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Objective: The purpose of the present study was to evaluate the influence of comorbid disorders on the degree of change and the endpoint of cognitive-behavioral treatment in anxious young people. Method: Data on 750 children 6 to 18 years old were compiled from different samples within one clinic. All children had a primary anxiety disorder and were engaged in a manual-based, 10-session, cognitive-behavioral treatment program. Outcome was determined according to diagnostic status and continuous symptom measurements. Analyses compared results among four groups: no comorbidity, comorbid anxiety disorders, comorbid externalizing disorders, comorbid mood disorders. All analyses were intent-to-treat analyses. Results: Children with comorbid depression were the least likely to be free of their primary anxiety diagnosis at the end of treatment and follow-up. According to child and maternal reports, symptoms of anxiety decreased similarly over time in all groups, but children with comorbid mood disorders scored significantly highest at all time points. Examining the effects of anxiety treatment on comorbid disorders showed that comorbid mood disorders, but not externalizing disorders, decreased significantly over time. Conclusions: The existence of comorbid disorders does not appear to affect the rate or extent of response to cognitive-behavioral treatment for child anxiety. However, comorbidity has a marked influence on the endpoint of treatment. Children with nonanxiety comorbidity and especially with comorbid mood disorders exhibit greater severity at the outset and remain worse after treatment. On the positive side, treatment for anxiety disorders appears to decrease comorbid mood disorders, although it has less effect on comorbid externalizing disorders. (Contains 3 tables.)

In order to treat adolescent depression, a number of empirically supported treatments (ESTs) have been developed from both the cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT-A) frameworks. Research has shown that in order for these treatments to be implemented in routine clinical practice (RCP), effective therapist training must be generated and provided. However, before such training can be developed, a good understanding of the therapist competencies needed to implement these ESTs is required. Sburlati et al. ("Clin Child Fam Psychol Rev" 14:89-109, 2011) developed a model of therapist competencies for implementing CBT using the well-established Delphi technique. Given that IPT-A differs considerably to CBT, the current study aims to develop a model of therapist competencies for the implementation of IPT-A using a similar procedure as that applied in Sburlati et al. ("Clin Child Fam Psychol Rev" 14:89-109, 2011). This method involved: (1) identifying and reviewing an empirically supported IPT-A approach, (2) extracting therapist competencies required for the implementation of IPT-A, (3) consulting with a panel of IPT-A experts to generate an overall model of therapist competencies, and (4) validating the overall model with the IPT-A manual author. The resultant model offers an empirically derived set of competencies necessary for effectively treating adolescent depression using IPT-A and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines. This model, therefore, provides an empirical framework for the development of dissemination and implementation programs aimed at ensuring that adolescents with depression receive effective care in RCP settings. Key similarities and differences between CBT and IPT-A, and the therapist competencies required for implementing these treatments, are also highlighted throughout this article.

Objective: Behavioral inhibition (BI) in early childhood is associated with increased risk for anxiety. The present research examines BI alongside family environment factors, specifically maternal negativity and overinvolvement, maternal anxiety, and mother-child attachment, with a view to providing a broader understanding of the development of child anxiety. Method: Participants were 202 children classified at age 4 years as either behaviorally inhibited (N = 102) or behaviorally uninhibited (N = 100). Family environment, BI and child anxiety were assessed at baseline and child anxiety and BI were assessed again 2 years later when participants were 6 years of age. Results: After controlling for baseline anxiety, BI participants were significantly more likely to meet criteria for a diagnosis of social phobia and generalized anxiety disorder at follow-up. Path analysis suggested that maternal anxiety significantly affected child anxiety over time, even after controlling for the effects of BI and baseline anxiety. No significant paths from parenting or attachment to child anxiety were found. Maternal overinvolvement was significantly associated with BI at follow-up. Conclusions: At age 4 years, BI, child anxiety, maternal anxiety, and maternal overinvolvement represent risk factors for anxiety at age 6 years. Furthermore, overinvolved parenting increases risk for BI at age 6, which may then lead to the development of anxiety in later childhood. (Contains 3 figures and 3 tables.)

While a plethora of cognitive behavioral empirically supported treatments (ESTs) are available for treating child and adolescent anxiety and depressive disorders, research has shown that these are not as effective when implemented in routine practice settings. Research is now indicating that is partly due to ineffective EST training methods, resulting in a lack of therapist competence. However, at present, the specific competencies that are required for the effective implementation of ESTs for this population are unknown, making the development of more effective EST training difficult. This study therefore aimed to develop a model of therapist competencies for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders using a version of the well-established Delphi technique. In doing so, the authors: (1) identified and reviewed cognitive behavioral ESTs for child and adolescent anxiety and depressive disorders, (2) extracted therapist competencies required to implement each treatment effectively, (3) validated these competency lists with EST authors, (4) consulted with a panel of relevant local experts to generate an overall model of therapist competence for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders, and (5) validated the overall model with EST manual authors and relevant international experts. The resultant model offers an empirically derived set of competencies necessary for effectively treating children and adolescents with anxiety and depressive disorders and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines for working with this population. This model thus brings us one step closer to bridging the gap between science and practice when treating child and adolescent anxiety and depression.

Objective: The present study determined interrater agreement on diagnoses achieved using the parent and child versions of the Anxiety Disorders Interview Schedule for Children for DSM-IV (ADIS-C/P) and examined informant, age, and gender influences on reliability. Method: Diagnoses established for 153 seven- to 16-year-old children during live administration of the ADIS-C/P were compared to diagnoses identified by a second rater after viewing a video recording of the interviews. Results: When information from both parent and child interviews was used, the level of agreement between raters for principal diagnosis ([kappa] = 0.92) and the individual anxiety disorders ([kappa] = 0.80-1.0) was excellent. Agreement on common comorbid disorders was good ([kappa] = 0.65-0.77). Agreement was also good to excellent when diagnoses were assigned based on separate child or parent interviews, aside from children's report of externalizing disorders. Age and gender did not consistently impact interrater agreement. Conclusions: The data indicate that the present version of the ADIS-C/P provides consistent diagnostic results across different clinicians and indicates improvements in the reliability of diagnoses following criterion changes in DSM-IV. (Contains 4 tables.)

The current trial examined the value of modifying empirically validated treatment for childhood anxiety for application via written materials for parents of anxious children. Two hundred sixty-seven clinically anxious children ages 6-12 years and their parents were randomly allocated to standard group treatment, wait list, or a bibliotherapy version of treatment for childhood anxiety. In general, parent bibliotherapy demonstrated benefit for children relative to wait list but was not as efficacious as standard group treatment. Relative to wait list, use of written materials for parents with no therapist contact resulted in around 15% more children being free of an anxiety disorder diagnosis after 12 and 24 weeks. These results have implications for the dissemination and efficient delivery of empirically validated treatment for childhood anxiety.

Objective: The current study determined the viability of using the telephone to facilitate assessment of children using the Anxiety Disorders Interview Schedule for children for DSM-IV (ADIS-C-IV). Method: Diagnoses established during telephone administration of the ADIS-C-IV-Parent version were compared with diagnoses obtained during standard administration of the ADIS-C-IV using both Child and Parent versions. Seventy-three children and their parents participated in counterbalanced, repeated assessments. Results: The level of agreement between telephone and standard administration for principal diagnosis ([kappa] = 0.86), individual anxiety disorders ([kappa] = 0.63-0.86), and other disorders ([kappa] = 0.79-0.91) were in the good to excellent range. Additionally, agreement on overall suitability for an anxiety treatment program was excellent ([kappa] = 0.97). Conclusions: The data indicate that telephone administration of the ADIS-C-IV is a valid way to differentiate children who have anxiety disorders from those who have no disorder or other disorders, providing a less resource-demanding alternative to face-to-face assessment. J. Am. Acad. Child Adolesc. Psychiatry, 2005;44(3):274-282. Key Words: child anxiety, telephone assessment, structured interview.