Children’s Perceptions of Barriers to Session Attendance in School-Based Treatment for Anxiety

  • Jeffrey E. Pella
  • Golda S. Ginsburg
  • Elizabeth Casline
  • Paige J. Pikulski
  • Kelly L. Drake
Original Paper


This study examined children’s perceived barriers to attending school-based anxiety treatment. One hundred and twenty-two anxious youth (mean age = 11.03 years; 51.6% female; 46.7% non-white) were randomized to receive either a modular cognitive behavioral anxiety treatment or usual care. The frequencies of 13 child-reported perceived barriers were examined following randomization and during one of the first three treatment sessions. Correlates of perceived barriers were also examined using a multi-informant assessment including: (1) child/family demographics, (2) child clinical characteristics, and (3) parental/family factors. Results indicated that 87.7% of children reported at least one perceived barrier to attending treatment. The most common barriers were worries about missing classroom work (45.3%) and the stigma associated with receiving mental health services (37.7%). Several factors were correlated with greater perceived barriers including minority racial/ethnic background, low parental education, higher child anxiety, and higher teacher-reported child externalizing behavior in the classroom. A multiple regression model showed that the strongest association was between teacher-rated externalizing behavior and children’s perceived barriers. Although school-based treatment removes logistical problems, children’s perceived barriers are still common. Assessing and reducing these perceived barriers, particularly among racial minority families and families with parents who did not attend college, may be beneficial.


Perceived barriers Child anxiety School-based treatment Treatment attendance 



This research was supported by a grant from the Institute of Educational Sciences, US Department of Education, through Grant R324A120405 awarded to Dr. Golda S. Ginsburg. The opinions expressed are those of the authors and do not represent views of the Institute or the US Department of Education.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the Institutional Review Board of UConn Health. All procedures performed in this study were in accordance with the 1964 Declaration of Helsinki and its later amendments.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of Connecticut School of MedicineWest HartfordUSA
  2. 2.The Johns Hopkins, University School of Medicine, and Anxiety Treatment Center of MarylandEllicott CityUSA

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