Little Children with Big Worries: Addressing the Needs of Young, Anxious Children and the Problem of Parent Engagement

Abstract

Anxiety disorders in preschool-age children represent an important clinical problem due to high prevalence, substantial impairment, persistence, and associated risk for later emotional problems. Early intervention may mitigate these problems by capitalizing on a strategic developmental period. Elevated neuroplasticity, availability of screening tools, and the potential to modify parenting practices position anxiety as a good candidate for early intervention and preventive efforts. While some novel interventions show promise, the broad success of such programs will largely depend on parent engagement. Since parents are less likely to identify and seek help for anxiety problems compared to other childhood behavior problems, especially in a preventive manner, methods for understanding parents' decisions to participate and enhancing levels of engagement are central to the success of early childhood anxiety prevention and intervention. Understanding these processes is particularly important for families characterized by sociodemographic adversity, which have been underrepresented in anxiety treatment research. This review summarizes the developmental phenomenology of early emerging anxiety symptoms, the rationale for early intervention, and the current state of research on interventions for young, anxious children. The roles of parent engagement and help-seeking processes are emphasized, especially among economically disadvantaged and ethnic minority communities who are acutely at risk. Evidence-based strategies to enhance parent engagement to facilitate the development and dissemination of efficacious programs are offered.

Effectiveness of an implementation optimisation intervention aimed at increasing parent engagement in HENRY, a childhood obesity prevention programme - the Optimising Family Engagement in HENRY (OFTEN) trial: study protocol for a randomised controlled trial

“…This resounds with literature exploring the difficulties of recruiting parents to attend population-based programmes in the absence of health problems in their children [9, 30]. Early childhood provides an opportunity to intervene to establish healthy behaviours that are critical for optimum growth and development [7], but the failure to attract parents to programmes such as HENRY (particularly in populations theorised to have the greatest benefit) is a threat to the success and viability of such programmes.…”

“…The effectiveness of interventions in real-world conditions may not match the efficacy found in research studies [29]. This may be particularly relevant to population-based prevention programmes, in which parents may be less likely to be motivated to attend because their children show no clinical symptoms [30, 31]. Thus, it is imperative to create tailored methods to maximise parent participation and enhance successful implementation in childhood obesity prevention programmes.…”

“…Failure to attend interventions is complicated by issues of health inequalities; socio-demographic attributes; and, in some cases, challenges related to safeguarding [30, 32, 33]. Literature on non-attendance in other areas (clinical appointments) indicates that attendance is lower in certain populations and may be an indicator of vulnerability [34].…”

Targeted Prevention of Childhood Anxiety: Engaging Parents in an Underserved Community

“…However, parent engagement has been studied almost exclusively in the context of externalizing problems. While much can be learned from this research, parents are generally less likely to seek help for anxiety compared to externalizing problems (Mian 2014;Pavuluri et al 1996), suggesting that engagement in anxiety programs may be even more challenging. This research suggests a need for methods to enhance engagement, as well as expanding research on engagement for anxiety-focused, preventive interventions.…”

Predictors of Childhood Anxiety: A Population-Based Cohort Study

“…However, little is known about the risk factors for anxiety in young children [ 9 , 10 ]. Most research to date has focused on factors associated with anxiety onset in pre-adolescents and adolescents, despite emerging evidence that supports the need to assess and intervene earlier in childhood [ 11 ]. Furthermore, existing research is limited by small samples and the inclusion of few predictors, predominantly occurring beyond the perinatal period (e.g., parenting, child temperament [ 12 , 13 ]).…”