ORCID Profile
0000-0003-1889-0956
Current Organisation
University of Oxford
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Publisher: Wiley
Date: 09-03-2018
DOI: 10.1111/JCPP.12872
Publisher: Elsevier BV
Date: 09-2021
Publisher: Springer Science and Business Media LLC
Date: 13-08-2019
Publisher: Elsevier BV
Date: 06-2018
Publisher: American Psychological Association (APA)
Date: 08-2019
DOI: 10.1037/PAS0000700
Publisher: Springer Science and Business Media LLC
Date: 09-04-2017
Publisher: Wiley
Date: 31-03-2023
DOI: 10.1002/JCV2.12139
Abstract: The threats to health, associated restrictions and economic consequences of the COVID‐19 pandemic have been linked to increases in mental health difficulties for many. Parents, in particular, have experienced many challenges such as having to combine work with home‐schooling their children and other caring responsibilities. Yet, it remains unclear how parental mental health has changed throughout the pandemic or what factors may have mitigated or compounded the impact of the pandemic on parents' mental health. We examined monthly survey data from two linked UK‐based longitudinal studies: COVID‐19: Supporting Parents, Adolescents and Children during Epidemics' (Co‐SPACE) and COVID‐19: Supporting Parents and Young Children during Epidemics' (Co‐SPYCE). Data from 5576 parents/carers of 2–17‐year‐old children collected between April 2020 and January 2021 was analysed using mixed‐effect modelling and latent class growth (mixture) modelling. Parental stress and depression, but not anxiety, were higher during the periods of restrictions. This pattern was most pronounced for parents with primary‐school‐aged children, those that worked at home or had other adults in the household. Being younger, reporting secondary or below education, working out of home, having secondary‐school‐aged children or children with special education needs (SEN)/neurodevelopmental disorders (ND) further moderated whether, how and when parental mental health symptoms changed. Although around three quarters of parents reported consistently low mental health symptoms, a substantial minority reported consistently high or increasing symptoms of anxiety, stress and depression. The latter were more likely to be parents who were younger than average, were a single adult in the household, had a pre‐existing mental health diagnosis or had a child with special educational needs or a ND. These findings emphasise how different personal circumstances and pre‐existing inequalities shaped how parents were affected by this unprecedented global pandemic and highlight the need for support and consideration to meet the needs of families in the future.
Publisher: Wiley
Date: 21-01-2020
DOI: 10.1111/JCPP.13186
Abstract: Despite significant advancements in our knowledge of anxiety disorders in children and adolescents, they continue to be underrecognised and undertreated. It is critical that these disorders are taken seriously in children and young people as they are highly prevalent, have a negative impact on educational, social and health functioning, create a risk of ongoing anxiety and other mental health disorders across the life span and are associated with substantial economic burden. Yet very few children with anxiety disorders access evidence‐based treatments, and there is an urgent need for widespread implementation of effective interventions. This review aimed to provide an overview of recent research developments that will be relevant to clinicians and policymakers, particularly focusing on the development and maintenance of child anxiety disorders and considerations for assessment and treatment. Given the critical need to increase access to effective support, we hope this review will contribute to driving forward a step change in treatment delivery for children and young people with anxiety disorders and their families.
Publisher: Wiley
Date: 19-07-2020
DOI: 10.1111/JCPP.13283
Publisher: Hindawi Limited
Date: 07-10-2015
DOI: 10.1002/DA.22430
Publisher: Center for Open Science
Date: 21-07-2022
Abstract: BackgroundThe threats to health, associated restrictions and economic consequences of the COVID-19 pandemic have been linked to increases in mental health difficulties for many. Parents, in particular, have experienced many challenges such as having to combine work with home-schooling their children and other caring responsibilities. Yet, it remains unclear how parental mental health has changed throughout the pandemic or what factors may have mitigated or compounded the impact of the pandemic on parents' mental health.MethodsWe examined monthly survey data from two linked UK-based longitudinal studies: COVID-19: Supporting Parents, Adolescents and Children during Epidemics' (Co-SPACE) and COVID-19: Supporting Parents and Young Children during Epidemics' (Co-SPYCE). Data from 5576 parents/carers of 2–17-year-old children collected between April 2020 and January 2021 was analysed using mixed-effect modelling and latent class growth (mixture) modelling.ResultsParental stress and depression, but not anxiety, were higher during the periods of restrictions. This pattern was most pronounced for parents with primary-school-aged children, those that worked at home or had other adults in the household. Being younger, reporting secondary or below education, working out of home, having secondary-school-aged children or children with special education needs (SEN)/neurodevelopmental disorders (ND) further moderated whether, how and when parental mental health symptoms changed. Although around three quarters of parents reported consistently low mental health symptoms, a substantial minority reported consistently high or increasing symptoms of anxiety, stress and depression. The latter were more likely to be parents who were younger than average, were a single adult in the household, had a pre-existing mental health diagnosis or had a child with special educational needs or a ND.ConclusionsThese findings emphasise how different personal circumstances and pre-existing inequalities shaped how parents were affected by this unprecedented global pandemic and highlight the need for support and consideration to meet the needs of families in the future.
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.CPR.2016.12.002
Abstract: Cognitive Behavior Therapy (CBT) is a well-established treatment for childhood anxiety disorders. Meta-analyses have concluded that approximately 60% of children recover following treatment, however these include studies using a broad range of diagnostic indices to assess outcomes including whether children are free of the one anxiety disorder that causes most interference (i.e. the primary anxiety disorder) or whether children are free of all anxiety disorders. We conducted a meta-analysis to establish the efficacy of CBT in terms of absence of all anxiety disorders. Where available we compared this rate to outcomes based on absence of primary disorder. Of 56 published randomized controlled trials, 19 provided data on recovery from all anxiety disorders (n=635 CBT, n=450 control participants). There was significant heterogeneity across those studies with available data and full recovery rates varied from 47.6 to 66.4% among children without autistic spectrum conditions (ASC) and 12.2 to 36.7% for children with ASC following treatment, compared to up to 20.6% and 21.3% recovery in waitlist and active treatment comparisons. The lack of consistency in diagnostic outcomes highlights the urgent need for consensus on reporting in future RCTs of childhood anxiety disorders for the meaningful synthesis of data going forwards.
Publisher: Springer Science and Business Media LLC
Date: 23-05-2019
DOI: 10.1038/S41398-019-0481-Y
Abstract: Major depressive disorder and the anxiety disorders are highly prevalent, disabling and moderately heritable. Depression and anxiety are also highly comorbid and have a strong genetic correlation ( r g ≈ 1). Cognitive behavioural therapy is a leading evidence-based treatment but has variable outcomes. Currently, there are no strong predictors of outcome. Therapygenetics research aims to identify genetic predictors of prognosis following therapy. We performed genome-wide association meta-analyses of symptoms following cognitive behavioural therapy in adults with anxiety disorders ( n = 972), adults with major depressive disorder ( n = 832) and children with anxiety disorders ( n = 920 meta-analysis n = 2724). We estimated the variance in therapy outcomes that could be explained by common genetic variants ( h 2 SNP ) and polygenic scoring was used to examine genetic associations between therapy outcomes and psychopathology, personality and learning. No single nucleotide polymorphisms were strongly associated with treatment outcomes. No significant estimate of h 2 SNP could be obtained, suggesting the heritability of therapy outcome is smaller than our analysis was powered to detect. Polygenic scoring failed to detect genetic overlap between therapy outcome and psychopathology, personality or learning. This study is the largest therapygenetics study to date. Results are consistent with previous, similarly powered genome-wide association studies of complex traits.
Publisher: Elsevier BV
Date: 10-2005
DOI: 10.1016/J.BRAT.2004.10.009
Abstract: Interpretation biases towards threat play a prominent role in cognitive theories of anxiety, and have been identified amongst highly anxious adults and children. Little is known, however, about the development of these cognitive biases although family processes have been implicated. The current study investigated the nature of threat interpretation of anxious children and their mothers through (i) comparison of a clinic and non-clinic population, (ii) analysis of in idual differences and (iii) pre- and post-treatment comparisons. Participants were 27 children with a primary anxiety disorder and 33 children from a non-clinic population and their mothers. Children and mothers completed self-report measures of anxiety and indicated their most likely interpretation of ambiguous scenarios. Clinic and non-clinical groups differed significantly on measures of threat interpretation. Furthermore, mothers' and children's threat interpretation correlated significantly. Following treatment for child anxiety, both children and their mothers reported a reduction in threat interpretation.
Publisher: Wiley
Date: 31-10-2018
Publisher: Wiley
Date: 31-01-2023
DOI: 10.1002/REV3.3385
Abstract: Anxiety problems are common in children and can have profound adverse effects on personal, social and academic life. Almost 40% of anxiety disorders emerge before age 14, making primary schools invaluable settings for prevention and early support of child anxiety. Research indicates that school‐based interventions can be costly and difficult to schedule, school staff lack confidence to deliver them effectively, and outcomes are mixed. One solution may be for school staff to adapt and enhance their day‐to‐day practices to better support children with anxiety. This systematic review aims to summarise what is known about the relationship between teachers' classroom management and anxiety in primary school‐aged children. We searched ASSIA, British Education Index, Education Abstracts, Embase, ERIC, MEDLINE, PsycINFO and Scopus in December 2020 and June 2022, using a predefined strategy. We included studies of any design, published in peer‐reviewed journals at any time, in any language, reporting associations between day‐to‐day classroom management strategies/methods and anxiety/internalising outcomes in children aged 4–11 years, taught in mainstream primary schools. Studies were assessed for quality/risk of bias. We identified eight studies (six quantitative, two qualitative) including 4505 children. We found some evidence that authoritarian, controlling and punitive classrooms may be linked to higher levels of anxiety, although, overall, existing evidence indicates either a weak or no association between classroom management and anxiety. This review highlights a paucity of research in this area. Furthermore, variability in design, measures and quality makes drawing firm conclusions difficult. Recommendations for future research are discussed. This review explores what is currently known about the relationship between teachers' day‐to‐day classroom management practices and anxiety in primary school‐aged children. Anxiety problems are common and often start in the primary years, however there is scant evidence to inform primary school educators on how day‐to‐day classroom practices can be used to better support children with or at risk of anxiety problems. This review is relevant for primary classroom practitioners, school leaders, education professionals, academics, researchers and policymakers keen to better understand how to support those with or at risk of anxiety. Although overall findings indicate very small associations between teaching styles ractices and anxiety in children, there is very little research to draw on. Research is urgently needed that uses robust designs to focus on whether specific, feasible, day‐to‐day strategies can be used by school staff to effectively manage and minimise children's anxiety problems and, if so, how school staff can best be supported and equipped to deliver them.
Publisher: Wiley
Date: 27-05-2019
DOI: 10.1111/CCH.12672
Abstract: Anxiety disorders are among the most common psychopathologies in childhood however, a high proportion of children with anxiety disorders do not access effective treatments. The aim of the present qualitative study was to understand families' experiences of seeking help and accessing specialist treatment for difficulties with childhood anxiety. Parents of 16 children (aged 7-12 years) referred to a child mental health service for difficulties with anxiety were interviewed about their experiences of seeking and accessing treatment within Child and Adolescent Mental Health Service (CAMHS). All interviews were transcribed verbatim and thematically analysed for similarities and differences in families' experiences. Factors that helped and/or hindered families accessing treatment related to (a) parental recognition, (b) contact with professionals, (c) reaching CAMHS, (d) parental effort, and (e) parental knowledge and concerns. High demands on services and parents' uncertainty surrounding the help-seeking process presented key hurdles for families. The critical role of parental persistence and support from general practitioners and school staff was evident across interviews. Findings highlighted the need for information and guidance on identifying child anxiety difficulties and professional, peer, and self-help support, and ensuring sufficient provision is available to allow families prompt access to support.
Publisher: Elsevier BV
Date: 2021
Publisher: Wiley
Date: 13-12-2022
DOI: 10.1111/CAMH.12612
Abstract: Anxiety problems are extremely common and have an early age of onset. We previously found, in a study in England, that fewer than 3% of children with an anxiety disorder identified in the community had accessed an evidence‐based treatment (Cognitive Behavioural Therapy CBT). Key ways to increase access to CBT for primary school‐aged children with anxiety problems include (a) proactive identification through screening in schools, (b) supporting parents and (c) the provision of brief, accessible interventions (and capitalising on technology to do this). We provided a brief, therapist guided treatment called Online Support and Intervention (OSI) to parents/carers of children identified, through school‐based screening, as likely to have anxiety problems. Fifty out of 131 children from 17 Year 4 classes in schools in England screened positive for ‘possible anxiety problems’ and 42 (84%) of these (and 7 who did not) took up the offer of OSI. We applied quantitative and qualitative approaches to assess children's outcomes and families' experiences of this approach. Inbuilt outcome monitoring indicated session on session improvements throughout the course of treatment, with substantial changes across measures by the final module (e.g. Child Outcome Rating Scale d = 0.84 Goal Based Outcomes d = 1.52). Parent engagement and satisfaction was high as indicated by quantitative and qualitative assessments, and intervention usage. We provide promising preliminary evidence for the use of OSI as an early intervention for children identified as having anxiety problems through school‐based screening.
Publisher: Springer Science and Business Media LLC
Date: 27-01-2021
DOI: 10.1007/S00787-020-01707-0
Abstract: Anxiety and depressive disorders are the most common mental health disorders in adolescents, yet only a minority of young people with these disorders access professional help. This study aims to address this treatment gap by improving our understanding of barriers and facilitators to seeking/accessing professional help as perceived by adolescents with anxiety/depressive disorders identified in the community. Twenty-two adolescents, aged 11–17 years, who met diagnostic criteria for a current anxiety and/or depressive disorder were identified through school-based screening. In-depth qualitative interviews were conducted one-to-one with each adolescent and adolescents’ parents were interviewed separately for the purpose of data triangulation. Data were analysed using reflexive thematic analysis. We identified four themes capturing adolescent perceived barriers and facilitators to seeking/accessing professional help for anxiety and depressive disorders: (1) making sense of difficulties, (2) problem disclosure, (3) ambivalence to seeking help, and (4) the instrumental role of others. Barriers/facilitators identified within each theme reflect important developmental characteristics of adolescence, such as a growing need for autonomy and concerns around negative social evaluation. At the same time, the results highlight adolescents’ dependency on other people, mainly their parents and school staff, when it comes to successfully accessing professional help for their mental health difficulties. This study identifies a number of barriers/facilitators that influence help-seeking behaviour of adolescents with anxiety and/or depressive disorders. These factors need to be addressed when targeting treatment utilisation rates in this particular group of young people.
Publisher: Wiley
Date: 20-10-2018
DOI: 10.1111/JCPP.12822
Publisher: JMIR Publications Inc.
Date: 13-04-2022
DOI: 10.2196/29846
Abstract: Internet-based treatments for child anxiety may help to increase access to evidence-based therapies however, user engagement, uptake, and adherence within routine clinical practice remain as challenges. Involving the intended end users in the development process through user-centered design and usability testing is crucial for maximizing user engagement and adoption of internet-based treatments, but so far this has been lacking for internet-based treatments for child anxiety. The aim of this study is to develop an internet-based treatment for child anxiety through a process of user-centered design (phase 1) and usability testing (phase 2), based on an existing evidence-based, face-to-face, therapist-supported, parent-led cognitive behavioral therapy intervention. It is intended that the internet-based version of this treatment would consist of a parent website, case management system for clinicians, and mobile game app for children. Parents, children, and clinicians who were familiar with the face-to-face version of the treatment were recruited from 2 National Health Service clinics. In phase 1, participants participated in 3 workshops to gain feedback on the overall concept, explore their wants and needs for the websites and game, generate ideas on how the treatment may look, and gain feedback on initial mock-ups of the websites and game. In phase 2, participants attended 3 in idual usability testing sessions where they were presented with working prototypes of the website or game and asked to perform a series of tasks on the website (parents and clinicians) or play the game (children). The frequency and details on usability errors were recorded. Participants were asked for their feedback on the website and game using a standardized usability questionnaire and semistructured interviews. The websites and game were iterated after each round of usability testing in response to this feedback. In phase 1, participants approved the general concept and rated the initial mock-ups of the website and game positively. In phase 2, working prototypes were rated positively and usability errors declined across the iterations and were mainly cosmetic or minor issues relating to esthetic preference, with few issues regarding ability to navigate the website or technical issues affecting functionality. Feedback from the semistructured interviews further supported the positive response of participants to the website and game, and helped identify areas for improvement during the iteration process. The final iteration of the website and game are presented. Taking an iterative approach to development through user-centered design and usability testing has resulted in an internet-based treatment for child anxiety (Online Support and Intervention for child anxiety) that appears to meet the needs and expectations of the intended users (parents, children, and clinicians) and is easy and enjoyable to use.
Publisher: Springer Science and Business Media LLC
Date: 25-01-2018
Publisher: Elsevier BV
Date: 03-2018
Publisher: Wiley
Date: 11-08-2020
DOI: 10.1111/JCPP.13310
Abstract: Childhood Social Anxiety Disorder (SAD) is common and impairing. The recommended treatment is a disorder specific form of cognitive behavioural therapy (CBT) that includes social skills training and, whilst they appear to be more effective than more general treatments, it is not clear whether social skills training is the critical component involved in improved outcomes, particularly given that evidence for the relationship between social anxiety and social skills deficits in children is inconsistent. This may be partly due to an overlap in their observable features, and because the nature of the association may vary in different contexts (e.g. according to child age). An alternative approach is to examine the association between social anxiety and the social cognitive capacities that underpin social skills. This paper aims to examine the association between social anxiety and social cognition in children and adolescents, and examine conceptual and methodological moderators of this relationship. Papers published between 1980 and 2019 were screened systematically. Fifty studies were identified from which an effect size could be calculated for the relationship between social anxiety and social cognition, including 15,411 children and adolescents. An overall significant, but moderate effect ( r = −.15) was identified, where increased social anxiety was associated with lower social cognitive ability. Moderation analyses revealed specific associations within studies examining social anxiety among participants with and without ASD who were older than 7 years old, and studies assessing the relationship between social anxiety and specific aspects of Theory of Mind (ToM). No significant association was identified between social anxiety and emotion recognition. Significant associations between social anxiety and social cognitive abilities appear to be accounted for by elevated social anxiety among children with ASD, and those with difficulties in specific aspects of ToM but not broader social skills, such as emotion recognition. This reinforces the importance of accurately identifying and treating social anxiety within ASD populations. In addition, treatments for social anxiety among neurotypical populations may benefit from targeting particular aspects of ToM rather than emotion recognition and other broad social skills.
Publisher: Royal College of Psychiatrists
Date: 02-2016
DOI: 10.1192/BJP.BP.114.154997
Abstract: We previously reported an association between 5HTTLPR genotype and outcome following cognitive–behavioural therapy (CBT) in child anxiety (Cohort 1). Children homozygous for the low-expression short-allele showed more positive outcomes. Other similar studies have produced mixed results, with most reporting no association between genotype and CBT outcome. To replicate the association between 5HTTLPR and CBT outcome in child anxiety from the Genes for Treatment study (GxT Cohort 2, n = 829). Logistic and linear mixed effects models were used to examine the relationship between 5HTTLPR and CBT outcomes. Mega-analyses using both cohorts were performed. There was no significant effect of 5HTTLPR on CBT outcomes in Cohort 2. Mega-analyses identified a significant association between 5HTTLPR and remission from all anxiety disorders at follow-up (odds ratio 0.45, P = 0.014), but not primary anxiety disorder outcomes. The association between 5HTTLPR genotype and CBT outcome did not replicate. Short-allele homozygotes showed more positive treatment outcomes, but with small, non-significant effects. Future studies would benefit from utilising whole genome approaches and large, homogenous s les.
Publisher: Wiley
Date: 03-05-2023
DOI: 10.1002/JCV2.12166
Abstract: Selective mutism (SM) is an anxiety disorder that often starts in early years with serious and lasting consequences. Nonpharmacological interventions are commonly seen as the preferred first treatment. This systematic review identifies outcome measures used and outcomes achieved for nonpharmacological interventions for children and adolescents with SM. Systematic searches were conducted using 13 electronic databases and hand searches, including peer‐reviewed and grey literature since 1992. Twenty‐five studies were identified. While specific measures varied, all studies reported an outcome measure for speaking behaviour and 18 used a measure of anxiety. Few studies reported measures of SM remission ( k = 6), well‐being ( k = 6), academic impact ( k = 2), or quality of life ( k = 1). Within subject outcomes for nonpharmacological interventions were variable for improvements in speaking behaviours (very small to large positive effects) and reduction in anxiety symptoms (very small negative to large positive effects). Only five randomised controlled trials (RCTs) were included in the meta‐analysis. Three studies compared a combined systems/behavioural approach with waitlist controls indicating a significant and large effect (Hedges g = 1.06, p .0001, 95% CI: 0.57–1.56) on improved speaking behaviour. Two of these RCTs showed a large effect for SM remission favouring the intervention (Risk Ratio = 4.25, p = .1774, 95% CI: 0.52–34.84) but this did not reach statistical significance. Non‐significant outcomes for two RCTs with active controls (Hedges g = 0.55, p .2885, 95% CI: −0.47 to 1.57) showed considerable heterogeneity in approach and outcomes, one with large and one with negligible effects. Despite the considerable impairment caused by SM, there has been little systematic evaluation of non‐pharmacological interventions. Although combined systems/behavioural interventions are promising, further systematic evaluations are urgently needed to inform treatment approaches. Cross‐study measurement harmonisation is required to promote learning from all studies, including wider clinical and economic outcomes. Not applicable.
Publisher: Springer Science and Business Media LLC
Date: 25-06-2020
Publisher: Royal College of General Practitioners
Date: 23-10-2017
Abstract: Anxiety disorders have a median age of onset of 11 years and are the most common emotional disorders in childhood however, a significant proportion of those affected do not access professional support. In the UK, GPs are often the first medical professional that families see so are in a prime position to support children with anxiety disorders however, currently there is little research available on GPs’ perspectives on and experiences of supporting children with these disorders. To explore the experiences of GPs in relation to identification, management, and access to specialist services for children ( years) with anxiety disorders. Twenty semi-structured interviews were conducted with GPs in primary care throughout England. GPs reflected a erse group in relation to the ethnic and socioeconomic profile of registered patients, GP age, sex, professional status, previous engagement with research, and practice size and location. Purposive s ling was used to recruit GPs until theoretical saturation was reached. Data were analysed using a constant comparative method of thematic analysis. Data from 20 semi-structured interviews were organised into three themes: decision making, responsibility, and emotional response, with an overarching theme of GPs feeling ill equipped. These themes were retrospectively analysed to illustrate their role at different stages in the primary care process (identification, management, and access to specialist services). GPs feel ill equipped to manage and support childhood anxiety disorders, demonstrating a need for medical training to include greater emphasis on children’s mental health, as well as potential for greater collaboration between primary and specialist services.
Publisher: Springer Science and Business Media LLC
Date: 16-09-2014
DOI: 10.1038/TP.2014.83
Abstract: Anxiety disorders that are the most commonly occurring psychiatric disorders in childhood, are associated with a range of social and educational impairments and often continue into adulthood. Cognitive behaviour therapy (CBT) is an effective treatment option for the majority of cases, although up to 35–45% of children do not achieve remission. Recent research suggests that some genetic variants may be associated with a more beneficial response to psychological therapy. Epigenetic mechanisms such as DNA methylation work at the interface between genetic and environmental influences. Furthermore, epigenetic alterations at the serotonin transporter ( SERT ) promoter region have been associated with environmental influences such as stressful life experiences. In this study, we measured DNA methylation upstream of SERT in 116 children with an anxiety disorder, before and after receiving CBT. Change during treatment in percentage DNA methylation was significantly different in treatment responders vs nonresponders. This effect was driven by one CpG site in particular, at which responders increased in methylation, whereas nonresponders showed a decrease in DNA methylation. This is the first study to demonstrate differences in SERT methylation change in association with response to a purely psychological therapy. These findings confirm that biological changes occur alongside changes in symptomatology following a psychological therapy such as CBT.
Publisher: BMJ
Date: 04-2021
DOI: 10.1136/BMJOPEN-2020-044852
Abstract: Anxiety difficulties are among the most common mental health problems in childhood. Despite this, few children access evidence-based interventions, and school may be an ideal setting to improve children’s access to treatment. This article describes the design, methods and expected data collection of the Identifying Child Anxiety Through Schools – Identification to Intervention (iCATS i2i) study, which aims to develop acceptable school-based procedures to identify and support child anxiety difficulties. iCATS i2i will use a mixed-methods approach to codesign and deliver a set of procedures—or ‘pathway’—to improve access to evidence-based intervention for child anxiety difficulties through primary schools in England. The study will consist of four stages, initially involving in-depth interviews with parents, children, school staff and stakeholders (stage 1) to inform the development of the pathway. The pathway will then be administered in two primary schools, including screening, feedback to parents and the offer of treatment where indicated (stage 2), with participating children, parents and school staff invited to provide feedback on their experience (stages 3 and 4). Data will be analysed using Template Analysis. The iCATS i2i study was approved by the University of Oxford’s Research Ethics Committee (REF R64620/RE001). It is expected that this codesign study will lead on to a future feasibility study and, if indicated, a randomised controlled trial. The findings will be disseminated in several ways, including via lay summary report, publication in academic journals and presentation at conferences. By providing information on child, parent, school staff and other stakeholder’s experiences, we anticipate that the findings will inform the development of an acceptable evidence-based pathway for identification and intervention for children with anxiety difficulties in primary schools and may also inform broader approaches to screening for and treating youth mental health problems outside of clinics.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.JAD.2017.07.035
Abstract: Intolerance of uncertainty (IU) has been implicated in the development and maintenance of worry and anxiety in adults and there is an increasing interest in the role that IU may play in anxiety and worry in children and adolescents. We conducted a systematic review and meta-analysis to summarize existing research on IU with regard to anxiety and worry in young people, and to provide a context for considering future directions in this area of research. The systematic review yielded 31 studies that investigated the association of IU with either anxiety or worry in children and adolescents. The meta-analysis showed that IU accounted for 36.00% of the variance in anxiety and 39.69% in worry. Due to the low number of studies and methodological factors, examination of potential moderators was limited and of those we were able to examine, none were significant moderators of either association. Most studies relied on questionnaire measures of IU, anxiety, and worry all studies except one were cross-sectional and the majority of the studies were with community s les. The inclusion of eligible studies was limited to studies published in English that focus on typically developing children. There is a strong association between IU and both anxiety and worry in young people therefore IU may be a relevant construct to target in treatment. To extend the existing literature, future research should incorporate longitudinal and experimental designs, and include s les of young people who have a range of anxiety disorders.
Publisher: JMIR Publications Inc.
Date: 23-04-2021
Abstract: nternet-based treatments for child anxiety may help to increase access to evidence-based therapies however, user engagement, uptake, and adherence within routine clinical practice remain as challenges. Involving the intended end users in the development process through user-centered design and usability testing is crucial for maximizing user engagement and adoption of internet-based treatments, but so far this has been lacking for internet-based treatments for child anxiety. he aim of this study is to develop an internet-based treatment for child anxiety through a process of user-centered design (phase 1) and usability testing (phase 2), based on an existing evidence-based, face-to-face, therapist-supported, parent-led cognitive behavioral therapy intervention. It is intended that the internet-based version of this treatment would consist of a parent website, case management system for clinicians, and mobile game app for children. arents, children, and clinicians who were familiar with the face-to-face version of the treatment were recruited from 2 National Health Service clinics. In phase 1, participants participated in 3 workshops to gain feedback on the overall concept, explore their wants and needs for the websites and game, generate ideas on how the treatment may look, and gain feedback on initial mock-ups of the websites and game. In phase 2, participants attended 3 in idual usability testing sessions where they were presented with working prototypes of the website or game and asked to perform a series of tasks on the website (parents and clinicians) or play the game (children). The frequency and details on usability errors were recorded. Participants were asked for their feedback on the website and game using a standardized usability questionnaire and semistructured interviews. The websites and game were iterated after each round of usability testing in response to this feedback. n phase 1, participants approved the general concept and rated the initial mock-ups of the website and game positively. In phase 2, working prototypes were rated positively and usability errors declined across the iterations and were mainly cosmetic or minor issues relating to esthetic preference, with few issues regarding ability to navigate the website or technical issues affecting functionality. Feedback from the semistructured interviews further supported the positive response of participants to the website and game, and helped identify areas for improvement during the iteration process. The final iteration of the website and game are presented. aking an iterative approach to development through user-centered design and usability testing has resulted in an internet-based treatment for child anxiety (Online Support and Intervention for child anxiety) that appears to meet the needs and expectations of the intended users (parents, children, and clinicians) and is easy and enjoyable to use.
Publisher: Royal College of Psychiatrists
Date: 09-2016
DOI: 10.1192/BJP.BP.115.168229
Abstract: Anxiety disorders are common, and cognitive–behavioural therapy (CBT) is a first-line treatment. Candidate gene studies have suggested a genetic basis to treatment response, but findings have been inconsistent. To perform the first genome-wide association study (GWAS) of psychological treatment response in children with anxiety disorders ( n = 980). Presence and severity of anxiety was assessed using semi-structured interview at baseline, on completion of treatment (post-treatment), and 3 to 12 months after treatment completion (follow-up). DNA was genotyped using the Illumina Human Core Exome-12v1.0 array. Linear mixed models were used to test associations between genetic variants and response (change in symptom severity) immediately post-treatment and at 6-month follow-up. No variants passed a genome-wide significance threshold ( P =5×10 –8 ) in either analysis. Four variants met criteria for suggestive significance ( P ×10 –6 ) in association with response post-treatment, and three variants in the 6-month follow-up analysis. This is the first genome-wide therapygenetic study. It suggests no common variants of very high effect underlie response to CBT. Future investigations should maximise power to detect single-variant and polygenic effects by using larger, more homogeneous cohorts.
Publisher: Wiley
Date: 20-05-2022
DOI: 10.1002/JCV2.12080
Abstract: Cognitive Behavioural Therapy (CBT) is the gold standard intervention for anxiety and related mental health disorders among young people however, the efficacy of in idual elements of CBT (e.g., exposure to feared stimuli) have received little scrutiny. This scoping review, informed by three stakeholder groups and a scientific advisory group, aimed to identify the nature and extent of the available research literature on the efficacy of exposure to feared stimuli, moderators of effectiveness in young people aged 14–24 years. Three international stakeholder groups composed of clinicians ( N = 8), parents/carers ( N = 5) and youth with lived experience of anxiety ( N = 7) provided input into study design and results. Using the PRISMA extension for scoping reviews, a search of MEDLINE/Ovid, PsycINFO, PubMed, CINAHL, SCOPUS, EMBASE, ERIC, and Health Collection (informit) was conducted using terms related to anxiety, ages 14–24, and exposure. From 3508 unique abstracts, 64 papers were included for the review. While there was evidence for the efficacy of exposure as a treatment for youth anxiety disorders, fundamental gaps in knowledge of exposure in this age group were identified. Most studies examined post‐traumatic stress disorder, obsessive–compulsive disorder, and specific phobias with no randomised clinical trials uniquely evaluating exposure for the treatment of DSM‐5 anxiety disorders. Exposure was typically delivered accompanied by other anxiety management techniques. A multitude of optimisation strategies have been tested, yet only one of these effects (timing relative to sleep) showed preliminary evidence of replication. A systematic and theoretically driven program of research investigating the efficacy of exposure in young people and factors that moderate its efficacy, along with methods to overcome barriers for delivery, is urgently needed.
Publisher: Springer Science and Business Media LLC
Date: 04-01-2017
Publisher: Wiley
Date: 16-11-2020
Publisher: Springer Science and Business Media LLC
Date: 21-01-2020
DOI: 10.1007/S00787-019-01469-4
Abstract: Mental health disorders in children and adolescents are highly prevalent yet undertreated. A detailed understanding of the reasons for not seeking or accessing help as perceived by young people is crucial to address this gap. We conducted a systematic review (PROSPERO 42018088591) of quantitative and qualitative studies reporting barriers and facilitators to children and adolescents seeking and accessing professional help for mental health problems. We identified 53 eligible studies 22 provided quantitative data, 30 provided qualitative data, and one provided both. Four main barrier/facilitator themes were identified. Almost all studies (96%) reported barriers related to young people’s in idual factors, such as limited mental health knowledge and broader perceptions of help-seeking. The second most commonly (92%) reported theme related to social factors, for ex le, perceived social stigma and embarrassment. The third theme captured young people’s perceptions of the therapeutic relationship with professionals (68%) including perceived confidentiality and the ability to trust an unknown person. The fourth theme related to systemic and structural barriers and facilitators (58%), such as financial costs associated with mental health services, logistical barriers, and the availability of professional help. The findings highlight the complex array of internal and external factors that determine whether young people seek and access help for mental health difficulties. In addition to making effective support more available, targeted evidence-based interventions are required to reduce perceived public stigma and improve young people’s knowledge of mental health problems and available support, including what to expect from professionals and services.
Publisher: S. Karger AG
Date: 2016
DOI: 10.1159/000444023
Abstract: b i Background: /i /b The differential susceptibly hypothesis suggests that certain genetic variants moderate the effects of both negative and positive environments on mental health and may therefore be important predictors of response to psychological treatments. Nevertheless, the identification of such variants has so far been limited to preselected candidate genes. In this study we extended the differential susceptibility hypothesis from a candidate gene to a genome-wide approach to test whether a polygenic score of environmental sensitivity predicted response to cognitive behavioural therapy (CBT) in children with anxiety disorders. b i Methods: /i /b We identified variants associated with environmental sensitivity using a novel method in which within-pair variability in emotional problems in 1,026 monozygotic twin pairs was examined as a function of the pairs' genotype. We created a polygenic score of environmental sensitivity based on the whole-genome findings and tested the score as a moderator of parenting on emotional problems in 1,406 children and response to in idual, group and brief parent-led CBT in 973 children with anxiety disorders. b i Results: /i /b The polygenic score significantly moderated the effects of parenting on emotional problems and the effects of treatment. In iduals with a high score responded significantly better to in idual CBT than group CBT or brief parent-led CBT (remission rates: 70.9, 55.5 and 41.6%, respectively). b i Conclusions: /i /b Pending successful replication, our results should be considered exploratory. Nevertheless, if replicated, they suggest that in iduals with the greatest environmental sensitivity may be more likely to develop emotional problems in adverse environments but also benefit more from the most intensive types of treatment.
Publisher: Springer Science and Business Media LLC
Date: 14-05-2016
Publisher: Wiley
Date: 27-06-2016
DOI: 10.1002/AJMG.B.32467
Publisher: Royal College of General Practitioners
Date: 12-09-2016
Publisher: Elsevier BV
Date: 06-2015
Publisher: American Psychological Association (APA)
Date: 10-2018
DOI: 10.1037/PAS0000570
Publisher: Wiley
Date: 19-07-2020
DOI: 10.1111/BJOP.12468
Publisher: Informa UK Limited
Date: 03-2014
DOI: 10.1111/CP.12037
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Cathy Creswell.