Developing Measurement and Intervention Tools for Anxiety of Primary School Children

Abstract

Some degree of anxiety helps to deal with challenges in life but intense and excessive anxiety (i.e. anxiety disorder) interferes with normal life functioning and threatens individual well-being. Anxiety disorders in children and adolescents have become a concern globally and also in Bangladesh where its high prevalence rate poses a threat to the country’s future growth and development. Though effective actions are needed to deal with childhood anxiety, there is a dearth of culturally appropriate anxiety measures and intervention programs to tackle the problem. To address the needs, three studies were carried out in the present PhD project with the aim of adapting anxiety measures and developing an intervention program suitable for the children and youths of Bangladesh. In the first study, three anxiety measures, namely Child and Adolescent Worry Scale, Spence Children’s Anxiety Scale and Spence Children’s Anxiety Scale-Parent Version were adapted and validated in Bangla. The adapted scales had excellent internal consistency, test-retest reliability, content validity, criterion validity and construct validity. In the second study, a four-week intervention protocol was designed combining CBT and bibliotherapy where five story books were written based on cognitive behavior therapy (CBT) to address various anxiety disorders including separation anxiety, selective mutism, specific phobia, social phobia and generalized anxiety. The stories taught children various techniques of dealing with anxiety, such as relaxation, psychoeducation, role-playing, imagery, cognitive restucturing, distancing, talking back to anxieties, container exercises, graded exposure and positive self-talk. To conduct intervention sessions, self-help activity book and modules (manuals and materials) were also prepared. Subject matter experts, children and parents evaluated the intervention program to be appropriate for handling anxiety.In the third study, the effectiveness of the intervention program was investigated in primary school children in school settings. The three adapted anxiety measures were used before and after the intervention within the framework of a quasi-experimental mixed design. Results indicate that the intervention significantly reduced anxiety in children; anxiety level dropped from the pretest to the post-test phase in the experimental condition but not in the control condition. The qualitative assessment of the program by the children and their parents further supported the findings. The newly developed intervention program is theoretically sound (i.e. based on established theories on psychopathology), culturally sensitive (i.e. appropriate to use in Bangladesh), efficient (i.e. requires few sessions and can be used in group settings with low cost), and effective in reducing anxiety in children. The adapted scales can be used to assess anxiety in children in various settings. Altogether, the outcomes of the present PhD project are expected to contribute to improve the mental health and quality of life of children and young people in Bangladesh.