Abstract
The high prevalence and early onset of anxiety disorders have inspired innovative prevention efforts targeting young at-risk children. With parent–child prevention models showing success for older children and adolescents, the goal of this study was to evaluate a parent–child indicated preventive intervention for preschoolers with mild to moderate anxiety symptoms. Sixteen children (ages 3–5) and at least one of their parents participated in Strengthening Early Emotional Development (SEED), a new 10-week intervention with concurrent groups for parents and children. Outcome measures included clinician-rated and parent-rated assessments of anxiety symptoms, as well as measures of emotion knowledge, parent anxiety, and parental attitudes about children’s anxiety. Participation in SEED was associated with reduced child anxiety symptoms and improved emotion understanding skills. Parents reported decreases in their own anxiety, along with attitudes reflecting enhanced confidence in their children’s ability to cope with anxiety. Reductions in child and parent anxiety were maintained at 3-month follow-up. Findings suggest that a parent–child cognitive-behavioral preventive intervention may hold promise for young children with mild to moderate anxiety. Improvements in parent anxiety and parental attitudes may support the utility of intervening with parents. Fostering increased willingness to encourage their children to engage in new and anxiety-provoking situations may help promote continued mastery of new skills and successful coping with anxiety.
Similar content being viewed by others
References
Merikangas KR, He J, Burstein M, Swanson SA, Avenevoli S, Cui L et al (2010) Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 49:980–989
Costello EJ, Egger HL, Angold A (2005) The development epidemiology of anxiety disorders: phenomenology, prevalence, and comorbidity. Child Adolesc Psychiatr Clin N Am 14:631–648
Edwards SL, Rapee RM, Kennedy SJ, Spence SH (2010) The assessment of anxiety symptoms in preschool-age children: the revised Preschool Anxiety Scale. J Clin Child Adolesc Psychol 39:400–409
Spence SH, Rapee R, McDonald C, Ingram M (2001) The structure of anxiety symptoms among preschoolers. Behav Res Ther 39:1293–1316
Ialongo N, Edelsohn G, Werthamer-Larsson L, Crockett L, Kellam S (1994) The significance of self-reported anxious symptoms in first-grade children. J Abnorm Child Psychol 22:441–455
Ialongo N, Edelsohn G, Werthamer-Larsson L, Crockett L, Kellam S (1995) The significance of self-reported anxious symptoms in first grade children: prediction to anxious symptoms and adaptive functioning in fifth grade. J Child Psychol Psychiatry 36:427–437
Feng X, Shaw DS, Silk JS (2008) Developmental trajectories of anxiety symptoms among boys across early and middle childhood. J Abnorm Psychol 117:32–47
Mian ND, Wainwright L, Briggs-Cowan MJ, Carter AS (2011) An ecological risk model for early childhood anxiety: the importance of early child symptoms and temperament. J Abnorm Child Psychol 39:501–512
Merikangas KR, He JP, Burstein M, Swendsen J, Avenevoli S, Case B et al (2011) Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 50:32–45
Essau CA (2005) Frequency and patterns of mental health services utilization among adolescents with anxiety and depressive disorders. Depress Anxiety 22:130–137
Bayer JK, Rapee RM, Hiscock H, Ukoumunne OC, Mihalapolous C, Wake M (2011) Translational research to prevent internalizing problems early in childhood. Depress Anxiety 28:50–57
Fox JK, Halpern LF, Forsyth JP (2008) Mental health checkups for children and adolescents: a means to identify, prevent, and minimize suffering associated with anxiety and mood disorders. Clin Psychol Sci Pract 14:182–211
Hirshfeld-Becker DR, Biederman J (2002) Rationale and principle for early intervention with young children at risk for anxiety disorders. Clin Child Fam Psychol Rev 5:161–172
Rapee RM, Kennedy SJ, Ingram M, Edwards SL, Sweeney L (2010) Altering the trajectory of anxiety in at-risk young children. Am J Psychiatry 167:1518–1525
Feldner MT, Zvolensky MJ, Schmidt NB (2004) Prevention of anxiety psychopathology: a critical review of the empirical literature. Clin Psychol Sci Pract 11:405–424
Neil AL, Christensen H (2009) Efficacy and effectiveness of school-based prevention and early intervention programs for anxiety. Clin Psychol Rev 29:208–215
Dadds MR, Roth JH (2008) Prevention of anxiety disorders: results of a universal trial with young children. J Child Fam Stud 17:320–335
Kennedy SJ, Rapee RM, Edwards SL (2009) Selective intervention program for inhibited preschool-aged children of parents with an anxiety disorder: effects on current anxiety disorders and temperament. J Am Acad Child Adolesc Psychiatry 48:602–609
LaFreniere PJ, Capuano F (1997) Preventive intervention as means of clarifying direction of effects in socialization: anxious-withdrawn preschoolers case. Dev Psychopathol 9:551–564
Rapee RM, Kennedy S, Ingram M, Edwards S, Sweeney L (2005) Prevention and early intervention of anxiety disorders in inhibited preschool children. J Consult Clin Psychol 73:488–497
Horowitz JL, Garber J (2006) The prevention of depressive symptoms in children and adolescents: a meta-analytic review. J Consult Clin Psychol 74:401–415
Merry S, McDowell H, Hetrick S, Bir J, Muller N (2004) Psychological and/or educational interventions for the prevention of depression in children and adolescents. Cochrane Database Syst Rev 2:CD003380
Stice E, Shaw H, Bohon C, Marti CN, Rohde P (2009) A meta-analytic review of depression prevention programs for children and adolescents: factors that predict magnitude of intervention effects. J Consult Clin Psychol 77:486–503
Hirshfeld-Becker DR, Masek B, Henin A, Blakely LR, Pollock-Wurman RA, McQuade J et al (2010) Cognitive behavioral therapy for 4- to 7-year-old children with anxiety disorders: a randomized clinical trial. J Consult Clin Psychol 78:489–510
Monga S, Young A, Owens M (2009) Evaluating a cognitive behavioral therapy group program for anxious five to seven year old children: a pilot study. Depress Anxiety 26:243–250
Dadds MR, Spence SH, Holland DE, Barrett PM, Laurens KR (1997) Prevention and early intervention for anxiety disorders: a controlled trial. J Consult Clin Psychol 65:627–635
Vasey MW, Dadds MR (2001) An introduction to the developmental psychopathology of anxiety. In: Vasey MW, Dadds MR (eds) The developmental psychopathology of anxiety. Oxford University Press, New York, pp 3–26
Eley TC, Bolton D, O’Connor TG, Perrin S, Smith P, Plomin R (2003) A twin study of anxiety-related behaviours in pre-school children. J Child Psychol Psychiatry 44:945–960
Eley TC, Gregory AM, Lau JY, McGuffin P, Napolitano M, Rijsdijk FV et al (2008) In the face of uncertainty: a twin study of ambiguous information, anxiety, and depression in children. J Abnorm Child Psychol 36:55–65
Lau JY, Pine DS (2008) Elucidating risk mechanisms of gene-environment interactions on pediatric anxiety: Integrating findings from neuroscience. Eur Arch Psychiatry Clin Neurosci 258:97–106
Eley TC, Napolitano M, Lau JY, Gregory AM (2010) Does childhood anxiety evoke maternal control? A genetically informed study. J Child Psychol Psychiatry 51:772–779
Rubin RH, Nelson LJ, Hastings P, Asendorpf J (1999) The transaction between parents’ perceptions of their children’s shyness and their parenting styles. Int J Behav Dev 23:937–957
Burstein M, Ginsburg GS (2010) The effect of parental modeling of anxious behaviors and cognitions in school-aged children: an experimental pilot study. Behav Res Ther 48:506–515
Moore PS, Whaley SE, Sigman M (2004) Interactions between mothers and children: impacts of maternal and child anxiety. J Abnorm Psychol 113:471–476
Rubin KH, Burgess KB, Hastings PD (2002) Stability and social-behavioral consequences of toddlers’ inhibited temperament and parenting behaviors. Child Dev 73:483–495
Ginsburg GS (2009) The Child Anxiety Prevention Study: intervention model and primary outcomes. J Consult Clin Psychol 77:580–587
Brotman LM, Calzada E, Huang KY, Kingston S, Dawson-McClure S, Kamboukos D et al (2011) Promoting effective parenting practices and preventing child behavior problems in school among ethnically diverse families from underserved, urban communities. Child Dev 82:258–276
Brotman LM, Gouley KK, Chesir-Teran D, Dennis T, Klein RG, Shrout P (2005) Prevention for preschoolers at high risk for conduct problems: immediate outcomes on parenting practices and child social competence. J Clin Child Adolesc Psychol 34:724–734
Brotman LM, Gouley KK, Huang KY, Rosenfelt A, O’Neal C, Klein RG et al (2008) Preventive intervention for preschoolers at familial risk for antisocial behavior: long-term effects on child physical aggression and parenting practices. J Clin Child Adolesc Psychol 37:386–396
Silverman WK, Albano AM (1996) The anxiety disorders interview schedule for children for DSM-IV (child and parent versions). Psychological Corporation, San Antonio
Domitrovich CE, Cortes R, Greenberg MT (2007) Improving young children’s social and emotional competence: a randomized trial of the Preschool PATHS Program. J Prim Prev 28:67–91
Rapee RM, Lyneham HJ, Schniering CA, Wuthrich V, Abbott MA, Hudson JL et al (2006) The cool kids child and adolescent anxiety program therapist manual. Centre for Emotional Health, Macquarie University, Sydney
Barrett PM, Dadds MR, Rapee RM (1996) Family treatment of childhood anxiety: a controlled trial. J Consult Clin Psychol 64:333–342
Research Units on Pediatric Psychopharmacology Anxiety Study Group (2001) Fluvoxamine for the treatment of anxiety disorders in children and adolescents. N Engl J Med 344:1279–1285
Research Units on Pediatric Psychopharmacology Anxiety Study Group (2002) The Pediatric Anxiety Rating Scale (PARS): development and psychometric properties. J Am Acad Child Adolesc Psychiatry 41:1061–1069
Ginsburg GS, Keeton CP, Drazdowski TK, Riddle MA (2011) The utility of clinicians ratings of anxiety using the Pediatric Anxiety Rating Scale (PARS). Child Youth Care For 40:93–105
Broeren S, Muris P (2008) Psychometric evaluation of two new parent-rating scales for measuring anxiety symptoms in young Dutch children. J Anxiety Disord 22:949–958
Denham SA (1986) Social cognition, prosocial behavior, and emotion in preschoolers: contextual validation. Child Dev 57:194–201
Garner PW, Jones DC, Miner JL (1994) Social competence among low-income preschoolers: emotion socialization practices and social cognitive correlates. Child Dev 65:622–637
Meyer TJ, Miller ML, Metzger RL, Borkovec TD (1990) Development and validation of the Penn State Worry Questionnaire. Behav Res Ther 28:487–495
Thienemann M, Moore P, Tompkins K (2006) A parent-only group intervention for children with anxiety disorders: pilot study. J Am Acad Child Adolesc Psychiatry 45:37–46
Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale
Southam-Gerow MA, Kendall PC (2002) Emotion regulation and understanding: implications for child psychopathology and therapy. Clin Psychol Rev 22:189–222
Burstein M, Ginsburg GS, Tien J-Y (2010) Parental anxiety and child symptomatology: an examination of additive and interactive effects of parent psychopathology. J Abnorm Child Psychol 38:897–909
Acknowledgments
This research was supported by a federal grant awarded to Drs. Carrie Masia Warner and Christopher Lucas from the National Institute of Mental Health, R34, MH075917. The authors would like to thank all of the children and parents who participated, as well as the research assistants who helped with data collection and entry, including Emily Ocner and Corinne Sweeney.
Conflict of interest
Drs. Fox, Masia Warner, Ludwig, Ryan, Colognori, Lucas, and Brotman, and Ms. Lerner report no biomedical financial interests or potential conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fox, J.K., Warner, C.M., Lerner, A.B. et al. Preventive Intervention for Anxious Preschoolers and Their Parents: Strengthening Early Emotional Development. Child Psychiatry Hum Dev 43, 544–559 (2012). https://doi.org/10.1007/s10578-012-0283-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10578-012-0283-4