Parental Responses to Children’s Avoidance in Fear-Provoking Situations: Relation to Child Anxiety and Mediators of Intervention Response

Background Parenting behaviors have consistently been shown to be associated with elevated anxiety symptoms and disorders in children. However, this literature is limited as most studies have focused on global rather than specific parenting behaviors, failed to consistently account for the influence of parental anxiety, and omitted examining whether changes in parenting behaviors mediate intervention outcomes. Objective This study addressed these limitations by examining five specific parental responses to children’s avoidance behavior during fear-provoking situations in relation to their child’s anxiety and as a mediator of outcomes in the context of a child anxiety prevention intervention. Parental responses included Positive Reinforcement, Punishment, Use of Force, Reinforcement of Dependence, and Positive Modeling. Methods Anxious parents ( N = 136) and their non-anxious children (mean age 8.69; 55.9% female; 84.6% Caucasian) who participated in the Child Anxiety Prevention Study served as participants; independent evaluators conducted diagnostic interviews at baseline, post-intervention, and at 6- and 12-month follow-ups. Parental responses were assessed using the parent-report version of the adapted Child Development Questionnaire. Results At baseline parental use of Punishment, Force, and Positive Reinforcement were positively associated with child anxiety severity, after controlling for parental anxiety. The intervention, compared to the control condition, led to significant reductions in Reinforcement of Dependence at each time point and these changes mediated the intervention’s impact on child anxiety. Conclusions Findings highlight the value of examining specific parental responses to children’s avoidance of feared situations and confirm that reducing parental accommodation is important to child anxiety prevention.