Cognitive Behavioral Therapy for 4-to 7-Year-Old Children With Anxiety Disorders: A Randomized Clinical Trial
Cognitive Behavioral Therapy for 4-to 7-Year-Old Children With Anxiety Disorders: A Randomized Clinical Trial
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DOI：
10.1037/a0019055
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发表时间：
2010-08-01
影响因子：
5.9
通讯作者：
Biederman, Joseph
中科院分区：
文献类型：
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作者：
Hirshfeld-Becker, Dina R.;Masek, Bruce;Biederman, Joseph
目的：探讨适合儿童发展的亲子认知行为治疗（CBI）方案对4-7岁儿童焦虑症的疗效。方法：设计：随机对照试验。行为：64名患有焦虑症的儿童（53%为女性，平均年龄5.4岁，80%为欧洲裔美国人）被随机分配到父母儿童CBT干预组（n = 34）或6个月等待名单条件组（n = 30）。通过对治疗分配不知情的访谈者，使用与父母的结构化诊断访谈，行为抑制的实验室评估和父母问卷对儿童进行评估。分析：结果率的卡方分析和重复测量的线性和有序回归，检查干预相互作用的时间。结果如下：在57名完成者中，应答率（焦虑临床总体印象量表改善很多或非常多）为69% vs 32%（CBT vs对照组），p <0.01;意向治疗：59% vs 30%，p = 0.016。与对照组相比，治疗组儿童的焦虑障碍显著减少（效应量[ES] = 0.55），父母评定的应对方式显著增加（ES = 0.69），社交恐惧症/回避障碍（ES = 0.95）、分离焦虑症（ES = 0.82）和特定恐惧症（ES = 0.78）的CGI改善显著更好，但广泛性焦虑症的CGI改善不明显。儿童行为检查表内化量表的结果并不显着，并受到低回报率的限制。治疗反应与年龄或父母焦虑无关，但与行为抑制呈负相关。在1年随访时仍保持增益。结论：研究结果表明，发展修改的父母子女CBT可能会显示承诺，在4至7岁的儿童。
Objective: To examine the efficacy of a developmentally appropriate parent child cognitive behavioral therapy (CBI) protocol for anxiety disorders in children ages 4-7 years. Method: Design: Randomized wait-list controlled trial. Conduct: Sixty-four children (53% female, mean age 5.4 years, 80% European American) with anxiety disorders were randomized to a parent child CBT intervention (n = 34) or a 6-month wait-list condition (n = 30). Children were assessed by interviewers blind to treatment assignment, using structured diagnostic interviews with parents, laboratory assessments of behavioral inhibition, and parent questionnaires. Analysis: Chi-square analyses of outcome rates and linear and ordinal regression of repeated measures, examining time by intervention interactions. Results: The response rate (much or very much improved on the Clinical Global Impression Scale for Anxiety) among 57 completers was 69% versus 32% (CBT vs. controls), p < .01; intent-to-treat: 59% vs. 30%, p = .016. Treated children showed a significantly greater decrease in anxiety disorders (effect size [ES] = .55) and increase in parent-rated coping (ES = .69) than controls, as well as significantly better CGI improvement on social phobia/avoidant disorder (ES = .95), separation anxiety disorder (ES = .82), and specific phobia (ES = .78), but not on generalized anxiety disorder. Results on the Child Behavior Checklist Internalizing scale were not significant and were limited by low return rates. Treatment response was unrelated to age or parental anxiety but was negatively predicted by behavioral inhibition. Gains were maintained at 1-year follow-up. Conclusions: Results suggest that developmentally modified parent child CBT may show promise in 4- to 7-year-old children.