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Behavioral inhibition (BI) and, subsequent, social withdrawal (SW), are overlapping, but distinct concepts, and both are risk factors for the development of later child anxiety. Anxiogenic parenting (i.e. any parenting behavior that promotes anxiety in offspring) and negative peer interactions both contribute to the pathway from child BI/SW to later anxiety (Rubin, Coplan, & Bowker, 2009). Parents’ own anxiety is associated with offspring anxiety and may raise the risk for anxiogenic parenting (Murray, Creswell & Cooper, 2009). Thus, through targeting anxiogenic parenting and negative peer relations, early intervention has the potential to alter the trajectory from child BI/SW to later anxiety.

However, several gaps exist in the literature. One, few treatments exist for preschool BI/SW. Two, despite parents’ key role during the preschool years and robust evidence showing parent anxiety reduces treatment efficacy for older anxious youth, the role of parent clinical anxiety in preschool treatment outcomes has not been rigorously assessed. Three, despite meta-analytic data showing fathers’ importance in the development of preschool anxiety (Möller, Nikolić, Majdandžić, & Bögels, 2016), few researchers have examined effects of fathers’ anxiety on preschool treatment outcomes. Relatedly, the unique effects of mothers’ and fathers’ anxiety on preschool treatment outcomes have yet to be tested. Lastly, despite the dual roles of parents and peers in the pathway from child BI/SW to later anxiety, no study has used a true experimental design to test whether treatment for preschool BI/SW that targets both domains can attenuate the effect of parent anxiety on reduced treatment outcomes more than that of interventions that directly target parents only, the most common approach used in existing interventions for preschool BI/SW or anxiety.

The current dissertation study was drawn from a larger NIMH-funded study comparing two early intervention programs for preschool BI/SW. The first program was Cool Little Kids (CLK), a parent-only psychoeducation group, which has been shown to be efficacious in reducing later anxiety among highly inhibited preschoolers (Rapee, Kennedy, Ingram, Edwards, & Sweeney 2005). The second program was the “Turtle Program,” which included concurrent parent and child groups, targeting both anxiogenic parenting and child social skills, respectively (Chronis-Tuscano et al., 2015). The first study aim was to examine the separate and unique roles of clinician-rated maternal and paternal lifetime anxiety disorders (ADs) as predictors of preschool treatment outcome across treatment conditions. It was hypothesized that, separately, maternal and paternal lifetime ADs would negatively predict child treatment outcome in both groups. When maternal and paternal lifetime ADs were examined in the same model, it was further hypothesized that paternal lifetime ADs would continue to predict child treatment outcomes.

The second aim was to examine whether the associations between maternal and paternal lifetime ADs and child treatment outcomes differed as a function of treatment condition. It was hypothesized that the in-vivo, intensive nature of the “Turtle Program” might mitigate the negative effects of parents’ anxiety, such as parental avoidance, anxious modeling, and overcontrol, on child treatment outcomes. Further, the child group component of the Turtle Program might improve child social approach behaviors, making it easier for parents to facilitate child social exposures. Thus, it was hypothesized that maternal and paternal lifetime ADs would have weaker associations with child treatment outcome in the “Turtle Program” than in CLK.

Lastly, given that child BI/SW are predictors of social anxiety specifically, and social anxiety is heritable (Isomura et al., 2015), the role of maternal and paternal lifetime social anxiety disorder (SAD) on child treatment outcomes was also examined as an exploratory aim.

Results indicated that, when examined in the same model, maternal lifetime ADs predicted worse post-treatment child total anxiety, but paternal lifetime ADs predicted better post-treatment child total anxiety. This relation did not significantly differ as a function of treatment condition. Regarding the exploratory aim, when examined in the same model, maternal (not paternal) SAD predicted worse post-treatment child total anxiety. Further, maternal SAD predicted worse post-treatment child total anxiety only in CLK (and not the Turtle Program), suggesting that in-vivo therapist coaching of parents and/or direct child social skills training may have mitigated negative effects of maternal SAD on reduced treatment efficacy. Clinical implications and future directions are discussed.