Small brave steps: what helps anxious young children
The short version: For young children with real anxiety, approaches built on gradual, step-by-step brave practice — with parents closely involved — help most of them. Even a brief course for parents of shy preschoolers reduced later anxiety disorders.
The studies
Hirshfeld-Becker, D. R., Masek, B., Henin, A., et al. (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. doi:10.1037/a0019055
Who was studied: 64 children aged 4 to 7 (average age 5.4) with anxiety disorders.
Design: Randomized controlled trial (vs. a 6-month waitlist)
What they found: A parent-child version of cognitive behavioral therapy adapted for young children, including step-by-step facing of fears, led to much or very much improvement in 69% of children who completed it, compared with 32% of children on the waitlist.
Rapee, R. M., Kennedy, S., Ingram, M., Edwards, S., & Sweeney, L. (2005). Prevention and early intervention of anxiety disorders in inhibited preschool children. Journal of Consulting and Clinical Psychology, 73(3), 488–497. doi:10.1037/0022-006X.73.3.488
Who was studied: Preschoolers who were unusually withdrawn and inhibited — one of the best-known risk factors for later anxiety.
Design: Randomized controlled trial
What they found: Parents who took a brief six-session group course had children with a significantly greater drop in anxiety diagnoses a year later than children whose parents had no course. The children's shyness itself changed little.
How strong is the evidence?
Good for this age, with caveats. Both are randomized trials, but they're modest in size, and the first involved children with diagnosed anxiety disorders, not everyday fears.
What these studies don't show
- They don't show that shyness goes away. In the preschool trial, temperament stayed much the same — what changed was how often it turned into an anxiety disorder.
- They don't show that pushing a child into the fear works. The steps were small and the child had a say in them.
What it means for parents
- Break a fear into small steps and let the child choose the next one. "One step, then stop" is a complete success.
- Say it out loud together: "I'm scared, and I'm going." Brave doesn't mean not scared.
- If fear is stopping ordinary life or getting worse over weeks, ask your pediatrician — this is very treatable at this age.
Courage, the Bravery Ladder and True or Made Up (lessons 9, 10 and 12) use the same step-by-step approach, in a playful form for everyday fears.