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Findings have been mixed regarding the relationship between comorbid depression and anxiety and treatment outcomes for anxious youth. The current study compared a sample of anxious youth with a comorbid depressive disorder (n = 20) and those without comorbid depression (n = 137). All participants received 16 weekly sessions of Coping Cat and completed measures assessing anxiety/depression severity, impairment, and functioning at pretreatment and posttreatment. Results indicated that anxiety-focused CBT is efficacious for anxious youth with and without comorbid depressive disorders, with a higher rate of symptom improvement for youth with comorbid depression during treatment. However, comorbid depression was associated with higher severity at baseline and after treatment. Thus, despite the higher rate of symptom improvement, anxious youth with comorbid depression may benefit from additional treatment to address remaining symptoms.

OBJECTIVE: Accommodation, or the ways in which families modify their routines and expectations in response to a child’s anxiety, is common and interferes with anxiety treatment outcomes. However, little research has examined family accommodation among youth with autism spectrum disorder and anxiety. The current study aimed to (a) identify pre-treatment correlates of accommodation, (b) examine changes in accommodation after treatment, and (c) assess relationships between accommodation and post-treatment anxiety severity. METHOD: The sample consisted of 167 youth (mean age=9.90 years; 79.6% male; 18% Latinx) with clinically significant anxiety and a diagnosis of autism spectrum disorder who were enrolled in a randomized clinical trial comparing two cognitive behavioral therapy interventions for anxiety and treatment as usual. Participants were evaluated for symptom severity and family accommodation at pre- and post-treatment. RESULTS: Results indicated that clinician-rated anxiety severity and parent-rated externalizing behaviors and autism spectrum disorder severity significantly predicted pre-treatment accommodation. Accommodation significantly decreased from pre- to post-treatment and non-responders showed significantly higher accommodation at post-treatment compared to responders. Finally, youth with higher pre-treatment accommodation had higher post-treatment anxiety. CONCLUSIONS: Findings indicate that accommodation for anxiety is common among youth with autism spectrum disorder and anxiety. Furthermore, accommodation is implicated in treatment outcomes and should be targeted in treatment for youth with autism spectrum disorder and anxiety.

The current study explored whether patient characteristics predicted patterns of antidepressant use (i.e., never used, single episode of use, or two or more episodes) in a naturalistic follow-up. Participants in the child/adolescent multimodal (CAMS) extended long-term study. (n = 318) indicated medication use over the course of eight follow-up visits, 3-12 years after receiving treatment in CAMS. 40.6% of participants reported never using an antidepressant during follow-up, 41.4% reported a single episode of antidepressant use, and 18.0% reported multiple episodes of antidepressant use. Greater baseline anxiety severity marginally predicted a single episode of antidepressant use; baseline depression severity predicted multiple episodes of use. Reasons for discontinuing antidepressants included perceived ineffectiveness (31.8%), side effects (25.5%), and improvement in symptoms (18.5%). Exploratory analyses examined predictors of medication use. Findings suggest that antidepressant use is common among anxious youth, as is discontinuation of antidepressant use. Clinical implications and future directions are discussed.

Cognitive behavioral therapy (CBT) is well established as an efficacious treatment for anxious youth, yet a number of youth remain symptomatic after the 10–16 sessions of treatment stipulated by most CBT treatment manuals. While a significant minority do not respond, no study has examined the frequency and impact of additional therapy sessions. This study examined youth receiving outpatient therapy at an anxiety clinic who were offered the option to continue treatment after completing 16 sessions of manual-based CBT. Fifty-nine percent of participants chose to continue treatment, with an average of approximately 20 total sessions across participants. Therapist ratings demonstrated a significant overall improvement between session 16 and the final session. No pre-treatment measure of symptom severity differed between those who extended treatment and those who ended at session 16. Parent-rated anxiety differed between groups at session 16, as did the length of time between the pre-treatment assessment and week 16 assessments. Findings indicate that extending treatment is not uncommon, is typically limited to several additional sessions, and is associated with an increase in treatment gains. Current results suggest that two factors at session 16, parental perceptions of anxiety and time to complete 16 sessions, are influential and may be central to the decision to continue treatment past this point. Clinical implications and future directions are discussed.

Accommodation refers to the ways in which parents or other family members modify routines or expectations to alleviate a child’s symptoms and emotional distress. In the context of youth obsessive-compulsive disorder (OCD) and anxiety, accommodation contributes to both the development and the maintenance of the disorder. We review the literature on accommodation in youths, including evidence for the central role that accommodation plays in the maintenance of OCD and anxiety. We then highlight several issues requiring further research, including the role of accommodation in other disorders and settings.

Anxiety disorders are highly prevalent among youth, with comorbid diagnoses being the norm, not the exception. Few guidelines exist regarding the best approach to treating anxious youth with comorb...

Accommodation refers to the ways in which family members act to alleviate a child's symptoms and distress. In the context of youth obsessive-compulsive disorder (OCD) and anxiety, accommodation may contribute to the development and maintenance of the disorder. We review the theory and research literature on accommodation, including measures of accommodation. Findings support the idea that accommodation is not a preferred parenting strategy; the sequelae of accommodation are negative and are often associated with both parent and sibling distress. Accommodation should be assessed and targeted in treatment for youth OCD and anxiety. We conclude by identifying several areas for future research, including the development of interventions that specifically target accommodation, the evaluation of potential family factors implicated in accommodation, and the exploration of the construct of accommodation in other childhood disorders.

Anxiety in youth is a concern, and stepped care provides appropriate services for differential levels of distress and increases the number of youth able to receive services. Youth, and families, with mild anxiety benefit from print and Internet resources. Youth whose anxiety persists can receive direct guidance (e.g., computer-assisted programs). A third step increases the intensity of services (e.g., therapy). Finally, for severely problematic anxiety, intensive programs may be needed. Throughout, it is important to monitor anxiety and related impairment as well as to take into account client and family characteristics. Research on interventions within each step has identified many to be efficacious, but studies are needed to examine the decision-making features as well as the effectiveness of a stepped care approach.

Background Parental accommodation refers to the ways in which a parent modifies their behavior to avoid or reduce the distress their child experiences. Parents of youth with anxiety disorders have been found to accommodate their child's anxiety in a variety of ways that contribute to the maintenance of the disorder. The current study evaluated the relationship between parental accommodation and the outcome of treatment for youth with anxiety. Methods Sixty-two youth (age 6–17) and their parents were evaluated for youth anxiety and parental accommodation before and after treatment. All youth received individual cognitive behavioral therapy (CBT). Results Parental accommodation was significantly reduced from before to after treatment. Reduction in parent-rated accommodation was significantly associated with the severity of youth's posttreatment anxiety, even when controlling for pretreatment youth anxiety. Level of pretreatment accommodation was significantly associated with treatment response. Conclusions Findings indicate that parental accommodation is significantly reduced after individual youth CBT, and suggest that accommodation may be an important treatment focus. Clinical implications and future directions are discussed.

This paper describes the rationale, design, and methods of the Treatment for Anxiety in Autism Spectrum Disorders study, a three-site randomized controlled trial investigating the relative efficacy of a modular CBT protocol for anxiety in ASD (Behavioral Interventions for Anxiety in Children with Autism) versus standard CBT for pediatric anxiety (the Coping Cat program) and a treatment-as-usual control. The trial is distinct in its scope, its direct comparison of active treatments for anxiety in ASD, and its comprehensive approach to assessing anxiety difficulties in youth with ASD. The trial will evaluate the relative benefits of CBT for children with ASD and investigate potential moderators (ASD severity, anxiety presentation, comorbidity) and mediators of treatment response, essential steps for future dissemination and implementation.

Cognitive behavioral therapy (CBT) is an empirically supported and well-established treatment for youth anxiety disorders. CBT therapists often involve parents and school staff in treatment to promote the generalization of therapeutic gains across settings. To facilitate therapist communication with those who provide collateral support, we discuss both general guidelines and specific examples of how parents and teachers can best support anxious youth by acting as coping models, labeling and validating anxious feelings, rewarding brave behavior, and reducing accommodations. We provide answers to questions commonly asked by parents (e.g., “How should I respond ‘in the moment’ when my child is anxious?”) and by school personnel (e.g., “What is a useful role for a school in child treatment”). Handouts summarizing main concepts for parents and schools are provided.

Anxiety disorders are one of the most common mental health problems that children and adolescents experience worldwide, including in Australia. Anxiety is an innate reaction to a real and/or perceived threat. Although everyone experiences anxiety, youth with anxiety disorders experience excessive, pervasive and often unfounded fear or worry that can negatively impact ones’ academic, social and family life. When left untreated anxiety can lead to a number of mental health problems, as well as academic underachievement. Schools represent an ideal setting for the assessment and treatment of anxiety in youth given that youth spend the majority of their day at school and often display anxiety there. School personnel are uniquely able to identify the emergence of anxiety and can provide treatment therefore limiting common barriers of transportation and scheduling. Determination of clinical levels of anxiety is indicated by the level of interference and distress in the child’s life. Well-validated and commonly used measures to assess this include measures such as the Anxiety Disorders Interview Schedule, Multidimensional Anxiety Scale for Children, and the Spence Children’s Anxiety Scale. The most efficacious psychological treatment for youth with anxiety disorders is cognitive behavioural therapy, which teaches youth skills to reduce anxiety to manageable levels by developing more helpful thinking patterns and reducing behavioural avoidance. It is important to consider the advantages and disadvantages of identifying children at risk within the school setting, and to consider ethical and legal issues related to delivering treatment within the school setting.

Parental accommodation refers to the ways in which a parent modifies their behavior to avoid or reduce the distress their child experiences. Parents of youth with anxiety disorders have been found to accommodate their child's anxiety in a variety of ways that contribute to the maintenance of the disorder. The current study evaluated the relationship between parental accommodation and the outcome of treatment for youth with anxiety.Sixty-two youth (age 6-17) and their parents were evaluated for youth anxiety and parental accommodation before and after treatment. All youth received individual cognitive behavioral therapy (CBT).Parental accommodation was significantly reduced from before to after treatment. Reduction in parent-rated accommodation was significantly associated with the severity of youth's posttreatment anxiety, even when controlling for pretreatment youth anxiety. Level of pretreatment accommodation was significantly associated with treatment response.Findings indicate that parental accommodation is significantly reduced after individual youth CBT, and suggest that accommodation may be an important treatment focus. Clinical implications and future directions are discussed.