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Anxiety problems are common in children and can have profound adverse effects on personal, social and academic life. Almost 40% of anxiety disorders emerge before age 14, making primary schools invaluable settings for prevention and early support of child anxiety. Research indicates that school-based interventions can be costly and difficult to schedule, school staff lack confidence to deliver them effectively, and outcomes are mixed. One solution may be for school staff to adapt and enhance their day-to-day practices to better support children with anxiety. This systematic review aims to summarise what is known about the relationship between teachers' classroom management and anxiety in primary school-aged children. We searched ASSIA, British Education Index, Education Abstracts, Embase, ERIC, MEDLINE, PsycINFO and Scopus in December 2020 and June 2022, using a predefined strategy. We included studies of any design, published in peer-reviewed journals at any time, in any language, reporting associations between day-to-day classroom management strategies/methods and anxiety/internalising outcomes in children aged 4-11 years, taught in mainstream primary schools. Studies were assessed for quality/risk of bias. We identified eight studies (six quantitative, two qualitative) including 4505 children. We found some evidence that authoritarian, controlling and punitive classrooms may be linked to higher levels of anxiety, although, overall, existing evidence indicates either a weak or no association between classroom management and anxiety. This review highlights a paucity of research in this area. Furthermore, variability in design, measures and quality makes drawing firm conclusions difficult. Recommendations for future research are discussed.

Obsessive Compulsive Disorder (OCD) has negative impacts on affected preadolescent children; however, little is known about parents' experiences of parenting a preadolescent child with OCD, and limited provision exists to help parents to support their children. This study aimed to explore parents' experiences of parenting a preadolescent child with OCD using semi-structured, qualitative interviews to inform the development of such provision. Twenty-two parents (15 mothers; 7 fathers) of 16 children (7- to 14-years-old) who had experienced OCD were interviewed. Reflexive thematic analysis was used to generate two overarching themes: (1) challenge and frustration, and (2) helplessness, and five themes: (1) the journey to understanding and coming to terms with OCD, (2) the battle for support, (3) navigating how to respond to OCD, (4) OCD is in control, and (5) the emotional turmoil of parenting a preadolescent child with OCD. The need for clear, accessible, and scalable support for parents of preadolescent children with OCD was identified.

Cognitive behavioral therapy (CBT) is an effective treatment for child anxiety disorders. Low-intensity forms of CBT, such as guided parent-delivered CBT (GPD-CBT), have been developed to increase access; however, it is unclear why some children benefit from this treatment and others do not. This qualitative study aimed to increase understanding of parents' experiences of GPD-CBT and what facilitates and creates barriers to good outcomes. The sample was derived from a sample of families who took part in long-term follow-up assessments (reported in). Data were analyzed using thematic analysis. Two themes containing five subthemes were developed from the data. Theme 1 described factors influencing the experience of GPD-CBT. Theme 2 described perceived outcomes in the child and wider changes within the family. The identification of facilitators and barriers to the success of GPD-CBT could inform and improve future treatment delivery.

The purpose of this study was to identify items from the Revised Childrens Anxiety and Depression Scale - RCADS-C/P that provided a brief, reliable and valid screen for anxiety and/or depressive disorders in adolescents. In addition, we examined whether adding items assessing suicidal ideation (Moods and Feelings Questionnaire - MFQ- C/P) and symptom impact and duration (items adapted from the Strengths and Difficulties Questionnaire - SDQ) improved the identification of adolescents with anxiety and/or depressive disorders. We compared two samples of adolescents and their parents - a community sample, recruited through secondary schools in England (n = 214) and a clinic-referred sample, who met diagnostic criteria for anxiety and/or depressive disorder and were recruited through a university-based research clinic (n = 246). Participants completed the RCADS-C/P with additional symptom impact and duration items, and the MFQ-C/P. Using ROC curve analyses, we identified a set of 11 RCADS-C/P items (6 addressing anxiety and 5 depression symptoms) for adolescent- and parent-report. This set of 11 symptom items achieved sensitivity/specificity values > .75, which were comparable to corresponding values for the RCADS-47-C/P. Combining adolescent and parent-report improved the identification of anxiety/depression in adolescents compared to using adolescent-report alone. Finally, adding two symptom impact items further improved the sensitivity/specificity of the 11 symptom items, whereas adding suicidal ideation items did not. The 11 RCADS items accurately discriminated between the community and clinic-referred sample with anxiety and/or depressive disorders and have the potential to quickly and accurately identify adolescents with these disorders in community settings.

Few children with mental health problems access evidence-based interventions. Primary schools may be an ideal setting to improve access to treatment through screening and intervention programmes, but some families' circumstances and experiences may increase barriers to benefiting from this approach. Interviews were carried out with parents of children living in potentially challenging circumstances, including foster and military-connected families. We aimed to explore parent perceptions of a school-based screening/intervention programme and potential barriers to uptake. Parents described that due to their past experiences, that they might not trust or engage with a school-based screening/intervention. Nonetheless, parents considered that the delivery of a sensitive school screening/intervention programme might provide an opportunity for schools to strengthen their relationship with families. These findings highlight the need for future school-based screening/intervention programmes for child mental health to consider the needs of families of children from varied circumstances, and ensure steps are taken to promote trust.

Schools may be well-placed to identify signs of mental health (MH) problems in children; however, there has been little research into how school-based screening and intervention initiatives should be delivered. One-to-one in-depth interviews were carried out with 15 practitioners that support children's MH within primary school settings. Data were analysed with template analysis. We explored practitioners' perceptions of a school-based screening/intervention programme for childhood MH problems and views about potential barriers to uptake. Three themes were identified. First, practitioners described feeling overwhelmed by the volume of children requiring support and the limited capacity of their service. Second, practitioners identified potential barriers to engagement in a school screening/intervention programme, including familial concerns about stigma. Finally, practitioners were optimistic that a screening/intervention programme could have positive effects for children who might otherwise not be identified as potentially benefitting from support. This study highlights that a primary school-based screening/intervention programme designed in partnership with stakeholders would be well received by practitioners supporting MH within school settings.

Background: Children and adolescents demonstrate diverse patterns of symptom change and disorder remission following cognitive behavioural therapy (CBT) for anxiety disorders. To better understand children who respond sub‐optimally to CBT, this study investigated youths (N = 1,483) who continued to meet criteria for one or more clinical anxiety diagnosis immediately following treatment or at any point during the 12 months following treatment. Methods: Data were collected from 10 clinical sites with assessments at pre‐and post‐treatment and at least once more at 3, 6 or 12‐month follow‐up. Participants were assigned to one of three groups based on diagnostic status for youths who: (a) retained an anxiety diagnosis from post to end point (minimal responders); (b) remitted anxiety diagnoses at post but relapsed by end point (relapsed responders); and (c) retained a diagnosis at post but remitted to be diagnosis free at end point (delayed responders). Growth curve models assessed patterns of change over time for the three groups and examined predictors associated with these patterns including demographic, clinical and parental factors, as well as treatment factors. Results: Higher primary disorder severity, being older, having a greater number of anxiety disorders, having social anxiety disorder, as well as higher maternal psychopathology differentiated the minimal responders from the delayed and relapsed responders at the baseline. Results from the growth curve models showed that severity of the primary disorder and treatment modality differentiated patterns of linear change only. Higher severity was associated with significantly less improvement over time for the minimal and relapsed response groups, as was receiving group CBT, when compared to the delayed response group. Conclusions: Sub‐optimal response patterns can be partially differentiated using variables assessed at pre‐treatment. Increased understanding of different patterns of change following treatment may provide direction for clinical decision‐making and for tailoring treatments to specific groups of clinically anxious youth. Future research may benefit from assessing progress during treatment to detect emerging response patterns earlier. [ABSTRACT FROM AUTHOR]

Objectives: To provide detailed information on the codesign of a digital intervention to support parents with bipolar disorder (BD) who have young children. Each step of this process is reported, as well as a detailed description of the final version of the intervention in line with the TIDieR framework. Methods: Clinical experience and lived experience experts participated in online workshops, meetings, and remote feedback requests, informed by Integrated Knowledge Translation (IKT) principles. The IKT research group responded to each phase of recommendations from the knowledge users. Results: Five clinical experience experts and six lived experience experts engaged with the codesign process. Their recommendations for principles, content, look, and feel, and functionality of the digital intervention were structured over five iterative phases. This led to a final implemented design that was identified by the clinical and lived experience experts (referred to together as the knowledge users group) as genuinely reflecting their input. Conclusions: The IKT principles offer an accessible structure for engaging with clinical and lived experience experts throughout a codesign process, in this case for a digital intervention for parents with BD. The resulting intervention is described in detail for transparency to aid further evaluation and development and to help other teams planning codesign approaches to intervention development. [ABSTRACT FROM AUTHOR]

The Preschool Anxiety Scale (PAS) is a parent-report scale measuring young children's anxiety symptoms involving five specific anxiety symptoms (separation anxiety, physical injury fears, social phobia, obsessive–compulsive disorder, generalized anxiety) that load on a higher-order factor representing general anxiety shared by all specific anxiety symptom subtypes. Although the PAS has been widely used to assess anxiety symptoms in young children, few studies have tested its measurement invariance for group comparisons. Using data from a sample of 2,221 children and their parents/carers in the United Kingdom, this study investigated the measurement invariance of the higher-order model of the PAS across child age (4–6 years vs. 6–7 years), gender (girls vs. boys), parental anxiety (low vs. high level), and children's living circumstances (before vs. after the removal of COVID-19 restrictions). Our findings demonstrated the good factor structure, internal consistency, and convergent validity of the higher-order model of the PAS in all subgroups and supported its configural, metric, and scalar invariance across these subgroups. Therefore, the findings suggest that the PAS is a reliable and valid instrument for assessing specific anxiety symptoms and general anxiety among young children in the United Kingdom and that comparisons can be made between the subgroups under examination. Public Significance Statement: The Preschool Anxiety Scale (PAS) is a reliable and valid instrument for assessing specific anxiety symptoms and general anxiety in young children in the United Kingdom. Furthermore, given that the findings indicate measurement invariance of the higher-order model of the PAS, the specific anxiety symptom subscales and general anxiety scale of the PAS can be compared across child age, child gender, parent/carers' anxiety levels, and children's living circumstances (e.g., before and after the removal of the COVID-19 restrictions). [ABSTRACT FROM AUTHOR]

Background: It is estimated that 78% of children experience the death of a close friend or family member by 16 years of age, yet longitudinal research examining the mental health outcomes of wider experiences of bereavement is scarce. We conducted a longitudinal investigation of the association between maternal experienced bereavement before the age of 11 years and offspring depressive and anxiety disorders at age 18 and examined moderation of this association by modifiable parental factors. Methods: We analysed data from the Avon Longitudinal Study of Parents and Children, a UK‐based birth cohort, including 9,088 child participants with data available on bereavement. Bereavement was measured via maternal report at eight timepoints until children were 11 years. Offspring depressive and anxiety‐related disorders were self‐reported at 18 years old using the Clinical Interview Schedule‐Revised (CIS‐R). The potential moderating roles of maternal anxiety, maternal depression, parental monitoring, positive parenting and negative parenting practices were examined. Results: Maternal experienced bereavement was not associated with depression or anxiety‐related disorders in early adulthood among offspring. In addition, no support was found for negative parenting practices, parental monitoring or maternal anxiety and depression as moderators of the relationship between maternal experienced bereavement and offspring mental health problems at 18 years old. Findings in relation to the moderating role of positive parenting practices were inconsistent. Conclusions: Findings suggest that a large number of children are exposed to maternal experienced bereavement. We found no evidence that maternal experienced bereavement during childhood increases the risk for offspring psychiatric disorders in early adulthood. Several methodological considerations prudent to bereavement research are discussed. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavioural therapy (CBT) including exposure and response prevention (ERP) is an effective treatment for preadolescent children with obsessive compulsive disorder (OCD); however, there is a need to increase access to this treatment for affected children. Aims: This study is a preliminary evaluation of the efficacy and acceptability of a brief therapist-guided, parent-led CBT intervention for pre-adolescent children (5–12 years old) with OCD using a non-concurrent multiple baseline approach. Method: Parents of 10 children with OCD were randomly allocated to no-treatment baselines of 3, 4 or 5 weeks before receiving six to eight individual treatment sessions with a Psychological Wellbeing Practitioner. Diagnostic measures were completed prior to the baseline, 1-week post-treatment, and at a 1-month follow-up, and parents completed weekly measures of children's OCD symptoms/impairment. Results: Seventy percent of children were 'responders' and/or 'remitters' on diagnostic measures at post-treatment, and 60% at the 1-month follow-up. At least 50% of children showed reliable improvements on parent-reported OCD symptoms/impairment from pre- to post-treatment, and from pre-treatment to 1-month follow-up. Crucially, the intervention was acceptable to parents. Conclusions: Brief therapist-guided, parent-led CBT has the potential to be an effective, acceptable and accessible first-line treatment for pre-adolescent children with OCD, subject to the findings of further evaluations. [ABSTRACT FROM AUTHOR]