Personalized Assessment of Anxiety and Avoidance in Children and Their Parents—Development and Evaluation of the Anxiety and Avoidance Scale for Children

In treating childhood anxiety disorders, therapists use highly individualized anxiety hierarchies to assess anxiety-eliciting situations and to personalize treatment. In contrast, psychometric assessment of anxiety symptoms in children usually consists of standardized questionnaires, assessing either total anxiety or disorder-specific symptom scores, prioritizing comparability over individual information. To account for interindividual differences, the Anxiety and Avoidance Scale for Children (AVAC) was developed, following a precise, personalized, assessment approach. In responding to the questionnaire, children and parents identify the most anxiety-eliciting situations before starting treatment, and rate them for anxiety and avoidance. Ratings are repeated over the course of treatment. The aim of this study is to introduce the new questionnaire and present first data on psychometric properties. The AVAC was administered to 389 children with separation anxiety disorder (N = 148), social anxiety disorder (N = 110) or specific phobia (N = 131) aged 8 to 16 and their parents, along with other measures of anxiety and psychopathology before and after cognitive behavioral treatment. Results showed adequate to good test-retest reliability. The AVAC items correlated significantly with established anxiety questionnaires, indicating convergent construct validity. Regarding divergent construct validity, the AVAC showed only small correlations with externalizing symptoms, demonstrating its precision in measuring anxiety and avoidance. The questionnaire was also sensitive to change after treatment, with medium to large effects in the reduction of anxiety and avoidance. The present analyses suggest that the new personalized assessment approach with the AVAC is a reliable and valid assessment of individualized anxiety and avoidance, as well as change in those constructs over the course of CBT treatment.

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Treatment Modifications Based on Childhood Anxiety Diagnosis: Demonstrating the Flexibility in Manualized Treatment

Journal of Cognitive Psychotherapy ◽

10.1891/jcop.20.3.275 ◽

2006 ◽

Vol 20 (3) ◽

pp. 275-286 ◽

Cited By ~ 13

Author(s):

Rachel L. Grover ◽

Alicia A. Hughes ◽

R. Lindsey Bergman ◽

Julie Newman Kingery

Keyword(s):

Anxiety Disorder ◽

Behavioral Treatment ◽

Relaxation Training ◽

School Personnel ◽

Selective Mutism ◽

Childhood Anxiety ◽

Separation Anxiety Disorder ◽

Cognitive Behavioral ◽

Treatment Manual ◽

Cognitive Behavioral Treatment

The current article presents suggestions for modifications to common manualized treatments to tailor the interventions to specific anxiety diagnoses and common comorbid diagnoses. The authors utilize one cognitive-behavioral treatment manual (Coping Cat; Kendall, 2000) to demonstrate appropriate clinical accommodations. As the majority of cognitive-behavioral treatment manuals contain both skill (e.g., relaxation training, cognitive restructuring, problem solving) and exposure components, suggestions for accommodations are grouped into relevant skill or exposure sections. Recommended modifications include a focus on imaginal exposure for generalized anxiety disorder, involvement of parents in the treatment of separation anxiety disorder, completion of a variety of in vivo exposures for social phobia, and involvement of school personnel in the treatment of selective mutism. Brief recommendations are also included for common comorbid symptoms of depression and attention-deficit/hyperactivity disorder.

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Patterns and Predictors of Subjective Units of Distress in Anxious Youth

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465810000287 ◽

2010 ◽

Vol 38 (4) ◽

pp. 497-504 ◽

Cited By ~ 23

Author(s):

Courtney L. Benjamin ◽

Kelly A. O'Neil ◽

Sarah A. Crawley ◽

Rinad S. Beidas ◽

Meredith Coles ◽

...

Keyword(s):

Anxiety Disorder ◽

Hierarchical Linear Modeling ◽

Behavioral Treatment ◽

Separation Anxiety ◽

Separation Anxiety Disorder ◽

Cognitive Behavioral Treatment ◽

Linear Modeling ◽

Anxious Youth ◽

Distress Scale

Background: Subjective Units of Distress Scale (SUDS) ratings are commonly used during exposure tasks in cognitive behavioral treatment (CBT) for anxiety. Aims: The present study examined patterns and predictors of SUDS in a sample of anxiety-disordered youth. Method: Youth (N = 99) aged 7 to 14 (M = 10.4, SD = 1.8) were treated with CBT for social phobia (SP), generalized anxiety disorder (GAD), and/or separation anxiety disorder (SAD). Analyses were conducted using hierarchical linear modeling. Results: Child's peak SUDS and magnitude of change in SUDS significantly increased between sessions. Higher child self-reported pretreatment total Multidimensional Anxiety Scale for Children (MASC) score predicted greater change in SUDS within the first exposure session. Primary GAD diagnosis predicted less increase in change in SUDS between sessions. Conclusions: Results suggest that higher pretreatment total MASC scores are associated with increased first exposure within-session habituation. Additionally, youth with a principal diagnosis of GAD experienced less between-session habituation, perhaps because they may have required more imaginal than in-vivo exposures.

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