Externalizing behaviors in youth with anxiety : a replication and extension of previous findings

This study examined the nature of externalizing behaviors among 500+ youth ages 7-17 with a primary diagnosis of Generalized Anxiety Disorder (GAD), Separation Anxiety Disorder (SAD), and/or Social Phobia (SoP). It builds on previous findings suggesting that externalizing symptoms may be an under-recognized feature of childhood anxiety disorders (Garland & Garland, 2001; Mireault, Rooney, Kouwenhoven, & Hannan, 2008; Williams, Dahan, Silverman, & Pettit, 2013). As a first step, this study employed two exploratory techniques that sought to classify participants into subgroups based on their presentation of externalizing symptoms. Results of a two-step cluster analysis indicated a best-fitting 2-cluster model in which subgroups differed by average severity of aggressive behaviors. Results of the second classification approach, Latent Class Analysis (LCA), indicated a best-fitting 3-class model in which subgroups differed by overall severity of externalizing symptoms. These results were largely similar to a prior study that used the same approach to classify a similar sample of anxious youth (Williams et al., 2013). A comparison of subgroups within each analysis suggested that externalizing problems among anxious youth are related to anxiety severity, anxiety subtype, and to youth age; no relation was found with regard to youth gender. Furthermore, exploratory findings highlighted a handful of specific behaviors that are particularly likely to co-occur with childhood anxiety (e.g., arguing, disobedience, temper tantrums). These behaviors may reflect the youth’s attempt to avoid anxiety-induced distress. A second phase of analysis utilized post-treatment data to examine the relationship between externalizing behaviors and response to anxiety treatment. Contrary to the investigator’s hypothesis, results of regression analyses indicated that externalizing symptoms prior to treatment were not significantly related to child treatment response, suggesting that anxious youth with greater externalizing problems may benefit from treatment as much as those who do not present with these behavioral challenges. Taken together, these findings have implications for the identification, assessment, and treatment of youth anxiety disorders.Educational Psycholog