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Abstract Anxiety disorders are widespread in childhood and adolescence but not all anxieties need medical treatment. Statistics Citations Dimensions. Downloads 1 download since deposited on 13 Apr 0 downloads since 12 months Detailed statistics. Users please log in : suggest update or correction for this item.
Repository Staff Only: item control page. Item availability may be restricted. Nonanxious participants were recruited via announcements in local newspapers, magazines, internet, schools, and family centers. Inclusion criteria for children with SepAD included meeting full diagnostic criteria for SepAD according to the Diagnostic and Statistical Manual for Mental Disorders—Text Revision DSM-IV-TR [ 34 ], age between 5 and 13 years old, German-speaking, not taking medication, and written parental informed consent and verbal child assent to randomized condition assignment and completion of psychological assessments.
Families received free diagnostic assessment and treatment for their participation in the study. Inclusion criteria for children in the healthy control group included having no current DSM-IV-TR axis I diagnoses, having no lifetime SAD or SoP diagnoses, age between 5 and 13 years old, German-speaking, not taking medication, and written parental informed consent and verbal child assent to participation in psychological assessments. In the first trial, forty-three children aged 5—7 years who met DSM-IV-TR criteria for SepAD were randomized to the immediate TAFF treatment condition 9 boys and 12 girls or the delayed TAFF treatment condition, in which children received therapy after a waiting period equal to the duration of therapy 9 boys and 13 girls [ 16 ].
Assignments to condition were randomized by a statistician using a computerized permuted block design [ 35 ], with assignments concealed until the time of participation. In the first trial, a total of four families dropped out and were lost to follow-up at 4-weeks post-treatment three in the immediate treatment condition, one in the delayed treatment condition. In the second trial, all children underwent an initial 4-week waiting period before treatment. All available data were used in the analyses with only baseline data for 13 families.
The total combined sample in the present study consisted of parents of children ages 5—13 who received treatment for SepAD either TAFF or CC and a control group of parents of 45 healthy children who did not receive any treatment. In total, parents mothers, 88 fathers were in the child treatment condition assessed at baseline and 4-weeks post-treatment and 74 parents 42 mothers, 32 fathers were in the control condition assessed at baseline and the equivalent of four weeks post-treatment.
At baseline, child mean age was 9. The children in the SepAD therapy group had a mean age of 8. Parents in the SepAD therapy group had a mean age of Table 1 contains information on educational level and income, as well as tests for differences between groups non significant. Clinician-based ratings of the degree of distress and impairment in home, school, friendship, and leisure domains caused by the presenting symptoms for the child are provided on a 4-point scale from 0 not at all to 3 very strong.
Interviews were conducted at baseline and post-therapy by trained clinical psychologists or advanced masters students, blinded to group status at all evaluations.
Parental pathology was assessed using self-report questionnaires and structured diagnostic interviews for both mothers and fathers. Scores are calculated by summing the responses for each item, for a final score ranging from 0 to Parent separation anxiety was assessed with 35 items from the Maternal Separation Anxiety Scale MSAS [ 42 ], which were translated into German [ 43 ], and also adapted for use with both parents. Prior research indicates good construct validity, good internal consistency with reliabilities of.
Mothers and fathers also individually completed the German version [ 44 ] of the Beck Depression Inventory BDI [ 45 ] to assess manifestations of general depression.
The BDI is a well-established item self-report measure, with items assessing the severity of depression symptoms such as sadness during the past 7 days a scale which presents statements of increasing strength regarding the symptoms ranging from 0 not at all to 3 strong. In the present study, one item assessing experiences not typical for children in the younger age group e. Each of the 45 items is rated on a scale ranging from 0 very untrue to 10 very true.
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High scores indicate high levels of dysfunctional beliefs. Authors of the scale hypothesized nine different factors: Outside world full of danger e.
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However, a factor analysis in prior research indicated a one-factor-solution [ 4 ]. The total score was calculated from an average of the 45 items. To test sample differences in psychopathology levels at baseline, t-tests for independent samples were conducted comparing pathology levels between parents with children treated for SepAD and parents of healthy children receiving no treatment. Random coefficient models, a type of linear mixed model [ 50 ], with unstructured covariance structure, were used to analyze the parental outcomes variables i.
Linear mixed models provide more efficient and less biased results than complete case analyses or analyses in which missing values are imputed using the last observation carried forward method [ 51 ]. Further, linear mixed models include participants with missing outcome values in the analyses, minimizing data loss, and increasing power. A statistical model was set up for each measure for each parent i.
[Depressive disorders in childhood and adolescence - an analysis of KinderAGATE 2010].
The predictors were time pre-, 4-weeks post-treatment , group child treatment condition versus control condition , and time by group interaction. We calculated effect sizes for independent-groups pretest-posttest designs based on the descriptions by Feingold [ 53 ] for all outcome measures. Effect sizes were calculated using mean change scores for the treatment and the control group and standard deviations of the raw scores in baseline data [ 54 ].
We conducted analyses including on all available data from parents of all children initially randomized in the studies. Means and standard deviations by group and time are presented in Table 2.
Baseline t-tests indicated that baseline pathology levels were generally higher among mothers of children treated for SepAD than mothers of healthy children receiving no treatment. There was a significant effect of time on both maternal and paternal levels of pathology, on all three tests: separation anxiety depression and general anxiety. Results indicated that symptoms of maternal and paternal pathology decreased from pre-treatment to post-treatment across groups.
Results of linear mixed models, presented in Table 3 , with time baseline, 4-week follow-up and group children treated for SepAD vs. There were significant effects of group on maternal depression and separation anxiety, with a trend level effect on maternal anxiety. Further, there was a significant effect of group on paternal separation anxiety. Results indicated that mothers in the treatment group generally reported more overall pathology symptoms than mothers in the control group, and fathers in the treatment group reported more separation anxiety than fathers in the control group.
This interaction effect indicates that the decrease in maternal levels of depression was larger than what could be expected by time effects only. This interaction effect suggests that the decrease in maternal levels of separation anxiety cannot solely be explained by normal fluctuations due to time e.
There was no significant time by group effect on maternal symptoms of general anxiety, indicating that the course of general anxiety levels of mothers of treated children was comparable to the course of general anxiety levels of mothers in the control group. Further, there were no significant time by group effects on any measure of paternal pathology, indicating that the course of symptoms among fathers of treated children was comparable to the course of symptoms among fathers in the control group.
This did not change the significance of the other effects, so they only the original models are presented here. These analyses were conducted in the treatment group only, as the healthy group had too little baseline to post change to examine relationships between difference scores. This study examined the transgenerational effects of two versions of cognitive-behavioral treatments for child Separation Anxiety Disorder SepAD on the mental health of parents.
A large body of research has demonstrated the efficacy of CBT programs on child anxiety in general [ 9 ] and child SepAD in particular [ 16 , 17 ]. Elevated levels of parental anxiety and depression tend to co-occur with anxiety disorders among children [ 24 ]. However, relatively little is known regarding the potential beneficial effects of child treatments on mental health of parents of children with anxiety disorders. The present study investigates pre- and post-treatment differences before and after participation in evidence-based CBT for children on symptoms of separation anxiety, general anxiety, and depression among mothers and fathers of children treated for SepAD.
Strengths of the present study include the relatively large sample size as combined from two clinical trials, and the use of data from clinical trials where the child treatment efficacy was established. Results showed significant improvements in symptoms of separation anxiety and depression among mothers of children treated for SepAD, post-child-treatment, in comparison to mothers of healthy children.
Compared to the pre-treatment assessment, symptoms of separation anxiety and depression were significantly lower at post-treatment assessment for mothers of children with SepAD. Remarkably, post-hoc comparisons indicated that maternal levels of separation anxiety and depressive symptoms were comparable to levels of mothers of healthy children after child treatment. No significant effect of child treatment across time was found in the level of general anxiety among mothers. A possible explanation for these differential effects may be floor effects in that that child treatment can only reduce pathology, when pathology levels are not already near the floor at baseline.
However, in the present study, mothers of children with SepAD and mothers of healthy children did not significantly differ in general anxiety at baseline, while baseline differences existed in separation anxiety and depressive levels, which were significantly reduced in the treatment condition compared to the control condition.
For mothers, change in child separation anxiety was not related to change in parent pathology in mothers in the treatment group. That is, despite some baseline-to-post effects, these changes were not directly related to change in child anxiety. Possibly, this may be attributable to low statistical power, as the sample size of fathers participating in the present study was lower than the sample size of mothers participating in the present study.
A possible explanation for this difference between mothers and fathers is that fathers are typically less involved in the treatment of their children, and thus would not benefit as much from spill-over effects or non-specific treatment factors i. For fathers, actual changes in their child's behaviors may be necessary for anxiety and cognitions to improve. Previous studies have already reported effects of interventions for parents on mental health and health behavior of children [ 29 ] and initial evidence also suggests transgenerational treatment effects from children to parents [ 31 , 32 ].
Up to this point, studies examining child treatment effects on parents have focused on children with ASD, while transgenerational effects of treatment for children with a primary diagnosis of an anxiety disorder is a topic rarely explored [ 33 ]. Previous work on therapy for child separation anxiety indicates secondary effects of child SepAD treatment on dysfunctional cognitions of parents [ 17 ]. Here, a reduction in dysfunctional beliefs of parents was found after child treatment. However, the study only compared two treatment conditions and did not include a control group to control for naturally occurring time effects.
Although findings indicate a decline in dysfunctional cognitions among parents, the effects of child treatment on parental mental health have not yet been examined.
Related Depressive Störungen im Kindes- und Jugendalter (German Edition)
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