New ‘Timid to Tiger’ parenting-based group intervention for young anxious children shows promise

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This randomised controlled trial published in the Journal of the American Academy of Child and Adolescent Psychiatry looks at the effectiveness of a new cognitive-behavioural parenting-based approach for treating anxiety in young children.

Timid to Tiger is an entirely parenting-based approach to managing anxiety in children aged nine years or below. It is based on evidence that anxious children benefit substantially from a parenting style that is clear, calm and consistent. Parents learn a new approach to managing their children, using attachment-based play, lots of praise and reward for good and confident behaviours, and gentle disciplinary techniques and planned ignoring for unwanted behaviours. Parents are also taught a number of simple cognitive-behavioural techniques for managing their children’s fear and worry.

This RCT involved the families of 74 anxious children (aged 9 years or less) and compared the new 10-session, group-format intervention with a wait-list control condition. Outcome measures included blinded diagnostic interview and self-reports from parents and children.

Intention-to-treat analyses indicated that children whose parent(s) received the intervention were significantly less anxious at the end of the study than those in the control condition:

  • 57% of those receiving the new intervention were free of their primary disorder, compared with 15% in the control condition
  • 32% of treated children were free of any anxiety diagnosis at the end of the treatment period, compared with 6% of those in the control group
  • Treatment gains were maintained at 12-month follow-up

The authors of the research concluded:

This new parenting-based intervention may represent an advance in the treatment of this previously neglected group.


  • Cartwright-Hatton S, et al. A new parenting-based group intervention for young anxious children: results of a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2011 Mar;50(3):242-251.e6. [PubMed abstract]
  • From Timid to Tiger: parenting the anxious child. British Psychological Society workshop in London, 3rd October 2011.
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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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