Search

The article presents the intervention model and primary outcomes of a preventive intervention designed to reduce anxiety symptoms and prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders. Participants were 40 volunteer children (mean age = 8.94 years: 45% girls: 90% Caucasian) whose parents met criteria for a broad range of anxiety disorders. Families were randomly assigned to an 8-week cognitive-behavioral intervention, the Coping and Promoting Strength program (CAPS: n = 20) or a wait list control condition (WL: n = 20). Independent evaluators (IEs) conducted diagnostic interviews, and children and parents completed measures of anxiety symptoms. Assessments were conducted pre- and postintervention and 6 and 12 months after the postintervention assessment. On the basis of intent to treat analyses, 30% of the children in the WL group developed an anxiety disorder by the 1-year follow-up compared with 0% in the CAPS group. IE and parent-reported (but not child-reported) levels of anxiety showed significant decreases from the preintervention assessment to the 1-year follow-up assessment in the CAPS but not the WL group. Parental satisfaction with the intervention was high. Findings suggest that a family-based intervention may prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders. Keywords: anxiety disorders, prevention, children

We examined a brief program aimed at preventing anxiety and other problems in early childhood. Participants (N = 734, age 3-6 years) were drawn from 25 preschools across Brisbane, Australia. Assessments occurred four times over 14 months, with a diagnostic interview at follow-up. Parent and teacher reports included information on child temperament, social behavior, inhibition, parent characteristics, and parent-child interactions. REACH for RESILIENCE, a universal prevention program developed for this study, consisted of a six-session training program for parents focusing on building positive expectations and social competency in children. Parents rated the program positively and attended well, especially highly stressed parents who thus became over-represented in the treatment group as time progressed. Despite this difficulty with interpreting results, the intervention resulted in decreases in child problems via teacher report for both internalizing and externalizing problems. However, the effect sizes were not impressive and no changes were noted in parent's diagnostic ratings. Results, directions for further research, and refinement of methods are discussed. Keywords Prevention * Anxiety * Child

This study examined the developmental trajectory of anxiety symptoms among 290 boys and evaluated the association of trajectory groups with child and family risk factors and children's internalizing disorders. Anxiety symptoms were measured using maternal reports from the Child Behavior Check-list (T. M. Achenbach, 1991, 1992) for boys between the ages of 2 and 10. A group-based trajectory analysis revealed 4 distinct trajectories in the development of anxiety symptoms: low, low increasing, high declining, and high-increasing trajectories. Child shy temperament tended to differentiate between initial high and low groups, whereas maternal negative control and maternal depression were associated with increasing trajectories and elevated anxiety symptoms in middle childhood. Follow-up analyses to diagnoses of preadolescent depression and/or anxiety disorders revealed different patterns on the basis of trajectory group membership. The results are discussed in terms of the mechanisms of risk factors and implications for early identification and prevention. Keywords: childhood anxiety, temperament, emotion regulation, parent-child interaction, maternal depression

A nursing intervention that focuses on health rather than illness and that involves the family as well as the patient appears effective in preventing psychosocial maladjustment in children with chronic illnesses. A total of 332 children and their families were studied. Tests measuring the parent's evaluation of the child's behavior and the child's self-perception were administered before and after the intervention. Improvements were noted on tests of anxiety and depression as well as on tests of self-perception. Analysis of the parent-completed questionnaires indicated there were significant improvements in child behavior and adjustment. Surprisingly, children between four and seven years old rated themselves lower in peer acceptance after the intervention. This was not the case for the children between eight and 16 years old., Objective. This study was conducted to determine whether a specialized form of nursing could help prevent or reduce psychosocial maladjustment among children, aged 4 to 16 years, with chronic physical disorders. In contrast to other studies, nurses were chosen to provide the intervention based on their central role in health care and the appropriateness of their training for this task. Methodology. A clinical trial was concluded in which 332 children and their families were randomly assigned either to receive this specialized nursing for a 1-year period, or to remain in the control condition. The children were all active outpatients in nine clinics at the Montreal Children's Hospital. Three measures of psychosocial functioning administered before and after the intervention were the basis for assessing its efficacy. The measures included the behavior problems profile of the Achenbach Child Behavior Checklist, the Personal Adjustment and Role Skills, completed by the parents, and two versions of the Self-Perception Profile (Harter) for children aged 4 to 7 years and 8 to 16 years. Results. Differences between groups were examined both categorically and quantitatively. In the former, the percent of children with clinical scores (those above or below a cut-off indicative of maladjustment) at baseline and postintervention were compared. In the latter, the mean scores at the end of the trial were analyzed using analysis of covariance with the baseline scores as covariates. Statistically significant positive differences were found in the domain of anxiety/depression on the Personal Adjustment and Role Skills, and in the areas of scholastic competence, behavior, and global self-worth on the Harter. Conclusion. The results indicate that this intervention helps children with chronic disorders by preventing or reducing maladjustment. Most university-prepared nurses already have the basic skills required to achieve these results; only a modest investment in reorientation may be needed. Thus, other pediatric centers should be able to replicate these findings and thereby take a major step toward improving the lives of children with chronic disorders. Pediatrics 1994,94:70-75, chronic physical disorders, randomized clinical trial, nursing intervention, psychosocial adjustment.

Giving children the drug midazolam via a nose spray may help calm them during certain medical procedures. Midazolam is a sedative and can be easily and quickly absorbed in a nasal spray. Researchers randomly assigned 43 children with cancer to receive a nasal spray containing midazolam or a placebo before a medical procedure. The children in the midazolam group all reported less anxiety during the procedure. However, midazolam is not a painkiller, so the children still experienced pain and discomfort. Many children also objected to the nasal spray., Objective. Anxiety and pain even in minor procedures are still great problems in pediatrics, not least in pediatric oncology. Conscious sedation is indicated when other means to overcome a child's fear fail The aim of this study was to investigate whether intranasal administration of midazolam given before insertion of a needle in a subcutaneously implanted central venous port could reduce anxiety, discomfort, pain, and procedure problems. Method. Forty-three children with cancer participated in this randomized, double-blind, placebo-controlled, crossover study in which nasal administration of midazolam spray, .2 mg/kg body weight, was compared with placebo. Children, parents, and nurses completed a visual analog scale questionnaire to evaluate efficacy. Results. Parents and nurses reported reduced anxiety[39] discomfort, and procedure problems for children in the midazolam group and would prefer the same medication at next procedure. They also reported pain reduction. Children reported reduced anxiety and procedure problems but reduction of pain and discomfort was not significant. No serious or unexpected side effects occurred. Nasal discomfort was the most common side effect (17/38 [approximately equals] 45%) and the primary reason for dropouts (8/43 [approximately equals] 19%). Anxiety varied with age but not with gender. When anxiety increased, the differences between midazolam and placebo increased. Conclusion. Nasal midazolam spray offers relief to children anxious about procedures, such as insertion of a needle in a subcutaneously implanted intravenous port, venous blood sampling, venous cannulation, etc. Its use, however, may be limited by nasal discomfort in some patients for whom rectal and oral routes might be alternatives. Pediatrics 2000;105:73-78; pediatric procedure sedation, anxiety, procedure, midazolam, administration, intranasal., ABBREVIATIONS. IV, intravenous; EMLA, eutectic mixture of local anesthetics; VAS, visual analog scale. Many studies show that pain in children is underestimated and, therefore, inadequately treated.[1-3] Anxiety and pain even [...]