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1.
J Anxiety Disord ; 80: 102399, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33892347

RESUMO

The Attentional Control Scale for Children (ACS-C) is a widely used self-report questionnaire that measures attentional control in youth. Previous research examined factor-structure and validation of the ACS-C and yielded a 2-factor structure with Attentional Focusing and Attentional Shifting subscales. This study used a confirmatory factor analysis in a large, ethnically diverse sample of clinic-referred anxious youth (N = 442, ages 7-16 years) to compare model fit of three models, the original two-factor model of the ACS-C, a two-factor model of a modified ACS-C (two items re-assigned from Attentional Focusing to Attentional Shifting, three items removed from Attentional Focusing, and two items removed from Attentional Shifting), and a single-factor model. Results reveal best model fit for the two-factor modified ACS-C. This model had strong factorial invariance across sex, partial invariance across ethnicity, and was variant across age. Also, total and subscale scores for the two-factor modified ACS-C correlated with anxiety and depression symptom scale scores, supporting its concurrent validity. Findings confirm the two-factor structure of the modified ACS-C. Future research implications relating to attentional control in children are discussed.

2.
J Clin Child Adolesc Psychol ; 50(2): 155-176, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33739908

RESUMO

This Evidence Base Update of parent-report measures of youth anxiety symptoms is a companion piece to our update on youth self-report anxiety symptom measures (Etkin et al., 2021). We rate the psychometric properties of the parent-report measures as Adequate, Good, or Excellent using criteria developed by Hunsley and Mash (2008) and Youngstrom et al. (2017). Our review reveals that the evidence base for parent-report measures is considerably less developed compared with the evidence base for youth self-report measures. Nevertheless, several measures, the parent-report Screen for Child Anxiety-Related Emotional Disorders, Multidimensional Anxiety Scale for Children, and Spence Children's Anxiety Scale, were found to have Good to Excellent psychometric properties. We conclude our review with suggestions about which parent-report youth anxiety measures are best suited to perform different assessment functions and directions for additional research to expand and strengthen the evidence base.

3.
Artigo em Inglês | MEDLINE | ID: mdl-33624848

RESUMO

BACKGROUND: Identifying moderators of response to treatment for childhood anxiety can inform clinical decision-making and improve overall treatment efficacy. We examined moderators of response to child-based cognitive-behavioral therapy (CBT) and parent-based SPACE (Supportive Parenting for Anxious Childhood Emotions) in a recent randomized clinical trial. METHODS: We applied a machine learning approach to identify moderators of treatment response to CBT versus SPACE, in a clinical trial of 124 children with primary anxiety disorders. We tested the clinical benefit of prescribing treatment based on the identified moderators by comparing outcomes for children randomly assigned to their optimal and nonoptimal treatment conditions. We further applied machine learning to explore relations between moderators and shed light on how they interact to predict outcomes. Potential moderators included demographic, socioemotional, parenting, and biological variables. We examined moderation separately for child-reported, parent-reported, and independent-evaluator-reported outcomes. RESULTS: Parent-reported outcomes were moderated by parent negativity and child oxytocin levels. Child-reported outcomes were moderated by baseline anxiety, parent negativity, and parent oxytocin levels. Independent-evaluator-reported outcomes were moderated by baseline anxiety. Children assigned to their optimal treatment condition had significantly greater reduction in anxiety symptoms, compared with children assigned to their nonoptimal treatment. Significant interactions emerged between the identified moderators. CONCLUSIONS: Our findings represent an important step toward optimizing treatment selection and increasing treatment efficacy.

5.
Artigo em Inglês | MEDLINE | ID: mdl-33534096

RESUMO

This study examined: 1) the relationship between negative parental beliefs about child anxiety (i.e., it is harmful), insecure parental attachment and parental accommodation of child anxiety; 2) whether parental attachment insecurity moderates the effect of negative beliefs about anxiety on parent accommodation; and 3) a path model of parental factors affecting accommodation and child anxiety severity. Participants were 139 parents of children (6-18 years) with a primary anxiety disorder. Parents completed measures of parental accommodation of their child's anxiety, beliefs about child anxiety, and attachment security. Child anxiety diagnosis and severity was determined using semi-structured clinical interviews. Negative beliefs about child anxiety were directly associated with levels of parental accommodation. There was no direct relationship between insecure attachment and accommodation; however anxious attachment moderated the effect of parental beliefs about anxiety on parental accommodation. Among parents with more secure attachment, negative beliefs about anxiety were associated with greater parental accommodation. However, among parents with less secure attachment, accommodation was high regardless of beliefs about anxiety. A path model suggested that negative beliefs about anxiety was related to increased parental accommodation, which in turn was related to increased child anxiety severity. Psychoeducation about the nature of anxiety is likely to be beneficial in helping to reduce accommodation among parents with more secure attachment styles. However, among those with greater anxious attachment, psychoeducation may need to be tailored to focus on corrective information about the impact of treatment processes on the parent-child relationship.

6.
J Affect Disord ; 282: 611-616, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33445083

RESUMO

BACKGROUND: Research links fibroblast growth factor 2 (FGF2) to anxiety and depression in rodents and human adults. Our study is the first to examine FGF2 levels in a pediatric population. METHODS: We assayed serum FGF2 in 163 children with a broad range of anxiety and depressive symptoms; 111 were clinic-referred anxious and depressed children; 52 were non-referred children. We examined associations between FGF2 and anxiety and depression symptoms, and between each of the three facets of behavioral activation (Reward-Responsiveness, Drive, Fun-Seeking) and behavioral avoidance. We used confirmatory factor analysis (CFA) to determine the relative contribution of anxiety and depression indicators and of FGF2 to a latent variable of Anxiety/Depression. We also examined stability of FGF2 levels. RESULTS: FGF2 levels in clinic-referred children were significantly lower compared with non-referred children. Bivariate correlations and CFA showed negative associations between FGF2 and anxiety, depression and behavioral avoidance. FGF2 levels were positively correlated with the Reward-Responsiveness facet of behavioral activation, implicated in depression. FGF2 levels were stable over six months. LIMITATIONS: We did not have data on behavioral avoidance and stability of FGF2 in the entire sample. CONCLUSIONS: Our results implicate FGF2 in anxiety and depression in children, providing an important first step in showing FGF2 may serve as a stable biomarker for these prevalent and impairing problems.


Assuntos
Transtornos do Comportamento Infantil , Depressão , Adulto , Ansiedade , Transtornos de Ansiedade , Criança , Fator 2 de Crescimento de Fibroblastos , Humanos
7.
Artigo em Inglês | MEDLINE | ID: mdl-33459884

RESUMO

We investigated whether a novel visitation model for school-aged youth with mental health problems based on a stage-based stepped-care approach facilitated a systematic identification and stratification process without problems with equity in access. The visitation model was developed within the context of evaluating a new transdiagnostic early treatment for youth with anxiety, depressive symptoms, and/or behavioural problems. The model aimed to identify youth with mental health problems requiring an intervention, and to stratify the youth into three groups with increasing severity of problems. This was accomplished using a two-phase stratification process involving a web-based assessment and a semi-structured psychopathological interview of the youth and parents. To assess problems with inequity in access, individual-level socioeconomic data were obtained from national registers with data on both the youth participating in the visitation and the background population. Altogether, 573 youth and their parents took part in the visitation process. Seventy-five (13%) youth had mental health problems below the intervention threshold, 396 (69%) were deemed eligible for the early treatment, and 52 (9%) had symptoms of severe mental health problems. Fifty (9%) youth were excluded for other reasons. Eighty percent of the 396 youth eligible for early treatment fulfilled criteria of a mental disorder. The severity of mental health problems highlights the urgent need for a systematic approach. Potential problems in reaching youth of less resourceful parents, and older youth were identified. These findings can help ensure that actions are taken to avoid equity problems in future mental health care implementations.

8.
Res Child Adolesc Psychopathol ; 49(3): 381-392, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33403493

RESUMO

The neuropeptide oxytocin (OT) plays a central role in the regulation of affiliative bonds and anxiety. However, the degree to which its levels are synchronized between interaction partners has not yet been assessed. Physiological synchrony assessed using other peripheral measures (e.g., heart rate, etc.) has been tied to positive outcomes for the individual and the dyad. The present study examined OT synchrony in the context of child anxiety and maternal depression by examining mother-child dyads. Mothers and their children with anxiety disorders participated in a behavioral interaction task. Changes in OT levels and mother-child OT synchrony before and after the interaction, as well as their moderation by maternal depression, were assessed. Ninety-eight youth with anxiety disorders (ages 10 to 17) and their mothers underwent psychiatric evaluation, and mothers rated their own depressive symptoms and their children's behavior problems. Salivary OT was assayed from mother and child before and after the task. Behavioral coding showed that interactions were characterized by high behavioral synchrony between mothers and their children, and both individuals displayed higher levels of positive vs. negative affect during the interactions. Mothers and their children also showed decreases in OT levels after the interaction. As hypothesized, OT synchrony increased following the task, but only dyads in which mothers showed high levels of depressive symptoms showed this increase. As hypothesized, lower levels of OT-synchrony were associated with higher levels of child internalizing symptoms. The findings suggest that positive interactions may be beneficial for youth with anxiety disorders with mothers with depression.

9.
Dev Neurorehabil ; : 1-4, 2021 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-33393399

RESUMO

Background: Few questionnaires are tailored for siblings of children with disabilities. The Negative Adjustment Scale (NAS) was developed to measure siblings' adjustment, but has not yet been validated. Objective: To investigate the factor structure and convergent validity of the NAS. Method: We examined the validity of the NAS in terms of factor structure and convergent validity against a general mental health measure. The sample comprised 107 siblings (M age = 11.5 years, SD = 2.1, 53.8% boys) of children with disabilities. Results: We confirmed a one-factor structure for the NAS. Convergent validity was demonstrated through significant correlations (r=.29-.44) with sibling externalizing and internalizing mental health difficulties. Conclusion: The NAS holds promise as a measure tailored for the assessment of sibling's adjustment.

10.
JAMA Psychiatry ; 78(3): 250-260, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33355633

RESUMO

Importance: Behavioral therapy and cognitive-behavioral therapy (CBT) programs targeting a single class of problems have not been widely implemented. The population of youths with common mental health problems is markedly undertreated. Objective: To determine the effectiveness of a new transdiagnostic CBT program (Mind My Mind [MMM]) compared with management as usual (MAU) in youths with emotional and behavioral problems below the threshold for referral to mental health care. Design, Setting, and Participants: This pragmatic, multisite, randomized clinical trial of MMM vs MAU was conducted from September 7, 2017, to August 28, 2019, including 8 weeks of postintervention follow-up, in 4 municipalities in Denmark. Consecutive help-seeking youths were randomized (1:1) to the MMM or the MAU group. Main inclusion criteria were age 6 to 16 years and anxiety, depressive symptoms, and/or behavioral disturbances as a primary problem. Data were analyzed from August 12 to October 25, 2019. Interventions: The MMM intervention consisted of 9 to 13 weekly, individually adapted sessions of manualized CBT delivered by local psychologists. The MAU group received 2 care coordination visits to enhance usual care. Main Outcomes and Measures: The primary outcome was change in mental health problems reported by parents at week 18, using the Strengths and Difficulties Questionnaire (SDQ) Impact scale (range, 0-10 points, with higher scores indicating greater severity of distress and impairment). Primary and secondary outcomes were assessed in the intention-to-treat population at week 18. Maintenance effects were assessed at week 26. Results: A total of 396 youths (mean [SD] age, 10.3 [2.4] years; 206 [52.0%] boys) were randomized to MMM (n = 197) or MAU (n = 199), with primary outcome data available in 177 (89.8%) and 167 (83.9%), respectively, at 18 weeks. The SDQ Impact score decreased by 2.34 points with MMM and 1.23 with MAU, from initial scores of 4.12 and 4.21, respectively (between-group difference, 1.10 [95% CI, 0.75-1.45]; P < .001; Cohen d = 0.60). Number of responders (≥1-point reduction in SDQ Impact score) was greater with MMM than with MAU (144 of 197 [73.1%] vs 93 of 199 [46.7%]; number needed to treat, 4 [95% CI, 3-6]). Secondary outcomes indicated statistically significant benefits in parent-reported changes of anxiety, depressive symptoms, daily functioning, school attendance, and the principal problem. All benefits were maintained at week 26 except for school attendance. Conclusions and Relevance: In this randomized clinical trial, the scalable transdiagnostic cognitive-behavioral intervention MMM outperformed MAU in a community setting on multiple, clinically relevant domains in youth with emotional and behavioral problems. Trial Registration: ClinicalTrials.gov Identifier: NCT03535805.

11.
J Anxiety Disord ; 76: 102318, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33011554

RESUMO

BACKGROUND: Anxiety disorders are the most common childhood-onset psychiatric disorders and are extensively associated with child functional impairment. Data suggest that family accommodation plays a role in the association between anxiety severity and functional impairment in children, but more empirical evidence is needed. METHODS: Participants were 425 clinically anxious children (ages 6-17 years), and their mothers. We first examined associations between child anxiety symptom severity, family accommodation, and child functional impairment. Next, we investigated the hypothesized mediation pathway linking anxiety severity to child impairment through increased family accommodation using structural equation modeling. We tested two models: one using parent ratings of their child's anxiety and the other using the child's self-ratings. Finally, we estimated the effect sizes of the mediation pathway in both models. RESULTS: Family accommodation was significantly correlated with all the study variables. Child functional impairment was significantly correlated with parent-rated and self-rated child anxiety severity. Both structural equation models provided excellent fit for the data and supported the theoretical model by which family accommodation significantly explains part of the association between anxiety symptoms and functional impairment. The indirect effect sizes indicate that family accommodation accounts for between a fifth and a half of the impairment associated with symptom severity. CONCLUSIONS: The data provide important empirical evidence that family accommodation mediates the association between child anxiety and functional impairment and accounts for up to 50 % of this association. These findings contribute to the growing understanding of the critical role of family accommodation and underscore the importance of assessing accommodation when evaluating and treating anxious children.

12.
Trials ; 21(1): 851, 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33054825

RESUMO

BACKGROUND: Siblings and parents of children with neurodevelopmental disorders are at risk of mental health problems and poorer family communication. Some group interventions for siblings exist, but few have clearly described parent components and none are considered evidence-based. METHODS: We are conducting a randomized controlled trial comparing a five-session manual-based group intervention for siblings (aged 8 to 16 years) and parents of children with neurodevelopmental disorders to a 12-week waitlist, called SIBS-RCT. The intervention comprises three separate sibling and parent group sessions and two joint sessions in which each sibling talks to their parent alone. The intervention aims at improving parent-child communication and covers themes such as siblings' understanding of the neurodevelopmental disorder, siblings' emotions, and perceived family challenges. Participants are recruited through municipal and specialist health centers across Norway. The primary outcome is sibling mental health. Quality of life and family communication are secondary outcomes. Participants are block-randomized to the intervention or 12-week waitlist in groups of six. Measures are collected electronically at pre- and post-intervention/waitlist, as well as 3, 6, and 12 months post-intervention. The main effect to be examined is the difference between the intervention and waitlist at 12 weeks post. All outcomes will also be examined using growth curve analyses. We plan to include 288 siblings and their parents by the end of 2022. DISCUSSION: SIBS-RCT represents a major contribution to the research and practice field towards establishing an evidence-based intervention for siblings. In the event that intervention and waitlist are no different, the impact of SIBS-RCT is still substantial in that we will aim to identify participant subgroups that show positive response and effective components of the SIBS manual by examining group leader adherence as an outcome predictor. This will allow us to continue to re-engineer the SIBS manual iteratively to improve outcomes, and avoid the promotion of a less-than-optimal intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT04056884 . Registered in August 2019.

13.
Artigo em Inglês | MEDLINE | ID: mdl-33095373

RESUMO

This report examines the relationship between pediatric anxiety disorders and implicit bias evoked by threats. To do so, the report uses two tasks that assess implicit bias to negative-valence faces, the first by eye-gaze and the second by measuring body-movement parameters. The report contrasts task performance in 51 treatment-seeking, medication-free pediatric patients with anxiety disorders and 36 healthy peers. Among these youth, 53 completed an eye-gaze task, 74 completed a body-movement task, and 40 completed both tasks. On the eye-gaze task, patients displayed longer gaze duration on negative relative to non-negative valence faces than healthy peers, F(1, 174) = 8.27, p = .005. In contrast, on the body-movement task, patients displayed a greater tendency to behaviorally avoid negative-valence faces than healthy peers, F(1, 72) = 4.68, p = .033. Finally, implicit bias measures on the two tasks were correlated, r(38) = .31, p = .049. In sum, we found an association between pediatric anxiety disorders and implicit threat bias on two tasks, one measuring eye-gaze and the other measuring whole-body movements. Converging evidence for implicit threat bias encourages future research using multiple tasks in anxiety.

14.
Neuropharmacology ; 180: 108301, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-32910952

RESUMO

Social anxiety disorder (SAD) usually onsets in childhood or adolescence and is associated with brain development and chronic family stress during this period. As an information hub, the thalamus plays a crucial role in the development of emotion processing and stress regulation. Its structural and functional lateralization have been related to mental disorders. This study examined the age-dependent asymmetry of the thalamic volume in children and adolescents with SAD. We further examined the role of the thalamic asymmetry in moderating the relationships between parental alienation, which is a main source of familial stress for children and adolescents, and anxiety symptoms in this population. Fifty-three medication-free children and adolescents with SAD and 53 typical developing controls (age: 8-17) were included. Anxiety severity was measured using the Screen for Child Anxiety-Related Emotional Disorders (SCARED). We estimated the bilateral thalamic volume and examined diagnosis effect and age-group difference on the thalamic asymmetry. We further examined the moderation of the thalamic asymmetry on the associations between scores on the parental alienation, social phobia, and total SCARED. Compared with controls, the SAD group exhibited significantly abnormal asymmetry in thalamic volume. This asymmetry became more evident in the older age group. Furthermore, this asymmetry significantly weakened the relationships between parental attachment and total SCARED score. The asymmetry of the thalamic volume and its age-group difference provide novel evidence to support brain developmental abnormalities in children and adolescents with SAD. The findings further revealed interactions between physiological and chronic stress in children and adolescents with SAD. This article is part of the special issue on 'Stress, Addiction and Plasticity'.

15.
J Clin Child Adolesc Psychol ; : 1-20, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32915074

RESUMO

Evidence-based assessment serves several critical functions in clinical child psychological science, including being a foundation for evidence-based treatment delivery. In this Evidence Base Update, we provide an evaluative review of the most widely used youth self-report measures assessing anxiety and its disorders. Guided by a set of evaluative criteria (De Los Reyes & Langer, 2018), we rate the measures as Excellent, Good, or Adequate across their psychometric properties (e.g., construct validity). For the eight measures evaluated, most ratings assigned were Good followed by Excellent, and the minority of ratings were Adequate. We view these results overall as positive and encouraging, as they show that these youth anxiety self-report measures can be used with relatively high confidence to accomplish key assessment functions. Recommendations and future directions for further advancements to the evidence base are discussed.

16.
Psychol Med ; : 1-11, 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32787994

RESUMO

BACKGROUND: While taxonomy segregates anxiety symptoms into diagnoses, patients typically present with multiple diagnoses; this poses major challenges, particularly for youth, where mixed presentation is particularly common. Anxiety comorbidity could reflect multivariate, cross-domain interactions insufficiently emphasized in current taxonomy. We utilize network analytic approaches that model these interactions by characterizing pediatric anxiety as involving distinct, inter-connected, symptom domains. Quantifying this network structure could inform views of pediatric anxiety that shape clinical practice and research. METHODS: Participants were 4964 youths (ages 5-17 years) from seven international sites. Participants completed standard symptom inventory assessing severity along distinct domains that follow pediatric anxiety diagnostic categories. We first applied network analytic tools to quantify the anxiety domain network structure. We then examined whether variation in the network structure related to age (3-year longitudinal assessments) and sex, key moderators of pediatric anxiety expression. RESULTS: The anxiety network featured a highly inter-connected structure; all domains correlated positively but to varying degrees. Anxiety patients and healthy youth differed in severity but demonstrated a comparable network structure. We noted specific sex differences in the network structure; longitudinal data indicated additional structural changes during childhood. Generalized-anxiety and panic symptoms consistently emerged as central domains. CONCLUSIONS: Pediatric anxiety manifests along multiple, inter-connected symptom domains. By quantifying cross-domain associations and related moderation effects, the current study might shape views on the diagnosis, treatment, and study of pediatric anxiety.

17.
Artigo em Inglês | MEDLINE | ID: mdl-32683742

RESUMO

BACKGROUND: Anxiety disorders in children and young people are common and bring significant personal and societal costs. Over the last two decades, there has been a substantial increase in research evaluating psychological and pharmacological treatments for anxiety disorders in children and young people and exciting and novel research has continued as the field strives to improve efficacy and effectiveness, and accessibility of interventions. This increase in research brings potential to draw together data across studies to compare treatment approaches and advance understanding of what works, how, and for whom. There are challenges to these efforts due largely to variation in studies' outcome measures and variation in the way study characteristics are reported, making it difficult to compare and/or combine studies, and this is likely to lead to faulty conclusions. Studies particularly vary in their reliance on child, parent, and/or assessor-based ratings across a range of outcomes, including remission of anxiety diagnosis, symptom reduction, and other domains of functioning (e.g., family relationships, peer relationships). METHODS: To address these challenges, we convened a series of international activities that brought together the views of key stakeholders (i.e., researchers, mental health professionals, young people, parents/caregivers) to develop recommendations for outcome measurement to be used in treatment trials for anxiety disorders in children and young people. RESULTS AND CONCLUSIONS: This article reports the results of these activities and offers recommendations for selection and reporting of outcome measures to (a) guide future research and (b) improve communication of what has been measured and reported. We offer these recommendations to promote international consistency in trial reporting and to enable the field to take full advantage of the great opportunities that come from data sharing going forward.

18.
J Clin Child Adolesc Psychol ; : 1-13, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-32401557

RESUMO

Objectives: Family accommodation is linked to poor treatment outcomes for childhood anxiety. Progress in research on the role of accommodation in treatment has been hindered by the relatively weak association between child and parent reports on accommodation. In this study, we suggest that parent-child agreement on family accommodation may provide a dependable estimation of this construct, and investigated whether the level of parent-child agreement on family accommodation predicts subsequent treatment outcome. We further examined whether the effect was greater in Supportive Parenting for Anxious Childhood Emotions (SPACE), which directly targets family accommodation, than in individual child-focused cognitive behavioral therapy (CBT).Methods: Participants were 104 children (aged 6-15) with anxiety disorders, and their mothers, randomized to SPACE or CBT. Accommodation was rated by mothers and children before treatment, halfway through treatment, and at treatment end, using respective versions of Family Accommodation Scale-Anxiety. To accurately estimate agreement, we conducted multilevel response surface analysis by polynomial regression, with agreement on accommodation at each time point predicting subsequent child anxiety severity, over the course of treatment.Results: Parent-child agreement and disagreement on accommodation were significant predictors of subsequent anxiety symptom severity. Different results were obtained for SPACE and CBT, suggesting potentially distinct underlying mechanisms.Conclusions: The findings suggest treatment-specific roles of accommodation in SPACE vs. CBT. Multiple-informant assessment of accommodation provides important information, which may have important implications for optimal treatment personalization.

19.
Front Psychol ; 11: 586, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32328012

RESUMO

There is large heterogeneity among youth with school attendance problems (SAPs). For this reason, protocols for the treatment of SAPs need to be flexible. Back2School (B2S) is a new manual-based, modular transdiagnostic cognitive behavioral intervention to increase school attendance among youth with SAPs. It also aims to increase the self-efficacy of these youth and their parents. B2S includes evidence-based modules addressing youth anxiety, depression, and behavior problems, together with modules focused on parent guidance and school consultation. The current study examined the feasibility of evaluating B2S in an randomized controlled trial and acceptability of the B2S program in a non-randomized trial, including both qualitative and quantitative data, in preparation for a randomized controlled trial of its effectiveness. Youth, parents, and teachers completed questionnaires at baseline, post-intervention, and follow-up. School attendance data were collected from school registers. Twenty-four youth with a SAP (defined as more than 10% absenteeism during the last 3 months) were recruited from primary and lower secondary schools in Aarhus Municipality, Denmark. Their parents also participated in B2S. Two of the 24 families withdrew during the intervention, after sessions two and six respectively. Of the remaining 22 families, 19 (86%) completed all 10 sessions. Parents and youth rated their satisfaction with B2S as high, and high levels of satisfaction were maintained 1 year after the intervention. Teacher satisfaction was lower than that of youth and parents, but the majority found the school's participation in the intervention helpful. Preliminary evaluation of intervention outcomes showed significant increase in school attendance and decrease in psychological symptoms, as well as a significant increase in self-efficacy for both youth and parents. Based on this feasibility data, adaptations were made to the B2S manual and study procedures prior to commencement of a randomized controlled effectiveness trial. The main adaptation to the manual was to increase school consultation. The main procedural adaptation was to broaden recruitment. Furthermore, it was necessary to increase level of staffing by psychologists because treatment delivery was more time consuming than expected.

20.
Behav Ther ; 51(2): 211-222, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32138933

RESUMO

Children with anxiety disorders often present with other co-occurring symptom clusters, of which irritability is among the most highly co-occurring. Despite compelling clinical and pathophysiological evidence linking anxiety and irritability, little is known regarding the clinical presentation and associated impairment of children with both anxiety and irritability. In this study, our aims were to confirm the preponderance of irritability in clinically anxious children and compare clinically anxious children with irritability to those without irritability across sociodemographic, clinical, psychosocial, and family domains. Participants were 230 children with anxiety disorders (ages 6-14 years) and their mothers, and 91 healthy controls (ages 6-17 years) and their mothers. Of the clinically anxious children, 121 were anxious and irritable; 109 were anxious but not irritable. Irritability levels were significantly higher in the clinically anxious children compared with the healthy controls. Children with anxiety disorders and irritability presented with greater severity and impairment across clinical phenomenology, psychosocial, and family domains relative to anxious children without irritability. Regression analysis findings were convergent in that greater severity and impairment across these same domains predicted higher irritability levels in the children with anxiety disorders. Results support the meaningful distinction between anxious children with and without irritability. Implications of the findings are discussed particularly in regard to assessment and treatment and future research directions are delineated.


Assuntos
Transtornos de Ansiedade/psicologia , Ansiedade/psicologia , Transtornos do Comportamento Infantil/psicologia , Humor Irritável , Índice de Gravidade de Doença , Adolescente , Criança , Feminino , Humanos , Masculino , Síndrome
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