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

Evaluating the long-term effects of cognitive behavioural therapy as an early intervention for at-risk anxiety disorders among preschool children in Asia

There are few evaluations of early intervention for the prevention of anxiety disorders in East Asia, and those that exist generally evaluate outcomes to a maximum of 6-12 months. The current study evaluated the long-term effect (5 years) of an anxiety prevention program presented to preschool children and their parents in Japan. Participants for the study were 10 inhibited children 5-6 years old and their parents. The parent's and children's program comprised group sessions of a cognitive-behavioural program. Parents and teachers completed the anxious/depressed, withdrawn and behavioural inhibition at pre-post-intervention and 3-month follow-up. Five years after starting the intervention, participants were invited to a diagnostic interview, Anxiety Disorders Interview Schedule (ADIS) to examine a long-term preventive effect of the intervention. The majority of children showed a reduction in anxious/depressed, behavioral inhibition, and approximately half showed reliable change according to parents' and teachers' reports. Moreover, the results indicated that 9 of the 10 children did not met the diagnostic criteria for anxiety disorders. These results suggested that the early intervention had preventive effects because the diagnostic criteria for anxiety disorders were not met in the follow-up assessment conducted five years later.

Early childhood anxiety disorders: continuity and predictors in adolescence

Anxiety disorders are among the most common disorders in early childhood. Although many older children and adolescents with anxiety disorders recover and remain well, little is known about the continuity of early childhood anxiety and the factors that predict persistence/recurrence in later childhood and adolescence. We followed 129 children who met anxiety disorder criteria at age 3 and/or 6 and determined how many continued to experience an anxiety disorder between age 7 and 15, as well as the continuity of specific anxiety disorders. We explored whether biological sex, number of anxiety disorders, early childhood persistence (i.e., anxiety diagnosis at both age 3 and 6), childhood comorbidities, temperamental behavioral inhibition, a maternal history of anxiety, and authoritarian and overprotective parenting predicted persistence/recurrence of an anxiety disorder from age 7 to 15. Sixty-five (50.4%) of the adolescents with an early childhood anxiety disorder met anxiety disorder criteria during the age 7-15 interval. Homotypic continuity from early childhood to school-age/mid-adolescence was observed for social anxiety disorder, separation anxiety disorder, and generalized anxiety disorder (GAD). Early childhood agoraphobia predicted school-age/mid-adolescent GAD and early childhood GAD predicted school-age/mid-adolescent specific phobia. In bivariate analyses, number of anxiety disorders, persistence of anxiety from age 3 to 6, and having a mother with a history of anxiety predicted the persistence/recurrence of anxiety disorders from age 7 to 15. Only early childhood persistence of anxiety uniquely predicted the persistence/recurrence of an anxiety disorder over and above the other predictors. Early intervention efforts should focus on identifying and intervening with young children who demonstrate a protracted course of anxiety.

An Integrative Model of Youth Anxiety: Cognitive-Affective Processes and Parenting in Developmental Context

Multiple theoretical frameworks have been proposed to provide a more comprehensive picture of the risk factors that influence anxiety-related developmental trajectories. Nonetheless, there remains a need for an integrative model that outlines: (1) which risk factors may be most pertinent at different points in development, and (2) how parenting may maintain, exacerbate, or attenuate an affective style that is characterized by high negative emotional reactivity to unfamiliar, uncertain, and threatening situations. A developmentally informed, integrative model has the potential to guide treatment development and delivery, which is critical to reducing the public health burden associated with these disorders. This paper outlines a model integrating research on many well-established risk mechanisms for anxiety disorders, focusing on (1) the developmental progression from emotional reactivity constructs early in life to those involving higher-level cognitive processes later in youth, and (2) potential pathways by which parenting may impact the stability of youth's cognitive-affective responses to threat-relevant information across development.

Anxiety disorders in children and adolescents: A summary and overview of the literature

Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances.

Problematic behaviours associated with generalized anxiety disorder during pregnancy and the postpartum period: A thematic analysis

Generalized anxiety disorder (GAD) is one of the most common anxiety disorders in pregnancy and the postpartum (perinatal) period. Perinatal women with GAD engage in problematic behaviours, yet the focus and function of these behaviours remain unknown.

OBJECTIVE

Given that worry during the perinatal period is largely maternally focused, the objective of this study was to explore the accompanying behavioural features of GAD during pregnancy and the postpartum period.

DESIGN

A qualitative study was conducted.

METHODS

Twenty-five pregnant (n = 10) and postpartum (n = 15) women were recruited through clinical referrals and the Hamilton community. Following the completion of a semistructured diagnostic interview and symptom measures, participants participated in one of seven focus groups to learn about behaviours utilized in response to their worries. A thematic analysis was conducted to identify behaviour themes and subthemes in pregnant and postpartum women.

RESULTS

Five behaviour themes and 12 subthemes were identified. Specifically, participants endorsed engaging in excessive reassurance seeking, checking and repeating, overcontrol, overpreparation and avoidance behaviours.

CONCLUSIONS

Our results confirm that perinatal women with GAD engage in comparable problematic behaviours to those with GAD in the general population, yet the presentation, frequency and focus of those behaviours differ. These findings have implications for theoretical formulations of GAD, and the clinical management of this disorder during the perinatal period.

Are fearful boys at higher risk for anxiety? Person-centered profiles of toddler fearful behavior predict anxious behaviors at age 6

Dysregulated fear (DF), the presence of fearful behaviors in both low-threat and high-threat contexts, is associated with child anxiety symptoms during early childhood (e.g., Buss et al., 2013). However, not all children with DF go on to develop an anxiety disorder (Buss and McDoniel, 2016). This study leveraged the data from two longitudinal cohorts (N = 261) to (1) use person-centered methods to identify profiles of fearful temperament, (2) replicate the findings linking DF to anxiety behaviors in kindergarten, (3) test if child sex moderates associations between DF and anxiety behaviors, and (4) examine the consistency of findings across multiple informants of child anxiety behaviors. We identified a normative fear profile (low fear in low-threat contexts; high fear in high-threat contexts), a low fear profile (low fear across both low- and high-threat contexts) and a DF profile (high fear across both low- and high-threat contexts). Results showed that probability of DF profile membership was significantly associated with child self-reported overanxiousness, but not with parent-reported overanxiousness. Associations between DF profile membership and overanxiousness was moderated by child sex such that these associations were significant for boys only. Additionally, results showed that probability of DF profile membership was associated with both parent-reported social withdrawal and observations of social reticence, but there were no significant associations with child self-report of social withdrawal. Results highlight the importance of considering person-centered profiles of fearful temperament across different emotion-eliciting contexts, and the importance of using multiple informants to understand associations with temperamental risk for child anxiety.

A Multi-level Longitudinal Model of Risk Factors for Generalized and Separation Anxiety Symptoms in a Community Sample of 6-year-olds

The current longitudinal study examined the relations between variables in four domains-contextual (SES, family conflict, stress), parent (caretaker depression), parenting (support hostility, autonomy granting), and child (negative affect, effortful control, sensory regulation, attachment)-and both the presence of generalized and separation anxiety symptoms at age 6 in a community sample of 796 children and the change in these anxiety symptoms from ages 4 to 6. Anxiety was highly stable over time. Specific results revealed both direct and indirect pathways between age 4 and age 5 variables, and age 6 anxiety. Caretaker depression and the child variables of attachment, effortful control, negative affect, and sensory regulation were directly related to anxiety symptoms at age 6. Contextual variables (SES) at age 4 were indirectly related to age 6 anxiety through parent depression at age 5. Parent depression was indirectly related to age 6 anxiety through age 5 child negative affect. Child negative affect at age 4 was indirectly related to age 6 anxiety through age 5 effortful control and age 4 effortful control was indirectly related to age 6 anxiety through age 5 negative affect. With the exception of attachment, there was a reduction in the impact of other variables when initial levels of anxiety symptoms were included in the model. Implications of results for early intervention and further study are discussed.

Bidirectional and interactive effects of child temperament and parenting in early childhood on the trajectory of social anxiety in adolescence

INTRODUCTION

Research suggests that certain parenting behaviors are best suited to promote optimal child development, depending on a child's distinctive temperamental presentation. This multimethod, longitudinal study examines the interactive effect of parenting and temperament in early childhood on the developmental trajectory of social anxiety in adolescence.

METHODS

Longitudinal growth modeling was used to examine the developmental trajectory of child social anxiety from age 9-15 and the interactive effect of parenting and child temperament at 36 months on the developmental trajectory of child social anxiety from age 9-15.

RESULTS

The slope of social anxiety from age 9-15 suggested a decrease in social anxiety throughout early adolescence. Furthermore, 36-month behavioral inhibition (BI) predicted the trajectory of child social anxiety from age 9-15 when parents displayed low and high levels of dismissive and supportive parenting (at 36 months).

CONCLUSIONS

Results support an interactive effect of infant temperament and parenting in early childhood (at 36 months) on the developmental trajectory of child social anxiety from age 9-15. Specifically, results suggest that engaging highly inhibited children with high supportive and low dismissive parenting may help reduce social anxiety over time in adolescence. Furthermore, parenting needs may differ for children high or low in BI to impact the developmental trajectory of social anxiety in adolescence, such that children who are high BI seem to benefit from low dismissive and high supportive parenting, and children who are low in BI seem to benefit more from high dismissive parenting.

Preschool Temperament as a Factor of Risk and Protection for Later Childhood Psychopathology

BACKGROUND

Temperament might be considered as a risk factor as well as a resilience factor for later externalizing and internalizing disorders. Therefore, this study examines different dimensions of temperament in preschool age with regard to their predictive value for psychopathology later in childhood.

METHODS

A total of 76 patients (63.2% male) were assessed in a special psychiatric consultation for preschool age at measuring point time t1 (x = 4.2) and measuring point time t2 (x = 9.2). At t1, the Integrative Child Temperament Inventory (ICTI) was used for assessment. At t2, parents completed the Strengths and Difficulties Questionnaire SDQ. Multiple regression analyses were used to test if the temperament factors of the ICTI predicted clinical abnormalities in the SDQ subscales or total difficulties score.

RESULTS

SDQ total difficulties score as an indicator of total psychiatric disturbance in childhood appears to be good predicted by the temperament factor frustration/anger. Sensory sensitivity in preschoolers serves as a risk factor for later emotional symptoms, whereas high activity levels appear to prevent later emotional symptoms. Behavioral inhibition appears to protect against hyperactivity/inattention.

CONCLUSION

Our data suggests that preschool temperament contributes differently to the development of externalizing and internalizing problems in childhood. The temperament factor frustration/anger in preschool children might be a strong predictor of the general mental condition in childhood at nine years of age and can therefore be used as a target for prevention of psychopathology in children. On one hand, high sensory sensitivity can be a predictor to identify preschool children at risk for later emotional symptoms, on the other hand, activity level acts as a protective factor against later emotional symptoms. An increased level of behavioral inhibition might be protective against the development of hyperactivity/inattention symptoms. Overall, this study illustrates the complexity and ambiguity of temperament in child development.

Targeting risk factors for inhibited preschool children: An anxiety prevention program

OBJECTIVE

Children with a behaviorally inhibited temperament during early childhood have been shown to have an increased risk for developing anxiety disorders. This study evaluated the efficacy of an anxiety prevention program aimed at reducing the risk of anxiety in behaviorally inhibited preschool children.

METHOD

Participants were 86 children aged 41-57 months and their mothers. Children were selected if their mothers reported high levels of child behavioral inhibition on a screening measure. Participants were randomly allocated to a nine-session intervention or a waitlist control condition. Mothers and children both participated in the intervention.

RESULTS

At follow-up, the intervention group had significantly fewer clinician-rated child anxiety disorders and fewer mother-reported child anxiety symptoms than at baseline but this change was not significantly different to the change seen in the waitlist control group.

CONCLUSIONS

On average, across the course of the study, anxiety decreased in all children irrespective of group. A number of potential reasons for this are discussed along with implications for research and clinical practice.

Implementation of the diffusion model on dot-probe task performance in children with behavioral inhibition

Attentional bias to threat, the process of preferentially attending to potentially threatening environmental stimuli over neutral stimuli, is positively associated with behavioral inhibition (BI) and trait anxiety. However, the most used measure of attentional bias to threat, the dot-probe task, has been criticized for demonstrating poor reliability. The present study aimed to assess whether utilizing a sequential sampling model to describe performance could detect adequate test-retest reliability for the dot-probe task, demonstrate stronger cueing effects, and improve the association with neural signals of early attention. One hundred and twenty children aged 9-12 years completed the dot-probe task twice. During the second administration, event-related potentials (ERPs) were obtained as time-sensitive neural markers of attention. BI was not associated with traditional or diffusion model measures of performance. Traditional and diffusion model measures of performance were also not associated with N1, P2, or N2 ERP amplitude. There were main effects of Visit, in which RTs were faster and standard deviation of RT smaller during the second administration due to an increase in drift rate and a decrease in non-decision time. The traditional RT bias score (r = 0.06) and bias scores formed via diffusion model parameters (all r's < 0.40) all demonstrated poor reliability. Results confirm recommendations to move away from using the dot-probe task as the primary or sole index of attentional bias.

Prospective Association between Childhood Behavioral Inhibition and Anxiety: a Meta-Analysis

Behavioral inhibition (BI) is a risk factor for anxiety. However, the estimates of the strength of this association vary widely. In addition, while BI is a strong predictor of social anxiety disorder (SAD), its association with other anxiety disorders is unclear. The current study sought to establish the relationship between BI and anxiety and to quantify this association for a range of anxiety disorders. We searched PsycInfo, PubMed and Embase for articles published before May 18th, 2019 using search terms for BI, anxiety and prospective study design. We selected articles which assessed the prospective relationship between BI in childhood and anxiety. Using random-effects meta-analysis with robust variance estimation, which allowed for the inclusion of multiple follow-ups of the same sample, we established the association between BI and any anxiety. We also explored the association between BI and individual anxiety disorders. Data from 27 studies consisting of 35 follow-ups of 20 unique samples indicated that BI prospectively increases the odds of anxiety (OR = 2.80, 95% CI 2.03 to 3.86, p < 0.001). There was also a positive association between BI and all individual anxiety disorders, with effect sizes ranging from small in the case of specific phobia (OR = 1.49, 95% CI 1.03 to 2.14, p = 0.03) to large in the case of SAD (OR = 5.84, 95% CI 3.38 to 10.09, p < 0.001). BI in early childhood is a strong risk factor for anxiety. Targeting BI may help reduce the number of children who will develop anxiety disorders.

Adventurous Play as a Mechanism for Reducing Risk for Childhood Anxiety: A Conceptual Model

In this conceptual article, we draw upon the literature regarding cognitive and behavioural factors that underpin childhood anxiety to outline how a range of these risk markers might be targeted through adventurous play. When children play in an adventurous way, climbing trees, riding their bikes fast downhill and jumping from rocks, they experience feelings of fear and excitement, thrill and adrenaline. We propose that the positive, thrilling and playful emotions associated with this type of child-led play facilitate exposure to fear-provoking situations and, in doing so, provide opportunities for children to learn about physiological arousal, uncertainty and coping. We hypothesise that these learning opportunities will, over time, reduce children's risk for elevated anxiety by increasing children's expectations and ability to cope with anxiety, decreasing intolerance of uncertainty and preventing catastrophic misinterpretations of physiological arousal. If our conceptual model is correct, then ensuring that children have the physical and psychological space required to play in an adventurous way may help to decrease their risk for elevated or clinical anxiety.

Research Review: Pediatric anxiety disorders - what have we learnt in the last 10 years?

BACKGROUND

Anxiety disorders first emerge during the critical developmental periods of childhood and adolescence. This review synthesizes recent findings on the prevalence, risk factors, and course of the anxiety disorders; and their neurobiology and treatment.

METHODS

For this review, searches were conducted using PubMed, PsycINFO, and clinicaltrials.gov. Findings related to the epidemiology, neurobiology, risk factors, and treatment of pediatric anxiety disorders were then summarized.

FINDINGS

Anxiety disorders are high prevalence, and early-onset conditions associated with multiple risk factors including early inhibited temperament, environment stress, and structural and functional abnormalities in the prefrontal-amygdala circuitry as well as the default mode and salience networks. The anxiety disorders are effectively treated with cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs).

CONCLUSIONS

Anxiety disorders are high prevalence, early-onset conditions associated with a distinct neurobiological fingerprint, and are consistently responsive to treatment. Questions remain regarding who is at risk of developing anxiety disorders as well as the way in which neurobiology predicts treatment response.

Your Fear is My Fear: The Relationship Between Parental and Offspring Anxieties

Contrary to the well-documented link between parental and offspring clinical anxiety, little is known about the relationship between parental everyday-life anxieties (e.g., concerning family, finances, health) and offspring anxieties. To close this gap, we assessed the frequency of parental symptoms of DSM-IV anxiety disorders and everyday-life anxieties, as well as the frequency of offspring anxiety symptoms in a representative sample by self-report. Parents reported that 48.4% of the children were free of specific symptoms of DSM-IV anxiety disorders within the last 12 months, 39.2% showed low symptom load (1-3 symptoms) and 12.4% were moderately or severely strained (4-10 symptoms). Replicating previous studies, parental DSM-IV symptoms increased offspring risk for the same symptoms. In addition, parental everyday-life anxieties showed a positive relationship with offspring symptom severity. Demographic variables (female sex, low socioeconomic status and younger age) and parental anxiety markers explained 18% of variance in offspring symptom severity. The data are discussed in light of current models of familial transmission.

Factors Associated With Anxiety Symptoms in Australian Deaf or Hard of Hearing Children

Deaf/deaf or hard of hearing (DHH) children are at an increased risk of developing mental health problems, with growing evidence that they may experience greater anxiety symptoms than hearing peers. The present study investigated whether Australian children with varying degrees of hearing loss experienced increased anxiety symptoms compared to hearing children. Furthermore, we examined whether child anxiety symptoms were associated with known risk factors including psychological symptoms of anxiety and depression in parents, age at detection, early intervention and device fitting, type of hearing device, and peer problems. Participants were 65 parents of children with hearing loss aged between 4 and 11 years old (M = 6.05, SD = 1.60) seeking treatment for hearing loss at a specialized hearing clinic in Australia. Based on parent reports, we found that the children with hearing loss had fewer anxiety symptoms than their hearing peers (using normative data). Psychological distress of parents was the only factor that uniquely associated with child anxiety. Parents of children with hearing loss were found to experience greater emotional distress compared to parents of hearing children. This suggests parents may require additional support to cope with the social and economic strains associated with childhood hearing loss.

Protocol for a systematic review and network meta-analysis of randomised controlled trials examining the effectiveness of early parenting interventions in preventing internalising problems in children and adolescents

BACKGROUND

Internalising problems, such as depression and anxiety, are common and represent an important economical and societal burden. The effectiveness of parenting interventions in reducing the risk of internalising problems in children and adolescents has not yet been summarised. The aims of this review are to assess the effectiveness of parenting interventions in the primary, secondary and tertiary prevention of internalising problems in children and adolescents and to determine which intervention components and which intervention aspects are most effective for reducing the risk of internalising problems in children and adolescents.

METHODS

Electronic searches in OVID SP versions of MEDLINE, EMBASE and PsycINFO; Cochrane Central Register of Controlled Trials; EBSCO version of ERIC and ClinicalTrials.gov have been performed to identify randomised controlled trials or quasi-randomised controlled trials of parenting interventions. At least two independent researchers will assess studies for inclusion and extract data from each paper. The risk of bias assessment will be conducted independently by two reviewers using the Cochrane Collaboration's Risk of Bias Assessment Tool. Statistical heterogeneity is anticipated given potential variation in participant characteristics, intervention type and mode of delivery, and outcome measures. Random effects models, assuming a common between-study variability, will be used to account for statistical heterogeneity. Results will be analysed using a network meta-analysis (NMA). If appropriate, we will also conduct a component-level NMA, where the 'active ingredients' of interventions are modelled using a network meta-regression approach.

DISCUSSION

Preventing and reducing internalising problems could have major beneficial effects at the economic and societal level. Informing policy makers on the effectiveness of parenting interventions and on which intervention's component is driving the effect is important for the development of treatment strategies.

SYSTEMATIC REVIEW REGISTRATION

International Prospective Register for Systematic Reviews (PROSPERO) number CRD42020172251.

Early Childhood Predictors of Anxiety in Early Adolescence

This longitudinal study examined a multitude of early childhood predictors of anxiety symptoms and disorders over an 8-year period. The purpose of the study was to identify early life predictors of anxiety across childhood and early adolescence in a sample of at-risk children. The sample included 202 preschool children initially identified as behaviorally inhibited or uninhibited between the ages of 3 years 2 months and 4 years 5 months. Temperament and familial environment variables were assessed using observation and parent report at baseline. Anxiety symptoms and disorders were assessed using questionnaires and diagnostic interviews at baseline (age 4), and at age 6, 9 and 12 years. In line with our hypotheses, the findings showed that preschool children were more likely to experience anxiety symptoms and disorders over time i) when the child was inhibited, ii) when there was a history of maternal anxiety disorders or iii) when mothers displayed high levels of overinvolvement. Further, the study identified a significant interaction effect between temperament and maternal overvinvolvement such that behaviorally inhibited preschoolers had higher anxiety symptoms at age 12, only in the presence of maternal overinvolvement at age 4. The increased risk of anxiety in inhibited children was mitigated when mothers demonstrated low levels of overinvolvement at age 4. This study provides evidence of both additive and interactive effects of temperament and family environment on the development of anxiety and provides important information for the identification of families who will most likely benefit from targeted early intervention.

Similarities and differences between young children with selective mutism and social anxiety disorder

A growing body of evidence points to a strong overlap between selective mutism (SM) and social anxiety disorder in children, specifically with regard to characteristics such as social reticence and anxiety. Yet few studies have directly compared these populations, especially with young children. This study compared 25 children (aged 3-7 years) with a primary diagnosis of SM, 17 children with a primary diagnosis of social anxiety disorder and 15 non-clinical controls using interviews and questionnaires on expressions of social anxiety and behavioural inhibition. Results showed that children with SM or social anxiety disorder were more anxious than non-clinical controls and did not significantly differ from each other on either non-verbal social anxiety or non-social forms of anxiety. Both children with SM and social anxiety disorder had fewer friends and experienced greater difficulties forming friendships than non-clinical controls. However, children with SM scored higher than children with social anxiety disorder and non-clinical controls on a few measures of inhibition (both verbal and nonverbal). The results support assertions of strong similarities between SM and social anxiety disorder, but suggest that children with SM may show even greater severity in certain symptoms at a young age. These findings point to the need for treatment to include both cognitive behavioural skills to manage social anxiety and structured practice of social skills in order to improve treatment efficacy for children with SM.

The role of maternal anxiety disorder subtype, parenting and infant stable temperamental inhibition in child anxiety: a prospective longitudinal study

BACKGROUND

Social anxiety disorder (SAD) aggregates in families. To elucidate intergenerational transmission of risk, we examined whether childhood SAD and symptoms of anxiety were prospectively predicted by stable infant temperamental inhibition, maternal SAD, maternal generalized anxiety disorder (GAD) and maternal parenting behaviours.

METHODS

We conducted a longitudinal study beginning prenatally with follow-up at 4, 10, 14 and 58 months postnatally. Mothers were assessed for anxiety disorders prenatally and assigned to one of three groups: SAD (n = 67), GAD (n = 56) and nonanxious controls (n = 94). We assessed infant temperamental inhibition at 4 and 14 months, maternal parenting behaviours at 10 and 58 months, and child anxiety disorders and symptoms at 58 months.

RESULTS

Child SAD at 58 months was predicted by prenatal maternal SAD (OR = 23.76, 95% CI = 1.15-60.37), but not by prenatal maternal GAD (OR = 7.44, 95% CI = 0.32-124.49), stable temperamental inhibition or maternal behaviours. Child anxiety symptoms at 58 months were predicted specifically by maternal SAD (but not GAD), and also by concurrent maternal intrusiveness. Stable temperamental inhibition moderated the association between 10-month maternal encouragement and 58-month child anxiety symptoms.

CONCLUSIONS

We found evidence for specificity of risk for child SAD and anxiety symptoms from maternal SAD compared to maternal GAD. Childhood anxiety symptoms were also predicted by an interaction between a lack of maternal encouragement in infancy and stable temperamental inhibition, as well as concurrent maternal intrusiveness. The findings have clinical implications for targeted prevention of child anxiety.

Behavioral Inhibition in Childhood as A Risk Factor for Development of Social Anxiety Disorder: A Longitudinal Study

Previous research has suggested the association between behavioral inhibition (BI) and the development of social anxiety disorder in childhood. However, there is scarce research using longitudinal methodology in Spanish-speaking populations. To cover this gap, the sample comprised 73 children ranging from six to eight years who had been examined for BI two years earlier in home and school settings. Children and their parents were administered the Anxiety Disorders Interview Schedule for DSM-5-Child and Parent Versions to assess the presence of possible anxiety disorders. The results revealed the stability of BI symptomatology over time. Data also showed that BI children were almost ten times more likely to develop social anxiety disorder two years later, compared to no-BI children. As a result, findings suggest behavioral inhibition strongly predicts social anxiety disorder, making BI a logical focus for selective preventive interventions. Therefore, screening for behavioral inhibition holds promise for primary prevention.

Specific relations of dimensional anxiety and manifest anxiety disorders during pregnancy with difficult early infant temperament: a longitudinal cohort study

Anxiety in the antenatal period is a common experience, associated with adverse consequences for mother and child. Specific types of prenatal anxiety may have unique associations with infant temperament. This study examines the prospective relationships between general prenatal anxiety, fear of childbirth, and specific prenatal anxiety disorders and early infant temperament 8 weeks postpartum. Data were derived from the Akershus Birth Cohort (ABC), a longitudinal cohort study which targeted all women scheduled to give birth at Akershus University Hospital, Norway. Psychometric measures pertained to general prenatal anxiety (Hopkins Symptom Checklist), fear of childbirth (Wijma delivery expectancy questionnaire), screening for manifest prenatal anxiety disorders based on questions from the mini-international neuropsychiatric interview, and difficult infant temperament (Infant Characteristics Questionnaire). The sample for the present study included 2206 women. General prenatal anxiety, fear of childbirth, agoraphobia, generalized anxiety disorder, and specific phobia presented unique significant prospective contributions to difficult infant temperament 8 weeks postpartum. Separate hierarchical regression models indicated that general prenatal anxiety and fear of childbirth provided the strongest unique contributions. Considering the burden on mothers and the potential long-term effects on child development, the findings of this study highlight the importance of screening women for different types of prenatal anxiety in routine obstetric care. Clinical awareness of the condition and its consequences is warranted. Due to the complexity of infant temperament as a construct with various influences, future research should consider mechanisms and influential factors pertaining to the relationship between prenatal anxiety and infant temperament.

Validation of the parent report version of the Spence Children's Anxiety Scale (SCAS-P) for Spanish children

Although Spence Children's Anxiety Scale (SCAS) is a widely used anxiety measure in many countries around the world, until now, research has barely focused on the usefulness of the parent version (SCAS-P) in young children. This study examines the psychometric properties and the factor structure of the SCAS-P in a Spanish community sample of 181 children aged 6-8 years (M = 6.87, SD = 0.78). Confirmatory factor analysis showed a good fit of the original six-factor model to the Spanish sample. The internal consistency and the test-retest reliability of the scale were high. Regarding the validity of this measure, higher and significant correlations between the SCAS-P and internalizing problems and lower correlations with externalizing problems were obtained, as found in the original version. Girls seemed to show more anxiety problems than boys, but no significant differences were found. The results suggest that the SCAS-P is an adequate measure to assess anxious symptomatology in young children. The availability of measures with good psychometric properties allows psychologists to assess and carry out a correct and early diagnosis of anxiety disorders in children, making possible an early clinical intervention.

Limbic and prefrontal neural volume modulate social anxiety in children at temperamental risk

BACKGROUND

Clinical levels of a social anxiety disorder (SAD) often appear during childhood and rise to a peak during late adolescence. The temperament trait behavioral inhibition (BI), evident early in childhood, has been linked to increased risk for SAD. Functional and structural variations in brain regions associated with the identification of, and response to, fear may support the BI-SAD relation. Whereas relevant functional studies are emerging, the few extant structural studies have focused on adult samples with mixed findings.

METHODS

A moderated-mediation model was used to examine the relations between BI, SAD symptoms, and brain-volume individual differences in a sample of children at risk for anxiety (ages 9-12; N = 130, 52 BI).

RESULTS

Our findings indicate that at higher levels of BI, children with smaller anterior insula volumes showed stronger correlations between BI and SAD. In addition, larger ventrolateral prefrontal cortex (vlPFC) volumes were associated with fewer SAD symptoms.

CONCLUSIONS

These findings support previous reports linking SAD levels with variations in volume and reactivity in both limbic (insula) and prefrontal (vlPFC) regions. These findings set the foundation for further examination of networks of neural structures that influence the transition from BI to SAD across development, helping further clarify mechanisms of risk and resilience.

Parenting and Anxiety: Bi-directional Relations in Young Children

Developmental psychopathologists have long posited a reciprocal relation between parenting behaviors and the development of child anxiety symptoms. Yet, little empirical research has utilized a longitudinal design that would allow exploration of this bi-directional influence. The present study examined the reciprocal relations between parental respect for autonomy, parental hostility, and parental support, and the development of childhood anxiety during a critical developmental period-the transition from preschool to kindergarten and then first grade. Study participants included a community sample of 391 male and 405 female socioeconomically, racially and ethnically diverse 4 to 6-7 year olds. 54 % of the sample was White, non-Hispanic, 16.8 % was African American, 20.4 % was Hispanic, 2.4 % were Asian and 4.4 % self-identified as Other or mixed race. Parent report and observational methodology were used. Parenting and anxiety were found to interact reciprocally over time. Higher levels of age 4 anxiety led to reduced respect for child autonomy at age 5. At age 4 higher levels of parental hostility led to small increases in age 5 anxiety, and increased age 5 anxiety led to increased levels of age 6 parent hostility. Parental support at age 5 resulted in decreased anxiety symptoms at age 6-7 while higher age 5 anxiety levels were associated with reductions in age 6-7 parental support. No relations were found between these variables at the younger ages. Although the magnitude of these findings was small, they suggest that early treatment for childhood anxiety should include both parent intervention and direct treatment of the child's anxiety symptoms.

The Relations Between Maternal Prenatal Anxiety or Stress and Child's Early Negative Reactivity or Self-Regulation: A Systematic Review

In the present review, we examine the association between maternal prenatal stress or anxiety and children's early negative reactivity or self-regulation. The review includes 32 studies that focus on pregnancy-related anxiety, state or trait anxiety, perceived stress, and stressful life events in relation to child's crying, temperament, or behavior during the first 2 years of life. We searched four electronic databases and 32 studies were selected based on the inclusion criteria. Twenty-three studies found an association between maternal prenatal anxiety or stress and a child's negative reactivity or self-regulation, and typically the effect sizes varied from low to moderate. The association was found regardless of the form of prenatal stress or anxiety and the trimester in which the prenatal stress or anxiety was measured. In conclusion, several forms of prenatal anxiety and stress may increase the risk of emotional and self-regulatory difficulties during the first 2 years of life.

Combining child social skills training with a parent early intervention program for inhibited preschool children

BACKGROUND

Previous studies have demonstrated the efficacy of early intervention for anxiety in preschoolers through parent-education. The current study evaluated a six-session early intervention program for preschoolers at high risk of anxiety disorders in which a standard educational program for parents was supplemented by direct training of social skills to the children.

METHODS

Seventy-two children aged 3-5 years were selected based on high behavioural inhibition levels and concurrently having a parent with high emotional distress. Families were randomly assigned to either the intervention group, which consisted of six parent-education group sessions and six child social skills training sessions, or waitlist. After six months, families on waitlist were offered treatment consisting of parent-education only.

RESULTS

Relative to waitlist, children in the combined condition showed significantly fewer clinician-rated anxiety disorders and diagnostic severity and maternal (but not paternal) reported anxiety symptoms and life interference at six months. Mothers also reported less overprotection. These gains were maintained at 12-month follow-up. Parent only education following waitlist produced similar improvements among children. Quasi-experimental comparison between combined and parent-only interventions indicated greater reductions from combined intervention according to clinician reports, but no significant differences on maternal reports.

CONCLUSIONS

Results suggest that this brief early intervention program for preschoolers with both parent and child components significantly reduces risk and disorder in vulnerable children. The inclusion of a child component might have the potential to increase effects over parent-only intervention. However, future support for this conclusion through long-term, randomised controlled trials is needed.

Depression and Anxiety in Preschoolers: A Review of the Past 7 Years

This article reviews recent empirical literature on the prevalence, correlates, assessment, and treatment of preschool-onset internalizing disorders. Major advances in the acceptance and recognition of both preschool-onset depression and anxiety have occurred over the past decade. This work has been greatly enhanced by the discovery of genetic, neural, and physiologic indicators, which further validate these constellations of symptoms in young children. Despite this growth in research, much work still needs to be done to further elucidate the cause, risk, treatment, and protective factors for preschool-onset internalizing disorders.

Father- and Youth-Reported Family Affective Expression Differentially Predicts Youth Internalizing and Externalizing Symptoms

Temperamental approach is associated with adolescent internalizing and externalizing symptoms. Negative family affective expression, or problematic communication about emotions, is also associated with youth's risk for symptoms. However, it is unclear whether negative family affective expression differentially predicts symptoms based on (a) youth's temperamental approach and (b) informants' perceptions of negative family affective expression. To address these issues, we explored whether mother-, father-, and youth-reported negative family affective expression moderated the relation between youth temperamental approach and symptoms. Participants were 775 youths (71% male, 76% Caucasian) assessed at ages 10-12 (Time 1) and 12-14 (Time 2). Mothers, fathers, and youths reported on negative family affective expression and youths reported on temperamental approach at Time 1. Teachers reported on youth symptoms at Times 1 and 2. Youth- and father-reported, but not mother-reported, negative family affective expression moderated the relation between youth approach and symptoms. When youths reported higher negative family affective expression, youths lower in approach exhibited higher internalizing symptoms than youths higher in approach. In contrast, when fathers reported lower negative family affective expression, youths lower in approach exhibited higher internalizing and externalizing symptoms than youths higher in approach. Assessments and interventions for youth symptoms should include not only temperamental features, but also multiple informants' perspectives of family affective expression. Such efforts could promote greater family communication, address problematic family dynamics, and potentially attenuate risk for youth symptoms.

Parents' behavioral inhibition moderates association of preschoolers' BI with risk for age 9 anxiety disorders

BACKGROUND

Temperamental behavioral inhibition (BI) in children predicts later anxiety disorders. However, many children with BI do not develop anxiety disorders, suggesting the importance of identifying moderating factors. The current study examined whether parents' history of BI moderates the associations between preschoolers' BI and anxiety disorders at age 9.

METHODS

The sample was 392 children and their parents from the community. Child BI was measured at age 3 using observational (Laboratory Temperament Assessment Battery; Lab-TAB) and parent report (Behavior Inhibition Questionnaire; BIQ) measures. In addition, both parents reported on their own history of childhood BI using the Retrospective Measure of Behavioral Inhibition (RMBI). When the children were 9 years old, a parent and the child were interviewed using the Kiddie Schedule for the Affective Disorders and Schizophrenia - Present and Lifetime version (K-SADS-PL).

RESULTS

Parents' reports of their own BI moderated the associations of both observed and parent-reported child BI at age 3 with children's anxiety disorders at age 9. Among children whose parents reported having had higher childhood BI, those who exhibited high BI at age 3 were more likely to meet criteria for anxiety disorders at age 9.

LIMITATIONS

The major limitation is the use of a retrospective measure of parental BI.

CONCLUSIONS

These findings demonstrate that parents' histories of childhood BI moderate the association between their young children's BI and subsequent anxiety disorders. Thus, parental BI appears to identify a subgroup of BI children at particularly high risk for developing anxiety disorders by late childhood.

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.

The aetiology and maintenance of social anxiety disorder: A synthesis of complimentary theoretical models and formulation of a new integrated model

BACKGROUND

Within maintenance models of social anxiety disorder (SAD), a number of cognitive and behavioural factors that drive the persistence of SAD have been proposed. However, these maintenance models do not address how SAD develops, or the origins of the proposed maintaining factors. There are also models of the development of SAD that have been proposed independently from maintenance models. These models highlight multiple factors that contribute risk to the onset of SAD, but do not address how these aetiological factors may lead to the development of the maintaining factors associated with SAD.

METHODS

A systematic review of the literature was conducted to identify aetiological and maintenance models of SAD. We then united key factors identified in these models and formulated an integrated aetiological and maintenance (IAM) model of SAD. A systematic review of the literature was then conducted on the components of the IAM model.

RESULTS

A number of aetiological and maintaining factors were identified in models of SAD. These factors could be drawn together into the IAM model. On balance, there is empirical evidence for the association of each of the factors in the IAM model with social anxiety or SAD, providing preliminary support for the model.

LIMITATIONS

There are relationships between components of the IAM model that require empirical attention. Future research will need to continue to test the IAM model.

CONCLUSIONS

The IAM model provides a framework for future investigations into the development and persistence of SAD.

[Attachment Patterns and their Relation to the Development of Anxiety Symptoms in Childhood and Adolescence]

From the perspective of attachment theory, insecure attachment can be seen as a key risk factor for the development of anxiety symptoms and anxiety disorders. This systematic review addresses the current state of empirical research on the relationship between attachment status and anxiety symptoms respective anxiety disorders in childhood and adolescence. 21 current international studies published between 2010 and 2014 were included in this systematic review. These studies were heterogeneous in target populations, methods and study design. The majority of studies supported the assumed correlation between insecure attachment and anxiety symptoms or anxiety disorders. These findings are more evident in studies with school-age children than with preschool children or adolescents. Furthermore, the disorganized-disoriented type of attachment seems to be a particular risk factor for the development of anxiety symptoms and anxiety disorders. Results were discussed in relation to attachment theory and with reference to the results of previous relevant reviews.

Stressful Life Events and Child Anxiety: Examining Parent and Child Mediators

While a number of factors have been linked with excessive anxiety (e.g., parenting, child temperament), the impact of stressful life events remains under-studied. Moreover, much of this literature has examined bivariate associations rather than testing more complex theoretical models. The current study extends the literature on life events and child anxiety by testing a theory-driven meditational model. Specifically, one child factor (child cognitions/locus of control), two parent factors (parent psychopathology and parenting stress), and two parent-child relationship factors (parent-child dysfunctional interaction and parenting style) were examined as mediators in the relationship between stressful life events and severity of child anxiety. One hundred and thirty anxious parents and their nonanxious, high-risk children (ages ranged from 7 to 13 years) participated in this study. Results indicated that levels of parenting stress, parental anxious rearing, and dysfunctional parent-child interaction mediated the association between stressful life events and severity of anxiety symptoms. Child cognition and parent psychopathology factors failed to emerge as mediators. Findings provide support for more complex theoretical models linking life events and child anxiety and suggest potential targets of intervention.

Störungstypische Erziehungsfaktoren bei Aufmerksamkeits- und Angststörungen im Kindes- und Jugendalter

Zusammenfassung. Theoretischer Hintergrund: Die Erziehungsfaktoren Negativität und Kontrolle werden sowohl im Zusammenhang mit der Aufmerksamkeits-Defizit-Hyperaktivitäts-Störung (ADHS) als auch mit Angststörungen (AS) diskutiert. Fragestellung: Unklar ist bislang, ob ADHS und AS gleichermaßen mit negativer Erziehung zusammenhängen oder ob verschiedene Erziehungsfaktoren bei den jeweiligen Störungsbildern eine störungstypische Rolle spielen. Methode: Einschlägige Studien aus dem Zeitraum von 1994 bis 2014 wurden systematisch analysiert. Neben generellen Zusammenhängen wurden moderierende Faktoren ermittelt. Ergebnisse: Während kindliche ADHS verstärkt mit elterlicher Negativität, zum Teil aber auch mit Kontrolle, assoziiert ist, zeigt sich bei kindlichen AS insbesondere ein Zusammenhang mit elterlicher Kontrolle. Die Ergebnisse werden von verschiedenen Faktoren wie Erhebungsmethode (Fragebogen vs. Beobachtung) und Medikation moderiert. Schlussfolgerungen: Störungstypische Zusammenhänge zwischen kindlicher Psychopathologie und Erziehungsfaktoren betonen die Relevanz gegenüberstellender Forschung von ADHS und AS und können Implikationen für eine störungsorientierte Psychotherapie haben.

Avoidance expression in rats as a function of signal-shock interval: strain and sex differences

Inbred Wistar Kyoto (WKY) rats express inhibited temperament, increased sensitivity to stress, and exaggerated expressions of avoidance. A long-standing observation for lever press escape/avoidance learning in rats is the duration of the warning signal (WS) determines whether avoidance is expressed over escape. Outbred female Sprague-Dawley (SD) rats trained with a 10-s WS efficiently escaped, but failed to exhibit avoidance; avoidance was exhibited to a high degree with WSs longer than 20-s. We examined this longstanding WS duration function and extended it to male SD and male and female WKY rats. A cross-over design with two WS durations (10 or 60 s) was employed. Rats were trained (20 trials/session) in four phases: acquisition (10 sessions), extinction (10 sessions), re-acquisition (8 sessions) and re-extinction (8 sessions). Consistent with the literature, female and male SD rats failed to express avoidance to an appreciable degree with a 10-s WS. When these rats were switched to a 60-s WS, performance levels in the initial session of training resembled the peak performance of rats trained with a 60-s WS. Therefore, the avoidance relationship was acquired, but not expressed at 10-s WS. Further, poor avoidance at 10-s does not adversely affect expression at 60-s. Failure to express avoidance with a 10-s WS likely reflects contrasting reinforcement value of avoidance, not a reduction in the amount of time available to respond or competing responses. In contrast, WKY rats exhibited robust avoidance with a 10-s WS, which was most apparent in female WKY rats. Exaggerated expression of avoidances by WKY rats, especially female rats, further confirms this inbred strain as a model of anxiety vulnerability.

Variations in the influence of parental socialization of anxiety among clinic referred children

This study examined the relations between parental socialization of child anxious behaviors (i.e., reinforcement, punishment, modeling, transmission of information) and child anxiety and related problems at varying child sensitivity levels. Data corresponding to 70 clinic-referred children (M age = 9.86 years; 50% girls; 49% Hispanic/Latino, 51% Caucasian) showed that for children with low (but not high) anxiety sensitivity, anxiety-related parental socialization behaviors were associated with more child anxiety and depression symptoms. Findings also indicated that parental socialization of anxious behaviors and anxiety sensitivity functioned similarly in the prediction of anxiety and depression across Caucasian and Hispanic/Latino children. There were no significant mean level variations across child sociodemographic characteristics in general, but anxiety-promoting parenting behaviors were twice as high in Hispanic/Latino compared to Caucasian families.

Preschool environment and temperament as predictors of social and nonsocial anxiety disorders in middle adolescence

OBJECTIVE

Of the few risk factors identified for the development of anxiety disorders, behavioral inhibition has received the strongest support. However, studies examining prediction of anxiety disorder from inhibition over time have not been extensive, and very few have assessed the impact of inhibition assessed early in life on anxiety in adolescence.

METHOD

The current study assessed 3 risk factors among 91 children when they were approximately 4 years of age, and determined anxiety diagnoses when the children were in midadolescence (mean age, 15 years). Children were included in the study at preschool age if they scored high (n = 57) or low (n = 34) on behavioral inhibition. Maternal anxiousness and maternal attitudes toward the child were assessed at the same time. Diagnoses at age 15 years were categorized as social anxiety disorder or other anxiety disorders.

RESULTS

Social anxiety disorder at age 15 years was predicted by both inhibition and maternal anxiousness at age 4 years, whereas other anxiety disorders were predicted only by maternal anxiousness. Almost 37% of inhibited preschool-aged children demonstrated social anxiety disorder at age 15, compared with 15% of uninhibited children.

CONCLUSIONS

The results support a growing body of research pointing to the importance of behavioral inhibition as a risk for social anxiety well into adolescence, and also highlight maternal anxiousness as a more general risk across anxiety disorders.

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.

Preschool predictors of childhood anxiety disorders: a prospective community study

BACKGROUND

Anxiety disorders are often present at preschool age. Research on older children and studies contrasting preschoolers with high versus low behavioral inhibition (BI) highlight several risk factors, but these have not been investigated in community samples of young children. Child, parent, and peer factors at age 4 were therefore examined as potential predictors of anxiety disorders at age 6.

METHODS

Two birth cohorts of 4-year olds living in the city of Trondheim, Norway, were screened for emotional and behavioral problems. A subsample oversampled for emotional and behavioral problems were drawn to take part in the study; 82.1% consented. Parents of 1000 children were interviewed with the Preschool Age Psychiatric Assessment and provided ratings of children's BI, victimization by peers and their own anxiety symptoms. Assessments of attachment and parent-child interaction were based on observation. Preschool teachers rated children's social competence. Children were reassessed after 2 years (N = 797).

RESULTS

High scores on BI, attention-deficient/hyperactivity disorder, parental anxiety, and peer victimization, along with low scores on social skills at age 4 collectively predicted anxiety disorders at age 6 after controlling for initial anxiety and other disorders. The effect of parental anxiety did only apply to children with high levels of BI. No effects of age-4 anxiety, gender, parenting, parental SES, divorce, peer acceptance, or attachment emerged.

CONCLUSIONS

Behavioral inhibition, parental anxiety, and peer victimization function as risk factors whereas high social competence may protect against anxiety disorders in young children.

Emotionsdysregulation im Kindesalter

Emotionsdysregulation wird im Kontext von Angststörungen und aggressivem Verhalten im Kindesalter erläutert; desweiteren werden entsprechende Hinweise auf die Autismus-Spektrum-Störungen gegeben. Verschiedene dysfunktionale Regulationsstrategien werden identifiziert. Neben der generellen Betrachtung von Emotionsdysregulation im Kontext der genannten Störungsbilder wird die Frage, ob und inwiefern es sich bei der Verwendung solch ungünstiger Strategien um einen störungsübergreifenden Faktor handelt, diskutiert.

Skittish, shielded, and scared: relations among behavioral inhibition, overprotective parenting, and anxiety in native and non-native Dutch preschool children

This study examined behavioral inhibition and overprotective parenting as correlates and predictors of anxiety disorder symptoms in preschoolers with a multi-cultural background (N=168). Parents of 3- to 6-year-old children completed a set of questionnaires twice, 12 months apart. Parents were also interviewed with the Anxiety Disorders Interview Schedule for DSM-IV at the 12-month point to assess the clinical severity of children's anxiety symptoms. Behavioral inhibition consistently emerged as a significant concurrent correlate of anxiety symptoms and this was particularly true for social anxiety symptoms. Overprotective parenting also emerged as a significant correlate of anxiety, but only in the case of non-social anxiety symptoms and mainly in non-native Dutch children. Prospective analyses revealed that behavioral inhibition was a significant predictor of social anxiety symptoms, while overprotective parenting did not explain significant variance in the development of children's anxiety over time. The support for an interactive effect of behavioral inhibition and overprotective parenting was unconvincing. Finally, it was found that children who exhibited stable high levels of behavioral inhibition throughout the study ran the greatest risk for developing an anxiety disorder.

Future directions in the study of social relationships as regulators of the HPA axis across development

Many promising findings support the notion that social relationships can dampen hypothalamic-pituitary-adrenocortical (HPA) axis stress responses and protect individuals from maladaptive psychological and physical disease states. Despite the public health relevance of this topic, little is known about developmental changes in the social regulation of the HPA system, with most prior research having focused on early childhood and adulthood. This gap is particularly striking with regards to adolescence, an age period when it seems likely that reliance on parents as sources of stress-buffering decreases, even as the security of friends and relationship partners as stress buffers may not yet be certain. Furthermore, we speculate that early life stress or abnormal social experiences may impact the propensity to draw mental and physical health benefits from social relationships, but more empirical support for these ideas is needed. Last, research linking social support to cumulative life stress has mostly relied on self-report measures of stress, making it difficult to show that social support impacts the type of chronic stress exposure that is associated with increased allostatic load or "wear and tear" on the body and on psychological functioning. Recent advancements in methodology (e.g., assessing hair cortisol levels) as well as composite measures of allostatic load using biomarkers that capture the activity of multiple neuroendocrine, cardiovascular, immune, and metabolic systems will allow us to ask new questions about the extent to which social relationships can impact cumulative life stress and health.

Maternal over-control moderates the association between early childhood behavioral inhibition and adolescent social anxiety symptoms

Behavioral inhibition (BI) and maternal over-control are early risk factors for later childhood internalizing problems, particularly social anxiety disorder (SAD). Consistently high BI across childhood appears to confer risk for the onset of SAD by adolescence. However, no prior studies have prospectively examined observed maternal over-control as a risk factor for adolescent social anxiety (SA) among children initially selected for BI. The present prospective longitudinal study examines the direct and indirect relations between these early risk factors and adolescent SA symptoms and SAD, using a multi-method approach. The sample consisted of 176 participants initially recruited as infants and assessed for temperamental reactivity to novel stimuli at age 4 months. BI was measured via observations and parent-report across multiple assessments between the ages of 14 months and 7 years. Maternal over-control was assessed observationally during parent-child interaction tasks at 7 years. Adolescents (ages 14-17 years) and parents provided independent reports of adolescent SA symptoms. Results indicated that higher maternal over-control at 7 years predicted higher SA symptoms and lifetime rates of SAD during adolescence. Additionally, there was a significant interaction between consistently high BI and maternal over-control, such that patterns of consistently high BI predicted higher adolescent SA symptoms in the presence of high maternal over-control. High BI across childhood was not significantly associated with adolescent SA symptoms when children experienced low maternal over-control. These findings have the potential to inform prevention and early intervention programs by identifying particularly at-risk youth and specific targets of treatment.