A Preliminary Examination of the Link Between Maternal Experiential Avoidance and Parental Accommodation in Anxious and Non-anxious Children

Studies point to parental experiential avoidance (EA) as a potential correlate of maladaptive parenting behaviors associated with child anxiety. However, research has not examined the relationship between EA and parental accommodation of child anxiety, nor the extent to which parental negative beliefs about child anxiety help explain such a relationship. In a sample of mothers (N = 45) of anxious and non-anxious children, the present study investigated the potential link between maternal EA and accommodation of child anxiety and whether this link may be indirectly accounted for via maternal negative beliefs about child anxiety. EA was significantly and positively associated with accommodation of child anxiety, but when negative beliefs about child anxiety were incorporated into the model this direct effect was no longer significant. Findings highlight the contribution of parental emotions and cognitions to behaviors that may exacerbate child anxiety, and may inform treatment and prevention efforts with families of anxious youth.

The Link Between Anxiety Severity and Irritability Among Anxious Youth: Evaluating the Mediating Role of Sleep Problems

Although recent studies have linked pediatric anxiety to irritability, research has yet to examine the mechanisms through which youth anxiety may be associated with irritability. Importantly, sleep related problems (SRPs) have been associated with both child anxiety and irritability, but research has not considered whether the link between youth anxiety and irritability may be accounted for by SRPs. The present study investigated whether SRPs mediated the relationship between anxiety severity and irritability in a large sample of treatment-seeking anxious youth (N = 435; ages 7-19 years, M = 12.7; 55.1% female). Anxiety severity, SRPs and irritability showed significant pairwise associations, and the indirect effect of youth anxiety severity on irritability, via SRPs, was positive and significant. The present analysis is the first to examine youth anxiety, irritability, and SPRs in a single model in a sample of anxious youth, and provides preliminary evidence that SRPs partially mediate links between child anxiety and irritability.

The Effectiveness of School-Based Mental Health Services for Elementary-Aged Children: A Meta-Analysis

OBJECTIVE

Given problems and disparities in the use of community-based mental health services for youth, school personnel have assumed frontline mental health service roles. To date, most research on school-based services has evaluated analog educational contexts with services implemented by highly trained study staff, and little is known about the effectiveness of school-based mental health services when implemented by school professionals.

METHOD

Random-effects meta-analytic procedures were used to synthesize effects of school-based mental health services for elementary school-age children delivered by school personnel and potential moderators of treatment response. Forty-three controlled trials evaluating 49,941 elementary school-age children met the selection criteria (mean grade 2.86, 60.3% boys).

RESULTS

Overall, school-based services demonstrated a small-to-medium effect (Hedges g = 0.39) in decreasing mental health problems, with the largest effects found for targeted intervention (Hedges g = 0.76), followed by selective prevention (Hedges g = 0.67), compared with universal prevention (Hedges g = 0.29). Mental health services integrated into students' academic instruction (Hedges g = 0.59), those targeting externalizing problems (Hedges g = 0.50), those incorporating contingency management (Hedges g = 0.57), and those implemented multiple times per week (Hedges g = 0.50) showed particularly strong effects.

CONCLUSION

Considering serious barriers precluding youth from accessing necessary mental health care, the present meta-analysis suggests child psychiatrists and other mental health professionals are wise to recognize the important role that school personnel, who are naturally in children's lives, can play in decreasing child mental health problems.

Consumer Smartphone Apps Marketed for Child and Adolescent Anxiety: A Systematic Review and Content Analysis

Anxiety disorders are collectively the most prevalent mental health problems affecting youth. To increase the reach of mental health care, recent years have seen increasing enthusiasm surrounding mobile platforms for expanding treatment delivery options. Apps developed in academia and supported in clinical trials are slow to reach the consumer marketplace. Meanwhile, proliferation of industry-developed apps on consumer marketplaces has been high. The present study analyzed content within mobile products prominently marketed toward consumers for anxiety in youth. Systematic inventory of the Google Play Store and Apple Store using keyword searches for child and adolescent anxiety yielded 121 apps, which were evaluated on the basis of their descriptive characteristics, mobile functionalities, and adherence to evidence-based treatment principles. Findings revealed that evidence-based treatment content within the sample is scant and few comprehensive anxiety self-management apps were identified. Advanced features that leverage the broader functionalities of smartphone capabilities (e.g., sensors, ecological momentary assessments) were rarely present. Findings underscore the need to increase the prominence and accessibility of quality child anxiety intervention products for consumers. Strategies for improving marketing of supported apps to better penetrate consumer markets are discussed.

Factor structure of the intolerance of uncertainty scale for children

Intolerance of uncertainty (IU), a dispositional negative orientation toward uncertainty and its consequences, has been studied in adults, but research has only recently examined IU in youth. Despite some advances, little is known about the factor structure of measures of IU in youth. The present study used confirmatory factor analysis to examine the structure of IU as measured by the Intolerance of Uncertainty Scale for Children (IUSC; Comer et al., 2009) in a sample of youth (N=368) 9-18 years of age (M_age=12.47) with and without anxiety disorders and their mothers. Findings demonstrated multiple acceptable factor structures: a correlated factors 2-factor structure and a bifactor model where a general factor underlies all items. While the bifactor model provides better fit and reliability to the data, multivariate analyses indicated that the 2-factor structure distinguishes apprehensive anxiety regarding future events (prospective IU) from present-focused inhibition of behavior due to uncertainty and negative reactions to the presence of uncertainty (inhibitory IU); a total IU score predicted all anxiety domains for self- and parent-reports except for parent-report harm avoidance. Findings are discussed in terms of consistency of IU across adult and youth samples, and how results can inform treatment efforts and etiologic models of IU and anxiety.

Secondary Outcomes From the Child/Adolescent Anxiety Multimodal Study: Implications for Clinical Practice

BACKGROUND

Controlled evaluations comparing medication, cognitive-behavioral therapy (CBT), and their combination in the treatment of youth anxiety have predominantly focused on global ratings by independent evaluators. Such ratings are resource-intensive, may be of limited generalizability, and do not directly inform our understanding of treatment responses from the perspective of treated families. We examined outcomes from the perspective of treated youth and parents in the Child/Adolescent Anxiety Multimodal Study (CAMS).

METHODS

Participants (N=488; ages 7-17 years) who had a primary diagnosis of separation, social, and/or generalized anxiety disorder were randomly assigned to a treatment condition in the CAMS trial. Linear mixed-effects and ANCOVA models examined parent- and youth-reported anxiety symptoms, impact of anxiety, broader internalizing and externalizing psychopathology, depressive symptoms, and family burden throughout the 12-week acute treatment phase and 6-month follow-up.

RESULTS

At week 12, combination treatment showed superiority over placebo, sertraline, and CBT with regard to parent-reported youth anxiety symptoms, and sertraline and CBT as monotherapies showed superiority over placebo with regard to parent-reported youth anxiety. Combination therapy and sertraline also showed week 12 superiority over placebo with regard to parent-reported internalizing psychopathology, and superiority over placebo and CBT with regard to parent-reported impact of anxiety, family burden, and youth depressive symptoms. By week 36, parent reports of many youth outcomes were comparable across active conditions. Youth measures tracked parent measures on many outcomes.

CONCLUSIONS

Findings were drawn on brief, readily available questionnaires that in conjunction with clinician measures can inform patient-centered care and collaborative decision-making.Trial Registry Name: Child and Adolescent Anxiety Disorders (CAMS)Registry identification number: NCT00052078Registry URL: https://www.clinicaltrials.gov/ct2/show/NCT00052078.

Using technology to enhance and expand interventions for couples and families: Conceptual and methodological considerations

Technological advances provide tremendous opportunities for couple and family interventions to overcome logistical, financial, and stigma-related barriers to treatment access. Given technology's ability to facilitate, augment, or at times even substitute for face-to-face interventions, it is important to consider the appropriate role of different technologies in treatment and how that may vary across specific instances of technology use. To that end, this article reviews the potential contributions of telemental health (aka, telehealth; e.g., videoconferencing to remotely deliver real-time services) and asynchronous behavioral intervention technologies (BITs; e.g., apps, web-based programs) for couple and family interventions. Design considerations-such as software and hardware requirements and recommendations, characteristics of intended users, ways to maximize engagement, and tips for integrating therapists/coaches-are included for both types of technology-based intervention. We also present suggestions for the most effective recruitment and evaluation strategies for technology-based couple and family interventions. Finally, we present legal and ethical issues that are especially pertinent when integrating technology into couple and family interventions. (PsycINFO Database Record

Delivering Parent-Teen Therapy for ADHD through Videoconferencing: A Preliminary Investigation

Adolescents with ADHD demonstrate notoriously poor treatment utilization. Barriers to access have been partially addressed through tailored therapy content and therapist delivery style; yet, additional challenges to engaging this population remain. To leverage modern technology in support of this aim, the current study investigates parent-teen therapy for ADHD delivered over a videoconferencing format. In this preliminary feasibility study, teens and parents (N=20) received an empirically supported dyadic therapy that incorporates skills-based modules with motivational interviewing. The videoconferencing interface was deemed feasible with nearly all families completing treatment. Acceptable therapeutic alliance was reported and key mechanisms of change were engaged (i.e., adolescent motivation to meet goals, parent strategy implementation). Families reported high satisfaction, despite minor disturbances associated with delivering therapy via videoconferencing. Treatment integrity and fidelity were acceptable, though slightly reduced compared to clinic-based trials of the same protocol. Therapists perceived that videoconferencing enhanced treatment for 50% of families. Reductions in participant ADHD symptoms and organization, time management, and planning problems from baseline to post-treatment were noted by parents and teachers. However, open trial results of this study should be interpreted with caution due to their uncontrolled and preliminary nature.

Examining the scope and patterns of deliberate self-injurious cutting content in popular social media

BACKGROUND

Social networking services (SNS) have rapidly become a central platform for adolescents' social interactions and media consumption patterns. The present study examined a representative sample of publicly accessible content related to deliberate self-injurious cutting across three SNS platforms: Twitter, Tumblr, and Instagram.

METHODS

Data collection simulated searches for publicly available deliberate self-injury content on Twitter, Tumblr, and Instagram. Over a six-month period at randomly generated time points, data were obtained by searching "#cutting" on each SNS platform and collecting the first 10 posts generated. Independent evaluators coded posts for presence of the following: (a) graphic content, (b) negative self-evaluations, (c) references to mental health terms, (d) discouragement of deliberate self-injury, and (e) recovery-oriented resources. Differences across platforms were examined.

RESULTS

Data collection yielded a sample of 1,155 public posts (770 of which were related to mental health). Roughly 60% of sampled posts depicted graphic content, almost half included negative self-evaluations, only 9.5% discouraged self-injury, and <1% included formal recovery resources. Instagram posts displayed the greatest proportion of graphic content and negative self-evaluations, whereas Twitter exhibited the smallest proportion of each.

CONCLUSIONS

Findings characterize the graphic nature of online SNS deliberate self-injury content and the relative absence of SNS-posted resources for populations seeking out deliberate self-injurious cutting content. Mental health professionals must recognize the rapidly changing landscape of adolescent media consumption, influences, and social interaction as they may pertain to self-harm patterns.

Delivering Parent-Teen Therapy for ADHD through Videoconferencing: A Preliminary Investigation

Adolescents with ADHD demonstrate notoriously poor treatment utilization. Barriers to access have been partially addressed through tailored therapy content and therapist delivery style; yet, additional challenges to engaging this population remain. To leverage modern technology in support of this aim, the current study investigates parent-teen therapy for ADHD delivered over a videoconferencing format. In this preliminary feasibility study, teens and parents (N=20) received an empirically supported dyadic therapy that incorporates skills-based modules with motivational interviewing. The videoconferencing interface was deemed feasible with nearly all families completing treatment. Acceptable therapeutic alliance was reported and key mechanisms of change were engaged (i.e., adolescent motivation to meet goals, parent strategy implementation). Families reported high satisfaction, despite minor disturbances associated with delivering therapy via videoconferencing. Treatment integrity and fidelity were acceptable, though slightly reduced compared to clinic-based trials of the same protocol. Therapists perceived that videoconferencing enhanced treatment for 50% of families. Reductions in participant ADHD symptoms and organization, time management, and planning problems from baseline to post-treatment were noted by parents and teachers. However, open trial results of this study should be interpreted with caution due to their uncontrolled and preliminary nature.

Maternal emotion regulation during child distress, child anxiety accommodation, and links between maternal and child anxiety

Environmental contributions are thought to play a primary role in the familial aggregation of anxiety, but parenting influences remain poorly understood. We examined dynamic relations between maternal anxiety, maternal emotion regulation (ER) during child distress, maternal accommodation of child distress, and child anxiety. Mothers (N=45) of youth ages 3-8 years (M=4.8) participated in an experimental task during which they listened to a standardized audio recording of a child in anxious distress pleading for parental intervention. Measures of maternal and child anxiety, mothers' affective states, mothers' ER strategies during the child distress, and maternal accommodation of child anxiety were collected. Mothers' resting respiratory sinus arrhythmia (RSA) reactivity during the recording was also acquired. Higher maternal negative affect and greater maternal ER switching (i.e., using multiple ER strategies in a short time without positive regulatory results) during child distress were associated with child anxiety. Sequential mediation modeling showed that maternal anxiety predicted ineffective maternal ER during child distress exposure, which in turn predicted greater maternal accommodation, which in turn predicted higher child anxiety. Findings support the mediating roles of maternal ER and accommodation in linking maternal and child anxiety, and suggest that ineffective maternal ER and subsequent attempts to accommodate child distress may act as mechanisms underlying the familial aggregation of anxiety.

Teacher perspectives on indicators of adolescent social and emotional problems

Teachers are a primary source of referral to mental health services for children and adolescents. However, studies find that students identified by teachers differ from those identified by standardized screening scales. This suggests possible discrepancies in conceptualizations of student emotional and behavioral challenges. The current article describes results of a study that explores how teachers conceptualize the emotional and behavioral challenges of adolescents. Middle and high school teachers across the U.S. were identified using a stratified random sampling process and recruited for participation. Twenty-nine teachers (26% of those recruited) were interviewed and asked to describe markers that indicated to them that a student was experiencing emotional and behavioral challenges. Themes in teacher responses were identified and coded. Teachers identified multiple, diverse markers that they perceived were indicators of emotional and behavioral challenges among their students. Markers described by teachers were compared to those typically measured by standardized screening scales. Discrepancies between markers identified by teachers and screening scales are highlighted as potential areas for professional development and enhanced school-based intervention efforts. These findings underscore the importance of integrating teacher perspectives in understanding the referral process for students.

Disqualified qualifiers: evaluating the utility of the revised DSM-5 definition of potentially traumatic events among area youth following the Boston marathon bombing

The DSM-5 includes a revised definition of the experiences that qualify as potentially traumatic events. This revised definition now offers a clearer and more exclusive definition of what qualifies as a traumatic exposure, but little is known about the revision's applicability to youth populations. The present study evaluated the predictive utility of the revised DSM definitional boundaries of traumatic exposure in a sample of youth exposed to the 2013 Boston Marathon bombing and related events METHODS: Caregivers (N = 460) completed surveys 2 to 6 months postbombing about youth experiences during the events and youth posttraumatic stress (PTS) symptoms RESULTS: Experiencing DSM-5 qualifying traumatic events (DSM-5 QTEs) significantly predicted child PTS symptoms (PTSS), whereas DSM-5 nonqualifying stressful experiences (DSM-5 non-QSEs) did not after accounting for DSM-5 QTEs. Importantly, child age moderated the relationship between DSM-5 QTEs and PTSS such that children 7 and older who experienced DSM-5 QTEs showed greater postbombing PTSS, whereas there was no such relationship in children ages 6 and below CONCLUSIONS: Data largely support the revised posttraumatic stress disorder (PTSD) definition of QTEs in older youth, and also highlight the need for further refinement of the QTE definition for children ages 6 and below.

Adapting Internet-Delivered Parent-Child Interaction Therapy to Treat Co-Occurring Disruptive Behavior and Callous-Unemotional Traits: A Case Study

Disruptive behavior disorders (DBD) are highly prevalent, emerge in early childhood, exhibit considerable stability across time, and are associated with profound disability. When DBD co-occur with callous-unemotional (CU) traits (i.e., lack of empathy/guilt), the risk of early-onset, stable, and severe disruptive behavior is even higher, relative to DBD alone. Early intervention is critical, and there is robust empirical support for the efficacy of parent management training (PMT) for reducing disruptive behavior in young children. However, broad access to these interventions is hindered by numerous systemic barriers, including geographic disparities in availability of services. To overcome these barriers and enhance access and quality of care to underserved communities, several PMT programs have been adapted to online delivery formats, including Parent-Child Interaction Therapy (PCIT). PCIT is an evidence-supported treatment that attempts to reduce disruptive child behavior by improving the parent–child relationship and implementing consistent and effective discipline strategies. Comer and colleagues proposed an online adaptation of PCIT (I-PCIT) that is delivered using video teleconferencing (VTC). I-PCIT was implemented with the family of a 5-year-old Australian boy presenting with clinically significant disruptive behavior and CU traits living in a rural community. Findings from this case report (a) document an improvement in disruptive behavior that was maintained to follow-up and (b) provide preliminary support for adapting PCIT to online delivery formats to enhance accessibility of services and improve child and parent outcomes.

Parasympathetic reactivity and disruptive behavior problems in young children during interactions with their mothers and other adults: A preliminary investigation

Parasympathetic nervous system influences on cardiac functions-commonly indexed via respiratory sinus arrhythmia (RSA)-are central to self-regulation. RSA suppression during challenging emotional and cognitive tasks is often associated with better emotional and behavioral functioning in preschoolers. However, the links between RSA suppression and child behavior across various challenging interpersonal contexts remains unclear. The present study experimentally evaluated the relationship between child RSA reactivity to adult (mother vs. study staff) direction and disruptive behavior problems in children ages 3-8 with varying levels of disruptive behavior problems (N = 43). Reduced RSA suppression in the context of mothers' play-based direction was associated with more severe child behavior problems. In contrast, RSA suppression in the context of staff play-based direction was not associated with behavior problems. Findings suggest that the association between RSA suppression and child behavior problems may vary by social context (i.e., mother vs. other adult direction-givers). Findings are discussed in regard to RSA as an indicator of autonomic self-regulation that has relevance to child disruptive behavior problems.

The Relationship Between Worry and Dimensions of Anxiety Symptoms in Children and Adolescents

BACKGROUND

Worry is a common feature across many anxiety disorders. It is important to understand how and when worry presents from childhood to adolescence to prevent long-term negative outcomes. However, most of the existing studies that examine the relationship between worry and anxiety disorders utilize adult samples.

AIMS

The present study aimed to assess the level of worry in children and adolescents and how relationships between worry and symptoms of separation anxiety disorder (SAD) and social anxiety disorder (Soc) may present differently at different ages.

METHOD

127 children (age 8-12 years) and adolescents (age 13-18 years), diagnosed with any anxiety disorder, presenting at a child anxiety out-patient clinic, completed measures of worry, anxiety and depression.

RESULTS

Worry scores did not differ by age group. Soc symptoms were significantly correlated with worry in both age groups; however, SAD symptoms were only significantly correlated with worry in younger participants. After the inclusion of covariates, SAD symptoms but not Soc symptoms remained significant in the regression model with younger children, and Soc symptoms remained significant in the regression model with older children.

CONCLUSIONS

The finding that worry was comparable in both groups lends support for worry as a stable construct associated with anxiety disorders throughout late childhood and early adolescence.

Development of a scale to evaluate young children's responses to uncertainty and low environmental structure

Intolerance of Uncertainty (IU), defined as the dispositional interpretation of uncertain or ambiguous events as stressful and problematic, has been linked to excessive worry and other anxiety-related problems in adults and youth. IU has been conceptualized as a vulnerability factor for excessive worry and anxiety, but the historical absence of a supported measure of IU in young children has hampered longitudinal research needed to evaluate temporal relationships between IU and anxiety and the differential developmental pathways of IU leading to different anxiety disorders and depression. The present study evaluated the psychometric properties of a newly developed 17-item parent-report measure of younger children's Responses to Uncertainty and Low Environmental Structure (i.e., the RULES questionnaire). We examined the preliminary structure, reliability, and validity of the RULES within a treatment-seeking sample of children aged 3-10 (N=160) with anxiety. Findings from an exploratory factor analysis supported a one-factor model that retained all 17 items. The RULES demonstrated strong internal consistency, and predictive, convergent, and divergent validity. In this early childhood sample, the RULES also showed stronger associations with anxiety than did a previously supported measure of IU developed for older youth, and showed preliminary sensitivity to treatment-related change. Findings provide preliminary psychometric support for the RULES as a parent-report measure of children's responses to uncertainty and low environmental structure that may inform etiologic models of anxiety.

Internet-delivered, family-based treatment for early-onset OCD: A pilot randomized trial

OBJECTIVE

Despite advances in supported treatments for early onset obsessive-compulsive disorder (OCD), progress has been constrained by regionally limited expertise in pediatric OCD. Videoteleconferencing (VTC) methods have proved useful for extending the reach of services for older individuals, but no randomized clinical trials (RCTs) have evaluated VTC for treating early onset OCD.

METHOD

RCT comparing VTC-delivered family based cognitive-behavioral therapy (FB-CBT) versus clinic-based FB-CBT in the treatment of children ages 4-8 with OCD (N = 22). Pretreatment, posttreatment, and 6-month follow-up assessments included mother-/therapist-reports and independent evaluations masked to treatment condition. Primary analyses focused on treatment retention, engagement and satisfaction. Hierarchical linear modeling preliminarily evaluated the effects of time, treatment condition, and their interactions. "Excellent response" was defined as a 1 or 2 on the Clinical Global Impressions-Improvement Scale.

RESULTS

Treatment retention, engagement, alliance and satisfaction were high across conditions. Symptom trajectories and family accommodation across both conditions showed outcomes improving from baseline to posttreatment, and continuing through follow-up. At posttreatment, 72.7% of Internet cases and 60% of Clinic cases showed "excellent response," and at follow-up 80% of Internet cases and 66.7% of Clinic cases showed "excellent response." Significant condition differences were not found across outcomes.

CONCLUSIONS

VTC methods may offer solutions to overcoming traditional barriers to care for early onset OCD by extending the reach of real-time expert services regardless of children's geographic proximity to quality care. (PsycINFO Database Record

Adapting Manualized CBT for a Cognitively Delayed Child With Multiple Anxiety Disorders

This study examined the effectiveness of a modified cognitive-behavioral therapy (CBT) program for the treatment of a cognitively delayed 8-year-old girl presenting with social phobia, selective mutism, and generalized anxiety disorder (GAD). Multimethod assessment, at pretreatment and posttreatment, included a semistructured diagnostic interview, self-reports, and parent and teacher reports. Cognitive delays were apparent at the initial assessment and confirmed on review of previous evaluations. CBT for anxious youth was implemented in a modified fashion to ensure that the methods built on the child’s competencies and were compatible with her developmental capacities. Following 20 CBT sessions, posttreatment assessment indicated significant reduction in anxiety symptoms, as indicated by the diagnostic interview and self-report and other report of symptomatology. The child no longer met diagnostic criteria for GAD or selective mutism at posttreatment. The case study illustrates how CBT can be modified and applied flexibly in response to individual needs and limitations of the child.

Caregiver-reports of Internet Exposure and Posttraumatic Stress Among Boston-Area Youth Following the 2013 Marathon Bombing

Although practitioners and researchers have considered children's television-based terrorism exposure, Internet-based exposure has not been sufficiently examined. We examined the scope and correlates of children's Internet-based exposure following the Boston Marathon bombing among Boston-area youth (N=460; 4-19 years), and the potential moderating role of age. Further exploratory analyses examined patterns of caregiver attempts to regulate child Internet exposure. Caregivers reported on child Internet-based and direct exposure to traumatic bombing-related events, and youth posttraumatic stress (PTS). Online youth consumed on average over two daily hours of Internet coverage, and roughly one-third consumed over three daily hours of coverage. Internet exposure was particularly high among children over 12. Greater Internet-based exposure was associated with PTS, and 12-15 year olds were particularly vulnerable. Further exploratory analyses found that although most caregivers reported believing media exposure can cause children further trauma, a considerable proportion of caregivers made no attempt to restrict or regulate their child's Internet-based exposure. These findings help practitioners clarify forms of indirect exposure that can place youth at risk following terrorism. Future work is needed to examine the important roles caregivers play as media regulators and as promoters of child coping and media literacy following terrorism.

Videoteleconferencing Early Child Anxiety Treatment: A Case Study of the Internet-Delivered PCIT CALM (I-CALM) Program

Anxiety disorders are one of the most prevalent and impairing classes of mental health difficulties affecting young children. Though the vast majority of supported programs for child anxiety focus on youth ages 7 years and up, preliminary support has emerged for exposure-based adaptations of parent-coaching interventions, i.e., the Parent Child Interaction Therapy (PCIT) CALM Program, to address anxiety disorders in early childhood. Despite these advances, low rates of community service use and accessibility persist. The increased ubiquity of Internet access has positioned videoteleconferencing (VTC) as a powerful tool to overcome traditional barriers to care. The present case study details the VTC delivery of the PCIT CALM Program in the treatment of a 6 year-old boy presenting with generalized anxiety disorder and separation anxiety disorder. This case provides qualitative support for the feasibility of delivering integrated real-time parent coaching and exposure therapy to address early childhood anxiety disorders via VTC. The remission of the patient's anxiety across treatment sessions suggests that the telehealth format may be a useful modality for the delivery of early childhood anxiety treatment. The technical considerations for the delivery of VTC therapy as well as the implications for treatment are discussed.