Youth Anxiety and Parent Factors Over Time: Directionality of Change Among Youth Treated for Anxiety

Abstract

The relationship between improvements in child anxiety and changes in parent factors (e.g., parental anxiety, parenting behaviors) is poorly understood. The present study investigated the directionality of change for child anxiety and parent factors among youth treated for anxiety disorders. Structural equation modeling examined these relationships pre- to posttreatment and at 1-year follow-up for 111 youth aged 7 to 14 (57% male, 84% Caucasian). Child anxiety was measured using the Anxiety Disorders Interview Schedule for Children and the Child Behavior Checklist. The State-Trait Anxiety Inventory, Children's Report of Parental Behavior Inventory, and Family Assessment Device were used to measure maternal anxiety, psychological control, behavior control, and family affective involvement. Findings suggest that decreases in mother-reported child anxiety led to decreases in maternal anxiety. Decreases in maternal psychological control and family affective involvement preceded decreases in clinician-rated child anxiety. Youth who showed the most reductions in anxiety over the course of treatment were those who tended to have lower family affective involvement, behavior control, and maternal anxiety at pretreatment. Stability of the parent factors and child anxiety over time suggest that stability was greater for behavior control and maternal anxiety relative to affective involvement and psychological control. The findings are consistent with previous research indicating the importance of these parent factors as they relate to anxiety in youth. Furthermore, results indicate that changes in child anxiety may precede changes in parent factors and suggest that parental psychological control and affective involvement are important treatment targets for youth with anxiety disorders.

Acknowledgments

This research was supported in part by National Institute of Mental Health grants (MH59087; MH063747; MH086438) awarded to Philip C. Kendall. We would like to thank Mark F. Schmitz for his help with this project.

Notes

¹An alternate model that controlled for treatment condition was tested and results did not differ from those of the original model across all analyses.

²Values of skew and kurtosis were within normal limits with the exception of one variable at one time point (STAI at 1-year follow-up). A sensitivity analysis was conducted to assess the impact of outliers, and results were unchanged, indicating that outliers did not influence results.

Note: Posttreatment = 16 weeks after pretreatment; follow-up = 1 year after pretreatment; CBCL-A = Child Behavior Checklist–Anxiety Scale; CSR = clinician severity rating based on the Anxiety Disorders Interview Schedule for Children (ADIS-C/P); STAI = State-Trait Anxiety Inventory; CRPBI = Children's Report of Parent Behavior Inventory; FAD = Family Assessment Device.

Note: All chi-squares are nonsignificant at p > .05. Chi-square is a goodness of fit index based on maximum likelihood criterion (model degrees of freedom = 2); CFI = comparative fit index; RMSEA = root mean square error approximation test; CI = confidence interval; p close = p value for close fit associated with the RMSEA; STAI = State-Trait Anxiety Inventory; CBCL-A = Child Behavior Checklist–Anxiety Scale; CSR = clinician severity rating based on the Anxiety Disorders Interview Schedule for Children (ADIS-C/P); CRPBI = Children's Report of Parent Behavior Inventory; FAD = Family Assessment Device.

Note: Standardized coefficient shown in parentheses. Letters of paths refer to paths in Figure 1. STAI = State-Trait Anxiety Inventory; CBCL-A = Child Behavior Checklist–Anxiety Scale; CSR = clinician severity rating based on the Anxiety Disorders Interview Schedule for Children (ADIS-C/P); CRPBI = Children's Report of Parent Behavior Inventory; FAD = Family Assessment Device.

^a Trend for significance, p < .06.

*p < .05.