Andrew R. Eisen

The phenomenology of panic disorder in youngsters: An empirical study of a clinical sample

Questions about the existence of panic disorder in youngsters are now evolving into questions about the phenomenology of panic disorder in children and adolescents. The current study thus examined the primary clinical features of panic disorder in an outpatient sample of older children and adolescents with panic disorder. Youngsters with panic disorder were compared to a matched-gender group of youngsters with non-panic anxiety disorders. Dependent variables included diagnoses and self-ratings of fear, depression, general anxiety, and anxiety sensitivity. The panic group was found to display more frequent diagnoses of depression and greater levels of self-reported anxiety sensitivity than the non-panic group. These results are discussed in the context of one potential cognitive developmental pathway of panic disorder, and preliminary assessment and treatment recommendations are offered.

Prescriptive treatment for generalized anxiety disorder in children

This investigation compared the preliminary efficacy of prescriptive and nonprescriptive cognitive-behavioral interventions (i.e., cognitive therapy/exposure or relaxation training/exposure) for problematic response classes (cognitive or somatic symptoms) of 4 overanxious children (8 to 12 years) using a multiple baseline design across subjects. Participants also met DSM-IV criteria for generalized anxiety disorder. All children improved on pre-post child and parent self-report measures, independent clinician ratings, and physiologic recordings. Treatment gains were generally maintained at 6-month follow-up. Although both treatments were effective, only prescriptive treatments produced sufficient improvement for participants to meet positive end-state criteria. Implications for the prescriptive treatment of anxiety disorders in children are discussed.

The Unique Impact of Parent Training for Separation Anxiety Disorder in Children

This investigation examined the preliminary efficacy of an integrated cognitive-behavioral parent-training protocol for six families of separation-anxious children (7 to 10 years of age) using a multiple baseline design across participants. Although families were assessed on child, parent, and clinician ratings at pre- and posttreatment as well as 6-month follow-up, only parents received education and training. Although the parent-training protocol was largely effective and treatment gains were maintained at 6-month follow-up, only those child participants whose parents experienced clinically significant improvement on parental process measures (i.e., enhanced efficacy or satisfaction, reduced stress) achieved high end-state functioning. Implications regarding the importance of individualized family-based interventions for treating anxious youth are discussed.

Contingent social reinforcement for fluid compliance in a hemodialysis patient.

Two approaches, (a) patient education and (b) compliance-contingent social reinforcement, were employed to improve compliance with fluid restrictions in a chronically noncompliant hemodialysis patient of borderline intellectual functioning. Results indicated that only social reinforcement led to improved compliance (i.e., decreased intersession weight gain). Treatment effects were well maintained at both 3- and 6-month follow-ups. Contingency management strategies are recommended as a potentially cost effective treatment for noncompliance in hemodialysis patients.

Separation Anxiety Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR; American Psychiatric Association [APA], 2000), the central feature of separation anxiety disorder (SAD) is unrealistic and excessive anxiety upon separation or anticipation of separation from major attachment figures. SAD is the only anxiety disorder based on specific child criteria as well as having a childhood onset. DSM-IV-TR requires evidence of at least three (of eight) separation-related symptoms that cause (1) significant interference in social and academic functioning and (2) continuous disturbance for at least 1 month. These impairment criteria are important since separation anxiety is typical and can be developmentally appropriate in young children (Hanna, Fischer, & Fluent, 2006).

Early evidence for factorial structure of the separation anxiety symptom inventory in Italian children.

The aim of this study was to explore the internal consistency and confirm the factor structure of the Separation Anxiety Symptom Inventory for Children (SASI–C) in a community sample of 329 Italian children, ages 6 to 10 years. A confirmatory factor analysis yielded two interpretable factors. Correlations between scores for the SASI–C and the Italian Fear Survey Schedule for Children were calculated to estimate convergent validity; medium effect sizes are hypothesized. Implications regarding the clinical utility of the SASI–C are discussed.