Prevention Science

, Volume 12, Issue 3, pp 255–268 | Cite as

The Prevention of Child and Adolescent Anxiety: A Meta-analytic Review

  • Brian J. FisakJr.Email author
  • Dan Richard
  • Angela Mann


The purpose of this study was to provide a comprehensive review of the effectiveness of child and adolescent anxiety prevention programs. Mean weighted effect sizes were calculated, and studies were encoded for potential moderator variables. A statistically significant effect size of .18 was obtained at post-intervention, which is consistent with effect sizes reported in reviews of depression, eating disorder, and substance abuse prevention programs. However, the effect sizes obtained at follow-up yielded mixed results. Significant moderators of program effectiveness were found including provider type (professional versus lay provider) and the use of the FRIENDS program. In contrast, program duration, participant age, gender, and program type (universal versus targeted) were not found to moderate program effectiveness. Clinical implications and directions for future research are discussed, including the need for more long-term follow-up, early prevention programs, and studies that systematically examine the impact of parent involvement on program effectiveness.


Anxiety Prevention Meta-analysis Child Adolescent 


References marked with an asterisk indicate studies included in the meta-analysis

  1. *Aune T., & Stiles, T. C. (2010). Universal-based prevention of syndromal and subsyndromal social anxiety: A randomized controlled study. doi:  10.1037/a0015813.
  2. *Barrett, P. M., Farrell, L. J., Ollendick, T. H., & Dadds, M. (2006). Long-term outcomes of an Australian universal prevention trial of anxiety and depression symptoms in children and youth: An evaluation of the Friends Program. Journal of Clinical Child and Adolescent Psychology, 35, 403-411. doi: 10.1207/s15374424jccp3503_5.PubMedCrossRefGoogle Scholar
  3. *Barrett, P. M., Lock, S., & Farrell, L. J. (2005). Developmental differences in universal preventive intervention for child anxiety. Clinical Child Psychology and Psychiatry, 10, 539-555. doi: 10.1177/1359104505056317.CrossRefGoogle Scholar
  4. Barrett, P. M., Lowry-Webster, H., & Holmes, J. (1999). Friends for children group leader manual (2nd ed.). Brisbane: Australian Academic.Google Scholar
  5. *Barrett, P. M., Moore, A. F., & Sonderegger, R. (2000). The FRIENDS program for young former-Yugoslavian refugees in Australia: A pilot study. Behaviour Change, 17, 124-133. doi: 10.1375/bech.17.3.124.CrossRefGoogle Scholar
  6. Barrett, P. M., & Pahl, K. M. (2006). School-based intervention: Examining a universal approach to anxiety management. Australian Journal of Guidance Counselling, 16, 55–75. doi: 10.1375/ajgc.16.1.55.CrossRefGoogle Scholar
  7. *Barrett, P.M., Sonderegger, R., & Sonderegger, N. R. (2001). Evaluation of an anxiety-prevention and positive-coping program (FRIENDS) for children and adolescents of non-English-speaking background. Behaviour Change, 18, 78-91. doi: 10.1375/bech.18.2.78.CrossRefGoogle Scholar
  8. *Barrett, P. M., Sonderegger, R., & Xenos, S. (2003). Using Friends to combat anxiety and adjustment problems among young migrants to Australia: A national trial. Clinical Child Psychology and Psychiatry, 8, 241-260. doi: 10.1177/1359104503008002008.CrossRefGoogle Scholar
  9. *Barrett, P., & Turner, C. (2001). Prevention of anxiety symptoms in primary school children: Preliminary results from a universal school-based trial. British Journal of Clinical Psychology, 40, 399-410.PubMedCrossRefGoogle Scholar
  10. Baumeister, H., & Härter, M. (2007). Prevalence of mental disorders based on general population surveys. Social Psychiatry and Psychiatric Epidemiology, 42, 537–546. doi: 10.1007/s00127-007-0204-1.PubMedCrossRefGoogle Scholar
  11. Borenstein, M., Hedges, L., & Rothstein, H. (2007). Meta-analysis: Fixed effect vs. random effects. (Retrieved: December 10, 2008).
  12. *Calear, A. L., Christensen, H., Mackinnon, A., Griffiths, K. M., & O’Kearney, R. (2009). The YouthMood Project: A cluster randomized controlled trial of an online cognitive behavioral program with adolescents. Journal of Consulting and Clinical Psychology, 77, 1021–1032. doi: 10.1037/a0017391.PubMedCrossRefGoogle Scholar
  13. Cartwright-Hatton, S., McNicol, K., & Doubleday, E. (2006). Anxiety in a neglected population: Prevalence of anxiety disorders in pre-adolescent children. Clinical Psychology Review, 26, 817–817.PubMedCrossRefGoogle Scholar
  14. Chavira, D., Stein, M. B., Bailey, K., & Stein, M. T. (2004). Child anxiety in primary care: Prevalent but untreated. Depression and Anxiety, 20, 115–164. doi: 10.1002/da.20039.CrossRefGoogle Scholar
  15. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Erlbaum.Google Scholar
  16. *Cooley, M. R., Boyd, R. C., & Grados, J. J. (2004). Feasibility of anxiety preventive intervention for community violence exposed African-American children. The Journal of Primary Prevention, 25, 105–123. doi: 10.1023/B:JOPP.0000039941.85452.ea.CrossRefGoogle Scholar
  17. Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60, 837–844.PubMedCrossRefGoogle Scholar
  18. *Cradock, C., Cotler, S., & Jason, L. A. (1978). Primary prevention: Immunization of child speech anxiety. Cognitive Therapy and Research, 4, 389–396.CrossRefGoogle Scholar
  19. Craske, M. G., & Zucker, B. (2002). Prevention of anxiety disorders: A model for intervention. Applied & Preventative Psychology, 10, 155–175. doi: 10.1016/S0962-1849(01)80012-3.CrossRefGoogle Scholar
  20. *Dadds, M. R., Holland, K. R., Laurens, K. R., Mullins, M., Barrett, P. M., & Spence, S. H. (1999). Early intervention and prevention of anxiety disorders in children: Results at 2-year follow-up. Journal of Consulting and Clinical Psychology, 67, 145-150. doi: 10.1037/0022-006X.67.1.145.Google Scholar
  21. *Dadds, M. R., & Roth, J. H. (2008). Prevention of anxiety disorders: Results of universal trial with young children. Journal of Child and Family Studies, 17, 320–335. doi: 10.1007/s10826-007-9144-3.CrossRefGoogle Scholar
  22. *Dadds, M. R., Spence, S. H., Holland, D. H., Barrett, P. M., & Laurens, K. R. (1997). Prevention and early intervention for anxiety disorders: A controlled community trial. Journal of Consulting and Clinical Psychology, 65, 627–635.PubMedCrossRefGoogle Scholar
  23. Donovan, C. L., & Spence, S. H. (2000). Prevention of childhood anxiety disorders. Clinical Psychology Review, 4, 509–531. doi: 10.1016/S0272-7358(99)00040-9.CrossRefGoogle Scholar
  24. *Drake, K.L. (2007). Youth at risk for anxiety: Evaluation of a brief panic prevention program. Dissertation Abstracts International: Section B: The Sciences and Engineering, 68, 1921.Google Scholar
  25. Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta­analysis detected by a simple, graphical test. British Medical Journal, 315, 629–634.PubMedGoogle Scholar
  26. Farrell, L. J., & Barrett, P. M. (2007). Prevention of childhood emotional disorders: Reducing the burden of suffering associated with anxiety and depression. Child and Adolescent Mental Health, 12, 58–65. doi: 10.1111/j.1475-3588.2006.00430.x.CrossRefGoogle Scholar
  27. Feldner, M. T., Zvolensky, M. J., & Schmidt, N. B. (2004). Prevention of anxiety psychopathology: A critical review of the empirical literature. Clinical Psychology: Science and Practice, 11, 405–424. doi: 10.1093/clipsy.bph098.CrossRefGoogle Scholar
  28. *Felner, R. D., Norton, P. L., Cowen, E. L., & Farber, S. S. (1981). Prevention program for children experiencing life crisis. Professional Psychology, 12, 446–452. doi: 10.1037/0735-7028.12.4.446.CrossRefGoogle Scholar
  29. Fingeret, M. C., Warren, C. S., Cepeda-Benito, A., & Gleaves, D. H. (2006). Eating disorder prevention research: A meta-analysis. Eating Disorders: The Journal of Treatment & Prevention, 14, 191–213. doi: 10.1080/10640260600638899.Google Scholar
  30. Garber, J. (2006). Depression in children and adolescents: Linking risk research and prevention. American Journal of Preventative Medicine, 31, 104–125. doi: 10.1016/j.amepre.2006.07.007.CrossRefGoogle Scholar
  31. *Gallegos, J. (2009). Preventing childhood anxiety and depression: Testing the effectiveness of a school-based program in Mexico. Dissertation Abstracts International Section A: Humanities and Social Sciences, 69, 4686.Google Scholar
  32. *Gillham, J. E. (2003). Targeted prevention is not enough: Commentary on "Treatment is not enough: We must prevent major depression in women. Prevention and Treatment, 6.Google Scholar
  33. Gillham, J. E., Reivich, K. J., Freres, D. R., Lascher, M., Litzinger, S., Shatte, A., et al. (2006). School-based prevention of depression and anxiety symptoms in early adolescence: A pilot of a parent intervention component. School-Psychology Quarterly, 21, 323–348. doi: 10.1521/scpq.2006.21.3.323.CrossRefGoogle Scholar
  34. Gillham, J. E., Shatte, A. J., Reivich, K. (2001). Needed for prevention research: Long-term follow-up and the evaluation of mediators, moderators, and lay providers. Prevention and Treatment, 4.Google Scholar
  35. *Ginsburg, G. S. (2009). The child anxiety prevention study: Intervention model and primary outcomes. Journal of Consulting and Clinical Psychology, 77, 580–587. doi: 10.1037/a0014486.PubMedCrossRefGoogle Scholar
  36. Ginsburg, G. S., & Drake, K. L. (2002). School-based treatment for anxious African-American adolescents: A controlled pilot study. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 768–775. doi: 10.1097/00004583-200207000-00007.CrossRefGoogle Scholar
  37. Gleser, L. J., & Olkin, I. (1994). Stochastically dependent effect sizes. In H. Cooper & L. V. Hedges (Eds.), The handbook of research synthesis (pp. 339–355). New York: Sage.Google Scholar
  38. Gottfredson, D. C., & Wilson, D. B. (2003). Characteristics of effective school-based substance abuse prevention. Prevention Science, 4, 27–38. doi: 10.1023/A:1021782710278.PubMedCrossRefGoogle Scholar
  39. Hedges, L. V. (1981). Distribution theory for Glass's estimates of effect size and related estimators. Journal of Educational and Behavioral Statistics, 6, 107–128. doi: 10.3102/10769986006002107.CrossRefGoogle Scholar
  40. Hirshfeld-Becker, D. R., & Biederman, J. (2002). Rationale and principles for early intervention with young children at risk for anxiety disorders. Clinical Child and Family Psychology Review, 5, 161–172. doi: 10.1023/A:1019687531040.PubMedCrossRefGoogle Scholar
  41. Horowitz, J. L., & Garber, J. (2006). The prevention of depressive symptoms in children and adolescents: A meta-analytic review. Journal of Consulting and Clinical Psychology, 74, 401–415. doi: 10.1037/0022-006X.74.3.401.PubMedCrossRefGoogle Scholar
  42. Jane-Llopis, E., Hosman, C., Jenkins, R., & Anderson, P. (2003). Predictors of efficacy in depression programmes: Meta-analysis. British Journal of Psychiatry, 183, 384–397. doi: 10.1192/bjp.183.5.384.PubMedCrossRefGoogle Scholar
  43. *Kennedy, S., Rapee, R., & Edwards, S. (2009). A selective intervention program for inhibited preschool-aged children of parents with an anxiety disorder: Effects on current anxiety disorders and temperament. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 602–609. doi: 10.1097/CHI.0b013e31819f6fa9.PubMedCrossRefGoogle Scholar
  44. *Kiselica, M. S., Baker, S. B., Thomas, R. N., & Reedy, S. (1994). Effects of stress inoculation training on anxiety, stress, and academic performance among adolescents. Journal of Counseling Psychology, 41, 335–342.CrossRefGoogle Scholar
  45. *LaFreniere, P. J., & Capuano, F. (1997). Preventive intervention as means of clarifying direction of effects in socialization: Anxious-withdrawn preschoolers case. Development and Psychopathology, 9, 551–564.PubMedCrossRefGoogle Scholar
  46. Langley, A. K., Bergman, R. L., McCracken, J., & Piacentini, J. C. (2004). Impairment in childhood anxiety disorders: Preliminary examination of the child anxiety impact scale-parent version. Journal of Child and Adolescent Psychopharmacology, 14, 105–114. doi: 10.1089/104454604773840544.PubMedCrossRefGoogle Scholar
  47. Last, C. G., Perrin, S., Hersen, M., & Kazdin, A. E. (1996). A prospective study of childhood anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 35, 1502–1510. doi: 10.1097/00004583-199611000-00019.CrossRefGoogle Scholar
  48. *Lock, S., & Barrett, P. M. (2003). A longitudinal study of developmental differences in universal preventive intervention for child anxiety. Behaviour Change, 20, 183–199. doi: 10.1375/bech. Scholar
  49. *Lowry-Webster, H. M., Barrett, P. M., & Dadds, M. R. (2001). A universal prevention trial of anxiety and depression symptomatology in childhood: Preliminary from an Australian study. Behaviour Change, 18, 36–50. doi: 10.1375/bech.18.1.36.CrossRefGoogle Scholar
  50. *Lowry-Webster, H. M., Barrett, P. M., & Lock, S. (2003). A universal prevention trial of anxiety symptomology during childhood: Results at 1-year follow-up. Behaviour Change, 20, 25–43. doi: 10.1375/bech. Scholar
  51. Masia-Warner, C., Klein, R. G., Dent, H. C., Fisher, P. H., Alvir, J., Albano, A. M., et al. (2005). School-based intervention for adolescents with social anxiety disorder: Results of a controlled study. Journal of Abnormal Child Psychology, 33, 707–722. doi: 10.1007/s10802-005-7649-z.PubMedCrossRefGoogle Scholar
  52. *McLaughlin, K.A. (2008). A public health approach to the study and prevention of adolescent depression & anxiety. Dissertation Abstracts International: Section B: The Sciences and Engineering, 69, 3272.Google Scholar
  53. *Mifsud, C., & Rapee, R. M. (2005). Early intervention for childhood anxiety in a school setting: Outcomes for an economically disadvantaged population. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 996–1004. doi: 10.1097/01.chi.0000173294.13441.87.PubMedCrossRefGoogle Scholar
  54. Mrazek, P. J., & Haggerty, R. J. (Eds.). (1994). Reducing the risks for mental disorders: Frontiers from preventative intervention research. Washington: National Academy.Google Scholar
  55. Neil, A. L., & Christensen, H. (2009). Efficacy and effectiveness of school-based prevention and early intervention programs for anxiety. Clinical Psychology Review, 29, 208–215. doi: 10.1016/j.cpr.2009.01.002.PubMedCrossRefGoogle Scholar
  56. *Rapee, R. M., Kennedy, S., Ingram, M., Edwards, S., & Sweeney, L. (2005). Prevention and early intervention of anxiety disorders in inhibited preschool children. Journal of Consulting and Clinical Psychology, 73, 488–497. doi: 10.1037/0022-006X.73.3.488.PubMedCrossRefGoogle Scholar
  57. Reynolds, C. R., & Richmond, B. O. (1985). The revised children's manifest anxiety scale: Manual. New York: Western Psychological Services.Google Scholar
  58. *Roberts, C. M., Kane, R., Bishop, B., Cross, D., Fenton, J., & Hart, B. (2010). The prevention of anxiety and depression in children from disadvantages schools. Behaviour Research and Therapy, 48, 68–73.PubMedCrossRefGoogle Scholar
  59. *Rose, H., Miller, L., & Martinez, Y. (2010). FRIENDS for Life: The results of a resilience-building, anxiety-prevention program in a Canadian elementary school. Professional School Counseling, 12, 400–407. doi: 10.5330/PSC.n.2010-12.400.CrossRefGoogle Scholar
  60. Rosenthal, R. (1979). The “File-drawer Problem” and tolerance for null results. Psychological Bulletin, 86, 638–641.CrossRefGoogle Scholar
  61. *Simpson, A. T. (2007). The roles of self-regulation and coping in a preventative cognitive-behavioural intervention for school-age children at-risk for internalizing disorders. Dissertation Abstracts International: Section B: The Sciences and Engineering, 69, 3862.Google Scholar
  62. *Siu, A. F. Y. (2007). Using FRIENDS to combat internalizing problems among primary school children in Hong Kong. Journal of Cognitive and Behavioral Psychotherapies, 7, 11–26.Google Scholar
  63. Spence, S. H., & Shortt, A. L. (2007). Can we justify the widespread dissemination of universal, school-based interventions for the prevention of depression among children and adolescents? Journal of Child Psychology and Psychiatry, 48, 526–542. doi: 10.1111/j.1469-7610.2007.01738.x.PubMedCrossRefGoogle Scholar
  64. Spoth, R., Trudeau, L., Guyll, M., Shin, C., & Redmond, C. (2009). Universal intervention effects on substance sue among young adults medicated by delayed adolescent substance initiation. Journal of Consulting and Clinical Psychology, 77, 620–632. doi: 10.1037/a0016029.PubMedCrossRefGoogle Scholar
  65. *Stallard, P., Simpson, N., Anderson, S., Carter, T., Osborn, C., & Bush, S. (2005). An evaluation of the FRIENDS programme: A cognitive behaviour therapy intervention to promote emotional resilience. Archives of Disease in Childhood, 90, 1016–1019.PubMedCrossRefGoogle Scholar
  66. *Stallard, P., Simpson, N., Anderson, S., & Goddard, M. (2008). The FRIENDS emotional health prevention programme: 12 month follow-up of a universal UK school based trial. European Child & Adolescent Psychiatry, 17, 283–289. doi: 10.1007/s00787-007-0665-5.CrossRefGoogle Scholar
  67. *Stallard, P., Simpson, N., Anderson, S., Hibbert, S., & Osborn, C. (2007). The FRIENDS Emotional Health Programme: Initial findings from a school-based project. Child and Adolescent Mental Health, 12, 32–37. doi: 10.1111/j.1475-3588.2006.00421.x.CrossRefGoogle Scholar
  68. *Stallard, P., Velleman, R., Salter, E., Howse, I., Yule, W., & Taylor, G. (2006). A randomized controlled trial to determine the effectiveness of an early psychological intervention with children involved in road traffic accidents. Journal of Child Psychology and Psychiatry, 47, 127–134. doi: 10.1111/j.1469-7610.2005.01459.x.PubMedCrossRefGoogle Scholar
  69. Stice, E., & Shaw, H. (2004). Eating disorder prevention programs: A meta-analytic review. Psychological Bulletin, 130, 206–227. doi: 10.1037/0033-2909.130.2.206.PubMedCrossRefGoogle Scholar
  70. Zvolensky, M. J., Schmidt, N. B., Bernstein, A., & Keough, M. E. (2006). Risk-factor research and prevention programs for anxiety disorders: A translational research framework. Behaviour Research and Therapy, 44, 1219–1239. doi: 10.1016/j.brat.2006.06.001.PubMedCrossRefGoogle Scholar

Copyright information

© Society for Prevention Research 2011

Authors and Affiliations

  1. 1.University of North FloridaJacksonvilleUSA
  2. 2.University of South FloridaTampaUSA

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