Lauren F. McLellan

Comparing outcomes for children with different anxiety disorders following cognitive behavioural therapy.

OBJECTIVE The purpose of this study was to compare treatment outcomes following a group family-based cognitive behavioural therapy for children with different anxiety disorders (social anxiety disorder, separation anxiety disorder, generalised anxiety disorder, specific phobia and obsessive compulsive disorder). METHOD This study utilised a clinical sample of 842 children and adolescents (aged between 6 and 18 years) and assessed outcome using diagnostic interview, parent-report and child-report. RESULTS Based on diagnostic data and parent-reported symptoms, results revealed that children with a diagnosis of social anxiety disorder experienced a slower rate of change and poorer diagnostic outcomes at post treatment and follow-up than children with other anxiety disorders. Children with GAD showed better response to this broad-based intervention and children with OCD showed better response on one measure. CONCLUSIONS This study provides evidence for differential response to broad-based CBT for children, based on type of anxiety diagnoses.

Pre-treatment Predictors of Outcome in Childhood Anxiety Disorders: A Systematic Review

Cognitive behaviour therapy (CBT) is an efficacious treatment for paediatric anxiety disorders, yet not all children improve following standard treatment protocols. Identifying pre-treatment predictors of poor treatment response is an important area of research to maximise outcomes for children with anxiety disorders. This paper presents a systematic review of pre-treatment predictors of child/adolescent anxiety treatment outcome, including child demographic, child diagnostic and parental factors. Results are based on 47 peer-reviewed articles and 4 dissertations. Results for each predictor are reported according to method of measuring outcome (e.g., endpoint or rate of change). No consistent and clear pre-treatment predictors of paediatric anxiety outcome were identified. Yet, it is worth noting that a number of trends emerged; some significant predictors were identified in more than one study including primary anxiety diagnosis, severity, comorbidity and parental anxiety/psychopathology. With regards to primary anxiety diagnosis, there was emerging evidence that Social Anxiety Disorder predicted poorer treatment response, while GAD predicted better outcome. Greater symptom severity and comorbid externalising symptoms/disorder were also associated with poorer treatment response but not dependably across studies. Some inconsistent evidence also emerged showing that presence of comorbidity, comorbid depression, parental psychopathology, parental anxiety and maternal anxiety were associated with poorer outcomes when outcome was assessed as an endpoint. There were a number of pre-treatment factors that were not related to treatment outcome: age, gender, ethnicity and socio-economic status. Based on a small number of studies, comorbid anxiety, maternal depression, paternal anxiety and paternal depression also failed to predict treatment outcome. Further methodologically strong research is needed to clarify the conclusions made in this review and to investigate a range of predictors considered under preliminary investigation.

Prevalence of anxiety disorders among children who stutter

PURPOSE Stuttering during adulthood is associated with a heightened rate of anxiety disorders, especially social anxiety disorder. Given the early onset of both anxiety and stuttering, this comorbidity could be present among stuttering children. METHOD Participants were 75 stuttering children 7-12 years and 150 matched non-stuttering control children. Multinomial and binary logistic regression models were used to estimate odds ratios for anxiety disorders, and two-sample t-tests compared scores on measures of anxiety and psycho-social difficulties. RESULTS Compared to non-stuttering controls, the stuttering group had six-fold increased odds for social anxiety disorder, seven-fold increased odds for subclinical generalized anxiety disorder, and four-fold increased odds for any anxiety disorder. CONCLUSION These results show that, as is the case during adulthood, stuttering during childhood is associated with a significantly heightened rate of anxiety disorders. Future research is needed to determine the impact of those disorders on speech treatment outcomes.

A review of scales to measure social anxiety disorder in clinical and epidemiological studies

To advance research into social anxiety disorder (SAD) and provide efficacious treatments for individuals with SAD, researchers and clinicians must have effective assessment instruments for identifying the disorder in terms of its diagnostic criteria, symptoms, and the presence of specific maintaining factors. This review highlights the main lines of existing adult and youth research on scales that form part of diagnostic instruments that assess SAD, scales that measure social anxiety symptoms, and scales that measure theory-based psychological maintaining factors associated with SAD. The review also highlights methodological issues that impact on the use of the aforementioned scales. The continued refinement and comparative evaluation of measures for SAD, culminating in the ascertainment of optimal measures, will improve the assessment and identification of the disorder. Improved identification of the disorder will contribute to the advancement of SAD research and treatment.

Anticipatory Processing, Maladaptive Attentional Focus, and Postevent Processing for Interactional and Performance Situations: Treatment Response and Relationships With Symptom Change for Individuals With Social Anxiety Disorder ☆

Anticipatory processing, maladaptive attentional focus, and postevent processing are key cognitive constructs implicated in the maintenance of social anxiety disorder (SAD). The current study examined how treatment for SAD concurrently affects these three cognitive maintaining processes and how these processes are associated with each other as well as with symptom change from pre- to posttreatment. The sample consisted of 116 participants with SAD receiving group cognitive behavioral therapy. All three cognitive maintaining processes were measured relative to a speech task and again relative to a conversation task. Across both tasks, the three cognitive process variables demonstrated decreases from pre- to posttreatment. Within the same task, a slower rate of decrease in a specific cognitive process variable from pre- to posttreatment was predicted from higher pretreatment levels of either one or both of the other cognitive process variables. Additionally, higher levels of pretreatment conversation-related anticipatory processing and maladaptive attentional focus predicted a slower rate of decrease in social anxiety symptoms from pre- to posttreatment. Results are consistent with cognitive models of SAD and have important implications for enhancing existing treatments.

Navigating the development and dissemination of internet cognitive behavioral therapy (iCBT) for anxiety disorders in children and young people : A consensus statement with recommendations from the #iCBTLorentz Workshop Group

Initial internet-based cognitive behavioral therapy (iCBT) programs for anxiety disorders in children and young people (CYP) have been developed and evaluated, however these have not yet been widely adopted in routine practice. The lack of guidance and formalized approaches to the development and dissemination of iCBT has arguably contributed to the difficulty in developing iCBT that is scalable and sustainable beyond academic evaluation and that can ultimately be adopted by healthcare providers. This paper presents a consensus statement and recommendations from a workshop of international experts in CYP anxiety and iCBT (#iCBTLorentz Workshop Group) on the development, evaluation, engagement and dissemination of iCBT for anxiety in CYP.

Development and validation of a measure of maladaptive social- evaluative beliefs characteristic of social anxiety disorder in youth: the Report of Youth Social Cognitions (RYSC)

Recent research has started to examine the applicability of influential adult models of the maintenance of social anxiety disorder (SAD) to youth. This research is limited by the lack of psychometrically validated measures of underlying constructs that are developmentally appropriate for youth. One key construct in adult models of SAD is maladaptive social-evaluative beliefs. The current study aimed to develop and validate a measure of these beliefs in youth, known as the Report of Youth Social Cognitions (RYSC). The RYSC was developed with a clinical sample of youth with anxiety disorders (N = 180) and cross-validated in a community sample of youth (N = 305). In the clinical sample, the RYSC exhibited a 3-factor structure (negative evaluation, revealing self, and positive impression factors), good internal consistency, and construct validity. In the community sample, the 3-factor structure and the internal consistency of the RYSC were replicated, but the test of construct validity showed that the RYSC had similarly strong associations with social anxiety and depressed affect. The RYSC had good test–retest reliability overall, although the revealing self subscale showed lower temporal stability which improved when only older participants were considered (age ≥9 years). The RYSC in general was also shown to discriminate between youth with and without SAD although the revealing self subscale again performed suboptimally but improved when only older participants were considered. These findings provide psychometric support for the RYSC and justifies its use with youth in research and clinical settings requiring the assessment of maladaptive social-evaluative beliefs.

Cognition-Focused Interventions for Social Anxiety Disorder Among Adolescents

The focus of this chapter is on cognitive interventions for adolescents with social anxiety disorder (SAD). The chapter identifies the important aspects of clinical assessments that inform a comprehensive cognitive intervention approach and provide a detailed description of interventions that target cognitions and/or cognitive processes. This description includes both cognitive and cognitive behavioural interventions. Finally, we will present a session-by-session outline of a psychosocial intervention for an adolescent male with SAD.

Psychological distress, help-seeking, and perceived barriers to psychological treatment among Australian parents

Abstract Objective Parental psychological distress is an influential predictor of maladaptive parenting practices, negative outcomes in children, and poorer outcomes of parenting programs. Despite these negative outcomes, treatment engagement among parents appears to be low. This study aimed to explore Australian parents’ history of help‐seeking behaviour and perceived barriers to psychological treatment for their own and their childrens psychological wellbeing. Method A sample of 2,555 Australian parents completed an online survey exploring psychological distress, help‐seeking, perceived barriers to treatment for parents and their children, and interest in an online parental wellbeing course. Results Parents reported high levels of personal psychological distress (70.4% in the moderate to very high ranges) and high rates of emotional and behavioural difficulties in their children (34.2% in abnormal range). Parents were more likely to seek informal types of help‐seeking, such as advice from family and friends. They were less likely to enlist formal types of help seeking, such as psychotherapy. The most commonly endorsed barriers to seeking treatment for parents and their children included lack of time and money and the belief that mental health difficulties were insufficient to warrant treatment. However, parents expressed a high level of interest in a free online parental wellbeing course. Conclusion The findings highlight the need for effective and accessible psychological treatments to target the psychological wellbeing of parents and their dependent children. Early evidence suggests that an online parental wellbeing course may offer an acceptable alternative to face‐to‐face treatment that may overcome many barriers reported in this study.

Generalised Anxiety Disorder

Excessive, uncontrollable worry represents the core diagnostic criteria of generalised anxiety disorder (GAD). Youth meeting criteria typically worry about many areas of life, report physical symptoms associated with worry and as a result experience significant distress, impairment and disability. This chapter presents a review of the diagnostic history of GAD as it relates to changes across revisions of the Diagnostic and Statistical Manual (DSM); it then reviews the available research on the symptom presentation, aetiology, epidemiology, comorbidity and impairment of GAD in childhood and adolescents, with a particular focus on the developmental considerations relevant to this age group. The chapter concludes with a description of available treatments and reviews their efficacy in youth. While the focus is on providing a review of GAD in childhood and adolescents, at times, research on overanxious disorder (OAD), the earlier diagnostic form of GAD in childhood, and research on GAD in adults will be drawn on where limited research is available on youth.