Papers by Wendy Silverman
Http Dx Doi Org 10 1080 15374416 2015 1038824, May 18, 2015
The current study presents an approach for empirically identifying tailoring variables at midtrea... more The current study presents an approach for empirically identifying tailoring variables at midtreatment of cognitive behavioral therapy (CBT) protocols for youth with anxiety disorders that can be used to guide moves to second-stage treatments. Using 2 independent data sets (Study 1 N = 240, M age = 9.86 years; Study 2 N = 341; M age = 9.53 years), we examined treatment response patterns after 8 sessions of CBT (i.e., CBT midtreatment). We identified and replicated 3 classes of response patterns at CBT midtreatment: Early Responders, Partial Responders, and Nonresponders. Class membership at CBT midtreatment was predictive of outcome at CBT posttreatment. Receiver operating characteristics curves were used to derive guidelines to optimize accuracy of assignment to classes at CBT midtreatment. These findings support the promise of treatment response at CBT midtreatment to identify tailoring variables for use in abbreviating first-stage treatments and facilitating moves to second-stage treatments.
Journal of Child Psychology and Psychiatry and Allied Disciplines, Sep 1, 1999
The discriminant validity of children's and parents' ratings of the child's fear on the Revised F... more The discriminant validity of children's and parents' ratings of the child's fear on the Revised Fear Survey Schedule for Children (FSSC-R ;) was examined using a clinic sample of children who met DSM criteria for phobic disorders (N l 120). Discriminant function analyses and item analyses were conducted to determine if children meeting diagnostic criteria for a primary disorder of social phobia, simple phobia of the dark\sleeping alone, simple phobia of animals, or a simple phobia of shots\doctors could be differentiated on the basis of FSSC-R subscale scores and items. Results of the discriminant function analyses indicated that the child-completed as well as the parent-completed FSSC-Rs were similarly useful in differentiating the specific types of phobias. Results of the item analyses indicated that child-completed FSSC-R items could discriminate among the different simple phobias but not social phobia and that parent-completed FSSC-R items could discriminate not only the different simple phobias but also social phobia. Results are discussed in terms of the utility of the FSSC-R in the assessment of clinically significant fears in children with phobic disorders and the relative utility of child and parent ratings in the assessment of childhood fears.
Journal of Child Psychology and Psychiatry, 2015
In individual cognitive behavioral therapy (ICBT) for youth anxiety disorders, it is unclear whet... more In individual cognitive behavioral therapy (ICBT) for youth anxiety disorders, it is unclear whether, and from whose perspective, the alliance predicts outcome. We examined whether youth- and therapist-rated alliance, including level of youth-therapist alliance agreement, predicted outcome in a randomized controlled trial. Youth (N = 91, M age = 11.4 years (SD = 2.1), 49.5% boys, 86.8% Caucasian) diagnosed with separation anxiety disorder, social phobia, or generalized anxiety disorder drawn from the ICBT condition of an effectiveness trial were treated with an ICBT program. Youth- and therapist-rated alliance ratings, assessed with the Therapeutic Alliance Scale for Children (TASC-C/T), were collected following session 3 (early) and 7 (late). Early alliance, change in alliance from early to late, and level of youth-therapist agreement on early alliance and alliance change were examined, in relation to outcomes collected at posttreatment and 1-year follow-up. Outcome was defined as primary diagnosis loss and reduction in clinicians' severity ratings (CSR; Anxiety Disorders Interview Schedule; ADIS-C/P) based on youth- and parent-report at posttreatment and follow-up, and youth treatment satisfaction collected at posttreatment (Client Satisfaction Scale; CSS). Early TASC-C scores positively predicted treatment satisfaction at posttreatment. Higher levels of agreement on change in TASC-C and TASC-T scores early to late in treatment predicted diagnosis loss and CSR reduction at follow-up. Only the level of agreement in alliance change predicted follow-up outcomes in ICBT for youth anxiety disorders. The findings support further examination of the role that youth-therapist alliance discrepancies may play in promoting positive outcomes in ICBT for youth anxiety disorders. Clinical trial number NCT00586586, clinicaltrials.gov.
Journal of Cognitive Psychotherapy, 1993
Psychoneuroendocrinology, 2016
Clinical anxiety disorders in youth are common and associated with interpersonal behaviors includ... more Clinical anxiety disorders in youth are common and associated with interpersonal behaviors including reliance on parents for family accommodation, or changes that parents make to their own behaviors to help the youth avoid anxiety related distress. The neuropeptide oxytocin is associated with the regulation of anxiety and of close interpersonal behavior leading to the hypothesis that oxytocinergic functioning plays a role in youth anxiety and its disorders, and the resulting family accommodation. To test this hypothesis salivary OT from 50 youth with primary DSM-5 anxiety disorders was assayed. A multi-source/multi-method anxiety assessment including semistructured interviews with youth and mothers, rating scales, and behavioral observations was used to assess anxiety disorders and symptoms, and family accommodation. Youth with separation anxiety disorder had significantly lower salivary OT levels than clinically anxious youth not diagnosed with separation anxiety disorder. Salivary OT levels were significantly negatively correlated with separation anxiety symptoms based on both youth- and mother-ratings. Anxious behavior displayed by youth during interactions with their mothers was associated with lower salivary OT levels in youth. Maternal ratings of family accommodation were negatively associated with salivary OT levels in youth. Results support the role of the oxytocinergic system in youth anxiety and its disorders and in parental involvement in youth anxiety through family accommodation. OT may be particularly important for diagnoses and symptoms of separation anxiety, which is inherently interpersonal in nature. Findings have potentially important implications for assessment and treatment of anxiety in youth.
Http Dx Doi Org 10 1080 00223890802484183, Aug 23, 2011
Journal of Clinical Child and Adolescent Psychology the Official Journal For the Society of Clinical Child and Adolescent Psychology American Psychological Association Division 53, 2008
Behaviour Research and Therapy, 2015
A substantial number of children with anxiety disorders do not improve following cognitive behavi... more A substantial number of children with anxiety disorders do not improve following cognitive behavioral therapy (CBT). Recent effectiveness studies have found poorer outcome for CBT programs than what is typically found in efficacy studies. The present study examined predictors of treatment outcome among 181 children (aged 8-15 years), with separation anxiety, social phobia, or generalized anxiety disorder, who participated in a randomized, controlled effectiveness trial of a 10-session CBT program in community clinics. Potential predictors included baseline demographic, child, and parent factors. Outcomes were as follows: a) remission from all inclusion anxiety disorders; b) remission from the primary anxiety disorder; and c) child- and parent-rated reduction of anxiety symptoms at post-treatment and at 1-year follow-up. The most consistent findings across outcome measures and informants were that child-rated anxiety symptoms, functional impairment, a primary diagnosis of social phobia or separation anxiety disorder, and parent internalizing symptoms predicted poorer outcome at post-treatment. Child-rated anxiety symptoms, lower family social class, lower pretreatment child motivation, and parent internalizing symptoms predicted poorer outcome at 1-year follow-up. These results suggest that anxious children with more severe problems, and children of parents with elevated internalizing symptom levels, may be in need of modified, additional, or alternative interventions to achieve a positive treatment outcome.
Depression and Anxiety, 2015
Hypothalamic-pituitary-adrenal (HPA) axis functioning has been implicated in the development of s... more Hypothalamic-pituitary-adrenal (HPA) axis functioning has been implicated in the development of stress-related psychiatric diagnoses and response to adverse life experiences. This study aimed to investigate the association between genetic and epigenetics in HPA axis and response to cognitive behavior therapy (CBT). Children with anxiety disorders were recruited into the Genes for Treatment project (GxT, N = 1,152). Polymorphisms of FKBP5 and GR were analyzed for association with response to CBT. Percentage DNA methylation at the FKBP5 and GR promoter regions was measured before and after CBT in a subset (n = 98). Linear mixed effect models were used to investigate the relationship between genotype, DNA methylation, and change in primary anxiety disorder severity (treatment response). Treatment response was not associated with FKBP5 and GR polymorphisms, or pretreatment percentage DNA methylation. However, change in FKBP5 DNA methylation was nominally significantly associated with treatment response. Participants who demonstrated the greatest reduction in severity decreased in percentage DNA methylation during treatment, whereas those with little/no reduction in severity increased in percentage DNA methylation. This effect was driven by those with one or more FKBP5 risk alleles, with no association seen in those with no FKBP5 risk alleles. No significant association was found between GR methylation and response. Allele-specific change in FKBP5 methylation was associated with treatment response. This is the largest study to date investigating the role of HPA axis related genes in response to a psychological therapy. Furthermore, this is the first study to demonstrate that DNA methylation changes may be associated with response to psychological therapies in a genotype-dependent manner.
The British journal of psychiatry : the journal of mental science, Jan 20, 2015
BackgroundWe previously reported an association between 5HTTLPR genotype and outcome following co... more BackgroundWe previously reported an association between 5HTTLPR genotype and outcome following cognitive-behavioural therapy (CBT) in child anxiety (Cohort 1). Children homozygous for the low-expression short-allele showed more positive outcomes. Other similar studies have produced mixed results, with most reporting no association between genotype and CBT outcome.AimsTo replicate the association between 5HTTLPR and CBT outcome in child anxiety from the Genes for Treatment study (GxT Cohort 2, n = 829).MethodLogistic and linear mixed effects models were used to examine the relationship between 5HTTLPR and CBT outcomes. Mega-analyses using both cohorts were performed.ResultsThere was no significant effect of 5HTTLPR on CBT outcomes in Cohort 2. Mega-analyses identified a significant association between 5HTTLPR and remission from all anxiety disorders at follow-up (odds ratio 0.45, P = 0.014), but not primary anxiety disorder outcomes.ConclusionsThe association between 5HTTLPR genotype...
Journal of the American Academy of Child & Adolescent Psychiatry, 2015
Cognition & Emotion, 2008
This study used confirmatory factor analysis (CFA) to investigate whether test anxiety (TA) can b... more This study used confirmatory factor analysis (CFA) to investigate whether test anxiety (TA) can be conceptualised as a bidimensional construct consisting of cognitive and emotional facets in 152 African American school children, ages 8 to 13 years, M=9.98 years (SD=1.13 years); 54% girls. A two-factor model was determined a priori by classifying items from the Test Anxiety Scale for Children
Depression and anxiety, 2015
Fear and anxiety in children are associated with similar symptoms in parents. Parental modeling o... more Fear and anxiety in children are associated with similar symptoms in parents. Parental modeling of fearful or avoidant behavior is believed to contribute to this association. We employed a novel motion-tracking experimentation platform to test the hypothesis that mothers' behavioral avoidance of spiders moderates the association between fear of spiders in mothers and children. Participants were 86 children (aged 7-17) presenting with an anxiety disorder, and their mothers. Children and mothers completed the Spider Phobia Questionnaire. Mothers completed a motion-tracking assessment of behavioral avoidance of spiders. Fear of spiders in mothers was associated with fear of spiders in children (r85 = 0.48, 95%CI 0.30 - 0.63, P < 0.001). Two metrics of behavioral avoidance in mothers were associated with mothers' self-reported fear of spiders (r = -0.49, 95% CI 0.31-0.64, P < 0.001; and r = 0.42, 95%CI 0.23 - 0.58 P < 0.001). Mothers' behavioral avoidance moderated...
Journal of Anxiety Disorders, 2015
The aim was to investigate predictors of treatment dropout among 182 children (aged 8-15 years) p... more The aim was to investigate predictors of treatment dropout among 182 children (aged 8-15 years) participating in an effectiveness trial of manual-based 10-session individual and group cognitive behavior therapy (CBT) for anxiety disorders in community clinics. The dropout rate was 14.4%, with no significant difference between the two treatment conditions. We examined predictors for overall dropout (n = 26), early (≤session 4, n = 15), and late dropout (≥session 5, n = 11). Overall dropout was predicted by low child and parent rated treatment credibility, and high parent self-rated internalizing symptoms. Low child rated treatment credibility predicted both early and late dropout. High parent self-rated internalizing symptoms predicted early dropout, whereas low parent rated treatment credibility predicted late dropout. These results highlight the importance of addressing treatment credibility, and to offer support for parents with internalizing symptoms, to help children and families remain in treatment.
Journal of Youth and Adolescence, 2013
Most past research on the effects of early pubertal timing on girls&amp;amp;amp;amp;amp;amp;a... more Most past research on the effects of early pubertal timing on girls&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; depressive symptoms and delinquent behavior has focused on either age of menarche or has combined multiple indicators of development into a single index of puberty. Past research has rarely examined both the onset of puberty such as age of menarche, as well more psychologically mediated impressions of puberty (i.e., perceived pubertal timing) within the same study. This study extends past research on racial differences and pubertal related effects on girls&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; depressive symptoms and delinquent behavior by examining the independent influence of different indicators of puberty (age of menarche, development of breasts, and perceived pubertal timing). Two waves of data (100% females) were used from African Americans (N = 481) and European Americans (N = 1259) who were enrolled in seventh- and eighth-grade during the first wave of data collection in the National Longitudinal Study of Adolescent Health. Early age of menarche was associated with high levels of depressive symptoms at Wave 1. Additionally, both early and late perceived pubertal timing were associated with high levels of depressive symptoms and high delinquent behaviors at Wave 1. The structural relationships among these variables were similar for African Americans and European Americans. Age of menarche and perceived pubertal timing influenced depressive symptoms and delinquent behavior at Wave 2 through depressive symptoms and delinquent behavior reported at Wave 1. The implications of these findings are discussed with an emphasis on how the specific indicator used to assess puberty is important in efforts to understand pubertal timing effects.
Journal of the American Academy of Child & Adolescent Psychiatry, 1992
Test-retest reliability of child and parent reports of anxious symptomatology, using a structured... more Test-retest reliability of child and parent reports of anxious symptomatology, using a structured interview (The Anxiety Disorders Interview Schedule for Children; ADIS-C and ADIS-P), was examined with 50 outpatients and their parents. The test-retest was 10 to 14 days. Reliability was examined for three parameters: (1) an exact match on primary anxiety diagnoses; (2) symptom scale scores; and (3) clinician&#39;s agreement on severity ratings. Overall, satisfactory reliability across the three parameters was found. The results were viewed to be promising in light of previous research that parents and children tend to be unreliable in making such reports. Age differences in reliability were also examined between children 6 to 11 and 12 to 17 years old. Discrepancies between parent and child reports and age differences between samples (i.e., 6-11, 12-17) are discussed.
Journal of Personality Assessment, 2009
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Papers by Wendy Silverman