Parental Therapy Helps Children with Anxiety

Eli Lebowitz, PhD

Parents can help significantly reduce their child’s anxiety.

A team led by Eli R. Lebowitz, PhD, of the Yale University Child Study Center, compared Supportive Parenting for Anxious Childhood Emotions (SPACE) treatment to standard cognitive behavioral therapy (CBT) for treating children with anxiety disorders.

Treatment for childhood anxiety disorders can be insufficient for many and research has implicated family accommodations in the maintenance and course of childhood anxiety.

Previous research has focused on parental involvement to augment child-based cognitive-behavioral therapy. However, there is no studies comparing the efficacy of stand-alone parent-based treatment to CBT.

The study included 124 children between 7-14 years old with primary anxiety disorders. Each child was randomly either the parental therapy group or CBT without parental treatment. A total of 97 participants completed all treatment sessions and assessments and attrition did not differ significantly between the 2 groups.

The SPACE program teaches parents to reduce their accommodation and respond to a child’s anxiety symptoms in a more supportive manner to convey acceptance of the child’s genuine distress and instill confidence in the individual’s ability to cope with anxiety.

The investigators sought primary anxiety outcomes of diagnostic interview and clinician-rated scales. They also sought secondary outcomes including parent and child ratings of anxiety severity, family accommodation and parenting stress.

The investigators determined noninferiority margins based on statistical and clinical considerations and examined changes in family accommodation and parenting stress using mixed models’ analyses,

The team found SPACE was noninferior relative to CBT for both the primary and secondary anxiety outcomes based on the ratings provided by independent evaluators, parents, and children. They also found that family accommodation and parenting stress were substantially reduced in both treatment groups, but there was significantly greater reductions in family accommodation in the SPACE group.

Approximately 60 percent of the children in both treatment groups longer met the diagnostic criteria for any anxiety disorder following treatment and 87.5% for SPACE and 75.5% for CBT showed significant improvement in their symptoms.

“SPACE is an acceptable and efficacious treatment for childhood anxiety disorders, is noninferior to CBT, and provides an alternative strategy for treating anxiety in children,” the authors wrote.

While sleep troubles is common for infants, they also could foreshadow emotional and psychological issues later on in life.

A team, led by Fallon Cook, PhD, Department of Pediatrics at the University of Melbourne, determined whether infants with severe persistent sleep problems are at an increased risk of meeting the diagnostic criteria for a psychiatric disorder at age 10 or have elevated symptoms of mental health difficulties at ages 4 and 10.

Infants with persistent severe sleep problems are more likely to report an emotional disorder at age 10 (adjusted OR, 2.37; 95% CI, 1.05-5.36; P = 0.04).

These infants also had elevated symptoms of separation anxiety (AOR, 2.44; 95% CI, 1.35-4.41; P <0.01), fear of physical injury (AOR, 2.14; 95% CI, 1.09-4.18; P = 0.03), and overall elevated anxiety (AOR, 2.20; 95% CI, 1.13-4.29; P = 0.02) at age 10.

“Infants with persistent severe sleep problems during the first postnatal year have an increased risk of anxiety problems and emotional disorders at age 10,” the authors wrote.

Approximately 17% of all infants suffer from sleep difficulties, including frequent waking at night and trouble falling asleep with the aid of a parent. This can have a deleterious impact on parental mental health and family functioning. It is also associated with poorer mental health during early childhood.

The study, “Parent-Based Treatment as Efficacious as Cognitive-Behavioral Therapy for Childhood Anxiety: A Randomized Noninferiority Study of Supportive Parenting for Anxious Childhood Emotions,” was published online in the Journal of the American Academy of Child & Adolescent Psychiatry.