The Effect of Child Distress on Accommodation of Anxiety: Relations With Maternal Beliefs, Empathy, and Anxiety

The roots of compassion in early childhood: Relationships between theory of mind and attachment representations with empathic concern and prosocial behavior

This study focused on attachment representations and theory of mind as potential developmental origins of individual differences in preschoolers' peer- and adult-directed empathic concern and prosocial behavior. In two experiments, 3- to 6-year-olds were exposed to either a high-distressed or low-distressed adult or child using a laboratory setting (Experiment 1; N = 263) or hypothetical vignettes (Experiment 2; N = 202). Self-reported and coded expressions of empathic concern and prosocial behaviors were used as early indicators of compassion. The findings indicated that children expressed more empathic concern and engaged in more prosocial behavior in the high-distress condition than in the low-distress condition. Children's empathic concern and prosocial behavior increased with age. Secure attachment and theory of mind abilities played significant moderating roles in the association between distress conditions and empathic concern. Children with more advanced theory of mind abilities and secure attachment were better at recognizing the concerns of distressed peers or adults and showed significantly more empathic concern. Resistant and disorganized children exhibited more self-distress in response to others' distress. The implications for early interventions directed at increasing empathic concern and prosocial behavior are discussed.

Family Accommodation and Separation Anxiety: The Moderating Role of Child Attachment

Family accommodation, or changes in parental behavior aimed at avoiding or alleviating child anxiety-related distress, contributes to the severity of anxiety symptoms, and is most strongly associated with separation anxiety. This study examined whether child attachment security, characterized as the degree to which children perceive their parents to be reliable, available, and communicative, moderates the association between family accommodation and separation anxiety symptoms, and whether this moderation is specific to separation anxiety among other anxiety symptoms. In a sample of clinically anxious children (N = 243, 6-12 years), family accommodation was significantly positively associated with separation anxiety symptoms across levels of attachment security. Family accommodation was more strongly associated with parent-reported separation anxiety symptoms in children with lower attachment security compared with those with higher attachment security. No significant moderation effect emerged for other anxiety symptoms. Findings enhance understanding of the role of attachment within family accommodation of child anxiety.

Maternal beliefs about the benefits and costs of child and adolescent friendship

The goals of this study were to examine maternal beliefs about the primary benefits and costs of their children's time spent with friends, and to explore child age and gender differences in these beliefs. Participants were N = 512 mothers (Mchildage  = 10.18 years; 11% ethnic minority). Open-ended responses to questions about the benefits and costs were coded and analysed, with results indicating that mothers consider opportunities for social skills and social-cognitive development a primary benefit of spending time with friends. Negative friend influence was the most commonly cited cost of friendship. Child age was associated with a number of maternal beliefs (e.g., mothers of adolescents were more likely than mothers of young children to report intimacy as a benefit), but child gender was not. Findings highlight the importance of considering child age in studies of maternal beliefs about friendship and set the stage for future research in this area.

Family Accommodation and Separation Anxiety: The Moderating Role of Child Attachment

Family accommodation, or changes in parental behavior aimed at avoiding or alleviating child anxiety-related distress, contributes to the severity of anxiety symptoms, and is most strongly associated with separation anxiety symptoms. This study examined whether child attachment security, characterized as the degree to which children perceive their parents to be reliable, available, and communicative, moderates the association between family accommodation and separation anxiety symptoms, and whether this moderator is specific to separation anxiety among other anxiety symptoms. In a sample of clinically anxious youth (N = 243, 6-12 yrs), family accommodation was significantly positively associated with separation anxiety symptoms across levels of attachment security. Family accommodation was more strongly associated with separation anxiety symptoms in children with lower attachment security compared with those with higher attachment security. No significant moderation effect emerged for other anxiety symptoms. Findings enhance understanding of the role of attachment within family accommodation of child anxiety.

The Relations between Repetitive Behaviors and Family Accommodation among Children with Autism: A Mixed-Methods Study

Restricted and repetitive behaviors and interests (RRBI) are a significant component in diagnosing autism spectrum disorder (ASD). They often pose the main challenge in day-to-day functions for children with ASD and their families. Research addressing family accommodation behaviors (FAB) in the ASD population is scarce, and associations with the characteristics of the children's behaviors are unclear. This sequential mixed-methods study assessed the correlation between RRBI and FAB within the ASD group to deepen the understanding of parents' subjective experiences regarding their children's RRBI. It included a quantitative phase with a follow-up qualitative study. A total of 29 parents of children with autism (5-13 yr) completed the study questionnaires; a total of 15 also were interviewed regarding their children's RRBI and related FAB. We used the Repetitive Behavior Scale-Revised (RBS-R) to assess RRBI, and the Family Accommodation Scale (FAS-RRB) to assess FAS. In-depth interviews from phenomenological methodology were used in the qualitative phase. We found significant positive correlations between the RRBI and FAB overall and their subscores. Qualitative research supports these findings, adding descriptive examples of the accommodations families make to address the RRBI-related challenges. The results indicate relations between RRBI and FAB and the importance of practically addressing children with autism's RRBI and their parents' experiences. Both affect and are affected by the children's behaviors.

Construct Validation for Toddler-Solicited Maternal Comforting Behavior as Relevant to Family Accommodation and Child Anxiety Risk

Reciprocal parent-child interactions are theorized to play a crucial role in child anxiety development and maintenance. The current study tested whether toddler-solicited maternal comforting behavior in low-threat (mildly challenging and novel) situations may be a unique, early indicator of anxiety-relevant interactions. Controlling for other types of maternal comforting behavior, a path model tested solicited comforting behavior in a low-threat context in relation to both family accommodation (FA) and child anxiety symptoms, which may subsequently continue to predict each other over time. Identifying the emergence of this cycle in early childhood could bolster anxiety development theory and preventative interventions. Mother-child dyads (n = 166) of predominantly non-Hispanic/Latinx European American and socioeconomically diverse backgrounds were assessed at child ages 2, 4, and school-age via laboratory observation and maternal report. A longitudinal path model showed that solicited comforting observed in a low-threat situation at age 2 predicted mother-reported FA and child anxiety symptoms at age 4, above and beyond unsolicited comforting behavior and comforting behavior in a high-threat context. Furthermore, FA and child anxiety were bidirectionally related between age 4 and school-age assessments. Results suggest that toddler-solicited comforting in low-threat situations may be a unique indicator of child-directed anxiogenic family processes. The current study also expands the FA literature by providing empirical evidence for a bi-directional relation between anxiety and accommodation in young children.

Criticism and accommodation are associated with treatment concerns in close others to those with anxiety

OBJECTIVES

Those close to people with mental health difficulties (e.g., family members, romantic partners and close friends) are often involved in their care decisions. Research shows that criticism by close others and accommodation of symptoms are associated with symptom severity and treatment response. Recent research has found that those close to someone with an anxiety disorder report a range of concerns about their loved one starting cognitive-behaviour therapy (e.g., that treatment will cause the person to change in undesirable ways). The purpose of this study was to examine the relationship between close others' criticism and symptom accommodation and their treatment concerns, hypothesizing that these relationships would be significant.

DESIGN

Close others to those with notable anxiety (N = 287) completed self-report measures online. Multiple regression was used to test our hypothesis.

METHODS

Respondents who identified as being close to someone with notable anxiety completed measures of their accommodation of anxiety symptoms, feelings of criticism/hostility towards them, concerns about them starting treatment, perceived impairment due to anxiety, and their own and their loved ones' treatment history.

RESULTS

Greater criticism and accommodation significantly predicted greater treatment concerns, with a medium effect size, controlling for degree of impairment due to anxiety and treatment history.

CONCLUSIONS

Criticism and accommodation may reflect appraisal of the person with anxiety as weak or fragile, which may evoke concerns about treatment success. Implications for clinicians and anxiety treatment are discussed.

Unpacking parental accommodation: Relationship to parent distress tolerance and cognitive styles

Accommodation, or changes to parent behaviors or routines to avoid or alleviate child distress related to psychopathology, is one maladaptive parent response that is common in anxiety disorders and associated with poor youth outcomes. Little is known about the processes in parents that contribute to accommodation. Thus, the current study examined how accommodation relates to parent distress tolerance and cognitive styles. The present study utilized data from 295 parents (289 female) of children ages 4-10 who were recruited for a randomized trial of an internet-based single-session intervention targeting parent accommodation (NCT04453865). Results indicate a positive relationship between parent rumination and worry and accommodation, highlighting the influence of parent cognitive processes on their tendency to accommodate. In addition, results suggest a positive relationship between reduced parent distress tolerance and greater accommodation, and this relationship may be influenced by other factors. Future research that uses multiple methods of assessment will add to effective interventions for parent accommodation that can be used to improve youth outcomes.

A Pilot Feasibility Open Trial of an Interpretation Bias Intervention for Parents of Anxious Children

Interpretation bias is a transdiagnostic mechanism underlying anxiety. Theoretical models highlight the role of parental interpretation bias in predicting and maintaining child anxiety. However, very few studies have examined parent interpretation bias as a treatment target. The current pilot study tested the feasibility and acceptability of an interpretation bias intervention delivered by a smartphone app, called HabitWorks, in parents of anxious children who self-reported at least mild symptoms of anxiety and negative interpretation bias. Parents of anxious youth (ages 8 to 16) were recruited from the waitlists of three child anxiety clinics. They were asked to complete interpretation modification exercises via the HabitWorks app 3 times per week for 1 month. Participants completed assessments at pre- and post-intervention and 1-month follow-up to assess changes in interpretation bias, anxiety symptoms, and overall perceptions of HabitWorks. Participants (N=14) (Mage=44.36; 14.29% men, 85.71% women) completed an average of 13.29 exercises out of the 12 prescribed. Acceptability ratings were high. Interpretation bias, as measured by an assessment version of the intervention exercise, significantly improved from pre- to posttreatment, and these improvements were maintained at the 1-month follow-up. Anxiety symptoms significantly improved from the "mild" severity range to the "none to minimal" range. In this pilot feasibility study in parents of anxious youth, HabitWorks was a feasible and acceptable low-intensity intervention. These preliminary results support a future controlled trial of HabitWorks for parents. Future studies are also needed to test whether targeting interpretation bias in parents has downstream effects on maladaptive parent behaviors and ultimately, child interpretation bias and anxiety.

Frequency and Correlates of Fathers' Accommodation in Pediatric Anxiety Disorders

Previous studies investigating family accommodation (FA) in pediatric anxiety disorders have primarily relied on mothers' reports, while data on FA by fathers remains scarce. We examined the frequency and correlates of fathers' FA of anxious children and compared fathers' and mothers' reports of FA. Participants were 69 parents of treatment-seeking children and adolescents with a primary anxiety disorder. FA was highly prevalent amongst fathers, with the majority of fathers participating in symptom-related behaviors and modifying family routines due to child anxiety. Fathers' accommodation levels were significantly correlated with fathers' reports of child internalizing symptoms, child externalizing symptoms, and fathers' own anxiety symptoms. Fathers' and mothers' reports of FA were moderately correlated, whereas their reports of their respective distress related to the need to accommodate were only weakly correlated. Fathers reported a significantly lower frequency of FA than did mothers. These findings highlight the importance of obtaining reports from both fathers and mothers when assessing FA. Results are particularly relevant to family-focused and parent-based interventions designed to address and reduce FA amongst parents of clinically anxious children.

Exploring the Link Between Transdiagnostic Cognitive Risk Factors, Anxiogenic Parenting Behaviors, and Child Anxiety

Theoretical models suggest parent anxiety leads to increased anxiogenic parenting, an important etiological factor for child anxiety disorders. Evidence suggests that parents engage in anxiogenic parenting to reduce distress in response to their child's anxiety; however, further study of this mechanism is needed. Cognitive risk factors, including distress intolerance, anxiety sensitivity, emotion-related impulsivity, and repetitive negative thinking are promising to examine as they impact emotion regulation. This study examined whether an indirect association between parent anxiety and anxiogenic parenting via these risk factors exists, and if child anxiety moderated this effect. Findings demonstrated evidence for an indirect association via distress intolerance in mothers at high levels of child anxiety, but not low levels. An unmoderated indirect effect via emotion-related impulsivity was found. Anxiety sensitivity and repetitive negative thinking did not demonstrate significant indirect effects. These findings suggest distress intolerance and emotional-related impulsivity may be targets for parent-focused child anxiety treatments.

Empowering Anxious Parents to Manage Child Avoidance Behaviors: Randomized Control Trial of a Single-Session Intervention for Parental Accommodation

BACKGROUND

A majority of youth who need anxiety treatment never access support. This disparity reflects a need for more accessible, scalable interventions-particularly those that may prevent anxiety in high-risk children, mitigating future need for higher-intensity care. Self-guided single-session interventions (SSIs) may offer a promising path toward this goal, given their demonstrated clinical utility, potential for disseminability, and low cost. However, existing self-guided SSIs have been designed for completion by adolescents already experiencing symptoms, and their potential for preventing anxiety in children-for instance, by mitigating known anxiety risk factors-remains unexplored.

OBJECTIVE

This trial evaluated the acceptability and proximal effects of project EMPOWER: a web-based, self-guided SSI designed to reduce parental accommodation, a parenting behavior known to increase the risk of anxiety in offspring.

METHODS

In total, 301 parents who reported elevated anxiety symptoms with children aged 4-10 years received either project EMPOWER or an informational control (containing psychoeducational materials and resources); parents self-reported their accommodation of child anxiety and overall distress tolerance at baseline and 2-week follow-up.

RESULTS

Relative to control-group parents, those who received the intervention outlined in project EMPOWER reported significant reductions in their accommodation of child anxiety (d_s=0.61; P<.001) and significant increases in their distress tolerance (d_s=0.43; P<.001) from baseline to 2-week follow-up. Additionally, parents rated project EMPOWER as highly acceptable (ie, easy to use, helpful, and engaging) in accordance with preregistered benchmarks.

CONCLUSIONS

Project EMPOWER is an acceptable self-guided SSI for parents of children at-risk for anxiety, which yields proximal reductions in clinically relevant targets.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04453865; https://tinyurl.com/4h84j8t9.

Assessing parental cognitions about child anxiety: Are parents' thoughts about child anxiety associated with child anxiety and anxiety sensitivity?

Anxiety sensitivity (AS) or the fear of anxious symptomatology, has garnered support in both adult and child samples for its predictive validity of anxiety disorders. Recent efforts to identify familial factors that predict anxiety amongst youth have identified a construct similar to AS amongst parents, but instead focused on the child rather than on the self. The overarching goal of the present study was to examine the extent to which two measures of this construct [the Parent Sensitivity to Child Anxiety Index (PSCAI) and the Parental Beliefs about Anxiety Questionnaire (PBA-Q)] correlated with child and parent AS and anxiety and how these measures explained the relationships between parent- and child-reported AS and anxiety. A secondary aim of the present study was to psychometrically compare the PSCAI and the PBA-Q with respect to not only their convergence with parent and child AS and anxiety, but also the extent to which each mediated the parent-child relationships between these variables. The PSCAI and PBA-Q significantly mediated the relationship between parent and child AS, each yielding small significant indirect effects. Support was also observed for a double mediation model in which parental anxiety predicted parental AS, which predicted parental beliefs about and parental sensitivity to child anxiety, which in turn predicted child anxiety. Findings suggest that both parental beliefs about and sensitivity to child anxiety are both correlated with and partially explain the relationship between parent and child AS and anxiety, providing potential points of intervention in treatment and prevention efforts for child anxiety.

The Role of Parental Beliefs About Anxiety and Attachment on Parental Accommodation of Child Anxiety

This study examined: 1) the relationship between negative parental beliefs about child anxiety (i.e., it is harmful), insecure parental attachment and parental accommodation of child anxiety; 2) whether parental attachment insecurity moderates the effect of negative beliefs about anxiety on parent accommodation; and 3) a path model of parental factors affecting accommodation and child anxiety severity. Participants were 139 parents of children (6-18 years) with a primary anxiety disorder. Parents completed measures of parental accommodation of their child's anxiety, beliefs about child anxiety, and attachment security. Child anxiety diagnosis and severity was determined using semi-structured clinical interviews. Negative beliefs about child anxiety were directly associated with levels of parental accommodation. There was no direct relationship between insecure attachment and accommodation; however anxious attachment moderated the effect of parental beliefs about anxiety on parental accommodation. Among parents with more secure attachment, negative beliefs about anxiety were associated with greater parental accommodation. However, among parents with less secure attachment, accommodation was high regardless of beliefs about anxiety. A path model suggested that negative beliefs about anxiety was related to increased parental accommodation, which in turn was related to increased child anxiety severity. Psychoeducation about the nature of anxiety is likely to be beneficial in helping to reduce accommodation among parents with more secure attachment styles. However, among those with greater anxious attachment, psychoeducation may need to be tailored to focus on corrective information about the impact of treatment processes on the parent-child relationship.

The Relationship of Family Accommodation with Pediatric Anxiety Severity: Meta-analytic Findings and Child, Family and Methodological Moderators

Given the importance of family accommodation for the course, treatment and prognosis of anxiety in pediatric populations, we conducted a meta-analysis to estimate the magnitude and potential moderators of the relationship between accommodation and anxiety severity. Study selection criteria were: (1) included quantitative measures of accommodation and anxiety severity, (2) sampled participants younger than 19 years, (3) a sample size greater than 10, (4) reported statistical data needed to compute effect sizes, and (4) be in English or Spanish. Search procedures included assessment of electronic databases, systematic reviews and empirical studies, and email inquiries. Effect size was Pearson correlation coefficient, assuming a random-effects model. Positive moderate association was observed for measures administered to parents. This was moderated by the percentage of children with separation anxiety and selective mutism. Global effect sizes were small for measures administered to children and when accommodation was reported by parents and anxiety by children. Implications for assessment and treatment are discussed.

Measuring Family Accommodation of Childhood Anxiety: Confirmatory Factor Analysis, Validity, and Reliability of the Parent and Child Family Accommodation Scale - Anxiety

OBJECTIVE

Research on family accommodation is burgeoning, implicating it in the development, maintenance, and treatment of childhood anxiety. Additional data are needed to guide theory development and clinical application in this area. The factors underlying family accommodation measures have never been confirmed, nor have any test-retest data been reported. The study's objectives were to provide confirmatory data of the factorial structure and the first test-retest reliability data on the most widely used measure of family accommodation of child anxiety, the Family Accommodation Scale - Anxiety (FASA), and the child-rated FASA-CR.

METHOD

Participants were 331 children (51% female; mean age = 10.44 yrs, SD = 2.95; 84.6% White) and their parent, presenting consecutively to an anxiety disorders program. Exploratory factor analysis (EFA) was conducted first on a random sampling of 105 child-parent dyads; factors were confirmed with confirmatory factor analysis (CFA) in the remaining independent sample of 226 dyads. Test-retest reliability (mean retest interval = 10 days) was examined for FASA and FASA-CR. Convergent validity was examined in relation to child anxiety symptoms, and parenting stress. Divergent validity was examined in relation to child depression symptoms.

RESULTS

EFA and CFA supported a two-factor model of family accommodation, representing Participation in child-anxiety-driven behaviors, and child-anxiety-related Modification of family routines and schedules. Test-retest reliability was satisfactory for parents and adolescents; less so for children aged 6 to 12 years.

CONCLUSIONS

Family accommodation is a key construct in childhood anxiety, with two underlying factors that can be validly and reliably assessed using FASA and FASA-CR.

The interaction between sleep disturbances and anxiety sensitivity in relation to adolescent anger responses to parent adolescent conflict

INTRODUCTION

Sleep disturbances are common among adolescents and are associated with elevated anxiety, and difficulties managing affect. Familial conflict is associated with both anxiety sensitivity and adolescent sleep disturbances. No work to date has examined how adolescent sleep disturbances may interact with anxiety sensitivity in relation to adolescent affective responding to parent-adolescent conflict. The current study was designed to address this gap in the literature by examining how adolescent sleep disturbances, anxiety sensitivity, conflict elicited anger, and conflict avoidance are associated.

METHOD

Seventy-two American adolescents (n = 39 males) between the ages of 12 and 16 years (M_age = 13.84, SD = 1.38) completed a baseline assessment as well as a well-validated mother-adolescent laboratory-based conflict task.

RESULTS

For youth low in anxiety sensitivity, greater sleep disturbance related positively to conflict-elicited anger, which in turn predicted higher conflict avoidance. In contrast, this indirect effect was not significant for adolescents relatively higher in anxiety sensitivity. Instead, for these adolescents, increased sleep disturbances were associated with lower levels of conflict elicited anger.

CONCLUSIONS

Results suggest that the effects of sleep disturbances on conflict elicited anger may vary as a function of adolescent anxiety vulnerability. These findings highlight the importance of considering the unique effects of sleep disturbances on adolescent affect as a function of adolescent anxiety vulnerability.

A randomized-controlled examination of the effect of cognitive reappraisal instruction on maternal accommodation of child anxiety symptoms

Parental accommodation plays a key role in the maintenance of child anxiety, yet much of the research to date has been correlational, making it difficult to draw conclusions about underlying mechanisms. Given preliminary evidence that parental beliefs play a role in parental accommodation, the present study sought to experimentally reduce accommodation by targeting parental attitudes about child anxiety. Mothers of children ages 4-9 (N = 47) were randomly assigned to either receive brief instruction in cognitive reappraisal (EXP) or to a control intervention in which they received no instruction (CON). At pre- and post-intervention mothers were presented with bogus information that their child was experiencing varying levels of distress while completing a task in a nearby room. Maternal distress, negative affect and perceived likelihood of accommodation in the context of child distress were measured pre- and post-intervention. EXP mothers reported greater pre- to post-intervention decreases in distress and perceived likelihood of accommodation, compared to CON mothers. EXP and CON mothers showed similar changes in negative affect. Findings from this study provide preliminary experimental evidence that targeting maternal beliefs about child anxiety can result in changes in maternal distress and behavior following exposure to child distress. Implications for prevention and treatment are discussed.

Intolerance of Uncertainty and Parental Accommodation: Promising Targets for Personalized Intervention for Youth Anxiety

PURPOSE OF REVIEW

After reviewing predictors of differential outcomes of cognitive behavioral therapy (CBT) for pediatric anxiety, we identify and discuss recent evidence for the role of (a) intolerance of uncertainty (IU) and (b) parental accommodation as meaningful targets for personalized intervention.

RECENT FINDINGS

Few studies to date have identified promising, theory-driven predictors of differential CBT outcomes. Recent findings suggest that increased IU and high levels of parental accommodation are associated with a poorer response to CBT. Several adaptations of CBT and new interventions targeting either IU or parental accommodation have been developed and found to be efficacious in preliminary studies. IU and parental accommodation are promising constructs for personalizing intervention, both in the identification of who will respond to treatment and in the development of targeted intervention. We recommend that future work test if individuals high in IU and/or parental accommodation will respond more optimally to treatments that specifically target these constructs. The results of this future work may help to move the field closer to personalized intervention.

Parent and child emotion and distress responses associated with parental accommodation of child anxiety symptoms

OBJECTIVE

Parental accommodation contributes to the maintenance of child anxiety and related symptoms. The current study examines the contributions of parent and child factors to parental accommodation in a sample of anxious youth.

METHODS

Sixty-four treatment-seeking youth (6-16 years) and their mothers, as well as a subset of fathers (N = 41) reported on parental accommodation, parental distress and emotion regulation, child psychopathology, child externalizing behaviors, and child intolerance of uncertainty.

RESULTS

Parental accommodation was not related to parental distress or emotion regulation. Parents who viewed their child as being more symptomatic (e.g., anxious, externalizing, and intolerant of uncertainty) were more likely to engage in accommodation. For mothers, child anxiety and externalizing symptoms were notable predictors of accommodation.

CONCLUSIONS

Parent perceptions of child symptomology is an important factor significantly related to accommodation behaviors. This finding can be used to inform programming designed to target parental responses to child anxiety and related disorders.

Parent-Child Agreement on Family Accommodation Differentially Predicts Outcomes of Child-Based and Parent-Based Child Anxiety Treatment

Objectives: Family accommodation is linked to poor treatment outcomes for childhood anxiety. Progress in research on the role of accommodation in treatment has been hindered by the relatively weak association between child and parent reports on accommodation. In this study, we suggest that parent-child agreement on family accommodation may provide a dependable estimation of this construct, and investigated whether the level of parent-child agreement on family accommodation predicts subsequent treatment outcome. We further examined whether the effect was greater in Supportive Parenting for Anxious Childhood Emotions (SPACE), which directly targets family accommodation, than in individual child-focused cognitive behavioral therapy (CBT).Methods: Participants were 104 children (aged 6-15) with anxiety disorders, and their mothers, randomized to SPACE or CBT. Accommodation was rated by mothers and children before treatment, halfway through treatment, and at treatment end, using respective versions of Family Accommodation Scale-Anxiety. To accurately estimate agreement, we conducted multilevel response surface analysis by polynomial regression, with agreement on accommodation at each time point predicting subsequent child anxiety severity, over the course of treatment.Results: Parent-child agreement and disagreement on accommodation were significant predictors of subsequent anxiety symptom severity. Different results were obtained for SPACE and CBT, suggesting potentially distinct underlying mechanisms.Conclusions: The findings suggest treatment-specific roles of accommodation in SPACE vs. CBT. Multiple-informant assessment of accommodation provides important information, which may have important implications for optimal treatment personalization.

Cognitive Predictors of Parental Rescue Behavior and Malleability of Behavior Using a Brief Psychoeducation Intervention

Cognitive factors, such as beliefs that anxiety is harmful, may lead parents to engage excessively in over-controlling parenting practices, such as "rescuing" children from distress. The present study examined whether parental rescue behavior, or the speed at which parents intervened to rescue an increasingly distressed child during an audio paradigm, was associated with beliefs about child anxiety. We also evaluated the impact of psychoeducation on rescue behavior during the audio paradigm. A nonclinical sample of 310 parents was recruited from an online crowdsourcing platform. Findings support the hypothesis that parents' stronger beliefs that anxiety is harmful relate to parents' faster speed of rescue. Additionally, participants who received psychoeducation delayed their rescue responses more than did participants who received benign information. Findings add to the growing body of evidence that cognitive factors contribute to countertherapeutic parent behavior and indicate that psychoeducation can be an important component of family-based child anxiety treatment.

Family accommodation in psychopathology: A synthesized review

Family accommodation describes changes that family members make to their own behavior, to help their relative who is dealing with psychopathology, and to avoid or alleviate distress related to the disorder. Research on family accommodation has expanded greatly in the past few years. The aim of this study was to provide a synthesized review of recent findings on family accommodation in psychopathology. Electronic databases were searched for available, peer-reviewed, English language papers, published between September 2015 and March 2018, cross-referencing psychiatric disorders with accommodation and other family-related terms. Ninety-one papers were identified and reviewed, of which 69 were included. In obsessive-compulsive disorder and anxiety disorders family accommodation has been linked to symptom severity, functional impairment, caregiver burden, and poorer treatment outcomes. Several randomized controlled trials explored the efficacy of treatments aimed at reducing family accommodation. A growing number of studies have reported family accommodation in eating disorders where it is associated with greater symptom severity and caregiver burden. Family accommodation has also been studied in other disorders, including autism spectrum disorders, tic disorders, and posttraumatic stress disorder. Research on family accommodation in psychopathology is advancing steadily, expanding across disorders. The study highlights the importance of addressing family accommodation in the assessment and treatment of various disorders.

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

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

Improving empathy and self-efficacy in caregivers of persons with intellectual disabilities, using m-learning (HiSense APP-ID): study protocol for a randomized controlled trial

Background

A secure attachment with one or more caregivers is one of the most important predictors of cognitive development and emotional wellbeing. Persons with intellectual disabilities (ID) have extra need for secure relationships with primary caregivers but can find making connections difficult. This study aims to explore the effect of a non-invasive m-learning intervention on the empathy and self-efficacy of caregivers, in view of improving attachment relationships with persons with ID.

Methods

A randomized controlled trial (RCT) will be conducted to assess the efficacy of the HiSense APP-ID. The study will include 100 parents/relatives and 100 professional caregivers of adults with mild or moderate ID (18 years and older). Of both groups of participants, half will complete the m-learning intervention. Data will be collected before the intervention starts, immediately after completion of the m-learning, and 1 month after the intervention. Participants will complete questionnaires concerning knowledge about attachment theory, empathy and self-efficacy (primary outcome measures) and social validity (secondary measures).

Discussion

The intervention aims to increase caregiver understanding of attachment theory and to improve empathy and self-efficacy, which may lead to better care and less stress in social interactions. The HiSense APP-ID is an m-learning intervention that can be done independently on any digital device. The course is therefore easily accessible for caregivers of persons with ID. The current study will provide insight into the effectiveness of the intervention for parents/family members and professional caregivers of persons with mild or moderate ID.

Trial registration

Nederlands Trial Register, NTR 6944. Registered on 16 December 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2772-7) contains supplementary material, which is available to authorized users.

Anxiety Sensitivity Moderates the Relation Between Family Accommodation and Anxiety Symptom Severity in Clinically Anxious Children

High levels of family accommodation (FA), or parental involvement in child symptoms, are associated with child anxiety symptom severity. The strength of associations has varied across studies, however, highlighting the need to identify moderating variables. We investigated whether anxiety sensitivity (AS) moderated the FA-anxiety symptom severity association in clinically anxious children (N = 103, ages 6-17; mean age 11.07 years). We collected child and mother ratings of FA, child anxiety symptom severity, and child AS ratings. AS significantly moderated the FA-child anxiety severity link. Specifically, this link was significant for low-AS but not high-AS children. Findings suggest that FA may operate in the typically observed fashion for low-AS children-alleviating immediate distress while inadvertently exacerbating longer-term anxiety-whereas high-AS children may experience distress following anxiety-provoking stimuli regardless of FA. Assessing AS in research and clinical settings may help identify subsets of children for whom FA is more closely tied to anxiety severity.

Placebo Response in Pediatric Anxiety Disorders: Results from the Child/Adolescent Anxiety Multimodal Study

OBJECTIVES

The aim of this study is to identify predictors of pill placebo response and to characterize the temporal course of pill placebo response in anxious youth.

METHODS

Data from placebo-treated patients (N = 76) in the Child/Adolescent Anxiety Multimodal Study (CAMS), a multisite, randomized controlled trial that examined the efficacy of cognitive-behavioral therapy, sertraline, their combination, and placebo for the treatment of separation, generalized, and social anxiety disorders, were evaluated. Multiple linear regression models identified features associated with placebo response and models were confirmed with leave-one-out cross-validation. The likelihood of improvement in patients receiving pill placebo-over time-relative to improvement associated with active treatment was determined using probabilistic Bayesian analyses.

RESULTS

Based on a categorical definition of response (Clinical Global Impressions-Improvement Scale score ≤2), nonresponders (n = 48), and pill placebo responders (n = 18) did not differ in age (p = 0.217), sex (p = 0.980), race (p = 0.743), or primary diagnosis (all ps > 0.659). In terms of change in anxiety symptoms, separation anxiety disorder and treatment expectation were associated with the degree of pill placebo response. Greater probability of placebo-related anxiety symptom improvement was observed early in the course of treatment (baseline to week 4, p < 0.0001). No significant change in the probability of placebo-related improvement was observed after week 4 (weeks 4-8, p = 0.07; weeks 8-12, p = 0.85), whereas the probability of improvement, in general, significantly increased week over week with active treatment.

CONCLUSIONS

Pill placebo-related improvement occurs early in the course of treatment and both clinical factors and expectation predict this improvement. Additionally, probabilistic approaches may refine our understanding and prediction of pill placebo response.

Dimensions of parenting among mothers and fathers in relation to social anxiety among female adolescents

Social anxiety is the most common anxiety disorder among youth; theoretical and empirical work suggest specific parenting behaviors may be relevant. However, findings are inconsistent, particularly in terms of maternal as compared to paternal effects. In the current study, we evaluated the indirect effects of perceived psychological control on the relation between anxious rearing behaviors and child social anxiety among 112 community-recruited girls (ages 12-15 years). In addition to self-report, adolescent participants completed a laboratory-based social stress task. In line with hypotheses, results indicated indirect effects of psychological control on the relation between anxious rearing behaviors and child social anxiety in maternal but not paternal models. Findings are discussed in terms of their theoretical and empirical implications for clarifying the role of parental relations in adolescent social anxiety.

Antidepressant Prescribing by Pediatricians: A Mixed-Methods Analysis

Among pediatricians, perceived knowledge of efficacy, tolerability, dosing, and side effects of antidepressants represent significant sources of variability in the use of these medications in youth with depressive and anxiety disorders. Importantly, the qualitative factors that relate to varying levels of comfort with antidepressants and willingness to prescribe are poorly understood. Using a mixed-methods approach, in-depth interviews were conducted with community-based and academic medical center-based pediatricians (N = 14). Interviews were audio recorded and iteratively coded; themes were then generated using inductive thematic analysis. The relationship between demographic factors, knowledge of antidepressants, dosing, and side effects, as well as prescribing likelihood scores for depressive disorders, anxiety disorders or co-morbid anxiety and depressive disorders, were evaluated using mixed models. Pediatricians reported antidepressants to be effective and well-tolerated. However, the likelihood of individual physicians initiating an antidepressant was significantly lower for anxiety disorders relative to depressive disorders with similar functional impairment. Pediatricians considered symptom severity/functional impairment, age and the availability of psychotherapy as they considered prescribing antidepressants to individual patients. Antidepressant choice was related to the physician׳s perceived knowledge and comfort with a particular antidepressant, financial factors, and the disorder-specific evidence base for that particular medication and consultation with mental health practitioners. Pediatricians noted similar efficacy and tolerability profiles for antidepressants in youth with depressive disorders and anxiety disorders, but tended to utilize "therapy first" approaches for anxiety disorders relative to depressive disorders. Parental and family factors that influenced prescribing of antidepressants by pediatricians included parental ambivalence, family-related dysfunction and impairment secondary to the child׳s psychopathology as well as the child׳s psychosocial milieu. Pediatricians consider patient- and family-specific challenges when choosing prescribing antidepressant medications and are, in general, less likely to prescribe antidepressants for youth with anxiety disorders compared to youth with depressive disorders. The lower likelihood of prescribing antidepressants for anxious youth is not related to perception of the efficacy or tolerability, but rather to a perception that anxiety disorders are less impairing and more appropriately managed with psychotherapy.

Parental Attitudes, Beliefs, and Understanding of Anxiety (PABUA): Development and psychometric properties of a measure

The Parental Attitudes, Beliefs, and Understanding of Anxiety (PABUA) was developed to assess parental beliefs about their child's anxiety, parents' perceived ability to cope with their child's anxiety and to help their child manage anxious symptoms, and to evaluate parents' understanding of various parenting strategies in response to their child's anxiety. The study evaluated the PABUA in mother-child dyads (N=192) seeking treatment for youth anxiety. Exploratory factor analysis yielded a three-factor solution and identified PABUA scales of Overprotection, Distress, and Approach (with Cronbach's alpha ranging from .67 to .83). Convergent and divergent validity of PABUA scales was supported by the pattern of associations with measures of experiential avoidance, beliefs related to children's anxiety, empathy, trait anxiety, and depressive symptoms; parent-reported family functioning; parent- and youth-reported anxiety severity; and parent-reported functional impairment (n=83). Results provide preliminary support for the PABUA as a measure of parental attitudes and beliefs about anxiety, and future studies that investigate this measure with large and diverse samples are encouraged.