Journal of the American Academy of Child & Adolescent Psychiatry
ArticlesFamilial Predictors of Treatment Outcome in Childhood Anxiety Disorders
Section snippets
Family Functioning
Problematic family relationships are more prevalent in anxious than nonanxious children and have been related to increased impairment in childhood anxiety disorders (Manassis and Hood, 1998, Messer and Beidel, 1994). Although poor family functioning is a correlate of childhood anxiety, the causal relationship between the two is not yet known. Families of anxious children are more involved, more controlling, more rejecting, and less intimate than those of comparison children without anxiety (
FAMILY FACTORS RELATED TO OUTCOME
There is some support for our hypothesis that pretreatment family functioning can affect treatment outcome. Outcome studies with anxious adults show that individuals are significantly more likely to relapse if they have only moderately good family functioning (as opposed to very good family functioning) (Scheibe and Albus, 1997), poor social interactions (Scheibe and Albus, 1997), or tension and friction in their marital relationship (Durham et al., 1997, Lelliott et al., 1987). Similar studies
STUDY OBJECTIVES
The main objective of this study is to examine whether family dysfunction, parental frustration (a further indication of troubled parent–child relationships), parental psychopathology, and parenting stress predict the treatment outcome of children with anxiety disorders. Second, we will examine whether family functioning changes over the course of treatment. It is expected that children with poorer pretreatment family relationships will improve less with treatment than children with good family
Participants
Participants were 61 children (34 males, 27 females) aged 8 to 12 years (mean = 10.0, SD = 1.4) and their parents. Of the children participating in this study, primary diagnoses included generalized anxiety disorder (65.6%), separation anxiety disorder (21.1%), simple phobia (5.6%), social phobia (2.2%), panic disorder (1.1%), and other (such as trichotillomania and selective mutism; 4.4%). The majority of the sample was white (85%); the rest were of African-American or Asian descent (15%),
Correlational Analyses
Clinician-Rated Children's Global Assessment Scale. Child reports of family dysfunction and child-rated parental frustration were significantly associated with clinician-rated global functioning. Partial correlations are negative because lower CGAS scores indicate more impairment. Table 1 shows the significant partial correlations between predictor variables and CGAS.
Mother Reports of Child Anxiety. Mother and father reports of family dysfunction and mother-rated total parenting stress were
DISCUSSION
This study found that a variety of family factors predicted child treatment outcome. Furthermore, parental frustration and maternal psychopathology improved over the course of the treatment program. Predictors of outcome are discussed separately for each reporter (clinician, mother, child, and father), as correspondence between child anxiety ratings for different reporters is only fair for internalizing disorders (Manassis et al., 1997).
Child reports of family dysfunction and parental
REFERENCES (34)
- et al.
Anxiety disorders of childhood and adolescence: a critical review
J Am Acad Child Adolesc Psychiatry
(1991) - et al.
Perceived control as a mediator of family environment in etiological models of childhood anxiety
Behav Ther
(1998) - et al.
The development of childhood anxiety disorders: toward an integrated model
J Appl Dev Psychol
(1994) - et al.
Attachment in mothers with anxiety disorders and their children
J Am Acad Child Adolesc Psychiatry
(1994) - et al.
Individual and familial predictors of impairment in childhood anxiety disorders
J Am Acad Child Adolesc Psychiatry
(1998) - et al.
Cognitive-behavioral group treatments in childhood anxiety disorders: the role of parental involvement
J Am Acad Child Adolesc Psychiatry
(1999) - et al.
Psychosocial correlates of childhood anxiety disorders
J Am Acad Child Adolesc Psychiatry
(1994) Potential role of childrearing practices in the development of anxiety and depression
Clin Psychol Rev
(1997)- et al.
Behavioral genetic analyses of self-reported anxiety at 7 years of age
J Am Acad Child Adolesc Psychiatry
(1999) Parenting Stress Index: Professional Manual
(1995)
Parenting Stress Index: a measure of the parent-child system
The relationship of early family variables to children's subsequent behavioral adjustment
J Clin Child Psychol
Family process and child anxiety and aggression: an observational analysis
J Abnorm Child Psychol
BSI: Administration, Scoring and Procedures Manual-II
SCL-90-R, Brief Symptom Inventory, and matching clinical rating scales
On predicting improvement and relapse in generalized anxiety disorder following psychotherapy
Br J Clin Psychol
The Coping Cat Workbook
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2021, Journal of Affective DisordersCitation Excerpt :The same may be true for the instruments used to measure primary outcomes, which were rather different and ranged from diagnostic tools (e.g. K-SADS) to dimensional measures (e.g. CGAS). Concerning the results of the third hypothesis, it should be emphasized that parental psychopathology was operationalized in various ways, as mentioned before and presented in Table A2: While some studies analyzed the effects of parents’ categorical diagnoses or symptomatology that was above clinically relevant cut-offs (Bodden et al., 2008; Cobham et al., 1998), others used continuous measures of general psychopathology (such as the Brief Symptom Inventory, used by Crawford & Manassis, 2001, Ginsburg et al., 2012, and Ginsburg et al., 2014) or measures specific to anxiety and/or depression (e.g. the Depression Anxiety Stress Scales by Lovibond & Lovibond, 1995, used by Liber et al., 2008, and Wergeland et al., 2016). Therefore, the summary effect sizes for parental psychopathology must be interpreted with additional caution as it is unclear how results would have differed in the case of more uniform operationalizations and the number of studies was too limited for more sophisticated analyses.
The authors gratefully acknowledge support from the Ontario Mental Health Foundation. Special thanks to Lisa Fiksenbaum, David Avery, and Bess Crawford for their help on this project.