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OBJECTIVE: The relative contribution of individual cognitive behavioral therapy (CBT) components to treatment outcomes for child anxiety disorders (CADs) is unclear. Recent meta-analyses suggest that exposure may be the primary active ingredient in CBT for CADs, and that relaxation may be relatively less effective. This brief report tests the hypothesis that exposure-focused CBT (EF-CBT) would outperform a relaxation-based active therapy control (Relaxation Mentorship Training; RMT) for the treatment of CADs. METHOD: Participants were 102 youth with CADs (mean age=11.91, 26 males; 76.4% White, 14.7% Multiracial, 3.9% Black, 3.9% Asian, 0.9% other/do not wish to identify) as part of an ongoing neuroimaging randomized controlled trial. Participants were randomly assigned (ratio 2:1) to receive 12 sessions of EF-CBT (n=70) or RMT (n=32). Clinical improvement was measured at Week 12 (Clinical Global Impression – Improvement scale; CGI-I); treatment response was defined as receiving a rating of ‘very much’ or ‘much improved’ on the CGI-I. Anxiety severity was measured at Weeks 1, 6, 9, 12 (Pediatric Anxiety Rating Scale; PARS). Outcome measures were completed by an independent evaluator unaware of condition. RESULTS: EF-CBT exhibited 2.98 times higher odds of treatment completion than RMT; 13 treatment non-completers were included in analyses. Estimated treatment response rates were higher for EF-CBT (57.3%) than for RMT (19.2%). Longitudinal analyses indicated that EF-CBT was associated with faster and more pronounced anxiety reductions than RMT on the PARS (Hedges’ g=.77). CONCLUSIONS: Results suggest that EF-CBT without relaxation is effective for CADs, and more effective than a relaxation-based intervention.

The approximate number system (ANS) is widely considered to be a foundation for the acquisition of uniquely human symbolic numerical capabilities. However, the mechanism by which the ANS may support symbolic number representations and mathematical thought remains poorly understood. In the present study, we investigated two pathways by which the ANS may influence early math abilities: variability in the acuity of the ANS representations, and children’s’ ability to manipulate ANS representations. We assessed the relation between 4-year-old children’s performance on a non-symbolic numerical comparison task, a non-symbolic approximate addition task, and a standardized symbolic math assessment. Our results indicate that ANS acuity and ANS manipulability each contribute unique variance to preschooler’s early math achievement, and this result holds after controlling for both IQ and executive functions. These findings suggest that there are multiple routes by which the ANS influences math achievement. Therefore, interventions that target both the precision and manipulability of the ANS may prove to be more beneficial for improving symbolic math skills compared to interventions that target only one of these factors.