Treatment of Child Anxiety Disorder in the Context of Maternal Anxiety: A Randomised Controlled Trial

Anxiety disorders ? such as extreme social fears, excessive worrying, and marked fears about being separated from a parent - are the most common form of emotional problem in children. These disorders have a significant adverse impact on children?s social and emotional functioning and they commonly continue into adulthood. A form of treatment called ?cognitive behaviour therapy? (or CBT), which has been shown to be particularly effective in the treatment of anxiety disorders in adults, has recently been shown to also be helpful to anxious children, although not all children respond. There has been little careful study into the factors responsible for why some anxious children respond to CBT and others do not, although two related factors are likely to be important: the presence of anxiety in the mother, and difficulties in the relationship between the mother and child. A careful scientific study is to be conducted in which anxious children receive standard CBT as well as one of two other ingredients: treatment of the mother?s anxiety, and measures to improve the quality of the mother-child relationship. The children?s anxiety will be measured before the treatment and at various stages after treatment has begun, including a follow?up of how they are doing one year after the treatment has ended. The study will reveal whether these new ways of treating anxious children who have anxious mothers are an improvement on how they fare with standard CBT. It will also tell us how important it is to anxious children?s development that anxious mothers tackle their own problems, and how important it is that there are changes to the mother child relationship.

Anxiety disorders in children are frequent, disabling and commonly persist into adulthood. Cognitive behaviour therapy (CBT) has been shown to be of significant benefit, however outcome is highly variable and a significant proportion of children do not respond. There has been little research into the factors that predict response to CBT in anxious children, although two factors are likely to be especially significant: anxiety in the mother, and the quality of the mother-child relationship. Around two thirds of the mothers of anxious children themselves have a current anxiety disorder; and anxiety in the mother is associated with a poor response by the child to treatment. One study has suggested that where there is also an anxious parent, providing treatment to the parent improves child outcome. Specific features of the mother-child relationship have been implicated in the maintenance of child anxiety, in particular an over-controlling and over-protective maternal style and associated maternal cognitions and expectations about child competence. Findings from a recent trial suggest that including measures to improve the mother-child relationship could be of benefit to child outcome. Indeed, the treatment studies and the family interaction research (together with the family history data) collectively point to the need for a new approach to the treatment of child anxiety in the context of maternal anxiety disorder. The study proposed will meet this need by assessing the efficacy and cost-effectiveness of two novel treatments. In a randomised controlled trial two index treatment groups will be compared to a control condition involving standard child CBT (controlling for individual and mother-child therapist contact time): child CBT with individual CBT for maternal anxiety disorder; and child CBT with specific measures to address disturbances in the mother-child relationship. 210 anxious children (with anxious mothers) will be recruited into the trial and randomly assigned to one of the three trial conditions. The study is powered to establish the efficacy of the addition to standard child CBT of both treatment for maternal anxiety and of therapeutic measures to improve the mother-child relationship. Independent assessments will be made of child anxiety before treatment and up to 12 months following treatment; and assessments of maternal anxiety and the mother-child relationship will also be made.