Anxiety disorders are common among young children, with earlier onset typically associated with greater severity and persistence. A stable behaviorally inhibited (BI) temperament and subsequent shyness and social withdrawal (SW) place children at increased risk of developing anxiety disorders, particularly social anxiety. In this Future Directions article, we briefly review developmental and clinical research and theory that point to parenting and peer interactions as key moderators of both the stability of BI/SW and risk for later anxiety, and we describe existing interventions that address early BI/SW and/or anxiety disorders in young children. We recommend that future research on early intervention to disrupt the trajectory of anxiety in children at risk (a) be informed by both developmental science and clinical research, (b) incorporate multiple levels of analysis (including both individual and contextual factors),

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 5year-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.

The COVID-19 pandemic is an unprecedented social-emotional stressor significantly impacting intervention services for at-risk college students with attention-deficit/hyperactivity disorder (ADHD). In order to succeed in the new remote learning context, students are tasked with employing strong organizational, time management, and planning skills. They must self-regulate thoughts, actions, and emotions, inhibit task-irrelevant activity, and cope with unprecedented stressors. These ingredients for success nearly completely overlap with the core dysfunctions of ADHD. Recognizing the importance of providing psychosocial services during this high-risk time and in response to social distancing and university guidelines, we initiated a telehealth version of our program for college students with ADHD (i.e., SUCCEEDS). In the current paper, we describe novel and creative clinical strategies designed to assist students with ADHD in problem solving, adaptive coping, organizational skills, and time management strategies during the COVID-19 pandemic. Specifically, we: (1) detail the initial set-up of remote delivery services and supervision, (2) describe key components of the SUCCEEDS program developed to support students' unique needs during the COVID-19 pandemic, (3) present focus group and qualitative feedback from SUCCEEDS coaches and students, (4) provide an illustrative case vignette of application, and (5) discuss future directions and "lessons learned" in moving SUCCEEDS to a remote platform. In so doing, our hope is to contribute to an ongoing dialog surrounding optimal delivery of remote services to college students with ADHD, particularly during high-risk periods.

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Behavioral inhibition (BI) is a temperamental style that poses risk for later anxiety. Efficacious interventions have been developed for inhibited children, but their success depends on parent engagement. However, little is known regarding predictors of parent engagement in early interventions for BI. This study examined parent-, child-and treatment-level (i.e., parent-only or parent-child) factors as independent and interactive predictors of parent engagement (attendance, and parentreported homework completion and treatment satisfaction) in a randomizedcontrolled trial comparing two interventions for inhibited preschoolers (N = 151). Results suggest that child anxiety may motivate parent engagement, particularly when children receive concurrent treatment and/or in-vivo coaching. However, intensive treatment may be too burdensome for depressed parents, whereas less intensive treatments may be more acceptable to non-anxious parents of anxious children.