Treating Anxiety Disorders in a School Setting.

Abstract Anxiety disorders are among the most prevalent childhood psychological disorders. In addition to causing acute distress to the child, parent and school staff, anxiety disorders may also have a significant impact on a child's educational and social development and persist chronically into adulthood. Recent work has begun to identify the school as an important setting for both the treatment and prevention of anxiety disorders in children. This paper begins with a description of several prevalent anxiety disorders and their presentation in a school setting. It then describes some of the more common assessment tools designed specifically for the assessment of anxiety in children, as well as some of the advantages and limitations different methods of assessment offer. Three school-based treatment programs are reviewed; Cool Kids, Friends and Skills for Social and Academic Success (SASS). Both Cool Kids and Friends are suitable for the treatment of anxiety disorders broadly, whereas the SASS has been included in the review as an example of a program designed specifically for social phobia. Several practical issues such as universal versus targeted delivery, parental involvement and implementation are also discussed. ********** This paper aims to provide information on child and adolescent anxiety disorders for people involved with their education or care. Anxiety disorders are one of the most prevalent childhood mental disorders (Ford, Goodman & Meltzer, 2003). Conservatively affecting around 10% of children and adolescents, anxiety not only causes distress, but is also related to higher rates of depression, attention and concentration difficulties, poor self-esteem and increased difficulty developing peer relationships and social behaviors (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003; Ialongo, Edelsohn, Werthamer-Larsson, Crockett, & Kellam, 1996; Strauss, Frame, & Forehand, 1987). It is therefore of great importance that people involved in the supervision, emotional growth and well-being of children and adolescents be equipped to recognise anxiety disorders and either provide adequate assessment, treatment or referral in cases of need. To begin, we describe several childhood anxiety disorders, their prevalence and their presentation in the school setting. The paper reviews useful tools for the assessment of anxiety, including the benefits and limitations of each when used in the school environment. In this paper the most common childhood anxiety disorders are discussed, however several less prevalent childhood anxiety disorders (such as Obsessive Compulsive Disorder, Panic with or without Agoraphobia and Posttraumatic Stress Disorder) will not be included in the discussion of anxiety disorders or the assessment and treatment sections that follow. After the initial discussion of anxiety, its prevalence, assessment and treatment, the paper will then examine the role of schools in the treatment of anxiety. Issues such as resources and responsibility are discussed and three school-based treatment programs are reviewed. The paper closes with a discussion of barriers common to the implementation of anxiety programs in the school setting. Prevalence and Prognosis of Childhood Anxiety Anxiety disorders are among the most prevalent childhood emotional disorders (Ford, Goodman, & Meltzer, 2003) experienced by 10%-21% of children (Anderson, Williams, McGee, & Silva, 1987; Bernstein, Bochardt, & Perwien, 1996; Costello et al., 2003; Kashani & Orvaschel, 1990). The prevalence of anxiety varies by age and gender. When examined by age, anxiety shifts from more concrete specific fears to more abstract worries and interpersonal concerns as children mature (Vasey, Crnic, & Carter, 1994). In terms of disorder, younger children tend to report higher levels of separation anxiety, whereas older children tend to report more social and generalized fears (Ford et al. …