Testing reciprocal associations between child anxiety and parenting across early interventions for inhibited preschoolers

Abstract

Background: Given the robust evidence base for the efficacy of evidence-based treatments targeting youth anxiety, researchers have advanced beyond efficacy outcome analysis to identify mechanisms of change and treatment directionality. Grounded in developmental transactional models, interventions for young children at risk for anxiety by virtue of behaviorally inhibited temperament often target parenting and child factors implicated in the early emergence and maintenance of anxiety. In particular, overcontrolling parenting moderates risk for anxiety among highly inhibited children, just as child inhibition has been shown to elicit overcontrolling parenting. Although longitudinal research has elucidated the temporal unfolding of factors that interact to place inhibited children at risk for anxiety, reciprocal transactions between these child and parent factors in the context of early interventions remain unknown.

Method: This study addresses these gaps by examining mechanisms of change and treatment directionality (i.e., parent-to-child vs. child-to-parent influences) within a randomized controlled trial comparing two interventions for inhibited preschoolers (N = 151): the multicomponent Turtle Program ('Turtle') and the parent-only Cool Little Kids program ('CLK'). Reciprocal relations between parent-reported child anxiety, observed parenting, and parent-reported accommodation of child anxiety were examined across four timepoints: pre-, mid-, and post-treatment, and one-year follow-up (NCT02308826).

Results: Hypotheses were tested via latent curve models with structured residuals (LCM-SR) and latent change score (LCS) models. LCM-SR results were consistent with the child-to-parent influences found in previous research on cognitive behavioral therapy (CBT) for older anxious youth, but only emerged in Turtle. LCS analyses revealed bidirectional effects of changes in parent accommodation and child anxiety during and after intervention, but only in Turtle.

Conclusion: Our findings coincide with developmental transactional models, suggesting that the development of child anxiety may result from child-to-parent influences rather than the reverse, and highlight the importance of targeting parent and child factors simultaneously in early interventions for young, inhibited children.

Keywords: Early intervention; anxiety; parenting; temperament.

Figure 1

CONSORT diagram. CLK, Cool Little Kids; Turtle, The Turtle Program. Five families who did not complete the post-treatment assessment completed the one-year follow-up assessment in CLK. Two families who did not complete the post-treatment assessment completed the one-year follow-up assessment in Turtle

Figure 2

The Turtle Program and Cool Little Kids session content. BDI, Bravery Directed Interaction; CDI, Child Directed Interaction; CG, Child Group; PDI, Parent Directed Interaction; PG, Parent Group. For more information, see Chronis-Tuscano et al. (2015), Danko et al. (2018) and Rapee et al. (2005)

Figure 3

(A) LCM-SR examining reciprocal relations between child anxiety and parent accommodation of child anxiety in Turtle. (B) LCM-SR examining reciprocal relations between child anxiety and parent accommodation of child anxiety in CLK. Accom./ACC, parent accommodation of child anxiety; ANX, child anxiety; CLK, Cool Little Kids; LCM-SR, Latent curve model with structured residuals; T1, pretreatment; T2, mid-treatment (4 weeks into treatment); T3, post-treatment (4 weeks after T2); T4, one-year follow-up; Turtle, The Turtle Program; ε, residual of observed measures; ψ, fixed factor variance; only significant direct paths with standardized estimates are included for clarity. ^†p = trend; *p < .05; **p < .01; ***p ≤ .001

Figure 4

(A) LCM-SR examining reciprocal relations between child anxiety and observed parenting in Turtle. (B) LCM-SR examining reciprocal relations between child anxiety and observed parenting in Turtle in CLK. ANX, child anxiety; CLK, Cool Little Kids; LCM-SR, Latent curve model with structured residuals; NEG, observed parent negative control; POS, observed parent positive affect; T1, pretreatment; T2, mid-treatment (4 weeks into treatment), T3, post-treatment (4 weeks after T2), T4, one-year follow-up; Turtle, The Turtle Program; ε = residual of observed measures; only significant within-person direct paths with standardized estimates are included; ^†p = trend, *p < .05, **p < .01, ***p ≤ .001