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Farley R, de Diaz NAN, Emerson LM, Simcock G, Donovan C, Farrell LJ. Mindful Parenting Group Intervention for Parents of Children with Anxiety Disorders. Child Psychiatry Hum Dev 2024; 55:1342-1353. [PMID: 36689038 PMCID: PMC9869845 DOI: 10.1007/s10578-023-01492-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/24/2023]
Abstract
Parenting behaviour and rearing style contribute to the intergenerational relationship between parental and child anxiety. Current psychological interventions for child anxiety typically do not adequately address parental mental health, parenting behaviours or the parent-child relationship. The current pilot study examines the effectiveness of a mindful parenting intervention (MPI) for parents of young children with clinical anxiety. It was hypothesised that the intervention would be associated with improvements in parental stress, mental health, and mindfulness, and a reduction in child clinical anxiety symptoms. Twenty-one parents of children aged 3-7 years diagnosed with anxiety disorders participated in an 8-week group MPI program that aimed to increase their intentional moment to moment awareness of the parent-child relationship. Parental (anxiety, depression, hostility, stress, burden, mindfulness, mindful parenting) and child (anxiety diagnoses, anxiety severity, comorbidities) outcomes were assessed at pre- and post-intervention, and at 3-month follow-up. Parents reported a significant increase in mindful parenting and a significant reduction in parent-child dysfunctional interaction, but no change in mental health symptoms. There was a significant reduction in parent-rated child anxiety symptoms, severity of child anxiety diagnosis and number of comorbid diagnoses at post and 3-month follow-up. Limitations include a lack of waitlist control, small sample size, and participants were largely mothers, from intact families and highly educated. There was attrition of 43% and outcomes were predominantly self-report. MPIs offer a novel and potentially effective method of increasing mindful parenting, decreasing dysfunctional parent-child interactions, reducing parenting stress and might also be an effective early intervention for indirectly decreasing young children's clinical anxiety symptoms. Larger-scale controlled trials of MPIs are needed.
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Affiliation(s)
- Robyn Farley
- Griffith University, Gold Coast, Australia.
- School of Applied Psychology, Health Building (G40), Parklands Drive, Southport, QLD, 4222, Australia.
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Takahashi T, Ishikawa SI, Aiboshi T, Miyauchi M. Evaluating the long-term effects of cognitive behavioural therapy as an early intervention for at-risk anxiety disorders among preschool children in Asia. Clin Child Psychol Psychiatry 2024; 29:994-1010. [PMID: 37578134 DOI: 10.1177/13591045231194104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
There are few evaluations of early intervention for the prevention of anxiety disorders in East Asia, and those that exist generally evaluate outcomes to a maximum of 6-12 months. The current study evaluated the long-term effect (5 years) of an anxiety prevention program presented to preschool children and their parents in Japan. Participants for the study were 10 inhibited children 5-6 years old and their parents. The parent's and children's program comprised group sessions of a cognitive-behavioural program. Parents and teachers completed the anxious/depressed, withdrawn and behavioural inhibition at pre-post-intervention and 3-month follow-up. Five years after starting the intervention, participants were invited to a diagnostic interview, Anxiety Disorders Interview Schedule (ADIS) to examine a long-term preventive effect of the intervention. The majority of children showed a reduction in anxious/depressed, behavioral inhibition, and approximately half showed reliable change according to parents' and teachers' reports. Moreover, the results indicated that 9 of the 10 children did not met the diagnostic criteria for anxiety disorders. These results suggested that the early intervention had preventive effects because the diagnostic criteria for anxiety disorders were not met in the follow-up assessment conducted five years later.
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Affiliation(s)
| | | | | | - Mai Miyauchi
- Hanagashima Clinic, Social Welfare Corporation Canvasnokai, Miyazaki, Japan
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Koelen J, Klein A, Wolters N, Bol E, De Koning L, Roetink S, Van Blom J, Boutin B, Schaaf J, Grasman R, Van der Heijde CM, Salemink E, Riper H, Karyotaki E, Cuijpers P, Schneider S, Rapee R, Vonk P, Wiers R. Web-Based, Human-Guided, or Computer-Guided Transdiagnostic Cognitive Behavioral Therapy in University Students With Anxiety and Depression: Randomized Controlled Trial. JMIR Ment Health 2024; 11:e50503. [PMID: 38896474 PMCID: PMC11222767 DOI: 10.2196/50503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Internet-based cognitive behavioral interventions (iCBTs) are efficacious treatments for depression and anxiety. However, it is unknown whether adding human guidance is feasible and beneficial within a large educational setting. OBJECTIVE This study aims to potentially demonstrate the superiority of 2 variants of a transdiagnostic iCBT program (human-guided and computer-guided iCBT) over care as usual (CAU) in a large sample of university students and the superiority of human-guided iCBT over computer-guided iCBT. METHODS A total of 801 students with elevated levels of anxiety, depression, or both from a large university in the Netherlands were recruited as participants and randomized to 1 of 3 conditions: human-guided iCBT, computer-guided iCBT, and CAU. The primary outcome measures were depression (Patient Health Questionnaire) and anxiety (Generalized Anxiety Disorder scale). Secondary outcomes included substance use-related problems (Alcohol Use Disorder Identification Test and Drug Abuse Screening Test-10 items). Linear mixed models were used to estimate the effects of time, treatment group, and their interactions (slopes). The primary research question was whether the 3 conditions differed in improvement over 3 time points (baseline, midtreatment, and after treatment) in terms of depression and anxiety symptoms. Results were analyzed according to the intention-to-treat principle using multiple imputation. Patients were followed exploratively from baseline to 6 and 12 months. RESULTS In both short-term and long-term analyses, the slopes for the 3 conditions did not differ significantly in terms of depression and anxiety, although both web-based interventions were marginally more efficacious than CAU over 6 months (P values between .02 and .03). All groups showed significant improvement over time (P<.001). For the secondary outcomes, only significant improvements over time (across and not between groups) were found for drug use (P<.001). Significant differences were found in terms of adherence, indicating that participants in the human-guided condition did more sessions than those in the computer-guided condition (P=.002). CONCLUSIONS The transdiagnostic iCBT program offers a practical, feasible, and efficacious alternative to usual care to tackle mental health problems in a large university setting. There is no indication that human guidance should be preferred over technological guidance. The potential preference of human support also depends on the scale of implementation and cost-effectiveness, which need to be addressed in future trials. TRIAL REGISTRATION International Clinical Trials Registry Platform NL7328/NTR7544; https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON26795.
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Affiliation(s)
- Jurrijn Koelen
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Anke Klein
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Nine Wolters
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Eline Bol
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Lisa De Koning
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Samantha Roetink
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Jorien Van Blom
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Bruno Boutin
- Technical Support Psychology Department, University of Amsterdam, Amsterdam, Netherlands
| | - Jessica Schaaf
- Cognitive Neuroscience Department, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Raoul Grasman
- Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands
| | - Claudia Maria Van der Heijde
- Department of Research, Development and Prevention, Student Health Service, University of Amsterdam, Amsterdam, Netherlands
| | - Elske Salemink
- Experimental Psychopathology and Clinical Psychology Lab, Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| | - Heleen Riper
- Amsterdam Public Health Research Institute, Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Eirini Karyotaki
- Amsterdam Public Health Research Institute, Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Pim Cuijpers
- Amsterdam Public Health Research Institute, Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Department of Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Ronald Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Peter Vonk
- Department of Research, Development and Prevention, Student Health Service, University of Amsterdam, Amsterdam, Netherlands
| | - Reinout Wiers
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
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Skumsnes T, Fjermestad KW, Wergeland GJ, Aalberg M, Heiervang ER, Kodal A, Ingul JM. Behavioral Inhibition and Social Anxiety Disorder as Predictors of Long-Term Outcomes of Cognitive Behavioral Therapy for Youth Anxiety Disorders. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01215-8. [PMID: 38869750 DOI: 10.1007/s10802-024-01215-8] [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: 05/17/2024] [Indexed: 06/14/2024]
Abstract
The temperamental trait behavioral inhibition (BI) is related to the development and maintenance of anxiety, particularly much so to social anxiety disorder. We investigated if BI and social anxiety disorder predicted cognitive behavioral therapy (CBT) outcomes for youth anxiety. Youth (N = 179; Mage = 11.6 years) were assessed 4 years following a randomized controlled CBT effectiveness trial. BI was measured by the parent-reported Behavioral Inhibition Questionnaire at baseline. The outcomes were diagnostic recovery, youth- and parent-reported anxiety symptoms, and clinical severity at post-treatment, 1-year, and 4-year follow-up. Having social anxiety disorder negatively predicted diagnostic recovery and predicted higher clinical severity at all assessment points and was the only significant predictor of outcomes at 4-year follow-up. Higher BI negatively predicted diagnostic recovery and predicted higher clinical severity and parent-reported symptom levels at post-treatment and 1-year follow-up, and predicted higher youth-reported anxiety levels at 1-year follow-up. Higher BI was the only predictor of youth- and parent-reported anxiety symptoms. BI and social anxiety disorder seem to be unique predictors of CBT outcomes among youth with anxiety disorders. CBT adaptations may be indicated for youth with high BI and social anxiety disorder.
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Affiliation(s)
- Toril Skumsnes
- Tynset Child and Adolescents Mental Health Service, Innlandet Hospital Trust, Tynset, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Marianne Aalberg
- Department for Research and Development, Division of Mental Health and Substance Use, Akershus University Hospital, Oslo, Norway
| | - Einar R Heiervang
- Tynset Child and Adolescents Mental Health Service, Innlandet Hospital Trust, Tynset, Norway
| | - Arne Kodal
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Jo Magne Ingul
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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Bolton B, Rooney RM, Hughes A, Hopkins A, Mancini VO. Systematic review and meta-analysis of the prevention of internalizing disorders in early childhood. Front Psychol 2023; 14:1061825. [PMID: 38155699 PMCID: PMC10752964 DOI: 10.3389/fpsyg.2023.1061825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/03/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction Internalizing problems comprise a significant amount of the mental health difficulties experienced during childhood. Implementing prevention programs during early childhood may prevent internalizing problems. The present systematic review and meta-analysis aimed to evaluate the effect of both targeted and universal prevention programs in preventing internalizing problems for children aged 3- to 5-years and their parents. Methods PsycINFO, Embase, and MEDLINE were systematically searched, and 17 randomized control trials, consisting of 3,381 children, met eligibility criteria. There were seven universal prevention programs, and 10 targeted prevention programs. Four prevention programs were delivered to children, 10 prevention programs were delivered to parents/caregivers, and three prevention programs were delivered to both parents and children. Results Prevention programs led to significantly fewer internalizing problems at 6- and 7-month post-intervention (n = 7, p = 0.02, CI -0.69, 0.06) with a small-to-moderate effect size (g = -0.38), however, not at post-intervention or at 12-month follow up. Discussion Overall, findings suggest that there may be value in ongoing development and evaluation of prevention programs for internalizing problems, as they improve social and emotional wellbeing in students and reduce internalizing difficulties within the 6- to 7-month timeframe following prevention programs. Systematic review registration PROSPERO: CRD42021261323.
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Affiliation(s)
- Brigid Bolton
- Psychology Department, Curtin School of Population Health, Faculty of Health Sciences, Bentley, WA, Australia
| | - Rosanna Mary Rooney
- Psychology Department, Curtin School of Population Health, Faculty of Health Sciences, Bentley, WA, Australia
| | - Anya Hughes
- Psychology Department, Curtin School of Population Health, Faculty of Health Sciences, Bentley, WA, Australia
| | - Amber Hopkins
- Discipline of Psychology, School of Population Health, Curtin University, Bentley, WA, Australia
| | - Vincent Oreste Mancini
- Psychology Department, Curtin School of Population Health, Faculty of Health Sciences, Bentley, WA, Australia
- Human Development and Community Wellbeing, Telethon Kids Institute, Nedlands, WA, Australia
- Division of Paediatrics, UWA Medical School, University of Western Australia, Perth, WA, Australia
- The Fathering Project, Sydney, NSW, Australia
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Novick DR, Meyer CT, Wagner NJ, Rubin KH, Danko CM, Dougherty LR, Druskin LR, Smith KA, Chronis-Tuscano A. Testing reciprocal associations between child anxiety and parenting across early interventions for inhibited preschoolers. J Child Psychol Psychiatry 2023; 64:1665-1678. [PMID: 37644651 PMCID: PMC11289767 DOI: 10.1111/jcpp.13879] [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] [Accepted: 07/28/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Given the robust evidence base for the efficacy of evidence-based treatments targeting youth anxiety, researchers have advanced beyond efficacy outcome analysis to identify mechanisms of change and treatment directionality. Grounded in developmental transactional models, interventions for young children at risk for anxiety by virtue of behaviorally inhibited temperament often target parenting and child factors implicated in the early emergence and maintenance of anxiety. In particular, overcontrolling parenting moderates risk for anxiety among highly inhibited children, just as child inhibition has been shown to elicit overcontrolling parenting. Although longitudinal research has elucidated the temporal unfolding of factors that interact to place inhibited children at risk for anxiety, reciprocal transactions between these child and parent factors in the context of early interventions remain unknown. METHOD This study addresses these gaps by examining mechanisms of change and treatment directionality (i.e., parent-to-child vs. child-to-parent influences) within a randomized controlled trial comparing two interventions for inhibited preschoolers (N = 151): the multicomponent Turtle Program ('Turtle') and the parent-only Cool Little Kids program ('CLK'). Reciprocal relations between parent-reported child anxiety, observed parenting, and parent-reported accommodation of child anxiety were examined across four timepoints: pre-, mid-, and post-treatment, and one-year follow-up (NCT02308826). RESULTS Hypotheses were tested via latent curve models with structured residuals (LCM-SR) and latent change score (LCS) models. LCM-SR results were consistent with the child-to-parent influences found in previous research on cognitive behavioral therapy (CBT) for older anxious youth, but only emerged in Turtle. LCS analyses revealed bidirectional effects of changes in parent accommodation and child anxiety during and after intervention, but only in Turtle. CONCLUSION Our findings coincide with developmental transactional models, suggesting that the development of child anxiety may result from child-to-parent influences rather than the reverse, and highlight the importance of targeting parent and child factors simultaneously in early interventions for young, inhibited children.
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Affiliation(s)
- Danielle R. Novick
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
- Yale School of Medicine, Yale Child Study Center, New Haven, CT, USA
| | - Christian T. Meyer
- Department of Human Development & Quantitative Methodology, University of Maryland, College Park, College Park, MD, USA
| | - Nicholas J. Wagner
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - Kenneth H. Rubin
- Department of Human Development & Quantitative Methodology, University of Maryland, College Park, College Park, MD, USA
| | - Christina M. Danko
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Lea R. Dougherty
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | | | - Kelly A. Smith
- Department of Human Development & Quantitative Methodology, University of Maryland, College Park, College Park, MD, USA
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Chen W, Zhou X, Yin X, Zhao S. A parent-report measure of children's anxiety: psychometric properties of the Macquarie Anxiety Behavioural Scale (MABS) in a Chinese sample of preschool children. BMC Psychol 2023; 11:414. [PMID: 38012807 PMCID: PMC10680268 DOI: 10.1186/s40359-023-01463-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/22/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE The Macquarie Anxiety Behavioural Scale (MABS) is a newly developed scale to assess anxiety in children and teenagers. The present study aimed to evaluate the reliability and validity of the Chinese version of the MABS, as well as the measurement invariance across different age groups in a preschool-aged sample. METHODS A total of 1007 parents with children aged 3-6 years participated in the study. Internal consistency was assessed by calculating Cronbach's alpha, McDonald's omega and average inter-item correlation values. Confirmatory factor analysis (CFA) was conducted to examine the five-factor model. Multi-group CFA was conducted to test the measurement equivalence across different age groups (3- and 4-year-olds and 5- and 6-year-olds). Convergent, divergent, and criterion-related validity were assessed with Pearson correlation coefficients. RESULTS Internal consistency for the MABS total score was good and that of the subscales was acceptable. The CFA results showed that the five-factor structure of the MABS was supported in preschoolers (e.g., CFI = 0.929, TLI = 0.914, RMSEA = 0.050). In addition, scalar invariance of the MABS was supported across different age groups (e.g., ΔCFI = - 0.003, ΔTLI = 0, ΔRMSEA = 0). Furthermore, the MABS showed good convergent and divergent validity as well as criterion-related validity. CONCLUSION The Chinese version of the MABS demonstrated satisfactory psychometric properties and appeared to be a valid and reliable instrument for measuring anxiety in preschool children.
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Affiliation(s)
- Wei Chen
- School of Psychology, Guizhou Normal University, Guiyang, China
- Center for Big Data Research in Psychology, Guizhou Normal University, Guiyang, China
| | - Xingrong Zhou
- School of Psychology, Guizhou Normal University, Guiyang, China
- Center for Big Data Research in Psychology, Guizhou Normal University, Guiyang, China
- Bishan Gaoxin Middle School, Chongqing, China
| | - Xingyu Yin
- School of Psychology, Guizhou Normal University, Guiyang, China
- Center for Big Data Research in Psychology, Guizhou Normal University, Guiyang, China
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Creswell C, Chessell C, Halliday G. Parent-led cognitive behaviour therapy for child anxiety problems: overcoming challenges to increase access to effective treatment. Behav Cogn Psychother 2023; 51:512-532. [PMID: 36458498 DOI: 10.1017/s1352465822000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Anxiety problems have a particularly early age of onset and are common among children. As we celebrate the anniversary of the BABCP, it is important to recognise the huge contribution that cognitive behavioural therapy (CBT) has made to the treatment of anxiety problems in children. CBT remains the only psychological intervention for child anxiety problems with a robust evidence base, but despite this, very few children with anxiety problems access CBT. Creative solutions are urgently needed to ensure that effective treatments can be delivered at scale. Here we focus on parent-led CBT as this offers a potential solution that is brief and can be delivered by clinicians without highly specialised training. Over the last decade there has been a substantial increase in randomised controlled trials evaluating this approach with consistent evidence of effectiveness. Nonetheless clinicians, and parents, often have concerns about trying the approach and can face challenges in its delivery. METHOD We draw on empirical evidence and our clinical experience to address some of these common concerns and challenges, with particular emphasis on the key principles of empowering parents and working with them to provide opportunities for new learning for their children. CONCLUSIONS We conclude by highlighting some important directions for future research and practice, including further evaluation of who does and does not currently benefit from the approach, determining how it should be adapted to optimise outcomes among groups that may not currently get maximum benefits and across cultures, and capitalising on recent technological developments to increase engagement and widen access.
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Affiliation(s)
- Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Chloe Chessell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Gemma Halliday
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
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Janus M, Ryan J, Pottruff M, Reid-Westoby C, Brownell M, Bennett T, Birken CS, Duku E, Ferro MA, Forer B, Georgiades S, Gorter JW, Guhn M, Maguire J, Manson H, Pei J, Santos R, Coplan RJ. Population-Based Teacher-Rated Assessment of Anxiety Among Canadian Kindergarten Children. Child Psychiatry Hum Dev 2023; 54:1309-1320. [PMID: 35244815 PMCID: PMC8894824 DOI: 10.1007/s10578-022-01332-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/13/2022]
Abstract
Despite anxiety being a prevalent mental health problem in children, little data exist on the pervasiveness and levels of anxiety symptoms in kindergarteners. Data from the Early Development Instrument, a teacher-completed, population-level measure of child development, were collected across Canada from 2004 to 2015. The final analytic sample consisted of 974,319 children of whom 2.6% were classified as "highly anxious". Compared to children who exhibited "few to none" anxious behaviors, highly anxious children were more likely to be male, have English/French as a second language, and have a special needs designation. Furthermore, compared with their less anxious peers, highly anxious children had between 3.5 and 6.1 higher odds of scoring below the 10th percentile cut-off in physical, social, language/cognitive and communication domains. Our findings suggest that anxious behaviors are related to children's overall health and illustrate the consistency and extensiveness of anxiety at a very young age among Canadian children.
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Affiliation(s)
- Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
| | - Julia Ryan
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Molly Pottruff
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Caroline Reid-Westoby
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Marni Brownell
- Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Teresa Bennett
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Catherine S Birken
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Mark A Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Barry Forer
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Stelios Georgiades
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jonathon Maguire
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Rob Santos
- Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Robert J Coplan
- Department of Psychology, Carleton University, Ottawa, ON, Canada
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10
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Druskin LR, Novick DR, Smith KA, Chronis-Tuscano A, Wagner NJ, Pham S, Fleece HM, Danko CM, Rubin KH. Comparison of behaviorally inhibited and typically developing children's play behaviors in the preschool classroom. Front Psychol 2023; 14:1193915. [PMID: 37502750 PMCID: PMC10369178 DOI: 10.3389/fpsyg.2023.1193915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction Behavioral inhibition (BI) is a temperamental trait characterized by a bias to respond with patterns of fearful or anxious behavior when faced with unfamiliar situations, objects, or people. It has been suggested that children who are inhibited may experience early peer difficulties. However, researchers have yet to systematically compare BI versus typically developing children's observed asocial and social behavior in familiar, naturalistic settings. Method We compared the in-school behaviors of 130 (M = 54 months, 52% female) highly inhibited preschoolers (identified using the parent-reported Behavioral Inhibition Questionnaire) to 145 (M = 53 months, 52% female) typically developing preschoolers. Both samples were observed on at least two different days for approximately 60 min. Observers used the Play Observation Scale to code children's behavior in 10-s blocks during free play. Teachers completed two measures of children's behavior in the classroom. Results Regression models with robust standard errors controlling for child sex, age, and weekly hours in school revealed that preschoolers identified as BI engaged in significantly more observed reticent and solitary behavior, and less social play and teacher interaction than the typically developing sample. Children with BI also initiated social interaction with their peers and teachers less often than their counterparts who were not inhibited. Teachers reported that children identified as BI were more asocial and less prosocial than their non-BI counterparts. Discussion Significantly, the findings indicated that inhibited children displayed more solitude in the context of familiar peers. Previous observational studies have indicated behavioral differences between BI and unfamiliar typical age-mates in novel laboratory settings. Children identified as BI did not receive fewer bids for social interaction than their typically developing peers, thereby suggesting that children who are inhibited have difficulty capitalizing on opportunities to engage in social interaction with familiar peers. These findings highlight the need for early intervention for children with BI to promote social engagement, given that the frequent expression of solitude in preschool has predicted such negative outcomes as peer rejection, negative self-regard, and anxiety during the elementary and middle school years.
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Affiliation(s)
- Lindsay R. Druskin
- Department of Psychology, West Virginia University, Morgantown, WV, United States
| | - Danielle R. Novick
- Department of Psychology, University of Maryland, College Park, MD, United States
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - Kelly A. Smith
- Department of Human Department & Quantitative Methodology, University of Maryland, College Park, MD, United States
| | | | - Nicholas J. Wagner
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, United States
| | - Stephanie Pham
- Department of Human Department & Quantitative Methodology, University of Maryland, College Park, MD, United States
| | - Hailey M. Fleece
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, MD, United States
| | - Christina M. Danko
- Department of Psychology, University of Maryland, College Park, MD, United States
| | - Kenneth H. Rubin
- Department of Human Department & Quantitative Methodology, University of Maryland, College Park, MD, United States
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11
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Fisak B, Penna A, Mian ND, Lamoli L, Margaris A, Cruz SAMFD. The Effectiveness of Anxiety Interventions for Young Children: A Meta-Analytic Review. JOURNAL OF CHILD AND FAMILY STUDIES 2023; 32:1-12. [PMID: 37362628 PMCID: PMC10205556 DOI: 10.1007/s10826-023-02596-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/04/2023] [Indexed: 06/28/2023]
Abstract
Anxiety symptoms and disorders are prevalent and impairing in young children and these symptoms often persist and worsen over time, indicating the need for efficacious interventions for this age group. The purpose of this study was to evaluate the effectiveness of psychosocial interventions targeting anxiety in younger children and to assess the potential moderators of outcome. The effect sizes from 24 trials were assessed based on a random effect model. The mean weighted effect size was found to be significant and moderate in magnitude. Moderators, including level of intervention, intervention approach, rater, and level of training of the provider/program facilitator, are assessed and discussed. Overall, the findings indicate that anxiety interventions are effective in reducing anxiety in young children, and targeted trials show particularly strong promise.
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Affiliation(s)
- Brian Fisak
- University of Central Florida, Orlando, FL USA
| | | | | | | | | | - Sonia Ann Marie F. Dela Cruz
- University of Central Florida/HCA Healthcare Graduate Medical Education Consortium Psychiatry Residency Program of Greater Orlando, Orlando, FL USA
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12
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Lewis KM, Barrett P, Freitag G, Ollendick TH. An Ounce of Prevention: Building resilience and targeting anxiety in young children. Clin Child Psychol Psychiatry 2023; 28:795-809. [PMID: 35996946 DOI: 10.1177/13591045221121595] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anxiety disorders are among the most common psychiatric disorders in childhood and can develop as early as the preschool years. Therefore, providing young children who display early signs of anxiety with skills to prevent the development of later psychopathology is invaluable. The current study evaluates the effectiveness of Fun FRIENDS, an anxiety prevention and resilience program for young children. METHOD Fifty-seven kindergartners across three classrooms participated in a 15-week anxiety prevention program and teachers completed a behavioral screening measure and anxiety questionnaire at pre, post, 3 month, and 10-month follow-up assessment points. RESULTS Anxiety positively correlated with emotional symptoms, peer difficulties, and total difficulties at pre-intervention. Anxiety symptoms decreased from pre-intervention to follow-up. Additionally, prosocial behaviors improved and moderated the relationship between pre-and post-intervention anxiety symptoms. CONCLUSIONS These findings yield promising implications regarding the effectiveness of prevention and intervention programs on increasing social emotional skills and reducing anxiety symptoms in young children.
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Affiliation(s)
- Krystal M Lewis
- 25944National Institute of Mental Health, Bethesda, MD, USA.,Department of Psychology, 1757Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Paula Barrett
- 2219Australian National University, Canberra, ACT, Australia
| | - Gabrielle Freitag
- Department of Psychology, 5450Florida International University, Miami, FL, USA
| | - Thomas H Ollendick
- Department of Psychology, 1757Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
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13
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Bayer JK, Prendergast LA, Brown A, Bretherton L, Hiscock H, Nelson-Lowe M, Gilbertson T, Noone K, Bischof N, Beechey C, Muliadi F, Mihalopoulos C, Rapee RM. Prediction of clinical anxious and depressive problems in mid childhood amongst temperamentally inhibited preschool children: a population study. Eur Child Adolesc Psychiatry 2023; 32:267-281. [PMID: 34368891 DOI: 10.1007/s00787-021-01857-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/31/2021] [Indexed: 11/30/2022]
Abstract
Shy/inhibited young children are at risk for internalising difficulties; however, for many, this temperamental style does not result in mental health problems. This study followed a population-based sample of temperamentally inhibited preschool children into mid childhood to explore the aetiology of clinical-level anxious and depressive problems. Amongst inhibited preschool children, we aimed to predict each of clinical child anxiety and depressive problems in mid childhood from a broad range of potential risks (demographics, traumatic events and broader recent stressors, parents' well-being, and parenting practices). This study is based on data from a wider population trial of Cool Little Kids that recruited a representative sample of inhibited preschool children enrolled in their year before starting school. In 2011-2012, an inhibition screen was universally distributed to parents of children in their year before school (age 4 years) across eight diverse government areas in Melbourne, Australia. Participants were 545 parents of inhibited preschoolers (78% uptake, 545/703) who were followed to mid childhood (three annual waves 2015-2017, age 7-10 years) with 84% retention (456/545). Parents completed questionnaires spanning child ages 4-10 years, along with diagnostic interviews for child anxiety. Children also completed questionnaires in mid childhood. The questionnaires encompassed a variety of potential risks including sociodemographics, traumatic events, recent life stressors, parent wellbeing and parenting practices. In mid childhood, 57% (246/430) of inhibited preschoolers had a clinical level of anxiety problems while 22% (95/432) had depressive problems (by one or more sources). The aetiology analyses highlighted parent distress and parenting practices (overinvolved/protective, harsh discipline) as key predictors of inhibited preschoolers' internalising problems by mid childhood. Some high-risk families may not have participated. Child depression was not assessed with a diagnostic interview. The measures did not include every possible risk factor. The findings lend support to parenting programs for shy/inhibited young children that aim to prevent the development of anxiety and depression as they grow.
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Affiliation(s)
- Jordana K Bayer
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia.
- Murdoch Children's Research Institute, Melbourne, Australia.
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - Luke A Prendergast
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia
| | - Amy Brown
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Lesley Bretherton
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
| | - Margaret Nelson-Lowe
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Tamsyn Gilbertson
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Kate Noone
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Natalie Bischof
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Cassima Beechey
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Fenny Muliadi
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, Australia
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14
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Valadez EA, Morales S, Buzzell GA, Troller-Renfree SV, Henderson HA, Chronis-Tuscano A, Pine DS, Fox NA. Development of Proactive Control and Anxiety Among Behaviorally Inhibited Adolescents. J Am Acad Child Adolesc Psychiatry 2022; 61:1466-1475. [PMID: 35490841 PMCID: PMC9613813 DOI: 10.1016/j.jaac.2022.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/26/2022] [Accepted: 04/21/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Behavioral inhibition (BI) is an infant temperament characterized by heightened reactivity and negative affect in response to novel people and situations. BI is among the earliest and strongest predictors of future anxiety problems. However, not all children with a history of BI will manifest anxiety problems. A growing body of evidence suggests that proactive control skills may help buffer youth with BI from future anxiety difficulties; yet, it remains unclear how temperament may interact with the development of cognitive control to influence anxiety risk. The present study tested whether enhancements in proactive control occurring during adolescence may reduce risk for anxiety among youth with a history of BI. METHOD Participants included 185 adolescents (56% female) whose temperament was assessed during toddlerhood. In adolescence, participants completed anxiety assessments and an AX Continuous Performance Test (AX-CPT) to assess cognitive control strategy. Both assessments were administered at age 13 years and again at 15 years. RESULTS Latent change score modeling revealed that, on average, participants increasingly used proactive control strategies and experienced worsening anxiety from age 13-15 years. Early BI was associated with a smaller anxiety increase from 13-15 years, but only among participants whose proactive control skills improved at mean or greater rates. CONCLUSION The present findings suggest that greater proactive control development during adolescence protects youth with high BI from age-related increases in anxiety. Results support a framework that highlights cognitive control as a key moderator of anxiety risk among children with a history of high BI.
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Affiliation(s)
| | | | | | | | | | | | - Daniel S Pine
- National Institute of Mental Health, Bethesda, Maryland
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15
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Anna-Kaisa V, Virpi KK, Mervi R, Elisa R, Terhi L, Marjo K, André S, Eila K. Review: Economic evidence of preventive interventions for anxiety disorders in children and adolescents - a systematic review. Child Adolesc Ment Health 2022; 27:378-388. [PMID: 34472208 DOI: 10.1111/camh.12505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anxiety disorders are common in children and youth. Also, in prevention, be it universal, selective or indicated, economic evaluation supports decision-making in the allocation of scarce resources. This review identified and summarised the existing evidence of economic evaluations for the prevention of anxiety disorders in children and adolescents. METHODS A systematic search was conducted on the EBSCO, Scopus, Web of Science, ProQuest, Cochrane and PubMed databases. We included studies that focused on children and adolescents under 18 years of age, aimed to prevent anxiety disorders and presented an incremental analysis of costs and effectiveness. A registered checklist was used that assessed the quality of the included articles. RESULTS The search yielded 1697 articles. Five articles were included in this review. Three were RCT-based, and two were model-based studies. Out of five included interventions, one was a universal school-based intervention, two selective interventions and two indicated interventions. Universal school-based prevention of anxiety was not cost-effective compared with usual teaching. Selective parent training and indicative child- and parent-focused CBT prevention were likely cost-effective compared with usual care or doing nothing. CONCLUSION Parent education and cognitive behaviour therapy interventions can be cautiously interpreted as being a cost-effective way of preventing anxiety in children and adolescents. However, the evidence is weakly related to cost-effectiveness as there are only a few studies, with relatively small sample sizes and short follow-ups.
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Affiliation(s)
- Vartiainen Anna-Kaisa
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Kuvaja-Köllner Virpi
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Rantsi Mervi
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Rissanen Elisa
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Luntamo Terhi
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Kurki Marjo
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Sourander André
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Kankaanpää Eila
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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16
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Urao Y, Yoshida M, Sato Y, Shimizu E. School-based cognitive behavioural intervention programme for addressing anxiety in 10- to 11-year-olds using short classroom activities in Japan: a quasi-experimental study. BMC Psychiatry 2022; 22:658. [PMID: 36284274 PMCID: PMC9594947 DOI: 10.1186/s12888-022-04326-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although several school-based cognitive behavioural intervention programmes have been developed in Japan to prevent and improve children's anxiety disorders, the substantial time required for their completion remains a problem. METHODS A brief version of the cognitive behavioural programme called 'Journey of the Brave', developed for Japanese children was conducted among 90 children aged 10‒11 years using 20-min short classroom activities, and its effectiveness was examined. The children were divided into two groups: the intervention (n = 31) and control groups (n = 59). The control group did not attend any programme sessions and followed regular school curriculum. We conducted 14 weekly programme sessions and assessed children at pre-intervention, post-intervention, and 2-month follow-up (6 months after the beginning). The primary and secondary outcome measures were the Spence Children's Anxiety Scale (SCAS) to assess children's anxiety symptoms and the Strengths and Difficulties Questionnaire (SDQ) to measure behaviour problems, respectively. RESULTS A statistically significant reduction in the SCAS score in the intervention group was found at 2-month follow-up compared with the control group. A significant reduction was also observed in the SDQ score. CONCLUSIONS Our findings suggested that the 'Journey of the Brave' programme, which requires only 5 h of short classroom activities, demonstrates promising results compared with previous programmes. A larger randomised control trial would be desirable. TRIAL REGISTRATION UMIN, UMIN000009021, Registered 10 March 2012.
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Affiliation(s)
- Yuko Urao
- Research Centre for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Michiko Yoshida
- grid.136304.30000 0004 0370 1101Department of Cognitive Behavioural Physiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
| | - Yasunori Sato
- grid.26091.3c0000 0004 1936 9959Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Eiji Shimizu
- grid.136304.30000 0004 0370 1101Research Centre for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan ,grid.136304.30000 0004 0370 1101Department of Cognitive Behavioural Physiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
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17
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Brown A, Noone K, Rapee RM, Kangas M, Anderson V, Bayer JK. Preventing internalising problems in preschoolers with chronic physical health conditions. J Child Health Care 2022; 26:228-241. [PMID: 33913784 DOI: 10.1177/13674935211013192] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This pilot study aimed to explore the suitability of a preventative intervention for internalising problems in young children with chronic physical health conditions. The pilot study focused on a subsample of 27 children with chronic physical health conditions within a population-level randomised controlled trial of the Cool Little Kids parenting programme. The Cool Little Kids parenting programme aims to prevent the development of internalising problems in inhibited (shy/anxious) preschool children by educating parents to reduce young children's avoidant coping styles and manage their anxiety/distress. The wider trial recruited 545 temperamentally inhibited preschool children. Measures included child health/development concerns and internalising symptoms at baseline, feedback on Cool Little Kids post-intervention and child internalising problems at one- and two-year longitudinal follow-up. At baseline, inhibited children with and without chronic physical health conditions had levels of internalising symptoms above the normative mean. At post-intervention, parents of children with chronic physical health conditions gave feedback that Cool Little Kids was helpful for managing their child's emotional distress. At follow-up, significantly fewer intervention than control children with chronic physical health conditions had specific phobia after 1 year (25% vs 70%) and specific fear symptoms after 2 years (mean 9.57 vs 16.89). As the pilot findings are promising, a further trial of Cool Little Kids in a physical health treatment service with a larger sample of children with chronic physical illness diagnoses would be worthwhile.
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Affiliation(s)
- Amy Brown
- School of Psychology and Public Health, 2080La Trobe University, Melbourne, Australia
| | - Kate Noone
- School of Psychology and Public Health, 2080La Trobe University, Melbourne, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, 7788Macquarie University, Sydney, Australia
| | - Maria Kangas
- Centre for Emotional Health, 7788Macquarie University, Sydney, Australia
| | - Vicki Anderson
- 34361Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, 2281University of Melbourne, Melbourne, Australia
| | - Jordana K Bayer
- School of Psychology and Public Health, 2080La Trobe University, Melbourne, Australia.,34361Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, 2281University of Melbourne, Melbourne, Australia
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18
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Gazelle H. Two Models of the Development of Social Withdrawal and Social Anxiety in Childhood and Adolescence: Progress and Blind Spots. CHILDREN 2022; 9:children9050734. [PMID: 35626911 PMCID: PMC9140141 DOI: 10.3390/children9050734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/04/2022] [Accepted: 05/13/2022] [Indexed: 11/23/2022]
Abstract
This commentary features a review of two recently reformulated models of the development of child and adolescent: (1) social withdrawal by Rubin and Chronis-Tuscano 2021, and (2) social anxiety by Spence and Rapee 2016. The articles that present these reformulated models now cover advances made during the prior 12 to 18 years of research, including increased knowledge of genetic vulnerability to anxiety and longitudinal patterns of development, and acknowledgement of multiple pathways towards and away from the development of social withdrawal or social anxiety (i.e., equifinality, multifinality). However, these reformulated models also contain several blind spots. The model of social withdrawal development would be improved by explicitly referring to peer treatment (not only attitudinal peer rejection), especially peer exclusion; and incorporating the potential development of clinically significant anxiety in childhood (not only adolescence) and delays in developmental milestones in adulthood. The model of social anxiety development would be improved by featuring social withdrawal as a proximal affective-behavioral profile (rather than a temperament) and drawing upon the literature on social withdrawal and its links to peer relations. Overall, there is a continuing lack of integration between developmental and clinical research and models of the development of social withdrawal and social anxiety.
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Affiliation(s)
- Heidi Gazelle
- Human Development and Family Science, Florida State University, Tallahassee, FL 32306, USA
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19
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Ooi J, Dodd HF, Meiser-Stedman R, Hudson JL, Bridges J, Pass L. The efficacy of interventions for behaviourally inhibited preschool-aged children: A meta-analysis. J Anxiety Disord 2022; 88:102559. [PMID: 35366584 DOI: 10.1016/j.janxdis.2022.102559] [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: 05/17/2021] [Revised: 03/01/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
Abstract
The current systematic review and meta-analyses examined the efficacy of psychological interventions targeting behavioural inhibition and anxiety in preschool-aged children, evaluated within randomised controlled trials. Web of Science, MEDLINE, PsycINFO and CINAHL were systematically searched from inception to March 2021. Ten studies (N = 1475 children, aged 3 - 7 years) were included in the current review. Separate analyses were conducted for behavioural inhibition, anxiety symptoms, and anxiety diagnosis as reported by parents, teachers, and observer-ratings. Pooled outcomes ranged from post-intervention to 12-month follow-up due to the limited number of studies. Meta-analyses revealed that intervention did not reduce behavioural inhibition as assessed by independent observers (SMD = -0.13, 95% CI = -0.63 to.38), but did reduce behavioural inhibition as reported by parents (SMC = -0.64, 95% CI = -1.00 to -0.27) and teachers (SMD = -0.69, 95% CI = -1.02 to -0.36). Additionally, intervention appeared to reduce the risk of anxiety disorders (RR =0.75, 95% CI =0.62 to.90), and parent-report anxiety symptoms (SMC = -0.47, 95% CI = -0.83 to -0.12) in preschool-aged children. Intervention may be efficacious in reducing anxiety in preschool-aged behaviourally inhibited children. It is less clear whether intervention leads to change in BI.
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Affiliation(s)
- Jinnie Ooi
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; Department of Clinical Psychology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, UK.
| | - Helen F Dodd
- College of Medicine and Health, St Luke's Campus, Heavitree Road, University of Exeter, Exeter EX1 2LU, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Jennifer L Hudson
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW 2031, Australia
| | - Jessica Bridges
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Laura Pass
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
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20
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Busch HEC, Viana AG, Raines EM, Trent ES, Zvolensky MJ, Storch EA. Fearful Temperament, Catastrophizing, and Internalizing Symptoms in Clinically Anxious Youth. J Cogn Psychother 2022; 37:JCP-2021-0022.R1. [PMID: 35470150 DOI: 10.1891/jcp-2021-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A fearful temperament in childhood is associated with child internalizing symptoms. However, the cognitive mechanisms explaining this association are poorly understood. We examined the effects of child fearful temperament on child internalizing symptoms and the underlying role of catastrophizing cognitions among clinically anxious youth. Children (N = 105; M age = 10.09 years, SD = 1.22; 56.7% female; 62% ethnic minority) completed a diagnostic interview; self-report measures of temperament, catastrophizing, and internalizing symptoms; and behaviorally-indexed measures of catastrophizing and anxiety. Indirect effects were found for child fearful temperament on child self-reported internalizing symptoms by way of self-reported (but not behaviorally-indexed) catastrophizing cognitions. Models predicting behaviorally-indexed child anxiety were not significant. Our findings suggest that targeting fearful temperament during childhood before catastrophizing cognitions develop may have clinical utility. Likewise, among children temperamentally at-risk, addressing catastrophic cognitions may prevent later internalizing psychopathology.
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Affiliation(s)
| | - Andres G Viana
- Department of Psychology, University of Houston, Houston, TX, 77204
- Texas Institute of Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, 77204
| | | | - Erika S Trent
- Department of Psychology, University of Houston, Houston, TX, 77204
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, 77204
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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21
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Aune T, Nordahl HM, Beidel DC. Social anxiety disorder in adolescents: Prevalence and subtypes in the Young-HUNT3 study. J Anxiety Disord 2022; 87:102546. [PMID: 35248811 DOI: 10.1016/j.janxdis.2022.102546] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 02/03/2022] [Accepted: 02/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few studies have examined the prevalence of social anxiety disorder (SAD) among adolescents and the associated sex-specific fears. No previous studies have reported variance in SAD prevalence among adolescents based on a stepwise diagnostic approach. METHODS Using various diagnostic thresholds from the Anxiety Disorders Interview Schedule child version, and the diagnostic criteria from both the 4th and 5th editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), we explored the point prevalence of SAD among a population-based sample of 8216 adolescents aged 13-19 years. RESULTS Overall, 2.6% of adolescents met the SAD diagnostic criteria. The prevalence varied from 2.0% to 5.7% depending on the criteria-set. Twice as many females met the overall SAD criteria. The DSM-IV generalized SAD subtype was assigned to 86.5% of the sample, while 3.5% met the DSM-5 performance-only subtype. Compared with males aged 16-19 years, significantly more of those aged 13-15 years met the SAD criteria; no significant age group differences were found among females. CONCLUSIONS This is the first study to demonstrate variance in SAD prevalence among adolescents based on the diagnostic threshold method. Depending on the threshold applied, SAD prevalence among adolescents varied from 2.0% to 5.7%. Age and sex differences in social fear experiences highlight the importance of considering developmental heterogeneity in SAD, especially for adapting prevention and treatment interventions.
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Affiliation(s)
- Tore Aune
- Norwegian Directorate for Children, Youth and Family Affaires, Bomvegen 3, 7725 Steinkjer, Norway; Faculty of Nursing and Health Sciences, Nord University, Norway.
| | - Hans M Nordahl
- Department of Mental Health, NTNU, Trondheim, Norway; St. Olavs Hospital, Division of Psychiatry, Nidaros DPS, Trondheim, Norway
| | - Deborah C Beidel
- UCF RESTORES, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816, USA
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22
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Segal SC, Gobin KC. Threat-biased attention in childhood anxiety: A cognitive-affective developmental model. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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23
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Meyer A. On the relationship between the error-related negativity and anxiety in children and adolescents: From a neural marker to a novel target for intervention. Psychophysiology 2022; 59:e14050. [PMID: 35324015 DOI: 10.1111/psyp.14050] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/20/2022] [Accepted: 02/23/2022] [Indexed: 01/02/2023]
Abstract
The current review focuses on our work on the relationship between the error-related negativity (i.e., ERN) and anxiety in children and adolescents. The ERN is an event-related potential (ERP) that appears as a negative deflection in the ERP waveform when individuals make errors and has been found to be increased in anxious individuals. We, and others, have extended this work into developmental populations, finding that the ERN can be measured reliably in children and that the ERN is increased among clinically anxious youth. Furthermore, we have found that the ERN predicts risk for increases in anxiety across development, among healthy and clinically anxious children. We have done work to elucidate what psychological phenomena the increased ERN among anxious children may reflect by creating a self-report measure of error sensitivity (i.e., the Child Error Sensitivity Index) that relates to the ERN. Moreover, we review our work on parenting and the ERN, which suggests that harsh or critical parenting styles may potentiate the ERN in offspring. And, building on these findings, we discuss our recent work to develop novel, computerized intervention strategies to reduce the ERN and thereby risk for anxiety.
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Affiliation(s)
- Alexandria Meyer
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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Chronis-Tuscano A, Novick DR, Danko CM, Smith KA, Wagner NJ, Wang CH, Druskin L, Dougherty LR, Rubin KH. Early intervention for inhibited young children: a randomized controlled trial comparing the Turtle Program and Cool Little Kids. J Child Psychol Psychiatry 2022; 63:273-281. [PMID: 34184792 PMCID: PMC11270476 DOI: 10.1111/jcpp.13475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Children classified as behaviorally inhibited (BI) are at risk for social anxiety. Risk for anxiety is moderated by both parental behavior and social-emotional competence. Grounded in developmental-transactional theory, the Turtle Program involves both parent and child treatment components delivered within the peer context. Our pilot work demonstrated beneficial effects of the Turtle Program ('Turtle') over a waitlist control group. Herein, we report results of a rigorous randomized controlled trial (RCT) comparing Turtle to the best available treatment for young children high in BI, Cool Little Kids (CLK). METHODS One hundred and fifty-one parents and their 3.5- to 5-year-old children selected on the basis of BI were randomly assigned to Turtle or CLK, delivered in group format over 8 weeks. Effects on child anxiety, life interference, BI, and observed parenting were examined at post-treatment and 1-year follow-up. ClinicalTrials.gov registration: NCT02308826. RESULTS No significant main effect differences were found between Turtle and CLK on child anxiety; children in both programs evidenced significant improvements in BI, anxiety severity, family accommodation, and child impairment. However, Turtle yielded increased observed warm/engaged parenting and decreased observed negative control, compared with CLK. Parental social anxiety moderated effects; parents with higher anxiety demonstrated diminished improvements in child impairment, and parent accommodation in CLK, but not in Turtle. Children of parents with higher anxiety demonstrated more improvements in child BI in Turtle, but not in CLK. CONCLUSIONS Turtle and CLK are both effective early interventions for young children with BI. Turtle is more effective in improving parenting behaviors associated with the development and maintenance of child anxiety. Turtle also proved to be more effective than CLK for parents with social anxiety. Results suggest that Turtle should be recommended when parents have social anxiety; however, in the absence of parent anxiety, CLK may offer a more efficient treatment model.
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Affiliation(s)
| | | | | | - Kelly A. Smith
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Nicholas J. Wagner
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Christine H. Wang
- Division of Endocrinology and Diabetes, Children’s National Hospital, Washington, DC, USA
| | - Lindsay Druskin
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Lea R. Dougherty
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Kenneth H. Rubin
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
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25
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Reardon T, Dodd H, Hill C, Jasper B, Lawrence PJ, Morgan F, Rapee RM, Ukoumunne OC, Violato M, Davey E, Halliday G, Jones B, Martineau L, McCall A, Niekamp N, Placzek A, Potts R, Weisser T, Creswell C. Minimising young children's anxiety through schools (MY-CATS): protocol for a cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of an online parent-led intervention compared with usual school practice for young children identified as at risk for anxiety disorders. Trials 2022; 23:149. [PMID: 35168635 PMCID: PMC8848959 DOI: 10.1186/s13063-022-06010-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying and supporting young children who are at risk of developing anxiety disorders would benefit children, families, and wider society. Elevated anxiety symptoms, inhibited temperament, and high parental anxiety are established risk factors for later anxiety disorders, but it remains unclear who is most likely to benefit from prevention and early intervention programmes. Delivering an online intervention through schools to parents of young children who have one or more of these risks could maximise reach. The primary aim of this trial is to evaluate the effectiveness and cost-effectiveness of delivering an online parent-led intervention, compared with usual school provision only, for children (aged 4-7) identified as at risk for anxiety disorders on the basis of at least one risk factor. We also aim to identify the characteristics of children who do and do not benefit from intervention and mechanisms of change from the intervention. METHODS The design will be a parallel group, superiority cluster randomised controlled trial, with schools (clusters) randomised to intervention or usual school practice arms in a 1:1 ratio stratified according to level of deprivation within the school. The study will recruit and randomise at least 60 primary/infant schools in England, and on the basis of recruiting 60 schools, we will recruit 1080 trial participants (540 per arm). Parents of all children (aged 4-7) in sampled Reception, Year 1, and Year 2 classes will be invited to complete screening questionnaires. Children who screen positive on the basis of anxiety symptoms, and/or behavioural inhibition, and/or parent anxiety symptoms will be eligible for the trial. Parents/carers of children in schools allocated to the intervention arm will be offered a brief online intervention; schools in both arms will continue to provide any usual support for children and parents throughout the trial. Assessments will be completed at screening, baseline (before randomisation), 6 weeks, 12 weeks, and 12 months post-randomisation. The primary outcome will be the absence/presence of an anxiety disorder diagnosis at 12 months. DISCUSSION The trial will determine if delivering an online intervention for parents of young children at risk of anxiety disorders identified through screening in schools is effective and cost-effective. TRIAL REGISTRATION ISRCTN 82398107 . Prospectively registered on Jan. 14, 2021.
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Affiliation(s)
- Tessa Reardon
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.
| | - Helen Dodd
- College of Medicine and Health, University of Exeter, Exeter, UK
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Claire Hill
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Bec Jasper
- Parents and Carers Together, Suffolk, UK
| | - Peter J Lawrence
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, England
| | | | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Emily Davey
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Gemma Halliday
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Benjamin Jones
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Lindsey Martineau
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Amy McCall
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Natascha Niekamp
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Anna Placzek
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Ruth Potts
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Tamatha Weisser
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
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26
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Acceptability and Outcomes of the Cool Little Kids Parenting Group Program for Culturally and Linguistically Diverse Families Within an Australian Population-Based Study. Child Psychiatry Hum Dev 2022:10.1007/s10578-021-01293-5. [PMID: 35034229 DOI: 10.1007/s10578-021-01293-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2021] [Indexed: 11/03/2022]
Abstract
This feasibility study explored suitability of a preventive intervention for internalising problems in young children for culturally and linguistically diverse families in Australia. A subsample of 62 families whose main language at home was other than English was selected from a population-based randomised trial of the Cool Little Kids parenting program. The population trial recruited 545 inhibited preschool children. Measures included family demographics, feedback post-intervention and child internalising problems at longitudinal follow-up. Parents of children whose main language at home was not English gave feedback that Cool Little Kids was helpful for managing their inhibited child's emotional distress. Significantly fewer intervention than control children whose main language at home was not English had separation anxiety symptoms after 2 years (M (SD) = 3.00 (3.15) versus 5.95 (3.98), p = 0.041). Further work to expand accessibility of Cool Little Kids to recent immigrant parents who do not speak English could be worthwhile.
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27
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The Cool Kids as a School-Based Universal Prevention and Early Intervention Program for Anxiety: Results of a Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020941. [PMID: 35055763 PMCID: PMC8775776 DOI: 10.3390/ijerph19020941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
Abstract
The efficacy of the Cool Kids program has been consistently demonstrated both within Australia and internationally, but limited data are available on the use of Cool Kids as a universal program. The purpose of the study is to evaluate Cool Kids as a universal program for preventing childhood anxiety in the school context. There were 73 Italian children (35 boys and 36 girls, ages 10–13 years) attending the last year of primary school and the first year of middle school who participated in an active intervention based on a school adaptation of the Cool Kids protocol. Results of t-test analyses highlighted a downward trend of anxiety symptoms, especially in total anxiety, somatic anxiety, generalized anxiety, separation anxiety, social anxiety and school phobia at post-treatment assessed by children. Even the score of depression symptoms, measured as a second outcome measure, decreased after the treatment. This study contributes to the evidence base for the Cool Kids program as a universal program for preventing childhood anxiety in the school context. Although these preliminary results show some promise, their replication in future research is necessary given current study limitations.
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Bayer JK, Brown A, Prendergast LA, Bretherton L, Hiscock H, Mihalopoulos C, Nelson-Lowe M, Gilbertson T, Noone K, Bischof N, Beechey C, Muliadi F, Rapee RM. Follow-up of the Cool Little Kids translational trial into middle childhood. J Child Psychol Psychiatry 2022; 63:88-98. [PMID: 34128236 DOI: 10.1111/jcpp.13464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Public health advocates have highlighted internalising problems as a leading cause of global burden of disease. Internalising problems (anxiety/depression) affect up to 20% of school-age children and can impact peer relations, school engagement and later employment and mortality. This translational trial aimed to determine whether a selective/indicated parenting group programme to prevent internalising distress in shy/inhibited preschool children had sustained effects in middle childhood. Translational design aspects were a brief parent-report screening tool for child inhibition offered universally across the population via preschools in the year before school, followed by an invitation to parents of all inhibited children to attend the parenting programme at venues in their local community. METHODS Design of the study was a randomised controlled trial. The setting was 307 preschool services across eight socioeconomically diverse government areas in Melbourne, Australia. Participants were 545 parents of inhibited four-year-old children of which 456 (84%) were retained during middle childhood (age of seven to 10 years). Early intervention was the Cool Little Kids parenting group programme, and control was 'usual care' access to available support services in the community. Primary outcomes were child anxiety and depression symptoms (parent and child report) and DSM-IV anxiety disorders (assessor masked). Secondary outcomes were parenting practices and parent mental health. RESULTS There was no significant difference in anxiety disorders between the intervention and control group during the three annual follow-ups of the cohort in middle childhood (2015 43% vs. 41%, 2016 40% vs. 36%, 2017 27% vs. 30%, respectively; p's > .05). There were also no significant differences in child anxiety or depression symptoms (by child or parent report), parenting practices or parent mental health, between the intervention and control group during middle childhood. However, a priori interaction tests suggested that for children with anxious parents, early intervention attenuated risk for middle childhood internalising problems. CONCLUSIONS An issue for population translation is low levels of parent engagement in preventive interventions. Initial effects of the Cool Little Kids parenting group programme in reducing shy/inhibited preschool children's internalising distress at school entry dissipated over time, perhaps due to low engagement. Future translational research on early prevention of internalising problems could benefit from screening preschool children in the population at higher risk (combining temperamental inhibition and parent distress) and incorporating motivational techniques to facilitate family engagement. Trial registration ISRCTN30996662 http://www.isrctn.com/ISRCTN30996662.
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Affiliation(s)
- Jordana K Bayer
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia
| | - Amy Brown
- Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Luke A Prendergast
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Vic, Australia
| | - Lesley Bretherton
- Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia.,Royal Children's Hospital, Melbourne, Vic, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Vic, Australia
| | | | | | - Kate Noone
- Royal Children's Hospital, Melbourne, Vic, Australia
| | - Natalie Bischof
- Eastern Health Child and Youth Mental Health Service, Melbourne, Vic, Australia
| | | | | | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
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29
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Lawrence PJ, Harvey K, Williams C, Creswell C. Barriers and facilitators to targeted anxiety prevention programmes in families at risk: a qualitative interview study. Eur Child Adolesc Psychiatry 2022; 31:565-575. [PMID: 33346882 PMCID: PMC9034995 DOI: 10.1007/s00787-020-01703-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 12/07/2020] [Indexed: 12/24/2022]
Abstract
Anxiety disorders are the most common psychiatric disorder in children and young people. They can be prevented in those at risk, but families do not always take up opportunities to participate in prevention programmes. This qualitative study aimed to understand what families with children who were at prospective risk of anxiety disorders perceived to be the barriers to access to targeted anxiety prevention programmes, and to explore what would help facilitate access. We used Information Power to determine our sample size, and individually interviewed seven young people (14-17 years) who had anxiety disorders and their mothers, each of whom had pre-natal anxiety disorders. We transcribed all interviews and thematically analyzed them to identify perceived barriers and facilitators to targeted anxiety prevention programmes. Perceived potential barriers to access included possible negative consequences of anxiety prevention, difficulties in identifying anxiety as a problem and concerns about how professions would respond to raising concerns about anxiety. Possible facilitators included promoting awareness of anxiety prevention programmes and involvement of schools in promotion and delivery of prevention. Our findings illustrate that implementation of targeted anxiety prevention could be improved through (i) the provision of tools for parents to recognize anxiety in their children as a problem, (ii) promotion of awareness, as well as delivery, of anxiety prevention via schools and (iii) the involvement of parents and possibly adolescents in the intervention programme, but not younger children.
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Affiliation(s)
- P J Lawrence
- School of Psychology, University of Southampton, Southampton, UK.
| | - K Harvey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - C Williams
- Department of Experimental Psychology , University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - C Creswell
- Department of Experimental Psychology , University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
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30
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Jones LB, Hall BA, Kiel EJ. Systematic review of the link between maternal anxiety and overprotection. J Affect Disord 2021; 295:541-551. [PMID: 34509069 PMCID: PMC8551038 DOI: 10.1016/j.jad.2021.08.065] [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: 01/25/2021] [Revised: 08/10/2021] [Accepted: 08/25/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Theoretical and empirical evidence suggests that maternal anxiety relates to overprotection, yet studies have found conflicting evidence. The literature would benefit from a systematic review. METHODS In April 2020, a systematic review on the relation between maternal anxiety and overprotection was conducted. The search was updated in January 2021. A total of 13 articles were included. RESULTS Of 16 reported bivariate correlations, 12 showed that maternal anxiety accounted for significant variance in overprotection (7 reported a small effect and 5 reported a medium effect). In a group differences study, mothers with anxiety showed greater overprotection. Additionally, in 4 out of 7 multivariate relations maternal anxiety accounted for significant variance in overprotection over and above other factors while 3 suggested that maternal anxiety did not account for significant variance in overprotection. In a multivariate, longitudinal study, maternal anxiety predicted overprotection, over and above other factors. Given conflicting evidence, we evaluated article's methodological strength and found stronger evidence supporting a small to medium size relation compared to evidence supporting no significant relation. LIMITATIONS We report ranges of coefficients and effect sizes, but meta-analytic results are needed to determine the magnitude of these relations based on various factors. More longitudinal studies are needed to determine directionality. CONCLUSIONS Although the literature shows conflicting results, the present review supports that maternal anxiety relates to overprotection, though the effect of this relation is small to medium. It may be beneficial to incorporate mental health for parents into existing parenting interventions.
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Affiliation(s)
- Lauren B. Jones
- Lauren B. Jones may be contacted at or 513-529-2400. Additionally, she may be contacted at Miami University, 90 N. Patterson Ave., Oxford, OH, 45056
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31
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Dominick KC, Andrews HF, Kaufmann WE, Berry-Kravis E, Erickson CA. Psychotropic Drug Treatment Patterns in Persons with Fragile X Syndrome. J Child Adolesc Psychopharmacol 2021; 31:659-669. [PMID: 34818076 DOI: 10.1089/cap.2021.0042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: Psychiatric comorbidity is common in fragile X syndrome (FXS) and often addressed through pharmacological management. Here we examine data in the Fragile X Online Registry With Accessible Research Database (FORWARD) to characterize specific symptoms being treated with psychotropic medication, patterns of medication use, as well as the influence of gender, intellectual disability (ID), age, and autism spectrum disorder (ASD) diagnosis. Methods: Data were drawn from the 975 participants who have a completed clinician form. We explored the frequency of psychotropic medication use for the following symptom clusters: attention, hyperactivity, anxiety, hypersensitivity, obsessive-compulsive disorder (OCD), mood swings, irritability/agitation, aggression, and self-injury (IAAS). Results: A majority of participants (617 or 63.3%) were taking a psychotropic medication, including investigational drugs. Medications were often targeting multiple symptoms. Psychotropic medication use was more common in males, adolescents, and those with comorbid ID and ASD. Anxiety was the most frequently targeted symptom, followed by attention-deficit/hyperactivity disorder symptoms and IAAS. Selective serotonin reuptake inhibitors (SSRIs) were the most frequently prescribed medication class among all patients (n = 266, 43%), followed by stimulants (n = 235, 38%), each with no gender difference. Antipsychotics were the third most frequently prescribed medication class (n = 205, 33%), and were more frequently prescribed to males and those with ID and ASD. Conclusions: Anxiety, attention and hyperactivity were the most common symptom targets for psychopharmacologic intervention in FXS. Our results support clinical knowledge that males with comorbid ASD and ID have a more severe presentation requiring more intervention including medications. These results highlight the need for examination of symptom overlap and interaction.
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Affiliation(s)
- Kelli C Dominick
- Department of Psychiatry, University of Cincinnati College of Medicine. Cincinnati, Ohio, USA.,Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Howard F Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Walter E Kaufmann
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elizabeth Berry-Kravis
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurological Sciences, and Rush University Medical Center, Chicago, Illinois, USA.,Department of Biochemistry, Rush University Medical Center, Chicago, Illinois, USA
| | - Craig A Erickson
- Department of Psychiatry, University of Cincinnati College of Medicine. Cincinnati, Ohio, USA.,Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Slade EP, Ginsburg GS, Riddle MA. Cost-benefit Analysis of the Coping and Promoting Strength Program. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:1096-1107. [PMID: 34647197 DOI: 10.1007/s11121-021-01309-5] [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: 09/15/2021] [Indexed: 11/24/2022]
Abstract
This study sought to estimate the net benefits and return on investment (ROI, %) of the Coping and Promoting Strength (CAPS) program to families and insurers, respectively, using data from a multi-year follow up of 136 US families who had participated in a randomized efficacy trial of CAPS. CAPS is a brief parent-focused psychosocial intervention that was compared to information monitoring in the trial. Of the 136 original participants, 113 (83%) completed follow-up interviews 7.1 years, on average, after the CAPS study baseline (mean follow-up age: 15.8 years; range: 13.1 to 20.8 years). Parent-reported willingness-to-pay values and estimates of behavioral healthcare cost savings from delayed onset of anxiety were used to simulate the average net benefits of CAPS to families and insurance plans, respectively, assuming patients pay 20% coinsurance. Psychologists in private offices were expected to charge an average of approximately $195 per CAPS session or $1417 in total in 2020 dollars. The estimated family share of the total CAPS session cost was $283 per youth, while the insurer share was $1134 per youth. Given these costs, the CAPS intervention was estimated to result in average overall net benefits of $1033 per youth (95% CI: -$546 to $2611). Families gained $344 (95% CI: $232 to $455 per family) for an ROI of 121%. Insurance plans on average gained a net savings of $689 per youth (95% CI: -$778 to $2156 per youth) for an average ROI of 61%. In this multiyear follow-up of offspring of anxious parents, exposure to the CAPS pediatric anxiety prevention program was found to be more economically efficient than was waiting for an anxiety disorder to be diagnosed. ClinicalTrials.gov Identifier: NCT00847561.
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Affiliation(s)
- Eric P Slade
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Golda S Ginsburg
- School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Mark A Riddle
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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33
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Keefer A, Vasa RA. DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD. J Neurodev Disord 2021; 13:46. [PMID: 34635048 PMCID: PMC8504090 DOI: 10.1186/s11689-021-09396-9] [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: 01/07/2021] [Accepted: 09/22/2021] [Indexed: 12/28/2022] Open
Abstract
Background Anxiety disorders are highly prevalent in children and adolescents with autism spectrum disorder and often emerge before the age of 6 years. Yet, only a few studies have examined anxiety treatment for this group. Preliminary evidence from these studies suggests that utilizing cognitive behavioral therapy (CBT) as well as strategies to target intolerance of uncertainty (IU) and parental accommodation, known mechanistic and maintaining factors of anxiety may improve anxiety and optimize outcomes in this age group. Main body To meet this need, we developed an integrated treatment called DINO Strategies for Anxiety and intolerance of Uncertainty Reduction (DINOSAUR), a 12-week group telehealth treatment for 4- to 6-year-old children with ASD. DINOSAUR works with young children and their parents to deliver CBT along with interventions targeting IU and parental accommodation. In this paper, we first discuss the rationale for developing this treatment and then describe a pilot study of its feasibility and preliminary efficacy. Conclusions There is a great need to develop anxiety treatments for young children with ASD. We proposed a novel integrated treatment approach that aims to alter the way young children and parents respond to fear, which could potentially improve short- and long-term mental health outcomes for this age group. Trial registration ClinicalTrials.govNCT04432077 on June 03, 2020
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Affiliation(s)
- Amy Keefer
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, USA. .,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Roma A Vasa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
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34
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Targeting risk factors for inhibited preschool children: An anxiety prevention program. Behav Res Ther 2021; 147:103982. [PMID: 34678709 DOI: 10.1016/j.brat.2021.103982] [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: 06/12/2020] [Revised: 08/30/2021] [Accepted: 09/30/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Children with a behaviorally inhibited temperament during early childhood have been shown to have an increased risk for developing anxiety disorders. This study evaluated the efficacy of an anxiety prevention program aimed at reducing the risk of anxiety in behaviorally inhibited preschool children. METHOD Participants were 86 children aged 41-57 months and their mothers. Children were selected if their mothers reported high levels of child behavioral inhibition on a screening measure. Participants were randomly allocated to a nine-session intervention or a waitlist control condition. Mothers and children both participated in the intervention. RESULTS At follow-up, the intervention group had significantly fewer clinician-rated child anxiety disorders and fewer mother-reported child anxiety symptoms than at baseline but this change was not significantly different to the change seen in the waitlist control group. CONCLUSIONS On average, across the course of the study, anxiety decreased in all children irrespective of group. A number of potential reasons for this are discussed along with implications for research and clinical practice.
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35
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Valadez EA, Troller-Renfree SV, Buzzell GA, Henderson HA, Chronis-Tuscano A, Pine DS, Fox NA. Behavioral inhibition and dual mechanisms of anxiety risk: Disentangling neural correlates of proactive and reactive control. JCPP ADVANCES 2021; 1. [PMID: 34595482 PMCID: PMC8477434 DOI: 10.1002/jcv2.12022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Behavioral inhibition (BI) is a temperament style characterized by heightened reactivity and negative affect in response to novel people and situations, and it predicts anxiety problems later in life. However, not all BI children develop anxiety problems, and mounting evidence suggests that how one manages their cognitive resources (cognitive control) influences anxiety risk. The present study tests whether more (proactive control) or less (reactive control) planful cognitive strategies moderate relations between early BI and later anxiety. Methods: Participants included 112 adolescents (55% female; Mage = 15.4 years) whose temperament was assessed during toddlerhood. In adolescence, participants completed an AX Continuous Performance Test while electroencephalography was recorded to disentangle neural activity related to proactive (cue-locked P3b) and reactive (probe-locked N2) control. Results: Greater BI was associated with greater total anxiety scores only among adolescents with smaller ΔP3bs and larger ΔN2s—a pattern consistent with decreased reliance on proactive strategies and increased reliance on reactive strategies. Additionally, a larger ΔP3b was associated with greater total anxiety scores; however, this effect was largely explained by the fact that females tended to have larger ΔP3bs and greater anxiety than males. Conclusions: Early BI relates to risk for later anxiety specifically among adolescents who rely less on proactive strategies and more on reactive control strategies. Thus, cognitive control strategy moderates the association between developmental context (i.e., temperament) and later anxiety. The present study is the first to characterize how proactive and reactive control uniquely relate to pathways toward anxiety risk.
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Affiliation(s)
- Emilio A Valadez
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
| | - Sonya V Troller-Renfree
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - George A Buzzell
- Department of Psychology, Florida International University, Miami, Florida, USA
| | | | | | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland, USA
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
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Bayer JK, Prendergast LA, Brown A, Harris L, Bretherton L, Hiscock H, Beatson R, Mihalopoulos C, Rapee RM. Cool Little Kids translational trial to prevent internalising: two-year outcomes and prediction of parent engagement. Child Adolesc Ment Health 2021; 26:211-219. [PMID: 33247555 DOI: 10.1111/camh.12420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim was to determine outcomes in the first year of school of a population-delivered parenting program to prevent internalising problems in temperamentally inhibited preschool children and predictors of engagement in parenting groups. METHOD Design: Randomised controlled trial. SETTING 307 preschool services across eight socio-economically diverse government areas in Melbourne, Australia. PARTICIPANTS 545 parents of inhibited 4-year-old children; 469 (86%) retained at two-year follow-up. INTERVENTION Cool Little Kids program. Primary outcomes were child internalising symptoms and anxiety disorders. Secondary outcomes were parenting, parent well-being and engagement. Trial registration ISRCTN30996662 http://www.isrctn.com/ISRCTN30996662. RESULTS In the first year of school (M (SD) age 6.7 (0.4) years), child anxiety symptoms were reduced in the intervention versus control arm (PAS-R M (SD): total 36.2 (17.2) versus 39.4 (18.5); adjusted difference -3.26, 95% CI -6.46 to -0.05, p = .047; specific fears 9.1 (6.2) versus 10.7 (6.8), adjusted difference -1.53; 95% CI -2.69 to -0.38, p = .009). However, there was little difference in broader child internalising (CMFWQ M (SD): 2.2 (0.5) versus 2.3 (0.6); adjusted difference -0.03, 95% CI -0.13 to 0.06, p = .489) or anxiety disorders (37.6% vs. 42.6%; adjusted OR 0.79, 95% CI 0.53 to 1.18, p = .242). Lower income, younger mothers, less educated and more culturally diverse fathers engaged less with the intervention. Continued skills practice was less frequent for parents of girls and in advantaged neighbourhoods. CONCLUSIONS There were population effects of Cool Little Kids in the first year of school for anxiety symptoms but not disorders. Considering motivation techniques to engage subgroups of families would be helpful in translation research.
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Affiliation(s)
- Jordana K Bayer
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Luke A Prendergast
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Vic., Australia
| | - Amy Brown
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - Lana Harris
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - Lesley Bretherton
- Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Vic., Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Centre for Community Child Health, The Royal Children's Hospital Melbourne, Melbourne, Vic., Australia
| | - Ruth Beatson
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Vic., Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
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Comer JS, Furr JM, Del Busto C, Silva K, Hong N, Poznanski B, Sanchez A, Cornacchio D, Herrera A, Coxe S, Miguel E, Georgiadis C, Conroy K, Puliafico A. Therapist-Led, Internet-Delivered Treatment for Early Child Social Anxiety: A Waitlist-Controlled Evaluation of the iCALM Telehealth Program. Behav Ther 2021; 52:1171-1187. [PMID: 34452671 DOI: 10.1016/j.beth.2021.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/17/2020] [Accepted: 01/16/2021] [Indexed: 12/14/2022]
Abstract
Despite recent advances in the treatment of early child social anxiety, the broad accessibility of brick-and-mortar services has been limited by traditional barriers to care, and more recently by new obstacles related to efforts to slow the spread of COVID-19. The present waitlist-controlled trial examined the preliminary efficacy of a family-based behavioral parenting intervention (i.e., the iCALM Telehealth Program) that draws on Parent-Child Interaction Therapy and videoconferencing to remotely deliver clinician-led care for anxiety in early childhood. Young children (3-8 years) with a diagnosis of social anxiety disorder (N = 40; 65% from ethnic/racial minority backgrounds) were randomly assigned to iCALM or waitlist. Intent-to-treat analyses found that at post, independent evaluators classified roughly half of the iCALM-treated children, but only 6% of waitlist children, as "Responders" (Wald test = 4.51; p = .03). By Post, iCALM led to significantly greater reductions than waitlist in child anxiety symptoms, fear, discomfort, and anxiety-related social impairment, and also led to greater improvements in child soothability. By 6-month follow-up, the percentage of iCALM-treated children classified as "Responders" rose to roughly 60%. Exploratory moderation tests found iCALM was particularly effective in reducing life impairments and parental distress among families presenting with higher, relative to lower, levels of baseline parental accommodation. The present findings add to a growing body of research supporting the promise of technology-based strategies for broadening the portfolio of options for delivering clinician-led mental health services.
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38
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Rubin KH, Chronis-Tuscano A. Perspectives on Social Withdrawal in Childhood: Past, Present, and Prospects. CHILD DEVELOPMENT PERSPECTIVES 2021; 15:160-167. [PMID: 34434251 DOI: 10.1111/cdep.12417] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In this article, we provide definitional clarity for the construct of social withdrawal as it was originally construed, and review the original theoretical and conceptual bases that led to the first research program dedicated to the developmental study of social withdrawal (the Waterloo Longitudinal Project). We also describe correlates (e.g., social and social-cognitive incompetence), precursors (e.g., dispositional characteristics, parenting, insecure attachment), and consequences (e.g., peer rejection and victimization, negative self-regard, anxiety) of social withdrawal, and discuss how the study of this type of withdrawal led to a novel intervention that targets risk factors that predict social withdrawal and its negative consequences.
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39
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Cordier R, Speyer R, Mahoney N, Arnesen A, Mjelve LH, Nyborg G. Effects of interventions for social anxiety and shyness in school-aged children: A systematic review and meta-analysis. PLoS One 2021; 16:e0254117. [PMID: 34242303 PMCID: PMC8270412 DOI: 10.1371/journal.pone.0254117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/20/2021] [Indexed: 11/19/2022] Open
Abstract
In school, shyness is associated with psychosocial difficulties and has negative impacts on children's academic performance and wellbeing. Even though there are different strategies and interventions to help children deal with shyness, there is currently no comprehensive systematic review of available interventions. This systematic review and meta-analysis aim to identify interventions for shy children and to evaluate the effectiveness in reducing psychosocial difficulties and other impacts. The methodology and reporting were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and checklist. A total of 4,864 studies were identified and 25 of these met the inclusion criteria. These studies employed interventions that were directed at school-aged children between six and twelve years of age and described both pre- and post-intervention measurement in target populations of at least five children. Most studies included an intervention undertaken in a school setting. The meta-analysis revealed interventions showing a large effect in reducing negative consequences of shyness, which is consistent with extant literature regarding shyness in school, suggesting school-age as an ideal developmental stage to target shyness. None of the interventions were delivered in a classroom setting, limiting the ability to make comparisons between in-class interventions and those delivered outside the classroom, but highlighting the effectiveness of interventions outside the classroom. The interventions were often conducted in group sessions, based at the school, and involved activities such as play, modelling and reinforcement and clinical methods such as social skills training, psychoeducation, and exposure. Traditionally, such methods have been confined to a clinic setting. The results of the current study show that, when such methods are used in a school-based setting and involve peers, the results can be effective in reducing negative effects of shyness. This is consistent with recommendations that interventions be age-appropriate, consider social development and utilise wide, school-based programs that address all students.
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Affiliation(s)
- Reinie Cordier
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
- Faculty of Health Sciences, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Renée Speyer
- Faculty of Health Sciences, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Natasha Mahoney
- Faculty of Health Sciences, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Anne Arnesen
- The Norwegian Center for Child Behavioral Development (NUBU), Oslo, Norway
| | - Liv Heidi Mjelve
- Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - Geir Nyborg
- Department of Special Needs Education, University of Oslo, Oslo, Norway
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40
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Lewis KM, Rafihi-Ferreira RE, Freitag GF, Coffman M, Ollendick TH. A 25-Year Review of Nighttime Fears in Children: Past, Present, and Future. Clin Child Fam Psychol Rev 2021; 24:391-413. [PMID: 34125354 DOI: 10.1007/s10567-021-00354-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Nighttime fears in children are common, interfere with daily functioning, and result in considerable disruption in the family. The aim of the present review was to examine empirical literature from the past 25 years that investigated the assessment of nighttime fears in young children and the efficacy and effectiveness of psychosocial treatments for children's nighttime fears. The last review of this literature was in 1997 and examined studies conducted in and prior to 1995 (King et al. in Clin Psychol Rev 17:431-443, 1997). Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review of the literature aimed at providing a synthesis of the Randomized Control Trials (RCTs) and controlled single-case multiple baseline design studies (MBLs) on the treatment of nighttime fears in children. A search of the literature identified 12 articles, with nine studies utilizing a between-group randomized controlled trial design and three studies utilizing a multiple baseline design. Results demonstrated significant improvements in children's nighttime fears and reductions in disruptive nighttime behaviors using behavioral interventions and cognitive-behavioral strategies. This review provides a commentary on the effectiveness and limitations of the assessment and treatment approaches for nighttime fears in children and suggests directions for future research.
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Affiliation(s)
- Krystal M Lewis
- National Institute of Mental Health, 9000 Rockville Pike, 10 Center Drive, Bldg.10 RM B1D43S, Bethesda, MD, 20814, USA.
| | - Renatha El Rafihi-Ferreira
- Institute of Psychiatry, Hospital da Clinicas - Faculty of Medicine, University of Sao Paulo, 785 Ovídio Pires de Campos, São Paulo, SP, 05403903, Brazil
| | - Gabrielle F Freitag
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | | | - Thomas H Ollendick
- Department of Psychology, Child Study Center, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24060, USA
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41
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Trajectories of behavioral avoidance in real time: Associations with temperament and physiological dysregulation in preschoolers. J Exp Child Psychol 2021; 209:105177. [PMID: 34089921 DOI: 10.1016/j.jecp.2021.105177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 12/28/2022]
Abstract
Although excessive avoidance has been implicated in mental health problems and socioemotional difficulties, relatively little is known about dynamic changes of avoidance behaviors. We used a latent class growth analysis to examine the temporal course of avoidance behaviors in real time and determined whether the derived classes were distinguishable on temperament and physiological markers of regulation and reactivity (N = 153; Mage = 4.20 years). A three-class solution was found and identified a low, medium, and high increasing avoidance group. The high and increasing avoidance group had the highest physiological reactivity (cortisol reactivity) and shyness, and the lowest physiological regulation (i.e., respiratory sinus arrythmia suppression). High and increasing avoidance may therefore be associated with temperamental and physiological indices of risk implicated in maladjustment and highlight the value of data-driven, group-based approaches for examining dynamic patterns of behavior.
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42
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Fox NA, Buzzell GA, Morales S, Valadez EA, Wilson M, Henderson HA. Understanding the Emergence of Social Anxiety in Children With Behavioral Inhibition. Biol Psychiatry 2021; 89:681-689. [PMID: 33353668 PMCID: PMC7954867 DOI: 10.1016/j.biopsych.2020.10.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/23/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022]
Abstract
Behavioral inhibition (BI) is a temperament characterized in early childhood by distress to novelty and avoidance of unfamiliar people, and it is one of the best-known risk factors for the development of social anxiety. However, nearly 60% of children with BI do not go on to meet criteria for social anxiety disorder. In this review we present an approach to understanding differential developmental trajectories among children with BI. We review research using laboratory-based tasks that isolate specific attention processes that enhance versus mitigate risk for social anxiety among behaviorally inhibited children and studies that suggest that BI is associated with heightened detection of novelty or threat. Moreover, stimulus-driven control processes, which we term "automatic control," increase the probability that behaviorally inhibited children display socially reticent behavior and develop social anxiety. In contrast, goal-driven control processes, which we term "planful control," decrease risk for anxiety. We suggest that these three categories of processes (detection, automatic control, and planful control) function together to determine whether behaviorally inhibited children are able to flexibly regulate their initial reactions to novelty, and in turn, decrease risk for social anxiety. Although laboratory-based tasks have identified these processes underlying risk and resilience, the challenge is linking them to the emotions, thoughts, and behaviors of behaviorally inhibited children in real-world contexts.
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Affiliation(s)
- Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland.
| | - George A Buzzell
- Department of Psychology, Florida International University, Miami, Florida
| | - Santiago Morales
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | - Emilio A Valadez
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | - McLennon Wilson
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
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43
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Creswell C, Nauta MH, Hudson JL, March S, Reardon T, Arendt K, Bodden D, Cobham VE, Donovan C, Halldorsson B, In-Albon T, Ishikawa SI, Johnsen DB, Jolstedt M, de Jong R, Kreuze L, Mobach L, Rapee RM, Spence SH, Thastum M, Utens E, Vigerland S, Wergeland GJ, Essau CA, Albano AM, Chu B, Khanna M, Silverman WK, Kendall PC. Research Review: Recommendations for reporting on treatment trials for child and adolescent anxiety disorders - an international consensus statement. J Child Psychol Psychiatry 2021; 62:255-269. [PMID: 32683742 DOI: 10.1111/jcpp.13283] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/03/2020] [Accepted: 05/12/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anxiety disorders in children and young people are common and bring significant personal and societal costs. Over the last two decades, there has been a substantial increase in research evaluating psychological and pharmacological treatments for anxiety disorders in children and young people and exciting and novel research has continued as the field strives to improve efficacy and effectiveness, and accessibility of interventions. This increase in research brings potential to draw together data across studies to compare treatment approaches and advance understanding of what works, how, and for whom. There are challenges to these efforts due largely to variation in studies' outcome measures and variation in the way study characteristics are reported, making it difficult to compare and/or combine studies, and this is likely to lead to faulty conclusions. Studies particularly vary in their reliance on child, parent, and/or assessor-based ratings across a range of outcomes, including remission of anxiety diagnosis, symptom reduction, and other domains of functioning (e.g., family relationships, peer relationships). METHODS To address these challenges, we convened a series of international activities that brought together the views of key stakeholders (i.e., researchers, mental health professionals, young people, parents/caregivers) to develop recommendations for outcome measurement to be used in treatment trials for anxiety disorders in children and young people. RESULTS AND CONCLUSIONS This article reports the results of these activities and offers recommendations for selection and reporting of outcome measures to (a) guide future research and (b) improve communication of what has been measured and reported. We offer these recommendations to promote international consistency in trial reporting and to enable the field to take full advantage of the great opportunities that come from data sharing going forward.
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Affiliation(s)
- Cathy Creswell
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Jennifer L Hudson
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Sonja March
- School of Psychology and Counselling, University of Southern Queensland, Springfield, QLD, Australia
| | - Tessa Reardon
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Denise Bodden
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Vanessa E Cobham
- Children's Health QLD Child and Youth Mental Health Service, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Caroline Donovan
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Brynjar Halldorsson
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK.,Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy Unit, University of Koblenz and Landau, Landau, Germany
| | | | | | - Maral Jolstedt
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Rachel de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Leonie Kreuze
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Lynn Mobach
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Ronald M Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Susan H Spence
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia.,Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD, Australia
| | | | - Elisabeth Utens
- Research Institute of Child Development and Education, University of Amsterdam / The Bascule / Amsterdam UMC, Amsterdam, The Netherlands.,Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sarah Vigerland
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Gro Janne Wergeland
- Division of Psychiatry, Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Cecilia A Essau
- Department of Psychology, University of Roehampton, London, UK
| | - Anne Marie Albano
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
| | - Brian Chu
- Department of Clinical Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Muniya Khanna
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Wendy K Silverman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
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44
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Dodd HF, Lester KJ. Adventurous Play as a Mechanism for Reducing Risk for Childhood Anxiety: A Conceptual Model. Clin Child Fam Psychol Rev 2021; 24:164-181. [PMID: 33464448 PMCID: PMC7880968 DOI: 10.1007/s10567-020-00338-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 01/05/2023]
Abstract
In this conceptual article, we draw upon the literature regarding cognitive and behavioural factors that underpin childhood anxiety to outline how a range of these risk markers might be targeted through adventurous play. When children play in an adventurous way, climbing trees, riding their bikes fast downhill and jumping from rocks, they experience feelings of fear and excitement, thrill and adrenaline. We propose that the positive, thrilling and playful emotions associated with this type of child-led play facilitate exposure to fear-provoking situations and, in doing so, provide opportunities for children to learn about physiological arousal, uncertainty and coping. We hypothesise that these learning opportunities will, over time, reduce children's risk for elevated anxiety by increasing children's expectations and ability to cope with anxiety, decreasing intolerance of uncertainty and preventing catastrophic misinterpretations of physiological arousal. If our conceptual model is correct, then ensuring that children have the physical and psychological space required to play in an adventurous way may help to decrease their risk for elevated or clinical anxiety.
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Affiliation(s)
- Helen F Dodd
- School of Psychology and Clinical Language Sciences, University of Reading, Whiteknights, Reading, RG6 6AL, UK.
| | - Kathryn J Lester
- School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QH, UK
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45
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Muris P, Ollendick TH. Current Challenges in the Diagnosis and Management of Selective Mutism in Children. Psychol Res Behav Manag 2021; 14:159-167. [PMID: 33623447 PMCID: PMC7896755 DOI: 10.2147/prbm.s274538] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/03/2021] [Indexed: 01/05/2023] Open
Abstract
Selective mutism (SM) is a childhood disorder characterized by a consistent failure to speak in specific social situations (eg, school) despite speaking normally in other settings (eg, at home). This article summarizes evidence supporting the recent classification of SM as an anxiety disorder and discusses the implications of this re-classification for the assessment and treatment of SM in clinical practice. Meanwhile, clinicians should also realize that SM sometimes is a heterogeneous disorder in which other problems are also present that complicate the management of children with SM. As examples, we discuss speech and language problems, developmental delay, and autism spectrum disorders.
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Affiliation(s)
- Peter Muris
- Department of Clinical Psychological Sciences, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Departement Sielkunde, Stellenbosch University, Stellenbosch, South Africa
| | - Thomas H Ollendick
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.,Department of Psychology, University of Roehampton London, London, UK
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46
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Yeo K, Frydenberg E, Northam E, Deans J. Coping with stress among preschool children and associations with anxiety level and controllability of situations. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12047] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kelly Yeo
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Victoria, Australia,
| | - Erica Frydenberg
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Victoria, Australia,
| | - Elizabeth Northam
- Department of Psychology, Royal Children's Hospital, Melbourne, Victoria, Australia,
| | - Janice Deans
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Victoria, Australia,
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47
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James AC, Reardon T, Soler A, James G, Creswell C. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 2020; 11:CD013162. [PMID: 33196111 PMCID: PMC8092480 DOI: 10.1002/14651858.cd013162.pub2] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Previous Cochrane Reviews have shown that cognitive behavioural therapy (CBT) is effective in treating childhood anxiety disorders. However, questions remain regarding the following: up-to-date evidence of the relative efficacy and acceptability of CBT compared to waiting lists/no treatment, treatment as usual, attention controls, and alternative treatments; benefits across a range of outcomes; longer-term effects; outcomes for different delivery formats; and amongst children with autism spectrum disorders (ASD) and children with intellectual impairments. OBJECTIVES To examine the effect of CBT for childhood anxiety disorders, in comparison with waitlist/no treatment, treatment as usual (TAU), attention control, alternative treatment, and medication. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (all years to 2016), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO (each to October 2019), international trial registries, and conducted grey literature searches. SELECTION CRITERIA We included randomised controlled trials of CBT that involved direct contact with the child, parent, or both, and included non-CBT comparators (waitlist/no treatment, treatment as usual, attention control, alternative treatment, medication). Participants were younger than age 19, and met diagnostic criteria for an anxiety disorder diagnosis. Primary outcomes were remission of primary anxiety diagnosis post-treatment, and acceptability (number of participants lost to post-treatment assessment), and secondary outcomes included remission of all anxiety diagnoses, reduction in anxiety symptoms, reduction in depressive symptoms, improvement in global functioning, adverse effects, and longer-term effects. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as recommended by Cochrane. We used GRADE to assess the quality of the evidence. MAIN RESULTS We included 87 studies and 5964 participants in quantitative analyses. Compared with waitlist/no treatment, CBT probably increases post-treatment remission of primary anxiety diagnoses (CBT: 49.4%, waitlist/no treatment: 17.8%; OR 5.45, 95% confidence interval (CI) 3.90 to 7.60; n = 2697, 39 studies, moderate quality); NNTB 3 (95% CI 2.25 to 3.57) and all anxiety diagnoses (OR 4.43, 95% CI 2.89 to 6.78; n = 2075, 28 studies, moderate quality). Low-quality evidence did not show a difference between CBT and TAU in post-treatment primary anxiety disorder remission (OR 3.19, 95% CI 0.90 to 11.29; n = 487, 8 studies), but did suggest CBT may increase remission from all anxiety disorders compared to TAU (OR 2.74, 95% CI 1.16 to 6.46; n = 203, 5 studies). Compared with attention control, CBT may increase post-treatment remission of primary anxiety disorders (OR 2.28, 95% CI 1.33 to 3.89; n = 822, 10 studies, low quality) and all anxiety disorders (OR 2.75, 95% CI 1.22 to 6.17; n = 378, 5 studies, low quality). There was insufficient available data to compare CBT to alternative treatments on post-treatment remission of primary anxiety disorders, and low-quality evidence showed there may be little to no difference between these groups on post-treatment remission of all anxiety disorders (OR 0.89, 95% CI 0.35 to 2.23; n = 401, 4 studies) Low-quality evidence did not show a difference for acceptability between CBT and waitlist/no treatment (OR 1.09, 95% CI 0.85 to 1.41; n=3158, 45 studies), treatment as usual (OR 1.37, 95% CI 0.73 to 2.56; n = 441, 8 studies), attention control (OR 1.00, 95% CI 0.68 to 1.49; n = 797, 12 studies) and alternative treatment (OR 1.58, 95% CI 0.61 to 4.13; n=515, 7 studies). No adverse effects were reported across all studies; however, in the small number of studies where any reference was made to adverse effects, it was not clear that these were systematically monitored. Results from the anxiety symptom outcomes, broader outcomes, longer-term outcomes and subgroup analyses are provided in the text. We did not find evidence of consistent differences in outcomes according to delivery formats (e.g. individual versus group; amount of therapist contact time) or amongst samples with and without ASD, and no studies included samples of children with intellectual impairments. AUTHORS' CONCLUSIONS CBT is probably more effective in the short-term than waiting lists/no treatment, and may be more effective than attention control. We found little to no evidence across outcomes that CBT is superior to usual care or alternative treatments, but our confidence in these findings are limited due to concerns about the amount and quality of available evidence, and we still know little about how best to efficiently improve outcomes.
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Affiliation(s)
- Anthony C James
- Department of Psychiatry, University of Oxford, Oxford, UK
- Highfield Unit, Warneford Hospital, Oxford, UK
| | - Tessa Reardon
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | | | | | - Cathy Creswell
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
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48
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Byrne SP, Farrell LJ, Rapee RM. Using cognitive enhancers to improve the treatment of anxiety disorders in young people: Examining the potential for D‐cycloserine to augment exposure for child anxiety. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/j.1742-9552.2011.00005.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Simon P. Byrne
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, and
| | - Lara J. Farrell
- Behavioural Basis of Health, Griffith Health Institute, Griffith University, Brisbane, Queensland, Australia
| | - Ronald M. Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, and
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49
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Baughman N, Prescott SL, Rooney R. The Prevention of Anxiety and Depression in Early Childhood. Front Psychol 2020; 11:517896. [PMID: 33101112 PMCID: PMC7554369 DOI: 10.3389/fpsyg.2020.517896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 08/18/2020] [Indexed: 11/23/2022] Open
Abstract
Recent statistics suggest that anxiety and depressive symptoms and disorders can occur earlier in life than previously thought, and appear to be on the increase. The burden that is associated with internalizing symptoms is large, with children's social, emotional, and cognitive development negatively impacted. Research suggests that early intervention and prevention is vital for adaptive development, and this review set out to explore the literature regarding social-emotional learning programs for children of preschool age that aim to prevent and reduce symptoms of anxiety and depression. The review focused on interventions that could be delivered universally in the school context to children aged 4-6 years or their parents. Only six programs were identified that met these criteria. The results of this review suggest that intervention and prevention efforts in early childhood are needed and can be effective in terms of reducing the burden associated with internalizing symptoms in childhood, at least in the short term. This appears to be the case particularly when parents are actively involved in the intervention, too. However, more rigorous research is needed that involves larger randomized controlled trials with multiple reporters and consistent administration of assessments across the samples.
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Affiliation(s)
- Natalie Baughman
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Susan L. Prescott
- The ORIGINS Project, Telethon Kids Institute and the Division of Paediatrics, University of Western Australia, Nedlands, WA, Australia
- School of Medicine, University of Western Australia, Nedlands, WA, Australia
- Perth Children’s Hospital, Nedlands, WA, Australia
| | - Rosanna Rooney
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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50
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Novick DR, Smith KA, Barstead MG, Danko CM, Rubin KH, Badders RN, Druskin L, Dougherty L, Chronis-Tuscano A. Predictors and Moderators of Parent Engagement in Early Interventions for Behaviorally Inhibited Preschool-Aged Children. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2020; 5:452-467. [PMID: 38845747 PMCID: PMC11155698 DOI: 10.1080/23794925.2020.1784060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Behavioral inhibition (BI) is a temperamental style that poses risk for later anxiety. Efficacious interventions have been developed for inhibited children, but their success depends on parent engagement. However, little is known regarding predictors of parent engagement in early interventions for BI. This study examined parent-, child- and treatment-level (i.e., parent-only or parent-child) factors as independent and interactive predictors of parent engagement (attendance, and parent-reported homework completion and treatment satisfaction) in a randomized-controlled trial comparing two interventions for inhibited preschoolers: Cool Little Kids (CLK) and the Turtle Program ("Turtle"). We also explored predictors of co-parent (CP) attendance. The sample comprised 151 primary parents (PPs) and their 45-64-month-old children. Attendance was greater in Turtle and homework completion was slightly greater in CLK, with no group difference in satisfaction. In Turtle, child anxiety predicted greater PP attendance and PP depression predicted lower satisfaction. In CLK, the interaction between child and PP anxiety significantly predicted satisfaction. Across groups, child anxiety predicted greater homework completion and CP anxiety predicted greater CP attendance. Results suggest that child anxiety may motivate parent engagement, particularly when children receive concurrent treatment and/or in-vivo coaching. However, intensive treatment may be too burdensome for depressed parents, whereas less intensive treatments may be more acceptable to non-anxious parents of anxious children. These findings can inform approaches to improve parent engagement in early interventions targeting BI.
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Affiliation(s)
| | - Kelly A Smith
- Department of Human Development & Quantitative Methodology, University of Maryland, College Park, USA
| | - Matthew G Barstead
- Department of Human Development & Quantitative Methodology, University of Maryland, College Park, USA
| | | | - Kenneth H Rubin
- Department of Human Development & Quantitative Methodology, University of Maryland, College Park, USA
| | | | - Lindsay Druskin
- Department of Human Development & Quantitative Methodology, University of Maryland, College Park, USA
| | - Lea Dougherty
- Department of Psychology, University of Maryland, College Park, USA
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