Cognitive-behavioural interventions for prevention and treatment of anxiety in young children: A systematic review and meta-analysis

Abstract

BackgroundAnxiety disorders are common and impairing throughout the life course. Propensity to anxiety disorders manifests as distress and avoidance of novel stimuli (called behavioural inhibition) as early as in infancy. Already in preschool children, anxiety disorders impact emotional development and school readiness. Anxiety disorders and behavioural inhibition are prospectively associated with increased risk of mood disorders, substance use, and suicide. Therefore, early targeted prevention and treatment need to be considered. Cognitive-behavioural interventions are effective for anxiety in older age group but their efficacy for preschool children remains to be established. MethodsWe searched PsycINFO, PubMed, and Embase until September 19th, 2019 using terms describing anxiety, behavioural inhibition, intervention, and young children. We included studies with young children participating in a cognitive-behavioural intervention for anxiety disorders, anxiety symptoms, or behavioural inhibition. We completed random-effects robust meta-analyses to (1) compare anxiety measures before and after intervention and to (2) compare intervention and control groups. ResultsWe identified 43 samples including 2656 participants with a mean age of 5.45 (SD = 1.00) years. Anxiety decreased after cognitive-behavioural intervention (standardized mean difference [SMD] = −1.34, 95%CI -1.59 to −1.09, p < 0.0001). Anxiety decreased more in children who received intervention than in children in control conditions (SMD = -0.81, 95%CI -1.00 to −0.63, p < 0.0001). The difference remained significant after correcting for potential publication bias and outliers (SMD = −0.89, 95% CI -1.13 to −0.66, p < 0.0001). The improvement was maintained over follow-up. ConclusionsCognitive-behavioural interventions are effective for prevention and treatment of anxiety in young children.