Search

Background: Anxiety problems are extremely common and have an early age of onset. We previously found, in a study in England, that fewer than 3% of children with an anxiety disorder identified in the community had accessed an evidence‐based treatment (Cognitive Behavioural Therapy; CBT). Key ways to increase access to CBT for primary school‐aged children with anxiety problems include (a) proactive identification through screening in schools, (b) supporting parents and (c) the provision of brief, accessible interventions (and capitalising on technology to do this). Method: We provided a brief, therapist guided treatment called Online Support and Intervention (OSI) to parents/carers of children identified, through school‐based screening, as likely to have anxiety problems. Fifty out of 131 children from 17 Year 4 classes in schools in England screened positive for 'possible anxiety problems' and 42 (84%) of these (and 7 who did not) took up the offer of OSI. We applied quantitative and qualitative approaches to assess children's outcomes and families' experiences of this approach. Results: Inbuilt outcome monitoring indicated session on session improvements throughout the course of treatment, with substantial changes across measures by the final module (e.g. Child Outcome Rating Scale d = 0.84; Goal Based Outcomes d = 1.52). Parent engagement and satisfaction was high as indicated by quantitative and qualitative assessments, and intervention usage. Conclusions: We provide promising preliminary evidence for the use of OSI as an early intervention for children identified as having anxiety problems through school‐based screening. [ABSTRACT FROM AUTHOR]

Background: Online treatments for child anxiety offer a potentially cost-effective and non-stigmatizing means to widen access to evidence-based treatments and meet the increasing demand on services; however, uptake in routine clinical practice remains a challenge. This study conducted an initial evaluation of the clinical effectiveness, feasibility and acceptability of OSI (Online Support and Intervention for child anxiety) within clinical practice. OSI is a co-designed online therapist-supported, parent-led CBT treatment for pre-adolescent children with anxiety problems. Method: This case series was part of routine service evaluation in a clinic in England where families were offered OSI to treat a primary anxiety difficulty among 7- to 12-year-old children; 24 families were offered OSI, and 23 took it up. Measures of anxiety symptomatology, functional impairment and progress towards therapeutic goals were taken at pre-treatment, post-treatment and 4-week follow-up. Treatment satisfaction and engagement were also measured throughout the intervention. Results: Mean anxiety symptoms significantly improved to below the clinical cut-off post-treatment, with further reduction at follow-up. Functional impairment also significantly improved and significant progress was made towards treatment goals. The majority of children showed reliable change in anxiety symptoms and reliable recovery by follow-up, and were discharged without needing further treatment for anxiety. Uptake, adherence and engagement in OSI were excellent, and parents reported high levels of satisfaction with the treatment. Conclusions: We have provided initial evidence that OSI is feasible, acceptable to families, and appears to be associated with good outcomes within routine clinical practice. [ABSTRACT FROM AUTHOR]

Background: Randomised controlled trials suggest that cognitive behavioural therapy (CBT) delivered by parents who are guided, in groups, by clinicians (Group GPD‐CBT) is an efficacious and potentially efficient treatment approach for child anxiety. The extent to which these results translate to routine settings is unclear. We evaluated Group GPD‐CBT as delivered in UK routine clinical services. Method: Retrospective data regarding attendance and outcomes were routinely collected for 83 children whose parent(s) had attended Group GPD‐CBT. Semistructured interviews were conducted with 14 clinicians who had delivered Group GPD‐CBT. Results: By 3–8 months (M = 5.22, SD = 1.17) post‐treatment, 70% of children were discharged or referred for support for other (non‐anxiety) conditions, without any further intervention for anxiety. Of the subset (N = 20) with available parent‐report symptom data, there was a significant decline in total anxiety score from pre‐ to post‐treatment. Clinician interviews were analysed using thematic analysis. This revealed that clinicians found Group GPD‐CBT to be acceptable and described it as a helpful, practical and empowering treatment for child anxiety. They highlighted additional benefits associated with group process factors (e.g. peer support, enhanced engagement), although noted that some, particularly anxious, parents were reluctant to attend a group format. Conclusions: Results were promising regarding children's outcomes following Group GPD‐CBT delivered in routine practice. Group GPD‐CBT was viewed by clinicians as acceptable and helpful, and group process factors were seen to provide additional benefits. Some parents may find it difficult to attend a group format, suggesting that services should give careful consideration to how groups are presented and introduced to parents. [ABSTRACT FROM AUTHOR]

Anxiety disorders are among the most common psychiatric disorders in children and adolescents. They commonly interfere with peer relationships, schooling and family life, and persist into adulthood if left untreated. This paper gives an overview of the identification, assessment and treatment of anxiety disorders in children and young people. Identification of anxiety disorders is often poor and many young people with anxiety disorders go untreated. We present a brief review of the evidence base for pharmacological and psychological treatment approaches to the management of anxiety disorders in youth. Both have been found to be effective in the treatment of anxiety disorders, although psychological treatments such as Cognitive Behavioural Therapy (CBT) are considered the first-line treatment due to relative benefits in terms of patient safety and parental preference. Low intensity CBT approaches such as bibliotherapy and online therapies are effective and have the potential to improve access to evidence-based interventions. CBT approaches have also been found to be effective with particular patient groups, such as those with long-term physical health conditions and autism spectrum disorders, who are at an increased risk of anxiety disorders. [ABSTRACT FROM AUTHOR]

Background: High levels of parental anxiety are associated with poor treatment outcomes for children with anxiety disorders. Associated parental cognitions and behaviours have been implicated as impediments to successful treatment. We examined the association between parental responsibility beliefs, maternal anxiety and parenting behaviours in the context of childhood anxiety disorders.Methods: Anxious and non-anxious mothers of 7-12 year old children with a current anxiety disorder reported their parental responsibility beliefs using a questionnaire measure. Parental behaviours towards their child during a stressor task were measured.Results: Parents with a current anxiety disorder reported a greater sense of responsibility for their child's actions and wellbeing than parents who scored within the normal range for anxiety. Furthermore, higher parental responsibility was associated with more intrusive and less warm behaviours in parent-child interactions and there was an indirect effect between maternal anxiety and maternal intrusive behaviours via parental responsibility beliefs.Limitations: The sample was limited to a treatment-seeking, relatively high socio-economic population and only mothers were included so replication with more diverse groups is needed. The use of a range of stressor tasks may have allowed for a more comprehensive assessment of parental behaviours.Conclusions: The findings suggest that parental anxiety disorder is associated with an elevated sense of parental responsibility and may promote parental behaviours likely to inhibit optimum child treatment outcomes. Parental responsibility beliefs may therefore be important to target in child anxiety treatments in the context of parental anxiety disorders. [ABSTRACT FROM AUTHOR]

Vitamin A deficiency is a major health risk for infants and children in low- and middle-income countries. This scoping review identified, quantified, and mapped research for use in updating nutrient requirements and upper limits for vitamin A in children aged 0 to 48 months, using health-based or modelling-based approaches. Structured searches were run on Medline, EMBASE, and Cochrane Central, from inception to 19 March 2021. Titles and abstracts were assessed independently in duplicate, as were 20% of full texts. Included studies were tabulated by question, methodology and date, with the most relevant data extracted and assessed for risk of bias. We found that the most recent health-based systematic reviews and trials assessed the effects of supplementation, though some addressed the effects of staple food fortification, complementary foods, biofortified maize or cassava, and fortified drinks, on health outcomes. Recent isotopic tracer studies and modelling approaches may help quantify the effects of bio-fortification, fortification, and food-based approaches for increasing vitamin A depots. A systematic review and several trials identified adverse events associated with higher vitamin A intakes, which should be useful for setting upper limits. We have generated and provide a database of relevant research. Full systematic reviews, based on this scoping review, are needed to answer specific questions to set vitamin A requirements and upper limits. [ABSTRACT FROM AUTHOR]

Background: A large proportion of UK children do not reach the recommended levels of physical activity (PA) required for optimum health. Few studies have investigated the psychosocial correlates of objectively measured PA in preadolescents. This study examined child attitudes and parental behaviours as correlates of children’s activity. Methods: In total, 278 children (138 boys and 140 girls) aged 7–9 years were recruited as part of the Physical Exercise and Appetite in Children Study (PEACHES). Activity was objectively measured using the Actigraph GT1M accelerometer; the variables were total PA (mean accelerometer counts min−1) and moderate and vigorous PA (MVPA) >2000 counts min−1. Child-focussed variables were self-efficacy (Physical Activity Self-Efficacy scale), physical performance self-concept (Self-Perception Profile for Children), positive and negative outcome expectancies and liking for PA. Parental variables were PA and support for child activity. Results: Significant sex-by-psychosocial outcome interactions were observed for total PA and MVPA, so data from boys and girls were analysed separately. No psychosocial or parental outcomes were correlated with activity in girls. Significant correlates of activity in boys (self-efficacy, self-concept and parental support) were entered in to a hierarchical regression using both total PA and MVPA and, controlling for BMI SD, SES and ethnicity. PA self-efficacy and self-concept were significantly independently associated with total PA, explaining around 12% of the variance. Self-efficacy was significantly associated with time spent in MVPA, also explaining around 12% of the variance in this behaviour. Parental support was not significant in the regression model. Conclusion: PA self-efficacy and self-concept are significant correlates of objectively measured PA in UK boys. [ABSTRACT FROM AUTHOR]