Early intervention of anxiety in preschoolers involving social skills training and parent education

Anxiety disorders are able to be diagnosed in children as young as 3 years of age. The primary aim of this thesis was to evaluate an early intervention program that targeted children at a high-risk of anxiety disorders. In order to determine key issues pertaining to prevention interventions, a detailed review of anxiety prevention programs was first presented in chapter 2. This review examined early intervention and prevention efforts targeted at specific types of anxiety such as PTSD and panic disorder, and also at those aimed at broader, non-specific forms of anxiety. Preliminary results have been encouraging, with universal and targeted prevention interventions showing some positive results. Several issues were identified and discussed in detail. These issues included favourable methods used for identifying at-risk participants, motivation for compliance with the prevention programs, optimal age for intervention as well as the expertise necessary for administration of the intervention. Following the review, chapter 3 reported an early intervention program targeted at preschoolers with high risk factors for anxiety. This 6-session brief intervention program targeted core risk factors and combined parent-education with direct social skills training for the child. Seventy-two children aged 3 to 5 years were selected based on high behavioral inhibition levels and concurrently having a parent with high emotional negativity. Families were randomly assigned to either the combined intervention group or waitlist. After six months, families on the waitlist were offered a treatment consisting of the parent-education component only. Compared with the waitlist, children in the combined parent and child intervention showed significantly greater reduction on measures of anxiety disorders, symptoms, life interference and behavioral inhibition at the 6-month follow-up. These children maintained their gains at the 12-month follow-up. Quasi-experimental comparisons of the two active treatments (combined Vs parent-only) showed that those who attended the combined intervention had slightly better outcomes. A comparison of effect sizes between the combined condition and previous parent-only interventions showed that the inclusion of a child component has the potential to increase the effects of the intervention. Finally, chapter 4 examined the influence of parental overprotection as a moderator of treatment outcome and the role of overprotection as a mediator through which interventions achieve their effects. The data set used for this study was a combination of the cohort from chapter 3 and another data set from a previous early intervention (Kennedy, Rapee, & Edwards, 2009). Ninety-five children aged between 3 to 5 years, with known risks for anxiety such as high behavioral inhibition and parental anxiety received an intervention program. Changes in parental overprotection, clinician severity ratings of anxiety disorders and parent-reported anxiety symptoms were examined. The analyses were based on the 81 mothers and 64 fathers who returned questionnaires at the 6-month follow-up. Results reflected a negative relationship between baseline maternal overprotection and the outcome of treatment measured by clinician severity ratings, but a non-significant relationship when outcome was measured using maternal-reported anxiety symptoms. This suggests that maternal overprotection may only moderate some aspects of treatment outcome that is measured by clinicians. On the other hand, overprotection by fathers at baseline was not found to be associated with clinician ratings or paternal-reported symptoms. Finally, changes in both maternal and paternal overprotection were not found to be significantly associated with treatment outcome reported by either clinicians or parents, suggesting that the treatment did not achieve its effects through the alteration of parental overprotection.