Reduce Anxiety In Children Research Articles

Investigating the psychometric properties of PaRCADS-Parenting to Reduce Child Anxiety and Depression Scale in a Norwegian sample.

Parents play a pivotal role in child development and several parental factors have been identified as risk or protective factors for childhood anxiety and depression. To assess and target these parental factors in interventions, there is a need for a comprehensive, easy-to-use instrument. This study aimed to investigate the psychometric properties of an adapted version of the Parenting to Reduce Child Anxiety and Depression Scale, PaRCADS(N) in a Norwegian community sample (N=163) of parents of children aged 8-12years. Our findings indicate that PaRCADS(N) has acceptable psychometric properties. These results are comparable to those of the original study of the PaRCADS in Australia. Based on these results, we recommend that PaRCADS(N) can be utilized by health care workers as a tool for assessment and identification of parental practices related to child anxiety and/or depression to target relevant risk and protective factors in treatment and prevention.

A Comparative Study on Effectiveness of Parental Presence versus Sedative Premedication for Reducing Anxiety in Children Undergoing General Anesthesia.

Preoperative anxiety is an important, yet often unattended problem in children. Minimizing anxiety and distress at the time of anesthetic induction may reduce adverse psychological and physiological outcomes. Sedative premedication and parental presence during anesthesia induction are among the most commonly employed strategies for reducing child anxiety. The study aimed to compare the effectiveness of a pharmacological intervention (premedication with midazolam) versus behavioral intervention (parental presence) in reducing preoperative anxiety in children undergoing general anesthesia. Sixty patients of age group of 4-12 years, of ASA Grade 1 and 2 and either sex posted for elective surgery under general anesthesia were divided into two groups of 30 each Group M (midazolam group) and Group P (parental presence). Group M received intravenous midazolam 0.03-0.05 mg/kg preoperatively and anxiety was measured in preoperative room, during separation from parents and during introduction of anesthesia mask, whereas in Group P, parents accompanied the child inside the operation theater and anxiety was measured at preoperative room and during introduction of mask. Parental anxiety was measured in both groups at preoperative room and waiting room. Modified Yale Preoperative Anxiety Scale (mYPAS) and State Trait Anxiety Inventory (STAI) tool was used to measure anxiety in children and parents, respectively. The mean mYPAS score while the introduction of anesthesia mask in Group M was 31.30 ± 12.04 and in Group P was 63.19 ± 25.31, and the difference was found to be statistically significant (P = 0.001). In preoperative room, there was no significant difference in anxiety in the two study groups. The mean STAI score in Group P was 45.63 ± 1.45 and in Group M was 41.10 ± 1.69, and the difference was found to be statistically significant (P = 0.001). In preoperative room, parental anxiety was found to be comparable among the two groups. The mean duration of induction of anesthesia in Group M was 5.53 ± 1.01 min, and in Group P, it was 8.77 ± 2.03 min. The difference was found to be statistically significant (P = 0.001). Both interventions were effective in reducing anxiety in children, but midazolam was more effective compared to parental presence. Parents in Group M were less anxious in the waiting room than Group P. Children in Group M were more compliant during the induction of anesthesia, hence a lesser duration of induction than Group P.

Effectiveness of a Web-Based Intervention to Prevent Anxiety in the Children of Parents With Anxiety: Protocol for a Randomized Controlled Trial.

Anxiety is the most common childhood mental health condition and is associated with impaired child outcomes, including increased risk of mental health difficulties in adulthood. Anxiety runs in families: when a parent has anxiety, their child has a 50% higher chance of developing it themselves. Environmental factors are predominant in the intergenerational transmission of anxiety and, of these, parenting processes play a major role. Interventions that target parents to support them to limit the impact of any anxiogenic parenting behaviors are associated with reduced anxiety in their children. A brief UK-based group intervention delivered to parents within the UK National Health Service led to a 16% reduction in children meeting the criteria for an anxiety disorder. However, this intervention is not widely accessible. To widen access, a 9-module web-based version of this intervention has been developed. This course comprises psychoeducation and home practice delivered through text, video, animations, and practice tasks. This study seeks to evaluate the feasibility of delivering this web-based intervention and assess its effectiveness in reducing child anxiety symptoms. This is the protocol for a randomized controlled trial (RCT) of a community sample of 1754 parents with self-identified high levels of anxiety with a child aged 2-11 years. Parents in the intervention arm will receive access to the web-based course, which they undertake at a self-determined rate. The control arm receives no intervention. Follow-up data collection is at months 6 and months 9-21. Intention-to-treat analysis will be conducted on outcomes including child anxiety, child mental health symptoms, and well-being; parental anxiety and well-being; and parenting behaviors. Funding was received in April 2020, and recruitment started in February 2021 and is projected to end in October 2022. A total of 1350 participants have been recruited as of May 2022. The results of this RCT will provide evidence on the utility of a web-based course in preventing intergenerational transmission of anxiety and increase the understanding of familial anxiety. ClinicalTrials.gov NCT04755933; https://clinicaltrials.gov/ct2/show/NCT04755933. DERR1-10.2196/40707.

Comparison of the effectiveness of online supportive parenting intervention (SPACE) and timid to tiger program (FTTT) on childhood anxiety disorders and family accommodation with samples of Iranian parents.

Studies have supported the effectiveness of the From Timid to a Tiger (FTTT) and Supportive Parenting for Anxious Childhood Emotions (SPACE) program in reducing childhood anxiety. This study is the first to compare the effectiveness of the two programs in the treatment of childhood anxiety disorder and reducing family accommodations levels. Parents of children aged 6 to 9 (n = 49, 49% boys) were randomly allocated to either FTTT (n 26) or SPACE (n = 23) groups, and each attended ten online sessions following the manuals of the interventions. Throughout the study, 9 participants dropped out, resulting in a total of 49 participants, and we performed statistical analyses based on data from these 49 participants. The assessment took place pre- and post-treatment and at a ten-week follow-up on parent-rated child anxiety and family accommodation measures. Analyses of variance (repeated measures) and gain scores were conducted to examine the data. The results indicated that both treatments approaches produced significant reductions in outcome measures, and the post-treatment gains of both treatments were maintained at a ten-week follow-up, though when considering the mean differences and effect sizes across the assessment scores and between groups, overall, the FTTT was significantly more effective in reducing child anxiety scores and family accommodation levels. Our results demonstrated that FTTT significantly outperformed the SPACE program in reducing childhood anxiety problems and family accommodation levels.

When a Flower Does Not Bloom: Design a School Group Play Programme for Reducing Anxiety in Children Aged 4 to 6 Years with and without Autism Spectrum Disorder- A Scoping Review

This research designed a peer-mediated play programme for reducing anxiety for children aged 4 to 6 years with autism spectrum disorder (ASD) based on a scoping review in preparation of a systematic literature review. Specifically, the research sought to identify the prevalence of concurrent anxiety disorders and autism spectrum disorder, and the needs of children with comorbid anxiety and ASD. The methodology utilised a scoping review of the literature regarding the available non-pharmacological play-based intervention to reduce anxiety in children with concurrent anxiety and ASD. Six databases were selected, and search terms included “autism“, “anxiety”, “worry”, “children”, “intervention”, “group”, “therapy”, “peer”, “lego”, “duplo”, and “play therapy”. Results showed that the majority of the approaches were cognitive behavioural therapy (CBT) (41), one Lego-Based Therapy, and eight play-based approaches. This paper will report on the effectiveness of the eight other approaches which has never been discussed. Based on these findings, we propose an innovative, overarching group intervention to be conducted in school settings. This research makes a valuable contribution to knowledge in the area of early intervention and ASD studies. It expands the scope of Universal Design by applying a UDL framework to early intervention. It also proposes an overarching framework to place children in their bio-ecological context and incorporate neurodiversity, contributing to Hong Kong, Ireland and beyond.

The psychological impact of COVID-19 quarantine on children, and the role of parental support and physical environment design

Coronavirus disease 2019 is a contagious infection that caused a global lockdown and affected children who needed to stay home. There is a lack of knowledge about the role of parental stress and physical environment design on children’s mental wellbeing in quarantine. We hypothesis that COVID-19 quarantine affected child mental health, and that paternal stress or support, and child physical environment including household space, colors, sunlight exposure, and natural views, impacted child mental wellbeing in the quarantine. To assess the effect of quarantine on a child’s mental health, an online survey was administered globally through scientific organizations and social media. Those over 18 years old, and guardians of children were asked to participate in the survey. The survey was filled by 114 guardians from 31 countries. Descriptive statistics were used to summarize the data. Most participants experienced stress in the quarantine and reported child anxiety symptoms including focus reduction, sleeping difficulties, and appetite changes. Family fun activities and encouraging words, were mostly successful in reducing child anxiety. Reporting anxiety symptoms in children were more common in parents who had mental hardships compared to those who did not experience mental problems or had an improved mental status. Physical environment assessment showed that households with bright walls associated with fewer reports of child mental problems compared to households with neutral wall colors, and that most guardians thought that their children’s living space was not sufficient to play and study. Architects can provide evidence-based recommendations for customers to support children’s mental health.

Evaluation of a parent-led cognitive behaviour therapy programme in routine clinical practice: A controlled trial.

Parent-led cognitive behavioural therapy for child anxiety disorders have garnered a growing evidence base. However, it is unclear how such approaches translate into routine clinical practice. The current study aims to evaluate the effectiveness of an 8-session treatment (From Timid to Tiger) in reducing child anxiety and behavioural difficulties, as well as family accommodation. The parents of 71 children (aged 4-11) were assigned to the treatment or a waitlist control. Parent report measures were completed pre-treatment, at treatment-end, and at 3-month follow-up. Parents assigned to the waitlist were assessed 8weeks after the initial assessment. Findings indicated that parents who attended the group reported significant reductions in child anxiety and behavioural difficulties. In addition, the parents in the treatment group reported a reduction in family accommodation compared to those in the waitlist. The current control trial provides tentative evidence of the use and effectiveness of such parent-led approaches in addressing child anxiety difficulties commonly seen in routine clinical practice. PRACTITIONER POINTS: Parent-led approaches are effective treatments in managing child anxiety difficulties. Very little research to date has assessed the effectiveness of such approaches in routine clinical practice. The From Timid to Tiger program is a brief parent-led CBT intervention. The programme was effective in reducing child anxiety and behavioural difficulties. Parents also reported a reduction in behaviours related to family accommodation. Such programmes show promise and can be used in routine clinical practice.

SPACE, Parent-Based Treatment for Childhood and Adolescent Anxiety: Clinical Case Illustration

Efficacious treatments for childhood anxiety disorders include Cognitive Behavioral Therapy (CBT) and medications, yet there is urgent need for additional efficacious treatment modalities. Parent-based treatment provides such an alternative. Recent literature has supported that SPACE (Supportive Parenting for Anxious Childhood Emotions), an entirely parent-based treatment, is as efficacious as CBT in reducing child anxiety. SPACE focuses on systematically reducing family accommodation, or changes to parental behavior aimed at alleviating or avoiding a child's distress related to their anxiety disorder, while maintaining a supportive stance toward the child. To date, SPACE is the only intervention that places the reduction of parental accommodation at the center of its theoretical foundation and treatment objectives. This article provides theoretical and empirical background for SPACE and illustrates its implementation through a case description.

Music Therapy and Bibliotherapy to Reduce Child Anxiety When Given Intravenous Therapy

Introduction: Children often experience anxiety when undergoing the treatment process at the hospital. Efforts to reduce such anxiety can be done with music therapy and bibliotherapy. This study aims to analyze the differences in the effectiveness of music therapy and bibliotherapy in reducing anxiety in children before getting intravenous therapy.Methods: The research design was quasi-experimental, with the pretest and posttest approach. The population was 178 with 32 samples, each of the 16 respondents were given music therapy and bibliotherapy using a purposive sampling technique. Data were collected with observation sheets from the adoption of the HAM-A scale, analyzed by the Wilcoxon test and independent T test at a significance level of p ≤ 0.05.Results: There were differences in children's anxiety when getting intravenous therapy before and after music therapy and bibliotherapy with p = 0.001 (p <0.05), and there was no difference in the effectiveness of the two p values = 0.91 (p> 0.05), but the average bibliotherapy reduced anxiety by 65%, and music therapy by 57%.Conclusion: Bibliotherapy can be given as complementary therapy in children before intravenous therapy.

واقع مشارکة الوالدین فی برامج التدخل اللغوی المبکر للأطفال من ذوی التأخر اللغوی من وجهة نظر معالجی النطق واللغة The reality of Parents' participation in early language intervention programs for children with language delay from the perspective of speech and language therapists

هدفت الدراسة إلى التعرف على مشارکة الوالدين في برامج التدخل اللغوي للأطفال من ذوي التأخر اللغوي من وجهة نظر معالجي النطق واللغة، ولتحقيق هدف الدراسة استخدمت الباحثة المنهج الوصفي، عبر بناء أداة الدراسة وتحتوي الاستبانة على (٤٣) عبارة، وتکونت عينة الدراسة من (٢٣٧)، وتوصلت الدراسة إلى النتائج التالية: أن أبرز ملامح صور مشارکة الوالدين حدوثا تتمثل في توجيه الوالدين خيارات لطفلهما أثناء عرض الأشياء عليه، بينما جاءت أقل ملامح صور مشارکة الوالدين حدوثا في حرص الوالدين على کتابة التقييم المنزلي لطفلهما أسبوعيا وذلک من وجهة نظر المعالجين. وأن أبرز فوائد مشارکة الوالدين تتضح في العبارة التالية وهي: تساهم مشارکة الوالدين في برنامج التدخل اللغوي في تحسين اللغة التعبيرية لطفلهما، بينما جاءت العبارة تساعد مشارکة الوالدين في برنامج التدخل اللغوي في خفض قلق الطفل وخوفه من التواصل مع الآخرين من أقل العبارات رتبة من وجهة نظر المعالجين. وأن أبرز معوقات مشارکة الوالدين تتمثل في العبارة التالية وهي: اعتقاد الوالدين بأن المعالج هو المسؤول المباشر عن التطور اللغوي للطفل بينما جاءت العبارة تدني قدرة المعالجين على التعامل بفاعلية مع الوالدين کشريک مهم في برامج التدخل اللغوي المبکر من أقل العبارات رتبة من وجهة نظر المعالجين. أما فيما يخص الاستراتيجيات الفاعلة التي يمکن أن يستخدمها معالجو النطق واللغة لتنمية مشارکة الوالدين في برامج التدخل اللغوي للأطفال من ذوي التأخر اللغوي تتمثل العبارة الأعلى رتبة يقوم المعالجون بتوعية الوالدين بالأساليب والأدوات للتدريب في المنزل ، في حين أن توثيق الجلسات التدريبية مع الطفل من خلال تسجيل الفيديو ليستفيد منها الوالدان جاءت من أقل العبارات رتبة من وجهة نظر المعالجين The study aimed at identifying the participation of parents in early language intervention programs for children with language delays from the perspective of speech and language therapists. To achieve the goal of the study, the researcher used the descriptive method and developed the study tool; namely, a questionnaire with (43) phrases covering four topics. The sample of the study consisted of (237) speech and language therapists at the level of the regions of Saudi Arabia. The study reached the following results: The most prominent feature of parents’ participation was the “parents’ offer of options to their children while presenting items to them”, and the least common feature of parents’ participation from the therapist's point of view was “parental keenness to carry out their child's weekly assessment”. The main benefit of parents’ participation was expressed in the following phrase, “parents’ participation in early language intervention program contributes to the improvement of the child's expressive language”, while the phrase, “parents’ participation in early language intervention program helps reduce child anxiety and fear of communicating with others” came last according to the therapists. The most prominent barrier to parents’ participation was expressed in the following statement, “parents believe that the therapist is directly responsible for the child's language development”, while “therapists have low ability to deal effectively with parents as an important partner in early language intervention programs” was one of the least ranked statements from the perspective of therapists. For effective strategies that speech and language therapists can use to develop parents’ participation in early language intervention programs for children with language delays, the highest-level phrase was “therapists educate parents about methods and tools for home training,” while “training sessions with the child are documented by the means of video recording for the benefit of the parents” came at the bottom of the list from the point of view of the therapists.

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.

Aerobic exercise training reduces anxiety in children

Introduction Aerobic exercise seems to decrease anxiety in children. However, those studies are subject to methodological deficiencies (e.g. no control group, cross-sectional study). Therefore, we conducted a longitudinal study where we investigated how 10-week of aerobic or coordination training affects the anxiety of primary school children. Method Sixty-four children aged 9–10 years were randomly divided into an aerobic (AE; n =25), a coordinative (CE, n =23) and a control group (CON, n =20). The intervention groups received three times a week for 10 weeks for 45minutes additional physical education. The AE completed an aerobic exercise training at an intensity of 60–70% of maximum heart rate (HR max ). The CE completed a coordinative training, with an intensity of 55–65% of HR max . Anxiety was measured by the external version of the State-Trait Anxiety Inventory for Children (STAIC PTD). Results and discussion A repeated-measures ANOVA of group (AE, CE, CON)×test time (pre, post) showed a significant reduction in anxiety over time, F (1, 64)=7.337, P =.009, η 2 .=.103. The interaction effect of group x test time was also significant, F (2, 64)=3.445, P =.037, η 2 =.097. Only participants in the AE showed decreased anxiety ( P =.009). In the post-measurement, AE significantly differed from CE ( P =.023); the difference to CON was marginally significant ( P =.081). The results are discussed in terms of exercise type and the slightly different intensities of the experimental groups.

Family-Based Intervention May Help Prevent Anxiety Disorders in Children

Family-Based Intervention May Help Prevent Anxiety Disorders in Children

Changing problematic parent–child interaction in child anxiety disorders: The promise of Acceptance and Commitment Therapy (ACT)

Anxiety disorders present a significant concern for children, affecting up to 20% of those under 12 years old. The importance of parenting behavior in the development and maintenance of childhood anxiety disorders has been established both theoretically and empirically. We review the literature on cognitive-behavioral parenting interventions aimed at reducing child anxiety and discuss the limitations of this approach and of the research to date. We then present Acceptance and Commitment Therapy (ACT) as a treatment model that holds promise for shifting problematic parent–child interactions, and we review the relevant theoretical and empirical literature supporting this promise.

Enhancing the Capacity of School Nurses to Reduce Excessive Anxiety in Children: Development of the CALM Intervention.

Excessive anxiety is among the most common psychiatric problems facing youth. Because anxious youth tend to have somatic complaints, many seek help from the school nurse. Thus, school nurses are in an ideal position to provide early intervention. This study addresses this problem and describes the plans to develop and test a new intervention (Child Anxiety Learning Modules; CALM), delivered by school nurses, to reduce child anxiety and improve academic functioning. An iterative development process including consultation with an expert panel, two open trials, and a pilot randomized controlled study comparing CALM to usual care is proposed. Feedback will be solicited from all participants during each phase and data on outcome measures will be provided by children, parents, teachers, and independent evaluators. Data will be collected on intervention satisfaction and feasibility. Primary outcomes that include child anxiety symptoms, classroom behavior, and school performance (e.g., attendance, grades, standardized test scores) will be collected at pre- and post-interventions and at a 3-month follow-up evaluation. Pediatric anxiety is a common problem that school nurses frequently encounter. Consequently, they are well positioned to play a key role in enhancing access to behavioral health interventions to reduce anxiety and may therefore make a significant positive public health impact.

Can School-based CBT Programmes Reduce Anxiety in Children? Results From the Preventing Anxiety in Children Through Education in Schools (PACES) Randomised Controlled Trial.

Introduction Cognitive Behaviour Therapy (CBT) is an effective psychological intervention for children and young people with anxiety disorders (James et al, 2013). This has led to interest in whether CBT programmes can be widely provided in schools to prevent or ameliorate anxiety symptoms in children. Objective Results from school based anxiety prevention trials are encouraging (Neil & Christensen 2009; Fisak, Richard, Mann 2011). Before the widespread use of school based preventive programmes can be advocated methodologically robust evaluations are required to demonstrate that they are effective when transported to everyday settings. Aim To undertake a pragmatic randomised controlled trial (RCT) of a universal school based CBT programme (Friends for Life) for children aged 9-10 years of age . Methods Three arm RCT comparing Friends for Life delivered by trained health or school leaders with usual school provision (Stallard et al,2012). Primary outcome the Revised Child Anxiety and Depression Scale (RCADS) at 12 month follow-up. Results A total of 1362 children from 40 schools participated with 1257 (92%) being re-assessed at follow-up. There was a difference in adjusted mean child report RCADS scores for health-led versus school-led FRIENDS (−3.94, 95%CI −6.41 to −1.47) and health-led FRIENDS versus usual school provision (2.66, 95%CI −5.22 to −0.09). Health-led CBT resulted in greater reductions in symptoms of anxiety than the other two arms (Stallard et al 2014), Conclusion Our pragmatic trial demonstrates that universally delivered anxiety prevention programmes can be effective when transported into schools. However, effectiveness varies depending upon who delivers them.

Preparation of parents by teaching of distraction techniques does not reduce child anxiety at anaesthetic induction.

Introduction For those children having surgery, induction of anaesthesia is one of the most stressful procedures the child experiences perioperatively. Current work has failed to show a benefit of parental presence at induction of anaesthesia for all children. The reasons for lack of effect may include the high anxiety levels of some parents and also that the role for parents at their child's induction is not delineated. The main aim of this study was to see if parental preparation by teaching of distraction techniques could reduce their child's anxiety during intravenous induction of anaesthesia.Methods After ethics committee approval 40 children aged 2–10 years old, ASA status I or II undergoing daycase surgery under general anaesthesia were enrolled into the study. To avoid possible confounding factors children with a history of previous, surgery, chronic illness or developmental delay were excluded form participation. No children were given sedative premedication. After written informed consent by the parent, each child and parent was randomly assigned to an intervention or control group. Parents in the intervention group received preparation from a play specialist working on the children's surgical ward. It involved preparation for events in the anaesthetic room and instruction on methods of distraction for their child during induction using novel toys, books or blowing bubbles appropriate to the child's age. Preoperative information collected included demographic and baseline data. The temperament of the child was measured using the EASI (Emotionality, Activity, Sociability, Impulsivity) instrument of child temperament(l). In the anaesthetic room all children were planned to have intravenous induction of anaesthesia after prior application of EMLA cream. Anxiety of the child was measured by the modified Yale Preoperative Anxiety Scale (mYPAS)(2) by a blinded independent observer at three time points: entrance to the anaesthetic room, intravenous cannulation and at anaesthesia induction. Cooperation of the child was measured by the Induction Compliance Checklist (ICC) by the same observer (3). Postoperative data collected included parental satisfaction and anxiety scores measured by the Stait Trait Anxiety Inventory (STAI)(4) and at one week the behaviour of the child was measured Using the Posthospitalisation Behavioural Questionnaire (PHBQ)(5). Normally distributed data were analysed by a two‐sample t‐test, categorical data by Pearson's Chi‐squared test and non‐parametric data by the Wilcoxon rank‐sum test.Results One parent withdrew after enrolment. This left 22 children in the control group and 17 in the intervention group. There were no significant differences in demographic and baseline data of the children between the two groups including ethnic origin, number of siblings, birth order of the child, recent stressful events in the child's life, previous hospital admissions and the temperament of the child. Parent demographics were also similar between groups including parent's age, sex, relationship to child and level of education. There were no significant differences in child anxiety or cooperation during induction measured by mYPAS and ICC between the control and intervention groups. More parents in the preparation group distracted their child than those without preparation but this did not reach significance. Parental anxiety immediately postinduction was similar between groups as was the level of parental satisfaction. The incidence of development of new negative postoperative behaviour of the child at one week was not significantly different between groups.Discussion This study shows that giving an active role for parents in the induction room, particularly by instructing them on distracting techniques for their child, does not reduce their child's anxiety compared to conventional parental presence. We conclude resources should not be directed at this type of parental preparation. Further work should examine the usefulness of distraction by nursing staff or play specialists during anaesthetic induction.

Commentary: well-established treatments for procedure-related pain: issues for future research and policy implications.

administration of a topical anesthetic provided a greater reduction in child self-reported anxiety and nurse ratings of child anxiety during the venipuncture than the use of the topical anesthetic alone. These results suggest that interventions that combine a behavioral approach with a pharmacological approach may be more effective than pharmacologic approaches, particularly in reducing child anxiety. Although pain may be treated effectively using

Tell-show-do: reducing anticipatory anxiety in emergency paediatric dental patients

Tell-show-do is widely used as a means of managing paediatric dental patients. Although widely used, the ability of this technique to prepare, acclimatise and reduce child anxiety remains an area for research. Two hundred children referred in pain for general anaesthetic extractions were invited to take part. They were randomly divided into intervention and control groups. Anticipatory anxiety was assessed using an observational schedule and by monitoring heart rate prior to and during treatment. The children in the intervention group had lower observed anxiety and heart rate prior to treatment compared with the control children. However, tell-show-do was unable to reduce heart rate in children who had previous experience of general anaesthesia. The work presented here has important implications for all those involved in providing invasive health care for children. This study illustrates the role of tell-show-do for preparing new child patients while demonstrating its limitations in reducing anticipatory anxiety in those who have previous experience of dental treatment.

Psychological Preparation of Children for Hospitalization and Surgery

Most medical staff will agree that it is important to reduce child anxiety prior to medical procedures, hospitalization, or surgery. Certain children are at increased risk for responding poorly to these circumstances, including those who have a history of responding poorly to medical situations, have a negative prior experience with a similar or the same medical procedure, are younger than 7 years old, have a predisposition to avoidant coping styles, have parents who have a punishing style of response or foster dependency/avoidance behavior, have parents who cope poorly with stress themselves, or have parents who are in a high state of anxiety relative to the impending procedure.