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

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 Southam-Gerow, M. A. &; Prinstein, M. J. (2014). Evidence base updates: The evolution of the evaluation of psychological treatments for children and adolescents. Journal of Clinical Child &; Adolescent Psychology, 43, 1–6. doi:10.1080/15374416.2013.855128[Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]), 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 of Psychosocial Treatments for Child and Adolescent Depression

Depression in youth is prevalent and disabling and tends to presage a chronic and recurrent course of illness and impairment in adulthood. Clinical trial research in youth depression has a 30-year history, and evidence-based treatment reviews appeared in 1998 and 2008. The current review of 42 randomized controlled trials (RCTs) updates these reviews to include RCTs published between 2008 and 2014 (N = 14) and reevaluates previously reviewed literature. Given the growing maturity of the field, this review utilized a stringent set of methodological criteria for trial inclusion, most notable for excluding trials based in subclinical samples of youth that had been included in previous reviews (N = 12) and including well-designed RCTs with null and negative findings (N = 8). Findings from the current review suggest that evidence for child treatments is notably weaker than for adolescent interventions, with no child treatments achieving well-established status and the evidentiary basis of treatments downgraded from previous reports. Cognitive behavioral therapy (CBT) for clinically depressed children appears to be possibly efficacious, with mixed findings across trials. For depressed adolescents, both CBT and interpersonal psychotherapy are well-established interventions, with evidence of efficacy in multiple trials by independent investigative teams. This positive conclusion is tempered by the small size of the interpersonal psychotherapy literature (N = 6) and concern that CBT effects may be attenuated in clinically complicated samples and when compared against active control conditions. Data on predictors, moderators, and mediators are examined and priorities for future research discussed.     

Evidence Base Update for Psychosocial Treatments for Disruptive Behaviors in Children

This article reviews the state of the science on psychosocial treatments for disruptive behaviors in children, as an update to Eyberg, Nelson, and Boggs (2008). We followed procedures for literature searching, study inclusion, and treatment classification as laid out in Southam-Gerow and Prinstein (2014), focusing on treatments for children 12 years of age and younger. Two treatments (group parent behavior therapy, and individual parent behavior therapy with child participation) had sufficient empirical support to be classified as well-established treatments. Thirteen other treatments were classified as probably efficacious. Substantial variability in effectiveness of different programs within the same treatment family has been previously documented; thus, a particular level of evidence might not hold true for every individual program in a treatment family. Systematic investigations of implementation, dissemination, and uptake are needed to ensure that children and families have access to effective treatments. Investigations into how to blend the strengths of the effective approaches into even more effective treatment might also lead to greater impact.     

Evidence Base Update of Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth

The current review provides an evidence base update of psychosocial treatments for self-injurious thoughts and behaviors (SITBs) in youth. A systematic search was conducted of 2 major scientific databases (PsycInfo and PubMed) and ClinicalTrials.gov for relevant randomized controlled trials (RCTs) published prior to June 2018. The search identified 26 RCTs examining interventions for SITBs in youth: 17 were included in the 2015 review and 9 trials were new to this update. The biggest change since the prior review was the evaluation of Dialectical Behavior Therapy for adolescents (DBT-A) as the first Level 1: Well-established intervention for reducing deliberate self-harm (composite of nonsuicidal and suicidal self-injury) and suicide ideation in youth and Level 2: Probably efficacious for reducing nonsuicidal self-injury and suicide attempts. Five other interventions were rated as Level 2: Probably efficacious for reducing SITBs in youth, with the new addition of Integrated Family Therapy. This evidence base update indicates that there are a few promising treatments for reducing SITBs in youth. Efficacious interventions typically include a significant family or parent training component as well as skills training (e.g., emotion regulation skills). Aside from DBT-A, few treatments have been examined in more than one RCT. Given that replication by independent research groups is needed to evaluate an intervention as Well-established, future research should focus on replicating the five promising interventions currently evaluated as Probably efficacious. In addition, an important future direction is to develop brief efficacious interventions that may be scalable to reach large numbers of youth.     

Sleep-Related Problems and the Effects of Anxiety Treatment in Children and Adolescents

This study examined (a) demographic and clinical characteristics associated with sleep-related problems (SRPs) among youth with anxiety disorders, and (b) the impact of anxiety treatment: cognitive-behavioral therapy (CBT; Coping Cat), medication (sertraline), their combination, and pill placebo on SRPs. Youth (N?=?488, ages 7–17, 50% female, 79% White) with a principal diagnosis of generalized anxiety disorder, separation anxiety disorder, or social phobia participated. SRPs were reported by parents and youth. Findings differed by informant and by type of SRP, with evidence that SRPs are associated with age, anxiety severity, externalizing problems, functional impairment, and family burden at pretreatment. Anxiety treatment reduced SRPs; effect sizes were small to medium. Reductions in parent-reported separation-related sleep difficulties were significantly greater in active treatment than in the placebo condition, with the greatest reductions reported by parents of youth whose active treatment was multimodal or included sertraline. Youth whose anxiety treatment involved CBT reported significantly greater decreases in dysregulated sleep (e.g., sleeplessness). Both CBT for anxiety and sertraline appear to be somewhat effective in reducing SRPs, and multimodal treatment may be preferable depending on the symptom presentation. To inform practice, future research should examine a broad range of SRPs, incorporate objective measures of sleep, and evaluate the impact of behavioral strategies that directly target SRPs in youth with anxiety disorders.     

The Role of Parenting in Childhood Anxiety: Etiological Factors and Treatment Implications

Theoretical models of anxiety disorders suggest that family processes and parenting are important factors in the development, maintenance, and transmission of childhood anxiety. The direction of effects between parenting and childhood anxiety, however, remains unclear. This review article integrates theoretical, empirical, and applied knowledge regarding the association between parenting and childhood anxiety as a means to better understand the implications of involving parents in the treatment of their children's anxiety. The present article expands Rapee and colleagues' (2009) review on the main etiological factors related to childhood anxiety and parenting, drawing attention to the influence of parental behavior on treatment effectiveness for childhood anxiety. Limitations of empirical findings and future directions are discussed.     

Evidence Base Update for Psychosocial Treatments for Children and Adolescents Exposed to Traumatic Events

Child and adolescent trauma exposure is prevalent, with trauma exposure-related symptoms, including posttraumatic stress, depressive, and anxiety symptoms often causing substantial impairment. This article updates the evidence base on psychosocial treatments for child and adolescent trauma exposure completed for this journal by Silverman et al. (2008). For this review, we focus on 37 studies conducted during the seven years since the last review. Treatments are grouped by overall treatment family (e.g., cognitive behavioral therapy), treatment modality (e.g., individual vs. group), and treatment participants (e.g., child only vs. child and parent). All studies were evaluated for methodological rigor according to Journal of Clinical Child & Adolescent Psychology evidence-based treatment evaluation criteria (Southam-Gerow & Prinstein, 2014), with cumulative designations for level of support for each treatment family. Individual CBT with parent involvement, individual CBT, and group CBT were deemed well-established; group CBT with parent involvement and eye movement desensitization and reprocessing (EMDR) were deemed probably efficacious; individual integrated therapy for complex trauma and group mind–body skills were deemed possibly efficacious; individual client-centered play therapy, individual mind–body skills, and individual psychoanalysis were deemed experimental; and group creative expressive + CBT was deemed questionable efficacy. Advances in the evidence base, with comparisons to the state of the science at the time of the Silverman et al. (2008) review, are discussed. Finally, we present dissemination and implementation challenges and areas for future research.     

成人中重度烧伤早期焦虑抑郁及相关因素分析

目的探讨成人中重度烧伤患者早期焦虑抑郁状况及其相关因素,为进一步实施护理干预积累临床资料。方法对80例中重度烧伤成人患者,在入院1周内脱离危险后,用一般情况调查表和焦虑自评量表(SAS)与抑郁自评量表(SDS)进行调查,分析性别、年龄、文化程度、婚姻、职业、户籍、经济状况、付费类别和社会支持以及烧伤原因、程度和部位,对患者早期焦虑抑郁状况的影响。结果本组患者SAS和SDS评分均显著高于国内常模(t=21.050,21.118;P均<0.001);SAS与SDS显著正相关(r=0.548,P<0.001);多元回归分析,性别、户籍和烧伤程度3因子进入SAS逐步回归方程:y=68.28+9.09x1+5.036x2+3.497x3(F=48.916,P<0.001);烧伤部位、性别和烧伤程度3因子进入SDS逐步回归方程:y=85.651-8.995x1+2.905x2+2.037x3(F=153.055,P<0.001)。结论中重度烧伤成人患者在烧伤早期普遍严重的焦虑抑郁情绪,女性、重度、农村、头面部烧伤患者焦虑抑郁程度更重。     

儿童精神分裂症预后影响因素分析

目的 探讨儿童精神分裂症的预后及其影响因素.方法 收集2005年8月1日-2007年7月31日在我院首次住院 (年龄≤18岁)经CCMD-3诊断为精神分裂症的患者184例,采用临床总体印象量表(疾病严重程度CGI-S)、个人和社会功能量表(PSP)及自制调查表,随访与量表现场测评相结合的方法获得资料,最后完成随访的患者164例,脱落20例.结果 经x2检验分析得出女性患者的复发率较男性患者低(x2=8.89,P＜0.05),女性患者的社会功能恢复状况较男性患者好(x2=10.62,P＜0.05).经多元回归分析显示,影响预后的主要因素有:CGI得分、居住地、自知力恢复程度、是否为独生子女.结论 女性儿童精神分裂症预后较男性好,CGI得分越高的患者社会功能越差,居住在城市、自知力恢复好、是独生子女的患者预后较好.     

Anxiety Treatment and Targeted Sleep Enhancement to Address Sleep Disturbance in Pre/Early Adolescents with Anxiety

Sleep disturbance is prevalent in anxious youth and prospectively predicts poor emotional adjustment in adolescence. Study 1 examined whether anxiety treatment improves subjective and objective sleep disturbance in anxious youth. Study 2 examined whether a sleep intervention called Sleeping TIGERS can further improve sleep following anxiety treatment. Study 1 examined 133 youth (ages 9–14; 56% female; 11% ethnic/racial minority) with generalized, social, or separation anxiety over the course of anxiety treatment (cognitive behavioral treatment or client-centered treatment). Sleep-related problems (parent-, child-report) and subjective (diary) and objective (actigraphy) sleep patterns were assessed across treatment in an open trial design. Study 2 included 50 youth (ages 9–14; 68% female; 10% ethnic/racial minority) who continued to report sleep-related problems after anxiety treatment and enrolled in an open trial of Sleeping TIGERS. Pre- and postassessments duplicated Study 1 and included the Focal Interview of Sleep to assess sleep disturbance. Study 1 demonstrated small reductions in sleep problems and improvements in subjective sleep patterns (diary) across anxiety treatment, but outcomes were not deemed clinically significant, and 75% of youth stayed above clinical cutoff. Study 2 showed clinically significant, large reductions in sleep problems and small changes in some subjective sleep patterns (diary). Anxiety treatment improves, but does not resolve, sleep disturbance in peri-pubertal youth, which may portend risk for poor emotional adjustment and mental health. The open trial provides preliminary support that Sleeping TIGERS can improve sleep in anxious youth to a clinically significant degree.     

广泛性焦虑障碍的临床治疗

苯二氮(艹卓)类药物治疗广泛性焦虑障碍(GAD)疗效肯定,但因过度镇静、依赖性撤药反应等副作用,限制了这类药物的长期使用.三环类抗抑郁剂治疗广泛性焦虑障碍也有效,但这些药物本身的副反应使患者的依从性低.近年来的研究发现,选择性5-羟色胺重吸收抑制剂具有较好的抗焦虑作用.本文报道舍曲林(左洛复)治疗广泛性焦虑障碍的临床开放性研究结果.     

Physiological Response and Childhood Anxiety: Association With Symptoms of Anxiety Disorders and Cognitive Bias

This study examined the physiological response (skin conductance and heart rate [HR]) of youth exposed to a mildly phobic stimulus (video of a large dog) and its relation to child- and parent-reported anxiety symptoms and cognitive bias in a community-recruited sample of youth (n = 49). The results of this study indicated that HR and skin-conductance response were associated with youth report but not parent report of their child's symptoms of anxiety disorders and that HR response was more strongly associated with anxiety symptoms than skin-conductance response. Physiological response was uniquely associated with youth-reported symptoms of anxiety rather than youth-reported depression. Finally, HR response interacted with cognitive bias in predicting childhood anxiety disorder symptoms in a manner consistent with theories of the etiology of anxiety disorders.     

糖尿病伴发焦虑的相关因素和中西医结合治疗

根据世界卫生组织的统计 ,人类的健康和长寿4 0 %取决于遗传和客观因素[1] ,6 0 %依靠自己建立的生活方式和心理行为习惯。近年来 ,随着医学模式的转变[2 ] ,躯体疾病伴发的精神障碍也日益受到关注。糖尿病作为一种心身疾病已得到医学界的认同 ,心身交互影响在糖尿病的发生、发展、转归过程中起着重要作用[3,4 ] 。目前 ,通过调节心理和行为以降低血糖水平的研究时有报道。Calle等人研究发现 ,以行为矫正为基础的心理治疗 ,可使反映病情的各项生理指标均有显著改善。Crady等人曾观察 ,用生物反馈放松合并胰岛素治疗 1型糖尿病患者 ,10周后…     

Effects of Maternal Hospitalization in Early Childhood: Anticipated Anxiety Associated with an Analog Separation for Childbirth and Surgery

Assessed early childhood anticipation of anxiety in responseto analog 3-day maternal hospitalization for surgery or childbirth.Reaction to analog nonhospital separation was also assessed.Within each condition, gender effects were examined. Participantswere 120 first-grade children at four elementary schools. Between-groupscomparisons showed maternal separation for surgery was anticipatedas more anxiety provoking, whereas anxiety associated with separationfor childbirth and nonhospital separation was anticipated assimilar. In general, within each separation situation, girlsand boys anticipated similar levels of anxiety.     

Behavioral validation of the Childhood Anxiety Sensitivity Index in children

Examined the construct validity of the Childhood Anxiety Sensitivity Index (CASI) in young children through the use of a behavioral challenge task. Elementary-school children completed the CASI as well as seff-report measures of state and trait anxiety and subjective fear prior to and immediately following a stair-stepping task designed to increase physiological arousal. Results indicate that the CASI was a significant predictor of the degree of state anxiety and subjective fear reported in response to the challenge task, even after controlling for pretask levels of state anxiety and fear, respectively. Additionally, the CASI predicted changes in fear experienced in response to the challenge task. The findings lend support to the validity of the CASI in preadolescent children and suggest that the CASI possesses unique clinical utility relative to measures of trait anxiety. However, results of this study must be interpreted cautiously, because a large portion of the variance in response to arousal was left unaccounted for by the CASI and the overall model.     

A Developmental Cascade Model of Behavioral Sleep Problems and Emotional and Attentional Self-Regulation Across Early Childhood

This article documents the longitudinal and reciprocal relations among behavioral sleep problems and emotional and attentional self-regulation in a population sample of 4,109 children participating in Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC)–Infant Cohort. Maternal reports of children’s sleep problems and self-regulation were collected at five time-points from infancy to 8–9 years of age. Longitudinal structural equation modeling supported a developmental cascade model in which sleep problems have a persistent negative effect on emotional regulation, which in turn contributes to ongoing sleep problems and poorer attentional regulation in children over time. Findings suggest that sleep behaviors are a key target for interventions that aim to improve children’s self-regulatory capacities.     

Differential Occurrence of Comorbidity Within Childhood Anxiety Disorders

Investigated differences in comorbidity in children ages 8 to 13 (N = 199) with primary diagnoses of generalized anxiety disorder (GAD), separation anxiety disorder (SAD), or social phobia (SP). Children with primary SAD were found to have the highest number of comorbid diagnoses. Specific phobias were more common in children with primary SAD than in those with primary SP, whereas neither group differed from children with primary GAD. Mood disorders were more common in children with GAD or SP than in children with primary SAD. Comorbid externalizing disorders, although present in 17% of the sample, were not found to vary across diagnostic groups. Functional enuresis was most common in children with primary SAD. Results are discussed with respect to diagnostic and treatment issues.