The Cognitive Behaviour Therapy Scale for Children and Young People (CBTS-CYP): development and psychometric properties

Background: There is increased interest in developing training in cognitive behaviour therapy (CBT) with children and young people. However, the assessment of clinical competence has relied upon the use of measures such as the Cognitive Therapy Scale-Revised (CTSR: Blackburn et al., 2001) which has been validated to assess competence with adults. The appropriateness of this measure to assess competence when working with children and young people has been questioned. Aim: This paper describes the development and initial evaluation of the Cognitive Behaviour Therapy Scale for Children and Young People (CBTSCYP) developed specifically to assess competence in CBT with children and young people. Method: A cross section of child CBT practitioners (n = 61) were consulted to establish face validity. Internal reliability, convergent validity and discriminative ability were assessed in two studies. In the first, 12 assessors independently rated a single video using both the Cognitive Behaviour Therapy Scale for Children and Young People (CBTS-CYP) and Cognitive Therapy Scale-Revised (CTS-Revised: Blackburn et al., 2001). In the second, 48 different recordings of CBT undertaken with children and young people were rated on both the CBTS-CYP and CTS-R. Results: Face validity and internal reliability of the CBTS-CYP were high, and convergent validity with the CTS-R was good. The CBTS-CYP compared well with the CTSR in discriminative ability. Conclusion: The CBTS-CYP provides an appropriate way of assessing competence in using CBT with children and young people. Further work is required to assess robustness with younger children and the impact of group training in reducing interrater variations.

Computerised therapies for anxiety and depression in children and young people: a systematic review and meta-anaylsis

One quarter of children and young people (CYP) experience anxiety and/or depression before adulthood, but treatment is sometimes unavailable or inadequate. Self-help interventions may have a role in augmenting treatment and this work aimed to systematically review the evidence for computerised anxiety and depression interventions in CYP aged 5–25 years old. Databases were searched for randomised controlled trials and 27 studies were identified. For young people (12–25 years) with risk of diagnosed anxiety disorders or depression, computerised CBT (cCBT) had positive effects for symptoms of anxiety (SMD −0.77, 95% CI −1.45 to −0.09, k = 6, N = 220) and depression (SMD −0.62, 95% CI −1.13 to −0.11, k = 7, N = 279). In a general population study of young people, there were small positive effects for anxiety (SMD −0.15, 95% CI −0.26 to −0.03; N = 1273) and depression (SMD −0.15, 95% CI −0.26 to −0.03; N = 1280). There was uncertainty around the effectiveness of cCBT in children (5–11 years). Evidence for other computerised interventions was sparse and inconclusive. Computerised CBT has potential for treating and preventing anxiety and depression in clinical and general populations of young people. Further program development and research is required to extend its use and establish its benefit in children.

Observing interactions between children and adolescents and their parents: the effects of anxiety disorder and age

Parental behaviors, most notably overcontrol, lack of warmth and expressed anxiety, have been implicated in models of the development and maintenance of anxiety disorders in children and young people. Theories of normative development have proposed that different parental responses are required to support emotional development in childhood and adolescence, yet age has not typically been taken into account in studies of parenting and anxiety disorders. In order to identify whether associations between anxiety disorder status and parenting differ in children and adolescents, we compared observed behaviors of parents of children (7–10 years) and adolescents (13–16 years) with and without anxiety disorders (n=120), while they undertook a series of mildly anxiety-provoking tasks. Parents of adolescents showed significantly lower levels of expressed anxiety, intrusiveness and warm engagement than parents of children. Furthermore, offspring age moderated the association between anxiety disorder status and parenting behaviors. Specifically, parents of adolescents with anxiety disorders showed higher intrusiveness and lower warm engagement than parents of non-anxious adolescents. A similar relationship between these parenting behaviors and anxiety disorder status was not observed among parents of children. The findings suggest that theoretical accounts of the role of parental behaviors in anxiety disorders in children and adolescents should distinguish between these different developmental periods. Further experimental research to establish causality, however, would be required before committing additional resources to targeting parenting factors within treatment.

Shared cognition in childhood anxiety: interpretation bias in preschool children and their parents

Although interpretation bias has been associated with the development and/or maintenance of childhood anxiety, its origins remain unclear. The present study is the first to examine intergenerational transmission of this bias from parents to their preschool-aged children via the verbal information pathway. A community sample of fifty parent–child pairs was recruited. Parents completed measures of their own trait anxiety and interpretation bias, their child’s anxiety symptoms, and a written story-stem measure, to capture the way parents tell their children stories. Interpretation bias was assessed in preschool-aged children (aged between 2 years 7 months and 5 years 8 months) using an extended story-stem paradigm. Young children’s interpretation bias was not significantly associated with their own anxiety symptoms. Neither was there evidence for a significant association between parent and child interpretation bias. However, parents who reported they would tell their child one or more threatening story endings in the written story-stem task had significantly higher anxiety than those who did not include any threatening story endings. In turn, children whose parents did not include any threatening endings in their written stories had significantly lower threat interpretations on the child story-stem paradigm, compared to those with parents who included at least one threatening story ending. The results suggest that parental verbal information could play a role in the development of interpretation bias in young children.

‘I like playing on my trampoline; it makes me feel alive’ valuing physical activity: perceptions and meanings for children and implications for primary schools

This study investigated perceptions that children aged 6–10 years (n = 83) have of what it means to be physically active. Ideographic research was conducted utilising drawings and interviews to understand values that are placed on participating in physical activity (PA). The article questions the idea that whilst it may be commonly accepted by academics that there is a need to be active for health, little research has considered what this may actually mean for the child. Drawing on Bourdieu, the article utilises key concepts within the analysis of ‘capital' to frame an understanding of how children experience PA. Findings suggest that central to children's experiences is the place of social interaction and reciprocation. The article investigated the production and transference of forms of capital: physical, cultural and social. The potential for such concepts to be exploited by schools is discussed with reference to physical education and opportunities offered during free play.

Interpretation of ambiguity: differences between children and adolescents with and without an anxiety disorder

Background: Theory and treatment of anxiety disorders in young people are commonly based on the premise that interpretation biases found in anxious adults are also found in children and adolescents. Although there is some evidence that this may be the case, studies have not typically taken age into account, which is surprising given the normative changes in cognition that occur throughout childhood. The aim of the current study was to identify whether associations between anxiety disorder status and interpretation biases differed in children and adolescents. Methods: The responses of children (7-10 years) and adolescents (13-16 years) with and without anxiety disorders (n = 120) were compared on an ambiguous scenarios task. Results: Children and adolescents with an anxiety disorder showed significantly higher levels of threat interpretation and avoidant strategies than non-anxious children and adolescents. However, age significantly moderated the effect of anxiety disorder status on interpretation of ambiguity, in that adolescents with anxiety disorders showed significantly higher levels of threat interpretation and associated negative emotion than non-anxious adolescents, but a similar relationship was not observed among children. Conclusions: The findings suggest that theoretical accounts of interpretation biases in anxiety disorders in children and adolescents should distinguish between different developmental periods. For both ages, treatment that targets behavioral avoidance appears warranted. However, while adolescents are likely to benefit from treatment that addresses interpretation biases, there may be limited benefit for children under the age of ten.

Word length and landing position effects during reading in children and adults

The present study examined the effects of word length on children’s eye movement behaviour when other variables were carefully controlled. Importantly, the results showed that word length influenced children’s reading times and fixation positions on words. Furthermore, children exhibited stronger word length effects than adults in gaze durations and refixations. Adults and children generally did not differ in initial landing positions, but did differ in refixation behaviour. Overall, the results indicated that while adults and children show similar effects of word length for early measures of eye movement behaviour, differences emerge in later measures.

Visual information capture during fixations in reading for children and adults

Two experiments were undertaken to examine whether there is an age-related change in the speed with which readers can capture visual information during fixations in reading. Children’s and adults’ eye movements were recorded as they read sentences that were presented either normally or as “disappearing text”. The disappearing text manipulation had a surprisingly small effect on the children, inconsistent with the notion of an age-related change in the speed with which readers can capture visual information from the page. Instead, we suggest that differences between adults and children are related to the level of difficulty of the sentences for readers of different ages.

The binocular coordination of eye movements during reading in children and adults

Recent evidence indicates that each eye does not always fixate the same letter during reading and there has been some suggestion that processing difficulty may influence binocular coordination. We recorded binocular eye movements from children and adults reading sentences containing a word frequency manipulation. We found disparities of significant magnitude between the two eyes for all participants, with greater disparity magnitudes in children than adults. All participants made fewer crossed than uncrossed fixations. However, children made a higher proportion of crossed fixations than adults. We found no influence of word frequency on children’s fixations and on binocular coordination in adults.

Production of definite and indefinite articles in typically developing English-speaking children and children with SLI

The present paper examines the production of definite and indefinite articles in English-speaking typically developing (TD) children and children with Specific Language Impairment (SLI). Twenty four English-speaking children with SLI (mean age: 7;5), twenty nine TD age-matched (TD-AM) children (mean age: 7;5) and eleven younger (mean age: 5;5) TD vocabulary-matched (TD-VM) children participated in a production task involving short stories without picture props based on Schafer and de Villiers (2000). Article production was examined in two different semantic contexts for the definite article, namely in the anaphoric and the bridging context. In the anaphoric condition, definiteness is established via linguistic means, whereas in the bridging condition via shared world knowledge. Indefinite article production was examined in the referential specific, non-referential predicational, and non-referential instrumental contexts. The referential specific context involves [+speaker, −hearer] knowledge and the non-referential predicational and instrumental [−speaker, −hearer] knowledge. Results showed that in the definite article contexts, all three groups performed better on the bridging compared with the anaphoric condition; in the indefinite article contexts, they had better performance on the non-referential predicational vs. the referential specific and the non-referential instrumental conditions. In terms of errors, the TD-VM children and the children with SLI produced significantly more substitutions than the TD-AM children in the definite article contexts. In the indefinite article contexts, the three groups did not differ in terms of accuracy or error patterns. The present results point towards problems in the discourse integration of entities that are part of the speaker's and hearer's knowledge in children with SLI and TD-VM controls, especially in definite articles. These problems are accentuated in the children with SLI due to their grammatical impairment and suggest that children with SLI exhibit a delayed acquisition profile.

Incremental processing in head-final child language: online comprehension of relative clauses in Turkish-speaking children and adults

The present study investigates the parsing of pre-nominal relative clauses (RCs) in children for the first time with a realtime methodology that reveals moment-to-moment processing patterns as the sentence unfolds. A self-paced listening experiment with Turkish-speaking children (aged 5–8) and adults showed that both groups display a sign of processing cost both in subject and object RCs at different points through the flow of the utterance when integrating the cues that are uninformative (i.e., ambiguous in function) and that are structurally and probabilistically unexpected. Both groups show a processing facilitation as soon as the morphosyntactic dependencies are completed and parse the unbounded dependencies rapidly using the morphosyntactic cues rather than waiting for the clause-final filler. These findings show that five-year-old children show similar patterns to adults in processing the morphosyntactic cues incrementally and in forming expectations about the rest of the utterance on the basis of the probabilistic model of their language.

Threat interpretation bias in anxious children and their mothers

The role of parents in the development of anxiety disorders in children is of increasing research and clinical interest. This study investigated interpretation biases of anxious children and their mothers using the ambiguous stimuli task developed by Hadwin, Frost, French, and Richards (1997). Three groups of children (aged 7 to 12 years) and their mothers were recruited; 23 non-clinical controls, 18 children with an anxiety disorder and 15 children with an externalising disorder. Following diagnostic assessments of the children, children and their mothers independently completed the homophone task and self-report measures of anxiety. Mothers of anxious children had significantly higher self-reported anxiety than mothers of non-clinical children. As hypothesised, children in the anxious group had higher threat interpretation scores than the non-clinical group. The hypothesis that mothers of anxious children would make more threat interpretations was not supported. Paired correlations showed no significant association between threat interpretations made by children and their mothers. There was a significant positive correlation between maternal threat interpretation and child anxiety. The results suggest that there is a complex association between mother's anxiety and cognitions and those of their children, which requires further examination in controlled observational and experimental studies, including treatment trials.

Do Cognitive Models of Obsessive Compulsive Disorder Apply to Children and Adolescents?

Cognitive models of obsessive compulsive disorder (OCD) have been influential in understanding and treating the disorder in adults. Cognitive models may also be applicable to children and adolescents and would have important implications for treatment. The aim of this systematic review was to evaluate research that examined the applicability of the cognitive model of OCD to children and adolescents. Inclusion criteria were set broadly but most studies identified included data regarding responsibility appraisals, thought-action fusion or meta-cognitive models of OCD in children or adolescents. Eleven studies were identified in a systematic literature search. Seven studies were with non clinical samples, and 10 studies were cross-sectional. Only one study did not support cognitive models of OCD in children and adolescents and this was with a clinical sample and was the only experimental study. Overall, the results strongly supported the applicability of cognitive models of OCD to children and young people. There were, however, clear gaps in the literature. Future research should include experimental studies, clinical groups, and should test which of the different models provide more explanatory power.

Interviewing children and young people with learning disabilities: guidelines for researchers and multi-professional practice

We argue that it is important for researchers and service providers to not only recognize the rights of children and young people with learning disabilities to have a ‘voice’, but also to work actively towards eliciting views from all. A set of guidelines for critical self-evaluation by those engaged in systematically collecting the views of children and young people with learning disabilities is proposed. The guidelines are based on a series of questions concerning: research aims and ethics (encompassing access/gatekeepers; consent/assent; confidentiality/anonymity/secrecy, recognition, feedback and ownership; and social responsibility) sampling, design and communication