrstanding family development. Family Process, 23,
297-318.

Received November 30,1994

Final revision received September 13, 1995