Research

Proposal
612.01 Elysa Christy & Lindsay Birchall

Agenda

Purpose of Study
Literature Review
Research Question
Hypothesis
Participants
Sampling
Experimental Design
Instruments & Materials
Procedures
Ethical Considerations
Limitations

Purpose
of our
Study

Purpose

CBT based interventions for anxiety

Parent involvement is key
Examine Relationship
Efficacy
School
School & Home
Expand Knowledge
Student outcomes

Literature Review

What is a solid evidencebased intervention for

anxiety that is applicable
for use in schools?

Coping Cat!

What is Coping Cat?

Coping Cat (Kendall, 2000) is a cognitive-behavioral treatment for children with
anxiety disorders such as GAD, Social Phobia, or Separation Anxiety Disorder.
4 Components:

Recognizing and understanding emotional and physical reactions to anxiety

Clarifying thoughts and feelings in anxious situations
Developing plans for effective coping
Evaluating performance and giving self-reinforcement

Target Population:
children/adolescents aged 7 - 13 who are experiencing significant levels of anxiety
their parents/caregivers

Australian Adaptation: Cool Kids (Rapee et al., 2000)

(http://www.cebc4cw.org/program/coping-cat/detailed)

What is Coping Cat?

Implementation Plan:

16 weeks
One 50min. session per week
Delivered by trained personnel
Parents attend sessions in weeks 4 and 9

Resources:
Therapist manual
Participant workbooks

Delivery Options:

Individual/group
School
Private clinic
Community organization

(http://www.cebc4cw.org/program/coping-cat/detailed)

Evidence: Coping Cat for Anxiety

Rated 1 - Well-Supported by Research Evidence
California Evidence-Based Clearinghouse (www.cebc4cw.org/program/coping-cat)
Scientific Rating Scale based on published peer-reviewed research
6 RCTs cited, 10+ studies, many with 1+ year follow-up

Flannery-Schroeder, E. C., & Kendall, P. C. (2000). Group and individual cognitive-behavioral treatments for
youth with anxiety disorders: A randomized clinical trial. Cognitive Therapy and Research, 24(3), 251-278.
Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of
Consulting and Clinical Psychology, 62(1), 100-110.
Kendall, P. C., & Southam-Gerow, M. A. (1996). Long-term follow-up of a cognitive-behavioral therapy for
anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 64(4), 724-730.
Kendall, P. C., Flannery-Schroeder, E., Panichelli-Mindell, S. M., Southam-Gerow, M., Henin, A., & Warman,
M. (1997). Therapy for youths with anxiety disorders: A second randomized clinical trial. Journal of
Consulting and Clinical Psychology, 65(3), 366-380.

Evidence: Coping Cat for Anxiety

Summary of Findings from Kendall et al.s RCTs:
47-71% of anxiety-disordered children did not meet criteria for
diagnosis post-treatment
Gains were statistically significant, as compared to control groups
Maintenance of gains at 1-7 year follow-ups
Treatment efficacious individually and in group therapy
Results replicated in Australia with program modified for this
population (Cool Kids, Rapee et al., 2000)
Efficacious for: GAD, Social Phobia, SAD
Australian Psychological Society: Evidence-Based Best Practice
for Childhood Anxiety Disorders
Coping Cat (Kendall et al.) & Cool Kids (Rapee et al.)

Evidence: Coping Cat at School

Applicability of Coping Cat program in a school setting:
When done flexibly but with fidelity, Coping Cat can effectively be
implemented by school psychologists, counselors and social workers
(Mychailyszyn et al., 2011)

Cool Kids program resulted in significant reductions of anxious

symptoms (Barrett, Dadds, & Rapee, 1996; McLoone et al., 2006; McLoone & Rapee, 2012)
Cool Kids program showed efficacy with children deemed at risk for
developing anxiety disorders (Gosch et al., 2012)
Important for parents to attend required sessions (Mychailyszyn et al., 2011)

Evidence: Parent Involvement in School

Based Teams
Best Practice (Rathvon, 2008): Foster Relationships with
Key Participants in the Intervention Assistance Process
Success dependent on the cooperation of those implementing the
intervention.
The most carefully designed intervention plan wont enhance a students
chances for success unless adults take action, (p.34)
Unfortunately, collaborating with parents is one of the most neglected
aspects of Intervention Assistance Teams, (p.35)
Parents and teachers, working together, can enhance childrens
academic performance and school-related behaviors (Bates, 2005; Cox,
2005)-very few studies assessing parent participation with school based
teams, (Rathvon, 2008)
Interestingly, parent report of home support for interventions was a
predictor of goal attainment

Evidence: Ethics
Ethical Practice: linking interventions
between home and school, helping parents
gain skills and tailoring parental involvement,
(Rathvon, 2008, p. 43)

Ethical Obligation to offer services to parents

(IDEA), (Rathvon, 2008, p.43)
Parental Objections: Consultants must
respect parental wishes and provide alternative
resources (Rathvon, 2008, p. 44)

Statistics: Parent Participation in

School-based programs
Parent Participation in the intervention process is typically minimal
National Survey: only 28% of teams included parents as active members
(Truscott, et al. 2005)

9% reported interventions that involved working with parents

4% of interventions were designed to be implemented by parents

IRONY: Failure to promote meaningful

participation of parents in the intervention
process when teachers and team members
often attribute student problems to withinstudent or within-family factors,
(Rathvon, 2008)

Statistics: Parent participation and

adherence
Parental adherence to intervention
recommendations: approximately 3050%
Failure to attend treatment is an
enormous problem:
4075% of youth involved in child
therapy terminate treatment
prematurely
Adults terminate treatment early 4085% of the time
(Knock & Photos, 2006; Colonna-Pydyn, Gjesfjeld & Greeno, 2007; Oakes, 2005; Kazdin, Holland,
Crowley & Breton, 1997; Kazdin, Holland & Crowley, 1997)

Parent Participation & Adherence

Parent Treatment Motivation
Required in child and family treatments; the
parent must be motivated to manage treatment
participation (Knock & Photos, 2006)
Predicts treatment attendance and adherence to
recommendations
Three key elements:
Desire for change in their child
Parents willingness to change their
behaviours
Parents perceived ability to change their
behaviours

Parents & Children with Anxiety

Family aggregation studies:anxiety disorders run in families
Children of parents with anxiety disorders: 2 - 7 times more likely to have
an anxiety disorder compared with children from families in which neither
parent has an anxiety disorder
65% of children of parents with anxiety disorders meet criteria for an
anxiety disorder

Support for parental involvement

(Ginsburg, 2009)

Evidence: Parental Involvement in anxiety

treatment
Prevention research: Parents with anxiety implementing CBT,
children not yet diagnosed, (Ginsburg, 2009)
supported that family based interventions may prevent the onset of anxiety
disorders

Comparison of Coping Cat at Home vs. School

(McLoone & Rapee, 2012)
School & Home showed reduction in anxiety symptoms

Family treatment of Anxiety: Coping Cat in a clinical setting

combined with family therapy (Barrett, Dadds & Rapee, 1996)
Coping cat + family management management interventions showed best
outcomes: better outcomes than just CBT in a clinical setting alone

Research Question

Research Question
Will elementary students with GAD show reduced
symptoms of anxiety when they participate in the Coping
Cat intervention at school and at home, as compared to
students that only receive the Coping Cat intervention at
school, or that receive no intervention at all?

Coping Cat

Coping Cat

No
Treatment

Hypothesis

Hypothesis
Students previously diagnosed with GAD, aged 8-10 years, who participate in
the Coping Cat program, will demonstrate a statistically significant reduction in
anxiety symptoms, as measured using the Spence Childrens Anxiety Scale,
when the intervention is provided within both the school and home
environments, as compared to students who only receive the intervention in the
school environment, or who receive no intervention at all.

Coping Cat

Coping Cat

No
Treatment

IV Operational Definitions
Independent Variable: Type of intervention received
Control - No intervention; wait listed
Experimental #1 - School-based Coping Cat intervention only

16 50 min. weekly sessions

Delivered by school psychologist who has been trained in intervention
Small group - 4 to 8 children
Parents attend 2 sessions with same psychologist

Experimental #2 - School-based Coping Cat & home intervention

School-based Coping Cat intervention delivered as above
Parents attend 16 sessions with same school psychologist
Parents will commit to engaging in up to 4 hours of homework per week with their child,
based on specific goals assigned by their psychologist (e.g. generalizing a specific
target within exposure therapy at home).

DV Operational Definitions
Dependent Variable: Change in anxiety levels postintervention
Spence Childrens Anxiety Scale parent and self-report measures
pre-intervention (within 1 week before first session week 0)
post-intervention (within one week following last session week 16)

Ordinal Measurement - Likert Scale

Controlled Variables
The following variables will be controlled:
Types of Participants
Specific age range, geographic location, diagnosis, cognitive functioning level, preintervention level of anxiety
Delivery of Intervention
Psychologist trained in Coping Cat intervention follows published program
Environment
During school day, in quiet classroom or psychologists office
Evening sessions at school for parent group
Resources
Coping Cat manual and workbooks for Experimental Groups #1 & #2
Communication notebook for Experimental Group #2

Participants

Participants

Male and Female students

Some of their parents
8-10 year olds in grade 3, 4 or 5
Diagnosed with Generalized Anxiety Disorder
16 schools: Calgary, AB: included private, public, coeducational, singlesex, religious affiliated and charter schools
Varying degrees of SES
Not on medication for anxiety
Average cognitive functioning
Minimal externalizing behaviours (i.e. compliant and willing to participate)
Parental consent obtained

Sampling

Nonrandom Sampling
Purposive Sampling
Sample selection served a specific purpose
Chose individuals that meet a specific criteria
Sample believed to be representative of the
population
previously diagnosed with GAD
grades 3, 4 and 5
Experimental Group #2
Parents that we more likely to implement
intervention and assigned homework
(McLoone & Rapee, 2012)

Sampling Procedures

245
Children
&
their parents

Parental
Consent
Requested

68%
Returned
n=167

Documented
Cognitive deficits
n=3

n=164

(McLoone & Rapee, 2012)

Sampling Procedures

Interviews-High
amount of
Externalizing
Behaviours
removed
n=2

n=162

Administer
Spence
Childrens
Anxiety Scale:
Baseline

Children who
did not score in
the high
anxious range
were
eliminated

Final
Sample
n=114

n=48

(McLoone & Rapee, 2012)

Sampling Procedures
Parents contacted to
rate their willingness
to participate in
intervention

Waitlist
n=23
Remaining
n=87

Likert scale, 1=not

willing, 5=very willing
Commitment of 1
hour training and 4
hours of intervention
homework per week

(McLoone & Rapee, 2012)

Parents who rated 4

or 5 assigned to
Experimental Group
#2
(Home and School
Intervention)
n=27

Random assignment to
Experimental Group #1 School Intervention
n=45

Random Assignment to
Experimental Group #2
(n=19) - School and
Home Intervention
n=46

Sampling Procedures
Once parents and children were assigned to groups a
letter was sent to each family informing them of:
Which condition they had been allocated to (Exp Group 1, 2 or
waitlist)
What would be required of them (e.g. weekly training, assigned
homework)
Their right to withdraw from the study at any time

Families In Experimental Group #2 (Home and School)

were provided with necessary materials
Coping Cat Manual and Workbook
Communication Book

Second phase of Positive Consent was then sent

Waitlist Group was offered an opportunity to participate in the
intervention after the study had been completed

Final Sample
114 Children & their Parents
Waitlist/Control
n=23 (9.1 years)

16
girls

5 in
grade
3

7
boys

8 in
grade
4

10 in
grade
5

Experimental Group #1
School
n=45 (9.3 years)
31
girls
15 in
grade
3

14
boys
19 in
grade
4

11 in
grade
5

Experimental Group #2
Home and School
n=46 (8.9 years)
30
girls
17 in
grade
3

16
boys
13 in
grade
4

15 in
grade
5

Purposive Sampling Rationale

Experimental Group #2
Selecting parents who would be willing to participate in
the intervention
Increase Treatment Integrity:
Increased adherence to intervention/homework
Decreased dropout
Motivation increases outcome success
Measure if the outcome levels of anxiety would be
different for students, not if parents participated
Wanted to prevent confounding variable of nonadherence resulting in insufficient data

Experimental
Design

Quasi-Experimental Design
Static Group Control Design
Nonrandom selection of participants
Independent and Dependent Variables
IV: Type of intervention received
DV: Change in anxiety levels post-intervention
DV measured both pre- and post-exposure to IV
Experimental and control groups
Measurement of DV pre- and post-exposure
to IV reduces confounding effects of maturation
and history effects

Instruments &
Materials

Spence Children's Anxiety Scale

Affective Test-measures attitudes, emotions and perceptions

Childrens, Preschool and Parent scales available online in 23 languages
Best practice for Ax: Australian Psychological Society
Likert Scale: Child reads instructions on the printed form
Answers: Never, Sometimes, Often, Always (circles word)
No set time limit
Easy and quick completion (10 min)
Only 38 Anxiety items are scored (random allocation within form)
6 positively worded filler items
Never=0, Sometimes=1, Often =2, Always =3
Maximum score of 114
Developed to broadly assess severity of anxiety symptoms
Screening, Research, Assessment and Therapeutic Evaluation
Not intended to be used diagnostically in isolation
www.scaswebsite.com

Subscales
Subscale

SCAS Items

Separation Anxiety

5, 8, 12, 15, 16, 44

Social Phobia

6, 7, 9, 10, 29, 35

Obsessive
Compulsive Disorder

14, 19, 27, 40, 41, 42

Panic/agoraphobia

13, 21, 28, 30, 32, 34, 36, 37, 39

Physical Injury fears

2, 18, 23, 25, 33

Generalized Anxiety

1, 3, 4, 20, 22, 24

Recommended
Spreadsheet
Scas Total Score
Individual subscale scores
www.scaswebsite.com

Spence Children's Anxiety Scale

www.scaswebsite.com

Spence Children's Anxiety Scale

www.scaswebsite.com

Psychometric Properties

(www.scaswebsite.com)

Sufficient Norms: 10+ countries, M/F, 7-15 years, n=4916

Additional norms 7-19 years-7+ studies
T-scores rescaled: mean=50, SD=10
T-score of 60: sub-clinical, elevated levels of anxiety
Important to examine both Subscale Scores and Total SCAS score
It is possible to receive a score of 60+ on a subscale and still receive a
total score within the normal range
Necessary to use appropriate table

Boys aged 8-11

Boys aged 12-15
Girls aged 8-11
Girls aged 12-15

Psychometric Properties

(www.scaswebsite.com)

Sufficient Reliability
Internal Consistency .77 for GAD scales
Total SCAS scores .92-.93 per age group
Test-retest .6 for Total Scas
.66 for GAD subscale

Sufficient Validity
Items selected through intensive pilot study
Item correlations sufficient with Total Scas

Often used in Research: McLoone & Rapee, 2012;

Australian Psychological Study, 2014, Mychailyszyn et al.,
2011; McLoone & Rapee, 2006

Barriers to Treatment Participation Scale

Standardized:Affective Test: measures attitudes, emotions and perceptions
Likert Scale: 58 Items total
44 barrier rating items:1=never a problem; 5=very often a problem
14 critical events

Measures problems that parents may experience when implementing

intervention recommendations: Four primary areas

Stressors or Obstacles that compete with treatment (20 items)

Treatment demands and issues (10 items)
Perceived relevance of treatment (8 items)
Relationship with therapist (6 items)

(Nock & Photos, 2006; Kazdin, Holland, Crowley & Breton, 1997; Kazdin, Holland & Crowley, 1997)

BTPS
Parents and therapists complete the BTPS at the end
of treatment; can be used before treatment to predict
Parent and therapist ratings on the BTPS are
significantly correlated and are uniquely predictive of
premature termination from treatment
BTPS helps a clinician identify elements of a complex
process that contribute to individuals termination of
treatment, not simple demographic variables
(Nock & Photos, 2006; Oakes, 2005; Kazdin, Holland, Crowley & Breton, 1997; Kazdin, Holland &
Crowley, 1997)

BTPS-Items

(Colonna-Pydyn, Gjesfjeld & Greeno, 2007)

BTPS-Items

(Colonna-Pydyn, Gjesfjeld & Greeno, 2007)

BTPS-Items

(Colonna-Pydyn, Gjesfjeld & Greeno, 2007)

BTPS-Items

(Colonna-Pydyn, Gjesfjeld & Greeno, 2007)

Psychometric Properties
Not well documented psychometric properties
Previous studies have demonstrated:
Adequate internal consistency reliability (Cronbachs =.86)
The ability of the BTPS to predict premature termination from child
therapy (Nock & Photos, 2006; Kazdin, Holland, & Crowley, 1997; Kazdin, Holland,
Crowley & Breton, 1997).

Therapist and parent versions available: maximize statistical power

when parents terminate treatment early (Nock & Photos, 2006)
Four factor structure is well supported:some evidence of a two factor
model (Colonna-Pydyn, Gjesfjeld, & Greeno, 2007)
Used in multiple studies: McLoone & Rapee, 2012; Colonna-Pydyn, Gjesfjeld, &
Greeno, 2007; Oakes, 2005

Materials
Cognitive-Behavioural Therapy for
Anxious Children: Therapist
Manual, 3rd Edition
Chapter for each of 16 therapy sessions
that are in the Coping Cat workbook
Coping with anxiety
Explanations of rationale for each activity
Applied tips for new therapists
Includes strategies for potential
difficulties (e.g. noncompliance)

(www.workbookpublishing.com)

Coping Cat Workbook

Visually appealing, engaging and
developmentally appropriate
16 Sessions
Promote coping skills for dealing
with anxiety
Situation cards
Feelings barometer
Cut outs
Certificate of Achievement

Coping Cat Workbook

Materials
Daily Communication Book
Possible Exposure Therapy worksheets for assigned
homework

Procedures

Prior to Intervention
Participant Selection
Parents rate willingness to participate in home component
Assignment to Control, Experimental #1, Experimental #2

Informed Consent
Pre-Intervention Measurement of DV
SCAS Parent and Self-Report measures
All Groups: Control, Experimental #1, Experimental #2

Distribution of Materials
Experimental Group #1: Coping Cat workbook
Experimental Group #2: Coping Cat workbook, Coping Cat manual,
& Communication Book

Week 1-16: During Intervention

Experimental Group #1: Coping Cat Intervention

16 weeks
One 50min. session per week
Delivery by trained school psychologist; strict adherence to manual
Parents attend 2 sessions, as stipulated in manual

Experimental Group #2: Coping Cat & Parent Intervention at Home

School-based Coping Cat intervention delivered as above
Parents attend 16 sessions with school psychologist after school hours
Parents will commit to engaging in up to 4 hours of homework per week with their child,
based on specific goals assigned by their psychologist (e.g. generalizing a
specific target within exposure therapy at home).
Psychologist and parent utilize communication book and weekly checklists
to document assigned homework and record any difficulties with program implementation.

Post-Intervention
Post-Intervention Measurement of DV
Within 1 week after intervention ends
SCAS Parent and Self-Report measures
All Groups: Control, Experimental #1, Experimental #2

Post-Intervention Measurement of Treatment Adherence

Within 1 week after intervention ends
Barriers to Treatment Participation Scale (Kazdin, 1997)
Experimental Group #2 Only

2nd Session of Coping Cat Program

Within 1 month after intervention ends
Parents of control group offered places
in a subsequent 16-week Coping Cat program

Data Analysis
Removal of data for participants with low treatment adherence
Experimental Group #1
<90% attendance of Coping Cat sessions at school
Experimental Group #2
<90% attendance of Coping Cat sessions at school, and/or
<80% completion of homework

Data Analysis: Change in DV

DV: Change in anxiety levels
As measured by SCAS parent and self-report measures, pre- and post-intervention
T-scores: mean=50, SD=10
Comparison of mean T-scores for each group (Control, Experimental #1, Experimental #2)
pre- and post-intervention
Did Treatment Condition X show a statistically significant reduction in anxiety
symptoms?
Comparison of change in mean T-scores between groups
Is Treatment Condition Xs reduction in symptoms significantly
greater than that of Treatment Condition Ys?
Related Measures ANOVA (Analysis of Variance): comparing more
than two groups who have been tested more than once (Salkind, 2011)

Data Analysis: Exploratory

Exploratory Analysis
Barriers to Treatment Participation Scale
Post-intervention for Experimental Group #2
Four domains: stressors or obstacles that compete with treatment, treatment demands or
issues, perceived relevance of treatment, relationship with therapist
Exploration of the following questions:
What types of barriers to treatment were identified by any participants who were
eliminated from statistical analysis due to low treatment adherence?
What are the implications for future studies of this sort?
What are the implications for future school and home-based programs?

Ethical
Considerations

Ethical Considerations
Rights of Participants:Parents may not want to
participate in Exp group #2: Right to withdraw

Any manualized approach

consider parent and student capacity: may need
modifications: Coping Cat is a flexible program

Minimize Risk:psychological harm:Students and

parents consent to any exposure homework/targets:
Maintain respect
Psychologist and parents: careful with intensity of
anxiety response
Parents may be modeling/experiencing anxiety

Ethical Considerations
Having parents involved:
clarify confidentiality: when
confidentiality may be broken
Ensure confidentiality of all parents and
students who may identify or interact
with others in the program (e.g. pass in
the halls)
Waitlist/Control group: offered Coping
Cat sessions after the study was over

Ethical Considerations
All identifying information must be disposed of after the completion of
the research
Debriefing session: after all data is collected: for all families involved in
Experimental Groups #1 & #2

Limitations
Then, after 90% of respondents left the study,
we opted for a QED approach.

Study Limitations
Experimental Design & Sampling Procedures
Static Group Control Design
Nonrandom assignment to experimental groups
All participants were willing volunteers from a specific geographic
locale -- volunteers may differ significantly from non-volunteers
Priority assignment to Experimental Group #2 -- limits generalizability
of results, limits ecological validity
Treatment Adherence: Experimental Group #2
Homework completion measurement depends on
self-report
Honesty with reporting 80% homework completion

Study Limitations
Experimental Setting
Field: schools and homes
Implemented by different psychologists and parents
Treatment integrity at school -- effect of time constraints (McLoone & Rapee,
2012)

Treatment integrity at home -- the more complex an intervention and

the more time consuming for parents, the lower the adherence (Rathvon,
2008)

Less control over treatment integrity, but more

generalizable results, higher ecological validity

Study Limitations
Other Threats to Internal & External Validity

Testing effects: SCAS pretest may prime participants

Social Desirability Bias: SCAS self-report measure and faking good
Statistical regression: extreme pretest scores on SCAS
Attrition: drop out or disqualification for non-adherence
Particularly participants in Experimental Group #2 due to higher
time commitments
Similar study: parents reported they did not have sufficient time to
implement interventions at home or complete assigned homework
(McLoone & Rappee, 2012)

References
Barrett, P. M., Dadds, M. R., & Rapee, R. M. (1996). Family treatment of childhood anxiety: A controlled trial. Journal of
Consulting and Clinical Psychology, 64(2), 333-342.
Bates, S. L. (2005). Evidence-based family-school intervention with preschool children. School Psychology Quarterly, 20, 352-370
California Evidence-Based Clearinghouse for Child Welfare. (2014, April). Coping Cat. Retrieved from:
http://www.cebc4cw.org/program/coping-cat/detailed March 13th, 2015
Cox, D. D. (2005). Evidence-based interventions using home-school collaboration. School Psychology Quarterly, 20:473-497
Colonna-Pydyn, C., Gjesfjeld, C. D. & Greeno, C. G. (2007). The Factor Structure of the Barriers to Treatment Participation
Scale (BTPS): Implications for Future Barriers Scale Development. Adm Policy Ment Health (2007) 34:563569
doi: 10.1007/s10488-007-0139-6
Flannery-Schroeder, E. C., & Kendall, P. C. (2000). Group and individual cognitive-behavioral treatments for youth with anxiety
disorders: A randomized clinical trial. Cognitive Therapy and Research, 24(3), 251-278.
Ginsburg, G. A. (2009). The Child Anxiety Prevention Study: Intervention Model and Primary Outcomes. J Consult Clin Psychol,
77(3): 580587. doi:10.1037/a0014486.

References
Gosch, E. A., Flannery-Schroeder, E., & Brecher, R. J. (2012). Anxiety disorders: School-based cognitive-behavioral intervention.
In: R. B. Mennuti, R. W. Christner, & A. Freeman. (Eds.) Cognitive-behavioral interventions in educational settings (2nd ed.) New
York: Routledge.
Hudson, J. L., Creswell, C., & McLellan, L. (2014). A clinicians quick guide of evidence-based approaches: Childhood anxiety
disorders. Clinical Psychologist, 18, 52-53. doi: 10.1111/cp.12037
Kazdin, A. E., Holland, L., & Crowley, M. (1997). Family experience of barriers to treatment and premature termination from child
therapy. Journal of Consulting and Clinical Psychology, 65, 453463.
Kazdin, A. E., Holland, L., Crowley, M., & Breton, S. (1997). Barriers to treatment participation scale: Evaluation and validation in
the context of child outpatient treatment. Journal of Child Psychology and Psychiatry, 38, 10511062.
Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of Consulting and
Clinical Psychology, 62(1), 100-110.
Kendall, P. C., & Southam-Gerow, M. A. (1996). Long-term follow-up of a cognitive-behavioral therapy for anxiety-disordered
youth. Journal of Consulting and Clinical Psychology, 64(4), 724-730.
Kendall, P. C., Flannery-Schroeder, E., Panichelli-Mindell, S. M., Southam-Gerow, M., Henin, A., & Warman, M. (1997). Therapy
for youths with anxiety disorders: A second randomized clinical trial. Journal of Consulting and Clinical Psychology, 65(3), 366380.

References
McLoone, J., Hudson J. L., & Rapee, R. M. (2006). Treating anxiety disorders in a school setting. Education and Treatment of
Children, 29(2), 219-242.
McLoone, J. & Rapee, R. M. (2012). Comparison of an anxiety management program for children implemented at home and
school: Lessons learned. School Mental Health, 4, 231-242. doi: 10.1007/s12310-012-9088-7
Mychailyszyn, M. P., Beidas, R. S., Benjamin, C. L., Edmunds, J. M., Podell, J. L., Cohen, J. S., & Kendall, P. C. (2011).
Assessing and treating child anxiety in schools. Psychology in the Schools, 48(3), 223-232. doi: 10.1002/pits.20548
Nock, M. K. & Photos, V. (2006). Parent Motivation to Participate in Treatment: Assessment and Prediction of Subsequent
Participation, Journal of Child and Family Studies, 15(3):345-358. doi: 10.1007/s10826-006-9022-4
Oakes, R. (2005). Measuring Dropout from Therapy using the Barriers to Treatment Participation Scale. (Unpublished doctoral
dissertation). The City University of New York, New York
Salkind, N. J. (2011). Statistics for people who (think they) hate statistics (4th ed.) CA: Sage Publications.
Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36, 545-566. pii:
S0005-7967(98)00034-5

References
Truscott, S. D., Cohen, C. E., Sams, D. P., Sanborn, K. J. & Frank, A. J. (2005). The current state(s) of prereferral intervention
teams: A Report from two national surveys. Remedial and Special Education, 26:130-140.
Vesga-Lpez O., Schneier F.R., Wang S.,; Heimberg R. G., Liu S. M., Hasin D. S. & Blanco C. (2008). Gender Differences in
generalized anxiety disorder: results from the National Epidemiological Survey on Alcohol and Related conditions (NESARC).
Journal of Clinical Psychiatry, 69(10):1606-16. Retrieved from: http://www.medscape.com/medline/abstract/19192444
www.workbookpublishing.com. Anxiety. Retrieved from: http://www.workbookpublishing.com/cat_prod.php?cPath=21_26, March
15th, 2015
www.scaswebsite.com. Normative Sample. retrieved from http://scaswebsite.com/docs/normativesample.pdf, March 9th, 2015