The Prevention of Child and Adolescent Anxiety: A Meta-analytic Review

A Randomized Controlled Trial to Test the Effectiveness of an Immersive 3D Video Game for Anxiety Prevention among Adolescents

Adolescent anxiety is debilitating, the most frequently diagnosed adolescent mental health problem, and leads to substantial long-term problems. A randomized controlled trial (n = 138) was conducted to test the effectiveness of a biofeedback video game (Dojo) for adolescents with elevated levels of anxiety. Adolescents (11–15 years old) were randomly assigned to play Dojo or a control game (Rayman 2: The Great Escape). Initial screening for anxiety was done on 1,347 adolescents in five high schools; only adolescents who scored above the “at-risk” cut-off on the Spence Children Anxiety Survey were eligible. Adolescents’ anxiety levels were assessed at pre-test, post-test, and at three month follow-up to examine the extent to which playing Dojo decreased adolescents’ anxiety. The present study revealed equal improvements in anxiety symptoms in both conditions at follow-up and no differences between Dojo and the closely matched control game condition. Latent growth curve models did reveal a steeper decrease of personalized anxiety symptoms (not of total anxiety symptoms) in the Dojo condition compared to the control condition. Moderation analyses did not show any differences in outcomes between boys and girls nor did age differentiate outcomes. The present results are of importance for prevention science, as this was the first full-scale randomized controlled trial testing indicated prevention effects of a video game aimed at reducing anxiety. Future research should carefully consider the choice of control condition and outcome measurements, address the potentially high impact of participants’ expectations, and take critical design issues into consideration, such as individual- versus group-based intervention and contamination issues.

Preventing Onset of Anxiety Disorders in Offspring of Anxious Parents: A Randomized Controlled Trial of a Family-Based Intervention

OBJECTIVE

The authors examined the efficacy of a family-based intervention to prevent the onset of anxiety disorders in offspring of anxious parents.

METHOD

Participants were 136 families with a parent meeting DSM-IV criteria for an anxiety disorder and one child 6-13 years of age without an anxiety disorder. Families were randomly assigned to the family-based intervention (N=70) or to an information-monitoring control condition (N=66). All families were expected to complete assessments, administered by blind interviewers, at baseline, at the end of the intervention (or 8 weeks after randomization) and at 6- and 12-month follow-ups. Onset of any anxiety disorder and anxiety symptom severity (assessed using the Anxiety Disorders Interview Schedule for Children) at 12 months were the primary and secondary outcome measures, respectively.

RESULTS

The incidence of child anxiety disorders was 31% in the control group and 5% in the intervention group (odds ratio=8.54, 95% CI=2.27, 32.06). At the 1-year follow-up, youths in the control group also had higher anxiety symptoms ratings than those in the intervention group. Effect sizes were medium to large (0.81 at 6 months and 0.57 at 12 months for anxiety symptoms), and the number needed to treat was 3.9 at 12 months. Significant moderators included baseline levels of child anxiety; significant mediators were parental distress and modeling of anxiety. Child maladaptive cognitions and parental anxiety did not mediate outcomes.

CONCLUSIONS

A brief psychosocial prevention program holds promise for reducing the 1-year incidence of anxiety disorders among offspring of anxious parents.

A cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of a school-based cognitive–behavioural therapy programme (FRIENDS) in the reduction of anxiety and improvement in mood in children aged 9/10 years

Background

Anxiety in children is common, impairs everyday functioning and increases the risk of severe mental health disorders in adulthood, yet few children with anxiety are identified and referred for treatment.

Objective

To investigate the clinical effectiveness and cost-effectiveness of a universal school-based preventative programme (FRIENDS) in reducing symptoms of anxiety and low mood.

Design

Cluster randomised controlled trial. Schools (n = 41) were randomly assigned after recruitment on a 1 : 1 : 1 basis to health-led FRIENDS, school-led FRIENDS and usual school provision.

Setting

Primary schools in three local education authorities in the south-west of England.

Participants

Children (n = 1362) aged 9–10 years attending school and participating in personal, social and health education (PSHE).

Interventions

The FRIENDS programme is a cognitive–behavioural therapy programme that develops skills to counter the cognitive, emotional and behavioural aspects of anxiety. The FRIENDS programme was led by either a trained member of the school or a health leader external to the school and was delivered over 9 consecutive weeks. The comparison group received usual school PSHE lessons. Interventions were delivered in the academic year September 2011–July 2012.

Main outcome measures

Clinical effectiveness assessed by child report of symptoms of anxiety (Revised Child Anxiety and Depression Scale, RCADS); cost-effectiveness based on RCADS and quality-adjusted life-years (Child Health Utility 9 Dimensions, CHU-9D) between baseline and 6 months; process evaluation, evaluation of reach and attrition and qualitative feedback from children, school staff and parents.

Results

At 12 months there was a difference in the adjusted mean RCADS scores for health-led FRIENDS compared with school-led FRIENDS [–3.91, 95% confidence interval (CI) –6.48 to –1.35] and for health-led FRIENDS compared with usual school provision (–2.66, 95% CI –5.22 to –0.09). At 24 months we were able to assess only 43.6% of our cohort. There were few differences in baseline characteristics between completers and non-completers. Child-reported anxiety in all three groups had reduced by 24 months and there were no longer any group effects. There were no between-group effects for any parent- or child-completed secondary outcomes at 12 or 24 months. The cost of the FRIENDS programme was £52–56 per child. We found no evidence that the FRIENDS programme was cost-effective over a 6-month period; however, our subgroup for the economic analysis differed significantly from our main trial cohort.

Conclusions

Although greater reductions in anxiety were noted at 12 months when the FRIENDS programme was delivered by health leaders, these additional benefits were not maintained at 24 months. Children’s anxiety levels improved irrespective of the intervention that they received. Our economic evaluation and 24-month assessment had significant shortcomings. However, the universal delivery of specific anxiety prevention programmes will result in additional costs that may be beyond the finances available to most schools. Future work should identify the active ingredients and potential moderators of universal anxiety programmes to determine whether programme length can be reduced, short-term effectiveness maintained and cost-effectiveness improved. At present, our results find limited evidence to support the universal provision of specific anxiety prevention programmes in UK primary schools.

Trial registration

Current Controlled Trials ISRCTN23563048.

Funding

The National Institute for Health Research Public Health Research programme.

Profiles of Dispositional Expectancies and Affectivity Predict Later Psychosocial Functioning in Children and Adolescents With Cancer

OBJECTIVE

Examined how individual differences in disposition among pediatric cancer patients predict their later psychosocial functioning.

METHODS

Patients aged 8-17 years (N = 223) reported on their disposition at baseline. One and three years later, self-reports and parent reports of patient psychosocial functioning were obtained. Latent profile analysis was used to identify subgroups that differed on baseline disposition and to compare them on later outcomes.

ESULTS

Three groups were identified: The "Positive" group (59%) had high optimism and positive affectivity and low pessimism and negative affectivity; the "Moderate" group (39%) had a similar profile, with less exaggerated scores; a small, "Negative" group (2%) had the opposite profile (low optimism/positive affectivity; high pessimism/negative affectivity). These groups differed in psychosocial functioning at follow-up, generally in expected directions.

CONCLUSIONS

Most patients have a disposition that may be protective. A small minority at high risk for maladjustment is distinguished by their disposition.

Preventive Interventions for Children and Adolescents

Abstract. This systematic review examines the meta-analytic evidence on four broad categories of preventive interventions for children and adolescents, including: mentoring, service learning, outdoor adventure, and social and emotional learning (SEL) programs. There were 15 meta-analytic studies that fit the criteria for inclusion. For each intervention type, the target population, main implementation strategies, and meta-analytic evidence are reported. The review considers the effectiveness of these preventive interventions across various content areas and populations, providing an indication of which type of intervention has the strongest effects on what outcomes, where they are most beneficial, and for whom they are most promising. Experimental evidence has demonstrated that mentoring, service learning, outdoor adventure, and SEL programs can all promote positive development and prevent problematic behaviors. Overall, service learning, outdoor adventure, and SEL programs have shown small to large effects on a variety of outcomes, while mentoring has shown small but significant effects. The review concludes with a discussion of key criteria that should be considered when choosing a particular program type.

Parenting strategies for reducing the risk of childhood depression and anxiety disorders: A Delphi consensus study

BACKGROUND

Substantial evidence that some modifiable parental factors are associated with childhood depression and anxiety indicates that parents can play a crucial role in the prevention of these disorders in their children. However, more effective translation of research evidence is required.

METHODS

This study employed the Delphi methodology to establish expert consensus on parenting strategies that are important for preventing depression or anxiety disorders in children aged 5-11 years. A literature search identified 289 recommendations for parents. These were presented to a panel of 44 international experts over three survey rounds, who rated their preventive importance.

RESULTS

171 strategies were endorsed as important or essential for preventing childhood depression or anxiety disorders by ≥90% of the panel. These were written into a parenting guidelines document, with 11 subheadings: Establish and maintain a good relationship with your child, Be involved and support increasing autonomy, Encourage supportive relationships, Establish family rules and consequences, Encourage good health habits, Minimise conflict in the home, Help your child to manage emotions, Help your child to set goals and solve problems, Support your child when something is bothering them, Help your child to manage anxiety, and Encourage professional help seeking when needed.

LIMITATIONS

This study relied on experts from Western countries; hence the strategies identified may not be relevant for all ethnic groups.

CONCLUSIONS

This study produced new parenting guidelines that are supported by research evidence and/or international experts, which can now be promoted in Western English-speaking communities to help parents protect their children from depression and anxiety disorders.

Primary prevention of anxiety disorders in primary care: A systematic review

OBJECTIVE

Anxiety disorders are the most prevalent psychiatric disorders in primary care and have significant social, economic, and interpersonal costs. Primary care is an ideal setting to prevent the appearance of anxiety disorders. The aim of this study was to evaluate the efficacy and cost-effectiveness of primary prevention interventions in anxiety disorders in the adult population receiving primary health care.

METHODS

A literature search was carried out in four databases-PubMed, PsycInfo, Cochrane, and Web of Science-from January 1980 to November 2013. Clinical trials and systematic reviews published in English and non-English languages and that evaluated the efficacy and/or cost-effectiveness of interventions of primary prevention for anxiety in primary care in the general adult population were included. Risk of bias was assessed by the Cochrane Risk Bias Tool and Overview Quality Assessment Questionnaire.

RESULTS

No high-quality research was identified that studied primary prevention of anxiety disorders in the adult population in the primary care setting. The few studies that exist focus on the child-adolescent population or on other types of interventions, usually as secondary prevention.

CONCLUSION

This study emphasizes the need for the development of high-quality clinical trials on the prevention of anxiety disorders in primary care.

An Open Trial of the Anxiety Action Plan (AxAP): A Brief Pediatrician-Delivered Intervention for Anxious Youth

BACKGROUND

Anxiety disorders in youth are among the most common psychiatric disorders, yet the majority of affected youth do not receive treatment. One approach to improving access to care is identification and intervention within the primary care setting.

OBJECTIVE

This manuscript presents data from a single group pre-post open trial of the Anxiety Action Plan (AxAP), a brief pediatrician-delivered intervention to reduce anxiety in youth who present in the primary care setting.

METHODS

Eleven pediatricians conducted the intervention with 25 youth (mean age 11.16 years; range 6-18 years) with elevated levels of anxiety in their primary care practice setting.

RESULTS

Pediatricians' ratings of the AxAP training were positive (mean overall satisfaction was 4.82 on 5 point scale). Pediatricians and parents also reported high levels of intervention satisfaction and acceptability. Parents (but not children) who completed the intervention reported significant reductions from pre- to post-intervention on measures of child anxiety severity, impairment, and caregiver burden (Cohen's d 1.06, .75, .60, respectively).

CONCLUSIONS

Findings suggest that a brief, pediatrician-delivered intervention in primary care settings appears feasible and beneficial to patients. Additional controlled evaluation of the intervention's efficacy is needed.

Parental factors associated with childhood anxiety, depression, and internalizing problems: a systematic review and meta-analysis

BACKGROUND

There is a burgeoning and varied literature examining the associations between parental factors and depression or anxiety disorders in children. However, there is hitherto no systematic review of this complex literature with a focus on the 5-11 years age range, when there is a steep increase in onset of these disorders. Furthermore, to facilitate the application of the evidence in prevention, a focus on modifiable factors is required.

METHODS

Employing the PRISMA method, we conducted a systematic review of parental factors associated with anxiety, depression, and internalizing problems in children which parents can potentially modify.

RESULTS

We identified 141 articles altogether, with 53 examining anxiety, 50 examining depression, and 70 examining internalizing outcomes. Stouffer׳s method of combining p-values was used to determine whether associations between variables were reliable, and meta-analyses were conducted with a subset of eligible studies to estimate the mean effect sizes of associations between each parental factor and outcome.

LIMITATIONS

Limitations include sacrificing micro-level detail for a macro-level synthesis of the literature, the lack of generalizability across cultures, and the inability to conduct a meta-analysis on all included studies.

CONCLUSIONS

Parental factors with a sound evidence base indicating increased risk for both depression and internalizing problems include more inter-parental conflict and aversiveness; and for internalizing outcomes additionally, they include less warmth and more abusive parenting and over-involvement. No sound evidence linking any parental factor with anxiety outcomes was found.

Effect of a Social Emotional Learning Programme for Primary School Students

Objective/Background

This study evaluates the effect of a social emotional learning (SEL) programme for primary school students who have difficulties in social and emotional management, as reported by their teachers or parents.

Methods

Twenty-seven primary school students were recruited and randomly assigned to the treatment group (n = 14) and the control group (n = 13). The elementary school version of the Social Skills Rating System was used to assess the social skills and problem behaviours of the participants before and after the programme. The treatment group joined a six-session SEL programme, which was modified and localized based on the Strong Kids Programme. The programme aimed to improve participants’ social emotional skills, such as dealing with anxiety and understanding and identifying the emotions of self and others. Each session lasted for about 1 hour and was run in small groups.

Results

Problem behaviours were significantly less frequent in the treatment group after the programme (p = .008), but not in the control group. However, no significant changes were found in the measures of social skills.

Conclusion

The results of this pilot study show that the SEL can effectively reduce the problem behaviours of primary school students. Implications and future research directions are discussed.

Peer acceptance and the development of emotional and behavioural problems

Difficulties in peer acceptance during elementary school have been associated with emotional and behavioural problems. This study used a randomized controlled intervention design to test whether improvements in peer acceptance mediated reduced rates of emotional and behavioural problems in intervention compared to control-group children. A total of 615 elementary school children in the Netherlands were followed annually from kindergarten through second grade. Intervention children showed reductions in emotional and behavioural problems, and improved peer acceptance compared to controls. Improved peer acceptance mediated reductions in emotional and behavioural problem development. However, this mediation pathway held only for boys with low receptive vocabulary skills. These results indicate poor peer acceptance as a common underlying factor in emotional and behavioural problem development, particularly for children who are at risk for developing problems.

Classroom-based cognitive behaviour therapy (FRIENDS): a cluster randomised controlled trial to Prevent Anxiety in Children through Education in Schools (PACES)

BACKGROUND

Anxiety in children is common, impairs everyday functioning, and increases the risk of severe mental health disorders in adulthood. We investigated the effect of a classroom-based cognitive behaviour therapy prevention programme (FRIENDS) on anxiety symptoms in children.

METHODS

Preventing Anxiety in Children though Education in Schools (PACES) is a three-group parallel cluster randomised controlled trial. Interventions were given between September, 2011, and July, 2012, with schools as the unit of allocation and individual participants as the unit of analysis. We enrolled state-funded junior schools in southwest England. We sent information to all eligible schools (state-funded junior schools in southwest England) inviting them to enrol in the study. School year groups were assigned by computer-generated randomisation (1:1:1) to receive either school-led FRIENDS (led by teacher or school staff member), health-led FRIENDS (led by two trained health facilitators), or usual school provision. Children were not masked to treatment allocation. The allocated programme was given to all students (aged 9-10 years) in the school year (ie, universal delivery) as part of the school curriculum as nine, 60 min weekly sessions. Outcomes were collected by self-completed questionnaire administered by researchers masked to allocation. Primary outcome was symptoms of anxiety and low mood at 12 months assessed by the Revised Child Anxiety and Depression Scale (RCADS 30). Analyses were intention to treat and accounted for the clustered nature of the design. The study is registered, number ISRCTN23563048.

FINDINGS

45 schools were enrolled: 14 (n=497 children) were randomly assigned to school-led FRIENDS, 14 (n=509) to health-led FRIENDS, and 12 (n=442) to usual school provision. 1257 (92%) children completed 12 month assessments (449 in health-led FRIENDS, 436 in school-led FRIENDS, and 372 in usual school provision). We recorded a difference at 12 months in adjusted mean child-reported RCADS scores for health-led versus school-led FRIENDS (19·49 [SD 14·81] vs 22·86 [15·24]; adjusted difference -3·91, 95% CI -6·48 to -1·35; p=0·0004) and health-led FRIENDS versus usual school provision (19·49 [14·81] vs 22·48 [15·74]; -2·66, -5·22 to -0·09; p=0·043). We noted no differences in parent or teacher ratings. Training teachers to deliver mental health programmes was not as effective as delivery by health professionals.

INTERPRETATION

Universally delivered anxiety prevention programmes can be effective when used in schools. However, programme effectiveness varies depending on who delivers them.

FUNDING

National Institute for Health Research Public Health Research Programme.

A Combined Intervention Targeting both Teachers’ and Students’ Social-Emotional Skills: Preliminary Evaluation of Students’ Outcomes

The literature indicates increasing evidence showing the benefits of classroom-based, universal preventive interventions for mental health and the link between social and emotional learning and academic performance. The FRIENDS program has been extensively tested and has showed promising results not only for preventing childhood anxiety, but also for improving students’ self-concept, social skills and coping skills. However, when it comes to communities in disadvantage, the results are mixed, with some studies reporting the need to include enhancements to the context in which the program is implemented to better support communities at risk. A combined intervention aiming to promote students’ social-emotional skills was piloted in a school located in a low socio-economic status area. Teachers received training to teach social and emotional skills for students and a resilience program for themselves. Students’ social-emotional outcomes were assessed at pre, post, 3 and 6 months following the intervention. Results showed that the intervention helped students to decrease their anxiety, and the intervention was well accepted by participants.

A personalized and control systems engineering conceptual approach to target childhood anxiety in the contexts of cultural diversity

In the child and adolescent anxiety area, some progress has been made to develop evidence-based prevention protocols, but less is known about how to best target these problems in children and families of color. In general, data show differential program effects with some minority children benefiting significantly less. Our preliminary data, however, show promise and suggest cultural parameters to consider in the tailoring process beyond language and cultural symbols. It appears that a more focused approach to culture might help activate intervention components and its intended effects by focusing, for example, on the various facets of familismo when working with some Mexican parents. However, testing the effects and nuances of cultural adaption vis-à-vis a focused personalized approach is methodologically challenging. For this reason, we identify control systems engineering design methods and provide example scenarios relevant to our data and recent intervention work.

The prevention of anxiety in children through school-based interventions: study protocol for a 24-month follow-up of the PACES project

BACKGROUND

Anxiety in children is common and incapacitating and increases the risk of mental health disorders in adulthood. Although effective interventions are available, few children are identified and referred for specialist treatment. Alternative approaches in which prevention programmes are delivered in school appear promising. However, comparatively little is known about the best intervention leader (health care-led vs. school-led), long-term effects or the primary preventive value of such programmes.

METHODS/DESIGN

Preventing Anxiety in Children through Education in Schools, or PACES, is a pragmatic cluster randomised controlled trial evaluating the effectiveness of a cognitive-behavioural therapy prevention programme (FRIENDS) on symptoms of anxiety and low mood in 9- to 10-year-old children. Forty-one schools were randomly assigned to one of three conditions: school-led FRIENDS, health care-led FRIENDS or treatment as usual. Assessments were undertaken at baseline, 6 months and 12 months, with the primary outcome measure being the Revised Child Anxiety and Depression Scale score at 12 months. Secondary outcome measures are changes in self-esteem, worries, bullying and life satisfaction.

DISCUSSION

This protocol summarises the procedure for the 24-month follow-up of this cohort. The study will determine the medium-term effectiveness of an anxiety prevention programme delivered in schools.

TRIAL REGISTRATION

ISRCTN23563048.

Parenting strategies for reducing the risk of adolescent depression and anxiety disorders: a Delphi consensus study

BACKGROUND

The family setting, particularly parents, is a strategic target for preventive interventions for youth depression and anxiety disorders. However, more effective translation of relevant research evidence is required.

METHOD

This study employed the Delphi methodology to establish expert consensus on parenting strategies that are important for preventing adolescent depression or anxiety disorders. A literature search identified 402 recommendations for parents. These were presented to a panel of 27 international experts over three survey rounds, who rated their preventive importance.

RESULTS

One-hundred and ninety parenting strategies were endorsed as important or essential in reducing adolescents' risk of developing depression or anxiety disorders by ≥90% of the panel. These strategies were written into a document suitable for parents, categorised under 11 sub-headings: You can reduce your child's risk of depression and anxiety problems, Establish and maintain a good relationship with your teenager, Be involved and support increasing autonomy, Establish family rules and consequences, Minimise conflict in the home, Encourage supportive relationships, Help your teenager deal with problems, Encourage good health habits, Help your teenager to deal with anxiety, Encourage professional help seeking when needed, and Don׳t blame yourself.

LIMITATIONS

This study utilised an international panel of experts from Western countries, hence the strategies identified may not be relevant for families from other cultural groups.

CONCLUSIONS

This study produced a set of parenting strategies that are supported by research evidence and/or international experts, which can now be promoted in Western English-speaking communities to help parents protect their adolescents from depression and anxiety disorders.

Parental factors associated with depression and anxiety in young people: a systematic review and meta-analysis

BACKGROUND

There is a burgeoning and varied literature examining the associations between parental factors and depression or anxiety disorders in young people. However, there is hitherto no systematic review of this complex literature with a focus on the 12-18 years age range, when the first onset for these disorders peaks. Furthermore, to facilitate the application of the evidence in prevention, a focus on modifiable factors is required.

METHODS

Employing the PRISMA method, we conducted a systematic review of parental factors associated with depression and anxiety disorders in young people which parents can potentially modify.

RESULTS

We identified 181 articles altogether, with 140 examining depression, 17 examining anxiety problems, and 24 examining both outcomes. Stouffer's method of combining p values was used to determine whether associations between variables were reliable, and meta-analyses were conducted to estimate the mean effect sizes of associations between each parental factor and outcome.

LIMITATIONS

Limitations include sacrificing micro-level detail for a macro-level synthesis of the literature, not systematically reviewing moderators and mediators, the lack of generalizability across cultures and to younger or adult children, and the inability to conduct a meta-analysis on all included studies.

CONCLUSIONS

Parental factors with a sound evidence base indicating increased risk for both depression and anxiety include less warmth, more inter-parental conflict, over-involvement, and aversiveness; and for depression additionally, they include less autonomy granting and monitoring.

Overview of meta-analyses of the prevention of mental health, substance use, and conduct problems

This review presents findings from an overview of meta-analyses of the effects of prevention and promotion programs to prevent mental health, substance use, and conduct problems. The review of 48 meta-analyses found small but significant changes that reduce depression, anxiety, antisocial behavior, and substance use. Furthermore, the results were sustained over time. Meta-analyses often found that the effects were heterogeneous. A conceptual model is proposed to guide the study of moderators of program effects in future meta-analyses, and methodological issues in synthesizing findings across preventive interventions are discussed.

Online interventions for anxiety disorders

PURPOSE OF REVIEW

The present article updates knowledge regarding the evidence base for online interventions for anxiety disorders, and provides an overview of recent advances in online interventions for anxiety over the past 18 months.

RECENT FINDINGS

Computerized self-help is an effective strategy for providing evidence-based treatments for symptoms of anxiety and depression. Online delivery has numerous advantages for clinicians and patients, including greater accessibility, anonymity, convenience and cost-effectiveness. These may be particularly important for populations experiencing anxiety, which may face more pronounced barriers to accessing care. Recent meta-analyses have confirmed that computerized cognitive behaviour therapy (CBT) for anxiety demonstrates comparable clinical outcomes as face-to-face psychotherapy for individuals with anxiety. This review updates the status of current knowledge by providing a focused review of randomized controlled trials of computerized (including Internet and portable device-delivered) treatments for anxiety.

SUMMARY

Recent studies have confirmed the utility of computerized psychotherapy for anxiety. Future trials are required to elucidate the active constituents of effective programs, evaluate targeted approaches for specific groups, and to ascertain the optimal degree of guidance required. Clarification of these issues will assist in refining effective online programs operating within standalone virtual clinics or incorporated into clinician-supported stepped care approaches.

The preventative effects of a brief, early intervention for preschool-aged children at risk for internalising: follow-up into middle adolescence

BACKGROUND

  There are few evaluations of very early intervention for the prevention of internalising disorders and those that exist generally evaluate outcomes to a maximum of 12 months. The current study evaluated the very long term effects (11 years) of a brief internalising prevention program presented to parents of preschool aged children.

METHODS

  The original sample comprised 146 preschool-aged children who scored high on measures of inhibited temperament. Half of the parents were given a brief educational program (six-sessions) to assist them to help their children reduce anxiousness. Over 70% of the original sample (n = 103) was assessed for the current study, which occurred when the sample was approximately 15 years. They were assessed on current diagnoses of anxiety and depression, as well as symptoms of anxiety, depression, negative thoughts, and life interference.

RESULTS

  Compared with controls, girls whose parents had been through the early intervention program showed significantly fewer internalising disorders, maternally reported anxiety symptoms and self-reported life interference, and trends toward lower self-reported anxiety symptoms and self reported thoughts of loss and failure. Boys showed few differences.

CONCLUSIONS

  A brief early intervention program delivered to parents of preschool-aged children who are at risk for later internalising distress shows lasting benefits for girls into the high-risk period of middle adolescence. Given the low costs associated with this program, these results show promise for strong public health benefits.

Sensitivity and specificity of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a community-based study

The aim of this cross-sectional community-based study was to examine the sensitivity and specificity of the Screen for Child Anxiety Related Emotional Disorders (SCARED) to the diagnosis of anxiety disorders (AD). Participants were 119 students aged 9-18. Psychiatric diagnoses were assessed by a psychiatrist throughout a structural clinical interview (K-SADS-PL). Forty-four participants had positive diagnosis for at least one AD. The total score of the SCARED significantly differentiated anxious from non-anxious children with an optimal cutoff point of 22 (sensitivity = 81.8 %; specificity = 52.0 %). SCARED subscales of social phobia and separation anxiety disorder, but not generalized anxiety disorder, revealed better discrimination proprieties than total scores to screen for that specific disorder (p < .05). Both total and specific SCARED scores presented moderate sensitivity and specificity for detecting AD in a community sample. Investigators interested in screening for specific AD, rather than the group of AD, may benefit from using the specific subscales.

School-based intervention to reduce anxiety in children: study protocol for a randomized controlled trial (PACES)

Background

Emotional problems such as anxiety and low mood in children are common, impair everyday functioning and increase the risk of severe mental health disorders in adulthood. Relatively few children with emotional health problems are identified and referred for treatment indicating the need to investigate preventive approaches.

Methods/Design

The study is designed to be a pragmatic cluster randomized controlled trial evaluating the effectiveness of an efficacious school-based cognitive behavior therapy (CBT) prevention program (FRIENDS) on symptoms of anxiety and low mood in children 9 to 10 years of age. The unit of allocation is schools which are assigned to one of three conditions: school-led FRIENDS, health-led FRIENDS or treatment as usual. Assessments will be undertaken at baseline, 6 months and 12 months. The primary outcome measure is change on the Revised Child Anxiety and Depression Scale. Secondary outcome measures assess changes in self-esteem, worries, bullying and life satisfaction. An economic evaluation will be undertaken.

Discussion

As of September 2011, 41 schools have been recruited and randomized. Final 12-month assessments are scheduled to be completed by May 2013.

Trial Registration

ISRCTN23563048

Brazilian Portuguese version of the Spence Children's Anxiety Scale (SCAS-Brasil)

Objective: To describe the cross-cultural adaptation of the Spence Children's Anxiety Scale (SCAS) for use in Brazil. Methods: Cross-cultural adaptation followed a four-step process, based on specialized literature: 1) investigation of conceptual and item equivalence; 2) translation and back-translation; 3) pretest; and 4) investigation of operational equivalence. All these procedures were carried out for both the child and the parent versions of the SCAS. Results: A final Brazilian version of the instrument, named SCAS-Brasil, was defined and is presented. Conclusion: The SCAS-Brasil instrument seems to be very similar to the original SCAS in terms of conceptual and item equivalence, semantics, and operational equivalence, suggesting that future cross-cultural studies may benefit from this early version. As a result, a new instrument is now available for the assessment of childhood anxiety symptoms in community, clinical, and research settings.

Indicated prevention and early intervention for childhood anxiety: a randomized trial with Caucasian and Hispanic/Latino youth

OBJECTIVE

This trial of a randomized indicated anxiety prevention and early intervention explored initial program effects as well as the role of ethnicity and language on measured outcomes.

METHOD

A total of 88 youth (M = 10.36 years; 45 girls, 52 Latino) received 1 of 2 protocols with varying degrees of parent involvement, and response was measured at posttest and 6-month follow-up.

RESULTS

Findings showed that child anxiety symptoms improved significantly across protocols, although additional gains were found for children in the child plus parent condition. Program effects did not vary by Latino ethnicity or Spanish language use in the intervention.

CONCLUSIONS

The cognitive and behavioral strategies established for Caucasian children may be promising for Hispanic/Latino children when applied in a culturally responsive manner.