Background information
Brave Little Ones is a research group that investigates the potential prevention of anxiety disorders in children aged 3-6 years old who are very shy or anxious.
The goal of Brave Little Ones
The aim of Brave Little Ones is to investigate the effectiveness of a new program designed to prevent anxiety problems in toddlers and preschoolers who are shyer than their peers.
Rationale for the projects
Anxiety disorders are one of the most common mental health conditions among children and often develop at a relatively young age; approximately 20% of all children experience them before the age of 16 (10).
Despite the availability of effective treatments in the Netherlands, many people never seek treatment or only do so at a late stage. According to a recent Dutch study, the time between the development of an anxiety disorder and the first moment of contact for help is 12 years (15).
Therefore, there is a great relevance to focus on early prevention methods.
Received care for anxiety disorder
- 39 % No care received
- 43 % Care received after >1 year after developing complaints
- 18 % Care received after <1 year after developing complaints
Source: ten Have, M., van Dorsselaer, S., & de Graaf, R. (2012). Tijd tussen ontstaan van een psychische aandoening en eerste zorgcontact: Resultaten van de 'Netherlands Mental Health Survey and Incidence Study-2'(NEMESIS-2).
Behavioral inhibition
Previous research has shown that it is possible to use indicators to determine whether a child is susceptible to develop anxiety disorders later in life as early as toddler and preschool age. One of these indicators is behavioral inhibition.
It has been established that children that exhibit this trait have a 4 to 6 times bigger chance to develop (social) anxiety disorders. Because of this, behavioral inhibition is a very suitable indication for prevention methods (4-5).
Definition behavioral inhibition
Behavioral inhibition in toddlers and preschoolers is characterized by shy and withdrawn behavior in unfamiliar and/or exciting situations and with unfamiliar people.
BIQ-SF
Principal Investigator Dr. Leonie Vreeke investigated an instrument to measure behavioral inhibition in her previous research (16). This is the Behavioral Inhibition Questionnaire Short Form (BIQ-SF); a short parent-reported questionnaire. If the score on this questionnaire is above the cutoff value, this means that the child exhibits a high degree of behavioral inhibition and is therefore potentially vulnerable to developing anxiety problems.
Current research
Despite the availability of a tool to identify children at increased risk of developing anxiety problems at an early age, there are still no effective programs available in the Netherlands to prevent these children from suffering from such problems.
A potentially effective program is a parent training called ‘Cool Little Kids’ for parents of children aged 3-6 years old that exhibit high levels of behavioral inhibition. This program has shown to be effective in Australia in preventing anxiety problems up to 11 years later (11-13). Find more information about the program here.
However, we currently still do not know if this program can contribute to the prevention of anxiety problems in the Netherlands or whether the parental awareness that their child could be vulnerable to developing anxiety problems in combination with general parenting tips could already be enough. In addition, it is of importance to study the cost effectiveness of this Cool Little Kids program in the Netherlands.
Currently, the working elements behind the usefulness of the program are studied in the research project called ‘Building Blocks’ and a stepwise (matched-care) treatment for parents with shy/anxious children aged 3-6 years, ‘Brave Steps’, is being developed, which is tailored to the degree of need for help.