Monika Parkinson

Worry and problem‐solving skills and beliefs in primary school children

OBJECTIVE To examine the association between worry and problem-solving skills and beliefs (confidence and perceived control) in primary school children. METHOD Children (8-11 years) were screened using the Penn State Worry Questionnaire for Children. High (N= 27) and low (N= 30) scorers completed measures of anxiety, problem-solving skills (generating alternative solutions to problems, planfulness, and effectiveness of solutions) and problem-solving beliefs (confidence and perceived control). RESULTS High and low worry groups differed significantly on measures of anxiety and problem-solving beliefs (confidence and control) but not on problem-solving skills. CONCLUSIONS Consistent with findings with adults, worry in children was associated with cognitive distortions, not skills deficits. Interventions for worried children may benefit from a focus on increasing positive problem-solving beliefs.

Clinical outcomes and cost-effectiveness of brief guided parent-delivered cognitive behavioural therapy and solution-focused brief therapy for treatment of childhood anxiety disorders: a randomised controlled trial

Summary Background Half of all lifetime anxiety disorders emerge before age 12 years; however, access to evidence-based psychological therapies for affected children is poor. We aimed to compare the clinical outcomes and cost-effectiveness of two brief psychological treatments for children with anxiety referred to routine child mental health settings. We hypothesised that brief guided parent-delivered cognitive behavioural therapy (CBT) would be associated with better clinical outcomes than solution-focused brief therapy and would be cost-effective. Methods We did this randomised controlled trial at four National Health Service primary child and mental health services in Oxfordshire, UK. Children aged 5–12 years referred for anxiety difficulties were randomly allocated (1:1), via a secure online minimisation tool, to receive brief guided parent-delivered CBT or solution-focused brief therapy, with minimisation for age, sex, anxiety severity, and level of parental anxiety. The allocation sequence was not accessible to the researcher enrolling participants or to study assessors. Research staff who obtained outcome measurements were masked to group allocation and clinical staff who delivered the intervention did not measure outcomes. The primary outcome was recovery, on the basis of Clinical Global Impressions of Improvement (CGI-I). Parents recorded patient-level resource use. Quality-adjusted life-years (QALYs) for use in cost-utility analysis were derived from the Child Health Utility 9D. Assessments were done at baseline (before randomisation), after treatment (primary endpoint), and 6 months after treatment completion. We did analysis by intention to treat. This trial is registered with the ISCRTN registry, number ISRCTN07627865. Findings Between March 23, 2012, and March 31, 2014, we randomly assigned 136 patients to receive brief guided parent-delivered CBT (n=68) or solution-focused brief therapy (n=68). At the primary endpoint assessment (June, 2012, to September, 2014), 40 (59%) children in the brief guided parent-delivered CBT group versus 47 (69%) children in the solution-focused brief therapy group had an improvement of much or very much in CGI-I score, with no significant differences between groups in either clinical (CGI-I: relative risk 1·01, 95% CI 0·86–1·19; p=0·95) or economic (QALY: mean difference 0·006, −0·009 to 0·02; p=0·42) outcome measures. However, brief guided parent-delivered CBT was associated with lower costs (mean difference −£448; 95% CI −934 to 37; p=0·070) and, taking into account sampling uncertainty, was likely to represent a cost-effective use of resources compared with solution-focused brief therapy. No treatment-related or trial-related adverse events were reported in either group. Interpretation Our findings show no evidence of clinical superiority of brief guided parent-delivered CBT. However, guided parent-delivered CBT is likely to be a cost-effective alternative to solution-focused brief therapy and might be considered as a first-line treatment for children with anxiety problems. Funding National Institute for Health Research.

How Do Parent-Child Interactions Predict and Maintain Depression in Childhood and Adolescence? A Critical Review of the Literature

Background and Objective: Negative parent-child interaction patterns have been linked to youth depression, with a causal influence being assumed. However, the majority of empirical studies examining this issue have used self-report methods to assess parent-child relationships, which cannot capture the temporal dynamics of dyadic interactions and may be subject to reporting bias. This review considers the association between parent-child interactions and youth depression with a specific focus on observational methodology. Method: A literature search was conducted including studies that investigated the association between observed parent-child interactions and youth depressive symptomology. Literature was obtained using database searches, citation searches and screening of recent reviews. Results and Conclusion: Maternal disengagement, reduced adolescent autonomy granting, adolescent maladaptive emotion regulation, parental suppression of adolescent positivity and incongruent parent-child communication styles were relatively consistently related to youth depression. Nonetheless, there were conflicting findings and several studies demonstrated little or no contribution of parent-child interaction factors to youth depression. Overall, the evidence suggests that causal influences are likely to be modest. The majority of studies relate to maternal versus paternal interactions. Furthermore, the factors that mediate the association between parent-child interactions and youth depression remain largely unknown. Implications for future research and clinical practice are discussed.

The effect of targeting tolerance of children's negative emotions among anxious parents of children with anxiety disorders: A pilot randomised controlled trial.

Highlights • Parent-delivered CBT is effective for child anxiety when parent is also highly anxious.• Little evidence that improvements in parent tolerance are associated with treatment gains.• Adjunct treatment to target parent’s tolerance may not be necessary.• Tolerance improves as child anxiety improves, even if not targeted.