Department of Psychology, Ruhr-University Bochum, Bochum, Germany. silvia.schneider @ rub.de
Psychother Psychosom. 2011;80(4):206-15. doi: 10.1159/000323444. Epub 2011 Apr 14.
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.
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.
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.
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.
分离焦虑障碍（SAD）是儿童期最早和最常见的精神障碍之一，也是成年精神病理学的重要预测因素。尽管儿童焦虑障碍的心理治疗研究取得了重大进展，但对于患有 SAD 的幼儿，尚无针对特定疾病的治疗方案进行随机对照试验。
43 名患有 SAD 的儿童（年龄 5-7 岁）及其父母被分配到 16 节特定于疾病的 SAD 治疗方案中，包括父母培训和经典认知行为疗法（CBT）内容，或分配到 12 周的候补名单组。在基线、治疗/候补名单条件后和 4 周随访时，收集焦虑、损伤/困扰和生活质量的分类和/或连续数据。
意向治疗分析表明，在随访时，分配到治疗组的儿童中，有 76.19%的儿童明确不再符合 DSM-IV 中 SAD 的标准，而候补名单组中这一比例为 13.64%。在治疗后立即对全球成功评分进行自评或由父亲、母亲或治疗师进行评分时，91%至 100%的儿童认为自己或孩子在分离情况下的困扰/回避程度有很大或很大程度的改善。结果表明，在测试治疗条件后，不同信息提供者的痛苦/回避情况减少方面，时间与治疗条件的交互作用效应大小（d=0.98-1.41）非常大。此外，父母报告称，孩子在主要生活领域的损伤/困扰和孩子的生活质量有了显著改善。治疗效果在 4 周随访评估时得以维持。
结果表明，特定于疾病的 SAD 治疗方法具有短期疗效，并且是首批表明 CBT 方案适用于幼儿的研究之一。
