Activation During Observed Parent–Child Interactions
with Anxious Youths: A Pilot Study
Araceli Gonzalez & Phoebe S. Moore & Abbe M. Garcia &
Margo Thienemann & Lynne Huffman
Published online: 21 January 2011
# The Author(s) 2011. This article is published with open access at Springerlink.com
Abstract Parent–child interaction paradigms are often used
to observe dysfunctional family processes; however, the
influence of such tasks on a participant’s level of activation
remain unclear. The aim of this pilot project is to explore
the stimulus value of interaction paradigms that have been
commonly used in child anxiety research. Twenty-nine
parent–child dyads with clinically anxious (n=16) and non-
anxious (n=13) youths engaged in a series of tasks (threat
and non-threat) used in previous studies of parenting and
youth anxiety. Heart rate (HR) data, as an indicator of
physiological activation, were collected across tasks, and
participants rated the perceived representativeness of their
interactions in the laboratory to their usual behavior at
home. Significant HR changes were observed for both
parent and child. Change in child HR from baseline to non-
threat task was smaller than change in HR from baseline to
threat tasks. Change in parent HR from baseline to
ambiguous situations tasks was smaller than changes from
baseline to other threat tasks. Differences in HR change
between anxious and non-anxious children were explored.
Participants rated laboratory interactions as similar to those
experienced in the home. Results suggest that presumably
emotionally-charged discussion tasks may produce in-
creased activation compared to tasks that were designed to
be more neutral. Implications for future research and
limitations are discussed.
Keywords Child anxiety.Parent–child interactions.
Theorists in the field of anxiety research posit an important
role for parenting behavior in the development and
maintenance of child anxiety disorders (e.g., Chorpita et
al. 1998; Ginsburg and Schlossberg 2002; Manassis and
Bradley 1994; Rubin and Mills 1991; Wood et al. 2003).
Dysfunctional behavioral patterns may emerge between
parent and child, which may then serve to create, sustain, or
exacerbate anxiety in the child (Dadds et al. 1996; Hudson
and Rapee 2001; Rapee 1997), and there is increasing
evidence for reciprocal models of anxiety development and
maintenance (Hudson et al. 2009; Silverman et al. 2009).
There is a growing consensus among researchers in the
area of child anxiety that observational methodology is
superior to self-, parent-, and clinician-report for assessing
dysfunctional parent and child behaviors that may trigger or
maintain child anxiety disorder (e.g., Hawes and Dadds 2006;
McLeod et al. 2007; Wood et al., 2003). In the field of
anxiety research, it is generally believed that the use of
observational paradigms and collection of behavioral sam-
ples can circumvent problems associated with self-report
measures, including interpretative and recall biases (e.g.,
Costa and Weems 2005; Krain and Kendall 2000; Vasey et
al. 1995) and social desirability (Kendall and Chansky
1991), thus providing a more useful and valid representation
A. Gonzalez (*)
Joint Doctoral Program in Clinical Psychology,
San Diego State University / University of California, San Diego,
San Diego, CA, USA
P. S. Moore
University of Massachusetts Medical School
and UMass Memorial Medical Center,
Worcester, MA, USA
A. M. Garcia
Brown University Medical Center,
Providence, RI, USA
M. Thienemann:L. Huffman
Stanford University Medical Center,
Stanford, CA, USA
J Psychopathol Behav Assess (2011) 33:159–170
of important parent–child processes. Empirical support for
the use of observational methods has also emerged. A recent
meta-analysis of the association between parenting and child
anxiety reported a medium effect size (r=0.28) of parenting
in studies when observational methods were used, an effect
significantly higher than those obtained from self-report
(r=0.20) or interview (r=0.15) measures of parenting
(McLeod et al. 2007). Together, these findings support the
notion that the observed behavior approach to assessment
may be a uniquely powerful tool for investigating the
association between anxiety and family relationships.
Although observational paradigms have garnered both
theoretical and empirical support as a best-practice model for
the assessment of parent–child interaction, measurement of
dyadic behavioral patterns presents conceptual and logistical
challenges to research (e.g., quantification of behaviors,
reliability of coding) and some aspects of this promising
methodology have not been well evaluated. For example, it is
likely that the different types of interaction tasks can produce
varying levels of emotional activation and thereby influence
the behavioral styles displayed by research subjects. Indeed,
there is emerging evidence that not all interaction tasks are
created equal. One examination of interactions between
anxious mothers and their children provided evidence that
observational research may elicit parenting behaviors at
different frequencies depending on the nature of the interac-
tion task (e.g., structured vs. unstructured; Ginsburg et al.
2006). Further, a recent meta-analysis of child and parent
anxiety reported that structured discussion and performance
tasks yielded higher effect sizes than unstructured tasks in
assessing parental control (van der Bruggen et al. 2008).
Thus, it appears that examination of the stimulus value of
commonly used interaction tasks could enhance our current
understanding of how tasks work and may help guide
researchers with appropriate task selection. To provide a
context for the current investigation regarding the stimulus
value of commonly utilized family interaction paradigms, we
briefly describe tasks that have been commonly used in the
pediatric anxiety literature.
Types of Interaction Tasks Currently Employed
in Pediatric Anxiety Research
Various paradigms have been used to assess parenting
behaviors in an observational format. Frequently, parents
and children are asked to engage in discussion or complete a
of relevant findings from studies, see Ginsburg et al. 2004b;
McLeod et al., 2007; van der Bruggen et al. 2008; and Wood
et al. 2003. Below, we briefly describe four major types of
tasks employed in recent research of parent–child interac-
tions in families with an anxious parent or child:
(e.g., Barrett et al. 1996, 2002; Shortt et al. 2001; Varela et
al. 2004). Variations of this task have often been utilized.
Parent and child are given scenarios, typically related to
potential physical or social threat. For example, dyads may
be prompted with “You/your child sees a group of students
from another class playing a great game. You/your child
walks over and wants to join in, and hears the children
laughing—What do you think is happening and what would
your child do?” (e.g., Barrett et al. 2002, p. 600). The dyad
is tasked with interpreting the scenario and determining an
appropriate response. The degree of threat interpreted in the
situation and the amount of avoidance employed in the
selected response are often quantified in these tasks.
(Conflict and Anxiety conversations; Challacombe and
Salkovskis 2009; McCarty et al. 2004; Moore et al. 2004;
Siqueland et al. 1996; Whaley et al. 1999). Parent and child
have two conversations, typically timed, about a conflict
and/or something that is anxiety-provoking to the youth.
For the conflict task, some investigators have asked the
dyad to discuss a “hot topic” chosen by the mother (e.g.,
Siqueland et al. 1996) or a conflictual topic agreed upon by
both dyad members (e.g., Moore et al. 2004; Whaley et al.
1999) and asked to attempt to reach an agreement or
resolution. Presumably, these tasks are aimed at provoking
stressful interactions in the dyad. When coding these tasks,
investigators often use Likert-type scales to rate the
frequency of or the degree to which certain pre-defined
parenting behaviors are displayed (e.g., autonomy granting,
(e.g., unsolvable anagrams/tangrams; Buckley and
Woodruff-Borden 2006; Hudson and Rapee 2001;
Woodruff-Borden et al. 2002; origami challenge task;
Greco and Morris 2002). In these tasks, the child is
presented with a challenging task (e.g., tangrams—putting
smaller geometric pieces to form larger shapes; Hudson and
Rapee 2001; unsolvable word puzzles; Buckley and
Woodruff-Borden 2006), with little or no likelihood of
success. The parent is typically instructed not to intervene
unless the child requires help, however, some investigators
instruct parents that it is OK to help (e.g., Buckley and
Woodruff-Borden 2006). These situations allow for the
observation of the child’s reaction to stressful situations and
the parent’s behavioral reaction (e.g., overcontrol) to the
child in an unsuccessful situation. Latency to parental
response is often measured along with behavioral ratings,
160J Psychopathol Behav Assess (2011) 33:159–170
and global ratings of specific parenting dimensions and
behaviors are generated.
(e.g., preparing a speech; Buckley and Woodruff-Borden
2006; Cobham et al. 1999; Gar and Hudson 2008; Hudson
et al. 2009; Woodruff-Borden et al. 2002; Etch-a-sketch;
Ginsburg et al. 2004a; Ideal person task; Whaley et al.
1999; Moore et al. 2004; Grocery Store Game; Dumas et al.
1995; Risk Room; Turner et al. 2003). The majority of
these tasks are aimed at challenging the dyad in some
manner and raising stress levels—e.g., the parent must help
the (sometimes socially anxious) child prepare a speech,
typically on a topic of the child’s choosing (e.g., Gar and
Hudson 2008); the parent and child must work together to
solve a difficult puzzle or create a piece of artwork (copy
designs onto an Etch-A-Sketch toy with each dyad member
controlling one of the two knobs; Ginsburg et al. 2004a).
As with other types of tasks, investigators often attempt to
quantify the occurrence of parenting behaviors (e.g.,
providing unsolicited help) or the expression of negative
affect (e.g., Woodruff-Borden et al. 2002).
Rationale for Examining the Stimulus Value of Interaction
Researchers who utilize observational paradigms seldom
discuss assumptions underlying the use of such tasks
(Gardner 2000) but potential intentions can be inferred
from the task design and content. Typically, parent–child
dyads are not asked to discuss the weather or happy
memories of family harmony, but instead are asked to
engage in discussion or tasks that may produce dysfunc-
tional behaviors—whether discussing an area of conflict,
preparing a speech, or working on an unsolvable puzzle. It
seems, then, that a potential goal of these tasks may be to
provoke disagreement, anxiety, or frustration in order to
elicit the dysfunctional behaviors hypothesized to charac-
terize problematic interactions. Theoretically, this makes
sense, as the overprotective, rejecting, or catastrophizing
parenting behaviors that often are identified as risk or
maintenance factors for child anxiety disorder may emerge
only when the child or parent is anxious or otherwise
It is reasonable to suspect that dysfunctional interaction
patterns would coincide with excitable emotions (e.g.,
anger, distress) and that physiological activation would
ensue. However, the degree to which such arousal actually
occurs during the interaction task has not been evaluated in
the extant research. If arousal varies by task type, this may
provide useful hypotheses about why some tasks may be
more likely to produce dysfunctional behaviors than others.
Further, examination of potential physiological arousal may
be useful in elucidating whether the tasks produce non-
observable features of anxiety that would not be captured in
behavioral ratings. For example, Siqueland and colleagues
(1996) noted that a child’s expression of avoidance or
submission in response to a controlling statement of the
parent may not be captured in a behavioral coding system.
Thus, activation may be a useful avenue by which to
examine unobservable individual processes that occur
during family interactions. Examination of the stimulus
value of the tasks, independent of the observed behaviors
associated with them, may be informative, and using
arousal as an indicator of emotional reactivity seems an
important step in understanding the stimulus value of tasks
commonly used in pediatric anxiety research.
Another important consideration in this area of research
is whether behaviors displayed during observational para-
digms provide information regarding behavior patterns in
“real-life” family situations. The argument that families
may be reacting atypically to a novel or artificial setting is
certainly valid. These concerns have been examined in
studies with younger children with disruptive behaviors,
and this research indicates that observation of behavior in a
laboratory setting may be useful if the goal is to elicit
behaviors of interest (see Gardner 2000). To date, this point
has not been directly examined with anxious families.
Although this question cannot be conclusively addressed
through participant report, information regarding participants’
subjective experience may be a useful first step towards
examining the representativeness of their interactions. If
interactions are perceived as unnatural or unrepresentative,
thenthismaybea usefulindicator ofthe ecologicalvalidityof
As with any assessment tool, the properties of observation
paradigms warrant examination, and insight into the stimulus
about what the tasks are accomplishing with participants.
Surprisingly, little is known about the potential stimulus value
of some of these commonly used observation paradigms in
child anxiety research. The aim of this pilot investigation is to
enhance the current literature on this methodology by
assessing the experiences of dyads engaged in commonly
used interaction tasks. Specifically, the focus of this study
pertains tothe methods used to assessparent–child interaction
patterns rather than the relations of behaviors to child
outcome. The primary goal of this study is to determine
whether differences in level of emotional arousal, as indicated
by changes in heart rate from a baseline level, emerge across
various tasks. A second, exploratory aim is to examine
whether participants’ experiences of these tasks echo the
J Psychopathol Behav Assess (2011) 33:159–170 161
experience of interacting in a “real life” context by exploring
the perceived representativeness of tasks that occur in the
research office setting.
We used a pilot sample of parent–child dyads with anxious
and non-anxious youth to provide an initial exploration of the
activating value of two of these commonly used observational
paradigms (revealed differences and ambiguous situations
tasks). We selected tasks that had been previously used in
studies that produced significant group differences in dys-
functional behaviors and that easily allow participants to sit in
a chair without requiring movement. To evaluate the
hypothesis that tasks produce activation and arousal, heart
rate (HR) data were gathered for both dyad members
throughout the experiment as they engaged in a series of
interaction tasks. Copious data suggest that anxious states are
associated with increased HR (Beidel 1991; Weems et al.
2005) and that HR may be more strongly associated to self-
reported anxiety symptoms than other measures of arousal
(e.g., skin conductance; Weems et al. 2005). Therefore,
participant HR data were collected as an indicator of
psychophysiological arousal during interaction tasks aimed
at increasing anxiety or emotional arousal in the dyad, as
well as during comparison tasks designed to be non-
threatening. In addition, we conducted preliminary follow-
up analyses to assess whether patterns of activation varied by
child anxiety status. To evaluate parent and child perceived
representativeness of interactions, participants were asked,
upon completion of the interaction tasks, to provide ratings
of how similar their laboratory behavior was to their usual
behavior at home. This represents the first study to explore
this issue in an anxious pediatric population.
We hypothesized that, on a within-subject basis, revealed
differences and ambiguous situation parent–child interaction
tasks would be associated with greater HR change from
baseline than a low-demand comparison task that did not
involve anxiety or conflict-related content. Furthermore, we
predicted that parents and children would rate their behavior
inthe laboratory situation assimilar totheir behaviorat home.
Additionally, in exploratory analyses, we sought to evaluate
whether changes in HR across tasks differed for anxious and
non-anxious children. In order to better understand each
group’s responsetothe interactiontasktypes,we alsoplanned
to conduct within-group analyses examining patterns of HR
change within the group of anxious children and, separately,
within the group of non-anxious children.
The current study was approved by the Institutional Review
Board at the study institution. All parents and youths
provided signed informed consent and assent, respectively,
after reviewing the consent form in detail with a Ph.D.-level
member of the research team at the beginning of the first
meeting with researchers.
A total of 29 dyads, consisting of 28 mothers and 1 father
(Mean age=45.74 years, SD=5.48) and their 8- to 16-year-
old children (M=11.97, SD=2.68; 41.4% male), participat-
ed in this study. Participants were primarily Caucasian
families (80.3%) of middle-high socioeconomic status,
representative of the surrounding community in northern
California (Mean annual household income >$100,000).
Each participating parent was the primary caregiver of his/
her child. Dyads were recruited based on child anxiety
status. Anxious children were recruited through referrals
from clinicians at a university-based anxiety disorders
clinic in northern California. Non-anxious children were
recruited through flyers and announcements in the general
community. Two children who were recruited as non-
anxious comparisons met criteria for a clinically impairing
anxiety disorder during the diagnostic evaluation and were
thus included in the anxious child group. Characteristics of
the two groups and the sample as a whole are summarized
in Table 1.
Children with a clinically impairing anxiety disorder
(n=16; 55.2%) met criteria for primary diagnoses of social
phobia (n=5), generalized anxiety disorder (n=4), obsessive-
compulsive disorder (n=2), specific phobia (n=3), or
separation anxiety (n=2). Comorbidity with another anxiety
disorder was common; the mean number of anxiety
diagnoses in anxious children was 2.81 (SD=1.72).
Diagnostic Assessment Child anxiety diagnoses were
assessed using the Anxiety Disorders Interview Schedule
for Children and Parents (ADIS-IV-P/C; Silverman and
Albano 1996) during the first visit. Child and the parent
were each interviewed about the child. The ADIS-IV-P/C is
a semi-structured interview designed to generate diagnoses
based on the integration of both parent and child responses.
Reliability data on the child ADIS-IV have been found to
be excellent (Silverman et al. 2001). Parent and child
diagnostic interviews were conducted by a Ph.D.-level
investigator. All diagnostic questions regarding the partic-
ipating children were reviewed by a team of experienced
psychologists, psychiatrists, and psychology graduate
students who met in conference to arrive at consensus
diagnoses. This consensus process involved a thorough
review and discussion of all symptoms endorsed by the
child or parent on the diagnostic interview. To establish
reliability, a subset of a randomly selected 20% of the child
interviews were co-rated using audiotapes; raters were in
162J Psychopathol Behav Assess (2011) 33:159–170
complete agreement as to presence/absence of current and
past anxiety diagnoses (kappa=1.0).
All behavioral and physiological data on dyadic interac-
tions was collected during the second visit or during the
latter part of the visit if completed in one visit.
Heart Rate (HR) The psychophysiology equipment used to
collect heart rate (HR) was a James Long Co. integrated
system. Data were converted to average beats per minute
(bpm) for each epoch, and HR was collected on a second-
by-second basis. During data collection, dyads were seated
upright in chairs across from each other. Leads were
attached and data acquisition checked. Mean HR was
calculated for seven epochs of data, presumed to reflect
different levels of activation, from parent and child:
Baseline, Joke Task, Conflict Task, Anxiety Conversation,
Tummyache Conversation, Schoolyard Conversation, and
Recovery, as described below.
Movement Because HR is associated with level of individ-
ual movement, we attached motion sensors to the backs of
each chair to account for potential differences in movement
across task. Both chairs were wire framed and permitted a
certain amount of bouncing by participants.
Dyadic Interaction Tasks
Each dyad completed the following interactions while HR
and movement data were collected.
Baseline (2 min) The examiner entered the room and sat
in a chair 5 ft from the dyad, facing them. Dyads were
instructed, “For the next 2 min, we will just sit quietly
and try to relax.” The examiner kept time using a digital
timer and looked down at a clipboard during this period.
The purpose of this task was to collect a baseline HR
Joke Task (3–5 min) This task was designed as a non-
threat, non-emotionally charged, collaborative interaction
task. Once the baseline was completed, the examiner
handed a list of five jokes to the parent, including the
answers, and a list of the jokes to the child, without the
answers. Using standardized instructions, she instructed the
mother to read the jokes, one at a time, to the child; the
child was to try to guess the answers to the jokes. The dyad
was further instructed to discuss the jokes and decide
together which was the funniest joke and which was the
least funny. The examiner left the room after providing
instructions and returned when summoned by the dyad or
after 5 min; at this time, she asked the dyad for their
decision on the jokes.
Conflict Conversation (5 min) The Conflict Task was
modeled on the task used by several research groups (e.g.,
Gordon et al. 1989; Moore et al. 2004; Siqueland et al.
1996; Whaley et al. 1999). Prior to collection of behavioral
and physiology data, parents and children were asked
independently to generate lists of conflict topics for the
conflict task. The examiner chose a topic on which parent
and child agreed; if no topic was agreed upon, the examiner
chose a parent-selected topic. The dyad was instructed to
talk about the conflict topic for 5 min with an attempt to
reach an agreement or solve the problem. The examiner left
the room after giving the instructions for the task. After
5 min, the interviewer re-entered the room and redirected
the dyad toward the next task.
Anxiety Conversation (5 min) (Moore et al. 2004; Whaley
et al. 1999). The dyad was asked to talk for 5 min about
something that made the child anxious or worried. These
were the only instructions given to the dyad. Again, the
examiner left the room after giving the instructions for the
task. After 5 min, the interviewer re-entered the room and
redirected the dyad toward the next task. The order of
Conflict and Anxiety was counterbalanced to control for
order effects within task type.
Total sample N=29 Child anxious n=16 Child non-anxious n=13
Mean/NSD/%Mean/N SD/%Mean/N SD/%
# Minority child
# Intact families
Table 1 Demographic and clin-
ical characteristics of anxious
and non-anxious youths and
*Differ by child anxiety status
J Psychopathol Behav Assess (2011) 33:159–170163
Ambiguous Situations (≤5 min) (Barrett et al. 1996, 2002;
Shortt et al. 2001; Varela et al. 2004). The dyad was
presented verbally with two individual “ambiguous situa-
tions,” one detailing possible social threat (“[Child’s name]
is playing the schoolyard, and s/he notices a group of kids
from another class playing a great game. As s/he walks
over and wants to join in, s/he notices they are laughing”)
and the other detailing possible physical threat (“On the
way to school, [Child’s name] starts to get a stomach-
ache”). The dyad was asked to discuss the situation and
decide what is happening and what the child should do. The
examiner left the room for each discussion and returned
when summoned to ask the dyad what they had decided.
Scenarios were presented one at a time, with discussion
following, in a counterbalanced order. HR data for these
two separate discussions were combined into one data
collection epoch for two reasons. First, from a theoretical
standpoint, both discussions pulled for the same parent–
child behavioral process, 1) the interpretation of ambiguous
stimulus and 2) the effect of discussion on the likelihood of
a threat interpretation. Second, from a more pragmatic
position, the conversations tended to be short (averaging
approximately 2 min) and thus combining the two
conversations resulted in an epoch of comparable elapsed
no differences in average HR for the two ambiguous tasks.
Recovery (2 min) At the conclusion of the ambiguous
situations tasks, dyad members were asked to sit quietly
for 2 min. As with the Baseline Task, the examiner was
present and modeled sitting quietly with her eyes directed
Ratings of Perceived Representativeness
Upon completion of interaction tasks, parent and child were
each asked to rate how similar their experience in the
laboratory was to their experience of their typical behavior
at home. Each dyad member was asked to make a Likert-
type rating ranging from 1 to 10 (1 = not at all similar, 10 =
extremely similar) in response to the question “How similar
was your behavior here today with your parent/child to
your usual behavior at home?” This rating was a later
addition to the protocol and was administered after the fifth
dyad was assessed. Therefore, only 24 dyads completed
this rating (four anxious families and one non-anxious
family did not receive this rating form).
Data Analytic Plan
Steps were taken to quantify physiological data. HR was
averaged across epochs in beats per minute (bpm). Change
scores were computed for the HR by subtracting the
average value obtained during Baseline from the average
HR value during the relevant epoch; analyses were
conducted using these change scores.
While recent trends in the field have focused on the
advantage of mixed models for analyzing repeated meas-
ures (e.g., Gueorguieva and Krystal 2004), this global
approach tends to require larger sample sizes than was
available in this pilot study. We instead utilized repeated
measures analysis of variance, or rANOVA, which allows
for direct, one-at-a-time hypothesis testing. Violations of
the assumption of sphericity, when found, were corrected
using the Huynh-Feldt correction (Keselman et al. 2001).
We examined correlations between youth age and heart
rate change score for each epoch to determine if the
relationship of age to HR change scores should be
controlled in analyses. We did not find any significant
correlations between HR and age for any task (r=−.21−.09,
all p>.05), therefore, given sample size and associated
power, we did not include age as a covariate in analyses.
Because there were significantly more anxious than non-
anxious boys in this sample (Table 1), we did control for
gender in analyses of child HR data. In addition, we
conducted a preliminary test of whether movement, which
can influence HR, differed across non-threat and threat
tasks. When controlling for gender, the association between
task and movement was not significant, F (6, 156)=1.50,
p=.18, and therefore movement was not included in
Our primary hypotheses were tested in the whole
sample, examining patterns of HR change epoch-by-
epoch. To explore the question of whether anxious children
differed from their non-anxious peers on HR change scores
for the various tasks, the repeated measures model was
tested with anxiety status as a covariate. As a follow-up
exploratory analysis, we sought to explore whether within-
subject patterns of HR change across tasks varied between
anxious and non-anxious children. Therefore, to evaluate
within-subject differences between specific epochs, planned
a priori follow-up pairwise contrasts were used for child
data, comparing changes in HR from one task to the next
for each youth anxiety status group. Given the sample size
and associated power, our analyses are exploratory rather
than conclusive and therefore alpha was set at .05 for all
There were significantly more boys in the anxious than
non-anxious group, χ2(1)=6.56, p=. 01; anxious and non-
164J Psychopathol Behav Assess (2011) 33:159–170
anxious children did not differ on any other demographic
variables (Table 1). Parents of anxious children were older
than parents of non-anxious children, t27=2.08, p=.047;
parents of anxious and non-anxious youths did not
significantly differ on any other demographic or clinical
variables. Table 2 provides mean raw HR for children and
parents. There was no significant difference in HR at
baseline between anxious and non-anxious children, t28=
1.09, p=.29, nor between parents of anxious and non-
anxious children. HR did not significantly differ between
anxious and non-anxious youths on any task.
Within-subject HR Change
The HR patterns for children and parents are illustrated in
Figs. 1 and 2, respectively. Visual inspection of these
graphs indicates that HR varied across tasks. The HR
change patterns are illustrated in Figs. 3 and 4, respectively.
HR change scores for participants are reported in Table 3
for each epoch.
Within-subjects main effects were significant, demonstrat-
ing significant within-subjectdifferencesinHRchangeacross
the interaction tasks for parents, F(4.00,112.00)=47.64,
p<.001, and children, F(3.33,89.87)=3.30, p=.02, (child
analyses controlled for gender; Huynh-Feldt correction was
made for both tests). For children, Joke Task HR change
scores (i.e., average Joke Task HR minus average Baseline
HR) were smaller than Conflict Task, Anxiety Task, and
Ambiguous Situation HR change scores, suggesting that the
Joke Task was less activating than the other tasks for the
entire group of children, F(1,27)=7.55, p=.011. There were
no significant differences in HR change scores among the
threat tasks. For parents, Joke Task HR change scores were
similar to Conflict Task and Anxiety Task HR change scores.
Parental HR change score during the Ambiguous Situations
Task was significantly smaller than HR change score during
the Revealed Differences Tasks, F(1,28)=9.83, p=.004,
although still positive, indicating higher HR than Baseline
HR, t27=3.27, p<.005. On average, Recovery Task HR
change scores for parents and children had a negative
valence, indicating that Recovery Task HR was lower than
Exploratory Analyses: Main Effect of Child Anxiety
and Interaction of Child Anxiety with Task Type
We examined whether the influence of task type on HR
differed by youth anxiety status (controlling for gender).
Although the average HR at Baseline was higher for
anxious versus non-anxious children, this difference did
not reach statistical significance (t28=1.09, p=.09). The
between-subjects main effect for anxious and non-anxious
children was non-significant, F(1,26)=0.82, p=.77, indi-
cating that across all tasks, HR change scores for anxious
children were generally not larger than HR change scores
for non-anxious children. The within-subjects by between-
subjects interaction effect of child anxiety status by task
was also non-significant F(3.52, 91.61)=1.18, p=.32, with
Huynh-Feldt correction for sphericity, indicating that the
two groups did not significantly differ across tasks.
Exploratory Analyses: Within-Group Examination of HR
Change Across Task Type
We proceeded with our planned follow-up within-subjects
the groups of anxious and non-anxious youths, respectively.
larger HR change scores for the Conflict Task and Anxiety
Task compared to the Joke Task, (controlling for gender)
F(1, 14)=7.03, p=.02. Change scores for Ambiguous
Situations Task were not significantly larger or smaller than
for Conflict Task and Anxiety Task, indicating that anxious
children remained equally activated through the remainder of
the threat tasks.
In contrast to the findings with the anxious youth
sample, we did not find significant difference in HR change
scores for Jokes Task compared to Anxiety and Conflict
Tasks for non-anxious youths, F(1,11)=0.71, p=.42 (con-
trolling for gender) and the similar magnitude in change
scores suggests that Revealed Differences Tasks are not
more activating than the Joke Task for non-anxious youths.
There were no differences in change in movement across
Table 2 Mean HR by child anxiety status
TaskChild not anxious Child anxious
aHR difference was not statistically significant on any task
J Psychopathol Behav Assess (2011) 33:159–170 165
tasks between anxious and non-anxious youths, F(3.55,
92.21)=0.93, p=.44, suggesting that these results are not
simply an artifact of anxious children being more animated
during certain tasks.
There was no significant interaction between child anxiety
status and within-parent HR change, indicating that the
magnitude of HR changes for parents did not vary signifi-
cantly by child anxiety status. Follow-up contrasts for parents
were not planned a priori and were therefore not conducted.
Perceived Representativeness Ratings
Overall, both parents and children rated their behavior
during interaction tasks as similar to their behavior in the
home setting (range of mean ratings = 7–10). Ratings
between all parents (M=8.08, SD=1.77) and all youths
(M=7.96, SD=1.65) did not significantly differ. Represen-
tativeness ratings for children did not vary by child anxiety
status; however, parents of non-anxious children (M=9.08,
SD=0.79) rated their behaviors as more representative of
at-home interactions than did parents of anxious children
(M=7.08, SD=1.93), t22=3.32, p<.005.
The aim of this project was gain a better understanding of the
experiences of anxious dyads who engage in behavioral
research paradigms. Specifically, we sought to assess HR,
presumed to indicate emotional activation, and perceived
Heart Rate (average bpm)
Fig. 1 Mean raw HR scores
across tasks by child anxiety
BaselineJoke Conflict Anxiety
Average Hear Rate (bpm)
Parents of Non-
Fig. 2 Mean heart rate (bpm) of
parents of anxious and non-
166J Psychopathol Behav Assess (2011) 33:159–170
representativeness of behavior during interaction tasks com-
monly used in research on families affected by pediatric
anxiety. This is among the first investigations to explore the
stimulus value of these paradigms, and this information may
be useful for the generation of testable hypotheses regarding
the construct and ecological validity of behavioral paradigms
that appear frequently in the extant literature base.
The tasks employed in this study were physiologically
activating for both parents and children, as indicated by
positive HR change scores during interaction tasks. How-
ever, parents and children showed different patterns of
changes. Overall, children had relatively lower HR
response to a non-threat task in which dyads rate jokes,
whereas parents showed a lower response to discussion of
ambiguous situations. Thus, the hypotheses that deliberately
activating (i.e., threat) tasks (Revealed Differences and
Ambiguous Situations) would be more activating than the
low-demand (i.e., non-threat) comparison task (Joke Task)
was supported in the child sample. This finding requires
replication in larger samples.
We also explored whether within-subjects changes in HR
across task differed for anxious and non-anxious youths. We
did not detect a significant main effect of child anxiety status
on HR across tasks, however, separate examination of each
clinical group provides some interesting within-group data on
how the series of tasks was experienced by children. Within
the non-anxious group, all active tasks, both threat and non-
threat, were associated with the same size positive change
been relevant for the non-anxious group—interaction with the
HR Change (bpm)
Ambiguous Situations Recovery
Child HR Change Scores (from Baseline)
Fig. 3 Mean heart rate change
score (change in bpm from
baseline) of anxious and
non-anxious children across
HR Change (bpm)
Heart Rate Change Across Task for Parents
Parents of Anxious
Parents of Non-Anxious
Fig. 4 Mean heart rate change
score (change in bpm from
baseline) of parents of anxious
and non-anxious children
J Psychopathol Behav Assess (2011) 33:159–170167
This increase resolved at Recovery, wherein the children
returned to Baseline HR levels.
Within the anxious group, a different pattern emerged.
The HR change from Baseline to Jokes Task was
significantly smaller than the HR change from Baseline to
the three threat tasks. Visual inspection of the raw HR data
suggests that HR at baseline was similar to HR at Joke Task
(the change in average HR from Baseline to Joke Task was
a clinically negligible 0.51 bpm). There followed a
significant increase in HR change score once the threat
tasks were introduced. This increase resolved at Recovery
with children returning to Baseline HR levels. This pattern
suggests the possibility of a specific response to the threat
tasks within the anxious sample. In other words, it is
possible that anxious children respond to the kinds of tasks
used in observational research with a particularly robust
increase in arousal that is different from their response to
other, less-threatening tasks. This may provide support for
the construct validity of the Revealed Differences and
Ambiguous Situation task designs.
An additional exploratory aim of the present study was
to probe parent and child perspectives about the “real-life”
representativeness of laboratory interaction tasks. Results
provide preliminary evidence that the subjective experience
of parents and children of interactions in the laboratory
setting are perceived as similar to those that occur in the
home setting. While parents of both anxious and non-
anxious children generally rated their observed behaviors as
representative of those displayed in the home, parents of
anxious children rated their behaviors as somewhat less
representative. This detected difference may have implica-
tions for interpretation of findings produced from observa-
tional studies. Future research would benefit from
evaluation of representativeness of behavior as well as
exploration of how interactions at home may differ (e.g.,
Do parents feel that their children were more/less activated
at home? Are parents of anxious children more likely to
change their behavior in the laboratory setting?). It should
be noted that this study assessed perceived representative-
ness and that inferences regarding actual representativeness
would require independent measures of real-world inter-
actions (e.g., in the home setting).
The hypothesis that non-threat and threat tasks would be
associated with different HR arousal was not supported
using parental HR. Recent studies have questioned the
directionality of the influence of child anxiety (Hudson et
al. 2009; Silverman et al. 2009); if reciprocal models of
anxiety indicate that child anxiety may in turn elicit anxious
parenting behaviors, and if anxious youths are experiencing
activation during these tasks, results from the present study
suggests that these tasks may still be acceptable for use
with parents experiencing varying levels of anxiety.
To date, very little is known regarding the stimulus value
of such interaction tasks. While it is not explicitly stated,
one potential assumption is that the selected tasks are
physiologically and emotionally activating. It is reasonable
to suspect that tasks that are arousing may have behavioral
correlates (e.g., dysfunctional behaviors). While it is
possible that some parental behaviors, such as control,
may function to prevent or reduce youth anxiety/distress
and activation, an alternate hypothesis is that parents
engage in those behaviors once youth arousal has been
detected. It would be informative to conduct time-
sequenced coding of physiological activation in conjunc-
tion with behavioral data in order to determine which
hypothesis may be more accurate in explaining associations
between arousal and behaviors.
Findings from the present pilot study may provide an
additional line of support for investigators seeking to utilize
interaction tasks with anxious children and their parents.
However, results must be viewed as preliminary and several
limitations of this project warrant attention. The small
sample size precluded the use of hierarchical analytic
Table 3 Mean (SD) heart rate change score (change from baseline to task) by child anxiety status
Parents of anxious children
Parents of non-anxious children
dF for within-subjects analyses; significance adjusted for violations of sphericity via Huynh-Feldt correction
Items in a row with differing subscripts were significantly different at the p<.05 level
168 J Psychopathol Behav Assess (2011) 33:159–170
techniques, which may be appropriate for examining
repeated emotional activation nested within dyads. Further-
more, exploratory analyses were underpowered for confir-
matory hypothesis testing. It is possible that some
relationships may have emerged as significant in larger
samples, and our exploratory findings should be used for
hypothesis generation only. In addition, this sample
included primarily Caucasian, high-income families, and
findings should be replicated with ethnically and socio-
economically diverse families.
We used change in HR from baseline to task as a proxy of
emotional activation. A more comprehensive sampling of
physiological data would enhance the specificity of findings.
Because cardiac arousal is associated with a number of
emotions, we are unable to specify whether the interaction
tasks evoked anxiety or another emotion. Nevertheless, given
the content of conversation tasks (e.g., conflict, anxiety), it is
likely that physiological arousal was due to some distress
rather than a positive emotion (e.g., excitement). It is possible
that the baseline relaxation task was not entirely relaxing for
those prone to anxiety because they were in a novel setting,
and this may contribute to the observed lack of change in HR
the difference in HR at baseline between anxious and non-
explanation warrants further examination with larger samples.
By contrast, it is also possible that interaction tasks elicited
other forms of negative affect or responses that may not have
been captured using HR (e.g., avoidance). In future studies
that aim to identify associations between activation and
behaviors, it would be informative to code for indices of
positive or negative affect in order to relate activation to
specific aspects of parent and child emotion. In addition, the
method with which the content of the discussions tasks was
selectedmakesit difficulttodeterminewhether activationwas
influenced by the process of initiating discussions (e.g.,
examiner providing a topic vs. agreeing on a topic in the
moment). Our goal in this paper was to assess the stimulus
previously. While we did not detect HR differences within the
Revealed Differences Tasks within parent or youth partic-
ipants, investigators may choose to alter the administration of
these tasks infuturestudies toaddress thispotential confound.
Because the order of tasks was not counterbalanced overall
(only within task type), it is possible that timing, rather than
type of tasks, contributed to the pattern of findings. For
example, it is possible that parental HR for Revealed Differ-
ences Tasks was higher than during discussion of Ambiguous
Situations because parents were aware that discussion of
Ambiguous Situations was the last task. Further evidence is
needed from counterbalanced designs. Future work may also
benefit from inquiring about representativeness after each
individual task rather than at the end for all tasks. Finally,
while the current study aimed to examine frequently used
interaction tasks, knowledge may be enhanced with investi-
gation of more fear-provoking tasks that do not require dyads
to sit still (e.g., a videotaped speech task).
Observer ratings of behaviors employed during interac-
tion tasks are becoming the gold standard of methods used
to better understand family interaction patterns. Pending
replication with larger samples, present findings are
promising in that they provide preliminary evidence that
some commonly used family assessment tasks may indeed
be having their hypothesized effect—to arouse emotion.
This effect, which is relevant to the construct validity of
this type of behavioral assessment, had not been previously
evaluated. In addition, families endorse their interactions
during these tasks as representative of those experienced in
everyday life. While actual representativeness remains to be
determined, these results provide a promising indication
that laboratory tasks such as these may possess external
validity with some samples.
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