Child anxiety
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Understanding Child Anxiety: Key Insights from Recent Research
Prevalence and Treatment of Child Anxiety Disorders
Anxiety disorders are the most common mental health issues among children and adolescents. A comprehensive review of 111 treatment outcome studies, covering 204 treatment conditions from 1967 to 2013, highlights the effectiveness of various treatments for child and adolescent anxiety. Cognitive-behavioral therapy (CBT) stands out as the most effective first-line treatment, with substantial evidence supporting its use. Other treatments, while not primarily CBT-based, also show promise, indicating alternative options for children who do not respond well to CBT 1.
Parenting and Child Anxiety
Parenting plays a significant role in the development and maintenance of child anxiety. A meta-analysis of 47 studies found that parenting accounts for only 4% of the variance in child anxiety, with parental control being more strongly associated with child anxiety than parental rejection. Specific dimensions, such as autonomy-granting, have a more substantial impact, suggesting that disaggregating parenting behaviors can provide deeper insights into their effects on child anxiety 2. Another review confirms that parental behaviors, such as modeling fearful responses and reducing autonomy, contribute to the development of anxious cognitions in children 6.
Screening for Child Anxiety
The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a widely used instrument for evaluating anxiety symptoms in children and adolescents. A meta-analysis of 65 studies conducted between 1997 and 2017 confirms the robust psychometric properties of both the parent and child versions of SCARED. The instrument demonstrates excellent internal consistency, moderate to large test-retest reliabilities, and moderate to large parent-child agreement rates, making it a reliable tool for screening and monitoring anxiety in clinical and community settings 37.
Anxiety in Children with Autism Spectrum Disorder (ASD)
Children with Autism Spectrum Disorder (ASD) often experience anxiety. A review of 137 studies from the 1980s to 2017 identifies various interventions for managing anxiety in children with ASD, including pharmacological treatments, CBT, social recreational programs, and parent education. The findings suggest that a combination of approaches tailored to the child's specific needs is most effective 4.
Attachment and Child Anxiety
Attachment insecurity is moderately related to child anxiety, with a meta-analysis of 46 studies showing an overall effect size of r = .30. Ambivalent attachment, in particular, has the strongest association with anxiety. The relationship is more pronounced during adolescence and when measured through questionnaires and self-reports 5.
Parent-Based Treatment vs. CBT
Parent-based treatments can be as effective as CBT for childhood anxiety. A randomized noninferiority study comparing Supportive Parenting for Anxious Childhood Emotions (SPACE) with CBT found that SPACE, which focuses on reducing family accommodation of anxiety, is noninferior to CBT. Both treatments significantly reduce anxiety symptoms, family accommodation, and parenting stress, offering viable alternatives for treating childhood anxiety 8.
Long-Term Outcomes of Childhood Anxiety Disorders
Childhood anxiety disorders can predict a range of psychiatric disorders in adolescence. Longitudinal data from the Great Smoky Mountains Study indicate that specific anxiety disorders in childhood, such as separation anxiety disorder (SAD) and overanxious disorder (OAD), are associated with various adolescent psychiatric conditions, including panic attacks, depression, and conduct disorder. This underscores the importance of early identification and intervention to mitigate long-term mental health issues 10.
Conclusion
The research underscores the complexity of child anxiety, highlighting the importance of effective treatments like CBT, the nuanced role of parenting, and the utility of reliable screening tools like SCARED. Understanding the interplay between attachment, parental behaviors, and long-term outcomes can inform better strategies for managing and mitigating anxiety in children and adolescents.
Sources and full results
Most relevant research papers on this topic
Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety
CBT is an effective first-line treatment for youth with anxiety disorders, but there are other evidence-based approaches available for those who don't respond well to CBT.
Systematic Review
Highly CitedExamining the association between parenting and childhood anxiety: a meta-analysis.
Parenting plays a modest role in child anxiety, with parental control being more strongly associated with anxiety than parental rejection.
Meta-AnalysisHighly CitedScreening for childhood anxiety: A meta-analysis of the screen for child anxiety related emotional disorders.
The SCARED instrument has robust psychometric properties and performs consistently well in community and clinical settings across various countries, making it a valuable tool for diagnosing and monitoring childhood anxiety.
Meta-Analysis
Rigorous JournalReview of interventions for the management of anxiety symptoms in children with ASD
A combination of pharmacotherapy, psychosocial and CBT interventions, parent education, and school-based programs can effectively manage anxiety in children with ASD.
Systematic ReviewThe Relation Between Insecure Attachment and Child Anxiety: A Meta-Analytic Review
Insecure attachment is moderately related to anxiety in children, with ambivalent attachment showing the strongest association, and the relationship is stronger during adolescence.
Meta-AnalysisHighly CitedA systematic review of the role of parents in the development of anxious cognitions in children.
Parental factors play a role in the development of anxious cognitions in children by modeling fearful responses, reducing autonomy, and indirectly through their own expectations about their child.
Systematic ReviewRigorous JournalThe Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics.
The SCARED is a reliable and valid screening instrument for children with anxiety disorders, showing good internal consistency, test-retest reliability, and discriminative validity.
Observational StudyHighly CitedParent-Based Treatment as Efficacious as Cognitive-Behavioral Therapy for Childhood Anxiety: A Randomized Noninferiority Study of Supportive Parenting for Anxious Childhood Emotions.
SPACE is an effective and noninferior parent-based treatment for childhood anxiety disorders, providing an alternative strategy for treating anxiety in children.
RCTHighly CitedResearch review: the relation between child and parent anxiety and parental control: a meta-analytic review.
Child anxiety is significantly associated with parental control, while parent anxiety shows a nonsignificant but small but significant relationship with parental control.
Meta-AnalysisRigorous JournalHighly CitedWhat do childhood anxiety disorders predict?
Childhood anxiety disorders predict a range of psychiatric disorders in adolescence, with separation anxiety disorder (SAD) being the most predictive.
Observational StudyHighly Cited