School of Psychology and Clinical Language Sciences, University of Reading, PO Box 238, Reading RG6 6AL, United Kingdom.
Department of Psychiatry, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ 85721, United States.
J Affect Disord. 2018 Mar 15;229:469-476. doi: 10.1016/j.jad.2017.12.078. Epub 2018 Jan 3.
Cognitive Behaviour Therapy (CBT) is an effective treatment for childhood anxiety disorders, yet a significant proportion of children do not benefit from it. CBT for child anxiety disorders typically includes a range of strategies that may not all be applicable for all affected children. This study explored whether there are distinct subgroups of children with anxiety disorders who are characterized by their responses to measures of the key mechanisms that are targeted in CBT (i.e. interpretation bias, perceived control, avoidance, physiological arousal, and social communication).
379 clinically anxious children (7-12 years) provided indices of threat interpretation, perceived control, expected negative emotions and avoidance and measures of heart rate recovery following a speech task. Parents also reported on their children's social communication difficulties using the Social Communication Questionnaire (SCQ).
Latent profile analysis identified three groups, reflecting (i) 'Typically anxious' (the majority of the sample and more likely to have Generalized anxiety disorder); (ii) 'social difficulties' (characterized by high SCQ and more likely to have social anxiety disorder and be male); (iii) 'Avoidant' (characterized by low threat interpretation but high avoidance and low perceived control).
Some measures may have been influenced by confounding variables (e.g. physical variability in heart rate recovery). Sample characteristics of the group may limit the generalizability of the results.
Clinically anxious children appear to fall in to subgroups that might benefit from more targeted treatments that focus on specific maintenance factors. Treatment studies are now required to establish whether this approach would lead to more effective and efficient treatments.
认知行为疗法（CBT）是治疗儿童焦虑症的有效方法，但仍有相当一部分儿童对此治疗方法没有效果。儿童焦虑症的 CBT 通常包括一系列策略，但并非所有策略都适用于所有受影响的儿童。本研究探讨了是否存在具有不同特征的儿童焦虑症亚组，这些特征可以通过 CBT 中针对的关键机制（即解释偏差、感知控制、回避、生理唤醒和社交沟通）的测量结果来反映。
379 名临床焦虑儿童（7-12 岁）提供了威胁解释、感知控制、预期负面情绪和回避的指标，以及言语任务后心率恢复的测量值。父母还使用社交沟通问卷（SCQ）报告了他们孩子的社交沟通困难。
潜在剖面分析确定了三个亚组，反映了（i）“典型焦虑”（大多数样本，更可能患有广泛性焦虑症）；（ii）“社交困难”（特征为 SCQ 得分高，更可能患有社交焦虑症且为男性）；（iii）“回避”（特征为威胁解释较低，但回避和感知控制较高）。
一些测量方法可能受到混杂变量的影响（例如心率恢复的生理变异性）。该组的样本特征可能限制了结果的普遍性。
临床焦虑的儿童似乎可以分为亚组，这些亚组可能需要更有针对性的治疗方法，重点关注特定的维持因素。现在需要进行治疗研究，以确定这种方法是否会导致更有效和高效的治疗。
