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Angststoornissen bij kinderen: een behandeling gericht op de ouders is even effectief als cognitieve gedragstherapie gericht op het kind. Een gerandomiseerde non-inferioriteitsstudie naar Supportive Parenting for Anxious Childhood Emotions

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Gezinstherapie Wereldwijd Aims and scope

Samenvatting

Doelstelling: Behandelingen voor angststoornissen bij kinderen zijn vaak onvoldoende effectief.

Eerder is onderzocht of de resultaten van CGT verbeteren als ouders bij de behandeling worden betrokken, maar er is nog geen onderzoek gedaan waarin de effectiviteit van behandelingen voor alleen de ouders wordt vergeleken met CGT bij kinderen. In het voorliggende onderzoek vergeleken we CGT met de SPACE-interventie: Supportive Parenting for Anxious Childhood Emotions (‘steunend opvoeden bij angstige emoties van een kind’). SPACE is een behandeling voor de ouders van een angstig kind die leidt tot vermindering van de accommodatie aan de angst van hun kind. Voor dit onderzoek zijn CGT en SPACE vergeleken in een experiment naar non-inferioriteit.

Methode: deelnemers van de studie waren kinderen met primaire angststoornissen (N  = 124; 7–14 jaar; 53% meisjes; 83% wit), die aselect werden ingedeeld in SPACE (n = 64) – waarbij er geen direct contact was tussen de therapeut en het kind –, of ze werden ingedeeld bij CGT (n = 60), waarbij hun ouders geen behandeling kregen. In totaal voltooiden 97 deelnemers (78%) alle behandelsessies en metingen. De uitvalspercentages verschilden niet significant per groep. De meetinstrumenten voor angst waren een diagnostisch interview en enkele beoordelingsschalen die de therapeut invulde. Als secundaire uitkomsten werd bekeken hoe de ouders en de kinderen scoorden op de ernst van de angst, de mate van accommodatie van het gezin, en de opvoedingsstress. De marges voor non-inferioriteit werden bepaald op grond van statistische en klinische overwegingen. De veranderingen in de accommodatie van het gezin en de opvoedingsstress werden onderzocht met gemengde-modellenanalyses.

Resultaten: SPACE deed niet onder voor CGT (non-inferioriteit) in de primaire en secundaire uitkomsten op angst, en ook niet waar het aankwam op de scores door de onafhankelijke beoordelaars, ouders en kinderen. In beide behandelingen namen de accommodatie van het gezin en de opvoedingsstress in SPACE significant af; de afname in accommodatie van het gezin was zelfs significant groter in SPACE dan in CGT. De geloofwaardigheid van- en tevredenheid over de behandeling in SPACE waren hoog.

Conclusie: SPACE is een acceptabele en werkzame behandeling voor angststoornissen bij kinderen, de interventie doet niet onder voor CGT en daarmee is SPACE een volwaardige, alternatieve strategie voor het behandelen van angst bij kinderen.

Informatie over de registratie van de klinische trial: Explanatory Clinical Trial of a Novel Parent Intervention for Childhood Anxiety (SPACE); https://clinicaltrials.gov; NCT02310152.

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Dankbetuiging

De auteurs willen James Jaccard, PhD, van de New York University School of Social Work, bedanken voor zijn adviezen in de statistiek voor dit onderzoek. Verder bedanken de auteurs James Leckman, Md, PhD, van de Yale School of Medicine Child Study Center, en Ruth Feldman, PhD, van het Interdisciplinary Center of Herzyla, voor hun steun en adviezen tijdens dit project.

Financiering

De bijdrage aan dit manuscript van Dr. Leibowitz is gefinancierd door het National Institute on Mental Health (K23MH103555) en het Center for the Advancement of Translational Science (KL2TR000140).

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Correspondence to Eli R. Lebowitz.

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Dr. Lebowitz heeft royalties ontvangen van John Wiley and Sons, en financiering van het National Institute of Mental Health. Dr. Silverman ontving royalties van Oxford University Press en financiering van het NIMH. Dr. Marin en dr. Shimshoni, en mw. Martino hebben geen melding gemaakt van financiële belangen in het biomedische vakgebied of van mogelijke belangenverstrengeling.

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This material was originally published in English as Parent-based treatment as efficacious as cognitive-behavioral therapy for childhood anxiety: A randomized noninferiority study of Supportive Parenting for Anxious Childhood Emotions. Journal of the American Academy of Child and Adolescent Psychiatry, 2020; 59 (3): 362–372. © 2019 American Academy of Child and Adolescent Psychiatry. https://doi.org/10.1016/j.jaac.2019.02.014. Vertaling: Lieke Berkhuizen.

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Lebowitz, E.R., Marin, C., Martino, A. et al. Angststoornissen bij kinderen: een behandeling gericht op de ouders is even effectief als cognitieve gedragstherapie gericht op het kind. Een gerandomiseerde non-inferioriteitsstudie naar Supportive Parenting for Anxious Childhood Emotions. Gezinstherapie Wereldwijd 31, 435–457 (2020). https://doi.org/10.1007/s12440-020-00135-5

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