Concurrent Validity and Informant Agreement of the ADHD Module of the Anxiety Disorders Interview Schedule for DSM-IV

Self-esteem in children and adolescents with and without attention-deficit/hyperactivity disorder: A meta-analytic review

Meta-analytic methods were used to examine global and domain-specific (i.e., academic, social, behavioral) self-esteem in children and adolescents with and without ADHD. Potential moderators of effect size heterogeneity were also examined via meta-regressions within a three-level approach. Findings from 49 aggregated global self-esteem effect sizes (ADHDN = 2500, TDN = 9448), 12 academic self-esteem effect sizes (ADHDN = 386, TDN = 315), 11 social self-esteem effect sizes (ADHDN = 258, TDN = 254), and 8 behavioral self-esteem effect sizes (ADHDN = 231, TDN = 211) suggest that children and adolescents with ADHD experience moderate global (ES = 0.46, p < .001), academic (ES = 0.60, p = .009), and social (ES = 0.67, p = .001) self-esteem impairments compared to children and adolescents without the disorder. The aggregated behavioral self-esteem effect size (ES = 0.20, p = .54), however, was not significant, and the global self-esteem effect size was markedly smaller compared to effect sizes for the academic and social domains. Further, examination of potential moderators of effect size heterogeneity indicated null effects for medication status, diagnostic complexity, informant, age, sex, comorbid psychopathology, and self-esteem dimension. Collectively, findings suggest that children and adolescents with ADHD do not hold a ubiquitous negative self-perception of difficulties across academic, social, and behavioral domains of functioning, and unexamined domains that are distal to ADHD may serve to bolster global self-esteem.

Predictors and Moderators Two Treatments of Oppositional Defiant Disorder in Children

OBJECTIVE

The aim of this study was to examine predictors and moderators of behavioral improvement in children with Oppositional Defiant Disorder (ODD) following treatment with Parent Management Training (PMT) and Collaborative and Proactive Solutions (CPS). Initial problem severity, inconsistent discipline, parental attributions of child misbehavior, and child lagging cognitive skills were examined.

METHOD

One hundred and forty-five children aged between 7 and 14 (103 males, M = 8.88 years, ethnicity representative of the wider Australian population) were randomly assigned to PMT and CPS. Assessment was conducted at baseline, post-intervention, and at 6-month follow-up, using independently rated semi-structured diagnostic interviews and parent-ratings of ODD symptoms. Using an intent-to-treat sample in this secondary analysis (Murrihy et al., 2022), linear regressions and PROCESS (Hayes, 2017) were used to examine these predictors and possible moderators of treatment.

RESULTS

Higher pre-treatment levels of conduct problems, lagging skills, and inconsistent discipline predicted poorer behavioral outcomes following both treatments. The only characteristic that moderated treatment outcome was child-responsible attributions - mothers who were more likely to attribute their child's problematic behaviors to factors in the child had significantly poorer outcomes in PMT than CPS at 6-month follow-up.

CONCLUSIONS

CPS may be a more beneficial treatment than PMT for families who have been identified as having higher levels of child-responsible attributions before commencing treatment for ODD. While tentative, this provides promising insights as to how treatment outcomes for children with ODD may be improved.

Gifted Children with ADHD: How Are They Different from Non-gifted Children with ADHD?

The present study focused on inattention and hyperactivity/impulsivity differences of gifted children with and without attention deficit-hyperactivity disorder (ADHD). Based on clinical assessment utilizing the Anxiety Disorders Interview Schedule for Children (ADISC-IV) and the Wechsler Intelligence Scale for Children—Fourth Edition, attendees of a public outpatient child service (boys = 359, girls = 148), with mean age 10.60 years (SD = 3.08 years), were allocated into four groups: ADHD (N = 350), gifted (N = 15), gifted/ADHD (N = 18), and clinical controls (N = 124). The Strengths and Weaknesses of ADHD-Symptoms and Normal Behavior Scale dimensionally assessed inattention and hyperactivity/impulsivity variations. Compared to the gifted/ADHD group, the ADHD group had higher scores for inattention and comparable scores for hyperactivity/impulsivity. For most symptoms, the ADHD groups (gifted or not) rated higher than the non-ADHD groups (control and gifted without ADHD). Findings appeared to indicate that (i) ADHD is a valid diagnosis among children who are gifted, (ii) gifted children might tend to be less inattentive than non-gifted ADHD children, and (iii) ADHD-gifted children appear to differ from the non-ADHD-gifted children with regard to specific hyperactive and impulsive behaviors. The practical implication of these findings is that clinicians may wish to focus on these symptoms when diagnosing ADHD among children with high intelligence.

Sleep, Internalizing Problems, and Social Withdrawal: Unique Associations in Clinic-Referred Youth With Elevated Sluggish Cognitive Tempo Symptoms

Objective: We compared clinic-referred youth with ADHD + sluggish cognitive tempo (SCT; n = 34), ADHD Only (n = 108), and SCT Only (n = 22) on demographics, co-occurring symptomatology, comorbid diagnoses, and social functioning. Method: In total, 164 youth (age = 6-17 years, M = 9.97) and their parent(s) presented to an outpatient clinic for a psychoeducational assessment. Between-group analyses and regressions were used to examine study variables. Results: SCT groups were older and exhibited more parent-reported internalizing problems, externalizing problems, sleep problems, and social withdrawal on the Child Behavior Checklist. No significant differences emerged between groups on the Teacher Report Form. Regression analyses involving multiple covariates revealed that SCT symptoms were uniquely related to social withdrawal but not general social problems. Conclusion: Based on parent report, SCT symptoms have a unique relationship with internalizing problems, sleep problems, and social withdrawal. Future research should explore correlates of SCT in youth using multiple informants.

ROC Analyses of Relevant Conners 3-Short Forms, CBCL, and TRF Scales for Screening ADHD and ODD

Receiver operating characteristic curve analysis was used to examine and compare the diagnostic accuracy of the Conners 3-Parent Short Form (C 3-P(S)), and the Conners 3-Teacher Short Form (C 3-T(S)) inattention and hyperactivity/impulsivity scales, and the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) attention problems scales, to distinguish those with and without attention deficit/hyperactivity disorder (ADHD). It also examined and compared the diagnostic accuracy of the C 3-P(S) and C 3-T(S) Aggression (AG) scales, and the CBCL and TRF Aggressive Behavior (AB) scales, to distinguish those with and without oppositional defiant disorder (ODD). The study used archival data (N = 150-261) involving a large group of clinic-referred children aged between 6 and 11 years who had been interviewed for clinical diagnosis of ADHD and ODD using the Anxiety Disorders Interview Schedule for Children (ADISC-IV) as the reference standard, and then administered one or more of the screening measures. The findings provided empirical support for the use of the C 3-P(S) and CBCL for identifying ADHD and ODD, with the CBCL aggressive behavior scale having better ability to detect ODD. The implications of the findings for using the screening scales for diagnoses of ADHD and ODD are discussed.

Testing Multiple Conceptualizations of Oppositional Defiant Disorder in Youth

Recent theories conceptualize oppositional defiant disorder (ODD) as a two-dimensional construct with angry/irritable (i.e., affective) and argumentative/defiant (i.e., behavioral) components. This view has been supported by studies of nonreferred youth but not yet examined in clinic-referred youth. In a reanalysis of data regarding children who received one of two psychosocial ODD treatments, we examined multiple conceptualizations of ODD, whether children showed improvements across these ODD dimensions, and whether main and joint effects of ODD dimension improvement predicted clinical outcome. One hundred thirty-four clinic-referred youth (ages 7-14 years, 38% female, 84% White) who met Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for ODD received 1 of 2 psychosocial treatments. At pretreatment, 1-week follow-up, and 6-month follow-up, mothers reported child aggression and conduct problems, clinicians reported global clinical impairment and clinical improvement, and ODD symptom counts were collected from a semistructured diagnostic interview with mothers. Baseline ODD symptom were used to test previously supported multidimensional models. One- and two-factor conceptualizations were supported; however, the two-factor solution was preferred. With this solution, each dimension significantly and similarly improved across treatment conditions. Improvements across affective and behavioral ODD factors also had significant effects on clinician- and mother-reported clinical outcomes. The current findings provide empirical support for the ongoing study of multidimensional ODD conceptualizations in clinic-referred youth.

Cognitive-Behavioral Therapy for Children With Anxiety and Comorbid Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

To determine whether comorbid attention-deficit/hyperactivity disorder (ADHD) diagnosis (including subtype) predicts response to cognitive-behavior therapy (CBT) for anxiety in children and to examine change in ADHD symptoms after treatment of primary anxiety.

METHOD

A sample of 842 children 5 to 18 years of age received CBT for a primary anxiety disorder. A subsample of 94 children met criteria for comorbid mild-to-moderate ADHD, mostly consisting of predominantly inattentive (n = 61) and combined (n = 27) subtypes. Outcome was defined as response (change in diagnostic severity) and remission (absence of the primary diagnosis) at each time point (after treatment and 3- and/or 6-month follow-up) and analyzed using linear and logistic mixed models.

RESULTS

Neither ADHD diagnosis nor subtype predicted response or remission rates for children's primary anxiety disorders. Children with ADHD also showed modest yet significant improvements in ADHD symptoms after CBT for anxiety.

CONCLUSION

The present findings support the suitability of manual-based group-based CBT for anxiety treatment in children with nonprimary ADHD. Further research should examine whether the positive outcomes reported can be extended to children with primary or severe ADHD.

No Medication for My Child! A Naturalistic Study on the Treatment Preferences for and Effects of Cogmed Working Memory Training Versus Psychostimulant Medication in Clinically Referred Youth with ADHD

In this naturalistic clinical study, we explored the applicability and clinical effectiveness of Cogmed WMT, pharmacotherapy, and their combination for clinically referred children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Ninety youth with ADHD (ages 6-16 years) and their parents were offered the possibility to choose one of the three interventions. The motives for choosing various interventions were quite different. Medication was chosen because this treatment was expected to be most effective, but also because the Cogmed WMT program was regarded as too taxing. The choice for Cogmed WMT was mainly negatively motivated: participants tended to be strongly against the use of medication, found it a too rigorous step, or feared side effects and addiction problems. The choice for the combination treatment was strongly positively motivated: parents and youth indicated that they wanted to receive the best possible intervention and part of them also had high expectations of Cogmed WMT. In terms of clinical effectiveness, pharmacotherapy with stimulant medication and the combination treatment produced larger reductions in ADHD symptomatology than Cogmed WMT. Further, results indicated that Cogmed WMT selectively enhanced working memory performance. Finally, after conducting Cogmed WMT, youths and parents were more 'open' to accept pharmacotherapy as intervention, probably because the training increased greater insight in and awareness of the problematic features of ADHD.

Childhood ADHD and Negative Self-Statements: Important Differences Associated With Subtype and Anxiety Symptoms

The current study examined the role negative self-statements have on the comorbidity between anxious symptomatology and ADHD-combined presentation (ADHD-C) and ADHD-predominantly inattentive (ADHD-I). A total of 114 children and adolescents with ADHD (M age = 10.15; SD = 2.30; range = 7-16) from a clinic-referred sample were grouped based on a semistructured diagnostic interview and consensus approach (ADHD-C, n = 62; ADHD-I, n = 52). Negative self-statements were measured using the Children's Automatic Thoughts Scale and the total score from the Multidimensional Anxiety Scale for Children was used to measure anxious symptomatology. Findings indicated youth diagnosed with ADHD-C, compared to those diagnosed with ADHD-I, had more frequent personal failure (Cohen's d =.40) and hostile intent negative self-statements (Cohen's d =.47). The association of ADHD subtype and negative self-statements was moderated by anxiety; negative self-statements of personal failure were highest in anxious ADHD-C children (β =.31). A second sample of 137 children and adolescents (M age = 10.61; SD = 2.26; range = 7-16) from a larger clinic-referred sample was utilized to replicate our results dimensionally. Results indicated that both hyperactivity/impulsivity (β = .23, p < .01) and the interaction of hyperactivity/impulsivity and anxiety (β = .17, p < .05) were significant predictors of negative self-statements regarding personal failure, while holding child age, child gender, oppositional symptoms, and inattention constant. In all, negative self-statements should be considered in the treatment and assessment of ADHD with particular attention paid to ADHD subtype and internalizing comorbidity.

Evidence-Based Assessment of ADHD in Youth Using a Receiver Operating Characteristic Approach

Guidelines exist for the assessment of attention deficit/hyperactivity disorder (ADHD), but they are often unclear as to how a clinician should consider multiple informants, methods, and co-occurring symptoms to reach an overall diagnostic probability for an individual patient. The current study used receiver operating characteristic analyses and evidence-based medicine methods to evaluate the Achenbach System of Empirically Based Assessment measures and the Conners' Continuous Performance Test for ADHD diagnosis in youth. Children (n = 379) and their parent(s) presented at an outpatient clinic for a psychoeducational assessment. Analyses examined the diagnostic efficiency and utility of study measures for predicting a best-estimate ADHD diagnosis. The Child Behavior Checklist Attention Problems construct, Teacher Report Form Attention Problems construct, and Hit Reaction Time Standard Error showed adequate diagnostic efficiency and unique contributions to the prediction of ADHD, Combined Type diagnosis. None of these measures showed good diagnostic efficiency or utility for the prediction of ADHD, Predominantly Inattentive Type. Child anxiety did not moderate the relations between predictors and ADHD diagnosis. Both the Child Behavior Checklist and Teacher Report Form Attention Problems constructs can discriminate youth with ADHD, Combined Type from other clinic-referred youth. Although Hit Reaction Time Standard Error also showed diagnostic utility, the decision to include a computerized measure should consider time and expense and be utilized in cases where diagnostic probability is unclear. Finally, anxiety may be associated with elevated attention problems, but it does not appear that anxiety affects diagnostic cutoffs for ADHD.

Parent Management Training and Collaborative & Proactive Solutions: A Randomized Control Trial for Oppositional Youth

This study examined the efficacy of Collaborative & Proactive Solutions (CPS) in treating oppositional defiant disorder (ODD) in youth by comparing this novel treatment to Parent Management Training (PMT), a well-established treatment, and a waitlist control (WLC) group. One hundred thirty-four youth (ages 7-14, 61.9% male, 83.6% White) who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for ODD were randomized to CPS, PMT, or WLC groups. ODD was assessed with semistructured diagnostic interviews, clinical global severity and improvement ratings, and parent report measures. Assessments were completed pretreatment, posttreatment, and at 6 months following treatment. Responder and remitter analyses were undertaken using intent-to-treat mixed-models analyses. Chronological age, gender, and socioeconomic status as well as the presence of comorbid attention deficit/hyperactivity and anxiety disorders were examined as predictors of treatment outcome. Both treatment conditions were superior to the WLC condition but did not differ from one another in either our responder or remitter analyses. Approximately 50% of youth in both active treatments were diagnosis free and were judged to be much or very much improved at posttreatment, compared to 0% in the waitlist condition. Younger age and presence of an anxiety disorder predicted better treatment outcomes for both PMT and CPS. Treatment gains were maintained at 6-month follow-up. CPS proved to be equivalent to PMT and can be considered an evidence-based, alternative treatment for youth with ODD and their families.

Attentional Control Scale for Children: Factor Structure and Concurrent Validity Among Children and Adolescents Referred for Anxiety Disorders

OBJECTIVE

The present study examined the factor structure and concurrent validity of the Attentional Control Scale for Children (ACS-C; Muris, de Jong, & Engelen, 2004), a youth self-rating scale of attentional control.

METHOD

A multisource assessment approach was used with 186 children and adolescents referred to an anxiety disorders specialty clinic.

RESULTS

Exploratory factor analysis yielded a 2-factor structure with internally consistent and moderately correlated subscales of Attentional Focusing and Attentional Shifting. Total ACS-C and subscale scores demonstrated significant associations with youth and parent ratings of youth anxiety symptoms, youth self ratings of depressive symptoms, and youth diagnosis of attention deficit-hyperactivity disorder.

CONCLUSIONS

These findings support use of the ACS-C as a self-rating scale of attentional control among referred youth. Future research is encouraged to examine retest reliability of the ACS-C and to evaluate whether its internal structure could be enhanced by removing or modifying items that performed poorly.

Characteristics of Children With ADHD and Comorbid Anxiety

OBJECTIVE

The following comorbid subgroups of ADHD have been proposed: ADHD Only, ADHD + anxiety disorders (ANX), ADHD + oppositional defiant disorder/conduct disorder (ODD/CD), and ADHD + ODD/CD + ANX. The current study examined a subset of these groups.

METHOD

A total of 134 children and adolescents (M age = 9.92; range = 6-17) from a clinic-referred sample (n = 407) were grouped based on a semistructured diagnostic interview: ADHD only (n = 41), ADHD + ANX (n = 31), and ANX Only (n = 62).

RESULTS

Findings supported greater parent-reported anxiety symptoms in anxiety groups, and greater parent- and teacher-reported attention problems in ADHD groups. ADHD groups performed worse on a continuous performance test, whereas ADHD + ANX performed worse on working memory than ADHD Only. ADHD + ANX reported more physical anxiety symptoms than ADHD Only.

CONCLUSION

Comorbid anxiety should be considered in ADHD assessment and treatment.

Structure of the Wechsler Intelligence Scale for Children - Fourth Edition in a Group of Children with ADHD

Objective: This study used confirmatory factor analysis to examine the factor structure for the 10 core WISC–IV subtests in a group of children (N = 812) with ADHD.

Method: The study examined oblique four- and five-factor models, higher order models with one general secondary factor and four and five primary factors, and a bifactor model with a general factor and four specific factors.

Results: The findings supported all models tested, with the bifactor model being the optimum model. For this model, only the general factor had high explained common variance and omega hierarchical value, and it predicted reading and arithmetic abilities.

Conclusion: The findings favor the use of the FSIQ scores of the WISC-IV, but not the subscale index scores.

Maternal Ratings of the ADHD Symptoms: Subtypes Versus Severity in Clinic-Referred Children and Adolescents

OBJECTIVE

This study used confirmatory factor analysis (CFA), latent class analysis (LCA), and factor mixture model (FMM) to ascertain the best model for ADHD symptoms, as presented in the Strengths and Weaknesses of ADHD-Symptoms and Normal Behavior Scale (SWAN).

METHOD

Mother ratings of the ADHD symptoms of 418 clinic-referred children and adolescents were obtained.

RESULTS

The findings provided most support for an FMM with two classes (less severe inattention [IA] and hyperactivity/impulsivity [HI] symptoms and more severe IA/HI symptoms) and two factors (IA and HI) model. The more severe class had more individuals with the ADHD diagnosis, especially the combined type.

CONCLUSION

The findings are discussed in relation to dimensional and categorical views of ADHD.

Emotion Socialization in the Context of Risk and Psychopathology: Maternal Emotion Coaching Predicts Better Treatment Outcomes for Emotionally Labile Children with Oppositional Defiant Disorder

We examined whether maternal emotion coaching at pre-treatment predicted children's treatment response following a 12-week program addressing children's Oppositional Defiant Disorder (ODD) symptoms. Eighty-nine mother-child dyads participated. At pre-treatment, mothers and children engaged in an emotion talk task. Mothers also reported their beliefs about emotions at pre-treatment and their child's disruptive behavior symptoms, emotion regulation, and emotion lability/negativity at pre-, mid-, and post-treatment. Clinicians reported children's symptom severity at pre- and post-treatment. Children's emotion lability/negativity moderated effects of maternal emotion coaching on children's post-treatment ODD symptoms, with stronger benefits of emotion coaching for children high in emotion lability/negativity. Results suggest that emotion coaching may promote treatment response for children with ODD who are especially at risk due to their emotionality.

Latent profile analysis of working memory performance in a sample of children with ADHD

The current study used latent profile analysis (LPA) to ascertain distinct groups of children with ADHD (N = 701) in terms of performance on working memory (WM) tasks that tapped visuospatial sketchpad, spatial central executive, and verbal central executive functions. It compared the WM performances of these classes with a clinical comparison group (N = 59). The participants' age ranged from 7 to 16 years (586 males, 71 females). The results of the LPA supported three classes. For all three WM tasks, class 1 (N = 196) had more difficulties than classes 2 (N = 394) and 3 (N = 111), and the clinical comparison group. Class 2 had more difficulties than class 3 and the clinical comparison group, and there was no difference between class 3 and the clinical comparison group. Class 1 had lower IQ and academic abilities, and relatively more individuals with depressive disorders. The implications of the findings for understanding ADHD and its treatment are discussed.

Inattention symptoms and the diagnosis of comorbid attention-deficit/hyperactivity disorder among youth with generalized anxiety disorder

Generalized anxiety disorder (GAD) and attention-deficit/hyperactivity disorder (ADHD) commonly co-occur in childhood. Inattention symptoms can be hallmarks of both conditions, however assessment tools of inattention may not effectively distinguish between the two conditions. The present study used receiver operating characteristic (ROC) analyses to examine the high-end specificity of the Attention Problems Scale of the Child Behavior Checklist (CBCL) for detecting comorbid ADHD among youth with GAD (N=46). Results support the utility of the Attention Problems Scale for accurately distinguishing between the two groups (AUC=.84, SE=.06). Specifically, a cut score of 63 achieved the most favorable values across diagnostic utility indices; 74% of GAD youth with ADHD scored above this cutoff and 91% of GAD youth without ADHD scored below this cutoff. Findings provide support for the use of the CBCL Attention Problems Scale to supplement diagnostic interviews and identify inattention associated with ADHD among GAD youth.

Treatment Outcomes in Anxious Youth with and without Comorbid ADHD in the CAMS

The purpose of this study is to examine the influence of Attention-Deficit/Hyperactivity Disorder (ADHD), independent of Oppositional Defiant Disorder (ODD), on acute treatment response, remission rates and maintenance of gains at 6-month follow-up in anxious youth (ages 7-17, 76% Caucasian, 52% female) who received cognitive-behavioral therapy (CBT) alone, pharmacotherapy alone, the combination of CBT and pharmacotherapy or placebo pill in the Child/Adolescent Multimodal Study. Treatment response was defined as independent evaluator rated meaningful improvement in anxiety. Remission was operationalized as the absence of targeted anxiety disorders. ADHD and ODD were examined as moderators of outcomes at a diagnostic level. In the CBT group only, an ADHD diagnosis predicted poorer immediate treatment response and remission rates. However, these associations were not obtained for the pharmacotherapy groups. Participants with comorbid ODD were not less likely to achieve acute treatment response and remission rates than their counterparts across treatment conditions. Due to small sample size of the comorbid subgroups, our analyses must be considered preliminary. Nevertheless, our initial findings suggest further exploration of the separate roles of ADHD and ODD are worth pursuing, as they may be differentially associated with treatment outcomes in anxious youth treated with CBT but not youth treated with pharmacotherapy. If confirmed, findings may indicate that anxious youth with comorbid ADHD are less likely to benefit from CBT strategies alone and raise the possibility that these youth need adjunctive pharmacotherapy or psychosocial interventions.

Parental Emotion Coaching and Child Emotion Regulation as Protective Factors for Children with Oppositional Defiant Disorder

We assessed linkages of mothers' emotion coaching and children's emotion regulation and emotion lability/negativity with children's adjustment in 72 mother-child dyads seeking treatment for Oppositional Defiant Disorder (ODD). Dyads completed questionnaires and discussed emotion-related family events. Maternal emotion coaching was associated with children's emotion regulation, which in turn was related to higher mother-reported adaptive skills, higher child-reported internalizing symptoms, and lower child-reported adjustment. When children were high in emotion lability/negativity, mothers' emotion coaching was associated with lower mother and child reports of externalizing behavior. Results suggest the role of emotion regulation and emotion lability in child awareness of socio-emotional problems and support the potential of maternal emotion coaching as a protective factor for children with ODD, especially for those high in emotion lability.

Comorbidity in youth with specific phobias: Impact of comorbidity on treatment outcome and the impact of treatment on comorbid disorders

The purpose of the present study was twofold. In an analysis of data from an existing randomized control trial of brief cognitive behavioral treatment on specific phobias (One-Session Treatment, OST; Ollendick et al., 2009), we examined 1) the effect of comorbid specific phobias and other anxiety disorders on treatment outcomes, and 2) the effect of treatment of the specific phobia on these co-occurring disorders. These relations were explored in 100 youth presenting with animal, natural environment, situational, and "other" types of phobia. Youth were reliably diagnosed with the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent versions (Silverman & Albano, 1996). Clinician severity ratings at post-treatment and 6-month follow-up were examined as were parent and child treatment outcome satisfaction measures. Results indicated that the presence of comorbid phobias or anxiety disorders did not affect treatment outcomes; moreover, treatment of the targeted specific phobias led to significant reductions in the clinical severity of other co-occurring specific phobias and related anxiety disorders. These findings speak to the generalization of the effects of this time-limited treatment approach. Implications for treatment of principal and comorbid disorders are discussed, and possible mechanisms for these effects are commented upon.