Anxiety disorders are prevalent in school-aged children and may lead to difficulties in academic and interpersonal functioning. The purpose of the present study is to develop and evaluate treatment approaches for anxious children. The proposed study is for 9-13 year-old children identified as overanxious, separation anxiety, or avoidant disorder. The research will compare a cognitive-behavioral treatment program with a waiting-list control. An ancillary purpose of the present proposal is to assess the cognitive features involved in child anxiety and to develop relevant cognitive assessment strategies. Children who are referred by mental health professionals to the Child and Adolescent Anxiety Disorders Clinic will be screened for inclusion using a structured diagnostic interview. Those children who are diagnosed anxiety disordered will be randomly assigned to one of the conditions. All children will receive 15 weekly 55 minute sessions. The focus of the cognitive- behavioral treatment will be on four major components: 1. recognizing anxious thoughts and somatic reactions to anxiety. 2. clarifying cognitions in anxiety provoking situations. 3. developing a plan to cope with the situation. 4. evaluating the performance and self-reinforcement as appropriate. Behavioral techniques such as modeling, role play, relaxation and contingent reinforcement will be used. The waiting-list control condition will be administered the same measures as the children at the beginning and the end of the treatment period to control for treatment expectancies and the transience of anxiety. Treatment effects will be analyzed through a repeated measures (treatment conditional) * (assessment periods) mixed factorial ANOVA. Since dependent measures are highly interrelated, MANOVA will be used for same-method measures. ANCOVA will be used in the event of pretreatment differences. The assessment battery consists of children's self-report measures (RCMAS, STAIC, FSSC-R, CDI), parent and teacher measures (CBCL), cognitive assessment (CASSQ), and behavioral observations in an interview situation. Other measures, such as the child's perception of the therapeutic relationship (CPTR), the therapist's report of the child's compliance with homework, and a rating of the child's parent's perception of the child's coping skills will be examined. Client characteristics, pretreatment variables, and process variables will be examined in relation to outcome. The same battery will be used at 1 year follow-up. The diagnosis of specific anxiety disorders will be used to examine differential responsiveness of these disorders to the treatments.
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