Childhood and adolescent anxiety disorders are relatively common, occurring in between 5-18% of all children and adolescents. They are associated with significant morbidity and impairment in social and academic functioning, and when persistent, there is a risk of depression, suicide attempts and substance abuse in adulthood. There is accumulating evidence for the efficacy of cognitive behavioural therapy (CBT), with a number of randomised controlled trials (RCTs) suggesting benefit.
The objective of this review is to determine whether CBT is an effective treatment for childhood and adolescent anxiety disorders in comparison to waiting list or attention controls.

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Cognitive behavioural therapy for anxiety disorders in children and adolescents

Anxiety in a neglected population: Prevalence of anxiety disorders in pre-adolescent children.

Across 5 decades, hundreds of randomized trials have tested psychological therapies for youth internalizing (anxiety, depression) and externalizing (misconduct, attention deficit and hyperactivity disorder) disorders and problems. Since the last broad-based youth meta-analysis in 1995, the number of trials has almost tripled and data-analytic methods have been refined. We applied these methods to the expanded study pool (447 studies; 30,431 youths), synthesizing 50 years of findings and identifying implications for research and practice. We assessed overall effect size (ES) and moderator effects using multilevel modeling to address ES dependency that is common, but typically not modeled, in meta-analyses. Mean posttreatment ES was 0.46; the probability that a youth in the treatment condition would fare better than a youth in the control condition was 63%. Effects varied according to multiple moderators, including the problem targeted in treatment: Mean ES at posttreatment was strongest for anxiety (0.61), weakest for depression (0.29), and nonsignificant for multiproblem treatment (0.15). ESs differed across control conditions, with "usual care" emerging as a potent comparison condition, and across informants, highlighting the need to obtain and integrate multiple perspectives on outcome. Effects of therapy type varied by informant; only youth-focused behavioral therapies (including cognitive-behavioral therapy) showed similar and robust effects across youth, parent, and teacher reports. Effects did not differ for Caucasian versus minority samples, but more diverse samples are needed. The findings underscore the benefits of psychological treatments as well as the need for improved therapies and more representative, informative, and rigorous intervention science. (PsycINFO Database Record

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What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice.

Fathers' role in the etiology, prevention and treatment of child anxiety: a review and new model.

Anxiety disorders are the most common mental health disorder among children and adolescents. We examined 111 treatment outcome studies testing 204 treatment conditions for child and adolescent anxiety published between 1967 and mid-2013. Studies were selected for inclusion in this review using the PracticeWise Evidence-Based Services database. Using guidelines identified by this journal (Southam-Gerow & Prinstein, 2014), studies were included if they were conducted with children and/or adolescents (ages 1-19) with anxiety and/or avoidance problems. In addition to reviewing the strength of the evidence, the review also examined indicators of effectiveness, common practices across treatment families, and mediators and moderators of treatment outcome. Six treatments reached well-established status for child and adolescent anxiety, 8 were identified as probably efficacious, 2 were identified as possibly efficacious, 6 treatments were deemed experimental, and 8 treatments of questionable efficacy emerged. Findings from this review suggest substantial support for cognitive-behavioral therapy (CBT) as an effective and appropriate first-line treatment for youth with anxiety disorders. Several other treatment approaches emerged as probably efficacious that are not primarily CBT based, suggesting that there are alternative evidence-based treatments that practitioners can turn to for children and adolescents who do not respond well to CBT. The review concludes with a discussion of treatments that improve functioning in addition to reducing symptoms, common practices derived from evidence-based treatments, mediators and moderators of treatment outcomes, recommendations for best practice, and suggestions for future research.

Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety

Objective Despite recent advances, there are still no interventions that have been developed for the specific treatment of young children who have anxiety disorders. This study examined the impact of a new, cognitive–behaviorally based parenting intervention on anxiety symptoms. Method Families of 74 anxious children (aged 9 years or less) took part in a randomized controlled trial, which compared the new 10-session, group-format intervention with a wait-list control condition. Outcome measures included blinded diagnostic interview and self-reports from parents and children. Results Intention-to-treat analyses indicated that children whose parent(s) received the intervention were significantly less anxious at the end of the study than those in the control condition. Specifically, 57% of those receiving the new intervention were free of their primary disorder, compared with 15% in the control condition. Moreover, 32% of treated children were free of any anxiety diagnosis at the end of the treatment period, compared with 6% of those in the control group. Treatment gains were maintained at 12-month follow-up. Conclusions This new parenting-based intervention may represent an advance in the treatment of this previously neglected group. Clinical trial registration information: Anxiety in Young Children: A Randomized Controlled Trial of a New Cognitive-Behaviourally Based Parenting Intervention; http://www.isrctn.org/; ISRCTN12166762.

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A new parenting-based group intervention for young anxious children: results of a randomized controlled trial

PROBLEM: A number of interventions are effective in treating older children with internalizing symptoms. However, little is known about the efficacy of psychological interventions in treating younger children. This study examined the impact on internalizing symptoms of a parenting skills training program.

METHODS: Forty-three parents took part in a parenting skills training program. Externalizing and internalizing behaviors were measured before and after treatment and after a 6-month period.

FINDINGS: Externalizing symptoms fell after treatment. Interestingly, internalizing scores fell to an approximately equivalent degree.

CONCLUSIONS: An intervention targeted towards parenting may be efficacious in the treatment of children's internalizing symptoms.

Parenting skills training: an effective intervention for internalizing symptoms in younger children?

OBJECTIVES: This study examines the spontaneous causal attributions made by mothers about their preschool children's problem behaviour and investigates the relationship between causal attributions and maternal depression. DESIGN: Two groups of mothers were compared, a depressed and a non-depressed group, while all women included identified their preschool child as having some problem behaviours. There were 25 women in each group. METHODS: The spontaneous attributions of mothers were assessed from audiotaped interviews using an adaptation of the Leeds Attributional Coding System for the extraction and analysis of attributional statements. RESULTS: Depressed mothers made more spontaneous causal attributions about their children's problem behaviour than did the non-depressed group; and the depressed group perceived these causes as being more stable, more controllable and more personal to the child than their non-depressed counterparts. There was also evidence that depressed mothers made more internal attributions about themselves as the cause of their children's problem behaviour than non-depressed mothers. The study indicates that the personal-to-child dimension is the attributional variable most strongly associated with depression. CONCLUSIONS: This study provides evidence that depressed mothers have attributional biases when compared to non-depressed mothers. The authors suggest that their attributions may mediate coping responses and hence may influence parenting behaviour. The clinical and research implications of the findings are discussed.

Depressed and non-depressed mothers with problematic preschoolers: attributions for child behaviours.

Childhood anxiety disorders often have a poor prognosis. Despite this, there are currently no published treatment protocols for young children with anxiety difficulties. Individually focused therapies (e.g. CBT) are useful for older children, but likely to be less so for this group. This paper describes a pilot investigation of a new CBT based parenting intervention for the treatment of children aged 9 years and under. Sixteen parents of 11 anxious children took part in a 10-week intervention, completing the Child Behaviour Checklist at three time points. The intervention was based on a new cognitively enhanced parenting package, with an emphasis on coping with internalizing symptoms, and with additional modules on the specific skills needed for managing anxiety. All children were reported to experience substantial decreases in their internalizing symptoms by the end of the study. Parents' satisfaction with the intervention was high. This is a promising new intervention for the treatment of a currently neglected group.

A New Cognitive Behavioural Parenting Intervention for Families of Young Anxious Children: A Pilot Study

Parent training is one of the most effective interventions for behaviour problems in young children. Most models of parent training are largely behavioural in content and have been developed from social learning theory. As with developments in treatments for adult disorders, it is proposed that parent training implementation and parental engagement may be improved by the introduction of a cognitive component. In particular, the use of the “thoughts, feelings, behaviour cycle” throughout parent training is proposed as a tool for challenging parental beliefs and attributions regarding children's behaviour and increasing parental uptake of the behavioural strategies that are taught. Preliminary findings are discussed with reference to clinical implications and future research.

Caroline White

Papers

A new parenting-based group intervention for young anxious children: results of a randomized controlled trial

Parenting skills training: an effective intervention for internalizing symptoms in younger children?

Depressed and non-depressed mothers with problematic preschoolers: attributions for child behaviours.

A New Cognitive Behavioural Parenting Intervention for Families of Young Anxious Children: A Pilot Study

Cognitively enhanced parent training