Preventing Anxiety Disorders in Children and Adolescence
Paper 2
Ashanti S. Nedrick
PSY 36300
Spring 2023
Professor Haley Hancock
The City College of New York
May 11, 2023
Preventing Anxiety Disorders in Children and Adolescence
Introduction
Pediatric anxiety disorders are possible to prevent, yet US adolescents are not receiving evidence-based therapies (EBIs). The issue of whether efficacy can be maintained is raised by the modification of evidence-based interventions (EBI). The study’s major goal was to see whether community providers could implement their redesign with satisfactory levels of authenticity, quality, and effect of prevention and early intervention for adolescents. Results of the process evaluation revealed strong protocol fidelity, outstanding clinical process skills, a low number of protocol changes, and high (streamlined prevention and early intervention) SPEI satisfaction. Overall results point to the possibility that the modified SPEI might be a desirable and effective option for service delivery contexts (Armando A. Pina et.al, 2020). This randomized controlled study examined a condensed set of cognitive, behavioral, and social skill training techniques that are proven to stop and lessen the progression of anxiety symptoms and disorders in adolescents. A total of 109 adolescents who were considered at risk due to high anxiety levels were randomly assigned to the SPEI or control group and evaluated at the pretest, posttest, and 12-month follow-up. Overall, Armando A. Pina et.al hypothesized that SPEI participants would outperform participants in the control group in the immediate posttest and continue to improve at the 12-month follow-up. Additionally, they anticipated that kids with higher baseline anxiety would exhibit meaningful reductions in anxiety symptoms, which would be in accordance with extensive preventative studies demonstrating that those most at risk manifest benefits before their less severe peers.
I) Risk and Protective Factors
Armando A. Pina et.al states that it is most effective to treat young people’s anxiety in small groups of primary school children who have comparable social and emotional development needs. This study focuses on parents who are considered unmarried with a history of college education and a family income of between 20-40k. This is to see if marital status and family income relates to the parent relationship between the caregiver and the daughters of each family. The adolescents in this are girls who identify as African American, Native American, Latinx, or White as their race, as well as their ethnicity, is considered too to see if there is a significant difference in each race/ethnicity when testing for anxiety.
II) Malleable Factors
Armando A. Pina et.al discusses factors in the study that they hope to change throughout the study. Anxiety is quite common among parents and has been associated with depression, anxiety symptoms, and becoming unemployed as an adult. It frequently doesn’t go away on its own without intervention. Their tier-2 intervention was intended to minimize physiological hyperarousal and cognitive errors while also improving self-efficacy and social competence for handling anxiety-provoking settings (Armando A. Pina et.al, 2020).
III) Targeted Groups/Population
Armando A. Pina et.al discusses a change in focus from the signs to a self-evaluation of coping skills, and maybe even recognition of uncontrollability. The lack of coping skills raises negative emotions and physical arousal, which facilitates information processing distortions and anxiety. When it happens, pathological anxiety shows up as avoidance and prolonged CNS arousal. As a result, their approach to preventing the emergence of anxiety disorders in children is to improve their ability to handle cues. This is in line with studies on child anxiety that demonstrate improvements in coping self-efficacy generally, as well as immediate and beneficial cognitive restructuring, come before improvements in anxiety symptoms. Children with social and emotional issues who had anxiety symptoms were explicitly included in this study. Therefore, both of the specified stages of intervention are indicated in this study. People who are considered high risk with current symptoms and those who have a history of having anxious symptoms are indicated and are the ones who should receive special attention.
IV) Intervention Groups
The ability of community providers to implement their redesign with acceptable levels of authenticity, quality, and effect was one of the primary goals. The findings of the process evaluation revealed strong protocol fidelity, outstanding clinical process skills, a low number of protocol changes, and high SPEI satisfaction. Using a scale created by Fagan et al. (2012), fidelity, clinical process skills, modifications, content understanding, and program use were measured. Implementation was measured weekly for each session, with scores for each group receiving the SPEI being added across all aspects and sessions. After addressing any disagreements with the researchers, observers rated youth active involvement throughout sessions (0 = not at all; 5 = very, very much) with 100% inter-rater reliability. Armando A. Pina et.al used children’s self-reports to gauge satisfaction and stigma (Armando A. Pina et.al, 2020). Researchers use both children’s and parents’ self-reports to measure children’s anxiety. They also used student feedback from the Children’s Self-Efficacy Questionnaire for Handling School Situations to gauge program aims related to the fear-emotion theories mentioned. The SPEI is a six-session, six-week program that is tier-2 and is available to children during school hours. Each session lasts around 20 to 30 minutes. The SPEI is a training program for social, behavioral, and cognitive abilities. In the SPEI, parents, and teachers are in touch every week by email or postcard to explain the skill for the week and to urge kids to practice it throughout the course of the next six weeks and beyond. Sessions 1-6 with young people prepare them for and give corrective feedback that focuses on skill generalization (Armando A. Pina et.al, 2020). Armando A. Pina et.al then chose staff members (social workers, school psychologists) to act as providers. Teachers then sent home permission slips for 1539 screenings along with a brochure for parents of students enrolled in normal classes. As mentioned before, Armando A. Pina et.al uses both children’s and parents’ self-reports to measure children’s anxiety. They also used student feedback from the Children’s Self-Efficacy Questionnaire for Handling School Situations to gauge program aims related to the fear-emotion theories as their equipment. The three commercially accessible novels that made up the control group were: “A Guide for Children on What to Do When You’re Scared”, “Worried How To Get Organized Without Going Crazy” and “How To Finish Your Homework Without Puking”. Books and instructions are delivered to each household as part of this environmentally sound arm, and a phone call to the caregiver is then made to promote at-home practice. The interventions were received and conducted in the schools in Maricopa, Arizona, where teachers and parents as well, were a part of the study to teach the kids a new skill every week. The study placed quite a bit of attention on cultural background. Most of the kids in this study were a part of the Latinx culture while some were considered either white or other. With the exception of sex, there were no noticeable changes in the sociodemographic traits of identified and non-identified children. Although, more girls were identified in this study than boys. The study’s intervention phase lasted for approximately six to seven weeks. After they finished their post-test two months later, follow-up sessions started.
V) Research Methodologies
In Maricopa County, Arizona, 859 general education students (girls = 52%; White = 37%, Latinx = 45%, other = 18%) were examined at the school. 109 of the 142 eligible kids were randomly assigned to the SPEI or the control. There were no appreciable variations in sociodemographic traits (Armando A. Pina et.al, 2020). The average of all of the components was used to get the total scores for each scale. Armando A. Pina et.al employed child and parent self-reports from the SCAS and the MASC to quantify children’s anxiety. The Anxiety Disorders Interview Schedule for Children’s diagnosis of a child’s anxiety is predicted by the SCAS and MASC. The DSM pediatric anxiety symptoms are assessed by the MASC, whereas the SCAS focuses on normal levels of anxiety. Armando A. Pina et.al also employed adolescent responses from the Children’s Self-Efficacy Questionnaire for Handling School Situations, the Physiological Hyperarousal Scale for Children, and the Children’s Negative Cognitive Error Questionnaire to measure program aims connected to the fear-emotion theories mentioned (Armando A. Pina et.al, 2020). Using t-tests and x2 tests, they examined differences in 16 demographic and baseline characteristics between adolescents randomly assigned to the SPEI and those in the control arm. Each adolescent and parent outcome was regressed on the group assignment and baseline status on the outcome in intent-to-treat analyses. They looked at whether baseline status for adolescent and caregiver reports on the MASC, individually, influenced the effects of the SPEI on anxiety. Armando A. Pina et.al investigated whether Latinx vs non-Hispanic White ethnicity affected the SPEI’s effects on anxiety (Armando A. Pina et.al, 2020). 109 participants were allocated and randomized into this study. 50 were allocated to the control group and 59 were allocated to the experimental group (SPEI), leaving 45 completing the posttest from the control and 56 completing the posttest in the experimental group. 7 children and 15 parents dropped out from the posttest because some were not able to locate back from the study. Altogether, 91 completed the study after 2 month’s follow-up while 10 parents and 10 children dropped the study before the follow-up.
VI) Implementation
Depending on participant availability, participants were exposed to the intervention condition for six to seven weeks. There were a total of six 20 to 30-minute-long intervention sessions. The training concentrated on integrity in delivery and separating program strategies from change components. Work in environments of cultural diversity was covered in the course. Armando A. Pina et.al made no further in-person or online assistance available. Clinical data were gathered by study participants at the pretest, posttest (week 7), and FU (12 months), who were blind to the randomization and the hypotheses. The SPEI provided training for seven school psychologists and two school social workers, each of whom serves one or two schools. The original handbook was condensed from 40 to 12 pages, the lessons were reworked into cooperative game-based learning methodologies, and the handouts were transformed into game-based scoring cards. A 1-day/5-hour training at the school district site, two weeks before implementation, with no monetary compensation from the researchers, followed by no supervision from the researchers but support from trained peers implementing at other schools, was packaged as training for school staff providers to fit with desired training practices. Additionally, instructional resources were created to illustrate how anxiety affects academic performance for parents, teachers, and principals.
VII) Outcomes
There were not any apparent main or moderating effects of the SPEI on the outcomes at the post-test (week 7). However, compared to those in the control group, kids in the SPEI at the FU reported higher levels of self-efficacy for handling anxiety-provoking circumstances. Additionally, compared to controls, kids in the SPEI reported improved social skills and less detrimental cognitive mistakes. On autonomic arousal, there were no significant major effects discovered. The SCAS revealed that 109 adolescents had significant levels of anxiety at the pretest, but 48% of SPEI students and 39% of control students failed to meet the threshold at FU. Higher-risk children in the SPEI reported less anxiety at the FU based on the MASC scale and less anxiety overall based on the SCAS scale compared to those in the control group. They modified many tried-and-true cognitive, behavioral, and social skills interventions known to prevent and treat children’s anxiety disorders and symptoms in this study. The redesign might’ve succeeded in achieving the stated aims of developing an effective and appealing intervention for schools, according to both the procedure and outcome evaluations. Overall, there were fewer new cases than expected due to the lack of participants who were unable to locate. During the duration of this study, no negative effects were noted. Funding was supported by The National Institute of Mental Health. The contributors alone are responsible for the content, which does not necessarily reflect the funding organization’s official viewpoints. The Institutional Review Board examined and gave its approval to all study methods and procedures. There were a few changes in this study as well. There were increased levels of self-efficacy in the experimental group compared to the control group. There were also increased levels of social skills and fewer anxiety symptoms as well as decreased levels of anxiety in children who were at high risk. Lastly, there were fewer cognitive errors present in this study.
VIII) Conclusions and Future Recommendations
This study has a number of limitations. All young people were screened using the same score threshold. Cutoffs for Lx, a significant portion of the sampled population, were not available. Armando A. Pina et.al discovered that Lx adolescents are subject to greater cutoffs as a result of this investigation. Therefore, it’s possible that we overidentified Lx adolescents. Second, the stability of anxiety before randomization is uncertain since the inclusion criteria for anxiety were based on one evaluation point. Third, sample size restrictions prevent us from detecting anything except the medium effect size for results of the main and moderating effects (Armando A. Pina et.al, 2020). Due to the partially structured design and limited sample size, they took into consideration clustering by the schools, yet they did not take that into account for grouping by intervention group. Finally, while SPEI effects could be shown at 12-month FU, the exact time of such effects could not be determined. Early identification of changes in the program goals may point to opportunities to strengthen the delivery of treatment in school mental health practice and to speed prevention and recovery by increasing program dose.
References
Pina, A. A., Gonzales, N. A., Mazza, G. L., Gunn, H. J., Holly, L. E., Stoll, R. D., Parker, J., Chiapa, A., Wynne, H., & Tein, J.-Y. (2020). Streamlined Prevention and Early Intervention for Pediatric Anxiety Disorders: A Randomized Controlled Trial. Prevention Science, 21(4), 487–497. https://doi-org.ccny-proxy1.libr.ccny.cuny.edu/10.1007/s11121-019-01066-6
