Gloe, Lilianne M.

ABSTRACT Objectives Cognitive behavioral therapy (CBT) is the most researched treatment for childhood anxiety disorders (CADs). Improving outcomes and efficiency of CBT will require identifying and optimizing the most efficacious therapeutic components. Towards this end, a recent randomized controlled trial (RCT) found that Parent Coached Exposure Therapy (PCET) led to greater symptom improvement in less time than traditional CBT. To better understand and maximize these advantages, the current study explores the timing and course of symptom improvement in these two treatments for CADs, CBT, and PCET. Methods In this secondary analysis of data from the RCT, 56 youth aged 7−17 years (73.2% female) and a parent provided weekly ratings of anxiety symptom severity. Results The mean anxiety severity ratings decreased significantly in both conditions, but a significant condition by time interaction suggested that the pace of change differed between treatment for parent report, F (6.2, 335) = 2.96, p = 0.007. A series of post‐hoc comparisons indicated that the ratings became significantly lower in the PCET group beginning in session 3 (effect size = 0.77) through post‐treatment assessment. In addition, within each treatment condition the largest change in severity ratings occurred after the introduction of exposure, effect sizes of 0.68 for PCET and 0.56 for CBT. The child severity ratings followed a similar pattern but did not reach statistical significance. Discussion The implications of these exploratory and hypothesis‐generating findings for designing treatment protocols to deliver exposure in a manner to maximize the amount, and pace, of improvement are discussed.

Abstract Rumination syndrome (RS) is a common pediatric disorder of gut–brain interaction. However, a dearth of research on efficacious treatment to help guide clinical decision‐making remains. Thus, relying on well‐established treatment recommendations for other conditions with similar mechanisms or symptom profiles may be helpful; for example, conceptualizing RS treatment targets to address it as a “tic disorder of the gut” could be beneficial. To demonstrate the clinical utility of this conceptualization, we presented two cases that provide broad implications for treating pediatric RS. In both cases, akin to pediatric tic and related disorders, cognitive distress and physical discomfort were alleviated temporarily by rumination episodes. Thus, we recommend a targeted diagnostic assessment, including a functional analysis incorporating a transdiagnostic evaluation of symptoms. Close comanagement with specialty physicians and psychologists is also highly recommended. The patients represent complex yet standard cases seen in pediatric psychology outpatient clinics, suggesting the clinical utility of implications for psychologists and allied health professionals.

Childhood mental health problems are a leading cause of disability and frequently go untreated. Barriers to children receiving the most effective care available include shortfalls in three areas: identification, referral to specialists, and delivery of evidence-based treatment (EBT). The current paper details an effort to develop a digital health intervention, the Mental Health Advisor (MHA), to increase the number of children with mental health problems who receive optimal care through identification, specialty referral, and fidelity to EBT. We present this pilot as a case example to help guide other efforts to improve mental health care through technology.