• By Laura Whybra
  • Posted on Monday 06th January, 2014

Does parent involvement in the treatment of separation anxiety disorder improve outcomes?

strong>When children are terrified of leaving their parents, who should be the focus of treatment – kids, parents, or both? A new study turns up a surprising result: in a randomized trial, there was little difference between treating the children alone and treating both parents and kids. Children with separation anxiety disorder (SAD) have an intense and dysfunctional fear of being apart from their caregivers. In some cases, children’s SAD may result from parents’ dysfunctional ideas about their child. So it seems reasonable that treating both children and parents would give better results than treating children alone.But in the first randomized controlled trial comparing a disorder-specific program for SAD with a general anxiety program, a team of researchers from Germany and Switzerland found that adding parents to the treatment mix resulted in only a “slight advantage” over child-based therapy. A SAD-specific treatmentIn this study, 64 German-speaking children (aged 8-13) with separation anxiety disorder were randomly allocated to one of two treatment groups. Half of the children completed a general anxiety program. This program focused exclusively on the child, using cognitive behavioral techniques to help the child replace dysfunctional thought processes with more positive ones.The other participants completed the disorder-specific “TAFF” program (“TrennungsAngstprogramm Fur Familien,” which translates to “Separation Anxiety Family Therapy”). The TAFF program also used cognitive behavioral techniques, but there were some important differences. In this program, equal time was spent treating parent and child. The additional sections included discussing and reframing the parent’s dysfunctional thoughts, educating the parent about anxiety, and practicing real-life separation situations with their child.“Marginal benefits”Surprisingly, TAFF produced only marginally greater benefits than the general anxiety program. At one-month and one-year follow-ups, both programs produced positive outcomes for the children. There was no statistically significant difference between the two programs.Specifically, at one-month post-treatment, 87.5% of children in the TAFF program were free of SAD diagnosis, compared to 82.1% of children in the general anxiety program. Given the relatively small sample size – 52 of the original 64 families completed treatment – the difference was not statistically significant. Both programs also produced similar reductions in child distress. Most surprising was the finding that the general anxiety program was as good as the TAFF program at reducing dysfunctional parental cognitions, despite therapy in the general anxiety program focusing only on the child. For future researchThese findings have some important implications for the treatment of SAD and future research. First, slightly improved outcomes may be possible for children with SAD when their parents are also involved in treatment. Larger samples will be needed to get a more precise estimate of the difference. Nonetheless, general anxiety programs that do not require parent involvement are still effective and produce similarly positive results.Second, some children may benefit more than others from parents’ treatment. Arguably, children whose parents have the most dysfunctional cognitions and behaviors are those who would benefit the most from a disorder-specific treatment for SAD that involves parental training. If this is so, how can we best identify this sub-group of children with SAD? Future research may try to identify these children, so that they can receive more appropriate and effective family-based treatment. ***********Reference:Schneider, S., Blatter-Meunier, J., Herren, C., In-Albon, T., Adornetto, C., Meyer, A. & Lavallee, K. L. (2013). The efficacy of a family-based cognitive behavioral treatment for separation anxiety disorder in children aged 8-13: a randomized comparison with a general anxiety program. Journal of Consulting and Clinical Psychology. doi: 10.1037/a0032678

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