Transdiagnostic and modifiable correlates of approach–avoidance behaviors in anxious youth: An exploratory network analysis of child and caregiver reports

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Abstract
Objective: Approach–avoidance behaviors are key maintaining processes in pediatric anxiety and obsessive-compulsive disorder (OCD). However, limited research has examined which modifiable, transdiagnostic variables are most strongly and uniquely associated with these behaviors. Identifying modifiable variables is clinically important because they can be directly targeted in treatment, and transdiagnostic variables are relevant across multiple conditions that benefit from approach-based interventions. Method: Using baseline data from 112 parent–youth dyads enrolled in a larger intervention study, we applied an exploratory network analysis to examine the interconnections between candidate variables and both child- and parent-reported approach–avoidance behaviors. Results: Higher child-reported distress tolerance was uniquely associated with lower child-reported avoidance, whereas higher parent-reported child anxiety symptoms were uniquely associated with greater parent-reported child avoidance. Child- and parent-reported avoidance were also uniquely positively associated. Conclusions: Distress tolerance and anxiety symptom severity emerged as potentially important network correlates linked to approach–avoidance behaviors in anxious youth. These domains may warrant further investigation as potential intervention-relevant correlates of approach–avoidance behavior. Future research would benefit from examining correlates of approach–avoidance behaviors across additional clinical and non-anxiety contexts with larger samples.