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Background: To bring evidence-based interventions (EBIs) to individuals with behavioral health needs, psychosocial interventions must be delivered at scale. Despite an increasing effort to implement effective treatments in communities, most individuals with mental health and behavioral problems do not receive EBIs. We posit that organizations that commercialize EBIs play an important role in disseminating EBIs, particularly in the USA. The behavioral health and implementation industry is growing, bringing the implementation field to an important inflection point: how to scale interventions to improve access while maintaining EBI effectiveness and minimizing inequities in access to psychosocial intervention. Main body: We offer a first-hand examination of five illustrative organizations specializing in EBI implementation: Beck Institute for Cognitive Behavioral Therapy; Incredible Years, Inc.; the PAXIS Institute; PracticeWise, LLC; and Triple P International. We use the Five Stages of Small Business Growth framework to organize themes. We discuss practical structures (e.g., corporate structures, intellectual property agreements, and business models) and considerations that arise when trying to scale EBIs including balancing fidelity and reach of the intervention. Business models consider who will pay for EBI implementation and allow organizations to scale EBIs. Conclusion: We propose research questions to guide scaling: understanding the level of fidelity needed to maintain efficacy, optimizing training outcomes, and researching business models to enable organizations to scale EBIs. [ABSTRACT FROM AUTHOR]

An editorial is presented on the importance of utilizing ethical research methods, particularly longitudinal designs, to address significant questions in mental health. Topics discussed include the evaluation of the intergenerational effects of interventions like the Fast Track program, the impact of corporal punishment reduction, and the challenges of dissemination and implementation in schools.

Objective: To improve outcomes and create more personalized interventions, the field has sought to identify moderators of treatment response (variables that specify which treatments work for whom and under what conditions). Method: The current review examines moderators of youth anxiety treatments. Results: The majority of studies to date have examined variables of convenience, including demographics (age, sex, race, ethnicity, socioeconomic status), pretreatment youth clinical characteristics (anxiety severity, principal diagnosis, comorbidity) and pretreatment parent variables (parent psychopathology, parenting). Findings indicate few consistent moderators. Conclusions: Future directions are discussed, including (a) group to individual generalizability, (b) power considerations, and (c) updates to study design and measure selection. [ABSTRACT FROM AUTHOR]

The Coping Questionnaire (CQ)—child and parent version—is an idiographic measure of youth's perceived ability to cope in anxiety provoking situations. Participants (N = 442; aged 7–17) met DSM-IV criteria for separation anxiety disorder, generalized anxiety disorder, or social anxiety disorder. The internal consistency of the CQ was supported, and retest reliability and parent/child agreement were, as expected, modest. The CQ scores were significantly correlated in the expected direction with measures of anxiety symptoms and functioning, providing evidence of convergent and divergent validity. The criterion validity of the CQ also was supported: the CQ scores were significantly correlated with the clinical severity rating of the youth's principal diagnosis on ADIS. There was a significant correlation between change in CQ scores and in anxiety severity and symptoms following treatment. Results support the CQ as a measure to assess coping efficacy in anxious youths as part of evidence-based assessment. [ABSTRACT FROM AUTHOR]

The Coping Cat protocol has shown both efficacy and effectiveness in the treatment of youth anxiety across numerous randomized controlled trials (RCTs), leading to its designation as an empirically supported treatment. The treatment is completed in two phases. In the first phase, children are taught a series of coping skills outlined using the FEAR plan acronym. The FEAR plan is then practiced in exposure tasks during the second phase of treatment. To illustrate implementation of both phases, and highlight core treatment components (i.e., exposure, flexibility within fidelity), a case description is presented. Directions for future research are discussed. [ABSTRACT FROM AUTHOR]

The current study examined emotional awareness as a predictor of differential outcomes for youth treated for an anxiety disorder. 37 youth ages 7-15 received either individual cognitive-behavioral therapy or family cognitive-behavioral therapy to treat generalized anxiety disorder, separation anxiety disorder, and/or social phobia. Diagnoses were determined by independent evaluators, following semi-structured interviews (ADIS-IV-C/P) with youth and their parents. Self-report questionnaires, including the multidimensional anxiety scale for children and the emotion expressivity scale for children, were completed at pre- and posttreatment. Youth with higher levels of pretreatment emotional awareness had better treatment outcomes than youth with lower levels of emotional awareness, with specific regard to improved ability to cope with worry. Findings suggest that higher levels of emotional awareness facilitate better specific outcomes for anxious youth. Findings highlight the importance of understanding the emotions associated with worry during the treatment process. [ABSTRACT FROM AUTHOR]

The Child Behavior Checklist (CBCL) is widely used to assess behavioral and emotional problems in youth. The CBCL Diagnostic and Statistical Manual (DSM)-Oriented Anxiety Problems subscale (CBCL-AP) was developed for the identification of DSM-IV anxiety disorders. Using data from 298 youth aged 6- to 18, the CBCL-AP scale was examined to determine its ability to differentially predict, via Receiver Operating Characteristics (ROC) analysis, the presence of (a) generalized anxiety disorder (GAD), (b) separation anxiety disorder (SAD), (c) specific phobia (SPPH), or (d) the presence of any of these disorders. Independent Evaluators (IEs) administered the Anxiety Disorders Interview Schedule for Children (ADIS-C/P) to determine the presence of an anxiety disorder. The ability of the CBCL-AP to predict to anxiety disorders was compared to the ability of the CBCL Anxious/Depressed (CBCL-A/D) scale and the seven empirically derived CBCL syndrome subscales and five DSM-Oriented subscales to predict anxiety disorder diagnoses. Results revealed that CBCL-AP scores significantly predicted all diagnoses. CBCL-A/D scores significantly predicted SAD (AUC = 0.67), GAD (AUC = 0.69), and the presence of any of the three disorders (AUC = 0.72), but not the presence of SPPH (AUC = 0.52). Although the CBCL-AP scale may not be a substitute for extensive diagnostics, it has demonstrated utility as an instrument for assessing anxiety and can serve to identify anxious youth in need of mental health services. [ABSTRACT FROM AUTHOR]

Objective: To report functional outcomes from the multisite Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), which examined the impact of youth anxiety treatment (cognitive-behavioral therapy [CBT], coping cat; Sertraline, SRT; COMB [CBT + SRT]; pill placebo) on (a) global and (b) domain-specific functioning assessed an average of 3.1 times, 3- to 12-years postrandomization (first assessment = mean 6.5 years postrandomization). Method: Three-hundred and 19 of 488 families from the Child/Adolescent Anxiety Multimodal Study (CAMS; Walkup et al., 2008) participated. Growth curve modeling examined the impact of treatment condition and acute treatment outcomes (i.e., response, remission) on global functioning, global and domain-specific impairment, and life satisfaction across follow-up visits. Logistic regressions explored the impact of treatment remission and condition on low frequency events (arrests/convictions) and education. Results: Treatment responders and remitters demonstrated better global functioning, decreased overall impairment, and increased life satisfaction at follow-up. Treatment remission, but not response, predicted decreased domain-specific impairment (social relationships, self-care/independence, academic functioning), and maintenance of increased life satisfaction across follow-ups. Participants in the CBT condition, compared with pill placebo, demonstrated improved trajectories pertaining to life satisfaction, overall impairment, and impairment in academic functioning. Randomization to CBT or COMB treatment was associated with increasing employment rates. Trajectories for participants randomized to SRT was not significantly different from placebo. Treatment outcome and condition did not predict legal outcomes, school/work variables, or family life. Conclusion: Positive early intervention outcomes are associated with improved overall functioning, life satisfaction, and functioning within specific domains 6.5 years posttreatment. Treatment type differentially predicted trajectories of functioning. Findings support the positive impact of pediatric anxiety treatment into adolescence and early adulthood. [ABSTRACT FROM AUTHOR]

Little is known about the influence of child behaviors on accommodation of anxiety and how accommodation relates to other parent factors. The present study examined the comparative effect of high and low levels of child distress on mother-reported accommodation, mother factors in relation to accommodation, and moderators of the relation between accommodation and child distress. Maternal perceptions of accommodation were measured by vignettes depicting youth exhibiting high or low levels of distress in anxiety-provoking situations that elicited social anxiety, generalized anxiety, or separation anxiety in a sample of 7- to 17-year-old youth with anxiety disorders (N = 70,M = 11.66, 47.1% male). Findings indicated an effect of child distress on mother-reported accommodation of youth anxiety, such that mothers reported more overall accommodation under conditions of high child distress; situation-level analyses revealed this effect for social and generalized anxiety situations. Furthermore, an association was found between greater mother-reported accommodation and more negative beliefs about their child’s experience of anxiety, which held across situations. Maternal empathy moderated the relation between overall accommodation and child distress. Maternal anxiety also moderated the relation between accommodation and child distress, with results varying based on situation type. Findings, consistent with theory, indicate a relation between child distress and mother-reported accommodation and suggest that maternal beliefs about anxiety are an important treatment target. High maternal empathy may be related to a greater degree of adaptability in response to child behaviors, whereas maternal anxiety may be linked with less adaptive responses to child behaviors. [ABSTRACT FROM PUBLISHER]

Social phobia (SoP) in youth may manifest differently across development as parent involvement in their social lives changes and social and academic expectations increase. This cross-sectional study investigated whether self-reported and parent-reported functioning in youth with SoP changes with age in social, academic, and home/family domains. Baseline anxiety impairment data from 488 treatment-seeking anxiety-disordered youth (ages 7–17,N = 400 with a SoP diagnosis) and their parents were gathered using the Child Anxiety Impact Scale and were analyzed using generalized estimating equations. According to youth with SoP and their parents, overall difficulties, social difficulties, and academic difficulties increased with age, even when controlling for SoP severity. These effects significantly differed for youth with anxiety disorders other than SoP. Adolescents may avoid social situations as parental involvement in their social lives decreases, and their withdrawn behavior may result in increasing difficulty in the social domain. Their avoidance of class participation and oral presentations may increasingly impact their academic performance as school becomes more demanding. Implications are discussed for the early detection and intervention of SoP to prevent increased impairment over the course of development. [ABSTRACT FROM PUBLISHER]

Objective: Test changes in (a) coping efficacy and (b) anxious self-talk as potential mediators of treatment gains at 3-month follow-up in the Child/Adolescent Anxiety Multimodal Treatment Study (CAMS). Method: Participants were 488 youth (ages 7-17; 50.4% male) randomized to cognitive-behavioral therapy (CBT; Coping cat program), pharmacotherapy (sertraline), their combination, or pill placebo. Participants met Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Coping efficacy (reported ability to manage anxiety provoking situations) was measured by youth and parent reports on the Coping Questionnaire, and anxious self-talk was measured by youth report on the Negative Affectivity Self-Statement Questionnaire. Outcome was measured using the Pediatric Anxiety Rating Scale (completed by Independent Evaluators blind to condition). For temporal precedence, residualized treatment gains were assessed at 3-month follow-up. Results: Residualized gains in coping efficacy mediated gains in the CBT, sertraline, and combination conditions. In the combination condition, some unique effect of treatment remained. Treatment assignment was not associated with a reduction in anxious self-talk, nor did anxious self-talk predict changes in anxiety symptoms. Conclusions: The findings suggest that improvements in coping efficacy are a mediator of treatment gains. Anxious self-talk did not emerge as a mediator. [ABSTRACT FROM AUTHOR]

The article focuses on the new research paradigms and effectiveness studies are emerging, randomized clinical trials remain the methodological gold standard for determining whether a treatment can be considered en route to receiving the highly lauded label "empirically supported.

Anxiety disorders are common in adolescents (ages 12 to 18) and contribute to a range of impairments. There has been speculation that adolescents with anxiety are at risk for being treatment nonresponders. In this review, the authors examine the efficacy of cognitive-behavioral therapy (CBT) for adolescents with anxiety. Outcomes from mixed child and adolescent samples and from adolescent-only samples indicate that approximately two-thirds of youths respond favorably to CBT. CBT produces moderate to large effects and shows superiority over control/comparison conditions. The literature does not support differential outcomes by age: adolescents do not consistently manifest poorer outcomes relative to children. Although extinction paradigms find prolonged fear extinction in adolescent samples, basic research does not fully align with the processes and goals of real-life exposure. Furthermore, CBT is flexible and allows for tailored application in adolescents, and it may be delivered in alternative formats (i.e., brief, computer/Internet, school-based, and transdiagnostic CBT). [ABSTRACT FROM AUTHOR]

Objective Evidence for an independent relationship between anxiety and suicidality has been mixed. Few studies have examined this relationship in youth seeking treatment for anxiety. The present study examined the relationship between response to treatment for an anxiety disorder in childhood and suicidal ideation, plans, and attempts at a follow-up interval of 7 to 19 years. We hypothesized that successful treatment for an anxiety disorder in childhood would be protective against later suicidality. Method The present study was a 7- to 19-year (mean = 16.24 years; SD = 3.56 years) follow-up study. Adults (N = 66) completed cognitive-behavioral treatment (CBT) for anxiety as children. Information regarding suicidality at follow-up was obtained via the World Mental Health Survey Initiative version of the World Health Organization Composite International Diagnostic Interview (CIDI) and the Beck Depression Inventory-II (BDI-II). Results Results indicate that participants who responded favorably to CBT during childhood were less likely to endorse lifetime, past-month, and past-2-week suicidal ideation than treatment nonresponders. This was consistent across self-report and interview-report of suicidal ideation. Treatment response was not significantly associated with suicide plans or attempts, although the infrequent occurrence of both limited the ability to detect findings. Conclusion Results suggest more chronic and enduring patterns of suicidal ideation among individuals with anxiety in childhood that is not successfully treated. This study adds to the literature that suggests that successful CBT for childhood anxiety confers long-term benefits and underscores the importance of the identification and evidence-based treatment of youth anxiety. [ABSTRACT FROM AUTHOR]

This study’s objective was to examine associations between comorbid anxiety disorders and difficulties commonly attributed to both anxiety and ASD (autism spectrum disorder) including self-injury, depressive symptoms, functional communication, social skill deficits and parent stress, in a well-characterized sample of youth with ASD. Fifty-nine verbally fluent participants (7–17 years; 93% Caucasian) diagnosed with ASD and their parents completed semistructured diagnostic interviews to confirm ASD diagnosis and assess for anxiety disorders. Parents completed questionnaires on child behavior and social skill as well as parental stress. Co-occurring anxiety disorders were associated with more parent-reported self-injurious behavior, depressive symptoms, and parental stress in youth with ASD, after controlling for other influential variables (e.g., ASD severity, cognitive ability, medication status). In contrast, youth with co-occurring anxiety disorders appeared to have significantly stronger parent-reported functional communication than youth with ASD alone as well as a comparable ability, according to parents, to initiate social interaction and develop relationships. Findings support a profile of challenges and relative strengths associated with the presence of anxiety disorders in youth with ASD. Though more research is needed to determine the direction of these associations, results provide further rationale for improving recognition and targeted treatment of this comorbidity in clinical practice. [ABSTRACT FROM AUTHOR]

This response to the commentary by Gaynor (in press) (a) underscores the importance of defining terms (predictor, moderator, and mediator variables) used in psychological treatment outcome research, (b) notes the improvements in mediation analyses using treatment of youth anxiety as the illustration, and (c) encourages continued advancement in the methodology for mediation analyses. We agree with Gaynor (in press) both on the importance of temporal precedence and on the use of cautious language with regard to interpreting mediational analyses. [ABSTRACT FROM AUTHOR]

Youth ages 7–14 (N = 175; 52.6% male) and parents were evaluated. Father's and mother's acceptance, psychological control, and firm/behavioral control were measured. Children were diagnosed, and self-, parent-, and teacher-reports were gathered. Children with anxiety disorders perceived higher parental control than children without. Regressions found child-reported maternal acceptance was associated with lower child anxiety, depression, and externalizing, whereas psychological control predicted higher symptoms. Child-reported depressive symptoms moderated the maternal psychological control and children's anxiety relationship (the relationship was weaker for anxious children with more depressive symptoms). Findings support that children's perception of parenting behavior is associated with anxiety. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study examined the relations between treatment process variables and child anxiety outcomes. Method: Independent raters watched/listened to taped therapy sessions of 151 anxiety-disordered (6–14 yr-old; M = 10.71) children (43% boys) and assessed process variables (child alliance, therapist alliance, child involvement, therapist flexibility and therapist functionality) within a manual-based cognitive-behavioural treatment. Latent growth modelling examined three latent variables (intercept, slope, and quadratic) for each process variable. Child age, gender, family income and ethnicity were examined as potential antecedents. Outcome was analyzed using factorially derived clinician, mother, father, child and teacher scores from questionnaire and structured diagnostic interviews at pretreatment, posttreatment and 12-month follow-up. Results: Latent growth models demonstrated a concave quadratic curve for child involvement and therapist flexibility over time. A predominantly linear, downward slope was observed for alliance, and functional flexibility remained consistent over time. Increased alliance, child involvement and therapist flexibility showed some albeit inconsistent, associations with positive treatment outcome. Conclusion: Findings support the notion that maintaining the initial high level of alliance or involvement is important for clinical improvement. There is some support that progressively increasing alliance/involvement also positively impacts on treatment outcome. These findings were not consistent across outcome measurement points or reporters. [Copyright &y& Elsevier]

This study examined the role of comorbid depressive disorders (major depressive disorder or dysthymic disorder) and co-occurring depressive symptoms in treatment outcome and maintenance for youth (N = 72, aged 7–14) treated with cognitive-behavioral therapy for a principal anxiety disorder (generalized anxiety disorder, separation anxiety disorder, or social phobia). Hierarchical linear modeling examined treatment outcome and maintenance in terms of severity of the principal anxiety disorder. Results indicated that higher levels of child-reported depressive symptoms predicted less favorable treatment outcome. Higher levels of mother-reported depressive symptoms predicted less favorable treatment maintenance at a 1-year follow-up. Results suggest that co-occurring depressive symptoms play a role in effective treatment for anxiety-disordered youth and support the merits of treatment adaptations for these youth. [ABSTRACT FROM AUTHOR]

Objective."We examined the effect of perceived child anxiety status on parental latency to intervene with anxious and nonanxious youth. Method- Parents (68) of anxiety-disordered (PAD) and nonanxiety- disordered (PNAD; 56) children participated. Participants listened and responded to an audio vignette of a parent-child interaction: Half were told the child was anxious, and half were given a neutral description. Participants completed measures of anxiety and emotional responding before and after the audio vignette and signaled when the mother on the vignette should accommodate the child. Results: Whereas PNAD responded significantly faster when provided with neutral information about the child than when told the child was anxious, PAD did not differ in response latency. However, PAD exhibited a significant increase in state anxiety and negative affect and a decrease in positive affect after the vignette, whereas PNAD did not. Conclusions: Results suggest that PNAD are more flexible and adaptable in their parenting behavior than PAD and that the greater anxiety and emotional lability of PAD may influence their parenting. Suggestions for research are discussed. [ABSTRACT FROM AUTHOR]

Symptoms of autism spectrum disorder (ASD) were assessed (Social Responsiveness Scale-Parent (SRS-P); coded in-session behavior) in typically-developing, anxiety-disordered children ( N = 50) treated with cognitive-behavioral therapy (CBT). Study 1: children with moderate autistic symptomology (per SRS-P) were significantly more likely to improve from family CBT (FCBT) than individual CBT (ICBT; OR = 8.67). Coded behavior did not predict outcome. Study 2: CBT components were compared by treatment and ASD symptom status. At-home exposure completion was greater in FCBT and there was an interaction in child involvement for treatment and ASD status. Though both treatments reduced anxiety, FCBT outperformed ICBT for children with moderate ASD symptoms, a benefit potentially linked to more at-home exposures and greater child involvement in FCBT. [ABSTRACT FROM AUTHOR]

Building on the empirical data supporting the efficacy of cognitive-behavioral therapy (CBT) for child anxiety, researchers are working on the development and evaluation of cost-effective and transportable CBT approaches. Related to this, a widely endorsed goal is to disseminate evidence-based treatments from research settings to community settings. Computer-assisted treatments have emerged as a means to provide cost-effective and efficient service to an increased number of anxious youth for whom a CBT treatment would be otherwise unavailable. We offer a rationale for the development and evaluation of computer-assisted psychosocial treatments for anxiety in youth, offer illustrative advances made in this area, and describe our efforts in using computers to enhance dissemination of CBT for child anxiety. Specifically, our illustrations include a description of (a) Camp-Cope-A-Lot (CCAL), a computer-assisted CBT for the treatment of anxiety disorders in youth ages 7-12, and (b) CBT4CBT: Computer-based training in CBT for anxious youth. Findings from evaluations of these programs are summarized, and further advances are proposed and discussed. Depression and Anxiety, 2011. © 2010 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Objective: This study examined the feasibility, acceptability, and effects of Camp Cope-A-Lot (CCAL), a computer-assisted cognitive behavioral therapy (CBT) for anxiety in youth. Method: Children (49; 33 males) ages 7-13 (M = 10.1 ± 1.6; 83.7% Caucasian, 14.2% African American, 2% Hispanic) with a principal anxiety disorder were randomly assigned to (a) CCAL, (b) individual CBT (ICBT), or (c) a computer-assisted education, support, and attention (CESA) condition. All therapists were from the community (school or counseling psychologists, clinical psychologist) or were PsyD or PhD trainees with no experience or training in CBT for child anxiety. Independent diagnostic interviews and self-report measures were completed at pre- and posttreatment and 3-month follow-up. Results: At posttreatment, ICBT or CCAL children showed significantly better gains than CESA children; 70%, 81%, and 19%, respectively, no longer met criteria for their principal anxiety diagnosis. Gains were maintained at follow-up, with no significant differences between ICBT and CCAL. Parents and children rated all treatments acceptable, with CCAL and ICBT children rating higher satisfaction than CESA children. Conclusions: Findings support the feasibility, acceptability and beneficial effects of CCAL for anxious youth. Discussion considers the potential of computer-assisted treatments in the dissemination of empirically supported treatments. [ABSTRACT FROM AUTHOR]

Abstract: Reports the characteristics of a large, representative sample of treatment-seeking anxious youth (N =488). Participants, aged 7–17 years (mean 10.7 years), had a principal DSM-IV diagnosis of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), or social phobia (SP). Although youth with a co-primary diagnosis for which a different disorder-specific treatment would be indicated (e.g., major depressive disorder, substance abuse) were not included, there were few other exclusion criteria. Participants and their parent/guardian underwent an extensive baseline assessment using a broad array of measures capturing diagnostic status, anxiety symptoms and severity, and areas of functional impairment. Means and standard deviations of the measures of psychopathology and data on diagnostic status are provided. The sample had moderate to severe anxiety disorder and was highly comorbid, with 55.3% of participants meeting criteria for at least one non-targeted DSM-IV disorder. Anxiety disorders in youth often do not present as a single/focused disorder: such disorders in youth overlap in symptoms and are highly comorbid among themselves. [Copyright &y& Elsevier]

[Clin Psychol Sci Prac 17: 1–30, 2010] Evidence-based practice (EBP), a preferred psychological treatment approach, requires training of community providers. The systems-contextual (SC) perspective, a model for dissemination and implementation efforts, underscores the importance of the therapist, client, and organizational variables that influence training and consequent therapist uptake and adoption of EBP. This review critiques the extant research on training in EBP from an SC perspective. Findings suggest that therapist knowledge improves and attitudinal change occurs following training. However, change in therapist behaviors (e.g., adherence, competence, and skill) and client outcomes only occurs when training interventions address each level of the SC model and include active learning. Limitations as well as areas for future research are discussed. [ABSTRACT FROM AUTHOR]

Data from a randomized clinical trial comparing the relative efficacy of individual cognitive-behavioral therapy (ICBT), family CBT (FCBT), and a family-based education/support/attention control (FESA) condition were used to examine associations between in-session therapeutic techniques related to parent training (PT) and treatment outcomes. This study explored the extent to which therapists' use of PT techniques, specifically (a) parental anxiety management, (b) transfer of control from therapist to parent to child over child's coping, (c) communication skills training, and (d) contingency management training, contributed to treatment outcome in family-based CBT. Children (N = 53; 31 males; 7.8-13.8 years of age; M = 10.1 years, SD = 2.3; 85% Caucasian, 9% African American, 4% Asian, 2% "other" background) with a principal anxiety disorder completed 16 sessions of CBT with their parents. The relative contributions of PT components on treatment outcome were evaluated. As hypothesized, both transfer-of-control and parental anxiety management techniques significantly contributed to improvement on clinician and parent ratings of child global functioning within FCBT. PT did not significantly contribute to improvement on measures of child anxiety. These preliminary findings suggest that when FCBT is conducted for child anxiety, PT (i.e., transfer-of-control and parental anxiety management techniques) may contribute to improvements in the child's global functioning. [ABSTRACT FROM AUTHOR]

This study investigated the psychometric properties of the Positive and Negative Affect Scale for Children (PANAS-C) (Laurent et al. Psychol Asses 1: 326–338, 1999) in a sample of 139 children (ages 7–14 years) diagnosed with a principal anxiety disorder. Results from this study provided support for the convergent validity of the PANAS-C with established measures of childhood anxiety and depression. As predicted, negative affect was significantly associated with measures of anxiety and depression whereas positive affect was associated with depression. However, weaknesses in discriminant validity were found, most notably with regard to social anxiety. Consistent with previous research, social anxiety was significantly associated with low levels of positive affect (PA). Furthermore, results from regression analyses indicated that PA made a significant unique contribution to the prediction of social anxiety as well as depression scores. Findings are discussed with regard to the usefulness of the PANAS-C to differentiate anxiety and depression in children with anxiety disorders. [ABSTRACT FROM AUTHOR]

Therapy process research helps delineate common and specific elements essential to positive outcomes as well as develop best practice training protocols. Child involvement and therapist flexibility were rated in 63 anxious youth (ages 8–14) who received cognitive–behavioral therapy. Therapist flexibility, defined as therapist attempts to adapt treatment to a child's needs, was hypothesized to act as an engagement strategy that serves to increase child involvement during therapy. Flexibility was significantly related to increases in later child engagement, which subsequently predicted improvement in posttreatment diagnosis and impairment. Therapist flexibility was not associated with earlier measures of child engagement, so a mediation model could not be supported. It was also hypothesized that the impact of flexibility would be greatest for cases who began treatment highly disengaged (i.e., early involvement would moderate the effect of flexibility). Basic descriptive data supported this model, but formal analyses failed to confirm. Further descriptive analyses suggest therapists employ a range of adaptations and a profile of flexible applications within a manual-based treatment is provided. Treatment, measurement, and dissemination issues are discussed. © 2009 Wiley Periodicals, Inc. J Clin Psychol: 65: 1–19, 2009. [ABSTRACT FROM AUTHOR]

Knowledge about bipolar disorder is rapidly advancing. One consequence is that current evidence about the diagnostic definitions, prevalence, phenomenology, associated features and underlying processes, risk factors and predictors, and assessment or treatment strategies for bipolar disorder is often markedly different than the conventional wisdom reflected even in recent textbooks and clinical training. This Special Issue draws together a series of reviews discussing the evidence with emphasis on the contributions of psychological science and attention to the implications for evidence-based practice. International experts from multiple disciplines provide additional commentaries that set the reviews in a global, interdisciplinary context. [ABSTRACT FROM AUTHOR]

The study examined the shape of therapeutic alliance using latent growth curve modeling and data from multiple informants (therapist, child, mother, father). Children (n = 86) with anxiety disorders were randomized to family-based cognitive-behavioral treatment (FCBT; N = 47) with exposure tasks or to family education, support, and attention (FESA; N = 39). Children in FCBT engaged in exposure tasks in Sessions 9-16, whereas FESA participants did not. Alliance growth curves of FCBT and FESA youths were compared to examine the impact of exposure tasks on the shape of the alliance (between-subjects). Within FCBT, the shape of alliance prior to exposure tasks was compared with the shape of alliance following exposure tasks (within-subjects). Therapist, child, mother, and father alliance ratings indicated significant growth in the alliance across treatment sessions. Initial alliance growth was steep and subsequently slowed over time, regardless of the use of exposure tasks. Data did not indicate a rupture in the therapeutic alliance following the introduction of in-session exposures. Results are discussed in relation to the processes, mediators, and ingredients of efficacious interventions as well as in terms of the dissemination of empirically supported treatments. [ABSTRACT FROM AUTHOR]

The article presents concerns regarding manual-based treatments and contends that many of such concerns arise from misperceptions about how the treatments are optimally implemented in practice. It explains the flexible application of manuals through the examples drawn from the Coping Cat program, a cognitive-behavioral therapy for anxiety problems in youths that has been found to be efficacious. Examples given in the section outline the significance of implementing manual-based treatments within the context of a child-centered, individualized approach to facilitate the child's involvement in the treatment process.

Examined three aspects of childhood anxiety and peer liking: (1) whether or not children can detect anxiety in age-mates, (2) the degree to which peer-reported anxiety, self-reported anxiety, and presence of anxiety disorders are associated with peer liking, and (3) whether or not self-reported anxiety and presence of anxiety disorders are associated with peer liking after controlling for peer-reported anxiety. Peer raters (9.5-12.5 years) rated videotaped speech samples of target children with anxiety disorders (AD; 9.5-13 years) and target children without anxiety disorders (NAD; 9.5-13 years). Peer-rated anxiety was positively correlated with target children's self-reported anxiety and was higher among children with AD and children with social phobia (SP). Peer liking was inversely related to peer-reported anxiety and was lower for target children with SP. Target children with SP were liked less regardless of how anxious peers perceived them to be. Peer rater and target child demographics did not moderate the relationship between peer-rated anxiety and peer liking. [ABSTRACT FROM AUTHOR]

This randomized clinical trial compared the relative efficacy of individual (child) cognitive-behavioral therapy (ICBT), family cognitive-behavioral therapy (FCBT), and a family-based education/support! attention (FESA) active control for treating anxiety disordered youth ages 7-14 years (M = 10.27). Youth (N = 161; 44% female; 85% Caucasian, 9% African American, 3% Hispanic, 3% other/mixed) with a principal diagnosis of separation anxiety disorder, social phobia, or generalized anxiety disorder and their parents participated. Outcome analyses were conducted using hierarchical linear models on the intent-to-treat sample at posttreatment and 1-year follow-up using diagnostic severity, child self-reports, parent reports, and teacher reports. Chi-square analyses were also conducted on diagnostic status at post and 1-year follow-up. Children evidenced treatment gains in all conditions, although FCBT and ICBT were superior to FESA in reducing the presence and principality of the principal anxiety disorder, and ICBT outperformed FCBT and FESA on teacher reports of child anxiety. Treatment gains, when found, were maintained at 1-year follow-up. FCBT outperformed ICBT when both parents had an anxiety disorder. Implications for treatment and suggestions for research are discussed. [ABSTRACT FROM AUTHOR]

Abstract: We evaluated the utility of Anxiety scales for the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF). The scales (CBCL-A; TRF-A) were examined using mothers and teachers of anxiety-disordered (AD; 157 mothers, 70 teachers) and non-anxiety-disordered (NAD; 100 mothers, 17 teachers) children. Separate samples of parents and teachers of AD (mothers=145, fathers=120, teachers=137) and NAD (mothers=35, fathers=29, teachers=27) children cross-validated the original findings. CBCL-A and TRF-A scores significantly discriminated AD children from NAD children and correlated significantly with other measures of child anxiety. The CBCL-A and TRF-A were sensitive to treatment changes. Relative to the CBCL/TRF Anxious/Depressed syndromes and Internalizing dimensions, the CBCL-A and TRF-A improved prediction of anxiety status. Relative to Achenbach, Demenci, and Rescorla''s [Achenbach, T. M., Demenci, L., & Rescorla, L. A. (2003). DSM-oriented and empirically based approaches to constructing scales from the same item pools. Journal of Clinical Child and Adolescent Psychology, 32, 328–340] CBCL Anxiety subscale, the CBCL-A predicted comparably. Findings are discussed in terms of the CBCL-A and TRF-A as clinical tools. [Copyright &y& Elsevier]

Investigated the development and utility of the Negative Affectivity Self-Statement Questionnaire—Anxiety Scale (NASSQ-A) for youth. Participants in the initial anxiety-disordered (AD) sample were 68 children with a principal diagnosis of generalized anxiety disorder (GAD) or social phobia (SP), and participants in the non anxiety-disordered (NAD) sample were 37 children with no anxiety or mood disorder. Findings were then cross-validated on an additional sample of 138 children with a principal diagnosis of GAD or SP. Thirty-three negative self-statements were found to separate anxious from non-anxious participants, and were combined to form the NASSQ-A. Using Receiver Operating Characteristics (ROC) analyses, a NASSQ-A cutoff score of 49 was determined to be optimal for identifying anxiety-disordered youth. Findings are discussed with regard to the assessment of self-talk in anxiety disorders. [ABSTRACT FROM AUTHOR]

Research on the psychological impact of terrorism on youth is reviewed and evaluated. Children having proximal contact with terrorism show elevated posttraumatic stress, separation anxiety, and/or other symptoms. Following a terrorist attack, youth proximal and distal to the attack are exposed to a vast amount of attack-related media coverage and exposure to such media coverage is associated with postattack posttraumatic stress disorder (PTSD) symptomatology. However, the research is inchoate, including an insufficient scope and methodological limitations. Research has yet to examine the impact that exposure to an extended context of threat, expectation, and alert has on child development. Importantly, how are children influenced by secondhand terrorism—the context in which cultural influences disproportionately attend to the possibilities, rather than probabilities, of future terrorism? Research is needed to evaluate the impact of terrorism on psychopathology (beyond PTSD), functional impairment, and ethnic stereotyping in youth, and to examine the efficacy of psychological programs that strive to redress the problems of youth affected by terrorism. [ABSTRACT FROM AUTHOR]

The authors investigated features of self-statements as predictors of anxiety in children with and without anxiety disorder (AD) and as a mediator of treatment of ADs in children. Children (N = 145) between the ages of 9 and 13 years participated (71 AD youth, 84 controls). Self-statements were classified by valence and content. Results indicated that children's anxious, but not positive or depressed, self-statements significantly predicted anxiety in children with and without AD. For children with AD, changes in anxious self-statements mediated treatment gains, replicating a previously reported finding. A states of mind ratio mediated only 1 outcome measure, and positive and depressive cognitions served no mediating role. The impact of anxious self-talk on children's adjustment and implications for cognitive theory of anxiety in children are discussed. [ABSTRACT FROM AUTHOR]

The role and implementation of evidence-based practice and empirically supported treatments has been hotly contested among researchers and practitioners. Using examples of and from various empirically supported treatments the authors offer suggestions for smoothing the pathway for dissemination of evidence-based practice with children and adolescents. The authors underscore that mediational analyses, treatment process studies, and the continued creation of flexible treatment manuals as important components of successful dissemination. Flexibility within fidelity is proposed as the preferred perspective that eases the transition and dissemination of empirically supported treatments from research clinics to service clinics. [ABSTRACT FROM AUTHOR]

The research literature suggests that children and adolescents suffering from anxiety disorders experience cognitive distortions that magnify their perceived level of threat in the environment. Of these distortions, an attentional bias toward threat-related information has received the most theoretical and empirical consideration. A large volume of research suggests that anxiety-disordered youth selectively allocate their attention toward threat-related information. The present review critically examines this research and highlights several issues relevant to the study of threat-related attentional bias in youth, including the influences of temperament, trait anxiety, and state anxiety on threat-related attentional bias. It furthermore identifies the need for developmental and methodological considerations and recommends directions for research. [ABSTRACT FROM AUTHOR]

This study examined diagnostic agreement between children and their parents for seventy 9- to 13-year-olds (45 boys and 25 girls) who had received cognitive–behavioral treatment for anxiety disorders. Parent-child diagnostic rates and agreements for generalized anxiety disorder, separation anxiety disorder, and social phobia were evaluated at 3 time points: pretreatment, posttreatment, and 7.4-year follow-up. Results indicate that parent–child diagnostic agreement was typically poor to moderate (κ = –.03 to .64) and that estimates of agreement remained relatively unchanged (a) following treatment and (b) as the children enter adolescence and young adulthood. Parent–daughter agreement was better than parent–son agreement in some cases. Although it remains unclear whether parent or child diagnostic information is most accurate, positive treatment outcome appears to be possible despite poor parent–child diagnostic agreement. [ABSTRACT FROM AUTHOR]

The authors C.R. Snyder and T.R. Elliott in their article, "Twenty-First Century Graduate Education in Clinical Psychology: A Four Level Matrix Model" (this issue, pp. 1033-1054), reflect on the nature of training needed for optimal clinical psychologists, and offer suggestions for such training within a matrix model. Their position is largely consistent with current American Psychological Association preferences and general training guidelines, and has historical precedence. Indeed, the ideas, though not new or radical, are very sound. Amen, the wheel remains round. [ABSTRACT FROM AUTHOR]

Cognitive-behavioral therapy (CBT) for anxiety disorders in youth has been evaluated in randomized clinical trials (RCTs), and recent studies have sought to determine if the effects can be enhanced by an adjunctive parent component. The rationale for adding parents as active participants to treatment for anxious youth includes the notions that parenting factors (a) can contribute to the maintenance of anxiety, (b) could facilitate the generalization of treatment gains, and (c) have had favorable results in treatment of other childhood disorders. To date, there have been 9 CBT treatment outcome trials with anxious youth that included parents in treatment. This article (a) provides a critical review of the research on active parent involvement in CBT of anxious youth, (b) calculates and reports effect sizes emerging from these studies, and (c) recommends areas for future research. [ABSTRACT FROM AUTHOR]

Using a receiver operating characteristic (ROC) analysis, the present study investigated the ability of the Children's Depression Inventory (CDI) to correctly detect depression in a sample of treatment-seeking anxious youth (N=44). The ADIS-C/P was used to determine diagnostic status of participants. Anxious children who met diagnostic criteria for a depressive disorder scored higher on the CDI than anxious children who did not meet criteria for a depressive disorder, supporting the CDI as a continuous measure of depressive symptomatology. In contrast, with regard to detecting a depressive disorder, CDI cut scores did not achieve favorable values across diagnostic utility indices (including the cut score of 13 that has been recommended). These findings support the CDI as a continuous measure of depressive symptoms, but do not support the CDI as a sole assessment for a diagnosis of depression within a sample of anxiety-disordered youth. Depression and Anxiety 22:11–19, 2005. © 2005 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Explored the specific behavior of therapists contributing to a child client's perception of a therapeutic alliance with youth (n = 56) who received a manualized cognitive-behavioral treatment for anxiety disorders. The first 3 sessions were coded for 11 therapist behaviors hypothesized to predict ratings of alliance. Child, therapist, and observer alliance ratings were gathered after the 3rd and 7th therapy sessions. "Collaboration" positively predicted early child ratings of alliance, and "finding common ground" and "pushing the child to talk" negatively predicted early child ratings of alliance. Although no coded therapist behaviors predicted early therapist ratings of alliance, "collaboration" and "not being overly formal" positively predicted therapist alliance ratings by Session 7. Child, observer, and therapist ratings of alliance were significantly correlated.' Results are discussed with regard to the identified behavior of the therapist as a step toward the identification of empirically supported strategies for building a stronger child-therapist alliance. [ABSTRACT FROM AUTHOR]

In the treatment of anxious youth, children''s symptom presentations cannot always be readily distinguished as indicative of obsessive–compulsive disorder (OCD) or generalized anxiety disorder (GAD). Following a definition and brief description of the phenomenology, epidemiology, and treatment of OCD and GAD in youth, consideration is given to factors that contribute to the proximity of the two disorders. In an effort to better understand the distinctive and overlapping features of these neighboring disorders, we review (a) obsessions and worry, with reference to process, form, content, and metacognitive beliefs, and (b) the literature on pathological worry and covert compulsions. Studies from the adult literature are considered throughout, and the absence of related work with samples of youth, within a developmental framework, is highlighted. Suggestions for future research are offered. [Copyright &y& Elsevier]

Ratings of child involvement in manual-based cognitive- behavioral treatment for anxiety were associated with the absence of primary anxiety diagnosis and reductions in impairment ratings at posttreatment for 59 children with anxiety (ages 8-14 years). Good-to-excellent interrater reliability was established for the independent ratings of 237 therapy sessions, and strong psychometrics were established for the involvement measure. Child involvement at midtreatment, just prior to in vivo exposures. was positively associated with treatment gains but earlier involvement was not. Increased involvement during therapy (positive involvement shifts) may provide a useful index of change and may also predict outcomes. Involvement was not associated with client demographics or diagnostic category. Implications for treatment and measurement of psychotherapy process within manual-based treatments are discussed. [ABSTRACT FROM AUTHOR]

Objective: To examine parent-child agreement, at the symptom level, in the assessment of anxiety in youths. Differences between agreement at the diagnostic and symptom levels were explored as well as differences in agreement across symptom categories. Differences in the direction of disagreement across symptom categories were also examined. Method: Participants were 98 children, 7 to 14 years old (54 boys) who met diagnostic criteria for separation anxiety disorder, social phobia, or generalized anxiety disorder and their parents. Diagnostic and symptom data were obtained using the Anxiety Disorders Interview Schedule for Children and Parents. Results: Parent-child agreement at the symptom level was stronger than agreement at the diagnostic level for all three disorders. Parent-child agreement was stronger for observable symptoms than for unobservable symptoms and weaker for school-based symptoms than for non-school-based symptoms. In cases of discrepant symptom reports, the direction of disagreement varied according to the type of symptom. Conclusions: These findings buttress the need for a multi-informant approach in the assessment of childhood anxiety. Further, given the low parent-child agreement at the symptom level in the assessment of child anxiety, clinicians may do well to consider employing the "or rule" at the symptom level when integrating discrepant reports. [ABSTRACT FROM AUTHOR]

Research suggests that the sequelae of childhood anxiety disorders, if left untreated, can include chronic anxiety, depression, and substance abuse. The current study evaluated the maintenance of outcomes of children who received a 16-week cognitive-behavioral treatment for primary anxiety disorders (generalized, separation, and social anxiety disorders) an average of 7.4 years earlier. The 86 participants (ages 15 to 22 years; 91% of the original sample) and their parents completed diagnostic interviews and self- and parent-report measures. According to the diagnostic interviews, a meaningful percentage of participants maintained significant improvements in anxiety at long-term follow-up. With regard to sequelae, positive responders to anxiety treatment, as compared with less positive responders, had a reduced amount of substance use involvement and related problems at long-term follow-up. The findings are discussed with regard to child anxiety and some of its sequelae. [ABSTRACT FROM AUTHOR]

Objective: To examine whether separation anxiety disorder (SAD) in childhood is a risk factor for panic disorder and agoraphobia in adulthood. Method: Patients (n = 85) who had completed treatment for SAD, generalized anxiety disorder, and/or social phobia 7.42 years earlier (on average) were reassessed using structured diagnostic interviews. Results: Subjects with a childhood diagnosis of SAD did not display a greater risk for developing panic disorder and agoraphobia in young adulthood than those with other childhood anxiety diagnoses. Subjects with a childhood diagnosis of SAD did not more frequently meet full diagnostic criteria for panic disorder and agoraphobia, generalized anxiety disorder, social phobia, or major depressive disorder in adulthood than subjects with childhood diagnoses of generalized anxiety disorder or social phobia, but were more likely to meet criteria for other anxiety disorders (i.e., specific phobia, obsessive compulsive disorder, posttraumatic stress disorder, and acute stress disorder). Conclusions: These results argue against the hypothesis that childhood SAD is a specific risk factor for adult panic disorder and agoraphobia. Key Words: child anxiety; adult anxiety; separation anxiety disorder; panic disorder; agoraphobia. [ABSTRACT FROM AUTHOR]

Investigated differences in comorbidity in children ages 8 to 13 (N = 199) with primary diagnoses of generalized anxiety disorder (GAD), separation anxiety disorder (SAD), or social phobia (SP). Children with primary SAD were found to have the highest number of comorbid diagnoses. Specific phobias were more common in children with primary SAD than in those with primary SP, whereas neither group differed from children with primary GAD. Mood disorders were more common in children with GAD or SP than in children with primary SAD. Comorbid externalizing disorders, although present in 17% of the sample, were not found to vary across diagnostic groups. Functional enuresis was most common in children with primary SAD. Results are discussed with respect to diagnostic and treatment issues. [ABSTRACT FROM AUTHOR]