Treatment of Anxiety in Children and Adolescents

Attention bias modification for anxiety disorders in children and adolescents: A systematic review and meta-analysis

Despite accumulating evidence suggesting the effectiveness of Attention Bias Modification (ABM) in adults, little is known about its efficacy in children and adolescents. As anxiety has been the chief target in most studies and research in this area has grown rapidly in recent years, we conducted the first meta-analysis to establish the effects of ABM alone for anxiety disorders in children and adolescents. Studies were identified through a systematic search in three main databases: PubMed, EMBASE and PsycInfo, resulting in 17 randomized studies. The quality of these studies, possible publication bias and moderators were then examined. ABM had small but significant effects on clinician-rated anxiety symptoms and attention bias towards threat, while the effect on self or parent-reported anxiety measures was non-significant. Evidence quality ranged from moderate to very low. ABM was more effective when conducted as a stand-alone treatment than as an adjunct to other treatments. In addition, younger age and larger number of training sessions were associated with a greater reduction in clinician-rated anxiety symptoms. Results indicate that ABM may have significant effects on anxiety and attention bias in children and adolescents. Overall, the effects of ABM are mainly evident when clinical outcome is assessed by a clinician.

A School-Based Comparison of Positive Search Training to Enhance Adaptive Attention Regulation with a Cognitive-Behavioural Intervention for Reducing Anxiety Symptoms in Children

Many children experience anxiety but have limited access to empirically-supported interventions. School-based interventions using brief, computer-assisted training provide a viable way of reaching children. Recent evidence suggests that computer-delivered 'positive search training' (PST) reduces anxiety in children. This multi-informant, randomised controlled trial compared classroom-based, computer-delivered PST (N = 116) to a classroom-based, therapist-delivered cognitive-behavioural intervention (CBI) (N = 127) and a curriculum-as-usual control condition (CAU) (N = 60) in 7-11 year old children. Primary outcomes were child and parent report of child anxiety symptoms. Secondary outcomes were child and parent report of child depressive symptoms and child attention biases. Outcomes were assessed before and after the interventions, and six- and 12-months post-intervention. Teacher report of children's social-emotional functioning was assessed at pre- and post-intervention. As expected, compared to CAU, children receiving PST and the CBI reported greater anxiety reductions by post-intervention and six-month follow-up but, unexpectedly, not at 12-month follow-up. Partially consistent with hypotheses, compared to CAU, parents reported greater anxiety reductions in children receiving PST, but not the CBI, at 12-month follow-up. Contrary to expectation, there was a pre- to post-intervention increase in threat attention bias in PST compared to the other conditions, with no significant differences at follow-up. In support of hypotheses, teachers reported higher post-intervention social-emotional functioning in Year 5 students receiving the CBI but, unexpectedly, lower post-intervention functioning in students receiving PST. There were no effects on depressive symptoms. Further research is needed on strategies to maintain long-term benefits and determine preventative versus early intervention effects.