Jeffrey J. Wood

Parenting and childhood anxiety: theory, empirical findings, and future directions

Theories of anxiety development suggest that parental acceptance, control, and modeling of anxious behaviors are associated with childrens manifestations of anxiety. This paper reviews research published in the past decade on the relation between parenting and childhood anxiety. Observed parental control during parent-child interactions was consistently linked with shyness and child anxiety disorders across studies. Mixed support for the role of parental acceptance and modeling of anxious behaviors was found in observational studies. However, there was little evidence supporting the contention that self-reported parenting style was related to childrens trait anxiety. Because of limitations associated with past research, inferences about the direction of effects linking parenting and child anxiety cannot be made. A conceptual framework based on recent models of anxiety development (e.g., Vasey & Dadds, 2001) is presented to aid in the interpretation of extant research findings and to provide suggestions for future research and theory development. Improved methodological designs are proposed, including the use of repeated-measure and experimental designs for examining the direction of effects.

Concurrent Validity of the Anxiety Disorders Section of the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions

Evaluated the concurrent validity of the Anxiety Disorders Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994): Child and Parents Versions (ADIS for DSM-IV-C/P; Silverman & Albano, 1996) social phobia, separation anxiety disorder (SAD), generalized anxiety disorder (GAD), and panic disorder diagnoses. Children referred to an outpatient anxiety disorder clinic (N = 186; ages 8 to 17), and their parents completed the Multidimensional Anxiety Scale for Children (MASC; March, 1998) and the ADIS-C/P interview. There was no convergence between MASC scores and ADIS-C/P GAD diagnoses. However, there was strong correspondence between ADIS-C/P social phobia, SAD, and panic disorder diagnoses and the empirically derived MASC factor scores corresponding to these disorders. These results provide support for the concurrent validity of the anxiety disorders section of the ADIS-C/P.

Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial

BACKGROUND Children with autism spectrum disorders often present with comorbid anxiety disorders that cause significant functional impairment. This study tested a modular cognitive behavioral therapy (CBT) program for children with this profile. A standard CBT program was augmented with multiple treatment components designed to accommodate or remediate the social and adaptive skill deficits of children with ASD that could pose barriers to anxiety reduction. METHOD Forty children (7-11 years old) were randomly assigned to 16 sessions of CBT or a 3-month waitlist (36 completed treatment or waitlist). Therapists worked with individual families. The CBT model emphasized behavioral experimentation, parent-training, and school consultation. Independent evaluators blind to treatment condition conducted structured diagnostic interviews and parents and children completed anxiety symptom checklists at baseline and posttreatment/postwaitlist. RESULTS In intent-to-treat analyses, 78.5% of the CBT group met Clinical Global Impressions-Improvement scale criteria for positive treatment response at posttreatment, as compared to only 8.7% of the waitlist group. CBT also outperformed the waitlist on diagnostic outcomes and parent reports of child anxiety, but not childrens self-reports. Treatment gains were maintained at 3-month follow-up. CONCLUSIONS The CBT manual employed in this study is one of the first adaptations of an evidence-based treatment for children with autism spectrum disorders. Remission of anxiety disorders appears to be an achievable goal among high-functioning children with autism.

Effect of anxiety reduction on children's school performance and social adjustment.

This study tested the effect of reductions in childrens anxiety over time on improvements in school performance and social functioning in the context of participation in a cognitive-behavioral intervention program. Participants included 40 children with high anxiety (6-13 years of age). Independent evaluators, children, and parents rated child anxiety; parents rated school performance; and children and parents rated social functioning. Measures were completed at preintervention, midintervention, and postintervention. Fixed-effects regression analyses and random-effects regression analyses indicated that decreased anxiety was predictive of improved school performance and social functioning over the course of the intervention. These findings suggest that changes in anxiety influence trajectories of childrens scholastic and social functioning.

Controlled Comparison of Family Cognitive Behavioral Therapy and Psychoeducation/Relaxation Training for Child Obsessive-Compulsive Disorder

OBJECTIVE To examine the efficacy of exposure-based cognitive-behavioral therapy (CBT) plus a structured family intervention (FCBT) versus psychoeducation plus relaxation training (PRT) for reducing symptom severity, functional impairment, and family accommodation in youths with obsessive-compulsive disorder (OCD). METHOD A total of 71 youngsters 8 to 17 years of age (mean 12.2 years; range, 8-17 years, 37% male, 78% Caucasian) with primary OCD were randomized (70:30) to 12 sessions over 14 weeks of FCBT or PRT. Blind raters assessed outcomes with responders followed for 6 months to assess treatment durability. RESULTS FCBT led to significantly higher response rates than PRT in ITT (57.1% vs 27.3%) and completer analyses (68.3% vs. 35.3%). Using HLM, FCBT was associated with significantly greater change in OCD severity and child-reported functional impairment than PRT and marginally greater change in parent-reported accommodation of symptoms. These findings were confirmed in some, but not all, secondary analyses. Clinical remission rates were 42.5% for FCBT versus 17.6% for PRT. Reduction in family accommodation temporally preceded improvement in OCD for both groups and child functional status for FCBT only. Treatment gains were maintained at 6 months. CONCLUSIONS FCBT is effective for reducing OCD severity and impairment. Importantly, treatment also reduced parent-reported involvement in symptoms with reduced accommodation preceding reduced symptom severity and functional impairment. CLINICAL TRIALS REGISTRY INFORMATION: Behavior Therapy for Children and Adolescents with Obsessive-Compulsive Disorder (OCD); http://www.clinicaltrials.gov; NCT00000386.

Cognitive Behavioral Treatment of Comorbid Anxiety Disorders and Social Difficulties in Children with High-Functioning Autism: A Case Report

A substantial proportion of children with high-functioning autism (HFA) or Asperger syndrome (AS) have one or more comorbid anxiety disorders. Because anxiety disorders exacerbate the social difficulties and other functional impairments caused by an autism spectrum disorder (ASD), there is a need for efficacious treatments to address the clinical needs of youth with this comorbid presentation. This article describes an evidence-based cognitive behavioral therapy (CBT) treatment manual enhanced to address the unique characteristics and clinical needs of children with ASD. A case study is presented in which CBT was utilized in the successful treatment of an 11-year-old girl with HFA. The intervention was effective in reducing anxiety and improving social and adaptive functioning. These findings suggest that an enhanced CBT approach may be a viable intervention for children with comorbid HFA and anxiety disorders that should be further evaluated.

Behavior problems and peer rejection in preschool boys and girls

Abstract The authors tested the hypothesis that deviant behaviors within a preschool peer group would be linked with peer rejection, irrespective of child gender. Seventy-six children, aged 3 to 5 years, participated. Teachers rated childrens behavior on the Child Adaptive Behavior Inventory, and children provided sociometric ratings. For a subsample of children (n = 47), observers coded aggressive, noncompliant, and withdrawn behavior using a time-sampling system. For both boys and girls, noncompliance, hyperactivity, and social withdrawal were associated with peer rejection; overt aggression was associated with peer rejection for boys, but not for girls. Analysis revealed that approximately half of the variance in sociometric and teacher ratings of peer rejection was accounted for by aggression and social withdrawal for both boys and girls. The results suggest that the association between behavior problems and peer rejection emerges at a very early age.

Measuring Anxiety as a Treatment Endpoint in Youth with Autism Spectrum Disorder

Despite the high rate of anxiety in individuals with autism spectrum disorder (ASD), measuring anxiety in ASD is fraught with uncertainty. This is due, in part, to incomplete consensus on the manifestations of anxiety in this population. Autism Speaks assembled a panel of experts to conduct a systematic review of available measures for anxiety in youth with ASD. To complete the review, the panel held monthly conference calls and two face-to-face meetings over a fourteen-month period. Thirty eight published studies were reviewed and ten assessment measures were examined: four were deemed appropriate for use in clinical trials, although with conditions; three were judged to be potentially appropriate, while three were considered not useful for clinical trials assessing anxiety. Despite recent advances, additional relevant, reliable and valid outcome measures are needed to evaluate treatments for anxiety in ASD.

Acculturative Family Distancing (AFD) and Depression in Chinese American Families

OBJECTIVE Knowledge of acculturative processes and their impact on immigrant families remains quite limited. Acculturative family distancing (AFD) is the distancing that occurs between immigrant parents and their children and is caused by breakdowns in communication and cultural value differences. It is a more proximal and problem-focused formulation of the acculturation gap and is hypothesized to increase depression via family conflict. METHOD Data were collected from 105 Chinese American high school students and their mothers. Rasch modeling was used to refine the AFD measure, and structural equation modeling was used to determine the effects of AFD on youth and maternal depression. RESULTS Findings indicate that greater AFD was associated with higher depressive symptoms and risk for clinical depression. Family conflict partially mediated this relation for youths, whereas for mothers, AFD directly increased risk for depression. Greater mother-child heritage enculturation discrepancies were associated with greater mother and child AFD. Mainstream acculturation discrepancies and language gaps between mothers and youths were not significantly associated with any of the primary outcome variables. CONCLUSIONS Results highlight the need for better understanding of how AFD and other acculturation-gap phenomena affect immigrant mental health. They also underscore the need for prevention and intervention programs that target communication difficulties and intergenerational cultural value differences.

Child–therapist alliance and clinical outcomes in cognitive behavioral therapy for child anxiety disorders

BACKGROUND Few studies have examined the link between child-therapist alliance and outcome in manual-guided cognitive behavioral therapy (CBT) for children diagnosed with anxiety disorders. This study sought to clarify the nature and strength of this relation. METHODS The Therapy Process Observational Coding System for Child Psychotherapy - Alliance scale (TPOCS-A; McLeod, 2005) was used to assess the quality of the child-therapist alliance. Coders independently rated 123 CBT therapy sessions conducted with 34 children (aged 6-13 years) diagnosed with anxiety disorders. Parents reported on childrens symptomatology at pre- mid-, and post-treatment. RESULTS A stronger child-therapist alliance early in treatment predicted greater improvement in parent-reported outcomes at mid-treatment but not post-treatment. However, improvement in the child-therapist alliance over the course of treatment predicted better post-treatment outcomes. CONCLUSIONS The quality of the child-therapist alliance assessed early in treatment may be differentially associated with symptom reduction at mid- and post-treatment. Results underscore the importance of assessing the relation between alliance and outcome over the course of therapy to clarify the role the child-therapist alliance plays in child psychotherapy.