Early Intervention for Children at Risk for Anxiety
Overview
- Phase
- N/A
- Intervention
- "Being Brave: A Program for Coping with Anxiety for Young Children and Their Parents."
- Conditions
- Anxiety Disorder
- Sponsor
- Massachusetts General Hospital
- Enrollment
- 65
- Locations
- 2
- Primary Endpoint
- Number of Responders Based on Clinician Global Impression-Anxiety Improvement
- Status
- Completed
- Last Updated
- 8 days ago
Overview
Brief Summary
The aim of this study was to develop and pilot a cognitive-behavioral therapy (CBT) parent-child intervention for 4-7-year-old children at risk for anxiety disorders. The 20-session intervention was first piloted openly in 9 children (between 3/10/98 and 1/1/2001). The intervention was then tested in 65 children in a randomized controlled trial versus a monitoring-only wait-list control condition. Children had to either have an anxiety disorder, behavioral inhibition, or be the offspring of a parent with an anxiety disorder who had elevated symptoms of anxiety. In practice all children but one had at least one anxiety disorder at baseline. Children were blocked on presence or absence of parental anxiety disorder and randomized to the intervention or to a no-intervention wait-list control group. The intervention consisted of 6 parent-only sessions, 8-13 child-parent sessions, and a final parent session. Post-trial assessments were conducted at six months, and at one-year follow-up. The hypotheses were that the children assigned to the intervention group would show significantly better improvement (measured via Clinician Global Impression-Anxiety Improvement scale and absence of anxiety disorders) than children assigned to the wait-list condition.
Investigators
Dina R. Hirshfeld-Becker
Co-Director, Child CBT Program
Massachusetts General Hospital
Eligibility Criteria
Inclusion Criteria
- •The child is at risk for anxiety disorders, as indicated by at least one of the following:
- •the child has behavioral inhibition (as determined by observed behavioral assessment);
- •the child meets criteria for a DSM-IV or IIIR anxiety disorder (as determined by Kiddie-Schedule for Affective Disorders and Schizophrenia, Epidemiologic Version \[K-SADS-E\] with the mother); or
- •the child has both a parent with lifetime history of anxiety disorder (as determined by direct Structured Clinical Interview for DSM-IV \[SCID-IV\] with both parents) and the child has anxious symptomatology, as indicated by Child Behavior Checklist \[CBCL\] scale scores (T-scores) on Anxious/Depressed or Withdrawn of 55 or higher.
- •The child is between the ages of 4 and 7 years
- •The child and parent(s) have a working command of English
Exclusion Criteria
- •Psychosis in parent or child
- •Suicidality in parent or child
- •Current alcohol or substance abuse in a parent
- •Mental retardation or pervasive developmental disorder in parent or child
- •Child in current psychiatric treatment
- •Child judged too uncooperative or distractible to take part in intervention
- •(In the controlled trial): Child judged clinically unable to wait six months for treatment. The following criteria are used in determining whether the child can wait for 6 months before receiving treatment:
- •Suicidal Ideation
- •Serious impairment in eating or sleeping habits
- •Severe social isolation
Arms & Interventions
Active CBT
Seven parent-only and 8-13 child-only sessions focusing on CBT for anxiety disorders using the "Being Brave" protocol.
Intervention: "Being Brave: A Program for Coping with Anxiety for Young Children and Their Parents."
No intervention (wait-list controls)
Control children received no intervention.
Outcomes
Primary Outcomes
Number of Responders Based on Clinician Global Impression-Anxiety Improvement
Time Frame: Post-Treatment (6-months from baseline)
Clinicians blind to treatment assignment rated the child's global improvement on anxiety, using the Clinician Global Impression-Anxiety Improvement scale (CGI-Anxiety, best value 1, worst value 7). Responders were considered those with "very much" or "much" improvement (CGI-Anxiety scores of 1 or 2)