Affective disorder in the parents of a clinic sample of children with anxiety disorders

Cooper, Peter; Fearn, Vanessa; Willetts, Lucy; Seabrook, Hannah; Parkinson, Monika

doi:10.1016/j.jad.2006.03.017

Cited by 131 publications

(117 citation statements)

References 24 publications

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“…Cooper, Fearn, Willetts, Seabrook, & Parkinson, 2006). It has been shown that parental anxiety is a predictor of poorer child treatment outcome (Creswell & Cartwright-Hatton, 2007), and it has been demonstrated that assisting parents with their own anxiety can lead to better child outcomes (Cobham et al, 1998;Cobham, Dadds, Spence, & McDermott, 2010).…”

Section: Accepted M Manuscriptmentioning

confidence: 99%

Intensive Group-Based CBT for Child Social Phobia: A Pilot Study

et al. 2015

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Objective: Although CBT has proven efficacious in the treatment of child social phobia (SP), most children do not present for treatment and child SP may be less responsive to treatment than other anxiety disorders. Intensive, group-based, SP-specific CBT may improve the efficacy of, and access to, treatment for child SP. The aim of this study was to provide a preliminary examination of such a program. Method: Forty Australian children aged 7-12 years (15 male and 25 female) were allocated into treatment and waitlist groups. Clinical interviews to determine diagnostic status were conducted prior to treatment, following treatment and at 6-month follow-up. Parent and child questionnaire measures of child anxiety symptoms, internalising symptoms, depression, social skills, social competence, and parental social anxiety were administered at the same time points. Treatment was delivered in four separate 3-hour sessions conducted over three consecutive weekends. Results: At postassessment, 52.4% of children in the treatment group and 15.8% of children in the waitlist group were free of their SP diagnosis. At post-assessment, compared to waitlist children, treatment group children demonstrated a greater drop in clinical severity, a greater increase in overall functioning, and held fewer clinical diagnoses. Treatment group children also reported a greater reduction in SP symptoms compared to waitlist children, and treatment group parents reported a greater reduction in child internalising and anxiety symptoms, a greater increase in child social competence, and a greater decrease in parental SP symptoms, compared to parents of children in the waitlist group. By 6-month follow-up, 76.9% of the treatment group were free of their SP diagnosis and gains on all other measures were maintained. Conclusions: The results of this study are encouraging, and suggest that brief, intensive, group CBT for children with social anxiety is beneficial for many youngsters. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPTIntensive Group-Based CBT for Child Social Phobia 3 Social Phobia (SP) or Social Anxiety Disorder, is an anxiety disorder where the individual demonstrates a marked fear or anxiety about one or more social situations where they are exposed to possible scrutiny by others (American Psychiatric Association, 2013). It is one of the most common childhood anxiety disorders (Costello, Egger, & Angold, 2005), is associated with a myriad of deleterious short-and long-term consequences (Beidel, Turner, & Morris, 1999), and follows a chronic course if left untreated (Weissman et al., 1999).Fortunately, there have now been a number of studies confirming that cognitive behaviour therapy (CBT) is efficacious in treating childhood SP.Beidel and colleagues (Beidel & Turner, 2007;Beidel, Turner, & Young, 2006) conducted a series of studies demonstrating the efficacy of their behaviourally oriented Social Effectiveness Therapy for Children (SET-C). In the original randomized control trial of the SET-C program , it was found that...

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Section: Accepted M Manuscriptmentioning

confidence: 99%

Intensive Group-Based CBT for Child Social Phobia: A Pilot Study

et al. 2015

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“…It is well-established that anxiety runs in families; anxious parents are more likely to have an anxious child (Biederman et al, 2001) and anxious children are more likely than non-anxious children to have an anxious parent (Cooper, Fearn, Willetts, Seabrook, & Parkinson, 2006). However, the transmission of anxiety from parent to child is likely to be more than the transmission of genetic material.…”

Section: Parental Anxietymentioning

confidence: 99%

Temperament, Family Environment and Anxiety in Preschool Children

Hudson

Dodd

Bovopoulos

2011

J Abnorm Child Psychol

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“…17 Two studies to date have examined whether or not targeting parental anxiety might benefit child treatment outcome. Cobham and colleagues 9 found that supplementing child cognitive-behavioural therapy (CCBT) with parent anxiety management was associated with significantly improved diagnostic outcomes for children with anxiety disorders whose parents had elevated trait anxiety; however, this group did not maintain a specific benefit from the parent anxiety management treatment at a 3-year follow-up.…”

Section: Scientific Backgroundmentioning

confidence: 99%

“…Although paternal behaviours are likely to contribute to the maintenance of child anxiety disorder, this study focused on mothers for the following reasons: (i) it has been suggested that the parental responses that may promote anxiety among children differ for mothers and fathers; 31 (ii) anxiety disorders are more common among women than men 32 and, also, more common among mothers of children with anxiety disorders than fathers; 17 (iii) mothers are most commonly the primary caregiving parent in the study region and are more likely to attend treatment sessions for their child (e.g. in a recent study in the same region, 98% of parents nominated as primary caregivers in order to attend treatment were mothers 33 ).…”

Section: Rationale For the Researchmentioning

confidence: 99%

“…As noted above, the study focused on mothers as (i) intergenerational associations for anxiety disorders are most commonly found between mothers and their children; 17 (ii) mothers are most commonly the primary caregivers in the study region; and (iii) paternal behaviours may have different associations with childhood anxiety. 34 Participants were all referred to Berkshire Child Anxiety Clinic, run jointly by Berkshire Healthcare NHS Foundation Trust and the University of Reading, by a health or educational professional.…”

Section: Participantsmentioning

confidence: 99%

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Treatment of childhood anxiety disorder in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis

Creswell

Cruddace

Gerry

et al. 2015

Health Technology Assessment

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BackgroundCognitive–behavioural therapy (CBT) for childhood anxiety disorders is associated with modest outcomes in the context of parental anxiety disorder.ObjectivesThis study evaluated whether or not the outcome of CBT for children with anxiety disorders in the context of maternal anxiety disorders is improved by the addition of (i) treatment of maternal anxiety disorders, or (ii) treatment focused on maternal responses. The incremental cost-effectiveness of the additional treatments was also evaluated.DesignParticipants were randomised to receive (i) child cognitive–behavioural therapy (CCBT); (ii) CCBT with CBT to target maternal anxiety disorders [CCBT + maternal cognitive–behavioural therapy (MCBT)]; or (iii) CCBT with an intervention to target mother–child interactions (MCIs) (CCBT + MCI).SettingA NHS university clinic in Berkshire, UK.ParticipantsTwo hundred and eleven children with a primary anxiety disorder, whose mothers also had an anxiety disorder.InterventionsAll families received eight sessions of individual CCBT. Mothers in the CCBT + MCBT arm also received eight sessions of CBT targeting their own anxiety disorders. Mothers in the MCI arm received 10 sessions targeting maternal parenting cognitions and behaviours. Non-specific interventions were delivered to balance groups for therapist contact.Main outcome measuresPrimary clinical outcomes were the child’s primary anxiety disorder status and degree of improvement at the end of treatment. Follow-up assessments were conducted at 6 and 12 months. Outcomes in the economic analyses were identified and measured using estimated quality-adjusted life-years (QALYs). QALYS were combined with treatment, health and social care costs and presented within an incremental cost–utility analysis framework with associated uncertainty.ResultsMCBT was associated with significant short-term improvement in maternal anxiety; however, after children had received CCBT, group differences were no longer apparent. CCBT + MCI was associated with a reduction in maternal overinvolvement and more confident expectations of the child. However, neither CCBT + MCBT nor CCBT + MCI conferred a significant post-treatment benefit over CCBT in terms of child anxiety disorder diagnoses [adjusted risk ratio (RR) 1.18, 95% confidence interval (CI) 0.87 to 1.62,p = 0.29; adjusted RR CCBT + MCI vs. control: adjusted RR 1.22, 95% CI 0.90 to 1.67,p = 0.20, respectively] or global improvement ratings (adjusted RR 1.25, 95% CI 1.00 to 1.59,p = 0.05; adjusted RR 1.20, 95% CI 0.95 to 1.53,p = 0.13). CCBT + MCI outperformed CCBT on some secondary outcome measures. Furthermore, primary economic analyses suggested that, at commonly accepted thresholds of cost-effectiveness, the probability that CCBT + MCI will be cost-effective in comparison with CCBT (plus non-specific interventions) is about 75%.ConclusionsGood outcomes were achieved for children and their mothers across treatment conditions. There was no evidence of a benefit to child outcome of supplementing CCBT with either intervention focusing on maternal anxiety disorder or maternal cognitions and behaviours. However, supplementing CCBT with treatment that targeted maternal cognitions and behaviours represented a cost-effective use of resources, although the high percentage of missing data on some economic variables is a shortcoming. Future work should consider whether or not effects of the adjunct interventions are enhanced in particular contexts. The economic findings highlight the utility of considering the use of a broad range of services when evaluating interventions with this client group.Trial registrationCurrent Controlled Trials ISRCTN19762288.FundingThis trial was funded by the Medical Research Council (MRC) and Berkshire Healthcare Foundation Trust and managed by the National Institute for Health Research (NIHR) on behalf of the MRC–NIHR partnership (09/800/17) and will be published in full inHealth Technology Assessment; Vol. 19, No. 38.

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Affective disorder in the parents of a clinic sample of children with anxiety disorders

Cited by 131 publications

References 24 publications

Intensive Group-Based CBT for Child Social Phobia: A Pilot Study

Intensive Group-Based CBT for Child Social Phobia: A Pilot Study

Temperament, Family Environment and Anxiety in Preschool Children

Treatment of childhood anxiety disorder in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis

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