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Preliminary Evaluation of a Multimodal Early Intervention Program for Behaviorally Inhibited Preschoolers

Published on Jan 1, 2015in Journal of Consulting and Clinical Psychology4.36
· DOI :10.1037/a0039043
Andrea Chronis-Tuscano26
Estimated H-index: 26
,
Kenneth H. Rubin77
Estimated H-index: 77
+ 10 AuthorsMaureen Wimsatt2
Estimated H-index: 2
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Abstract
Fifteen to twenty percent of young children can be classified as behaviorally inhibited (BI) during infancy, and roughly half continue to display socially reticent behaviors throughout childhood (Degnan & Fox, 2007). Prospective studies demonstrate that stable BI across infancy and early childhood is associated with the development of later anxiety, particularly social anxiety disorder (SAD; Chronis-Tuscano et al., 2009) – suggesting a need for early intervention. Parenting characterized by inappropriate warmth, a lack of responsive supportiveness and high levels of control, intrusiveness, and overprotection predicts both the stability of BI over time (e.g., Rubin, Burgess, & Hastings, 2002) and the development of later anxiety (McLeod, Wood, & Weisz, 2007). Moreover, maternal overcontrol moderates risk for anxiety, such that children with stable BI who also experience maternal intrusive control and a lack of responsiveness are at greatest risk for adolescent social anxiety (Lewis-Morrarty et al., 2012). Within our theoretical model (Rubin et al., 2009), parents of children high in BI perceive them as vulnerable and thus respond to them in an unresponsive, unsupportive, and intrusive manner. Over time, these children become increasingly dependent on their parents and come to believe they are unequipped to deal with anxiety-provoking situations on their own. When parents respond to inhibited preschoolers with appropriate warmth and sensitivity, their children follow a healthier developmental trajectory (e.g., Hane, Cheah, Rubin, & Fox, 2008). Following from this transactional model, we developed an early intervention program for preschoolers displaying high BI and their parents. Unlike other programs for inhibited children (Rapee, Kennedy, Ingram, Edwards, & Sweeney, 2010), the “Turtle Program” targeted parent and child behavior. The parent component was derived from adaptations of Parent-Child Interaction Therapy (PCIT), an evidence-based treatment for externalizing disorders in young children that utilizes in-vivo coaching to teach parents skills to enhance the parent-child relationship and implement effective discipline (Eyberg, Nelson, & Boggs, 2008). Adapted PCIT may also be an effective treatment for anxiety. Pincus and colleagues (2005) adapted PCIT for separation anxiety disorder (SAD) by including a “Bravery Directed Interaction” (BDI) module. A more recent adaptation, Coaching Approach Behavior & Leading by Modeling (CALM), was developed to treat 3–8-year-olds with anxiety disorders (Comer et al., 2012). These PCIT adaptations appear promising, based upon a preliminary RCT (Puliafico, Comer & Pincus, 2012) and open trial (PCIT-CALM; Comer et al., 2012), but have not been tried specifically with inhibited children. We report results of an RCT examining preliminary effects of the “Turtle Program” compared to a waitlist control (WLC) condition. Although other groups have developed early intervention programs for young children with inhibition and/or anxiety disorders (Hirshfeld-Becker et al., 2010; Kennedy et al., 2009; Rapee et al., 2010), our study builds on previous studies by also incorporating in-vivo parent coaching within the peer context and reporting observational and teacher-report outcomes. Also, unlike other PCIT adaptations for anxious children, the Turtle Program allows for in-vivo parent coaching within the peer group context.1
  • References (23)
  • Citations (41)
Cite
References23
Newest
Published on Nov 1, 2012in Journal of Abnormal Child Psychology3.41
Erin Lewis-Morrarty3
Estimated H-index: 3
(UMD: University of Maryland, College Park),
Kathryn A. Degnan24
Estimated H-index: 24
(UMD: University of Maryland, College Park)
+ 5 AuthorsNathan A. Fox81
Estimated H-index: 81
(UMD: University of Maryland, College Park)
Behavioral inhibition (BI) and maternal over-control are early risk factors for later childhood internalizing problems, particularly social anxiety disorder (SAD). Consistently high BI across childhood appears to confer risk for the onset of SAD by adolescence. However, no prior studies have prospectively examined observed maternal over-control as a risk factor for adolescent social anxiety (SA) among children initially selected for BI. The present prospective longitudinal study examines the dir...
Anthony C. Puliafico10
Estimated H-index: 10
(Columbia University),
Jonathan S. Comer29
Estimated H-index: 29
(BU: Boston University),
Donna B. Pincus21
Estimated H-index: 21
(BU: Boston University)
Funding Sources: Dr. Comer: Foundation grant from the Mental Health Initiative (MINT); T-32 Award from the National Institutes of Health (T32 MH016434); K23 award from the National Institutes of Health (K23 MH090247). Dr. Pincus: K-23 award from the National Institute of Mental Health (NIMH: K-23MH64717). a Department of Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive Unit 74, New York, NY 10032, USA; b Department of Psychology, Boston University, Cente...
Published on Jan 1, 2012in Journal of Anxiety Disorders3.47
Jonathan S. Comer29
Estimated H-index: 29
(BU: Boston University),
Anthony C. Puliafico10
Estimated H-index: 10
(Columbia University)
+ 4 AuthorsAnne Marie Albano42
Estimated H-index: 42
(Columbia University)
Abstract As many as 9% of preschoolers suffer from an anxiety disorder, and earlier onset of disorder is associated with more intractable forms of psychopathology in later life. At present there is a relative dearth of empirical work examining the development of evidence-based treatments for anxiety disorders presenting in early childhood. Building on previous work supporting extensions of PCIT for separation anxiety disorder, the present study examines the preliminary feasibility and efficacy o...
Published on Dec 1, 2010in American Journal of Psychiatry13.65
Ronald M. Rapee75
Estimated H-index: 75
,
Susan J. Kennedy7
Estimated H-index: 7
+ 2 AuthorsLynne Sweeney2
Estimated H-index: 2
Objective:Increasing evidence for the importance of several risk factors for anxiety disorders is beginning to point to the possibility of prevention. Early interventions targeting known risk for anxiety have rarely been evaluated. The authors evaluated the medium-term (3-year) effects of a parent-focused intervention for anxiety in inhibited preschool-age children. Method:The study was a randomized controlled trial of a brief intervention program provided to parents compared with a monitoring-o...
Published on Jan 1, 2010in Infant and Child Development
Robert J. Coplan37
Estimated H-index: 37
(Carleton University),
Barry H. Schneider35
Estimated H-index: 35
(U of O: University of Ottawa)
+ 1 AuthorsAllison A. Graham3
Estimated H-index: 3
(Carleton University)
The aim of the present study was to develop and provide a preliminary evaluation of a social-skills-based early intervention program specifically designed to assist extremely inhibited preschoolers. Participants were a sample of n=22 extremely inhibited preschool-aged children, who were randomly assigned to either the Social Skills Facilitated Play (SST) or Waitlist Control (WLC) condition. As compared to wait-list controls, extremely inhibited children who participated in the SST-facilitated pl...
Andrea Chronis-Tuscano26
Estimated H-index: 26
,
Kathryn A. Degnan24
Estimated H-index: 24
+ 5 AuthorsNathan A. Fox81
Estimated H-index: 81
Objective: Behavioral inhibition (BI), a temperamental style identifiable in early childhood, is considered a risk factor for the development of anxiety disorders, particularly social anxiety disorder (SAD). However, few studies examining this question have evaluated the stability of BI across multiple developmental time points and followed participants into adolescenceVthe developmental period during which risk for SAD onset is at its peak. The current study used a prospective longitudinal desi...
Susan J. Kennedy7
Estimated H-index: 7
(Macquarie University),
Ronald M. Rapee75
Estimated H-index: 75
(Macquarie University),
Susan L. Edwards7
Estimated H-index: 7
(Macquarie University)
Abstract Objective The current study evaluated the efficacy of early intervention for preschool-aged children selected on the basis of risk who also met diagnostic criteria for anxiety disorders. Method Seventy-one 3- to 4-year-old children were selected based on demonstrating high levels of inhibition and having a parent with a current anxiety disorder. They were randomly allocated to an eight-session parent intervention or waitlist. Results At baseline, all of the children met criteria for one...
Published on Jan 1, 2009in Annual Review of Psychology19.75
Kenneth H. Rubin77
Estimated H-index: 77
(UMD: University of Maryland, College Park),
Robert J. Coplan6
Estimated H-index: 6
(Carleton University),
Julie C. Bowker19
Estimated H-index: 19
(UB: University at Buffalo)
Socially withdrawn children frequently refrain from social activities in the presence of peers. The lack of social interaction in childhood may result from a variety of causes, including social fear and anxiety or a preference for solitude. From early childhood through to adolescence, socially withdrawn children are concurrently and predictively at risk for a wide range of negative adjustment outcomes, including socio-emotional difficulties (e.g., anxiety, low self-esteem, depressive symptoms, a...
Published on Nov 1, 2008in Social Development1.81
Amie Ashley Hane17
Estimated H-index: 17
(Williams College),
Charissa S. L. Cheah18
Estimated H-index: 18
(UMBC: University of Maryland, Baltimore County)
+ 1 AuthorsNathan A. Fox81
Estimated H-index: 81
(UMD: University of Maryland, College Park)
The moderating effect of maternal behavior in the relations between social reticence and shyness in preschool and subsequent social withdrawal was investigated. Eighty children (47 females) were judged for degree of social reticence during play with unfamiliar peers at age four and mothers completed the Colorado child temperament inventory (CCTI). At age seven, the children were coded for degree of social withdrawal during peer play and mothers and children were observed during structured and un...
Published on Apr 1, 2008in Journal of Abnormal Child Psychology3.41
Robert J. Coplan37
Estimated H-index: 37
(Carleton University),
Kimberley A. Arbeau5
Estimated H-index: 5
(Carleton University),
Mandana Armer4
Estimated H-index: 4
(Carleton University)
The goal of this study was to explore the moderating role of maternal personality and parenting characteristics in the links between shyness and adjustment in kindergarten. Participants were 197 children enrolled in kindergarten programs (and their mothers and teachers). Multisource assessment was employed, including maternal ratings, behavioral observations, teacher ratings, and individual child interviews. Results indicated that shyness was associated with a wide range of socio-emotional and s...
Cited By41
Newest
Published on Oct 1, 2019in Journal of Experimental Child Psychology2.98
Jessica Stoltzfus Grady1
Estimated H-index: 1
(UOP: University of the Pacific (United States))
Abstract Gentle encouragement to approach appears to reduce risk for anxiety and is commonly incorporated into parenting interventions for inhibited preschoolers, yet little is known regarding whether gentle encouragement facilitates in-the-moment regulation as shy or inhibited children face social novelty, particularly during the toddler period. The current study used a sample of 55 temperamentally shy toddlers (21–24 months old) to examine toddler regulation in novel social contexts in relatio...
Published on Mar 1, 2019in Early Education and Development1.54
Jingjing Zhu2
Estimated H-index: 2
(SHNU: Shanghai Normal University),
Yan Li3
Estimated H-index: 3
(SHNU: Shanghai Normal University)
+ 2 AuthorsXinyin Chen41
Estimated H-index: 41
(UPenn: University of Pennsylvania)
Published on May 28, 2018in Journal of Abnormal Child Psychology3.41
Jordana K. Bayer21
Estimated H-index: 21
(University of Melbourne),
Amy J. Morgan22
Estimated H-index: 22
(La Trobe University)
+ 5 AuthorsRonald M. Rapee75
Estimated H-index: 75
(Macquarie University)
The aim of this study was to explore how some temperamentally inhibited young children and not others in the general population develop anxiety disorders and broader clinical-level internalizing (anxious/depressive) problems, with a focus on the family. A brief screening tool for inhibition was universally distributed to parents of children in their year before starting school across eight socioeconomically diverse government areas in Melbourne, Australia (307 preschool services). Screening iden...
Published on Feb 9, 2019in Journal of Abnormal Child Psychology3.41
Kelly A. Smith2
Estimated H-index: 2
(UMD: University of Maryland, College Park),
Paul D. Hastings31
Estimated H-index: 31
(UC Davis: University of California, Davis)
+ 1 AuthorsKenneth H. Rubin77
Estimated H-index: 77
(UMD: University of Maryland, College Park)
Behavioral inhibition (BI), a temperament trait characterized by fear and wariness in novel situations, has been identified as a risk factor for later social reticence and avoidance of peer interactions. However, the ability to regulate fearful responses to novelty may disrupt the link between BI and socially reticent behavior. The present study examined how and whether both behaviorally-manifested and physiological indices of emotion regulation moderate the relation between BI and later social ...
Published on May 1, 2019in Infant Behavior & Development1.35
Jessica Stoltzfus Grady1
Estimated H-index: 1
(UOP: University of the Pacific (United States)),
Delaney Callan (UOP: University of the Pacific (United States))
Abstract Shy children show reticence in social contexts, presumably as a way of regulating their fear. The present study evaluated whether toddler physiological regulation and parent emotion language facilitated shy toddlers’ (21–24 months) engagement with an unfamiliar female examiner. Toddler high basal respiratory sinus arrhythmia was positively associated with bold approach with the examiner. Parent emotion explanations were positively associated with toddler bold approach, particularly for ...
Published on Mar 1, 2019
Pan Liu (UWO: University of Western Ontario), Koraly Pérez-Edgar30
Estimated H-index: 30
(PSU: Pennsylvania State University)
Anxiety is among the most prevalent, early emerging, and detrimental mental conditions for children and adolescents. As with most psychiatric disorders, prevention and intervention efforts are most effective when the early etiology of the disorder is well understood from a developmental perspective. To illustrate this point, this article reviews the developmental psychopathology research in youth anxiety, with a focus on a prominent temperamental risk for anxiety, behavioral inhibition. This rev...
Published on Feb 22, 2019in Social Development1.81
Will E. Hipson2
Estimated H-index: 2
(Carleton University),
Robert J. Coplan37
Estimated H-index: 37
(Carleton University),
Daniel G. Séguin2
Estimated H-index: 2
(Mount Saint Vincent University)
Published on Jan 2, 2019
Maryse Guedes3
Estimated H-index: 3
(International Sleep Products Association),
Leandra Coelho1
Estimated H-index: 1
(International Sleep Products Association)
+ 4 AuthorsAndrea Chronis-Tuscano26
Estimated H-index: 26
(UMD: University of Maryland, College Park)
ABSTRACTThere has been an increasing interest in the development of evidence-based parent interventions aimed at reducing the early risk factors for the development of anxiety disorders, namely, behavioral inhibition, during the preschool years. However, these interventions are not yet available in European countries with a high prevalence of anxiety disorders, such as Portugal. This study aimed to explore the perceptions of Portuguese psychologists toward the acceptability of the parent compone...
Jonathan S. Comer29
Estimated H-index: 29
(FIU: Florida International University),
Natalie Hong (FIU: Florida International University)+ 2 AuthorsMaria Wilson (FIU: Florida International University)
The controlled evaluation of treatments for early childhood anxiety and related problems has been a relatively recent area of investigation, and accordingly, trials examining early childhood anxiety treatment have not been well represented in existing systematic reviews of youth anxiety treatments. This Evidence Base Update provides the first systematic review of evidence supporting interventions specifically for the treatment of early childhood anxiety and related problems. Thirty articles test...
Published on Jan 1, 2019
Elizabeth J. Kiel14
Estimated H-index: 14
(Miami University),
Anne E. Kalomiris2
Estimated H-index: 2
(Miami University)
Emotion processes are related to anxiety symptoms and disorders across the lifespan. This chapter uses emotional development as an explicit framework for understanding these associations, focusing mainly on child and adolescent populations. We begin by reviewing empirical studies of emotion reactivity, emotion regulation, and associated constructs as they relate to clinically relevant anxiety. These emotion processes are then reviewed from the developmental literature, highlighting how individua...