Unaccompanied migrant children in the United States: Implementation and effectiveness of trauma-focused cognitive behavioral therapy.

OBJECTIVE: The number of unaccompanied children (UC) arriving in the United States (U.S.) from other countries has increased significantly over the past decade. UC report high trauma exposure and greater posttraumatic stress symptoms compared with youth who immigrate with caregivers. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has demonstrated preliminary effectiveness with UC. However, few studies have treated U.S.-based samples of UC, who emigrate primarily from Central America. METHOD: One hundred thirty-eight UC were referred for treatment and 129 completed a pretreatment assessment including the Child and Adolescent Trauma Screen (CATS) and the Strengths and Difficulties Questionnaire (SDQ). Most UC were from Central America (n = 109; 79.0%) and resided in government facilities (n = 76; 55.1%). One hundred twenty-two youth began TF-CBT, had an average of 9.71 sessions (SD = 9.3, range: 1-48), and 41.8% (n = 51) completed treatment. One hundred four youth completed a brief, six-item progress monitoring measure of trauma symptoms, for which 84 had at least two observations during treatment. RESULTS: UC endorsed 3.80 traumatic events on average (SD = 2.38). High rates of violence, physical and sexual abuse, and serious injury were reported. There were significant improvements on most self-report rating scales (p < .05); within-subjects Cohen's d's ranged from .07 to 1.03 for pre- to posttreatment assessments and was d = .44 for the progress monitoring measure. Therapists reported on TF-CBT modifications for UC, including discussing mental health beliefs, navigating roles and relationships, tailoring treatment examples, exploring coping strategies, and addressing immigration factors. CONCLUSION: Preliminary findings support the utility of TF-CBT with UC. Implications for implementation and cultural modifications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Client-rated facilitators and barriers to long-term youth anxiety disorder recovery.

OBJECTIVE: This study examined client ratings of 26 facilitators and barriers to anxiety improvement approximately 6 years after randomization to treatment for anxiety. METHOD: 319 youth (average 17.12 years old; 82.1% Caucasian; 58.6% female) participated in the longitudinal follow-up study to child and adolescent anxiety multimodal study (CAMS), a randomized controlled trial of medication, cognitive-behavioral therapy (CBT), combination, and placebo. RESULTS: Correcting for multiple comparisons, CBT components (i.e., problem solving, changing unhelpful thoughts, relaxation skills) were rated significantly more helpful among youth without, versus with, an anxiety disorder at follow-up. Barriers that differentiated youth with and without an anxiety disorder included being bullied and difficulty applying therapy content to new situations. Comparisons between youth with different anxiety disorder trajectories (e.g., stable remission, relapsed, or chronically ill) also revealed several differences. CONCLUSION: Findings suggest that client-rated facilitators and barriers covary with anxiety disorder recovery and may serve as useful tools when evaluating long-term treatment efficacy.

Negative Life Events as Predictors of Anxiety Outcomes: An Examination of Event Type.

Long-term follow-up studies of anxiety treatment have found that greater exposure to negative life events (NLEs) predicts poorer anxiety outcomes, but none have examined whether specific types of NLEs are differentially associated with child outcomes. This study examined the frequency of NLEs and whether specific types of NLEs were associated with increased risk of having an anxiety disorder 6.5 years post randomization. Participants were 319 adolescents and adults, ages 11 to 26 (M = 17), enrolled in Child/Adolescent Anxiety Multimodal Extended Long-term Study. At their first follow-up visit, participants completed a diagnostic interview and a 40-item Life Events Scale that reflected whether specific events occurred since their last post treatment assessment. Life events were categorized into domains (i.e., family, academic, health, and social) via researcher consensus. Participants reported having experienced an average of four NLEs. Participants with an anxiety disorder at follow-up were significantly more likely to have failed a grade in school (OR = 5.9) and experienced a negative change in acceptance by peers (OR = 4.9; ps < 0.001). After controlling for gender, age, race, and SES, a greater number of NLEs in the academic domain increased the odds of having an anxiety disorder at follow-up (OR = 2.4, p < 0.001). No other domains were predictive of disorder status at follow-up. Findings highlight the value of examining specific NLEs in relation to the long-term child anxiety outcomes.

Long-Term Outcomes of Youth Treated for an Anxiety Disorder: A Critical Review.

Pediatric anxiety disorders are common, disabling, and chronic conditions. Efforts over the past two decades have focused on developing and testing effective treatments. Short-term efficacy of both Cognitive Behavioral Therapy (CBT) and selective serotonin reuptake inhibitors has been established. Data are emerging on the long-term (i.e., 2 years or longer) effectiveness of these treatments, but this literature has yet to be adequately synthesized. This study presents a systematic and critical qualitative review of published long-term follow-up (LTFU) studies of youth treated for an anxiety disorder. A comprehensive search of several databases identified 21 published reports (representing 15 LTFU cohorts of treated youth) meeting specified inclusion criteria. LTFU assessments occurred a mean of 5.85 years after initial treatment (range 2-19 years). Diagnostic rates at LTFU and predictors (e.g., demographic, baseline child clinical variables, treatment type) of outcomes at LTFU were also examined. A discussion of the limitations of this literature is provided to qualify interpretations of findings and to inform future studies. Findings can aid clinicians and families in making treatment decisions and setting reasonable expectations for the long-term prognosis after treatment for anxiety.