nstructions
See attached research article from a peer-reviewed journal. Make sure the article is about a quantitative research study and not a theory article, literature review, or case study. To complete this assignment, you will complete the items below.
§ Write an article critique, noting the strengths and weaknesses of the research design, the content of the article itself, and whether or not you think the results can be generalized to a larger population.
§ Save the critique as a Word file, and submit it along with the PDF file of the article you read.
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Generalization of an Early Intervention for Inhibited Preschoolers to the Classroom Setting Journal of Child and Family Studies (2018) 27:2943–2953 https://doi.org/10.1007/s10826-018-1142-0 ORIGINAL PAPER Generalization of an Early Intervention for Inhibited Preschoolers to the Classroom Setting Matthew G. Barstead1 ● Christina M. Danko2 ● Andrea Chronis-Tuscano2 ● Kelly A. O’Brien2 ● Robert J. Coplan3 ● Kenneth H. Rubin1 Published online: 17 June 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract 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. Keywords Behavioral inhibition ● Parent-child interaction therapy ● Preschool anxiety ● Social withdrawal ● Peer interactions Behavioral inhibition (BI) is a temperamental trait char- acterized by the expression of fear and wariness in the presence of novel objects, situations, and individuals (Fox et al. 2005). Approximately 15 to 20 percent of toddlers can be classified as extremely behaviorally inhibited (Degnan and Fox 2007; Rubin et al. 1997). Supporting the disposi- tional nature of BI, researchers have demonstrated that stable BI in early childhood is predicted by negative reactivity in infancy (Fox et al. 2001), and BI has been linked to physiological indicators of elevated sympathetic nervous system activity and heightened amygdala reactivity at baseline and in response to stressors (Fox et al. 2005). Importantly, considerable evidence has revealed that toddler BI is a risk factor for the display of social reticence among unfamiliar peers in early, middle, and late childhood, as well as the development of anxiety disorders (particularly social anxiety) in adolescence and adulthood (Chronis- Tuscano et al. 2009; Clauss and Blackford 2012; Hirshfeld- Becker et al. 2007; Muris et al. 2011). To date, a transactional model provides the most useful account of how temperament and interactions with sig- nificant others combine to link early BI, social reticence, and subsequent internalizing problems (Rubin et al. 2009). This model assumes that children high on measures of BI enter the world as infants with a set of biological systems that pre-dispose them to anxiously react to novel and uncertain settings (Fox et al. 2005). For a caregiver, the * Matthew G. Barstead barstead@umd.edu 1 Department of Human Development & Quantitative Methodology, University of Maryland – College Park, 3304 Benjamin Building, College Park, MD 20742, USA 2 Department of Psychology, University of Maryland – College Park, College Park, MD, USA 3 Department of Psychology, Carleton University, Ottawa, Canada 12 34 56 78 90 () ;,: 12 34 56 78 90 (); ,: http://crossmark.crossref.org/dialog/?doi=10.1007/s10826-018-1142-0&domain=pdf http://crossmark.crossref.org/dialog/?doi=10.1007/s10826-018-1142-0&domain=pdf http://crossmark.crossref.org/dialog/?doi=10.1007/s10826-018-1142-0&domain=pdf mailto:barstead@umd.edu frequent displays of distress in novel situations can be alarming and may even elicit such maladaptive patterns of parenting behavior as over-control and restrictiveness (Hastings et al. 2010). These parenting behaviors have been thought to play a role in the stability of maladaptive social responses including social reticence and withdrawal. Although such behavior may seem entirely warranted by parents when confronted with their child’s distress, fre- quently intervening may hamper the development of a child’s own internal regulatory capacities for managing stressful situations (Hastings et al. 2010). For anxious par- ents, whose children are at increased risk for the develop- ment of anxiety (Eley et al. 2015), this tendency to step in may be particularly difficult to override. Importantly, appropriately sensitive parenting, absent intrusive or over- controlling behaviors, has been shown to weaken the sta- bility of BI across childhood (Degnan and Fox 2007), and attenuate socio-emotional difficulties for young inhibited children (Coplan et al. 2008). As children enter preschool and subsequently transition to kindergarten, they are increasingly confronted with the social challenge of initiating and maintaining relationships with unfamiliar peers. Indeed, it is in the peer context that the costs of toddler BI seem most apparent as BI begins to manifest behaviorally as social reticence (Rubin et al. 2009). Especially problematic is that, for children high in BI, withdrawal and reticence can be negatively reinforcing in that they allow children to avoid sources of anxiety (i.e., novel settings and peers), while limiting opportunities to learn that feelings of anxiety may be unfounded or, at the very least, manageable. As displays of social withdrawal become increasingly ingrained, peers begin to recognize such behaviors as aberrant (Ladd 2006) resulting in peer exclusion, rejection, and victimization, even in early child- hood (Gazelle and Ladd 2003; Nelson et al. 2005). Being rejected can ultimately lead to a maladaptive cascade that, if left unchecked, may result in reduced displays of socially competent behaviors, elevated social anxiety, increased loneliness, lower self-esteem, and higher levels of depres- sion (Rubin et al. 2009). Despite the importance of BI to children’s social functioning, few researchers have examined whether existing treatments for young children with elevated BI and/or anxiety generalize to relevant social contexts, which is the primary aim of the present pilot study. Of course, not all inhibited children suffer social and emotional impairment with age (Gazelle and Rubin 2010). Just as maladaptive trajectories are compounded by over- controlling parenting and low-quality peer relationships, positive experiences within these social contexts can pre- vent negative psychosocial outcomes and promote social and emotional well-being, particularly for children high in BI (Booth-LaForce and Oxford 2008; Hastings et al. 2010; Oh et al. 2008; Rubin et al. 2018). The notion that parents and peers can serve equally as sources of adaptation or maladaptation across development is entirely consistent with Rubin et al.’s (2009) transactional model. In terms of intervention design, this duality implies that treatments should work to reduce features of parent and peer interac- tions that exacerbate BI and its correlates while simulta- neously promoting adaptive parenting behaviors, emotion regulation, and prosocial behaviors that can help children high in BI move off maladaptive trajectories (Chronis- Tuscano et al. 2018). Despite the importance of both parent and peer rela- tionships to the healthy development of children high in BI, the majority of intervention and prevention programs that have been developed to address BI and anxiety in young children tend to solely target parenting behaviors and the parent-child relationship. For example, Rapee and Jacobs (2002) developed Cool Little Kids (CLK) for parents of inhibited preschool-aged children, an intervention that focuses on changing parenting behaviors that worsen or maintain social withdrawal. Researchers compared CLK to a no-treatment control condition and found that fewer children in CLK had an anxiety diagnosis at one-year and three-year follow-ups compared with the control group; however, there was no effect of CLK on child BI (Rapee et al. 2010). Several other intervention programs have been developed to treat anxiety in young children by providing therapy sessions for individual parent-child dyads and have reported promising results (cognitive-behavioral therapy, CBT, Hirshfeld-Becker et al. 2010; parent-child interaction therapy, PCIT, Pincus 2005; Coaching Approach Behavior & Leading by Modeling, CALM, Puliafico et al. 2012). However, none of these studies examined whether treatment effects generalized to the school setting. One intervention for inhibited children has been devel- oped with the peer context solely in mind (Social Skills Facilitated Play, SSFP, Coplan et al. 2010). SSFP is a child group intervention that involves brief social skills training followed by free play in which facilitators encourage social approach behavior. An initial evaluation of SSFP found increased observer-rated social behaviors at preschool compared to a waitlist control (WLC) group, though tea- chers did not report similar changes (Coplan et al. 2010). More recently, investigators reported similar benefits of SSFP participation in observer-rated group play and pro- social behaviors during unstructured free play among Chi- nese youth (Li et al. 2016). Though each of these interventions has shown promise, the transactional model (Rubin et al. 2009) suggests that intervening simultaneously at the level of parent-child and child-peer relationships could maximize treatment benefits for children high in BI. Beyond theoretical considerations, there are also practical benefits that may be realized when parent- and peer-level interventions are combined. When 2944 Journal of Child and Family Studies (2018) 27:2943–2953 intervention programs are delivered in individualized set- tings with single parent-child dyads (CALM) or in settings with parent-only (CLK) or child-only groups (SSFP), the parent cannot be coached to utilize prescribed parenting skills to enhance social approach (and discourage avoid- ance) within the peer context. Combining parent and child treatment approaches may therefore provide a better basis for practicing and implementing skills that will more readily transfer to managing children’s anxiety in typical social contexts (Chronis-Tuscano et al. 2018). The Turtle Program: A Multi-Component Program for Behaviorally Inhibited Young Children was designed to harvest the theoretical and practical strengths of Rubin et al.’s (2009) transactional model, with a focus on exam- ining the generalization of treatment effects to the daily lives of young children high in BI (Chronis-Tuscano et al. 2015). This eight-session intervention is a combined adap- tation of PCIT and SSFP that targets overly intrusive par- enting and child BI to reduce risk for later anxiety (Chronis- Tuscano et al. 2018). This early intervention program is briefer than other individual and family treatments devel- oped for anxiety disorders in young children (Hirshfeld- Becker et al. 2010), and concurrent parent and child groups allow for peer group and dyadic social anxiety exposures. A preliminary evaluation found that compared to a WLC group, the Turtle Program resulted in medium-to-large positive effects on parent-reported child anxiety and BI as well as observed maternal positive affect/sensitivity (Chronis-Tuscano et al. 2015). Given that a purported mechanism linking early BI to adolescent and adult psychopathology is difficulty inte- grating with peers, we sought to extend the original eva- luation