Carmen Adornetto

Disorder-Specific Cognitive-Behavioral Therapy for Separation Anxiety Disorder in Young Children: A Randomized Waiting-List-Controlled Trial

Background: Separation anxiety disorder (SAD) is one of the earliest and most common mental disorders in childhood, and a strong predictor of adult psychopathology. Despite significant progress in psychotherapy research on childhood anxiety disorders, no randomized controlled trial has been conducted with a disorder-specific treatment program for young children suffering from SAD. Methods: Forty-three children (ages 5–7) with SAD and their parents were assigned to either a 16-session disorder-specific SAD treatment program including parent training and classical cognitive-behavioral therapy (CBT) components, or to a 12-week waiting list group. Categorical and/or continuous data for anxiety, impairment/distress and quality of life were collected at baseline, after treatment/waiting list condition, and at a 4-week follow-up. Results: Intention-to-treat analyses indicate that 76.19% of children allocated to the treatment group definitively no longer fulfilled DSM-IV criteria for SAD at follow-up, compared to 13.64% in the waiting list group. Between 91 and 100% of children rated themselves or were rated by their father, mother or therapist as very much or much improved on the global success rating immediately after treatment. Results indicated large time by treatment condition interaction effect sizes (d = 0.98–1.41) across informants for reduction of distress/avoidance in separation situations after the test for the treatment condition. Further, parents reported significant improvements in impairment/distress in the child’s major life domains and the child’s quality of life. Treatment gains were maintained at the 4-week follow-up assessment. Conclusions: Results indicate the short-term efficacy of a disorder-specific treatment approach for SAD, and are among the first to indicate that CBT programs work with young children.

The efficacy of a family-based cognitive-behavioral treatment for separation anxiety disorder in children aged 8-13: a randomized comparison with a general anxiety program.

BACKGROUND This randomized controlled trial examines the relative efficacy of a disorder-specific treatment program (TrennungsAngstprogramm Für Familien [TAFF]; English: Separation Anxiety Family Therapy) for children suffering from separation anxiety disorder (SAD) in comparison with a general anxiety program. METHOD Sixty-four children aged 8-13 with SAD and their parents were assigned either to a 16-session disorder-specific SAD treatment program, including parent training and classical cognitive-behavioral therapy (CBT) components (TAFF), or to a general child-focused 16-week comparison group (Coping Cat [CC]) without any parent training. Diagnoses and parent cognitions were assessed at baseline and at follow-ups. Global success ratings were collected at end of treatment and at follow-up. Ratings for anxiety, impairment/distress, and life quality were collected at Baseline 1, again after a 4-week waiting period, repeatedly throughout treatment, at 4 weeks, and at 1-year follow-up. RESULTS The response rate (no SAD diagnosis) at 4-week follow-up among the 52 treatment completers was 87.5% vs. 82.1% (TAFF vs. CC; intent-to-treat: 67.7% vs. 69.7%). At 1-year follow-up, the response was 83.3% versus 75% (TAFF vs. CC; intent to treat: 64.5% vs. 63.6%). Differences were nonsignificant. Results from rating scales indicated improvement for both groups across time points and assessment areas, with few between-group differences, and some small effects favoring the TAFF program. Both treatment programs yielded a reduction in parental dysfunctional beliefs. CONCLUSIONS Results indicate a slight advantage of the TAFF program over a general child-based treatment for SAD. However, these differences were less strong than hypothesized, indicating that the inclusion of parent training does not add large effects to classical child-based CBT in school-age children with SAD. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Interrater-Reliabilität des Diagnostischen Interviews bei psychischen Störungen im Kindes- und Jugendalter (Kinder-DIPS)

OBJECTIVE This study investigates the interrater reliability of the «Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter» (Kinder-DIPS; Schneider, Unnewehr & Margraf, 2009) based on child and parent interviews. It further investigates differences in the interrater reliability depending on age or sex of the children. METHOD 48 certified interviewers conducted 264 parent and 213 child interviews in various inpatient, outpatient, and research settings. RESULTS There is a good interrater reliability for the parent and child interviews for the major diagnostic categories of conduct disorders, tic disorders, elimination disorders, mood disorders, eating disorders, sleeping disorders, the majority of the specific psychiatric disorders, and the exclusion of psychiatric disorders. Neither the sex nor the age of the children influenced interrater reliability. CONCLUSIONS The second and expanded Kinder-DIPS proves to be a reliable parent and child interview for the assessment of mental disorders in both outpatient and inpatient settings.

The factor structure of the Childhood Anxiety Sensitivity Index in German children

The factor structure of the Childhood Anxiety Sensitivity Index (CASI) was investigated in four nonclinic German samples (N=1244, 225, 230, and 143) with participants aged 8-16-years-old. Factor solutions suggested for different CASI versions were tested using confirmatory factor analysis. The best goodness-of-fit indices were found for the 13-item CASI version with 4 factors (Disease Concerns, Unsteady Concerns, Mental Incapacitation Concerns, and Social Concerns). Testing for factorial invariance of this model with respect to age and gender revealed non-invariant factor loadings between children and adolescents as well as between boys and girls. The theoretical and clinical implications of these findings for anxiety sensitivity in children and adolescents are discussed.

Early Predictors of Separation Anxiety Disorder: Early Stranger Anxiety, Parental Pathology and Prenatal Factors

Objective: The present study seeks to extend research on the etiology of separation anxiety disorder (SAD) in a German-speaking sample by examining differences between children with SAD and healthy comparisons, using a retrospective-reporting paradigm. Method: The sample included 106 children with SAD and 44 healthy children between the ages of 4 and 14 years. Parents completed questionnaires and structured clinical interviews to assess parental pathology, pregnancy variables and strong early stranger anxiety. Results: Children with SAD were more likely than healthy children to have had a phase of stronger stranger anxiety in infancy. Further, early stranger anxiety remained a significant predictor of SAD after controlling for maternal depression. Meaningful effects were not found for the influence of parental age at birth or other pregnancy factors. Conclusion: This study provides beginning evidence of the potential predictive value of strong stranger anxiety in distinguishing children with SAD from those with no disorder, above and beyond the influence of parental pathology.

Concordances and discrepancies between ICD-10 and DSM-IV criteria for anxiety disorders in childhood and adolescence

BackgroundMental disorders are classified by two major nosological systems, the ICD-10 and the DSM-IV-TR, consisting of different diagnostic criteria. The present study investigated the diagnostic concordance between the two systems for anxiety disorders in childhood and adolescence, in particular for separation anxiety disorder (SAD), specific phobia, social phobia, and generalized anxiety disorder (GAD).MethodsA structured clinical interview, the Kinder-DIPS, was administered to 210 children and 258 parents. The percentage of agreement, kappa, and Yule’s Y coefficients were calculated for all diagnoses. Specific criteria causing discrepancies between the two classification systems were identified.ResultsDSM-IV-TR consistently classified more children than ICD-10 with an anxiety disorder, with a higher concordance between DSM-IV-TR and the ICD-10 child section (F9) than with the adult section (F4) of the ICD-10. This result was found for all four investigated anxiety disorders. The results revealed low to high levels of concordance and poor to good agreement between the classification systems, depending on the anxiety disorder.ConclusionsThe two classification systems identify different children with an anxiety disorder. However, it remains an open question, whether the research results can be generalized to clinical practice since DSM-IV-TR is mainly used in research while ICD-10 is widely established in clinical practice in Europe. Therefore, the population investigated by the DSM (research population) is not identical with the population examined using the ICD (clinical population).

Psychometrische Eigenschaften und Normierung der deutschen Version des Childhood Anxiety Sensitivity Index (CASI)

Zusammenfassung. Theoretischer Hintergrund: Bei dem KASI handelt es sich um die deutsche Ubersetzung des „Childhood Anxiety Sensitivity Index (CASI)” zur Erfassung von Angstsensitivitat bei Kindern und Jugendlichen. Fragestellung: Die psychometrischen Eigenschaften des „Kinder-Angstsensitivitatsindex (KASI)” wurden uberpruft. Methode: Insgesamt 1538 Kinder und Jugendliche fullten den Fragebogen aus. Ergebnisse: Die interne Konsistenz (Cronbachs Alpha) ist mit α ≥ .79 hoch. Die Datenanalysen zeigen signifikante Zusammenhange zwischen KASI und konstruktnahen Messinstrumenten (ACQ, BSQ) sowie Paniksymptomen, agoraphobischen Angsten und Trennungsangst. Erwartungsgemas geringer sind die Zusammenhange mit spezifischer und sozialer Phobie und Depression. Zudem konnten an einer Stichprobe von 1235 Schulern Normen fur das Testverfahren gewonnen werden. Schlussfolgerungen: Aufgrund der vorliegenden Befunde kann der KASI als ein reliables und valides Messinstrument bezeichnet werden.

Contents / Acknowledgement Vol. 44, 2011

R. Bentall, Manchester C.E. Berganza, Guatemala City D. Bhugra, London C. Brewin, London Y.-F. Chen, Beijing D. Clark, London N.M.J. Edelstyn, Keele H. Fabisch, Graz K. Fabisch, Graz P. Falkai, Göttingen H.J. Freyberger, Greifswald/Stralsund N. Ghaemi, Boston, Mass. C. Haasen, Hamburg A. Heerlein, Santiago P. Henningsen, München P. Hoff , Zürich Y. Kim, Tokyo A. Marneros, Halle/Saale M. Musalek, Wien F. Poustka, Frankfurt/Main J. Raboch, Prague P. Salkovskis, London I.M. Salloum, Miami, Fla. F. Schneider, Aachen J.C. Soares, Chapel Hill, N.C. J.S. Strauss, New Haven, Conn. E. Vieta, Barcelona M. Weisbrod, Karlsbad Official Journal of the World Psychiatric Association (WPA),