Examining outcome variability: correlates of treatment response in a child and adolescent anxiety clinic.

Examined correlates of treatment response in a clinic providing cognitive-behavioral therapy for children with anxiety disorders. Youth (ages 7 to 15) with a primary Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev., or 4th ed.; American Psychiatric Association, 1987, 1994) anxiety-disorder diagnosis (overanxious disorder, generalized anxiety disorder, separation anxiety disorder, social phobia, or avoidant disorder) participated. After completing a full course of treatment and posttreatment (n = 135) and 1-year follow-up (n = 107) assessments, participants were classified into 1 of 2 groups--poor treatment response and good treatment response--using parent diagnostic reports. Discriminant function analyses indicated that higher levels of maternal- and teacher-reported child-internalizing psychopathology at pretreatment, higher levels of maternal self-reported depressive symptoms, and older-child age were all associated with less favorable treatment response. Other factors, such as child ethnicity, child sex, family income, family composition (i.e., dual parent vs. single parent), child-reported symptomatology, and maternal-reported level of child-externalizing behavior problems did not predict treatment response. Both practical and conceptual implications of the findings are discussed.

Control-related beliefs and depressive symptoms in clinic-referred children and adolescents: developmental differences and model specificity.

The contingency-competence-control (CCC) model links contingency and competence beliefs to perceived control and, in turn, to depression. However, a developmental perspective suggests that noncontingency may be too abstract a concept to be directly tied to depression before adolescence. We tested the CCC model and this developmental notion, using structural equation modeling, with 360 clinic-referred 8- to 17-year-olds. The CCC model fit the data well for the full sample accounting for 46% of the variance in depression. Separate analyses by age group placed perceived contingency in the best-fit model for adolescents (ages 12-17 years) but not for children (8-11 years). This suggests that abstract cause-effect concepts may have more direct affective impact after the cognitive changes of adolescence (e.g., formal operations) than before. Finally, the CCC model accounted for much more variance in depression than conduct problems, suggesting diagnostic specificity.

A preliminary study of the emotion understanding of youths referred for treatment of anxiety disorders.

Examined the emotion understanding of children and adolescents referred for treatment of Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) anxiety disorders (separation anxiety disorder, generalized anxiety disorder, or social phobia). Referred youths (n = 17) and nonreferred youths (n = 21) and their parents participated by completing self-report and parent-report questionnaires and structured diagnostic interviews. We interviewed all youths by using an emotion understanding interview. Referred youths demonstrated poorer understanding of hiding emotions and changing emotions compared with nonreferred youth. The 2 groups were not significantly different regarding their understanding of emotion cues and multiple emotions, however. No statistically significant relation emerged between general intelligence and emotion understanding. Future research directions are discussed.

Therapy for youths with anxiety disorders: a second randomized clinical trial.

Ninety-four children (aged 9-13 years) with anxiety disorders were randomly assigned to cognitive behavioral treatment or waiting-list control. Outcomes were evaluated using diagnostic status, child self-reports, parent and teacher reports, cognitive assessment and behavioral observation: maintenance was examined using 1-year follow-up data. Analyses of dependent measures indicated significant improvements over time, with the majority indicating greater gains for those receiving treatment. Treatment gains returned cases to within nondeviant limits (i.e., normative comparisons) and were maintained at 1-year follow-up. Client age and comorbid status did not moderate outcomes. A preliminary examination of treatment segments suggested that the enactive exposure (when it follows cognitive-educational training) was an active force in beneficial change. Discussion includes suggestions for future research.

Long-term follow-up of a cognitive-behavioral therapy for anxiety-disordered youth.

This study examined the long-term effects of a psychosocial treatment for anxiety-disordered youth. Clients (N = 36) who had completed treatment 3.35 years earlier (on average) were reassessed using self- and parent-report instruments as well as structured diagnostic interviews. Results indicated that previously documented treatment gains were maintained. An examination of participants' recalled events within therapy suggested that the therapeutic relationship, games and activities, and discussion of problems were salient treatment components. Theoretically important components of treatment were also recalled by clients, and some were found to be related to long-term positive outcome.

Issues in the transportability of treatment: the case of anxiety disorders in youths.

This article reviews factors working against or in favor of the transportability of manual-based child treatments from research clinics to service practitioners. The review examines client factors, service-clinic therapist factors, and researcher factors that may contribute to the reported gap between research and practice outcomes. As requested for this special section, this article uses work with anxiety-disordered youths as an example of a potentially transportable manual-based treatment. Issues and future directions are discussed.