SPECIAL SERIES: Intensive Cognitive-Behavioral Treatments for Child and Adolescent Anxiety Disorders

Cognitive-behavioral treatments are efficacious intervention choices for anxious youth, yet the lack of access to and usage of evidence-based treatments outside of a research context continues to challenge efforts to disseminate and implement such interventions. One potential avenue for reconciling effective care and that most readily accessed by children and their families may be to offer treatment in an intensive format, typically consisting of a more concentrated dose of cognitive-behavioral treatment components. This special series in Cognitive and Behavioral Practice aims to explore the evolution of intensive cognitive-behavioral treatments currently under investigation across a variety of child and adolescent anxiety disorder populations, including specific phobias, obsessive-compulsive disorder, separation anxiety disorder, school refusal, and panic disorder. In addition to delineating the research support to date for intensive cognitive-behavioral treatment among children and adolescents with anxiety disorders, the articles included in this series provide detail on the application of each intensive intervention, highlight innovative treatment elements, and explore clinical and systematic issues unique to an abbreviated treatment format

Biased attentional behavior in childhood anxiety. A review of theory and current empirical investigation

This review examines the state of current theory and research regarding a relatively new area of study in childhood anxiety: the examination of attentional biases associated with the processing of threatening environmental stimuli. In particular, this paper focuses upon current attempts to extend an information processing framework traditionally associated with childhood psychopathology (i.e., Crick & Dodge [Psychol Bull 115 (1994) 74]) and anxiety-related attentional bias research previously conducted only with adults, to populations of anxious children. First, a thorough discussion of Crick and Dodge's model and its applicability to current theories of anxiety is presented. Although each stage of Crick and Dodge's model is shown to possess correlates with current conceptualizations of anxiety, the research investigations reviewed here focus upon the multiple approaches that have been undertaken to better comprehend anxious children's attentional biases in encoding and subsequent task performance decrements. Specifically, recent investigations of anxious children's attentional performance utilizing Stroop tasks, probe detection tasks, and the relatively new probe localization task are reviewed. A discussion of the disparate findings associated with recent studies of each of these tasks is given, with an eye toward the need to specify the developmental, theoretical, demographic, and clinically relevant characteristics associated with the biased attentional behavior observed among highly anxious children

Children's interpretation and avoidant response biases in response to non-salient and salient situations: relationships with mothers' threat perception and coping expectations

This study examined the effect of situation salience on interpretation and avoidant response biases in clinically anxious and non-clinical children. The relationship between mothers' threat perception and expectations of their children's coping, and children's threat perception and coping expectations was also assessed. Forty clinically anxious and 40 non-clinical children (ages 7-14) participated with their mothers. In response to hypothetical situations, children described their likely thoughts and actions; mothers listed a typical child's thoughts and what their child would do. Consistent with information processing theories of anxiety, anxious children displayed amplified cognitive biases in response to personally salient situations, compared to non-clinical children. Mothers of anxious children had lower expectations for their children's coping than mothers of non-anxious children, mirroring differences between the groups of children. Mothers' expectations of their children's coping predicted children's coping expectations in non-salient and salient situations and threat perception in salient situations. Implications of findings are discussed

Assessment And Behavioral Treatment Of Selective Mutism

Children with selective mutism present with a complicated set of symptoms, as they not only refuse to speak in particular social situations but are often shy, socially isolative, anxious, and may present as oppositional and negativistic in their behavior. Limited research on treatments for selective mutism suggests a need for additional research examining intervention possibilities. The following case description presents a 10-year-old male with selective mutism and concurrent anxiety symptoms. Treatment included the use of a significantly modified version of Social Effectiveness Therapy for Children (SET-C), a manualized behavioral treatment for social anxiety. In addition to SET-C, treatment also included concurrent parent training in the management of child anxiety. The rationale for the treatment selection and a description of treatment course are provided. Further, a discussion is presented concerning challenges to treatment progress, including cultural differences between the primary clinician and the client. © 2006 Sage Publications

Self-efficacy: a comparison between clinically anxious and non-referred youth

Although diminished self-efficacy has been linked to childhood psychopathology, including depression, it has only recently been studied in relation to childhood anxiety disorders. This study examines the relationship between self-efficacy and self-reported anxiety in children who have been referred for an assessment and possible treatment of anxiety symptoms as well as a comparison group of non-referred children. A self-efficacy questionnaire for children and a childhood anxiety measure were administered to a group of children referred for assessment and treatment of a clinical anxiety disorder (n = 50) and a non-referred control group (n = 50). Results indicate that the two samples differed significantly on measures of emotional self-efficacy, but not in terms of self-reported anxiety or other self-efficacy domains. Potential explanations for observed findings are discussed, including the possibility that self-reports of emotional self-efficacy in children may vary by clinical or referral status, amongst those reporting higher levels of anxiety overall

Assessment of parental experiential avoidance in a clinical sample of children with anxiety disorders

This investigation seeks to establish the psychometric properties of an adapted measure of experiential avoidance (EA) in the parenting context by assessing its relation to other parenting constructs and psychosocial correlates of child anxiety in a clinical sample. Participants were 154 children (90 female, 64 male) diagnosed with anxiety disorders and their parents (148 mothers, 119 fathers). The newly developed Parental Acceptance and Action Questionnaire (PAAQ) was administered to parents along with self-report measures of adult experiential avoidance, parental psychopathology, affective expression, and parental control behaviors. A subsample of participants, n = 35, were re-administered the PAAQ to assess temporal stability. Factor analysis of the PAAQ yielded a two-factor solution with factors labeled Inaction and Unwillingness. Temporal stability of the PAAQ was found to be moderate, r = .68-.74. Internal consistency was fair across subscales of the PAAQ, alpha = .64-.65. Correlational analysis of the PAAQ and parent-report measures support the criterion validity of the PAAQ, suggesting that the PAAQ correlates with parent-report measures of parental locus of control, affective expression, and controlling parental behaviors as well as child psychopathology symptoms. Finally, the clinical applicability of the PAAQ is indicated by the PAAQ's ability to predict a significant amount of variance in parent- and clinician-rated levels of child anxiety and related psychopathology

It\u27S A Dirty Job: Mental Health Consultation And The Challenges Of Treating Encopresis In A Preadolescent

This case study details limitations encountered while providing indirect and direct clinical services to children in applied settings through a behavioral mental health consultation model. Specifically, the case of AB, a 13-year-old male residing at a foster care facility, who demonstrates oppositional and defiant behavior problems and symptoms of both retentive encopresis and posttraumatic stress, is presented to illustrate potential pitfalls faced by a consultant providing multiple forms of intervention in applied settings. Although the provision of supportive, individual psychotherapy is reviewed, an emphasis is placed on the difficulties of implementing a behavior modification plan to treat AB\u27s encopresis at his residential foster care facility. The challenges associated with providing individual psychotherapy to AB while serving as the behavioral consultant at his residence are highlighted. Finally, recommendations are presented regarding how mental health consultants can work with applied service agencies to promote effective therapeutic interventions within frameworks established by those agencies. © 2003, SAGE Publications. All rights reserved