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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.)

Objective: Computerized cognitive behavioral interventions for anxiety disorders in adults have been shown to be efficacious, but limited data are available on the use of computerized interventions with young persons. Adolescents in particular are difficult to engage in treatment and may be especially suited to computerized technologies. This paper describes the results of a small randomized controlled trial of the Cool Teens program for adolescent anxiety, and examines potential barriers to treatment and user preferences of computerized technology in this population. Method: Forty-three adolescents with a primary diagnosis of anxiety were randomly allocated to the Cool Teens program, a 12-week computerized cognitive-behavioral therapy program for anxiety management, or a 12-week wait list. Effects on symptoms, negative thoughts, and life interference were assessed at post-treatment and 3-month follow-up, based on diagnosis as well as self and maternal report. Results: Using mixed-model analyses, at post-treatment and follow-up assessments, adolescents in the Cool Teens condition, compared with those on the wait list, were found to have significant reductions in the total number of anxiety disorders, the severity of the primary anxiety disorder, and the average severity for all disorders. These results were matched by significant reductions in mother and child questionnaire reports of anxiety, internalizing symptoms, automatic thoughts, and life interference. Further few barriers to treatment were found, and user preferences indicated that the computerized treatment was well suited to adolescents with anxiety. Conclusions: The Cool Teens program is efficacious for treatment of adolescent anxiety. Clinical trial registration information-A randomized controlled trial of the Cool Teens computerized program for anxious adolescents compared with waist list; http://www.anzctr.org.au; ACTRN12611000508976. (Contains 4 tables and 1 figure.)

The efficacy of early intervention for preschool-aged children at risk of anxiety disorders is investigated. Brief early intervention delivered through parents can reduce anxiety and associated risk and may alter the developmental trajectory of anxiety in some young children.

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.)

Objective: Stepped care is embraced as an ideal model of service delivery but is minimally evaluated. The aim of this study was to evaluate the efficacy of cognitive-behavioral therapy (CBT) for child anxiety delivered via a stepped-care framework compared against a single, empirically validated program.Method: A total of 281 youth with anxiety disorders (6-17 years of age) were randomly allocated to receive either empirically validated treatment or stepped care involving the following: (1) low intensity; (2) standard CBT; and (3) individually tailored treatment. Therapist qualifications increased at each step.Results: Interventions did not differ significantly on any outcome measures. Total therapist time per child was significantly shorter to deliver stepped care (774 minutes) compared with best practice (897 minutes). Within stepped care, the first 2 steps returned the strongest treatment gains.Conclusion: Stepped care and a single empirically validated program for youth with anxiety produced similar efficacy, but stepped care required slightly less therapist time. Restricting stepped care to only steps 1 and 2 would have led to considerable time saving with modest loss in efficacy. Clinical trial registration information-A Randomised Controlled Trial of Standard Care Versus Stepped Care for Children and Adolescents With Anxiety Disorders; http://anzctr.org.au/; ACTRN12612000351819. [ABSTRACT FROM AUTHOR]

Objective: Of the few risk factors identified for the development of anxiety disorders, behavioral inhibition has received the strongest support. However, studies examining prediction of anxiety disorder from inhibition over time have not been extensive, and very few have assessed the impact of inhibition assessed early in life on anxiety in adolescence. Method: The current study assessed 3 risk factors among 91 children when they were approximately 4 years of age, and determined anxiety diagnoses when the children were in midadolescence (mean age, 15 years). Children were included in the study at preschool age if they scored high (n = 57) or low (n = 34) on behavioral inhibition. Maternal anxiousness and maternal attitudes toward the child were assessed at the same time. Diagnoses at age 15 years were categorized as social anxiety disorder or other anxiety disorders. Results: Social anxiety disorder at age 15 years was predicted by both inhibition and maternal anxiousness at age 4 years, whereas other anxiety disorders were predicted only by maternal anxiousness. Almost 37% of inhibited preschool-aged children demonstrated social anxiety disorder at age 15, compared with 15% of uninhibited children. Conclusions: The results support a growing body of research pointing to the importance of behavioral inhibition as a risk for social anxiety well into adolescence, and also highlight maternal anxiousness as a more general risk across anxiety disorders. [ABSTRACT FROM AUTHOR]

The article presents a case study which examines potential obstacles to treatment of anxiety disorders in adolescents and user preferences of computer technology. Adolescents that took part in the randomized controlled trial of the Cool Teens anxiety control program engaged in a computerized cognitive-behavioral therapy program for anxiety management. Results suggest that adolescents that took part in the program noticed reductions in the severity of anxiety disorders.

The article focuses on a study which examines the efficacy of early parenting intervention for preschool-aged children with anxiety and behavioral inhibition disorders. The study demonstrates the high levels of inhibition of selected children of parents with a current anxiety disorder. Methods of the study include the controlled trials which examine the early intervention with strategies on graded exposure, contingency management, parent training, and parent anxiety management to help reduce the risk of anxiety in preschool-aged children. Results of the study emphasize that children with parent intervention show a significant reduction in the severity of anxiety disorders.

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-l V-Parent version were compared with diagnoses obtained during standard administration of the AD1S-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 (K = 0.86), individual anxiety disorders (K = 0.63-0.86), and other disorders (K = 0.79-0.91) were in the good to excellent range. Additionally, agreement on overall suitability for an anxiety treatment program was excellent (K = 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. [ABSTRACT FROM AUTHOR]

Objective: The Cool Little Kids parenting group program is an effective intervention for preventing anxiety disorders in young children who are at risk because of inhibited temperament. The program has six group sessions delivered by trained psychologists to parents of 3- to 6-year-old children. An online adaptation (Cool Little Kids Online) has been developed to overcome barriers to its wide dissemination in the community. This study tested the efficacy of Cool Little Kids Online in a randomized controlled trial.Method: A total of 433 parents of a child aged 3 to 6 years with an inhibited temperament were randomized to the online parenting program or to a 24-week waitlist. The online program has 8 interactive modules providing strategies that parents can implement with their child to manage their child's avoidant coping, reduce parental overprotection, and encourage child independence. Parents were provided telephone consultation support with a psychologist when requested. Parents completed self-report questionnaires at baseline and at 12 and 24 weeks after baseline.Results: The intervention group showed significantly greater improvement over time in child anxiety symptoms compared to the control group (d = 0.38). The intervention group also showed greater reductions in anxiety life interference (ds = 0.33-0.35) and lower rates of anxiety disorders than the control group (40% versus 54%), but there were minimal effects on broader internalizing symptoms or overprotective parenting.Conclusion: Results provide empirical support for the efficacy of online delivery of the Cool Little Kids program. Online dissemination may improve access to an evidence-based prevention program for child anxiety disorders. Clinical trial registration information-Randomised Controlled Trial of Cool Little Kids Online: A Parenting Program to Prevent Anxiety Problems in Young Children; http://www.anzctr.org.au/; 12615000217505. [ABSTRACT FROM AUTHOR]

Objective: We examined the effectiveness of targeted school-based cognitive-behavioral therapy (CBT) for adolescents (12-16 years of age) with anxiety, and tested whether brief CBT was noninferior to standard duration CBT.Method: A randomized controlled study of 313 adolescents (mean 14.0 years, SD = 0.84, 84% girls) were recruited through school health services to 10 weeks CBT group interventions. Groups of 5 to 8 adolescents were randomly allocated to brief (5 sessions, comprising 5.5 hours) or standard CBT (10 sessions, comprising 15 hours), or 10 weeks waitlist (WL). Self-reported and parent-reported youth anxiety symptoms, impairment from anxiety, depressive symptoms,and clinical severity were assessed pre- and postintervention, after WL, and at 1-year follow-up.Results: Targeted school based CBT significantly reduced adolescents' anxiety symptoms with small to moderate effect sizes compared to WL (Cohen d = 0.34 for youth report and d = 0.53 for parent report). According to the parents, also adolescents' impairment from anxiety was significantly reduced compared to WL (d = 0.51). Pre to post changes in anxiety symptoms were small to moderate (within-group effect sizes between d = 0.41 and d = 0.67). Although no significant differences in effects were found between brief and standard CBT, brief CBT was not noninferior to standard CBT. Outcomes from both interventions were sustained at 1-year follow-up.Conclusion: Targeted school-based CBT interventions reduced anxiety, impairment, and depressive symptoms in adolescents. Both brief and standard CBT demonstrated efficacy, but brief CBT was not noninferior to standard CBT. By administering school-based CBT to youths with anxiety symptoms, we may reach young people with effective interventions at an earlier phase in their lives.Clinical Trial Registration Information: School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/; NCT02279251. [ABSTRACT FROM AUTHOR]