Denise Bodden

Child versus family cognitive-behavioral therapy in clinically anxious youth: An efficacy and partial effectiveness study

OBJECTIVE The efficacy and partial effectiveness of child-focused versus family-focused cognitive-behavioral therapy (CBT) for clinically anxious youths was evaluated, in particular in relation to parental anxiety disorders and childs age. METHOD Clinically referred children with anxiety disorders (N = 128) and their parents were randomly assigned to child or family CBT and evaluated at pretreatment, posttreatment, and 3-month follow-up. Twenty-five families were measured before and after a 2- to 3-month waitlist period. RESULTS None of the waitlisted children recovered from their anxiety disorders. In contrast, 41% of the treated children no longer met criteria for any anxiety disorder after CBT, and 52% demonstrated continued improvement at the 3-month follow-up. Significantly more children were free of anxiety disorders (53%) in the child CBT condition compared with family CBT condition (28%) at posttreatment, whereas at 3-month follow-up, the superior effect of child CBT was no longer significant. Similar results were obtained from the questionnaire measures. Both child and family CBT were less effective if parents had an anxiety disorder themselves. On some of the measures, child CBT was superior if parents had anxiety disorders themselves, whereas family CBT was superior if parents had no anxiety disorders. Finally, younger children had better outcomes than older children, regardless of the treatment condition. CONCLUSIONS Overall, child CBT seems slightly more beneficial than family CBT. Because this study was conducted in a clinical setting with clinically referred children, results indicate partial effectiveness for child CBT.

The diagnostic utility of the Screen for Child Anxiety Related Emotional Disorders-71 (SCARED-71)

OBJECTIVE This study investigated the diagnostic utility of the 71-item Screen for Child Anxiety Related Emotional Disorders (SCARED-71), as a screening tool for identifying anxiety disorders in youth aged 8-18 years. METHOD The SCARED-71 and the Anxiety Disorder Interview Schedule (ADIS) were administered to clinically referred anxious children (n=138) and control children (n=38) as well as their parents. RESULTS Results showed that the SCARED-71 differentiated clinically anxious from control children on the total score and on all subscales. Girls generally reported higher levels of anxiety symptoms and there were also significant age effects for various anxiety subscales. Further, reliable cut-off scores were established for the child and parent version of the SCARED-71. The parent version displayed better sensitivity and specificity, and therefore seems to be a more optimal screen for anxiety problems in children and adolescents. Finally, evidence for the predictive validity across anxiety disorders was found. CONCLUSION The SCARED-71 can be used as a screening tool to detect clinically significant anxiety problems in children and adolescents and discriminates reasonably well among specific anxiety disorders.

Types of parental involvement in CBT with anxious youth: A preliminary meta-analysis

OBJECTIVE Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CBT) for anxious children is therapeutically beneficial. There is also great heterogeneity in the type of parental involvement included. We investigated parental involvement focused on contingency management (CM) and transfer of control (TC) as a potential outcome moderator using a meta-analysis with individual patient data. METHOD Investigators of randomized controlled trials (RCTs) of CBT for anxious children, identified systematically, were invited to submit their data. Conditions in each RCT were coded based on type of parental involvement in CBT (i.e., low involvement, active involvement without emphasis on CM or TC, active involvement with emphasis on CM or TC). Treatment outcomes were compared using a 1-stage meta-analysis. RESULTS All cases involved in active treatment (894 of 1,618) were included for subgroup analyses. Across all CBT groups, means of clinical severity, anxiety, and internalizing symptoms significantly decreased posttreatment and were comparable across groups. The group without emphasis on CM or TC showed a higher proportion with posttreatment anxiety diagnoses than the low-involvement group. Between posttreatment and 1-year follow-up, the proportion with anxiety diagnoses significantly decreased in CBT with active parental involvement with emphasis on CM or TC, whereas treatment gains were merely maintained in the other 2 groups. CONCLUSIONS CBT for anxious children is an effective treatment with or without active parental involvement. However, CBT with active parental involvement emphasizing CM or TC may support long-term maintenance of treatment gains. RESULTS should be replicated as additional RCTs are published.

Cognitive Behavioral Therapy Age Effects in Child and Adolescent Anxiety: An Individual Patient Data Metaanalysis

Investigations of age effects on youth anxiety outcomes in randomized trials (RCTs) of cognitive behavior therapy (CBT) have failed to yield a clear result due to inadequate statistical power and methodologic weaknesses. We conducted an individual patient data metaanalysis to address this gap.

Costs and Cost-Effectiveness of Family CBT Versus Individual CBT in Clinically Anxious Children

The objective of this study was to investigate the cost-effectiveness of family cognitive-behavioral therapy (CBT) compared with individual CBT in children with anxiety disorders. Clinically anxious children (aged 8—18 years) referred for treatment were randomly assigned to family or individual CBT and were assessed pre-treatment, post treatment, and at 3 months and 1 year after treatment. Cost-effectiveness ratios were calculated expressing the incremental costs per anxiety-free child and the incremental costs per Quality Adjusted Life Year (QALY) for the referred child. Neither societal costs nor effectiveness were significantly different between individual and family CBT. However, the point estimates of the cost-effectiveness ratios resulted in dominance for individual CBT, indicating that individual CBT is more effective and less costly than family CBT. These results were confirmed by bootstrap analyses and cost-effectiveness acceptability curves. Several secondary and sensitivity analyses showed that the results were robust. It can be concluded that family CBT is not a cost-effective treatment for clinically anxious children, compared with individual CBT.

Adolescent depression and negative life events, the mediating role of cognitive emotion regulation

Background Depression during adolescence is a serious mental health problem. Difficulties in regulating evoked emotions after stressful life events are considered to lead to depression. This study examined if depressive symptoms were mediated by various cognitive emotion regulation strategies after stressful life events, more specifically, the loss of a loved one, health threats or relational challenges. Methods We used a sample of 398 adolescents (Mage = 16.94, SD = 2.90), including 52 depressed outpatients, who all reported stressful life event(s). Path analyses in Mplus were used to test mediation, for the whole sample as well as separately for participants scoring high versus low on depression, using multigroup analyses. Results Health threats and relational challenging stressful life events were associated with depressive symptoms, while loss was not. More frequent use of maladaptive strategies was related to more depressive symptoms. More frequent use of adaptive strategies was related to less depressive symptoms. Specific life events were associated with specific emotion regulation strategies. The relationship between challenging, stressful life events and depressive symptoms in the whole group was mediated by maladaptive strategies (self-blame, catastrophizing and rumination). No mediation effect was found for adaptive strategies. Conclusion The association between relational challenging, stressful life events and depressive symptoms was mediated by maladaptive, cognitive emotion regulation strategies.

Factors associated with the referral of anxious children to mental health care: the influence of family functioning, parenting, parental anxiety and child impairment.

This study aims to identify factors that predict the mental health care referral of anxious children. In total, 249 children and families, aged 8–13 years, participated: 73 children were referred with anxiety disorders to mental health care [mean (M) age =10.28, standard deviation (SD) =1.35], 176 non‐referred anxious children recruited in primary schools (M age =9.94, SD =1.22). Child anxiety and other disorders were assessed with semi‐structured interviews. Child anxiety symptoms, behavioural problems, parental anxiety, the parenting styles overprotection, autonomy encouragement, rejection, and the family functioning dimensions control and relational functioning, were assessed with child, father and mother report on questionnaires. The summed interference rating of childrens anxiety disorders was a predictor of referral, consistent over child and parent reports, but not comorbidity. Most family and parenting variables did not predict referral, nor differed between the referred and non‐referred sample. Contrary to our hypothesis, maternal self‐reported anxiety decreased the odds of referral and child reported parental autonomy granting increased, while child reported overprotection decreased the odds of referral. The impairment for the child due to the number and severity of their anxiety disorder(s) is, based on child, mother and father report associated with referral. This indicates that those who need it most, receive clinical treatment. Copyright

Does Mother–Child Interaction Mediate the Relation Between Maternal Depressive Symptoms and Children’s Mental Health Problems?

The relation between maternal depressive symptoms and children’s mental health problems has been well established. However, prior studies have predominantly focused on maternal reports of children’s mental health problems and on parenting behavior, as a broad and unilateral concept. This cross-sectional study examined specific observed mother–child interaction behaviors through which maternal depressive symptoms are assumed to affect children’s mental health problems. We expected higher rates of maternal depressive symptoms to predict higher rates of children’s mental health problems, and we expected this relation to be mediated by low maternal warmth and high maternal psychological control. The sample consisted of 111 mother–child dyads referred for treatment. The mother–child interaction behaviors were coded according to the observed mother–child interaction tasks. Children’s mental health problems were assessed using both maternal reports and children’s self-reports. As expected, the results showed that maternal depressive symptoms were strongly related to maternal reports of children’s internalizing and externalizing mental health problems. Surprisingly, maternal depressive symptoms were unrelated to children’s self-reported depressive symptoms. Furthermore, mother–child interactions did not mediate the relation between maternal depressive symptoms and child mental health problems. Maternal depressive symptoms were associated with high maternal warmth, and high psychological control was associated with high levels of mother-reported externalizing mental health problems in children. These results partially replicate previous findings but add to these by using observational methods and multi-informant data. The importance of using a multi-informant and multi-method approach in assessing children’s mental health problems in clinical practice and research are discussed.

Ouders van angstige kinderen: laat ze maar thuis!

SamenvattingBij de behandeling van een angstig kind wordt er tegenwoordig steeds meer samengewerkt met de ouders. Maar is dit wetenschappelijk gezien ook zinvol? Met andere woorden, moeten ouders wel of niet betrokken worden bij de behandeling van hun angstige kind? In deze bijdrage zal ik een overzicht geven van studies die de effectiviteit van ouderlijke betrokkenheid bij de therapie van het angstige kind hebben onderzocht.

Development and initial validation of the comprehensive early childhood parenting questionnaire (CECPAQ) for parents of 1–4 year-olds

Abstract Parenting is a multifaceted task and the way in which parents fulfill this task plays an important role in children’s growth and development, especially in early childhood. Conceptualization and assessment of parenting behavior is elementary for research on child and family development and would fill a gap in clinical work, as there is a lack of questionnaires simultaneously assessing multiple parenting behaviors specific for early childhood. Therefore the Comprehensive Early Childhood Parenting Questionnaire (CECPAQ) was designed; a parent report measure of commonly occurring behaviors in five domains of parenting (i.e., support, stimulation, structure, harsh discipline, and positive discipline) central to early childhood. Data were collected from 1139 mothers and 526 fathers of 1–4 year-old children. Confirmatory factor analysis confirmed a five-factor structure (composed of 54 items). The five parenting domains were found to have good internal consistency and temporal stability. Preliminary evidence of validity of the CECPAQ was demonstrated by moderate relationships with measures of parental stress and child problem behavior. It is concluded that the CECPAQ is a promising measure of self-perceived parenting behavior for parents of 1–4 year-old children.