• By Laura Whybra
  • Posted on Friday 02nd October, 2015

Helping children to “roar” again – the Timid To Tiger approach to anxiety

strong>While cognitive-behavioral therapy (CBT) is often the “go-to” treatment for phobias and other anxiety disorders among teenagers, there has been little to suggest it works well with younger children. Researchers in the UK are intent on changing that by merging CBT methods into a promising new program where parents get the intervention and over-anxious children get the benefits.Surveys suggest anxiety disorders affect at least three per cent of children below the age of puberty at any one time and that they may be more widespread than depression or chronic behavioral problems. There is also growing evidence that parenting contributes to severe anxieties in childhood, not least if it is low on affection, overprotective, or characterized by harsh punishment, shouting and anger. Some researchers go further, arguing that highly anxious children are especially sensitive to the effects of poor parenting.From that perspective, it made sense for researchers at the University of Manchester to investigate the scope for an intervention where parents would not only discover how to establish a warmer, more nurturing relationship with their children, but also learn cognitive-behavioral techniques to encourage self-confidence and help them manage their fears.The resulting Timid to Tiger program was first piloted successfully with a small number of families and then tested in a randomized trial involving 74 children with probable anxiety disorders, aged two to nine. The children’s diagnoses spanned a wide range of conditions, including separation anxiety, panic disorder, phobias, depression and posttraumatic stress disorder.“Stairway to bravery”Their parents, working in groups of between three and seven families, attended ten parenting sessions lasting two hours each. Each session was delivered by clinical psychologists, who educated parents about the use of gentle, positive discipline to manage difficult behavior and promote confidence. The sessions also included guidance on how to play with children, praise and rewards, how to ignore poor behavior and techniques for dealing with worry, based on a “stairway to bravery”. Sessions were divided into two parts, with the first dedicated to recapping the homework exercises given the previous week, and the second introducing new material. Families taking part in the trial were randomly assigned to take part in Timid to Tiger, or to a waitlist control group who would receive the intervention 10 weeks later. Outcomes were measured by questioning parents using the Child Behavior Checklist (CBCL) and the Screen for Child Anxiety Related Disorders (SCARED). Children attended a diagnostic interview, but those aged six and over also completed the Multidimensional Anxiety Scale for Children (MASC) by having the questions read to them. Anxiety-free childrenThe intervention produced some impressive results. Of the 27 children in the treatment group, 21 no longer had their primary diagnosis after the intervention, compared with five out of 33 children in the control group. Moreover, 12 intervention children were found to be free of all anxiety diagnoses, compared with only two of the control children. In other words, taking part in the program made participants more than seven times as likely to be free of a primary diagnosis, or of all anxiety symptoms, than being part of the control group. Follow-up data also indicated that the positive results were being maintained a year later when 20 children in the intervention group remained free of their primary diagnosis and 17 no longer had any anxiety diagnosis. The scores calculated from children’s replies to the MASC questionnaire proved less encouraging, showing no statistically significant difference between the intervention and control groups. However, the MASC measure was designed for use with older children and the results may have been somewhat confounded by efforts made by the researchers to put the children (aged 6 to 9) at their ease while they were interviewed. Other limitations to the study included its relatively modest scale and the fact that it relied on parent reported data for its positive results, since efforts to gather enough data from children’s teachers were unsuccessful. This input could have been valuable as the interactions between children and their teachers can be very different to those with their parents. At this stage in the program’s development, the researchers limit their claims to an assertion that “a cognitive-behavior-based parenting intervention for anxiety in young children may be effective in the treatment of this neglected population.” Others may conclude – with less restraint – that the approach not only shows promise as a means of tackling childhood anxiety disorders, but also sheds important light on the part that parenting can play in the mechanisms through which children become severely and chronically anxious in the first place. ************Reference:Cartwright-Hatton, S., McNally, D., Field, A.P., Rust, S., Laskey, B., Dixon, C., Gallagher, B., Harrington, R., Miller, C., Pemberton, K., Symes, W., White, C., & Woodham, A. (2011). A New Parenting-based Group Intervention for Young Anxious Children: Results of a Randomized Controlled Trial. Journal of the American Academy of Child and Adolescent Psychiatry. 50 (3): 242-251 doi: 10.1016/j.jaac.2010.12.015.

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