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Single case design research on family centered positive behavior support (PBS) over the past 20 years has provided evidence of the approaches acceptability, effectiveness and durability when implemented with families of children with developmental disabilities and problem behavior. Although quality of life is a key tenet of PBS, only a few studies of PBS with families have measured quality of life outcomes. The purpose of this study is to present family functioning results from the second half of a longitudinal study that investigated the consequential validity of an ecological approach to family centered PBS. The approach aimed to transform coercive into constructive family processes in family routines during a process of comprehensive assessment, multicomponent plan design and implementation support in collaboration with families. Ten families of children with developmental disabilities participated. Settings were 32 family routines, with two to four routines per family. Family functioning measures were family quality of life, parental stress, parental locus of control and social support. A repeated measures, quasi-experimental group design across mothers and fathers evaluated the statistical significance of changes in family functioning when comparing baseline to intervention and follow-up phases. Results evidenced significant improvements for mothers in family quality of life and parental stress during intervention and follow-up, and in parental locus of control during follow-up. Results evidenced significant improvements for fathers in parental stress during intervention and follow-up, but no significant improvements in family quality of life or parental locus of control. Results are discussed in terms of contributions to the literature, implications for practice, limitations, and future research.

Overviews of systematic reviews (OSRs) provide rapid access to high quality, consolidated research evidence about prevention intervention options, supporting evidence-informed decision-making, and the identification of fruitful areas of new research. This OSR addressed three questions about prevention strategies for child and adolescent anxiety: (1) Does the intervention prevent anxiety diagnosis and/or reduce anxiety symptoms compared to passive controls? (2) Is the intervention equal to or more effective than active controls? (3) What is the evidence quality (EQ) for the intervention? Prespecified inclusion criteria identified systematic reviews and meta-analyses (2000-2014) with an AMSTAR quality score ≥ 3/5. EQ was rated using Oxford evidence levels EQ1 (highest) to EQ5 (lowest). Three reviews met inclusion criteria. One narrative systematic review concluded school-based interventions reduce anxiety symptoms. One meta-analysis pooled 65 randomized controlled trials (RCTs; any intervention) and reported a small, statistically significant reduction in anxiety symptoms and diagnosis incidence. Neither review provided pooled effect size estimates for specific intervention options defined by type (i.e., universal/selective/indicated), intervention content, or comparison group (i.e., passive/active control), thus precluding EQ ratings. One meta-analysis pooled trials of vigorous exercise and reported small, nonstatistically significant reductions in anxiety symptoms for comparisons against passive and active controls (EQ1). Better use of primary studies in meta-analyses, including program-specific pooled effect size estimates and network meta-analysis is needed to guide evidence-informed anxiety prevention program choices. RCTs of innovative community/primary care based interventions and web-based strategies can fill knowledge gaps.

Theoretical models of anxiety disorders suggest that family processes and parenting are important factors in the development, maintenance, and transmission of childhood anxiety. The direction of effects between parenting and childhood anxiety, however, remains unclear. This review article integrates theoretical, empirical, and applied knowledge regarding the association between parenting and childhood anxiety as a means to better understand the implications of involving parents in the treatment of their children's anxiety. The present article expands Rapee and colleagues' (2009) review on the main etiological factors related to childhood anxiety and parenting, drawing attention to the influence of parental behavior on treatment effectiveness for childhood anxiety. Limitations of empirical findings and future directions are discussed.

Extant research concerning the degree of multiple informant (that is, parent, clinician, teacher, and child) agreement for child anxiety ratings generally uses clinical samples, and results have been mixed.Our study used a community sample of public school children (n = 1039) to investigate child (self), parent, and teacher reports of child anxiety across 3 time points (pretreatement, posttreatment, and follow-up) in 3 independent school prevention and intervention trials.Results showed that parents and teachers had high informant agreement for ratings on anxiety across the 3 time points (r = 0.95 to 0.96, P0.001); agreement between parent and child (self) reports and between teacher and child (self) reports consistently showed lower agreement across the 3 time points (r = 0.14 and 0.28, respectively, P0.001). Group differences were also significant for sex and grade, whereby females more commonly self-reported higher anxiety and children in grades 3 and 4 self-reported higher anxiety, compared with students in grades 5 to 7.Correlations between parent and teacher with child ratings were poor over 3 time points, and significant differences were found for sex and grade. Research is needed to understand reasons for poor concordance between parent, child, and teacher ratings of anxiety for all children.

We conducted an overview of systematic reviews about child and adolescent anxiety treatment options (psychosocial; medication; combination; web/computer-based treatment) to support evidence informed decision-making. Three questions were addressed: (i) Is the treatment more effective than passive controls? (ii) Is there evidence that the treatment is superior to or non-inferior to (i.e., as good as) active controls? (iii) What is the quality of evidence for the treatment? Pre-specified inclusion criteria identified high quality systematic reviews (2000-2015) reporting treatment effects on anxiety diagnosis and symptom severity. Evidence quality (EQ) was rated using Oxford evidence levels [EQ1 (highest); EQ5 (lowest)]. Twenty-two of 39 eligible reviews were high quality (AMSTAR score≥3/5). CBT (individual or group, with or without parents) was more effective than passive controls (EQ1). CBT effects compared to active controls were mixed (EQ1). SSRI/SNRI were more effective than placebo (EQ1) but comparative effectiveness remains uncertain. EQ for combination therapy could not be determined. RCTs of web/computer-based interventions showed mixed results (EQ1). CBM/ABM was not more efficacious than active controls (EQ1). No other interventions could be rated. High quality RCTs support treatment with CBT and medication. Findings for combination and web/computer-based treatment are encouraging but further RCTs are required. Head-to-head comparisons of active treatment options are needed.

This study investigated the relationship between marital satisfaction and time spent bed sharing with infants in a community sample of 81 bed sharing mothers. Time spent bed sharing did not significantly predict variance in marital satisfaction when considering bed sharers as a whole. Moderation analysis, however, showed the interaction between time spent bed sharing and group classification either as "intentional," defined as parents who endorse the ideology of bed sharing, or "reactive," defined as parents who do not plan to bed share but bed share as a reaction to infant nighttime problems, explained a significant increase in variance in marital satisfaction, ΔR^sup 2^ = .075, F(1, 75) = 7.31, p = .008. None of the intended mediator variables (satisfaction with bed sharing, fatigue, and sexual satisfaction) were significantly correlated with time spent bed sharing. Results highlight the importance of recognizing the differences between intentional bed sharers and reactive bed sharers.Key Words: mothers, satisfaction with marriage and close relationships, transition to parenthood.The arrival of a new baby marks a period of change for first-time parents, as they negotiate the transition from a couple to a family (Belsky & Kelly, 1994). The family engages in the family stress process (Hill, 1958) as the family's equilibrium is disrupted and the couple is forced to make major adaptations and adjustments to their new life, moving from the spousal role to the parental role. Each couple may manage these changes differently, resulting in different levels of family satisfaction and functioning.The ABC-X model of family stress developed by Hill (1958) serves as the framework for current theories of family stress (for a review, see Malia, 2006). Variable A is the stressor event, which causes change to the family's current state. The family's resources at the time of the event (variable B) and parental perceptions or meanings attached to the event (variable C) influence variable X, the level of stress the family experiences. Boss (2002) refined the ABC-X model to include both internal (e.g., structural) and external (e.g., developmental) contextual considerations. The birth of a baby is a normal developmental stressor event (Boss, 1 987). The changes in the family structure that an addition of a new baby brings can influence the quality of the marital relationship (LeMasters, 1957), thereby contributing to family stress. Changing the family's current sleeping routine and arrangement by bringing the infant to sleep in bed with the parents may cause varying levels of stress in the marital relationship, depending on the parents' perceptions of bed sharing.Although some couples experience an increase in marital satisfaction during the transition to parenthood (Cowan & Cowan, 2000; Shapiro, Gottman, & Carrere, 2000), the majority (67%) experience a precipitous decline in marital quality within the first year after their infant's birth (Shapiro et al., 2000). Although many stressor events considered to contribute to changes in the marital relationship over the transition to parenthood have been explored, little research has addressed the link between marital satisfaction and parent-infant sleeping arrangements. The main purpose of this study is to describe the relationship between time spent parent-infant bed sharing and the mother's marital satisfaction at a point during the transition to parenthood.Bed Sharing PracticesWhen distinguishing between the terms bed sharing and cosleeping, cosleeping is increasingly being used to refer to the parent(s) sleeping in close proximity to the infant on either the same sleeping surface (bed sharing) or different sleeping surfaces (room sharing; McKenna, Ball, & Gettler, 2007). Previous literature does not often distinguish between bed sharing and room sharing when cosleeping is being studied . Whenever possible, this article will note if the researchers specifically studied bed sharing or room sharing; otherwise the general term cosleeping will be used. …

Anxiety disorders are prevalent in the school-aged population and are present across cultural groups. Scant research exists on culturally relevant prevention and intervention programs for mental health problems in the Aboriginal populations. An established cognitive behavioral program, FRIENDS for Life, was enriched to include content that was culturally relevant to Aboriginal students. Students (N = 533), including 192 students of Aboriginal background, participated in the cluster randomized control study. Data were collected three times over 1 year. A series of multilevel models were conducted to examine the effect of the culturally enriched FRIENDS program on anxiety. These analyses revealed that the FRIENDS program did not effectively reduce anxiety for the total sample or for Aboriginal children specifically. However, all students, regardless of intervention condition, Aboriginal status, or gender, reported a consistent decrease in feelings of anxiety over the 6-month study period.

This study evaluated a locally developed cognitive behavior therapy (CBT) intervention program in a public elementary school. In the prevention approach, 118 children were randomly assigned either to an 8-week intervention or to a waitlist control. Results of statistical analysis indicated that the manualized CBT intervention did not reduce symptoms of anxiety on either self-reports or parent reports of anxiety symptoms in the general school population. Challenges to translational efforts to public school settings are discussed.

The purpose of the study in this article was to replicate past findings showing the effectiveness of a cognitive, behavioral resilience-building/anxiety-prevention program, "FRIENDS for Life." The results of the controlled study of two Grade 4 classrooms in Canada (N = 52) indicate that all children reported reduced levels of anxiety regardless of receiving the FRIENDS program. Limitations of the study are discussed and future research concerning school counseling programs using evidence-based approaches is highlighted.

A few comprehensive reviews of the effectiveness of prevention programs of mental disorders in school-age children ( Greenberg et al., 2003 , Weisz et al., 2005 ) conclude that while several well-designed studies demonstrate the potential of preventive intervention, greater attention and ongoing rigorous research is critical. The benefits and difficulties of mounting prevention programming specifically targeting child anxiety, the most common of mental disorders, and the concomitant challenges for clinicians are presented here. Two examples of school-based prevention are described: one of a large-scale, primary prevention program specifically targeting child anxiety in public school children in a large Canadian province, and a specific case of an individual child that came to the attention of clinicians during the universal implementation.

This review attempts to integrate information and methods from CBT, family therapy and pharmacotherapy orientations, in the treatment of six adult anxiety disorders, and separation anxiety in pediatrie populations. Anxiety disorders have been under-recognized and undertreated, in part because practitioners of different orientations have too often worked in isolation from one another. Both CBT and pharmacotherapy are evidence-supported treatments. However, the effectiveness of CBT can be enhanced if it is provided within a family therapy context. Similarly, medications can be an important treatment partner in the management of anxiety disorders.

This chapter describes an ecological approach to behavioral intervention with families of children with developmental disabilities and severe problem behavior that is designed to promote survivable interventions in family contexts. The approach, ecological family centered positive behavior support, is based on an ecological unit of analysis, coercive processes in family routines. The unit of analysis represents a synthesis of behavioral theory, coercion theory, and ecocultural theory. The approach aims to transform coercive into constructive processes in family routines. The chapter discusses the challenges faced by families raising a child with a developmental disability. It describes the components of the ecological unit of analysis and their contributions to tertiary level behavioral intervention with families. Results of a longitudinal intervention study that investigated the efficacy of the approach are presented. Implications are offered for assessment and intervention with families of children with developmental disabilities who may need tertiary level behavioral intervention services.

The efficacy and consequential validity of an ecological approach to behavioral intervention with families of children with developmental disabilities was examined. The approach aimed to transform coercive into constructive parent-child interaction in family routines. Ten families participated, including 10 mothers and fathers and 10 children 3-8 years old with developmental disabilities. Thirty-six family routines were selected (2 to 4 per family). Dependent measures included child problem behavior, routine steps completed, and coercive and constructive parent-child interaction. For each family, a single case, multiple baseline design was employed with three phases: baseline, intervention, and follow-up. Visual analysis evaluated the functional relation between intervention and improvements in child behavior and routine participation. Nonparametric tests across families evaluated the statistical significance of these improvements. Sequential analyses within families and univariate analyses across families examined changes from baseline to intervention in the percentage and odds ratio of coercive and constructive parent-child interaction. Multiple baseline results documented functional or basic effects for 8 of 10 families. Nonparametric tests showed these changes to be significant. Follow-up showed durability at 11 to 24 months postintervention. Sequential analyses documented the transformation of coercive into constructive processes for 9 of 10 families. Univariate analyses across families showed significant improvements in 2- and 4-step coercive and constructive processes but not in odds ratio. Results offer evidence of the efficacy of the approach and consequential validity of the ecological unit of analysis, parent-child interaction in family routines. Future studies should improve efficiency, and outcomes for families experiencing family systems challenges.

Overviews of systematic reviews (OSRs) provide rapid access to high quality, consolidated research evidence about prevention intervention options, supporting evidence-informed decision-making, and the identification of fruitful areas of new research. This OSR addressed three questions about prevention strategies for child and adolescent anxiety: (1) Does the intervention prevent anxiety diagnosis and/or reduce anxiety symptoms compared to passive controls? (2) Is the intervention equal to or more effective than active controls? (3) What is the evidence quality (EQ) for the intervention? Prespecified inclusion criteria identified systematic reviews and meta-analyses (2000-2014) with an AMSTAR quality score ≥ 3/5. EQ was rated using Oxford evidence levels EQ1 (highest) to EQ5 (lowest). Three reviews met inclusion criteria. One narrative systematic review concluded school-based interventions reduce anxiety symptoms. One meta-analysis pooled 65 randomized controlled trials (RCTs; any intervention) and reported a small, statistically significant reduction in anxiety symptoms and diagnosis incidence. Neither review provided pooled effect size estimates for specific intervention options defined by type (i.e., universal/selective/indicated), intervention content, or comparison group (i.e., passive/active control), thus precluding EQ ratings. One meta-analysis pooled trials of vigorous exercise and reported small, nonstatistically significant reductions in anxiety symptoms for comparisons against passive and active controls (EQ1). Better use of primary studies in meta-analyses, including program-specific pooled effect size estimates and network meta-analysis is needed to guide evidence-informed anxiety prevention program choices. RCTs of innovative community/primary care based interventions and web-based strategies can fill knowledge gaps.

The inclusion of children in family therapy is an issue that has been largely overlooked in the research literature. Although many of the founders of family systems approaches espouse the inclusion of children in therapy, today family systems therapists are often not working with the entire family. In practice, family counselors more often than not exclude children or include them when convenient or by default. Reasons for this dichotomy are explored and implications for practice and training are discussed. An inventory of questions for professionals to consider including children in their own practice is offered.

Among the therapeutic strategies used in the treatment of anxiety, behavioral approaches featuring exposure to aversive stimuli occupy a central role. Research on the effectiveness of cognitive-behavior therapy (CBT) in the treatment of anxiety disorders generally places exposure at the heart of therapeutic change. In fact, these studies have shown their empirical effectiveness in adults as well as children (Barrett, 2009; Carr, 2009; Cartwright-Hatton et al., 2004). Despite their proven effectiveness, exposures can present significant challenges to the therapist as well as the client (see Bouchard et al., 2004; Davis et al., 2009).

The present research examined the effectiveness of a cognitive-behavioral therapy (CBT) based intervention program, FRIENDS, for children from grades 4 to 6, using random assignment at the school-level and an attention-control design in two longitudinal studies. The first study targeted children with anxiety symptoms (N = 191, mean age = 10.1) as screened with self, parent, and teacher-reports; the second study took a universal approach with full classrooms of children participating (N = 253, mean age = 9.8). The results showed no intervention effect in both studies, with children’s anxiety symptoms decreasing over time regardless of whether they were in the story-reading (attention control) or FRIENDS condition. The findings also indicated that girls reported a higher level of anxiety than boys and children in higher grades reported lower anxiety relative to younger children in both studies. In addition, similar patterns were found using a subgroup of children with high-anxiety symptoms from both studies.

The purpose of this chapter is to present our work and that of colleagues in the field of positive behavior support (PBS) (Carr et al., 2002; Koegel, Koegel, Dunlap, 1996) on the development of an empirically grounded ecological unit of analysis for behavioral assessment and intervention with families of children with developmental disabilities and severe problem behavior. Our aim is to provide practitioners and families with an empirical foundation for the design of comprehensive PBS plans in family contexts that are likely to be acceptable to family members, implemented by family members with fidelity, effective at improving the behavior and quality of life of the child and family, sustainable within the family ecology, and durable across a long period of time.

Fifty-eight survivors of the respiratory distress syndrome were evaluated at age 4 years for deficits in neuromotor performance and physical growth in a prospective study. Comparisons between RDS survivors and 290 matched controls plus 35,198 unmatched controls demonstrated that for each group the neuromotor performance was adversely affected by either low birth weight or low socioeconomic standing. Except for infants with birth weights above 2.5 kg, the RDS survivors performed as well as the two control groups. Comparisons with siblings failed to reveal a decrement in the RDS survivors. Hypothyroidism was more frequent among the RDS survivors than among the control subjects in the highest category of birth weight.