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The Prevention of Child and Adolescent Anxiety: A Meta-analytic Review

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Abstract

The purpose of this study was to provide a comprehensive review of the effectiveness of child and adolescent anxiety prevention programs. Mean weighted effect sizes were calculated, and studies were encoded for potential moderator variables. A statistically significant effect size of .18 was obtained at post-intervention, which is consistent with effect sizes reported in reviews of depression, eating disorder, and substance abuse prevention programs. However, the effect sizes obtained at follow-up yielded mixed results. Significant moderators of program effectiveness were found including provider type (professional versus lay provider) and the use of the FRIENDS program. In contrast, program duration, participant age, gender, and program type (universal versus targeted) were not found to moderate program effectiveness. Clinical implications and directions for future research are discussed, including the need for more long-term follow-up, early prevention programs, and studies that systematically examine the impact of parent involvement on program effectiveness.

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Notes

  1. Studies using a single-group pretest-post design were excluded from overall effect size estimates. However, five pretest-post test effect sizes were available. Sufficient information to compute an estimate of the sampling variance was available for only two of these effect size estimates; therefore, a weighted mean effect size using the inverse of the sample variance was not computed. The five effects were weighted by sample size and produced a weighted mean effect size of .41. One study (Cooley et al. 2004) reported an unusually large effect size (d = 2.92). When this effect size was removed from the analysis, the effect size weighted by sample size produced a d of .33.

  2. One study (Siu 2007) demonstrated substantial departure (well over two standard deviations) from the other effects in terms of its overall magnitude (d = 1.65). The analyses were recomputed with this outlier removed. Removal of this unusually large effect and recalculation did not substantively affect the primary interpretation of the overall effect size, d = .18 (95% CI of 0.22 to .13), Z = 7.06, p < .001. The distribution of effect sizes continued to demonstrate heterogeneity, Q (25) = 89.86, p < .001. To prevent the effect size estimate from the Sui (2007) article from having undue influence on the moderator analyses, the value was removed from subsequent analyses.

References

References marked with an asterisk indicate studies included in the meta-analysis

  • *Aune T., & Stiles, T. C. (2010). Universal-based prevention of syndromal and subsyndromal social anxiety: A randomized controlled study. doi: 10.1037/a0015813.

  • *Barrett, P. M., Farrell, L. J., Ollendick, T. H., & Dadds, M. (2006). Long-term outcomes of an Australian universal prevention trial of anxiety and depression symptoms in children and youth: An evaluation of the Friends Program. Journal of Clinical Child and Adolescent Psychology, 35, 403-411. doi:10.1207/s15374424jccp3503_5.

    Article  PubMed  Google Scholar 

  • *Barrett, P. M., Lock, S., & Farrell, L. J. (2005). Developmental differences in universal preventive intervention for child anxiety. Clinical Child Psychology and Psychiatry, 10, 539-555. doi:10.1177/1359104505056317.

    Article  Google Scholar 

  • Barrett, P. M., Lowry-Webster, H., & Holmes, J. (1999). Friends for children group leader manual (2nd ed.). Brisbane: Australian Academic.

    Google Scholar 

  • *Barrett, P. M., Moore, A. F., & Sonderegger, R. (2000). The FRIENDS program for young former-Yugoslavian refugees in Australia: A pilot study. Behaviour Change, 17, 124-133. doi:10.1375/bech.17.3.124.

    Article  Google Scholar 

  • Barrett, P. M., & Pahl, K. M. (2006). School-based intervention: Examining a universal approach to anxiety management. Australian Journal of Guidance Counselling, 16, 55–75. doi:10.1375/ajgc.16.1.55.

    Article  Google Scholar 

  • *Barrett, P.M., Sonderegger, R., & Sonderegger, N. R. (2001). Evaluation of an anxiety-prevention and positive-coping program (FRIENDS) for children and adolescents of non-English-speaking background. Behaviour Change, 18, 78-91. doi:10.1375/bech.18.2.78.

    Article  Google Scholar 

  • *Barrett, P. M., Sonderegger, R., & Xenos, S. (2003). Using Friends to combat anxiety and adjustment problems among young migrants to Australia: A national trial. Clinical Child Psychology and Psychiatry, 8, 241-260. doi:10.1177/1359104503008002008.

    Article  Google Scholar 

  • *Barrett, P., & Turner, C. (2001). Prevention of anxiety symptoms in primary school children: Preliminary results from a universal school-based trial. British Journal of Clinical Psychology, 40, 399-410.

    Article  PubMed  CAS  Google Scholar 

  • Baumeister, H., & Härter, M. (2007). Prevalence of mental disorders based on general population surveys. Social Psychiatry and Psychiatric Epidemiology, 42, 537–546. doi:10.1007/s00127-007-0204-1.

    Article  PubMed  Google Scholar 

  • Borenstein, M., Hedges, L., & Rothstein, H. (2007). Meta-analysis: Fixed effect vs. random effects. www.MetaAnalysis.com. (Retrieved: December 10, 2008).

  • *Calear, A. L., Christensen, H., Mackinnon, A., Griffiths, K. M., & O’Kearney, R. (2009). The YouthMood Project: A cluster randomized controlled trial of an online cognitive behavioral program with adolescents. Journal of Consulting and Clinical Psychology, 77, 1021–1032. doi:10.1037/a0017391.

    Article  PubMed  Google Scholar 

  • Cartwright-Hatton, S., McNicol, K., & Doubleday, E. (2006). Anxiety in a neglected population: Prevalence of anxiety disorders in pre-adolescent children. Clinical Psychology Review, 26, 817–817.

    Article  PubMed  Google Scholar 

  • Chavira, D., Stein, M. B., Bailey, K., & Stein, M. T. (2004). Child anxiety in primary care: Prevalent but untreated. Depression and Anxiety, 20, 115–164. doi:10.1002/da.20039.

    Article  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Erlbaum.

    Google Scholar 

  • *Cooley, M. R., Boyd, R. C., & Grados, J. J. (2004). Feasibility of anxiety preventive intervention for community violence exposed African-American children. The Journal of Primary Prevention, 25, 105–123. doi:10.1023/B:JOPP.0000039941.85452.ea.

    Article  Google Scholar 

  • Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60, 837–844.

    Article  PubMed  Google Scholar 

  • *Cradock, C., Cotler, S., & Jason, L. A. (1978). Primary prevention: Immunization of child speech anxiety. Cognitive Therapy and Research, 4, 389–396.

    Article  Google Scholar 

  • Craske, M. G., & Zucker, B. (2002). Prevention of anxiety disorders: A model for intervention. Applied & Preventative Psychology, 10, 155–175. doi:10.1016/S0962-1849(01)80012-3.

    Article  Google Scholar 

  • *Dadds, M. R., Holland, K. R., Laurens, K. R., Mullins, M., Barrett, P. M., & Spence, S. H. (1999). Early intervention and prevention of anxiety disorders in children: Results at 2-year follow-up. Journal of Consulting and Clinical Psychology, 67, 145-150. doi:10.1037/0022-006X.67.1.145.

    Google Scholar 

  • *Dadds, M. R., & Roth, J. H. (2008). Prevention of anxiety disorders: Results of universal trial with young children. Journal of Child and Family Studies, 17, 320–335. doi:10.1007/s10826-007-9144-3.

    Article  Google Scholar 

  • *Dadds, M. R., Spence, S. H., Holland, D. H., Barrett, P. M., & Laurens, K. R. (1997). Prevention and early intervention for anxiety disorders: A controlled community trial. Journal of Consulting and Clinical Psychology, 65, 627–635.

    Article  PubMed  CAS  Google Scholar 

  • Donovan, C. L., & Spence, S. H. (2000). Prevention of childhood anxiety disorders. Clinical Psychology Review, 4, 509–531. doi:10.1016/S0272-7358(99)00040-9.

    Article  Google Scholar 

  • *Drake, K.L. (2007). Youth at risk for anxiety: Evaluation of a brief panic prevention program. Dissertation Abstracts International: Section B: The Sciences and Engineering, 68, 1921.

  • Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta­analysis detected by a simple, graphical test. British Medical Journal, 315, 629–634.

    PubMed  CAS  Google Scholar 

  • Farrell, L. J., & Barrett, P. M. (2007). Prevention of childhood emotional disorders: Reducing the burden of suffering associated with anxiety and depression. Child and Adolescent Mental Health, 12, 58–65. doi:10.1111/j.1475-3588.2006.00430.x.

    Article  Google Scholar 

  • Feldner, M. T., Zvolensky, M. J., & Schmidt, N. B. (2004). Prevention of anxiety psychopathology: A critical review of the empirical literature. Clinical Psychology: Science and Practice, 11, 405–424. doi:10.1093/clipsy.bph098.

    Article  Google Scholar 

  • *Felner, R. D., Norton, P. L., Cowen, E. L., & Farber, S. S. (1981). Prevention program for children experiencing life crisis. Professional Psychology, 12, 446–452. doi:10.1037/0735-7028.12.4.446.

    Article  Google Scholar 

  • Fingeret, M. C., Warren, C. S., Cepeda-Benito, A., & Gleaves, D. H. (2006). Eating disorder prevention research: A meta-analysis. Eating Disorders: The Journal of Treatment & Prevention, 14, 191–213. doi:10.1080/10640260600638899.

    Google Scholar 

  • Garber, J. (2006). Depression in children and adolescents: Linking risk research and prevention. American Journal of Preventative Medicine, 31, 104–125. doi:10.1016/j.amepre.2006.07.007.

    Article  Google Scholar 

  • *Gallegos, J. (2009). Preventing childhood anxiety and depression: Testing the effectiveness of a school-based program in Mexico. Dissertation Abstracts International Section A: Humanities and Social Sciences, 69, 4686.

  • *Gillham, J. E. (2003). Targeted prevention is not enough: Commentary on "Treatment is not enough: We must prevent major depression in women. Prevention and Treatment, 6.

  • Gillham, J. E., Reivich, K. J., Freres, D. R., Lascher, M., Litzinger, S., Shatte, A., et al. (2006). School-based prevention of depression and anxiety symptoms in early adolescence: A pilot of a parent intervention component. School-Psychology Quarterly, 21, 323–348. doi:10.1521/scpq.2006.21.3.323.

    Article  Google Scholar 

  • Gillham, J. E., Shatte, A. J., Reivich, K. (2001). Needed for prevention research: Long-term follow-up and the evaluation of mediators, moderators, and lay providers. Prevention and Treatment, 4.

  • *Ginsburg, G. S. (2009). The child anxiety prevention study: Intervention model and primary outcomes. Journal of Consulting and Clinical Psychology, 77, 580–587. doi:10.1037/a0014486.

    Article  PubMed  Google Scholar 

  • Ginsburg, G. S., & Drake, K. L. (2002). School-based treatment for anxious African-American adolescents: A controlled pilot study. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 768–775. doi:10.1097/00004583-200207000-00007.

    Article  Google Scholar 

  • Gleser, L. J., & Olkin, I. (1994). Stochastically dependent effect sizes. In H. Cooper & L. V. Hedges (Eds.), The handbook of research synthesis (pp. 339–355). New York: Sage.

    Google Scholar 

  • Gottfredson, D. C., & Wilson, D. B. (2003). Characteristics of effective school-based substance abuse prevention. Prevention Science, 4, 27–38. doi:10.1023/A:1021782710278.

    Article  PubMed  Google Scholar 

  • Hedges, L. V. (1981). Distribution theory for Glass's estimates of effect size and related estimators. Journal of Educational and Behavioral Statistics, 6, 107–128. doi:10.3102/10769986006002107.

    Article  Google Scholar 

  • Hirshfeld-Becker, D. R., & Biederman, J. (2002). Rationale and principles for early intervention with young children at risk for anxiety disorders. Clinical Child and Family Psychology Review, 5, 161–172. doi:10.1023/A:1019687531040.

    Article  PubMed  Google Scholar 

  • Horowitz, J. L., & Garber, J. (2006). The prevention of depressive symptoms in children and adolescents: A meta-analytic review. Journal of Consulting and Clinical Psychology, 74, 401–415. doi:10.1037/0022-006X.74.3.401.

    Article  PubMed  Google Scholar 

  • Jane-Llopis, E., Hosman, C., Jenkins, R., & Anderson, P. (2003). Predictors of efficacy in depression programmes: Meta-analysis. British Journal of Psychiatry, 183, 384–397. doi:10.1192/bjp.183.5.384.

    Article  PubMed  Google Scholar 

  • *Kennedy, S., Rapee, R., & Edwards, S. (2009). A selective intervention program for inhibited preschool-aged children of parents with an anxiety disorder: Effects on current anxiety disorders and temperament. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 602–609. doi:10.1097/CHI.0b013e31819f6fa9.

    Article  PubMed  Google Scholar 

  • *Kiselica, M. S., Baker, S. B., Thomas, R. N., & Reedy, S. (1994). Effects of stress inoculation training on anxiety, stress, and academic performance among adolescents. Journal of Counseling Psychology, 41, 335–342.

    Article  Google Scholar 

  • *LaFreniere, P. J., & Capuano, F. (1997). Preventive intervention as means of clarifying direction of effects in socialization: Anxious-withdrawn preschoolers case. Development and Psychopathology, 9, 551–564.

    Article  PubMed  CAS  Google Scholar 

  • Langley, A. K., Bergman, R. L., McCracken, J., & Piacentini, J. C. (2004). Impairment in childhood anxiety disorders: Preliminary examination of the child anxiety impact scale-parent version. Journal of Child and Adolescent Psychopharmacology, 14, 105–114. doi:10.1089/104454604773840544.

    Article  PubMed  Google Scholar 

  • Last, C. G., Perrin, S., Hersen, M., & Kazdin, A. E. (1996). A prospective study of childhood anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 35, 1502–1510. doi:10.1097/00004583-199611000-00019.

    Article  CAS  Google Scholar 

  • *Lock, S., & Barrett, P. M. (2003). A longitudinal study of developmental differences in universal preventive intervention for child anxiety. Behaviour Change, 20, 183–199. doi:10.1375/bech.20.4.183.29383.

    Article  Google Scholar 

  • *Lowry-Webster, H. M., Barrett, P. M., & Dadds, M. R. (2001). A universal prevention trial of anxiety and depression symptomatology in childhood: Preliminary from an Australian study. Behaviour Change, 18, 36–50. doi:10.1375/bech.18.1.36.

    Article  Google Scholar 

  • *Lowry-Webster, H. M., Barrett, P. M., & Lock, S. (2003). A universal prevention trial of anxiety symptomology during childhood: Results at 1-year follow-up. Behaviour Change, 20, 25–43. doi:10.1375/bech.20.1.25.24843.

    Article  Google Scholar 

  • Masia-Warner, C., Klein, R. G., Dent, H. C., Fisher, P. H., Alvir, J., Albano, A. M., et al. (2005). School-based intervention for adolescents with social anxiety disorder: Results of a controlled study. Journal of Abnormal Child Psychology, 33, 707–722. doi:10.1007/s10802-005-7649-z.

    Article  PubMed  Google Scholar 

  • *McLaughlin, K.A. (2008). A public health approach to the study and prevention of adolescent depression & anxiety. Dissertation Abstracts International: Section B: The Sciences and Engineering, 69, 3272.

  • *Mifsud, C., & Rapee, R. M. (2005). Early intervention for childhood anxiety in a school setting: Outcomes for an economically disadvantaged population. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 996–1004. doi:10.1097/01.chi.0000173294.13441.87.

    Article  PubMed  Google Scholar 

  • Mrazek, P. J., & Haggerty, R. J. (Eds.). (1994). Reducing the risks for mental disorders: Frontiers from preventative intervention research. Washington: National Academy.

    Google Scholar 

  • Neil, A. L., & Christensen, H. (2009). Efficacy and effectiveness of school-based prevention and early intervention programs for anxiety. Clinical Psychology Review, 29, 208–215. doi:10.1016/j.cpr.2009.01.002.

    Article  PubMed  Google Scholar 

  • *Rapee, R. M., Kennedy, S., Ingram, M., Edwards, S., & Sweeney, L. (2005). Prevention and early intervention of anxiety disorders in inhibited preschool children. Journal of Consulting and Clinical Psychology, 73, 488–497. doi:10.1037/0022-006X.73.3.488.

    Article  PubMed  Google Scholar 

  • Reynolds, C. R., & Richmond, B. O. (1985). The revised children's manifest anxiety scale: Manual. New York: Western Psychological Services.

    Google Scholar 

  • *Roberts, C. M., Kane, R., Bishop, B., Cross, D., Fenton, J., & Hart, B. (2010). The prevention of anxiety and depression in children from disadvantages schools. Behaviour Research and Therapy, 48, 68–73.

    Article  PubMed  Google Scholar 

  • *Rose, H., Miller, L., & Martinez, Y. (2010). FRIENDS for Life: The results of a resilience-building, anxiety-prevention program in a Canadian elementary school. Professional School Counseling, 12, 400–407. doi:10.5330/PSC.n.2010-12.400.

    Article  Google Scholar 

  • Rosenthal, R. (1979). The “File-drawer Problem” and tolerance for null results. Psychological Bulletin, 86, 638–641.

    Article  Google Scholar 

  • *Simpson, A. T. (2007). The roles of self-regulation and coping in a preventative cognitive-behavioural intervention for school-age children at-risk for internalizing disorders. Dissertation Abstracts International: Section B: The Sciences and Engineering, 69, 3862.

  • *Siu, A. F. Y. (2007). Using FRIENDS to combat internalizing problems among primary school children in Hong Kong. Journal of Cognitive and Behavioral Psychotherapies, 7, 11–26.

    Google Scholar 

  • Spence, S. H., & Shortt, A. L. (2007). Can we justify the widespread dissemination of universal, school-based interventions for the prevention of depression among children and adolescents? Journal of Child Psychology and Psychiatry, 48, 526–542. doi:10.1111/j.1469-7610.2007.01738.x.

    Article  PubMed  Google Scholar 

  • Spoth, R., Trudeau, L., Guyll, M., Shin, C., & Redmond, C. (2009). Universal intervention effects on substance sue among young adults medicated by delayed adolescent substance initiation. Journal of Consulting and Clinical Psychology, 77, 620–632. doi:10.1037/a0016029.

    Article  PubMed  Google Scholar 

  • *Stallard, P., Simpson, N., Anderson, S., Carter, T., Osborn, C., & Bush, S. (2005). An evaluation of the FRIENDS programme: A cognitive behaviour therapy intervention to promote emotional resilience. Archives of Disease in Childhood, 90, 1016–1019.

    Article  PubMed  CAS  Google Scholar 

  • *Stallard, P., Simpson, N., Anderson, S., & Goddard, M. (2008). The FRIENDS emotional health prevention programme: 12 month follow-up of a universal UK school based trial. European Child & Adolescent Psychiatry, 17, 283–289. doi:10.1007/s00787-007-0665-5.

    Article  Google Scholar 

  • *Stallard, P., Simpson, N., Anderson, S., Hibbert, S., & Osborn, C. (2007). The FRIENDS Emotional Health Programme: Initial findings from a school-based project. Child and Adolescent Mental Health, 12, 32–37. doi:10.1111/j.1475-3588.2006.00421.x.

    Article  Google Scholar 

  • *Stallard, P., Velleman, R., Salter, E., Howse, I., Yule, W., & Taylor, G. (2006). A randomized controlled trial to determine the effectiveness of an early psychological intervention with children involved in road traffic accidents. Journal of Child Psychology and Psychiatry, 47, 127–134. doi:10.1111/j.1469-7610.2005.01459.x.

    Article  PubMed  Google Scholar 

  • Stice, E., & Shaw, H. (2004). Eating disorder prevention programs: A meta-analytic review. Psychological Bulletin, 130, 206–227. doi:10.1037/0033-2909.130.2.206.

    Article  PubMed  Google Scholar 

  • Zvolensky, M. J., Schmidt, N. B., Bernstein, A., & Keough, M. E. (2006). Risk-factor research and prevention programs for anxiety disorders: A translational research framework. Behaviour Research and Therapy, 44, 1219–1239. doi:10.1016/j.brat.2006.06.001.

    Article  PubMed  Google Scholar 

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  1. University of North Florida, Jacksonville, FL, USA

    Brian J. Fisak Jr. & Dan Richard

  2. University of South Florida, Tampa, FL, USA

    Angela Mann

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Fisak, B.J., Richard, D. & Mann, A. The Prevention of Child and Adolescent Anxiety: A Meta-analytic Review. Prev Sci 12, 255–268 (2011). https://doi.org/10.1007/s11121-011-0210-0

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