1. 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, pp5-14
Rosaleen McElvaney, Phd

2. 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
Rosaleen McElvaney, Phd

3. 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

4. Models of Development and Mental Health
Lecture 4:
Cognitive Model: Anxiety

5. 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

6. Rosaleen McElvaney, Phd
Anxiety Disorders
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

7. Prevalence of Anxiety Disorders
Obsessive Compulsive Disorder & Generalized Anxiety Disorders
1% for adolescents
2-4% for GAD
Adolescents> children
Girls>boys for GAD
No diff for OCD
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)
Separation Anxiety Disorder & Phobias
4% and 2-3%
Children > Adolescents
Girls > Boys
Rosaleen McElvaney, Phd

8. Additional Reference, Lecture 4, Cognitive Model & Anxiety
Gosch, E.A., Flannery-Schroeder, E., Mauro, C.F., Compton, S.N. (2006). Principles of cognitive-behavioral therapy for anxiety disorders in children, Journal of Cognitive Psychotherapy, Vol. 20 Issue 3, pp ,
Rosaleen McElvaney, Phd

9. 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

10. 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

11. 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, pp
Rosaleen McElvaney, Phd

12. 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
Rosaleen McElvaney, Phd

13. 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

14. 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

15. Therapeutic Intervention Gosch et al., 2006
Assessment
Psychoeducation
Affective education
Self-instruction training
Cognitive restructuring
Problem-solving
Relaxation training
Modelling
Contingency management
Exposure
Rosaleen McElvaney, Phd

16. 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

17. 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’ – sessions acccounting for 50-75% of clients’ recovery
Rosaleen McElvaney, Phd

18. 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

19. 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