Jeremy K. Fox

School-Based Anxiety Treatments for Children and Adolescents

Anxiety disorders are the most common class of psychopathology among youth, yet many of these youngsters do not receive treatment. This is particularly concerning given the chronic course of anxiety disorders, which often lead to mood disorders, substance abuse, and serious impairment. Schools are an optimal venue for identifying anxious students and delivering mental health treatment given access to youth and ability to overcome various barriers to treatment. This article reviews four school-based treatments for anxiety disorders that have been evaluated in controlled trials. Discussion centers on feasibility, challenges to school-based implementation, and future research directions for this critical area.

Preventive Intervention for Anxious Preschoolers and Their Parents: Strengthening Early Emotional Development.

The high prevalence and early onset of anxiety disorders have inspired innovative prevention efforts targeting young at-risk children. With parent–child prevention models showing success for older children and adolescents, the goal of this study was to evaluate a parent–child indicated preventive intervention for preschoolers with mild to moderate anxiety symptoms. Sixteen children (ages 3–5) and at least one of their parents participated in Strengthening Early Emotional Development (SEED), a new 10-week intervention with concurrent groups for parents and children. Outcome measures included clinician-rated and parent-rated assessments of anxiety symptoms, as well as measures of emotion knowledge, parent anxiety, and parental attitudes about children’s anxiety. Participation in SEED was associated with reduced child anxiety symptoms and improved emotion understanding skills. Parents reported decreases in their own anxiety, along with attitudes reflecting enhanced confidence in their children’s ability to cope with anxiety. Reductions in child and parent anxiety were maintained at 3-month follow-up. Findings suggest that a parent–child cognitive-behavioral preventive intervention may hold promise for young children with mild to moderate anxiety. Improvements in parent anxiety and parental attitudes may support the utility of intervening with parents. Fostering increased willingness to encourage their children to engage in new and anxiety-provoking situations may help promote continued mastery of new skills and successful coping with anxiety.

School-Based Treatment for Anxiety in Children and Adolescents: New Developments in Transportability and Dissemination

Delivering evidence-based treatments in schools is considered a promising avenue for addressing the high rates of anxious youth who do not receive treatment. This chapter reviews recent literature documenting progress toward evaluating the transportability and dissemination of anxiety interventions to school settings. Although training school professionals, such as guidance counselors, to deliver these treatments is an important step toward dissemination, additional study is needed. Critical issues for the future of this growing field are explored, namely the need to establish standardized methods of monitoring treatment fidelity and to develop feasible and effective training and supervision models. Such advances in implementation science will be essential for promoting the feasibility and sustainability of evidence-based treatments in school settings.

Children’s anxious reactions to an invasive medical procedure: The role of medical and non-medical fears

This study investigated the relationship of medical and non-medical fears to children’s anxiety, pain, and distress during an invasive medical procedure, the voiding cystourethrogram. Parents of 34 children completed the Fear Survey Schedule-II prior to their child’s procedure. Child distress behaviors during the procedure were audiotaped and coded using the Child–Adult Medical Procedure Interaction Scale-Revised. Ratings of child procedural anxiety and pain were obtained from children, parents, and examining technologists within minutes following the procedure. Associations were observed between medical fears, procedural anxiety (parent and staff reports), and coded distress behaviors. Findings may inform preparation efforts to reduce anxiety around invasive medical procedures.

Food allergy and social anxiety in a community sample of adolescents

ABSTRACT This investigation explored the relationship between food allergies and social anxiety in a school-based sample of adolescents. A total of 849 participants, including 87 endorsing food allergies, completed standardized questionnaires assessing social anxiety symptoms. Food allergic participants answered questions assessing allergy characteristics, worry and avoidance related to allergen exposure and allergy disclosure, and parental worry and control. Boys with food allergies reported higher social anxiety than boys without food allergies, though no differences were found in girls. Social anxiety was correlated with parental worry and control. Findings may inform anxiety prevention programs for youth with food allergies.

Assessing Clinical Improvement in School-Based Treatment for Social Anxiety Disorder: Agreement Between Adolescents, Parents, and Independent Evaluators

The Clinical Global Impressions of Improvement (CGI-I) scale is widely used in clinical trials to monitor clinically meaningful change during treatment. Although it is standard practice in research to have independent evaluators (IEs) complete the CGI-I, this approach is not practical in school and community settings. Few studies have explored the potential utility of other informants, such as youth and parents. Therefore, this study aimed to investigate agreement between IEs and both adolescents and parents in CGI-I improvement ratings in the context of a randomized controlled trial of cognitive-behavioral therapy for social anxiety disorder, as delivered by psychologists and school counselors. Multilevel growth models indicated that IEs were generally more conservative in their ratings of positive treatment response across time and treatment conditions, though greater agreement was observed between parents and IEs by post-intervention and 5-month follow-up. Possible explanations for these findings and suggestions for alternative approaches are discussed.

School-Based Intervention for Adolescents with Impairing Social Anxiety

Social anxiety disorder (SAD) is a common problem during adolescence that can result in a range of impairments to school-related functioning, including lower academic achievement and higher rates of peer rejection. Yet, most affected students with SAD do not receive mental health services, in part because SAD often goes undetected at home and school. Schools may be an appropriate venue for helping adolescents with SAD, as school-based interventions can directly target school-based impairment. Given the potential advantages of school-based mental health services, Masia Warner and colleagues developed Skills for Academic and Social Success (SASS), a cognitive-behavioral group treatment for adolescents with SAD designed for implementation in schools. This chapter provides an overview of the SASS intervention, including its structure and components, and describes findings from a series of randomized controlled trials which demonstrate its feasibility, efficacy, and effectiveness. We conclude by discussing future research directions, including the need to identify ways to enhance SASS’ sustainability and extend its generalizability to youth in underresourced schools and underserved communities.