When children are terrified of leaving their parents, who should be the focus of treatment – kids, parents, or both? A new study turns up a surprising result: in a randomised trial, there was little difference between treating the children alone and treating both parents and kids.
Children with separation anxiety disorder (SAD) have an intense and dysfunctional fear of being apart from their caregivers. In some cases, children’s SAD may result from parents’ dysfunctional ideas about their child. So it seems reasonable that treating both children and parents would give better results than treating children alone.
But in the first randomised controlled trial comparing a disorder-specific programme for SAD with a general anxiety programme, a team of researchers from Germany and Switzerland found that adding parents to the treatment mix resulted in only a “slight advantage” over child-based therapy.
In this study, 64 German-speaking children (aged 8-13) with separation anxiety disorder were randomly allocated to one of two treatment groups. Half of the children completed a general anxiety programme. This programme focused exclusively on the child, using cognitive behavioural techniques to help the child replace dysfunctional thought processes with more positive ones.
The other participants completed the disorder-specific “TAFF” programme (“TrennungsAngstprogrammem Fur Familien,” which translates to “Separation Anxiety Family Therapy”).
The TAFF programme also used cognitive behavioural techniques, but there were some important differences. In this programme, equal time was spent treating parent and child. The additional sections included discussing and reframing the parent’s dysfunctional thoughts, educating the parent about anxiety, and practicing real-life separation situations with their child.
Surprisingly, TAFF produced only marginally greater benefits than the general anxiety programme. At one-month and one-year follow-ups, both programmes produced positive outcomes for the children. There was no statistically significant difference between the two programmes.
Specifically, at one-month post-treatment, 87.5% of children in the TAFF programme were free of SAD diagnosis, compared to 82.1% of children in the general anxiety programme. Given the relatively small sample size – 52 of the original 64 families completed treatment – the difference was not statistically significant.
Both programmes also produced similar reductions in child distress.
Most surprising was the finding that the general anxiety programme was as good as the TAFF programme at reducing dysfunctional parental cognitions, despite therapy in the general anxiety programme focusing only on the child.
These findings have some important implications for the treatment of SAD and future research. First, slightly improved outcomes may be possible for children with SAD when their parents are also involved in treatment. Larger samples will be needed to get a more precise estimate of the difference. Nonetheless, general anxiety programmes that do not require parent involvement are still effective and produce similarly positive results.
Second, some children may benefit more than others from parents’ treatment. Arguably, children whose parents have the most dysfunctional cognitions and behaviours are those who would benefit the most from a disorder-specific treatment for SAD that involves parental training. If this is so, how can we best identify this sub-group of children with SAD? Future research may try to identify these children, so that they can receive more appropriate and effective family-based treatment.
Schneider, S., Blatter-Meunier, J., Herren, C., In-Albon, T., Adornetto, C., Meyer, A. & Lavallee, K. L. (2013). The efficacy of a family-based cognitive behavioural treatment for separation anxiety disorder in children aged 8-13: a randomised comparison with a general anxiety programme. Journal of Consulting and Clinical Psychology. doi: 10.1037/a0032678Return to Features