Behavioural Inhibition and the Prevention of Internalising Distress in Early Childhood



An inhibited temperamental style has been identified as one of the core risks for the later development of anxiety and related disorders. Several additional risks are believed to interact with child inhibition, including parent emotionality, parental rearing style, and poor social skills. These factors lend themselves to modification, opening the door to prevention of emotional disorders. To date there has been surprisingly little focus on the prevention of emotional disorder through identification of early child inhibition. The current chapter briefly summarises the current literature. It then moves on to consider several relevant issues including the best target for intervention, the most relevant population, and novel intervention strategies. Finally, the chapter describes some attempts to apply prevention at a population level and discusses barriers and future directions.


Inhibition Preschool Prevention Intervention Population health 


  1. Anticich, S. A., Barrett, P. M., Silverman, W., Lacherez, P., & Gillies, R. (2013). The prevention of childhood anxiety and promotion of resilience among preschool-aged children: A universal school based trial. Advances in School Mental Health Promotion, 6(2), 93–121.CrossRefGoogle Scholar
  2. Axford, N., Lehtonen, M., Kaoukji, D., Tobin, K., & Berry, V. (2012). Engaging parents in parenting programs: Lessons from research and practice. Children and Youth Services Review, 34, 2061–2071.CrossRefGoogle Scholar
  3. Bayer, J. K., Beatson, R., Bretherton, L., Hiscock, H., Wake, M., Gilbertson, T., … Rapee, R. M. (2018). Translational delivery of Cool Little Kids to prevent child internalising problems: Randomised controlled trial. Australian and New Zealand Journal of Psychiatry, 52, 181. CrossRefPubMedGoogle Scholar
  4. Bayer, J. K., Hiscock, H., Scalzo, K., Mathers, M., McDonald, M., Morris, A., … Wake, M. (2009). Systematic review of preventive interventions for children’s mental health: What would work in Australian contexts? Australian and New Zealand Journal of Psychiatry, 43(8), 695–710.CrossRefGoogle Scholar
  5. Bayer, J. K., Rapee, R. M., Hiscock, H., Ukoumunne, O. C., Mihalopoulos, C., Clifford, S., & Wake, M. (2011). The Cool Little Kids randomised controlled trial: Population-level early prevention for anxiety disorders. BMC Public Health, 11, 11.CrossRefGoogle Scholar
  6. Bayer, J. K., Ukoumunne, O. C., Lucas, N., Wake, M., Scalzo, K., & Nicholson, J. M. (2011). Risk factors for childhood mental health symptoms: National longitudinal study of Australian children. Pediatrics, 128, e865–e879.CrossRefGoogle Scholar
  7. Beatson, R. M., Bayer, J. K., Perry, A., Mathers, M., Hiscock, H., Wake, M., … Rapee, R. M. (2014). Community screening for preschool child inhibition to offer the ‘Cool Little Kids’ anxiety prevention programme. Infant and Child Development, 23(6), 650–661.CrossRefGoogle Scholar
  8. Cartwright-Hatton, S., McNally, D., Field, A. P., Rust, S., Laskey, B., Dixon, C., … Woodham, A. (2011). A new parenting-based group intervention for young anxious children: Results of a randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 50(3), 242–251.CrossRefGoogle Scholar
  9. Chronis-Tuscano, A., Rubin, K. H., O'Brien, K. A., Coplan, R. J., Thomas, S. R., Dougherty, L. R., … Wimsatt, M. (2015). Preliminary evaluation of a multimodal early intervention program for behaviorally inhibited preschoolers. Journal of Consulting and Clinical Psychology, 83(3), 534–540.CrossRefGoogle Scholar
  10. Clauss, J. A., & Blackford, J. U. (2012). Behavioral inhibition and risk for developing social anxiety disorder: A meta-analytic study. Journal of the American Academy of Child & Adolescent Psychiatry, 51(10), 1066–1075.CrossRefGoogle Scholar
  11. Coplan, R. J., Prakash, K., O’Neill, K., & Armer, M. (2004). Do you “want” to play? Distinguishing between conflicted shyness and social disinterest in early childhood. Developmental Psychology, 40(2), 244–258.CrossRefGoogle Scholar
  12. Coplan, R. J., Schneider, B. H., Matheson, A., & Graham, A. (2010). ‘Play skills’ for shy children: Development of a social skills facilitated play early intervention program for extremely inhibited preschoolers. Infant and Child Development, 19(3), 223–237.Google Scholar
  13. Degnan, K. A., Almas, A. N., & Fox, N. A. (2010). Temperament and the environment in the etiology of childhood anxiety. Journal of Child Psychology and Psychiatry, 51(4), 497–517.CrossRefGoogle Scholar
  14. Edwards, S. L., Rapee, R. M., & Kennedy, S. (2010). Prediction of anxiety symptoms in preschool-aged children: Examination of maternal and paternal perspectives. Journal of Child Psychology & Psychiatry, 51(3), 313–321.CrossRefGoogle Scholar
  15. Gazelle, H., & Ladd, G. W. (2003). Anxious solitude and peer exclusion: A diathesis-stress model of internalizing trajectories in childhood. Child Development, 74(1), 257–278.CrossRefGoogle Scholar
  16. Gazelle, H., & Shell, M. D. (2017). Behavioral profiles of anxious solitary children: Predicting peer relations trajectories from third to fifth grade. Merrill-Palmer Quarterly, 63(2), 237.CrossRefGoogle Scholar
  17. Giesen, F., Searle, A., & Sawyer, M. (2007). Identifying and implementing prevention programmes for childhood mental health problems. Journal of Paediatrics and Child Health, 43, 785–789.CrossRefGoogle Scholar
  18. Graeff-Martins, A. S., Flament, M. F., Fayyad, J., Tyano, S., Jensen, P., & Rohde, L. A. (2008). Diffusion of efficacious interventions for children and adolescents with mental health problems. Journal of Child Psychology and Psychiatry, 49, 335–352.CrossRefGoogle Scholar
  19. Heckman, J. (2000). Invest in the very young. Chicago, IL: Ounce of Prevention Fund and the University of Chicago Harris School of Public Policy Analysis.Google Scholar
  20. Hirshfeld-Becker, D. R., Masek, B., Henin, A., Blakely, L. R., Pollock-Wurman, R. A., McQuade, J., … Biederman, J. (2010). Cognitive behavioral therapy for 4- to 7-year-old children with anxiety disorders: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 78(4), 498–510.CrossRefGoogle Scholar
  21. Jarosz, E., & Bayer, J. K. (2017). Service evaluation of the Cool Little Kids parenting program delivered in the community. Advances in Mental Health, 1.
  22. Jitlina, K., Shumka, E., Miller, L. D., & Rapee, R. M. (2015). Disseminating evidence-based anxiety prevention strategies into the schools: Capitalizing on existing clinical anxiety treatment programs. Paper presented at the 49th ABCT Convention, Chicago, November 12–15.Google Scholar
  23. Kagan, J., Reznick, J. S., Clarke, C., Snidman, N., & Garcia-Coll, C. (1984). Behavioral inhibition to the unfamiliar. Child Development, 55, 2212–2225.CrossRefGoogle Scholar
  24. Kagan, J., Reznick, J. S., & Snidman, N. (1988). Biological bases of childhood shyness. Science, 240, 167–171.CrossRefGoogle Scholar
  25. Kagan, J., Snidman, N., Arcus, D., & Reznick, J. S. (1994). Galen’s prophecy: Temperament in human nature. New York, NY: Basic Books.Google Scholar
  26. Kennedy, S. J., Rapee, R. M., & Edwards, S. L. (2009). A selective intervention program for inhibited preschool-aged children of parents with an anxiety disorder: Effects on current anxiety disorders and temperament. Journal of the American Academy of Child & Adolescent Psychiatry, 48(6), 602–609.CrossRefGoogle Scholar
  27. Kerr, M. (2000). Childhood and adolescent shyness in long-term perspective. In W. R. Crozier (Ed.), Shyness: Development, consolidation and change (pp. 65–87). London, England: Routledge.Google Scholar
  28. LaFreniere, P. J., & Capuano, F. (1997). Preventive intervention as a means of clarifying direction of effects in socialization: Anxious-withdrawn preschoolers case. Development and Psychopathology, 9, 551–564.CrossRefGoogle Scholar
  29. Lau, E. X., Rapee, R. M., & Coplan, R. J. (2017). Combining child social skills training with a parent early intervention program for inhibited preschool children. Journal of Anxiety Disorders, 51, 32–38.CrossRefGoogle Scholar
  30. Lawrence, D., Johnson, S., Hafekost, J., Boterhoven De Haan, K., Sawyer, M. G., Ainley, J., & Zubrick, S. (2015). The mental health of children and adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Retrieved from Canberra, Australia.Google Scholar
  31. Li, Y., Coplan, R. J., Wang, Y., Yin, J., Zhu, J., Gao, Z., & Li, L. (2016). Preliminary evaluation of a social skills training and facilitated play early intervention programme for extremely shy young children in china (Vol. 25, p. 565). Infant and Child Development.Google Scholar
  32. Linetzky, M., Pergamin-Hight, L., Pine, D. S., & Bar-Haim, Y. (2015). Quantitative evaluation of the clinical efficacy of attention bias modification treatment for anxiety disorders. Depression and Anxiety, 32(6), 383–391.CrossRefGoogle Scholar
  33. Luke, F., Chan, C. C., Au, A., & Lai, S. M. K. (2017). Adaptive parenting for alleviating young children’s shyness: A randomized controlled trial of an early intervention program. Infant and Child Development, 26, e2030.CrossRefGoogle Scholar
  34. Lyneham, H. J., Hudson, J. L., & Rapee, R. M. (2014). Prevention of anxiety disorders. In T. Ehring & P. M. Emmelkamp (Eds.), International handbook of anxiety disorders (pp. 625–642). Chichester, England: Wiley.Google Scholar
  35. Mathers, C. D., & Loncar, D. (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine, 3(11), e442. CrossRefPubMedPubMedCentralGoogle Scholar
  36. McLeod, B. D., Wood, J. J., & Weisz, J. R. (2007). Examining the association between parenting and childhood anxiety: A meta-analysis. Clinical Psychology Review, 27, 155–172.CrossRefGoogle Scholar
  37. Merikangas, K. R., He, J.-P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., … Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989.CrossRefGoogle Scholar
  38. Mian, N. D. (2014). Little children with big worries: Addressing the needs of young, anxious children and the problem of parent engagement. Clinical Child and Family Psychology Review, 17, 85–96.CrossRefGoogle Scholar
  39. Micco, J. A., Henin, A., Mick, E., Kim, S., Hopkins, C. A., Biederman, J., & Hirshfeld-Becker, D. R. (2009). Anxiety and depressive disorders in offspring at high risk for anxiety: A meta-analysis. Journal of Anxiety Disorders, 23(8), 1158–1164.CrossRefGoogle Scholar
  40. Mihalopoulos, C., Vos, T., Rapee, R. M., Pirkis, J., & Carter, R. (2015). The population cost-effectiveness of a parenting intervention designed to prevent anxiety disorders in children. Journal of Child Psychology & Psychiatry, 56(9), 1026–1033.CrossRefGoogle Scholar
  41. Morgan, A. J., Rapee, R. M., & Bayer, J. K. (2016). Prevention and early intervention of anxiety problems in young children: A pilot evaluation of Cool Little Kids Online. Internet Interventions, 4, 105–112.CrossRefGoogle Scholar
  42. Morgan, A. J., Rapee, R. M., Salim, A., & Bayer, J. K. (2018). Predicting response to an internet-delivered parenting program for anxiety in early childhood. Behavior Therapy, 49, 237.CrossRefGoogle Scholar
  43. Morgan, A. J., Rapee, R. M., Salim, A., Goharpey, N., Tamir, E., McLellan, L. F., & Bayer, J. K. (2017). Internet-delivered parenting program for early intervention of anxiety problems in young children: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 56, 417.CrossRefGoogle Scholar
  44. Mrazek, P. J., & Haggerty, R. J. (1994). In P. J. Mrazek & R. J. Haggerty (Eds.), Reducing risks for mental disorders. Washington, DC: National Academy Press.Google Scholar
  45. Nozadi, S. S., Troller-Renfree, S., White, L. K., Frenkel, T. I., Degnan, K. A., Bar-Haim, Y., … Fox, N. A. (2016). The moderating role of attention biases in understanding the link between behavioral inhibition and anxiety. Journal of Experimental Psychopathology, 7(3), 451–465.CrossRefGoogle Scholar
  46. Oh, E., Mathers, M., Hiscock, H., Wake, M., & Bayer, J. K. (2015). Professional help seeking for young children with mental health problems. Australian Journal of Psychology, 67, 187–195.CrossRefGoogle Scholar
  47. Pedlow, R., Sanson, A., Prior, M., & Oberklaid, F. (1993). Stability of maternally reported temperament from infancy to 8 years. Developmental Psychology, 29(6), 998–1007.CrossRefGoogle Scholar
  48. Prior, M., Smart, D., Sanson, A., & Oberklaid, F. (2000). Does shy-inhibited temperament in childhood lead to anxiety problems in adolescence? Journal of the American Academy of Child and Adolescent Psychiatry, 39(4), 461–468.CrossRefGoogle Scholar
  49. Rapee, R. M. (1997). Potential role of childrearing practices in the development of anxiety and depression. Clinical Psychology Review, 17, 47–67.CrossRefGoogle Scholar
  50. Rapee, R. M. (2002). The development and modification of temperamental risk for anxiety disorders: Prevention of a lifetime of anxiety? Biological Psychiatry, 52, 947–957.CrossRefGoogle Scholar
  51. Rapee, R. M. (2013). The preventative effects of a brief, early intervention for preschool-aged children at risk for internalising: Follow-up into middle adolescence. Journal of Child Psychology and Psychiatry, 54(7), 780–788.CrossRefGoogle Scholar
  52. Rapee, R. M., & Coplan, R. J. (2010). Conceptual relations between anxiety disorder and fearful temperament. In H. Gazelle & K. H. Rubin (Eds.), Social anxiety in childhood: Bridging developmental and clinical perspectives. New directions for child and adolescent development (Vol. 127, pp. 17–31). San Francisco, CA: Jossey-Bass.Google Scholar
  53. Rapee, R. M., Kennedy, S., Ingram, M., Edwards, S. L., & Sweeney, L. (2005). Prevention and early intervention of anxiety disorders in inhibited preschool children. Journal of Consulting and Clinical Psychology, 73(3), 488–497.CrossRefGoogle Scholar
  54. Rapee, R. M., Kennedy, S., Ingram, M., Edwards, S. L., & Sweeney, L. (2010). Altering the trajectory of anxiety in at-risk young children. American Journal of Psychiatry, 167, 1518–1525.CrossRefGoogle Scholar
  55. Rapee, R. M., Lau, E. X., & Kennedy, S. J. (2010). The Cool Little Kids anxiety prevention program –s therapist manual. Sydney, NSW, Australia: Centre for Emotional Health, Macquarie University.Google Scholar
  56. Rapee, R. M., Schniering, C. A., & Hudson, J. L. (2009). Anxiety disorders during childhood and adolescence: Origins and treatment. Annual Review of Clinical Psychology, 5, 311–341.CrossRefGoogle Scholar
  57. Rubin, K. H., Coplan, R. J., & Bowker, J. C. (2009). Social withdrawal in childhood. Annual Review of Psychology, 60, 141–171. CrossRefPubMedPubMedCentralGoogle Scholar
  58. Sanders, M. R., & Kirby, J. N. (2015). Surviving or thriving: Quality assurance mechanisms to promote innovation in the development of evidence-based parenting interventions. Prevention Science, 16, 421–431.CrossRefGoogle Scholar
  59. Schor, E. L., Abrams, M., & Shea, K. (2007). Medicaid: Health promotion and disease prevention for school readiness. Health Affairs, 26, 420–429.CrossRefGoogle Scholar
  60. Wake, M., Sanson, A., Berthelsen, D., Hardy, P., Mission, S., Smith, K., Ungerer, J., & LSAC Research Consortium. (2008). How well are Australian infants and children aged 4 to 5 years doing? Findings from the Longitudinal Study of Australian Children Wave 1 (Social Policy Research Paper No. 36). Canberra, Australia: Department of Families, Housing, Community services and Indigenous Affairs, Australian Government.Google Scholar
  61. White, L. K., McDermott, J. M., Degnan, K. A., Henderson, H. A., & Fox, N. A. (2011). Behavioral inhibition and anxiety: The moderating roles of inhibitory control and attention shifting. Journal of Abnormal Child Psychology, 39(5), 735–747.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Centre for Emotional Health, Department of PsychologyMacquarie UniversitySydneyAustralia
  2. 2.School of Psychology and Public Health, La Trobe UniversityMelbourneAustralia

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