A pilot feasibility evaluation of the CALM Program for anxiety disorders in early childhood

Abstract

As many as 9% of preschoolers suffer from an anxiety disorder, and earlier onset of disorder is associated with more intractable forms of psychopathology in later life. At present there is a relative dearth of empirical work examining the development of evidence-based treatments for anxiety disorders presenting in early childhood. Building on previous work supporting extensions of PCIT for separation anxiety disorder, the present study examines the preliminary feasibility and efficacy of an anxiety-based modification of PCIT (The CALM Program; Coaching Approach behavior and Leading by Modeling) for the treatment of youth between the ages of three and eight presenting with separation anxiety disorder, social anxiety disorder, generalized anxiety disorder, and/or specific phobias (N=9; Mage=5.4 years, ranging 4–8 years; 55.6% of families endorsing racial or ethnic minority status). Intent-to-treat (ITT; N=9) and treatment completer (N=7) analyses were conducted to evaluate diagnostic and functional response across participants. Pre- and posttreatment structured diagnostic interviews were conducted (ADIS-C/P), and clinical impression measures were completed (e.g., CGI, CGAS). Roughly 80% of the sample completed all treatment sessions. All treatment completers were categorized as global treatment responders by independent evaluators, with all but one showing full diagnostic improvements, and all but one showing meaningful functional improvements. These findings lend preliminary support for the promising role of live parent coaching for the treatment of a range of anxiety disorders that present in early childhood. Future work is needed to replicate the present findings in larger samples utilizing randomized controlled comparisons.

Is Triple P effective in childhood anxiety disorder? A randomized controlled study

“…This approach has increased the reliability of the results by making the assessment more objective. In our study, the increased CGAS scores after intervention were in line with other patent-only CBT studies [17,18,36,39]. Even though CGAS has been a commonly used scale in these studies, CGI-S has rarely been used.…”

“…Stigma is one of the most important trammel for psychological treatment applications and parents consider that their children to be more vulnerable than their parents for stigmatization [15] so parent-focused intervention may be more acceptable than child-focused therapy and in this content, working with parents is a promising treatment strategy. In recent years, as an alternative to child-focused CBT, some parent-based CBT interventions have been found to be effective in reducing symptoms in children with anxiety disorders [16][17][18][19].…”

Paternal autonomy restriction, neighborhood safety, and child anxiety trajectory in community youth

“…Such parenting may inadvertently further maintain anxiety by preventing the child from fully engaging in anxiety-provoking situations that would enable the child to test and alter maladaptive cognitions regarding fear-eliciting stimuli (Dadds & Barrett, 2001; Wood, Piacentini, Southam-Gerow, Chi, & Sigman, 2006). For this reason, supported family-based treatments for childhood anxiety often target the reduction of parental intrusiveness/overinvolvement as a core treatment aim (e.g., Barrett, Dadds, & Rapee, 1996; Comer et al, 2012; Kendall, Hudson, Gosch, Flannery-Schroeder, & Suveg, 2008). …”

“…Given observed moderating effects of age within middle childhood and adolescence on parent and child anxiety in cross-sectional work (Verhoeven, Bogels, & van der Bruggen, 2012), as well as the growing recognition of peer relationships in psychological functioning in adolescence (Prinstein & La Greca, 2002; Siegel, La Greca, & Harrison, 2009), it is particularly important to investigate both the effects of early parenting on the trajectory of anxiety across childhood and cross-sectional relationships between paternal behavior and child anxiety in a cohort followed through middle childhood. Specifically, the investigation of these relationships at key developmental time points, including the initiation of full-time schooling (age 6) and later in the elementary years, will also serve to inform parent-directed content of child anxiety interventions targeted in early childhood populations (e.g., Comer et al, 2012; Hirshfeld-Becker et al, 2010), as well as those designed to treat children age 7 through age 17 (e.g., Kendall et al, 2008). …”

Addressing Early Childhood Emotional and Behavioral Problems

“…62,63 A randomized controlled trial demonstrated that modified PCIT was effective in helping parents recognize emotions, although not better than parent education in reducing depressive symptoms. 74 Significant controversy and limited data about the validity of diagnostic criteria for bipolar disorder remain, and no rigorous studies of nonpharmacologic interventions in this age group exist.…”