5.2 Research on the Taming Sneaky Fears Program
5.2.3 Comparative Study
After publication of the results of the aforementioned pilot study on the Taming Sneaky Fears group CBT program (Monga et al.,2009), Monga and her colleagues examined the question of whether the child component of the Taming Sneaky Fears program along with the parent component provided added benefit as compared to delivering the parent component alone. To address this question, Monga and her col- leagues (Monga, Rosenbloom, Tanha, Owens, & Young,2015) conducted a clinical
trial that compared a Child-Parent arm (where children and their parents attended the group CBT program and received the child and parent components of the Taming Sneaky Fears program) and a Parent-Only arm (where only the parents received the parent component of the Taming Sneaky Fears program and were taught CBT skills to use with their children). In order to control for the nonspecific aspects of child group attendance, the children in the Parent-Only arm attended a weekly non-CBT group program that matched the format and duration of the Taming Sneaky Fears child sessions; however, children listened to neutral stories, played games, and com- pleted neutral crafts while socializing with other children but did not learn any CBT concepts or skills.
As seen in Table5.1and as reported in Monga et al. (2015), the comparative study used a prospective, repeated-measures, comparative, longitudinal design. A total of 77 five- to seven-year-old children (Mage6.8 years;SD0.8; 29 males) and their parents participated. After an initial assessment was completed and informed consent to study participation was obtained, children waited for three months during which time no treatment took place. Children and parents were not randomly assigned to intervention type; instead, the intervention format (i.e., Child-Parent or Parent-Only) was randomly assigned two weeks before the start of each treatment group. In total, eight Child-Parent and six Parent-Only groups were conducted. Forty-five five- to seven-year-old children (Mage6.6 years;SD0.6; 16 males) participated in the Child-Parent arm and 32 children (Mage7.0 years;SD0.8; 13 males) and their parents participated in the Parent-Only arm. Research assessments took place at five time points, including at baseline, pre-treatment (within two weeks before treatment began), post-treatment (within two weeks of treatment ending), at six months post- treatment, and at 12 months post-treatment. Initial or baseline assessments took place three months prior to the start of the group intervention.
The Clinician Severity Rating of the Anxiety Disorders Interview Schedule par- ent interview (Silverman & Albano, 1996) was the primary outcome measure. A secondary outcome measure was the clinician rating of the children’s level of global functioning using the Children’s Global Assessment Scale (Shaffer et al., 1983).
Parents also completed a number of parent report measures including the Screen for Child Anxiety Related Emotional Disorders (Birmaher et al.,1997) to measure child anxiety and the Beck Anxiety Inventory (Beck & Steer,1990) to measure self-report levels of parent anxiety.
There were no significant differences in age, gender, ethnicity, Clinician Severity Rating of primary anxiety diagnosis, clinician rating of global functioning, parent report of child symptom scores, child temperament, or self-reported parent anxi- ety between the two treatment arms at baseline. There were no significant changes in either treatment arm on all clinical measures between baseline and pre-group assessment three months later, indicating that no change took place without treat- ment. Below, we report only on results related to the post-treatment and 12-month post-treatment time points (for additional details, see Monga et al.,2015).
5.2.3.1 Results at Post-treatment
At post-treatment, significantly more children no longer met criteria for their primary anxiety disorder in the Child-Parent arm (48.9%) compared to the Parent-Only arm (12.5%) (Fischer’s exact test,p0.001).
Furthermore, significant improvement, as measured by mean change in Clinician Severity Rating on the Anxiety Disorders Interview Schedule from pre- to post- treatment was noted within both treatment arms (Child-Parent arm mean change
−2.3; 95% CI −2.7,−1.9,p< 0.0001 and Parent-Only arm mean change − 0.9; 95% CI −1.4,−0.4,p0.001). More importantly, there was a significant difference between the two treatments, with the Child-Parent arm having significantly lower Clinician Severity Rating of anxiety compared to the Parent-Only arm (mean change −1.4; 95% CI −2.0, −0.7, p < 0.0001). In summary, significantly greater reductions in anxiety disorder severity were seen in the Child-Parent arm as compared to the Parent-Only arm, thus providing evidence for the added benefit the child group sessions confer to the Taming Sneaky Fears group CBT program.
Global functioning of children, as measured by mean change in Children’s Global Assessment Scale improved in both treatment arms (Child-Parent arm mean change 10.3; 95% CI8.7, 11.9,p< 0.0001 and Parent-Only arm mean change2.5; 95%
CI0.6, 4.5,p0.01). Again there was significantly greater improvement in global functioning in the Child-Parent arm as compared with the Parent-Only arm (mean change7.8; 95% CI5.3, 10.3,p< 0.0001), thus providing support for the added benefits the child group sessions confer to the Taming Sneaky Fears program.
Improvements in parent report of anxiety symptoms, as measured by changes in the total score of the parent Screen for Child Anxiety Related Emotional Disorders (mean change −5.6 (−9.1,−2.2)p0.002), were seen in the Child-Parent arm while only significant changes in the separation anxiety factor of the parent Screen for Child Anxiety Related Emotional Disorders (mean change −1.6 (−2.6,−0.6), p0.002) were noted in the Parent-Only arm. The observation that in the Parent- Only arm parent-reported improvements were only noted in the separation anxiety subscale of the Screen for Child Anxiety Related Emotional Disorders may have been related to the fact that even in the Parent-Only arm, parents and children had learned to separate for parent and child group attendance.
5.2.3.2 Results at 12 Months Post-treatment
At 12 months post-treatment, 77.8% of children no longer met criteria for a primary anxiety diagnosis in the Child-Parent arm, while 37.5% did not meet criteria for a primary anxiety diagnosis in the Parent-Only arm. Again, significant reductions in Anxiety Disorders Interview Schedule Clinician Severity Rating were seen in both treatment arms (mean change of −3.3, 95% CI −3.8,−2.9,p < 0.0001 in the Child-Parent arm and a mean change of−1.9, 95% CI −2.6,−1.3,p< 0.0001 in the Parent-Only arm), with a greater improvement observed in the Child-Parent arm
as compared to Parent-Only arm (mean change −1.4, 95% CI −2.2,−0.6p 0.001).
Global functioning, as measured by the Children’s Global Assessment Scale, improved significantly in both treatment arms (Child-Parent arm mean change was 19.0, 95% CI16.5, 21.5,p< 0.0001, while in the Parent-Only arm mean change was 7.0, 95% CI3.8, 10.2,p< 0.0001), but again, the children in the Child-Parent arm were functioning significantly better (mean change12.0 95% CI7.9, 16.0, p< 0.0001) than the children in the Parent-Only arm.
Parent total scores on the Screen for Child Anxiety Related Emotional Disorders were again significantly reduced (mean change −8.3 (−12.1,−4.4)p< 0.0001) in the Child-Parent arm; as well, significant improvements on several subscales were noted: separation anxiety subscale (mean change −1.8 (−2.7,−0.8),p0.001), social anxiety subscale (mean change −2.1, (−3.2,−1.1),p0.0002), and school refusal subscale (mean change −1.0, p0.002). In the Parent-Only arm, sig- nificant improvements were again noted in the separation anxiety subscale (mean change −2.9 (−4.2,−1.6),p< 0.0001) and in the total score of the Screen for Child Anxiety Related Emotional Disorders (mean change −9.4 (−14.4,−4.4)p 0.0004).
5.2.3.3 Summary of Comparative Study
Results of this comparative study suggest that without treatment, anxiety disorders in young children may not improve, given that there were no changes during the three-month no-treatment wait time. Numerous changes were noted as a result of treatment, and results suggest that treatment, not time, accounted for these changes.
Study results further suggest that providing both the child and parent components of the Taming Sneaky Fears program is more efficacious in decreasing the children’s severity of anxiety diagnoses and improving the children’s overall functioning than providing only the parent component. Additionally, the results from the comparative study provide empirical evidence that five- to seven-year-old children can learn and utilize CBT strategies when taught in an age-appropriate, fun, and playful fashion.
5.2.3.4 Selective Mutism and Social Anxiety Disorder Data
Data from a subgroup of 24 children who participated in the Child-Parent arm of the comparative study (Monga et al.,2015) and had a primary diagnosis of either selective mutism or social anxiety disorder, were re-examined. Thirty-eight percent of these children no longer met criteria for either diagnosis post-treatment and 71%
no longer met criteria for either diagnosis at 12 months post-treatment. These findings provided early evidence for the efficacy of the Taming Sneaky Fears program in the treatment of selective mutism and/or social anxiety disorder in five- to seven-year-old children. These findings also provided the impetus for the next research endeavor as despite these encouraging findings, clinical experience with young children with
selective mutism and social anxiety disorder suggested that the Taming Sneaky Fears program could be further refined to specifically target symptoms of selective mutism and social anxiety disorder.