Generalization of an Early Intervention for Inhibited Preschoolers to the Classroom Setting
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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.
KeywordsBehavioral 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).
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.
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: www.clinicaltrials.gov (#NCT 03486860).
Informed consent was obtained from all individual participants included in the study.
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