Lynn D. Miller

An Effectiveness Study of a Culturally Enriched School-Based CBT Anxiety Prevention Program

Anxiety disorders are prevalent in the school-aged population and are present across cultural groups. Scant research exists on culturally relevant prevention and intervention programs for mental health problems in the Aboriginal populations. An established cognitive behavioral program, FRIENDS for Life, was enriched to include content that was culturally relevant to Aboriginal students. Students (N = 533), including 192 students of Aboriginal background, participated in the cluster randomized control study. Data were collected three times over 1 year. A series of multilevel models were conducted to examine the effect of the culturally enriched FRIENDS program on anxiety. These analyses revealed that the FRIENDS program did not effectively reduce anxiety for the total sample or for Aboriginal children specifically. However, all students, regardless of intervention condition, Aboriginal status, or gender, reported a consistent decrease in feelings of anxiety over the 6-month study period.

Effects of School-Wide Positive Behavioral Interventions and Supports on Internalizing Problems: Current Evidence and Future Directions.

School-Wide Positive Behavioral Interventions and Supports (SWPBIS) has a large evidence base for preventing and addressing externalizing problem behavior, but there is little research examining its effects on internalizing problems, such as anxiety and depression. Given the prevalence of internalizing problems in today’s children and youth, it is worthwhile to examine the SWPBIS research base for evidence of effectiveness in preventing and treating internalizing problems. Hypothesized mechanisms by which the SWPBIS approach may support students with or at risk of internalizing problems include improving the clarity and predictability of the social environment, discouraging problem behavior that can threaten student safety, allowing instruction to take place, teaching effective responses to perceived environmental threats, and indirectly reducing internalizing problems by addressing externalizing problems. Support for internalizing challenges within a SWPBIS framework can be enhanced by adding evidence-based interventions for supporting internalizing needs within SWPBIS systems, providing professional development in identifying internalizing problems, and incorporating screening for internalizing problems into existing screening systems.

Multiple Informant Agreement of Child, Parent, and Teacher Ratings of Child Anxiety within Community Samples

Objective: Extant research concerning the degree of multiple informant (that is, parent, clinician, teacher, and child) agreement for child anxiety ratings generally uses clinical samples, and results have been mixed. Method: Our study used a community sample of public school children (n = 1039) to investigate child (self), parent, and teacher reports of child anxiety across 3 time points (pretreatement, posttreatment, and follow-up) in 3 independent school prevention and intervention trials. Results: Results showed that parents and teachers had high informant agreement for ratings on anxiety across the 3 time points (r = 0.95 to 0.96, P < 0.001); agreement between parent and child (self) reports and between teacher and child (self) reports consistently showed lower agreement across the 3 time points (r = 0.14 and 0.28, respectively, P < 0.001). Group differences were also significant for sex and grade, whereby females more commonly self-reported higher anxiety and children in grades 3 and 4 self-reported higher anxiety, compared with students in grades 5 to 7. Conclusion: Correlations between parent and teacher with child ratings were poor over 3 time points, and significant differences were found for sex and grade. Research is needed to understand reasons for poor concordance between parent, child, and teacher ratings of anxiety for all children.

Toward an Ecological Unit of Analysis in Behavioral Assessment and Intervention With Families of Children With Developmental Disabilities

The purpose of this chapter is to present our work and that of colleagues in the field of positive behavior support (PBS) (Carr et al., 2002; Koegel, Koegel, Dunlap, 1996) on the development of an empirically grounded ecological unit of analysis for behavioral assessment and intervention with families of children with developmental disabilities and severe problem behavior. Our aim is to provide practitioners and families with an empirical foundation for the design of comprehensive PBS plans in family contexts that are likely to be acceptable to family members, implemented by family members with fidelity, effective at improving the behavior and quality of life of the child and family, sustainable within the family ecology, and durable across a long period of time.

Treating child and adolescent anxiety effectively: Overview of systematic reviews ☆

We conducted an overview of systematic reviews about child and adolescent anxiety treatment options (psychosocial; medication; combination; web/computer-based treatment) to support evidence informed decision-making. Three questions were addressed: (i) Is the treatment more effective than passive controls? (ii) Is there evidence that the treatment is superior to or non-inferior to (i.e., as good as) active controls? (iii) What is the quality of evidence for the treatment? Pre-specified inclusion criteria identified high quality systematic reviews (2000-2015) reporting treatment effects on anxiety diagnosis and symptom severity. Evidence quality (EQ) was rated using Oxford evidence levels [EQ1 (highest); EQ5 (lowest)]. Twenty-two of 39 eligible reviews were high quality (AMSTAR score≥3/5). CBT (individual or group, with or without parents) was more effective than passive controls (EQ1). CBT effects compared to active controls were mixed (EQ1). SSRI/SNRI were more effective than placebo (EQ1) but comparative effectiveness remains uncertain. EQ for combination therapy could not be determined. RCTs of web/computer-based interventions showed mixed results (EQ1). CBM/ABM was not more efficacious than active controls (EQ1). No other interventions could be rated. High quality RCTs support treatment with CBT and medication. Findings for combination and web/computer-based treatment are encouraging but further RCTs are required. Head-to-head comparisons of active treatment options are needed.

Using Virtual Reality and Other Computer Technologies to Implement Cognitive-Behavior Therapy for the Treatment of Anxiety Disorders in Youth

Among the therapeutic strategies used in the treatment of anxiety, behavioral approaches featuring exposure to aversive stimuli occupy a central role. Research on the effectiveness of cognitive-behavior therapy (CBT) in the treatment of anxiety disorders generally places exposure at the heart of therapeutic change. In fact, these studies have shown their empirical effectiveness in adults as well as children (Barrett, 2009; Carr, 2009; Cartwright-Hatton et al., 2004). Despite their proven effectiveness, exposures can present significant challenges to the therapist as well as the client (see Bouchard et al., 2004; Davis et al., 2009).

Integrating School-based Family Counseling into School Psychology Practice

Aim : To integrate theoretical and applied knowledge regarding the benefits and limitations of school psychologists incorporating school-based family counselling into their practice. Study Design : Critical literature review paper. Structure of Paper : First, a brief rationale for delivering counselling to families at schools is given. Second, a description of the role of school psychologists is offered, based on the guidelines of professional psychological organizations in the United States and Canada. Third, the benefits and limitations of school psychologists incorporating school-based family counselling into their practice are discussed. Lastly, recommendations for promoting a role expansion for school psychologists in the school system are provided. Key Findings : The literature presents controversial arguments for school psychologists performing broader roles. On one hand, they have ethical responsibility to become involved in interventions and programs aimed at addressing problems that are broader than merely assessing and identifying children with special needs. However, other factors including the setting in which school psychologists work, the shortage of professionals, the overlap in roles with other qualified practitioners within the school, and the lack of training and experience in family counselling, present as barriers for school psychologists’ Mini -review Article

Integrating psychological and biological approaches to anxiety disorders : Best practices within a family context

Abstract This review attempts to integrate information and methods from CBT, family therapy and pharmacotherapy orientations, in the treatment of six adult anxiety disorders, and separation anxiety in pediatrie populations. Anxiety disorders have been under-recognized and undertreated, in part because practitioners of different orientations have too often worked in isolation from one another. Both CBT and pharmacotherapy are evidence-supported treatments. However, the effectiveness of CBT can be enhanced if it is provided within a family therapy context. Similarly, medications can be an important treatment partner in the management of anxiety disorders.