Childhood Anxiety Disorders: Developmental Risk Factors and Predictors of Treatment Response

Cognitive Behavioral Therapy (CBT) is the evidence-based treatment of choice for childhood anxiety disorders. Its blend of cognitive and behavioral coping strategies for anxiety management has more empirical support than any other intervention approach. Yet even after receiving CBT, more than 40% of anxious children still meet criteria for their anxiety disorder. Research is needed to identify factors associated with treatment response and non-response, and ultimately to inform treatment improvement. Three studies, reflecting this broad objective, focus on factors that may relate to child treatment response—environmental, biological, and cognitive factors suggested by theoretical models of anxiety and potentially relevant to treatment effectiveness research. Study 1 examined whether parental anxiety is a negative predictor, and child perception of control a positive predictor, of treatment outcome in CBT within a randomized controlled trial for childhood anxiety disorders. We found that parental anxiety and child perception of control were not associated with treatment outcomes in the CBT or Usual Care treatment conditions with the exception of child perceived social control. In addition, parental anxiety levels did not change from preto post-treatment but child perceived control increased from preto post-treatment in response to both CBT and Usual Care. Study 2 examined biological stress response in the context of exposure, the treatment component widely regarded as the heart of CBT for anxiety. Analyses of salivary analytes focused on activation of biological systems implicated in the social stress response (i.e., the hypothalamic-pituitaryadrenal axis and the autonomic nervous system) in children with Social Anxiety Disorder and