Search

Background: Paediatric anxiety disorders are associated with substantial disability and long-term adverse consequences, but only a small proportion of affected children have access to evidence-based treatment. Internet-delivered cognitive behavioural therapy (ICBT) could help increase accessibility but needs further rigorous assessment. We aimed to assess the efficacy and cost-effectiveness of ICBT in the treatment of paediatric anxiety disorders. Methods: We did a single-blind randomised controlled trial in a clinical research unit within the Child and Adolescent Mental Health Services in Stockholm (Sweden). Eligible participants were children aged 8-12 years with a diagnosis of a principal anxiety disorder (seperation anxiety disorder, generalised anxiety disorder, specific phobia, social anxiety disorder, or panic disorder) of at least moderate severity. We randomly allocated participants (1:1) to ICBT or internet-delivered child-directed play, an active comparator aimed to improve parent child relationships and increase a child's self-esteem without directly targeting anxiety. Block sizes for the randomisation varied between four and six and were generated using a computer random-number generator, and the allocation was concealed from the researchers by opaque sealed envelopes. Both treatment programmes comprised 12 modules presented over 12 weeks with weekly asynchronous online therapist support, and consisted of texts, films, illustrations, and exercises. The primary outcome was severity rating of the principal anxiety disorder 12-weeks post-treatment, via the Anxiety Disorder Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders-IV (a rating of at least 4 corresponds to meeting the criteria for the principal diagnosis), assessed by clinicians masked to treatment allocation. All participants were included in the primary analysis (intention-to-treat). This trial is registered at ClinicalTrials.gov, number NCTO 2350257. Findings: Between M

Objectives: Social anxiety disorder (SAD) is one of the most common psychiatric disorders in youth, with a prevalence of about 3%–4% and increased risk of adverse long-term outcomes, such as depression. Cognitive–behavioural therapy (CBT) is considered the first-line treatment for youth with SAD, but many adolescents remain untreated due to limited accessibility to CBT. The aim of this study was to develop and evaluate the feasibility and preliminary efficacy of a therapist-guided internet-delivered CBT treatment, supplemented with clinic-based group exposure sessions (BIP SOFT). Design: A proof-of-concept, open clinical trial with 6-month follow-up. Participants: The trial was conducted at a child and adolescent psychiatric research clinic, and participants (n=30) were 13–17 years old (83% girls) with a principal diagnosis of SAD. Intervention: 12 weeks of intervention, consisting of nine remote therapist-guided internet-delivered CBT sessions and three group exposure sessions at the clinic for the adolescents and five internet-delivered sessions for the parents. Results: Adolescents were generally satisfied with the treatment, and the completion rate of internet modules, as well as attendance at group sessions, was high. Posttreatment assessment showed a significant decrease in clinician-rated, adolescent-rated and parent-rated social anxiety (d=1.17, 0.85 and 0.79, respectively), as well as in general self-rated and parent-rated anxiety and depression (d=0.76 and 0.51), compared with pretreatment levels. Furthermore, 47% of participants no longer met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for SAD at posttreatment. At a 6-month follow-up, symptom reductions were maintained, or further improved, and 57% of participants no longer met criteria for SAD. Conclusion: Therapist-guided and parent-guided internetdelivered CBT, supplemented with a limited number of group exposure sessions, is a feasible and promising interventi, This work was supported by the Stockholm County Council (PPG project20150032; HSNV 140 99; HSN 1011-1176) and the Swedish Research Council and Swedish Research Council for Health, Working Life and Welfare (Forte 2014-4052).

Aggressive and disruptive behaviors in childhood are one of the most common reasons for referral to child psychiatric clinics and are predictive of a range of negative health outcomes later in life. The present thesis comprises four studies of parent training (PT) interventions targeting conduct problems (CP) in children aged 3 to 12. The main objectives were to evaluate issues pertaining to short- and long-term effects, dissemination modalities (Internet-based and face-to-face delivery) and predictors of change. Study I was a randomized controlled trial including parents of 104 children who were allocated to either an Internet-based PT program or a waitlist condition. At post-test, intervention families had improved significantly in parent-reported child CP and parenting practices, compared with waitlist families. Between-group effects sizes were in the moderate range for CP reductions, i.e., similar to effects commonly reported in meta-analyses of face-to-face PT programs. Study II concerned prediction of outcome for intervention families in the study-I sample. Results showed that children with elevated levels of callous-unemotional (CU) traits benefitted less from the Internet-based PT program, compared with low-CU children, despite the fact that parents of high-CU children reported increased use of positive/praiseful parenting, as well as decreased use of harsh parenting, following participation in the Internet-based PT program. Study III employed an 18-month follow-up of intervention families (from the study-I sample) showing further improvements of child CP and mostly maintenance of treatment gains in other domains (e.g., hyperactivity and prosocial behaviors). Within the same study, associations between homework compliance and outcomes were investigated. Results indicated that higher parental engagement in homework tasks related to conflict management (ignoring misbehavior and time out) was associated with greater reductions of child CP, compared to less enga