Treatment of child anxiety. an exploratory study of the role of maternal anxiety and behaviours in treatment outcome

Anxiety disorders are common among parents of anxious children and have been found to impede child treatment outcomes, yet it is unclear whether it is parental anxiety that needs to be targeted in therapy or associated parental behaviours. Twenty-two children (6-12 years) with a current anxiety disorder and their mothers received cognitive-behavioural treatment (CBT) for child anxiety. In addition, of the 12 mothers who met criteria for a current anxiety disorder, 6 received CBT for their own disorder. Assessments were made of the mother-child interaction. The main findings were: (1) children did less well from treatment where their mothers had a current anxiety disorder; (2) treatment of maternal anxiety disorder did not improve child treatment outcome; and (3) maternal overinvolvement and expression of fear was associated with child treatment outcome. The results suggest that in the context of maternal anxiety disorder, child treatment outcome may be improved by specifically targeting parenting behaviours. Copyright (C) 2008 John Wiley & Sons, Ltd

The development of anxiety disorders in childhood: an integrative review

We present an integrative review of the development of child anxiety, drawing on a number of strands of research. Family aggregation and genetic studies indicate raised vulnerability to anxiety in offspring of adults with the disorder (e.g. the temperamental style of behavioural inhibition, or information processing biases). Environmental factors are also important; these include adverse life events and exposure to negative information or modelling. Parents are likely to be key, although not unique, sources of such influences, particularly if they are anxious themselves. Some parenting behaviours associated with child anxiety, such as overprotection, may be elicited by child characteristics, especially in the context of parental anxiety, and these may serve to maintain child disorder. Emerging evidence emphasizes the importance of taking the nature of child and parental anxiety into account, of constructing assessments and interventions that are both disorder specific, and of considering bidirectional influences

Mobility as a contradictory resource: Peripatetic Qur’anic students in Kano, Nigeria

Mobility is a powerful resource young people can draw on to improve their lives, but it can also entail risks. This paper explores how mobility becomes a contradictory resource for peripatetic Qur'anic students (almajirai) in Kano State in northern Nigeria. Moving to urban areas allows the young almajirai to escape difficult conditions and to access educational and income opportunities absent in their rural homes. It makes it possible for them to adopt self-conceptions as migrants in search of sacred knowledge who were once widely respected. However, economic decline has made survival in the city more difficult. Lacking the economic and cultural resources to participate in displays of status, and without social superiors to speak for them, the almajirai feel they have become fair game for those searching for scapegoats

Symptoms of social anxiety, depression and stress in parents of children with social anxiety disorder

Objectives: It has been suggested that elevated maternal social anxiety may play a disorder specific role in maintaining childhood Social Anxiety Disorder (SAD), but few studies have examined whether mothers of children with SAD are more socially anxious than mothers of children with other anxiety disorders (ANX). This study set out to examine whether symptoms of social anxiety were more severe amongst mothers of 7-12 year old children presenting for treatment with SAD (n=260) compared to those presenting with ANX (n=138). In addition, we examined whether there were differences between these two groups in terms of maternal and paternal general anxiety, depression and stress. Method: Parents of 7-12 year old children referred for treatment of SAD or ANX completed self-report questionnaire measures of emotional symptoms. Results: Compared to mothers of children with ANX, mothers of children with SAD reported significantly higher levels of social anxiety, general anxiety, and depression. In addition, fathers of children with SAD reported significantly higher levels of anxiety, stress and depression than fathers of children with ANX. Conclusions: This study is one of the few existing studies that have examined mothers’ and fathers’ psychopathology across different childhood anxiety disorders. Compared to parents of children with ANX, parents of children with SAD may have poorer mental health which may inhibit optimum child treatment outcomes for children with SAD. Thus, targeting parental psychopathology may be particularly important in the treatment of childhood SAD

Family treatment of child anxiety: outcomes, limitations and future directions

Anxiety of childhood is a common and serious condition. The past decade has seen an increase in treatment-focussed research, with recent trials tending to give greater attention to parents in the treatment process. This review examines the efficacy of family-based cognitive behaviour therapy and attempts to delineate some of the factors that might have an impact on its efficacy. The choice and timing of outcome measure, age and gender of the child, level of parental anxiety, severity and type of child anxiety and treatment format and content are scrutinised. The main conclusions are necessarily tentative, but it seems likely that Family Cognitive Behaviour Therapy (FCBT) is superior to no treatment, and, for some outcome measures, also superior to Child Cognitive Behaviour Therapy (CCBT). Where FCBT is successful, the results are consistently maintained at follow-up. It appears that where a parent is anxious, and this is not addressed, outcomes are less good. However, for children of anxious parents, FCBT is probably more effective than CCBT. What is most clear is that large, well-designed studies, examining these factors alone and in combination, are now needed

Observing interactions between children and adolescents and their parents: the effects of anxiety disorder and age

Parental behaviors, most notably overcontrol, lack of warmth and expressed anxiety, have been implicated in models of the development and maintenance of anxiety disorders in children and young people. Theories of normative development have proposed that different parental responses are required to support emotional development in childhood and adolescence, yet age has not typically been taken into account in studies of parenting and anxiety disorders. In order to identify whether associations between anxiety disorder status and parenting differ in children and adolescents, we compared observed behaviors of parents of children (7–10 years) and adolescents (13–16 years) with and without anxiety disorders (n=120), while they undertook a series of mildly anxiety-provoking tasks. Parents of adolescents showed significantly lower levels of expressed anxiety, intrusiveness and warm engagement than parents of children. Furthermore, offspring age moderated the association between anxiety disorder status and parenting behaviors. Specifically, parents of adolescents with anxiety disorders showed higher intrusiveness and lower warm engagement than parents of non-anxious adolescents. A similar relationship between these parenting behaviors and anxiety disorder status was not observed among parents of children. The findings suggest that theoretical accounts of the role of parental behaviors in anxiety disorders in children and adolescents should distinguish between these different developmental periods. Further experimental research to establish causality, however, would be required before committing additional resources to targeting parenting factors within treatment

Sea level and climate changes during OIS 5e in the Western Mediterranean

Palaeontological, geomorphological and sedimentological data supported by isotopic dating on Oxygen Isotopic Stage (OIS) 5e deposits from the Spanish Mediterranean coast, are interpreted with the aim of reconstructing climatic instability in the Northern Hemisphere. Data point to marked climatic instability during the Last Interglacial (OIS 5e), with a change in meteorological conditions and, consequently, in the sedimentary environment. The oolitic facies generated during the first part of OIS 5e (ca. 135 kyr) shift into reddish conglomeratic facies during the second part (ca. 117 kyr). Sea surface Temperature (SST) and salinity are interpreted mainly on the basis of warm Senegalese fauna, which show chronological and spatial differential distribution throughout the Western Mediterranean. Present hydrological and meteorological conditions are used also as modern analogues to reconstruct climatic variability throughout the Last Interglacial, and this variability is interpreted within the wider framework of the North Atlantic record. All the available data indicate an increase in storminess induced by an increase in the influence of northwesterlies, a slight drop of SST in the northern Western Mediterranean, and an important change in meteorological conditions at the end of OIS 5e (117 kyr). These changes correlate well with the decrease in summer insolation and with the climatic instability recorded in North Atlantic high latitudes