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Zugman A, Winkler AM, Qamar P, Pine DS. Current and Future Approaches to Pediatric Anxiety Disorder Treatment. Am J Psychiatry 2024; 181:189-200. [PMID: 38425255 PMCID: PMC11256210 DOI: 10.1176/appi.ajp.20231037] [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] [Indexed: 03/02/2024]
Abstract
This overview critically appraises the literature on the treatment of pediatric anxiety disorders. The two established treatments for these conditions comprise cognitive-behavioral therapy (CBT) and antidepressant medications. Many youths receiving these treatments fail to achieve remission, which creates a need for new treatments. After summarizing the literature on CBT and currently available medications, the authors describe research that lays a foundation for improvements in the treatment of pediatric anxiety disorders. This foundation leverages neuroscientific investigations, also described in the overview, which provide insights on mechanisms of successful treatment.
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Affiliation(s)
- Andre Zugman
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
| | - Anderson M. Winkler
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
- Division of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Brownsville, Texas, United States
| | - Purnima Qamar
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
| | - Daniel S. Pine
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
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Hudson JL, Minihan S, Chen W, Carl T, Fu M, Tully L, Kangas M, Rosewell L, McDermott EA, Wang Y, Stubbs T, Martiniuk A. Interventions for Young Children's Mental Health: A Review of Reviews. Clin Child Fam Psychol Rev 2023; 26:593-641. [PMID: 37488453 PMCID: PMC10465658 DOI: 10.1007/s10567-023-00443-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/26/2023]
Abstract
To determine the efficacy of intervention programs for young children (4-9 years) with emerging mental health needs, we conducted a review of meta-analytic and systematic reviews of the intervention literature. Of 41,061 abstracts identified and 15,076 screened, 152 review articles met the inclusion criteria. We reviewed interventions across multiple disciplines targeting: (1) general mental health concerns; (2) internalizing symptoms; (3) externalizing symptoms; (4) anxiety; (5) depression; (6) trauma; (7) symptoms of attention-deficit/hyperactivity disorder; and (8) mental health concerns associated with autism spectrum disorder. Substantial evidence was found for the efficacy of behavioral and cognitive behavioral interventions for general mental health concerns, externalizing symptoms (generally, as well as ADHD, conduct, and other behavioral symptoms) and internalizing symptoms (generally, as well as anxiety) aged 4-9 years. Emerging evidence was identified for interventions targeting trauma symptoms, depression symptoms, and social, emotional and behavioral symptoms in autism spectrum disorder in children aged 4-9 years. Currently there is only limited emerging evidence regarding non-behavioral or non-cognitive behavioral interventions for programs targeting children ages 4-9 years where the aim is to deliver an evidence-based program to improve child social, emotional and/or behavioral functioning. Given the recent rises in mental health needs reported in children, targeted behavioral-and/or cognitive behavior therapy-based interventions should be made widely available to children (and their families) who experience elevated symptoms.
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Affiliation(s)
- Jennifer L Hudson
- Black Dog Institute, University of New South Wales, Sydney, Australia.
| | - Savannah Minihan
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Wenting Chen
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Talia Carl
- Black Dog Institute, University of New South Wales, Sydney, Australia
- School of Psychology, University of Sydney, Sydney, Australia
| | - Michele Fu
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Lucy Tully
- School of Psychology, University of Sydney, Sydney, Australia
| | - Maria Kangas
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Linda Rosewell
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Emma A McDermott
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Yiwen Wang
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Thomas Stubbs
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Byrne S, Cobham V, Richardson M, Imuta K. Do Parents Enhance Cognitive Behavior Therapy for Youth Anxiety? An Overview of Systematic Reviews Over Time. Clin Child Fam Psychol Rev 2023; 26:773-788. [PMID: 37217646 PMCID: PMC10465628 DOI: 10.1007/s10567-023-00436-5] [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] [Accepted: 05/01/2023] [Indexed: 05/24/2023]
Abstract
The last 20 years has seen debate regarding the merits of involving parents in cognitive behavior therapy (CBT) for youth anxiety played out across systematic reviews which have high impact. These reviews examined varying treatment formats in relation to parent involvement, including youth only CBT (Y-CBT), parent only CBT (P-CBT) and family CBT (youth and parent; F-CBT). This is a novel overview of systematic reviews examining evidence for parental involvement in CBT for youth anxiety over the period this was studied. Two independent coders systematically searched for studies in medical and psychological databases using the categories "Review", "Youth", "Anxiety", "Cognitive Behavior Therapy" and "Parent/Family". Of the 2,189 unique articles identified, there were 25 systematic reviews since 2005 which compared the effects of CBT for youth anxiety with varying parent involvement. Despite systematically studying the same phenomenon, the reviews were heterogeneous in outcome, design, inclusion criteria and often had methodological limitations. Of the 25 reviews, 21 found no difference between formats and 22 reviews were considered inconclusive. Yet while there were typically no statistical differences, consistent patterns in the direction of effects were detected over time. P-CBT was less effective than other formats, suggesting the importance of directly treating anxious youths. Early reviews favored F-CBT over Y-CBT, however, later reviews did not show this trend. We consider the effects of moderators including exposure therapy, long-term outcomes and the child's age. We consider how to manage heterogeneity in primary studies and reviews to better detect treatment differences where they exist.Trial registration This protocol is registered with the Open Science Framework: osf.io/2u58t.
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Affiliation(s)
- S Byrne
- School of Psychology, University of Queensland, Brisbane, QLD, Australia.
| | - V Cobham
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
- Parenting and Family Support Centre, University of Queensland, Brisbane, QLD, Australia
| | - M Richardson
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia
| | - K Imuta
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
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Jewell C, Wittkowski A, Collinge S, Pratt D. A Brief Cognitive Behavioural Intervention for Parents of Anxious Children: Feasibility and Acceptability Study. CHILD & YOUTH CARE FORUM 2022; 52:661-681. [PMID: 35975268 PMCID: PMC9372936 DOI: 10.1007/s10566-022-09704-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/21/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022]
Abstract
Background Parent-only psychological interventions can be effective treatments for child anxiety. Involving parents in treatment may be beneficial for children, ensuring that interventions are delivered effectively in a supportive environment. Few studies have investigated the feasibility and acceptability of parent-only interventions for child anxiety. Objective In this study, we report on feasibility, acceptability and preliminary clinical outcomes of a brief cognitive behavioural group intervention for parents of children (4- to 10-years-olds) experiencing anxiety in the absence of a diagnosed anxiety disorder. Method Parent participants attended a three-session group intervention delivered online. We collected feasibility information (recruitment and retention rates); parents and children (when appropriate) completed acceptability and clinical outcome measures after each session. Participants were also interviewed about the acceptability of the intervention and study processes. Results Nineteen parents consented to take part (child mean age 6.47, SD 1.23). Participant retention rates (68.4%) and intervention satisfaction (total mean CSQ score 28.52) were high. Calculated effect sizes were moderate to large for parent-rated outcomes, small for child self-reported anxiety, and small to moderate for parent confidence/efficacy. Thematic analysis of interview data identified benefits, such as connecting with parents and learning strategies, as well as challenges associated with the intervention. Conclusions Attendance appeared to be associated with positive changes for parents and children. Overall, participants found this to be an acceptable and useful intervention. These findings demonstrated the potential benefit of a brief intervention for parents of anxious children. A larger trial is required to further investigate these preliminary findings.
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Jewell C, Wittkowski A, Pratt D. The impact of parent-only interventions on child anxiety: A systematic review and meta-analysis. J Affect Disord 2022; 309:324-349. [PMID: 35460744 DOI: 10.1016/j.jad.2022.04.082] [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: 06/21/2021] [Revised: 02/28/2022] [Accepted: 04/13/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Parent-only interventions for childhood anxiety may be an important alternative to resource and time intensive child-focused cognitive behavioural therapy (CBT). This systematic review and meta-analysis aimed to investigate the efficacy of parent-only interventions in reducing symptoms of anxiety disorders in school-aged children. METHODS A systematic search of five databases (inception to March 2021) identified 29 eligible studies. A range of study designs were captured, including randomised controlled trials (RCTs) and case series. A narrative synthesis was conducted. Random effects meta-analyses were performed on parent- and child-reported outcomes and pre-test post-test effect sizes were calculated for uncontrolled studies. RESULTS Findings indicated a significant treatment effect for parent-only interventions compared to waitlist controls. No significant differences were found when comparing parent-only interventions with other active interventions; anxiety symptoms reduced in both conditions. No significant treatment effects were found for child-rated outcomes. Calculated effect sizes for uncontrolled studies were typically large, although sample sizes were small. No clear evidence was found for a superior type, duration or format of intervention. LIMITATIONS The methodological quality of many studies in this review (19/29) was rated 'weak'. Only English language papers were included. CONCLUSIONS To date, this is the first systematic review and meta-analysis of the efficacy of parent-only interventions for reducing symptoms of child anxiety disorders. Our results suggest that parent-only interventions may be effective in reducing child anxiety. These findings are important for clinical practice because they suggest that efficient, low intensity interventions delivered to parents may lead to positive outcomes for children.
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Affiliation(s)
- C Jewell
- Centre for New Treatments and Understanding in Mental Health, School of Health Sciences, The University of Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK
| | - A Wittkowski
- Centre for New Treatments and Understanding in Mental Health, School of Health Sciences, The University of Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health Foundation Trust, Manchester, UK.
| | - D Pratt
- Centre for New Treatments and Understanding in Mental Health, School of Health Sciences, The University of Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health Foundation Trust, Manchester, UK
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Liu F, Yang D, Liu Y, Zhang Q, Chen S, Li W, Ren J, Tian X, Wang X. Use of latent profile analysis and k-means clustering to identify student anxiety profiles. BMC Psychiatry 2022; 22:12. [PMID: 34986837 PMCID: PMC8728926 DOI: 10.1186/s12888-021-03648-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/07/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Anxiety disorders are often the first presentation of psychopathology in youth and are considered the most common psychiatric disorders in children and adolescents. This study aimed to identify distinct student anxiety profiles to develop targeted interventions. METHODS A cross-sectional study was conducted with 9738 students in Yingshan County. Background characteristics were collected and Mental Health Test (MHT) were completed. Latent profile analysis (LPA) was applied to define student anxiety profiles, and then the analysis was repeated using k-means clustering. RESULTS LPA yielded 3 profiles: the low-risk, mild-risk and high-risk groups, which comprised 29.5, 38.1 and 32.4% of the sample, respectively. Repeating the analysis using k-means clustering resulted in similar groupings. Most students in a particular k-means cluster were primarily in a single LPA-derived student profile. The multinomial ordinal logistic regression results showed that the high-risk group was more likely to be female, junior, and introverted, to live in a town, to have lower or average academic performance, to have heavy or average academic pressure, and to be in schools that have never or occasionally have organized mental health education activities. CONCLUSIONS The findings suggest that students with anxiety symptoms may be categorized into distinct profiles that are amenable to varying strategies for coordinated interventions.
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Affiliation(s)
- Fang Liu
- grid.412449.e0000 0000 9678 1884School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New District, Shenyang, 110122 Liaoning China
| | - Dan Yang
- Nanchong Physical and Mental Hospital (Nanchong Sixth People’s Hospital), No.99 Jincheng Street, Yingshan County, Nanchong, 637000 Sichuan China
| | - Yueguang Liu
- Nanchong Physical and Mental Hospital (Nanchong Sixth People’s Hospital), No.99 Jincheng Street, Yingshan County, Nanchong, 637000 Sichuan China
| | - Qin Zhang
- grid.412449.e0000 0000 9678 1884School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New District, Shenyang, 110122 Liaoning China
| | - Shiyu Chen
- Nanchong Physical and Mental Hospital (Nanchong Sixth People’s Hospital), No.99 Jincheng Street, Yingshan County, Nanchong, 637000 Sichuan China
| | - Wanxia Li
- Nanchong Physical and Mental Hospital (Nanchong Sixth People’s Hospital), No.99 Jincheng Street, Yingshan County, Nanchong, 637000 Sichuan China
| | - Jidong Ren
- Nanchong Physical and Mental Hospital (Nanchong Sixth People’s Hospital), No.99 Jincheng Street, Yingshan County, Nanchong, 637000 Sichuan China
| | - Xiaobin Tian
- Nanchong Physical and Mental Hospital (Nanchong Sixth People's Hospital), No.99 Jincheng Street, Yingshan County, Nanchong, 637000, Sichuan, China. .,Department of Preventive Medicine, North Sichuan Medical College, No.234 Fujiang Road, Nanchong, 637000, Sichuan, China.
| | - Xin Wang
- School of Health Management, China Medical University, No.77 Puhe Road, Shenyang North New District, Shenyang, 110122, Liaoning, China.
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Yin B, Teng T, Tong L, Li X, Fan L, Zhou X, Xie P. Correction to: Efficacy and acceptability of parent-only group cognitive behavioral intervention for treatment of anxiety disorder in children and adolescents: a meta-analysis of randomized controlled trials. BMC Psychiatry 2021; 21:101. [PMID: 33593293 PMCID: PMC7888087 DOI: 10.1186/s12888-021-03075-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- Bangmin Yin
- Department of Neurology, People’s Hospital of Deyang City, Deyang, China ,grid.452206.7Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.452206.7NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016 China
| | - Teng Teng
- grid.452206.7Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.452206.7NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016 China
| | - Lyu Tong
- grid.412449.e0000 0000 9678 1884Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Xuemei Li
- grid.452206.7Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.452206.7NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016 China
| | - Li Fan
- grid.452206.7Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.452206.7NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016 China
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, China.
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. .,NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, China.
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