The primary focus of this study was to examine the relationship between parent stress and child anxiety. In addition, differences in child anxiety by gender and ethnicity were explored. Finally, data were evaluated to determine differences in types of anxiety symptoms reported by children. Participants were 34 parent-child dyads from Morrison Child and Family Services in Portland, Oregon. Children (20 females, 14 males) ranged in age from 8 years to 12 years. The parent group (30 females, 4 males) included only biological parents or legal guardians, with 23 parents reporting a single-caregiver home. Results were not significant for correlations between parent stress or parent life stress and child anxiety or for differences in child anxiety by gender or ethnicity. Results did indicate that on the MASC, children reported significantly higher scores on the Harm Avoidance scale than any other index. Limitations and future directions are discussed. / text

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neuropsychiatric disorders in childhood among school-aged children. It is characterized by behavior disinhibition, overactivity and/or difficulty in sustaining attention. Psychotherapy and pharmacotherapy are reported ways of treating ADHD. Around 35% of individuals diagnosed with ADHD also met the criteria for anxiety disorders that commonly coexist with ADHD. If not treated up to 70% of children with ADHD continue to meet the diagnostic criteria into adolescence. Psychostimulants (Methylphenidate) are the first line of treatment in Turkey. The first aim of this present study was to introduce Spence Children&amp / #8217 / s Anxiety Scale Parent version (SCAS-P) by conducting Turkish translation, factor structure, and reliability-validity studies of the scale. Results of the principle component analysis extracted five factors for the Turkish version of SCAS-P. Inter-correlations among the factors (r=0.28 &amp / #8211 / 0.45) were found to be satisfactory indicating for convergent validity. Criterion validity of the scale was found to be significant as well. Analysis indicated that the top 27th percentile of the sample was significantly differenciated from the bottom 27th percentile of the sample (t(74)=9.63, p&lt / .05). Results revealed Cronbach alpha of .88, and the split half reliability of .79 for the total scale score. Internal consistency of the subscales of the SCAS-P ranged from 0.56 to 0.78. The second aim of this study was to examine the effects of Methylphenidate (MPH) on cognitive abilities, hyperactivity and anxiety level of children with ADHD since MPH is known to be a first line of treatment for Attention Deficit Hyperactivity Disorder (ADHD). Thirty-six elementary school children, from age seven to twelve were gathered from the local Hospital for the Social Security Office Child Psychiatry Clinic in Ankara via using purposive sampling. Seventeen children who met the DSM-IV diagnostic criteria for ADHD were assigned to the drug group, and nineteen children without ADHD were assigned to the comparison group. Bender Gestalt Visual Motor Perception Test, Wechsler Intelligence Scale for Children-Revised subscales, and Vigilance Task developed by the researcher were administered to participant children, for measuring cognitive abilities. Hacettepe ADHD Scale and SCAS-P were administered to parents of the participants for measuring hyperactivity level and child anxiety. Measurements were repeated after a 12-week follow up both for the drug group (N=17) and the comparison group (N=19). In the 12-week period, drug group received MPH treatment, and the comparison group received no interventions regarding ADHD. 2 (Drug group vs. Comparison group) x 2 (Pretest vs. Posttest) mixed ANOVA with repeated measures on the last factor was conducted for the results of each measurement scale separately. As expected, MPH treatment revealed improvement in cognitive abilities and hyperactivity level of children with ADHD. All participants were found to have high anxiety scores when first referred to the hospital, and were found to have lower scores of anxiety on posttest. The findings were discussed on the basis of literature and limitations of the present study.

The efficacy of cognitive-behavioural therapy (CBT) in the treatment of child anxiety disorders has been well established in the literature, with on average, just over 50% of children becoming free of their primary anxiety diagnosis immediately following treatment (James et al., 2008). Despite the existence of these efficacious treatments, up to two thirds of children with anxiety do not receive assistance for their difficulties (Essau et al., 2002). The reasons for this are varied, and include lack of available therapists or services, long waiting lists, high therapy costs and stigma associated with therapy. Computer- and internet-based interventions represent a modern alternative for delivering CBT interventions that may be more appealing and accessible to a greater proportion of children with anxiety. Various forms of computer-assisted therapies have been investigated, including palmtop computers, desktop computers, virtual reality and online programs. Although computerised interventions have demonstrated promise in the treatment of adult anxiety, they have only recently received interest in the child literature. Specifically, there are very few controlled trials evaluating the efficacy of computer- and internet-based interventions for childhood psychological disorders, including anxiety disorders. The present research involved the initial development and subsequent testing of an entirely internet-based, CBT intervention for child anxiety disorders. BRAVE-ONLINE was developed as an internet adaptation of The BRAVE Program, a clinic-based program which has demonstrated efficacy in the treatment of childhood anxiety. The online intervention is a therapist-mediated program, in which children and parents receive email and telephone assistance from a therapist throughout treatment. BRAVE-ONLINE is an interactive program consisting of 10 child and 6 parent sessions to be completed by families in their own home. Following the development of BRAVE–ONLINE, the first study of this thesis included a randomised control trial to investigate the efficacy of the internet-based intervention (NET) compared to a waitlist control (WL). Seventy-three children aged between 7 and 12 years, diagnosed with separation anxiety disorder, social phobia, generalised anxiety disorder or specific phobia were randomly allocated to NET and WL conditions. Treatment effects were evaluated at 10-14 weeks post-assessment and 6-month follow-up, using multiple outcome measures including a diagnostic interview, clinician ratings of severity, parent and child questionnaires. Results indicated that at post-assessment, 30% of NET participants in the completer sample (22.5% in the Intent-to-Treat (ITT) sample) no longer met criteria for their primary anxiety diagnosis, compared to 10% of WL participants. Significant gains were also evident for clinician severity ratings, global assessments of functioning, and several questionnaire measures. However, results also indicated that children and parents were slow to progress through therapy, such that a large proportion of families had not completed all treatment sessions at the post-assessment point. For this reason, 6-month follow-up may present a better indication of treatment efficacy. Indeed, at 6-month follow-up, treatment gains were improved upon such that 75% of children in the completer sample (52.5% in the ITT sample) no longer met criteria for their primary anxiety disorder. Reductions in severity ratings, global assessments of functioning and child and parent self-report measures were also improved upon at 6-month follow-up. Further, the online intervention was found to be highly acceptable to families and was associated with only minimal rates of attrition. The second study of this thesis aimed to explore factors associated with treatment outcome for the online intervention. Factors of interest included demographic factors (age, gender, income and educational background), treatment expectancy, initial symptom severity, program compliance and pre-treatment diagnostic comorbidity. Specifically, this study investigated the extent to which each of these factors predicted the improvement made by children on global assessments of functioning (CGAS) at 6-month follow-up. Results indicated that only some of these factors were directly associated with treatment outcome. Although treatment expectancy predicted compliance with the program, it was not associated with treatment outcome. Baseline severity also did not predict treatment outcome. Contrary to expectation, levels of program compliance by children negatively predicted outcome, such that children who were more compliant with the program showed fewer improvements in overall functioning. Parent compliance did not predict treatment outcome. A significant relationship was evident between diagnostic comorbidity (number of pre-treatment anxiety diagnoses) and treatment outcome, such that higher baseline comorbidity predicted poorer functioning on the CGAS at 6-month follow-up. None of the demographic factors were associated with treatment outcome. Overall, the findings of this research suggest that a CBT intervention delivered entirely over the internet was associated with reductions in indicators of anxiety at post-assessment, compared to a WL control, particularly for the completer sample. Further, these reductions were improved upon at 6-month follow-up, with a substantial proportion of children becoming free of their primary anxiety diagnosis. The results also indicated that the online intervention might not be as effective for children suffering from multiple anxiety disorders. The effects of program compliance were somewhat surprising and possible explanations are offered. Although these results are promising, conclusions should be regarded as tentative until further trials are conducted and the online intervention is compared with clinic-based treatments. Limitations of this research and areas for future research are discussed.

The efficacy of cognitive-behavioural therapy (CBT) in the treatment of child anxiety disorders has been well established in the literature, with on average, just over 50% of children becoming free of their primary anxiety diagnosis immediately following treatment (James et al., 2008). Despite the existence of these efficacious treatments, up to two thirds of children with anxiety do not receive assistance for their difficulties (Essau et al., 2002). The reasons for this are varied, and include lack of available therapists or services, long waiting lists, high therapy costs and stigma associated with therapy. Computer- and internet-based interventions represent a modern alternative for delivering CBT interventions that may be more appealing and accessible to a greater proportion of children with anxiety. Various forms of computer-assisted therapies have been investigated, including palmtop computers, desktop computers, virtual reality and online programs. Although computerised interventions have demonstrated promise in the treatment of adult anxiety, they have only recently received interest in the child literature. Specifically, there are very few controlled trials evaluating the efficacy of computer- and internet-based interventions for childhood psychological disorders, including anxiety disorders. The present research involved the initial development and subsequent testing of an entirely internet-based, CBT intervention for child anxiety disorders. BRAVE-ONLINE was developed as an internet adaptation of The BRAVE Program, a clinic-based program which has demonstrated efficacy in the treatment of childhood anxiety. The online intervention is a therapist-mediated program, in which children and parents receive email and telephone assistance from a therapist throughout treatment. BRAVE-ONLINE is an interactive program consisting of 10 child and 6 parent sessions to be completed by families in their own home. Following the development of BRAVE–ONLINE, the first study of this thesis included a randomised control trial to investigate the efficacy of the internet-based intervention (NET) compared to a waitlist control (WL). Seventy-three children aged between 7 and 12 years, diagnosed with separation anxiety disorder, social phobia, generalised anxiety disorder or specific phobia were randomly allocated to NET and WL conditions. Treatment effects were evaluated at 10-14 weeks post-assessment and 6-month follow-up, using multiple outcome measures including a diagnostic interview, clinician ratings of severity, parent and child questionnaires. Results indicated that at post-assessment, 30% of NET participants in the completer sample (22.5% in the Intent-to-Treat (ITT) sample) no longer met criteria for their primary anxiety diagnosis, compared to 10% of WL participants. Significant gains were also evident for clinician severity ratings, global assessments of functioning, and several questionnaire measures. However, results also indicated that children and parents were slow to progress through therapy, such that a large proportion of families had not completed all treatment sessions at the post-assessment point. For this reason, 6-month follow-up may present a better indication of treatment efficacy. Indeed, at 6-month follow-up, treatment gains were improved upon such that 75% of children in the completer sample (52.5% in the ITT sample) no longer met criteria for their primary anxiety disorder. Reductions in severity ratings, global assessments of functioning and child and parent self-report measures were also improved upon at 6-month follow-up. Further, the online intervention was found to be highly acceptable to families and was associated with only minimal rates of attrition. The second study of this thesis aimed to explore factors associated with treatment outcome for the online intervention. Factors of interest included demographic factors (age, gender, income and educational background), treatment expectancy, initial symptom severity, program compliance and pre-treatment diagnostic comorbidity. Specifically, this study investigated the extent to which each of these factors predicted the improvement made by children on global assessments of functioning (CGAS) at 6-month follow-up. Results indicated that only some of these factors were directly associated with treatment outcome. Although treatment expectancy predicted compliance with the program, it was not associated with treatment outcome. Baseline severity also did not predict treatment outcome. Contrary to expectation, levels of program compliance by children negatively predicted outcome, such that children who were more compliant with the program showed fewer improvements in overall functioning. Parent compliance did not predict treatment outcome. A significant relationship was evident between diagnostic comorbidity (number of pre-treatment anxiety diagnoses) and treatment outcome, such that higher baseline comorbidity predicted poorer functioning on the CGAS at 6-month follow-up. None of the demographic factors were associated with treatment outcome. Overall, the findings of this research suggest that a CBT intervention delivered entirely over the internet was associated with reductions in indicators of anxiety at post-assessment, compared to a WL control, particularly for the completer sample. Further, these reductions were improved upon at 6-month follow-up, with a substantial proportion of children becoming free of their primary anxiety diagnosis. The results also indicated that the online intervention might not be as effective for children suffering from multiple anxiety disorders. The effects of program compliance were somewhat surprising and possible explanations are offered. Although these results are promising, conclusions should be regarded as tentative until further trials are conducted and the online intervention is compared with clinic-based treatments. Limitations of this research and areas for future research are discussed.

No description available.

No description available.

No description available.

No description available.

This two wave panel study examined child self-regulation as a potential mediator of the relationship between marital attachment security in parents and anxiety in their adolescent child. Data for this study were taken from the two parent families in waves three and four of the Flourishing Families project which included 335 two-parent families with children between the ages of 14 and 16. Both parents and child completed the Novak and Clayton (2001) Self-regulation Scale with the child's self-regulation as the target, and both husbands and wives completed a modified version of the Experiences in Close Relationships Questionnaire (Fraley, Waller, & Brennan, 2000) for their attachment security in their marriage. Children completed the generalized anxiety subscale of the Spence Anxiety Inventory (Spence, 1998) at both waves. Findings showed that child self-regulation was a process through which wife insecure attachment in her marriage indirectly influenced child anxiety in both boys and girls. Self-regulation also mediated the relationship between husband insecure couple attachment and child anxiety for boys but not for girls. Only the mother insecure marital attachment was directly related to both boys' and girls' anxiety. Implications of the findings for family therapy are discussed.

No description available.