Cognitive Behavior Therapy for Anxious Adolescents: Developmental Influences on Treatment Design and Delivery

Anxiety disorders in adolescence are common and disruptive, pointing to a need for effective treatments for this age group. Cognitive behavior therapy (CBT) is one of the most popular interventions for adolescent anxiety, and there is empirical support for its application. However, a significant proportion of adolescent clients continue to report anxiety symptoms post-treatment. This paper underscores the need to attend to the unique developmental characteristics of the adolescent period when designing and delivering treatment, in an effort to enhance treatment effectiveness. Informed by the literature from developmental psychology, developmental psychopathology, and clinical child and adolescent psychology, we review the ‘why’ and the ‘how’ of developmentally appropriate CBT for anxious adolescents. ‘Why’ it is important to consider developmental factors in designing and delivering CBT for anxious adolescents is addressed by examining the age-related findings of treatment outcome studies and exploring the influence of developmental factors, including cognitive capacities, on engagement in CBT. ‘How’ clinicians can developmentally tailor CBT for anxious adolescents in six key domains of treatment design and delivery is illustrated with suggestions drawn from both clinically and research-oriented literature. Finally, recommendations are made for research into developmentally appropriate CBT for anxious adolescents

Anxiety in Children and Adolescents Rated by Patients, Parents, and Teachers: Factor Structure and Psychometric Properties of an ICD-10 and DSM-IV-based Rating Scale in a Large Clinical Sample

This study examined the psychometric properties of the German Self-Report and Parent Report Rating Scale for Anxiety Disorders (SRS-AD and PRS-AD), and a shortened teacher version of the PRS-AD (TRS-AD) in a large clinical sample. Data were collected from 585 children, adolescents and young adults with psychiatric disorders (aged 6-21 years), 821 parents and 378 teachers. Factorial validity, reliability and discriminating validity of the scales were examined and the agreement between different informants was assessed. Analyses were performed in the complete sample including a wide range of different psychiatric disorders as well as in a subsample of children, adolescents and young adults with anxiety disorders. Confirmatory factor analyses mostly supported a model with first-order factors according to the subscales and a second-order overall anxiety factor. Only for the SRS-AD analysed in the sample of participants with anxiety disorders, the results did not clearly favour a first-order solution with correlated factors according to the subscales or the second-order solution adopted for the other questionnaires. Internal consistencies for the total scale and subscales were mostly satisfactory. Significant mean differences between anxious and non-anxious participants were found for the mean total scores of the SRS-AD and PRS-AD, but not for the TRS-AD. The informant agreement was low-to-moderate. We concluded that the SRS-AD, PRS-AD and TRS-AD demonstrate satisfactory psychometric properties for use with clinically-referred children and adolescents