ARTICLES
Treating Comorbid Anxiety and Aggression in Children

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ABSTRACT

Objective:

The aim of the study was to evaluate the effectiveness of an intervention that targeted both anxious and aggressive behaviors in children with anxiety disorders and comorbid aggression by parent report.

Method:

The effects of a cognitive-behavioral therapy intervention targeting comorbid anxiety and aggression problems were compared with a standard cognitive-behavioral therapy intervention targeting anxiety only. The study was conducted over a period of 2 years, and 69 families were included, with participating children ranging in age from 8 to 14 years. Intervention effects were evaluated at posttreatment and 3 months following treatment.

Results:

An intent-to-treat analysis identified few significant differences between conditions in level of improvement following treatment and at follow-up, with the exception of parent-reported stress, anxiety, and depression, which improved in the anxiety treatment condition. Both treatment programs led to significant reductions in parent-reported child externalizing and internalizing problems and child-reported internalizing problems and to improved parenting practices.

Conclusions:

Comorbidity did not appear to significantly affect treatment outcome for anxiety disorders, and combining existing treatments to address comorbid problems did not enhance treatment effectiveness. Further trials are required to assess the effectiveness of an expanded combined treatment program that allows adequate time to address both internalizing and externalizing problems. Australian Clinical Trials Registry (ACTR) information-URL: http://actr.ctc.usyd.edu.au. Unique identifier: ACTRNO12607000253404.

Section snippets

Hypotheses

It was hypothesized that the combined program would lead to greater changes in child externalizing problems, parental well-being, and parenting practices following treatment than the anxiety program, both at posttreatment and at 3-month follow-up. It was also hypothesized that both treatment programs would lead to improvements in child internalizing problems, which would be maintained at follow-up.

Participants

Participants were children ages 8 to 14 years (mean 10.61, SD 1.69) and their parents, who were referred for treatment for both anxiety and aggression at a University Psychology Clinic in Sydney, Australia. Participants were recruited from general medical practitioners, mental health professionals, schools, advertisements in a local parents' magazine, write ups in local newspapers, and a radio interview during a 2-year period.

Children were required to meet DSM-IV diagnostic criteria for an

Diagnostic Status.

More than one third of children (35%) met criteria for at least two anxiety disorders. The distribution of diagnoses is included in Table 1. In addition, 88% of children met criteria for ODD, and 35% of children were reported by parents to be receiving special school services for learning difficulties. There was no difference in the proportion of children with learning difficulties between the treatment conditions (χ2 = 4.51, df = 2, p =.10).

Treatment Completers Versus Noncompleters.

Participants who did not complete treatment (n = 12)

DISCUSSION

The aim of this study was to investigate the effectiveness of a combined treatment for anxiety and aggression and compare it to a standard anxiety treatment program in a sample of children with co-occurring anxiety disorders and parent-reported aggressive behavior. The first hypothesis predicted that the combined program would lead to greater change in child problems and in parent variables following treatment than the anxiety program. Analyses indicated few differences between conditions, with

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    • Cited by (0)

    This study was conducted at the Psychology Clinic at the University of Sydney and at the Department of Psychological Medicine in the Children's Hospital at Westmead. The research was supported in part by a University of Sydney Research and Development Grant. The authors acknowledge the intern clinical psychologists who assisted in running the treatment programs.

    Disclosure: The authors have no financial relationships to disclose.

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    Copyright © 2007 The American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.