Matthew P. Mychailyszyn

Assessing and Treating Child Anxiety in Schools.

Anxiety disorders in youth are common and, if left untreated, can lead to a variety of negative sequelae. Randomized clinical trials have demonstrated that cognitive-behavioral therapy (CBT) is an efficacious treatment for anxiety disorders in youth with preliminary evidence showing that CBT can be successfully transported into schools. The present article provides (a) a discussion of the inherent challenges and advantages of implementing CBT in the school setting, (b) methods used to identify anxious youth, and (c) key components of CBT for anxious youth with an emphasis on adaptation and application in the school environment. Future research directions are discussed. The successful integration of a flexible CBT approach into the domain of school mental health would be a favorable step toward effective dissemination and would ensure the enduring provision of evidence-based practice to children and adolescents struggling with anxiety.

Evaluation of Trauma Characteristics as Predictors of Attrition from Cognitive-Behavioral Therapy for Child Victims of Violence

Little research has investigated psychotherapy attrition among child victims of violence, and no studies have evaluated the role of trauma characteristics (e.g., level of threat or injury, trauma frequency, perpetrator relationship, victim type, and trauma type). The current study evaluated premature psychotherapy termination with 134 child victims (ages 5–19 years) who were referred for exposure-based cognitive-behavioral therapy. Results indicated that premature treatment termination was associated with children who experienced (a) a single incident of trauma (compared to multiple), (b) neither life threat nor physical injury during the victimization, (c) and an incident that was perpetrated by an older child compared to a parental figure. Certain trauma characteristics may be important factors for identifying children at risk for terminating treatment prematurely.

Transporting Cognitive Behavior Interventions to the School Setting

Today’s children and adolescents face many challenges: increasing educational demands (Shepard & Smith, 1988), rising rates of divorce (Heckel, Clarke, Barry, McCarthy, & Selikowitz, 2009), media exposure to messages of violence and terrorism (Comer & Kendall, 2007), and other psychosocial stressors. These contribute to youth’s vulnerability to a wide range of associated mental-health difficulties, and, indeed, youth psychopathology prevalence rates have been found to range from 1 to 51 %, with the most reliable estimates suggesting that between 12 and 20 % of youth struggle with clinical-level symptoms of disorder at any given time (Costello, Egger, & Angold, 2005; Roberts, Attkisson, & Rosenblatt, 1998). Such figures are generally consistent with estimates made by the United States Congress, suggesting that between 5.6 million and 6.8 million (18–22 %) youth are in need of mental-health services (U.S. Public Health Service, 2000).

Systematic Review and Meta-Analysis of the "Skills for Social and Academic Success" ("SASS") Program.

Abstract The purpose of this systematic review and meta-analysis was to synthesize the available research on the Skills for Social and Academic Success (SASS) program, a school-based cognitive/behavioural intervention for adolescents with social anxiety disorder. A search of online databases, combined with reference list examination and communication with program implementers/developers, led to the identification of five (5) studies that explored the effects of the SASS program (N = 227). Given the age of target individuals, analyses focused on self-report of anxiety, with effect sizes aggregated according to a random effects model and calculated as differences in scores between time points (e.g. Standardized Mean Gain). This program is unique in that it was developed specifically for implementation within school systems. The preliminary evidence based on existing studies suggests that the program holds promise for assisting teens with social anxiety in an ecologically valid setting. In the contemporary context of evidence-based practice, it demonstrates initial empirical support, though additional trials are needed to bolster the overall sample size of youth served, and additional generalization studies are needed.

Issues in Differential Diagnosis: Considering Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder

An accurate diagnosis provides a foundation for case conceptualization and facilitates effective treatment practices. Accurate diagnoses are also critical to the organization of participants in empirical research. Although not without its own problems, the Diagnostic and Statistical Manual of Mental Disorders – Text Revision (DSMIV- TR), currently in its fourth iteration (American Psychiatric Association, 2000), is the most frequently used taxonomic system for organizing psychological disorders. Within this framework, disorders are presented as categories (discrete entities) characterized by specific criteria. However, one of the shortcomings associated with a categorical approach is the existence of considerable overlap in symptomatology among disorders. Moreover, comorbidity is common and, among youth with anxiety disorders, it is the norm (Kendall, Brady, & Verduin, 2001). For example, Curry, March, and Hervey (2004) found that 30–65% of children who met criteria for an anxiety disorder also met criteria for an additional disorder. Differential diagnosis among disorders (i.e., the anxiety disorders) poses challenges to both researchers and clinicians.