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Phillips KE, Buinewicz SAP, Kagan E, Frank HE, Dunning E, Benito KG, Kendall PC. The Pediatric Accommodation Scale: Psychometric Evaluation of a Therapist-Report Format. Child Psychiatry Hum Dev 2024; 55:667-679. [PMID: 36149550 DOI: 10.1007/s10578-022-01447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/03/2022]
Abstract
Anxiety disorders are the most common mental health problem in youth, and accommodation is prevalent among youth with anxiety disorders. The Pediatric Accommodation Scale (PAS) is an interview administered by trained evaluators and a parent-report form (PAS-PR) to assess accommodation and its impact. Both have strong psychometric properties including internal consistency, inter-rater reliability, and data supporting construct validity. The present study evaluates the Pediatric Accommodation Scale - Therapist Report (PAS-TR), a therapist-reported version of the PAS-PR. Participants were 90 youth enrolled in cognitive behavioral therapy for anxiety. Therapists completed the PAS-TR over 16 therapy sessions. Internal consistency at baseline, convergent validity, divergent validity, and parent-therapist agreement were evaluated. Results suggest that the PAS-TR has mixed psychometric qualities suggesting that while not strong prior to the initiation of treatment, the PAS-TR may be a useful measure for therapists to rate accommodation as treatment progresses. Implications for assessment, treatment, and research are discussed.
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Affiliation(s)
- Katherine E Phillips
- Department of Psychology, Temple University, Temple University, 1701 North 13th St, 19122, Philadelphia, PA, USA.
| | | | - Elana Kagan
- Massachusetts General Hospital, Boston, MA, USA
| | - Hannah E Frank
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Erin Dunning
- Department of Psychology, Temple University, Temple University, 1701 North 13th St, 19122, Philadelphia, PA, USA
| | - Kristen G Benito
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Temple University, 1701 North 13th St, 19122, Philadelphia, PA, USA
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2
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Seipp V, Hagelweide K, Stark R, Weigelt S, Christiansen H, Kieser M, Otto K, Reck C, Steinmayr R, Wirthwein L, Zietlow A, Schwenck C. Parenting stress in parents with and without a mental illness and its relationship to psychopathology in children: a multimodal examination. Front Psychiatry 2024; 15:1353088. [PMID: 38374978 PMCID: PMC10875068 DOI: 10.3389/fpsyt.2024.1353088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
Objective Children of parents with a mental illness are at heightened risk to develop a mental illness themselves due to genetics and environmental factors. Although parenting stress (PS) is known to be associated with increased psychopathology in parents and children, there is no study investigating PS multimodally in a sample of parents with a mental illness. This study aims to compare PS of parents with and without a mental illness and further to examine the relationship between PS and psychopathology of children. Methods Participants were parents with a mental illness and parents without a mental illness and their children aged four to sixteen years. We assessed PS multimodally using a questionnaire, parents' evaluation of children's behavior (relational schemas) and psychophysiological arousal of parents during free speech task. Results Self-reported PS was increased, and evaluation of children's behavior was more negative and less positive in parents with a mental illness compared to parents without a mental illness. Children's psychopathology was associated with self-reported PS and relational schemas of parents. Regarding psychophysiological arousal, parents with a mental illness showed reduced reactivity in heart rate from baseline to free speech task in comparison to parents without a mental illness. Conclusions Our findings highlight the importance of implementing intervention programs to reduce PS for parents and children. In particular, parents with a mental illness might benefit from specific intervention programs in order to interrupt the transgenerational transmission of mental disorders.
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Affiliation(s)
- Vanessa Seipp
- Department of Clinical Child and Adolescent Psychology, Justus Liebig University Giessen, Giessen, Germany
| | - Klara Hagelweide
- Department of Rehabilitation Sciences, Technical University Dortmund, Dortmund, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus-Liebig University Giessen, Giessen, Germany
| | - Sarah Weigelt
- Department of Rehabilitation Sciences, Technical University Dortmund, Dortmund, Germany
| | - Hanna Christiansen
- Department of Psychology, Clinical Child and Adolescent Psychology, Philipps-University Marburg, Marburg, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Kathleen Otto
- Department of Work and Organizational Psychology, Philipps-University Marburg, Marburg, Germany
| | - Corinna Reck
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ricarda Steinmayr
- Department of Psychology, Technical University Dortmund, Dortmund, Germany
| | - Linda Wirthwein
- Department of Psychology, Technical University Dortmund, Dortmund, Germany
| | - Anna–Lena Zietlow
- Clinical Child and Adolescent Psychology, Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Christina Schwenck
- Department of Clinical Child and Adolescent Psychology, Justus Liebig University Giessen, Giessen, Germany
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Veit L, Jungmann SM, Freitag CM. The Course of Anxiety-Specific Cognitive Bias Following Daycare/Inpatient Treatment in Youths with Social Phobia and School Absenteeism. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2024; 52:1-10. [PMID: 37768010 DOI: 10.1024/1422-4917/a000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Social phobia (SP) is a common mental disorder in youth often accompanied by absence from school, which may require daycare or inpatient intervention (DC/IN). Objective: The present explorative study investigates changes in anxiety-specific implicit assumptions and interpretation bias following DC/IN. Methods: The study included 16 youths with SP (M age = 15.8 [SD = 1.24], females: 62.5 %) participating in DC/IN. We assessed the main outcomes using the Implicit Association Test and Affective Misattribution Procedure. Results: A large effect was shown for reducing implicit assumptions of feeling anxious (p = .142; η2p = .171) and for reducing the implicit interpretation bias (p = .137; η2p = .162). No change was indicated by effect size in implicit assumptions of feeling socially rejected (p = .649; η2p = .016). Social phobia symptoms initially correlated with changes in implicit assumptions of feeling anxious (r = .45). Conclusion: Effect sizes indicate that implicit anxiety-specific assumptions and interpretation bias descriptively improved following DC/IN. Thus, DC/IN may lead to meaningful improvements of anxiety-specific cognition in some individuals with high SP symptoms, emphasizing the relevance of cognitive behavioral approaches in the treatment of SP. Several limitations are discussed.
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Affiliation(s)
- Lisa Veit
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Stefanie Maria Jungmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Germany
| | - Christine Margarete Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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Kwon A, Cho YI, Kim HJ, Suh J, Kim DH. The mediating effects of parenting style on the relationship between parental stress and behavioral problems in girls with precocious puberty in Korea: a cross-sectional study. BMC Pediatr 2023; 23:352. [PMID: 37438739 DOI: 10.1186/s12887-023-04172-1] [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: 11/21/2022] [Accepted: 07/02/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND This study aimed to examine the mediating effects of parenting style on the relationship between parental stress and behavioral problems of girls with precocious puberty. METHODS This cross-sectional study analyzed a convenience sample of 200 mothers of girls with precocious puberty at a university hospital located in a metropolitan area. The Parental Stress measurement, Parents as Social Context Questionnaire, and Korean version Child Behavior Checklist (K-CBCL) 6-18 were measured via self-report questionnaires. Descriptive, t-test, Pearson correlation, and bootstrapping analyses were used to analyze the data. RESULTS Negative parenting styles had a full mediating effect on the relationship between parental stress and internalizing and externalizing behavioral problems. CONCLUSIONS Care plans for parents of girls with precocious puberty should be designed and applied in health care settings to reduce internalizing and externalizing behavioral problems by decreasing negative parenting styles.
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Affiliation(s)
- Ahreum Kwon
- Department of Pediatrics, College of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Young Il Cho
- College of Police and Criminal Justice, Dongguk University, 30, Pildong-ro 1-gil, Jung-gu, Seoul, Republic of Korea
| | - Hyo Jin Kim
- College of Nursing, Seoul National University, 103, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Junghwan Suh
- Department of Pediatrics, College of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Dong Hee Kim
- College of Nursing Science, Sungshin Women's University, 55, Dobong-ro 76ga-gil, Gangbuk-gu, Seoul, Republic of Korea.
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Liu L, Wang Y, Zhao J, Wang M. Parental reports of stress and anxiety in their migrant children in China: The mediating role of parental psychological aggression and corporal punishment. CHILD ABUSE & NEGLECT 2022; 131:105695. [PMID: 35714439 DOI: 10.1016/j.chiabu.2022.105695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Both ecological system theory and developmental contextualism framework have pointed out that family is one of the most direct microsystem environmental factors affecting children adjustment, especially for migrant children. As two major family microsystem factors, parenting stress and harsh discipline may be closely related to migrant children's anxiety. OBJECTIVE This study examined the predictive effects of both mothers' and fathers' parenting stress on Chinese migrant children's anxiety one year later in the single model and the mediating role of mothers' and fathers' harsh discipline (psychological aggression and corporal punishment). PARTICIPANTS Participants were 483 mother-father dyads with at least one elementary school-age child of Chinese migrant families. METHODS Parenting stress, parental harsh discipline (psychological aggression and corporal punishment), and children's anxiety were all reported by mothers and fathers. Structural equation modeling (SEM) was used to examine the direct effects of both maternal and paternal parenting stress (T1) on child anxiety (T3), and the mediating roles of both maternal and paternal harsh discipline (psychological aggression and corporal punishment) (T2) in the effects. RESULTS Our findings indicated that maternal but not paternal parenting stress had direct effects on Chinese migrant children's anxiety one year later, and both maternal and paternal parenting stress had indirect effects on migrant children's anxiety through parental psychological aggression but not corporal punishment. CONCLUSIONS Findings from the present study highlight the importance of simultaneously considering the influence of both maternal and paternal parenting on child adjustment.
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Affiliation(s)
- Li Liu
- School of Psychology, Shandong Normal University, PR China
| | - Yanxia Wang
- School of Psychology, Shandong Normal University, PR China
| | - Jianshe Zhao
- Radiology Department, Qilu Children Hospital of Shandong University, PR China
| | - Meifang Wang
- Research Center for Child Development, College of Elementary Education, Capital Normal University, PR China.
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Inguscio BMS, Nicastri M, Giallini I, Greco A, Babiloni F, Cartocci G, Mancini P. School wellbeing and psychological characteristics of online learning in families of children with and without hearing loss during the Covid-19 pandemic. PSYCHOLOGY IN THE SCHOOLS 2022; 60:PITS22761. [PMID: 35942392 PMCID: PMC9350277 DOI: 10.1002/pits.22761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/13/2022] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
Abstract
This study investigated the psychological characteristics of online learning on Italian students with and without hearing loss (HL) and on their parents, who were forced into isolation during the Covid-19 pandemic. An online survey collected information on socio-demographic data and opinions concerning online learning from 61 children (mean age 11; 25 males, 36 females), including 43 with HL and also from their parents; additionally, school wellbeing and anxiety were assessed. The results showed that, in both the student and parent groups, no significant effect of HL on school wellbeing and anxiety was found. Additionally, in parents, State Anxiety was significantly higher than Trait Anxiety, suggesting one possible impact of lockdown on psychological wellbeing. Differences due to HL were observed and discussed in correlation analyses. The Authors believe that this study is the first contribution to the psychological evaluation of the impact of online learning on families with hearing-impaired children, from the perspective of a successful, inclusive didactic.
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Affiliation(s)
| | - Maria Nicastri
- Department of Sense OrgansSapienza University of RomeRomeItaly
| | - Ilaria Giallini
- Department of Sense OrgansSapienza University of RomeRomeItaly
| | - Antonio Greco
- Department of Sense OrgansSapienza University of RomeRomeItaly
| | - Fabio Babiloni
- BrainSigns SrlLungotevere MichelangeloRomeItaly
- Department of Molecular MedicineSapienza University of RomeRomeItaly
- Department of Computer ScienceHangzhou Dianzi University, Xiasha Higher Education ZoneHangzhouChina
| | - Giulia Cartocci
- BrainSigns SrlLungotevere MichelangeloRomeItaly
- Department of Molecular MedicineSapienza University of RomeRomeItaly
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Giani L, Caputi M, Forresi B, Michelini G, Scaini S. Evaluation of Cognitive-Behavioral Therapy Efficacy in the Treatment of Separation Anxiety Disorder in Childhood and Adolescence: a Systematic Review of Randomized Controlled Trials. Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00129-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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A Randomized Control Trial of Using Baby Books to Reduce New Mothers' Feelings of Stress and Depression. Matern Child Health J 2021; 25:1615-1625. [PMID: 34328588 DOI: 10.1007/s10995-021-03200-9] [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: 11/07/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine whether embedding educational information about child development and optimal parenting practices from the Bright Futures Guidelines for Health Supervision into baby books can reduce women's depressive symptoms and parenting stress during the first 18 months of motherhood. METHODS A sample of 167 low-income, primarily African-American, first-time mothers were randomized into three conditions while pregnant: an educational book group, a non-educational book group, or a no-book group. Depressive symptoms and parenting stress were assessed using two questionnaires during home visits when women were in their third trimester of pregnancy (baseline) and when their child was 2, 4, 6, 9, 12, and 18 months of age. RESULTS Hierarchical Linear Models showed that women who received books with educational information shed depressive symptoms and parenting stress at a faster rate than women who received similar books without educational information and women who did not receive books. CONCLUSIONS These findings indicate that providing women with child development and parenting information via baby books can be an effective strategy for promoting new mothers' emotional wellbeing. Since feelings of sadness and stress are risky for both mothers and their infants, this easy to implement intervention holds great promise.
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Svenning A, Panzarino R, Vanryckeghem M, Vestner T. Life partners' perceptions of the emotional, speech disruptive, and attitudinal correlates of stuttering. JOURNAL OF FLUENCY DISORDERS 2021; 67:105821. [PMID: 33290956 DOI: 10.1016/j.jfludis.2020.105821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 08/29/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of the current investigation was to explore the extent to which the life partners (LPs) of people who stutter (PWS) perceive their loved ones' speech-situation specific emotional reaction, expectancy of speech disruption, and speech-related communication attitude. METHODS Three subtests of the Behavior Assessment Battery (BAB): the Speech Situation Checklist - Emotional Reaction (SSC-ER), the Speech Situation Checklist - Speech Disruption (SSC-SD) and the Communication Attitude Test for Adults Who Stutter (BigCAT) were administered to 33 PWS and modified versions were administered to their LPs via Qualtrics Survey Software. Effect of relationship duration on subtest scores was considered. Perceived stuttering severity by the participant and their LP was also queried as part of a demographic questionnaire. RESULTS PWS and their LPs rated BigCAT items in a similar way, while they rated certain SSC-ER and SSC-SD items differently. Importantly, between-group agreement was not affected by relationship duration. Among the PWS and LP, perceived stuttering severity influenced all BAB subtest scores. CONCLUSION LPs of PWS appear to be in tune with the cognitive aspects of their partner's experience of stuttering. This has important clinical implications as it relates to active involvement of the family in speech intervention targeting fluency.
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Affiliation(s)
- A Svenning
- University of Central Florida, United States.
| | - R Panzarino
- University of Central Florida, United States
| | | | - T Vestner
- Birkbeck, University of London, United Kingdom
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10
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Crane ME, Norris LA, Frank HE, Klugman J, Ginsburg GS, Keeton C, Albano AM, Piacentini J, Peris TS, Compton SN, Sakolsky D, Birmaher B, Kendall PC. Impact of treatment improvement on long-term anxiety: Results from CAMS and CAMELS. J Consult Clin Psychol 2021; 89:126-133. [PMID: 33705168 PMCID: PMC7959050 DOI: 10.1037/ccp0000523] [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] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This article examined associations between change in youth and family characteristics during youth anxiety treatment and long-term anxiety severity and overall functioning. METHOD Participants (N = 488; age 7-17 years; 45% male; 82% white) were randomized to 12 weeks of cognitive behavioral therapy (Coping Cat), medication (sertraline), their combination, or pill placebo in the Child/Adolescent Anxiety Multimodal Study (CAMS). A subset participated in the naturalistic follow-up Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS; n = 319; 3.70-11.83 years post-treatment). The current secondary analyses examined how change in anxiety severity (Child Global Impression-Severity), overall functioning (Children's Global Assessment Scale), caregiver psychopathology (Brief Symptom Inventory), caregiver strain (Family Burden Assessment Scale), and family dysfunction (Brief Family Assessment Measure) during CAMS was associated with anxiety severity and overall functioning years later (M = 7.72 years). CAMS procedures were registered on clinialtrials.gov. RESULTS Improvements in factors related to functioning (i.e., overall functioning, family dysfunction, caregiver strain) were associated with improvements in anxiety severity in CAMELS (|βys| ≥ .04, ps ≤ .04). Improvements in factors related to psychopathology (i.e., anxiety severity, caregiver psychopathology) were associated with improvements in overall functioning in CAMELS (|βys| ≥ .23, ps ≤ .04). It was changes in each of the variables examined (rather than baseline values) that predicted anxiety severity and overall functioning. CONCLUSIONS Both youth and family factors play a significant role in long-term treatment outcomes. Therapists would be wise to monitor how these factors change throughout treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | - Hannah E. Frank
- Department of Psychology, Temple University, Philadelphia, PA
| | - Joshua Klugman
- Department of Sociology, Temple University, Philadelphia, PA
| | - Golda S. Ginsburg
- Department of Psychiatry University of Connecticut of Medicine, Farmington, CT
| | - Courtney Keeton
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anne Marie Albano
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Medical Center, New York, NY
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | | | - Scott N. Compton
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, NC
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
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Kunas SL, Lautenbacher LM, Lueken PU, Hilbert K. Psychological Predictors of Cognitive-Behavioral Therapy Outcomes for Anxiety and Depressive Disorders in Children and Adolescents: A Systematic Review and Meta-Analysis. J Affect Disord 2021; 278:614-626. [PMID: 33035949 DOI: 10.1016/j.jad.2020.09.092] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/15/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND By understanding specific differences between responders to a treatment and non-responders, treatment modalities may be fitted to the individual in order to increase effectiveness, a concept known as "precision medicine". This systematic review and meta-analysis investigated which pretreatment patient and family characteristics may predict the outcome of cognitive-behavioral therapy (CBT) in clinically anxious and/or depressed youth. In particular, higher symptom severity, more severe co-occurring anxiety or depression and more severe parental psychopathology were hypothesized to predict a worse CBT outcome. METHODS The databases PubMed, PsycINFO and Cochrane Library were searched; 73 publications were included in the review from which 23 studies were used for the meta-analysis. RESULTS Higher symptom severity represented a clinically relevant predictor of a worse CBT outcome, with large effects estimated by meta-analysis. Further, parental psychopathology was significant and detrimental for CBT outcome in anxious but not depressed youth, while the effects for co-occurring anxiety and depression remained unclear. The additional results of the review show that only few characteristics seemed to be clearly associated with a worse CBT outcome, namely worse coping skills and, restricted to depressed patients, more non-suicidal self-injury. LIMITATIONS The available evidence was of only moderate quality in general, further high-quality research with more transparent reporting is needed. CONCLUSIONS The patient characteristics identified as being relevant for CBT outcome may represent important candidates for use in single patient prediction models for precision medicine in the field of child and adolescent psychotherapy. The review was preregistered on PROSPERO (ID: CRD42018116881).
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Affiliation(s)
- Stefanie L Kunas
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany; Psychologische Hochschule Berlin, Berlin, Germany.
| | | | | | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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12
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Adolph D, Margraf J, Schneider S. Your Fear is My Fear: The Relationship Between Parental and Offspring Anxieties. Child Psychiatry Hum Dev 2021; 52:772-781. [PMID: 32948972 PMCID: PMC8405516 DOI: 10.1007/s10578-020-01060-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2020] [Indexed: 11/26/2022]
Abstract
Contrary to the well-documented link between parental and offspring clinical anxiety, little is known about the relationship between parental everyday-life anxieties (e.g., concerning family, finances, health) and offspring anxieties. To close this gap, we assessed the frequency of parental symptoms of DSM-IV anxiety disorders and everyday-life anxieties, as well as the frequency of offspring anxiety symptoms in a representative sample by self-report. Parents reported that 48.4% of the children were free of specific symptoms of DSM-IV anxiety disorders within the last 12 months, 39.2% showed low symptom load (1-3 symptoms) and 12.4% were moderately or severely strained (4-10 symptoms). Replicating previous studies, parental DSM-IV symptoms increased offspring risk for the same symptoms. In addition, parental everyday-life anxieties showed a positive relationship with offspring symptom severity. Demographic variables (female sex, low socioeconomic status and younger age) and parental anxiety markers explained 18% of variance in offspring symptom severity. The data are discussed in light of current models of familial transmission.
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Affiliation(s)
- Dirk Adolph
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Massenbergstrasse 9-13, 44847, Bochum, Germany.
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Massenbergstrasse 9-13, 44847, Bochum, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Massenbergstrasse 9-13, 44847, Bochum, Germany
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Stewart SL, Toohey A, Poss JW. iCCareD: The Development of an Algorithm to Identify Factors Associated With Distress Among Caregivers of Children and Youth Referred for Mental Health Services. Front Psychiatry 2021; 12:737966. [PMID: 34867533 PMCID: PMC8637612 DOI: 10.3389/fpsyt.2021.737966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Caregiver well-being plays an important role in children's development and a number of factors have been found to impact distress levels among caregivers of children and youth referred for mental health services. Further, caregiver distress impacts youth psychopathology, its acuity as well as related mental health interventions. The purpose of this study was to develop and validate an algorithm for identifying caregivers who are at greatest risk of experiencing caregiver distress. This algorithm was derived from, and will be embedded in, existing comprehensive interRAI child and youth instruments. Ontario data based on the interRAI Child and Youth Mental Health assessment instruments (ChYMH and ChYMH-DD) were analyzed to identify predictors of distress among caregivers of children and youth ages 4-18 years. Starting with proactive aggression, the algorithm uses 40 assessment items to assign one of 30 nodes that are grouped into five levels of risk. The interRAI ChYMH Caregiver Distress (iCCareD) algorithm was validated using longitudinal data from mental health agencies across Ontario and was found to be a good predictor among this sample with a c-statistic of 0.71 for predicting new or ongoing caregiver distress and 65% for both sensitivity and specificity using algorithm values of 3 or greater. This algorithm provides an evidence-based decision-support tool embedded within a comprehensive assessment tool that may be used by clinicians to inform their selection of supports and services for families.
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Affiliation(s)
| | - Ashley Toohey
- Faculty of Education, Western University, London, ON, Canada
| | - Jeffrey W Poss
- Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Chouksey A, Pandey S. Functional Movement Disorders in Children. Front Neurol 2020; 11:570151. [PMID: 33281706 PMCID: PMC7688912 DOI: 10.3389/fneur.2020.570151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/26/2020] [Indexed: 01/28/2023] Open
Abstract
Functional movement disorders (FMDs) are not uncommon in children. The age at onset may have a bearing on the phenomenological pattern of abnormal movement, risk factors, and response to different treatment modalities in this age group. FMDs in children resemble their adult counterparts in terms of gender preponderance, but risk factors are quite different, and often influenced by cultural and demographic background. FMDs contribute to a significant proportion of acute pediatric movement disorder patients seen in emergency settings, ranging from 4.3 to 23% in different case series. The most common movement phenomenologies observed in pediatric FMDs patients are tremor, dystonia, gait disturbances, and functional tics. Various social, physical, and familial precipitating factors have been described. Common social risk factors include divorce of parents, sexual abuse, bullying at school, examination pressure, or other education-related issues, death of a close friend, relative, or family members. Physical trauma like minor head injury, immunization, tooth extraction, and tonsillectomy are also known to precipitate FMDs. The response to treatment appears to be better among pediatric patients. We aim to review FMDs in children to better understand the different aspects of their frequency, clinical features, precipitating factors, diagnosis, treatment, and outcome.
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Affiliation(s)
- Anjali Chouksey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
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15
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Norris LA, Kendall PC. Moderators of Outcome for Youth Anxiety Treatments: Current Findings and Future Directions. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:450-463. [PMID: 33140992 DOI: 10.1080/15374416.2020.1833337] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: To improve outcomes and create more personalized interventions, the field has sought to identify moderators of treatment response (variables that specify which treatments work for whom and under what conditions).Method: The current review examines moderators of youth anxiety treatments.Results: The majority of studies to date have examined variables of convenience, including demographics (age, sex, race, ethnicity, socioeconomic status), pretreatment youth clinical characteristics (anxiety severity, principal diagnosis, comorbidity) and pretreatment parent variables (parent psychopathology, parenting). Findings indicate few consistent moderators.Conclusions: Future directions are discussed, including (a) group to individual generalizability, (b) power considerations, and (c) updates to study design and measure selection.
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16
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Phillips KE, Norris LA, Kendall PC. Separation Anxiety Symptom Profiles and Parental Accommodation Across Pediatric Anxiety Disorders. Child Psychiatry Hum Dev 2020; 51:377-389. [PMID: 31907734 PMCID: PMC8109254 DOI: 10.1007/s10578-019-00949-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Parental accommodation refers to ways in which caregivers modify their behavior to decrease child distress in the short-term. Accommodation is prevalent among anxious youth and related to decreased treatment and functional outcomes. Although separation anxiety disorder (SAD) is associated with increased accommodation, SAD is not a predictor of treatment response, suggesting that a diagnosis of SAD alone may not be enough to clarify the relationship between accommodation and separation anxiety symptoms within a clinical context. Participants were youth with a primary anxiety disorder (N = 186; aged 7-17) enrolled in an outpatient anxiety clinic. Latent class analysis was used to extract profiles from parent-reported SAD symptoms using the Anxiety Disorders Interview Schedule for DSM-IV/5. Profiles were compared on pre-treatment accommodation. Low, moderate, and interfering SAD classes emerged. Interfering SAD was associated with high accommodation. Results help to clarify the association between SAD and accommodation and has implications for personalized intervention.
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Affiliation(s)
- Katherine E Phillips
- Department of Psychology, Temple University, 1701 North 13th St, Philadelphia, PA, 19122, USA.
| | - Lesley A Norris
- Department of Psychology, Temple University, 1701 North 13th St, Philadelphia, PA, 19122, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, 1701 North 13th St, Philadelphia, PA, 19122, USA.
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17
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Stockdale L, Coyne SM. Parenting paused: Pathological video game use and parenting outcomes. Addict Behav Rep 2020; 11:100244. [PMID: 32467833 PMCID: PMC7244913 DOI: 10.1016/j.abrep.2019.100244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/17/2018] [Indexed: 11/01/2022] Open
Abstract
For most people, playing video games is a normal recreational activity, with little disruption to gamers' emotional, social, or physical health and well-being. However, for a small percentage of gamers, video gaming can become pathological (Fam, 2018). Substantial research has examined pathological gaming in teens and young adults (Cheng, Cheung, & Wang, 2018; Choo, Gentile, Sim, Khoo, & Liau, 2010), yet pathological gaming in adults (c.f. Holgren, 2017), especially in the context of parenthood, has been relatively ignored. The current study sought to address this limitation by studying associations between pathological gaming characteristics and parenting outcomes in a sample of men and women who have had a child in the last year. Fathers spent more time than mothers playing video games and displayed more pathological video gaming tendencies. Pathological gaming for mothers and fathers was related to increased depressive symptoms. Depressive symptoms mediated the relationship between pathological gaming and decreased feelings of parental efficacy, perceived parental competence, increased parenting stress, and increased perceived impact of parenting. Pathological video game playing was also directly related to decreased feelings of parental efficacy for mothers and fathers. Implications of the results and directions for future research are discussed.
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18
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Murphy LK, Preacher KJ, Rights JD, Rodriguez EM, Bemis H, Desjardins L, Prussien K, Winning AM, Gerhardt CA, Vannatta K, Compas BE. Maternal Communication in Childhood Cancer: Factor Analysis and Relation to Maternal Distress. J Pediatr Psychol 2019; 43:1114-1127. [PMID: 30016505 DOI: 10.1093/jpepsy/jsy054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 06/17/2018] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to characterize mothers' communication with their children in a sample of families with a new or newly relapsed pediatric cancer diagnosis, first using factor analysis and second using structural equation modeling to examine relations between self-reported maternal distress (anxiety, depression, and posttraumatic stress) and maternal communication in prospective analyses. A hierarchical model of communication was proposed, based on a theoretical framework of warmth and control. Methods The sample included 115 children (age 5-17 years) with new or newly relapsed cancer (41% leukemia, 18% lymphoma, 6% brain tumor, and 35% other) and their mothers. Mothers reported distress (Beck Anxiety Inventory, Beck Depression Inventory-II, and Impact of Events Scale-Revised) 2 months after diagnosis (Time 1). Three months later (Time 2), mother-child dyads were video-recorded discussing cancer. Maternal communication was coded with the Iowa Family Interaction Ratings Scales. Results Confirmatory factor analysis demonstrated poor fit. Exploratory factor analysis suggested a six-factor model (root mean square error of approximation = .04) with one factor reflecting Positive Communication, four factors reflecting Negative Communication (Hostile/Intrusive, Lecturing, Withdrawn, and Inconsistent), and one factor reflecting Expression of Negative Affect. Maternal distress symptoms at Time 1 were all significantly, negatively related to Positive Communication and differentially related to Negative Communication factors at Time 2. Maternal posttraumatic stress and depressive symptoms each predicted Expression of Negative Affect. Conclusions Findings provide a nuanced understanding of maternal communication in pediatric cancer and identify prospective pathways of risk between maternal distress and communication that can be targeted in intervention.
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Affiliation(s)
- Lexa K Murphy
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Jason D Rights
- Department of Psychology & Human Development, Vanderbilt University
| | - Erin M Rodriguez
- Department of Psychology & Human Development, Vanderbilt University
| | - Heather Bemis
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Kemar Prussien
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
| | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
| | - Bruce E Compas
- Department of Psychology & Human Development, Vanderbilt University
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19
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Kujawa A, Burkhouse KL, Karich SR, Fitzgerald KD, Monk CS, Phan KL. Reduced Reward Responsiveness Predicts Change in Depressive Symptoms in Anxious Children and Adolescents Following Treatment. J Child Adolesc Psychopharmacol 2019; 29:378-385. [PMID: 31062997 PMCID: PMC6585168 DOI: 10.1089/cap.2018.0172] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives: Reduced reward responsiveness, as measured by the event-related potential (ERP) component, the reward positivity (RewP), has been shown to play a role in the development of internalizing disorders, but implications for treatment remain unclear. In adult patients with anxiety and/or depression, reduced RewP has emerged as a predictor of greater change in symptoms following cognitive behavior therapy (CBT) or selective serotonin reuptake inhibitor (SSRI) treatment. The objectives of this preliminary study were to extend these findings to children and adolescents with anxiety disorders by evaluating RewP to reward as a predictor of change in anxiety severity or depressive symptoms following treatment with CBT or SSRI and to explore whether RewP differentially predicts response to one type of treatment. Methods: Patients (7-19 years old) with social and/or generalized anxiety disorder (N = 27) completed baseline measures of anxiety severity and depressive symptoms, as well as an ERP monetary reward anticipation and feedback task. RewP was measured in response to reward and breaking even feedback. Patients were then randomly assigned to CBT or SSRI treatment, and completed measures of anxiety and depressive symptom severity at the last treatment session. Results: Reduced reward responsiveness, as measured by RewP to rewards, predicted greater change in depressive symptoms following treatment, adjusting for baseline symptoms, age, and RewP to breaking even. RewP was not a significant predictor of change in anxiety symptoms. Although preliminary, exploratory analyses suggested that among anxious youth, RewP specifically predicted change in depressive symptoms following CBT, rather than SSRI. Conclusion: Results provide preliminary support for the utility of ERP measures of reward responsiveness in predicting treatment response in youth. With further research and standardization, ERP assessments could potentially be implemented in clinical settings to inform prognosis and treatment planning for youth with internalizing disorders.
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Affiliation(s)
- Autumn Kujawa
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Katie L. Burkhouse
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois.,Address correspondence to: Katie L. Burkhouse, PhD, Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor Street, Chicago, IL 60608
| | - Shannon R. Karich
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | | | - Christopher S. Monk
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - K. Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois.,Mental Health Service, Jesse Brown VA Medical Center, Chicago, Illinois.,Department of Anatomy and Cell Biology, and Graduate Program in Neuroscience, University of Illinois at Chicago, Chicago, Illinois
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20
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Escovar EL, Drahota A, Hitchcock C, Chorpita BF, Chavira DA. Vicarious Improvement Among Parents Participating in Child-Focused Cognitive-Behavioral Therapy for Anxiety. CHILD & FAMILY BEHAVIOR THERAPY 2019; 41:16-31. [PMID: 31920215 PMCID: PMC6952065 DOI: 10.1080/07317107.2019.1571770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/10/2017] [Accepted: 05/20/2017] [Indexed: 06/10/2023]
Abstract
Parental variables likely have important and bidirectional influences on the etiology of child anxiety. Although some child-focused cognitive-behavioral therapy (CCBT) anxiety trials have found vicarious improvements among parents who participated in their children's treatment, this is an understudied area. We hypothesized that parental variables (psychopathology, stress, and burden) will significantly decrease from pre-to post-CCBT and will be associated with child treatment response. We explored whether intervention delivery method-in-person CCBT versus parent-mediated bibliotherapy-influenced vicarious parental improvements. Parental variables decreased from pre- to post-CCBT and were associated with child treatment response. Effects did not interact with delivery method. Parent participation in anxiety CCBT may result in vicarious improvements for parents.
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Affiliation(s)
- Emily L Escovar
- Clinical Psychology Doctoral Program, Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Carla Hitchcock
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Alexandria Veterans Affairs Health Care System, Pineville, LA, USA
| | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Denise A Chavira
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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21
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Hronis A, Roberts R, Roberts L, Kneebone I. Fearless Me! © : A feasibility case series of cognitive behavioral therapy for adolescents with intellectual disability. J Clin Psychol 2019; 75:919-932. [PMID: 30659608 DOI: 10.1002/jclp.22741] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 10/26/2018] [Accepted: 11/06/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study evaluated the feasibility of the Fearless Me! program, an online cognitive behavioral therapy (CBT) program for children with intellectual disability (ID) and anxiety. METHOD Twenty-one adolescents with mild to moderate ID participated in ten sessions of the therapist-assisted Fearless Me! program, combining face-to-face group sessions and an online component. A case series design was adopted to assess anxiety symptoms at baseline, throughout intervention, and postintervention. Feasibility of the measures, intervention, and trial design were considered. RESULTS The measures were appropriate and sensitive to changes in anxiety, whereas the need for attention to factors influencing parent's completion of them was identified. Reliable Change Index and visual analyses of results indicated reductions in anxiety, particularly for older adolescents with heightened levels of anxiety at baseline. CONCLUSIONS This is one of the first CBT programs for adolescents with ID, and provides preliminary evidence of adapted CBT as a feasible treatment.
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Affiliation(s)
- Anastasia Hronis
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Rachel Roberts
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Lynette Roberts
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Ian Kneebone
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
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22
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Bunford N, Kujawa A, Fitzgerald KD, Swain JE, Hanna GL, Koschmann E, Simpson D, Connolly S, Monk CS, Phan KL. Neural Reactivity to Angry Faces Predicts Treatment Response in Pediatric Anxiety. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:385-395. [PMID: 27255517 PMCID: PMC5800984 DOI: 10.1007/s10802-016-0168-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Although cognitive-behavioral psychotherapy (CBT) and pharmacotherapy are evidence-based treatments for pediatric anxiety, many youth with anxiety disorders fail to respond to these treatments. Given limitations of clinical measures in predicting treatment response, identifying neural predictors is timely. In this study, 35 anxious youth (ages 7-19 years) completed an emotional face-matching task during which the late positive potential (LPP), an event-related potential (ERP) component that indexes sustained attention towards emotional stimuli, was measured. Following the ERP measurement, youth received CBT or selective serotonin reuptake inhibitor (SSRI) treatment, and the LPP was examined as a predictor of treatment response. Findings indicated that, accounting for pre-treatment anxiety severity, neural reactivity to emotional faces predicted anxiety severity post- CBT and SSRI treatment such that enhanced electrocortical response to angry faces was associated with better treatment response. An enhanced LPP to angry faces may predict treatment response insofar as it may reflect greater emotion dysregulation or less avoidance and/or enhanced engagement with environmental stimuli in general, including with treatment.
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Affiliation(s)
- Nora Bunford
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60608, USA. .,Department of Psychology, Ohio University, Athens, OH, 45701, USA. .,Department of Psychiatry, University of Illinois at Chicago, 1747 W. Roosevelt Rd., Rm. 277, Chicago, IL, 60612, USA.
| | - Autumn Kujawa
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60608, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - James E Swain
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA.,Department of Psychology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Gregory L Hanna
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA
| | | | - David Simpson
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60608, USA
| | - Sucheta Connolly
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60608, USA
| | - Christopher S Monk
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA.,Department of Psychology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60608, USA.,Department of Psychology, University of Michigan, Ann Arbor, MI, 48109, USA.,Departments of Psychology and Anatomy & Cell Biology, and Graduate Program in Neuroscience, University of Illinois at Chicago, Chicago, IL, 6012, USA
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23
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Flessner CA, Murphy YE, Brennan E, D'Auria A. The Parenting Anxious Kids Ratings Scale-Parent Report (PAKRS-PR): Initial Scale Development and Psychometric Properties. Child Psychiatry Hum Dev 2017; 48:651-667. [PMID: 27770232 DOI: 10.1007/s10578-016-0688-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Developmental models of pediatric anxiety posit multiple, maladaptive parenting behaviors as potential risk factors. Despite this, a standardized means of assessing multiple of these practices (i.e., anxiogenic parenting) in a comprehensive and efficient manner are lacking. In Study 1531 parents of children 7-17 years old completed an online survey via Amazon Mechanical Turk. In Study 2, a separate community sample (N = 109; 9-17 years old) was recruited and completed a comprehensive assessment battery as part of a larger study. All parents (Study 1 and 2 samples) completed the Parenting Anxious Kids Ratings Scale-Parent Report (PAKRS-PR), a measurement tool designed to assess anxiogenic parenting. Factor analysis conducted as part of Study 1 revealed a 32-item scale consisting of five factors: conflict, overinvolvement, accommodation/beliefs, modeling, and emotional warmth/support. Four of these factors were significantly correlated with parent-report of anxiety severity. Within Study 2, the parents of children diagnosed with an anxiety or related disorder reported significantly higher levels of anxiogenic parenting practices as compared to the parents of healthy controls. The PAKRS-PR and respective subscales demonstrated acceptable reliability and validity in both the internet (Study 1) and community (Study 2) samples. The PAKRS-PR may be a beneficial multidimensional parenting scale for use among anxious youths.
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Affiliation(s)
| | - Yolanda E Murphy
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA
| | - Elle Brennan
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA
| | - Alexandra D'Auria
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA
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24
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Parental Involvement in Cognitive Behavior Therapy for Children with Anxiety Disorders: 3-Year Follow-Up. Child Psychiatry Hum Dev 2017; 48:444-454. [PMID: 27405872 DOI: 10.1007/s10578-016-0671-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Parental factors have been linked to childhood anxiety, hence, parental involvement in cognitive behavioral therapy (CBT) for anxious children has been examined. However, findings do not consistently show added effects of parent-enhanced CBT, longitudinal investigations are scarce and long-term effects unclear. In the present study, 40 out of 54 families who, 3 years previously, completed one of two types of CBT treatment: with limited or active parental involvement, were assessed using semi-structured diagnostic interviews. Diagnostic status at 3-years follow-up was compared between groups. Changes in diagnostic status across assessment points: posttreatment, 6-month and 3-year follow-up were analyzed within groups. Diagnostic change from 6-month to 3-year follow-up was compared between groups. Intent-to-treat analyses revealed no significant difference in diagnostic status between groups at 3-year follow-up. Nonetheless, children whose parents actively participated in treatment showed significantly more remission from 6-month to 3-year follow-up than children with limited parental participation.
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25
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Hosokawa R, Katsura T, Shizawa M. Relations of mother's sense of coherence and childrearing style with child's social skills in preschoolers. Child Adolesc Psychiatry Ment Health 2017; 11:11. [PMID: 28286549 PMCID: PMC5341473 DOI: 10.1186/s13034-017-0147-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 02/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We examined the relationships between mothers' sense of coherence (SOC) and their child's social skills development among preschool children, and how this relationship is mediated by mother's childrearing style. METHODS Mothers of 1341 Japanese children, aged 4-5 years, completed a self-report questionnaire on their SOC and childrearing style. The children's teachers evaluated their social skills using the social skills scale (SSS), which comprises three factors: cooperation, self-control, and assertion. RESULTS Path analyses revealed that the mother's childrearing mediated the positive relationship between mother's SOC and the cooperation, self-control, and assertiveness aspects of children's social skills. Additionally, there was a significant direct path from mother's SOC to the self-control component of social skills. CONCLUSIONS These findings suggest that mother's SOC may directly as well as indirectly influence children's social skills development through the mediating effect of childrearing. The results offer preliminary evidence that focusing on support to improve mothers' SOC may be an efficient and effective strategy for improving children's social skills development.
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Affiliation(s)
- Rikuya Hosokawa
- Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
- School of Nursing, Nagoya City University, Nagoya, Aichi Japan
| | - Toshiki Katsura
- Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Miho Shizawa
- 3 Graduate School of Nursing, Kyoto Prefectural University of Medicine, Kyoto, Japan
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26
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van Steensel FJA, Zegers VM, Bögels SM. Predictors of Treatment Effectiveness for Youth with ASD and Comorbid Anxiety Disorders: It all Depends on the Family? J Autism Dev Disord 2017; 47:636-645. [PMID: 28004234 PMCID: PMC5352781 DOI: 10.1007/s10803-016-2956-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The study aimed to explore predictors of treatment effectiveness in a sample of 79 children with ASD who received cognitive behavioral therapy (CBT) for their anxiety disorders. Severity of anxiety disorders and anxiety symptoms were used to measure treatment effectiveness and was assessed pre-treatment, post-treatment, 3 months-, 1 and 2 years after CBT. Child characteristics and maternal anxiety did not predict treatment effect. Children with anxious fathers and children in 'un-involved' families had less anxiety symptoms at pre-treatment and displayed a less steep decline. Children from 'authoritarian' families showed higher pre-treatment anxiety levels but responded quite well to treatment. Findings stress the importance of parent (father) and family factors in the treatment of anxiety disorders in youth with ASD.
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Affiliation(s)
- F J A van Steensel
- Child Development and Education, Research Priority Area YIELD, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands.
| | - V M Zegers
- Child Development and Education, Research Priority Area YIELD, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
| | - S M Bögels
- Child Development and Education, Research Priority Area YIELD, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
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27
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Perez Algorta G, MacPherson HA, Youngstrom EA, Belt CC, Arnold LE, Frazier TW, Taylor HG, Birmaher B, Horwitz SM, Findling RL, Fristad MA. Parenting Stress Among Caregivers of Children With Bipolar Spectrum Disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 47:S306-S320. [PMID: 28278600 DOI: 10.1080/15374416.2017.1280805] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Caregivers of psychiatrically impaired children experience considerable parenting stress. However, no research has evaluated parenting stress within the context of pediatric bipolar spectrum disorders (BPSD). Thus, the aim of this investigation was to identify predictors and moderators of stress among caregivers in the Longitudinal Assessment of Manic Symptoms study. Participants included 640 children and their caregivers in the Longitudinal Assessment of Manic Symptoms cohort. Children had a mean age of 9.4 ± 1.9 years (68% male, 23% BPSD); parents had a mean age of 36.5 ± 8.3 years (84% mothers). Children with BPSD had more service utilization, psychiatric diagnoses, mood and anxiety symptoms, and functional impairment but fewer disruptive behavior disorders. Caregivers of children with BPSD were more likely than caregivers of children without BPSD to have a partner, elevated depressive symptoms, antisocial tendencies, and parenting stress (Cohen's d = .49). For the whole sample, higher child IQ, mania, anxiety, disruptive behavior, and caregiver depression predicted increased parenting stress; maternal conduct disorder predicted lower stress. Child anxiety and disruptive behavior were associated with elevated caregiver stress only for non-BPSD children. Caregivers of children with BPSD experience significant burden and thus require specialized, family-focused interventions. As stress was also elevated, to a lesser degree, among depressed caregivers of children with higher IQ, mania, anxiety, and disruptive behavior, these families may need additional supports as well. Although parents with conduct/antisocial problems evidenced lower stress, these difficulties should be monitored. Thus, parenting stress should be evaluated and addressed in the treatment of childhood mental health problems, especially BPSD.
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Affiliation(s)
- Guillermo Perez Algorta
- a Spectrum Centre for Mental Health Research/Division of Health Research , Lancaster University
| | | | - Eric A Youngstrom
- c Department of Psychology , University of North Carolina at Chapel Hill
| | | | - L Eugene Arnold
- e Department of Psychiatry and Behavioral Health , The Ohio State University Wexner Medical Center
| | | | - H Gerry Taylor
- g Department of Pediatrics , Case Western Reserve University and Rainbow Babies & Children's Hospital
| | - Boris Birmaher
- h Department of Psychiatry , University of Pittsburgh Medical Center
| | - Sarah McCue Horwitz
- i Department of Child and Adolescent Psychiatry , New York University School of Medicine
| | - Robert L Findling
- j Department of Psychiatry , Johns Hopkins University/Kennedy Krieger Institute
| | - Mary A Fristad
- e Department of Psychiatry and Behavioral Health , The Ohio State University Wexner Medical Center.,k The LAMS Team
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28
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Pishva R. Becoming Therapeutic Agents: A Grounded Theory of Mothers' Process When Implementing Cognitive Behavioural Therapy at Home with an Anxious Child. Clin Psychol Psychother 2016; 24:766-784. [PMID: 27687013 DOI: 10.1002/cpp.2046] [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: 01/29/2016] [Revised: 08/30/2016] [Accepted: 09/14/2016] [Indexed: 11/09/2022]
Abstract
The premise of parent-centred programmes for parents of anxious children is to educate and train caregivers in the sustainable implementation of cognitive behaviour therapy (CBT) in the home. The existing operationalization of parent involvement, however, does not address the systemic, parent or child factors that could influence this process. The qualitative approach of grounded theory was employed to examine patterns of action and interaction involved in the complex process of carrying out CBT with one's child in one's home. A grounded theory goes beyond the description of a process, offering an explanatory theory that brings taken-for-granted meanings and processes to the surface. The theory that emerged from the analysis suggests that CBT implementation by mothers of anxious children is characterized by the evolution of mothers' perception of their child and mothers' perception of their role as well as a shift from reacting with emotion to responding pragmatically to the child. Changes occur as mothers recognize the crisis, make links between the treatment rationale, child's symptoms and their own parenting strategies, integrate tenets of CBT for anxiety and eventually focus on sustaining therapeutic gains through natural life transitions. The theory widens our understanding of mothers' role, therapeutic engagement, process, and decision-making. The theory also generates new hypotheses regarding parent involvement in the treatment of paediatric anxiety disorders and proposes novel research avenues that aim to maximize the benefits of parental involvement in the treatment of paediatric anxiety disorders. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE Mothers of anxious youth who take part in parent-centred programmes experience a shift in their perception of the child and of their role. Parental strategy after CBT implementation shifts from emotional empathy to cognitive empathy. Mothers experience significant challenges and require additional support in prevention of relapse and knowledge translation.
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Affiliation(s)
- Rana Pishva
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
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Kendall PC, Makover H, Swan A, Carper MM, Mercado R, Kagan E, Crawford E. What steps to take? How to approach concerning anxiety in youth. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12156] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lundkvist-Houndoumadi I, Thastum M, Nielsen K. Parents' difficulties as co-therapists in CBT among non-responding youths with anxiety disorders: Parent and therapist experiences. Clin Child Psychol Psychiatry 2016; 21:477-90. [PMID: 26614573 DOI: 10.1177/1359104515615641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
No increased effect has been associated with parent involvement in cognitive behavioral therapy (CBT) for youths with anxiety disorders. The purpose of this study was to explore parent and therapist experiences of CBT among non-responding youths with anxiety disorders, with a primary focus on parent involvement in therapy. Interpretative phenomenological analysis was applied to 24 sets of semi-structured interviews with families and therapists of anxiety-disordered youths who had not profited from CBT with parental inclusion. From the superordinate theme parents' difficulties acting as co-therapists, which emerged from the analyses, two master themes represented the perspectives of parents (difficulty working together with the youth and feeling unqualified, with limited resources), and two represented the perspectives of therapists (family dynamics stood in the way of progress and difficulty transferring control to parents). Parent and therapist experiences complemented each other, offering two different perspectives on parent difficulties as co-therapists. However, the two groups' views on their respective roles in therapy were in conflict. Parents wished to remain being "just the parents" and for the experts to take over, while therapists wished to act as facilitators transferring the control to parents. Clinical implications are drawn for parental involvement and enhancement of treatment outcomes for likely non-responders.
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Affiliation(s)
| | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Denmark
| | - Klaus Nielsen
- Department of Psychology and Behavioural Sciences, Aarhus University, Denmark
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Creswell C, Cruddace S, Gerry S, Gitau R, McIntosh E, Mollison J, Murray L, Shafran R, Stein A, Violato M, Voysey M, Willetts L, Williams N, Yu LM, Cooper PJ. Treatment of childhood anxiety disorder in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis. Health Technol Assess 2016; 19:1-184, vii-viii. [PMID: 26004142 DOI: 10.3310/hta19380] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cognitive-behavioural therapy (CBT) for childhood anxiety disorders is associated with modest outcomes in the context of parental anxiety disorder. OBJECTIVES This study evaluated whether or not the outcome of CBT for children with anxiety disorders in the context of maternal anxiety disorders is improved by the addition of (i) treatment of maternal anxiety disorders, or (ii) treatment focused on maternal responses. The incremental cost-effectiveness of the additional treatments was also evaluated. DESIGN Participants were randomised to receive (i) child cognitive-behavioural therapy (CCBT); (ii) CCBT with CBT to target maternal anxiety disorders [CCBT + maternal cognitive-behavioural therapy (MCBT)]; or (iii) CCBT with an intervention to target mother-child interactions (MCIs) (CCBT + MCI). SETTING A NHS university clinic in Berkshire, UK. PARTICIPANTS Two hundred and eleven children with a primary anxiety disorder, whose mothers also had an anxiety disorder. INTERVENTIONS All families received eight sessions of individual CCBT. Mothers in the CCBT + MCBT arm also received eight sessions of CBT targeting their own anxiety disorders. Mothers in the MCI arm received 10 sessions targeting maternal parenting cognitions and behaviours. Non-specific interventions were delivered to balance groups for therapist contact. MAIN OUTCOME MEASURES Primary clinical outcomes were the child's primary anxiety disorder status and degree of improvement at the end of treatment. Follow-up assessments were conducted at 6 and 12 months. Outcomes in the economic analyses were identified and measured using estimated quality-adjusted life-years (QALYs). QALYS were combined with treatment, health and social care costs and presented within an incremental cost-utility analysis framework with associated uncertainty. RESULTS MCBT was associated with significant short-term improvement in maternal anxiety; however, after children had received CCBT, group differences were no longer apparent. CCBT + MCI was associated with a reduction in maternal overinvolvement and more confident expectations of the child. However, neither CCBT + MCBT nor CCBT + MCI conferred a significant post-treatment benefit over CCBT in terms of child anxiety disorder diagnoses [adjusted risk ratio (RR) 1.18, 95% confidence interval (CI) 0.87 to 1.62, p = 0.29; adjusted RR CCBT + MCI vs. control: adjusted RR 1.22, 95% CI 0.90 to 1.67, p = 0.20, respectively] or global improvement ratings (adjusted RR 1.25, 95% CI 1.00 to 1.59, p = 0.05; adjusted RR 1.20, 95% CI 0.95 to 1.53, p = 0.13). CCBT + MCI outperformed CCBT on some secondary outcome measures. Furthermore, primary economic analyses suggested that, at commonly accepted thresholds of cost-effectiveness, the probability that CCBT + MCI will be cost-effective in comparison with CCBT (plus non-specific interventions) is about 75%. CONCLUSIONS Good outcomes were achieved for children and their mothers across treatment conditions. There was no evidence of a benefit to child outcome of supplementing CCBT with either intervention focusing on maternal anxiety disorder or maternal cognitions and behaviours. However, supplementing CCBT with treatment that targeted maternal cognitions and behaviours represented a cost-effective use of resources, although the high percentage of missing data on some economic variables is a shortcoming. Future work should consider whether or not effects of the adjunct interventions are enhanced in particular contexts. The economic findings highlight the utility of considering the use of a broad range of services when evaluating interventions with this client group. TRIAL REGISTRATION Current Controlled Trials ISRCTN19762288. FUNDING This trial was funded by the Medical Research Council (MRC) and Berkshire Healthcare Foundation Trust and managed by the National Institute for Health Research (NIHR) on behalf of the MRC-NIHR partnership (09/800/17) and will be published in full in Health Technology Assessment; Vol. 19, No. 38.
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Affiliation(s)
- Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Susan Cruddace
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Stephen Gerry
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Rachel Gitau
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jill Mollison
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Lynne Murray
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Rosamund Shafran
- Institute of Child Health, University College London, London, UK
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Mara Violato
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Merryn Voysey
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Lucy Willetts
- Berkshire Healthcare NHS Foundation Trust, Reading, UK
| | - Nicola Williams
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Peter J Cooper
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Prevention and Intervention for Anxiety Disorders in Children and Adolescents: A Whole School Approach. ACTA ACUST UNITED AC 2016. [DOI: 10.1017/s1037291100004738] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper explores a whole school approach to the prevention and intervention for anxiety disorders in children and adolescents. Anxiety disorders are the most prevalent psychopathology in childhood and adolescence. In addition to having serious consequences for academic, social and family life, anxiety has also been shown to be a precursor to depression, substance abuse and eating disorders. School counsellors are well placed to identify students with anxiety disorders, instigate prevention programs and treat or refer anxious students. Prevention and early intervention for anxiety disorders needs to be coordinated and integrated into the regular curriculum as well as into the life of the classroom and the school. Barriers to schools working well in this area are identified and discussed.
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Lundkvist-Houndoumadi I, Thastum M. Anxious Children and Adolescents Non-responding to CBT: Clinical Predictors and Families' Experiences of Therapy. Clin Psychol Psychother 2015; 24:82-93. [DOI: 10.1002/cpp.1982] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/31/2015] [Accepted: 09/04/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | - Mikael Thastum
- Department of Psychology and Behavioural Sciences; Aarhus University; Aarhus Denmark
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Wei C, Kendall PC. Parental involvement: contribution to childhood anxiety and its treatment. Clin Child Fam Psychol Rev 2015; 17:319-39. [PMID: 25022818 DOI: 10.1007/s10567-014-0170-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Anxiety disorders are prevalent in youth. Despite demonstrated efficacy of cognitive behavioral therapy (CBT), approximately 40% of anxiety-disordered youth remain unresponsive to treatment. Because developmental and etiological models suggest that parental factors are relevant to the onset and maintenance of childhood anxiety, researchers have proposed and investigated family-based interventions with increased parent work in treatment, aiming to improve the efficacy of treatment for childhood anxiety. However, contrary to what theoretical models suggest, data to date did not indicate additive benefit of family-based CBT in comparison with child-centered modality. Is parent/family involvement unnecessary when treating childhood anxiety disorders? Or could there be the need for specificity (tailored family-based treatment) that is guided by a revised conceptualization that improves the implementation of a family-based intervention? The current review examines (1) relevant parental factors that have been found to be associated with the development and maintenance of childhood anxiety and (2) interventions that incorporate parental involvement. Relevant findings are integrated to formulate a "targeted" treatment approach for parental involvement in CBT for youth anxiety. Specifically, there is potential in the assessment of parent/family factors prior to treatment (for appropriateness) followed by a target-oriented implementation of parent training.
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Affiliation(s)
- Chiaying Wei
- Department of Psychology, Temple University, Weiss Hall, 1701 North 13th Street, Philadelphia, PA, 19087, USA,
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Higa-McMillan CK, Francis SE, Rith-Najarian L, Chorpita BF. Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 45:91-113. [PMID: 26087438 DOI: 10.1080/15374416.2015.1046177] [Citation(s) in RCA: 259] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Anxiety disorders are the most common mental health disorder among children and adolescents. We examined 111 treatment outcome studies testing 204 treatment conditions for child and adolescent anxiety published between 1967 and mid-2013. Studies were selected for inclusion in this review using the PracticeWise Evidence-Based Services database. Using guidelines identified by this journal (Southam-Gerow & Prinstein, 2014), studies were included if they were conducted with children and/or adolescents (ages 1-19) with anxiety and/or avoidance problems. In addition to reviewing the strength of the evidence, the review also examined indicators of effectiveness, common practices across treatment families, and mediators and moderators of treatment outcome. Six treatments reached well-established status for child and adolescent anxiety, 8 were identified as probably efficacious, 2 were identified as possibly efficacious, 6 treatments were deemed experimental, and 8 treatments of questionable efficacy emerged. Findings from this review suggest substantial support for cognitive-behavioral therapy (CBT) as an effective and appropriate first-line treatment for youth with anxiety disorders. Several other treatment approaches emerged as probably efficacious that are not primarily CBT based, suggesting that there are alternative evidence-based treatments that practitioners can turn to for children and adolescents who do not respond well to CBT. The review concludes with a discussion of treatments that improve functioning in addition to reducing symptoms, common practices derived from evidence-based treatments, mediators and moderators of treatment outcomes, recommendations for best practice, and suggestions for future research.
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Affiliation(s)
| | | | | | - Bruce F Chorpita
- c Department of Psychology , University of California Los Angeles
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Murphy YE, Flessner CA. Family functioning in paediatric obsessive compulsive and related disorders. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2015; 54:414-34. [PMID: 26017183 DOI: 10.1111/bjc.12088] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 03/19/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Research among youths with obsessive compulsive disorder (OCD) has shown a significant relationship between illness severity, treatment outcome, and the family environment yet little work has been undertaken among the broader class of obsessive compulsive and related disorders (OCRDs) - Trichotillomania, body dysmorphic disorder (BDD), skin picking disorder (SPD), and hoarding. The aim of this study was to (1) review the family functioning literature among paediatric OCRDs, (2) address limitations to previous studies, and (3) highlight areas in need of further research. METHODS A review of the literature was conducted using several databases (i.e., Google Scholar, PubMed, ScienceDirect) and employing key search terms (e.g., 'family functioning', 'paediatric OCD'). The resultant articles examined several domains subsumed under the broader heading of family environment including parental mental health, parenting practices, family dynamics, family involvement with symptoms, and family emotional climate. RESULTS The literature reviewed demonstrated a strong relationship between paediatric OCD and adverse family functioning (e.g., parental symptoms of anxiety and depression, family accommodation, family strain and stress, parental guilt and fear) in all identified domains. While family functioning research in paediatric HPD was relatively scant, research suggested similar familial dysfunction (e.g., limited independence, low family cohesion, family violence). Collectively, only 1 article, examining BDD, assessed family functioning within other OCRDs. CONCLUSIONS This review supports the need for further research in the OCRDs. Limitations to the available literature and targeted suggestions for future research are discussed. PRACTITIONER POINTS The domains of family environment in this study indicate specific family functioning deficits that may serve as aetiological and/or maintenance factors in paediatric OCRDs, possibly contributing to the understanding of these complex disorders. The recognition of family deficits in paediatric OCRDs may prove beneficial in developing or bolstering preventative and/or therapeutic interventions. Insufficient number of articles pertaining to family functioning in some paediatric OCRDs (i.e., hoarding, skin picking) inhibits formal conclusions. Magnitudes of family functioning effects were not calculated; therefore, future research should consider meta-analytic analyses.
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Donovan CL, Cobham V, Waters AM, Occhipinti S. Intensive group-based CBT for child social phobia: a pilot study. Behav Ther 2015; 46:350-64. [PMID: 25892171 DOI: 10.1016/j.beth.2014.12.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 12/13/2014] [Accepted: 12/18/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Although CBT has proven efficacious in the treatment of child social phobia (SP), most children do not present for treatment and child SP may be less responsive to treatment than other anxiety disorders. Intensive, group-based, SP-specific CBT may improve the efficacy of, and access to, treatment for child SP. The aim of this study was to provide a preliminary examination of such a program. METHOD Forty Australian children aged 7-12 years (15 male and 25 female) were allocated into treatment and waitlist groups. Clinical interviews to determine diagnostic status were conducted prior to treatment, following treatment and at 6-month follow-up. Parent and child questionnaire measures of child anxiety symptoms, internalizing symptoms, depression, social skills, social competence, and parental social anxiety were administered at the same time points. Treatment was delivered in 4 separate 3-hour sessions conducted over 3 consecutive weekends. RESULTS At postassessment, 52.4% of children in the treatment group and 15.8% of children in the waitlist group were free of their SP diagnosis. At postassessment, compared to waitlist children, treatment group children demonstrated a greater drop in clinical severity, a greater increase in overall functioning, and held fewer clinical diagnoses. Treatment group children also reported a greater reduction in SP symptoms compared to waitlist children, and treatment group parents reported a greater reduction in child internalizing and anxiety symptoms, a greater increase in child social competence, and a greater decrease in parental SP symptoms, compared to parents of children in the waitlist group. By 6-month follow-up, 76.9% of the treatment group were free of their SP diagnosis and gains on all other measures were maintained. CONCLUSIONS The results of this study are encouraging, and suggest that brief, intensive, group CBT for children with social anxiety is beneficial for many youngsters.
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Kennedy P, Rooney RM, Kane RT, Hassan S, Nesa M. The enhanced Aussie Optimism Positive Thinking Skills Program: The relationship between internalizing symptoms and family functioning in children aged 9-11 years old. Front Psychol 2015; 6:504. [PMID: 25983698 PMCID: PMC4415400 DOI: 10.3389/fpsyg.2015.00504] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 04/09/2015] [Indexed: 11/13/2022] Open
Abstract
The family context plays a critical role in the health of the child. This was the first study to examine the usefulness of the General Functioning subscale of the Family Assessment Device (FAD-GF) in assessing family functioning and its relationship to internalizing symptoms in school-aged children aged between 9 and 11 years of age. Eight hundred and forty-seven year 4 and 5 students from 13 schools (607 intervention students, and 240 control students) participated in the Aussie Optimism Positive Thinking Skills Program (AO-PTS) – a universal school-based program targeting internalizing symptoms. Students rated how ‘healthy’ they perceived their family to be at pre-test and at 6-months follow-up. Although some aspects of validity and reliability could be improved, results indicated that perceptions of family functioning at pre-test were predictive of internalizing symptoms at the 6-months follow-up. The FAD-GF therefore showed promise as a potential measure of family functioning for children as young as 9 years old. Regardless of children’s pre-test levels of perceived family functioning, no intervention effects were found on the anxiety and depression scales; this finding suggests that child perceptions of family functioning may act as a general protective factor against internalizing symptomology.
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Affiliation(s)
- Patricia Kennedy
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University Perth, WA, Australia
| | - Rosanna M Rooney
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University Perth, WA, Australia
| | - Robert T Kane
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University Perth, WA, Australia
| | - Sharinaz Hassan
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University Perth, WA, Australia
| | - Monique Nesa
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University Perth, WA, Australia
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Gonzalez A, Peris TS, Vreeland A, Kiff CJ, Kendall PC, Compton SN, Albano AM, Birmaher B, Ginsburg GS, Keeton CP, March J, McCracken J, Rynn M, Sherrill J, Walkup JT, Piacentini J. Parental anxiety as a predictor of medication and CBT response for anxious youth. Child Psychiatry Hum Dev 2015; 46:84-93. [PMID: 24610431 PMCID: PMC4159442 DOI: 10.1007/s10578-014-0454-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this investigation was to evaluate how parental anxiety predicted change in pediatric anxiety symptoms across four different interventions: cognitive-behavioral therapy, medication (sertraline; SRT), their combination (COMB), and pill placebo. Participants were 488 youths (ages 7-17) with separation anxiety disorder, generalized anxiety disorder, and/or social phobia and their primary caregivers. Latent growth curve modeling assessed how pre-treatment parental trait anxiety symptoms predicted trajectories of youth anxiety symptom change across 12 weeks of treatment at four time points. Interactions between parental anxiety and treatment condition were tested. Parental anxiety was not associated with youth's pre-treatment anxiety symptom severity. Controlling for parental trait anxiety, youth depressive symptoms, and youth age, youths who received COMB benefitted most. Counter to expectations, parental anxiety influenced youth anxiety symptom trajectory only within the SRT condition, whereas parental anxiety was not significantly associated with youth anxiety trajectories in the other treatment conditions. Specifically, within the SRT condition, higher levels of parental anxiety predicted a faster and greater reduction in youth anxiety over the acute treatment period compared to youths in the SRT condition whose parents had lower anxiety levels. While all active treatments produced favorable outcomes, results provide insight regarding the treatment-specific influence of parental anxiety on the time course of symptom change.
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Affiliation(s)
- Araceli Gonzalez
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 760 Westwood Plaza, Semel Room 67-467, Los Angeles, CA, 90024, USA,
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Benito KG, Caporino NE, Frank HE, Ramanujam K, Garcia A, Freeman J, Kendall PC, Geffken G, Storch EA. Development of the pediatric accommodation scale: reliability and validity of clinician- and parent-report measures. J Anxiety Disord 2015; 29:14-24. [PMID: 25481401 DOI: 10.1016/j.janxdis.2014.10.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 10/06/2014] [Accepted: 10/21/2014] [Indexed: 01/27/2023]
Abstract
The present study developed parallel clinician- and parent-rated measures of family accommodation (Pediatric Accommodation Scale, PAS; Pediatric Accommodation Scale-Parent Report; PAS-PR) for youth with a primary anxiety disorder. Both measures assess frequency and impact of family accommodation on youth and families. Studying youth ages 5-17 (N=105 caregiver-youth dyads), results provide evidence for the psychometric properties of the PAS, including internal consistency, inter-rater reliability, and convergent and discriminant validity. The PAS-PR exhibited good internal consistency and convergent validity with the PAS. Nearly all parents (>95%) endorsed some accommodation and accommodation frequency was associated with parent-rated impairment (home and school), and with youth-rated impairment (school only). Greater impact of accommodation on parents was associated with parent self-reported depressive symptoms. Findings support the common occurrence of family accommodation in youth with anxiety disorders, as well as for the use of the PAS and PAS-PR to measure family accommodation in this population.
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Affiliation(s)
- Kristen G Benito
- Alpert Medical School of Brown University/Bradley-Hasbro Children's Research Center, USA.
| | | | - Hannah E Frank
- Alpert Medical School of Brown University/Bradley-Hasbro Children's Research Center, USA
| | - Krishnapriya Ramanujam
- Alpert Medical School of Brown University/Bradley-Hasbro Children's Research Center, USA
| | - Abbe Garcia
- Alpert Medical School of Brown University/Bradley-Hasbro Children's Research Center, USA
| | - Jennifer Freeman
- Alpert Medical School of Brown University/Bradley-Hasbro Children's Research Center, USA
| | | | - Gary Geffken
- Departments of Psychiatry and Pediatrics, University of Florida, USA
| | - Eric A Storch
- Morsani College of Medicine, University of South Florida, USA; Rogers Behavioral Health - Tampa Bay, USA
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Lundkvist-Houndoumadi I, Hougaard E, Thastum M. Pre-treatment child and family characteristics as predictors of outcome in cognitive behavioural therapy for youth anxiety disorders. Nord J Psychiatry 2014; 68:524-35. [PMID: 24754469 DOI: 10.3109/08039488.2014.903295] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) has been found to be effective for children and adolescents (6-18 years) with anxiety disorders, but the non-response rate is high-a fact that may argue for the importance of studies on pre-treatment characteristics of children and their families that predict treatment outcome. AIMS To provide a systematic review of clinical and demographic pre-treatment child and family predictors of treatment outcome in CBT for anxiety disorders in youth. METHOD A systematic literature search was conducted based on electronic databases (PsycINFO, Embase and PubMed), and retrieved studies were analysed according to the box-score method of counting significant findings. RESULTS 24 studies with a sample size ≥ 60 were located. Most studies dealt with the following predictors: child age, gender, comorbidity, symptom severity and parental psychopathology. There was some evidence that a higher degree of pre-treatment symptomatic severity and non-anxiety comorbidity predicted higher end-state severity, but not a lesser degree of improvement. There was some but inconsistent support for a negative influence of parental psychopathology. CONCLUSION Studies on pre-treatment child and family predictors of outcome in CBT for youth anxiety disorders have until now resulted in few findings of clinical or theoretical significance.
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Affiliation(s)
- Irene Lundkvist-Houndoumadi
- Irene Lundkvist-Houndoumadi, M.Sc., Department of Psychology and Behavioural Sciences , Aarhus University , Denmark
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Schleider JL, Ginsburg GS, Keeton CP, Weisz JR, Birmaher B, Kendall PC, Piacentini J, Sherrill J, Walkup JT. Parental psychopathology and treatment outcome for anxious youth: roles of family functioning and caregiver strain. J Consult Clin Psychol 2014; 83:213-24. [PMID: 25222799 DOI: 10.1037/a0037935] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Research has examined the effects of parental psychopathology, family functioning, and caregiver strain on treatment response in anxious youths. Although these variables have shown individual links to youth treatment response, theoretical models for their combined effects remain unexplored. This study tested the hypothesis that improvements in family functioning and reductions in caregiver strain explained the effects of parental psychopathology on youth treatment outcome in an anxiety treatment trial. METHOD A multiple mediation technique was used to test the proposed model across independent evaluator (IE), parent, and youth informants in 488 youths, aged 7-17 years (50% female; mean age = 10.7) meeting Diagnostic and Statistical Manual of Mental Disorders criteria for social phobia, separation anxiety, and/or generalized anxiety disorder. Youths were randomized to receive 12 weeks of cognitive-behavioral treatment (Coping Cat), medication (sertraline), their combination, or a pill placebo. At pre- and posttreatment, parents completed self-report measures of global psychopathology symptoms, family functioning, and caregiver strain; parents, youths, and IEs rated youths' anxiety symptom severity. RESULTS Changes in family functioning and caregiver strain jointly explained relations between parental psychopathology and reductions in youth anxiety. Specifically, across IE and parent informants, families with higher pretreatment parental psychopathology showed more improvement in family functioning and caregiver strain, which in turn predicted greater youth anxiety reductions. Further, higher pretreatment parental psychopathology predicted greater caregiver strain reductions and, in turn, greater youth anxiety reductions, based on youths' reports of their own anxiety. CONCLUSIONS Findings suggest that improvements in family functioning and reductions in caregiver strain can influence treatment outcomes for anxious youths, especially among youths with more distressed parents.
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Affiliation(s)
| | - Golda S Ginsburg
- Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine
| | - Courtney P Keeton
- Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine
| | | | | | | | - John Piacentini
- Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Joel Sherrill
- Division of Services and Intervention Research, National Institute of Mental Health
| | - John T Walkup
- Department of Psychiatry, Weill Cornell Medical College
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44
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The prevention of anxiety in preschool-aged children: Development of a new program and preliminary findings. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.mhp.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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45
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Thulin U, Svirsky L, Serlachius E, Andersson G, Ost LG. The effect of parent involvement in the treatment of anxiety disorders in children: a meta-analysis. Cogn Behav Ther 2014; 43:185-200. [PMID: 24950054 DOI: 10.1080/16506073.2014.923928] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Among clinicians, it is common practice to include parents in treatment, and it has been taken for granted that parents' involvement in their children's treatment is beneficial for therapy outcome, although research on this issue is far from clear. A meta-analysis was carried out in order to investigate whether parent involvement potentiates the outcome for children with anxiety disorders when treated with cognitive-behavior therapy. Sixteen studies, which directly compared parent-involved treatments with child-only treatments, were included in the meta-analysis. The results showed a small, nonsignificant effect size of - 0.10 in favor of the child-only treatments. There was no indication of publication bias in the analysis. Implications of the results are discussed.
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Affiliation(s)
- Ulrika Thulin
- a Department of Clinical Neuroscience , Centre for Psychiatric Research and Education, Karolinska Institutet , Stockholm , Sweden
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46
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Keeton CP, Ginsburg GS, Drake KL, Sakolsky D, Kendall PC, Birmaher B, Albano AM, March JS, Rynn M, Piacentini J, Walkup JT. Benefits of child-focused anxiety treatments for parents and family functioning. Depress Anxiety 2013; 30:865-72. [PMID: 23390005 PMCID: PMC4144828 DOI: 10.1002/da.22055] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/12/2012] [Accepted: 12/16/2012] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To examine (1) changes in parent (global psychological distress, trait anxiety) and family (dysfunction, burden) functioning following 12 weeks of child-focused anxiety treatment, and (2) whether changes in these parent and family factors were associated with child's treatment condition and response. METHODS Participants were 488 youth ages 7-17 years (50% female; mean age 10.7 years) who met DSM-IV-TR criteria for social phobia, separation anxiety, and/or generalized anxiety disorder, and their parents. Youth were randomly assigned to 12 weeks of "Coping Cat" individual cognitive-behavioral therapy (CBT), medication management with sertraline (SRT), their combination (COMB), or medication management with pill placebo (PBO) within the multisite Child/Adolescent Anxiety Multimodal Study (CAMS). At pre- and posttreatment, parents completed measures of trait anxiety, psychological distress, family functioning, and burden of child illness; children completed a measure of family functioning. Blinded independent evaluators rated child's response to treatment using the Clinical Global Impression-Improvement Scale at posttreatment. RESULTS Analyses of covariance revealed that parental psychological distress and trait anxiety, and parent-reported family dysfunction improved only for parents of children who were rated as treatment responders, and these changes were unrelated to treatment condition. Family burden and child-reported family dysfunction improved significantly from pre- to posttreatment regardless of treatment condition or response. CONCLUSIONS Findings suggest that child-focused anxiety treatments, regardless of intervention condition, can result in improvements in nontargeted parent symptoms and family functioning particularly when children respond successfully to the treatment.
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Affiliation(s)
- Courtney P. Keeton
- Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, Maryland,Correspondence to: Courtney P. Keeton, Division of Child & Adolescent Psychiatry, The Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 201A, Baltimore, MD 21205.
| | - Golda S. Ginsburg
- Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly L. Drake
- Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dara Sakolsky
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Philip C. Kendall
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Anne Marie Albano
- Department of Psychiatry, Columbia University Medical Center, New York, New York
| | - John S. March
- Department of Psychiatry and Behavioral Services, Duke University Medical Center, Durham, North Carolina
| | - Moira Rynn
- Department of Psychiatry, Columbia University Medical Center, New York, New York
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
| | - John T. Walkup
- Division of Child and Adolescent Psychiatry, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, New York
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47
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Silk JS, Sheeber L, Tan PZ, Ladouceur CD, Forbes EE, McMakin DL, Dahl RE, Siegle GJ, Kendall PC, Mannarino A, Ryan ND. "You can do it!": The role of parental encouragement of bravery in child anxiety treatment. J Anxiety Disord 2013; 27:439-46. [PMID: 23851000 PMCID: PMC3766422 DOI: 10.1016/j.janxdis.2013.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 02/27/2013] [Accepted: 06/01/2013] [Indexed: 11/26/2022]
Abstract
Individual cognitive-behavioral therapy (CBT) provides anxious youth with skills and experiences to increase "brave" behavior in the face of feared situations. This study addresses whether parental encouragement of bravery during an anxiety provoking and potentially avoidable naturalistic speech task (a) differs between parents of youth (ages 9-13) with anxiety disorders (N=47) and parents of healthy non-anxious controls (N=20); (b) influences response to treatment; and (c) changes during treatment for anxious youth randomized to receive CBT (N=30) or Child-Centered Therapy (CCT; a non-directive active comparison treatment; N=17). Parent-child dyads were videotaped during a discussion of whether or not the child should complete an optional speech task. Parents of anxious youth showed less encouragement of bravery than parents of controls. Encouragement of bravery increased from pre- to post-treatment for youth who received CBT but not CCT, and pre-treatment encouragement of bravery predicted a better response to treatment, particularly for youth receiving CBT.
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Affiliation(s)
- Jennifer S. Silk
- University of Pittsburgh, Western Psychiatric Institute and Clinic
| | | | - Patricia Z. Tan
- University of Pittsburgh, Western Psychiatric Institute and Clinic
| | | | - Erika E. Forbes
- University of Pittsburgh, Western Psychiatric Institute and Clinic
| | - Dana L. McMakin
- University of Pittsburgh, Western Psychiatric Institute and Clinic
| | - Ronald E. Dahl
- University of California at Berkeley, School of Public Health
| | - Greg J. Siegle
- University of Pittsburgh, Western Psychiatric Institute and Clinic
| | | | | | - Neal D. Ryan
- University of Pittsburgh, Western Psychiatric Institute and Clinic
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48
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Podell JL, Kendall PC, Gosch EA, Compton SN, March JS, Albano AM, Rynn MA, Walkup JT, Sherrill JT, Ginsburg GS, Keeton CP, Birmaher B, Piacentini JC. Therapist Factors and Outcomes in CBT for Anxiety in Youth. ACTA ACUST UNITED AC 2013; 44:89-98. [PMID: 25419042 DOI: 10.1037/a0031700] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the relationship between therapist factors and child outcomes in anxious youth who received cognitive-behavioral therapy (CBT) as part of the Child-Adolescent Anxiety Multimodal Study (CAMS). Of the 488 youth who participated in the CAMS project, 279 were randomly assigned to one of the CBT conditions (CBT only or CBT plus sertraline). Participants included youth (ages 7-17; M = 10.76) who met criteria for a principal anxiety disorder. Therapists included 38 cognitive-behavioral therapists. Therapist style, treatment integrity, and therapist experience were examined in relation to child outcome. Child outcome was measured via child, parent, and independent evaluator report. Therapists who were more collaborative and empathic, followed the treatment manual, and implemented it in a developmentally appropriate way had youth with better treatment outcomes. Therapist "coach" style was a significant predictor of child-reported outcome, with the collaborative "coach" style predicting fewer child-reported symptoms. Higher levels of therapist prior clinical experience and lower levels of prior anxiety-specific experience were significant predictors of better treatment outcome. Findings suggest that although all therapists used the same manual-guided treatment, therapist style, experience, and clinical skills were related to differences in child outcome. Clinical implications and recommendations for future research are discussed.
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49
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Festen H, Hartman CA, Hogendoorn S, de Haan E, Prins PJM, Reichart CG, Moorlag H, Nauta MH. Temperament and parenting predicting anxiety change in cognitive behavioral therapy: the role of mothers, fathers, and children. J Anxiety Disord 2013; 27:289-97. [PMID: 23602942 DOI: 10.1016/j.janxdis.2013.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 03/05/2013] [Accepted: 03/08/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE A considerable amount of children with anxiety disorders do not benefit sufficiently from cognitive behavioral treatment. The present study examines the predictive role of child temperament, parent temperament and parenting style in the context of treatment outcome. METHOD Participants were 145 children and adolescents (ages 8-18) with DSM-IV-TR anxiety disorders who received a 12-session CBT program and were assessed at pretreatment, posttreatment and three months follow-up. Multiple-regression analyses were used to evaluate the following pretreatment and posttreatment variables as potential predictors of treatment response at follow-up: baseline level of anxiety symptoms, child reported maternal and paternal rearing style (emotional warmth, rejection, and overprotection), parent reported child temperament traits (negative affect, effortful control, and extraversion), and mothers' and fathers' self-report temperament traits. RESULTS More maternal negative affect and less emotional warmth as perceived by the child before treatment were related to less favorable treatment outcome (accounting for 29% of the variance in anxiety at follow-up). Furthermore, maternal negative affect and children's extraversion measured after treatment also predicted anxiety at follow-up (together accounting for 19% of the variance). Paternal temperament and parenting style were unrelated to treatment outcome, as were children's pretreatment temperament traits. CONCLUSION The results suggest that tailoring intervention to include strategies to reduce maternal negative affect and promote an emotional warm rearing style may improve treatment outcome.
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Affiliation(s)
- Helma Festen
- Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands.
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50
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Predictors and moderators of outcome in child and adolescent anxiety and depression: a systematic review of psychological treatment studies. Eur Child Adolesc Psychiatry 2013; 22:69-87. [PMID: 22923065 DOI: 10.1007/s00787-012-0316-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 07/29/2012] [Indexed: 10/28/2022]
Abstract
The aim of this literature review was to examine pre-treatment child and adolescent characteristics as predictors and moderators of outcome in psychotherapy treatment trials of anxiety and depressive disorders. A literature search was conducted using several databases and resulted in 45 published studies (32 anxiety studies and 13 depression studies) meeting predefined methodological criteria. Ten client demographic (age, gender, ethnicity, IQ) and clinical factors (duration, type of diagnosis, pre-treatment severity, comorbidity) were examined across studies. The majority of findings showed non-significant associations between demographic factors (gender and age) with treatment outcome for both the anxiety and the depression treatment trials. Some important differences between the results of the anxiety and depression treatment trials were found. The majority of findings for the anxiety studies suggest that there are no demographic or clinical factors that predict or moderate treatment outcome. For the depression studies, however, the findings suggest that baseline symptom severity and comorbid anxiety may impact on treatment response. Overall, existing studies of pre-treatment patient variables as predictors and moderators of anxiety and depression treatment outcome provide little consistent knowledge concerning for what type of patients and under what conditions treatments work. Suggestions for future research are discussed.
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