School Mental Health

, Volume 10, Issue 3, pp 243–253 | Cite as

Effects of the First Step to Success Intervention on Preschoolers with Disruptive Behavior and Comorbid Anxiety Problems

  • John R. SeeleyEmail author
  • Jason W. Small
  • Edward G. Feil
  • Andy J. Frey
  • Hill M. Walker
  • Annemieke Golly
  • Steven R. Forness
Original Paper


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.


Anxiety 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.

Ethical Approval

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

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • John R. Seeley
    • 1
    • 2
    Email author
  • Jason W. Small
    • 1
  • Edward G. Feil
    • 1
  • Andy J. Frey
    • 3
  • Hill M. Walker
    • 1
    • 2
  • Annemieke Golly
    • 1
  • Steven R. Forness
    • 4
  1. 1.Oregon Research InstituteEugeneUSA
  2. 2.University of OregonEugeneUSA
  3. 3.University of LouisvilleLouisvilleUSA
  4. 4.University of California-Los AngelesLos AngelesUSA

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