Title: Treatments for childhood anxiety disorders: Improving patient access and clinical effectiveness
Funder: Department of Health and Social Care

Abstract: Background Anxiety disorders affect approximately one child in every classroom and are characterised by high levels of distress and avoidance. They impact on children's social, academic and family lives, and present a significant risk for ongoing anxiety disorders and other serious mental health problems. Effective treatments using Cognitive Behaviour Therapy (CBT) have been developed, however access to treatment is poor, and, even with treatment, a significant proportion of children retain their diagnoses. Aims The overall aims of this Professorship are to (i) increase access to evidence based treatments, and (ii) improve treatment outcomes for children with anxiety disorders. The first aim will be achieved by addressing the following research questions: (a) What are the barriers to seeking treatment for parents of children with anxiety disorders? (b) What are the barriers to referring children for evidence based treatments for general practitioners? (c) Does a stepped care approach to treatment increase access to effective treatments and have health economic benefits, and (d) Can a parent-led CBT treatment be delivered in an online format to improve access to effective treatments? The second aim focuses on children with Social Anxiety Disorder (SAnxD), a group with a particularly poor response to generic CBT treatment. Recent findings suggest this poor prognosis may be because generic CBT programmes do not adequately address social communication difficulties and specific attentional processes. This work will investigate whether a significant subgroup of children with SAnxD have underlying social communication difficulties and/or an increase in self-focussed attention when under social stress. This will be followed by experimental studies to examine the effects of targeting specific deficits, leading to the development of novel therapeutic interventions to improve outcomes. Investigation plan The first workstream (WS1) will involve three components to address access to treatment. (1) A systematic review and qualitative interviews to inform the development of questionnaires for parents and GPs, which will then be used to identify barriers to treatment seeking among parents of affected children and barriers to referral for specialist care. (2) A further grant application will be made for funding for a randomised controlled trial to evaluate a stepped care mode of treatment delivery. Finally, (3) a brief parent-led CBT for childhood anxiety disorders will be adapted to an internet format, and piloted, with a view to obtaining additional funding for further evaluation within a randomised controlled trial. WS2 will also involve three novel components. (1) Social communication difficulties and self-focussed attention will be compared among children with SAnxD, other anxiety disorders and no anxiety disorder (using existing and new datasets). (2) Where group differences are identified, the maintaining role of these processes will be examined among participants with SAnxD by training specific skills and assessing consequent changes in children's social interactive behaviours and social anxiety. (3) Where training is successful, this will inform the modification of existing CBT treatments; and this new treatment for children with SAnxD would then be ready for formal evaluation. Benefits Outcomes of WS1 will directly inform guidance and practice to increase access to evidence-based psychological treatments for children with anxiety disorders. The proposed trial of stepped care treatment will provide direct information on cost-effective delivery of evidence based treatments within the NHS. The development of an online treatment, delivered via parents, will benefit affected families by providing an accessible version of treatment, reducing the demands of travel to appointments and having to take time off work/school. Potentially, this internet treatment will provide a highly cost-effective mode of treatment delivery. WS2 will benefit patients and services by ultimately providing an efficient, targeted approach to treatment that will improve treatment outcomes for children with SAnxD.

Lay abstract: Mental health problems account for one quarter of ill health in the UK and often first arise in childhood. Anxiety disorders are among the most common mental health difficulties experienced by children; they disrupt family life and represent a significant risk for the development of other serious mental health conditions, particularly depression. Evidence-based treatments for childhood anxiety disorders do exist but they are expensive and access to them is limited. Furthermore, a significant number of treated children do not benefit. The Professorship aims are to increase access to evidence based treatments and improve treatment outcomes for children with anxiety disorders.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH