Supplementary Material for: Disorder-Specific Cognitive-Behavioral Therapy for Separation Anxiety Disorder in Young Children: A Randomized Waiting-List-Controlled Trial

<i>Background:</i> Separation anxiety disorder (SAD) is one of the earliest and most common mental disorders in childhood, and a strong predictor of adult psychopathology. Despite significant progress in psychotherapy research on childhood anxiety disorders, no randomized controlled trial has been conducted with a disorder-specific treatment program for young children suffering from SAD. <i>Methods:</i> Forty-three children (ages 5–7) with SAD and their parents were assigned to either a 16-session disorder-specific SAD treatment program including parent training and classical cognitive-behavioral therapy (CBT) components, or to a 12-week waiting list group. Categorical and/or continuous data for anxiety, impairment/distress and quality of life were collected at baseline, after treatment/waiting list condition, and at a 4-week follow-up. <i>Results:</i> Intention-to-treat analyses indicate that 76.19% of children allocated to the treatment group definitively no longer fulfilled DSM-IV criteria for SAD at follow-up, compared to 13.64% in the waiting list group. Between 91 and 100% of children rated themselves or were rated by their father, mother or therapist as very much or much improved on the global success rating immediately after treatment. Results indicated large time by treatment condition interaction effect sizes (d = 0.98–1.41) across informants for reduction of distress/avoidance in separation situations after the test for the treatment condition. Further, parents reported significant improvements in impairment/distress in the child’s major life domains and the child’s quality of life. Treatment gains were maintained at the 4-week follow-up assessment. <i>Conclusions:</i> Results indicate the short-term efficacy of a disorder-specific treatment approach for SAD, and are among the first to indicate that CBT programs work with young children.

背景：分离焦虑障碍（Separation Anxiety Disorder, SAD）是儿童时期最早出现且最为常见的精神障碍之一，同时也是成人精神病理的强预测因子。尽管儿童焦虑障碍的心理治疗研究已取得显著进展，但目前尚无针对患有分离焦虑障碍的年幼儿童开展的专项治疗方案的随机对照试验。
方法：本研究共纳入43名5至7岁的分离焦虑障碍患儿及其家长，将其随机分配至两个组别：一组为包含家长培训与经典认知行为疗法（Cognitive-Behavioral Therapy, CBT）模块的16次专项分离焦虑障碍治疗方案组；另一组为12周等待队列组。研究分别在基线期、治疗/等待干预结束后，以及4周随访时，收集患儿焦虑症状、功能损害/痛苦程度与生活质量的分类数据及/或连续数据。
结果：意向性治疗分析显示，治疗组中76.19%的患儿在随访时已完全不符合DSM-IV分离焦虑障碍诊断标准，而等待队列组的这一比例仅为13.64%。治疗结束后即刻，91%至100%的患儿自评或由其父亲、母亲及治疗师评定为“显著改善”或“大幅改善”，总体疗效评级良好。针对治疗组的分析表明，在不同信息提供者的评分中，分离情境下的痛苦/回避症状缓解均存在显著的时间×治疗条件交互效应（d=0.98~1.41），效应量较大。此外，家长报告显示患儿在主要生活领域的功能损害/痛苦程度及生活质量均得到显著改善。治疗获益在4周随访评估中得以维持。
结论：本研究结果证实了针对分离焦虑障碍的专项治疗方案的短期有效性，亦是首批证实认知行为疗法可应用于年幼儿童群体的相关研究之一。