Question 1

How do I identify which cautious-temperament children will develop anxiety disorders, and what can I do early?

Accepted Answer

Behavioral inhibition (BI) — extreme caution and avoidance of novelty in 15-20% of infants — carries a sevenfold increase in risk for social anxiety disorder (weighted OR = 7.59, 95% CI: 3.03-19.00). Social BI specifically predicts social anxiety; non-social BI predicts separation anxiety and specific phobias. The Cool Little Kids program (six 90-minute parent sessions teaching graded exposure instead of accommodation) significantly reduced anxiety diagnoses at 3-year follow-up in an RCT.

Question 2

What is behavioral inhibition and how strong is it as a predictor (OR 7.59 for SAD)?

Accepted Answer

Behavioral inhibition (BI) — extreme caution and avoidance of novelty in 15-20% of infants — carries a sevenfold increase in risk for social anxiety disorder (weighted OR = 7.59, 95% CI: 3.03-19.00). Social BI specifically predicts social anxiety; non-social BI predicts separation anxiety and specific phobias. The Cool Little Kids program (six 90-minute parent sessions teaching graded exposure instead of accommodation) significantly reduced anxiety diagnoses at 3-year follow-up in an RCT.

Question 3

At what age should I screen for behavioral inhibition?

Accepted Answer

Behavioral inhibition (BI) — extreme caution and avoidance of novelty in 15-20% of infants — carries a sevenfold increase in risk for social anxiety disorder (weighted OR = 7.59, 95% CI: 3.03-19.00). Social BI specifically predicts social anxiety; non-social BI predicts separation anxiety and specific phobias. The Cool Little Kids program (six 90-minute parent sessions teaching graded exposure instead of accommodation) significantly reduced anxiety diagnoses at 3-year follow-up in an RCT.

Question 4

What is the Cool Little Kids program and what's its evidence base?

Accepted Answer

Behavioral inhibition (BI) — extreme caution and avoidance of novelty in 15-20% of infants — carries a sevenfold increase in risk for social anxiety disorder (weighted OR = 7.59, 95% CI: 3.03-19.00). Social BI specifically predicts social anxiety; non-social BI predicts separation anxiety and specific phobias. The Cool Little Kids program (six 90-minute parent sessions teaching graded exposure instead of accommodation) significantly reduced anxiety diagnoses at 3-year follow-up in an RCT.

Question 5

If a parent has an anxiety disorder, how much does that increase their child's risk?

Accepted Answer

Behavioral inhibition (BI) — extreme caution and avoidance of novelty in 15-20% of infants — carries a sevenfold increase in risk for social anxiety disorder (weighted OR = 7.59, 95% CI: 3.03-19.00). Social BI specifically predicts social anxiety; non-social BI predicts separation anxiety and specific phobias. The Cool Little Kids program (six 90-minute parent sessions teaching graded exposure instead of accommodation) significantly reduced anxiety diagnoses at 3-year follow-up in an RCT.

PsychHQ

Behavioral Inhibition: Identifying At-Risk Children Before Anxiety Develops