Development of Child- and Parent-Report Measures of Behavioral Avoidance Related to Childhood Anxiety Disorders

doi:10.1016/j.beth.2013.02.006

Behavior Therapy

Volume 44, Issue 2, June 2013, Pages 325-337

https://doi.org/10.1016/j.beth.2013.02.006 Get rights and content

Highlights

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Avoidance is theorized to contribute to childhood anxiety disorders
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We developed child- and parent-report measures of behavioral avoidance
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Both measures demonstrated good psychometric properties
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Parent-report predicted changes in child anxiety over a 1-year period
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Avoidance decreased with successful treatment

Abstract

The current report describes 3 studies conducted to develop 8-item child- and parent-report measures to further the understanding of the role of behavioral avoidance in the development, maintenance, and treatment of childhood anxiety disorders. Participants included both clinical (N = 463; ages 8 to 12) and community (N = 421; ages 7 to 18) samples of children and their parents from primarily Caucasian intact families. Follow-up data were collected from 104 families in the community sample. Overall, the measures were internally consistent and related to anxiety, distress, and alternative measures of avoidance in both samples. Parent report of children’s behavioral avoidance evidenced the strongest psychometric properties, differentiated among clinical and community populations, and most importantly, predicted children’s anxiety at least 8 months later over and above initial anxiety ratings. Moreover, decreases in avoidance were associated with successful exposure therapy. These results are consistent with the role of behavioral avoidance in the development of anxiety and provide an efficient tool for assessing the role of avoidance in clinical and research settings.

Section snippets

Methods and Results

The development of the avoidance scales proceeded in three phases. Study 1 consisted of item generation and preliminary analyses to remove weaker items. Study 2 examined the reliability and validity of the items in a community sample. Finally, Study 3 attempted to replicate the reliability of the scales in a clinical sample and expand the support for the scales’ validity. In each study an identified child and one parent completed a survey including the avoidance scales being created and

Study 1

Study 1 was undertaken to generate items for the proposed avoidance scales and to refine these items in a small pilot sample. The analyses were designed to be exploratory and to remove items that were unlikely to be successful before administering the item pool to a larger sample.

Study 2

Study 2 was undertaken to examine the reliability and validity of the items generated in Study 1 (8 items for each the CAMS and CAMP). Given the aim of developing a measure to identify avoidance behavior that contributes to the development of anxiety disorders, data were collected in a community sample across time in order to establish normative levels of avoidance.

Study 3

Study 3 was undertaken to determine whether the psychometric properties of the eight-item scales resulting from Study 2 applied to a clinical population and to collect further data supporting the scales’ validity.

Discussion

The current study aimed to develop and establish the psychometric properties of the CAMS and the parent-report version, the CAMP. Results support the reliability and validity of the CAMP and, to a lesser degree, the CAMS, to measure behavioral avoidance in the context of child anxiety. These are the first questionnaires to measure the extent to which children engage in behavioral avoidance that are applicable to the full spectrum of anxiety disorders. The small-to-moderate correlations between

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Brief behavioral therapy (BBT) is an efficacious transdiagnostic intervention for pediatric anxiety and depression that targets behavioral avoidance as a key mechanism. It is unknown if change in avoidance mediates treatment effects, as theorized. Data on avoidance at baseline and Week 16 were available on 52 youth (ages 8–16 years) from a randomized controlled trial (Weersing et al., 2017, Weersing et al., 2017) comparing BBT and assisted referral to community care (ARC). BBT had significant effects on youth-reported behavioral avoidance, and significant indirect effects on functioning and anxiety, statistically mediated through changes in youth-reported behavioral avoidance. Change in youth-reported avoidance was not a significant mediator of depression. Parent-report of avoidance was not impacted by treatment and was not a significant mediator. Overall, BBT appears to be an effective treatment for targeting behavioral avoidance, which in turn, may improve functioning and lessen anxiety.
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Development of Child- and Parent-Report Measures of Behavioral Avoidance Related to Childhood Anxiety Disorders

Highlights

Abstract

Section snippets

Methods and Results

Study 1

Study 2

Study 3

Discussion

Journal of the American Academy of Child & Adolescent Psychiatry

Journal of Behavior Therapy & Experimental Psychiatry

Behaviour Research and Therapy

Behaviour Research and Therapy

Behavior Therapy

Behaviour Research and Therapy

Behaviour Research & Therapy

Personality & Individual Differences

Behaviour Research & Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Anxiety Disorders

Biological Psychiatry

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of American Academy of Child and Adolescent Psychiatry

Journal of Anxiety Disorders

Journal of Anxiety Disorders

Cognitive and Behavioral Practice

Quick reference to the diagnositic criteria from DSM-IV-TR

Anxiety and its disorders: The nature and treatment of anxiety and panic

Behavioral avoidance test for childhood obsessive-compulsive disorder: A home-based observation

American Journal of Psychotherapy

Behavioral treatment of childhood social phobia

Journal of Consulting and Clinical Psychology

Pediatric anxiety: How family accommodation may hinder treatment

Brown University Child & Adolescent Behavior Letter

Pediatric procedural approach-avoidance coping and distress: a multitrait-multimethod analysis

Journal of Pediatric Psychology

An empirical evaluation of the use of fixed cutoff points in RMSEA test statistic in structural equation models

Sociological Methods & Research

Modular cognitive-behavioral therapy for childhood anxiety disorders