Chantal Herren

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.

DSM-IV criteria for childhood separation anxiety disorder: informant, age, and sex differences.

BACKGROUND The present study examines frequency of DSM-IV symptom and diagnostic criteria for separation anxiety disorder (SAD) by informant, age, and sex. METHODS Children aged 4-15 years with a primary DSM-IV diagnosis of SAD (N=106) were assessed using structured diagnostic interviews (Kinder-DIPS; DSM-IV-TR Version). Frequency of DSM-IV symptom and diagnostic criteria were examined as a function of informant and child characteristics, along with impairment and distress ratings. RESULTS The most frequently reported symptoms were separation-related distress, avoidance of being alone/without an adult and sleeping away from caregivers or from home, with nightmares the least frequently endorsed criterion. Child report did not yield any significant sex or age differences. However, parent report revealed greater reluctance or avoidance of school attendance for girls than boys, and for younger children (<8 years). Parent report indicated greater symptom-related impairment than child report, and the number of symptoms was correlated with impairment based on parent report, and with distress based on child report. CONCLUSIONS The primary indicators of SAD appear to be separation distress, avoidance of being alone, and sleeping away from caregivers. Findings suggest that parents may be best placed to determine impairment, while children may be the most accurate reporters of more covert internal distress. Implications for clinicians are that reports from multiple informants should be used to gain the most comprehensive information about childhood SAD.

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).

Reliabilität des Diagnostischen Interviews bei Psychischen Störungen (DIPS für DSM-IV-TR) unter klinischen Routinebedingungen

Hintergrund: Ziel dieser Studie ist die Überprüfung der Interrater- und Retest-Reliabilität des an die DSM-IV-TR-Kriterien angepassten und erweiterten Diagnostischen Interviews bei Psychischen Störungen [DIPS für DSM-IVTR; Schneider und Margraf, 2006]. Methode: 10 geschulte Interviewerinnen führten 237 Interviews in klinischen ambulanten und stationären Einrichtungen durch. Ergebnisse: Die Ergebnisse sprechen für eine gute bis sehr gute Interrater-Reliabilität der Oberklassen Angststörungen, affektive Störungen, somatoforme Störungen, Schlafstörungen, Essstörungen, Substanz- und Alkoholmissbrauch/-abhängigkeit sowie aller überprüfbarer Diag nosekategorien und für den Ausschluss psychischer Störungen. Ein vergleichbares Bild ergab sich für die Retest-Reliabilitäten: Lediglich die Störungsoberklasse Schlafstörungen sowie die Diagnoseklassen generalisierte Angststörung und dysthyme Störung zeigten eine nicht zufriedenstellende Reliabilität. Die Reliabilitätswerte waren für die verschiedenen klinischen Settings (ambulant vs. stationär) vergleichbar. Schlussfolgerung: Die Ergebnisse zeigen, dass auch das vollständig überarbeitete und erweiterte DIPS für DSM-IV-TR ein reliables Interview zur Diagnostik psychischer Störungen darstellt und komorbide Störungsbilder, wie sie insbesondere im klinischen Alltag häufig anzutreffen sind, zuverlässig abbilden kann.

HPA AXIS RELATED GENES AND RESPONSE TO PSYCHOLOGICAL THERAPIES: GENETICS AND EPIGENETICS.

Hypothalamic–pituitary–adrenal (HPA) axis functioning has been implicated in the development of stress‐related psychiatric diagnoses and response to adverse life experiences. This study aimed to investigate the association between genetic and epigenetics in HPA axis and response to cognitive behavior therapy (CBT).

Non-replication of the association between 5HTTLPR and response to psychological therapy for child anxiety disorders

Background We previously reported an association between 5HTTLPR genotype and outcome following cognitive–behavioural therapy (CBT) in child anxiety (Cohort 1). Children homozygous for the low-expression short-allele showed more positive outcomes. Other similar studies have produced mixed results, with most reporting no association between genotype and CBT outcome. Aims To replicate the association between 5HTTLPR and CBT outcome in child anxiety from the Genes for Treatment study (GxT Cohort 2, n = 829). Method Logistic and linear mixed effects models were used to examine the relationship between 5HTTLPR and CBT outcomes. Mega-analyses using both cohorts were performed. Results There was no significant effect of 5HTTLPR on CBT outcomes in Cohort 2. Mega-analyses identified a significant association between 5HTTLPR and remission from all anxiety disorders at follow-up (odds ratio 0.45, P = 0.014), but not primary anxiety disorder outcomes. Conclusions The association between 5HTTLPR genotype and CBT outcome did not replicate. Short-allele homozygotes showed more positive treatment outcomes, but with small, non-significant effects. Future studies would benefit from utilising whole genome approaches and large, homogenous samples.

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.

HPA AXIS RELATED GENES AND RESPONSE TO PSYCHOLOGICAL THERAPIES: GENETICS AND EPIGENETICS: Research Article: HPA Axis Genes and CBT Response

Hypothalamic–pituitary–adrenal (HPA) axis functioning has been implicated in the development of stress‐related psychiatric diagnoses and response to adverse life experiences. This study aimed to investigate the association between genetic and epigenetics in HPA axis and response to cognitive behavior therapy (CBT).

HPA axis related genes and response to psychological therapies

Hypothalamic–pituitary–adrenal (HPA) axis functioning has been implicated in the development of stress‐related psychiatric diagnoses and response to adverse life experiences. This study aimed to investigate the association between genetic and epigenetics in HPA axis and response to cognitive behavior therapy (CBT).

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),