Development and Preliminary Evaluation of a One-Week Summer Treatment Program for Separation Anxiety Disorder

doi:10.1016/j.cbpra.2008.12.005

Cognitive and Behavioral Practice

Volume 16, Issue 3, August 2009, Pages 317-331

https://doi.org/10.1016/j.cbpra.2008.12.005 Get rights and content

Abstract

Numerous clinical trials have demonstrated the efficacy of cognitive behavior therapy (CBT) for the treatment of childhood Separation Anxiety Disorder (SAD) and other anxiety disorders yet additional research may still be needed to better access and engage anxious youth. In this study, we investigated the acceptability and preliminary utility of a group cognitive-behavioral intervention for school-aged girls with SAD provided within an intensive, 1-week setting. The development of the proposed treatment strategy, a 1-week summer treatment program, was predicated on evidence supporting the need for childhood treatments that are developmentally sensitive, allow for creative application of intervention components, incorporate a child's social context, and ultimately establish new pathways for dissemination to the community. The summer treatment program for SAD was pilot-tested using a case-series design with 5 female children, aged 8 to 11, each with a principal diagnosis of SAD. For 4 of the 5 participants, treatment gains were evidenced by changes in diagnostic status, significant reductions in measures of avoidance, and improvements on self- and parent-report measures of anxiety symptomology. Specifically, severity of SAD symptoms decreased substantially at posttreatment for each participant and, 2 months following treatment, none of the participants met diagnostic criteria for the disorder. A fifth participant experienced substantive improvement in diagnostic status prior to the onset of treatment and, though she evidenced continued improvements following treatment, the role of the intervention in such improvements is less clear.

Section snippets

Overview of Sample Characteristics

The summer treatment program for SAD was pilot tested with five female children¹

Diagnostic Status

Table 2 displays the diagnostic status of each participant at pre- and posttreatment, and two-month follow-up. Treatment gains were evidenced through changes in diagnostic status across all participants. Specifically, the reductions in the severity of the SAD diagnoses were clinically meaningful for each participant at post-treatment. Immediately following treatment, three participants no longer met diagnostic criteria for the disorder and, by 2-month follow-up, none of the participants met

Discussion

Results from this initial investigation suggest that school-aged, female children with SAD responded positively to a 7-day, exposure-based, intensive group treatment program. From pretreatment to posttreatment and 2-month follow-up points, children showed improvement in SAD severity and related anxiety symptomology, as well as high levels of treatment satisfaction. As might be anticipated with a relatively brief intervention, treatment gains, although notable immediately following the

References (59)

Cartwright-HattonS. et al.
Anxiety in a neglected population: Prevalence of anxiety disorders in pre-adolescent children
Clinical Psychology Review
(2006)
LynehamH.J. et al.
Interrater reliability of the anxiety disorders interview schedule for DSM-IV: Child and parent version
Journal of the American Academy of Child & Adolescent Psychiatry
(2007)
MurisP. et al.
Correlations among two self-report questionnaires for measuring DSM-defined anxiety disorder symptoms in children: The Screen for Child Anxiety Related Emotional Disorders and the Spence Children's Anxiety Scale
Personality and Individual Differences
(2000)
MurisP. et al.
Three traditional and three new childhood anxiety questionnaires: Their reliability and validity in a normal adolescent sample
Behaviour Research and Therapy
(2002)
SilvermanW.K. et al.
Age differences in the reliability of parent and child reports of child anxious symptomatology using a structured interview
Journal of the American Academy of Child & Adolescent Psychiatry
(1992)
SilvermanW.K. et al.
The anxiety disorders interview schedule for children
Journal of the American Academy of Child and Adolescent Psychiatry
(1988)
SpenceS.H.
A measure of anxiety symptoms among children
Behaviour Research and Therapy
(1998)
SpenceS.H. et al.
Psychometric properties of the Spence Children's Anxiety Scale with young adolescents
Journal of Anxiety Disorders
(2003)
StorchE.A. et al.
Family-based Cognitive-Behavioral Therapy for pediatric Obsessive-Compulsive Disorder: Comparison of intensive and weekly approaches
Journal of the American Academy of Child & Adolescent Psychiatry
(2007)
AlbanoA.M. et al.
Breaking the vicious cycle: Cognitive-behavioral group treatment for socially anxious youth

AlbanoA.M. et al.

Therapists guide to the use of the Anxiety Disorders Interview Schedule for DSM-IV-child and parent versions

(1996)

BarrettP.M.

Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders

Journal of Clinical Child Psychology

(1998)

BarrettP.M. et al.

Family treatment of childhood anxiety: A controlled trial

Journal of Consulting and Clinical Psychology

(1996)

BeidelD.C. et al.

Shy children, phobic adults: Nature and treatment of social anxiety disorders

(2007)

BiedermanJ. et al.

Childhood antecedents to panic disorder in referred and non referred adults

Journal of Child and Adolescent Psychopharmacology

(2005)

Bell-DolanD.

Separation Anxiety Disorder

Cartwright-HattonS. et al.

Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders

British Journal of Psychiatry

(2004)

ChorpitaB.F. et al.

The development of anxiety: The role of control in the early environment

Psychological Bulletin

(1998)

ChorpitaB.F. et al.

Identifying and selecting the common elements of evidence based interventions: A distillation and matching model

Mental Health Services Research

(2005)

DaddsM.R. et al.

Family process and child anxiety and aggression: An observational analysis

Journal of Abnormal Child Psychology

(1996)

Flannery-SchroederE. et al.

Group and individual cognitive-behavioral treatments for youth with anxiety disorders: 1 year follow-up

Cognitive Therapy and Research

(2005)

FriedbergR.D. et al.

Clinical practice of cognitive therapy with children and adolescents: The nuts and bolts

(2002)

HerschellA.D. et al.

Clinical child psychology's progress in disseminating empirically supported treatments

Clinical Psychology: Science and Practice

(2004)

Hirshfeld-BeckerD.R. et al.

Rationale and principles for early intervention with young children at risk for anxiety disorders

Clinical Child and Family Psychology Review

(2002)

HowardB.L. et al.

Cognitive-behavioral family therapy for anxiety-disordered children: A multiple-baseline evaluation

Cognitive Therapy and Research

(1996)

HowardB.L. et al.

Cognitive-behavioral family therapy for anxious children: Therapist manual

(2000)

IshikawaS. et al.

Cognitive Behavioural Therapy for Anxiety Disorders in Children and Adolescents: A Meta-Analysis

Child and Adolescent Mental Health

(2007)

KazdinA.E.

Behavior modification in applied settings

(1994)

KazdinA.E. et al.

Identifying and developing empirically supported child and adolescent treatments

Journal of Consulting and Clinical Psychology

(1998)

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Children with selective mutism (SM) experience significant challenges in a variety of social situations, leading to difficulties with academics, peers, and family functioning. Despite the extensive evidence base for cognitive-behavioral interventions for youth anxiety, the literature has seen relatively limited advancement in specialized treatment methods for SM. In addition, geographic disparities in SM treatment expertise and the roughly 6-month duration of some of the supported SM treatment protocols can further restrict the accessibility and acceptability of quality SM care. Intensive group behavioral treatment (IGBT) for SM was developed to expand the portfolio of evidence-based SM treatment options by offering brief, but high-dose, expert SM intervention in a group format for youth ages 3–10 years that can be completed in 1 week. In this article, we outline IGBT for SM program, which has already received initial support in a waitlist-controlled trial. Our presentation is organized around the five main components of the treatment model: (1) individual “lead-in” sessions, (2) camp (i.e., all-day group sessions for children held in a simulated classroom setting, with an emphasis on graduated exposures and structured reinforcement), (3) parent training, (4) school outreach, and (5) booster treatment, as needed. We conclude with a discussion of clinical considerations and future directions for further IGBT refinement and evaluation.
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L’objectif de ce travail est de présenter la prise en charge en thérapie comportementale et cognitive (TCC) d’une enfant souffrant d’anxiété de séparation se manifestant par un refus scolaire anxieux à travers une étude de cas. Les données épidémiologiques semblent indiquer que le trouble anxiété de séparation chez les enfants pré-pubères est de l’ordre de 4 à 5 % dans la population générale (Massi et al., 2001). En ce qui concerne les facteurs de risque identifiés, ils incluent notamment l’attachement (Brumariu et Kerns, 2010) ou encore les pratiques parentales comme la surprotection (Mofrad et al., 2009). D’autre part, en ce qui concerne l’âge de début, il semble exister un pic vers 5–7 ans, lors de l’entrée au cours préparatoire (Doerfler et al., 2008). Les chercheuses et cliniciennes Blatter-Meunier et Schneider (2011) ont créé le programme familial contre l’anxiété de séparation (PFAS) qui est un programme thérapeutique comportemental du traitement de l’anxiété de séparation vérifié empiriquement. Ce programme a été suivi dans la prise en charge de Maeva âgée de 7 ans et de sa famille. Ce cas clinique est également l’occasion de souligner la place centrale de l’intégration de la famille et de l’environnement de l’enfant dans la conceptualisation de cas, l’analyse fonctionnelle et dans la prise en charge d’enfants en TCC.
The aim of this study was to present the cognitive-behavioral therapy of a child with a separation anxiety disorder and severe school refusal behavior. Epidemiologic studies suggest that anxiety separation disorder in pre-pubescent children affects between 4 to 5% of the general population (Massi et al., 2001). The identified risk factors include attachment (Brumariu and Kerns, 2010) or parental practices such as overprotection (Mofrad et al., 2009). The researchers and clinicians Blatter-Meunier and Schneider (2011) created the family program against separation anxiety (PFAS) which is an empirically verified behavioral treatment of separation anxiety. The first four sessions contain psychoeducation about the difference between normal anxiety, pathological anxiety and anxiety during child growth. The child begins to develop positive thoughts against fear and anxiety. It also provides the opportunity to explore the child's personal experiences about the disappearance of fear, to talk about other situations and to identify avoidant behaviors and parental dysfunctional thoughts which could maintain fear of separation. Then, the child and their family choose anxiety exposition situations and the active phase of the therapy begins. This program was followed in cognitive-behavioral therapy with Maeva, a 7-year-old girl and her family. Maeva was a smiling and joyful girl when she was with her mother. As soon as her mother left the room, she became anxious, bit her nails, asked the time and pretended to have something to find in her mother's handbag. According to her mother, Maeva never slept alone. She used to sleep with her parents and she had slept with her grandmother since her grandfather had died. Severe separation anxiety began at the same time as her parent's separation. For six weeks, Maeva had cried every morning in front of the school and entered the classroom late. Crying fits lasted longer and longer and Maeva was unable to participate in learning and class activities. The psychotherapist used the Screen for Child Anxiety Related Emotional Disorders (SCARED; Birmaher, 1997), the Children Depression Inventory (CDI; Kovacs, 1981, 1992), the Schedule for Affective Disorders and Schizophrenia for School-Age-Children Present and Lifetime version (Kiddie-SADS-PL; Puig-Antich and Chambers, 1978), behavioral observations from Maeva's mother and teacher and the Situations Émotions Cognitions Comportements Anticipations (SECCA; Cottraux, 1990) to assess psychopathological disorders and to do the functional analysis and case conceptualization. Maeva and her mother quickly and actively adhered to this program. The girl no longer worried about separation and going to school. She gained autonomy and maturity. Indicators used to assess symptoms and behaviors before, after and two months after the therapy decreased considerably. The overall improvement in total anxiety was 55% and 66% about separation anxiety. Social interactions were no longer a problem. The main difficulty was to plan sessions with Maeva's grandmother who was constantly unavailable. Maeva's parents were asked to become mediators between therapy and the grandmother. They had to include the grandmother in exercises at home and to teach her psychoeducation elements they had seen in sessions. This case also provided an opportunity to highlight the importance of including family members and the child's environment in case conceptualization, functional analysis and the child's individual care in cognitive-behavioral therapy.
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View full text

Development and Preliminary Evaluation of a One-Week Summer Treatment Program for Separation Anxiety Disorder

Abstract

Section snippets

Overview of Sample Characteristics

Diagnostic Status

Discussion

Clinical Psychology Review

Journal of the American Academy of Child & Adolescent Psychiatry

Personality and Individual Differences

Behaviour Research and Therapy

Journal of the American Academy of Child & Adolescent Psychiatry

Journal of the American Academy of Child and Adolescent Psychiatry

Behaviour Research and Therapy

Journal of Anxiety Disorders

Journal of the American Academy of Child & Adolescent Psychiatry

Breaking the vicious cycle: Cognitive-behavioral group treatment for socially anxious youth

Therapists guide to the use of the Anxiety Disorders Interview Schedule for DSM-IV-child and parent versions

Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders

Journal of Clinical Child Psychology

Family treatment of childhood anxiety: A controlled trial

Journal of Consulting and Clinical Psychology

Shy children, phobic adults: Nature and treatment of social anxiety disorders

Childhood antecedents to panic disorder in referred and non referred adults

Journal of Child and Adolescent Psychopharmacology

Separation Anxiety Disorder

Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders

British Journal of Psychiatry

The development of anxiety: The role of control in the early environment

Psychological Bulletin

Identifying and selecting the common elements of evidence based interventions: A distillation and matching model

Mental Health Services Research

Family process and child anxiety and aggression: An observational analysis

Journal of Abnormal Child Psychology

Group and individual cognitive-behavioral treatments for youth with anxiety disorders: 1 year follow-up

Cognitive Therapy and Research

Clinical practice of cognitive therapy with children and adolescents: The nuts and bolts

Clinical child psychology's progress in disseminating empirically supported treatments

Clinical Psychology: Science and Practice

Rationale and principles for early intervention with young children at risk for anxiety disorders

Clinical Child and Family Psychology Review

Cognitive-behavioral family therapy for anxiety-disordered children: A multiple-baseline evaluation

Cognitive Therapy and Research

Cognitive-behavioral family therapy for anxious children: Therapist manual

Cognitive Behavioural Therapy for Anxiety Disorders in Children and Adolescents: A Meta-Analysis

Child and Adolescent Mental Health

Behavior modification in applied settings

Identifying and developing empirically supported child and adolescent treatments

Journal of Consulting and Clinical Psychology