Teacher awareness of anxiety symptoms in children

Mental Health Literacy for Supporting Children: A Systematic Review of Teacher and Parent/Carer Knowledge and Recognition of Mental Health Problems in Childhood

The level of mental health literacy (MHL) in adults who work with or care for children is likely to influence the timeliness and adequacy of support that children receive for mental health problems. The aim of this study was to systematically review the literature on mental health literacy for supporting children (MHLSC, recognition/knowledge) among parents and teachers of school aged children (5 to 12 years old). A systematic search was conducted for quantitative studies published between 2000 and June 2021 using three databases (MEDLINE, PsycINFO and ERIC) and relevant citations reviewed in Scopus. To be included, studies needed to measure at least either 'mental health knowledge' or 'recognition'. Synthesis proceeded according to study design, adult population, child MHP, then MHL outcome. Study quality was assessed using AXIS. 3322 documents were screened, 39 studies met inclusion criteria. 49% of studies examined teachers' knowledge or recognition of ADHD; only five studies reported on parent samples. Synthesis found a nascent field that was disparate in definitions, methods and measures. Little research focussed on knowledge and recognition for internalizing problems, or on parents. Methods used for measuring knowledge/recognition (vignette vs screening) were associated with different outcomes and the quality of studies was most often low to moderate. Adults appear to have good recognition of childhood ADHD but their knowledge of internalizing disorders is less clear. Further research is required to develop standard definitions and validated measures so gaps in MHLSC can be better identified across populations who have a role in supporting children with their mental health.

In Sync: Inclusive school communities supporting students with anxiety

This study aimed to investigate the experiences of educators (working in inclusive schools) supporting students with anxiety and anxiety-related disorders.

Method

A qualitative refractive phenomenological case study was used to collect data from 44 participants (educators in various roles) in six Australian primary and secondary schools, which previous research identified as using inclusive practices to support a diverse range of students.

Results

Educators shared that they supported what they saw as learning needs using intrinsic, intuitive, and inclusive (3I's) ways of working. Interestingly, all educators reported that students felt supported despite a lack of explicit strategies focused on reducing anxiety. The 3I's were a way of working educators used to support all students, even though they experienced difficulties in recognising anxiety as behaviours were often internalised. This was particularly the case where disability and anxiety disorders co-occurred. Furthermore, educators did not identify evidence to support any one type of intervention being effective in mitigating anxiety.

Conclusions

The data suggests that there is a culture of inclusion reducing student anxiety, even though teachers and support staff may not have recognise the student's anxiety. Parents were mostly the first identifier of anxiety in their child. This research highlights the need for educators to engage in professional development around recognising anxiety and, secondly, in the implementation of specific strategies to support students with anxiety or anxiety-related disorders.

Teacher Nominations of Preschool Children at Risk for Mental Health Problems: how False Is a False Positive Nomination and What Make Teachers Concerned?

Identification attempts in populations with a low prevalence of problems usually result in a considerable number of false positives. Thus, the aim of the current study was to investigate the false positive rate following nomination of developmental concerns by preschool teachers and the reasons for which teachers raise developmental concerns about children who display non-clinical levels of mental health problems.A total of 1430 children aged 1 to 6 years in Norwegian childcare centers were classified as true positive, false positive, true negative, or false negative by comparing preschool teachers’ nomination with their ratings on the Caregiver-Teacher Report Form, resulting in 127 (9%) false positives and 1142 (80%) true negatives.Compared to the true negative group, the false positive group received significantly higher scores on internalizing problems, externalizing problems than true negatives, conflict and significantly lower scores on closeness. Children’s internalizing and externalizing problems and age were the main factors that increased the likelihood of teachers raising concerns, while increased closeness in the teacher-child relationship reduced the likelihood of being nominated. Children’s gender and conflict level were not significant when adjusting for other factors.These findings suggest that preschool teachers’ concerns about children’s development should not be discarded as the false positive group did show elevated levels of problem behavior and poorer teacher-child relationship compared to the true negative group. Scrutinizing concerns in collaboration with parents and other mental health professionals may be beneficial to ensure healthy development for children with elevated problem levels.

Spanish Validation of the School Anxiety Scale-Teacher Report (SAS-TR)

This study aimed to examine the factorial structure and psychometric properties of the School Anxiety Scale-Teacher Report (SAS-TR) in a community sample of 315 Spanish children aged 5 to 12 years. Thirty-seven teachers from eleven schools completed the SAS-TR and the Strengths and Difficulties Questionnaire (SDQ) for each child. Confirmatory factor analysis supported the original two-factor structure, but a better fit model was obtained after removing four items. The scale was found to have high internal consistency (α = 0.91) and satisfactory test-retest reliability (ICC = 0.87) for the Spanish sample. Convergent validity was supported by positive significant correlations between the SAS-TR and the Emotional Symptoms subscale of the SDQ. Lower correlations between the SAS-TR and the SDQ Conduct Problems subscale supported the divergent validity. Overall, the findings suggest that the Spanish version of the SAS-TR is a reliable and valid instrument for teachers to assess anxiety in Spanish children.

What is the Threshold of Teachers' Recognition and Report of Concerns About Anxiety and Depression in Students? An Exploratory Study With Teachers of Adolescents in Regional Australia

Introduction:Anxiety and depression in adolescence is prevalent but often unrecognised and untreated. This can lead to serious disorders in later life. This study explored how teachers recognise anxiety and depression in secondary school students and act on their concerns.Method:Twenty teachers from four secondary colleges in regional Victoria, Australia were interviewed regarding their experiences. In-depth interviews were analysed using descriptive thematic analysis in order to understand how teachers respond to this issue.Results:Teachers' recognition of mental health problems in students and the threshold for reporting their concerns was subjective and not based on any formal knowledge of how to identify anxiety or depression risk factors in students. Years of teaching experience was not associated with increased knowledge of mental health problems in students. Time pressures and lack of resources in student wellbeing teams were barriers to teachers reporting their concerns about students.Conclusion:Education bodies and teaching universities responsible for training teachers and providing ongoing professional learning need to ensure that mental health training is part of every teacher's core skill set, so that teachers can confidently promote mental wellbeing, identify emerging mental health problems, know how to facilitate access to more specialist intervention where required and contribute effectively to follow-up support.

Werden Ängste und depressive Symptome bei Kindern und Jugendlichen in der Schule übersehen?

Lehrkräfte können eine wichtige Rolle bei der Früherkennung psychischer Fehlentwicklungen bei Kindern und Jugendlichen spielen. Diese Studie untersucht, wie Lehrpersonen internalisierende vs. externalisierende Symptome bei Schülern wahrnehmen. Hierfür wurde 345 Sechst- und Zehntklässlern der Strengths and Difficulties Questionnaire (SDQ) vorgelegt und parallel wurden die Lehrkräfte befragt, bei welchen zwei Schülern ihrer Klasse sie am ehesten emotionale und bei welchen zwei Schülern sie am ehesten Verhaltensstörungen vermuten. Die Ergebnisse zeigen, dass Lehrkräfte mäßig in der Lage sind, psychische Beschwerden bei ihren Schülern wahrzunehmen. Die Übereinstimmung zwischen Lehrerurteil und Selbstangabe fällt bei externalisierenden Problemen höher aus als bei internalisierenden. Weiterhin liegen die Einschätzungen der Lehrkräfte bei Mädchen näher an den selbst berichteten Beschwerden als bei den Jungen. Es werden Schlussfolgerungen für die Lehrerprofessionalisierung und für zukünftige Forschungsbemühungen präsentiert.

Self-Disclosure and Mental Health Service Use in Socially Anxious Adolescents

Social anxiety disorder is highly prevalent in adolescence, persistent into adulthood, and associated with multiple impairments. Despite the development of efficacious treatments for socially anxious youth, few affected adolescents receive such treatment. This study examined service use in a sample of high school students (n = 1,574), as well as predictors of treatment delay and factors associated with adolescents' disclosure of social difficulties. Self-report measures of social anxiety and service utilization were administered by study staff to 10th- and 11th-grade classrooms across three public high schools. Consistent with the literature, results indicated low treatment utilization (14 %) and lengthy delays in treatment initiation. Symptom severity, impairment, and disclosing anxiety to school personnel were significant predictors of service utilization. Several demographic and illness-specific factors were associated with a higher likelihood of disclosing social discomfort. These findings underscore the important role of school personnel in identifying and referring youth with anxiety disorders. Implications are discussed for increasing access to services, including school-wide screenings and training of school personnel to recognize and provide intervention for anxious youth.

Trajectories of anxiety in a population sample of children: clarifying the role of children's behavioral characteristics and maternal parenting

This study pursued three goals. The first goal was to explore children's trajectories of anxiety from age 6 to 12 using a representative community sample. The second goal was to assess the link between certain behavioral characteristics assessed in kindergarten (i.e., inattention, hyperactivity, aggressiveness, and low prosociality) and these trajectories. The third goal was to determine whether certain aspects of maternal parenting (i.e., warmth and discipline) could moderate the association between these characteristics and the trajectories of anxiety. A population sample of 2,000 children (1,001 boys, 999 girls) participated in this longitudinal study. Developmental trajectory analyses allowed us to identify four trajectory groups: low, low-increasing, high-declining, and high anxiety groups. Moreover, multinomial logistic regressions revealed a profile of children at risk of developing high anxiety symptoms (i.e., high group), characterized by sociofamily adversity, inattention, and low prosociality in the classroom. Hyperactivity was also found in this profile, but only for children exposed to a mother who showed little affective warmth. Finally, mothers' high level of discipline increased the odds of belonging to the high anxiety group. The results are discussed in relation to studies examining the association among anxiety, behavioral characteristics, and parenting during childhood.

The correlates and consequences of early appearing social anxiety in young children

Social anxiety is the fear of social situations and being negatively evaluated by others. Most previous studies of childhood social anxiety have employed clinical samples of children aged 10 years and older. The current study explored the correlates of social anxiety in an unselected sample of young children. Participants were n=178 elementary school children in grade 2 (aged 7-8 years). Children were individually administered the Social Anxiety Scale for Children-Revised (SASC-R), as well as measures of socio-emotional adjustment. Teachers completed measures of children's socio-emotional problems and school adjustment. Results indicated that social anxiety was positively associated with self-reported loneliness, school avoidance, and internalizing coping, and negatively related to school liking. However, social anxiety was mostly unrelated to teacher-rated outcomes. Findings are discussed in terms of use of the SASC-R for this type of population and reasons for the disparity between child and teacher reports of adjustment outcomes.

Generalized anxiety disorder in a nonclinical sample of children: symptom presentation and predictors of impairment

Presentation of generalized anxiety disorder (GAD) in a nonclinical sample of children (7-11 years old) and factors that predict overall impairment were examined. Symptom presentation was compared in children with GAD (n=49) and anxious children without GAD (n=42). Children with GAD endorsed significantly more worries, greater intensity of worries, and more DSM-IV associated symptoms than anxious children without GAD. Eighty-six percent of children with GAD had a comorbid diagnosis with 4% having a depressive disorder. Number of associated symptoms was most predictive of GAD impairment based on child perspective and intensity of worry was most predictive based on clinician perspective. Overall, findings from the current study are consistent with reports based on clinical samples. The DSM-IV-TR criteria for GAD were supported, with the exception that children with GAD typically present with several associated symptoms, rather than only one.