Indicated prevention and early intervention for childhood anxiety: a randomized trial with Caucasian and Hispanic/Latino youth.

Anxiety disorders are not only among the most prevalent psychiatric disorders in children and adolescents, they are typically chronic and lead to significant impairment, including poor academic performance, depression, and the early initiation of the use of alcohol, tobacco, and other illicit drugs (Costello, Egger, & Angold, 2005, Kessler, Ruscio, Shear, & Wittchen, 2009). This constellation of negative outcomes has led to the development of evidence-based interventions aimed at preempting anxiety disorders (Fisak, Richard, & Mann, 2011) as well as treatments for clinically anxious children (Silverman, Pina, & Viswesvaran, 2008). The Arizona Anxiety Resilience Building Project builds on this past literature and aims at developing and evaluating theory-driven, culturally robust, interventions to reduce anxiety and prevent the onset and exacerbation of anxiety disorders in children. In this study, a main objective was to conduct an initial evaluation of an indicated prevention and early intervention protocol for anxiety with Hispanic/Latino and Caucasian children. Focusing on Hispanic/Latino children is important because census data show that Hispanic/Latinos comprise the largest ethnic minority group in the U.S. (Humes, Jones, & Ramirez, 2011) and also because this segment of the U.S. population appears to suffer from anxiety significantly more than Caucasians (Pina & Silverman, 2004; Roberts, Roberts, & Xing, 2006). Regrettably, there is no randomized trial evaluating anxiety program effects among Hispanic/Latino children, although evidence from secondary data analyses corresponding to highly acculturated English-speaking Cuban-American children shows that cognitive-behavior treatment is promising (Pina, Silverman, Fuentes, Kurtines, & Weems, 2003). Building on this work, the focus of the present study was on degree of caregiver involvement and the role of ethnicity/language. In terms of caregiver involvement, evidence supporting the role of parents in child anxiety treatment appears equivocal (Barmish & Kendall, 2005), and when it comes to anxiety prevention, every program to date has included some degree of caregiver training making it unclear whether parent training enhances program effects on anxiety (Fisak et al., 2011). Why involve caregivers in child anxiety interventions? Typically, anxious children are found to have anxious parents and parents of anxious children often model and reinforce anxious behaviors (Ginsburg, Silverman, & Kurtines, 1995; Hudson & Rapee, 2005). As such, including parents in child anxiety interventions appears indispensable, at least conceptually. Moreover, when it comes to Hispanic/Latinos, qualitative data from parent focus groups and in-depth interviews (in English and Spanish) show a preference for parental involvement in child-focused interventions (Dumka, Gonzales, Wood, & Formoso, 1998; Pina, Villalta, & Zerr, 2009), perhaps because Hispanic/Latinos place great emphasis on caregiving and family (c.f. Familismo). Continuing with ethnicity (Caucasian/Latino) and language (Spanish/English), in Griner and Smith’s (2006) meta-analyses of adult psychotherapy studies, Latinos treated in Spanish appeared to benefit greatly from adapted interventions but no study has examined this issue in children. Also, some Hispanic/Latino parents involved in interventions prefer/require delivery in Spanish rendering it important for program effects to remain robust in translation. Thus, this study examined program effects for Hispanic/Latino and Caucasian children with anxiety, across two conditions with varying degrees of parent involvement, and via clinician, child, and parent measures. The role of ethnicity and language on program effects also was explored.