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Familial Predictors of Treatment Outcome in Childhood Anxiety Disorders

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ABSTRACT

Objective

To determine whether family factors are predictive of outcome in children with anxiety disorders who are receiving cognitive-behavioral treatment.

Method

Participants were 61 children aged 8 to 12 years (mean = 10.0, SD = 1.4) with Axis I anxiety disorders who had been referred to a large Toronto children's hospital. Parents and children completed measures assessing family functioning, parenting stress, parental frustration, and parental psychopathology before and after treatment. Outcome measures included clinician-rated functioning (Children's Global Assessment Scale) and self-and parent-rated anxiety (Revised Children's Manifest Anxiety Scale).

Results

Child ratings of family dysfunction and frustration predicted clinician-rated improvement (total R 2 = 0.28, p < .001). Mother and father reports of family dysfunction, and maternal parenting stress, predicted mother-rated child improvement (total R 2 = 0.18, p < .01). Father-rated somatization and child reports of family dysfunction and frustration predicted child-rated improvement (total R 2 = 0.25, p < .001). Several family factors improved with treatment.

Conclusion

Family dysfunction appears to be related to less favorable treatment outcome in children with 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

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    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.

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