Effects of Cognitive-Behavioral Intervention on the School Performance of Students with Emotional or Behavioral Disorders and Anxiety

Article excerpt


Despite widespread treatment success in clinical settings, anxiety disorders are rarely targeted for intervention in students with emotional or behavioral disorders (EBD) who exhibit them. This study examined the effects of a school-based anxiety intervention on the performance of 3 students attending school in a self-contained EBD setting. Using a single-subject, multiple-baseline design across students, this study examined changes in anxiety, maladaptive behavior, and academic engagement as functions of participation in the cognitive-behavioral anxiety intervention, FRIENDS for Life. All 3 participants showed improvement across all measures. Implications for the implementation of a school-based intervention for EBD students who experience high degrees of anxiety, as well as study limitations and directions for future research, are discussed.

* Students with emotional and behavioral disorders (EBD) exhibit a wide variety of behavioral and mental health needs (Individuals with Disabilities Education Act [IDEA], 2004; Kauffman, 2005). Among these are anxiety disorders, a category of mental health disorders typified by different forms of excessive fear and worry (Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision [DSM-IV-TR]; American Psychiatric Association, 2000). Approximately 14% of students with EBD meet the DSM-IV-TR diagnostic criteria for an anxiety disorder (Dery, Toupin, Pauze, & Verlaan, 2004; Garland et al., 2001).

Given the academic deficits generally exhibited by students with EBD (Wagner, Kutash, Duchnowski, Epstein, & Sumi, 2005), including those with internalizing disorders such as anxiety, it is perhaps not surprising that research has shown anxiety to have a detrimental effect on school performance. Students who experience anxiety report that they have difficulty concentrating and doing homework (Dobbs, Doctoroff, Fisher, & Arnold, 2006; Langley, Bergman, McCracken, & Piacentini, 2004) and are less likely to complete high school than their nonanxious peers (Van Ameringen, Mancini, & Farvolden, 2003). Anxious symptoms can predict later reading and mathematical achievement (lalongo, Edelsohn, Werthamer-Larsson, Crockett, & KeI lam, 1 994) and can be used to explain a proportion of variance in overall academic scores (Durbrow, Shaefer, & Jimerson, 2000). Teachers, as well as researchers, have noted anxiety's effects, describing anxious students not only as academically underperforming but underperforming to the same degree as students with externalizing behavioral difficulties (Benjamin, Costello, & Warren, 1990; Strauss, Frame, & Forehand, 1987).

In recent years, cognitive-behavioral therapy (CBT) has become a standard means of treating anxiety in children and adolescents (Compton et al., 2004; Kendall, 1994; King, Heyne, & Ollendick, 2005; Silverman, Pina, & Viswesvaran, 2008). As many as 70% of children with anxiety who complete CBT no longer meet diagnostic criteria for an anxiety disorder (Bernstein, Layne, Egan, & Tennison, 2005; Flannery-Schroeder & Kendall, 2001; King et al., 1999; Wood, 2006), an effect that has been replicated in large-group, smallgroup, individual, child-focused, and concurrent child and parent groups formats (Compton et al., 2004). These effects are long term in duration, with improvements that persist for up to 7 years (Barrett, Duffy, Rapee, & Dadds, 2001; Clark et al., 1999; Dadds et al., 1999; Kendall, Safford, Flannery-Schroeder, & Webb, 2004). Moreover, the symptoms of anxiety that occur at school appear to respond both to clinic-based (e.g., Suveg et al., 2009; Wood, 2006) and classroom-based (e.g., Barrett & Turner, 2001; Bernstein et al., 2005; Dadds, Spence, Holland, Barrett, & Laurens, 1997; Lowry-Webster, Barrett, & Dadds, 2001) models of CBT intervention.

Despite the strength of findings regarding the effectiveness of CBT in treating children's anxiety, current research regarding schoolbased CBT presents a number of limitations that prevent generalization to students with EBD. …


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