There is a need to reinvent evidence-based interventions (EBIs) for pediatric anxiety problems to better address the demands of real-word service delivery settings and achieve public health impact. The time- and resource-intensive nature of most EBIs for youth anxiety has frequently been noted as a barrier to the utilization of EBIs in community settings, leading to increased attention towards exploring the viability of briefer, more accessible protocols. Principally, this research reports between-group effect sizes from brief-interventions targeting pediatric anxiety and classifies each as well-established, probably efficacious, possibly efficacious, experimental, or questionable. brief interventions yielded an overall mean effect size of 0.19 on pediatric anxiety outcomes from pre to post. Effect sizes varied significantly by level of intervention: Pre to post-intervention effects were strongest for brief-treatments (0.35), followed by brief-targeted prevention (0.22), and weakest for brief-universal prevention (0.09). No participant or other intervention characteristic emerged as significant moderators of effect sizes. In terms of standard of evidence, one brief intervention is well-established, and five are probably efficacious, with most drawing on cognitive and behavioral change procedures and/or family systems models. At this juncture, the minimal intervention needed for clinical change in pediatric anxiety points to in-vivo exposures for specific phobias (~3 hours), cognitive-behavioral therapy (CBT) with social skills training (~3 hours), and CBT based parent training (~6 hours, eight digital modules with clinician support). This research concludes with a discussion on limitations to available brief EBIs, practice guidelines, and future research needed to capitalize on the viability of briefer protocols in enhancing access to, and impact of, evidence-based care in the real-world.

Frequent flyers are students who make repeated, unplanned visits to the school nurse, mostly presenting with somatic symptoms like headaches, stomachaches, and musculoskeletal pain. Somatic symptoms are characteristic of pediatric anxiety symptoms and disorders, but the relation between anxiety symptoms and frequent flyer status never has been systematically examined. This study employs data corresponding to 209 students in the 4th and 5th grade (Mage = 9.51, 43.5% girls, 50.9% 51.2% Caucasian, 23.9% Hispanic/Latino) to examine the relation between students' visits to the school nurse (frequent flyer status) and anxiety, including possible variations by children's socio-demographic characteristics, including sex and race/ethnicity. Findings showed statistically significant relations between anxiety and an increased number of nurse visits. A relation between anxiety and sex leading to increased nurse visits was not statistically significant. The statistical model testing race/ethnicity and anxiety in relation to increased nurse visits was found to be significant but driven solely by anxiety. Implications for this study include reframing how frequent flyers are viewed by teachers and addressing possible anxiety in these students.

Anxiety and depression are among the most prevalent disorders in youth, with prevalence rates ranging from 15% to 25% for anxiety and 5% to 14% for depression. Anxiety and depressive disorders cause significant impairment, fail to spontaneously remit, and have been prospectively linked to problematic substance use and legal problems in adulthood. These disorders often share a high-degree of comorbidity in both clinical and community samples, with anxiety disorders typically preceding the onset of depression. Given the nature and consequences of anxiety and depressive disorders, a plethora of treatment and preventative interventions have been developed and tested with data showing significant pre to post to follow-up reductions in anxiety and depressive symptoms. However, little is known about the mediators by which these interventions achieve their effects. To address this gap in the literature, the present thesis study combined meta-analytic methods and path analysis to evaluate the effects of youth anxiety and depression interventions on outcomes and four theory-driven mediators using data from 55 randomized controlled trials (N = 11,413). The mediators included: (1) information-processing biases, (2) coping strategies, (3) social competence, and (4) physiological hyperarousal. Meta-analytic results showed that treatment and preventative interventions reliably produced moderate effect sizes on outcomes and three of the four mediators (information-processing biases, coping strategies, social competence). Most importantly, findings from the path analysis showed that changes in information-processing biases and coping strategies consistently mediated changes in outcomes for anxiety and depression at both levels of intervention, whereas gains in social competence and reductions in physiological hyperarousal did not emerge as significant mediators. Knowledge of the mediators underlying intervention effects is important because they can refine testable models of treatment and prevention efforts and identify which anxiety and depression components need to be packaged or strengthened to maximize intervention effects. Allocating additional resources to significant mediators has the potential to reduce costs associated with adopting and implementing evidence-based interventions and improve dissemination and sustainability in real-world settings, thus setting the stage to be more readily integrated into clinical and non-clinical settings on a large scale.