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Kessler, R. C. et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch. Gen. Psychiatry 62, 593–602 (2005).
Compton, S. N. et al. Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: an evidence-based medicine review. J. Am. Acad. Child Adolesc. Psychiatry 43, 930–959 (2004).
Last, C. G., Perrin, S., Hersen, M. & Kazdin, A. E. A prospective study of childhood anxiety disorders. J. Am. Acad. Child Adolesc. Psychiatry 35, 1502–1510 (1996).
Hill, R. M., Castellanos, D. & Pettit, J. W. Suicide-related behaviors and anxiety in children and adolescents: a review. Clin. Psychol. Rev. 31, 1133–1144 (2011).
Walkup, J. T. et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N. Engl. J. Med. 359, 2753–2766 (2008).
Silverman, W. K. et al. Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. J. Clin. Child Adolesc. Psychol. 37, 156–183 (2008).
James, A. C., Reardon, T., Soler, A., James, G. & Creswell, C. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst. Rev. 11, CD013162 (2020).
Higa-McMillan, C. K., Francis, S. E., Rith-Najarian, L. & Chorpita, B. F. Evidence base update: 50 years of research on treatment for child and adolescent anxiety. J. Clin. Child Adolesc. Psychol. 45, 91–113 (2016).
Gibby, B. A., Casline, E. P. & Ginsburg, G. S. Long-term outcomes of youth treated for an anxiety disorder: a critical review. Clin. Child Fam. Psychol. Rev. 20, 201–225 (2017).
Settipani, C. A., O’Neil, K. A., Podell, J. L., Beidas, R. S. & Kendall, P. C. Youth anxiety and parent factors over time: directionality of change among youth treated for anxiety. J. Clin. Child Adolesc. Psychol. 42, 9–21 (2013).
Silverman, W. K., Kurtines, W. M., Jaccard, J. & Pina, A. A. Directionality of change in youth anxiety treatment involving parents: an initial examination. J. Consult. Clin. Psychol. 77, 474–485 (2009).
Etkin, R. G., Lebowitz, E. R. & Silverman, W. K. in Handbook of Child and Adolescent Psychology Treatment Modules (eds Farrell, L. J. et al.) 341–358 (Elsevier, 2023).
Thulin, U., Svirsky, L., Serlachius, E., Andersson, G. & Öst, L.-G. The effect of parent involvement in the treatment of anxiety disorders in children: a meta-analysis. Cogn. Behav. Ther. 43, 185–200 (2014).
Cardy, J. L., Waite, P., Cocks, F. & Creswell, C. A systematic review of parental involvement in cognitive behavioural therapy for adolescent anxiety disorders. Clin. Child Fam. Psychol. Rev. 23, 483–509 (2020).
Breinholst, S., Esbjørn, B. H., Reinholdt-Dunne, M. L. & Stallard, P. CBT for the treatment of child anxiety disorders: a review of why parental involvement has not enhanced outcomes. J. Anxiety Disord. 26, 416–424 (2012).
Lebowitz, E. R., Omer, H., Hermes, H. & Scahill, L. Parent training for childhood anxiety disorders: the SPACE program. Cogn. Behav. Pract. 21, 456–469 (2014).
Wei, C. & Kendall, P. C. Parental involvement: contribution to childhood anxiety and its treatment. Clin. Child Fam. Psychol. Rev. 17, 319–339 (2014).
Wood, J. J., Piacentini, J. C., Southam-Gerow, M., Chu, B. C. & Sigman, M. Family cognitive behavioral therapy for child anxiety disorders. J. Am. Acad. Child Adolesc. Psychiatry 45, 314–321 (2006).
Silverman, W. K. et al. Contingency management, self-control, and education support in the treatment of childhood phobic disorders: a randomized clinical trial. J. Consult. Clin. Psychol. 67, 675–687 (1999).
Cobham, V. E., Dadds, M. R. & Spence, S. H. The role of parental anxiety in the treatment of childhood anxiety. J. Consult. Clin. Psychol. 66, 893–905 (1998).
Peris, T. S., Thamrin, H. & Rozenman, M. S. Family intervention for child and adolescent anxiety: a meta-analytic review of therapy targets, techniques and outcomes. J. Affect. Disord. 286, 282–295 (2021).
Silverman, W. K., Rey, Y., Marin, C. E., Jaccard, J. & Pettit, J. W. Does training parents in reinforcement skills or relationship skills enhance individual youths’ cognitive behavioral therapy for anxiety? Outcome, specificity and mediation. Clin. Psychol. Sci. 10, 355–373 (2022).
Lebowitz, E. R., Marin, C., Martino, A., Shimshoni, Y. & Silverman, W. K. Parent-based treatment as efficacious as cognitive-behavioral therapy for childhood anxiety: a randomized noninferiority study of supportive parenting for anxious childhood emotions. J. Am. Acad. Child Adolesc. Psychiatry 59, 362–372 (2020).
Jewell, C., Wittkowski, A. & Pratt, D. The impact of parent-only interventions on child anxiety: a systematic review and meta-analysis. J. Affect. Disord. 309, 324–349 (2022).
Haller, S. P. et al. Cognitive behavioral therapy normalizes fronto-parietal activation in unmedicated patients with pediatric anxiety disorders. Am. J. Psychiatry 181, 201 (2024).
Gee, D. G. Sensitive periods of emotion regulation: influences of parental care on frontoamygdala circuitry and plasticity. New Dir. Child Adolesc. Dev. 153, 87–110 (2016).
Gee, D. G. & Cohodes, E. M. Influences of caregiving on development: a sensitive period for biological embedding of predictability and safety cues. Curr. Dir. Psychol. Sci. 30, 376–383 (2021).
Glenn, C. R. et al. The development of fear learning and generalization in 8–13 year-olds. Dev. Psychobiol. 54, 675–684 (2012).
Gao, Y., Raine, A., Venables, P. H., Dawson, M. E. & Mednick, S. A. The development of skin conductance fear conditioning in children from ages 3 to 8 years. Dev. Sci. 13, 201–212 (2010).
Jovanovic, T. et al. Development of fear acquisition and extinction in children: effects of age and anxiety. Neurobiol. Learn. Memory 113, 135–142 (2014).
Leeb, R. T. Child Maltreatment Surveillance: Uniform Definitions for Public Health and Recommended Data Elements (Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2008).
McLaughlin, K. A. et al. Childhood adversities and first onset of psychiatric disorders in a national sample of US adolescents. Arch. Gen. Psychiatry 69, 1151–1160 (2012).
Britton, J. C., Lissek, S., Grillon, C., Norcross, M. A. & Pine, D. S. Development of anxiety: the role of threat appraisal and fear learning. Depress. Anxiety 28, 5–17 (2011).
Strawn, J. R., Lu, L., Peris, T. S., Levine, A. & Walkup, J. T. Research Review: pediatric anxiety disorders—what have we learnt in the last 10 years? J. Child Psychol. Psychiatry 62, 114–139 (2021).
Craske, M. G. et al. Is aversive learning a marker of risk for anxiety disorders in children? Behav. Res. Ther. 46, 954–967 (2008).
Bernstein, R. A. et al. Threat appraisal and pediatric anxiety: proof of concept of a latent variable approach. Clin. Psychol. Sci. 12, 772–781 (2024).
Barrett, P. M., Rapee, R. M., Dadds, M. M. & Ryan, S. M. Family enhancement of cognitive style in anxious and aggressive children. J. Abnorm. Child Psychol. 24, 187–203 (1996).
Lebowitz, E. R., Leckman, J. F., Silverman, W. K. & Feldman, R. Cross-generational influences on childhood anxiety disorders: pathways and mechanisms. J. Neural Transm. 123, 1053–1067 (2016).
Buss, K. A., Zhou, A. M. & Trainer, A. Bidirectional effects of toddler temperament and maternal overprotection on maternal and child anxiety symptoms across preschool. Depress. Anxiety 38, 1201–1210 (2021).
Silverman, W. K., Marin, C. E., Rey, Y., Jaccard, J. & Pettit, J. W. Directional effects of parent and child anxiety 1 year following treatment of child anxiety, and the mediational role of parent psychological control. Depress. Anxiety 38, 1289–1297 (2021).
Hudson, J. L. & Rapee, R. M. Parent–child interactions and anxiety disorders: an observational study. Behav. Res. Ther. 39, 1411–1427 (2001).
Lebowitz, E. R., Shic, F., Campbell, D., MacLeod, J. & Silverman, W. K. Avoidance moderates the association between mothers’ and children’s fears: findings from a novel motion-tracking behavioral assessment. Depress. Anxiety 32, 91–98 (2015).
Feinberg, L., Kerns, C., Pincus, D. B. & Comer, J. S. A preliminary examination of the link between maternal experiential avoidance and parental accommodation in anxious and non-anxious children. Child Psychiatry Hum. Dev. 49, 652–658 (2018).
Zeytinoglu, S. et al. The roles of parental verbal communication and child characteristics in the transmission and maintenance of social fears. J. Child Psychol. Psychiatry 66, 1642–1652 (2025).
Nook, E. C. et al. Affective language spreads between anxious children and their mothers during a challenging puzzle task. Emotion 23, 1513–1521 (2023).
Sicouri, G. et al. Threat interpretation and parental influences for children with asthma and anxiety. Behav. Res. Ther. 89, 14–23 (2017).
Lebowitz, E. R. et al. Family accommodation in pediatric anxiety disorders. Depress. Anxiety 30, 47–54 (2013).
Kitt, E. R. et al. Family accommodation in pediatric anxiety: relations with avoidance and self-efficacy. Behav. Res. Ther. 154, 104107 (2022).
de Barros, P. M. F. et al. Family accommodation mediates the impact of childhood anxiety on functional impairment. J. Anxiety Disord. 76, 102318 (2020).
La Buissonnière-Ariza, V. et al. Family accommodation of anxiety symptoms in youth undergoing intensive multimodal treatment for anxiety disorders and obsessive-compulsive disorder: nature, clinical correlates and treatment response. Compr. Psychiatry 80, 1–13 (2018).
Iniesta-Sepúlveda, M., Rodriguez-Jimenez, T., Lebowitz, E. R., Goodman, W. K. & Storch, E. A. The relationship of family accommodation with pediatric anxiety severity: meta-analytic findings and child, family and methodological moderators. Child Psychiatry Hum. Dev. 52, 1–14 (2021).
Salloum, A. et al. Family accommodation as a predictor of cognitive-behavioral treatment outcome for childhood anxiety. Fam. Soc. 99, 45–55 (2018).
Affrunti, N. W. & Ginsburg, G. S. Exploring parental predictors of child anxiety: the mediating role of child interpretation bias. Child Youth Care Forum 41, 517–527 (2012).
Falcone, M. M. et al. Parent psychological control and youth social anxiety: examining attention control and its components as moderators. Cogn. Ther. Res. 49, 376–384 (2025).
Affrunti, N. W. & Ginsburg, G. S. Maternal overcontrol and child anxiety: the mediating role of perceived competence. Child Psychiatry Hum. Dev. 43, 102–112 (2012).
Phelps, E. A., Delgado, M. R., Nearing, K. I. & LeDoux, J. E. Extinction learning in humans: role of the amygdala and vmPFC. Neuron 43, 897–905 (2004).
Milad, M. R. et al. Recall of fear extinction in humans activates the ventromedial prefrontal cortex and hippocampus in concert. Biol. Psychiatry 62, 446–454 (2007).
LeDoux, J. The amygdala. Curr. Biol. 17, R868–R874 (2007).
Narita, K. et al. Associations among parenting experiences during childhood and adolescence, hypothalamus-pituitary-adrenal axis hypoactivity, and hippocampal gray matter volume reduction in young adults. Hum. Brain Mapp. 33, 2211–2223 (2012).
Farber, M. J., Kim, M. J., Knodt, A. R. & Hariri, A. R. Maternal overprotection in childhood is associated with amygdala reactivity and structural connectivity in adulthood. Dev. Cogn. Neurosci. 40, 100711 (2019).
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T. & Vervliet, B. Maximizing exposure therapy: an inhibitory learning approach. Behav. Res. Ther. 58, 10–23 (2014).
Silverman, W. K. & Kurtines, W. M. Anxiety and Phobic Disorders: A Pragmatic Approach (Springer, 1996).
Moriceau, S. & Sullivan, R. M. Maternal presence serves as a switch between learning fear and attraction in infancy. Nat. Neurosci. 9, 1004–1006 (2006).
Tottenham, N., Shapiro, M., Flannery, J., Caldera, C. & Sullivan, R. M. Parental presence switches avoidance to attraction learning in children. Nat. Hum. Behav. 3, 1070–1077 (2019).
Ollendick, T. H., Lewis, K. M., Cowart, M. J. & Davis III, T. Prediction of child performance on a parent-child behavioral approach test with animal phobic children. Behav. Modif. 36, 509–524 (2012).
Levine, S., Johnson, D. F. & Gonzalez, C. A. Behavioral and hormonal responses to separation in infant rhesus monkeys and mothers. Behav. Neurosci. 99, 399–410 (1985).
Seltzer, L. J., Ziegler, T. E. & Pollak, S. D. Social vocalizations can release oxytocin in humans. Proc. R. Soc. B Biol. Sci. 277, 2661–2666 (2010).
Hostinar, C. E., Johnson, A. E. & Gunnar, M. R. Parent support is less effective in buffering cortisol stress reactivity for adolescents compared to children. Dev. Sci. 18, 281–297 (2015).
Gee, D. G. et al. Maternal buffering of human amygdala-prefrontal circuitry during childhood but not during adolescence. Psychol. Sci. 25, 2067–2078 (2014).
Abramson, L. et al. The effects of parental presence on amygdala and mPFC activation during fear conditioning: an exploratory study. Dev. Sci. 27, e13505 (2024).
McClure, E. B. et al. Abnormal attention modulation of fear circuit function in pediatric generalized anxiety disorder. Arch. Gen. Psychiatry 64, 97–106 (2007).
Thomas, K. M. et al. Amygdala response to fearful faces in anxious and depressed children. Arch. Gen. Psychiatry 58, 1057–1063 (2001).
Hamm, L. L. et al. Aberrant amygdala functional connectivity at rest in pediatric anxiety disorders. Biol. Mood Anxiety Disord. 4, 15 (2014).
Monk, C. S. et al. Amygdala and ventrolateral prefrontal cortex activation to masked angry faces in children and adolescents with generalized anxiety disorder. Arch. Gen. Psychiatry 65, 568–576 (2008).
Conner, O. L. et al. Mom—it helps when you’re right here! Attenuation of neural stress markers in anxious youths whose caregivers are present during fMRI. PLoS ONE 7, e50680 (2012).
Callaghan, B. L. et al. Decreased amygdala reactivity to parent cues protects against anxiety following early adversity: an examination across 3 years. Biol. Psychiatry Cogn. Neurosci. Neuroimaging 4, 664–671 (2019).
Silk, J. S. et al. ‘You can do it!’: the role of parental encouragement of bravery in child anxiety treatment. J. Anxiety Disord. 27, 439–446 (2013).
Aktar, E., Nimphy, C. A., Van Bockstaele, B. & Pérez-Edgar, K. The social learning of threat and safety in the family: Parent-to-child transmission of social fears via verbal information. Dev. Psychobiol. 64, e22257 (2022).
Perlman, S. B., Lunkenheimer, E., Panlilio, C. & Pérez-Edgar, K. Parent-to-child anxiety transmission through dyadic social dynamics: a dynamic developmental model. Clin. Child Fam. Psychol. Rev. 25, 110–129 (2022).
Aktar, E., Majdandžić, M., De Vente, W. & Bögels, S. M. Parental expressions of anxiety and child temperament in toddlerhood jointly predict preschoolers’ avoidance of novelty. J. Clin. Child Adolesc. Psychol. 47, S421–S434 (2018).
Aktar, E., Venetikidi, M., Bockstaele, B. V., Giessen, D. V. D. & Pérez-Edgar, K. Pupillary responses to dynamic negative versus positive facial expressions of emotion in children and parents: links to depression and anxiety. Dev. Psychobiol. 66, e22522 (2024).
Kitt, E. R. et al. The role of family-level factors in childhood anxiety during the COVID-19 pandemic. J. Emot. Psychopathol. 1, 129–151 (2023).
Perry, R. & Sullivan, R. M. Neurobiology of attachment to an abusive caregiver: short-term benefits and long-term costs. Dev. Psychobiol. 56, 1626–1634 (2014).
Robinson-Drummer, P. A. et al. Infant trauma alters social buffering of threat learning: emerging role of prefrontal cortex in preadolescence. Front. Behav. Neurosci. 13, 132 (2019).
Hostinar, C. E., Johnson, A. E. & Gunnar, M. R. Early social deprivation and the social buffering of cortisol stress responses in late childhood: an experimental study. Dev. Psychol. 51, 1597–1608 (2015).
Craske, M. G. & Barlow, D. H. Mastery of Your Anxiety and Panic: Therapist Guide (Oxford Univ. Press, 2022).
Craske, M. G., Hermans, D. & Vervliet, B. State-of-the-art and future directions for extinction as a translational model for fear and anxiety. Phil. Trans. R. Soc. B Biol. Sci. 373, 20170025 (2018).
Craske, M. G. et al. Optimizing inhibitory learning during exposure therapy. Behav. Res. Ther. 46, 5–27 (2008).
Hornstein, E. A. & Eisenberger, N. I. Unpacking the buffering effect of social support figures: social support attenuates fear acquisition. PLoS ONE 12, e0175891 (2017).
Odriozola, P. & Gee, D. G. Learning about safety: conditioned inhibition as a novel approach to fear reduction targeting the developing brain. Am. J. Psychiatry 178, 136–155 (2021).
Goetz, A. R., Davine, T. P., Siwiec, S. G. & Lee, H.-J. The functional value of preventive and restorative safety behaviors: a systematic review of the literature. Clin. Psychol. Rev. 44, 112–124 (2016).
Etkin, R. G., Zilcha-Mano, S. & Lebowitz, E. R. Clinical update: the role of family accommodation in youth anxiety treatment outcomes. Evid. Based Pract. Child Adolesc. Ment. Health 7, 295–305 (2022).
Maslowsky, J. et al. A preliminary investigation of neural correlates of treatment in adolescents with generalized anxiety disorder. J. Child Adolesc. Psychopharmacol. 20, 105–111 (2010).
Burkhouse, K. L. et al. Anterior cingulate activation to implicit threat before and after treatment for pediatric anxiety disorders. Prog. Neuro-Psychopharmacol. Biol. Psychiatry 84, 250–256 (2018).
Carter, C. S., Heckers, S., Nichols, T., Pine, D. S. & Strother, S. Optimizing the design and analysis of clinical functional magnetic resonance imaging research studies. Biol. Psychiatry 64, 842–849 (2008).
Koikegami, H. & Yoshida, K. Pupillary dilatation induced by stimulation of amygdaloid nuclei. Psychiatry Clin. Neurosci. 7, 109–126 (1953).
Silk, J. S. et al. Pupillary reactivity to emotional information in child and adolescent depression: links to clinical and ecological measures. Am. J. Psychiatry 164, 1873–1880 (2007).
Wood, K. H., Ver Hoef, L. W. & Knight, D. C. The amygdala mediates the emotional modulation of threat-elicited skin conductance response. Emotion 14, 693–700 (2014).
Sequeira, S. L. et al. ‘Don’t judge me!’: links between in vivo attention bias toward a potentially critical judge and fronto-amygdala functional connectivity during rejection in adolescent girls. Dev. Cogn. Neurosci. 49, 100960 (2021).
van Rooij, S. J. et al. Maternal buffering of fear-potentiated startle in children and adolescents with trauma exposure. Soc. Neurosci. 12, 22–31 (2017).
Giedd, J. N. et al. Quantitative MRI of the temporal lobe, amygdala, and hippocampus in normal human development: ages 4–18 years. J. Comp. Neurol. 366, 223–230 (1996).
Gabard-Durnam, L. et al. Human amygdala functional network development: a cross-sectional study from 3 months to 5 years of age. Dev. Cogn. Neurosci. 34, 63–74 (2018).
Casey, B., Heller, A. S., Gee, D. G. & Cohen, A. O. Development of the emotional brain. Neurosci. Lett. 693, 29–34 (2019).
Calabro, F. J., Murty, V. P., Jalbrzikowski, M., Tervo-Clemmens, B. & Luna, B. Development of hippocampal-prefrontal cortex interactions through adolescence. Cereb. Cortex 30, 1548–1558 (2020).
Swartz, J. R., Carrasco, M., Wiggins, J. L., Thomason, M. E. & Monk, C. S. Age-related changes in the structure and function of prefrontal cortex-amygdala circuitry in children and adolescents: a multi-modal imaging approach. NeuroImage 86, 212–220 (2014).
Casey, B. J., Getz, S. & Galvan, A. The adolescent brain. Dev. Rev. 28, 62–77 (2008).
Klune, C. B. et al. Developmentally distinct architectures in top–down pathways controlling threat avoidance. Nat. Neurosci. 28, 823–835 (2025).
Guassi Moreira, J. F. & Telzer, E. H. Mother still knows best: maternal influence uniquely modulates adolescent reward sensitivity during risk taking. Dev. Sci. 21, e12484 (2018).
Rogers, C. R., Perino, M. T. & Telzer, E. H. Maternal buffering of adolescent dysregulation in socially appetitive contexts: from behavior to the brain. J. Res. Adolesc. 30, 41–52 (2020).
Kwon, S. J., Do, K. T., McCormick, E. M. & Telzer, E. H. Neural correlates of conflicting social influence on adolescent risk taking. J. Res. Adolesc. 31, 139–152 (2021).
Lansford, J. E. Annual research review: cross-cultural similarities and differences in parenting. J. Child Psychol. Psychiatry 63, 466–479 (2022).
Patriarca, G. C. et al. Parent involvement enhances CBTs for anxiety disorders in Hispanic/Latino youth: acculturation as a moderator. J. Consult. Clin. Psychol. 90, 827–836 (2022).

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