Behavioral inhibition/social reticence (BI/RET) is one of the most stable dispositional characteristics reported in childhood. Early BI/RET is often reinforced and exacerbated by children's reciprocal interactions with parents across development. Importantly, stable BI/RET places young children at subsequent risk for diagnosable anxiety disorders (namely, social phobia) during adolescence and adulthood and this risk is moderated by (a) overly directive/controlling parenting and (b) the child' lack of socal and emotion-regulation skills. The purpose of the proposed project is to conduct and evaluate a full-scale, randomized controlled trial during which we will randomly assign 150 45-60 month old children and their parents to either the Turtle Program (combined adapted Parent Child Interaction Therapy and Social Skills Facilitated Play (PCIT and SSFP) or to a less intensive, 6-session parent psychoeducation group, the best available treatment for preschool BI. The Turtle Program components highlight the development of skills to intervene in the reciprocal cycle of parent-child and peer interactions that contribute to the development of anxiety. Importantly, the group- based nature of SSFP provides a social context in which parents can practice behavioral skills with their child while being coached by the therapists. This trial will examine mediators an moderators of treatment response. Outcome measures (collected at pre-treatment, mid-treatment, post-treatment, and one-year follow-up) will include parent and teacher ratings/questionnaires of child anxiety symptoms/disorders, temperament, and social functioning; observational measures of parenting and children's social behaviors in the classroom; and heart rate physiology (a biological index of emotional reactivity and regulation).

Public Health Relevance

Stable, early behavioral inhibition (BI)/social reticence (RET) is a risk factor for the development of later social anxiety disorder, and overly directive/controlling parenting moderates this risk. Pilot data obtained from our NIMH-funded R34 provides preliminary efficacy data for the Turtle Program, a developmentally-grounded, multi-component early intervention program which combines an adaptation of Parent-Child Interaction Therapy and a social skills program to simultaneously address child BI/RET and parenting. The proposed randomized controlled trial aims to evaluate the Turtle Program compared to the best available treatment for preschool BI, Cool Little Kids, a parent psychoeducation group, and to examine mediators and moderators of intervention effects.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Interventions Committee for Disorders Involving Children and Their Families (ITVC)
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Haim, Adam
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University of Maryland College Park
Schools of Arts and Sciences
College Park
United States
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Chronis-Tuscano, Andrea; Danko, Christina M; Rubin, Kenneth H et al. (2018) Future Directions for Research on Early Intervention for Young Children at Risk for Social Anxiety. J Clin Child Adolesc Psychol 47:655-667
Wagner, Nicholas J; Hastings, Paul D; Rubin, Kenneth H (2018) Children's autonomic functioning moderates links between maternal rejecting attitudes and preschool aggressive behaviors. Dev Psychobiol 60:739-747
Smith, Kelly A; Barstead, Matthew G; Rubin, Kenneth H (2017) Neuroticism and Conscientiousness as Moderators of the Relation Between Social Withdrawal and Internalizing Problems in Adolescence. J Youth Adolesc 46:772-786
Almirall, Daniel; Chronis-Tuscano, Andrea (2016) Adaptive Interventions in Child and Adolescent Mental Health. J Clin Child Adolesc Psychol 45:383-95