Anxiety Disorders Interview Schedule Research Articles

Behavioral Inhibition in Childhood as A Risk Factor for Development of Social Anxiety Disorder: A Longitudinal Study.

Previous research has suggested the association between behavioral inhibition (BI) and the development of social anxiety disorder in childhood. However, there is scarce research using longitudinal methodology in Spanish-speaking populations. To cover this gap, the sample comprised 73 children ranging from six to eight years who had been examined for BI two years earlier in home and school settings. Children and their parents were administered the Anxiety Disorders Interview Schedule for DSM-5-Child and Parent Versions to assess the presence of possible anxiety disorders. The results revealed the stability of BI symptomatology over time. Data also showed that BI children were almost ten times more likely to develop social anxiety disorder two years later, compared to no-BI children. As a result, findings suggest behavioral inhibition strongly predicts social anxiety disorder, making BI a logical focus for selective preventive interventions. Therefore, screening for behavioral inhibition holds promise for primary prevention.

0997 The Sleep Disturbance Scale For Children In Youth With Tourette’S Disorder

Abstract Introduction Sleep disturbance is common in youth with Persistent Tic Disorders (PTDs), including Tourette’s Disorder. However, studies elucidating the nature of sleep problems in PTDs are limited. The present study examines the types of sleep disturbance present in youth with PTDs relative to healthy controls, and investigates the relationship between sleep disturbance and tic severity. Methods Participants were 56 youth ages 8 to 17 (M=11.9, SD=2.86), including individuals with PTDs (n=27), and healthy controls (n=29). An interviewer evaluated psychiatric diagnosis using the Anxiety Disorders Interview Schedule, and tic severity using the Yale Global Tic Severity Scale (YGTSS). Parents rated sleep using the Sleep Disturbance Scale for Children (SDSC), and tic severity using the Parent Tic Questionnaire (PTQ). Independent-samples t-tests and bivariate correlations were performed. Results Higher SDSC Total scores, t(30)=-3.74, p=.001) were found in youth with PTDs relative to healthy controls. Youth with PTDs endorsed elevated sleep disturbance with respect to: Disorders of Initiating and Maintaining Sleep, t(35)=-2.43, p=.02), Sleep-Wake Transition Disorders, t(37)=-3.04, p=.004), and Disorders of Excessive Somnolence, t(33)=-2.36, p=.02). No significant group differenceswere shown for Sleep Breathing Disorders, Disorders of Arousal, and Sleep Hyperhydrosis. There was a positive association between SDSC Total scores and YGTSS Total (p=.01, r=.56) and YGTSS Impairment scores (p= .03, r=.33). Finally, there was a positive relationship between SDSC Total and PTQ Total scores (p=.01, r=.61). Conclusion Findings suggest youth with PTDs are more likely to experience sleep disturbance than healthy children, particularly difficulties with sleep initiation and maintenance, abnormal movements during sleep, and daytime sleepiness. Further, there is a relationship between sleep disturbance and tic severity. Findings highlight the need for sleep screening and targeted sleep intervention in youth with PTDs. Support N/A

Separation Anxiety Symptom Profiles and Parental Accommodation Across Pediatric Anxiety Disorders.

Parental accommodation refers to ways in which caregivers modify their behavior to decrease child distress in the short-term. Accommodation is prevalent among anxious youth and related to decreased treatment and functional outcomes. Although separation anxiety disorder (SAD) is associated with increased accommodation, SAD is not a predictor of treatment response, suggesting that a diagnosis of SAD alone may not be enough to clarify the relationship between accommodation and separation anxiety symptoms within a clinical context. Participants were youth with a primary anxiety disorder (N = 186; aged 7-17) enrolled in an outpatient anxiety clinic. Latent class analysis was used to extract profiles from parent-reported SAD symptoms using the Anxiety Disorders Interview Schedule for DSM-IV/5. Profiles were compared on pre-treatment accommodation. Low, moderate, and interfering SAD classes emerged. Interfering SAD was associated with high accommodation. Results help to clarify the association between SAD and accommodation and has implications for personalized intervention.

Therapist-Guided Internet-Delivered Cognitive Behavioural Therapy Versus Internet-Delivered Supportive Therapy for Children and Adolescents with Social Anxiety Disorder: A Randomised Controlled Trial

Background: This single-masked randomised controlled superiority trial evaluated the efficacy and cost-effectiveness of therapist guided internet-delivered cognitive behavioural therapy (ICBT) for social anxiety disorder (SAD) in youth compared with an active comparator, internet-delivered supportive therapy (ISUPPORT). Methods: Participants were 103 children and adolescents aged 10-17 years with a principal diagnosis of SAD, and their parents. Participants were randomly allocated to 10 weeks of ICBT (n=51) or ISUPPORT (n=52). Both interventions included three video call sessions with a therapist. The primary outcome measure was the Clinician Severity Rating (CSR), derived from the Anxiety Disorder Interview Schedule (ADIS-C), rated by masked clinicians post treatment and three months after the end of treatment (primary endpoint). Secondary outcomes included clinician-rated diagnostic status of SAD and global functioning, as well as child- and parent-reported social anxiety and comorbid depression. Findings: ICBT was significantly more efficacious than ISUPPORT in reducing the severity of SAD symptoms with a significant between-group effect size of d=0·66 (95% CI [0·27, 1·11]) at the 3-month follow-up. Similarly, most of the secondary outcome measures demonstrated moderate effect sizes favouring ICBT. The cost-effectiveness analyses indicated cost savings associated with ICBT compared to ISUPPORT. One suicide attempt was reported and managed in the ISUPPORT condition. No other serious adverse events were reported in either condition. Interpretation: ICBT is an efficacious and cost-effective intervention for children and adolescents with SAD. Implementation in clinical practice could markedly increase the availability of effective interventions for SAD. Trial Registration: The trial was registered at ClinicalTrials.gov with id NCT03247075 Funding: This work was funded by the Swedish Research Council for Health, Working Life and Welfare (Forte 2014-4052) and Region Stockholm (HNSV 14099). JH was supported by Region Stockholm (Dnr: K0173-2016; clinical postdoctoral appointment: 2017-2020). ES was supported by Region Stockholm (clinical research appointment; 2017-0605). Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf. Dr. Mataix-Cols reports personal fees from Elsevier, personal fees from UpToDate, Inc., outside the submitted work. None of the other authors declare any conflict of interests. Ethics Approval Statement: The trial was approved by the Stockholm regional ethical review board (2017/1027-31/2).

Treating depressive disorders with the Unified Protocol: A preliminary randomized evaluation

ObjectivesThis study aims to examine the efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) for individuals diagnosed with a depressive disorder. MethodParticipants included 44 adults who met criteria for major depressive disorder, persistent depressive disorder, or another specified depressive disorder according to the Anxiety Disorder Interview Schedule (ADIS). These individuals represent a subset of patients from a larger clinical trial comparing the UP to single-disorder protocols (SDPs) for discrete anxiety disorders and a waitlist control (WLC) condition (Barlow et al., 2017); inclusion criteria for the parent study required participants to have a principal anxiety disorder. ResultsSignificant reductions in depressive symptoms were observed within the UP condition across clinician-rated and self-report measures of depression from baseline to post-treatment, as well as to the 12-month follow-up assessment. Compared to the WLC group, individuals in the UP condition demonstrated significantly lower levels on our continuous, clinician-rated measure of depressive symptoms at post-treatment. There were no differences between the UP and SDP conditions on depressive symptoms at post-treatment or at the 12-month follow-up timepoint. ConclusionsIn this exploratory set of analyses, the UP evidenced efficacy for reduction of depressive symptoms, adding to the growing support for its utility in treating depression.

Does the treatment of anxiety in children with Attention-Deficit/Hyperactivity Disorder (ADHD) using cognitive behavioral therapy improve child and family outcomes? Protocol for a randomized controlled trial

BackgroundUp to 60% of children with Attention-Deficit/Hyperactivity Disorder (ADHD) meet diagnostic criteria for at least one anxiety disorder, including Social, Generalized and/or Separation Disorder. Anxiety in children with ADHD has been shown to be associated with poorer child and family functioning. Small pilot studies suggest that treating anxiety in children with ADHD using cognitive-behavioral therapy (CBT) has promising benefits. In a fully powered randomized controlled trial (RCT), we aim to investigate the efficacy of an existing CBT intervention adapted for children with ADHD and comorbid anxiety compared with usual care.MethodsThis RCT is recruiting children aged 8–12 years (N = 228) from pediatrician practices in Victoria, Australia. Eligibility criteria include meeting full diagnostic criteria for ADHD and at least one anxiety disorder (Generalized, Separation or Social). Eligible children are randomized to receive a 10 session CBT intervention (Cool Kids) versus usual clinical care from their pediatrician. The intervention focuses on building child and parent skills and strategies to manage anxiety and associated impairments including cognitive restructuring and graded exposure. Minor adaptations have been made to the delivery of the intervention to meet the needs of children with ADHD including increased use of visual materials and breaks between activities. The primary outcome is change in the proportion of children meeting diagnostic criteria for an anxiety disorder at 5 months randomization. This will be assessed via diagnostic interview with the child’s parent (Anxiety Disorders Interview Schedule for Children V) conducted by a researcher blinded to intervention condition. Secondary outcomes include a range of child (e.g., anxiety symptoms, ADHD severity, behavior, quality of life, sleep, cognitive functioning, school attendance) and parent (e.g., mental health, parenting behaviors, work attendance) domains of functioning assessed at 5 and 12 months post-randomization. Outcomes will be analyzed using logistic and mixed effects regression.DiscussionThe results from this study will provide evidence on whether treating comorbid anxiety in children with ADHD using a CBT approach leads to improvements in anxiety and/or broader functional outcomes.Trial registrationThis trial was prospectively registered: Current Controlled Trials ISRCTN59518816 (https://doi.org/10.1186/ISRCTN59518816). The trial was first registered 29/9/15 and last updated 15/1/19.

Cognitive Behavioural Therapy for Anxiety Disorders in Young Children: A Dutch Open Trial of the Fun FRIENDS Program

AbstractAnxiety disorders in young children are highly prevalent and increase the risk of social, school, and familial problems, and also of psychiatric disorders in adolescence and adulthood. Nevertheless, effective interventions for this age group are lacking. One of the few available interventions is the Fun FRIENDS program. We examined whether young children with anxiety disorders showed less anxiety after participating in Fun FRIENDS. Twenty-eight clinically anxious children (4–8 years old) participated in the cognitive behavioural Fun FRIENDS program. The program consists of 12 weekly 1.5-hour sessions and was provided in groups of 3 to 5 children. At preintervention and direct postintervention, parents completed the Anxiety Disorders Interview Schedule for Children and Child Behavior Checklist. Clinically and statistically significant decreases were found in number of anxiety disorders, symptom interference, emotional and behavioural problems, internalising problems, and anxiety problems. The decrease in anxious/depressed problems and externalising problems was not significant. Furthermore, higher preintervention anxiety levels predicted more treatment progress, whereas sex and age did not. The Dutch version of Fun FRIENDS is promising in treating anxiety disorders in young children. Randomised controlled trials are needed to draw definite conclusions on the effectiveness of Fun FRIENDS in a clinical setting.

Changes in rejection and psychological control during parent-child interactions following CBT for children's anxiety disorder.

This study examined changes in mothers' and fathers' rejection and psychological control during parent-child interactions after cognitive-behavioral therapy (CBT) for children's anxiety disorders. We studied whether family CBT reduced rejection (vs. warmth) and psychological control (vs. autonomy-granting) more than child CBT, and whether parents own anxiety disorders resulted in smaller decreases in these parenting behaviors. Participants were 128 clinically referred children and adolescents (52 boys; Mage = 12.4, SDage = 2.7) with anxiety disorders and their parents, randomly assigned to either family CBT (n = 64) or child CBT (n = 64). The Anxiety Disorders Interview Schedule was used to assess children's and parents' anxiety disorders. Before and after treatment, parents' rejection and psychological control toward their child was rated during conflict and anxiety discussions of mother-child dyads, father-child dyads, and mother-father-child triads. As expected, during dyadic and triadic interactions, mothers' and fathers' rejection toward their child decreased after child and family CBT. Unexpectedly, during triadic conflict interactions, mothers, after child CBT and family CBT, as well as fathers, after child CBT, displayed increased psychological control. During triadic anxiety interactions, only mothers, after child CBT, showed increased psychological control. Changes in parenting did not depend on whether or not parents had anxiety disorders themselves. Thus, CBT for anxiety-disordered children can successfully reduce parents' rejection. The unexpected findings of increased psychological control after treatment, particularly by mothers in the presence of the father, suggests potential benefits of mothers' psychological control with anxious children. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

ROC Analyses of Relevant Conners 3-Short Forms, CBCL, and TRF Scales for Screening ADHD and ODD.

Receiver operating characteristic curve analysis was used to examine and compare the diagnostic accuracy of the Conners 3-Parent Short Form (C 3-P(S)), and the Conners 3-Teacher Short Form (C 3-T(S)) inattention and hyperactivity/impulsivity scales, and the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) attention problems scales, to distinguish those with and without attention deficit/hyperactivity disorder (ADHD). It also examined and compared the diagnostic accuracy of the C 3-P(S) and C 3-T(S) Aggression (AG) scales, and the CBCL and TRF Aggressive Behavior (AB) scales, to distinguish those with and without oppositional defiant disorder (ODD). The study used archival data (N = 150-261) involving a large group of clinic-referred children aged between 6 and 11 years who had been interviewed for clinical diagnosis of ADHD and ODD using the Anxiety Disorders Interview Schedule for Children (ADISC-IV) as the reference standard, and then administered one or more of the screening measures. The findings provided empirical support for the use of the C 3-P(S) and CBCL for identifying ADHD and ODD, with the CBCL aggressive behavior scale having better ability to detect ODD. The implications of the findings for using the screening scales for diagnoses of ADHD and ODD are discussed.

Emotion regulation as the mediator of reductions in anxiety and depression in the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders: double-blind randomized clinical trial.

An important subject in evaluation of the efficacy of treatments is to examine how the intervention is effective and to identify the consequences of that treatment. In this regard, the current study investigates the role of emotion regulation as the mediator of the treatment outcomes of therapy using the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders. This article describes a double-blind randomized clinical trial. A sample of 26 individuals was selected based on cut-off scores for the Beck Depression Inventory and Beck Anxiety Inventory and their final diagnoses were confirmed with the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). The sample was randomly divided into two groups: control and treatment (13 patients each). The treatment group received 20 one-hour UP sessions. The Beck Depression Inventory, the Beck Anxiety Inventory, and the Difficulties in Emotion Regulation Scale were administered at two stages, pre-treatment and post-treatment. The UP reduced anxiety and depression in patients through improvement in emotion regulation. Furthermore, the results showed that the difficulty engaging in goal-directed behavior and non-acceptance of emotional response subscales were capable of predicting 62% of variance in anxiety scores. In turn, two subscales, difficulty engaging in goal-directed behavior and lack of emotional clarity, predicted 72% of variance in depression scores. Emotion regulation can be considered as a potential mediating factor and as predictive of outcomes of transdiagnostic treatment based on the UP. Iranian Registry of Clinical Trials, IRCT2017072335245N1.

Gifted Children with ADHD: How Are They Different from Non-gifted Children with ADHD?

The present study focused on inattention and hyperactivity/impulsivity differences of gifted children with and without attention deficit-hyperactivity disorder (ADHD). Based on clinical assessment utilizing the Anxiety Disorders Interview Schedule for Children (ADISC-IV) and the Wechsler Intelligence Scale for Children—Fourth Edition, attendees of a public outpatient child service (boys = 359, girls = 148), with mean age 10.60 years (SD = 3.08 years), were allocated into four groups: ADHD (N = 350), gifted (N = 15), gifted/ADHD (N = 18), and clinical controls (N = 124). The Strengths and Weaknesses of ADHD-Symptoms and Normal Behavior Scale dimensionally assessed inattention and hyperactivity/impulsivity variations. Compared to the gifted/ADHD group, the ADHD group had higher scores for inattention and comparable scores for hyperactivity/impulsivity. For most symptoms, the ADHD groups (gifted or not) rated higher than the non-ADHD groups (control and gifted without ADHD). Findings appeared to indicate that (i) ADHD is a valid diagnosis among children who are gifted, (ii) gifted children might tend to be less inattentive than non-gifted ADHD children, and (iii) ADHD-gifted children appear to differ from the non-ADHD-gifted children with regard to specific hyperactive and impulsive behaviors. The practical implication of these findings is that clinicians may wish to focus on these symptoms when diagnosing ADHD among children with high intelligence.

Ascertainment and Prevalence of Post-Traumatic Stress Disorder (PTSD) in People with Intellectual Disabilities

ABSTRACT Introduction: Post-traumatic stress disorder (PTSD) may be under-recognized in people with intellectual disabilities (PWID) and reviews on appropriate screening tools and prevalence are lacking. This review aims to identify PTSD screening tools for PWID and estimate the prevalence of PTSD within this population. Method: Medline, PubMed, Embase, PsycINFO, Cochrane, Global Health, and Web of Science databases were searched (inception to October 2017) to identify eligible literature. Papers were also found via manual searches of the references of eligible studies. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines, subjected to exclusion criteria and quality appraised using STROBE criteria for observational studies and an adapted form of the Newcastle-Ottawa scale for cross-sectional studies. Seven studies were identified. Meta-analysis was carried out on the prevalence studies and heterogeneity quantified using I2. Results: Three tools for screening PTSD in PWID were found: two for use in adults (the Lancaster and Northgate Trauma Scale and the Impact of Event Scale – Intellectual Disabilities) and the Adapted Anxiety Disorders Interview Schedule for Children with PTSD. Five studies reported PTSD prevalence in PWID. The weighted pooled prevalence of PTSD in PWID was found to be 10%, 95% CI [0.4%, 19.5%], toward the upper limit of estimated PTSD prevalence in the general population (5–10%). Conclusion: PTSD can be diagnosed in PWID but may go unrecognized by health-care professionals. The identified tools should be further compared and assessed for acceptability and efficacy to improve the identification of PTSD in PWID.

Treatment of anxiety and mood comorbidities in cognitive-behavioral and psychodynamic therapies for panic disorder

BackgroundIt is not known whether common anxiety/mood comorbidities of panic disorder (PD) improve with panic-focused psychological treatment, nor whether there is differential efficacy between therapies in treating comorbidities. MethodsIn a randomized controlled trial for PD with and without agoraphobia comparing Cognitive-Behavioral Therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP), symptomatic comorbidities of agoraphobia, MDD, GAD, and social anxiety disorder (SAD) were assessed pre-to-post treatment with the Anxiety Disorders Interview Schedule (ADIS). Comparative efficacy of CBT versus PFPP for treating comorbid disorders was tested at termination and 1 year's follow-up. Covariance between panic and comorbidity improvements was also analyzed. ResultsMost treatment completers (n = 120) evidenced diagnostic remission of their comorbidity (range = 54–69%), which typically reflected a subclinical score on the ADIS (mean range = 1.3 to 1.8). These improvements were generally retained at follow-up. However, patients with MDD dropped out significantly more often (HR = 2.79). No significant symptom change or remission differences emerged between CBT and PFPP for any comorbidity at termination or at follow-up. Panic change was strongly related to improvements in agoraphobia (r = 0.70) and MDD (r = 0.53), moderately related for GAD (r = 0.31), and not significantly related for SAD (r = 0.20). DiscussionPatients completing panic-focused psychotherapies often experience meaningful remission for diagnoses of agoraphobia, MDD, GAD, and SAD, with no detectable differences between treatments, although sample sizes for the MDD and SAD comparisons were small. In addition, additional efforts may be needed to keep MDD-comorbid patients in treatment.

Components of Attentional Bias to Threat in Clinically Anxious Children: An Experimental Study Using the Emotional Spatial Cueing Paradigm

Attentional bias to threat is believed to play a key role in the development and maintenance of anxiety disorders. However, the underlying attentional mechanisms related to anxiety are not well understood. The aim of the present study was to investigate the effect of cognitive therapy on the engagement and disengagement components of attentional bias to threat in clinically anxious children using the emotional spatial cueing paradigm. Anxiety was diagnosed using the Anxiety Disorders Interview Schedule and the Revised Child Anxiety and Depression Scale. Results from 27 clinically anxious children and 27 control children (7–13 years old) indicated that clinically anxious children showed significantly faster engagement to angry faces than control children. Results also indicated that clinically anxious children showed significantly faster disengagement from angry faces before treatment in comparison to control children and significantly slower disengagement from angry faces after treatment than they did before treatment. Findings suggests that cognitive therapy reduces attentional avoidance of threat in clinically anxious children and challenges the assumption that results can be generalized from subclinical to clinical samples.

An Analysis of the Child Behavior Checklist Anxiety Problems Scale's Predictive Capabilities.

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.

Efficacy and cost-effectiveness of therapist-guided internet cognitive behavioural therapy for paediatric anxiety disorders: a single-centre, single-blind, randomised controlled trial

Paediatric anxiety disorders are associated with substantial disability and long-term adverse consequences, but only a small proportion of affected children have access to evidence-based treatment. Internet-delivered cognitive behavioural therapy (ICBT) could help increase accessibility but needs further rigorous assessment. We aimed to assess the efficacy and cost-effectiveness of ICBT in the treatment of paediatric anxiety disorders. We did a single-blind randomised controlled trial in a clinical research unit within the Child and Adolescent Mental Health Services in Stockholm (Sweden). Eligible participants were children aged 8-12 years with a diagnosis of a principal anxiety disorder (seperation anxiety disorder, generalised anxiety disorder, specific phobia, social anxiety disorder, or panic disorder) of at least moderate severity. We randomly allocated participants (1:1) to ICBT or internet-delivered child-directed play, an active comparator aimed to improve parent-child relationships and increase a child's self-esteem without directly targeting anxiety. Block sizes for the randomisation varied between four and six and were generated using a computer random-number generator, and the allocation was concealed from the researchers by opaque sealed envelopes. Both treatment programmes comprised 12 modules presented over 12 weeks with weekly asynchronous online therapist support, and consisted of texts, films, illustrations, and exercises. The primary outcome was severity rating of the principal anxiety disorder 12-weeks post-treatment, via the Anxiety Disorder Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders-IV (a rating of at least 4 corresponds to meeting the criteria for the principal diagnosis), assessed by clinicians masked to treatment allocation. All participants were included in the primary analysis (intention-to-treat). This trial is registered at ClinicalTrials.gov, number NCT02350257. Between March 11, 2015, and Oct 21, 2016, 131 participants were recruited and allocated to either ICBT (n=66) or internet-delivered child-directed play (n=65). The clinician-assessed severity rating of the principal anxiety disorder improved significantly after the 12-weeks treatment period for participants in both ICBT (within-group effect size 1·22, 95% CI 0·78-1·65) and the active control (0·72, 0·44-1·00) groups. However, greater improvement was seen with ICBT than with the active control (estimated mean difference 0·79, 95% CI 0·42-1·16, p=0·002; between-group effect size 0·77, 95% CI 0·40-1·15). 29 (48%) participants in the ICBT group no longer had their principal diagnosis, compared to nine (15%) in the active control group (odds ratio 5·41, 95% CI 2·26 to 12·90, p<0·0001); the number needed to treat for ICBT to gain one additional participant in remission was three (95% CI 2·85 to 3·15). ICBT resulted in an average societal-cost saving of €493·05 (95% CI 477·17 to 508·92) per participant. No severe adverse events were reported. ICBT is an efficacious and cost-effective treatment for paediatric anxiety disorders that should be considered for implementation in routine clinical care. The Swedish Research Council for Health, Working Life and Welfare, and Stockholm County Council.

Do clinical experience, formal cognitive behavioural therapy training, adherence, and competence predict outcome in cognitive behavioural therapy for anxiety disorders in youth?

The aim was to investigate whether clinical experience, formal cognitive behavioural therapy (CBT) training, adherence, and competence predict outcome in CBT for anxiety disorders in youth. Videotapes (N=181) from the sessions in a randomized controlled effectiveness trial (Wergeland et al., 2014, Behaviour Research and Therapy, 57, 1-12) comprising youth (N=182, M age=11.5years) with mixed anxiety disorders were assessed for treatment adherence and competence using the Competence and Adherence Scale for CBT for anxiety disorders in youth (Bjaastad et al., 2016, Psychological Assessment, 28, 908-916). Therapists' (N=17) clinical experience and educational background were assessed. Participants completed a diagnostic interview (Anxiety Disorders Interview Schedule, child and parent versions) and an anxiety symptom measure (Spence Children's Anxiety Scale, child and parent versions) at pretreatment, posttreatment, and 1-year follow-up. Higher therapist adherence was related to better treatment outcomes, whereas number of years of clinical experience and competence was related to worse outcomes. However, these findings were not consistent across informants and the time points for the assessments. Interaction effects suggested that competence among therapists with formal CBT training was related to better patient outcomes. Therapist adherence, competence, and clinical experience are associated with outcomes of manualized CBT for youth anxiety disorders, but mixed findings indicate the need for more research in this area.

Efficacy of the Unified Protocol for transdiagnostic treatment of comorbid psychopathology accompanying emotional disorders compared to treatments targeting single disorders

ObjectiveThis study aimed to examine whether the Unified Protocol (UP), a transdiagnostic cognitive-behavioral therapy for emotional disorders (i.e., anxiety, mood, and related disorders), is efficacious in the treatment of co-occurring emotional disorders compared to established single disorder protocols (SDPs) that target specific disorders (e.g., panic disorder). MethodParticipants included 179 adults seeking outpatient psychotherapy. Participant age ranged from 18 to 66 years, with an average of 30.66 years (SD = 10.77). The sample was 55% female and mostly Caucasian (83%). Diagnostic assessments were completed with the Anxiety Disorder Interview Schedule (ADIS), and disorder-specific, clinician-rated measures for the comorbid diagnoses of interest. ResultsIn both treatment conditions, participants' mean number of diagnoses dropped significantly from baseline to posttreatment, and baseline to 12-month follow-up. Additionally, large effects were observed for changes in comorbid generalized anxiety (ESSG: UP = −1.72; SDP = −1.98), social anxiety (ESSG: UP = −1.33, −0.86; SDP = −1.60, −1.54), and depression (ESSG: UP = −0.83; SDP = −0.84). Significant differences were not observed in between-group comparisons. ConclusionsResults suggest that both the UP and SDPs are efficacious in reducing symptoms of comorbid emotional disorders. The clinical, practical, and cost-effective advantages of transdiagnostic CBT are discussed.

Modular Cognitive-Behavioral Therapy for an Early Adolescent With Autism Spectrum Disorder and Comorbid Obsessive Compulsive Disorder

This case report outlines the use of a modular cognitive-behavioral therapy (CBT) protocol used to treat “Larry,” a 12-year-old male, with obsessive compulsive disorder (OCD) and autism spectrum disorder (ASD). Larry participated in 16 weekly 90-min CBT sessions, following a protocol developed for youth with ASD and anxiety/OCD. Upon completion of the treatment, Larry was remitted of his OCD diagnosis (as defined by a subthreshold score of 3 on the Anxiety Disorders Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders–4th ed. [ DSM-IV]–parent [ADIS]) and demonstrated marked improvements in his top presenting problems (washing hands immediately after touching something, checking tablet for smudges, and being around litter). This case report indicates useful adaptations to traditional CBT for OCD when working with youth with ASD.

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