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Modification
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Cognitive Errors, Anxiety Sensitivity, and Anxiety Control Beliefs:


Their Unique and Specific Associations With Childhood Anxiety
Symptoms
Carl F. Weems, Natalie M. Costa, Sarah E. Watts, Leslie K. Taylor and Melinda
F. Cannon
Behav Modif 2007 31: 174
DOI: 10.1177/0145445506297016
The online version of this article can be found at:
http://bmo.sagepub.com/content/31/2/174

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Cognitive Errors, Anxiety


Sensitivity, and Anxiety
Control Beliefs

Behavior Modification
Volume 31 Number 2
March 2007 174-201
2007 Sage Publications
10.1177/0145445506297016
http://bmo.sagepub.com
hosted at
http://online.sagepub.com

Their Unique and Specific


Associations With Childhood
Anxiety Symptoms
Carl F. Weems
Natalie M. Costa
Sarah E. Watts
Leslie K. Taylor
Melinda F. Cannon
University of New Orleans, LA

This study examined the interrelations among negative cognitive errors, anxiety
sensitivity, and anxiety control beliefs and explored their unique and specific
associations with anxiety symptoms in a community sample of youth. Existing
research has suggested that these constructs are related to childhood anxiety disorder symptoms; however, additional research is needed to test the interrelations
among negative cognitive errors, anxiety sensitivity, and anxiety control beliefs
and to determine if they show unique and specific associations with anxiety
symptoms. The results of this study indicated that negative cognitive errors, anxiety sensitivity, and anxiety control beliefs were associated with each other and
that they demonstrated unique concurrent associations with childhood anxiety
disorder symptoms. Moreover, certain cognitive biases showed specificity in
their association with anxiety symptoms versus depressive symptoms.
Keywords: anxiety; child and adolescents; cognition; anxiety sensitivity;
cognitive errors; control

nxiety has been broadly conceptualized as a complex response system


involving behavioral, physiological, and cognitive components (e.g.,
Barlow, 2002; Lang, 1977). Anxiety disorders are thought to result from
quantitative and/or qualitative deviations in the normative mechanisms of
the anxiety response system (Barlow, 2002; Vasey & Dadds, 2001). Cognitive
models focus on the hypothesis that anxiety disorders can stem from faulty,
174

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biased, or negative ways of thinking and the biased processing of information


(e.g., Beck, 1976; Ellis, 1962). Although a large number of studies have
shown that cognitive biases are associated with depression in youth and that
various forms of biases may help predict depressive symptoms (Garber,
Keiley, & Martin, 2002; see Joiner & Wagner, 1995, for a review), far less
research has been focused on their role in childhood anxiety. Alfano,
Beidel, and Turner (2002) have argued that the literature to date has only
provided modest support for a role of cognitive aberrations (p. 1209) or
cognitive biases in childhood anxiety and anxiety disorders. In particular,
the empirical support for the conceptual distinctions among various cognitive biases and their specificity to anxiety is limited (Weems & Watts, 2005).
The purpose of this study was to address some of these gaps in knowledge.
The research on cognitive models of anxiety in youth has focused on biased
interpretation, biased judgment, biased memory, and selective attention (see,
e.g., Vasey & MacLeod, 2001). These various biases are hypothesized to work
together at various stages of information processing to foster and maintain
heightened anxiety. Weems and Watts (2005) developed a model of the cognitive influences on childhood anxiety, which suggests that attention biases may
foster the selective encoding of threat information into memory and that such
selective attention could thus increase the number of negatively biased threat
memories. Memory biases, in turn, may become internalized in cognitive
working models or cognitive schemas, thus fostering interpretive and judgment biases. For example, existing threat memories may bias attention toward
only the threatening part of the situation and away from mitigating aspects of
the situation such as safety signals, thereby fostering anxiety-provoking interpretations. Another way is that existing threat memories may bias the new
interpretation of the event and help to consolidate existing interpretation and
judgment biases. The model thus predicts that the various cognitive biases will
be related to each other but, at least to some extent, will each be incrementally
related to anxiety and anxiety-related distress.
Conceptually, attention and memory are quite distinct and research suggests that they show unique associations with anxiety in youth (Watts &
Weems, in press); however, judgment biases and interpretation biases are very
similar and our review of the literature (see Weems & Watts, 2005) suggests
that additional research and conceptual work is needed to elucidate the

Authors Note: This research was supported in part by a grant from the National Institute of
Mental Health (MH067572) awarded to Carl F. Weems. Correspondence concerning this article should be addressed to Carl F. Weems, Department of Psychology, University of New
Orleans, New Orleans, LA 70148; e-mail: cweems@uno.edu.

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uniqueness of the concepts and the uniqueness of the associations among


judgment biases, interpretation biases, and anxiety in youth. Interpretive
bias involves being predisposed toward negative or erroneous interpretations of neutral, ambiguous, or potentially threatening stimuli or situations.
Judgment bias involves negative and/or lowered estimates of the individuals coping ability or style. Both interpretive and judgment biases thus
involve a similar cognitive style and so individuals who have a tendency for
negative judgments about their own ability are likely to have negative interpretations of events (and vice versa), and so interpretive and judgment
biases are likely to be related. However, this similarity also raises the possibility that they are not uniquely associated with anxiety (i.e., variance in
one may account for the association between anxiety and the other). The
focus of this study is on two types of interpretive biasesnegative cognitive errors and anxiety sensitivityand a judgment bias, namely, anxiety
control beliefs. These three constructs were chosen because they have been
hypothesized to be important to childhood anxiety problems (e.g., Epkins,
1996; Weems & Silverman, 2006).

Interpretive Biases
As noted, interpretive bias involves being predisposed toward negative
or erroneous interpretations of neutral, ambiguous, or potentially threatening stimuli or situations. Negatively biased cognitions1 have long been
thought to be core processes in emotional problems such as anxiety disorders (Beck, 1976; Ellis, 1962). Research has shown that clinically anxious
youth presented with ambiguous vignettes and then asked to explain what
was happening in the story are more likely to provide interpretations indicating threat than are nonanxious controls (Barrett, Rapee, Dadds, & Ryan,
1996; Chorpita, Albano, & Barlow, 1996).
Negative cognitive errors are thought to be particularly salient to emotional problems in youth (Leitenberg, Leonard, & Carroll-Wilson, 1986)
and concern the interpretation of events and situations in ones life. For
example, catastrophizing involves expecting the worst possible outcome of
an event or situation, overgeneralizing involves believing that a single negative outcome is representative of all similar future events, personalizing
involves attributing control over the outcome of negative events to internal
causes, and selective abstraction involves selectively focusing on only the
negative aspects of an event or situation. The existing research on these
cognitive errors using the Childrens Negative Cognitive Error Questionnaire
(CNCEQ; Leitenberg et al., 1986) suggests that they are associated with

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symptoms of anxiety and depression and that certain errors, such as catastrophizing and overgeneralizing, may be more related to anxiety, whereas
selective abstraction may be more related to depression (Epkins, 1996;
Leitenberg et al., 1986; Leung & Wong, 1998; Weems, Berman, Silverman,
& Saavedra, 2001). However, as theoretically predicted by the cognitive content specificity hypothesis (Beck, 1976; Beck, Brown, Steer, Eidelson, &
Riskind, 1987; Laurent & Stark, 1993), greater specificity has been obtained
when the content of the cognitions are centered on depressive versus anxious content (Leung & Poon, 2001). Such findings suggest that it is not the
type of bias per se that is specific to anxiety but the content of the bias (see
also Laurent & Stark, 1993).
Catastrophic interpretations of anxiety-related sensations have been the
focus of the literature on anxiety sensitivity. The concept of anxiety sensitivity refers to beliefs that anxiety-related sensations have severe and negative consequences (Reiss, 1991). Defined in this way, anxiety sensitivity
provides specificity to the concept of catastrophizing by focusing on anxietyrelated events and situations. Research indicates that anxiety sensitivity predicts panic beyond that predicted by trait anxiety in adult samples (e.g.,
Schmidt, Lerew, & Jackson, 1997, 1999), prospectively predicts the development of panic attacks in youth (Hayward, Killen, Kraemer, & Taylor,
2000; Weems, Hayward, Killen, & Taylor, 2002), and that anxiety sensitivity is concurrently and prospectively related to self-report of anxiety and
panic symptoms (Ginsberg & Drake, 2002; Lau, Calamari, & Waraczynski,
1996; Silverman, Fleisig, Rabian, & Peterson, 1991). Moreover, studies
have demonstrated that although anxiety sensitivity is related to depression,
it is more uniquely associated with anxiety symptoms in youth (see Dehon,
Weems, Stickle, Costa, & Berman, 2005; Joiner et al., 2002).
Weems et al. (2001) examined the association between negative cognitive errors assessed with the CNCEQ and anxiety symptoms as well as anxiety sensitivity assessed with the Childhood Anxiety Sensitivity Index
(Silverman et al., 1991) in a sample of children and adolescents who were
clinic referred for anxiety disorders (N = 251, ages 6-16 years). Results
indicated that the types of errors, except selective abstraction, were significantly positively related to self-reported anxiety and anxiety sensitivity
even when controlling for levels of depression (correlations ranged from
.39 to .43). Results of regression analyses indicated that age moderated the
relation between the cognitive errors and anxiety. The pattern that emerged
was statistically significant but there were somewhat smaller correlations
between CNCEQ subscale scores and the anxiety measures in children
ages 6 to 11 (average r = ~.35) than adolescents ages 12 to 17 years

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(average r = ~.45). These results suggest that for younger children with
anxiety disorders, negative cognitive errors were less strongly related to
their anxious symptoms than for older youth with anxiety disorders.
Additional results indicated that selective abstraction was more uniquely
associated with depression and that catastrophizing and overgeneralizing
were more uniquely associated with anxiety symptoms. However, the
unique associations among anxiety, anxiety sensitivity, and CNCEQ scores
were not examined.

Judgment Biases
As noted, judgment bias involves negative and/or lowered estimates of the
individuals coping ability or style. Judgment biases in children can refer to
lowered expectations of their ability to handle threatening situations or
events. Common definitions of control involve a judgment as to ones ability
and have thus been the most common way that judgment biases have been
studied in youth. Barlows (2002) model of anxiety suggests that a perceived
lack of control over external threats (i.e., events, objects, or situations that are
fear producing for an individual) and/or control over negative internal emotional and bodily reactions are central to the experience of anxiety problems;
that is, beliefs that anxiety-related events and sensations are uncontrollable is
part of what makes anxiety a problem for individuals with anxiety disorders.
In other words, nonpathological anxiety in individuals who do not have anxiety disorders is differentiated from pathological anxiety by heightened levels
of anxiety in response to the experience of threatening situations but also by
the judgment that they cannot control these events.
Research on control and anxiety has produced an encouraging body of
knowledge. For example, studies suggest that there seems to be a fairly consistent relation between an external locus of control and self-reported anxiety in children (Nunn, 1988; Rawson, 1992). Similar findings also have
been evidenced using diverse methods of assessing control (e.g., Capps,
Sigman, Sena, Henker, & Whalen, 1996; Cortez & Bugental, 1995). However,
control is also strongly related to depression as well as anxiety (see Joiner
& Wagner, 1995).
Barlow and colleagues (Barlow, 2002; Rapee, Craske, Brown, & Barlow,
1996) model of control provides a more anxiety-specific conceptualization.
Drawing on Barlows (2002) model of control in anxiety disorders, Rapee
et al. (1996) developed a measure of control over anxiety, the Anxiety Control
Questionnaire (ACQ), for use with adults. Ones perception of control over

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anxiety-related events is assessed by the ACQ in terms of control over emotional reactions and frightening events. Specifically, in the ACQ, the internalexternal distinction refers to the stimuli to be controlled (i.e., internal anxiety
reactions such as heart palpitations or feelings of panic; external threats
such as a dog or social situations).
Weems, Silverman, Rapee, and Pina (2003) investigated the role of control beliefs in childhood anxiety disorders using a developmentally modified version of Rapee et al.s (1996) Anxiety Control Questionnaire (i.e., the
ACQ-C) in a sample of 117 youth ages 9 to17 years. Eighty-six participants
were clinic referred and met diagnostic criteria for an anxiety disorder, and
31 participants were nonreferred comparison participants. Findings indicated that perceived control over anxiety-related events was significantly
negatively correlated with youth self-reported anxiety symptoms and that
youth with anxiety disorders reported significantly lower perceived control
about anxiety than the nonreferred youth. Results of logistic regression
analysis indicated that the perceptions of control over anxiety predicted
anxiety disorder status even when controlling for anxiety levels using an
existing measure of anxiety as well as locus of control. Although this initial
research is encouraging, the specificity of anxiety control beliefs to anxiety
versus depression and its association to other forms of cognitive bias has
not been examined.

Summary
There is evidence that negative cognitive errors, anxiety sensitivity, and
anxiety control beliefs are associated with anxiety in youth. However,
research is needed to examine the interrelations among negative cognitive
errors, anxiety sensitivity, and anxiety control beliefs and to examine if they
are each uniquely associated with anxiety. For example, anxiety sensitivitys
association with anxiety may be explained by the more general cognitive
bias of catastrophizing. Similarly, it could be argued that personalizing or
attributing control over the outcome of negative events to internal causes is
tapping the same cognitive process as control over anxiety. Moreover, the
judgment that anxiety sensations are uncontrollable might be tapping the
same beliefs that are central to anxiety sensitivity (i.e., they are not empirically unique). Theoretically, biases such as control over anxiety involve a
perceived lack of ability, competence, or skill and are thus centered on the
individual making the judgment, whereas interpretive biases involve disproportionately negative interpretations of stimuli or situations and are thus

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centered on a context, stimuli, or external event (i.e., they theoretically should


be empirically unique predictors of anxiety). According to the cognitive content specificity hypothesis (Beck et al., 1987), the concepts of anxiety sensitivity and anxiety control should show greater specificity to anxiety than
depression. Without research that tests the uniqueness and specificity of
these constructs (e.g., Do measures of personalizing, catastrophizing, anxiety sensitivity, and control predict unique variance in anxiety symptoms and
how specific are they to anxiety symptoms vs. depression?), the conceptual
validity of the constructs remains questionable.

The Present Study


The purpose of this study was to extend existing research by examining
the interrelations among negative cognitive errors, anxiety sensitivity, and
anxiety control beliefs and by examining their unique associations with
anxiety symptoms in a community sample of youth. Based on the model
proposed by Weems and Watts (2005), theoretical basis for the constructs,
and existing research, we predicted that catastrophizing, anxiety sensitivity,
and anxiety control would each predict unique variance in anxiety disorder
symptoms. We also hypothesized that anxiety sensitivity and anxiety control would show specific associations with anxiety (i.e., would be related to
anxiety even when controlling for depression). Based on previous research,
we predicted that selective abstraction would show unique prediction of
symptoms of depression (e.g., Epkins, 1996; Weems et al., 2001). We also
examined the 1-year test-retest reliability of the measures of negative cognitive errors (CNCEQ), anxiety sensitivity (Childhood Anxiety Sensitivity
Index [CASI]), and anxiety control beliefs (ACQ-C) and examined if these
predicted anxiety symptoms after 1 year in a subsample (n = 52) of the
child participants.
Given the role that age may play in the associations, we recruited a sample of youth from a wide age range. This was done so that the potential
moderating role of age could be examined. Based on previous findings in
the depression literature (e.g., Nolen-Hoeksema, Girgus, & Seligman,
1992; Turner & Cole, 1994) and previous research (Calamari et al., 2001;
Rabian, Embry, & MacIntyre, 1999; Weems et al., 2001; Weems, HammondLaurence, Silverman, & Ginsburg, 1998), we expected some moderation of
CNCEQ subscales by age, but not anxiety sensitivity. In the absence of any
data on the ACQ-C, we did not make a priori predictions. By using the term
some moderation, we expected that the association would be weaker but

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that the measures of cognitive biases would still be significantly associated


with anxiety in younger children. However, we expected that age-related
differences in the size of the association between cognitive biases and anxiety may be specific to clinical samples because of overall larger effect sizes
in such samples. The potential moderating role of gender and ethnicity also
was tested; however, based on Weems et al. (2001), we expected that gender
would not be a moderator. The moderating role of ethnicity was examined
for exploratory purposes in response to the call for greater attention to ethnic differences in childhood anxiety research (Cooley & Boyce, 2004).
In addition, although youth are probably in the best position to report on
their cognitions, reliance solely on self-report of anxiety symptoms in testing the validity of these measures may have biased estimates of the association. However, there tends to be fairly low correspondence between parent
and child reports of the childs behavior (e.g., Achenbach, McConaughy, &
Howell, 1987, in a review of the literature, report an average correlation of
r = .25). Such discrepancies among reporters can lead to different or inconsistent conclusions about the prediction of behavioral problems (De Los
Reyes & Kazdin, 2004). Reasons for the bias in reporting anxiety symptoms may stem from the parent or from the child. For example, bias may be
due to the child underreporting his or her own anxiety for reasons of social
desirability, or parents may underreport relative to the child because the
nature of anxiety makes it less salient to parents and thus they are not aware
of true levels of anxiety in their child. De Los Reyes and Kazdin (2004)
recently examined different options for examining informant discrepancies.
They concluded that the standardized difference between reporters is a preferred measure of discrepancy between parent and child reports because it
correlates equally with each of the sources from which it is derived.
Drawing from this recommendation, we employed a technique for handling
discrepancy when predicting parent-reported symptoms with child-reported
cognitive biases. Results obtained from parents alone and from combining
parent and child reports of the childs anxiety also are presented.

Method
Participants
Data were collected from a socioeconomic and ethnically diverse sample
of 145 youth (ages 6-17 years, M age = 11.36 years, SD = 3.5 years)2 and
their primary caregiver (mothers = 90%, fathers = 7%, grandparents = 3%).

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Participants were Euro-American (42%), African American (42%), Hispanic


(8%), Asian (2%), and 6% were of other or mixed ethnic backgrounds, with
a median family income of between $20,000 and $40,000 a year. Fifty-five
percent of the sample was female. Families were recruited through the adult
students enrolled in courses at the University of New Orleans (UNO) as
well as through area schools and media outreach. Participants received a
small monetary reward as compensation for participating in the research
study (paid to the parent for the child).
Children were excluded if parents indicated during an initial assessment
screening that the child had a history of one or more of the following
diagnosesall pervasive developmental disorders, mental retardation, selective mutism, organic mental disorders, schizophrenia, and other psychotic
disordersor were at risk for harm to self or others (only one child was
excluded whose parent indicated the child had a diagnosis of pervasive
developmental disordernot otherwise specified [PDD-NOS]). Interested
families were informed that we were conducting a study of youth behaviors, emotions, and anxiety and that they could receive a free screening for
anxiety-related problems. However, potential participants were told that
families are eligible to participate regardless of whether they have anxiety
problems. This recruitment process was designed to help normalize the distribution of anxiety symptoms to facilitate the use of parametric statistics.
However, only 6% of children or mothers were currently on any form of
psychotropic medications. On the basis of our assessment, 9 children (6%)
were referred to further assessment or intervention services. All data used
in this study were collected before families were referred to or enrolled in
intervention services.
A representative subsample (n = 52)3 of the child participants completed
the measures again approximately 1 year (11-14 months) after the initial
assessment to obtain 1-year test-retest reliability estimates and to examine
the predictive ability of negative cognitive errors, anxiety sensitivity, and
anxiety control beliefs. The mean age of the follow-up sample at Time 1
was 11.15 years (SD = 3.2 years). Participants were Euro-American (42%),
African American (46%), Hispanic (7%), and 4% were of other or mixed
ethnic backgrounds, with a median family income of between $20,000 and
$40,000 a year. Sixty-one percent of the sample was female. Completers of
this Time 2 follow-up were compared to the rest of the sample on Time 1
variables. The follow-up sample did not differ on age, gender, overall ethnic distribution, income, anxiety, and depression scores or any of the cognitive variables.

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Measures
The CNCEQ (Leitenberg et al., 1986) was used to assess catastrophizing, overgeneralization, personalizing, and selective abstraction. This
24-item measure is designed to assess the four errors via four theoretically
derived subscales. Each subscale contains six questions. Each item on each
subscale presents the child with a hypothetical vignette and a negative interpretation of the vignette to which the child responds if he or she would
interpret the situation in a similar fashion. For example, one of the items
assessing selective abstraction has the hypothetical situation of playing basketball where it is indicated that during the game the child scored five baskets and missed two easy shots. After the game, the child thought, I played
poorly. Children are asked to rate on a 5-point scale how similar the
thought was to their own thoughts in a similar situation (e.g., 1 = not at all
like I would think, 5 = almost exactly like I would think). The CNCEQ has
demonstrated acceptable internal consistency, test-retest reliability, and
construct validity estimates (Leitenberg et al., 1986; Weems et al., 2001).
For example, in terms of convergent validity, Mazur, Wolchik, and Sandler
(1992) found that total distortion scores were significantly related to
childrens anxiety scores as measured by the Revised Childrens Manifest
Anxiety Scale (RCMAS) while controlling for gender using partial correlations (partial r = .28).
The CASI (Silverman et al., 1991) was used to assess anxiety sensitivity. The CASI is an 18-item measure designed to assess childrens fear of
different symptoms of anxiety. Children rate each question by selecting one
of three choices (none, some, or a lot). Each item is scored with a 1, 2, or
3. Example questions are, It scares me when I feel shaky and It scares
me when I feel nervous. The CASI has been shown to have satisfactory
reliability estimates (Silverman et al., 1991). For example, Cronbachs
alpha coefficient has been estimated at .87 and 2-week test-retest reliability
at .76. With regard to validity, the CASI has been shown to (a) concurrently
relate to panic symptoms, fears, and negative cognitive errors; (b) predict
anxiety-relevant responding to behavioral-stress challenge tasks; and (c) be
prospectively associated with panic symptoms (e.g., Ginsburg & Drake,
2002; Lau et al., 1996; Rabian et al., 1999; Silverman et al., 1991; Weems
et al., 2001).
The ACQ-C (Weems et al., 2003) was developed by adapting the method
used in Rapee et al. (1996). Questions were designed to measure perceived
lack of control over external threats (e.g., events, objects, or situations that
are fear producing for an individual) and control over negative, internal,

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emotional, and bodily reactions associated with anxiety (e.g., shaking or


trembling, the subjective experience of anxiety). In adapting the methods
used by Rapee et al. (1996), Rapee et al.s items were subjected to a developmental analysis of the wording by the authors and modified to render
them understandable by children. For example, phrasing and wording on
the question, There is little I can do to influence peoples judgments of
me was changed to I can change the way that people feel about me.
Children were asked to rate their agreement with each question along a
rating scale as follows: 0 (none), 1 (a little), 2 (some), 3 (a lot), or 4 (very, very
much). Total control belief score is obtained by summing the items. Internal
consistency estimates (i.e., coefficient alpha) for the total scale were .94
and .92 in two independent samples (Weems et al., 2003). The ACQ-C also
has produced good validity estimates. For example, the ACQ-C had convergent validity with the NSLOC (r = .22) and RCMAS (r = .47).
The Revised Child Anxiety and Depression Scales (RCADS; Chorpita,
Yim, Moffitt, Umemoto, & Francis, 2000; Spence, 1997) were used to
assess symptoms of anxiety disorders and depression. The RCADS is a
47-item instrument that assesses symptoms of each anxiety disorder (except
posttraumatic stress disorder [PTSD] and specific phobias) and depression
based on the Diagnostic and Statistical Manual of Mental DisordersIV
(DSM-IV) criteria (American Psychiatric Association, 1994). The scale is
scored 1 (never), 2 (sometimes), 3 (often), and 4 (always). The RCADS is
an adaptation of the Spence Anxiety Scales (Spence, 1997). Chorpita et al.
(2000) modified the Spence scales for DSM-IV and evaluated the RCADS
by examining the measures factorial validity in a school sample of 1,641
children and adolescents (ages 6.2-18.9 years) and its reliability and validity
in an independent sample of 246 children and adolescents (ages 8.3-18.3 yrs).
The results suggested an item set and factor definitions that were consistent
with DSM-IV anxiety disorders and depression. Moreover, the RCADS
demonstrated convergent validity with existing measures of childhood anxiety and depression (Chorpita et al., 2000).
Parents also completed a parent version of the RCADS (RCADS-P)
designed identical to the RCADS with minor modifications (i.e., wording
was changed from I to My child). Because the RCADS-P has not been
used before, the Revised Childrens Manifest Anxiety Scale (RCMAS-P)
was completed by parents (Pina, Silverman, Saavedra, & Weems, 2001;
Reynolds & Richmond, 1978) and was administered to assess convergent
validity with the RCADS-P. The RCMAS-P has good validity estimates
(Pina et al., 2001) and asks parents to rate their childs anxiety with virtually the same items as the RCMAS (i.e., wording is changed from I to

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My child), and thus, 28 items are summed from yes or no responses to


yield a Total Anxiety score (nine items comprise a lie scale). Each item is
scored with a 0 or 1. Convergent validity of the RCADS-P anxiety scale
with the RCMAS-P was .81 in the full sample, .78 in the youth ages 6 to 11
years, and .84 in the youth ages 12 to 17 years (all ps < .01). Cross-informant
validity of the RCADS-P anxiety scale with the RCADS anxiety was .27 in
the full sample, .25 in the youth ages 6 to 11 years, and .27 in the youth ages
12 to 17 years (all ps < .05). RCADS-P depression scale was significantly
correlated with RCMAS-P scores: .73 in the full sample, .69 in the youth
ages 6 to 11 years, and .80 in the youth ages 12 to 17 years (all ps < .01).

Procedures
Informed consent was obtained from the parent and informed assent was
obtained from the child. Completion of the assessment took place in a quiet
room and the child completed the assessment in a separate room from the
parent. Both the youth and parent were greeted and given a general
overview of the assessment procedures. Standardized specific instructions
were then given to the parent and child separately. Youth completed the
measures and were assisted as necessary by trained research assistants (e.g.,
young participants were read the assessment battery by research assistants
who monitored the childs comprehension of the questions). At the conclusion of the study, participants were debriefed and given a small monetary
reward. Missing or incomplete data on one or more measures was handled
by pair- or analysis-wise (when more than two variables) deletion of missing cases (Tabachnick & Fidell, 2001). Age groups4 (children, ages 6-11
years, and adolescents, ages 12-17) were formed on the basis of sample
size, predicted change in cognitive development (Piaget, 1950, 1983), and
for consistency with past research for dichotomous age analyses.

Results
Preliminary Analyses
Means and standard deviations for each of the measures for the total
sample and by age and gender are presented in Table 1. Examination of the
cognitive and symptom scores ranges and skew indicated acceptable levels
for the planned analyses. Results of 2 (gender) 2 (age group) ANOVAs
are summarized in Table 1 and indicated that boys and girls differed on

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Table 1
Means and Standard Deviations for Cognitive and Symptom
Measures by Age and Gender
Measure

Full Sample
M (SD)

6-11 Years
M (SD)

12-17 Years
M (SD)

Boys
M (SD)

Girls
M (SD)

1. RCADS-(A)a,b
2. RCADS-(PA)
3. CASIa,b
4. ACQ-Cb
5. CNCEQ-CT
6. CNCEQ-OG
7. CNCEQ-PS
8. CNCEQ-SA
9. RCADS-(D)
10. RCADS-(PD)

64.15 (16.7)
51.55 (10.3)
29.31 (6.9)
71.03 (20.1)
12.09 (4.8)
12.45 (5.0)
13.22 (5.1)
12.38 (4.6)
16.71 (4.8)
13.41 (3.5)

68.90 (17.6)
52.48 (10.0)
31.25 (6.8)
70.51 (19.2)
12.01 (4.8)
12.90 (5.2)
13.98 (5.3)
12.59 (5.2)
17.39 (4.9)
13.22 (3.5)

58.83 (14.0)
50.33 (10.8)
27.19 (6.4)
71.60 (21.1)
12.17 (4.8)
11.95 (4.8)
12.38 (4.7)
12.15 (4.0)
15.93 (4.7)
13.60 (3.7)

59.83 (16.1)
51.51 (10.6)
26.89 (6.3)
76.82 (22.1)
12.17 (5.3)
11.92 (4.9)
13.39 (5.1)
12.00 (4.3)
15.98 (4.6)
13.48 (4.1)

67.79 (16.5)
51.58 (10.2)
31.30 (6.8)
66.02 (16.8)
12.01 (4.4)
12.90 (5.1)
13.06 (5.0)
12.71 (5.0)
17.31 (4.8)
13.34 (3.0)

Note: RCADS = The Revised Child Anxiety and Depression Scales; A = Anxiety; D =
Depression; PA = Parent-Completed Anxiety; PD = Parent-Completed Depression; CASI =
Childhood Anxiety Sensitivity Index; ACQ-C = Anxiety Control Questionnaire for Children;
CNCEQ = Childrens Negative Cognitive Error Questionnaire; CT = Catastrophizing; OG =
Overgeneralizing; PS = Personalizing; SA = Selective Abstraction.
a. Significant age group difference.
b. Significant gender difference.

RCADS anxiety scores, CASI scores, and ACQ-C scores and that the age
groups differed on RCADS anxiety and CASI scores. Because the sample
sizes for the other ethnicities were small, the role of ethnicity was considered separately and only the African American and Euro-American participants were used for the ethnic comparisons. Results of t tests indicated that
African American and Euro-American participants significantly differed on
CNCEQ catastrophizing (African American M = 13.16, SD = 5.5; EuroAmerican M = 11.01, SD = 4.0), t(120) = 2.46, p < .05; CNCEQ personalizing (African American M = 14.69, SD = 5.4; Euro-American M = 12.43,
SD = 4.4), t(120) = 2.44, p < .05; CASI (African American M = 31.77,
SD = 6.2; Euro-American M = 27.34, SD = 6.8), t(120) = 3.76, p < .001;
and RCADS anxiety (African American M = 69.72, SD =17.9; EuroAmerican M =59.39, SD =14.7), t(120) = 3.48, p < .01.
Pearsons correlations among the measures and internal consistency are
presented in Table 2 and indicated that child-reported RCADS anxiety
scores were significantly but modestly correlated with each of the cognitive
measures. RCADS anxiety was significantly and highly correlated with

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.27**
.60**
.37**
.31**
.41**
.33**
.35**
.73**
.11
.93
.92
.93

.07
.12
.04
.01
.09
.10
.21*
.74**
.93
.91
.95

.23**
.24**
.27**
.32**
.25**
.43**
.06
.86
.83
.88

.10
.24**
.09
.21*
.29**
.08
.91
.89
.94

.67**
.66**
.66**
.35**
.03
.73
.71
.76

.61**
.64**
.39**
.00
.74
.73
.76

.64**
.31**
.09
.74
.71
.77

.40**
.07
.71
.73
.67

.19*
.71
.65
.77

.82
.83
.82

10

Note: RCADS = The Revised Child Anxiety and Depression Scales; A = Anxiety; D = Depression; PA = Parent-Completed Anxiety; PD = ParentCompleted Depression; CASI = Childhood Anxiety Sensitivity Index; ACQ-C = Anxiety Control Questionnaire for Children; CNCEQ = Childrens
Negative Cognitive Error Questionnaire; CT = Catastrophizing; OG = Overgeneralizing; PS = Personalizing; SA = Selective Abstraction.
*p < .05. **p < .01, two-tailed.

1. RCADS-(A)
2. RCADS-(PA)
3. CASI
4. ACQ-C
5. CNCEQ-CT
6. CNCEQ-OG
7. CNCEQ-PS
8. CNCEQ-SA
9. RCADS-(D)
10. RCADS-(PD)
Coefficient alpha
Age 6-11 (n = 75)
Age 12-17 (n = 70)

Table 2
Internal Consistency and Correlations Among the Measures of Cognitive Bias, Anxiety, and Depression

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child-reported depression. RCADS depression also was correlated with


each of the cognitive biases. Anxiety sensitivity was significantly correlated
with each of the other cognitive biases; anxiety control beliefs were significantly correlated with the other cognitive measures except catastrophizing
and personalizing. Scores for the cognitive errors on the CNCEQ were all
highly correlated. RCADS-P anxiety and depression scores were significantly correlated with child-reported anxiety and depression but were not
correlated with any of the cognitive measures. Because of this, child-reported
symptoms are the focus of the following sets of analyses and parentreported symptoms are considered separately in the last section.

Do Each of the Cognitive Measures


Predict Unique Variance in Anxiety Symptoms?
A hierarchical regression analysis was conducted to determine if each of
the cognitive biases predicted child-reported anxiety while controlling for
age and gender,5 and the results are summarized in Table 3. RCADS anxiety scores were used as the criterion variable, age and gender were added
into the model in the first step, and each of the cognitive measures was
entered in the second step. The significance tests and standardized betas for
the measures from the CNCEQ were calculated in separate regressions to
reduce the influence of multicolinearity because the correlations among the
subscales were stronger (~.60) than with symptom scores (~.30), as suggested by Tabachnick and Fidell (2001). CASI scores, ACQ-C scores, and
each of the CNCEQ subscale scores were significant predictors, together
accounting for an additional 32% of the variance in RCADS anxiety scores
beyond age and gender.
Next, a series of hierarchical regression analyses were conducted to
examine the unique (incremental) contribution of each of the measures to
predicting anxiety. Each of the cognitive measures unique contribution was
estimated by calculating the change in R2 for each measure beyond each of
the other cognitive measures. Specifically, RCADS anxiety scores were
again used as the criterion variable and age and gender were added into the
model in the first step. In Step 2, each of the cognitive measures except one
was entered (e.g., ACQ-C, CNCEQ were entered in Step 2). In the last step,
the excluded measure was entered (e.g., CASI in Step 3). CNCEQ subscale
scores were entered in separate analyses when testing their incremental
contribution and CNCEQ total scores were used when testing the incremental contribution of the ACQ-C and CASI to reduce the potential effects
of multicolinearity. Results of the analyses indicated that the CASI, ACQ-C,

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Table 3
Summary of Regression Analyses Predicting Child Anxiety
Step

R2

Change in R2

Semipartial r

VIF

.17
.07
.34
.19
.20
.24
.15
.09

1.1
1.2
1.4
1.1
1.1
1.1
1.1
1.2

.17
.08
.28
.19
.16
.22
.11
.15

1.1
1.2
1.4
1.1
1.1
1.1
1.1
1.2

Model 1: Predicting child-reported anxiety


1. Age
Gender
2. CASI
ACQ-C
CNCEQ-CT
CNCEQ-OG
CNCEQ-PS
CNCEQ-SA

.18

.18

.50

.32

2.8
1.1
5.5
3.1
3.1
3.9
2.4
2.8

.006
.272
.000
.003
.002
.000
.018
.005

.18
.08
.40
.20
.20
.25
.16
.10

Model 2: Predicting reporter-combined anxiety


1. Age
Gender
2. CASI
ACQ-C
CNCEQ-CT
CNCEQ-OG
CNCEQ-PS
CNCEQ-SA

.16

.16

.39

.23

2.5
1.1
4.1
2.7
2.4
3.2
1.6
2.2

.012
.264
.000
.007
.020
.002
.109
.033

.18
.08
.33
.20
.17
.23
.12
.16

Note: F for all steps and all full models is p < .01. VIF = Variance Inflation Factors; CASI =
Childhood Anxiety Sensitivity Index; ACQ-C = Anxiety Control Questionnaire for Children;
CNCEQ = Childrens Negative Cognitive Error Questionnaire; CT = Catastrophizing; OG =
Overgeneralizing; PS = Personalizing; SA = Selective abstraction.

and CNCEQ subscales each significantly added to the prediction of anxiety


beyond the other indices (CNCEQ personalizing 2%, selective abstraction 3%,
catastrophizing 3%, overgeneralizing 4%, ACQ-C 4%, and CASI 12% additional variance), with the CASI accounting for the largest unique variance.
Similar analyses were conducted with RCADS depression scores as the
criterion. CASI scores, ACQ-C scores, and each of the CNCEQ subscale
scores were significant predictors, together accounting for an additional
25% of the variance in RCADS depression scores beyond age and gender.
Results of incremental analyses indicated that the CASI, ACQ-C, and
CNCEQ subscales each significantly added to the prediction of depression
beyond the other indices (ACQ-C 2%, CNCEQ personalizing 3%, CASI 5%,
CNCEQ catastrophizing 7%, overgeneralizing 7%, and selective abstraction
8% additional variance), with selective abstraction accounting for the largest
unique variance.

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Are Certain Cognitive Biases


Specific to Anxiety Versus Depression?
Hierarchical regression analyses were conducted to determine which of
the cognitive biases predicted anxiety while controlling for depression.
RCADS anxiety scores were used as the criterion variable; age, gender, and
RCADS depression scores were added into the model in the first step; and
each of the cognitive measures were entered in the second step. (The significance tests and standardized betas for the measures from the CNCEQ
were again calculated in separate regressions to reduce the influence of
multicolinearity.) CASI scores (partial r = .35, semipartial r = .21, = .26,
p < .01) and ACQ-C scores (partial r = .20, semipartial r = .11, = .12,
p < .05) were significant predictors.
Hierarchical regression analyses were conducted to determine which of the
cognitive biases predicted depression while controlling for anxiety. RCADS
depression scores were used as the criterion variable; age, gender, and
RCADS anxiety were added into the model in the first step; and each of the
cognitive measures were entered in the second step (CNCEQ subscales again
were calculated in separate analyses). Only CNCEQ selective abstraction (partial r = .23, semipartial r = .15, = .13, p < .05) was a significant predictor.

Age, Gender, or Ethnicity Moderation


Hierarchical multiple linear regression analyses were conducted to
examine if age moderated the relation between the four different cognitive
errors and anxiety. In the first set of regressions, RCADS anxiety scores
were used as the criterion variable and then age, the measures of cognitive
biases, and interaction terms of Age Measures of Cognitive Biases (age
was used as a continuous variable and centering of age was used to reduce
the effects of multicolinearity; see Stewart, 1987; Tabachnick & Fidell,
2001) were entered in hierarchically as predictors. The interaction terms
entered on the third step did not produce a significant change in R2, suggesting that age did not moderate the relation. Inspection of variance inflation factors (VIF) indicated acceptable but somewhat elevated levels
(Stewart, 1987) for each of the steps. To ensure that multicolinearity was
not affecting results, separate age-moderated regression analyses for each
of the measures of cognitive biases were conducted. Results again indicated
that age did not moderate the association. Age group also was tested and
produced identical, nonsignificant results. Gender was tested in a similar
fashion and results suggest that gender did not significantly moderate the

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associations between the cognitive measures and anxiety. Ethnicity moderated regression analyses similar to those conducted for age, and gender
indicated that ethnicity did not significantly moderate associations between
the cognitive measures and anxiety.

Prediction of Parent-Reported Anxiety


As can be seen in Table 2, parent-reported anxiety symptoms were not
correlated with the cognitive measures. However, because this finding may
be due to bias in reporting, we used standardized discrepancies to select out
cases with greater than a 1.5 positive or negative discrepancy score. The
basic idea is that associations that have been obscured by disagreement may
be identified by controlling for disagreement, such as when one source is
underreporting for reasons of social desirability or because the nature of the
behavior makes it less salient to one of the reporters. Standardized discrepancy was computed by subtracting standardized parent report from the standardized child report drawing from De Los Reyes and Kazdin (2004). An
absolute value of 1.5 (roughly 1.5 SDs from a M of roughly 0) was chosen
as a cut-off to maximize sample size (n = 107) while eliminating the most
discrepant scores.
In addition to using discrepancy scores, a traditional and commonly used
method of integrating the sources (using the highest score for the child on
either RCADS or RCADS-P) was employed to compare conclusions. This
technique facilitates identifying a behavior of interest when one source may
be underreporting for reasons of social desirability or because the nature of
the behavior makes it less salient to one of the reporters (Piacentini, Cohen,
& Cohen, 1992). Internal consistency for this combined measure was .91
for the anxiety scale and .80 for the depression scale.
Hierarchical regression analysis with parent and child combined anxiety
scores was used as the criterion variable. Age and gender were added into
the model in the first step and each of the cognitive measures was entered
in the second step (see Table 3). The significance tests and standardized
betas for the measures from the CNCEQ were again calculated in separate
regressions. CASI scores, ACQ-C scores, and each of the subscale scores
of the CNCEQ except personalizing were significant predictors, together
accounting for an additional 23% of the variance in RCADS-P anxiety
scores beyond age and gender (separately, CNCEQ catastrophizing 3%,
overgeneralizing 5%, ACQ-C 3%, and CASI 8% additional variance).
Controlling for combined depression scores, CASI scores ( = .23, p < .01)
were still significant and ACQ-C scores showed a trend ( = .10, p = .06).

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Next, participants whose standardized discrepancy was between 1.5


and 1.5 were used and, similar to the hierarchical regression analysis for
child RCADS, the RCADS-P anxiety scores were used as the criterion variable. Age and gender were added into the model in the first step and each
of the cognitive measures were entered in the second step. The significance
tests and standardized betas for the measures from the CNCEQ were again
calculated in separate regressions. Results indicated that CASI scores ( =
.31, p < .01) and ACQ-C scores ( = .20, p < .05) were significant predictors together accounting for 13% of the variance beyond age and gender.
Controlling for RCADS-P depression scores, both CASI scores ( = .23,
p < .01) and ACQ-C scores ( = .15, p < .05) were still significant predictors. No evidence for age, gender, or ethnicity moderation was found using
either the discrepancy cut-off or the combined scale.

Prospective Analyses
One-year test-retest correlations were calculated on the subsample of
youth (n = 52) who completed the Time 2 assessment for the cognitive variables and child-reported anxiety. The retest correlation for the CASI was r =
.48, for the ACQ-C was r = .59, for the CNCEQ was r = .70, and for the
RCADS was r = .49, all p values less than .01. Hierarchical regression analyses were conducted to determine which of the cognitive biases predicted anxiety levels at Time 2. RCADS anxiety scores at Time 2 were used as the
criterion variable and each of the cognitive measures at Time 2 were entered
in as predictors. CASI scores ( = .30, p < .05) and CNCEQ scores ( = .32,
p < .05) were significant predictors but the ACQ-C was not ( = .09 p > .1).
Together, the variables accounted for 27% of the variance in anxiety levels at
Time 2. Supplemental regressions were run to examine the incremental variance predicted by the CASI and CNCEQ in Time 2 anxiety. Incrementally,
the CASI accounted for 10.4% of the variance beyond CNCEQ scores and
the CNCEQ accounted for 9.8% of the variance beyond CASI scores.

Discussion
This study adds to the existing research on interpretive and judgment
biases by adding to the empirical support for the conceptual distinctions
among the concepts. Consistent with conceptual distinctions, the measures
of interpretive and judgment biases showed incremental predictive validity.
For example, anxiety sensitivitys association with anxiety does not appear

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to be explained by the more general cognitive bias of catastrophizing.


Results also suggest the uniqueness of the judgment biases such as anxiety
control beliefs and the interpretation biases. In particular, anxiety sensitivity, anxiety control, and CNCEQ subscales each demonstrated incremental
validity over each other in predicting anxiety scores. Results from the 1-year
follow-up point to good 1-year test-retest reliability in the cognitive measures and suggest that both CASI scores and CNCEQ scores predicted later
anxiety symptoms. Results thus support the conceptual distinctions among
the constructs but also point toward specificity.
Epkins (1996) hypothesized that selective abstraction may be more associated with depression than anxiety because focusing on the negative
while minimizing the positive is a feature of depression (p. 85). As noted,
previous results have supported this contention (Epkins, 1996; Weems
et al., 2001) and findings in this study were consistent with this conclusion
as well. Results also were consistent with the idea that the specificity shown
by anxiety sensitivity and anxiety control beliefs (and lack of specificity to
anxiety with regard to catastrophizing, overgeneralizing, and personalizing)
may be due to the focus of the content of concepts toward anxiety-related
sensations and events as opposed to the specific cognitive processes (Beck,
1976; Laurent & Stark, 1993; Leung & Poon, 2001). Our findings suggest
that it is not necessarily the concepts or the cognitive process (e.g., to catastrophize) that show the greatest specificity but that it is the content of the
concepts that more strongly differentiates anxiety and depression.
However, a number of studies (e.g., Calamari et al., 2001; Weems et al.,
1998, 2003) as well as the results of this study, showing that both the CASI
and ACQ-C demonstrated incremental validly over each other, suggest that
this association is not just due to item or content overlap between the cognitive measures and measures of anxiety. Additional research is needed,
however, to explore cognitive content and process distinctions (e.g., Is catastrophizing about anxiety empirically the same as anxiety sensitivity? Can
the content of selective abstraction be made specific to anxiety?).
Results suggest that age did not significantly moderate the associations
between the cognitive variables and anxiety. At first glance, these results
may seem somewhat inconsistent with previous research (i.e., Weems et al.,
2001); however, such results are consistent with research on anxiety sensitivity (Calamari et al., 2001; Weems et al., 1998). Moreover, such findings
are consistent with the idea that age-related differences in the size of the
association between cognitive biases and anxiety may be specific to clinical
sample because of overall larger effect sizes (indeed, effect sizes in this community sample were somewhat smaller than those of Weems et al., 2001,

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who reported correlations between CNCEQ scores and anxiety to be in the


.4-.45 range) or due to the measures of anxiety used in past research. This is
encouraging for researchers with interests in predicting the development of
anxiety at early ages, but further research, in particular prospective research,
is needed. Concepts from cognitive development may help to explain why
cognitive processes may be related to anxiety even at early ages.
Often, the process of cognitive development is not a simple linear one
because various domains of cognition may develop differentially even
within the same child (Gold, 1983; Piaget, 1950, 1983). This process of
individual differential cognitive development has been termed horizontal
decalage. Put simply, the basic explanation for horizontal decalage is that
children who have substantial experience in a domain, for example, working with different quantities of substances, will begin to use more complex
reasoning about conservation of substance before they use such reasoning
in other domains such as quantity. This is thought to happen because experience trains the childs cognitive ability in that specific domain before a
general ability in conservation emerges. Drawing from research on the concept of horizontal decalage (Gold, 1983), one might hypothesize that more
complex, or more adult-like, cognitive beliefs may emerge with regard to
anxiety in children who have more experience with anxiety, that is, children
who experience anxiety often (or possibly who have parents who have anxiety problems) may be more likely to have the opportunity to develop complex beliefs about the consequences of anxiety through experience. Additional
research examining if parents anxiety levels might interact with age to predict the validity of the assessment of cognitive constructs may help to
answer the developmental questions raised by this study and previous
research.
This study also adds to the understanding of reporter influence on the
association between the cognitive measures and child anxiety. In terms
of cross-informant validity, effect sizes between parent and child reports
of anxious and depressive symptoms were similar to previous research
(Achenbach et al., 1987). However, parent-reported anxiety symptoms
were not correlated with the cognitive measures in the full sample. Results
were consistent with the idea that this finding may be due to bias in reporting. The basic idea is that theoretically predicted associations may have
been obscured by disagreement on the target behavior (anxiety). Results of
hierarchical regression analysis with parent and child combined anxiety
scores (using the higher of the two reporters) produced results similar to
using only child reports. These results also were similar to findings that
resulted from selecting participants on the basis of agreement that produced

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similar but somewhat more conservative estimates of the associations. Such


findings add to confidence in the associations found. However, this confidence rests largely on the proposition that the source of disagreement is due
to children underreporting for reasons of social desirability or because the
nature of the behavior makes anxiety less salient to some parents who
underreport because they are unaware, as we speculated. A comprehensive
test of this idea seems warranted from our findings. Such a test would necessarily include measures of social desirability, anxiety, and cognition by
both parent and child report and the inclusion of observational measures.
Despite the important contributions that this investigation makes to the
understanding of cognitive bias in youth, the study is not without limitations. In particular, because multiple self-report measures were employed,
there is the potential issue of single method bias. The use of multiple measures of cognitive bias coupled with the findings of incremental prediction
suggests that associations are not entirely due to method (i.e., given the
similar method for each of the cognitive measures, if the association was
all method, incremental prediction would be unlikely). However, the
development of laboratory procedures to assess interpretive and judgment
biases such as those used to assess attention and memory biases (see, e.g.,
Watts & Weems, in press) would strengthen such conclusions. The present
study also is limited by the cross-sectional nature of the investigation and
thus the study does not inform us regarding whether negative thoughts are
predictive or just associated with anxiety. Although the research on anxiety
sensitivity is beginning to clarify the temporal associations among anxiety
sensitivity and anxiety disorders in youth (Hayward et al., 2000; Weems
et al., 2002), research is needed to firmly establish which comes first, cognitive biases or anxious symptoms, as is being conducted in terms of depression (e.g., Cole, Martin, Peeke, Seroczynski, & Hoffman, 1998; Garber
et al., 2002). In addition, we did not assess two other forms of cognitive
biases, namely, memory and attention biases (see Vasey & MacLeod, 2001).
Research is needed to examine the interrelations among interpretive, judgment, memory, and attention biases. Moreover, our recruitment strategy
may limit the generalizability of the studys findings and thus replication in
additional samples of youth also is needed. Finally, we did not assess parent
report of cognitive biases. Research is needed to examine if parents can
validly report on their childrens cognitive biases.
The results of our prospective analyses should be considered preliminary because we only had a small subsample of participants at follow-up.
Results for the CNCEQ and CASI were encouraging; however, the ACQ-C
was not predictive of later anxiety despite showing acceptable test-retest.

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Such results are at odds with Ginsburg, Lambert, and Drake (2004), who found
that general external attributions of control (using the Multidimensional
Measure of Childrens Perceptions of Control [MMCPC]) and control in
anxiety-specific situations (a measure similar to the ACQ-C) were positively, concurrently associated with panic symptoms but only attributions of
control in anxiety-specific situations (i.e., not the scales from the MMCPC)
were predictive of panic symptoms 6 months later in a community sample of
African American adolescents (N = 109; M age = 15.75 years). Replication
in larger samples may be necessary. In addition, aspects of control may not
always assume a direct etiological role in the development of anxiety disorders but may nonetheless influence the maintenance, trajectory, or
expression of anxiety symptoms. In some of our most recent work in this
area, we (Taylor, Costa, & Weems, 2005) have found that anxiety control
beliefs were stable over time and that they interacted with initial anxiety
levels in a manner consistent with control beliefs serving as a maintainer of
stable elevated anxiety levels during a 1-year period in a community sample of youth. An important challenge that therefore lies ahead is to disentangle the thorny relations among control and other risk factors in our
efforts to improve understanding about the development and prediction of
pathological anxiety.
One potential problem in moving the area of cognitive models of childhood anxiety forward may be in the lack of a comprehensive framework
and set of common definitions delineating the various biases. Following
previous work, we see the cognitive biases as broadly falling into one of
four categories, namely, biased interpretation, biased judgment, biased
memory, and selective attention (see, e.g., Vasey & MacLeod, 2001).
Although additional work is needed, the findings in this article suggest that
judgment biases (control beliefs) and interpretation biases (anxiety sensitivity, catastrophizing) do demonstrate incremental validity. However, it is
not entirely clear, for example, that personalizing or attributing control over
the outcome of negative events to internal causes (i.e., blaming yourself for
a negative thing) is not better considered a judgment bias or that control
over anxiety is not better considered an interpretive bias. For the purpose of
conceptual clarity, we suggest the following distinctions in categorizing the
concepts, specifically, that judgment biases involve a perceived lack of
ability, competence, or skill and are thus centered on the individual making
the judgment, whereas interpretation biases involve disproportionately negative interpretations of stimuli or situations and are thus centered on a context or event. For example, in placing personalizing with the interpretation
biases, we are thus focusing on the interpretation of the external event

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aspect of personalizing as opposed to blaming of oneself, although it is also


an aspect of personalizing. In placing control with judgment biases, we are
focusing on the judgment of self-competence aspect of control.
We suggest that common definitions of control and self-efficacy involve
a judgment as to ones ability and thus are the most common ways that judgment biases have been studied. Self-efficacy, for example, involves the individuals beliefs about their confidence in their competence to successfully
execute behaviors to produce and regulate events in their lives. Similarly,
perceived control has been thought of as involving the individuals perception of the capacity to regulate their lives and events. The cognitive errors in
the CNCEQ vignettes ask children to what extent their beliefs or interpretation are similar to the child in the vignettes, and so considering negative cognitive errors, interpretation biases make sense. Similarly, anxiety sensitivity
concerns the negative interpretation of anxiety-related events, and so it makes
sense to classify it with the interpretation biases.
In sum, the results of this study indicated that negative cognitive errors,
anxiety sensitivity, and anxiety control beliefs were associated with each
other and that they demonstrated unique concurrent associations with childhood anxiety disorder symptoms. Anxiety sensitivity and anxiety control
beliefs showed specificity in their association with anxiety symptoms versus depressive symptoms. Age, gender, and ethnicity did not appear to modify the associations. Findings also indicated that negative cognitive errors,
anxiety sensitivity, and anxiety control beliefs all had good 1-year testretest correlations.

Notes
1. We will use the term interpretive or judgment biases to distinguish these two classes
and cognitive biases to refer more generally to both classes. The term cognitive errors is
used to refer to the interpretive biases assessed with the Childrens Negative Cognitive Error
Questionnaire (CNCEQ) consistent with past usage.
2. Because of the wide age range, a number of steps were taken to ensure developmental
appropriateness of the assessment and measures. These steps included establishing estimates
of internal consistency for both older and younger participants (see Table 2) and testing the
influence of age on the main findings and results (e.g., controlling for age in the analyses).
Convergent validity estimates were conducted by age group and produced similar estimates in
both younger and older youth. Detailed results are available from the authors.
3. Data collection for this study took place in several waves (of approximately 30 participants per wave). The follow-up sample in this study represents roughly the first two waves of
participants. The plan was to reassess the entire sample but Time 2 data collection was halted
by the Hurricane Katrina disaster.
4. The terms children and adolescents are used for convenience.

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5. Ethnicity is considered in a separate section and was not included in these regression
analyses because of the small number of ethnicities other than African American and EuroAmerican. Moreover, ethnicity was not a significant covariate in the context of the other predictors.

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Carl F. Weems, PhD, is an associate professor of psychology at the University of New Orleans
and director of the Child and Family Anxiety, Stress, and Phobia Lab. His research focuses on
the developmental psychopathology of anxiety and depression. In particular, his research integrates developmental, cognitive, biological, and behavioral theories in attempting to understand the etiology and course of internalizing disorders in childhood.
Natalie M. Costa is a doctoral candidate at the University of New Orleans and her research
focuses on parent factors in the development of childhood anxiety.
Sarah E. Watts is a doctoral student at the University of New Orleans with an interest in the
role of attention, memory, and interpretation biases in the development and maintenance of
anxiety problems.
Leslie K. Taylor is a doctoral student at the University of New Orleans whose research has
focused on the definition and role of traumatic stress in childhood anxiety problems.
Melinda F. Cannon is a doctoral student at the University of New Orleans with interests in
the comorbidity between anxiety and depression.

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