Internalizing problems (IP) in adolescents - such as anxiety and depression - are prevalent and have increased in recent decades (Bor et al., 2014; Bussieres et al., 2021; Fischer et al., 2022; Polanczyk et al., 2015). IP often arise early in childhood, and the impact of these problems on a child's life can be significant. For example, IP in childhood have been associated with underperforming in school (Pedersen et al., 2019), sleeping problems (Alvaro et al., 2013), and physical health problems (Jamnik & DiLalla, 2019).

Therefore, it is important to identify children who are at a higher risk for developing IP in an early stage. One of the most robust predictors of anxiety disorders, as well as depressive disorders, is behavioral inhibition (Fox et al., 2023; Sandstrom et al., 2020), which can be characterized by extreme shyness and withdrawal when faced with new situations. Although we can easily detect and identify children who are at a higher risk for developing IP, there is still no intervention protocol that is tailored to children and their specific level of anxiety and shyness. This underlines the need to develop effective treatments methods and evaluate those methods.

Our research group is currently investigating the effectiveness of the Cool Little Kids intervention programme as an prevention programme for children who are prone to anxiety, but do not yet meet the criteria for an anxiety disorder (step 2 in this project). During the screening process and in our communication with the mental health institutions with whom we work, we noticed that there is also a significant group of children who have more severe problems and do already meet the criteria for an anxiety disorder, but who have not yet been referred to specialized health care (treatment/step 3 in this project). At the same time, there are also anxiety-sensitive children who may benefit from a less intensive intervention, such as a parent webinar with psychoeducation and online knowledge clips (step 1 in this project). This may also be appropriate for parents who are less motivated, unable to participate because of their busy schedules, or less likely to participate in a group intervention. In such cases, a parent webinar with psychoeducation and online knowledge clips could be a viable solution and help lower the threshold for participation in any follow-up steps of the intervention.

However, this step-by-step approach for anxiety-prone children does not yet exist in the Netherlands.

Research aim

The aim of this project is to develop a step-by-step treatment for young children who are very shy, taking into account the level of shyness and the impact this has on the child. The research project will investigate the effectiveness of this approach in anxiety-prone preschool children aged 3 to 6 years living in the Netherlands.

Approach

In collaboration with GGD Amsterdam and Groningen, an Amsterdam-based mental health organization (MOC 't Kabouterhuis), a Rotterdam-based mental health organization (Indigo), a Hague-based mental health organization (Youz), the municipality of Rotterdam, a client organization (Stichting Angst Dwang Fobie) and Macquirie University, this project will develop a step-by-step treatment, starting with:

• an online webinar for parents (step 1)
• the Cool Little Kids group treatment (step 2)
• intensive individual treatment (step 3)

Each step will consists of a different level of intervention, starting from a low-threshold intervention (step 1) to intensive treatment (step 3). At the same time it will be investigated which type of support is most suitable for which group of parents and children.

With the help of the ZonMw grant, the effectiveness of this stepwise program for the prevention of anxiety problems can be carefully investigated.

• anxiety
• intervention
• parenting
• prevention

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