Brief, Non-Pharmacological, Interventions for Pediatric Anxiety: Meta-Analysis and Evidence Base Status.

In 1998, Ost published [One-session treatment of specific phobias-a rapid and effective method] [in Swedish] giving rise to the idea that brief, intensive, and concentrated psychosocial interventions could exhibit public health impact. At this juncture, and per criteria of the Society for Clinical Child and Adolescent Psychology, there are data supporting that brief, non-pharmacological intervention [prescriptions] for pediatric anxiety can be considered well-established or probably efficacious. In addition, data from 76 randomized controlled trials (N = 17,203 youth) yield an overall mean effect size of 0.19 on pediatric anxiety outcomes (pre-post). Note, however, that effect sizes vary significantly. These data point to the capacity for clinical change coming from in-vivo exposures for specific phobias (~3 h, one session), CBT with social skills training (~3 h, six sessions for indicated prevention and early intervention), and CBT-based parent training (~6 h, eight digital modules with clinician support). Given such evidence, we recommend efforts be made to establish ways to position such treatment innovations for rapid deployment facilitated by high-quality training, monitoring, technical assistance, and ongoing disclosures.

Streamlined Prevention and Early Intervention for Pediatric Anxiety Disorders: A Randomized Controlled Trial.

There is a need to optimize the fit between psychosocial interventions with known efficacy and the demands of real-word service delivery settings. However, adaptation of evidence-based interventions (EBI) raises questions about whether effectiveness can be retained. This randomized controlled trial (RCT) evaluated a streamlined package of cognitive, behavior, and social skills training strategies known to prevent and reduce anxiety symptom and disorder escalation in youth. A total of 109 youth (Mage = 9.72; 68% girls; 54% Latinx) at risk based on high anxiety were randomized to the streamlined prevention and early intervention (SPEI) (n = 59) or control (n = 50) and were assessed at pretest, posttest, and 12-month follow-up. A main objective was to determine whether our redesign could be delivered by community providers, with acceptable levels of fidelity, quality, and impact. In terms of process evaluation results, there was high protocol fidelity, excellent clinical process skills, few protocol adaptations, and high satisfaction with the SPEI. In terms of outcomes, there were no significant main or moderated effects of the SPEI at the immediate posttest. However, at the follow-up, youth in the SPEI reported greater self-efficacy for managing anxiety-provoking situations, greater social skills, and fewer negative cognitive errors relative to controls. Collectively, findings suggest that the redesigned SPEI might be an attractive and efficient solution for service delivery settings.

Evidence-Based Psychosocial Interventions for Ethnic Minority Youth: The 10-Year Update.

This is the official update on the status of evidence-based psychosocial interventions for ethnic minority youth. Compared to a decade ago, there has been expansion of well-designed intervention studies, growth in the number (not type) of interventions meeting evidence-based criteria, and greater focus on testing ethnicity/race moderator effects. In terms of standard of evidence, 4 psychosocial interventions are now well-established and 10 are probably efficacious or possibly efficacious, with most protocols drawing on cognitive and behavioral change procedures and/or family systems models. Yet the research literature remains mostly focused on testing interventions with European Americans (White Caucasians), and little to no progress has been made in testing the effects of interventions with Asian American or Native American youth. Knowledge of the effects of cultural tailoring on program engagement, outcomes, and mechanisms of change remains scant.

Prediction of Children's Early Academic Adjustment from Their Temperament: The Moderating Role of Peer Temperament.

The goal of the study was to examine whether target children's temperamental negative emotional expressivity (NEE) and effortful control in the fall of kindergarten predicted academic adjustment in the spring and whether a classmate's NEE and effortful control moderated these relations. Target children's NEE and effortful control were measured in the fall via multiple methods, academic adjustment was measured via reading and math standardized tests in the spring, and observations of engagement in the classroom were conducted throughout the year. In the fall, teachers nominated a peer with whom each target child spent the most time and rated that peer's temperament. Target children with high effortful control had high reading and math achievement (ps = .04 and < .001, respectively), and children with low NEE increased in engagement during the year (p < .001). Peers' temperament did not have a direct relation to target children's academic adjustment. Peers' negative emotion, however, moderated the relation between target children's effortful control, as well as NEE, and changes in engagement (ps = .03 and .05, respectively). Further, peers' effortful control moderated the relations between target children's NEE and reading and changes in engagement (ps = .02 and .04, respectively). In each case, target children's temperament predicted the outcome in expected directions more strongly when peers had low NEE or high effortful control. Results are discussed in terms of how children's temperamental qualities relate to academic adjustment, and how the relation between NEE and changes in engagement, in particular, depends on peers' temperament.

Trajectories of the Expression of Negative Emotion from Kindergarten to First Grade: Associations with Academic Outcomes.

We examined individual trajectories, across four time points, of children's (N = 301) expression of negative emotion in classroom settings and whether these trajectories predicted their observed school engagement, teacher-reported academic skills, and passage comprehension assessed with a standardized measure in first grade. In latent growth curve analyses, negative expressivity declined from kindergarten to first grade with significant individual differences in trajectories. Negative expressivity in kindergarten inversely predicted first grade school engagement and teacher-reported academic skills, and the slope of negative expressivity from kindergarten to first grade inversely predicted school engagement (e.g., increasing negative expressivity was associated with lower school engagement). In addition, we examined if prior academic functioning in kindergarten moderated the association between negative expressivity (level in kindergarten and change over time) and academic functioning in first grade. The slope of negative expressivity was negatively associated with first grade school engagement and passage comprehension for children who had lower kindergarten school engagement and passage comprehension, respectively, but was unrelated for those with higher academic functioning in kindergarten. That is, for children who had lower kindergarten school engagement and passage comprehension, greater declines in negative expressivity were associated with higher first grade school engagement and passage comprehension, respectively. The findings suggest that negative emotional expressivity in school is associated with academic outcomes in first grade and, in some cases, this association is more pronounced for children who had lower kindergarten academic functioning.

Control Over Anxiety and Dispositional Coping Tendencies Are Associated With Presleep Arousal Among Children Referred for Anxiety Problems.

Anxious youth typically experience sleep-related difficulties, but little is known about the role children's coping and perceived control over anxiety may play in these relations. We examined children's perceived levels of control over external anxiety-provoking events and internal anxious emotional reactions, as well as two dispositional coping tendencies (avoidant, support-seeking), and whether these were associated with anxious children's (N = 86) presleep arousal. Low perceived control over anxiety was significantly associated with high levels of presleep arousal. For children with low perceived control, higher avoidance was associated with greater presleep arousal, whereas lower avoidance was associated with lower presleep arousal levels. Findings suggest that efforts to avoid stressful life events may contribute to presleep arousal, especially under conditions where anxious arousal seems uncontrollable.

Variations in the influence of parental socialization of anxiety among clinic referred children.

This study examined the relations between parental socialization of child anxious behaviors (i.e., reinforcement, punishment, modeling, transmission of information) and child anxiety and related problems at varying child sensitivity levels. Data corresponding to 70 clinic-referred children (M age = 9.86 years; 50% girls; 49% Hispanic/Latino, 51% Caucasian) showed that for children with low (but not high) anxiety sensitivity, anxiety-related parental socialization behaviors were associated with more child anxiety and depression symptoms. Findings also indicated that parental socialization of anxious behaviors and anxiety sensitivity functioned similarly in the prediction of anxiety and depression across Caucasian and Hispanic/Latino children. There were no significant mean level variations across child sociodemographic characteristics in general, but anxiety-promoting parenting behaviors were twice as high in Hispanic/Latino compared to Caucasian families.

A personalized and control systems engineering conceptual approach to target childhood anxiety in the contexts of cultural diversity.

In the child and adolescent anxiety area, some progress has been made to develop evidence-based prevention protocols, but less is known about how to best target these problems in children and families of color. In general, data show differential program effects with some minority children benefiting significantly less. Our preliminary data, however, show promise and suggest cultural parameters to consider in the tailoring process beyond language and cultural symbols. It appears that a more focused approach to culture might help activate intervention components and its intended effects by focusing, for example, on the various facets of familismo when working with some Mexican parents. However, testing the effects and nuances of cultural adaption vis-à-vis a focused personalized approach is methodologically challenging. For this reason, we identify control systems engineering design methods and provide example scenarios relevant to our data and recent intervention work.

Streamlined pediatric anxiety program for school mental health services.

There needs to be serious transformation of evidence-based interventions (EBIs) into real-world solutions; otherwise, EBIs will never achieve the intended public health impact. In a randomized trial, we reported effects of a redesigned anxiety program. Herein, we described the redesign process that led to the program. Survey data revealed provider preferences for school mental health anxiety services. Focus groups and prototype feedback sessions revealed service barriers to uptake, implementation, and sustainability along with corresponding enabling strategies. Prototype feedback sessions also focused on refinement and fine-tuning of the redesign. In the end, traditional EBI strategies were transformed and packaged into six lessons, lasting 20-30 minutes each, and amenable to delivery in small-group format. The redesign achieved the intended purpose of retaining elements from cognitive and behavior therapy and social skills training for the target population of the intervention (e.g., 3rd to 5th graders with heterogeneous anxiety problems - identified and referred). The streamlined EBI is accessible from PBS LearningMedia™ - a service that hosts public, research-based, and school-ready materials.

Peers' Emotionality and Children's Academic Achievement in Second Grade: Testing the Moderating Role of Children's Behavioral Self-Regulation.

Although there is interest in the role of peers in children's schooling experiences, few researchers have examined associations and related underlying processes between peers' emotionality, an aspect of temperament, and children's academic achievement. This study evaluated whether target children's (N = 260) own self-regulation, assessed with two behavioral measures, served a moderating function for associations between peers' emotionality and children's own academic achievement in second grade. There was a positive association between peers' positive emotionality and reading scores for children with higher self-regulation. Peers' negative emotionality was negatively related to target children's reading scores, particularly for children with higher self-regulation levels, but was unrelated to math scores. Peers' positive and negative emotionality did not predict math scores, and there was no strong evidence for the moderating role of target children's self-regulation in this association. This study highlights the potential role of children's self-regulation in modulating peer effects on academic achievement, particularly reading.

Longitudinal relations between behavioral engagement and academic achievement: The moderating roles of socio-economic status and early achievement.

This study investigated developmental trajectories of observationally coded engagement across the early elementary years and whether these trajectories were associated with children's academic achievement. Furthermore, we evaluated if these relations varied as a function of children's family socio-economic status and early reading and math skills. Data were collected from 301 children who were studied from kindergarten (Mage = 65.74 months; 49% boys) to 2nd grade. Children's behavioral engagement was observed in kindergarten, 1st, and 2nd grade. Reading and math skills were assessed via standardized tests in kindergarten and 2nd grade. Growth mixture models identified two classes of behavioral engagement: most children (87.0%) displayed relatively high behavioral engagement in the fall of kindergarten and decreased significantly across time (referred to below as high-decreasing class), and other children (13.0%) exhibited moderate behavioral engagement in the fall of kindergarten that was stable across time (referred to below as moderate-stable class). After controlling for academic skills in kindergarten and demographic variables (i.e., child age, sex, ethnicity, and family socio-economic status), children in the high-decreasing class displayed higher reading skills, but not math skills, than children in the moderate-stable class. Additional analyses revealed that differences in reading skills between the two classes were present only for children from low socio-economic status families or for children low in kindergarten reading skills. The findings suggest that economically or academically at-risk students might benefit more than their peers from high behavioral engagement.

Pre-sleep arousal and sleep problems of anxiety-disordered youth.

The current study examined sleep problems and pre-sleep arousal among 52 anxious children and adolescents, aged 7-14 years, in relation to age, sex, ethnicity, and primary anxiety disorder. Assessment included structured diagnostic interviews and parent and child completed measures of sleep problems and pre-sleep arousal. Overall, 85% of parents reported clinically-significant child sleep problems, whereas 54% of youth reported trouble sleeping. Young children, those with primary generalized anxiety disorder, and Latino youth experienced the greatest levels of sleep disturbance. Additionally, greater levels of pre-sleep cognitive rather than somatic arousal were found and pre-sleep thoughts were associated with decreased total sleep duration and greater sleep problems. Findings suggest that attention to sleep should be part of assessment procedures for anxious children in both research and clinical settings.

Pubertal timing and its link to behavioral and emotional problems among 'at-risk' African American adolescent girls.

Using an 'at-risk' sample of African American girls, the present study examined the link between girls' retrospective reports of pubertal timing, girls' perceived relative pubertal timing, and their behavioral and emotional problems as rated by the girls themselves (N=102; 11-17 years), as well as teachers and parents. Structural equation modeling results indicated that the girls' retrospective reports of menarche were significantly related to their perceived relative menarche, whereas the girls' retrospective reports of development of their breasts were not related to their perceived relative development of breasts. Girls who perceived their breasts developing early relative to their peers were more likely to engage in delinquent behaviors according to teacher report. Significant effects of teacher reported adolescent internalizing problems also were found for girls who retrospectively reported either early or late development of breasts. The study's findings underscore the importance of teasing apart the effects of different indicators of girls' pubertal development on psychosocial adjustment and including teachers' reports of girls' emotional and behavioral problems, particularly among girls with the additional risks associated with residing in an economically disadvantaged urban setting.

Cross-ethnic measurement equivalence of the RCMAS in Latino and White youth with anxiety disorders.

We examined the measurement equivalence of the Revised Children's Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1979) in a sample of 667 White and Latino youth with anxiety disorders. Findings supported the factorial invariance of the Physiological Anxiety, Worry/Oversensitivity, and Social Concerns/Concentration subscales as well as the construct validity equivalence of the RCMAS Total Anxiety scale. The RCMAS appears to have measurement equivalence across Latino and White youth.

Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents.

The article reviews psychosocial treatments for phobic and anxiety disorders in youth. Using criteria from Nathan and Gorman (2002), 32 studies are evaluated along a continuum of methodological rigor. In addition, the treatments evaluated in each of the 32 studies are classified according to Chambless et al.'s (1996) and Chambless and Hollon's (1998) criteria. Findings from a series of meta-analyses of the studies that used waitlists also are reported. In accordance with Nathan and Gorman, the majority of the studies were either methodologically robust or fairly rigorous. In accordance with Chambless and colleagues, although no treatment was well-established, Individual Cognitive Behavior Therapy, Group Cognitive Behavior Therapy (GCBT), GCBT with Parents, GCBT for social phobia (SOP), and Social Effectiveness Training for children with SOP each met criteria for probably efficacious. The other treatments were either possibly efficacious or experimental. Meta-analytic results revealed no significant differences between individual and group treatments on diagnostic recovery rates and anxiety symptom reductions, as well as other youth symptoms (i.e., fear, depression, internalizing and externalizing problems). Parental involvement was similarly efficacious as parental noninvolvement in individual and group treatment formats. The article also provides a summary of the studies that have investigated mediators, moderators, and predictors of treatment outcome. The article concludes with a discussion of the clinical representativeness and generalizability of treatments, practice guidelines, and future research directions.

Evidence-based psychosocial treatments for child and adolescent obsessive-compulsive disorder.

Child and adolescent obsessive-compulsive disorder (OCD) is a chronic and debilitating condition associated with a wide range of impairments. This article briefly discusses the phenomenology of OCD, the theory underlying current treatment approaches, and the extant psychosocial treatment literature for child and adolescent OCD relative to the criteria for classification as an evidence-based intervention. Studies were evaluated for methodological rigor according to the classification system of Nathan and Gorman (2002) and then were assessed relative to the criteria for evidence-based treatments specified by Chambless et al. (1998), Chambless et al. (1996), and Chambless and Hollon (1998). Results from exposure-based cognitive behavioral therapy (CBT) trials with children and adolescents have been consistent, with remission rates of the disorder ranging from 40% to 85% across studies. Findings from this review indicate that individual exposure-based CBT for child and adolescent OCD can be considered as a probably efficacious treatment. CBT delivered in a family-focused individual or group format can be considered as a possibly efficacious treatment. Moderators, mediators, and predictors of treatment outcome are discussed, as are implications and generalizability of extant findings to real-world settings. We conclude with recommendations for best practice and future research directions.

Social support, discrimination, and coping as predictors of posttraumatic stress reactions in youth survivors of Hurricane Katrina.

This study examined the influence of aspects of the post-Hurricane Katrina recovery environment (i.e., discrimination, social support) and coping behaviors on children's posttraumatic stress reactions (symptoms of posttraumatic stress disorder [PTSD], anxiety, and depression). Data corresponding to 46 youth (M = 11.43 years; 39% girls; 33% African American, 67% European American) revealed that greater helpfulness from extrafamilial sources of social support predicted lower levels of child-rated symptoms of PTSD, anxiety, and depression. A positive predictive relation was found between helpfulness from professional support sources and PTSD, perhaps suggesting that parents whose children were experiencing higher PTSD symptom levels sought professional support and reported it to be helpful. Youths' avoidant coping behaviors predicted both PTSD and anxiety symptoms. Discrimination, active coping, and familial support did not predict any of the posttraumatic stress reactions assessed in this study.

Reluctance to express emotion explains relation between cognitive distortions and social competence in anxious children.

Guided by social information processing and affective social competence models, the focal objective of this research was to examine the relations among anxious children's cognitive distortions, social skill competence, and reluctance to express emotion. In addition, we explored whether children's attention control played any meaningful role. Using a sample of 111 anxious children (Mage  = 9.63, SD = 0.73; 75.7% girls; 56% Hispanic/Latino), we found that cognitive distortions were negatively related to social competence. In addition, tests of moderated mediation showed that the negative association between cognitive distortions and social skill competence was indirect via reluctance to express emotion, but this only was the case for anxious children with high attention control and for distortions in the academic domain. The findings of this study may set the stage for new ways to conceptualize the role of higher attention control among anxious youth. Statement of contribution What is already known on this subject? Cognitive errors are prevalent in anxious youth Anxious children show socio-emotion deficits What does this study add? Cognitive errors are related to socio-emotion deficits in anxious youth Relations depend on attention control.

Predisaster trait anxiety and negative affect predict posttraumatic stress in youths after hurricane Katrina.

On the basis of theory and previous research, it was hypothesized that predisaster child trait anxiety would predict disaster-related posttraumatic stress symptoms and generalized anxiety disorder symptoms, even after controlling for the number of hurricane exposure events. Results support this hypothesis and further indicate that predisaster negative affect predicted disaster-related posttraumatic stress symptoms and generalized anxiety disorder symptoms. Also, Katrina-related posttraumatic stress disorder symptoms were predicted by the number of hurricane exposure events and sex (being female). Predisaster generalized anxiety disorder symptoms predicted postdisaster generalized anxiety disorder symptoms, and predisaster trait anxiety predicted postdisaster depressive symptoms. Findings are discussed in terms of their relevance for developing interventions to mitigate the impact of disasters in youths.