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, pp514
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
Anxiety Disorders
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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
•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)
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Obsessive Compulsive
Disorder & Generalized
Anxiety Disorders
1% for adolescents
2-4% for GAD
Adolescents> children
Girls>boys for GAD
No diff for OCD
•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 cognitivebehavioral 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
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
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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
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