Date Presented 3/30/2017
A content analysis addressing interventions for anxiety in children was completed. Promising interventions included cognitive–behavioral therapy, social skills, yoga, deep pressure, and occupation-based groups. Tools were created to inform and measure intervention and outcomes based on the research.
Primary Author and Speaker: Nina Handojo
Additional Authors and Speakers: Christine Hsu-Nazzal, Nadia Kabbani, Yvonne Swinth
Contributing Authors: George Tomlin, Kristen Brubaker
PURPOSE: Current occupational therapy (OT) literature addressing intervention for children with anxiety is limited. However, practitioners are reporting an increasing number of clients with anxiety in their practice. The purpose of this content analysis study was to determine which interventions geared toward children and youth with anxiety and related disorders are effective in reducing symptoms and increasing participation in occupations.
DESIGN: A systematic review of the literature through content analysis and critical appraisal was completed. Articles addressing anxiety (at any level) and related disorders (e.g., obsessive–compulsive disorder, phobias) were included. Interventions addressed were for children and youth (ages 3–18 yr) and were appropriate for an occupational therapist to implement in a clinic or school as defined by the Occupational Therapy Practice Framework (American Occupational Therapy Association, 2014). All types of research articles (e.g., experimental, outcome, descriptive) were included. Participatory action research, in collaboration with a clinician, was then implemented to monitor the translation of the research results.
METHOD: Data were collected through a systematic review using key words including child, intervention, and anxiety in OT, psychology, and education journals. Three researchers reviewed articles to determine if they met the inclusion criteria. Those that met the criteria were summarized into a content analysis table, and then a critical appraisal was completed to summarize the evidence, including implications for OT practitioners. Reliability checks were completed across the five researchers throughout the process. Knowledge translation tables were developed addressing intervention recommendations and how to measure intervention effectiveness based on the research literature. Outcomes of the knowledge translation were collected through a survey to clinicians to address the likelihood of implementing change and the monitoring of intervention outcomes.
RESULTS: Cognitive–behavioral therapy had the strongest research base and outcomes (Ale, McCarthy, Rothschild, & Whiteside, 2015). Social skills programs also had beneficial outcomes (Schohl et al., 2013). In one study, higher friendship quality predicted absence of anxiety symptoms (Baker & Hudson, 2013). Other emerging treatments related to anxiety, such as music therapy, yoga, deep pressure, occupation-based groups, and emotional education, were also found to be successful in decreasing anxiety levels (Stulmaker & Ray, 2015; Weaver & Darragh, 2015). However, more research is needed in these areas to address applicability to OT. Survey results indicated that the summary of the literature and the knowledge translation tables were useful and were leading to a change in the ability to address anxiety in children and youth.
CONCLUSION: There is evidence that there is a role for OT practitioners to collaborate with other service providers to address anxiety and related disorders in children and youth. Practitioners can incorporate cognitive–behavioral strategies, occupation-based and child-centered play interventions, yoga, and music as part of their interventions. These may improve functional performance and participation. Social skills and the ability to build high-quality friendships effectively supplement anxiety interventions. However, due to limitations in the OT literature, therapists should monitor outcomes before, during, and after the intervention to ensure improved occupational performance.
IMPACT STATEMENT: Practitioners have noted the rise of anxiety in children and its impact on preventing participation in daily occupations. Practitioners can use the information in this content analysis table and knowledge translation tables for decision making regarding intervention strategies and outcome measurement.
References
Ale, C. M., McCarthy, D. M., Rothschild, L. M., & Whiteside, S. P. (2015). Components of cognitive behavioral therapy related to outcome in childhood anxiety disorders. Clinical Child and Family Psychology Review, 18, 240–251. https://doi.org/10.1007/s10567-015-0184-8
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006
Baker, J. R., & Hudson, J. L. (2013). Friendship quality predicts treatment outcome in children with anxiety disorders. Behaviour Research and Therapy, 51, 31–36. https://doi.org/10.1016/j.brat.2012.10.005
Schohl, K. A., Van Hecke, A. V., Carson, A. M., Dolan, B., Karst, J., & Stevens, S. (2013). A replication and extension of the PEERS intervention: Examining effects on social skills and social anxiety in adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44, 532–545. https://doi.org/10.1007/s10803-013-1900-1
Stulmaker, H. L., & Ray, D. C. (2015). Child-centered play therapy with young children who are anxious: A controlled trial. Children and Youth Services Review, 57, 127–133. https://doi.org/10.1016/j.childyouth.2015.08.005
Weaver, L. L., & Darragh, A. R. (2015). Systematic review of yoga interventions for anxiety reduction among children and adolescents. American Journal of Occupational Therapy, 69, 6906180070. https://doi.org/10.5014/ajot.2015.020115
