The Role of Executive Functioning in Treatment Outcome for Child Anxiety

ABSTRACT

One possible predictor of treatment outcome in cognitive-behavioral therapy (CBT) is executive functioning (EF; i.e., planning, initiating, and maintaining goal-directed behavior), but the role of EF in treatment outcome has not been studied in pediatric anxiety disorders. The current study examines the predictive role of pre-treatment EF and change in EF over treatment (EF change) in the Resilience Builder Program® (RBP), a manualized, 12-week CBT group intervention implemented in a private practice. The RBP targets social competence and resilience skills.

The current study examines 73 children ages 7–13 years (mean age = 9.95 ± 1.53 years, 69.86% male, 79.45% White) diagnosed with an anxiety disorder who completed the RBP. The studied outcome variables included anxiety symptomatology, social competence, and resilience. Hierarchical linear modeling and hierarchical linear regressions were used to examine if pre-treatment EF and EF change predicted post-treatment symptomatology, controlling for pre-treatment functioning and ADHD diagnosis. Pre-treatment EF was not significantly related to any of the outcome variables. EF change was significantly related to improved anxiety and resilience, but not social competence. Adding EF change to the model significantly improved model fit when predicting resilience. Change in EF predicted parent-reported reductions in anxiety symptomatology and increases in resilience over and above pre-treatment EF levels. EF change was particularly important for predicting resilience outcomes. Results indicate that, for children with anxiety, pre-treatment EF is not an important predictor of outcome, but improvement in EF during treatment may improve treatment response as measured by anxiety symptomatology and resilience.

Acknowledgments

The authors wish to thank the children and families who participated in this study, as well as the clinicians who directed groups and research assistants who directed the project and data collection.

Disclosure statement

Dr. Mary Alvord is the author of Resilience Builder Program for children and adolescents: Enhancing social competence and self-regulation–A cognitive-behavioral group approach and receives royalties from Research Press. The other authors report no financial or other conflicts of interest associated with this work.

Additional information

Funding

This research was supported in part by funding from the Group Foundation for Advancing Mental Health.