Children with generalized anxiety disorder: developing a mindfulness intervention
Chan, Priscilla Tien Hui
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Generalized Anxiety Disorder (GAD) is one of the most common and impairing childhood anxiety disorders, impacting over 10% of children with an average age of onset at 8.5 years. GAD in childhood increases the risk for developing additional anxiety and depressive disorders, academic and social difficulties, and, if left untreated, continuity into adulthood. While treatments incorporating mindfulness techniques have been shown to be efficacious among adults, relatively few studies have examined the efficacy of these techniques in the treatment of children. Mindfulness skills may be able to target maladaptive cognitive patterns by teaching children more flexible ways of thinking and viewing the world and providing children additional coping skills that may positively impact their overall functioning long-term. The aim of the present study was to develop and provide preliminary evaluation of a mindfulness-based intervention for GAD in school-aged children. Four children aged 9 to 12 with a principal diagnosis of GAD completed an open trial pilot phase of a 6-session individual format mindfulness intervention. Each session emphasized mindful awareness of breath, body, and thoughts, and involved child and parent participation. An additional twelve children were randomized to either an immediate treatment (n = 6) or a waitlist (i.e., delayed treatment; n = 6) condition during the course of a randomized waitlist-controlled clinical trial. Measures were administered at pre-waitlist (if applicable), post-waitlist/pre-treatment, post-treatment, and eight weeks following treatment to assess overall program satisfaction and changes in symptoms and diagnosis. Overall, treatment dropout was low, and families reported high satisfaction with treatment. Relative to waitlist, children in the immediate treatment group evidenced significant difference in mean change scores on Clinical Global Improvement Severity score and Child Behavioral Checklist Internalizing and Anxiety Problems scales. Effect size statistics indicated very large effect sizes between the waitlist and immediate treatment groups for change in GAD Clinical Severity Rating, child self-report of worries, and mindfulness ability, despite non-statistical significance. Overall, the intervention demonstrated feasibility, acceptability, and preliminary evidence of potential efficacy even in this small pilot study. Effect size estimates suggest a larger randomized clinical trial is warranted to fully evaluate treatment efficacy.