早期干预抑制型幼儿：“海龟项目”与“酷小孩”的随机对照试验
Early intervention for inhibited young children: a randomized controlled trial comparing the Turtle Program and Cool Little Kids.
机构信息
Department of Psychology, University of Maryland, College Park, MD, USA.
Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA.
出版信息
J Child Psychol Psychiatry. 2022 Mar;63(3):273-281. doi: 10.1111/jcpp.13475. Epub 2021 Jun 29.
BACKGROUND
Children classified as behaviorally inhibited (BI) are at risk for social anxiety. Risk for anxiety is moderated by both parental behavior and social-emotional competence. Grounded in developmental-transactional theory, the Turtle Program involves both parent and child treatment components delivered within the peer context. Our pilot work demonstrated beneficial effects of the Turtle Program ('Turtle') over a waitlist control group. Herein, we report results of a rigorous randomized controlled trial (RCT) comparing Turtle to the best available treatment for young children high in BI, Cool Little Kids (CLK).
METHODS
One hundred and fifty-one parents and their 3.5- to 5-year-old children selected on the basis of BI were randomly assigned to Turtle or CLK, delivered in group format over 8 weeks. Effects on child anxiety, life interference, BI, and observed parenting were examined at post-treatment and 1-year follow-up. ClinicalTrials.gov registration: NCT02308826.
RESULTS
No significant main effect differences were found between Turtle and CLK on child anxiety; children in both programs evidenced significant improvements in BI, anxiety severity, family accommodation, and child impairment. However, Turtle yielded increased observed warm/engaged parenting and decreased observed negative control, compared with CLK. Parental social anxiety moderated effects; parents with higher anxiety demonstrated diminished improvements in child impairment, and parent accommodation in CLK, but not in Turtle. Children of parents with higher anxiety demonstrated more improvements in child BI in Turtle, but not in CLK.
CONCLUSIONS
Turtle and CLK are both effective early interventions for young children with BI. Turtle is more effective in improving parenting behaviors associated with the development and maintenance of child anxiety. Turtle also proved to be more effective than CLK for parents with social anxiety. Results suggest that Turtle should be recommended when parents have social anxiety; however, in the absence of parent anxiety, CLK may offer a more efficient treatment model.
背景
被归类为行为抑制（BI）的儿童有患社交焦虑症的风险。焦虑风险受到父母行为和社会情感能力的调节。基于发展性交易理论，海龟计划包括父母和孩子在同伴环境中接受的治疗内容。我们的初步工作表明，海龟计划（“海龟”）对等待名单对照组具有有益的效果。在此，我们报告了一项严格的随机对照试验（RCT）的结果，该试验将海龟与针对高 BI 幼儿的最佳可用治疗方法“酷小孩（CLK）”进行了比较。
方法
根据 BI 选择了 151 名父母及其 3.5 至 5 岁的孩子，并将他们随机分配到海龟或 CLK 组中，以小组形式在 8 周内完成治疗。在治疗后和 1 年随访时评估了儿童焦虑、生活干扰、BI 和观察到的父母养育方式的影响。ClinicalTrials.gov 注册：NCT02308826。
结果
在儿童焦虑方面，海龟和 CLK 之间没有发现显著的主要效应差异；两个项目的儿童都在 BI、焦虑严重程度、家庭适应和儿童障碍方面有显著改善。然而，与 CLK 相比，海龟组观察到的温暖/投入型养育方式增加，负面控制减少。父母的社交焦虑症调节了效果；焦虑程度较高的父母在 CLK 中表现出对儿童障碍改善的减少，以及父母的适应，但在海龟组中则不然。父母焦虑程度较高的儿童在海龟中 BI 改善更多，而在 CLK 中则不然。
结论
海龟和 CLK 都是针对 BI 幼儿的有效早期干预措施。与儿童焦虑的发展和维持相关的养育行为，海龟的改善效果更好。对于患有社交焦虑症的父母，海龟也被证明比 CLK 更有效。结果表明，当父母有社交焦虑症时，应推荐使用海龟；然而，在没有父母焦虑的情况下，CLK 可能提供更有效的治疗模式。
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