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Treatment Concerns and Functional Impairment in Pediatric Anxiety

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Abstract

Although there are efficacious, evidence-based treatments for anxiety disorders, youth often experience delays in seeking therapy. Myriad reasons may contribute to this lag in treatment initiation, with some youth possessing concerns about therapy. Treatment concerns are broadly characterized by worries/ambivalence about seeking treatment, including concerns about the negative reactions, consequences, and inconvenience of treatment. As no studies exist for youth with anxiety disorders, this study examined the phenomenology of treatment concerns in 119 treatment-seeking, anxious youth and utilized a structural equation model to examine the relationship between child anxiety, depressive symptoms, treatment concerns, and anxiety-related functional impairment. Over 90 % of the children positively endorsed some type of treatment-related fear, with the most frequently expressed concern being that therapy would take too much time (50.4 %). Based on the model, both child anxiety and depressive symptoms predicted functional impairment, and treatment concerns mediated the relationship between child anxiety and functional impairment.

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References

  1. Beesdo K, Knappe S, Pine DS (2009) Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatr Clin North Am 32:483–524

    Article  PubMed  PubMed Central  Google Scholar 

  2. Langley AK, Bergman RL, McCracken J, Piacentini JC (2004) Impairment in childhood anxiety disorders: preliminary examination of the child anxiety impact scale-parent version. J Child Adolesc Psychopharmacol 14:105–114

    Article  PubMed  Google Scholar 

  3. La Greca AM, Lopez N (1998) Social anxiety among adolescents: linkages with peer relations and friendships. J Abnorm Child Psychol 26:83–94

    Article  PubMed  Google Scholar 

  4. Lebowitz ER, Scharfstein LA, Jones J (2014) Comparing family accommodation in pediatric obsessive–compulsive disorder, anxiety disorders, and nonanxious children. Depress Anxiety 31:1018–1025

    Article  PubMed  Google Scholar 

  5. van Steensel FJ, Bögels SM, Dirksen CD (2012) Anxiety and quality of life: clinically anxious children with and without autism spectrum disorders compared. J Clin Child Adolesc Psychol 41:731–738

    Article  PubMed  Google Scholar 

  6. Bastiaansen D, Koot HM, Ferdinand RF, Verhulst FC (2004) Quality of life in children with psychiatric disorders: self-, parent, and clinician report. J Am Acad Child Adolesc Psychiatry 43:221–230

    Article  PubMed  Google Scholar 

  7. Wang PS, Berglund P, Olfson M, Pincus HA, Wells KB, Kessler RC (2005) Failure and delay in initial treatment contact after first onset of mental disorders in the national comorbidity survey replication. Arch Gen Psychiatry 62:603–613

    Article  PubMed  Google Scholar 

  8. Wang PS, Angermeyer M, Borges G, Bruffaerts R, Tat Chiu W, De Girolamo G et al (2007) Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry 6:177–185

    PubMed  PubMed Central  Google Scholar 

  9. Christiana JM, Gilman SE, Guardino M, Mickelson K, Morselli PL, Olfson M et al (2000) Duration between onset and time of obtaining initial treatment among people with anxiety and mood disorders: an international survey of members of mental health patient advocate groups. Psychol Med 30:693–703

    Article  PubMed  Google Scholar 

  10. Rowa K, Gifford S, McCabe R, Milosevic I, Antony MM, Purdon C (2014) Treatment fears in anxiety disorders: development and validation of the Treatment Ambivalence Questionnaire. J Clin Psychol 70:979–993

    Article  PubMed  Google Scholar 

  11. Selles RR, Rowa K, McCabe R, Purdon C, Storch EA (2013) Prevalence and clinical correlates of treatment concerns in a sample of treatment seeking youth with obsessive–compulsive disorder. J Obsessive Compuls Relat Disord 2:286–291

    Article  Google Scholar 

  12. Strauss CC, Frame CL, Forehand R (1987) Psychosocial impairment associated with anxiety in children. J Clin Child Psychol 16:235–239

    Article  Google Scholar 

  13. Dadds MR, Spence SH, Holland DE, Barrett PM, Laurens KR (1997) Prevention and early intervention for anxiety disorders: a controlled trial. J Consult Clin Psychol 65:627–635

    Article  PubMed  Google Scholar 

  14. Flannery-Schroeder EC (2006) Reducing anxiety to prevent depression. Am J Prev Med 31:S136–S142

    Article  PubMed  Google Scholar 

  15. Hirshfeld-Becker DR, Biederman J (2002) Rationale and principles for early intervention with young children at risk for anxiety disorders. Clin Child Fam Psychol Rev 5:161–172

    Article  PubMed  Google Scholar 

  16. Garber J, Weersing VR (2010) Comorbidity of anxiety and depression in youth: implications for treatment and prevention. Clin Psychol 17:293–306

    Google Scholar 

  17. Wolk CB, Kendall PC, Beidas RS (2015) Cognitive-behavioral therapy for child anxiety confers long-term protection from suicidality. J Am Acad Child Adolesc Psychiatry 54:175–179

    Article  PubMed  Google Scholar 

  18. Schleider JL, Krause ED, Gillham JE (2014) Sequential comorbidity of anxiety and depression in youth: present knowledge and future directions. Curr Psychiatry Rev 10:75–87

    Article  Google Scholar 

  19. Birmaher B, Ryan ND, Williamson DE, Brent DA, Kaufman J, Dahl RE et al (1996) Childhood and adolescent depression: a review of the past 10 years. Part I. J Am Acad Child Adolesc Psychiatry 35:1427–1439

    Article  PubMed  Google Scholar 

  20. Luby JL, Belden AC, Pautsch J, Si X, Spitznagel E (2009) The clinical significance of preschool depression: impairment in functioning and clinical markers of the disorder. J Affect Disord 112:111–119

    Article  PubMed  Google Scholar 

  21. Storch EA, Salloum A, King MA, Crawford EA, Andel R, McBride NM et al (2015) A randomized controlled trial in community mental health centers of computer-assisted cognitive-behavioral therapy versus treatment as usual for children with anxiety. Depress Anxiety. doi:10.1002/da.22399

  22. Research Units on Pediatric Psychopharmacology Anxiety Study Group (2002) The Pediatric Anxiety Rating Scale (PARS): development and psychometric properties. J Am Acad Child Adolesc Psychiatry 41:1061–1069

    Article  Google Scholar 

  23. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn, Text Revision Ed. American Psychiatric Association, Arlington, VA

  24. Silverman WK, Albano AM (1996) The Anxiety Disorders Interview Schedule for DSM-IV—child and parent versions. Graywind Publications, San Antonio

    Google Scholar 

  25. March JS, Parker JDA, Sullivan K, Stallings P, Conners CK (1997) The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry 36:554–565

    Article  PubMed  Google Scholar 

  26. March JS, Sullivan K (1999) Test–retest reliability of the Multidimensional Anxiety Scale for children. J Anxiety Disord 13:349–358

    Article  PubMed  Google Scholar 

  27. Langley AK, Falk A, Peris T, Wiley JF, Kendall PC, Ginsburg G et al (2014) The child anxiety impact scale: examining parent- and child-reported impairment in child anxiety disorders. J Clin Child Adolesc Psychol 43:579–591

    Article  PubMed  Google Scholar 

  28. Kovacs M (1984) The Children’s Depression Inventory (CDI). Psychopharmacol Bull 21:995–998

    Google Scholar 

  29. Saylor CF, Finch AJ Jr, Spirito A, Bennett B (1984) The Children’s Depression Inventory: a systematic evaluation of psychometric properties. J Consult Clin Psychol 52:955–967

    Article  PubMed  Google Scholar 

  30. Timbremont B, Braet C, Dreessen L (2004) Assessing depression in youth: relation between the Children’s Depression Inventory and a structured interview. J Clin Child Adolesc Psychol 33:149–157

    Article  PubMed  Google Scholar 

  31. Johnco CJ, De Nadai AS, Lewin AB, Ehrenreich-May J, Wood JJ, Storch EA (2015) Defining treatment response and symptom remission for anxiety disorders in pediatric autism spectrum disorders using the Pediatric Anxiety Rating Scale. J Autism Dev Disord 45:3232–3242

  32. Caporino NE, Brodman DM, Kendall PC, Albano AM, Sherrill J, Piacentini J et al (2013) Defining treatment response and remission in child anxiety: signal detection analysis using the pediatric anxiety rating scale. J Am Acad Child Adolesc Psychiatry 52:57–67

    Article  PubMed  Google Scholar 

  33. Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT et al (2008) Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med 359:2753–2766

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kendall PC, Hudson JL, Gosch E, Flannery-Schroeder EC, Suveg C (2008) Cognitive-behavioral therapy for anxiety disordered youth: a randomized clinical trial evaluating child and family modalities. J Consult Clin Psychol 76:282

    Article  PubMed  Google Scholar 

  35. Wood JJ, Piacentini JC, Bergman RL, McCracken J, Barrios V (2002) Concurrent validity of the anxiety disorders section of the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. J Clin Child Adolesc Psychol 31:335–342

    Article  PubMed  Google Scholar 

  36. Silverman WK, Saavedra LM, Pina AA (2001) Test–retest reliability of anxiety symptoms and diagnoses with the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. J Am Acad Child Adolesc Psychiatry 40:937–944

    Article  PubMed  Google Scholar 

  37. Kline RB (2011) Principles and practice of structural equation modeling, 3rd edn. Guilford Press, New York

    Google Scholar 

  38. Hu L, Bentler PM (1998) Fit indices in covariance structure modeling: sensitivity to underparameterized model misspecification. Psychol Methods 3:424

    Article  Google Scholar 

  39. Hu L, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model 6:1–55

    Article  Google Scholar 

  40. Mausbach BT, Moore R, Roesch S, Cardenas V, Patterson TL (2010) The relationship between homework compliance and therapy outcomes: an updated meta-analysis. Cogn Ther Res 34:429–438

    Article  Google Scholar 

  41. Klein RG (1991) Parent–child agreement in clinical assessment of anxiety and other psychopathology: a review. J Anxiety Disord 5:187–198

    Article  Google Scholar 

  42. Choudhury MS, Pimentel SS, Kendall PC (2003) Childhood anxiety disorders: parent–child (dis) agreement using a structured interview for the DSM-IV. J Am Acad Child Adolesc Psychiatry 42:957–964

    Article  PubMed  Google Scholar 

  43. Engel NA, Rodrigue JR, Geffken GR (1994) Parent–child agreement on ratings of anxiety in children. Psychol Rep 75:1251–1260

    Article  PubMed  Google Scholar 

  44. Comer JS, Kendall PC (2004) A symptom-level examination of parent–child agreement in the diagnosis of anxious youths. J Am Acad Child Adolesc Psychiatry 43:878–886

    Article  PubMed  Google Scholar 

  45. Murray L, Creswell C, Cooper PJ (2009) The development of anxiety disorders in childhood: an integrative review. Psychol Med 39:1413–1423

    Article  PubMed  Google Scholar 

  46. Addis ME, Carpenter KM (2000) The treatment rationale in cognitive behavioral therapy: psychological mechanisms and clinical guidelines. Cogn Behav Pract 7:147–156

    Article  Google Scholar 

  47. Burstein M, Ginsburg GS, Tein JY (2010) Parental anxiety and child symptomatology: an examination of additive and interactive effects of parent psychopathology. J Abnorm Child Psychol 38:897–909

    Article  PubMed  PubMed Central  Google Scholar 

  48. Cobham VE, Dadds MR, Spence SH (1998) The role of parental anxiety in the treatment of childhood anxiety. J Consult Clin Psychol 66:893–905

    Article  PubMed  Google Scholar 

  49. Hudson JL, Keers R, Roberts S, Coleman JR, Breen G, Arendt K et al (2015) Clinical predictors of response to cognitive-behavioral therapy in pediatric anxiety disorders: the genes for treatment (GxT) study. J Am Acad Child Adolesc Psychiatry 54:454–463

    Article  PubMed  PubMed Central  Google Scholar 

  50. Schleider JL, Ginsburg GS, Keeton CP, Weisz JR, Birmaher B, Kendall PC et al (2015) Parental psychopathology and treatment outcome for anxious youth: roles of family functioning and caregiver strain. J Consult Clin Psychol 83:213–224

    Article  PubMed  Google Scholar 

  51. Grills AE, Ollendick TH (2003) Multiple informant agreement and the anxiety disorders interview schedule for parents and children. J Am Acad Child Adolesc Psychiatry 42:30–40

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank John M. Ferron, Ph.D. for his statistical expertise. We would also like to thank all of the families for their participation. This work was supported by a grant to the last author from the Agency for Healthcare Research and Quality (R18HS018665). The content is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality.

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Authors and Affiliations

  1. Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL, 33701, USA

    Monica S. Wu, Alison Salloum, Adam B. Lewin, Robert R. Selles, Nicole M. McBride & Eric A. Storch

  2. Department of Psychology, University of South Florida, Tampa, FL, USA

    Monica S. Wu, Adam B. Lewin, Robert R. Selles & Eric A. Storch

  3. School of Social Work, University of South Florida, Tampa, FL, USA

    Alison Salloum

  4. Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA

    Adam B. Lewin & Eric A. Storch

  5. Department of Psychology, Temple University, Philadelphia, PA, USA

    Erika A. Crawford

  6. Department of Health Policy and Management, University of South Florida, Tampa, FL, USA

    Eric A. Storch

  7. Rogers Behavioral Health – Tampa Bay, Tampa, FL, USA

    Eric A. Storch

  8. All Children’s Hospital – Johns Hopkins Medicine, St. Petersburg, FL, USA

    Eric A. Storch

Authors
  1. Monica S. Wu
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  2. Alison Salloum
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  4. Robert R. Selles
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  6. Erika A. Crawford
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  7. Eric A. Storch
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Correspondence to Monica S. Wu.

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Wu, M.S., Salloum, A., Lewin, A.B. et al. Treatment Concerns and Functional Impairment in Pediatric Anxiety. Child Psychiatry Hum Dev 47, 627–635 (2016). https://doi.org/10.1007/s10578-015-0596-1

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  • DOI: https://doi.org/10.1007/s10578-015-0596-1

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