1
|
Whitaker E, Chessell C, Klapow M, Creswell C. A Systematic Review of Guided, Parent-Led Digital Interventions for Preadolescent Children with Emotional and Behavioural Problems. Clin Child Fam Psychol Rev 2025:10.1007/s10567-025-00521-x. [PMID: 40349266 DOI: 10.1007/s10567-025-00521-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2025] [Indexed: 05/14/2025]
Abstract
Emotional and behavioural problems (EBP) are prevalent amongst children, and guided, parent-led digital interventions offer one method of improving access to effective treatments. This systematic review (PROSPERO: CRD42023484098) aimed to examine the evidence base for, and characteristics of, these types of interventions through a narrative synthesis. Systematic searches were conducted using Medline, EMBASE, PsycINFO, Scopus and Web of Science in January 2024 and February 2025, supplemented with hand searching in March/April 2024 and February 2025. Studies were eligible if they reported outcomes related to preadolescent EBP from a guided, fully parent-led, fully digital intervention. Thirteen studies were eligible, including 2643 children and covering eight interventions (addressing anxiety problems, comorbid anxiety and depression, attention deficit hyperactivity disorder, conduct disorder and disruptive behaviour). Studies included randomised controlled trials and pre-post studies. The QualSyst checklist was used to assess study quality; all studies were rated as good quality. All studies showed statistically significant improvements in the child's symptoms or interference levels, with small to very large effect sizes immediately post-treatment, and at least medium effect sizes by follow-up, suggesting a promising evidence base. A wide range of intervention characteristics were identified, forming a basis for future intervention development for childhood EBP. However, there was a lack of consistency in how information was reported across studies (such as completion rates) and studies lacked information on parent demographics and key intervention details. Further high quality randomised controlled trials for a wider range of EBP are needed to continue building the evidence base.
Collapse
Affiliation(s)
- Emily Whitaker
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Chloe Chessell
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Maxwell Klapow
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Cathy Creswell
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
2
|
Trent ES, Tan SXL, Cheng JSC, Storch EA. Involving Parents in the Management and Treatment of Youth Anxiety. Curr Psychiatry Rep 2025:10.1007/s11920-025-01614-8. [PMID: 40343658 DOI: 10.1007/s11920-025-01614-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2025] [Indexed: 05/11/2025]
Abstract
PURPOSE OF REVIEW Childhood anxiety disorders are impairing and chronic unless addressed early. While cognitive behavioral therapy with exposures has a strong evidence base, many youth continue to experience symptoms posttreatment. Enlisting parents may help improve the management and treatment of childhood anxiety. RECENT FINDINGS Parental factors that influence childhood anxiety include family accommodation, parental emotion socialization, parental overcontrol, and parental anxiety. The merits of involving parents in childhood anxiety treatment have been debated. However, when specific, empirically- and theoretically-informed mechanisms are targeted, parental involvement in treatment appears efficacious and holds promise to increase access to care. Clinicians should consider the child's presentation, treatment barriers, and family dynamics to guide decision-making. Researchers and clinicians should also be aware of stressors that parents themselves face, considering ways to help children via supporting parents with their own mental health concerns.
Collapse
Affiliation(s)
- Erika S Trent
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS: BCM 350, Houston, TX, 77030, USA.
| | - Samantha X L Tan
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS: BCM 350, Houston, TX, 77030, USA
| | - Jessica Szu-Chi Cheng
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS: BCM 350, Houston, TX, 77030, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS: BCM 350, Houston, TX, 77030, USA
| |
Collapse
|
3
|
Fox JK, Fleming LE. Parental cognitions and child anxiety: A systematic review. J Anxiety Disord 2025; 112:103021. [PMID: 40279836 DOI: 10.1016/j.janxdis.2025.103021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 03/11/2025] [Accepted: 04/15/2025] [Indexed: 04/29/2025]
Abstract
Given the well-established link between maladaptive parenting behaviors (e.g., control, accommodation) and the development and maintenance of child anxiety, it is important to understand parental cognitions that may underlie these parenting behaviors. The goal of this systematic review was to examine the extent to which parental cognitions are associated with child anxiety. A systematic electronic database search of PubMed, PsycINFO, ProQuest Psychology, and EBSCO Child Development and Adolescent Studies was conducted in February 2024. In total, 31 studies met inclusion criteria from 9867 abstracts initially identified. The review revealed that a large number of studies have consistently found associations between child anxiety and two types of parental cognitions, negative beliefs about child anxiety and negative expectations of the child's anxiety. In contrast, studies investigating parental worries about threats to their child and cognitions about parenting are more limited and have produced mixed findings and smaller effects. Future research should examine the directionality and mechanisms of relations between parental cognitions and child anxiety using longitudinal designs, as well as explore the role of cultural factors. Findings suggest that parental cognitions may be an important factor in understanding child anxiety and a potential target for prevention and early intervention.
Collapse
Affiliation(s)
- Jeremy K Fox
- Psychology Department, Montclair State University, Montclair, NJ, United States.
| | - Lauren E Fleming
- Psychology Department, Montclair State University, Montclair, NJ, United States
| |
Collapse
|
4
|
Elfström S, Rosengren A, Andersson R, Engelbrektsson J, Isaksson A, Meregalli M, van Leuven L, Lalouni M, Öst LG, Ghaderi A, Åhlén J. Evaluating a program to prevent anxiety in children of anxious parents: a randomized controlled trial. J Child Psychol Psychiatry 2025. [PMID: 40077809 DOI: 10.1111/jcpp.14151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2025] [Indexed: 03/14/2025]
Abstract
BACKGROUND Pediatric anxiety disorders are prevalent, particularly among children with anxious parents. This trial evaluated a program for anxious parents aimed at preventing offspring anxiety disorders and symptoms over 12 months. METHODS This parallel, randomized, controlled, open-label trial was conducted at Karolinska Institutet, Stockholm, Sweden. Inclusion criteria comprised heightened parental anxiety and the child (5-9 years old) not currently meeting criteria for an anxiety disorder. The program, Confident Parents-Brave Children (CPBC) involves six video conferencing group sessions. An external researcher randomly allocated (1:1) participants to CPBC or a self-help control. The primary outcome was change in clinical severity ratings (CSR) between pre- and 12-month assessments, assessed by the Anxiety Disorders Interview Schedule. Secondary outcomes included parent-rated child anxiety symptoms and parental self-efficacy. The study was preregistered at ClinicalTrials.gov (NCT04722731). RESULTS The trial included 215 parents (91% female) and 277 children (48% girls, mean age 7.0). At the 12-month assessment, no statistically significant difference was found between conditions on the primary outcome (change in CSR), OR = 0.67 (95% CI: 0.30, 1.48). No statistically significantly lower prevalence of anxiety disorder at the 12-month assessment was found in the CPBC group compared with the control group, OR = 0.57 (95% CI: 0.24, 1.31). When stratifying by age, children 5-6 years in CPBC showed lower risk of increased CSR, OR = 0.24 (95% CI: 0.08, 0.77), and anxiety diagnosis, OR = 0.23 (95% CI: 0.05, 0.84), compared to controls. Regarding secondary outcomes, CPBC children exhibited larger decreases in anxiety symptoms than control children from pre- to the 12-month assessment, Cohen's d = .35 (95% CI: 0.15, 0.55). Parents in both conditions showed increased parental self-efficacy over time, with no significant between-group effect. The 12-month assessment was completed by 204 parents (95%). CONCLUSIONS The CPBC may have potential for preventing anxiety in young children; however, further research is warranted.
Collapse
Affiliation(s)
- Sigrid Elfström
- Department of Global Public health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Rosengren
- Department of Global Public health, Karolinska Institutet, Stockholm, Sweden
| | - Rebecca Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Health Care Services Stockholm County, Stockholm, Sweden
| | - Johanna Engelbrektsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Health Care Services Stockholm County, Stockholm, Sweden
| | - Albin Isaksson
- Department of Global Public health, Karolinska Institutet, Stockholm, Sweden
- Health Care Services Stockholm County, Stockholm, Sweden
| | - Micaela Meregalli
- Department of Global Public health, Karolinska Institutet, Stockholm, Sweden
- Health Care Services Stockholm County, Stockholm, Sweden
| | - Livia van Leuven
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Maria Lalouni
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Health Care Services Stockholm County, Stockholm, Sweden
| | - Lars-Göran Öst
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johan Åhlén
- Department of Global Public health, Karolinska Institutet, Stockholm, Sweden
- Health Care Services Stockholm County, Stockholm, Sweden
| |
Collapse
|
5
|
Grajdan MMV, Etel E, Farrell LJ, Donovan CL. A Systematic Review of Parental Involvement in Digital Cognitive Behavioural Therapy Interventions for Child Anxiety. Clin Child Fam Psychol Rev 2025; 28:22-70. [PMID: 39511110 DOI: 10.1007/s10567-024-00505-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2024] [Indexed: 11/15/2024]
Abstract
Cognitive behavioural therapy (CBT) is an efficacious intervention for child anxiety that has been translated into accessible digital formats, many of which involve parents in treatment. However, the value of parental involvement in treatment is not clearly understood. This systematic review examined characteristics of parental involvement (i.e., format and content of sessions, level of therapist guidance, and parent session compliance) in digital CBT for child anxiety (mean child age ≤ 12 years) and their relation to child outcomes (primary disorder remission, clinician-, parent-, and child-rated anxiety, and global functioning). Systematic searches in CINAHL, Embase, ERIC, PsychINFO, PubMed, and Scopus up to 14th August 2023, and citation searching, identified 27 articles (as 23 studies) assessing 14 interventions. Two were parent-only programmes for 3-6-year-old children, with the remaining being parent-child programmes targeting older children. Parents were actively involved as coaches/collaborators, assisting their children with anxiety management and exposure, and less often as co-clients working on their own difficulties. Benefits of treatment were observed across interventions, except for one, psychoeducation-based programme. Higher remission rates were more frequently observed in interventions delivered in controlled settings, those with fewer parent-only sessions, or those incorporating more parent- or therapist-led exposure sessions. Most studies were conducted with affluent samples, limiting generalisability, and several received a high risk of bias rating. Future research should examine parent and family related mechanisms of change and modify interventions for improved adherence, such as restricting the number of modules parents are required to complete and teaching key therapeutic strategies such as exposure early in the programme.
Collapse
Affiliation(s)
- Meri M V Grajdan
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia.
| | - Evren Etel
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Lara J Farrell
- Griffith University Centre for Mental Health, Griffith University, Brisbane, QLD, Australia
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| | - Caroline L Donovan
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
- Griffith University Centre for Mental Health, Griffith University, Brisbane, QLD, Australia
| |
Collapse
|
6
|
Rienks K, Salemink E, Laas Sigurðardóttir LB, Melendez-Torres GJ, Staaks JPC, Leijten P. Supporting parents to reduce children's anxiety: A meta-analysis of interventions and their theoretical components. Behav Res Ther 2025; 185:104692. [PMID: 39847956 DOI: 10.1016/j.brat.2025.104692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 12/11/2024] [Accepted: 01/17/2025] [Indexed: 01/25/2025]
Abstract
Parent-focused interventions hold promise for reducing child anxiety, but their content varies greatly, and little is known on the intervention content. We estimated the effects of parent-focused interventions on child anxiety and the most effective combinations of theoretical components. We searched PsycINFO, Medline, and Web of Science in October 2022 for randomized trials on parent-focused interventions to reduce children's anxiety. We used robust variance estimation to estimate main effects and differential effects by individual theoretical components, and network meta-analysis to estimate the effects of clusters of components (preregistration: PROSPERO CRD42022362983). We identified 26 studies (k = 157, N = 4098). Parent-focused interventions had a significant medium effect on children's anxiety (d = -0.59; 95% CI [-0.92, -0.26]). Interventions used seven theoretically distinct components. No significant differential effects were found, but all clusters of components that produced significant effects contained a behavioral component. Adding cognitive and emotional components to behavioral components seemed beneficial. This meta-analysis highlights the potential of parent-focused interventions for children's anxiety, and of behavioral components in particular, but is limited by the very low certainty of evidence. More high-quality research is needed to understand the exact potential of parent-focused interventions on children's anxiety, and their most effective components.
Collapse
Affiliation(s)
- Karen Rienks
- University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, the Netherlands.
| | - Elske Salemink
- Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands
| | | | | | - Janneke P C Staaks
- University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, the Netherlands
| | - Patty Leijten
- University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, the Netherlands
| |
Collapse
|
7
|
Nowland R, Christian DL, Aspinall G, Berzins K, Khalid S, Ahuja S, Gallagher L, Gee B, Mickleburgh E, Fernandes B, Kelsall A, Randell B, Michelson D. Children's involvement in the development and evaluation of parent-focused mental health interventions: a scoping review protocol. JBI Evid Synth 2025; 23:408-415. [PMID: 39938532 DOI: 10.11124/jbies-23-00525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2025]
Abstract
OBJECTIVE This review will i) describe methods used to involve children in the development and/or evaluation of parent-focused interventions to prevent or treat child mental health problems; ii) summarize the perspectives of children or adults about these methods; iii) highlight any reported enablers and barriers; and iv) identify guidance and make recommendations for further research. INTRODUCTION Parent-focused interventions (where children are not primarily involved or are excluded) have been implemented to address various child mental health outcomes. However, it is unclear to what extent, and to what end, children have been involved in developing and evaluating such interventions. Engaging children in formative research activities, with or without their parents, has the potential to improve quality and implementation of the interventions. INCLUSION CRITERIA Eligible studies will involve children (5-12 years) in the development and/or evaluation of parent-focused interventions aimed at preventing or treating common child mental health problems (eg, anxiety, depression, ADHD, disruptive behavior) delivered in any setting (eg, school, community, home, health facility). Eligible interventions may include one or more psychosocial practice elements targeting behavioral, cognitive, emotional, interpersonal, social, and/or environmental factors implicated in the onset and maintenance of child mental health problems. METHODS Comprehensive searches will be conducted in 5 electronic databases (PsycINFO, MEDLINE, CINAHL, Embase, and Scopus). Gray literature will be sourced using Google as well as through searches of key organization websites and via notifications on social media. Only English-language primary studies will be considered. Findings across a range of methodologies will be charted and combined into a narrative synthesis. REVIEW REGISTRATION Open Science Framework https://osf.io/x9376/.
Collapse
Affiliation(s)
- Rebecca Nowland
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Danielle L Christian
- NIHR Applied Research Collaboration Northwest Coast, University of Central Lancashire, Preston, UK
| | - Georgia Aspinall
- NIHR Applied Research Collaboration Northwest Coast, University of Central Lancashire, Preston, UK
| | - Kathryn Berzins
- NIHR Applied Research Collaboration Northwest Coast, University of Central Lancashire, Preston, UK
| | - Sundus Khalid
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Shalini Ahuja
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Methodologies Research Division, Faculty of Nursing Midwifery and Palliative Care, King's College, London, UK
| | - Lucy Gallagher
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Brioney Gee
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Blossom Fernandes
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Becca Randell
- Health Innovation Kent, Surrey and Sussex, Crawley, UK
| | - Daniel Michelson
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
8
|
Shimshoni Y, Etkin RG, Lebowitz ER. Parent-Only Treatment for Child Anxiety. ADVANCES IN PSYCHIATRY AND BEHAVIORAL HEALTH 2024; 4:71-80. [PMID: 39676822 PMCID: PMC11636585 DOI: 10.1016/j.ypsc.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2024]
|
9
|
Pine AE, Baumann MG, Modugno G, Compas BE. Parental Involvement in Adolescent Psychological Interventions: A Meta-analysis. Clin Child Fam Psychol Rev 2024; 27:1-20. [PMID: 38748300 PMCID: PMC11486598 DOI: 10.1007/s10567-024-00481-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 10/18/2024]
Abstract
Psychological interventions for adolescents have shown mixed efficacy, and including parents in interventions may be an important avenue to improve treatment outcomes. Evidence from meta-analyses examining the role of parents in interventions for youth is inconsistent and has typically combined findings for both children and adolescents together. No prior meta-analysis has examined the specific role of parents in adolescent interventions as compared with interventions focused solely on adolescents across several disorders. To address this gap, systematic literature reviews were conducted utilizing a combination of searches among keywords including (parent * OR family) AND (intervention OR therap * OR treatment OR prevent*) AND (adolescen*). Inclusion criteria were (1) a randomized controlled trial of an individual psychological intervention compared to the same intervention with a parental component, and (2) adolescents must have at least current symptoms or risk to be included. Literature searches identified 20 trials (N = 1251). Summary statistics suggested that interventions involving parents in treatment have a significantly greater impact on adolescent psychopathology when compared to interventions that targeted adolescents alone (g = - 0.18, p < .01, 95% CI [- 0.30, - 0.07]). Examination with symptom type (internalizing or externalizing) as a moderator found that the significant difference remained for externalizing (g = - 0.20, p = .01, 95% CI [- 0.35, - 0.05]) but not internalizing psychopathology (p = .11). Findings provide evidence of the importance of including parents in adolescent therapy, particularly for externalizing problems.
Collapse
Affiliation(s)
- Abigail E Pine
- Department of Psychology and Human Development, Vanderbilt University, Peabody 552, 230 Appleton Place, Nashville, TN, 37203, USA.
| | - Mary G Baumann
- Department of Psychology and Human Development, Vanderbilt University, Peabody 552, 230 Appleton Place, Nashville, TN, 37203, USA
| | - Gabriella Modugno
- Department of Psychology and Human Development, Vanderbilt University, Peabody 552, 230 Appleton Place, Nashville, TN, 37203, USA
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Peabody 552, 230 Appleton Place, Nashville, TN, 37203, USA
| |
Collapse
|
10
|
Dittman CK, Sanders MR, Rynne SB, Mallett CJ, Lefebvere JS. Play Well Triple P: Developing and Evaluating a Program to Promote Positive Parental Involvement in Junior Sport. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01725-y. [PMID: 38888711 DOI: 10.1007/s10578-024-01725-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 06/20/2024]
Abstract
Parents play a central role in children's ongoing participation and enjoyment of sport. Despite compelling evidence that parental behaviour can undermine the quality of children's experiences in sport, little research has examined whether strategies to support parents to engage in positive sports parenting behaviour are effective. In this paper, we report two studies that had the overall aim of developing, implementing and evaluating a program designed to promote positive parental involvement and improve spectator behaviour in junior rugby league in Australia. Study 1 involved the development of a prototype version of the program, named Play Well Triple P, which was qualitatively evaluated through interviews with 19 parents about their satisfaction with the program. In Study 2, we used feedback from Study 1 to refine the program and develop a pilot version, which was then evaluated in a quasi-experimental feasibility study with 101 parents (mean age = 38.42 years; 72% mothers) of junior rugby league players. The pilot version involved one interactive online module and text messages to reinforce content and prompt strategy implementation across the season. Participation in Play Well Triple P was associated with increased positive sports parenting behaviour and reduced controlling and intrusive sports parenting behaviour, with a trend towards reducing over-reactive parenting practices at home. These findings are discussed in relation to the feasibility of implementing a brief and engaging sports parenting intervention in the context of a broader integrated system designed to facilitate ongoing participation of children in sport.
Collapse
Affiliation(s)
- Cassandra K Dittman
- Cluster for Resilience and Wellbeing, Appleton Institute, Central Queensland University, Bundaberg, Australia.
- Manna Institute, Central Queensland University, Bundaberg, Australia.
- School of Psychology, The University of Queensland, Brisbane, Australia.
- School of Health, Medical and Applied Sciences, CQUniversity, Locked Bag 3333, Bundaberg DC, QLD, 4670, Australia.
| | - Matthew R Sanders
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Steven B Rynne
- School of Human Movement Studies and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Clifford J Mallett
- School of Human Movement Studies and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Jordan S Lefebvere
- School of Human Movement Studies and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| |
Collapse
|
11
|
Tømmerås T, Backer-Grøndahl A, Høstmælingen A, Laland H, Gomez MB, Apeland A, Karlsson LRA, Grønlie AA, Torsvik S, Bringedal GE, Monica A, Fisher PA, Gardner F, Kjøbli J, Malmberg-Heimonen I, Nissen-Lie HA. Study protocol for a randomized controlled trial of supportive parents - coping kids (SPARCK)-a transdiagnostic and personalized parent training intervention to prevent childhood mental health problems. BMC Psychol 2024; 12:264. [PMID: 38741201 PMCID: PMC11092081 DOI: 10.1186/s40359-024-01765-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND To meet the scientific and political call for effective prevention of child and youth mental health problems and associated long-term consequences, we have co-created, tested, and optimized a transdiagnostic preventive parent-training intervention, Supportive parents - coping kids (SPARCK), together with and for the municipal preventive frontline services. The target group of SPARCK is parents of children between 4 and 12 years who display symptoms of anxiety, depression, and/or behavioral problems, that is, indicated prevention. The intervention consists of components from various empirically supported interventions representing different theorical models on parent-child interactions and child behavior and psychopathology (i.e., behavioral management interventions, attachment theory, emotion socialization theory, cognitive-behavioral therapy, and family accommodation intervention). The content and target strategies of SPARCK are tailored to the needs of the families and children, and the manual suggests how the target strategies may be personalized and combined throughout the maximum 12 sessions of the intervention. The aim of this project is to investigate the effectiveness of SPARCK on child symptoms, parenting practices, and parent and child stress hormone levels, in addition to later use of specialized services compared with usual care (UC; eg. active comparison group). METHODS We describe a randomized controlled effectiveness trial in the frontline services of child welfare, health, school health and school psychological counselling services in 24 Norwegian municipalities. It is a two-armed parallel group randomized controlled effectiveness and superiority trial with 252 families randomly allocated to SPARCK or UC. Assessment of key variables will be conducted at pre-, post-, and six-month follow-up. DISCUSSION The current study will contribute with knowledge on potential effects of a preventive transdiagnostic parent-training intervention when compared with UC. Our primary objective is to innovate frontline services with a usable, flexible, and effective intervention for prevention of childhood mental health problems to promote equity in access to care for families and children across a heterogeneous service landscape characterized by variations in available resources, personnel, and end user symptomatology. TRIAL REGISTRATION ClinicalTrials.gov ID: NTCT05800522.
Collapse
Affiliation(s)
- T Tømmerås
- Norwegian Center for Child Behavioral Development, Oslo, Norway.
| | | | - A Høstmælingen
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - H Laland
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - M B Gomez
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - A Apeland
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - L R A Karlsson
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - A A Grønlie
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - S Torsvik
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - G E Bringedal
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - Aas Monica
- Norwegian Center for Child Behavioral Development, Oslo, Norway
- Social, Genetic and Developmental Psychiatry Centre, Psychology and Neuroscience, Kings College, London, UK
| | - Phillip Andrew Fisher
- Norwegian Center for Child Behavioral Development, Oslo, Norway
- Stanford University, Graduate School of Education, Stanford, US
| | - Frances Gardner
- Norwegian Center for Child Behavioral Development, Oslo, Norway
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - John Kjøbli
- Norwegian Center for Child Behavioral Development, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Ira Malmberg-Heimonen
- Norwegian Center for Child Behavioral Development, Oslo, Norway
- Oslo Metropolitan University, Faculty of Social Work, Oslo, Norway
| | - Helene Amundsen Nissen-Lie
- Norwegian Center for Child Behavioral Development, Oslo, Norway
- University of Oslo, Department of Psychology, Oslo, Norway
| |
Collapse
|
12
|
Poetar CR, Dobrean A, Andersson G. Preliminary efficacy of a transdiagnostic parent-led internet-delivered intervention for children with anxiety and depressive symptoms: a pilot randomized controlled trial. Child Adolesc Psychiatry Ment Health 2024; 18:31. [PMID: 38448874 PMCID: PMC10918968 DOI: 10.1186/s13034-024-00721-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND There is extensive research indicating that transdiagnostic interventions are effective for adults and children with anxiety and depressive disorders; however, limited research has been conducted on the efficacy of such programs targeting parents of children with anxiety and depressive symptoms delivered via the Internet. This study aims to investigate the preliminary efficacy of a transdiagnostic Internet-delivered intervention for Romanian parents of children with elevated anxiety and depressive symptoms. METHODS We conducted a single-blinded pilot randomized controlled trial. Forty-two parents of children with anxiety and depressive symptoms (Mage = 39.79, 78.6% women) from Romania were randomly assigned to one of the two groups, to ParentKIT, an Internet-delivered intervention based on Rational Emotive and Behavioral Therapy (n = 21), or to a delayed treatment condition (waitlist group) (n = 21). ParentKIT consisted of a brief transdiagnostic intervention delivered through nine modules with therapist guidance. RESULTS A significant Group by Time effect was found for child emotional problems as reported by parents (Cohen's d = - 0.85) and for parental self-efficacy (Cohen's d = 0.71). CONCLUSION A transdiagnostic Internet-delivered intervention addressed to parents of children with elevated anxiety and depressive symptoms is a promising approach. Future research should include blind assessments as well as multiple outcome assessors and investigate the long-term efficacy of the intervention. TRIAL REGISTRATION NCT05341297.
Collapse
Affiliation(s)
- Costina-Ruxandra Poetar
- Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania.
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania.
| | - Anca Dobrean
- Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
13
|
Cobham VE, Radtke SR, Hawkins I, Jordan M, Ali NR, Ollendick TH, Sanders MR. Piloting a one-day parent-only intervention in the treatment of youth with anxiety disorders: child and family-level outcomes. Child Adolesc Psychiatry Ment Health 2024; 18:8. [PMID: 38218829 PMCID: PMC10787495 DOI: 10.1186/s13034-023-00702-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE Parent-only cognitive-behavioural therapy (CBT) interventions have promise for youth with anxiety disorders. Fear-Less Triple P (FLTP) is one such intervention that has been found comparable to child-focused CBT. Although traditionally administered in six sessions, a one-day workshop format of FLTP was developed to improve accessibility. The current study compared the effectiveness of the six-session and one-day workshop formats. METHOD Seventy-three youth (mean age, 8.4 years; 74% male) were randomized to traditional FLTP (6-week group) or the one-day workshop format. Anxiety diagnostic status, self- and parent-reported anxiety symptoms scores, independent evaluator-rated improvement, treatment satisfaction, and measures of family functioning were included to assess treatment outcome. Data were collected prior to treatment, and 1-week, 6-months, and 12-months following treatment. RESULTS Both conditions resulted in significant improvement in child anxiety symptom scores per parent report (on both questionnaire and diagnostic interview measures). Furthermore, significant decreases in sibling anxiety were observed in both treatment conditions. There were no statistically significant differences between conditions on any outcome measure. CONCLUSIONS Results of this study add to the growing evidence that brief, low-intensity, parent-only interventions can effectively target child psychopathology. These brief interventions are ideal for families for whom the resources and time required to commit to a standard multi-week intervention are prohibitive. REGISTRATION OF CLINICAL TRIALS This trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN 12615001284550).
Collapse
Affiliation(s)
- Vanessa E Cobham
- School of Psychology, University of Queensland, St. Lucia, QLD, 4072, Australia.
| | - Sarah R Radtke
- Virginia Tech: Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Ingrid Hawkins
- School of Psychology, University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Michele Jordan
- School of Psychology, University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Nasriah Rizman Ali
- School of Psychology, University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Thomas H Ollendick
- Virginia Tech: Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Matthew R Sanders
- School of Psychology, University of Queensland, St. Lucia, QLD, 4072, Australia
| |
Collapse
|
14
|
Creswell C, Chessell C, Halliday G. Parent-led cognitive behaviour therapy for child anxiety problems: overcoming challenges to increase access to effective treatment. Behav Cogn Psychother 2023; 51:512-532. [PMID: 36458498 DOI: 10.1017/s1352465822000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Anxiety problems have a particularly early age of onset and are common among children. As we celebrate the anniversary of the BABCP, it is important to recognise the huge contribution that cognitive behavioural therapy (CBT) has made to the treatment of anxiety problems in children. CBT remains the only psychological intervention for child anxiety problems with a robust evidence base, but despite this, very few children with anxiety problems access CBT. Creative solutions are urgently needed to ensure that effective treatments can be delivered at scale. Here we focus on parent-led CBT as this offers a potential solution that is brief and can be delivered by clinicians without highly specialised training. Over the last decade there has been a substantial increase in randomised controlled trials evaluating this approach with consistent evidence of effectiveness. Nonetheless clinicians, and parents, often have concerns about trying the approach and can face challenges in its delivery. METHOD We draw on empirical evidence and our clinical experience to address some of these common concerns and challenges, with particular emphasis on the key principles of empowering parents and working with them to provide opportunities for new learning for their children. CONCLUSIONS We conclude by highlighting some important directions for future research and practice, including further evaluation of who does and does not currently benefit from the approach, determining how it should be adapted to optimise outcomes among groups that may not currently get maximum benefits and across cultures, and capitalising on recent technological developments to increase engagement and widen access.
Collapse
Affiliation(s)
- Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Chloe Chessell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Gemma Halliday
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
15
|
Ward AL, McPherson L, Mc Glanaghy E. Discussion Surrounding Theory, Knowledge, and Practical Applications for Clinical Nurse Specialists to Aid Them in Caring for Parents with Cancer Who Have Young Children. Semin Oncol Nurs 2023; 39:151483. [PMID: 37567835 DOI: 10.1016/j.soncn.2023.151483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE To identify the theory, knowledge, and practical applications that clinical nurse specialists should consider adding to their "toolkit" to support them in caring for people affected by cancer with young children. DATA SOURCES Expert opinion and relevant studies on the topic formed the basis of this article. CONCLUSION A conversation with experts identified five key areas of knowledge important to supporting clinical nurse specialists in caring for people affected by cancer with young children: family-centered and systemic practice, nursing responsibilities and competencies, trauma-informed practice, adult life stages, and stages of child development. Key areas identified have relevance to all healthcare professionals working in cancer care. IMPLICATIONS FOR NURSING PRACTICE This article provides a useful overview of psychological theories important to supporting healthcare professionals in caring for people affected by cancer. A discussion on the boundaries and competencies of the nursing role led to agreement about practical advice rooted in theory and knowledge that could benefit clinical practice. Concepts of emotional labor and the wounded healer were identified as important to inform reflection and supervision when caring for a parent affected by cancer who has a young family.
Collapse
Affiliation(s)
- Ashleigh Lauren Ward
- Consultant Nurse Cancer and Palliative Care, Directorate of Nursing, NHS Forth Valley, Stirling, UK; Honorary Clinical Senior Lecturer, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
| | - Lorraine McPherson
- Cancer and Palliative Care Facilitator, Directorate of Nursing, NHS Forth Valley, Stirling, UK
| | - Edel Mc Glanaghy
- Clinical Psychologist, Adult Psychological Therapies, NHS Forth Valley, Falkirk Community Hospital, Falkirk, UK
| |
Collapse
|
16
|
Byrne S, Cobham V, Richardson M, Imuta K. Do Parents Enhance Cognitive Behavior Therapy for Youth Anxiety? An Overview of Systematic Reviews Over Time. Clin Child Fam Psychol Rev 2023; 26:773-788. [PMID: 37217646 PMCID: PMC10465628 DOI: 10.1007/s10567-023-00436-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/24/2023]
Abstract
The last 20 years has seen debate regarding the merits of involving parents in cognitive behavior therapy (CBT) for youth anxiety played out across systematic reviews which have high impact. These reviews examined varying treatment formats in relation to parent involvement, including youth only CBT (Y-CBT), parent only CBT (P-CBT) and family CBT (youth and parent; F-CBT). This is a novel overview of systematic reviews examining evidence for parental involvement in CBT for youth anxiety over the period this was studied. Two independent coders systematically searched for studies in medical and psychological databases using the categories "Review", "Youth", "Anxiety", "Cognitive Behavior Therapy" and "Parent/Family". Of the 2,189 unique articles identified, there were 25 systematic reviews since 2005 which compared the effects of CBT for youth anxiety with varying parent involvement. Despite systematically studying the same phenomenon, the reviews were heterogeneous in outcome, design, inclusion criteria and often had methodological limitations. Of the 25 reviews, 21 found no difference between formats and 22 reviews were considered inconclusive. Yet while there were typically no statistical differences, consistent patterns in the direction of effects were detected over time. P-CBT was less effective than other formats, suggesting the importance of directly treating anxious youths. Early reviews favored F-CBT over Y-CBT, however, later reviews did not show this trend. We consider the effects of moderators including exposure therapy, long-term outcomes and the child's age. We consider how to manage heterogeneity in primary studies and reviews to better detect treatment differences where they exist.Trial registration This protocol is registered with the Open Science Framework: osf.io/2u58t.
Collapse
Affiliation(s)
- S Byrne
- School of Psychology, University of Queensland, Brisbane, QLD, Australia.
| | - V Cobham
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
- Parenting and Family Support Centre, University of Queensland, Brisbane, QLD, Australia
| | - M Richardson
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia
| | - K Imuta
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
17
|
Byrne S, Richardson M, Riba M, Imuta K. Parent Versus Individual Cognitive Behavioral Therapy for Youth Anxiety: Protocol for an Overview of Systematic Reviews Over Time. JMIR Res Protoc 2023; 12:e48077. [PMID: 37384370 PMCID: PMC10365617 DOI: 10.2196/48077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) has shown to be highly effective for treating youth anxiety; yet, there is ongoing debate as to whether involving parents improves outcomes. For example, parents who attend may learn CBT skills to help their child in an ongoing way; yet, they could also distract their child from treatment depending on how they interact. As evidence has accumulated, reviews and meta-analyses have attempted to examine the most effective treatment format. These reviews often have high impact in the field; however, they use varied methodologies and draw on different primary studies. Different formats of CBT for youth anxiety have been developed in relation to parental involvement, including youth-only CBT (Y-CBT; where the youth alone attends treatment), youth and parent or family CBT (F-CBT; where youths and their parents attend together), and, most recently, parent-only CBT (P-CBT; where the parent alone attends). OBJECTIVE This protocol describes an overview of systematic reviews comparing the relative efficacy of different formats of CBT for youth anxiety (Y-CBT, F-CBT, and P-CBT) over the study period. The protocol will also examine the moderating effects of variables on the efficacy of different formats; for example, youths' age and long-term outcomes. METHODS We will analyze the results of systematic reviews that compare different levels and types of parental involvement in CBT for youth anxiety over the study period. A systematic review of medical and psychological databases (PsycINFO, PubMed, SCOPUS, Web of Science, Cochrane Library, and Embase) will identify reviews comparing the efficacy of different formats of parent involvement in CBT for youth anxiety. Data extraction will include (1) author names (and year of publication), (2) review design, (3) age range, (4) analysis type, (5) conclusions, and (6) moderators. This overview will present the relative efficacy of formats chronologically in a table and then describe the main results longitudinally in a narrative summary. A Measurement Tool to Assess Systematic Reviews, 2nd Edition (AMSTAR 2), quality rating will be given to each review, and the amount of primary study overlap across reviews will be quantified. RESULTS The last search was conducted on July 1, 2022. The reviews were published between 2005 and 2022. We found a total of 3529 articles, of which we identified 25 for the final analysis. CONCLUSIONS This overview will compare and report the relative efficacy of Y-CBT, P-CBT, and F-CBT for youth anxiety over the study period, describe the heterogeneity across reviews and primary studies, and consider the moderating effect of relevant variables. It will describe the limitations of an overview, including the potential for nuance in the data to be lost, and provide conclusions and recommendations for conducting systematic reviews regarding parental involvement for CBT for youth anxiety. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/48077.
Collapse
Affiliation(s)
- Simon Byrne
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Meg Richardson
- School of Psychology, University of Queensland, Brisbane, Australia
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, Australia
| | - Marcos Riba
- University of Queensland Library, Brisbane, Australia
| | - Kana Imuta
- School of Psychology, University of Queensland, Brisbane, Australia
| |
Collapse
|
18
|
Jewell C, Wittkowski A, Collinge S, Pratt D. A Brief Cognitive Behavioural Intervention for Parents of Anxious Children: Feasibility and Acceptability Study. CHILD & YOUTH CARE FORUM 2022; 52:661-681. [PMID: 35975268 PMCID: PMC9372936 DOI: 10.1007/s10566-022-09704-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/21/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022]
Abstract
Background Parent-only psychological interventions can be effective treatments for child anxiety. Involving parents in treatment may be beneficial for children, ensuring that interventions are delivered effectively in a supportive environment. Few studies have investigated the feasibility and acceptability of parent-only interventions for child anxiety. Objective In this study, we report on feasibility, acceptability and preliminary clinical outcomes of a brief cognitive behavioural group intervention for parents of children (4- to 10-years-olds) experiencing anxiety in the absence of a diagnosed anxiety disorder. Method Parent participants attended a three-session group intervention delivered online. We collected feasibility information (recruitment and retention rates); parents and children (when appropriate) completed acceptability and clinical outcome measures after each session. Participants were also interviewed about the acceptability of the intervention and study processes. Results Nineteen parents consented to take part (child mean age 6.47, SD 1.23). Participant retention rates (68.4%) and intervention satisfaction (total mean CSQ score 28.52) were high. Calculated effect sizes were moderate to large for parent-rated outcomes, small for child self-reported anxiety, and small to moderate for parent confidence/efficacy. Thematic analysis of interview data identified benefits, such as connecting with parents and learning strategies, as well as challenges associated with the intervention. Conclusions Attendance appeared to be associated with positive changes for parents and children. Overall, participants found this to be an acceptable and useful intervention. These findings demonstrated the potential benefit of a brief intervention for parents of anxious children. A larger trial is required to further investigate these preliminary findings.
Collapse
|