• By Kevin Mount
  • Posted on Wednesday 31st October, 2007

Queensland assault against anxiety builds on the FEAR plan

Depression, antisocial behavior and hyperactivity are familiar targets for prevention and early intervention programs. But what about common-or-garden anxiety?Mark Dadds, Professor of Clinical Psychology at the University of New South Wales in Sydney, Australia, has been involved in a series of studies and evaluations aimed at understanding, preventing and responding to childhood anxiety.His Queensland Early Intervention and Prevention of Anxiety Project (QEIPAP) combines school-based and parenting interventions. Initial experimental evaluation indicates some impact on children's well-being, at least in the short term. The challenge now is to improve implementation fidelity and to replicate the results at scale.Several interventions have been shown to be effective in the treatment of children with diagnosed anxiety disorders. Dadds's interest has been in designing an effective response to children exhibiting early signs of anxious behavior. The target has been known risk factors, such as inhibited temperament, exposure to traumatic and negative life events, and having anxious or overprotective parents.The Queensland work is reminiscent of the cognitive restructuring pioneered by Philip Kendall, Professor of Psychology at Temple University in Pennsylvania, US. He developed what has become known as the 'FEAR Plan' to challenge 'F' - feeling frightened, and 'E' - expecting bad things to happen, and to promote 'A' attitudes and actions that will help to bring 'R' - results and rewards. QEIPAP owes much to Kendall's earlier Coping Cat anxiety program for children.The primary evaluation of QEIPAP took place in in Brisbane, Australia among eight primary schools with 1,786 students. It was targeted at 128 children who met criteria for anxiety on two screens, one carried out by teachers the other by parents. Children with other special needs were excluded from the program. The evaluation involved randomly assigning schools matched for size, demographics and socio-economic status of their students to an intervention group - for QEIPAP- or to control group where they received services as normal.Six months after intervention, children receiving QEIPAP were over three times less likely to develop a diagnosable anxiety disorder. One in six in the intervention group developed an anxiety disorder compared with one in two of the control group.Evidence on longer term effects is more mixed. A year after the intervention the benefit of QEIPAP appeared to have faded, but some gains, for example less avoidance of children by their parents, were still apparent two years later.QEIPAP uses a cognitive-behavioral program to teach children how to manage their distress. In addition, parents are encouraged to develop skills to regulate both their own anxiety and their children's.Dadds's work represents an important, and lately neglected, avenue of enquiry. Anxiety is common, and is associated with a range of other impairments to children's health and development. The results of the evaluation are not unequivocal and require replication. It will also be important to understand the less positive results: are they the result of inadequate screening, poor program fidelity or the characteristics of contexts in which the program was tried?

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