Cognitive-behavioral therapy (CBT) is the first-line psychological intervention for youth with an anxiety disorder. Despite the prevalence of anxiety in youth with physical disabilities, the application and evaluation of CBT for such youth is sparse. The current report illustrates ways to adapt, implement, and evaluate CBT for youth with anxiety and a physical disability describing "Olivia," a 12-year-old Caucasian female with generalized anxiety disorder, separation anxiety disorder, panic attacks, and cerebral palsy. Olivia received 24 one-hour sessions of outpatient CBT over the course of 9 months. At post-treatment, Olivia no longer met criteria for any anxiety diagnosis by parent-and child-report, with gains maintained at 2-month follow-up. Important therapeutic issues for working with comorbid anxious and physically challenged youth are addressed, such as therapeutic engagement, working within a multidisciplinary team, conflation of psychological and physical symptoms, parental accommodation, family interaction patterns, and modification of exposures and related treatment strategies.
The present study examined the psychometric properties, including discriminant validity and clinical utility, of the youth self-report and parent-report forms of the Multidimensional Anxiety Scale for Children (MASC) among youth with anxiety disorders. The sample included parents and youth (N= 488, 49.6% male) ages 7 – 17 who participated in the Child/Adolescent Anxiety Multimodal Study (CAMS). Although the typical low agreement between parent and youth self-reports was found, the MASC evidenced good internal reliability across MASC subscales and informants. The main MASC subscales (i.e., Physical Symptoms, Harm Avoidance, Social Anxiety, and Separation/Panic) were examined. The Social Anxiety and Separation/Panic subscales were found to be significantly predictive of the presence and severity of social phobia and separation anxiety disorder, respectively. Using multiple informants improved the accuracy of prediction. The MASC subscales demonstrated good psychometric properties and clinical utilities in identifying youth with anxiety disorders.
Guidelines for conducting effective exposure treatment with anxious youth emphasize preparation for and processing of the exposure task as important elements, but limited research has examined these guidelines. Using multiple regression, this study evaluated the extent to which independent observers' ratings of preparation and processing of in-session exposure tasks were associated with treatment outcome in a sample of 61 anxiety-disordered youth. Results indicated that preparation for exposure was not related to outcome, but postevent processing of the exposure task was significantly associated with clinician-rated diagnostic improvements. Exploratory analyses suggest that treatment responders were more likely to be assigned between-session exposure tasks as "homework" and were more likely to be rewarded for their efforts in session. Although time is spent preparing youth for exposure tasks, the activities that occur after the task is conducted are influential in reducing youth anxiety over the course of treatment. Additional implications and future directions are discussed.
This paper describes the rationale, design, and methods of the Treatment for Anxiety in Autism Spectrum Disorders study, a three-site randomized controlled trial investigating the relative efficacy of a modular CBT protocol for anxiety in ASD (Behavioral Interventions for Anxiety in Children with Autism) versus standard CBT for pediatric anxiety (the Coping Cat program) and a treatment-as-usual control. The trial is distinct in its scope, its direct comparison of active treatments for anxiety in ASD, and its comprehensive approach to assessing anxiety difficulties in youth with ASD. The trial will evaluate the relative benefits of CBT for children with ASD and investigate potential moderators (ASD severity, anxiety presentation, comorbidity) and mediators of treatment response, essential steps for future dissemination and implementation.
Social phobia (SoP) in youth may manifest differently across development as parent involvement in their social lives changes and social and academic expectations increase. This cross-sectional study investigated whether self-reported and parent-reported functioning in youth with SoP changes with age in social, academic, and home/family domains. Baseline anxiety impairment data from 488 treatment-seeking anxiety-disordered youth (ages 7-17, N = 400 with a SoP diagnosis) and their parents were gathered using the Child Anxiety Impact Scale (CAIS) and were analyzed using generalized estimating equations. According to youth with SoP and their parents, overall difficulties, social difficulties, and academic difficulties increased with age, even when controlling for SoP severity. These effects significantly differed for youth with anxiety disorders other than SoP. Adolescents may avoid social situations as parental involvement in their social lives decreases, and their withdrawn behavior may result in increasing difficulty in the social domain. Their avoidance of class participation and oral presentations may increasingly impact their academic performance as school becomes more demanding. Implications are discussed for the early detection and intervention of SoP to prevent increased impairment over the course of development.
Anxiety disorders are prevalent in children and adolescents (Costello, Egger, & Angold, 2005), and they are associated with concurrent and future functional impairment across domains (for a review, see Swan & Kendall, 2016). Studies support that children and adolescents with anxiety experience increased interpersonal and peer difficulties compared with their nonanxious peers (e.g., Verduin & Kendall, 2008). Children and adolescents with anxiety often experience heightened anxiety at school, resulting in difficulty concentrating and decreased academic achievement (e.g., Mychailyszyn, Mendez, & Kendall, 2010;Van Ameringen, Mancini, & Farvolden, 2003). Additionally, anxiety in children and adolescents is associated with increased family dysfunction and caregiver strain (e.g., Essau,
Integrating behavioral health services within pediatric primary care may help address barriers to these services for youth, especially the underserved. Models of primary care behavioral health include coordinated, colocated, integrated, and collaborative care. This study began exploring the comparative utility of these models by investigating differences in the demographics and diagnoses of patients seen for a behavioral health warm handoff (integrated model) and a scheduled behavioral health visit (colocated model) across 3 pediatric primary care sites. The 3 sites differed in their rates of warm handoff usage, and there were differences in certain diagnoses given at warm handoffs versus scheduled visits. Depression diagnoses were more likely to be given in warm handoffs, and disruptive behavior, trauma/adjustment, and attention-deficit/hyperactivity disorder–related diagnoses were more likely to be given in scheduled visits. These results have implications for the influence of office structure and standardized procedures on behavioral health models used in pediatric primary care.
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