The child's impact on parenting in the maintenance of child anxiety disorders: Toward an interactive model

This study addressed the relationship between child anxiety, changes in child anxiety, and parent characteristics. This relationship was explored by analyzing how child anxiety and parent characteristics change in relationship to each other over time (waitlist condition) and over a child-focused, cognitive-behavioral treatment (treatment condition). Twenty-three children with an anxiety disorder who participated in a 16-session treatment and their families were compared to 23 children with an anxiety disorder and their families who participated in a waitlist condition. Children (ages 9-13) rated their parents and parents rated themselves on the parenting variables of (a) warmth/acceptance and (b) psychological control. Similar constructs were rated based on behavioral observations gathered from a sample of an 8-minute family interaction task. Self-report, parent-report, and behavioral observation data were analyzed for change from pre- to post-treatment assessments for the treated group and the wait-list group. In this randomized clinical trial, the groups were compared on (a) measures of parenting and (b) independent observers' ratings of family interaction before and following each condition. Analyses indicated significant differences in child perceptions of mother's psychological control between children who demonstrate decreases in anxiety versus children who do not decrease in anxiety over time. In both the treatment and waitlist conditions, children who reported significant decreases in their own levels of anxiety also perceived their mothers as significantly less psychologically controlling. Children who did not evidence significant improvement in their anxiety symptoms did not report changes in mother's psychological control. Parents did not decrease in their reported use of psychological control or increase in acceptance in response to viewing their child as less anxious following the treatment.