Donna B. Pincus

Parent-Child Interaction Therapy for Treatment of Separation Anxiety Disorder in Young Children: A Pilot Study.

Research suggests that Parent-Child Interaction therapy (PCIT) works to improve the childs behavior by changing the child-parent interaction. PCIT has been effective in treating disruptive behavior in young children. This article describes a pilot study to apply PCIT to the treatment of separation anxiety disorder (SAD). A multiple-baseline design was used with 3 families with a child between the ages of 4 and 8 who had a principal diagnosis of SAD. Following treatment with PCIT, clinically significant change in separation anxiety was observed on all measures. Disruptive behaviors also decreased following treatment. Treatment gains were maintained at a 3-month follow-up interval. These findings suggest that PCIT may be particularly useful for treatment of young children with SAD, the most prevalent yet underresearched anxiety disorder of childhood. The results of this study support research delineating the important contribution of family factors to anxiety in childhood. Several mechanisms are proposed that may account for the dramatic decrease in separation-anxious behaviors seen in children during PCIT, including increased levels of child control, increased social reinforcement of brave behaviors, improved parent-child attachment, and decreased levels of parent anxiety. Results of this study provide promising initial evidence that PCIT may be efficacious for treating young children with SAD. A randomized clinical trial is warranted to further elucidate the efficacy of PCIT for treatment of SAD in young children.

Alliance, Technology, and Outcome in the Treatment of Anxious Youth.

A strong therapeutic alliance is intuitively important in a cognitive-behavioral treatment of anxious youth where the child must confront feared stimuli in numerous exposure tasks. Research examining alliance-outcome relationships and the specific role of the alliance is currently limited. Is the alliance supportive in nature, does it enhance client motivation, or is it an active mediator through which change occurs? Technology-based treatment aids and modalities (e.g., interactive CDs, virtual reality exposure, and single-session treatment) offer the potential benefit of promoting active child engagement, an essential goal of CBT, but they also challenge traditional notions of the therapeutic relationship. Conceptual definitions and methodological considerations for assessing the alliance in child anxiety treatment are discussed. A review of technology, outcome, and its effect on process follows, concluding with a recommendation that further alliance research is necessary and that advanced technologies provide an opportunity to understand the treatment process further.

The Liebowitz social anxiety scale for children and adolescents: an initial psychometric investigation.

OBJECTIVE To examine the psychometric properties of a newly developed clinician rating scale, the Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA). METHOD A total of 154 children and adolescents participated in an assessment consisting of a diagnostic interview, the LSAS-CA, and other measures of psychopathology and impairment. Sixty-one of these children also participated in a second LSAS-CA administration, by a different rater blind to diagnosis, within 7 days of the initial assessment. RESULTS High internal consistency (alpha =.90-.97 for full sample and.83-.95 for social phobia group) and test-retest reliability (intraclass correlation coefficient = 0.89-0.94) were obtained for LSAS-CA total and subscale scores. LSAS-CA scores had stronger associations with measures of social anxiety and general impairment than with a measure of depression. Subjects with social anxiety disorder had significantly higher LSAS-CA scores than subjects with other anxiety disorders and healthy controls. A LSAS-CA cutoff score of 22.5 represented the best balance of sensitivity and specificity when distinguishing between individuals with social phobia and normal controls, whereas a cutoff of 29.5 was optimal for distinguishing social phobia from other anxiety disorders. CONCLUSION Initial findings suggest that the LSAS-CA is a reliable and valid instrument for the assessment of social anxiety disorder.

Sleep-Related Problems in Children and Adolescents With Anxiety Disorders

This study examined the prevalence and patterns of sleep problems in a sample of children with anxiety disorders. Participants were 175 children, aged 6 to 18 years, with a primary diagnosis of generalized anxiety disorder, separation anxiety disorder, social phobia, or obsessive–compulsive disorder, presenting for assessment at an anxiety specialty clinic. Ninety percent of the sample demonstrated at least one sleep-related problem (SRP), and 82% experienced two or more. Frequencies of sleep problems did not differ between males and females or across younger and older children. However, type of sleep problems varied by diagnostic category. Findings also revealed strong associations between SRPs and a range of child anxiety measures, as well as a predictive relationship whereby number of anxiety disorders predicted number of sleep problems. Results highlight the high co-occurrence of sleep and anxiety problems, emphasizing the need for assessment and intervention efforts targeting sleep disturbance in this population.

The metacognitions questionnaire for children: Development and validation in a clinical sample of children and adolescents with anxiety disorders

A self-report measure of metacognition for both children and adolescents (ages 7-17) (Metacognitions Questionnaire for Children; MCQ-C) was adapted from a previous measure, the MCQ-A (Metacognitions Questionnaire for Adolescents) and was administered to a sample of 78 children and adolescents with clinical anxiety disorders and 20 non-clinical youth. The metacognitive processes included were (1) positive beliefs about worry (positive meta-worry); (2) negative beliefs about worry (negative meta-worry); (3) superstitious, punishment and responsibility beliefs (SPR beliefs) and (4) cognitive monitoring (awareness of ones own thoughts). The MCQ-C demonstrated good internal-consistency reliability, as well as concurrent and criterion validity, and four valid factors. In line with predictions, negative meta-worry was significantly associated with self-reports of internalizing symptoms (excessive worry and depression). Age-based differences on the MCQ-C were found for only one subscale, with adolescents reporting greater awareness of their thoughts than children. Adolescent girls scored higher on the total index of metacognitive processes than adolescent boys. Overall, these results provide preliminary support for the use of the MCQ-C with a broader age range as well as an association between metacognitive processes and anxiety symptomatology in both children and adolescents, with implications for cognitive behavioral interventions with anxious youth.

Characteristics of anxious and depressed youth seen in two different clinical contexts.

Previous research has revealed that youth seen at community clinics present with a higher frequency of externalizing problems and are demographically different from youth seen at research clinics. This study extends findings on these discrepancies by examining differences between youth at research and community clinics meeting criteria for two different primary disorders (anxiety and depression). Consistent with prior research, community clinic youth reported lower incomes, were more ethnically diverse, and had higher rates of externalizing problems compared to research clinic youth, regardless of primary diagnosis. Findings are discussed in terms of enhancing dissemination of evidence-based treatments for internalizing disorders in community settings.

Cognitive-Behavioral Treatment of Panic Disorder in Adolescence

This investigation represents the first randomized controlled trial to evaluate the feasibility and efficacy of Panic Control Treatment for Adolescents (PCT-A). Thirteen adolescents, ages 14 to 17, were randomized to 11 weekly sessions of PCT-A treatment, whereas 13 were randomized to a self-monitoring control group. Results indicate that adolescents receiving immediate PCT-A showed a significant reduction in clinician-rated severity of panic disorder and in self-reported anxiety, anxiety sensitivity, and depression, in comparison to control group participants. These treatment gains were maintained at 3- and 6-month follow-up. Clinical severity of panic continued to improve from posttreatment to 3-month follow-up and then remained stable at 6-month follow-up. In light of study limitations, these findings suggest that cognitive-behavioral treatment for panic disorder in adolescence is a feasible and potentially efficacious intervention for this debilitating condition in youth.

Extending Parent–Child Interaction Therapy for Early Childhood Internalizing Problems: New Advances for an Overlooked Population

Although efficacious psychological treatments for internalizing disorders are now well established for school-aged children, until recently there have regrettably been limited empirical efforts to clarify indicated psychological intervention methods for the treatment of mood and anxiety disorders presenting in early childhood. Young children lack many of the developmental capacities required to effectively participate in established treatments for mood and anxiety problems presenting in older children, making simple downward extensions of these treatments for the management of preschool internalizing problems misguided. In recent years, a number of research groups have successfully adapted and modified parent–child interaction therapy (PCIT), originally developed to treat externalizing problems in young children, to treat various early internalizing problems with a set of neighboring protocols. As in traditional PCIT, these extensions target child symptoms by directly reshaping parent–child interaction patterns associated with the maintenance of symptoms. The present review outlines this emerging set of novel PCIT adaptations and modifications for mood and anxiety problems in young children and reviews preliminary evidence supporting their use. Specifically, we cover (a) PCIT for early separation anxiety disorder; (b) the PCIT-CALM (Coaching Approach behavior and Leading by Modeling) Program for the full range of early anxiety disorders; (c) the group Turtle Program for behavioral inhibition; and (d) the PCIT-ED (Emotional Development) Program for preschool depression. In addition, emerging PCIT-related protocols in need of empirical attention—such as the PCIT-SM (selective mutism) Program for young children with SM—are also considered. Implications of these protocols are discussed with regard to their unique potential to address the clinical needs of young children with internalizing problems. Obstacles to broad dissemination are addressed, and we consider potential solutions, including modular treatment formats and innovative applications of technology.

Parent–Child Agreement in the Assessment of Obsessive-Compulsive Disorder

The purpose of the current study was to extend research regarding parent–child agreement in the assessment of anxiety disorders to include youth with obsessive-compulsive disorder (OCD). Ninety-three children and adolescents with OCD (50 female, 43 male), ages 6 to 17 years, and their parents were administered the Anxiety Disorders Interview Schedule for Children. Data were obtained from a review of records of children and their parents seeking services from a university-based research and treatment clinic. Consistent with previous research on the assessment of anxiety disorders in youth, results indicated that parent–child agreement in the assessment of OCD is relatively poor at both the diagnostic and symptom levels. Our findings highlight the importance of multiple informant diagnostic systems in assessing childhood OCD.

EVALUATION OF THE PROPOSED SOCIAL ANXIETY DISORDER SPECIFIER CHANGE FOR DSM-5 IN A TREATMENT-SEEKING SAMPLE OF ANXIOUS YOUTH

The current proposal for the DSM‐5 definition of social anxiety disorder (SAD) is to replace the DSM‐IV generalized subtype specifier with one that specifies fears in performance situations only. Relevant evaluations to support this change in youth samples are sparse.