Journal of Child and Family Studies

, Volume 27, Issue 9, pp 2943–2953 | Cite as

Generalization of an Early Intervention for Inhibited Preschoolers to the Classroom Setting

  • Matthew G. BarsteadEmail author
  • Christina M. Danko
  • Andrea Chronis-Tuscano
  • Kelly A. O’Brien
  • Robert J. Coplan
  • Kenneth H. Rubin
Original Paper


Considerable evidence has accumulated supporting transactional influences between early childhood behavioral inhibition (BI), parent-child and child-peer relationships, and the development of anxiety disorders in adolescence and adulthood. Drawing from this literature, the Turtle Program was designed to treat children high in BI by intervening at the level of both parents and peers. In this pilot study, we sought to determine whether benefits of participating in the Turtle Program extended to children’s classrooms in the form of increased positive social interactions with peers. Forty inhibited children (42–60 months) and their parent(s) were randomized to either the Turtle Program (n = 18) or a waitlist control group (WLC; n = 22). The Turtle Program involved 8 weeks of concurrent parent and child treatment. Trained research assistants, blind to treatment condition, coded participants’ social interactions with peers during free play at each child’s preschool at the beginning and end of treatment. Teachers unaware of group assignment also provided reports of social behaviors at these time points. Reliable change index scores revealed that both Turtle Program and WLC participants experienced relatively high rates of reliable increases in observed peer play interactions from pre- to post-treatment (73.3% and 42.1% respectively). Additionally, Turtle Program participants experienced high rates of reliable increase in observed initiations to peers (73.3%) as well as a moderate degree of reliable decrease in teacher-reported displays of fear/anxiety (33.3%). These data provide preliminary, but promising, evidence that increases in children’s social behaviors as a result of participation in the Turtle Program generalize to their preschool classrooms.


Behavioral inhibition Parent-child interaction therapy Preschool anxiety Social withdrawal Peer interactions 



This study was funded by the National Institute of Mental Health (R34 MH083832-01) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32 HD007542).

Author Contributions

MGB and CMD planned the current report, wrote and edited the manuscript, and cleaned/analyzed the data. KAO assisted with the initial study design, created and implemented recruitment procedures, delivered the intervention, and edited the manuscript. RJC assisted with the initial study design, consulted in adapting the Social Skills Facilitated Play program, and edited the manuscript. ACT and KHR are the principal investigators for the NIMH grant that funded this pilot work; they developed the original study protocols and intervention in consultation with RJC, assisted in planning the current report, and edited the manuscript. All authors contributed to reviewing and revising the final paper and approved the final version.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Study procedures were reviewed and approved by the Institutional Review Board at the University of Maryland, College Park. Trial registration: (#NCT 03486860).

Informed Consent

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


  1. Berument, S. K., Rutter, M., Lord, C., Pickles, A., & Bailey, A. (1999). Autism screening questionnaire: diagnostic validity. The British Journal of Psychiatry, 175, 444–451. Scholar
  2. Bishop, G., Spence, S. H., & McDonald, C. (2003). Can parents and teachers provide a reliable and valid report of behavioral inhibition? Child Development, 74, 1899–1917. Scholar
  3. Booth-LaForce, C., & Oxford, M. L. (2008). Trajectories of social withdrawal from grades 1 to 6: prediction from early parenting, attachment, and temperament. Developmental Psychology, 44, 1298–1313. Scholar
  4. Chronis-Tuscano, A., Danko, C. M., Rubin, K. H., Coplan, R. J., & Novick, D. R. (2018). Future directions for research on early intervention for young children at risk for social anxiety. Journal of Clinical Child & Adolescent Psychology, advance Online Publication. Scholar
  5. Chronis-Tuscano, A., Degnan, K. A., Pine, D. S., Perez-Edgar, K., Henderson, H. A., & Diaz, Y., et al. (2009). Stable early maternal report of behavioral inhibition predicts lifetime social anxiety disorder in adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 48, 928–935. Scholar
  6. Chronis-Tuscano, A., Rubin, K. H., O’Brien, K. A., Coplan, R. J., Thomas, S. R., & Dougherty, L. R., et al. (2015). Preliminary evaluation of a multimodal early intervention program for behaviorally inhibited preschoolers. Journal Consulting & Clinical Psychology, 83, 534–540. Scholar
  7. Clauss, J. A., & Blackford, J. U. (2012). Behavioral inhibition and risk for developing social anxiety disorder: a meta-analytic study. Journal of the American Academy of Child & Adolescent Psychiatry, 51, 1066–1075. Scholar
  8. Comer, J. S., Puliafico, A. C., Aschenbrand, S. G., McKnight, K., Robin, J. A., Goldfine, M. E., & Albano, A. M. (2012). A pilot feasibility evaluation of the CALM Program for anxiety disorders in early childhood. Journal of Anxiety Disorders, 26, 40–49. Scholar
  9. Coplan, R. J., Arbeau, K. A., & Armer, M. (2008). Don’t fret, be supportive! Maternal characteristics linking child shyness to psychosocial and school adjustment in kindergarten. Journal of Abnormal Child Psychology, 36, 359–371. Scholar
  10. Coplan, R. J., Debow, A., Schneider, B. H., & Graham, A. A. (2009). The social behaviors of inhibited children in and out of preschool. British Journal of Developmental Psychology, 27, 891–905. Scholar
  11. Coplan, R. J., Schneider, B. H., Matheson, A., & Graham, A. (2010). ‘Play skills’ for shy children: development of a social skills facilitated play early intervention program for extremely inhibited preschoolers. Infant and Child Development, 19, 223–237. Scholar
  12. Danko, C. M., O’Brien, K. A., Rubin, K. H., & Chronis-Tuscano, A. (in press). The Turtle Program: PCIT for young children displaying behavioral inhibition. In Niec, L. N. (Ed.), Handbook of Parent-Child Interaction Therapy: Innovations and Applications for Research and Practice. New York: Springer.Google Scholar
  13. Degnan, K. A., & Fox, N. A. (2007). Behavioral inhibition and anxiety disorders: multiple levels of a resilience process. Development & Psychopathology, 19, 729–746. Scholar
  14. Eley, T. C., McAdams, T. A., Rijsdijk, F. V., Lichtenstein, P., Narusyte, J., & Reiss, D., et al. (2015). The intergenerational transmission of anxiety: a children-of-twins study. American Journal of Psychiatry, 172, 630–637. Scholar
  15. Fox, N. A., Henderson, H. A., Rubin, K. H., Calkins, S. D., & Schmidt, L. A. (2001). Continuity and discontinuity of behavioral inhibition and exuberance: psychophysiological and behavioral influences across the first four years of life. Child Development, 72, 1–21. Scholar
  16. Fox, N. A., Henderson, H. A., Marshall, P. J., Nichols, K. E., & Ghera, M. M. (2005). Behavioral inhibition: linking biology and behavior within a developmental framework. Annual Review of Psychology, 56, 235–262. Scholar
  17. Gazelle, H., & Ladd, G. W. (2003). Anxious solitude and peer exclusion: a diathesis-stress model of internalizing trajectories in childhood. Child Development, 74, 257–278. Scholar
  18. Gazelle, H., & Rubin, K. H. (2010). Social anxiety in childhood: bridging developmental and clinical perspectives. New Directions for Child and Adolescent Development, 2010, 1–16. Scholar
  19. Grissom, R. J., & Kim, J. J. (2005). Effect sizes for research: A broad practical approach. Mawah, NJ: Lawrence Erlbaum Associates.Google Scholar
  20. Hageman, W. J. J. M., & Arrindell, W. A. (1999). Establishing clinically significant change: Increment of precision and the distinction between individual and group level analysis. Behaviour Research & Therapy, 37, 1169–1193. Scholar
  21. Hastings, P. D., Nuselovici, J. N., Rubin, K. H., & Cheah, C. S. L. (2010). Shyness, parenting, and parent-child relationships. In K. H. Rubin & R. J. Coplan (Eds.), The Development of Shyness and Social Withdrawal (pp. 107–130). New York: Guilford Press.Google Scholar
  22. Hirshfeld-Becker, D. R., Biederman, J., Henin, A., Faraone, S. V., Davis, S., Harrington, K., & Rosenbaum, J. F. (2007). Behavioral inhibition in preschool children at risk is a specific predictor of middle childhood social anxiety: A five-year follow-up. Journal of Developmental & Behavioral Pediatrics, 28, 225–233. Scholar
  23. Hirshfeld-Becker, D. R., Masek, B., Henin, A., Blakely, L. R., Pollock-Wurman, R. A., & McQuade, J., et al. (2010). Cognitive behavioral therapy for 4- to 7-year-old children with anxiety disorders: a randomized clinical trial. Journal of Consulting & Clinical Psychology, 78, 498–510. Scholar
  24. Jacobson, N. S., & Traux, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19. Scholar
  25. Ladd, G. W. (2006). Peer rejection, aggressive or withdrawn behavior, and psychological maladjustmnet from ages 5 to 12: an examination of four predictive models. Child Development, 77, 822–846. Scholar
  26. Ladd, G. W., & Profilet, S. M. (1996). The child behavior scale: a teacher-report measure of young children’s aggressive, withdrawn, and prosocial behaviors. Developmental Psychology, 32, 1008–1024. Scholar
  27. Li, Y., Coplan, R. J., Wang, Y., Yin, J., Zhu, J., Gao, Z., & Li, L. (2016). Preliminary evaluation of a social skills training and facilitated play early intervention programme for extremely shy young children in China. Infant and Child Development, 25, 565–574. Scholar
  28. Muris, P., van Brakel, A. M., Arntz, A., & Schouten, E. (2011). Behavioral inhibition as a risk factor for the development of childhood anxiety disorders: A longitudinal study. Journal of Child & Family Studies, 20, 157–170. Scholar
  29. Nelson, L. J., Rubin, K. H., & Fox, N. A. (2005). Social withdrawal, observed peer acceptance, and the development of self-perceptions in children ages 4 to 7 years. Early Education and Development, 20, 185–200. Scholar
  30. Oh, W., Rubin, K. H., Bowker, J. C., Booth-LaForce, C., Rose-Krasnor, L., & Laursen, B. (2008). Trajectories of social withdrawal from middle childhood to early adolescence. Journal of Abnormal Child Psychology, 36, 553–556. Scholar
  31. Pincus, D. B. (2005). Adapting parent-child interaction therapy for young children with separation anxiety disorder. Education and Treatment of Children, 28, 163–181.Google Scholar
  32. Puliafico, A. C., Comer, J. S., & Pincus, D. B. (2012). Adapting parent-child interaction therapy to treat anxiety disorders in young children. Child and Adolescent Psychiatric Clinics of North America, 21, 607–619. Scholar
  33. Rapee, R. M., & Jacobs, D. (2002). The reduction of temperamental risk for anxiety in withdrawn preschoolers: a pilot study. Behavioural and Cognitive Psychotherapy, 30, 211–215. Scholar
  34. Rapee, R. M., Kennedy, S., Ingram, M., Edwards, S. L., & Sweeney, L. (2010). Altering the trajectory of anxiety in at-risk young children. American Journal of Psychiatry, 167, 1518–1525. Scholar
  35. Rapee, R. M., Schniering, C. A., & Hudson, J. L. (2009). Anxiety disorders during childhood and adolescence: origins and treatment. Annual Review of Clinical Psychology, 5, 311–341. Scholar
  36. Rubin, K. H. (2008). The Play Observation Scale –Revised. College Park: University of Maryland.Google Scholar
  37. Rubin, K. H., Coplan, R. J., & Bowker, J. C. (2009). Social withdrawal in childhood. Annual Review of Psychology, 60, 141–171. Scholar
  38. Rubin, K. H., Bowker, J. C., Barstead, M. G., & Coplan, R. J. (2018). Avoiding and withdrawing from the peer group. In W. M. Bukowski, B. Laursen & K. H. Rubin (Eds.), Handbook of peer interactions, relationships, and groups. 2nd ed. (pp. 322–346). New York: Guilford.Google Scholar
  39. Rubin, K. H., Hastings, P. D., Stewart, S. L., Henderon, H. A., & Chen, X. (1997). The consistency and concomitants of inhibition: some of the children, all of the time. Child Development, 68, 467–483. Scholar
  40. Rubin, K. H., & Krasnor, L. R. (1980). Changes in the play behaviors of preschoolers: a short-term longitudinal investigation. Canadian Journal of Behavioural Science, 12, 278–282.CrossRefGoogle Scholar
  41. van der Bruggen, C. O., Stams, G. J., & Bogels, S. M. (2008). The relation between child and parent anxiety and parental control: a meta-analytic review. Journal of Child Psychology & Psychiatry, 49, 1257–1269. Scholar

Copyright information

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

Authors and Affiliations

  • Matthew G. Barstead
    • 1
    Email author
  • Christina M. Danko
    • 2
  • Andrea Chronis-Tuscano
    • 2
  • Kelly A. O’Brien
    • 2
  • Robert J. Coplan
    • 3
  • Kenneth H. Rubin
    • 1
  1. 1.Department of Human Development & Quantitative MethodologyUniversity of Maryland – College ParkCollege ParkUSA
  2. 2.Department of PsychologyUniversity of Maryland – College ParkCollege ParkUSA
  3. 3.Department of PsychologyCarleton UniversityOttawaCanada

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