One-Session Treatment of Specific Phobias in Children: Recent Developments and a Systematic Review.

One-Session Treatment is a well-established evidence-based treatment for specific phobias in youths that incorporates reinforcement, cognitive challenges, participant modeling, psychoeducation, and skills training into a single, massed session of graduated exposure. This review begins by briefly examining the phenomenology, etiology, epidemiology, and assessment of specific phobias and then pivots to a description of One-Session Treatment. We examine the use of One-Session Treatment with children and adolescents, briefly discussing its components and application, and subsequently review almost two decades of research supporting its efficacy. Finally, we propose future directions for research and practice.

Maternal Impression Management in the Assessment of Childhood Depressive Symptomatology.

BACKGROUND: Self-report instruments are commonly used to assess for childhood depressive symptoms. Historically, clinicians have relied heavily on parent-reports due to concerns about childrens' cognitive abilities to understand diagnostic questions. However, parents may also be unreliable reporters due to a lack of understanding of their child's symptomatology, overshadowing by their own problems, and tendencies to promote themselves more favourably in order to achieve desired assessment goals. One such variable that can lead to unreliable reporting is impression management, which is a goal-directed response in which an individual (e.g. mother or father) attempts to represent themselves, or their child, in a socially desirable way to the observer. AIMS: This study examined the relationship between mothers who engage in impression management, as measured by the Parenting Stress Index-Short Form defensive responding subscale, and parent-/child-self-reports of depressive symptomatology in 106 mother-child dyads. METHODS: 106 clinic-referred children (mean child age = 10.06 years, range 7-16 years) were administered the Child Depression Inventory, and mothers (mean mother age = 40.80 years, range 27-57 years) were administered the Child-Behavior Checklist, Parenting Stress Index-Short Form, and Symptom Checklist-90-Revised. RESULTS: As predicted, mothers who engaged in impression management under-reported their child's symptomatology on the anxious/depressed and withdrawn subscales of the Child Behavior Checklist. Moreover, the relationship between maternal-reported child depressive symptoms and child-reported depressive symptoms was moderated by impression management. CONCLUSIONS: These results suggest that children may be more reliable reporters of their own depressive symptomatology when mothers are highly defensive or stressed.

Differentiating among singular and comorbid obsessive-compulsive disorder and social phobia symptomology.

Social phobia is a frequent co-occurring diagnosis with obsessive-compulsive disorder (OCD); however, co-occurring OCD in those with social phobia is less common. Genetic, environmental, and cognitive traits are common risk factors for anxiety disorders broadly. It is plausible that shared variables related to OCD and/or social phobia could provide insight into the co-occurrence of these two disorders. The current study explored differences in fear of negative evaluation (FNE) and perfectionism among four groups: those with (1) elevated social phobia symptoms, (2) elevated OCD symptoms, (3) elevated symptoms of OCD and social phobia, and those who were (4) asymptomatic as a control group. A non-clinical sample of 196 participants completed several online questionnaires about social phobia and OCD symptomology. Results identified three cognitive variables (i.e., FNE, total perfectionism, and concern over mistakes) as differential variables in comorbid symptom presentation of OCD and social phobia. A fourth variable (i.e., doubts about actions) was identified as a potential dual risk factor, and four subsequent variables (i.e., parental criticism, personal standards, parental expectations, and organization) were not implicated in differential symptom presentation. Given the different rates of OCD and social phobia co-occurrence, identification of differentiating variables could aid in better understanding of potential risk factors, which may enhance preventative and therapeutic techniques. Study implications, limitations, and future recommendations are discussed.

The role of intolerance of uncertainty in social anxiety subtypes.

OBJECTIVES: Intolerance of uncertainty (IU) is thought to underlie several internalizing disorders; however, it has only begun to be explored within social anxiety (SA). This study extends previous findings by examining IU's relation to performance and interaction SA subtypes and by accounting for obsessive-compulsive symptoms. METHODS: A total of 472 undergraduates completed measures of IU, SA, perfectionism, worry, obsessions/compulsions, and fear of negative evaluation (FNE). RESULTS: IU and obsessions/compulsions predicted performance SA beyond FNE. IU predicted interaction SA beyond FNE. Inhibitory anxiety IU contributed to both SA types but contributed more to performance SA. Prospective anxiety IU was negatively related to performance SA and unrelated to interaction SA, though a trend emerged. Contrasts between those high in one SA type, both, or neither revealed IU was highest when both types were present. CONCLUSIONS: Inhibitory IU plays a significant role in both SA subtypes and may play a slightly greater role in performance SA.

Specific Phobia, Fear, and the Autism Spectrum in Children and Adolescents: Adapting OST for ASD.

Fears and phobias are a common mental health concern for youth, and particularly for autistic youth. The following review briefly summarizes the extant literature on specific phobias and specific phobias in autistic youth. The evidence base is briefly highlighted pointing to the strong base behind behavioral and cognitive-behavioral treatments and techniques. A broad discussion of key evidence-based treatment findings is presented, leading up to the impactful work of Thomas H. Ollendick in researching Öst's One-Session Treatment (OST) with children and adolescents. OST for child specific phobias is discussed, and particular emphasis is given to this treatment's ongoing adaptation for use with youth on the autism spectrum.

A Systematic Review of Parental Self-Efficacy in Parents of Autistic Children.

Parental self-efficacy (PSE) assesses a parent's expectations and beliefs about their ability to effectively parent their child. PSE has implications for a parent's well-being, parenting practices, mental health, the parent-child relationship, and child adjustment. While PSE has been extensively examined within the broader parenting literature, the examination of PSE specifically for parents of autistic children has gained increasing attention in recent years. The following systematic review aimed to investigate the role of PSE for parents of autistic children by examining variables that predict PSE or are predicted by PSE in relation to how they align with the broader parenting literature and are unique to autism. Utilizing PRISMA guidelines, peer-reviewed articles were included if (a) participants included caregivers of autistic children, (b) at least one quantitative outcome measure of PSE was utilized, and (c) the role of PSE was examined as an outcome, predictor, or variable in an explanatory model. A total of 53 studies were included in the review and the role of PSE was examined regarding family (e.g., parental characteristics, parent stress, well-being, and support) and child factors (e.g., autism symptomology, problem behaviors, interventions). Several themes emerged including a positive relationship between PSE and support, and a negative relationship between PSE and parenting stress, parent mental health outcomes (e.g., anxiety, depression), and autism symptomology. Findings were compared to the broader parenting and PSE literature to examine how increased considerations and challenges (e.g., child problem behaviors, social impairment, and caregiver strain) associated with raising an autistic child might impact PSE.

Intolerance of uncertainty as a mediator of the relationship between perfectionism and obsessive-compulsive symptom severity.

BACKGROUND: Intolerance of uncertainty (IU) and perfectionism have both been shown to predict severity of obsessive-compulsive disorder (OCD) symptoms in populations diagnosed with OCD, as well as analogue samples. According to cognitive models of OCD, symptoms are maintained by dysfunctional beliefs including IU and perfectionism. The purpose of the current study is to extend research on the cognitive theory of OCD by describing how dysfunctional thoughts interact with each other. METHODS: In an analogue sample for OCD (N = 475), undergraduate students completed measures online pertaining to IU (IU scale), perfectionism (Frost Multidimensional Perfectionism Scale), and OCD symptoms and severity (Florida Obsessive-Compulsive Inventory). RESULTS: The proposed model of IU fully mediating the relationship between perfectionism and OCD severity was supported using structural equation modeling (SEM) analysis. Bootstrapping testing within AMOS 20 and Sobel tests further corroborated full mediation. CONCLUSIONS: Results from the current study suggest that IU fully mediates the relationship between perfectionism and severity of OCD symptoms. This finding has an impact for understanding the nature and treatment of OCD with perfectionism as a primary symptom. Findings suggest that in order to address perfectionism, it is necessary to first treat cognitions and obsessions associated with IU and that this practice would lessen distress and interference associated with perfectionistic obsessions.

One-session treatment for specific phobias: a review of Öst's single-session exposure with children and adolescents.

The purpose of this brief paper is to review the current status of one-session treatment (OST) for specific phobias in children and adolescents. Following a brief historical overview and description of OST, we systematically describe eight studies that have examined its efficacy in children and adolescents aged between 7 and17 years. We also explore phobia subtypes, age, gender, and comorbidity as possible moderators of treatment outcome. Studies have been conducted in Australia, Austria, the Netherlands, the USA, and Sweden. Although there is limited evidence that OST works better for animal phobias than other subtypes of phobias and for girls than boys, across studies there is considerable evidence that it is generally effective across phobia subtypes and for both boys and girls. No age differences in outcomes were noted, nor were any differences noted due to comorbidity. OST was found to be equally effective with children and adolescents with co-occurring multiple phobias and other anxiety disorders. Moreover, in at least one study, it was found to reduce untreated phobic and anxiety disorders in addition to the treated phobias. It is concluded that OST is a highly effective intervention for the treatment of specific phobias in children and adolescents.

Treating selective mutism using modular CBT for child anxiety: a case study.

Selective mutism is a rare, debilitating condition usually seen in children. Unfortunately, there is little research examining effective treatments for this disorder, and designing an evidence-based treatment plan can be difficult. This case study presents the evidence-based treatment of an 8-year-old Caucasian boy with selective mutism using an established treatment for anxiety--Modular Cognitive-Behavioral Therapy for Childhood Anxiety Disorders (Chorpita, 2007). The treatment consisted of 21 sessions and included modules on psychoeducation, exposure, cognitive restructuring, social skills, and maintenance and relapse prevention. The client's symptoms were greatly improved by the end of treatment based on fear hierarchy ratings, self-report and parent-report questionnaires, and child and parent clinical interviews. In addition, at discharge the client no longer met criteria for selective mutism. Improvements were maintained when the client was reassessed at 1-month and 6-month follow-up appointments.

Telehealth and Autism Prior to and in the Age of COVID-19: A Systematic and Critical Review of the Last Decade.

There has been growing interest in the use of telehealth; however, the COVID-19 pandemic and the subsequent isolation and restrictions placed on in-person services have fast-tracked implementation needs for these services. Individuals with autism spectrum disorder (ASD) have been particularly affected due to the often-intensive service needs required by this population. As a result, the aim of this review was to examine the evidence base, methodology, and outcomes of studies that have used telehealth for assessment and/or intervention with children and adolescents with ASD as well as their families over the last decade. Further, the goal is to highlight the advances in telehealth and its use with this special population. A systematic search of the literature was undertaken, with 55 studies meeting inclusion criteria and quality analysis. Specified details were extracted from each article, including participant characteristics, technology, measures, methodology/study design, and clinical and implementation outcomes. Services provided via telehealth included diagnostic assessments, preference assessments, early intervention, applied behavior analysis (ABA), functional assessment and functional communication training, and parent training. Findings, although still emerging, encouragingly suggested that services via telehealth were equivalent or better to services face-to-face. Results support the benefits to using telehealth with individuals with ASD. Future research should continue to explore the feasibility of both assessments and interventions via telehealth with those having ASD to make access to assessment services and interventions more feasible for families, while acknowledging the digital divide it could create.