Altering the trajectory of anxiety in at-risk young children.

OBJECTIVE: Increasing evidence for the importance of several risk factors for anxiety disorders is beginning to point to the possibility of prevention. Early interventions targeting known risk for anxiety have rarely been evaluated. The authors evaluated the medium-term (3-year) effects of a parent-focused intervention for anxiety in inhibited preschool-age children. METHOD: The study was a randomized controlled trial of a brief intervention program provided to parents compared with a monitoring-only condition. Participants were 146 inhibited preschool-age children and their parents; data from two or more assessment points were available at 3 years for 121 children. Study inclusion was based on parent-reported screening plus laboratory-observed inhibition. The six-session group-based intervention included parenting skills, cognitive restructuring, and in vivo exposure. The main outcome measures were number and severity of anxiety disorders, anxiety symptoms, and extent of inhibition. RESULTS: Children whose parents received the intervention showed lower frequency and severity of anxiety disorders and lower levels of anxiety symptoms according to maternal, paternal, and child report. Levels of inhibition did not differ significantly based on either parent report or laboratory observation. CONCLUSIONS: This brief, inexpensive intervention shows promise in potentially altering the trajectory of anxiety and related disorders in young inhibited children.

Prevention and early intervention of anxiety disorders in inhibited preschool children.

This article reports results from an early intervention program aimed at preventing the development of anxiety in preschool children. Children were selected if they exhibited a high number of withdrawn/inhibited behaviors--one of the best identified risk factors for later anxiety disorders--and were randomly allocated to either a 6-session parent-education program or no intervention. The education program was group based and especially brief to allow the potential for public health application. Children whose parents were allocated to the education condition showed a significantly greater decrease in anxiety diagnoses at 12 months relative to those whose parents received no intervention. However, there were no significant effects demonstrated on measures of inhibition/withdrawal. The results demonstrate the value of (even brief) very early intervention for anxiety disorders, although these effects do not appear to be mediated through alterations of temperament.

Parent-child interaction therapy: one- and two-year follow-up of standard and abbreviated treatments for oppositional preschoolers.

The long-term effect of two parent training programs for conduct problem preschoolers is reported. Families of 54 behaviorally disturbed preschool-aged children were randomly assigned to 1 of 3 treatment conditions: standard Parent-Child Interaction Therapy (STD), an abbreviated form of PCIT (ABB), and a no-treatment waitlist control group (WL). Of the families who completed treatment (STD and ABB), data were collected on 97% and 94% of families at 1- and 2-year follow-up, respectively. Follow-up assessment of parent report and independent observations indicated that treatment gains were largely maintained for both treatment conditions with little difference between the two treatments. The findings suggest that an abbreviated form of PCIT has long-term benefits for families with young children displaying early conduct problems.

Parent-child interaction therapy: a comparison of standard and abbreviated treatments for oppositional defiant preschoolers.

Families of 54 behaviorally disturbed preschool-aged children (3 to 5 years) were randomly assigned to 1 of 3 treatment conditions: standard parent-child interaction therapy (PCIT; STD); modified PCIT that used didactic videotapes, telephone consultations, and face-to-face sessions to abbreviate treatment; and a no-treatment waitlist control group (WL). Twenty-one nondisturbed preschoolers were recruited as a social validation comparison condition. Posttreatment assessment indicated significant differences in parent-reported externalizing behavior in children, and parental stress and discipline practices from both treatment groups on most measures compared with the WL group. Clinical significance testing suggested a superior effect for the STD immediately after intervention, but by 6-month follow-up, the two groups were comparable. The findings indicate that abbreviated PCIT may be of benefit for families with young conduct problem children.