Prevention Of Anxiety In Children Research Articles

Analysis of anxiety and mental health of schoolchildren in China (on the example of schools in the Autonomous Region of Inner Mongolia)

The article focuses on the experience of testing the mental health of school pupils in the Inner Mongolia Autonomous Region of the People's Republic of China. The ultimate aims of research are to examine and compare the results of anxiety level experienced by pupils, to discover a correlation between an anxiety level of pupils and their personality. The Mental Health Test (MHT) and questionnaire named "Small Five of the Personality of a Teenager" are used as data-collection techniques in this research.  This research was conducted with four hundred and twenty pupils studying from seventh to tenth grades. The data were analyzed descriptively and categorized using the seven scales SPSS 23.0. The results showed that 57.6% of pupils were experiencing severe learning anxiety. On the other hand, students were generally demonstrating a healthy mental and emotional state (40,87±17,68), but the learning anxiety level and physical health state represents above the average results. The highest learning anxiety level was experienced by seventh grade students; nevertheless, high school students showed relatively lower score of a learning anxiety. This case can be explained by the fact that the seventh-grade students has just entered secondary school (in the PRC, children study in primary, middle and high schools) and are currently facing the difficulties of adapting to the new environment and establishing a new interpersonal relationship.  A positive correlation was found between schoolchildren’ anxiety level and their emotional indicators as neuroticism or emotional instability. Meanwhile, learning anxiety and extraversion indicators demonstrated a negative correlation (p<0.01). Suggestions for school psychologists and teachers on the prevention of anxiety in children are proposed. Keywords: school pupils, learning anxiety level, mental health, China, school psychologist.

SpeakApp-Kids! Virtual reality training to reduce fear of public speaking in children – A proof of concept

Virtual reality exposure therapy (VRET) is a promising tool to reduce public speaking anxiety in adults, while treatment and prevention of public speaking anxiety in children has been largely neglected. We examined whether repeated brief exposures to a virtual audience embedded in a prototype of the Virtual Reality (VR) SpeakApp-Kids! helped to reduce (1) self-reported state anxiety during three public speaking practice sessions, (2) state anxiety during the actual presentation that followed, and (3) general public speaking anxiety from the first practice session until after the actual presentation in children aged 9–12 years (n = 40). First, we found a decrease in state anxiety during the first two practice sessions. Also in line with our expectations, pupils in the SpeakApp-Kids! condition reported lower state anxiety during the actual presentation than the control (at home) condition (n = 49). Finally, we found a larger decrease in general public speaking anxiety from the first practice session until one week after the actual presentation for the SpeakApp-Kids! condition, as compared to the control children preparing their presentations as usual. Taking limitations into account, this VR SpeakApp-Kids! is a promising tool to be developed further as it has potential to serve as an educational tool for speech practice and thereby reducing public speaking anxiety. More importantly, it has potential to prevent public speaking anxiety from developing in the first place.

Innovative Strategies and Challenges for the Prevention of Pathological Anxiety in Children and Adolescents

The effects of pathological anxiety on public health have led to the realization that anxious children might experience significant limitations in their lives. Evidence-based cognitive-behavioral (CB) interventions are now being implemented in schools at a group level to combat anxiety.Childhood emotional health should be considered a national and global priority for an effective strategy promoting the prevention of mental health. The aim of this study is the description of novel data on the effectiveness of preventive interventions for anxious children, as well as the study of selective parameters that appear to affect treatment outcome.Furthermore, a brief review is cited regarding two empirically supported interventions, which include the Friends and Pyramid Club program and the Super Skills for Life program. Schools are considered suitable places for all types of prevention programs; they provide a familiar environment to a child, and by providing access to the prevention programs to many children, school programs could be the ideal way for anxious young individuals to practice and generalize their skills. Schools also offer an ideal space for collaboration between teachers and mental health professionals. Most programs have been effective in reducing anxiety, especially those based on the principles of CB, where the effects appear to be independent of the professional status of the leader (trained teacher or mental health professional). Friends and Pyramid Club interventions are well-established, multifaceted, and cost-effective programs, which include combinations of techniques (mostly behavioral activation, cognitive preparation, teaching social skills, and relaxation techniques). Super Skills for Life is a promising program, which also uses video feedback as a part of treatment. Prevention programs have been established as a vital part of the treatment options for specialists. Research related to childhood anxiety is increasing, while the perspectives for finding novel data seem promising for the upcoming years.In this context, several studies reveal the need for early, selective, intensive, persistent, multifaceted, and participatory interventions.

The role of maternal anxiety disorder subtype, parenting and infant stable temperamental inhibition in child anxiety: a prospective longitudinal study.

Social anxiety disorder (SAD) aggregates in families. To elucidate intergenerational transmission of risk, we examined whether childhood SAD and symptoms of anxiety were prospectively predicted by stable infant temperamental inhibition, maternal SAD, maternal generalized anxiety disorder (GAD) and maternal parenting behaviours. We conducted a longitudinal study beginning prenatally with follow-up at 4, 10, 14 and 58 months postnatally. Mothers were assessed for anxiety disorders prenatally and assigned to one of three groups: SAD (n=67), GAD (n=56) and nonanxious controls (n=94). We assessed infant temperamental inhibition at 4 and 14 months, maternal parenting behaviours at 10 and 58 months, and child anxiety disorders and symptoms at 58 months. Child SAD at 58 months was predicted by prenatal maternal SAD (OR=23.76, 95% CI=1.15-60.37), but not by prenatal maternal GAD (OR=7.44, 95% CI=0.32-124.49), stable temperamental inhibition or maternal behaviours. Child anxiety symptoms at 58 months were predicted specifically by maternal SAD (but not GAD), and also by concurrent maternal intrusiveness. Stable temperamental inhibition moderated the association between 10-month maternal encouragement and 58-month child anxiety symptoms. We found evidence for specificity of risk for child SAD and anxiety symptoms from maternal SAD compared to maternal GAD. Childhood anxiety symptoms were also predicted by an interaction between a lack of maternal encouragement in infancy and stable temperamental inhibition, as well as concurrent maternal intrusiveness. The findings have clinical implications for targeted prevention of child anxiety.

Development and evaluation of the Parenting to Reduce Child Anxiety and Depression Scale (PaRCADS): assessment of parental concordance with guidelines for the prevention of child anxiety and depression.

BackgroundInvolving parents in the prevention of mental health problems in children is prudent given their fundamental role in supporting their child’s development. However, few measures encapsulate the range of risk and protective factors for child anxiety and depression that parents can potentially modify. The Parenting to Reduce Child Anxiety and Depression Scale (PaRCADS) was developed as a criterion-referenced measure to assess parenting against a set of evidence-based parenting guidelines for the prevention of child anxiety and depressive disorders.MethodsIn Study 1, 355 parents of children 8–11 years old across Australia completed the PaRCADS and measures of parenting, general family functioning, child anxiety and depressive symptoms, and parent and child health-related quality of life. Their children completed measures of parenting, anxiety and depressive symptoms, and health-related quality of life. In Study 2, six subject-experts independently evaluated the PaRCADS items for item-objective congruence and item-relevance. Item analysis was conducted by examining item-total point-biserial correlation, difficulty index, B-index, and expert-rated content validity indices. Reliability (or dependability) was assessed by agreement coefficients for single administration. Construct validity was examined by correlational analyses with other measures.ResultsFour items were removed to yield a 79-item, 10-subscale PaRCADS. Reliability estimates for the subscale and total score range from .74 to .94. Convergent validity was indicated by moderate to strong correlations with other parenting and family functioning measures, and discriminant validity was supported by small to moderate correlations with a measure of parents’ health-related quality of life. Higher scores on the PaRCADS were associated with fewer anxiety and depressive symptoms and better health-related quality of life in the child. PaRCADS total score was associated with parental age, parent reported child’s history of mental health diagnosis and child’s current mental health problem.DiscussionResults showed that the PaRCADS demonstrates adequate psychometric properties that provide initial support for its use as a measure of parenting risk and protective factors for child anxiety and depression. The scale may be used for intervention and evaluative purposes in preventive programs and research.

Maternal Trauma Exposure and Childhood Anxiety Outcomes: Examining Psychosocial Mechanisms of Risk.

The current study aimed to explore the relationship between maternal exposure to various types of trauma and child anxiety outcomes, and to investigate maternal depression and parenting quality as potential mediators of these relationships. Aims were examined within a sample of 185 mother-child dyads who participated in a longitudinal study assessing maternal trauma history, maternal depression, and parenting quality at preschool age (ages 2.5 to 5.5years), and for whom maternal and secondary caregiver reports of child anxiety were obtained at school age (ages 6 to 11years). Hypotheses were that (1) maternal exposure to trauma would be positively associated with anxiety levels in offspring and that (2) parenting quality and maternal depression would mediate the relationship between maternal exposure to trauma and child anxiety. Results suggest a direct association between maternal trauma history and child anxiety, as well as indirect associations through parenting quality and maternal depression. These findings are discussed with regard to their implications for the prevention of child anxiety, as well as their implications for the advancement of the literature on intergenerational effects of trauma.

Parental Responses to Children’s Avoidance in Fear-Provoking Situations: Relation to Child Anxiety and Mediators of Intervention Response

Parenting behaviors have consistently been shown to be associated with elevated anxiety symptoms and disorders in children. However, this literature is limited as most studies have focused on global rather than specific parenting behaviors, failed to consistently account for the influence of parental anxiety, and omitted examining whether changes in parenting behaviors mediate intervention outcomes. This study addressed these limitations by examining five specific parental responses to children’s avoidance behavior during fear-provoking situations in relation to their child’s anxiety and as a mediator of outcomes in the context of a child anxiety prevention intervention. Parental responses included Positive Reinforcement, Punishment, Use of Force, Reinforcement of Dependence, and Positive Modeling. Anxious parents (N = 136) and their non-anxious children (mean age 8.69; 55.9% female; 84.6% Caucasian) who participated in the Child Anxiety Prevention Study served as participants; independent evaluators conducted diagnostic interviews at baseline, post-intervention, and at 6- and 12-month follow-ups. Parental responses were assessed using the parent-report version of the adapted Child Development Questionnaire. At baseline parental use of Punishment, Force, and Positive Reinforcement were positively associated with child anxiety severity, after controlling for parental anxiety. The intervention, compared to the control condition, led to significant reductions in Reinforcement of Dependence at each time point and these changes mediated the intervention’s impact on child anxiety. Findings highlight the value of examining specific parental responses to children’s avoidance of feared situations and confirm that reducing parental accommodation is important to child anxiety prevention.

Child Anxiety Prevention Study: Impact on Functional Outcomes.

This study examined the impact of a selective anxiety prevention program for offspring of clinically anxious parents on three domains of child functioning: (1) social, (2) familial, and (3) emotional/behavioral. Dyads were randomized into either the Coping and Promoting Strength program (CAPS; n=70) or Information Monitoring (IM; n=66) comparison group. Multi-informant assessments were conducted at baseline, post intervention, and 6 and 12months follow-ups. Random effects mixed models under the linear growth modeling (LGM) framework was used to assess the impact of CAPS on growth trajectories. Over time, children in the CAPS group had significantly lower anxiety, anxious/depressed symptoms, and lower total behavior problems (parent report), compared to children in IM group. The intervention did not impact other domains assessed (e.g., social functioning), which may be due to "floor effects" on these measures. Longitudinal follow-up data is needed to provide valuable information about this high risk population.

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

BackgroundAnxiety 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/DesignPreventing 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.DiscussionThis 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 registrationISRCTN23563048

An explorative cost-effectiveness analysis of school-based screening for child anxiety using a decision analytic model

Anxiety in children is highly frequent and causes severe dysfunction. Various studies have used screening procedures to identify high-anxious children and offer them indicated prevention, but the cost-effectiveness of these screening procedures in combination with a preventive intervention has never been examined. This study compared four potential strategies in relation to the prevention of child anxiety: (1) a one-time school-based screening which offers a child-focused intervention, (2) the screening and offering of a parent-focused intervention, (3) the screening and differentially offering a child- or parent-focused intervention, depending on whether or not the parents are anxious themselves, and (4) or doing nothing. An economic evaluation from a societal perspective (i.e. including direct healthcare costs, direct non-healthcare costs, indirect costs, and out-of-pocket costs), using a decision-analytic model. The model was based on the real-world 2-year participation rates of screening and intervention, and real-world costs and effects of high- and median-anxious children (aged 8-12) from regular primary schools. Incremental cost-effectiveness ratios were calculated, and several secondary and one-way sensitivity analyses were performed. The strategy of doing nothing and the strategy of screening and differentially offering the child- or parent-focused intervention, depending on parental anxiety levels were both worthwhile, with the latter strategy costing relatively little extra money compared to doing nothing. In conclusion, some evidence for the cost-effectiveness of screening and intervening was found. Screening and offering a parent-focused intervention to children of anxious parents, and a child-focused intervention to children of non-anxious parents, were found to be the most cost-effective approach.

Cost-effectiveness of child-focused and parent-focused interventions in a child anxiety prevention program

In this study, the cost-effectiveness of three indicated anxiety prevention strategies was examined from a societal perspective. Children (aged 8–12) were recruited via primary schools, selecting children scoring as high-anxious on an anxiety screening questionnaire. Participating children and their parents were randomized to a child – a parent-focused, or non-intervention group. All groups completed a diagnostic interview and standardized cost-diaries at pretest, and 1- and 2-year follow-up. Incremental cost-effectiveness ratios per ‘ADIS improved’ child (based on diagnostic information) were calculated and cost-effectiveness acceptability curves and frontiers were plotted. The base-case and most secondary analyses showed it would be cost-effective to offer high-anxious children an intervention, and the parent-focused intervention to be the optimal strategy at lower monetary threshold values than the child-focused intervention and when parents were anxious. The child-focused intervention was dominant when analyses were performed from a healthcare perspective, for boys, and for children of grades 7–8 of primary school.

Mother and child interpretations of threat in ambiguous situations: Relations with child anxiety and autonomic responding.

This study examined maternal and child interpretive bias to threat (IBT) during dyadic conversation, child physiological reactivity and regulation during dyadic conversation, and maternal report of child anxiety in a community sample of 35 mothers and their 8- to 10-year-old children. Mothers and children discussed one neutral and six ambiguous scenarios, which were subsequently coded for frequency of maternal and child initiation, minimization, and expansion of threat-related themes. Child electrocardiogram data were collected during these conversations and maternal reports of child anxiety and internalizing problems were obtained. Across the sample, children initiated threat-related discussion more often than mothers. Maternal threat expansions were significantly positively correlated with child anxiety and internalizing behaviors. Maternal minimizations of threat were significantly associated with augmented child vagal tone throughout the IBT paradigm. Implications for prevention of child anxiety and directions for extending IBT research within the context of the mother-child dyad are discussed.

Efficacy of Child-Focused and Parent-Focused Interventions in a Child Anxiety Prevention Study

This study examined anxiety development in median- (n = 74) and high-anxious children (n = 183) aged 8–13, the effect of parent- and child-focused preventive interventions on child/parental anxiety, and the effect of parental anxiety on child anxiety. High-anxious children were randomized into a parent-focused (n = 69), child-focused (n = 58) or non-intervention (n = 56) group. Families completed a pretest and 1- and 2-year follow-ups. Children selected as high-anxious or at risk were found to remain more susceptible to having anxiety problems and developing anxiety disorders than median-anxious children. Both intervention types showed favorable outcomes compared to no intervention on the number of “ADIS improved” children. These findings underline the need for effective preventive interventions for child anxiety. General improvements over time were found for symptoms of child and parental anxiety, however, and parental anxiety did not predict improvement in child anxiety after controlling for intervention. Therefore, it may not be necessary to focus on parental anxiety in interventions aimed at preventing child anxiety.

Perioperative anxiety in children

OBJECTIVES & AIM: The purpose of this investigation was to examine children's anxiety across the perioperative setting. Although several studies have examined preoperative anxiety in children, few researchers have illustrated perioperative anxiety; that is, anxiety in children throughout the pre and postoperative continuum. Participants were 261 children ages 2-12. Anxiety was rated prior to surgery, immediately after surgery, and for 2 weeks at home following surgery. Low child sociability and high parent anxiety predicted perioperative anxiety. Perioperative anxiety was related to postoperative pain and negative postoperative behavioral change. Identification and prevention of anxiety in children can help prevent negative outcomes following surgery.

Prospective community study of family stress and anxiety in (pre)adolescents: the TRAILS study

For prevention of anxiety in children and adolescents, it is important to know whether family stress is a predictor of anxiety. We studied this in 1,875 adolescents from the Tracking Adolescents’ Individual Lives Survey (TRAILS) who were followed up for 2 years, from age 10–12 to 12–14 years. Adolescents reported anxiety and depression symptoms at both assessments, and parents reported family stress (family dysfunction and parenting stress) at the first assessment. Family dysfunction was not associated with future anxiety, whereas high parenting stress was. Furthermore, family dysfunction was more strongly associated with anxiety than with depression, whereas parenting stress was more strongly associated with depression. Level of parental psychopathology explained part of the association of family stress with anxiety. The associations were modest and the understanding of the origins of adolescents’ anxiety will require identifying other factors than family stress that account for more of the variance.

Table of Contents

AbstractComplexities of Assessing and Treating Sexually Deviant Behavior in YouthRestorative Justice: An Alternative Model Whose Time has ComeChildren's Beliefs About Causes of DepressionPsychopathologic Prevalence in 4 Year OldsFetal Alcohol Syndrome Distinct from ADHDEarly Onset Persistent vs. Childhood‐Limited Conduct ProblemsComplementary Alternative Medicine in Children With AutismOutcomes from the Child Anxiety Prevention StudyA Radical Proposal — Involuntary Sterilization

The Child Anxiety Prevention Study: Intervention model and primary outcomes.

The article presents the intervention model and primary outcomes of a preventive intervention designed to reduce anxiety symptoms and prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders. Participants were 40 volunteer children (mean age = 8.94 years; 45% girls; 90% Caucasian) whose parents met criteria for a broad range of anxiety disorders. Families were randomly assigned to an 8-week cognitive-behavioral intervention, the Coping and Promoting Strength program (CAPS; n = 20) or a wait list control condition (WL; n = 20). Independent evaluators (IEs) conducted diagnostic interviews, and children and parents completed measures of anxiety symptoms. Assessments were conducted pre- and postintervention and 6 and 12 months after the postintervention assessment. On the basis of intent to treat analyses, 30% of the children in the WL group developed an anxiety disorder by the 1-year follow-up compared with 0% in the CAPS group. IE and parent-reported (but not child-reported) levels of anxiety showed significant decreases from the preintervention assessment to the 1-year follow-up assessment in the CAPS but not the WL group. Parental satisfaction with the intervention was high. Findings suggest that a family-based intervention may prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders.

Clowns for the prevention of preoperative anxiety in children: a randomized controlled trial

To determine if specially trained professional clowns allayed preoperative anxiety and resulted in a smooth anesthetic induction compared to the use of midazolam or no intervention. This was a randomized, controlled, and blinded study conducted with children 3-8 years of age undergoing general anesthesia and elective outpatient surgery. Patients were assigned to one of three groups: Group 1 did not receive midazolam or clown presence; group 2 received 0.5 mg x kg(-1) oral midazolam 30 min before surgery up to a maximum of 15 mg; and group 3 had two specially trained clowns present upon arrival to the preoperative holding area and throughout operating room (OR) entrance and mask application for inhalation induction of anesthesia. The children were videotaped for later grading. The clown group had a statistically significant lower modified-Yale Preoperative Anxiety Scale score in the preoperative holding area compared to the control and midazolam group. The clowns' effect on anxiety reduction continued when the children entered the OR but was equal at this point to the midazolam group. Upon application of the anesthesia mask no significant differences were detected between the groups. This study found that the use of preoperative medically trained clowns for children undergoing surgery can significantly alleviate preoperative anxiety. However, clowns do not have any effect once the anesthesia mask is introduced.

Prevention of Anxiety in Children and Adolescents in a School Setting: The Role of School-Based Practitioners

Although anxiety disorders represent the primary reason children and adolescents are referred for mental health services, children showing symptoms of these disorders are not easily recognized. School-based practitioners are in a unique position to help minimize the risk and prevent the development of anxiety disorders. This article examines the importance of early intervention and the applicability of the three-tiered prevention model to treat anxiety disorders. The three-tiered approach to preventive intervention distinguishes between universal, selected, and targeted levels of prevention. Examples of interventions for anxiety at each level of the model are described, and the role of school-based practitioners in implementing these interventions is discussed.

Anxiety prevention programs for youth: Practical and theoretical considerations.

Empirical evidence addressing the effectiveness of anxiety prevention programs is limited. Caps identified in this literature provide a lifetime of opportunity for prevention scientists. This commentary extends the discussion of anxiety prevention to issues relevant for designing preventive interventions for youth. Three specific questions are discussed: a) Which “at-risk” youth should be targeted? b) When developmentally might preventive interventions have the greatest impact? and c) What specific intervention strategies might be most effective? Key components of the Child Anxiety Prevention Study are presented to illustrate one approach to designing a child anxiety prevention program.