The purpose of this study was to examine the effects of a school-wide attendance and truancy intervention and universal procedures (ATI-UP) on student attendance. Student attendance was measured through average daily attendance and the percentage of students who would be considered chronically absent, i.e., missing 10% or more of school. The sample included 27 elementary schools in Oregon implementing school-wide positive behavior intervention and supports (SWPBIS) with varying levels of fidelity. Results indicate that schools can have a moderate effect on increasing average daily attendance (ADA) and a small effect on decreasing chronic absenteeism, although these results were not statistically significant. SWPBIS implementation did not act as a statistically significant moderator on the ATI-UP effects, although the treatment effect on ADA decreased with higher SWPBIS implementation.

Anxiety disorders are among the most prevalent psychiatric disorders in children and adolescents, with ten to fifteen percent of young children experiencing internalising problems (Briggs-Gowan, Carter, Irwin, Wachtel, & Cicchetti, 2004; Egger & Angold, 2006). Researchers have indicated that clinically significant anxiety can exist in preschool aged children and can be sub-typed into patterns similar to that of older children. This early identification of anxiety has lead researchers to recommend that prevention efforts occur early in the life course (Beinvenu & Ginsburg, 2007), before the onset of disorder(s). Research remains scarce as to when the ultimate time to intervene would be, as anxiety research with young children is minimal. The studies presented in this thesis attempt to expand the current literature within in the area of early childhood anxiety. The first objective of this thesis was to extend the literature in the field of early childhood anxiety by examining the aetiology of anxiety and behavioural inhibition (BI) through the investigation of potential risk factors. This study (Study One) represents one of the first investigations within the research to examine risk factors for early childhood anxiety. Two hundred and thirty-six children aged four to six years participated in this study. Parents of the children completed self-report questionnaires at one time point. Results revealed that BI did not significantly predict anxiety, nor did any of the risk factors significantly predict BI. Significant predictors of anxiety included mother’s negative affect and mother’s parenting stress. Father’s parenting stress was found to play a mediating role between mother’s parenting stress and child anxiety. Overall, the findings highlight the importance of both parents (directly or through mediation) in the aetiology of early childhood anxiety. The findings of Study One provide important information regarding the aetiology of early childhood anxiety and provide important implications for the development of preventative intervention programs. Study Two sought to examine the efficacy of a preventative intervention program (Fun FRIENDS; Barrett, 2007a) for preschool aged children, delivered as a school- based, universal intervention. This was the first study conducted evaluating the Fun FRIENDS program and was one of only a few prevention trials cited within the literature examining early childhood anxiety. The study involved a cohort of 263 children enrolled in one of 16 preschool classes. Children were aged between four and six years. Schools were randomly allocated to either an intervention group (IG) or a waitlist control group (WLG). Parents of the children and teachers completed self-report questionnaires at preintervention, postintervention, and at 12-month follow-up (parents in the IG only). Parent report data revealed no significant differences between intervention conditions on anxiety at postintervention, although participants in the IG experienced larger reductions in anxiety than participants in the WLG. Children in both conditions decreased in BI symptoms at postintervention, except for boys in the IG. Significant increases in social-emotional strength were found for girls in both conditions, but not for boys. When examining the IG only over the long-term (pre, post, 12 month follow-up), nearly significant decreases in anxiety were found at postintervention and significant decreases were found again at 12-month follow-up. Improvements in BI were found at all time points for girls but not for boys and improvements on social-emotional strength were found from preintervention to 12-month follow-up, with girls scoring significantly higher than boys. For teacher report, children in the IG improved significantly more on BI compared to the WLG at postintervention indicating that the intervention program may have had a positive impact on these children in learning strategies to manage BI symptoms. However, at pr-intervention, scores on BI were significantly different between the IG and the WLG. Similar to parent report, girls in the IG experienced the largest decrease in BI symptoms at postintervention. On social-emotional strength, children in the IG improved significantly more than children in the WLG at postintervention with girls in the IG experiencing the largest improvement from pre to postintervention. Overall, these findings suggest that the intervention program had a positive impact on some children as evidenced by improvements in anxiety, BI, and social-emotional strength at postintervention and at 12-month follow-up. Parent report indicated that children in the WLG also improved on these measures, making it difficult to contribute positive changes solely to the program. However, teacher report did indicate that children in the IG improved significantly more than children in the WLG. The improvements gained at 12-month follow-up highlight the potential long-term impact of the program although, without a comparison group, it is unknown whether significant differences would exist between both conditions. Implications of these results are discussed along with limitations and directions for future research.

Anxiety disorders are among the most prevalent psychiatric disorders in children and adolescents, with ten to fifteen percent of young children experiencing internalising problems (Briggs-Gowan, Carter, Irwin, Wachtel, & Cicchetti, 2004; Egger & Angold, 2006). Researchers have indicated that clinically significant anxiety can exist in preschool aged children and can be sub-typed into patterns similar to that of older children. This early identification of anxiety has lead researchers to recommend that prevention efforts occur early in the life course (Beinvenu & Ginsburg, 2007), before the onset of disorder(s). Research remains scarce as to when the ultimate time to intervene would be, as anxiety research with young children is minimal. The studies presented in this thesis attempt to expand the current literature within in the area of early childhood anxiety. The first objective of this thesis was to extend the literature in the field of early childhood anxiety by examining the aetiology of anxiety and behavioural inhibition (BI) through the investigation of potential risk factors. This study (Study One) represents one of the first investigations within the research to examine risk factors for early childhood anxiety. Two hundred and thirty-six children aged four to six years participated in this study. Parents of the children completed self-report questionnaires at one time point. Results revealed that BI did not significantly predict anxiety, nor did any of the risk factors significantly predict BI. Significant predictors of anxiety included mother’s negative affect and mother’s parenting stress. Father’s parenting stress was found to play a mediating role between mother’s parenting stress and child anxiety. Overall, the findings highlight the importance of both parents (directly or through mediation) in the aetiology of early childhood anxiety. The findings of Study One provide important information regarding the aetiology of early childhood anxiety and provide important implications for the development of preventative intervention programs. Study Two sought to examine the efficacy of a preventative intervention program (Fun FRIENDS; Barrett, 2007a) for preschool aged children, delivered as a school- based, universal intervention. This was the first study conducted evaluating the Fun FRIENDS program and was one of only a few prevention trials cited within the literature examining early childhood anxiety. The study involved a cohort of 263 children enrolled in one of 16 preschool classes. Children were aged between four and six years. Schools were randomly allocated to either an intervention group (IG) or a waitlist control group (WLG). Parents of the children and teachers completed self-report questionnaires at preintervention, postintervention, and at 12-month follow-up (parents in the IG only). Parent report data revealed no significant differences between intervention conditions on anxiety at postintervention, although participants in the IG experienced larger reductions in anxiety than participants in the WLG. Children in both conditions decreased in BI symptoms at postintervention, except for boys in the IG. Significant increases in social-emotional strength were found for girls in both conditions, but not for boys. When examining the IG only over the long-term (pre, post, 12 month follow-up), nearly significant decreases in anxiety were found at postintervention and significant decreases were found again at 12-month follow-up. Improvements in BI were found at all time points for girls but not for boys and improvements on social-emotional strength were found from preintervention to 12-month follow-up, with girls scoring significantly higher than boys. For teacher report, children in the IG improved significantly more on BI compared to the WLG at postintervention indicating that the intervention program may have had a positive impact on these children in learning strategies to manage BI symptoms. However, at pr-intervention, scores on BI were significantly different between the IG and the WLG. Similar to parent report, girls in the IG experienced the largest decrease in BI symptoms at postintervention. On social-emotional strength, children in the IG improved significantly more than children in the WLG at postintervention with girls in the IG experiencing the largest improvement from pre to postintervention. Overall, these findings suggest that the intervention program had a positive impact on some children as evidenced by improvements in anxiety, BI, and social-emotional strength at postintervention and at 12-month follow-up. Parent report indicated that children in the WLG also improved on these measures, making it difficult to contribute positive changes solely to the program. However, teacher report did indicate that children in the IG improved significantly more than children in the WLG. The improvements gained at 12-month follow-up highlight the potential long-term impact of the program although, without a comparison group, it is unknown whether significant differences would exist between both conditions. Implications of these results are discussed along with limitations and directions for future research.

Anxiety and depression are common in children and adolescents, and involve individual suffering, risk of future psychiatric problems, and high costs to society. However, only a limited number of children experiencing debilitating anxiety and depression are identified and receive professional help. One approach that could possibly reduce the prevalence of these conditions is universal school-based prevention aimed at reducing the impact of risk factors and strengthening protective factors involved in the development of anxiety and depression. The current thesis aimed to contribute to the literature on universal prevention of anxiety and depression in children. Study I involved a meta-analysis of earlier randomized, and cluster-randomized trials of universal prevention of anxiety and depression. Overall, the meta-analysis showed small but significant effects of universal preventive interventions, meaning that lower levels of anxiety and depression were evident after intervention completion and partially evident at follow-up assessments. No variables were found to significantly enhance the effects, however, there was a tendency for larger effects to be associated with mental health professionals delivering the interventions. In Study II, a widely adopted prevention program called Friends for Life was evaluated in a large school-based cluster-randomized effectiveness trial. The results showed no evidence of an intervention effect for the whole sample. However, children with elevated depressive symptoms at baseline and children with teachers who highly participated in supervision, seemed to benefit from the intervention in the short term. Study III involved a 3-year follow-up of Study II and an examination of the effects of sample attrition. The results showed no long-term effects for the whole sample and no maintenance of the short-term subgroup effects observed in Study II. Finally, to increase our understanding of the development of anxiety in children and to assist future improvements of universal prevention, Study IV evaluated different trajectories of overall anxiety together with related patterns of disorder-specific symptoms in a school-based sample over 39 months. Evidence favored a model of three different developmental trajectories across age. One trajectory was characterized by increasing levels of overall anxiety, but fluctuating disorder-specific symptoms arguably related to the normal challenges of children’s developmental level, which warrants an increased focus on age-relevant challenges in universal prevention. The four studies provide further understanding of the overall effectiveness of universal prevention of anxiety and depression in children, the short- and long-term effects of universal prevention in a Swedish context, and ideas for further development of preventive interventions.

Background: School-based mental health promotion aims to strengthen mental health and reduce stress. Results on the effectiveness of such programs are heterogeneous. This study realized a school-based mental health promotion program (StresSOS) for all students and aimed to identify moderators (mental health status, gender, grade level) of pre- to post-changes in stress symptoms and knowledge. Methods: Participants were N = 510 adolescents (from 29 classes; 46.7% female) aged 12–18 years (M = 13.88, SD = 1.00; grade levels 7–10). They were without mental health problems (65.9%), at risk for mental health problems (21.6%), or with mental health problems (12.5%) and participated in a 90 min per week face-to-face training with 8 sessions in class at school. Demographic variables, mental health status, stress symptoms, and knowledge about stress and mental health were collected at baseline. Program acceptance, stress symptoms, and knowledge were collected post-intervention. Multilevel mixed effects models were conducted with the fixed effects time (within factor), mental health status, gender, and grade level (between factors). Random effects for students within classes were included. Results: In the pre-post comparison, mental health status moderated the changes on psychological stress symptoms (p < 0.05). In adolescents with mental health problems the largest reduction in stress symptoms was observed between pre- and post-assessment. Gender and grade level were less relevant. For all adolescents knowledge gains were revealed (p < 0.001). Program acceptance was moderated by mental health status and grade level (p < 0.01). Mentally healthy adolescents and within the group of adolescents at-risk or with mental health problems, especially younger students (7th/8th grade), rated program acceptance higher. Conclusion: Psychological stress symptoms decreased among adolescents with mental health problems and not among adolescents at risk for or without mental health problems. Mental health-related knowledge increased for all adolescents. The results add to knowledge on school-based mental health intervention research and practice. Its implications for different prevention strategies (universal, selective or a combination of both) are discussed.

La pérennité des programmes contre la violence scolaire nécessite la mise en oeuvre adéquate des mesures de prévention universelle et la mobilisation de l’ensemble de l’équipe-école. Une étude exploratoire par Levasseur et al. (2019) avait rapporté des différences de perceptions sur trois dimensions de mise en oeuvre (socialisation, prévention et intervention) et trois facteurs de mobilisation (leadership de la direction, vision commune et sentiment d’efficacité personnelle) selon la fonction occupée par le personnel scolaire (enseignants, personnel éducatif autre et personnel de soutien). Ce mémoire visait à répliquer l’étude de Levasseur et al. (2019) à des fins confirmatoires avec un plus grand échantillon en comparant les perceptions du personnel scolaire des dimensions de mise en oeuvre et des facteurs de mobilisation selon la fonction occupée et en explorant les liens entre les perceptions des dimensions de mise en oeuvre et les facteurs de mobilisation selon la fonction. Pour ce faire, les perceptions des dimensions de mise en oeuvre et des facteurs de mobilisation ont été mesurées chez 1688 membres du personnel de 66 écoles primaires québécoises. Les résultats montrent que les groupes se sont distingués au niveau multivarié pour la prévention, l’intervention, le leadership de la direction et le sentiment d’efficacité personnelle. Des liens directs ont été observés pour l’ensemble du personnel sauf entre le leadership de la direction et la prévention pour le personnel éducatif autre. Ces résultats soutiennent l’importance d’une approche différentiée selon la fonction occupée pour cibler les groupes nécessitant davantage d’accompagnement et de soutien. / The sustainability of school violence programs requires the proper implementation of universal prevention measures and the mobilization of the entire school. An exploratory study by Levasseur et al. (2019) had reported differences in perceptions on three implementation dimensions (socialization, prevention, intervention) and three mobilization factors (principal’s leadership, shared vision of needs and solutions, self-efficacy to intervene) depending on the role held by school personnel (classroom teachers, other instructional staff, support staff). The purpose of this dissertation was to replicate the Levasseur et al. (2019) study for confirmatory purposes with a larger sample by comparing school personnel’s perceptions of the implementation dimensions and mobilization factors by staff’s roles and exploring the relationships between perceptions of the implementation dimensions and mobilization factors by staff’s roles. To this end, the perceptions of the implementation dimensions and mobilization factors were measured in 1688 staff members from 66 Quebec elementary schools. Results indicated that the groups differed at the multivariate level for prevention, intervention, principal’s leadership, and self-efficacy to intervene. Furthermore, direct relationships between implementation dimensions and mobilization factors were observed for all school personnel except for principal’s leadership and prevention for other instructional staff. These results support the importance of a differentiated approach by staff’s role to target groups of school personnel in need of further guidance and support.

Introduction Numerous preventive programmes have emerged, and need to be investigated to determine their effects on the normal population. Earlier studies have shown a decrease in depressive symptoms, positive effects on children’s disruptive behaviour problems, and an improvement in parental competence. About a fifth of the parents in previous studies had problem-oriented (targeted) reasons for enrolment, whereas the rest of the parents had general (universal) reasons. The results of those studies suggest that the programmes are cost effective in terms of Quality-Adjusted Life Years. Aim Four sub-studies were performed, and their aims were to investigate the effect of parental training programmes (PTPs) in a naturalistic setting on parents’ mental health in the general population, to investigate how PTPs affect parents’ sense of parental competence, to investigate how PTPs affect parental stress and analyse the parents open questions about the PTPs, and to investigate the feasibility and to measure the effect on depression, anxiety, and social problems of two preventive school programmes for pupils in grade 7. Method In a longitudinal quantitative study in a real-world setting, 279 parents from the general population in northern Sweden participated in five PTPs. A comparison group of 702 parents without intervention was included. Simultaneously, a community sample of 59 pupils in grade 7 participated in two preventive school programmes. Both studies were conducted from 2010 to 2013. Parents were assigned to professionally supported interventions that included 5-10 two-hour sessions. Respondents filled in a web-based questionnaire with the General Health Questionnaire (GHQ), the Parents Sense of Competence (PSOC) for parents who had children aged 0-17 years, and the Swedish Parenthood Stress Questionnaire (SPSQ) for parents who had children aged 0-10 years. The intervention groups’ results were compared to comparison group of 702 parents from northern Sweden that had not participated in any parental training programme. In the school study, one of the preventive programmes was an ongoing programme called “Life-Skills”, and the other was an implemented Canadian programme called “Choosing Healthy Actions and Thoughts” (CHAT). The pupils completed a test battery including the Sense of Coherence (SOC), the Children’s Depression Inventory (CDI), and the Youth Self-Report (YSR) instruments. Follow up of the parental programme study was done six months after the post-intervention measure, and follow up of the school study was at one year. Results The improvements in GHQ were statistically significant for the mean of the 279 parents in the intervention group compared to the mean of a comparison group of the 702 parents who did not receive any intervention. This suggests that evidence-based PTPs enhance parental well-being even for parents without problems. The intervention group showed a statistically significant improvement in parental competence compared to the comparison group over time. The intervention itself had a significant effect on parental satisfaction, but the efficacy effect was not sustained when taking into account potential confounders. In the SPSQ, the intervention group was smaller due to the fact that the instrument was not validated for children over the age of 10 and one of the parental training groups was only for parents of teenagers. A reduction of stress in the sub-scale of health problems was detected, but no other subscale showed the intervention to have a significant effect when controlling for confounding variables. In the school study, both programmes had good feasibility according to the stake- holders and had several positive mental health outcomes over time. Compared to Life-Skills, CHAT had more significant positive effects on reducing anxious/depressive symptoms and girls experienced significant positive effects on reduced anxious/depressive behaviour, while boys reduced their aggressive behaviours. Conclusions Earlier studies indicate that PTPs enhance perceived parental competence among referred parents. The present study shows that PTPs applied in the general population might also enhance perceived parental benefits such as improved health and satisfaction, suggesting that PTPs can be an important preventive strategy to enhance parenthood. The results suggest that parents who feel a need to increase their parenting competence might participate in PTPs based on lower scores than the comparison control group both before and after the intervention. The school-based programme shows that schools may be a suitable arena for preventive programmes because there was a significant short-term improvement in depression symptoms. Further studies need to explore how parents’ participation in PTPs affects children’s mental health in the general population in quantitative longitudinal studies in real-word settings. There is also a need for bigger studies and RCTs on school preventions and on how children’s health develops naturally in the population.