Evidence-based interventions targeted at behavioral inhibition, shyness, and anxious withdrawal during the preschool years: A rapid review

Abstract

High and stable behavioral inhibition (BI) during early childhood may place individuals at increased risk of experiencing anxiety during the COVID-19 crisis. Prior knowledge syntheses showed that selective prevention interventions were effective in reducing child BI and anxiety. However, the effectiveness of preschool-based universal and selective prevention interventions targeted at BI to improve child social outcomes remains unclear. Due to the vulnerability of highly inhibited children, this rapid review aimed to (1) synthetize the characteristics of evidence-based interventions targeted at BI, and (2) summarize intervention outcomes in domains of child individual and social functioning. Randomized controlled trials (RCTs), published between january 1991 and december 2021, conducted with highly inhibited children aged 3 to 5 years, were included in the review. Thirteen RCTs on four evidence-based interventions targeted at BI were retained. Most studies were conducted in samples of married/cohabitating and highly educated mothers and almost half of them described parent-only interventions. Three pilot RCTs on child-only and multimodal interventions found significant post-intervention improvements in observed child social competence and positive peer interactions. Pre-to-post intervention changes in parent and teacher ratings on child social outcomes were less consistent across studies. Further large-scale RCTs with medium-to-long term follow-ups are needed to examine intervention outcomes in domains of child social functioning, using a multi-informant and multi-method approach. After the COVID-19 crisis, preschool-based universal interventions targeting BI may enhance the engagement of inhibited children from diverse communities and contribute to the generalization of intervention effects to naturalistic peer settings.