Bidirectional Relationship Between Family Accommodation and Youth Anxiety During Cognitive-Behavioral Treatment

Family accommodation is associated with an increase in anxiety and has recently received attention as a target for intervention for youth anxiety. Existing theories posit that the increase in family accommodation increases youth anxiety and can attenuate the effect of psychotherapy. However, the directionality between family accommodation and youth anxiety has not been investigated. A cross-lagged cross-panel design was used to assess accommodation and anxiety for 10 sessions for 73 youths with an anxiety disorder, who were receiving cognitive-behavioral therapy. The analysis revealed a bidirectional relationship, such that to some extent previous session family accommodation increased youth anxiety symptoms (β = 0.11, 95% CI [0.06, 0.17]), but to an even greater extent previous session youth-rated anxiety symptoms increased family accommodation (β = 0.23, 95% CI [0.08, 0.38]). Family accommodation is an important target for reducing youth anxiety but should be addressed simultaneously as interventions directly targeting youth anxiety.publishedVersio

Parental early life maltreatment and related experiences in treatment of youth anxiety disorder

The role of parents’ early life maltreatment (ELM) (e.g. physical, sexual abuse) and related experiences, in relation to offspring anxiety is not well understood. The current study investigated the association between self-reported depression and ELM and related experiences in mothers (n = 79) and fathers (n = 50), and mother-, father-, and youth-reported symptoms of youth anxiety (n = 90). Outcomes were assessed at pre,- and posttreatment and 3-, 6-, and 12-months follow-up. Parental ELM were not associated with pre-treatment differences or differences in outcome of treatment. However ELM related experiences were associated with increased mother-, father-, and youth-rated youth anxiety at pretreatment. Fathers depressive symptoms were found to mediate the relationship between father ELM related experiences and father-rated youth anxiety symptoms. Future research is warranted on parental ELM and depression as factors affecting outcomes of treatment of youth anxiety. Trial registered at: helseforskning.etikkom.no (reg. nr. 2017/1367).publishedVersio

Benchmarked effectiveness of family and school involvement in group exposure therapy for adolescent anxiety disorder

Although cognitive-behavioral therapy (CBT) is an effective treatment for adolescents with anxiety disorders, the majority remain impaired following treatment. We developed a group CBT program (RISK) with high degrees of exposure practice and family and school involvement delivered in a community-based setting and investigated its effectiveness. The treatment involved adolescents (N = 90), with a primary diagnosis of anxiety disorder (82%) or obsessive-compulsive disorder (18%), and their families who received 38 hours of group treatment over 10 weeks. Diagnostic status and symptom severity were assessed at pre- and post-treatment, and a 12-month follow-up and benchmarked against previous effectiveness studies. Our results showed that, at post-treatment, the RISK-treatment was comparably effective as benchmarks on measures of diagnostic status, parent-rated measures, adolescent-rated measures, and clinician-rated measures. At 12-month follow-up all outcomes were superior to benchmarks, including the proportion of participants in remission (79.5%, 95% Highest Posterior Density Interval [74.7, 84.2]), indicating that the RISK-treatment enhanced effectiveness over time. The combination of group format, a high degree of exposure practice, and school and family involvement is a promising format for real-world settings that may help sustain and increase treatment effectiveness. Trial registered at helseforskning.etikkom.no (reg. nr. 2017/1367).publishedVersio

Physical couple and family violence among clients seeking therapy: identifiers and predictors

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Use of the Strengths and Difficulties Questionnaire in child and school health services among children aged 4 and 6 years in Southern Norway: clinical considerations

Background Parent reported mental health can be assessed by the Strengths and Difculties Questionnaire (SDQ). Currently, Norwegian norms for parent-reported SDQ do not exist, whereas Swedish, Danish, and United Kingdom (UK) norms have been published. We aimed to (1) describe parent-reported SDQ among children aged 4 and 6 years in Southern Norway, (2) evaluate empirical cutof values within the context of the Starting RightTM project in relation to the Swedish, Danish, and UK cutofs, and (3) evaluate the representativeness of the study sample with regard to parental socioeconomic status. Methods This study included parent-reported observations for 665 children (63% consent rate). Means and standard deviations were calculated for the domains of SDQ, and gender diferences were assessed. Based on the Swedish, Danish, and UK cutofs and the 80th and 90th percentile cutof values within the study, we calculated the total number of children with borderline and abnormal scores. Results Boys had higher mean total difculties (7.3 vs 5.6) and impact scores (0.3 vs 0.1) and lower prosocial scores (8.3 vs 8.8) than girls. The diferences in means were largest in the case of externalizing symptoms (5.0 vs 3.6) and hyperactivity subscore (3.2 vs 2.3). Using the UK cutof values, 28 and 25 children had borderline and abnormal total difculties scores, respectively. The corresponding numbers using the within study or Scandinavian cutof values were 84–99 and 54–79, respectively. Overall, our study sample was well representative of the target population. Conclusions Our fndings consistently indicated that girls had better SDQ scores than boys among children aged 4 and 6 years. Fewer children would be identifed as having mental health difculties using the UK cutof values than using the Scandinavian age- and gender-relevant cutof values.publishedVersio

Predictors of school-based cognitive behavior therapy outcome for youth with anxiety

Meta-analyses of school-based CBT have shown that prevention for anxiety symptoms typically report small but significant effects. There is limited knowledge regarding which youths may benefit most and least from such programs, and characteristics of youth who respond differentially to interventions of different intensity. The present study examined predictors of school-based CBT outcomes among 302 youths (mean age 14.0 years, SD 0.8, 84% female) who participated in a randomized waitlist-controlled trial comparing a 10-session and a 5-session group intervention. Potential predictors included youth and parental factors, and credibility and expectancy of the interventions. Pre-intervention anxiety and depression levels, and clinician rated severity were examined as moderators of intervention effects. Outcomes were youth-, and parent-reported youth anxiety and depressive symptoms at post-intervention and 1-year follow-up. Higher parent-reported impairment from youth anxiety predicted larger parent-reported anxiety and depressive symptom change, whereas higher caregiver strain was associated with less symptom change. Higher parent rated credibility and expectancy was associated with improved outcomes at post-intervention. At 1-year follow-up, no predictors of outcome were identified. No moderators were identified. Families with high levels of caregiver strain associated with youth anxiety may need extra support regardless of length of intervention program. Parents’ credibility and expectancy of interventions should be targeted to optimize school-based CBT.publishedVersio

Bidirectional Relationship Between Family Accommodation and Youth Anxiety During Cognitive-Behavioral Treatment

Family accommodation is associated with an increase in anxiety and has recently received attention as a target for intervention for youth anxiety. Existing theories posit that the increase in family accommodation increases youth anxiety and can attenuate the effect of psychotherapy. However, the directionality between family accommodation and youth anxiety has not been investigated. A cross-lagged cross-panel design was used to assess accommodation and anxiety for 10 sessions for 73 youths with an anxiety disorder, who were receiving cognitive-behavioral therapy. The analysis revealed a bidirectional relationship, such that to some extent previous session family accommodation increased youth anxiety symptoms (β = 0.11, 95% CI [0.06, 0.17]), but to an even greater extent previous session youth-rated anxiety symptoms increased family accommodation (β = 0.23, 95% CI [0.08, 0.38]). Family accommodation is an important target for reducing youth anxiety but should be addressed simultaneously as interventions directly targeting youth anxiety

Change in work functioning from pre- to post-treatment in feedback-informed Couple and Family Therapy in Norway

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Implementation of the norwegian ‘Starting right’ child health service innovation: implementation adjustments, adoption, and acceptability

Background: An increased and/or stable proportion of the child and adolescent population reports symptoms ofimpaired health, and the symptoms can be identified early. Therefore, structured child- and parent-reportedoutcome measures need to be implemented in child and school health services for decision support andidentification of children at risk. We aimed to (a) qualitatively examine adjustments of active implementation fromthe pilot implementation of the Norwegian‘Starting Right’health service innovation including an online childhealth assessment tool and practical routines, and (b) measure practitioners ́ adoption and parental acceptability. Methods: We used a mixed-methods design to qualitatively examine adjustments from working notes andmeeting memoranda, and quantitatively assess adoption and acceptability from user rates provided by the systemslog. Twenty-one child and school health nurses (CSHNs) from two child health centers participated in theimplementation pilot of online health assessments in children aged 2-, 4- and 6-year. We used a deductive andnarrative analysis approach using Fixsen et al. ́s core implementation components to code and sort adjustments. Results: Core implementation components were adjusted throughout the pilot implementation. Researchers ́increased their availability in reciprocity with staff evaluation to integrate active implementation adjustments. Welaunched a project for improved data systems integration. The overall CSHNs adoption rate was satisfactory andhigher in center A, where a medical secretary supported the nurses through the entire pilot phase, than in center B(96 vs. 55 %). Parental acceptability rate was overall high (77 %) with increased rates among parents of 6-year-oldchildren (98 %) compared with younger ones (78–85 %), and in cases where both parents received thequestionnaires. Conclusions: The ‘Starting Right’ health service innovation implementation was actively adjusted by integration of core implementation components mainly based on staff evaluation. The CSHNs adopted the innovation which was also acceptable to parents.publishedVersio