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Cognitive-Behavioral Therapy for Children With Anxiety Disorders in a Clinical Setting: No Additional Effect of a Cognitive Parent Training

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ABSTRACT

Objective

To evaluate a 12-week cognitive-behavioral treatment program for children with anxiety disorders and the additional value of a seven-session cognitive parent training program.

Method

Seventy-nine children with an anxiety disorder (aged 7–18 years) were randomly assigned to a cognitive behavioral treatment condition or a wait-list control condition. Families in the active treatment condition were randomly assigned to an additional seven-session cognitive parent training program. Semistructured diagnostic interviews were conducted with parents and children separately, before and after treatment and at 3 months follow-up. Questionnaires included child self-reports on anxiety and depression and parent reports on child's anxiety and behavioral problems.

Results

Children with anxiety disorders showed more treatment gains from cognitive-behavioral therapy than from a wait-list control condition. These results were substantial and significant in parent measures and with regard to diagnostic status, but not in child self-reports. In the active treatment condition, children improved on self-reported anxiety and depression, as well as on parent reports on their child's anxiety problems. These results were equal for clinically referred and recruited children. Child self-reports decreased to the normal mean, whereas parents reported scores that were lower than before treatment but were still elevated from the normal means. No significant outcome differences were found between families with or without additional parent training.

Conclusions

Children with anxiety disorders profited from cognitive-behavioral therapy. Children improved equally whether or not additional parent training was offered.

Section snippets

Participants

Children were either referred for anxiety problems to one of two mental health centers, or were recruited through GPs, schools, or media for participation in this study. Inclusion criteria were as follows: (1) meeting the criteria of a primary diagnosis of separation anxiety, social phobia, generalized anxiety, or panic with or without agoraphobia (by the Anxiety Disorder Interview Schedule), (2) IQ > 80, (3) age 7 to 18 years, (4) no current psychotherapy or medication for anxiety problems,

Pretreatment Comparisons

The children in the active and wait-list treatment condition did not differ significantly on demographic variables or level of anxiety. With regard to the children in the two active treatment conditions, no difference was found in demographic variables and in most variables related to pretreatment anxiety. The only difference found was that children in the CPT condition had longer histories of anxiety than children in the child-only condition (means of 44 months and 30 months, respectively; F

DISCUSSION

Results of this study were partly positive: with regard to diagnostic status and parent reports, children reached significantly higher treatment gains in the active treatment condition than in the wait-list control group. In contrast, the difference between the active and wait-list condition failed to reach significance in child self-reports. This may be due to test–retest reliability, which is not high (but acceptable) for the SCAS child self-report in a normal sample (Spence, 1998) and may be

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    The authors gratefully acknowledge Jaap Ringrose and Carla Appelboom for their participation and conscientious supervision of the therapists.

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