Cognitive processes associated with general anxiety disorder in children and adolescents

Abstract

RATIONALE: Cognitive processes and models that inform psychological treatment for children and adolescents with Generalized Anxiety Disorder (GAD) are based on research with adults. A systematic review of the cognitive processes associated with GAD in children and adolescents was conducted in order to consider the relevance of such processes to the development of GAD in this age group. The empirical study aimed to clarify the influence of a cognitive conceptual model, the intolerance of uncertainty model, on GAD symptoms in children and adolescents, and the moderating influence of gender and age on these relationships.

METHOD: The literature was systematically searched and additional sources sought for research relating to cognitive processes associated with GAD symptoms in children and adolescents. In the empirical study 326 young people, aged II 15 years, completed self-report measures relating to GAD symptoms and cognitive variables of the intolerance of uncertainty model.

RESULTS: Sixteen papers met inclusion criteria for the systematic review. Cognitive processes associated with GAD included attention bias, perceptual bias of external threat and familial relationships, perception of internal resources, anxiety sensitivity and maladaptive coping strategies. In the empirical study, intolerance of uncertainty and negative problem orientation were found to be predictive of GAD symptoms; positive beliefs about worry and cognitive avoidance were found to be less important in the prediction of such symptoms. Age and gender did not demonstrate significant moderating effects on key relationships in this model.

CONCLUSION: A diverse range of cognitive processes were highlighted as relevant to the possible development and maintenance of GAD in children and adolescents. Negatively biased perceptions and tolerance of uncertainty are processes that could be targeted in psychological interventions. From the empirical study, intolerance of uncertainty and negative problem orientation were the components of the intolerance of uncertainty model that appear most applicable to treatment of GAD in 11-15 year olds.