Journal of Abnormal Child Psychology

, Volume 26, Issue 1, pp 27–38 | Cite as

Methodological Issues in Treatment Research for Anxiety Disorders in Youth

  • Philip C. Kendall
  • Ellen C. Flannery-Schroeder
Article

Abstract

This article identifies and addresses three methodological domains relevant to the treatment of anxiety disorders in youth: (a) procedural matters, (b) the assessment of anxious distress, and (c) the analysis of treatment-produced change. Procedural topics include the need to manualize treatment, have diversity among participants and comparability of the duration of treatment and control conditions, and control for medication status. Multiple-method measurement issues include child and parent reports, observations, and structured interviewing. Our examination of change issues considers comorbidity, analyzing the intent-to-treat sample, treatment “spillover,” and clinical as well as statistical significance. Problems are identified and potential ameliorative strategies are offered.

Anxiety therapy research methods child treatment clinical and statistical significance anxiety measurement 

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REFERENCES

  1. Achenbach, T. M. (1991a). Manual for the Child Behavior Checklist/4–18 and 1991 Profile. Burlington: Department of Psychiatry, University of Vermont.Google Scholar
  2. Achenbach, T. M. (1991b). Manual for the Teacher's Report Form and 1991 Profile. Burlington: Department of Psychiatry, University of Vermont.Google Scholar
  3. Albano, A. M., Marten, P., & Holt, C. S. (1991). Therapist's manual for cognitive-behavioral group therapy for adolescent social phobia. Unpublished manuscript, State University of New York, Albany.Google Scholar
  4. Allen, A. J., Leonard, H., & Swedo, S. (1995). Current knowledge of medications for the treatment of childhood anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 976–986.Google Scholar
  5. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, (4th ed.). Washington, DC: Author.Google Scholar
  6. American Psychological Association Task Force on Promotion and Dissemination of Psychological Procedures. (1995). Training in and dissemination of empirically-validated psychological treatments: Report and recommendations. The Clinical Psychologist, 48, 3–24.Google Scholar
  7. Angold, A., Cox, A., Prendergast, M., Rutter, M., & Simonoff, E. (1995). The Child and Adolescent Psychiatric Assessment (CAPA). Psychological Medicine, 25, 739–753.Google Scholar
  8. Barlow, D. H. (1989). Treatment outcome evaluation methodology with anxiety disorders: Strengths and key issues. Advances in Behaviour Research and Therapy, 11, 121–132.Google Scholar
  9. Barrett, P. M., Dadds, M. R., & Rapee, R. M. (1996). Family treatment of childhood anxiety: A controlled trial. Journal of Consulting and Clinical Psychology, 64, 333–342.Google Scholar
  10. Barrios, B., Hartmann, D., & Shigetomi, C. (1981). Fears and anxieties in children. In E. Mash & L. Terdal (Eds.), Behavioral assessment of childhood disorders (pp. 259–304). New York: Guilford Press.Google Scholar
  11. Beutler, L. E. (1996). The view from the rear: An editorial. Journal of Consulting and Clinical Psychology, 64, 845–847.Google Scholar
  12. Beutler, L. E., Brown, M. T., Crothers, L., Booker, K., & Seabrook, M. K. (1996). The dilemma of factitious demographic distinctions in psychological research. Journal of Consulting and Clinical Psychology, 64, 892–902.Google Scholar
  13. Bierman, K., & Schwartz, L. (1986). Clinical child interviews: Approaches and developmental considerations. Journal of Child and Adolescent Psychotherapy, 3, 267–278.Google Scholar
  14. Brady, E., & Kendall, P. C. (1992). Comorbidity of anxiety and depression in children and adolescents. Psychological Bulletin, 111, 244–255.Google Scholar
  15. Chambless, D., & Hollon, S. (1998). Criteria for determining empirically-supported treatments. Journal of Consulting and Clinical Psychology, 66, 7–18.Google Scholar
  16. Davidson, G. C., & Lazarus, A. A. (1995). The dialectics of science and practice. In S. Hayes, V. Follette, R. Dawes, & K. Grady (Eds.), Scientific standards of psychological practice: Issues and recommendations (pp. 95–120). Reno, NV: Context Press.Google Scholar
  17. Dobson, K., & Shaw, B. (1988). The use of treatment manuals in cognitive therapy: Experience and issues. Journal of Consulting and Clinical Psychology, 56, 673–682.Google Scholar
  18. Edelbrock, C., & Costello, A. J. (1984). Structured psychiatric interviews for children and adolescents. In G. Goldstein & M. Hersen (Eds.), Handbook of psychological assessment (pp. 276–290). New York: Pergamon Press.Google Scholar
  19. Flaherty, J. A., & Meaer, R. (1980). Measuring racial bias in inpatient treatment. American Journal of Psychiatry, 137, 679–682.Google Scholar
  20. Flannery-Schroeder, E. C., & Kendall, P. C. (1996). Cognitive-behavioral therapy for anxious children: Therapist manual for group treatment. Ardmore, PA: Workbook Publishing.Google Scholar
  21. Flannery-Schroeder, E. C., & Kendall, P. C. (1997). Group versus individual cognitive-behavioral treatment for anxiety-disordered children: A randomized clinical trial. Unpublished doctoral dissertation, Department of Psychology, Temple University, Philadelphia, PA.Google Scholar
  22. Garfield, S. (1997). Some comments on empirically supported psychological treatments. Journal of Consulting and Clinical Psychology, 66, 121–125.Google Scholar
  23. Giebenhain, J., & O'Dell, S. (1984). Evaluation of a parent-training manual for reducing children's fear of the dark. Journal of Applied Behavior Analysis, 17, 121–125.Google Scholar
  24. Ginsburg, G., & Silverman, W. (1996). Phobic and anxiety disorders in Hispanic and Caucasian youth. Journal of Anxiety Disorders, 10, 517–528.Google Scholar
  25. Glennon, B., & Weisz, J. R. (1978). An observational approach to the assessment of anxiety in young children. Journal of Consulting and Clinical Psychology, 46, 1246–1257.Google Scholar
  26. Hollon, S., & DeRubeis, R. (1981). Placebo-psychotherapy combinations: Inappropriate representations of psychotherapy in drug-psychotherapy comparative trials. Psychological Bulletin, 90, 467–477.Google Scholar
  27. Homma-True, R., Greene, B., Lopez, S. R., & Trimble, J. E. (1993). Ethnocultural diversity in clinical psychology. The Clinical Psychologist, 46, 50–63.Google Scholar
  28. Howard, B., & Kendall, P. C. (1996). Family cognitive-behavioral therapy for anxiety-disordered children: A multiple-baseline evaluation. Cognitive Therapy and Research, 20, 423–443.Google Scholar
  29. Jensen, P., Vitiello, B., Leonard, H., & Laughren, T. (1994). Design and methodology issues for clinical treatment trials in children and adolescents. Psychopharmacology Bulletin, 30, 3–8.Google Scholar
  30. Johnson, S., & Melamed, B. (1979). The assessment and treatment of children's fears. In B. Lahey & A. Kazdin (Eds), Advances in clinical child psychology (Vol. 2, pp. 107–139. New York: Plenum Press.Google Scholar
  31. Kashani, J. H., & Orvaschel, H. (1988). Anxiety disorders in midadolescence: A community sample. American Journal of Psychiatry, 145, 960–964.Google Scholar
  32. Kazdin, A. E. (1982). Symptom substitution, generalization, and response covariation: Implications for psychotherapy outcome. Psychological Bulletin, 91, 349–365.Google Scholar
  33. Kazdin A. E., & Weisz, J. (1998). Treating psychological problems in youth: Status of empirically-supported treatments. Journal of Consulting and Clinical Psychology, 66, 19–36.Google Scholar
  34. Kendall, P. C. (1994). Treating anxiety disorders in youth: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62, 100–110.Google Scholar
  35. Kendall, P. C., & Brady, E. (1995). Comorbidity in the anxiety disorders of childhood. In K. Craig & K. Dobson (Eds.) Anxiety and depression in adults and children. Newbury Park, CA: Sage.Google Scholar
  36. Kendall, P. C., Cantwell, D. P., & Kazdin, A. E. (1989). Depression in youth: Assessment issues and recommendations. Cognitive Therapy and Research, 13, 109–146.Google Scholar
  37. Kendall, P. C., & Flannery-Schroeder, E. C. (1995). Rigor, but not rigor mortis, in depression research methodology. Journal of Personality and Social Psychology, 68, 892–894.Google Scholar
  38. Kendall, P. C., Flannery-Schroeder, E., Panichelli-Mindel, S., Southam-Gerow, M., Henin, A., & Warman, M. (1997). Therapy for anxiety-disordered youth: A second randomized clinical trial. Journal of Consulting and Clinical Psychology, 65, 366–380.Google Scholar
  39. Kendall, P. C., & Grove, W. (1988). Normative comparisons in therapy outcome. Behavioral Assessment, 10, 147–158.Google Scholar
  40. Kendall, P. C., & Hollon, S. D. (1983). Calibrating therapy: Collaborative archiving of tape samples from therapy outcome trials. Cognitive Therapy and Research, 7, 199–204.Google Scholar
  41. Kendall, P. C., & Ingram, R. E. (1989). Cognitive-behavioral perspectives: Theory and research on depression and anxiety. In P. C. Kendall & D. Watson (Eds.), Anxiety and depression: Distinctive and overlapping features (pp. 27–53). San Diego, CA: Academic Press.Google Scholar
  42. Kendall, P. C., Kane, M., Howard, B., & Siqueland, L. (1992). Cognitive-behavioral therapy for anxious children: Therapist manual. Ardmore, PA: Workbook Publishing.Google Scholar
  43. Kendall, P. C., Kortlander, E., Chansky, T., & Brady, E. (1992). Comorbidity of anxiety and depression in youth: Treatment implications. Journal of Consulting and Clinical Psychology, 60, 869–880.Google Scholar
  44. Kendall, P. C., & Ronan, K. (1990). Assessment of children's anxieties, fears, and phobias: Cognitive-behavioral models and methods. In C. Reynolds & R. Kamphaus (Eds.), Handbook of psychological and educational assessment of children: Personality, behavior and context (pp. 223–244). New York: Guilford Press.Google Scholar
  45. Kendall, P. C., & Southam-Gerow, M. (1997). Long-term follow-up of treatment for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 65, 883–888.Google Scholar
  46. LaGreca, A. M., & Stone, W. (1993). Social Anxiety Scale for Children—Revised: Factor structure and concurrent validity. Journal of Clinical Child Psychology, 22, 17–27.Google Scholar
  47. LaPouse, R., & Monk, M. A. (1959). Fears and worries in a representative sample of children. American Journal of Orthopsychiatry, 29, 803–818.Google Scholar
  48. Last, C., & Perrin, S. (1993). Anxiety disorders in African American and white children. Journal of Abnormal Child Psychology, 21, 153–164.Google Scholar
  49. Lavori, P. W. (1992). Clinical trials in psychiatry: Should protocol deviation censor patient data? Neuropsychopharmacology, 6, 39–48.Google Scholar
  50. Levin, M. (1992). Pretreatment predictors of outcome in anxiety-disordered children. Unpublished master's thesis, Department of Psychology, Temple University, Philadelphia, PA.Google Scholar
  51. Lopez, S. R. (1989). Patient variable biases in clinical judgement: Conceptual overview and methodological considerations. Psychological Bulletin, 106, 184–204.Google Scholar
  52. Luborsky, L., & DeRubeis, R. (1984). The use of therapy treatment manuals: A small revolution in psychotherapy research style. Clinical Psychology Review, 4, 5–14.Google Scholar
  53. March, J., & Mulle, K. (1996). Cognitive-behavioral psychotherapy for obsessive-compulsive disorder. Unpublished manuscript, Duke University Medical Center, Durham, NC.Google Scholar
  54. Melamed, B. G., & Bush, J. P. (1985). Family factors in children with acute illness. In S. Auerbach & A. Stolberg (Eds.), Crisis in families. New York: Hemisphere Publishing.Google Scholar
  55. Melamed, B. G., & Siegel, L. J. (1975). Reduction of anxiety in children facing hospitalization and surgery by use of filmed modeling. Journal of Consulting and Clinical Psychology, 43, 511–521.Google Scholar
  56. Miller, L., Barrett, C., & Hampe, E. (1974). Phobias of childhood in a prescientific era. In A. Davids (Ed.), Child personality and psychopathology: Current topics (pp. 89–134). New York: Wiley.Google Scholar
  57. Morris, R. J., & Kratchowill, T. R. (1983). Treating children's fear and phobias: A behavioral approach. New York: Pergamon Press.Google Scholar
  58. Nalven, F. B. (1970). Manifest fears and worries of ghetto versus middle class suburban children. Psychological Reports, 27, 285–286.Google Scholar
  59. Neal, A. M., Lilly, R. S., & Zakis, S. (1993). What are African American children afraid of? A preliminary study. Journal of Anxiety Disorders, 7, 129–139.Google Scholar
  60. Neal, A. M., & Turner, S. M. (1991). Anxiety disorders research with African Americans: Current status. Psychological Bulletin, 109, 400–410.Google Scholar
  61. Neighbors, H. W. (1985). Seeking help for personal problems: Black Americans' use of health and mental health services. Community Mental Health Journal, 21, 156–166.Google Scholar
  62. Neighbors, H. W. (1988). The help-seeking behavior of Black Americans. Journal of the National Medical Association, 80, 1009–1012.Google Scholar
  63. Ollendick, T. H. (1978). Fear Survey Schedule: Revised. (Available from the author, Virginia Polytechnic Institute and State University, Blacksburg, VA)Google Scholar
  64. Panichelli-Mindel, S., Flannery-Schroeder, E., Ashmore-Caliahan, S., & Kendall, P. C. (1995). Disclosure and nondisclosure among anxiety-disordered youth: Subject characteristics and treatment outcome differences. Poster presented at AABT, Washington, DC.Google Scholar
  65. Reynolds, C. R., & Richmond, B. O. (1978). What I Think and Feel: A revised measure of Children's Manifest Anxiety. Journal of School Psychology, 24, 313–319.Google Scholar
  66. Ronan, K. R., Kendall, P. C., & Rowe, C. (1994). Negative affectivity in children: Development and validation of a self-statement questionaire. Cognitive Therapy and Research, 18, 509–528.Google Scholar
  67. Schulte, D., Kunzel, R., Pepping, G., & Schulte-Bahrenberg, T. (1992). Tailor-made versus standardized therapy of phobic patients. Advances in Behaviour Research and Therapy, 14, 67–92.Google Scholar
  68. Silverman, W., & Albano, A. (1996). Anxiety Disorder Interview Schedule for Children (ADIS). Albany: Graywind Publications, State University of New York.Google Scholar
  69. Simon, R., Fleiss, J., Gurland, B., Stiller, P., & Sharpe, L. (1973). Depression and schizophrenia in hospitalized black and white mental patients. Archives of General Psychiatry, 28, 509–512.Google Scholar
  70. Spielberger, C. (1973). Manual for the State-Trait Anxiety Inventory for Children. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
  71. Strauss, C. C. (1987). Modification of the trait portion of the State-Trait Anxiety Inventory for Children—Parent Form. (Available from the author).Google Scholar
  72. Treadwell, K. H., Flannery-Schroeder, E. C., & Kendall, P. C. (1994). Ethnicity and gender in a sample of clinic-referred anxious children: Adaptive functioning, diagnostic status, and treatment outcome. Journal of Anxiety Disorders, 9, 373–384.Google Scholar
  73. Werry, J. S. (1986). Diagnosis and assessment. In R. Gitteiman (Ed.), Anxiety disorders of childhood (pp. 73–100). New York: Guilford Press.Google Scholar
  74. Wilson, G. T. (1995). Empirically validated treatments as a basis for clinical practice: Problems and prospects. In S. C. Hayes, V. M. Follette, R. D. Dawes, & K. Grady (Eds.), Scientific standards of psychological practice: Issues and recommendations (pp. 163–196). Reno, NV: Context Press.Google Scholar
  75. Wilson, G. T. (1996). Treatment of bulimia nervosa: When CBT fails. Behaviour Research and Therapy, 34, 197–212.Google Scholar

Copyright information

© Plenum Publishing Corporation 1998

Authors and Affiliations

  • Philip C. Kendall
    • 1
  • Ellen C. Flannery-Schroeder
    • 2
  1. 1.Department of PsychologyTemple UniversityPhiladelphia
  2. 2.Temple UniversityPhiladelphia

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