Top

Published in:

01-09-2011

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

Authors: Brian J. Fisak Jr., Dan Richard, Angela Mann

Published in: Prevention Science | Issue 3/2011

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.

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.

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.

*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.PubMedCrossRef

*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.CrossRef

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

*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.CrossRef

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.CrossRef

*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.CrossRef

*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.CrossRef

*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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.CrossRef

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

*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.CrossRef

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.PubMedCrossRef

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

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.CrossRef

*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.

*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.CrossRef

*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.PubMedCrossRef

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.CrossRef

*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

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.CrossRef

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.CrossRef

*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.CrossRef

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.

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.CrossRef

*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.CrossRef

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.PubMedCrossRef

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.CrossRef

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.

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.PubMedCrossRef

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.CrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

*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.PubMedCrossRef

*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.CrossRef

*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.PubMedCrossRef

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.PubMedCrossRef

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.CrossRef

*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.CrossRef

*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.CrossRef

*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.CrossRef

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.PubMedCrossRef

*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.PubMedCrossRef

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

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.PubMedCrossRef

*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.PubMedCrossRef

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

*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.PubMedCrossRef

*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.CrossRef

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

*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.

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.PubMedCrossRef

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.PubMedCrossRef

*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.PubMedCrossRef

*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.CrossRef

*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.CrossRef

*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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

Title: The Prevention of Child and Adolescent Anxiety: A Meta-analytic Review
Authors: Brian J. Fisak Jr.
Dan Richard
Angela Mann
Publication date: 01-09-2011
Publisher: Springer US
Published in: Prevention Science / Issue 3/2011
Print ISSN: 1389-4986
Electronic ISSN: 1573-6695
DOI: https://doi.org/10.1007/s11121-011-0210-0

At a glance: The STEP trials

Springer Medicine

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

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2011

Earlier Age of Smoking Initiation May Not Predict Heavier Cigarette Consumption in Later Adolescence

Food Insufficiency and Medication Adherence Among People Living with HIV/AIDS in Urban and Peri-Urban Settings

Sustaining Fidelity Following the Nationwide PMTO™ Implementation in Norway

Effects of a Social-Emotional and Character Development Program on the Trajectory of Behaviors Associated with Social-Emotional and Character Development: Findings from Three Randomized Trials

The Developmental Impact of Two First Grade Preventive Interventions on Aggressive/Disruptive Behavior in Childhood and Adolescence: An Application of Latent Transition Growth Mixture Modeling

Effects of Communities That Care on the Adoption and Implementation Fidelity of Evidence-Based Prevention Programs in Communities: Results from a Randomized Controlled Trial