Additional Reference – Lecture 2, Risk & Resilience Schaffer, H.R. (2000). The early experience assumption: Past, present, and future, International Journal of Behavioral Development, 24, 1, pp5-14 Rosaleen McElvaney, Phd

Additional Reference, Lecture 2, Risk & Resilience Preview Ravens Siberer, U., Erhart, M., Gosch, A., Wille, N., The European KIDSCREEN Group (2008), Mental health of children and adolescents in 12 European countries: Results from the European KIDSCREEN study, Clinical Psychology and Psychotherapy, 15, 3, pp. 154-163 Rosaleen McElvaney, Phd

Additional Reference – Lecture 3, Behavioural Model & ASD Eikeseth, S., Smith, T., Jahr, E and Eldevik, S. (2002). Intensive behavioural treatments at school for 4-to-7 year-old children with autism. Behaviour Modification, 26, 49-68 Rosaleen McElvaney, Phd

Models of Development and Mental Health Lecture 4: Cognitive Model: Anxiety

Changing focus of children’s fears Infancy: tend to fear strangers, loud noises, unexpected objects Ages 4 to 6: kidnappers, robbers, ghosts, and monsters Young children:. separation from parents, animals, loud noises, the dark, the toilet 6 years: fear of bodily injury, death and failure 10 –11: social comparison, physical appearance, personal conduct, school examinations. (Koplewicz, 1996, in Dadds & Barrett, 2001, JCPP, Weems & Costa, 2005) Rosaleen McElvaney, Phd

Rosaleen McElvaney, Phd Anxiety Disorders Separation anxiety disorder Specific phobias Selective mutism Obsessive compulsive disorder Generalised anxiety disorder Panic attacks Post Traumatic Stress Disorder/Acute Stress Disorder Rosaleen McElvaney, Phd

Prevalence of Anxiety Disorders Obsessive Compulsive Disorder & Generalized Anxiety Disorders 1% for adolescents 2-4% for GAD Adolescents> children Girls>boys for GAD No diff for OCD Anxiety Disorders 7.3% of population? Females>males Continuity into adulthood High co-morbidity 44 adults per 1,000 (Office of National Statistics, 2000, cited in NICE Guidelines, 2004) Separation Anxiety Disorder & Phobias 4% and 2-3% Children > Adolescents Girls > Boys Rosaleen McElvaney, Phd

Additional Reference, Lecture 4, Cognitive Model & Anxiety Gosch, E.A., Flannery-Schroeder, E., Mauro, C.F., Compton, S.N. (2006). Principles of cognitive-behavioral therapy for anxiety disorders in children, Journal of Cognitive Psychotherapy, Vol. 20 Issue 3, pp.247-262, Rosaleen McElvaney, Phd

Social Learning Theory Perspective Bandura (1977) Learning through direct observation as well as experience – modelling Children may learn anxious responses through observing this behaviour being modelled by significant others – role models doubting their own ability or overestimate the likelihood of threat Perceived self-efficacy to cope with and control anxiety-provoking stimuli Rosaleen McElvaney, Phd

Information Processing Perspective Cognitive bias at level of perception, encoding, interpretation and retrieval of information Anxious children more attentive to potential dangers, more likely to interpret situations as dangerous and more likely to remember fear-relevant cues (Beck, Emery & Greenberg, cited in Gosch et al., 2006) Rosaleen McElvaney, Phd

Triple vulnerability model Barlow, 2000 Genetic vulnerability General psychological vulnerability concerning a sense of impending uncontrollable and unpredicatble threat Specifc psychological vulnerability resulting from early learning experiences that lead a child to experience anxiety in certain situations Barlow, D. (2000). Unravelling the mysteries of anxiety and its disorders from the persepctive of emotion theory, American Psychologist, 55, pp1245-1263. Rosaleen McElvaney, Phd

Additional Reference, Lecture 4, Anxiety & Cognitive Model Kendall, P.C., Hudson, J.L., Gosch, E., Flannery-Schroeder, E., Suveg, C. (2008). Cognitive-behavioral therapy for anxiety disordered youth: A randomised clinical trial evaluating child and family modalities. Journal of Consulting and Clinical Psychology, Vol 76, 2, pp. 282-297 Rosaleen McElvaney, Phd

Rosaleen McElvaney, Phd Kendall et al. study Increasing parent involvement? Reciprocal relationships between parents & children Anxious children are more likely to have anxious parents whose behaviour may maintain anxiety and avoidance – parents may facilitate anxiety through reinforcement and modeling Familial variables – high levels of parental anxiety predict pororere outcomes Rosaleen McElvaney, Phd

Kendall et al. study contd. Effectiveness of child-focussed cbt supported by randomized control trials for anxiety disorders when compared to randomised controls ( Branmish & Kendall, 2005; Comptom et al., 2004, cited in Kendall et al., 2008) 56% of anxious youth no longer met criteria for diagnosis following cbt; 63% at 6-12 months follow up (Cartwright-Hatton et al., 2004, cited in Kendall et al., 2008) Rosaleen McElvaney, Phd

Therapeutic Intervention Gosch et al., 2006 Assessment Psychoeducation Affective education Self-instruction training Cognitive restructuring Problem-solving Relaxation training Modelling Contingency management Exposure Rosaleen McElvaney, Phd

Cognitive Model - critique Development of anxiety: Significant differences between those who suffer from anxiety and those who don’t, supports theory BUT Thinking causes disorder or is a result of disorder? Manualised therapeutic interventions Rigid procedures, need to take account of individuality Extensive support for short term effects Randomized controlled trials – ‘probably effective’ Rosaleen McElvaney, Phd

Rosaleen McElvaney, Phd Carr (2007) 4 meta analyses of CBT for children with various difficulties (350 studies) Average child fared better than 76% to 81% of children in control groups, 2 studies showed improvements maintained at 6 month follow up ‘dose effect’ – 20-45 sessions acccounting for 50-75% of clients’ recovery Rosaleen McElvaney, Phd

Caution in interpreting research Just because there is a abundance of empirical research conducted on CBT does not mean there is more evidence for effectiveness of CBT More amenable to traditional quantitative methodologies More focussed on easily measurable symptom change Does not take account of intrapersonal dynamics & relationships Rosaleen McElvaney, Phd

Addditional References, Lecture 4, Anxiety & Cogntive Model Butler, A., Chapman, J., Forman, E., & Beck, A. (2006). The empirical status of cognitive-behavioural therapy: A review of meta-analyses. Clinical Psychology Review. Carr, A. (2007). The effectiveness of psychotherapy: A review of research. Dublin: Irish Council of Psychotherapy. Rosaleen McElvaney, Phd