Conceptual relations between anxiety disorder and fearful temperament

Shyness subtypes and associations with social anxiety: A comparison study of Canadian and Chinese children

Previous research has shown that there are distinct types of children's shyness within eastern and western cultures, with different origins, developmental courses, and outcomes. However, the measures used to examine children's shyness in eastern contexts have been developed almost exclusively in the North American context. Whether shyness subtypes and their predictive associations are conserved between western and eastern cultures on a children's shyness measure developed in an eastern context is an empirical question. Here we examined (a) whether two subtypes from the Chinese Shyness Scale (i.e., anxious and regulated) were identified in a western context, and (b) whether cultural context moderated the relation between the two subtypes of shy behavior and a widely used western characterized social anxiety measure. The participants were children aged 3-5 years from China (Mage = 4.46 years, SD = 0.64, n = 182, 53.8% boys) and Canada (Mage = 3.99 years, SD = 0.82, n = 201, 42.3% boys). The results indicated that the two shyness subtypes and the one-factor social anxiety construct were identified in both cultures. Subsequently, latent moderation structural equation modelling revealed that anxious shyness was significantly and positively related to social anxiety in children from both countries, but more strongly in Canada. Conversely, regulated shyness was significantly and positively related to social anxiety in Canadian children, but not in Chinese children. Findings are discussed regarding possible cultural explanations for why the relations between two Chinese shyness subtypes and social anxiety are different in Chinese and Canadian contexts and their implications to understanding cross-cultural differences in developmental shyness. RESEARCH HIGHLIGHTS: Two subtypes of shyness (anxious and regulated shyness) reported in China were identified in both China and Canada Country/culture moderated the relation between shyness subtypes and social anxiety Anxious shyness was positively related to social anxiety in both countries Regulated shyness was positively related to social anxiety in Canadian children, but not in Chinese children.

Explaining the Patterns of Bullying Victimization Trajectories: Assessing the Generality of Low Self-Control and Crime Opportunity Models to Bullying Victims

This study hypothesizes that self-control and opportunity variables affect heterogeneity in developmental trajectories of bullying victimization. Using data from a follow-up study of 2,351 Korean adolescents, the study incorporates a latent class growth analysis approach to identify subgroups, each with a unique pattern of the trajectories. The model yields three subgroups of bullying victims: the early-onset and decreaser, the increaser and late-peak, and the normative groups. Results suggest that, compared to the normative group, the early-onset and decreasing group members manifest lower levels of self-control and engage in a greater range of delinquent behaviors. Also, the impact of low self-control on group membership was attenuated after controlling for those opportunity variables, indicating a partially mediating relationship. Social guardianship variables distinguished normative groups from other victim groups. Further, members of the increaser and late-peak group were more likely than the early-onset and decreaser group members to engage in cyber deviance over the long-term.

Modeling the normal:abnormal spectrum of early childhood internalizing behaviors: A clinical-developmental approach for the Multidimensional Assessment Profiles Internalizing Dimensions

BACKGROUND

We expanded the Multidimensional Assessment Profiles (MAPS) Scales developmental specification model to characterize the normal:abnormal spectrum of internalizing (anxious and depressive) behaviors in early childhood via the MAPS-Internalizing (MAPS-INT) scale.

METHODS

The MAPS-INT item pool was generated based on clinical expertise and prior research. Analyses were conducted on a sub-sample of families (n = 183) from the diverse When to Worry early childhood sample.

RESULTS

Normal:abnormal descriptive patterns for both anxious and depressive behaviors were consistent with prior work: (1) extremes of normative variation are abnormal when very frequent; and (2) pathognomonic indicators that most children do not engage in and are abnormal, even if infrequent. Factor analysis revealed a two-factor MAPS-INT Anxious Behaviors structure (Fearful-Worried and Separation Distress) and a unidimensional MAPS-INT Depressive Behaviors factor with good fit and good-to-excellent test-retest reliability and validity.

CONCLUSIONS

We characterized the normal:abnormal spectrum of internalizing behaviors in early childhood via the MAPS-INT. Future research in larger representative samples can replicate and extend findings, including clinical thresholds and predictive utility. The MAPS-INT helps lay the groundwork for dimensional characterization of the internalizing spectrum to advance neurodevelopmental approaches to emergent psychopathology and its earlier identification.

Children's Shyness, Frontal Brain Activity, and Anxiety in the Perioperative Context

Although preoperative anxiety affects up to 75% of children undergoing surgery each year and is associated with many adverse outcomes, we know relatively little about individual differences in how children respond to impending surgery. We examined whether patterns of anterior brain electrical activity (i.e., a neural correlate of anxious arousal) moderated the relation between children's shyness and preoperative anxiety on the day of surgery in 70 children (36 girls, Mage = 10.4 years, SDage = 1.7, years, range 8 to 13 years) undergoing elective surgery. Shyness was assessed using self-report approximately 1 week prior to surgery during a preoperative visit (Time 1), preoperative anxiety was assessed using self-report, and regional EEG (left and right frontal and temporal sites) was assessed using a dry sensory EEG headband on the day of surgery (Time 2). We found that overall frontal EEG alpha power moderated the relation between shyness and self-reported preoperative anxiety. Shyness was related to higher levels of self-reported anxiety on the day of surgery for children with lower average overall frontal alpha EEG power (i.e., higher cortical activity) but not for children with higher average overall frontal alpha EEG power (i.e., lower cortical activity). These results suggest that the pattern of frontal brain activity might amplify some shy children's affective responses to impending surgery. Findings also extend prior results linking children's shyness, frontal brain activity, and anxiety observed in the laboratory to a real-world, ecologically salient environment.

Relations between social withdrawal subtypes and socio-emotional adjustment among Chinese children and early adolescents

The aim of the present study was to compare the relations between subtypes of social withdrawal and socio-emotional adjustment in Chinese children and early adolescents. Participants included 571 children (Mage  = 9.62 years) and 345 adolescents Mage  = 12.12 years) in mainland China. Social withdrawal subtypes (i.e., shyness, unsociability, social avoidance) and indices of socio-emotional adjustment were assessed via self-reports, peer nominations, and teacher ratings. Shyness tended to be more strongly associated with emotional maladjustment in early adolescence, whereas unsociability was more strongly associated with socio-emotional difficulties in childhood. For social avoidance, associations with indices of negative adjustment (i.e., social anxiety, emotional symptoms, peer problems) were stronger in childhood, however, associations with indices of positive adjustment (i.e., life satisfaction, well-being) were stronger in early adolescence.

The Effectiveness of Anxiety Interventions for Young Children: A Meta-Analytic Review

Anxiety symptoms and disorders are prevalent and impairing in young children and these symptoms often persist and worsen over time, indicating the need for efficacious interventions for this age group. The purpose of this study was to evaluate the effectiveness of psychosocial interventions targeting anxiety in younger children and to assess the potential moderators of outcome. The effect sizes from 24 trials were assessed based on a random effect model. The mean weighted effect size was found to be significant and moderate in magnitude. Moderators, including level of intervention, intervention approach, rater, and level of training of the provider/program facilitator, are assessed and discussed. Overall, the findings indicate that anxiety interventions are effective in reducing anxiety in young children, and targeted trials show particularly strong promise.

Encouraging a Peer in Need: The Impacts of Social Anxiety and Peer Familiarity

Extant research has produced conflicting findings regarding the link between social fearfulness and prosocial behavior, with some studies reporting negative relations and others reporting null effects. Furthermore, these studies have focused predominantly on toddlerhood, and few have examined prosociality between peers. The present study investigated whether the link between social anxiety and a prosocial behavior (i.e., providing encouragement) varied depending on interpersonal and situational factors (i.e., one's familiarity with a peer, the level of support sought by a peer, respectively). We tested this question using a multimethod approach, which included an ecologically valid stress inducing task and dyadic design with a sample of 9- to 10-year-olds (N = 447). Results revealed that social anxiety was related negatively to providing encouragement among familiar and unfamiliar dyads. In familiar dyads, however, this main effect was qualified by an interaction with the level of support sought by one's peer. Compared to those low in social anxiety, children high in social anxiety provided relatively less encouragement in response to higher levels of support seeking from their peers. The findings are considered in relation to theorizing regarding the effect of overarousal on children's prosocial behavior.

Developmental changes in the structure of shyness and internalizing symptoms from early to middle childhood: A network analysis

Shyness is a temperamental trait that shares considerable conceptual overlap with aspects of internalizing problems, creating difficulties in operationalizing and assessing these two constructs and their association. This study addresses these issues by employing network analyses. Participants were, white, N = 555 children (M_age  = 52.45 months, SD = 15.96, 55% girls) followed longitudinally over 4 years (2016-2010) in Norway. Teachers rated child shyness and assessed children's internalizing symptoms. Results suggest that two behavioral shyness traits were the most central aspects of shyness. The centrality of these aspects was robust across age. The most influential symptom connecting internalizing symptoms with shyness was "unhappy." Shyness became more differentiated with development, and associations between anxiety-related symptoms and shyness increased as children entered formal schooling.

The role of early social play behaviors and language skills for shy children's later internalizing difficulties in school

Research has demonstrated links from early childhood shyness to socioemotional problems later in life. This longitudinal study explored the role of early social play behaviors and language skills in the associations between childhood shyness and later internalizing and language difficulties in school. Participants were N = 7,447 children (50.1% girls) from the Norwegian Mother, Father, and Child Cohort Study (MoBa). Latent direct, indirect, and interaction path analyses were performed within a structural equation framework. Results showed that mother-rated childhood shyness from age 18 months to age five years was associated with mother-rated internalizing difficulties and language problems at age eight years. Lower levels of teacher-reported social play behaviors and poorer language skills in preschool increased the risk of later anxiety problems among shy children, whereas higher levels of language competencies and social play behaviors buffered against later anxiety problems. The study identifies some of the early risk and protective factors that may influence shy children's socio-emotional functioning and adjustment.

Maternal Worry Socialization and Toddler Inhibited Temperament: Transactional Associations and Stability across Time

Caregiver socialization of child emotions has consequences for both typical development and anxiety risk, with caregivers' non-supportive responses to worry perhaps especially salient to children's anxiety development. Children, in turn, impact the caregiving environment they receive through their temperament. We investigated transactional relations between maternal non-supportive responses to child worry (mother-reported) and two differently-measured child inhibited temperament indices (i.e., mother-perceived child inhibition to novelty, laboratory-observed child dysregulated fear) in a sample of 136 predominantly non-Hispanic, White mother-toddler dyads. Worry socialization and mother-reported inhibition to novelty were measured at each of three time points (toddler age 2, 3, 4 years), and dysregulated fear was measured at ages 2 and 3. Constructs showed stability across time, with effect sizes ranging from medium to large. Child inhibited temperament measures positively correlated within time point at ages 2 and 3, and laboratory-observed child dysregulated fear predicted mothers' later perceptions of their children's inhibition to novelty. At toddler age 2, mothers of children showing more dysregulated fear reported responding more non-supportively to worry. However, when controlling for one another, more mother-perceived child inhibition to novelty and less laboratory-observed child dysregulated fear at age 3 predicted mothers' greater non-supportive worry responses at child age 4. There was an indirect effect across time, such that children's greater laboratory-observed dysregulated fear predicted their mothers' heightened perceptions of inhibited temperament, which in turn predicted mothers' greater non-supportive worry responses. Findings lend support to anxiety-relevant construct stability in toddlerhood, as well as child-elicited, rather than parent-elicited, associations across time.

The efficacy of interventions for behaviourally inhibited preschool-aged children: A meta-analysis

The current systematic review and meta-analyses examined the efficacy of psychological interventions targeting behavioural inhibition and anxiety in preschool-aged children, evaluated within randomised controlled trials. Web of Science, MEDLINE, PsycINFO and CINAHL were systematically searched from inception to March 2021. Ten studies (N = 1475 children, aged 3 - 7 years) were included in the current review. Separate analyses were conducted for behavioural inhibition, anxiety symptoms, and anxiety diagnosis as reported by parents, teachers, and observer-ratings. Pooled outcomes ranged from post-intervention to 12-month follow-up due to the limited number of studies. Meta-analyses revealed that intervention did not reduce behavioural inhibition as assessed by independent observers (SMD = -0.13, 95% CI = -0.63 to.38), but did reduce behavioural inhibition as reported by parents (SMC = -0.64, 95% CI = -1.00 to -0.27) and teachers (SMD = -0.69, 95% CI = -1.02 to -0.36). Additionally, intervention appeared to reduce the risk of anxiety disorders (RR =0.75, 95% CI =0.62 to.90), and parent-report anxiety symptoms (SMC = -0.47, 95% CI = -0.83 to -0.12) in preschool-aged children. Intervention may be efficacious in reducing anxiety in preschool-aged behaviourally inhibited children. It is less clear whether intervention leads to change in BI.

Don't Get Lost in Translation: Integrating Developmental and Implementation Sciences to Accelerate Real-World Impact on Children's Development, Health, and Wellbeing

Translation of developmental science discoveries is impeded by numerous barriers at different stages of the research-to-practice pipeline. Actualization of the vast potential of the developmental sciences to improve children's health and development in the real world is imperative but has not yet been fully realized. In this commentary, we argue that an integrated developmental-implementation sciences framework will result in a translational mindset essential for accelerating real world impact. We delineate key principles and methods of implementation science of salience to the developmental science audience, lay out a potential synthesis between implementation and developmental sciences, provide an illustration of the Mental Health, Earlier Partnership (MHE-P), and set actionable steps for realization. Blending these approaches along with wide-spread adoption of the translational mindset has transformative potential for population-level impact of developmental science discovery.

Normative Beliefs about Social Withdrawal in Adolescence

The goal of this study is to explore normative beliefs about social withdrawal during adolescence. Participants were N = 419 adolescents (M_age  = 16.13 years), who completed measures of normative beliefs about social withdrawal and their own social withdrawal (shyness, unsociability). Among the results, adolescents reported greater overall acceptance of unsociability compared to shyness, however, some gender differences also emerged. Specifically, adolescents were more accepting of unsociability when depicted by hypothetical females, and more accepting of shyness when depicted by hypothetical males. Participant social withdrawal was associated with greater acceptance of socially withdrawn behaviors in others. These findings provide a first look at normative beliefs about social withdrawal during a developmentally critical age period for this construct.

Pathways from maternal shyness to adolescent social anxiety

BACKGROUND

Social anxiety is amongst the most prevalent adolescent mental health problems; however, it is often unrecognized due to its comorbidity with other anxiety problems such as generalized anxiety. Thus, understanding the unique developmental pathways to social anxiety is critical for improving its prevention. We examined the pathway from maternal shyness, when children were 4 years old, to adolescents' social anxiety at age 15 through social wariness at age 7. We hypothesized that childhood social wariness would mediate the association between maternal shyness and social anxiety in adolescence.

METHODS

Participants (N = 291; 54% female) were followed from early childhood to adolescence. Mothers reported on their own shyness when children were 4 years old. Social wariness toward unfamiliar peers was observed in the laboratory at ages 4 and 7. Adolescent social anxiety and generalized anxiety were assessed via self-report, parent-report, and clinical diagnoses at age 15.

RESULTS

Maternal shyness was positively associated with adolescent social anxiety but not generalized anxiety at age 15. Higher levels of maternal shyness at age 4 predicted greater social wariness at age 7, which in turn predicted greater social anxiety but not generalized anxiety at age 15. Social wariness at age 7 partially mediated the association between maternal shyness and adolescent social anxiety.

CONCLUSIONS

This study identifies a unique developmental pathway from maternal shyness to adolescent social anxiety. Findings suggest that childhood social wariness connects maternal shyness to adolescent social anxiety.

Longitudinal Links among Mother and Child Emotion Regulation, Maternal Emotion Socialization, and Child Anxiety

Models of transdiagnostic family emotion processes recognize parents' emotion-related characteristics and behaviors as key contributors to child emotional development and psychological functioning. One such psychological outcome, child anxiety, is prevalent and early emerging, underscoring the importance of identifying early family- and emotion-related mechanisms involved in anxiety risk. We investigated the extent to which mother and child emotion-related traits and behaviors related to child anxiety in a community sample of 175 mother-child dyads. Using three time-points (child ages 2-4 years, assessments 1 year apart), we examined how mothers' emotion dysregulation predicted their emotion socialization practices (either supportive or non-supportive) and children's emotion regulation (ER; either attention- or caregiver-focused) over time, in relation to later child anxiety. Models controlled for child inhibited temperament and also tested the role of maternal anxiety in these trajectories. Mothers reported on their emotion dysregulation, emotion socialization, and their own and their child's anxiety, whereas child ER and inhibited temperament were measured using laboratory observation. In supportive emotion socialization models, maternal emotion dysregulation predicted child anxiety 2 years later. An indirect effect emerged, such that greater maternal emotion dysregulation predicted greater non-supportive emotion socialization, which in turn related to children's greater caregiver-focused ER. Maternal emotion dysregulation, maternal anxiety, and child inhibited temperament each predicted child anxiety above and beyond other variables, although their shared variance likely accounted for some of the results. Findings lend partial support to current theoretical models of transdiagnostic family emotion processes and child anxiety development, suggesting promising avenues of future research.

Anxiety Sensitivity Moderates the Association Between Father-Child Relationship Security and Fear Transmission

Observational fear learning can contribute to the development of fear-related psychopathologies, such as anxiety disorders and post-traumatic stress disorder. Observational fear learning is especially relevant during childhood. Parent-child attachment and anxiety sensitivity modulate fear reactions and fear learning but their impact on observational fear learning has not been investigated. This study investigated how these factors contribute to observational fear learning in children. We examined this question among 55 healthy parent-child dyads. Children (8–12 years old) watched a video of their parent undergoing a direct fear conditioning protocol, where one stimulus (CS+Parent) was paired with a shock and one was not (CS−), and a video of a stranger for whom a different stimulus was reinforced (CS+Stranger). Subsequently, all stimuli were presented to children (without shocks) while skin conductance responses were recorded to evaluate fear levels. Our results showed that children more sensitive to anxiety and who had lower father-child relationship security levels exhibited higher skin conductance responses to the CS+Parent. Our data suggest that the father-child relationship security influences vicarious fear transmission in children who are more sensitive to anxiety. This highlights the importance of the father-child relationship security as a potential modulator of children’s vulnerability to fear-related psychopathologies.

Principles for Guiding the Selection of Early Childhood Neurodevelopmental Risk and Resilience Measures: HEALthy Brain and Child Development Study as an Exemplar

The vast individual differences in the developmental origins of risk and resilience pathways combined with sophisticated capabilities of big data science increasingly point to the imperative of large, neurodevelopmental consortia to capture population heterogeneity and key variations in developmental trajectories. At the same time, such large-scale population-based designs involving multiple independent sites also must weigh competing demands. For example, the need for efficient, scalable assessment strategies must be balanced with the need for nuanced, developmentally sensitive phenotyping optimized for linkage to neural mechanisms and specification of common and distinct exposure pathways. Standardized epidemiologic batteries designed for this purpose such as PhenX (consensus measures for Phenotypes and eXposures) and the National Institutes of Health (NIH) Toolbox provide excellent "off the shelf" assessment tools that are well-validated and enable cross-study comparability. However, these standardized toolkits can also constrain ability to leverage advances in neurodevelopmental measurement over time, at times disproportionately advantaging established measures. In addition, individual consortia often expend exhaustive effort "reinventing the wheel," which is inefficient and fails to fully maximize potential synergies with other like initiatives. To address these issues, this paper lays forth an early childhood neurodevelopmental assessment strategy, guided by a set of principles synthesizing developmental and pragmatic considerations generated by the Neurodevelopmental Workgroup of the HEALthy Brain and Child Development (HBCD) Planning Consortium. These principles emphasize characterization of both risk- and resilience-promoting processes. Specific measurement recommendations to HBCD are provided to illustrate application. However, principles are intended as a guiding framework to transcend any particular initiative as a broad neurodevelopmentally informed, early childhood assessment strategy for large-scale consortia science.

Cognitive-behavioural interventions for prevention and treatment of anxiety in young children: A systematic review and meta-analysis

BACKGROUND

Anxiety disorders are common and impairing throughout the life course. Propensity to anxiety disorders manifests as distress and avoidance of novel stimuli (called behavioural inhibition) as early as in infancy. Already in preschool children, anxiety disorders impact emotional development and school readiness. Anxiety disorders and behavioural inhibition are prospectively associated with increased risk of mood disorders, substance use, and suicide. Therefore, early targeted prevention and treatment need to be considered. Cognitive-behavioural interventions are effective for anxiety in older age group but their efficacy for preschool children remains to be established.

METHODS

We searched PsycINFO, PubMed, and Embase until September 19th, 2019 using terms describing anxiety, behavioural inhibition, intervention, and young children. We included studies with young children participating in a cognitive-behavioural intervention for anxiety disorders, anxiety symptoms, or behavioural inhibition. We completed random-effects robust meta-analyses to (1) compare anxiety measures before and after intervention and to (2) compare intervention and control groups.

RESULTS

We identified 43 samples including 2656 participants with a mean age of 5.45 (SD = 1.00) years. Anxiety decreased after cognitive-behavioural intervention (standardized mean difference [SMD] = -1.34, 95%CI -1.59 to -1.09, p < 0.0001). Anxiety decreased more in children who received intervention than in children in control conditions (SMD = -0.81, 95%CI -1.00 to -0.63, p < 0.0001). The difference remained significant after correcting for potential publication bias and outliers (SMD = -0.89, 95% CI -1.13 to -0.66, p < 0.0001). The improvement was maintained over follow-up.

CONCLUSIONS

Cognitive-behavioural interventions are effective for prevention and treatment of anxiety in young children.

Parental Monitoring and Adolescent Problematic Mobile Phone Use: The Mediating Role of Escape Motivation and the Moderating Role of Shyness

In an attempt to reduce the negative consequences of adolescent media use, parents often monitor their children's online activities. However, research suggests that parental monitoring often does not reduce children's problematic mobile phone use as expected. Based on the results of a survey of 584 Chinese adolescents, we found that parental monitoring positively predicted children's problematic mobile phone use (PMPU) within a Chinese cultural context. The results also showed that children's escape motivation partially mediated this relationship, while their level of shyness moderated both the mediated path and the direct impact of parental monitoring on children's PMPU. The findings suggested that a higher level of shyness increased the likelihood that parental monitoring would increase the child's escape motivation and PMPU. The study results provide guidelines for parents and educators regarding interventions for adolescents' problematic phone use.

Maternal comforting behavior, toddlers' dysregulated fear, and toddlers' emotion regulatory behaviors

Developmental theories of emotion regulation suggest that influences from both extrinsic (e.g., from caregivers) and intrinsic (i.e., temperament) sources contribute to children's displays of emotion regulatory behaviors. Very few studies have examined specific caregiver behaviors in relation to specific regulatory behaviors. Further, few empirical investigations have tested theoretical notions that temperament may be an important context in which to understand the nature of the relation between caregiver behavior and toddlers' regulatory behaviors. The current study examined the specific maternal behavior of physical comfort in relation to three regulatory strategies exhibited by toddlers (attention-shifting, caregiver-focused behavior, and self-focused behavior) in 117 pairs of mothers and their 24-month-old toddlers. Further, we tested the temperament dimension of dysregulated fear, a more recent derivation of behavioral inhibition, both in relation to regulatory efforts and as a moderator of relations between maternal comforting and toddler regulatory behaviors. Dysregulated fear related directly and positively to attention-shifting, and it moderated the relation between maternal comforting and both caregiver-focused and self-focused behaviors. This study provides new evidence of the importance of both extrinsic and intrinsic correlates of emotion regulation in early childhood. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Infant withdrawal and behavior problems in urban Chinese toddlers: Roles of maternal sensitivity to infant distress and emerging delay ability

Using a longitudinal design, this study examined the associations between infant temperamental withdrawal and behavior problems during toddlerhood and tested the moderating effects of maternal sensitivity to infant distress (MSID) and toddlers' ability to delay gratification (ADG) in urban Chinese families. Participants were 84 Chinese children (37 boys, 47 girls) and their mothers. When the infants were 6 months old (T1: infancy), their mothers reported their temperamental withdrawal, and research assistants observed and coded MSID by using a subscale of the Maternal Behavior Q-Sort during free-play interaction. When the toddlers were 1 year old (T2: early toddlerhood), their mothers reported their internalizing and externalizing problems. When the toddlers were 2 years old (T3: late toddlerhood), their mothers again reported their internalizing and externalizing problems, and their abilities of delay gratification were assessed through a laboratory-based procedure. Infant temperamental withdrawal was associated with increased internalizing problems in early toddlerhood and increased externalizing problems during middle to late toddlerhood; infants whose mothers were extremely high sensitive or low sensitive to their distress or those with late poor ability of delay gratification were at particular risk. The findings highlight the importance of matching parenting and promotion of self-control for temperamental withdrawn children's optimal development.

Stranger Fear and Early Risk for Social Anxiety in Preschoolers with Fragile X Syndrome Contrasted to Autism Spectrum Disorder

This study investigated behavioral indicators of social fear in preschool boys with fragile X syndrome (FXS) with a low degree of autism spectrum disorder (ASD) symptoms (FXS-Low; n = 29), FXS with elevated ASD symptoms (FXS-High; n = 25), idiopathic ASD (iASD; n = 11), and typical development (TD; n = 36). Gaze avoidance, escape behaviors, and facial fear during a stranger approach were coded. Boys with elevated ASD symptoms displayed more avoidant gaze, looking less at the stranger and parent than those with low ASD symptoms across etiologies. The iASD group displayed more facial fear than the other groups. Results suggest etiologically distinct behavioral patterns of social fear in preschoolers with elevated ASD symptoms.

The Family Life Impairment Scale: Factor Structure and Clinical Utility with Young Children

Although it is well-established that young children experience significant psychopathology, diagnostic decisions continue to be challenging, in part due to the way impairment is understood, defined, and measured. Most existing clinical tools assess impairment in an individualized manner, whereas for many young children, impairment is more accurately conceptualized as a family-oriented, multidimensional construct, impacting various parental and family activities. Two studies were completed using the Family Life Impairment Scale (FLIS), a multidimensional parent-report measure of family and associated impairment designed for young children. In Study 1, factor analysis was used in a large (n = 945) representative sample (23-48 months of age). FLIS associations with measures of parent and child well-being were explored to investigate convergent validity. Study 2 was completed in a sample (n = 174) of young children (18-33 months of age) diagnosed with autism spectrum disorders to explore factorial consistency in a clinical sample. Study 1 yielded evidence of a four-factor solution, including parent impairment (affecting parental well-being), family impairment (affecting family activities and routines), childcare impairment (affecting challenges with childcare), and positive growth (parental learning and growth associated with the child's problem). Evidence of convergent validity was also found, as factors were differentially associated with established measures of child symptoms and parent stress. Factor structure was supported in the clinical sample. Results support both the factorial structure and clinical utility of the FLIS for use across clinical and nonclinical populations of young children.

Psychometric properties of the Child Anxiety Life Interference Scale - Preschool Version

Despite growing recognition of childhood anxiety as a common and often debilitating clinical concern, we have limited knowledge of the particular ways in which anxiety interferes with daily life for young children who have not yet entered formal schooling. The present study evaluated the psychometric properties of the Child Anxiety Life Interference Scale - Preschool Version (CALIS-PV). The CALIS-PV is a brief (18 item) parent-report measure of the impacts of a young child's anxiety on their own life and that of her or his parent. Participants were 784 parents of a child aged 3-7 years, who completed the CALIS-PV as a part of the follow-up assessment battery for two anxiety prevention trials targeted at preschool children with temperamental inhibition. Confirmatory factor analysis supported three CALIS-PV factors reflecting anxiety-related life interference at home, outside home and on parent life. The three factors showed good internal consistency and good convergent and divergent validity, and successfully differentiated children with and without an anxiety diagnosis. Findings provide initial support for the CALIS-PV as a reliable and valid measure of the daily life impacts of childhood anxiety for preschool-aged children and their parents.

Impaired cardiac profile in adolescents with an increasing trajectory of anxiety when confronting an acute stressor

Maladaptive patterns of cardiac adjustment to stress in adolescents may reveal their vulnerability to anxiety disorders (ADs). Traditional research in this field has focused on anxiety levels, whereas the time course of anxiety has rarely been considered. Nevertheless, since overall anxiety decreases as adolescence progresses, increasing time courses are clinically relevant and can be associated with maladaptive contextual adjustment. In this study, the cardiac pattern of adjustment to stress in adolescents with increasing anxiety was analysed. A sample of 44 adolescents (M = 14.88 years, SD = 0.53, 45.45% boys) were exposed to a socially relevant stress induction protocol, and their cardiac functioning was recorded. Participants with a trajectory of increasing anxious symptomatology over a 12-month period (n = 24) showed attenuated heart rate levels in the stage of maximum stress in comparison to their non-increasing anxious counterparts (p < 0.05), as well as a heightened pattern of sample entropy throughout the stress induction (p < 0.05). These findings suggest a loss of cardiac flexibility in those adolescents at risk of ADs when confronting an acute stressor.

Shyness and Social Anxiety Assessed Through Self-Report: What Are We Measuring?

The distinction between shyness and social anxiety remains unclear in the literature. In an attempt to shed further light on this issue, our research evaluated whether shyness and social anxiety were the same construct underlying various measurement scales. Participants (N = 801, M_age = 36.21, range = 18-74, female = 53.10%) responded to 10 questionnaires assessing either shyness or social anxiety. Evidence indicated that the scales were highly correlated and loaded onto 1 factor. Confirmatory factor analysis corroborated this finding. A second exploratory factor analysis revealed that all the shyness and social anxiety items best loaded together onto 3 factors: one corresponding to fear of negative evaluation, embarrassment, self-consciousness, scrutiny, authority, interaction anxiety, and shyness (71.0%); a second comprised of primarily interaction anxiety and shyness (17.7%); and a third associated with performance anxiety (7.5%). All scales were similarly discriminated from sociability. Overall, the constructs of shyness and social anxiety were not differentiated from each other. Researchers should carefully consider what items are included in shyness and social anxiety scales if these constructs are to be distinguished from one another.

Profiles of Temperament among Youth with Specific Phobias: Implications for CBT Outcomes

Specific phobias (SPs) are characterized by excessive fear or anxiety regarding an object or situation. SPs often result in a host of negative outcomes in childhood and beyond. Children with SPs are broadly assumed to show dispositional over-regulation and fearfulness relative to children without SPs, but there are few attempts to distinguish dispositional patterns among children with SPs. In the present study, we examined trajectories of differing temperamental profiles for youth receiving a CBT-based treatment for their SP. Participants were 117 treatment seeking youth (M Age = 8.77 years, Age Range = 6-15 years; 54.7% girls) who met criteria for a SP and their mothers. Three temperament profiles emerged and were conceptually similar to previously supported profiles: well-adjusted; inhibited; and under-controlled. While all groups showed similarly robust reductions in SP severity following treatment, differences among the three groups emerged in terms of broader internalizing symptoms, externalizing symptoms, and global outlook. The well-adjusted group was higher in functioning initially than the other two groups. The inhibited group had initial disadvantages in initial internalizing symptoms. The under-controlled group showed greatest comorbidity risks and had initial disadvantages in both internalizing and externalizing symptoms. These distinct clusters represent considerable heterogeneity within a clinical sample of youth with SP who are often assumed to have homogenous behavior tendencies of inhibition and fearfulness. Findings suggest that considering patterns of temperament among children with phobias could assist treatment planning and inform ongoing refinements to improve treatment response.

Maternal anxiety predicts attentional bias towards threat in infancy

Although cognitive theories of psychopathology suggest that attention bias toward threat plays a role in the etiology and maintenance of anxiety, there is relatively little evidence regarding individual differences in the earliest development of attention bias toward threat. The current study examines attention bias toward threat during its potential first emergence by evaluating the relations between attention bias and known risk factors of anxiety (i.e., temperamental negative affect and maternal anxiety). We measured attention bias to emotional faces in infants (N = 98; 57 male) ages 4 to 24 months during an attention disengagement eye-tracking paradigm. We hypothesized that (a) there would be an attentional bias toward threat in the full sample of infants, replicating previous studies; (b) attentional bias toward threat would be positively related to maternal anxiety; and (c) attention bias toward threat would be positively related to temperamental negative affect. Finally, (d) we explored the potential interaction between temperament and maternal anxiety in predicting attention bias toward threat. We found that attention bias to the affective faces did not change with age, and that bias was not related to temperament. However, attention bias to threat, but not attention bias to happy faces, was positively related to maternal anxiety, such that higher maternal anxiety predicted a larger attention bias for all infants. These findings provide support for attention bias as a putative early mechanism by which early markers of risk are associated with socioemotional development. (PsycINFO Database Record

Allostatic load and comorbidities: A mitochondrial, epigenetic, and evolutionary perspective

Stress-related pathophysiology drives comorbid trajectories that elude precise prediction. Allostatic load algorithms that quantify biological "wear and tear" represent a comprehensive approach to detect multisystemic disease processes of the mind and body. However, the multiple morbidities directly or indirectly related to stress physiology remain enigmatic. Our aim in this article is to propose that biological comorbidities represent discrete pathophysiological processes captured by measuring allostatic load. This has applications in research and clinical settings to predict physical and psychiatric comorbidities alike. The reader will be introduced to the concepts of allostasis, allostasic states, allostatic load, and allostatic overload as they relate to stress-related diseases and the proposed prediction of biological comorbidities that extend rather to understanding psychopathologies. In our transdisciplinary discussion, we will integrate perspectives related to (a) mitochondrial biology as a key player in the allostatic load time course toward diseases that "get under the skin and skull"; (b) epigenetics related to child maltreatment and biological embedding that shapes stress perception throughout lifespan development; and

The Attitudes About Parenting Strategies for Anxiety Scale: A Measure of Parenting Attitudes About Protective and Intrusive Behavior

Protective and intrusive parenting behaviors consistently relate to children's anxiety development. We present two studies describing the development of the Attitudes about Parenting Strategies for Anxiety (APSA) scale, which assesses parent distress about children's displays of anxiety and shyness as well as parent attitudes about the effectiveness of protective and intrusive responses across several domains. Study 1 included 594 parents who completed the APSA and additional measures online and established the factor structure, internal reliability, and validity of the measure. We also performed a latent profile analysis of the attitude items to understand common patterns and their correlates. Study 2 comprised 108 mothers participating in a laboratory-based study and provided additional evidence for the factor structure, reliability, and validity, as well as 1-year stability. The APSA appears to be a reliable and valid measure that could have utility for understanding the determinants of parenting behaviors relevant to child anxiety development.

Temperament Distinguishes Persistent/Recurrent from Remitting Anxiety Disorders Across Early Childhood

Up to 20% of preschool-age children meet criteria for anxiety disorders and, for a large subset, anxiety appears to persist throughout early childhood. However, little is known about which factors predict persistence/recurrence of anxiety in young children. Temperament, including behavioral inhibition (BI), negative emotionality (NE), and positive emotionality (PE), predict the onset of anxiety disorders, but to our knowledge no study has examined whether temperament predicts the course of anxiety in young children. From a community sample of 3-year-olds, we identified 89 children (79.8% White, non-Hispanic; 41.6% female) who met criteria for an anxiety disorder and examined whether observed and parent-reported BI, NE, and PE at age 3 distinguished children who continued to meet criteria for an anxiety disorder from those who remitted by age 6. Higher levels of BI and lower levels of PE assessed in the laboratory and higher parent-reported BI and shyness and lower surgency at age 3 significantly predicted persistence/recurrence of anxiety disorders from age 3 to 6. These data are the first to demonstrate the influence of temperament on the course of anxiety disorders in young children. These findings can enhance assessment and treatment of anxiety by focusing intervention efforts on children who are at risk for persistent or recurring anxiety rather than children who are displaying transient, and possibly developmentally normative, anxiety.

Longitudinal associations between social anxiety symptoms and cannabis use throughout adolescence: the role of peer involvement

There appear to be contradicting theories and empirical findings on the association between adolescent Social Anxiety Disorder (SAD) symptoms and cannabis use, suggesting potential risk as well as protective pathways. The aim of this six-year longitudinal study was to further examine associations between SAD symptoms and cannabis use over time in adolescents from the general population, specifically focusing on the potential role that adolescents' involvement with their peers may have in these associations. Participants were 497 Dutch adolescents (57 % boys; M age = 13.03 at T1), who completed annual self-report questionnaires for 6 successive years. Cross-lagged panel analysis suggested that adolescent SAD symptoms were associated with less peer involvement 1 year later. Less adolescent peer involvement was in turn associated with lower probabilities of cannabis use as well as lower frequency of cannabis use 1 year later. Most importantly, results suggested significant longitudinal indirect paths from adolescent SAD symptoms to cannabis use via adolescents' peer involvement. Overall, these results provide support for a protective function of SAD symptoms in association with cannabis use in adolescents from the general population. This association is partially explained by less peer involvement (suggesting increased social isolation) for those adolescents with higher levels of SAD symptoms. Future research should aim to gain more insight into the exact nature of the relationship between anxiety and cannabis use in adolescents from the general population, especially regarding potential risk and protective processes that may explain this relationship.

The epidemiology of observed temperament: Factor structure and demographic group differences

This study investigated the factor structure of observational indicators of children's temperament that were collected across the first three years of life in the Family Life Project (N=1205) sample. A four-factor model (activity level, fear, anger, regulation), which corresponded broadly to Rothbart's distinction between reactivity and regulation, provided an acceptable fit the observed data. Tests of measurement invariance demonstrated that a majority of the observational indicators exhibited comparable measurement properties for male vs. female, black vs. white, and poor vs. not-poor children, which improved the generalizability of these results. Unadjusted demographic group comparisons revealed small to moderate sized differences (Cohen ds=|.23-.42|) in temperamental reactivity and moderate to large sized differences (Cohen ds=-.64--.97) in regulation. Collectively, demographic variables explained more of the variation in regulation (R(2)=.25) than in reactivity (R(2)=.02-.06). Follow-up analyses demonstrated that race differences were substantially diminished in magnitude and better accounted for by poverty. These results help to validate the distinction between temperamental reactivity and regulation using observational indicators.

Longitudinal associations between temperament and socioemotional outcomes in young children: the moderating role of RSA and gender

Temperament is an important predictor of socioemotional adjustment, such as externalizing and internalizing symptoms. However, there is not a one-to-one correspondence between temperamental predispositions and these outcomes, implying that other factors also contribute to the development of internalizing and externalizing problems. Self-regulation is believed to interact with temperament, and has been studied as a predictor for later socioemotional outcomes. Respiratory sinus arrhythmia (RSA) is a psychophysiological measure of self-regulation that has been studied as a moderator of risk. The primary aim of the present study was to test if RSA baseline and RSA reactivity would moderate the link between temperament and socioemotional outcomes. Mothers reported the temperament of their infants (20 months; N = 154), RSA was collected at 24- and 42-months, and mothers reported externalizing and internalizing behaviors at kindergarten entry. RSA baseline and RSA reactivity moderated the relation between exuberant temperament and externalizing behaviors. However, these results were only significant for girls, such that high RSA baseline and greater RSA suppression predicted more externalizing behaviors when exuberance was high. Fearful temperament predicted later internalizing behaviors, but no moderation was present. These results are discussed in light of recent evidence regarding gender differences in the role of RSA as a protective factor for risk.

Temperament as a moderator of the effects of parenting on children's behavior

This study examined the role of child temperament as moderator of the effect of parenting style on children's externalizing and internalizing behaviors. A series of structural equation models were fit to a representative sample of 2,631 Canadian children from the National Longitudinal Survey of Children and Youth. In addition to testing for the presence of Temperament × Parenting interactions, these models also examined the direct and indirect effects of a number of additional contextual factors such as neighborhood problems, neighborhood cohesion, social support, and maternal depression. The results indicate that exposure to more positive parenting reduces behavior problems in children with difficult/unadaptable temperaments. No moderating effects of temperament on hostile parenting were found. Such results serve to highlight the pivotal role of positive features of the rearing environment as catalysts for the successful adaptation of children with difficult/unadaptable temperaments. The results of this modeling work also serve to emphasize the importance of considering the ways in which more distal factors can affect children's behavioral adaptation by contributing to changes in proximal family processes.

Temperament, peer victimization, and nurturing parenting in child anxiety: a moderated mediation model

Research has linked fearful temperament and childhood anxiety. Yet there remain numerous factors that moderate and mediate this relation. Two specific factors, identified in separate lines of research, are peer victimization and parenting. The current study tested a moderated mediational model to investigate the respective effects of peer victimization and nurturing parenting on the relation between fearful temperament and child anxiety. Participants were 124 parent-child dyads recruited from the community. Children were between the ages of 7 and 12 (56.5% male, 93.5% Caucasian) and most parents were mothers. Overall the data fit the model well. Analyses indicated that peer victimization was a mediator of the temperament to child anxiety relation, while nurturing parenting moderated this mediated effect. Nurturing parenting did not mediate the temperament to child anxiety relation directly. The findings suggest that nurturing parenting may be a specific, rather than global, protective factor for peer victimization in child anxiety.

A prospective longitudinal study of shyness from infancy to adolescence: stability, age-related changes, and prediction of socio-emotional functioning

This longitudinal, population-based and prospective study investigated the stability, age-related changes, and socio-emotional outcomes of shyness from infancy to early adolescence. A sample of 921 children was followed from ages 1.5 to 12.5 years. Parent-reported shyness was assessed at five time points and maternal- and self-reported social skills and symptoms of anxiety and depression were assessed at age 12.5 years. Piecewise latent growth curve analysis was applied, with outcomes regressed on latent shyness intercept and slope factors. Results showed moderate stability and increasing levels of shyness across time, with more variance and a steeper increase in early as compared to mid-to-late childhood. Both stable shyness and increased shyness in mid-to-late (but not early) childhood predicted poorer social skills and higher levels of anxiety and depression symptoms in early adolescence. The implications of the evidence for two developmental periods in shyness trajectories with differential impact on later socio-emotional functioning are discussed.

Temperament and family environment in the development of anxiety disorder: two-year follow-up

OBJECTIVE

Behavioral inhibition (BI) in early childhood is associated with increased risk for anxiety. The present research examines BI alongside family environment factors, specifically maternal negativity and overinvolvement, maternal anxiety, and mother-child attachment, with a view to providing a broader understanding of the development of child anxiety.

METHOD

Participants were 202 children classified at age 4 years as either behaviorally inhibited (N = 102) or behaviorally uninhibited (N = 100). Family environment, BI and child anxiety were assessed at baseline and child anxiety and BI were assessed again 2 years later when participants were 6 years of age.

RESULTS

After controlling for baseline anxiety, BI participants were significantly more likely to meet criteria for a diagnosis of social phobia and generalized anxiety disorder at follow-up. Path analysis suggested that maternal anxiety significantly affected child anxiety over time, even after controlling for the effects of BI and baseline anxiety. No significant paths from parenting or attachment to child anxiety were found. Maternal overinvolvement was significantly associated with BI at follow-up.

CONCLUSIONS

At age 4 years, BI, child anxiety, maternal anxiety, and maternal overinvolvement represent risk factors for anxiety at age 6 years. Furthermore, overinvolved parenting increases risk for BI at age 6, which may then lead to the development of anxiety in later childhood.

Reactive and self-regulatory dimensions of temperament: Interactive relations with symptoms of general distress and anhedonia

Converging evidence indicates that shared temperamental diatheses partly underlie the covariance between anxiety and depression. Although developmental psychopathology research suggests that self-regulatory temperament (e.g., effortful control or EC) mitigates reactive risks associated with negative affectivity (NA) and positive affectivity (PA), and their respective counterparts, behavioral inhibition- and activation sensitivity (BIS and BAS), no studies have established EC's protective effects in adulthood. This study examined concurrent relations between temperament and distress symptoms shared by anxiety and depression, and anhedonic symptoms unique to depression, in young adults. Anticipated two- and three-way interactions emerged supporting EC's moderating effect between reactive temperament (i.e., high BIS and low BAS) and both symptom dimensions. However, no interactive relations emerged between symptoms and NA, PA, and EC.