Anxiety disorders represent one of the most common and debilitating forms of psychopathology in children. While empirical research, mental health funding, and mental health professionals continue to focus on the treatment rather than prevention of anxiety disorders in children, preliminary research presents an optimistic picture for preventative strategies in the future. Knowledge of the risk factors, protective factors, and treatment strategies associated with childhood anxiety disorders, in conjunction with theories regarding the methods, timing, levels, and targets of prevention, equip us well for effectively preventing childhood anxiety disorders in the future.
THE ADAGE THAT “prevention is better than cure” would seem to make intuitive sense and is certainly a concept embraced by the medical profession. Immunisation, breast cancer screening, pap smear tests, and media campaigns aimed at decreasing skin cancer, are but a few examples of the emphasis on prevention within the field of medicine. Prevention and treatment research within the medical domain are considered to be of equal importance by researchers, funding bodies, and the general public. Furthermore, medical practitioners spend a significant proportion of their time engaged in preventative strategies and in advocating preventative strategies to their patients.
In contrast, the mental health sector has not, until recently, shared the emphasis on prevention. Despite the enormous economic, personal and social costs of many mental health problems, and the vast number of people suffering from them, the focus within mental health has continued to be on treatment rather than prevention. While there has been an encouraging increase in the number of psychological academic journal articles relating to prevention, the majority of papers have been theoretical in nature rather than rigorous empirical tests of particular preventative strategies.
Children may suffer from a number of mental health problems, however anxiety disorders represent one of the most common forms of psychopathology in children. In an epidemiological study of the prevalence of anxiety disorders in children, Kashani and Orvaschel (1990) found that 21% of children and adolescents demonstrated an anxiety disorder of some description. While separation anxiety disorder is the only anxiety disorder categorised as typically beginning in childhood and adolescence according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (American Psychiatric Association, 1994), children may also suffer from any of the anxiety disorders outlined for adulthood. From the following discussion it will become apparent that while the prevention of childhood anxiety remains in its infancy, preliminary research presents an optimistic picture for the future.
The above discussion has highlighted the debilitating consequences of childhood anxiety disorders and the benefits of prevention. Our knowledge of the many risk factors, protective factors, and effective treatment strategies for anxiety, equips us well for effectively preventing childhood anxiety disorders. It is evident that while further research is necessary, models already exist regarding the timing of preventative efforts (Spence, in press) and the different levels at which prevention should be aimed (personal, interpersonal, organisational/environmental, and institutional; Winett, 1998). Furthermore, models exist regarding the type of resources into which preventative efforts should be channelled and the different target groups and design strategies for intervention (universal, selective, and indicated). It seems likely that universal prevention methods that teach a broad spectrum of protective factors and focus on entire populations are most sensibly directed towards the prevention of a broad spectrum of mental disorders, given that many disorders share common risk and protective factors. In contrast, selective and indicated prevention strategies may be used effectively to target more specific disorders for which the presence of clear-cut risk factors can be used to identify children at risk for the disorder concerned.
Given the knowledge and theoretical underpinnings relating to the prevention of anxiety disorders in children, the above discussion also highlights the infancy of our empirical inquest into this area. The majority of studies investigating anxiety prevention have tended to be selective and aimed at the acquisition of personal competencies. While this is likely to be an important first step, multidimensional preventative strategies taking into account multiple risk and protective factors, aimed at different levels, and involving a number of preventative strategies are likely to be more effective in the prevention of childhood anxiety. Futhermore, enquiry into the outcome of preventative strategies requires the use of robust, controlled epidemiological methods and the use of long-term follow-up.
The research possibilities in the area of prevention are enormous. However, prevention research will only be possible and useful if the prevention of mental disorders as a concept is perceived as important by government, communities, funding bodies, clinicians, and the general public. Prevention strategies must be conducted on a wide-scale basis before significant reductions in the prevalence of disorders are demonstrated. Researchers, clinicians, and society as a whole must therefore value and embrace the concept of prevention in the area of mental health before effective prevention can be achieved.
