Dalhousie University, Department of Psychiatry, Halifax, NS, Canada; Nova Scotia Health Authority, Halifax, NS, Canada.
Dalhousie University, Department of Psychiatry, Halifax, NS, Canada; Dalhousie University, Department of Pathology, Halifax, NS, Canada.
Clin Psychol Rev. 2020 Nov;81:101904. doi: 10.1016/j.cpr.2020.101904. Epub 2020 Aug 15.
Anxiety disorders are common and impairing throughout the life course. Propensity to anxiety disorders manifests as distress and avoidance of novel stimuli (called behavioural inhibition) as early as in infancy. Already in preschool children, anxiety disorders impact emotional development and school readiness. Anxiety disorders and behavioural inhibition are prospectively associated with increased risk of mood disorders, substance use, and suicide. Therefore, early targeted prevention and treatment need to be considered. Cognitive-behavioural interventions are effective for anxiety in older age group but their efficacy for preschool children remains to be established.
We searched PsycINFO, PubMed, and Embase until September 19th, 2019 using terms describing anxiety, behavioural inhibition, intervention, and young children. We included studies with young children participating in a cognitive-behavioural intervention for anxiety disorders, anxiety symptoms, or behavioural inhibition. We completed random-effects robust meta-analyses to (1) compare anxiety measures before and after intervention and to (2) compare intervention and control groups.
We identified 43 samples including 2656 participants with a mean age of 5.45 (SD = 1.00) years. Anxiety decreased after cognitive-behavioural intervention (standardized mean difference [SMD] = -1.34, 95%CI -1.59 to -1.09, p < 0.0001). Anxiety decreased more in children who received intervention than in children in control conditions (SMD = -0.81, 95%CI -1.00 to -0.63, p < 0.0001). The difference remained significant after correcting for potential publication bias and outliers (SMD = -0.89, 95% CI -1.13 to -0.66, p < 0.0001). The improvement was maintained over follow-up.
Cognitive-behavioural interventions are effective for prevention and treatment of anxiety in young children.
焦虑障碍在整个生命周期中都很常见且会造成损害。焦虑障碍的倾向表现为婴儿期就出现的痛苦和对新刺激的回避（称为行为抑制）。在学龄前儿童中，焦虑障碍已经会影响情绪发展和上学准备。焦虑障碍和行为抑制与心境障碍、物质使用和自杀风险增加呈前瞻性相关。因此，需要考虑早期有针对性的预防和治疗。认知行为干预对老年人群的焦虑症有效，但对于学龄前儿童的疗效仍有待确定。
我们使用描述焦虑、行为抑制、干预和幼儿的术语，在 2019 年 9 月 19 日之前在 PsycINFO、PubMed 和 Embase 中进行了搜索。我们纳入了参加焦虑症、焦虑症状或行为抑制的认知行为干预的幼儿的研究。我们完成了随机效应稳健荟萃分析，以（1）比较干预前后的焦虑测量值，（2）比较干预组和对照组。
我们确定了 43 个样本，包括 2656 名平均年龄为 5.45 岁（SD=1.00）的参与者。认知行为干预后焦虑减轻（标准化均数差 [SMD]=-1.34，95%CI-1.59 至-1.09，p<0.0001）。接受干预的儿童比对照组的儿童焦虑减轻更多（SMD=-0.81，95%CI-1.00 至-0.63，p<0.0001）。在纠正潜在的发表偏倚和离群值后，差异仍然显著（SMD=-0.89，95%CI-1.13 至-0.66，p<0.0001）。随访中仍保持改善。
认知行为干预对预防和治疗幼儿的焦虑症有效。
