Lara J. Farrell

Long-term outcomes of an Australian universal prevention trial of anxiety and depression symptoms in children and youth: an evaluation of the friends program

This study evaluated the long-term effectiveness of the FRIENDS Program in reducing anxiety and depression in a sample of children from Grade 6 and Grade 9 in comparison to a control condition. Longitudinal data for Lock and Barretts (2003) universal prevention trial is presented, along with data from 12-month follow-up to 24- and 36-month follow-up. Results of this study indicate that intervention reductions in anxiety reported in Lock and Barrett were maintained for students in Grade 6, with the intervention group reporting significantly lower ratings of anxiety at long-term follow-up. A significant Time × Intervention Group × Gender Effect on Anxiety was found, with girls in the intervention group reporting significantly lower anxiety at 12-month and 24-month follow-up but not at 36-month follow-up in comparison to the control condition. Results demonstrated a prevention effect with significantly fewer high-risk students at 36-month follow-up in the intervention condition than in the control condition. Results are discussed within the context of prevention research.

Evidence-Based Psychosocial Treatments for Child and Adolescent Obsessive–Compulsive Disorder

Child and adolescent obsessive–compulsive disorder (OCD) is a chronic and debilitating condition associated with a wide range of impairments. This article briefly discusses the phenomenology of OCD, the theory underlying current treatment approaches, and the extant psychosocial treatment literature for child and adolescent OCD relative to the criteria for classification as an evidence-based intervention. Studies were evaluated for methodological rigor according to the classification system of Nathan and Gorman (2002) and then were assessed relative to the criteria for evidence-based treatments specified by Chambless et al. (1998), Chambless et al. (1996), and Chambless and Hollon (1998). Results from exposure-based cognitive behavioral therapy (CBT) trials with children and adolescents have been consistent, with remission rates of the disorder ranging from 40% to 85% across studies. Findings from this review indicate that individual exposure-based CBT for child and adolescent OCD can be considered as a probably efficacious treatment. CBT delivered in a family-focused individual or group format can be considered as a possibly efficacious treatment. Moderators, mediators, and predictors of treatment outcome are discussed, as are implications and generalizability of extant findings to real-world settings. We conclude with recommendations for best practice and future research directions.

Developmental Differences in Universal Preventive Intervention for Child Anxiety

We compared the effects of a universal school-based preventive intervention for child anxiety at two developmental stages. Six hundred and ninety-two participants enrolled in either grade 6 ( n = 293), children aged between 9 and 10 years, or grade 9 ( n = 399), children aged between 14 and 16 years, were allocated to either a school-based cognitive-behavioural intervention or to a monitoring group. Participants completed the Spence Child Anxiety Scale and the Child Depression Inventory and were stratified into low-, moderate-And high-risk groups based on their anxiety scores at the start of the study. The effects of the prevention programme were evaluated at post- and 12-month follow-up intervals. Post-study results indicated significant reductions in anxiety ( p < .001) and depression ( p < .05) across high- and moderate-risk groups in both the intervention and monitoring conditions. This trend was evident at 12-month follow-up, however, reductions in anxiety were greater in the intervention condition ( p < .05). At post assessment, grade 6 participants showed significant changes in anxiety compared with grade 9 participants ( p < .001), although both primary and secondary school participants showed equal reductions in anxiety at 12-month follow-up. Overall, findings suggest that universal intervention is potentially successful in reducing anxiety symptoms in children. Primary school children reported the greatest changes in anxiety symptoms, suggesting that earlier preventive intervention is potentially more advantageous than later intervention in adolescence. The implications and limitations of this study and directions for future research are discussed.

Obsessive‐compulsive disorder across developmental trajectory: Cognitive processing of threat in children, adolescents and adults

BACKGROUND While the cognitive theory of obsessive-compulsive disorder (OCD) is one of the most widely accepted accounts of the maintenance of the disorder in adults, no study to date has systematically evaluated the theory across children, adolescence and adults with OCD. METHOD This paper investigated developmental differences in the cognitive processing of threat in a sample of children, adolescents and adults with OCD. Using an idiographic assessment approach, as well as self-report questionnaires, this study evaluated cognitive appraisals of responsibility, probability, severity, thought-action fusion (TAF), thought-suppression, self-doubt and cognitive control. It was hypothesised that there would be age related differences in reported responsibility for harm, probability of harm, severity of harm, thought suppression, TAF, self-doubt and cognitive control. RESULTS Results of this study demonstrated that children with OCD reported experiencing fewer intrusive thoughts, which were less distressing and less uncontrollable than those experienced by adolescents and adults with OCD. Furthermore, responsibility attitudes, probability biases and thought suppression strategies were higher in adolescents and adults with OCD. Cognitive processes of TAF, perceived severity of harm, self-doubt and cognitive control were found to be comparable across age groups. CONCLUSIONS These results suggest that the current cognitive theory of OCD needs to address developmental differences in the cognitive processing of threat. Furthermore, for a developmentally sensitive theory of OCD, further investigation is warranted into other possible age related maintenance factors. Implications of this investigation and directions for future research are discussed.

Difficult-to-treat pediatric obsessive-compulsive disorder: Feasibility and preliminary results of a randomized pilot trial of D-cycloserine-augmented behavior therapy

This study examined the feasibility and preliminary effectiveness of d‐cycloserine (DCS)–augmented cognitive behavioral therapy (CBT) for children and adolescents with difficult‐to‐treat Obsessive Compulsive Disorder, in a double‐blind randomized controlled pilot trial (RCT).

D-Cycloserine Augmentation of Exposure-Based Cognitive Behavior Therapy for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders: A Systematic Review and Meta-analysis of Individual Participant Data

Importance Whether and under which conditions D-cycloserine (DCS) augments the effects of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders is unclear. Objective To clarify whether DCS is superior to placebo in augmenting the effects of cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders and to evaluate whether antidepressants interact with DCS and the effect of potential moderating variables. Data Sources PubMed, EMBASE, and PsycINFO were searched from inception to February 10, 2016. Reference lists of previous reviews and meta-analyses and reports of randomized clinical trials were also checked. Study Selection Studies were eligible for inclusion if they were (1) double-blind randomized clinical trials of DCS as an augmentation strategy for exposure-based cognitive behavior therapy and (2) conducted in humans diagnosed as having specific phobia, social anxiety disorder, panic disorder with or without agoraphobia, obsessive-compulsive disorder, or posttraumatic stress disorder. Data Extraction and Synthesis Raw data were obtained from the authors and quality controlled. Data were ranked to ensure a consistent metric across studies (score range, 0-100). We used a 3-level multilevel model nesting repeated measures of outcomes within participants, who were nested within studies. Results Individual participant data were obtained for 21 of 22 eligible trials, representing 1047 of 1073 eligible participants. When controlling for antidepressant use, participants receiving DCS showed greater improvement from pretreatment to posttreatment (mean difference, −3.62; 95% CI, −0.81 to −6.43; P = .01; d = −0.25) but not from pretreatment to midtreatment (mean difference, −1.66; 95% CI, −4.92 to 1.60; P = .32; d = −0.14) or from pretreatment to follow-up (mean difference, −2.98, 95% CI, −5.99 to 0.03; P = .05; d = −0.19). Additional analyses showed that participants assigned to DCS were associated with lower symptom severity than those assigned to placebo at posttreatment and at follow-up. Antidepressants did not moderate the effects of DCS. None of the prespecified patient-level or study-level moderators was associated with outcomes. Conclusions and Relevance D-cycloserine is associated with a small augmentation effect on exposure-based therapy. This effect is not moderated by the concurrent use of antidepressants. Further research is needed to identify patient and/or therapy characteristics associated with DCS response.

Comorbidity and treatment response in pediatric obsessive-compulsive disorder: A pilot study of group cognitive-behavioral treatment

This pilot study evaluated the effectiveness of group cognitive-behavioral treatment (CBT) on treatment outcomes for children and adolescents who presented with obsessive-compulsive disorder (OCD) and complex comorbid conditions, including depression, attention deficit/hyperactivity disorder and pervasive developmental disorders (PDD). Specifically, the impact of comorbidity on treatment response rates and remission rates was examined. Forty-three youth (aged 7-17) with OCD participated in group family-based CBT. Assessments were conducted at pre- and post-treatment and 6 months. Eighty-six percent of youth presented with a secondary psychiatric disorder, and 74% presented with a tertiary psychiatric condition. Contrary to the expected, comorbidity was not associated with poorer treatment outcomes at post-assessment. At longer term follow-up (6 months), however, treatment outcomes were poorer for youth with multiple comorbid conditions and for those with attention deficit/hyperactivity disorder. The finding that group CBT is largely effective for youth with comorbid conditions is of clinical and practical significance. Group delivery of CBT provides an efficient and cost-effective approach, and alleviates strain on services and service providers. Continued efforts are needed to improve long-term outcomes for youth with multiple comorbid conditions and attention deficit/hyperactivity disorder. Examining treatment response as a function of comorbidity with larger clinical samples is important to extend this research.

Does cognitive-behavioral therapy response among adults with obsessive–compulsive disorder differ as a function of certain comorbidities?

This study examines the impact of several of the most common comorbid psychiatric disorders (i.e., generalized anxiety disorder (GAD); major depressive disorder (MDD); social phobia, and panic disorder) on cognitive-behavioral therapy (CBT) response in adults with obsessive-compulsive disorder (OCD). One hundred and forty-three adults with OCD (range=18-79 years) received 14 sessions of weekly or intensive CBT. Assessments were conducted before and after treatment. Primary outcomes included scores on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), response rates, and remission status. Sixty-nine percent of participants met criteria for at least one comorbid diagnosis. Although baseline OCD severity was slightly higher among individuals with OCD+MDD and OCD+GAD (in comparison to those with OCD-only), neither the presence nor the number of pre-treatment comorbid disorders predicated symptom severity, treatment response, remission, or clinically significant change rates at post-treatment. These data suggest that CBT for OCD is robust to the presence of certain common Axis-I comorbidities.

Cognitive–behavioral treatment of childhood obsessive–compulsive disorder in community-based clinical practice: clinical significance and benchmarking against efficacy☆

OBJECTIVE To evaluate the feasibility and outcomes of evidence-based (EB) manualized, cognitive-behavioral treatment (CBT) for childhood obsessive-compulsive disorder (OCD), when delivered in an outpatient community-based specialist clinic. METHOD This study, conducted in an outpatient private clinic in South-East Queensland Australia, involved thirty-three children and adolescents with OCD. Children were assessed at pre- and post-treatment, by means of diagnostic interviews, symptom severity interviews, and self-report. Treatment involved 12 sessions CBT delivered either individually or in small groups and included parental involvement. RESULTS Manualized CBT could be transported to the community setting effectively, with 63% of the current sample responding positively, based on post-treatment diagnosis. Significant change was evident across a wide-range of outcomes; including, diagnostic severity, symptom severity, child reported depression and anxiety, and both child and parent reported OCD functional impairment. CONCLUSIONS This study provides evidence for the transportability of manualized CBT in clinical community practice for pediatric OCD. The next important step is larger community based dissemination and effectiveness studies to advance both research and clinical practice outcomes.

The relationships of child and parent factors with children's anxiety symptoms: parental anxious rearing as a mediator.

A considerable body of research has identified various child and parent factors that contribute to and maintain anxiety symptoms in children. Yet relatively few studies have examined child factors (including threat-based cognitive bias, neuroticism, gender, puberty and age) as well as parent factors (including maternal anxiety and child-rearing style) in association with child anxiety symptoms, and the extent to which these factors serve as unique predictors of child anxiety. Moreover, research is lacking on whether parent factors such as child-rearing style, which is often targeted in early intervention and treatment programs, might mediate the association between child factors such as neuroticism, and child anxiety symptoms. In a sample of 85 children between 7 and 12 years of age with varying levels of anxiety, including those with diagnosed anxiety disorders, results showed that children were more anxious when they were reported to be more advanced in pubertal status by their parents, when they had a tendency to interpret more threat in ambiguous situations, and when they self-reported more neuroticism. Regarding parent factors, maternal self-reported trait anxiety and childrens perceptions of their mother as having an anxious child-rearing style were associated with higher levels of child anxiety. Moreover, when these correlates of child anxiety were examined in a multivariate model to identify those that had direct as well as indirect associations via maternal anxious child-rearing style, child neuroticism remained as a significant and unique predictor of child anxiety that was also mediated by maternal anxious-rearing. Child neuroticism also mediated the relationship between child pubertal stage and anxiety symptoms. Results are discussed in terms of relevant theory and empirical evidence regarding the roles of both child and parent factors in the development of child anxiety.