Effects of the First Step to Success Intervention on Preschoolers with Disruptive Behavior and Comorbid Anxiety Problems
- 517 Downloads
Preschoolers with elevated anxiety symptoms are at high risk not only of developing more severe mental health disorders in later life but are also apt to respond more poorly to intervention if they present with comorbid disruptive behavior. Because early signs of anxiety disorders may not be recognized as such in preschool settings, many children selected for Tier 2 interventions that target externalizing problem behaviors may also have co-occurring anxiety symptoms and disorders. The First Step to Success intervention has recently been adapted for preschoolers with externalizing behaviors and was found to be efficacious in a randomized controlled trial. The current report examines effects of the First Step intervention on a subsample of 38 preschoolers with comorbid anxiety symptoms. Compared to usual-care controls, preschoolers who were assigned to the First Step intervention demonstrated medium-to-large effects in reducing externalizing behavior and improving social functioning outcomes, but had small effects for reductions in internalizing behaviors. Implications for intervening with preschoolers at risk of comorbid disruptive and anxiety behaviors are discussed.
KeywordsAnxiety Internalizing behavior Externalizing behavior School-based Behavioral intervention
This study was funded by a Grant from the National Institute of Child Health and Human Development (R01HD055334).
Compliance with Ethical Standards
Conflict of interest
Drs. Feil, Walker, and Golly are three of the authors of the Preschool First Step to Success intervention.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- American Psychological Association. (1994). Diagnostic and statistical manual (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
- Feil, E. G., Frey, A., Walker, H. M., Small, J. W., Seeley, J. R., Golly, A., et al. (2014). The efficacy of a home-school intervention for preschoolers with challenging behaviors. A randomized controlled trial of preschool First Step to Success. Journal of Early Intervention, 36, 151–170. doi: 10.1177/1053815114566090.CrossRefPubMedGoogle Scholar
- Feil, E. G., Small, J. W., Seeley, J. R., Walker, H. M., Golly, A., Frey, A., et al. (2016). Early intervention for preschoolers at risk for attention-deficit/hyperactivity disorder: Preschool First Step to Success. Behavioral Disorders, 41(2), 95–106. doi: 10.1177/1053815114566090.CrossRefPubMedPubMedCentralGoogle Scholar
- Franklin, M. E., Sapyta, J., Freeman, J. B., Khanna, M., Compton, S., Almirall, D., et al. (2011). Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: The Pediatric OCD Treatment Study II (POTS II) randomized controlled trial. Journal of the American Medical Association, 306, 1224–1232. doi: 10.1001/jama.2011.1344.CrossRefPubMedGoogle Scholar
- Franz, L., Angold, A., Copeland, W., Costello, E. J., Towe-Goodman, N., & Egger, H. (2013). Preschool anxiety disorders in pediatric primary care: Prevalence and comorbidity. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 1294–1303. doi: 10.1016/j.jaac.2013.09.008.CrossRefPubMedPubMedCentralGoogle Scholar
- Gadow, K. D., & Sprafkin, J. (1997). Early childhood inventory-4 norms manual. Stony Brook, NY: Checkmate Plus.Google Scholar
- Gadow, K. D., & Sprafkin, J. (2000). Early childhood inventory-4 screening manual. Stony Brook, NY: Checkmate Plus.Google Scholar
- Garcia, A. M., Sapyta, J. J., Moore, P. S., Freeman, J. B., Franklin, M. E., March, J. S., et al. (2010). Predictors and moderators of treatment outcome in the Pediatric Obsessive Compulsive Treatment Study (POTS I). Journal of the American Academy of Child and Adolescent Psychiatry, 49, 1024–1033. doi: 10.1016/j.jaac.2010.06.013.CrossRefPubMedPubMedCentralGoogle Scholar
- Golly, A. (2006). Five universal principles of positive behavior support and the story of my life. Verona, WI: Attainment Company.Google Scholar
- Gresham, F. M., & Elliott, S. N. (2008). Social skills improvement rating scales manual. Bloomington, MN: Pearson Assessments.Google Scholar
- Hudson, J. L., Keers, R., Roberts, S., Coleman, J. R. I., Breen, G., Arendt, K., et al. (2015). Clinical predictors of response to cognitive-behavioral therapy in pediatric anxiety disorders: The Genes for Treatment (GxT) study. Journal of the American Academy of Child and Adolescent Psychiatry, 54, 454–463. doi: 10.1016/j.jaac.2015.03.018.CrossRefPubMedPubMedCentralGoogle Scholar
- Mathews, T., Danese, A., Wertz, J., Ambler, A., Kelly, M., Diver, A., et al. (2015). Social isolation and mental health at primary and secondary school entry: A longitudinal cohort study. Journal of the American Academy of Child and Adolescent Psychiatry, 54(3), 225–232. doi: 10.1016/j.jaac.2014.12.008.CrossRefGoogle Scholar
- McHugh, R. K., Murray, H. W., & Barlow, D. H. (2009). Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: the promise of transdiagnostic interventions. Behaviour Research and Therapy, 47, 946–953. doi: 10.1016/j.brat.2009.07.005.CrossRefPubMedPubMedCentralGoogle Scholar
- Merikangas, K. R., He, J. P., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., et al. (2011). Service utilization for lifetime mental disorders in U.S. adolescents: Results of the National Comorbidity Survey-Adolescent Supplement (NCSA). Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 32–45. doi: 10.1016/j.jaac.2010.10.006.CrossRefPubMedGoogle Scholar
- Muthén, L. K., & Muthén, B. O. (1998-2012). Mplus user’s guide (7th ed.). Los Angeles, CA: Muthén & Muthén.Google Scholar
- Piacentini, J., Bennett, S., Compton, S. N., Kendall, P. C., Birmaher, B., Albano, A. M., et al. (2014). 24- and 36-week outcomes for the Child/Adolescent Anxiety Multimodal Study (CAMS). Journal of the American Academy of Child and Adolescent Psychiatry, 53, 297–310. doi: 10.1016/j.jaac.2013.11.010.CrossRefPubMedGoogle Scholar
- Rapee, R. M., Lyneham, H. J., Hudson, J. L., Kangas, M., Wuthrich, V. M., & Schniering, C. A. (2013). Effect of comorbidity on treatment of anxious children and adolescents: Results from a large, combined sample. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 47–56. doi: 10.1016/j.jaac.2012.10.002.CrossRefPubMedGoogle Scholar
- Sprague, J. R., & Golly, A. (2013). Best behavior: Building positive behavior support in schools (2nd ed.). Frederick, CO: Sopris West Educational Services.Google Scholar
- Sumi, W. C., Woodbridge, M. W., Javitz, H. S., Thornton, S. P., Wagner, M., Rouspil, K., et al. (2012). Assessing the effectiveness of First Step to Success: Are short-term results the first step to long-term behavioral improvements? Journal of Emotional and Behavioral Disorders, 21(1), 66–78. doi: 10.1177/1063426611429571.CrossRefGoogle Scholar
- Walker, H. M., & Gresham, F. M. (Eds.). (2014). Handbook of evidence-based practices for emotional and behavioral disorders. New York, NY: Guilford.Google Scholar
- Walker, H. M., Kavanagh, K., Stiller, B., Golly, A., Severson, H. H., & Feil, E. G. (1998). First Step to Success: An early intervention approach for preventing school antisocial behavior. Journal of Emotional and Behavioral Disorders, 6(2), 66–80. doi: 10.1177/106342669800600201.CrossRefGoogle Scholar
- Walker, H. M., Seeley, J. R., Small, J., Severson, H. H., Graham, B. A., Feil, E. G., et al. (2009). A randomized controlled trial of the First Step to Success early intervention: Demonstration of program efficacy outcomes in a diverse, urban school district. Journal of Emotional and Behavioral Disorders, 17, 197–212. doi: 10.1177/1063426609341645.CrossRefGoogle Scholar
- Walker, H., Severson, H., Seeley, J., Feil, E., Small, J., Golly, A., et al. (2014). The evidence base of the First Step to Success early intervention for preventing emerging antisocial behavior patterns. In H. Walker & F. Gresham (Eds.), Handbook of evidence-based practices for emotional and behavioral disorders (pp. 518–536). New York, NY: Guilford.Google Scholar
- Weersing, V. R., Brent, D. A., Rozenman, M. S., Gonzaleez, A., Jefferys, M., Dickerson, J. F., et al. (2017). Brief behavioral therapy for pediatric anxiety and depression in primary care: A randomized clinical trial. JAMA Psychiatry, 74(6), 571–578. doi: 10.1001/jamapsychiatry.2017.0429.CrossRefPubMedPubMedCentralGoogle Scholar
- Wood, J. J., Piacentini, J. C., Southam-Gerow, M., Chu, B. C., & Sigman, M. (2006). Family cognitive behavioral therapy for child anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45(3), 314–321. doi: 10.1097/01.chi.0000196425.88341.b0.CrossRefPubMedGoogle Scholar
- What Works Clearinghouse. (2011). Procedures and standards handbook (Version 2.1). Princeton, NJ: What Works Clearinghouse. Retrieved from ERIC database (ED565673) http://files.eric.ed.gov/fulltext/ED565673.pdf.