Evidence gap

What is the effect of parent-directed interventions for children and young people's mental health?

Executive summary

This study examined the effects of an online parent intervention for children aged 4–7 who were at increased risk of developing anxiety disorders. The project was driven by the need for early intervention: anxiety problems in childhood can have significant long-term consequences, while many families are not reached by existing support services.

The study was conducted as a cluster-randomised controlled trial (RCT) involving 95 schools. A total of 865 children identified as being at risk through screening were included in the study. Parents were either given access to the digital intervention or received standard school-based follow-up. Outcomes were assessed after 6 weeks, 12 weeks, and 12 months.

The findings showed clear improvements across several key risk factors associated with the development of anxiety. Although the study did not demonstrate a statistically significant difference in anxiety diagnoses after 12 months — the primary outcome measure — the intervention had positive effects on children’s symptoms, coping abilities, and parental behaviour.

The results suggest that the intervention influences the mechanisms that contribute to the development of anxiety and therefore has the potential to support long-term prevention. This highlights the value of accessible, low-threshold digital interventions that can reach families early in a child’s development.

Metode

The study was designed as a quantitative cluster-randomised controlled trial, with schools serving as the unit of randomisation. Participants were children aged 4–7 years, and a total of 2,328 pupils were screened to identify children at increased risk of anxiety disorders. Of these, 865 children were included in the study.

Data collection included parent questionnaires used for both screening and follow-up, as well as diagnostic assessments conducted after 12 months. Participants were followed up at three different points during the study period.

The analyses compared the intervention group with the control group, focusing on both clinical diagnoses as the primary outcome and changes in risk factors and symptoms as secondary outcomes.

The study also had several limitations. The prevalence of anxiety diagnoses was lower than expected, which reduced the ability to detect significant effects on the primary outcome. At the 12-month follow-up, participation rates had declined to 72 per cent, and the pandemic also affected recruitment to the study. Together, these factors made it more challenging to demonstrate statistically significant effects on anxiety diagnoses.

Resultater

Main findings: Influencing risk factors for anxiety — but not diagnostic outcomes

The study found no statistically significant difference in the prevalence of anxiety diagnoses after 12 months, which was the study’s primary outcome measure. The proportion of children who developed an anxiety disorder was 6.8 per cent in the intervention group, compared with 11.5 per cent in the control group. Although the difference was not statistically significant, the results showed clear improvements in several key risk factors linked to the development of anxiety.

The intervention contributed to reductions in children’s anxiety symptoms and avoidance behaviour, while also improving coping skills. Parents reported lower levels of personal anxiety and increased confidence in their parenting role. The findings therefore suggest that the intervention affects the mechanisms underlying the development of anxiety — not only the diagnostic outcome itself.

Secondary findings: Positive effects on mental health, parenting behaviour, and early identification

The study demonstrated several significant improvements in children’s mental health. Children experienced fewer anxiety symptoms, less uncertainty and avoidance, and reductions in externalising difficulties. These results were statistically significant, with p-values ranging from 0.002 to <0.001.

Parents emerged as a key factor in the change process. Participation in the intervention led to increased parental self-efficacy and greater confidence in parenting, while overprotective behaviour and parental anxiety were reduced.

The study also identified important mechanisms through which prevention may work. The intervention influenced both how children cope with fear and how parents respond to their children’s worries, providing valuable insight into how early intervention can reduce the risk of later mental health difficulties.

Parents additionally reported high satisfaction with the programme, describing it as useful, accessible, and flexible. The study also showed that school-based screening is an effective method for identifying children at elevated risk, thereby enabling early intervention on a larger scale.

Konklusjon

The study found no statistically significant difference in the prevalence of anxiety diagnoses after 12 months, which was the primary outcome measure. The proportion of children who developed an anxiety disorder was 6.8 per cent in the intervention group, compared with 11.5 per cent in the control group. Although this difference was not large enough to be considered statistically significant, the results showed clear improvements in several key risk factors known to contribute to the development of anxiety.

The intervention had particularly positive effects on children’s mental health and coping abilities. Children showed reductions in anxiety symptoms, avoidance behaviour, uncertainty, and externalising difficulties. At the same time, parents reported increased confidence in their parenting role and greater belief in their own ability to support their child effectively. The study also found reductions in parental anxiety and less overprotective behaviour.

The findings suggest that the intervention influences the mechanisms underlying the development of anxiety, both through how children learn to manage fear and how parents respond to and support their children. This provides important insight into how early prevention may work in practice.

Parents also reported high levels of satisfaction with the intervention. They described it as useful, accessible, and flexible, underlining the potential of low-threshold digital support services for families.

Further research

The study further demonstrated that school-based screening is an effective way to identify children at elevated risk and can provide a foundation for early intervention on a larger scale.