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Doctoral Researchers (DRs) are an important part of the academic community and, after graduating, make substantial social and economic contributions. Despite this importance, DR wellbeing has long been of concern. Recent studies have concluded that DRs may be particularly vulnerable to mental health problems, yet direct comparisons of the prevalence of mental health problems between this population and control groups are lacking. Here, by comparing DRs with educated working controls, we show that DRs report significantly greater anxiety and depression, and that this difference is not explained by a higher rate of pre-existing mental health problems. Moreover, most DRs perceive poor mental health as a ‘normal’ part of the PhD process. Thus, our findings suggest a hazardous impact of PhD study on mental health, with DRs being particularly at risk of developing common mental health problems. This provides an evidence-based mandate for universities and funders to reflect upon practices related to DR training and mental health. Our attention should now be directed towards understanding what factors may explain heightened anxiety and depression among DRs so as to inform preventative measures and interventions.

Background: The evidence suggests an increased risk of developing anxiety problems in children of anxious parents. The current study explored the feasibility and acceptability of an intervention with anxious parents of young children, to inform the possibility of further trials. Methods: Participants were recruited through primary and secondary care psychological services and social media. Participants who had a current or recent anxiety disorder and a child aged 12–47 months were included. Assessments of parental and child outcomes occurred at baseline, after the intervention (week-2) and follow-up (week-8). The intervention was delivered in a small group format, in two sessions, one week apart, using videoconferencing. Results: Out of 32 participants, 30 (94%) attended the full intervention. All found the intervention acceptable and reported it as useful and relevant. There was a reduction in parental depression (MD = 2.63, 95%CI 1.01–4.26), anxiety (MD = 3.93, 95%CI 2.49–5.37) and stress (MD = 4.60, 95% CI 3.02–6.18) and increases in parenting confidence. Conclusions: The online group intervention was feasible and acceptable. There were moderate to large effects on parental mental health and no adverse effects on children (decline on outcome measures). This indicates that intervening early in parenting with anxious parents is possible and warrants further investigation to establish prevention efficacy with a larger, controlled trial.

Objectives\ud Ascertaining whether mental health service users have children is a clinical requirement in UK health services, and acknowledgement of a patient’s parenting role is necessary to enable engagement with their parenting experience and to facilitate support, both of which are associated with improved outcomes for the parent–child dyad. The current study sought to investigate the practice of mental health practitioners working in UK adult mental health services with regard to the following: Ascertaining whether patients have children; engagement with the parenting role of patients; engagement with the construct of ‘think patient as parent’.\ud \ud Methods\ud Self-report online/paper survey of 1105 multi-disciplinary adult mental health practitioners working in 15 mental health trusts in England.\ud \ud Results\ud A quarter of adult mental health practitioners did not routinely ascertain whether patients had dependent children. Less than half of practitioners engaged with the parenting experience or the potential impact of parental mental health on children.\ud \ud Conclusions\ud The parenting role of patients is not routinely captured by large numbers of practitioners working in adult mental health settings. This is despite it being a mandatory requirement and an integral component of the systematic care of the adult, and preventative care for the offspring. Failure to engage with patients who are parents is a missed opportunity with profound downstream public health implications. The practice deficits identified in this study should be viewed in terms of broader structural failures to address the intergenerational transmission of poor mental health.\ud \ud Practitioner points\ud -Some parents who have mental health difficulties may struggle to provide appropriate and effective care to their children. The parenting role can also exacerbate mental health difficulties.\ud -Identification of dependent children is a mandatory component of adult mental health clinical practice and is necessary to understand a parent’s support needs.\ud -A quarter of adult mental health practitioners are failing to do so. A missed opportunity to engage with the support needs of the parent–child dyad.

Background: Borderline Personality Disorder (BPD) is associated with challenges around emotional intensity and interpersonal difficulties. The children of parents with BPD are at risk of poorer outcomes in terms of their own mental health, educational outcomes and wellbeing. The challenges of being a parent can also exacerbate the symptoms of those with BPD traits. There is a pressing need to understand the experience of these parents and to determine what support would be appropriate and useful.\ud \ud Aim: To explore and compare the experiences and support needs of parents with BPD traits with the experiences and understanding of practitioners who work with them.\ud \ud Methods: Interviews with 12 parents with BPD traits and 21 practitioners with experience of working with individuals with BPD. The two strands of interviews were analyzed independently using a thematic framework approach, after which the superordinate and subordinate themes were subject to comparison.\ud \ud Results: Parents with BPD traits represent themselves as experiencing considerable challenges in their role as a parent. These included the impact of emotional intensity, social isolation and lack of a positive parenting models to draw upon. Practitioners demonstrated a strong degree of shared understanding into these difficulties. Both groups highlighted a lack of appropriate support for these parents.\ud \ud Conclusion: This research highlights the clinical need for parenting-focused support for individuals with BPD traits. Preliminary suggestions for format and content are given.

This study tested the theory that anxious fathers pose a quantitatively different environmental influence on childhood anxiety than anxious mothers. The analysed sample contained 502 linked adoption units from the Early Growth and Development Study (EGDS), a longitudinal multisite study that follows 561 adopted children (57.2% boys) and their adoptive and birth parents, who were recruited through US adoption agencies. A Bayesian latent growth model predicted child anxiety symptoms between 18 months and 4.5 years from inherited (birth parent anxiety) and rearing parent anxiety. This model revealed little evidence for a difference in the influence of maternal and paternal rearing parent anxiety on child anxiety symptoms. Contrary to theoretical predictions, anxiety in the rearing father is likely to have an equivalent influence to that of the mother on both child anxiety symptoms at 18 months old and their developmental trajectory over the preschool years.

A substantial proportion of adults with eating disorders are parents. Studies suggest these parents may experience a range of parenting challenges, and their children may be at an increased risk for the development of eating disorders themselves. With parenting practices being one potential environmental mechanism for the intergenerational transmission of eating disorders, we systematically searched Scopus, Web of Science, PubMed, MEDLINE, PsychINFO, and PsychArticles for controlled studies in which parenting attitudes, behaviours, and parent-child interactions were examined for parents with and without probable eating disorders. 26,512 abstracts were screened, and 167 full-text manuscripts were retrieved, with 33 studies meeting the review inclusion criteria. Studies suggest that parents with eating disorders experience higher levels of parenting stress than control parents, and may on average be more intrusive, less sensitive, and provide less structuring/facilitation in non-feeding interactions with their children. These parents also appear, on average, to experience increased concern about their children's weight, and parent-child mealtime interactions may be problematic and characterised by high levels of conflict. Suggestions for future research are made with a view to enhancing understandings of the intergenerational transmission of eating disorders, which may lead to the identification of intervention targets for parents with eating disorders and their children.

This paper explores whether the increased vulnerability\ud of children of anxious parents to develop anxiety disorders may be partially explained by these children having increased cognitive biases towards threat compared with children of non-anxious parents. Parents completed questionnaires about their child’s anxiety symptoms. Children aged 5–9 (n = 85) participated in two cognitive bias tasks: 1) an emotion recognition task, and 2) an ambiguous situations questionnaire. For the emotion recognition task, there were no significant differences between at-risk children and children of non-anxious parents in their cognitive bias scores for reaction times or for accuracy in identifying angry or happy facial expressions. In addition, there were no significant differences between at-risk children and children of non-anxious parents in the number of threat interpretations made for the ambiguous situations questionnaire. It is possible that these cognitive biases only become present subsequent to the development of an anxiety disorder, or only in older at-risk children.

Children of anxious parents are at high risk of anxiety disorders themselves. The evidence suggests that this is due to environmental rather than genetic factors. However, we currently do little to reduce this risk of transmission. There is evidence that supporting parenting in those with mental health difficulties can ameliorate this risk. Therefore, the objective of this study was to test the feasibility of a new one-session, group-based, preventive parenting intervention for parents with anxiety disorders.Feasibility Randomized Controlled Trial.A total of 100 parents with anxiety disorders, recruited from adult mental health services in England (and child aged 3-9 years), were randomized to receive the new intervention (a 1-day, group workshop), or to treatment as usual. Children's anxiety disorder and anxiety symptoms were assessed to 12 months by outcome assessors who were blind to group allocation. Exploratory analyses were conducted on an intention to treat basis, as far as possible.A total of 51 participants were randomized to the intervention condition and 49 to the control condition (82% and 80% followed to 12 months, respectively). The attendance rate was 59%, and the intervention was highly acceptable to parents who received it. The RCT was feasible, and 12-month follow-up attrition rates were low. Children whose parents were in the control condition were 16.5% more likely to have an anxiety disorder at follow-up than those in the intervention group. No adverse events were reported.An inexpensive, light-touch, psycho-educational intervention may be useful in breaking the intergenerational cycle of transmission of anxiety disorders. A substantive trial is warranted.Anxiety disorders run in families, but we currently do little to help anxious parents to raise confident children. A brief group workshop was highly acceptable to such parents and was very inexpensive to run. Children of parents who took part in the brief intervention were 16.5% less likely to have an anxiety disorder, 1 year later, than children whose parents were in the control group. This was a feasibility study, and while it showed that both the intervention and the research were feasible, the study needs replicating with a much larger sample. Many parents faced barriers to attending the workshop, and future efforts should focus on widening accessibility. We were unable to obtain sufficient self-report data from children, so the outcomes are based on parent report only.

One theory suggests that anxious fathers may pose a greater environmental influence on childhood anxiety than anxious mothers. This study uses the Early Growth and Development Study (EGDS) to test rearing parent anxiety influences from mothers and fathers on child anxiety symptoms between 18 months and 4.5, while considering inherited influences. The EGDS is a longitudinal, multisite study of adopted children recruited through US adoption agencies, and their adoptive and birth parents. Bayesian latent growth models of the trajectory of child anxiety symptoms over 3 years predicted from inherited (birth parent anxiety) and adoptive parent anxiety influences were compared for maternal and paternal measures. Parameter estimates and their HPD intervals provided evidence that the slope for anxiety symptoms between 18 and 54 months is trivially affected by both rearing parent anxiety and inherited influences from both mothers and fathers. Similarly, rearing parental anxiety and inherited influence from both mothers and fathers had only a very small effect on the intercept for growth (anxiety symptoms at 18 months old). The evidence for differences between mothers and fathers for any of these parameters was, at best, weak. Contrary to theoretical predictions, anxiety in the rearing father is unlikely to have a more important role in fostering child anxiety symptoms than that in the rearing mother.

The metacognitive model has increased our understanding of the development and maintenance of generalized anxiety disorders in adults. It states that the combination of positive and negative beliefs about worry creates and sustains anxiety. A recent review argues that the model can be applied to children, but empirical support is lacking. The aim of the 2 presented studies was to explore the applicability of the model in a childhood sample. The first study employed a Danish community sample of youth (n = 587) ages 7 to 17 and investigated the relationship between metacognitions, worry and anxiety. Two multiple regression analyses were performed using worry and metacognitive processes as outcome variables. The second study sampled Danish children ages 7 to 12, and compared the metacognitions of children with a GAD diagnosis (n = 22) to children with a non-GAD anxiety diagnosis (n = 19) and nonanxious children (n = 14). In Study 1, metacognitive processes accounted for an additional 14% of the variance in worry, beyond age, gender, and anxiety, and an extra 11% of the variance in anxiety beyond age, gender, and worry. The Negative Beliefs about Worry scale emerged as the strongest predictor of worry and a stronger predictor of anxiety than the other metacognitive processes and age. In Study 2, children with GAD have significantly higher levels of deleterious metacognitions than anxious children without GAD and nonanxious children. The results offer partial support for the downward extension of the metacognitive model of generalized anxiety disorders to children.

Background: Previous meta-analyses of cognitive-behavioural therapy (CBT) for children and young people with anxiety disorders have not considered the efficacy of transdiagnostic CBT for the remission of childhood anxiety. Aim: To provide a meta-analysis on the efficacy of transdiagnostic CBT for children and young people with anxiety disorders. Methods: The analysis included randomized controlled trials using transdiagnostic CBT for children and young people formally diagnosed with an anxiety disorder. An electronic search was conducted using the following databases: ASSIA, Cochrane Controlled Trials Register, Current Controlled Trials, Medline, PsycArticles, PsychInfo, and Web of Knowledge. The search terms included “anxiety disorder(s)”, “anxi*”, “cognitive behavio*, “CBT”, “child*”, “children”, “paediatric”, “adolescent(s)”, “adolescence”, “youth” and “young pe*”. The studies identified from this search were screened against the inclusion and exclusion criteria, and 20 studies were identified as appropriate for inclusion in the current meta-analysis. Pre- and posttreatment (or control period) data were used for analysis. Results: Findings indicated significantly greater odds of anxiety remission from pre- to posttreatment for those engaged in the transdiagnostic CBT intervention compared with those in the control group, with children in the treatment condition 9.15 times more likely to recover from their anxiety diagnosis than children in the control group. Risk of bias was not correlated with study effect sizes. Conclusions: Transdiagnostic CBT seems effective in reducing symptoms of anxiety in children and young people. Further research is required to investigate the efficacy of CBT for children under the age of 6.

Aim The self-regulatory executive function model suggests that metacognitive beliefs play a role in all forms of psychological disorder, including psychosis. However, our understanding of these beliefs and their relationship with symptoms in adolescents with an at-risk mental state (ARMS) for psychosis is limited. Methods The Metacognitions Questionnaire short form (MCQ-30) was administered to 31 adolescents with an identified ARMS. Scores were subsequently compared to a control group of 76 adolescents drawn from a community population. Results As predicted, ARMS patients scored significantly higher on metacognition subscales, with negative beliefs (F = 42.97, P = 0.001), cognitive confidence (F = 17.11, P = 0.001) and need for control (F = 22.48, P = 0.001) subscales of the MCQ-30 distinguishing them from the comparison group. Conclusions The finding that metacognitive beliefs are significantly elevated in comparison to a community sample of adolescents is in keeping with previous adult-orientated research. Possible implications for clinical practice are discussed.

OBJECTIVES: \ud \ud Anxiety leads to biases in processing personally relevant information. This study set out to examine whether anxious parents also experience biases in processing child-relevant material.\ud \ud DESIGN AND METHODS: \ud \ud Ninety parents acted as a control condition, or received a social anxiety or child-related anxiety induction. They completed a task examining attentional biases in relation to child-threat words and social-threat words, and a task examining ability to categorize emotion in children's faces and voices.\ud \ud RESULTS: \ud \ud There was a trend indicating group differences in attentional bias towards social-threat words, and this appears to have been only in the social anxiety condition, but not the child anxiety or control conditions. For child-threat words, attentional bias was present in the child anxiety condition, but not the social anxiety or control conditions. In the emotion recognition task, there was no difference between the control and child anxiety conditions, but the social anxiety condition were more likely to erroneously label children's faces and voices as sad.\ud \ud CONCLUSIONS: \ud \ud Parents' anxious biases may spill over into their child's world.\ud \ud PRACTITIONER POINTS: \ud \ud Parents' anxious biases may spill over into their child's world. Anxious parents may have attentional biases towards threats in their children's environment. Anxious parents may over-attribute negative emotion to children.

Cognitive biases are known to play an important role in anxiety. In this study we investigate whether maternal anxiety is associated with biases in interpretation, attention, and catastrophic processing about self-referent stimuli that may signal potential threat in the mother's own environment. We also investigate whether maternal anxiety is associated with biases about stimuli that their own child may encounter or to child-related stimuli more broadly. Three hundred mothers with a child aged 6 to 10 years participated. All participants completed a trait anxiety measure and an ambiguous sentences task to assess interpretation bias for self- and child-referent situations. A subset of the sample completed a catastrophizing interview about a self- (n = 194) or child-referent (n = 99) worry topic and an attentional dot-probe task (n = 99) with general threat and child threat stimuli. Maternal anxiety was not significantly associated with an attentional bias for general or child threat stimuli but was significantly associated with a bias for threat interpretations of both self and child-referent situations. Higher maternal anxiety was also significantly associated with generating more catastrophic outcomes to both a self-referent and child-referent hypothetical worry situation. We consider whether maternal cognitive biases, which extend to influence how mothers process potential threats in their child's world, may be an important mechanism through which intergenerational transmission of anxiety could occur.

Internalizing disorders of childhood and adolescence are common conditions, but until the past decade, had received little scientific scrutiny. This paper overviews the new knowledge that the past decade of research has given us. The early research began by adopting adult models of disorders, and adult-based modes of treatment. This met with moderate success, but the focus now is on testing whether these models are appropriate for younger clients. The good news is that, for adolescents at least, the adult models do seem to be appropriate. The bad news is that, even in well-resourced treatment trials, barely half of all cases remit. In very recent years, there has been a focus on generating developmentally appropriate models of childhood internalizing disorders, and correspondingly, an increasing interest in developing treatment approaches that are appropriate for young people and their families. The paper concludes with our thoughts on the most important questions for research in the next decade.

Recent transdiagnostic models of psychological disorder posit that the separate diagnostic categories are underpinned by a remarkably similar set of processes. However, it has been suggested that these processes themselves may have substantial commonalities, and, in fact, be derivatives of one or more higher order factors (i.e. a ‘transprocess’ model). This study examined this proposition with relation to cognitive processes in social anxiety, with 559 undergraduates who completed measures of Social Phobia; capacity for generating visual imagery; rumination; worry, tendency to experience shame; and metacognitive response to intrusions. The best conceptualization of these cognitive processes as explanations of social anxiety was to view them as indicators of a higher order variable that was not measured. In other words, social anxiety was best predicted from a single cognitive process that was not measured directly, but is made up of the interpretation of intrusions, trait rumination, obsessive beliefs, shame and worry. Visual imagery did not appear to add significantly to the fit of the model to the data. There appears to be substantial overlap in the cognitive processes that underpin symptoms of social anxiety, providing support for the transprocess model.

There has been some support for the applicability of the Clark and Wells’ model of Social Phobia within an adolescent population. To date, however, there is limited research to support the existence of the main perpetuating element (i.e. observer perspective) in this population. One hundred and twenty-four adolescents (12–18 years) completed an anxiety-provoking social task. They were asked to generate an image in their mind of what they felt they were like during this situation. The study investigated whether adolescents could report the perspective that they took in this task, and whether increased levels of social anxiety were associated with an “observer” perspective. The study also explored whether age moderated this relationship. It was found that as social anxiety increased, the perspective of the participants moved towards that of an observer. Age was not found to influence the reporting of perspective, nor the association between this and social anxiety. This study provides evidence for the existence of observer perspective within an adolescent population and indicates that this is associated with social anxiety. It provides some indirect support for the continued use of video feedback strategies with this age group.

Research examining parenting factors in the development of anxiety has focused largely on the concepts of parental warmth and overcontrolling or intrusive parenting, This study investigated the relationship between these factors, and also parental discipline style and anxiety using self-report methodology with a sample of 16-18 year olds. In order to try to explain the relationship between parenting and anxiety, measures of cognition were also included. A multiple regression was conducted including all parenting factors as predictors of trait anxiety. The regression was a modest fit (R(2)=22%) and the model was significant (F(4, 141)=9.90, p

The aim of this introductory paper, and of this special issue of Cognition and Emotion, is to stimulate debate about theoretical issues that will inform child anxiety research in the coming years. Papers included in this special issue have arisen from an Economic and Social Research Council (ESRC, UK) funded seminar series, which we called Child Anxiety Theory and Treatment (CATTS). We begin with an overview of the CATTS project before discussing (1) the application of adult models of anxiety to children, and (2) the role of parents in child anxiety. We explore the utility of adult models of anxiety for child populations before discussing the problems that are associated with employing them uncritically in this context. The study of anxiety in children provides the opportunity to observe the trajectory of anxiety and to identify variables that causally influence its development. Parental influences are of particular interest and new and imaginative strategies are required to isolate the complex network of causal relationships therein. We conclude by suggesting that research into the causes and developmental course of anxiety in children should be developed further. We also propose that, although much is known about the role of parents in the development of anxiety, it would be useful for research in this area to move towards an examination of the specific processes involved. We hope that these views represent a constructive agenda for people in the field to consider when planning future research.

This study explored associations between maternal discipline, maternal trait anxiety and anxiety in preschool-aged children. The sample comprised 47 mothers and their children, aged 2–3 years. Maternal discipline was assessed by maternal self-report; and child anxiety by maternal and play leader report. Positive associations were found between self-reported, ineffective, maternal discipline and symptoms of anxiety in preschool-aged children. Associations were not found between self-reported “verbose” discipline (long reprimands or reliance on talking) and preschoolers' anxiety. There were also no associations between play leaders' reports of preschoolers' anxiety and any of the mothers' self-reported discipline measures. Positive associations were found between maternal trait anxiety and the use of self-reported ineffective disciplinary behaviours. Over-reactive discipline was shown to be a stronger predictor of preschoolers' anxiety symptoms than maternal anxiety or lax discipline. It was concluded that children's internalizing symptoms (according to mother report) may be associated with use of ineffective disciplinary strategies. Increased use of these strategies was also associated with anxiety in mothers, and it is suggested that use of ineffective discipline strategies might partially account for the association between maternal and child anxiety.

Anxiety of childhood is a common and serious condition. The past decade has seen an increase in treatment-focussed research, with recent trials tending to give greater attention to parents in the treatment process. This review examines the efficacy of family-based cognitive behaviour therapy and attempts to delineate some of the factors that might have an impact on its efficacy. The choice and timing of outcome measure, age and gender of the child, level of parental anxiety, severity and type of child anxiety and treatment format and content are scrutinised. The main conclusions are necessarily tentative, but it seems likely that Family Cognitive Behaviour Therapy (FCBT) is superior to no treatment, and, for some outcome measures, also superior to Child Cognitive Behaviour Therapy (CCBT). Where FCBT is successful, the results are consistently maintained at follow-up. It appears that where a parent is anxious, and this is not addressed, outcomes are less good. However, for children of anxious parents, FCBT is probably more effective than CCBT. What is most clear is that large, well-designed studies, examining these factors alone and in combination, are now needed.

This systematic review explores two questions: what parenting difficulties are experienced by mothers with borderline personality disorder (BPD); and what impact do these have on her children?Studies had to include mothers with a diagnosis of BPD, who was the primary caregiver to a child/children under 19 years. PsycINFO and MEDLINE were screened (update: July 2014), yielding 17 relevant studies.Mothers with BPD are often parenting in the context of significant additional risk factors, such as depression, substance use and low support. Interactions between mothers with BPD and their infants are at risk of low sensitivity and high intrusiveness, and mothers have difficulty in correctly identifying their emotional state. Levels of parenting stress are high, and self-reported competence and satisfaction are low. The family environment is often hostile and low in cohesion, and mothers with BPD show low levels of mind-mindedness but high levels of overprotection of older children. Outcomes for children are poor compared with both children of healthy mothers, and mothers with other disorders. Infants of mothers with BPD have poorer interactions with their mother (e.g., less positive affect and vocalising, more dazed looks and looks away). Older children exhibit a range of cognitive-behavioural risk factors (e.g., harm avoidance, dysfunctional attitudes and attributions), and have poorer relationships with their mothers. Unsurprisingly, given these findings, children of mothers with BPD have poorer mental health in a range of domains.This review highlights the elevated need for support in these mother-child dyads.

The National Institute for Clinical Excellence recently published their guidelines on the treatment of depression in children and young people. This article critically reviews these guidelines in terms of their likely impact on BABCP members and the services in which they work. The evidence base that underpins the guideline is very sparse. There is particularly limited information on which to base guidance to therapists working with younger children. The use that has been made of this evidence is discussed, and some controversial interpretations are criticized. Implications for services and therapists are outlined. In particular, attention is drawn to the pressing need for very substantial additional training if the guidelines are to be implemented correctly. Some suggestions for deployment of staff with differing levels of knowledge and expertise in CBT are offered. Finally, challenges for the field as a whole are discussed. In particular, a great deal more research is needed into the effectiveness of psychological therapies versus wait list and versus each other and medications, and into the levels of training required to provide competent CBT to children and adolescents.

PROBLEM: A number of interventions are effective in treating older children with internalizing symptoms. However, little is known about the efficacy of psychological interventions in treating younger children. This study examined the impact on internalizing symptoms of a parenting skills training program. METHODS: Forty-three parents took part in a parenting skills training program. Externalizing and internalizing behaviors were measured before and after treatment and after a 6-month period. FINDINGS: Externalizing symptoms fell after treatment. Interestingly, internalizing scores fell to an approximately equivalent degree. CONCLUSIONS: An intervention targeted towards parenting may be efficacious in the treatment of children's internalizing symptoms.

Childhood anxiety disorders often have a poor prognosis. Despite this, there are currently no published treatment protocols for young children with anxiety difficulties. Individually focused therapies (e.g. CBT) are useful for older children, but likely to be less so for this group. This paper describes a pilot investigation of a new CBT based parenting intervention for the treatment of children aged 9 years and under. Sixteen parents of 11 anxious children took part in a 10-week intervention, completing the Child Behaviour Checklist at three time points. The intervention was based on a new cognitively enhanced parenting package, with an emphasis on coping with internalizing symptoms, and with additional modules on the specific skills needed for managing anxiety. All children were reported to experience substantial decreases in their internalizing symptoms by the end of the study. Parents' satisfaction with the intervention was high. This is a promising new intervention for the treatment of a currently neglected group.

Background. Treatments for childhood social anxiety have traditionally employed social skills training, based on the assumption that effected children have social skills deficits. Recent conceptualisations of social anxiety in adults have questioned this assumption, and have suggested that socially anxious individuals merely believe that they have skill deficits. A recent study using children provided preliminary confirmation of this for younger populations, and also suggested that beliefs about appearing nervous are of particular importance. Methods. Two groups of children, aged 10–11 years (analogue high social anxiety/low social anxiety), participated in a conversation with an unfamiliar adult. They then rated their performance in a number of domains, after which independent observers also rated their performances. Results. Independent observers were unable to distinguish between the low and high social anxiety groups. However, high socially anxious children rated themselves as appearing significantly less skilled than their low socially anxious counterparts. Notably, high socially anxious children rated themselves particularly poorly in terms of how nervous they looked. Conclusions. Socially anxious children may not necessarily display social skill deficits. However, they may believe that they appear nervous during social encounters. Clinicians should consider using CBT techniques to address these concerns, rather than relying on social skill remediation. # 2003 Elsevier Ltd. All rights reserved.

BACKGROUND: Social anxiety of childhood is a common and pervasive problem. Traditional approaches to treating these difficulties have focused on providing afflicted children with social skills training. This approach has met with some, but not complete success. Recent reconceptualisations of social anxiety in the adult literature have emphasised the role of negative cognition regarding one's own social skills. Experimental evidence has demonstrated that a misperception of social skills, rather than a skills deficit per se, may be most pertinent to the understanding of social anxiety. This study set out to examine the relationship between self and observer ratings of social skill, and social anxiety in children. METHOD: One hundred and ten non-referred schoolchildren aged 8-11 years were asked to give a two-minute speech to a video camera, after which they were asked to rate their performance on a number of social skill dimensions. Neutral observers also watched the videos and rated each child on the same dimensions. RESULTS: There was very little correlation between social anxiety level and observer ratings of children's social skills. Indeed, some very anxious children achieved high observer rated social skill scores. State socially anxious children self-reported that their social skills were poorer than less anxious children. However, other than looking more nervous than less anxious children, the social skills of the high anxious children were indistinguishable from those of their less anxious peers. CONCLUSIONS: Socially anxious children may not necessarily lack social skills. Rather, their deficits may relate to nervousness and appraisals of their skills. Treatment programmes for these children should take care to assess social skills carefully before prescribing social skill remediation, and should consider employing a cognitive element to tackle negative misperceptions of subjective social skill.

Parent training is one of the most effective interventions for behaviour problems in young children. Most models of parent training are largely behavioural in content and have been developed from social learning theory. As with developments in treatments for adult disorders, it is proposed that parent training implementation and parental engagement may be improved by the introduction of a cognitive component. In particular, the use of the “thoughts, feelings, behaviour cycle” throughout parent training is proposed as a tool for challenging parental beliefs and attributions regarding children's behaviour and increasing parental uptake of the behavioural strategies that are taught. Preliminary findings are discussed with reference to clinical implications and future research.

This case study examines how parents can be incorporated into all aspects of cognitive-behavioral therapy (CBT) for child anxiety problems. This is an important issue, because although there are strong theoretical and empirical reasons for incorporating parents into treatment, evidence from randomized controlled trials has so far been inconclusive about whether outcomes are improved by involving parents. This case study describes the clinical benefits of a balanced focus on parent and child factors for “Laura,” an 8-year-old girl experiencing a range of fears and worries, including refusing to attend school. Treatment consisted of seven sessions of CBT, which targeted parent and child factors hypothesized to be critical to the development and maintenance of Laura’s anxiety problems. The clinician’s decision making and reasoning in carefully selecting CBT interventions to specifically address the presenting problems are illustrated. Laura showed marked reductions in avoidance behaviors and fears and returned full-time to school.

In this paper, we review the area of anxiety in children under the age of 11 years. We explore the literature examining the continuity of anxiety symptoms and behavioral inhibition when they appear in children of this age, and show that when these are present, there is a high likelihood of significant anxiety in later childhood, adolescence, and beyond. We then focus on the growing area of treatment research. We show that there are a number of promising new avenues for managing anxiety disorders in this young age group. Many of these interventions involve a key role for parents in the treatment process, but others have demonstrated success employing modified cognitive behavior therapy directed at the child. Limitations to the conclusions, caused by the limited amounts research, small sample sizes and significant methodological difficulties, are discussed.