Youth Anxiety and Parent Factors Over Time: Directionality of Change Among Youth Treated for Anxiety

Abstract

Objective The relationship between improvements in child anxiety and changes in parent factors (e.g., parental anxiety, parenting behaviors) is poorly understood. The present study investigated the directionality of change for child anxiety and parent factors among youth treated for anxiety disorders. Method Structural equation modeling examined these relationships pre- to post-treatment and at 1-year follow-up for 111 youth aged 7–14 (57% male, 84% Caucasian). Child anxiety was measured using the Anxiety Disorders Interview Schedule for Children and the Child Behavior Checklist. The State-Trait Anxiety Inventory, Children’s Report of Parental Behavior Inventory, and Family Assessment Device were used to measure maternal anxiety, psychological control, behavior control, and family affective involvement. Results Findings suggest that decreases in mother-reported child anxiety led to decreases in maternal anxiety. Decreases in maternal psychological control and family affective involvement preceded decreases in clinician-rated child anxiety. Youth who showed the most reductions in anxiety over the course of treatment were those who tended to have lower family affective involvement, behavior control, and maternal anxiety at pretreatment. Stability of the parent factors and child anxiety over time suggest that stability was greater for behavior control and maternal anxiety relative to affective involvement and psychological control. Conclusions The findings are consistent with previous research indicating the importance of these parent factors as they relate to anxiety in youth. Furthermore, results indicate that changes in child anxiety may precede changes in parent factors and suggest that psychological control and affective involvement are important treatment targets for youth with anxiety disorders.

A culturally-sensitive model of the development of child anxiety.

“…Additionally, lower levels of maternal psychological control and family affective involvement significantly predicted decreased clinician-reported child anxiety. Overall, children with lower levels of family affective involvement, behavioral control, and maternal anxiety demonstrated the greatest reductions in anxiety throughout treatment (Settipani et al, 2013). Based on findings that reductions in child anxiety predicted decreased maternal anxiety, Settipani and colleagues (2013) concluded that changes in child anxiety might precede changes in parent factors.…”

“…For example a study conducted by Rubin, Nelson, Hastings, and Asendorpf (1999) found that early child shyness predicted later parental control, while another study found that parental acceptance, as opposed to parental control, predicted later symptoms of anxiety in adolescents (Pederson, 1994). More recent longitudinal work conducted by Settipani, O'Neil, Podell, Beidas, and Kendall (2013) examined the directionality of changes in both child anxiety and parent behaviors using a sample of 11 seven-to 14-year olds who were being treated for anxiety disorders. Results from this study indicated that lower levels of mother-reported child anxiety predicted decreased maternal anxiety.…”

Cognitive behavior therapy for anxiety disorders in youth: Treatment specificity and mediation effects

“…Six studies in the youth anxiety treatment research literature investigated mediators of treatment response (Alfano et al, 2009;Hogendoorn et al, 2013;Kendall & Treadwell, 2007;Settipani et al, 2013;Silverman et al 2009;Treadwell & Kendall, 1996). Four of these studies (Alfano et al, 2009;Hogendoorn et al, 2013;Kendall et al, 2007;Treadwell et al, 1996) investigated youth variables (i.e., youth cognitions, social skills, and loneliness) as mediators of youth anxiety treatment outcome.…”

“…The other studies (Settipani et al, 2013;Silverman et al, 2009) summarized relate to this dissertation's interest in investigating parenting variables mediating parent-involvement CBT.…”

“…Only two studies (Settipani, O'Neil, Podell, Beidas, & Kendall, 2013;Silverman et al, 2009) have evaluated whether changes produced on parent variables mediated treatment response. These studies and their findings are described further in Chapter II.…”