Making the Grade: School-based Interventions for Pediatric Anxiety Disorders: Primary data presented looking at which school-based anxiety interventions are most effective[edit | edit source]
Golda S. Ginsburg, Ph.D.
University of Connecticut
This talk was given at MICAMH at FIU in Miami, Florida.
• Background: Why Anxiety? Why schools?
• What is treatment as usual (TAU) for anxiety dx in schools?
• Is CBT better than TAU in schools?
• Expanding the network of school providers
Children have valid concerns and worries during childhood. Anxiety is underestimated and under treated in children
- Not apparent and disruptive
- Anxiety in the classroom is avoided
- Try to adapt to the child and not put them in situations that cause discomfort
- Care providers believe they will grow out of it or it is not serious
Why is anxiety in children important to study?[edit | edit source]
- Measurement of anxiety is getting better
- Anxiety disorder is the most common psychiatric disorder- and is on the rise!
- 10-20% lifetime prevalence rates
- 2 in 20 students affected
- 2 more will not meet criteria but will likely meet some of the items
Problems caused by Childhood anxiety[edit | edit source]
- Social interactions
- Fewer friends
- Little to No extracurricular activities o Less likely to attend events like field trips
- Academic
- Preform lower
- Attendance is lower
- Familial o Tough parenting causes tensions
- Babying- allowing them to avoid situations that cause distress
- Causes parental conflict
- Family distress
- “Gateway illness” more likely to develop other disorders
- Adult anxiety
- Suicidality
- Other diagnoses
Primary Diagnosis: Generalized Anxiety
6-year-old boy
Key worries:
- Making mistakes/perfectionism/changes
- Hours getting ready looking just right
- Upset each morning afraid of missing the bus
- Hours on homework re-does assignments tears up assignment if makes a mistake
- Seeks reassurance
- Sought school nurse because of stomach aches
- Missed school due to anxiety
Separation Anxiety 10 years old girl
- Must be near mom at all times beg to stay home
- Leaves bathroom door open
- Texts mom during day and asks to leave school
- Stomach aches each morning causing her to be often late to school
How are we doing currently?[edit | edit source]
- Less than half of youth received services
- Likelihood of receiving treatment: 30% anxiety vs 70% ADHD
- Critical need to enhance access, bring services to school
- Takes away many barriers to seeking treatment
- School setting can trigger anxiety
- Separation, performance, social
- Better generalization of skills
- Treatment improves academic functioning
Evidence-based Treatments
- Cognitive Behavioral Therapy (CBT)
- Medication-SSRIs
CAMS: Response rates 60%-80%
- 60% is one treatment alone
- 80% is when both treatments are used
Primary Aim: Compare the effectiveness of a modular CBT (MCBT) to TAU[edit | edit source]
Modular CBT takes the elements of CBT but gives more flexibility to the clinician
- 6 year RCT in MD and CT: MCBT (n = 37) or TAU
- One day training; optional supervision
- 12 weeks of tx
Evaluations at pre, post, 1 year follow up
The CBT Modules
- Psychoeducation 1st session
- Exposure 2nd session and throughout
- Relaxation strategies
- Cognitive restructuring “changing thoughts”
- Problem solving
- Relapse prevention
- Meditation
Most children had more than one disorder
- Primary therapeutic orientation (n=25) CBT 68%
- Session summary forms (n=475) CBT 67%
- IE-report (n = 90 sessions) CBT 14%
A lot fell into the category of other for example:
- Emotional support for feelings
- Making holiday cards
- School clinicians are thinking about CBT
- The sample was small may not be generalizable
- We need more training for school psychologists
Is MCBT Better than TAU in Schools?[edit | edit source]
- Anxiety severity
- Anxiety did go down overtime and remained down
- Did not differ significantly between groups
- Global functions
- Improved over time
- No significant between group differences
Cams was more effective than stars but why?
- Lower dose (9 sessions for 20-30)
- Limited/poor training and supervision
- 1 day; optional supervision
- Low MCBT quality
- Key CBT element of exposure may have been missing
- Lower clinician adherence of exposure
- TAU- contaminated
- Diagnostic report provided
- Ongoing monitoring conducted
- Prescribed # of sessions
- CBT elements were used in TAU
Cochrane report (2013) data are “limited and inconclusive if CBT is more effective over TAU”
Implications and Solutions[edit | edit source]
More training but there are limits because of funding and cooperation
Expanding School Based Anxiety treatment
- Why and Who
- School nurses could help
- Familiarity with kids because of somatic problems
- Less stigma and beloved by students
- Overview
- 3-year study
- Intervention 1: CBT
- 6 Calm modules based on CBT
- Intervention 2: Only using relaxation exercises
- Relaxation, meditations, and other strategies
- Results
- Anxiety went down
- Somatic symptoms were reduced
- Behavioral avoidance decreased
- Automatic thoughts significant reductions
Follow up of Case 1 and Case 2[edit | edit source]
Many of the issues were resolved or reduced
- Who and why
- Teachers, can easily identify problems
- Overview
- Intervention development
- Open trails
- RCT
- Why a school and home model
- Better communication between teachers and parents is associated with better outcomes
- Trial run
- Reduction of anxiety
- From parent, child, and teacher report