The prevention of childhood anxiety and promotion of resilience among preschool-aged children: a universal school based trial

Systematic review and meta-analysis of the prevention of internalizing disorders in early childhood

Introduction

Internalizing problems comprise a significant amount of the mental health difficulties experienced during childhood. Implementing prevention programs during early childhood may prevent internalizing problems. The present systematic review and meta-analysis aimed to evaluate the effect of both targeted and universal prevention programs in preventing internalizing problems for children aged 3- to 5-years and their parents.

Methods

PsycINFO, Embase, and MEDLINE were systematically searched, and 17 randomized control trials, consisting of 3,381 children, met eligibility criteria. There were seven universal prevention programs, and 10 targeted prevention programs. Four prevention programs were delivered to children, 10 prevention programs were delivered to parents/caregivers, and three prevention programs were delivered to both parents and children.

Results

Prevention programs led to significantly fewer internalizing problems at 6- and 7-month post-intervention (n = 7, p = 0.02, CI -0.69, 0.06) with a small-to-moderate effect size (g = -0.38), however, not at post-intervention or at 12-month follow up.

Discussion

Overall, findings suggest that there may be value in ongoing development and evaluation of prevention programs for internalizing problems, as they improve social and emotional wellbeing in students and reduce internalizing difficulties within the 6- to 7-month timeframe following prevention programs.

Systematic review registration

PROSPERO: CRD42021261323.

Evaluating the effectiveness of a social and emotional learning program among preschool children in Japan: an experimental cohort study

BACKGROUND

Research on school maladjustment has increasingly focused on social skills, such as the ability to control emotions, collaborate with others, and achieve goals. Social and emotional learning (SEL) is one approach to nurturing social skills. However, few preventive interventions to promote SEL have been conducted among young children, particularly in Asian countries, including Japan. Therefore, this study examined the effectiveness of an SEL program-Fun FRIENDS-among children in Japan.

METHODS

In mid-2022, the Fun FRIENDS program was administered to 115 children aged 4-5 years, who were enrolled in two kindergartens. The program was administered to the entire class as part of their kindergarten activities. The control group included 93 children in three kindergartens. This study included 94 participants (81.7%) in the intervention group and 66 (71.0%) in the control group, whose parents agreed with the assessment of their skills. Fun FRIENDS is a support program based on a cognitive-behavioral approach. The program aims to teach children how to cope with anxiety and stress and develop resilience and confidence to face difficulties. The program includes 10 sessions, each lasting approximately 1 h and conducted once per week. To examine the program's effectiveness, teachers evaluated these children's social skills before and after program implementation using the Social Skill Scale.

RESULTS

Results showed significant post-intervention improvements in self-control and cooperation scores among children in the intervention group, compared with pre-intervention. Further, post-intervention self-control and cooperation scores were significantly higher among children in the intervention group than the control group.

CONCLUSIONS

SEL implemented on a class-wide basis could be effective in early childhood. An early approach targeting preschool-aged children is necessary to prevent school maladjustment. A universal approach implemented on a whole-class basis could contribute to improving children's social skills.

The Effectiveness of Anxiety Interventions for Young Children: A Meta-Analytic Review

Anxiety symptoms and disorders are prevalent and impairing in young children and these symptoms often persist and worsen over time, indicating the need for efficacious interventions for this age group. The purpose of this study was to evaluate the effectiveness of psychosocial interventions targeting anxiety in younger children and to assess the potential moderators of outcome. The effect sizes from 24 trials were assessed based on a random effect model. The mean weighted effect size was found to be significant and moderate in magnitude. Moderators, including level of intervention, intervention approach, rater, and level of training of the provider/program facilitator, are assessed and discussed. Overall, the findings indicate that anxiety interventions are effective in reducing anxiety in young children, and targeted trials show particularly strong promise.

An Ounce of Prevention: Building resilience and targeting anxiety in young children

BACKGROUND

Anxiety disorders are among the most common psychiatric disorders in childhood and can develop as early as the preschool years. Therefore, providing young children who display early signs of anxiety with skills to prevent the development of later psychopathology is invaluable. The current study evaluates the effectiveness of Fun FRIENDS, an anxiety prevention and resilience program for young children.

METHOD

Fifty-seven kindergartners across three classrooms participated in a 15-week anxiety prevention program and teachers completed a behavioral screening measure and anxiety questionnaire at pre, post, 3 month, and 10-month follow-up assessment points.

RESULTS

Anxiety positively correlated with emotional symptoms, peer difficulties, and total difficulties at pre-intervention. Anxiety symptoms decreased from pre-intervention to follow-up. Additionally, prosocial behaviors improved and moderated the relationship between pre-and post-intervention anxiety symptoms.

CONCLUSIONS

These findings yield promising implications regarding the effectiveness of prevention and intervention programs on increasing social emotional skills and reducing anxiety symptoms in young children.

Resilience Programs for Children and Adolescents: A Systematic Review and Meta-Analysis

Resilience may be defined as the ability to recover and adapt to adverse situations. Given that resilience involves cognitive and behavioral aspects, it could be promoted based on strategies that favor them, especially during childhood and adolescence. As a result, several resilience-focused programs have been developed and studied. This systematic review of Randomized Controlled Trials (RCTs) aimed to assess resilience-focused programs for children (<12 years old) and adolescents (12-22 years old) compared to active (treatment as usual, other program modalities, and educational curriculum at school) or inactive (waiting list, no treatment) control groups. We performed a systematic review of meta-analyses of RCTs. The following databases were searched: Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, and PsycINFO. Two authors independently selected the studies, extracted the data, and assessed the studies' risk of bias. Meta-analyses of random effects were conducted to calculate the standard mean differences (SMD) and 95% confidence interval (CI) of program effectiveness. Of the 17 RCTs that met the inclusion criteria, 13 provided sufficient data to assess the effectiveness of the programs after their implementation. Meta-analyses indicated overall effectiveness of the programs in promoting resilience (SMD = 0.48, 95% CI [0.15, 0.81], p = 0.0077). The subgroup analysis indicated effectiveness only among adolescents' resilience (SMD = 0.48, 95% CI [0.08, 0.88], p = 0.02). The follow-up analysis also indicated evidence of continuation of results within a period of up to 6 months up (SMD = 0.12, 95% CI [-0.44, 0.69], p = 0.02). These results indicated the effectiveness of promoting resilience, especially in adolescents, and its continuation in follow-up analyses. These findings are promising in the field of resilience programs; however, further studies are necessary to analyze the different possible characteristics of programs and their results. Clinical Trial Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020179874], [CRD42020179874].

School-based depression and anxiety prevention programs: An updated systematic review and meta-analysis

Depression and anxiety are often first experienced during childhood and adolescence, and interest in the prevention of these disorders is growing. The focus of this review was to assess the effectiveness of psychological prevention programs delivered in schools, and to provide an update to our previous review from five years ago (Werner-Seidler, Perry, Calear, Newby, & Christensen, 2017). Three electronic databases were systematically searched for published articles of randomised controlled trials (RCTs) evaluating the efficacy of school-based prevention programs until October 2020. There were 130 articles that met inclusion criteria, representing 118 unique trials and 45,924 participants. Small between-group effect sizes for depression (g = 0.21) and anxiety (g = 0.18) were detected immediately post-intervention. Subgroup analyses suggested that targeted prevention programs (for young people with risk factors or symptoms) were associated with significantly greater effect sizes relative to universal programs for depression, which was confirmed by meta-regression. There was also some evidence that external providers conferred some benefit over school-staff delivered programs. Overall, study quality was moderate and no association between risk of bias and effect size was detected. School-delivered psychological prevention programs have small effects in reducing symptoms of depression and anxiety. Refinement of these programs, and knowledge about how they can be sustainably delivered in schools beyond the trial period is now needed for population-level preventive effects. Systematic Review Registration Number: PROPSERO - CRD42020188323.

School-based interventions to prevent anxiety, depression and conduct disorder in children and young people: a systematic review and network meta-analysis

Background

Schools in the UK increasingly have to respond to anxiety, depression and conduct disorder as key causes of morbidity in children and young people.

Objective

The objective was to assess the comparative effectiveness of educational setting-based interventions for the prevention of anxiety, depression and conduct disorder in children and young people.

Design

This study comprised a systematic review, a network meta-analysis and an economic evaluation.

Data sources

The databases MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), PsycInfo® (American Psychological Association, Washington, DC, USA) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to 4 April 2018, and the NHS Economic Evaluation Database (NHS EED) was searched on 22 May 2019 for economic evaluations. No language or date filters were applied.

Main outcomes

The main outcomes were post-intervention self-reported anxiety, depression or conduct disorder symptoms.

Review methods

Randomised/quasi-randomised trials of universal or targeted interventions for the prevention of anxiety, depression or conduct disorder in children and young people aged 4–18 years were included. Screening was conducted independently by two reviewers. Data extraction was conducted by one reviewer and checked by a second. Intervention- and component-level network meta-analyses were conducted in OpenBUGS. A review of the economic literature and a cost–consequence analysis were conducted.

Results

A total of 142 studies were included in the review, and 109 contributed to the network meta-analysis. Of the 109 studies, 57 were rated as having an unclear risk of bias for random sequence generation and allocation concealment. Heterogeneity was moderate. In universal secondary school settings, mindfulness/relaxation interventions [standardised mean difference (SMD) –0.65, 95% credible interval (CrI) –1.14 to –0.19] and cognitive–behavioural interventions (SMD –0.15, 95% CrI –0.34 to 0.04) may be effective for anxiety. Cognitive–behavioural interventions incorporating a psychoeducation component may be effective (SMD –0.30, 95% CrI –0.59 to –0.01) at preventing anxiety immediately post intervention. There was evidence that exercise was effective in preventing anxiety in targeted secondary school settings (SMD –0.47, 95% CrI –0.86 to –0.09). There was weak evidence that cognitive–behavioural interventions may prevent anxiety in universal (SMD –0.07, 95% CrI –0.23 to 0.05) and targeted (SMD –0.38, 95% CrI –0.84 to 0.07) primary school settings. There was weak evidence that cognitive–behavioural (SMD –0.04, 95% CrI –0.16 to 0.07) and cognitive–behavioural + interpersonal therapy (SMD –0.18, 95% CrI –0.46 to 0.08) may be effective in preventing depression in universal secondary school settings. Third-wave (SMD –0.35, 95% CrI –0.70 to 0.00) and cognitive–behavioural interventions (SMD –0.11, 95% CrI –0.28 to 0.05) incorporating a psychoeducation component may be effective at preventing depression immediately post intervention. There was no evidence of intervention effectiveness in targeted secondary, targeted primary or universal primary school settings post intervention. The results for university settings were unreliable because of inconsistency in the network meta-analysis. A narrative summary was reported for five conduct disorder prevention studies, all in primary school settings. None reported the primary outcome at the primary post-intervention time point. The economic evidence review reported heterogeneous findings from six studies. Taking the perspective of a single school budget and based on cognitive–behavioural therapy intervention costs in universal secondary school settings, the cost–consequence analysis estimated an intervention cost of £43 per student.

Limitations

The emphasis on disorder-specific prevention excluded broader mental health interventions and restricted the number of eligible conduct disorder prevention studies. Restricting the study to interventions delivered in the educational setting may have limited the number of eligible university-level interventions.

Conclusions

There was weak evidence of the effectiveness of school-based, disorder-specific prevention interventions, although effects were modest and the evidence not robust. Cognitive–behavioural therapy-based interventions may be more effective if they include a psychoeducation component.

Future work

Future trials for prevention of anxiety and depression should evaluate cognitive–behavioural interventions with and without a psychoeducation component, and include mindfulness/relaxation or exercise comparators, with sufficient follow-up. Cost implications must be adequately measured.

Study registration

This study is registered as PROSPERO CRD42016048184.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.

Evaluation of FunFRIENDS program in prevention of anxiety in Brazilian children: a randomized controlled pilot trial

This study aimed to evaluate the effects of the FunFRIENDS protocol on anxiety symptoms, internalizing problems and prosocial behavior in 4- to 5-year old children. Participated of this study 43 children with an allocation ratio of 1:1 between groups (Intervention Group [IG], N = 21; Control Group [CG], N = 22) from a public school in the city of Sao Paulo participated in the study. Behaviors were evaluated by using standardized questionnaires (PAS, CBCL, SDQ, SCBE) assessing the behavioral profile of the children at three different periods; baseline (T0), one month (T1) and three months (T2) after the intervention. It was observed a reduction in the intensity of anxiety symptoms in the IG after the intervention but with no significant effect. Overall, there were no significant differences between the IG and the CG in most behaviors on all periods evaluated. On both Intention-to-Treat analyses also it was not detected significant effects of the intervention. This is the first Brazilian study evaluating the effects of FunFRIENDS program and the implications of these findings are discussed and its significance for future research.

The Prevention of Anxiety and Depression in Early Childhood

Recent statistics suggest that anxiety and depressive symptoms and disorders can occur earlier in life than previously thought, and appear to be on the increase. The burden that is associated with internalizing symptoms is large, with children's social, emotional, and cognitive development negatively impacted. Research suggests that early intervention and prevention is vital for adaptive development, and this review set out to explore the literature regarding social-emotional learning programs for children of preschool age that aim to prevent and reduce symptoms of anxiety and depression. The review focused on interventions that could be delivered universally in the school context to children aged 4-6 years or their parents. Only six programs were identified that met these criteria. The results of this review suggest that intervention and prevention efforts in early childhood are needed and can be effective in terms of reducing the burden associated with internalizing symptoms in childhood, at least in the short term. This appears to be the case particularly when parents are actively involved in the intervention, too. However, more rigorous research is needed that involves larger randomized controlled trials with multiple reporters and consistent administration of assessments across the samples.

Prevenção de Ansiedade Infantil a partir do Método Friends

Resumo Os Transtornos de Ansiedade têm se desenvolvido com mais frequência em crianças em idade escolar, prejudicando sua saúde, relações sociais e desenvolvimento global. Atualmente, tem-se buscado a prevenção desses transtornos. O Método FRIENDS, programa que visa prevenir ansiedade e depressão por meio do desenvolvimento de habilidades socioemocionais, resiliência e comportamentos para uma vida saudável, é uma possibilidade de intervenção. Nesse contexto, esta pesquisa objetivou verificar se a sintomatologia de ansiedade de crianças diminui após a participação destas no Método FRIENDS. Participaram do estudo 19 crianças, com idades entre 5 e 7 anos, de ambos os sexos. Foi utilizado como instrumento de avaliação o Spence Children’s Anxiety Scale, respondido pelos pais em pré-teste, pós-teste e follow up. Os dados foram comparados a partir de estatística descritiva e inferencial. Os resultados apontam para a diminuição do total de sintomas de ansiedade nas crianças que participaram do método logo após e no seguimento de dois meses.

Teacher Anxiety Program for Elementary Students (TAPES): intervention development and proposed randomized controlled trial

Background

Excessive student anxiety is a common problem that severely impairs short- and long-term academic functioning and increases teacher burden. Reducing student anxiety has been associated with improvement in educational functioning. Because anxiety manifests daily in the classroom, teachers are in an ideal position to identify and help students manage their anxiety. Unfortunately, teachers lack the knowledge and skills to support the learning of students with excessive anxiety. The Teacher Anxiety Program for Elementary Students (TAPES), a novel teacher-administered school-home collaborative intervention, was designed to address this gap.

Methods

This manuscript describes the protocol for developing and evaluating TAPES. Specifically, we present a description of: (1) the intervention and theoretical model; and (2) methods for the proposed randomized controlled trial comparing TAPES to a standard professional development seminar focused on reducing student anxiety.

Discussion

Primary aims examine the impact of the TAPES training on teacher knowledge and skill. Secondary aims examine the impact of TAPES on student outcomes. Exploratory aims will examine mediators based on our proposed theory of change. If effective, TAPES has the potential to directly benefit teachers (improving skills) and students (reducing anxiety and improving functioning).

Trial registration

ClinicalTrials.gov, NCT03899948. Registered on 28 March 2019.

Cognitive Behavioural Therapy for Anxiety Disorders in Young Children: A Dutch Open Trial of the Fun FRIENDS Program

Anxiety disorders in young children are highly prevalent and increase the risk of social, school, and familial problems, and also of psychiatric disorders in adolescence and adulthood. Nevertheless, effective interventions for this age group are lacking. One of the few available interventions is the Fun FRIENDS program. We examined whether young children with anxiety disorders showed less anxiety after participating in Fun FRIENDS. Twenty-eight clinically anxious children (4–8 years old) participated in the cognitive behavioural Fun FRIENDS program. The program consists of 12 weekly 1.5-hour sessions and was provided in groups of 3 to 5 children. At preintervention and direct postintervention, parents completed the Anxiety Disorders Interview Schedule for Children and Child Behavior Checklist. Clinically and statistically significant decreases were found in number of anxiety disorders, symptom interference, emotional and behavioural problems, internalising problems, and anxiety problems. The decrease in anxious/depressed problems and externalising problems was not significant. Furthermore, higher preintervention anxiety levels predicted more treatment progress, whereas sex and age did not. The Dutch version of Fun FRIENDS is promising in treating anxiety disorders in young children. Randomised controlled trials are needed to draw definite conclusions on the effectiveness of Fun FRIENDS in a clinical setting.

Mapping the frequency and severity of anxiety behaviors in preschool-aged children

Although anxiety can be early-emerging, impairing, and persistent, behaviors relevant to anxiety mirror typical development in early childhood. To better understand the spectrum of typical to problematic behavior, this study characterizes the range of frequency and severity of separation and social anxiety behaviors and associated impairment in preschool-aged children using a novel daily diary method. Primary caregivers of 291 3-5-year-old children reported the frequency of children's daily separation and social anxiety behaviors and related impairment for 14 days. Frequencies of each separation and social anxiety behavior were computed and item response theory analyses revealed the specific frequencies at which the behavior was considered psychometrically severe/rare. Patterns varied across items; for example, worry that caregiver would not return and shyness with familiar adults had to occur at least 3-4 times over 14 days for the behavior to be considered severe/rare, whereas shyness around peers and new people were not severe at any frequency. In addition, behaviors were associated with impairment. To our knowledge, these data are the first to delineate empirical, dimensional information about the frequency and severity of anxiety behaviors and associated impairment in early childhood. Such data could be useful for clinical practice to enhance empirically-driven assessment of anxiety.

Social and Emotional Learning Associated With Universal Curriculum-Based Interventions in Early Childhood Education and Care Centers: A Systematic Review and Meta-analysis

Importance

Social-emotional competence in early childhood influences long-term mental health and well-being. Interest in the potential to improve child health and educational outcomes through social and emotional learning (SEL) programs in early childhood education and care (ECEC) settings is increasing.

Objective

To conduct a systematic review and meta-analysis of studies examining the social, emotional, and early learning outcomes associated with universal curriculum-based SEL programs delivered to children aged 2 to 6 years in center-based ECEC settings.

Data Sources

Keyword searches of Education Resources Information Center (ERIC), MEDLINE Complete, PsycINFO, and Proquest Dissertations and Theses Global databases were conducted to identify all relevant studies published from January 1, 1995, through December 31, 2017.

Study Selection

Studies included in this review examined universal curriculum-based SEL intervention delivered to children aged 2 to 6 years in a center-based ECEC setting. All assessed individual-level social and/or emotional skill after the SEL intervention and used an experimental or quasi-experimental design (ie, studies that did not or were not able to randomly allocate participants to intervention and control groups) with a control group.

Data Extraction and Synthesis

A total of 13 035 records were screened, of which 362 were identified for full-text review. A systematic literature review was conducted on 79 studies. Multilevel random-effects meta-analyses were conducted on 63 eligible studies from October 2 through 18, 2018.

Main Outcomes and Measures

Social competence, emotional competence, behavioral self-regulation, behavior and emotional challenges, and early learning outcomes.

Results

This review identified 79 unique experimental or quasi-experimental studies evaluating the effect of SEL interventions on preschooler outcomes, including a total of 18 292 unique participants. Sixty-three studies were included in this meta-analysis. Compared with control participants, children in intervention conditions showed significant improvement in social competence (Cohen d [SE], 0.30; [0.06]; 95% CI, 0.18-0.42; P < .001), emotional competence (Cohen d [SE], 0.54 [0.16]; 95% CI, 0.22-0.86; P < .001), behavioral self-regulation (Cohen d [SE], 0.28 [0.09]; 95% CI, 0.11-0.46; P < .001), and early learning skills (Cohen d [SE], 0.18 [0.08]; 95% CI, 0.02-0.33; P = .03) and reduced behavioral and emotional challenges (Cohen d [SE], 0.19 [0.04]; 95% CI, 0.11-0.28; P < .001). Several variables appeared to moderate program outcomes, including intervention leader, type of assessment, informant, child age, and study quality.

Conclusions and Relevance

According to results of this study, social and emotional learning programs appeared to deliver at a relatively low intensity may be an effective way to increase social competence, emotional competence, behavioral self-regulation, and early learning outcomes and reduce behavioral and emotional difficulties in children aged 2 to 6 years. Social and emotional learning programs appear to be particularly successful at increasing emotional knowledge, understanding, and regulation.

The Development of Latent Dimensions of Psychopathology across Early Childhood: Stability of Dimensions and Moderators of Change

Recent research has described the structure of psychopathology as including one general and multiple specific factors, and this structure has been found in samples across development. However, little work has examined whether this structure is consistent across time, particularly in young children, within the same sample. Further, few studies have examined factors that influence the magnitude of the stability of latent dimensions of psychopathology. In the present study, we examine these issues in a community sample of 545 children assessed at ages 3 and 6. In addition, we explored child temperament, parental history of psychopathology, and parenting behaviors as potential moderators of the longitudinal stability of latent dimensions of psychopathology. We found that the same bifactor model structure identified at age 3 provided an adequate fit to the data at age 6. Further, our model revealed significant homotypic stability of the general, internalizing, and externalizing specific factors. We also found evidence of differentiation of psychopathology over time with the general factor at age 3 predicting the externalizing factor at age 6. However, we failed to identify moderators of the longitudinal associations between psychopathology latent factors. Overall, our results bolster support for the bifactor structure of psychopathology, particularly in early childhood.

Cognitive Behavioral Therapy for Childhood Anxiety Disorders: a Review of Recent Advances

PURPOSE OF REVIEW

We review recent research validating cognitive behavioral therapy (CBT) as a first-line intervention for childhood anxiety disorders. We also review recent research aimed at enhancing exposure-based CBT components and adapting CBT to work with specific populations.

RECENT FINDINGS

Exposure-based CBT is a well-established intervention. Different research groups have found positive evidence to augment CBT by evaluating inhibitory learning principles, the role of parents in child treatment, an individualized case formulation, computer and online forms of CBT, and virtual and augmented reality systems for exposure practice. Specific programs have been developed to meet specific needs of preschoolers, adolescents, and children with comorbid autism spectrum disorder and anxiety. Successful adaptations to CBT exist and the field should continue to improve the generalizability, feasibility, and expected benefit of CBT to improve its effectiveness.

Strategies included in cognitive behavioral therapy programs to treat internalized disorders: a systematic review

This review aimed to identify the strategies used in programs based on cognitive behavioral therapy (CBT) to prevent and treat symptoms of anxiety, depression, and internalized behaviors of children and adolescents. Based on an online search (ERIC, PsycInfo, Virtuose UQAM, and Google Scholar), 61 studies describing different cognitive behavioral programs were selected. Results showed that 40 strategies were implemented in at least one program. However, none of the strategies were systematically present in all programs, and only few were reported in more than 50% of the studies. Cognitive restructuring and problem-solving were the most popular strategies to treat depressive symptoms, whereas anxiety programs also generally included relaxation and exposure. Furthermore, six strategies were identified in a single anxiety program, whereas nine strategies were implemented in only one depression program. These results suggest that in anxiety and depression programs designed for children and adolescents, the label "CBT" encompasses a wide variety of programs with only few similar strategies. Such findings highlight the need to define a common basis for CBT programs, in order to better reflect CBT theory and to identify the effectiveness of the strategies included in these programs.

Usability of a Smartphone Application to Support the Prevention and Early Intervention of Anxiety in Youth

Anxiety disorders are among the most common psychiatric problems in youth, fail to spontaneously remit, and place some youth at risk for additional behavioral and emotional difficulties. Efforts to target anxiety have resulted in evidence-based interventions but the resulting prevention effects are relatively small, often weakening over time. Mobile health (mHealth) tools could be of use to strengthen the effects of anxiety prevention efforts. Although a large number of mHealth apps have been developed, few have been evaluated in terms of usability prior to clinical effectiveness testing. Because usability is one of the main barriers to mHealth usage and adoption, the objective of this research was to evaluate the usability of a smartphone application (app) corresponding to an indicated prevention and early intervention targeting youth anxiety. To accomplish this, 132 children (M age = 9.65; 63% girls) and 45 service providers (M age = 29.13, 87% female) rated our app along five established dimensions of usability (ease of use, ease of learning, quality of support information, satisfaction, and stigma) using a standardized group-based testing protocol. Findings showed that the app was highly and positively rated by both youth and providers, with some variations (lower ratings when errors occurred). Path analyses findings also showed that system understanding was significantly related to greater system satisfaction, but that such relation occurred through the quality of support information offered by the app.

Combining child social skills training with a parent early intervention program for inhibited preschool children

BACKGROUND

Previous studies have demonstrated the efficacy of early intervention for anxiety in preschoolers through parent-education. The current study evaluated a six-session early intervention program for preschoolers at high risk of anxiety disorders in which a standard educational program for parents was supplemented by direct training of social skills to the children.

METHODS

Seventy-two children aged 3-5 years were selected based on high behavioural inhibition levels and concurrently having a parent with high emotional distress. Families were randomly assigned to either the intervention group, which consisted of six parent-education group sessions and six child social skills training sessions, or waitlist. After six months, families on waitlist were offered treatment consisting of parent-education only.

RESULTS

Relative to waitlist, children in the combined condition showed significantly fewer clinician-rated anxiety disorders and diagnostic severity and maternal (but not paternal) reported anxiety symptoms and life interference at six months. Mothers also reported less overprotection. These gains were maintained at 12-month follow-up. Parent only education following waitlist produced similar improvements among children. Quasi-experimental comparison between combined and parent-only interventions indicated greater reductions from combined intervention according to clinician reports, but no significant differences on maternal reports.

CONCLUSIONS

Results suggest that this brief early intervention program for preschoolers with both parent and child components significantly reduces risk and disorder in vulnerable children. The inclusion of a child component might have the potential to increase effects over parent-only intervention. However, future support for this conclusion through long-term, randomised controlled trials is needed.

Temperament Distinguishes Persistent/Recurrent from Remitting Anxiety Disorders Across Early Childhood

Up to 20% of preschool-age children meet criteria for anxiety disorders and, for a large subset, anxiety appears to persist throughout early childhood. However, little is known about which factors predict persistence/recurrence of anxiety in young children. Temperament, including behavioral inhibition (BI), negative emotionality (NE), and positive emotionality (PE), predict the onset of anxiety disorders, but to our knowledge no study has examined whether temperament predicts the course of anxiety in young children. From a community sample of 3-year-olds, we identified 89 children (79.8% White, non-Hispanic; 41.6% female) who met criteria for an anxiety disorder and examined whether observed and parent-reported BI, NE, and PE at age 3 distinguished children who continued to meet criteria for an anxiety disorder from those who remitted by age 6. Higher levels of BI and lower levels of PE assessed in the laboratory and higher parent-reported BI and shyness and lower surgency at age 3 significantly predicted persistence/recurrence of anxiety disorders from age 3 to 6. These data are the first to demonstrate the influence of temperament on the course of anxiety disorders in young children. These findings can enhance assessment and treatment of anxiety by focusing intervention efforts on children who are at risk for persistent or recurring anxiety rather than children who are displaying transient, and possibly developmentally normative, anxiety.

The Treatment of Anxiety in Young Children: Results of an Open Trial of the Fun FRIENDS Program

Background: Preschool-aged children exhibit a relatively high prevalence rate of anxiety disorders, and the course of these disorders is often chronic. However, surprisingly few studies have focused on the treatment of anxiety in this age group. In response to this limitation, the purpose of the current study was to examine the effectiveness of an open trial of the Fun FRIENDS (FF) program, a downward extension of the FRIENDS programs for preschool-aged children (5–7 years), in a community clinic setting. Method: The sample included 31 children diagnosed with an anxiety disorder. Treatment consisted of 10 weekly sessions administered in a group format. Parents also received two information sessions. Child anxiety, behavioural inhibition, and resiliency were assessed at preintervention, immediate postintervention, and at 12-month follow-up. Results: Significant decreases in child anxiety and shyness and improvements on measures of resiliency were observed following the completion of treatment. Conclusions: The results of this study provide support for the effectiveness of the Fun FRIENDS program as a treatment for anxiety in young children. Further, this study adds to the relatively small body of research focused on the use of CBT to treat anxiety disorders in this population.