Transcript Noguchi, R.J.P., Knepp, M.M., & Ollendick, T.H.

Implications for Hemispheric Functioning in Youth with Generalized Anxiety Disorder
Ryoichi J. P. Noguchi, M.S., Michael M. Knepp, M.S., & Thomas H. Ollendick, Ph.D.
OTHER TITLE TEXT
 Studies of attention and memory have consistently shown threat
biases in anxiety groups across a range of contexts (Coles &
Heimberg, 2002; Mathews, 1990). In these studies, researchers
have hypothesized a link between frontal lobe dysfunction in
relation to its regulation of the amygdale.
Measures
 Child Behavior Checklist (CBCL; Achenbach, 1991). The
CBCL, a behavior checklist completed by parents who rate
children’s behavioral or emotional problems and competencies,
was used to identify internalizing and somatic symptoms.
 With respect to attentional focus, trait anxious individuals have
demonstrated faster reaction times for negatively primed stimuli
(Derryberry & Reed, 1998), suggesting the presence of a negative
threat bias. This effect, however, has been limited to targets
presented in the right visual field, implying left hemisphere
dominance.
 Wechsler Intelligence Scale for Children, Third & Fourth
Editions (WISC-III, WISC-IV; Wechsler, 1991, 2003). The
WISC served as a broad measure of neuropsychological
functioning, as intelligence has been found to be associated with
neural efficiency (Neubauer & Fink, 2003)
 Given this left hemisphere dominance, we can expect a decrease
in abilities on performance based tasks rather than verbal fluency
tasks because the left hemisphere has been associated with verbal
abilities, while the right hemisphere has been associated with
performance.
 We can further expect somatization and internalizing problems
to increase as potential indicators of autonomic dysregulation in
children and adolescents with generalized anxiety disorder like that
found by Thayer, Friedman, and Borkovec (1996) with adults.
 This study sought to investigate these associations in a clinical
sample of youth.
METHOD
Participants
 Participants were children and their parents referred to a child
research and assessment clinic for a psychoeducational assessment.
The sample consisted of 71 children and adolescents between the
ages of 7 and 16 years (M = 10.14, SD = 2.56) who received a
Generalized Anxiety Disorder (GAD) diagnosis.
 The comparison sample included 269 children and adolescents
between the ages of 7 and 16 (M = 10.12, SD = 2.75) referred to
the clinic who received a variety of diagnoses but not a GAD
diagnosis.
 Inclusionary criteria consisted of consensus diagnoses (Grills &
Ollendick, 2003) that were based on a clinical team conference that
included parent and child clinicians along with a licensed clinical
psychologist.
 Exclusionary criteria included a diagnosis of a pervasive
developmental disorder, schizophrenia, or bipolar disorder.
Procedure
 Children were seen at the clinic for three sessions and
administered a variety of assessments. Two clinicians worked
with every family such that one clinician interviewed and
administered measures to the parent(s), while another clinician
conducted the child assessment.
RESULTS
 Analyses reveal that on the WISC, children with GAD (M =
97.412, SD = 15.47) scored significantly lower on the
Perceptual Reasoning Index than their non-GAD counterparts
(M = 102.19, SD = 16.17), t(301) = 2.26 , p < .03.
 Specifically, on the Block Design subtest, GAD youth (M =
9.07, SD = 3.50) performed worse than non-GAD youth (M =
10.63, SD = 6.01), t(310) = 2.06, p < .05.
 GAD and non-GAD youth did not otherwise differ in their
performance on the WISC.
 On the CBCL, mothers of GAD children reported more
internalizing symptoms (T score M = 65.67, SD = 10.63) than
mothers of non-GAD children (T score M = 60.04, SD = 11.37),
t(301) = 3.68, p < .001
 This increased reporting of internalizing problems was also
seen through father reports such that fathers of GAD children (T
score M = 63.94, SD = 12.20) reported higher levels of
internalizing problems than fathers of non-GAD youth (T score
M = 55.42, SD = 10.67), t(207) = 4.17, p < .001.
 Similarly, mother reports of CBCL Somatic Symptoms were
higher for GAD youth (T score M = 63.94, SD = 9.91) when
compared with the controls (T score M = 59.90, SD = 9.05),
t(302) = 3.21, p < .005.
 Lastly, fathers of GAD children also reported higher Somatic
Symptoms (T score M = 62.02, SD = 10.43) than fathers of
non-GAD children (T score M = 56.76, SD = 7.80), t(208) =
3.82, p < .001.
Difference in Scores of Perceptual Reasoning in GAD and Non-GAD Youths
Perceptual Reasoning Index
Standard Score
INTRODUCTION
104
103
102
101
100
99
98
97
96
95
94
GAD
No GAD
Diagnosis
DISCUSSION
 The current results reveal that the Block Design performance
and perceptual reasoning were decreased in GAD youth,
indicating possible right hemispheric dysregulation. In addition,
parents of GAD youth reported higher levels of children’s
internalizing and somatic problems than non-GAD youth,
providing further evidence of autonomic dysregulation that has
been found in adult samples (Thayer et al., 1996).
 The results suggest a potential difference in right hemispheric
dysregulation and autonomic dysregulation in GAD children
when these children’s scores were compared to a clinical
control sample. The results suggest that GAD youth may be
more prone to problems with dysregulation than other clinical
samples of children and may suggest potential problems with
neural efficiency in GAD youth.
 The present findings were limited such that the measures
used (WISC, CBCL) are generally not indicators of hemispheric
or autonomic functioning. Additionally, the comparison sample
was also a clinical sample of children who received varying
diagnoses. Future research may benefit from investigating
potential mediating or moderating effects of hemispheric
functioning. Identifying factors that contribute to decreases in
hemispheric functioning can then allow us to devise
intervention strategies tailored towards GAD youth. Possible
interventions may include exercises to improve neural
efficiency and activation.
42nd Annual Convention of the Association for Behavioral and Cognitive Therapies, Orlando, FL, November 13-16, 2008