The stability of inhibited/uninhibited temperament from ages 3 to 11 years in Mauritian children

Social versus non-social behavioral inhibition: Differential prediction from early childhood of long-term psychosocial outcomes

Behavioral inhibition (BI) is a temperamental style characterized by cautious and fearful behaviors in novel situations. The present multi-method, longitudinal study examined whether young children's observed and parent-reported BI in social versus non-social contexts predicts different long-term psychosocial outcomes. Participants (N = 279) were drawn from a longitudinal study of socioemotional development. BI in social contexts ("social BI") was measured via children's observed wariness toward unfamiliar adults and peers at 24 and 36 months and parents' reports of children's social fear/shyness at 24, 36, and 48 months. BI in non-social contexts ("non-social BI") was measured via children's observed fearful responses to masks and novel toys, and parents' reports of children's distress to non-social novelty at 9 months and non-social fear at 48 months. At 15 years, anxiety was assessed via adolescent- and parent-reports, and global internalizing and externalizing problems were assessed via parent-reports. Confirmatory factor analysis showed that a two-factor model fit the BI data significantly better than a single-factor model, providing evidence for the dissociation of BI in social versus non-social contexts. Social BI was uniquely associated with adolescent social anxiety, whereas non-social BI was specifically associated with adolescent separation anxiety. Neither social BI nor non-social BI predicted global internalizing and externalizing problems, providing evidence for the specific relations between BI and anxiety problems. Together, these results suggest that young children's inhibited responses in social versus non-social situations predict different subtypes of anxiety problems in adolescence, highlighting the multifaceted nature of BI and the divergent trajectories of different anxiety problems.

Relationship of behavioral inhibition to separation anxiety in a sample (N = 377) of adult individuals with mood and anxiety disorders

BACKGROUND

Behavioral Inhibition (BI) is an early temperamental trait characterized by shyness, withdrawal, avoidance, uneasiness, and fear of unfamiliar situations, people, objects, and events. The DSM-5 refers to behavioral inhibition as a temperamental factor related to neurodevelopmental conditions in childhood, including attention deficit hyperactivity disorder, selective mutism, and specific phobias; and to its influence on adult anxiety disorders including social anxiety disorder, agoraphobia, and generalized anxiety disorder, but, interestingly, not separation anxiety disorder (SAD). However, there are phenomenological overlaps between BI and SAD. We aimed to explore whether there is a correlation between BI as an early temperamental trait and childhood or adult separation anxiety disorder.

METHODS

The study was conducted in 377 consecutive adults (mean age 40.2±12.4 years) outpatients with anxiety and mood disorders as the principal diagnosis, grouped on the presence/absence of a DSM-5 diagnosis of childhood or adult separation anxiety disorder. Separation anxiety was assessed by the Structured Clinical Interview for Separation Anxiety (SCI-SAS) and the Adult Separation Anxiety Checklist (ASA27). Behavioral inhibition was assessed by the Retrospective Self-Report of Inhibition (RSRI).

RESULTS

The four comparison groups included: 1) 168 patients without childhood or adult SAD, 2) 81 with adult SAD, 3) 97 with both adult SAD and childhood SAD, and 4) 31 with childhood SAD only. The group with both adult and childhood SAD had the highest scores on RSRI total and sub-scale scores. Both groups with adult SAD had significantly higher RSRI scores than the group with only childhood SAD or without SAD. Significant bivariate correlations were found between ASA-27 scores and RSRI scores. Correlations between RSRI scores and measures of anxiety and depressive symptoms were significantly weaker than those on the ASA-27. Regression analyses showed a significant predictive value of RSRI scores on ASA-27 total score, but not of age of onset of SAD.

CONCLUSIONS

BI has an onset in the very first years of life and may represent a potential developmental endophenotype for later anxiety disorders. Our findings indicate that BI and separation anxiety are connected in individuals with affective and anxiety disorders. This may have important clinical and therapeutic implications for preventive interventions.

[Personality Models in the Context of Child and Adolescent Psychiatry - Development, Change, Stability and Research Perspectives]

Personality models play an important role for the etiological understanding of abnormal development in clinical settings. In this selective review, relevant personality models are presented and, in particular, their developmental dynamics and adaptability over the life span, starting in childhood, are considered in detail. The focus is on the developmental psychopathological perspective of processes of ego-resiliency and self-regulation between the poles of disposition and social environment. This is particularly obvious in the discussion of developmental path models of personality dysfunction with experiences of abuse or disorganized attachment in the child's history. Psychopathologically, an ongoing impairment of self-regulation often results in stable patterns of maladaptation, which leads in the case of purely symptomatic treatment usually only to temporary behavioral modifications. On the other hand, the changeability of pathological personality traits through the use of targeted intervention approaches will favour of a positive outcome and contradicts a deterministic stability of personality characteristics. For future research perspectives in developmental psychopathology, various theoretical personality constructs are discussed and linked to clinical observations.

The unique contribution of blushing to the development of social anxiety disorder symptoms: results from a longitudinal study

BACKGROUND

Self-conscious emotional reactivity and its physiological marker - blushing has been proposed to be an etiological mechanism of social anxiety disorder (SAD), but so far, untested in longitudinal designs. This study tested, for the first time, whether self-conscious emotional reactivity (indexed as physiological blushing) contributes to the development of SAD symptoms over and above social behavioral inhibition (BI), which has been identified as the strongest predictor of SAD development in early childhood.

METHODS

One hundred fifteen children (45% boys) and their mothers and fathers participated at ages 2.5, 4.5, and 7.5 years. Social BI was observed at all time points in a stranger approach task, and physiological blushing (blood volume, blood pulse amplitude, and temperature increases) was measured during a public performance (singing) and watching back the performance at ages 4.5 and 7.5. Child early social anxiety was reported by both parents at 4.5 years, and SAD symptoms were diagnosed by clinicians and reported by both parents at 7.5 years.

RESULTS

Higher social BI at 2.5 and 4.5 years predicted greater social anxiety at 4.5 years, which, in turn, predicted SAD symptoms at 7.5 years. Blushing (temperature increase) at 4.5 years predicted SAD symptoms at 7.5 years over and above the influence of social BI and early social anxiety.

CONCLUSIONS

That blushing uniquely contributes to the development of SAD symptoms over and above social BI suggests two pathways to childhood SAD: one that entails early high social BI and an early onset of social anxiety symptoms, and the other that consists of heightened self-conscious emotional reactivity (i.e. blushing) in early childhood.

Extending the neurocircuitry of behavioural inhibition: a role for the bed nucleus of the stria terminalis in risk for anxiety disorders

Behavioural inhibition is a biologically based risk factor for anxiety disorders. Children with behavioural inhibition are shy, cautious and avoidant of new situations. Much research on behavioural inhibition has focused on the amygdala as an underlying neural substrate and has identified differences in amygdala function and volume; however, amygdala findings have yet to lead to meaningful interventions for prevention or treatment of anxiety disorders. The bed nucleus of the stria terminalis (BNST) is a prime candidate to be a neural substrate of behavioural inhibition, given current evidence of BNST function and development in human research and animal models. Children with behavioural inhibition have an increased startle response to safety cues and an increased cortisol response to social evaluative situations, both of which are mediated by the BNST. In rodents, activation of the BNST underlies contextual fear responses and responses to uncertain and sustained threat. Non-human primates with anxious temperament (the macaque equivalent of behavioural inhibition) have increased BNST activity to ambiguous social situations, and activity of the BNST in anxious temperament is significantly heritable. Importantly, the BNST is sexually dimorphic and continues to develop into adulthood, paralleling the development of anxiety disorders in humans. Together, these findings suggest that further investigation of the BNST in behavioural inhibition is necessary and may lead to new avenues for the prevention and treatment of anxiety disorders.

The BDNF gene val66met polymorphism and behavioral inhibition in early childhood

Stably elevated behavioural inhibition (BI) is an established risk factor for internalizing disorders. This stability may be related to genetic factors, including a valine-to-methionine substitution on codon 66 (val66met) of the brain-derived neurotrophic factor (BDNF) gene. Past work on the BDNF met variant has inconsistently linked it to vulnerability to internalizing problems; some of this inconsistency may stem from the failure to consider gene-trait interactions in shaping the course of early BI. Toward elucidating early pathways to anxiety vulnerability, we examined gene-by-trait interactions in predicting the course of BI over time in 476 children, assessed for BI using standardized laboratory methods. We found that children with the met allele showed lower stability of BI between ages 3 and 6 than those without this allele. While the mechanisms that underlie this effect are unclear, our findings are consistent with the notion that the met variant, in the context of early BI, influences the stability of this trait in early development.

The serotonin transporter promoter polymorphism moderates the continuity of behavioral inhibition in early childhood

Persistently elevated behavioral inhibition (BI) in children is a marker of vulnerability to psychopathology. However, little research has considered the joint influences of caregiver and child factors that may moderate the continuity of BI in early childhood, particularly genetic variants that may serve as markers of biological plasticity, such as the serotonin transporter linked polymorphic region (5-HTTLPR). We explored this issue in 371 preschoolers and their caregivers, examining whether parent characteristics (i.e., overinvolvement or anxiety disorder) and child 5-HTTLPR influenced the continuity of BI between ages 3 and 5. Measures were observational ratings of child BI, observational and questionnaire measures of parenting, and parent interviews for anxiety disorder history, and children were genotyped for the 5-HTTLPR. Parent factors did not moderate the association between age 3 and age 5 BI; however, child BI at age 3 interacted with children's 5-HTTLPR variants to predict age 5 BI, such that children with at least one copy of the short allele exhibited less continuity of BI over time relative to children without this putative plasticity variant. Findings are consistent with previous work indicating the 5-HTTLPR short variant increases plasticity to contextual influences, thereby serving to decrease the continuity of BI in early childhood.

A Longitudinal Investigation of Predictors of the Association Between Age 3 and Age 6 Behavioural Inhibition

Children who exhibit elevated levels of the temperament trait behavioural inhibition (BI) across time may be at greatest risk for anxiety. However, little research has investigated the influence of other temperamental traits, particularly positive emotionality (PE), on the continuity of BI in childhood, nor whether parental overprotection influences associations between early and later child BI. To explore whether PE and overprotection shape associations between early and later BI, this longitudinal study of three-year-olds (N = 446) followed up at age 6 included tasks tapping child temperament, and parental overprotection was assessed via interview ratings and parent-report. Lower levels of child PE and higher levels of caregiver overprotection at baseline predicted stronger associations between laboratory-assessed BI at ages 3 and 6. Findings elucidate influences shaping the developmental continuity of BI.

The nature of individual differences in inhibited temperament and risk for psychiatric disease: A review and meta-analysis

What makes us different from one another? Why does one person jump out of airplanes for fun while another prefers to stay home and read? Why are some babies born with a predisposition to become anxious? Questions about individual differences in temperament have engaged the minds of scientists, psychologists, and philosophers for centuries. Recent technological advances in neuroimaging and genetics provide an unprecedented opportunity to answer these questions. Here we review the literature on the neurobiology of one of the most basic individual differences-the tendency to approach or avoid novelty. This trait, called inhibited temperament, is innate, heritable, and observed across species. Importantly, inhibited temperament also confers risk for psychiatric disease. Here, we provide a comprehensive review of inhibited temperament, including neuroimaging and genetic studies in human and non-human primates. We conducted a meta-analysis of neuroimaging findings in inhibited humans that points to alterations in a fronto-limbic-basal ganglia circuit; these findings provide the basis of a model of inhibited temperament neurocircuitry. Lesion and neuroimaging studies in non-human primate models of inhibited temperament highlight roles for the amygdala, hippocampus, orbitofrontal cortex, and dorsal prefrontal cortex. Genetic studies highlight a role for genes that regulate neurotransmitter function, such as the serotonin transporter polymorphisms (5-HTTLPR), as well as genes that regulate stress response, such as corticotropin-releasing hormone (CRH). Together these studies provide a foundation of knowledge about the genetic and neural substrates of this most basic of temperament traits. Future studies using novel imaging methods and genetic approaches promise to expand upon these biological bases of inhibited temperament and inform our understanding of risk for psychiatric disease.

Longitudinal investigation of the role of temperament and stressful life events in childhood anxiety

The current study investigated the longitudinal relationships among behavioral inhibition (BI), life events, and anxiety in a sample of 102 BI children and 100 behaviorally uninhibited (BUI) children aged 3 to 4 years. Children's parents completed questionnaires on BI, stressful life events, and anxiety symptoms, and were administered a diagnostic interview three times in a 5-year period. In line with our hypotheses, negative life events, particularly negative behavior-dependent life events (i.e., life events that are related to the children's own behaviors), and the impact of negative life events were predictive of increases in subsequent anxiety symptoms, the likelihood of having an anxiety disorder, and increased number of anxiety diagnoses over the 5-year follow-up period. Experiencing more positive, behavior-independent life events decreased the risk of being diagnosed with an anxiety disorder. Furthermore, differences were found in life events between BI and BUI children. That is, BI children experienced fewer positive and specifically positive behavior-dependent life events, and the impact of these positive life events was also lower in BI children than in BUI children. However, BI did not interact with life events in the prediction of anxiety problems as hypothesized. Therefore, this study seems to indicate that BI and life events act as additive risk factors in the development of anxiety problems.

Psychometric properties of the Behavioral Inhibition Questionnaire in preschool children

We examined the psychometric properties of the Behavioral Inhibition Questionnaire (BIQ; Bishop, Spence, & McDonald, 2003), a rating scale for children's behavioral inhibition. Parent and teacher ratings, parent interviews, and laboratory observations were obtained for 495 preschoolers. Confirmatory factor analysis yielded 6 factors, each reflecting the BIQ's subscales, and all loading onto a second-order general dimension. Model fit was acceptable for parent ratings, but only marginal for teacher ratings. The convergent and discriminant validity of the BIQ was examined by using a multitrait-multimethod approach. Results indicate that the BIQ displays evidence of reliability and validity that can complement observational paradigms.

Social and non-social behavioral inhibition in preschool-age children: differential associations with parent-reports of temperament and anxiety

Behavioral inhibition (BI) has generally been treated as a unitary construct and assessed by combining ratings of fear, vigilance, and avoidance to both novel social and non-social stimuli. However, there is evidence suggesting that BI in social contexts is not correlated with BI in non-social contexts. The present study examined the distinction between social and non-social BI in a community sample of 559 preschool-age children using a laboratory assessment of child temperament, a diagnostic interview, and parent-completed questionnaires. Social and non-social BI were not significantly correlated and exhibited distinct patterns of associations with parent reports of temperament and anxiety symptoms. This study suggests that BI is heterogeneous, and that distinguishing between different forms of BI may help account for the variation in trajectories and outcomes exhibited by high BI children.

Preventing Adolescent Depression in Mauritius: A Universal School-Based Program

BACKGROUND

  This study evaluated the efficacy of a universal prevention program for adolescent depresssion implemented by school teachers in Mauritius.

METHOD

  160 adolescents were randomly assigned to the prevention program or wait-list.

RESULTS

  Decreased depressive symptoms for the intervention condition were found post-intervention, but not at follow-up. Significant changes in self-esteem and coping skills were seen both post-intervention and at the follow-up.

CONCLUSIONS

  The results, drawing from a culturally diverse population, suggest that universal programs such as RAP-A may be better seen as promoting positive mental health, rather than having direct prevention or intervention effects on clinical problems.

Hyperactivity, shyness, and sex: development and socio-emotional functioning

Based on formulations about the possible consequences for adaptation of gender nonnormative behaviour, we investigated predictive and concurrent relations of hyperactivity and shyness to various aspects of adaptation focusing on possible effects of sex. At ages 5-6, parents and preschool teachers rated hyperactivity and shyness for 151 children (50% boys). At age 9, we obtained teacher ratings of hyperactivity, internalizing and externalizing problems, self-ratings of trait anxiety, and peer nominations of shyness, social preference, and aggression. Several effects of sex were found. Hyperactivity ratings were more strongly related across time and raters for boys than for girls. In the predictive analyses, boys' hyperactivity was more strongly related to aggression than was girls' hyperactivity, and in concurrent analyses, girls' hyperactivity was more strongly associated with low social preference than was boys' hyperactivity. There was a protective effect of shyness with regard to aggression that applied only to boys, that is, at high hyperactivity levels, boys with high shyness levels were less aggressive than boys with low shyness levels. There were also main effects of hyperactivity and shyness. In predictive and concurrent analyses, hyperactivity was associated with low social preference, high levels of externalizing problems and with aggression, whereas shyness was associated with high levels of internalizing problems. Finally, there was an interactive effect of hyperactivity and shyness. In the concurrent analyses, an exacerbating effect was demonstrated insofar as high shyness was associated with low social preference at high, but not at low levels of hyperactivity. The different developmental risks of hyperactivity and shyness were discussed.

A psychometric evaluation of the behavioral inhibition questionnaire in a non-clinical sample of Dutch children and adolescents

The Behavioral Inhibition Questionnaire (BIQ) is a parent-rating scale for measuring temperamental characteristics referring to shyness, fearfulness, and withdrawal in young, preschool children. The present study evaluated the psychometric properties of the BIQ in a Dutch community sample of children with a broad age range. For this purpose,the reliability and validity of the BIQ was evaluated in three age groups: 4-7-year-olds,8-11-year-olds, and 12-15-year-olds. The results indicated that the internal consistency of most BIQ scales was satisfactory in all three age groups. Principal component analysis of the BIQ yielded a six-factor model that was largely in keeping with the hypothesized structure consisting of the social and non-social components of behavioral inhibition.Confirmatory factor analysis indicated that this model provided a reasonable fit for the data. Further, support for the validity of the measure was obtained in all age groups. That is, BIQ scores were positively correlated with a wide range of anxiety symptoms, although the most substantial links were found for symptoms of social anxiety. Finally, a self-report version of the BIQ, which was administered to children aged 9 years and above, was found to possess good internal consistency and adequate parent-child agreement. Altogether, the results of this study indicate that suggests that the BIQ might be a reliable and valid measure for assessing behavioral inhibition not only in preschoolers but also in older children and adolescents.

Socioeconomic inequalities in infant temperament: the generation R study

BACKGROUND

A low socioeconomic status (SES) has consistently been associated with behavioural problems during childhood. The studies of SES and behaviour in infants used temperament as a behavioural measure. However, these studies in younger children yielded inconsistent findings. Furthermore, they generally did not examine explanatory mechanisms underlying the association between SES and temperament. We investigated the association between SES and temperament in infancy.

METHODS

The study was embedded in the Generation R study, a population-based cohort in The Netherlands. Maternal and paternal education, family income, and maternal occupational status were used as indicators of SES. At the age of 6 months, 4,055 mothers filled out six scales of the Infant Behaviour Questionnaire-Revised.

RESULTS

Lower SES was associated with more difficult infant temperament as measured by five of the six temperament dimensions (e.g. Fear: unadjusted z-score difference between lowest and highest education: 0.57 (95%CI: 0.43, 0.71)). Only the direction of the association between SES and Sadness was reversed. The effect of SES on Distress to Limitations, Recovery from Distress, and Duration of Orienting scores was largely explained by family stress and maternal psychological well-being. These covariates could not explain the higher levels of Activity and Fear nor the lower Sadness scores of infants from low SES groups.

CONCLUSIONS

SES inequalities in temperament were already present in six months old infants and could partially be explained by family stress and maternal psychological well-being. The results imply that socioeconomic inequalities in mental health in adults may have their origin early in life.

Behavioural inhibition, anxious symptoms, and depressive symptoms: a short-term prospective examination of a diathesis-stress model

The purpose of the current study was to examine the relationship between behavioural inhibition (BI) and anxious symptoms within a diathesis-stress framework, using a short-term prospective design. In addition, we examined whether BI acts as a specific vulnerability to anxious symptoms, or as a common vulnerability to both anxious and depressive symptoms. At time 1, 384 children in grades 3 through 6 completed self-report measures of BI, anxious symptoms, and depressive symptoms. Six weeks later, they completed self-report measures of hassles, anxious symptoms, and depressive symptoms. Results demonstrated that children with high BI who experienced high levels of hassles during the 6-week follow-up interval showed increases in anxious symptoms, but not depressive symptoms.

Vulnerability factors for anxiety disorders in children and adolescents

With the maturation of community studies of adults in the past decade, there has been growing awareness of the importance of the magnitude and impact of anxiety disorders in the general population. The convergence of findings from adult and child epidemiology reveals that the onset of anxiety disorders occurs in childhood, and a substantial proportion of youth with anxiety continues to manifest lifelong problems with anxiety and other mental disorders. In this article, the major risk factors for the development of anxiety disorders in childhood and adolescence are reviewed.

Temperament and anxiety disorders

Recently, multidisciplinary research teams have come together to assess the emergence, course, and treatment of anxiety disorders in young children and adolescents. A number of researchers have suggested that early temperament traits may play a significant role in the causes and maintenance of early anxiety. This article reviews the current understanding of temperament and anxiety as separate constructs and then attempts to examine the developmental links between the two constructs. The authors examine the outstanding issues that must be addressed before the benefits of bridging these traditionally independent fields of study can be fully exploited.

Behavioral Inhibition: Linking Biology and Behavior within a Developmental Framework

Behavioral inhibition refers to a temperament or style of reacting that some infants and young children exhibit when confronted with novel situations or unfamiliar adults or peers. Research on behavioral inhibition has examined the link between this set of behaviors to the neural systems involved in the experience and expression of fear. There are strong parallels between the physiology of behaviorally inhibited children and the activation of physiological systems associated with conditioned and unconditioned fear. Research has examined which caregiving behaviors support the frequency of behavioral inhibition across development, and work on the interface of cognitive processes and behavioral inhibition reveal both how certain cognitive processes moderate behavioral inhibition and how this temperament affects the development of cognition. This research has taken place within a context of the possibility that stable behavioral inhibition may be a risk factor for psychopathology, particularly anxiety disorders in older children. The current chapter reviews these areas of research and provides an integrative account of the broad impact of behavioral inhibition research.

Relations between parent- and teacher-reported behavioral inhibition and behavioral observations of this temperamental trait

This study examined the relation between the Behavioral Inhibition Scale (BIS), a measure that was specifically developed for assessing behavioral inhibition, and behavioral observations of this trait. Children ages 6 to 10 years participated in a series of experimental tasks assessing behavioral features of the inhibited temperament. The parents and teachers of these children completed the BIS. Results showed that the BIS (in particular the parent version) was significantly related to the observational index of behavioral inhibition. An additional aim of the study was to examine the relation between behavioral inhibition as indexed by the BIS and observations, on the one hand, and measures of anxiety symptoms, fear, and behavioral symptoms, on the other hand. As expected, significant correlations between behavioral inhibition indexes and symptoms of anxiety and withdrawal were observed. The BIS is found to be a brief and easy-to-administer instrument, which seems to provide a meaningful first impression of children's level of behavioral inhibition, and this is particularly true when using the parent version of the BIS.

Interpersonal processes in social phobia

Social phobia is a condition in which anxiety impairs the person's ability to relate to others. Here, we draw on concepts from interpersonal theory to examine the literature on the role of interpersonal processes in creating and maintaining this disorder. Studies that examine interpersonal interactions with significant others and strangers are reviewed. We next consider topics of particular relevance to relationship impairment, such as the effect of anxiety on cognitive processing of social information, and the social developmental pathways to social phobia. The impact of interpersonal factors on the process and outcome of cognitive-behavioral treatment is also discussed. Finally, we identify emerging themes in the research literature and consider directions for future work. Throughout the paper we highlight topics central to the interpersonal perspective, such as the self-perpetuating interpersonal cycle, interpersonal variability in social phobia, and the relational nature of self-related information.

The psychophysiology of child misconduct

Psychophysiological evidence supports the notion that serious and persistent childhood misconduct is symptomatic of an internal dysfunction that dynamically interacts with other psychological and social causes. Childhood misconduct is a complex phenomenon with multiple causes and no easy solutions. Rather than think our civilization is doomed, however, we should realize that the great majority of our children grow up to be sociable and law-abiding individuals. For the others, we are afforded optimism that this problem can be minimized as we gain a more complete understanding of the interplay among biological, psychological, and social risks, and through the consequent refinement of interventions.

Behavioral inhibition and disinhibition as hypothesized precursors to psychopathology: implications for pediatric bipolar disorder

Attention has been devoted over the past two decades to the identification of temperamental risk factors for child psychopathology. These qualities, evident in toddlerhood or earlier, have the advantage of being measurable in standardized laboratory observations well before children reach the age of onset or diagnosis of psychiatric disorders. Our group's programmatic research over the past 15 years, and that of others, has provided evidence linking "behavioral inhibition to the unfamiliar" in toddlerhood or early childhood with later social anxiety disorder. In addition, recent results by our group have suggested that "behavioral disinhibition" in early childhood, measured by the same laboratory methods, may be linked with later disruptive behavior and comorbid mood disorders. In this article, we discuss our approach to the study of temperamental precursors to disorders in high-risk children, summarize the literature linking behavioral inhibition and disinhibition to later psychopathology, and suggest directions to take in applying this methodology to the search for temperamental precursors to pediatric bipolar disorder.

The developmental psychopathology of social anxiety disorder

The role of developmental theory and developmental psychopathology in understanding the development, maintenance, and course of social anxiety disorder (SAD) is explored in this article. Following a brief examination of the phenomenology of SAD in youth, we provide an overview of the tenets of developmental psychology and developmental psychopathology, including the principles of equifinality (i.e., the same outcome can result from diverse developmental pathways) and multifinality (i.e., the same risk factor can lead to or result in different outcomes). We review various pathways for the acquisition and maintenance of SAD (e.g., genetic and temperamental influences, parental factors, conditioning or learning experiences, peer influences, and cognitive styles) and conclude, consistent with a developmental psychopathology perspective, that multiple pathways to SAD exist and that the various precursors to SAD do not invariably lead to SAD. We suggest that specificity in outcome is afforded by the combination, timing, and circumstances surrounding these various risk factors. Finally, we propose studies to test the viability of the developmental psychopathology model in understanding SAD.

Anxiety and depression as correlates of self-reported behavioural inhibition in normal adolescents

In a previous study, Muris, Merckelbach, Wessel, and Van de Ven [Psychopathological correlates of self-reported behavioural inhibition in normal children. Behav. Res. Ther. 37 (1999) 575-584] found that children who defined themselves as high on behavioural inhibition displayed elevated levels of psychopathological symptoms compared to children who defined themselves as low or middle on behavioural inhibition. The present study further examined the relationship between self-reported behavioural inhibition and anxiety disorders and depression symptoms in a large sample of adolescents aged 12-18 years (N=968). Adolescents completed a measure of behavioural inhibition and questionnaires of anxiety and depression. Results indicated that adolescents who classified themselves as high on behavioural inhibition had higher scores of anxiety and depression than adolescents who classified themselves as low or middle on behavioural inhibition. Structural equations modelling was employed to test hypothetical models on the role of behavioural inhibition in childhood anxiety and depression. It was found that a pathway in which behavioural inhibition results in anxiety, which in turn leads to depression, provided the best fit for the data.

Social inhibition and overfriendliness as related to socioemotional functioning in 7- and 8-year-old children

Examined high, medium, and low social inhibition groups in a Swedish sample (N = 815) of 7- and 8-year-old children on the basis of parental reports about their children's reaction to novel social situations. High social inhibition was associated with increased levels of internalizing problems and low social competence. Among the low-inhibited children, we identified a subgroup by using an index of overfriendliness. Overfriendliness was associated with more internalizing, externalizing, and attention problems and lower prosocial orientation. The findings support the notion of high social inhibition as a risk factor for the development of internalizing problems and low social competence but question the view of low inhibition as descriptive of generally well-functioning children. Rather, this is true for low-inhibited children only when they are also low in overfriendliness. Thus, the results point to a need for a better understanding of developmental pathways for both high- and low-inhibited children.

Psychopathological correlates of self-reported behavioural inhibition in normal children

The present study examined the relationship between self-reported behavioural inhibition and psychopathological symptoms in a sample of 152 children aged 12-14 years. Children were provided with a definition of behavioural inhibition and then asked to classify themselves as low, middle or high on behavioural inhibition. Furthermore, children completed questionnaires of worry, depression and anxiety symptoms. Results showed that children who endorsed the high behavioural inhibition category had elevated levels of anxiety, worry and depression compared to children who endorsed the low or middle behavioural inhibition categories. Moreover, children high on behavioural inhibition more frequently reported anxiety disorders symptoms in the subclinical range. These findings fit well with those of previous studies on behavioural inhibition.

Low resting heart rate at age 3 years predisposes to aggression at age 11 years: evidence from the Mauritius Child Health Project

OBJECTIVE

Previous studies indicate that low resting heart rate is probably the best-replicated biological correlate of childhood antisocial and aggressive behavior. Nevertheless, there have been few longitudinal tests of this relationship, little control over potential confounds and mediators, and no test of its cross-cultural generalizability. This study tests the hypothesis that low resting heart rate at age 3 years predicts aggression at age 11 years.

METHOD

Resting heart rate at age 3 years was assessed in 1,795 male and female children from Mauritius. Aggressive and nonaggressive forms of antisocial behavior were assessed at age 11 years using the Child Behavior Checklist.

RESULTS

Aggressive children had lower heart rates than nonaggressive children (p < .001). Conversely, those with low heart rates were more aggressive than those with high heart rates (p < .003). There were no interactions with gender or ethnicity. Evidence was found for specificity of low heart rate to aggressive forms of antisocial behavior. Group differences in heart rate were not attributable to 11 biological, psychological, and psychiatric mediators and confounds.

CONCLUSIONS

It is concluded that low resting heart rate, a partly heritable trait reflecting fearlessness and stimulation-seeking, is an important, diagnostically specific, well-replicated, early biological marker for later aggressive behavior.