Behavioral inhibition and risk for developing social anxiety disorder: a meta-analytic study

Implementing mobile eye tracking in psychological research: A practical guide

Eye tracking provides direct, temporally and spatially sensitive measures of eye gaze. It can capture visual attention patterns from infancy through adulthood. However, commonly used screen-based eye tracking (SET) paradigms are limited in their depiction of how individuals process information as they interact with the environment in "real life". Mobile eye tracking (MET) records participant-perspective gaze in the context of active behavior. Recent technological developments in MET hardware enable researchers to capture egocentric vision as early as infancy and across the lifespan. However, challenges remain in MET data collection, processing, and analysis. The present paper aims to provide an introduction and practical guide to starting researchers in the field to facilitate the use of MET in psychological research with a wide range of age groups. First, we provide a general introduction to MET. Next, we briefly review MET studies in adults and children that provide new insights into attention and its roles in cognitive and socioemotional functioning. We then discuss technical issues relating to MET data collection and provide guidelines for data quality inspection, gaze annotations, data visualization, and statistical analyses. Lastly, we conclude by discussing the future directions of MET implementation. Open-source programs for MET data quality inspection, data visualization, and analysis are shared publicly.

Symptoms of Selective Mutism in Middle Childhood: Psychopathological and Temperament Correlates in Non-clinical and Clinically Referred 6- to 12-year-old Children

The purpose of this study was to study psychopathological and temperamental correlates of selective mutism (SM) (symptoms) in a mixed sample of non-clinical (n = 127) and clinically referred (n = 42, of whom 25 displayed the selective non-speaking behavior that is prototypical for SM) 6- to 12-year-old children. Parents completed questionnaires to measure their child's symptom levels of selective mutism, social anxiety, autism spectrum disorder, and the temperament trait of behavioral inhibition. The results first and foremost showed that SM symptoms were clearly linked to social anxiety and an anxiety-prone temperament (behavioral inhibition), but findings also suggested that autism spectrum problems are involved in the selective non-speaking behavior of children. While the latter result should be interpreted with caution given the methodological shortcomings of this study, findings align well with the notion that SM is a heterogeneous psychiatric condition and that clinical assessment and treatment need to take this diversity into account.

Genetic Vulnerability to Social Anxiety Disorder

Most anxiety disorders 'run within families': people suffering from an anxiety disorder often have family members who are highly anxious as well. In this chapter, we explore recent work devoted to unraveling the complex interplay between genes and environment in the development of anxiety. We review studies focusing on the genetic vulnerability to develop social anxiety disorder (SAD), as SAD is one of the most prevalent anxiety disorders, with an early onset, a chronic course, and associated with significant life-long impairments. More insight into the development of SAD is thus of uttermost importance.First, we will discuss family studies, twin studies, and large-sized population-based registry studies and explain what these studies can reveal about the genetic vulnerability to develop anxiety. Next, we describe the endophenotype approach; in this context, we will summarize results from the Leiden Family Lab study on Social Anxiety Disorder. Subsequently, we review the relationship between the heritable trait 'behavioral inhibition' and the development of SAD, and highlight the relevance of this work for the development and improvement of preventative and therapeutic interventions for socially anxious youth.

Neonatal neural responses to novelty related to behavioral inhibition at 1 year

Behavioral inhibition (BI), an early-life temperament characterized by vigilant responses to novelty, is a risk factor for anxiety disorders. In this study, we investigated whether differences in neonatal brain responses to infrequent auditory stimuli relate to children's BI at 1 year of age. Using functional magnetic resonance imaging (fMRI), we collected blood-oxygen-level-dependent (BOLD) data from N = 45 full-term, sleeping neonates during an adapted auditory oddball paradigm and measured BI from n = 27 of these children 1 year later using an observational assessment. Whole-brain analyses corrected for multiple comparisons identified 46 neonatal brain regions producing novelty-evoked BOLD responses associated with children's BI scores at 1 year of age. More than half of these regions (n = 24, 52%) were in prefrontal cortex, falling primarily within regions of the default mode or frontoparietal networks or in ventromedial/orbitofrontal regions without network assignments. Hierarchical clustering of the regions based on their patterns of association with BI resulted in two groups with distinct anatomical, network, and response-timing profiles. The first group, located primarily in subcortical and temporal regions, tended to produce larger early oddball responses among infants with lower subsequent BI. The second group, located primarily in prefrontal cortex, produced larger early oddball responses among infants with higher subsequent BI. These results provide preliminary insights into brain regions engaged by novelty in infants that may relate to later BI. The findings may inform understanding of anxiety disorders and guide future research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Categorical and latent profile approaches to temperamental infant reactivity and early trajectories of socioemotional adjustment

This article examines the patterns, and consequences, of infant temperamental reactivity to novel sensory input in a large (N = 357; 271 in current analysis) and diverse longitudinal sample through two approaches. First, we examined profiles of reactivity in 4-month-old infants using the traditional theory-driven analytic approach laid out by Jerome Kagan and colleagues, and derived groups characterized by extreme patterns of negative reactivity and positive reactivity. We then used a theory-neutral, data-driven approach to create latent profiles of reactivity from the same infants. Despite differences in sample characteristics and recruitment strategy, we noted similar reactivity groups relative to prior cohorts. The current data-driven approach found four profiles: high positive, high negative, high motor, and low reactive. Follow-up analyses found differential predictions of internalizing, externalizing, dysregulation, and competence trajectories across 12, 18, and 24 months of life based on 4-month reactivity profiles. Findings are discussed in light of the initial formulation of early reactivity by Kagan and the four decades of research that has followed to refine, bolster, and expand on this approach to child-centered individual differences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Role of Parental Verbal Threat Information in Children's Fear Acquisition: A Systematic Review and Meta-analysis

Children can acquire fears of novel stimuli as a result of listening to parental verbal threat information about these stimuli (i.e., instructional learning). While empirical studies have shown that learning via parental information occurs, the effect size of parental verbal threat information on child fear of a novel stimulus has not yet been measured in a meta-analysis. We conducted a systematic review and meta analysis to assess the effect of parents' verbal statements on their children's fear acquisition. Additionally, we explored potential moderators of this effect, namely, parent and child anxiety levels, as well as child age. WebOfScience, Pubmed, Medline, and PsycINFO were used to identify eligible studies that assessed children's (30 months to 18 years old) fear of novel stimuli after being exposed to parental verbal threat information. We selected 17 studies for the meta-analysis and 18 for the systematic review. The meta-analysis revealed a significant causal effect of parental verbal threat information on children's fear reaction towards novel stimuli [g = 1.26]. No evidence was found for a moderation of verbal learning effects, neither by child or parent anxiety levels nor by child age. The effect of parents' verbal threat information on children's fear of novel stimuli is large and not dependent on anxiety levels or child age.

Parenting as a Moderator of the Relation Between Child Inhibited Temperament and Anxiety in Western Contexts: A Systematic Review

The literature on the role of parenting in the relation between child inhibited temperament and child anxiety is inconsistent, with some literature supporting a moderating role and some literature supporting alternative (e.g., mediating) roles. A systematic review of the evidence that parenting moderates the longitudinal relation between child inhibited temperament and child anxiety is needed. A systematic review of the literature was conducted in February and March of 2022 and repeated in January of 2024. Ten articles met criteria for inclusion, with 39 moderation analyses of interest among them. All included studies were conducted in Western contexts with predominately White, middle-class families. Thus, the current review can only be generalized to this population. Despite inconsistent findings, some evidence indicated that avoidance-promoting parenting behaviors such as overprotection and overinvolvement moderate the relation between child inhibited temperament and social anxiety symptoms, in particular. There was a lack of evidence that parenting behaviors moderate the relation between child inhibited temperament and anxiety disorders, and that affect-related parenting behaviors (e.g., negativity) moderate the relation between child inhibited temperament and non-social anxiety symptoms. There was mixed evidence regarding the moderating role of control-related parenting behaviors in the relation between child inhibited temperament and non-social anxiety symptoms, with some evidence that encouraging behaviors moderate this relation. Future research is needed to clarify these inconsistent and nuanced findings and investigate this moderation in non-Western, non-White, and low-income populations.

"Nobody Here Likes Her"-The Impact of Parental Verbal Threat Information on Children's Fear of Strangers

Parental verbal threat (vs. safety) information about strangers may induce fears of these strangers in adolescents. In this multi-method experimental study, utilizing a within-subject design, parents provided standardized verbal threat or safety information to their offspring (N = 77, Mage = 11.62 years, 42 girls) regarding two strangers in the lab. We also explored whether the impact of parental verbal threat information differs depending on the social anxiety levels of parents or fearful temperaments of adolescents. Adolescent's fear of strangers during social interaction tasks was assessed using cognitive (fear beliefs, attention bias), behavioral (observed avoidance and anxiety), and physiological (heart rate) indices. We also explored whether the impact of parental verbal threat information differs depending on the social anxiety levels of parents or fearful temperaments of adolescents. The findings suggest that a single exposure to parental verbal threat (vs. safety) information increased adolescent's self-reported fears about the strangers but did not increase their fearful behaviors, heart rate, or attentional bias. Furthermore, adolescents of parents with higher social anxiety levels or adolescents with fearful temperaments were not more strongly impacted by parental verbal threat information. Longitudinal research and studies investigating parents' naturalistic verbal expressions of threat are needed to expand our understanding of this potential verbal fear-learning pathway.

Behavioral Inhibition and Social Anxiety Disorder as Predictors of Long-Term Outcomes of Cognitive Behavioral Therapy for Youth Anxiety Disorders

The temperamental trait behavioral inhibition (BI) is related to the development and maintenance of anxiety, particularly much so to social anxiety disorder. We investigated if BI and social anxiety disorder predicted cognitive behavioral therapy (CBT) outcomes for youth anxiety. Youth (N = 179; Mage = 11.6 years) were assessed 4 years following a randomized controlled CBT effectiveness trial. BI was measured by the parent-reported Behavioral Inhibition Questionnaire at baseline. The outcomes were diagnostic recovery, youth- and parent-reported anxiety symptoms, and clinical severity at post-treatment, 1-year, and 4-year follow-up. Having social anxiety disorder negatively predicted diagnostic recovery and predicted higher clinical severity at all assessment points and was the only significant predictor of outcomes at 4-year follow-up. Higher BI negatively predicted diagnostic recovery and predicted higher clinical severity and parent-reported symptom levels at post-treatment and 1-year follow-up, and predicted higher youth-reported anxiety levels at 1-year follow-up. Higher BI was the only predictor of youth- and parent-reported anxiety symptoms. BI and social anxiety disorder seem to be unique predictors of CBT outcomes among youth with anxiety disorders. CBT adaptations may be indicated for youth with high BI and social anxiety disorder.

Association between maternal employment and the child´s mental health: a systematic review with meta-analysis

The recent rise in maternal workforce participation has led to more research regarding the role of maternal employment for (early) childhood mental health. This systematic review with meta-analysis covers new evidence on the association of both variables. A systematic literature search was conducted. Studies had to compare children 0-7 years of age on the basis of their mothers' employment status, working amount, employment duration, i.e., how long the mother had been back at work after birth, or timing of return to work. Child mental health was operationalized as behavior problems and prosocial behavior. Narrative and meta-analytic syntheses of evidence were conducted. Maternal employment was associated with more conduct problems but less internalizing behavior problems and anxious/depressed behavior in children; full-time employment was linked to more externalizing behavior problems and more hyperactivity/inattention. Longer employment duration was related to less (internalizing) behavior problems and more prosocial behavior but also more externalizing behavior problems. Narrative syntheses indicated early maternal return to work to be associated with more child externalizing behavior problems and less prosocial behavior. Whether maternal employment is associated with child mental health strongly depends on both variables' operationalization. Especially part-time employment, longer employment duration, and return to work only after the first year postpartum may be beneficial for child mental health. Practical implications pertain to an expanded offer of family leave and the endorsement of maternal employment after the first year postpartum. Here, factors that may buffer the negative associations with full-time employment warrant consideration.

Risk factor patterns define social anxiety subtypes in adolescents with brain and clinical feature differences

Social anxiety disorder (SAD) is one of the most common psychiatric disorders in adolescents. The heterogeneity of both symptoms and etiology is an essential source of difficulties in the treatment and prevention of SAD. The study aimed to identify subtypes of adolescent SAD based on etiology-related phenotype dimensions and examine symptom and brain associations of the subtypes. We used a deeply phenotyped sample (47 phenotype subscales from 13 measures) of adolescents with SAD (n = 196) and healthy controls (n = 109) to extract etiology-relevant risk factors, based on which we identified subtypes of SAD. We compared the subtypes on clinical characteristics and brain morphometrics and functional connectivity, and examined subtype-specific links between risk factors, brain aberrance, and clinical characteristics. We identified six etiology-relevant risk factors and two subtypes of adolescent SAD. One subtype showed mainly elevated negative emotionality trait and coping style and diminished positive emotionality trait and coping style, while the other additionally had significantly high environmental risk factors, more severe impairments in social functioning, and significant abnormalities in brain structure and function. There were subtype-specific links between the risk factor profiles, brain aberrance, and clinical characteristics. The finding suggests two etiology-based subtypes of adolescent SAD, providing novel insights to the diversity of pathological pathways and precise intervention strategies.

Altered mechanisms of adaptation in social anxiety: differences in adapting to positive versus negative emotional faces

Social anxiety is characterised by fear of negative evaluation and negative perceptual biases; however, the cognitive mechanisms underlying these negative biases are not well understood. We investigated a possible mechanism which could maintain negative biases: altered adaptation to emotional faces. Heightened sensitivity to negative emotions could result from weakened adaptation to negative emotions, strengthened adaptation to positive emotions, or both mechanisms. We measured adaptation from repeated exposure to either positive or negative emotional faces, in individuals high versus low in social anxiety. We quantified adaptation strength by calculating the point of subjective equality (PSE) before and after adaptation for each participant. We hypothesised: (1) weaker adaptation to angry vs happy faces in individuals high in social anxiety, (2) no difference in adaptation to angry vs happy faces in individuals low in social anxiety, and (3) no difference in adaptation to sad vs happy faces in individuals high in social anxiety. Our results revealed a weaker adaptation to angry compared to happy faces in individuals high in social anxiety (Experiment 1), with no such difference in individuals low in social anxiety (Experiment 1), and no difference in adaptation strength to sad vs happy faces in individuals high in social anxiety (Experiment 2).

Mediation Effects of Group Cohesion in Group-Based Cognitive Behavioral Therapy for Youth Anxiety Disorders

There is limited research on group cohesion as a potential outcome facilitator in group-based cognitive-behavioral treatment (GCBT) for youth. We examined if group cohesion mediated the relation between the temperamental trait behavioral inhibition and posttreatment outcomes following GCBT for youth with anxiety disorders. The sample comprised 88 youth (M age = 11.2 years) from a randomized controlled effectiveness trial. The outcomes were posttreatment clinical severity and treatment satisfaction. Group cohesion fully mediated the relation between behavioral inhibition and posttreatment severity. Higher group cohesion was associated with lower posttreatment clinical severity. There was no significant association between behavioral inhibition and treatment satisfaction, hence no mediation. We conclude that group cohesion is a factor that can be targeted by clinicians to potentially enhance GCBT outcomes.

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.

Intergenerational transmission of maternal prenatal anxiety to infant fearfulness: the mediating role of mother-infant bonding

PURPOSE

This study is the first to directly investigate the mechanistic role of maternal bonding toward her infant in the early intergenerational pathway of risk from maternal anxiety to infant fearfulness.

METHODS

Mothers (N = 216; Mage=32.78) reported on their anxiety and bonding at four time-points between pregnancy and ten-months postpartum. At four and ten-months postpartum, infant temperamental precursors of anxiety were assessed through maternal report and observation.

RESULTS

Cross-lagged longitudinal path modeling indicated a significant link between prenatal maternal anxiety and infant temperamental fearful withdrawal at 10-months postpartum (R2 = 0.117), which was fully explained by decreased maternal bonding at one-month postpartum and increased infant temperamental negative reactivity at 4-months postpartum.

CONCLUSION

Results support the need to foster maternal bonding in preventive perinatal care, particularly in the context of maternal anxiety.

Androgen regulation of behavioral stress responses and the hypothalamic-pituitary-adrenal axis

Testosterone is a powerful steroid hormone that can impact the brain and behavior in various ways, including regulating behavioral and neuroendocrine (hypothalamic-pituitary-adrenal (HPA) axis) stress responses. Early in life androgens can act to alter development of brain regions associated with stress regulation, which ultimately impacts the display of stress responses later in life. Adult circulating androgens can also influence the expression of distinct genes and proteins that regulate stress responses. These changes in the brain are hypothesized to underlie the potent effects of androgens in regulating behaviors related to stress and stress-induced activation of the HPA axis. Androgens can induce alterations in these functions through direct binding to the androgen receptor (AR) or following conversion to estrogens and subsequent binding to estrogen receptors including estrogen receptor alpha (ERα), beta (ERβ), and G protein-coupled estrogen receptor 1 (GPER1). In this review, we focus on the role of androgens in regulating behavioral and neuroendocrine stress responses at different stages of the lifespan and the sex hormone receptors involved in regulating these effects. We also review the specific brain regions and cell phenotypes upon which androgens are proposed to act to regulate stress responses with an emphasis on hypothalamic and extended amygdala subregions. This knowledge of androgen effects on these neural systems is critical for understanding how sex hormones regulate stress responses.

The Role of Executive Function at 6 Years in the Association between Behavioral Inhibition at 5 Years and Anxiety at 7 Years

EF skills play a central role in the etiology and maintenance of anxiety, but it is unclear whether they act as moderators or mediators in the relation between early behavioral inhibition (BI) and later anxiety. The current study tested two models by examining whether two executive functions (EF) skills (cognitive flexibility and working memory) assessed at age 6 acted as moderators or mediators in the relation between BI at 5 years and anxiety symptoms at 7 years. The sample consisted of 422 children from the Quebec Longitudinal Study of Child Development. We tested the moderation model, main and interaction effects using hierarchical multiple regression analyses and the mediation model with the product of coefficients test. Results showed that higher BI at 5 years predicted high anxiety at 7 years only at low levels of cognitive flexibility or working memory at 6 years. This suggests that high levels of cognitive flexibility or working memory at 6 years may act as protective factors. In contrast, neither cognitive flexibility nor working memory at age 6 acted as mediators in the association between BI at 5 years and anxiety at 7 years. Results support the hypothesis that goal-driven cognitive control processes act as moderators and promote adaptive functioning by dampening the effect of early BI on later anxiety.

Adolescent social anxiety is associated with diminished discrimination of anticipated threat and safety in the bed nucleus of the stria terminalis

Social anxiety-which typically emerges in adolescence-lies on a continuum and, when extreme, can be devastating. Socially anxious individuals are prone to heightened fear, anxiety, and the avoidance of contexts associated with potential social scrutiny. Yet most neuroimaging research has focused on acute social threat. Much less attention has been devoted to understanding the neural systems recruited during the uncertain anticipation of potential encounters with social threat. Here we used a novel fMRI paradigm to probe the neural circuitry engaged during the anticipation and acute presentation of threatening faces and voices in a racially diverse sample of 66 adolescents selectively recruited to encompass a range of social anxiety and enriched for clinically significant levels of distress and impairment. Results demonstrated that adolescents with more severe social anxiety symptoms experience heightened distress when anticipating encounters with social threat, and reduced discrimination of uncertain social threat and safety in the bed nucleus of the stria terminalis (BST), a key division of the central extended amygdala (EAc). Although the EAc-including the BST and central nucleus of the amygdala-was robustly engaged by the acute presentation of threatening faces and voices, the degree of EAc engagement was unrelated to the severity of social anxiety. Together, these observations provide a neurobiologically grounded framework for conceptualizing adolescent social anxiety and set the stage for the kinds of prospective-longitudinal and mechanistic research that will be necessary to determine causation and, ultimately, to develop improved interventions for this often-debilitating illness.

Maternal mental health mediates the effect of prenatal stress on infant temperament: The Harvey Mom Study

Prenatal maternal stress and mental health problems are known to increase risk for developmental psychopathology in offspring, yet pathways leading to risk or resiliency are poorly understood. In a quasi-experimental design, we prospectively examined associations between disaster-related prenatal stress, maternal mental health symptoms, and infant temperament outcomes. Mothers who were pregnant during Hurricane Harvey (N = 527) reported on objective hardships (e.g., loss of belongings or income, evacuation, home flooding) related to the storm and subsequent mental health symptoms (anxiety/depression, posttraumatic stress) across time. At a postpartum assessment, mothers reported on their infant's temperament (negative affect, positive affect, orienting/regulatory capacity). Greater objective hardship indirectly predicted higher levels of infant orienting/regulatory capacity through its association with increased maternal posttraumatic stress symptoms. Greater objective hardship also indirectly predicted higher levels of infant negative affect through its association with increased maternal anxiety/depression symptoms across time. Our findings suggest a psychological mechanism linking prenatal stress with specific temperamental characteristics via maternal mental health symptoms. Findings point to the importance of high-quality assessment and mental health services for vulnerable women and young children.

Higher Intersubject Variability in Neural Response to Narrative Social Stimuli Among Youth With Higher Social Anxiety

OBJECTIVE

Social anxiety is associated with alterations in socioemotional processing, but the pathophysiology remains poorly understood. Movies present an opportunity to examine more naturalistic socioemotional processing by providing narrative and sensory context to emotion cues. This study aimed to characterize associations between neural response to contextualized social cues and social anxiety symptoms in children.

METHOD

Data from the Healthy Brain Network (final N = 740; age range 5-15 years) were split into discovery and replication samples to maximize generalizability of findings. Associations of parent- and self-reported social anxiety (Screen for Child Anxiety-related Emotional Disorders) with mean differences and person-to-person variability in functional magnetic resonance imaging-measured activation to 2 emotionally dynamic movies were characterized.

RESULTS

Though no evidence was found to indicate social anxiety symptoms were associated with mean differences in neural activity to emotional content (fit Spearman rs < 0.09), children with high social anxiety symptoms had higher intersubject activation variability in the posterior cingulate, supramarginal gyrus, and inferior frontal gyrus (Bonferroni familywise error-corrected ps < .05)-regions associated with attention, alertness, and emotion cue processing. Identified regions varied by age group and informant. Across ages, these effects were enhanced for scenes containing greater sensory intensity (brighter, louder, more motion, more vibrance).

CONCLUSION

These results provide evidence that children with high social anxiety symptoms show high person-to-person variability in the neural processing of sensory aspects of emotional content. These data indicate that children with high social anxiety may require personalized interventions for sensory and emotional difficulties, as the underlying neurology differs from child to child.

DIVERSITY & INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.

Understanding the heterogeneity of anxiety using a translational neuroscience approach

Anxiety disorders affect millions of people worldwide and present a challenge in neuroscience research because of their substantial heterogeneity in clinical presentation. While a great deal of progress has been made in understanding the neurobiology of fear and anxiety, these insights have not led to effective treatments. Understanding the relationship between phenotypic heterogeneity and the underlying biology is a critical first step in solving this problem. We show translation, reverse translation, and computational modeling can contribute to a refined, cross-species understanding of fear and anxiety as well as anxiety disorders. More specifically, we outline how animal models can be leveraged to develop testable hypotheses in humans by using targeted, cross-species approaches and ethologically informed behavioral paradigms. We discuss reverse translational approaches that can guide and prioritize animal research in nontraditional research species. Finally, we advocate for the use of computational models to harmonize cross-species and cross-methodology research into anxiety. Together, this translational neuroscience approach will help to bridge the widening gap between how we currently conceptualize and diagnose anxiety disorders, as well as aid in the discovery of better treatments for these conditions.

Interactions among stress, behavioral inhibition, and delta-beta coupling predict adolescent anxiety during the COVID-19 pandemic

The COVID-19 pandemic brought about unprecedented changes and uncertainty to the daily lives of youth. The range of adjustment in light of a near-universal experience of COVID restrictions highlights the importance of identifying factors that may render some individuals more susceptible to heightened levels of anxiety during stressful life events than others. Two risk factors to consider are temperamental behavioral inhibition (BI) and difficulties in emotion regulation (ER). As such, the current paper focused on BI examined prior to COVID, because of its developmental link to anxiety and ER, as difficulties may be associated with differences in anxiety. We examined a neurocognitive marker of ER processes, delta-beta coupling (DBC). The current paper had two goals: (1) to examine BI in relation to COVID-related worry and social anxiety experienced during the pandemic, and (2) to explore the role of individual differences in early DBC in the relationship between BI and anxiety outcomes 6 months apart during COVID-19 (n = 86; T1 Mage  = 15.95, SD = 1.73; T6 Mage  = 16.43, SD = 1.73). We found support for the moderating role of DBC in the relationship between BI levels and social anxiety disorder (SAD) symptom severity during the pandemic. Here, high BI was predictive of increased SAD symptom levels in adolescents with stronger DBC.

Rhesus infant nervous temperament predicts peri-adolescent central amygdala metabolism & behavioral inhibition measured by a machine-learning approach

Anxiety disorders affect millions of people worldwide and impair health, happiness, and productivity on a massive scale. Developmental research points to a connection between early-life behavioral inhibition and the eventual development of these disorders. Our group has previously shown that measures of behavioral inhibition in young rhesus monkeys (Macaca mulatta) predict anxiety-like behavior later in life. In recent years, clinical and basic researchers have implicated the central extended amygdala (EAc)-a neuroanatomical concept that includes the central nucleus of the amygdala (Ce) and the bed nucleus of the stria terminalis (BST)-as a key neural substrate for the expression of anxious and inhibited behavior. An improved understanding of how early-life behavioral inhibition relates to an increased lifetime risk of anxiety disorders-and how this relationship is mediated by alterations in the EAc-could lead to improved treatments and preventive strategies. In this study, we explored the relationships between infant behavioral inhibition and peri-adolescent defensive behavior and brain metabolism in 18 female rhesus monkeys. We coupled a mildly threatening behavioral assay with concurrent multimodal neuroimaging, and related those findings to various measures of infant temperament. To score the behavioral assay, we developed and validated UC-Freeze, a semi-automated machine-learning (ML) tool that uses unsupervised clustering to quantify freezing. Consistent with previous work, we found that heightened Ce metabolism predicted elevated defensive behavior (i.e., more freezing) in the presence of an unfamiliar human intruder. Although we found no link between infant-inhibited temperament and peri-adolescent EAc metabolism or defensive behavior, we did identify infant nervous temperament as a significant predictor of peri-adolescent defensive behavior. Our findings suggest a connection between infant nervous temperament and the eventual development of anxiety and depressive disorders. Moreover, our approach highlights the potential for ML tools to augment existing behavioral neuroscience methods.

In the anticipation of threat: Neural regulatory activity indicated by delta-beta correlation and its relation to anxiety

The anticipation of oncoming threats is emotionally challenging and related to anxiety. The current study aimed to investigate the neural regulatory processes during the anticipatory preparations in stressful situations in relation to trait anxiety, especially in an uncertainty-related stressful situation. To this end, we measured within-subjects delta-beta amplitude-amplitude correlation (AAC) and phase-amplitude coupling (PAC) with electroencephalography using a well-defined stress-inducing paradigm in 28 high-trait-anxiety (HTA) and 29 low-trait-anxiety (LTA) college students. Specifically, a threat probability task was conducted, where participants anticipated the future stimuli under the uncertain (i.e., an average of 50% electric shocks), certain (i.e., 100% electric shocks) and no threat conditions, as well as a resting state task. Results showed a generally larger delta-beta AAC in the LTA group relative to the HTA group across conditions, supporting the hypothesis that delta-beta AAC reflects the efficiency of stress regulation and trait anxiety could compromise this adaptive regulatory activity. Furthermore, a larger delta-beta PAC was found under the uncertain threat condition relative to the no threat condition, indicating the sensitivity of delta-beta PAC in reflecting state anxiety. These findings indicate that while delta-beta AAC is more related to trait anxiety and could distinguish between high and low trait anxiety irrespective of conditions, delta-beta PAC is more related to state anxiety and is sensitive enough to detect the uncertainty-related anxious state.

Children's shyness and early stages of emotional face processing

The ability to detect and recognize facial emotions emerges in childhood and is important for understanding social cues, but we know relatively little about how individual differences in temperament may influence early emotional face processing. We used a sample of 419 children (Mage = 10.57 years, SD = 1.75; 48% female; 77% White) to examine the relation between temperamental shyness and early stages of emotional face processing (assessed using the P100 and N170 event-related potentials) during different facial expressions (neutral, anger, fear, and happy). We found that higher temperamental shyness was related to greater P100 activation to faces expressing anger and fear relative to neutral faces. Further, lower temperamental shyness was related to greater N170 activation to faces expressing anger and fear relative to neutral faces. There were no relations between temperamental shyness and neural activation to happy faces relative to neutral faces for P100 or N170, suggesting specificity to faces signaling threat. We discuss findings in the context of understanding the early processing of facial emotional display of threat among shy children.

Current and Future Approaches to Pediatric Anxiety Disorder Treatment

This overview critically appraises the literature on the treatment of pediatric anxiety disorders. The two established treatments for these conditions comprise cognitive-behavioral therapy (CBT) and antidepressant medications. Many youths receiving these treatments fail to achieve remission, which creates a need for new treatments. After summarizing the literature on CBT and currently available medications, the authors describe research that lays a foundation for improvements in the treatment of pediatric anxiety disorders. This foundation leverages neuroscientific investigations, also described in the overview, which provide insights on mechanisms of successful treatment.

What's next for the field of multigenerational mental health? The need for deep behavioral phenotyping via a prenatal mental health registry

From its inception, development and psychopathology theorists have sought to uncover the earliest forms of risk for mental health challenges in children, to prevent the development of more severe, intractable manifestations of psychopathology. Large familial risk registries have advanced our understanding of early, potentially modifiable factors that could prevent or mitigate the expression of challenging symptoms of neurodevelopmental conditions, and similar registries have been proposed to advance understanding of ADHD and related phenotypes. Data from single-site studies, largely focused on perinatal exposure to maternal mood disorders, reveal that a robust predictor of child psychopathology is parental psychopathology. However, early developmental trajectories of psychopathology risk may be better captured using transdiagnostic approaches in pregnancy, capturing the full range of mental health symptoms. We describe here the need for a parental mental health registry that begins prenatally that includes deep behavioral phenotyping across a range of transdiagnostic indicators of mental health risk to prevent psychopathology in children. This registry has the potential to uncover pathways to psychopathology risk in childhood and support the discovery of novel mechanisms to be targeted for prevention and intervention.

Threat Responses in Schizophrenia: A Negative Valence Systems Framework

PURPOSE OF REVIEW

Emotions are prominent in theories and accounts of schizophrenia but are largely understudied compared to cognition. Utilizing the Research Domain Criteria (RDoC) Negative Valence Systems framework, we review the current knowledge of emotions in schizophrenia. Given the pivotal role of threat responses in theories of schizophrenia and the substantial evidence of altered threat responses, we focus on three components of Negative Valence Systems tied to threat responses: responses to acute threat, responses to potential threat, and sustained threat.

RECENT FINDINGS

Individuals with schizophrenia show altered responses to neutral stimuli during acute threat, bed nucleus of the stria terminalis connectivity in response to potential threat, and threat responses associated with sustained threat. Our review concludes that Negative Valence Systems are altered in schizophrenia; however, the level and evidence of alterations vary across the types of threat responses. We suggest avenues for future research to further understand and intervene on threat responses in schizophrenia.

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.

Anxiety symptoms and associated factors among school students after 2 years of the COVID-19 pandemic: a cross-sectional study in Zhejiang Province, China

OBJECTIVES

To ascertain the prevalence and associated factors of anxiety symptoms among middle and high school students in Zhejiang after 2 years of the COVID-19 pandemic.

DESIGN

A school-based cross-sectional study.

SETTING

30 counties/districts in Zhejiang Province, China.

PARTICIPANTS

27 019 students attending middle and high schools.

OUTCOME MEASURES

Anxiety symptoms were assessed using the Generalised Anxiety Disorder 7-item scale (GAD-7). A total score of 10 or more is considered indicative of anxiety symptoms.

RESULTS

The overall prevalence (95% CI) of anxiety symptoms was 14.2% (13.4 to 15.0), higher among girls (18.6%, 95% CI: 17.5 to 19.7) than boys (10.2%, 95% CI: 9.5 to 10.9) (p<0.001), higher among rural students (15.1%, 95% CI: 14.1 to 16.2) than urban students (12.5%, 95% CI: 11.6 to 13.4) (p<0.001). Older age (14-15 years, OR=1.25, 95% CI: 1.09 to 1.44; ≥16 years, OR=1.32, 95% CI: 1.07 to 1.63), being girls (OR=1.76, 95% CI: 1.58 to 1.96), living in rural areas (OR=1.14, 95%CI: 1.01 to 1.29), poor academic performance (OR=1.20, 95% CI: 1.03 to 1.41), alcohol drinking (OR=1.15, 95% CI: 1.01 to 1.30), inadequate fruits (OR=1.31, 95% CI: 1.19 to 1.45) and vegetables intake (OR=1.32, 95% CI: 1.10 to 1.57), insomnia (sometimes, OR=2.14, 95% CI: 1.93 to 2.38; often/always, OR=4.73, 95% CI: 4.03 to 5.56), loneliness (sometimes, OR=2.97, 95%CI: 2.59 to 3.41; often/always, OR=8.35, 95% CI: 7.20 to 9.69), sadness (OR=2.51, 95% CI: 2.25 to 2.79) and physical fight (OR=1.29, 95% CI: 1.13 to 1.48) were positively associated with anxiety symptoms, while studying at vocational high school (OR=0.61, 95% CI: 0.49 to 0.75), coming from family with middle income (OR=0.76, 95% CI: 0.64 to 0.89), being physically active 3-7 days weekly (OR=0.85, 95% CI: 0.75 to 0.95) were negatively associated with anxiety symptoms.

CONCLUSION

Anxiety symptoms prevailed among middle and high school students in China. A variety of factors, containing sociodemographic factors, lifestyle behaviours, mental health, academic performance and physical fight should be taken in consideration in addressing prevention and intervention of anxiety symptoms.

Gene expression in the primate orbitofrontal cortex related to anxious temperament

Anxiety disorders are among the most prevalent psychiatric disorders, causing significant suffering and disability. Relative to other psychiatric disorders, anxiety disorders tend to emerge early in life, supporting the importance of developmental mechanisms in their emergence and maintenance. Behavioral inhibition (BI) is a temperament that emerges early in life and, when stable and extreme, is linked to an increased risk for the later development of anxiety disorders and other stress-related psychopathology. Understanding the neural systems and molecular mechanisms underlying this dispositional risk could provide insight into treatment targets for anxiety disorders. Nonhuman primates (NHPs) have an anxiety-related temperament, called anxious temperament (AT), that is remarkably similar to BI in humans, facilitating the design of highly translational models for studying the early risk for stress-related psychopathology. Because of the recent evolutionary divergence between humans and NHPs, many of the anxiety-related brain regions that contribute to psychopathology are highly similar in terms of their structure and function, particularly with respect to the prefrontal cortex. The orbitofrontal cortex plays a critical role in the flexible encoding and regulation of threat responses, in part through connections with subcortical structures like the amygdala. Here, we explore individual differences in the transcriptional profile of cells within the region, using laser capture microdissection and single nuclear sequencing, providing insight into the molecules underlying individual differences in AT-related function of the pOFC, with a particular focus on previously implicated cellular systems, including neurotrophins and glucocorticoid signaling.

Testing reciprocal associations between child anxiety and parenting across early interventions for inhibited preschoolers

BACKGROUND

Given the robust evidence base for the efficacy of evidence-based treatments targeting youth anxiety, researchers have advanced beyond efficacy outcome analysis to identify mechanisms of change and treatment directionality. Grounded in developmental transactional models, interventions for young children at risk for anxiety by virtue of behaviorally inhibited temperament often target parenting and child factors implicated in the early emergence and maintenance of anxiety. In particular, overcontrolling parenting moderates risk for anxiety among highly inhibited children, just as child inhibition has been shown to elicit overcontrolling parenting. Although longitudinal research has elucidated the temporal unfolding of factors that interact to place inhibited children at risk for anxiety, reciprocal transactions between these child and parent factors in the context of early interventions remain unknown.

METHOD

This study addresses these gaps by examining mechanisms of change and treatment directionality (i.e., parent-to-child vs. child-to-parent influences) within a randomized controlled trial comparing two interventions for inhibited preschoolers (N = 151): the multicomponent Turtle Program ('Turtle') and the parent-only Cool Little Kids program ('CLK'). Reciprocal relations between parent-reported child anxiety, observed parenting, and parent-reported accommodation of child anxiety were examined across four timepoints: pre-, mid-, and post-treatment, and one-year follow-up (NCT02308826).

RESULTS

Hypotheses were tested via latent curve models with structured residuals (LCM-SR) and latent change score (LCS) models. LCM-SR results were consistent with the child-to-parent influences found in previous research on cognitive behavioral therapy (CBT) for older anxious youth, but only emerged in Turtle. LCS analyses revealed bidirectional effects of changes in parent accommodation and child anxiety during and after intervention, but only in Turtle.

CONCLUSION

Our findings coincide with developmental transactional models, suggesting that the development of child anxiety may result from child-to-parent influences rather than the reverse, and highlight the importance of targeting parent and child factors simultaneously in early interventions for young, inhibited children.

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.

Infant fearful distress, parent intrusiveness, and adversity in families experiencing homelessness

Infants experiencing homelessness face risk for developing mental health problems in the future. Parents residing in shelters experience adverse events at elevated rates compared to non-homeless individuals, which can impact their infants during a time of rapid development depending on how the parent copes. For some, trauma linked to these events may manifest in an intrusive parenting style that interferes with the child's developing capacity for self-regulation. We utilized a sample of 60 parent-infant dyads recruited while residing in emergency homeless shelters to evaluate associations among parents' history of adversity, intrusive parenting behaviors, and infants' fearful distress. Observed parent intrusiveness during a free play interaction was significantly associated with infant fearfulness observed in a separate behavioral task during which infants viewed a series of masks. Furthermore, there was a moderating effect for parent history of adversity such that the association between parent intrusiveness and infant fearful distress was stronger among parents with more past experiences of adversity.

Concurrent and prospective associations between infant frontoparietal and default mode network connectivity and negative affectivity

Emotion dysregulation is linked to differences in frontoparietal (FPN) and default mode (DMN) brain network functioning. These differences may be identifiable early in development. Temperamental negative affectivity has been identified as a precursor to later emotion dysregulation, though the underlying neurodevelopmental mechanism is unknown. The present study explores concurrent and prospective associations between FPN and DMN connectivity in infants and measures of negative affectivity. 72 infants underwent 5.03-13.28 min of resting state fMRI during natural sleep (M±SD age=4.90 ± 0.84 weeks; 54% male; usable data=9.92 ± 2.15 min). FPN and DMN intra- and internetwork connectivity were computed using adult network assignments. Crying was obtained from both parent-report and day-long audio recordings. Temperamental negative affectivity was obtained from a parent-report questionnaire. In this preregistered study, based on analyses conducted with a subset of this data (N = 32), we hypothesized that greater functional connectivity within and between FPN and DMN would be associated with greater negative affectivity. In the full sample we did not find support for these hypotheses. Instead, greater DMN intranetwork connectivity at age one month was associated with lower concurrent parent-reported crying and temperamental negative affectivity at age six months (ßs>-0.35, ps<.025), but not crying at age six months. DMN intranetwork connectivity was also negatively associated with internalizing symptoms at age eighteen-months (ß=-0.58, p = .012). FPN intra- and internetwork connectivity was not associated with negative affectivity measures after accounting for covariates. This work furthers a neurodevelopmental model of emotion dysregulation by suggesting that infant functional connectivity at rest is associated with later emotional functioning.

Developmental patterns of children's shyness: Relations with physiological, emotional, and regulatory responses to being treated unfairly

The dysregulation of social fear has been widely studied in children's shyness, but we know little about how shy children regulate during unfair treatment. We first characterized developmental patterns of children's shyness (N = 304, ngirls  = 153; 74% White, 26% Other) across 2 (Mage  = 2.07), 3 (Mage  = 3.08), 4 (Mage  = 4.08), and 6 (Mage  = 6.58) years of age. Data collection occurred from 2007 to 2014. At age 6, the high stable group had higher cardiac vagal withdrawal and lower expressed sadness and approach-related regulatory strategy than the low stable group when being treated unfairly. Although shy children may be more physiologically impacted by being treated unfairly, they may mask their sadness to signal appeasement.

Sexual differentiation of neural mechanisms of stress sensitivity during puberty

Anxiety disorders are a major public health concern and current treatments are inadequate for many individuals. Anxiety is more common in women than men and this difference arises during puberty. Sex differences in physiological stress responses may contribute to this variability. During puberty, gonadal hormones shape brain structure and function, but the extent to which these changes affect stress sensitivity is unknown. We examined how pubertal androgens shape behavioral and neural responses to social stress in California mice (Peromyscus californicus), a model species for studying sex differences in stress responses. In adults, social defeat reduces social approach and increases social vigilance in females but not males. We show this sex difference is absent in juveniles, and that prepubertal castration sensitizes adult males to social defeat. Adult gonadectomy does not alter behavioral responses to defeat, indicating that gonadal hormones act during puberty to program behavioral responses to stress in adulthood. Calcium imaging in the medioventral bed nucleus of the stria terminalis (BNST) showed that social threats increased neural activity and that prepubertal castration generalized these responses to less threatening social contexts. These results support recent hypotheses that the BNST responds to immediate threats. Prepubertal treatment with the nonaromatizable androgen dihydrotestosterone acts in males and females to reduce the effects of defeat on social approach and vigilance in adults. These data indicate that activation of androgen receptors during puberty is critical for programming behavioral responses to stress in adulthood.

Hispanic/Latinx ethnic differences in the relationships between behavioral inhibition, anxiety, and substance use in youth from the ABCD cohort

Introduction

Elevated levels of behavioral inhibition (BI) may connote risk for both anxiety and substance use disorders. BI has consistently been shown to be associated with increased levels of anxiety, while the association between BI and substance use has been mixed. It is possible that the relationship between BI and substance use varies by individual difference factors. Hispanic/Latinx (H/L) youth in particular may have stronger relationships between BI, anxiety, and substance use.

Methods

The present study therefore evaluated (1) the prospective relationships between BI [assessed via self-reported behavioral inhibition system (BIS) scale scores], anxiety, and substance use in youth (n = 11,876) across baseline, 1-, and 2-year follow-ups of the Adolescent Brain Cognitive Development (ABCD) Study (ages 9-12) and (2) whether these relationships differed by H/L ethnicity while covarying for average behavioral approach system scores, race, sex, age, highest parental income, highest parental education, and past-year substance use (for analyses involving substance use outcomes).

Results

Baseline levels of BIS scores predicted increased anxiety symptoms at both 1- and 2-year follow-ups and did not differ by H/L ethnicity. Baseline levels of BIS scores also prospectively predicted increased likelihood of substance use at 2-year follow-up, but only for H/L youth and not at 1-year follow-up.

Discussion

High scores on the BIS scale contribute risk to anxiety across ethnicities and may uniquely contribute to risk for substance use in H/L youth.

DREADD-mediated amygdala activation is sufficient to induce anxiety-like responses in young nonhuman primates

Anxiety disorders are among the most prevalent psychiatric disorders, with symptoms often beginning early in life. To model the pathophysiology of human pathological anxiety, we utilized Designer Receptors Exclusively Activated by Designer Drugs (DREADDs) in a nonhuman primate model of anxious temperament to selectively increase neuronal activity of the amygdala. Subjects included 10 young rhesus macaques; 5 received bilateral infusions of AAV5-hSyn-HA-hM3Dq into the dorsal amygdala, and 5 served as controls. Subjects underwent behavioral testing in the human intruder paradigm following clozapine or vehicle administration, prior to and following surgery. Behavioral results indicated that clozapine treatment post-surgery increased freezing across different threat-related contexts in hM3Dq subjects. This effect was again observed approximately 1.9 years following surgery, indicating the long-term functional capacity of DREADD-induced neuronal activation. [11C]deschloroclozapine PET imaging demonstrated amygdala hM3Dq-HA specific binding, and immunohistochemistry revealed that hM3Dq-HA expression was most prominent in basolateral nuclei. Electron microscopy confirmed expression was predominantly on neuronal membranes. Together, these data demonstrate that activation of primate amygdala neurons is sufficient to induce increased anxiety-related behaviors, which could serve as a model to investigate pathological anxiety in humans.

Development of Neural Mechanisms Underlying Threat Processing: Associations With Childhood Social Reticence and Adolescent Anxiety

Background

Social reticence in early childhood is characterized by shy and anxiously avoidant behavior, and it confers risk for pediatric anxiety disorders later in development. Aberrant threat processing may play a critical role in this association between early reticent behavior and later psychopathology. The goal of this longitudinal study is to characterize developmental trajectories of neural mechanisms underlying threat processing and relate these trajectories to associations between early-childhood social reticence and adolescent anxiety.

Methods

In this 16-year longitudinal study, social reticence was assessed from 2 to 7 years of age; anxiety symptoms and neural mechanisms during the dot-probe task were assessed at 10, 13, and 16 years of age. The sample included 144 participants: 71 children provided data at age 10 (43 girls, meanage = 10.62), 85 at age 13 (46 girls, meanage = 13.25), and 74 at age 16 (36 girls, meanage = 16.27).

Results

A significant interaction manifested among social reticence, anxiety symptoms, and time, on functional connectivity between the left amygdala and the left dorsolateral prefrontal cortex, voxelwise p < .001, clusterwise familywise error p < .05. Children with high social reticence showed a negative association between amygdala-dorsolateral prefrontal cortex connectivity and anxiety symptoms with age, compared to children with low social reticence, suggesting distinct neurodevelopmental pathways to anxiety.

Conclusions

These findings were present across all conditions, suggesting task-general effects in potential threat processing. Additionally, the timing of these neurodevelopmental pathways differed for children with high versus low social reticence, which could affect the timing of effective preventive interventions.

Anxiety and depression from age 3 to 8 years in children with and without ADHD symptoms

Childhood anxiety and depressive symptoms may be influenced by symptoms of attention deficit/hyperactivity disorder (ADHD). We investigated whether parent- and teacher-reported anxiety, depressive and ADHD symptoms at age 3 years predicted anxiety disorders and/or depression in children with and without ADHD at age 8 years. This study is part of the longitudinal, population-based Norwegian Mother, Father and Child Cohort Study. Parents of 3-year-olds were interviewed, and preschool teachers rated symptoms of anxiety disorders, depression and ADHD. At age 8 years (n = 783), Child Symptom Inventory-4 was used to identify children who fulfilled the diagnostic criteria for anxiety disorders and/or depression (hereinafter: Anx/Dep), and ADHD. Univariable and multivariable logistic regression analyses were used. In the univariable analyses, parent-reported anxiety, depressive and ADHD symptoms, and teacher-reported anxiety symptoms at age 3 years all significantly predicted subsequent Anx/Dep. In the multivariable analyses, including co-occurring symptoms at age 3 years and ADHD at 8 years, parent-reported anxiety and depressive symptoms remained significant predictors of subsequent Anx/Dep. At age 3 years, regardless of ADHD symptoms being present, asking parents about anxiety and depressive symptoms, and teachers about anxiety symptoms, may be important to identify children at risk for school-age anxiety disorders and/or depression.

Differences in anxiety sensitivity and experiential avoidance between subtypes of social anxiety disorder

Both anxiety sensitivity (AS) and experiential avoidance (EA) have been linked to social anxiety disorder (SAD). However, previous studies did not consider their joint variance and the heterogeneity of SAD. In this mixed methods cross-sectional survey, we examined 121 online participants (age range: 16-70 years) who self-reported as socially anxious. We compared AS and EA levels in individuals with a primary fear of noticeable anxiety symptoms vs. behaving ineptly. AS and EA were highly prevalent across the sample. Surprisingly, the noticeable symptoms subtype showed slightly lower AS and EA levels than the inept behavior subtype. The noticeable symptoms subtype scored notably lower on social anxiety measures (mean = 69.8) than the inept behavior subtype (mean = 89.3). EA was uniquely associated with social anxiety in both subtypes, while AS was uniquely associated with social anxiety only in the inept behavior subtype. The joint variance explained substantially more of the noticeable symptoms subtype's social anxiety (32.5%) compared to the inept behavior subtype's (9.4%). Qualitative themes aligned with these findings, indicating a self-reinforcing dynamic between high AS, high EA, and social anxiety symptoms. Potential clinical implications are discussed. Future research should examine causality in the AS-EA-SAD dynamic, considering the heterogeneity of SAD.

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.

Parent to Offspring Fear Transmission via Modeling in Early Life: A Systematic Review and Meta-Analysis

Infants can acquire fears vicariously by observing parents' fearful reactions to novel stimuli in everyday situations (i.e., modeling). To date, no systematic or meta-analytic review examined the role of modeling in parent-child transmission of fear and avoidance in early life. In our systematic review and meta-analysis, we aimed to investigate the effect of modeling parents' fearful reactions on infants' acquisition of fear and avoidance of novel stimuli and explore the moderation of this effect by child behavioral inhibition (BI) and parent trait anxiety. The search conducted in Web Of Science, Pubmed, Embase, and PsycINFO revealed 23 eligible studies for the systematic review and 19 for the meta-analysis. Eligible studies included published studies that measured infant fear and avoidance (infants aged up to 30 months) of novel stimuli following exposure to parental fearful expressions. Meta-analysis findings revealed a significant causal effect of modeling of parental fear on infants' fear [g = .44] and avoidance of novel stimuli [g = .44]. The findings support moderation by child BI on infant avoidance (not fear) acquisition, with the effects being larger for infants with higher BI. However, this moderation was only found, when including both experimental and correlational studies (p > .05), but not when exclusively including experimental studies (p = .17). This meta-analysis provides support for early parent-to-offspring fear transmission: a causal small to medium effect of parents' fearful reactions was shown on infants' fear and avoidance of novel stimuli. Elucidating parent-to-offspring anxiety transmission pathways can inform us about potential fear reduction and prevention strategies.

Understanding anxiety symptoms as aberrant defensive responding along the threat imminence continuum

Threat-anticipatory defensive responses have evolved to promote survival in a dynamic world. While inherently adaptive, aberrant expression of defensive responses to potential threat could manifest as pathological anxiety, which is prevalent, impairing, and associated with adverse outcomes. Extensive translational neuroscience research indicates that normative defensive responses are organized by threat imminence, such that distinct response patterns are observed in each phase of threat encounter and orchestrated by partially conserved neural circuitry. Anxiety symptoms, such as excessive and pervasive worry, physiological arousal, and avoidance behavior, may reflect aberrant expression of otherwise normative defensive responses, and therefore follow the same imminence-based organization. Here, empirical evidence linking aberrant expression of specific, imminence-dependent defensive responding to distinct anxiety symptoms is reviewed, and plausible contributing neural circuitry is highlighted. Drawing from translational and clinical research, the proposed framework informs our understanding of pathological anxiety by grounding anxiety symptoms in conserved psychobiological mechanisms. Potential implications for research and treatment are discussed.

Comparison of behaviorally inhibited and typically developing children's play behaviors in the preschool classroom

Introduction

Behavioral inhibition (BI) is a temperamental trait characterized by a bias to respond with patterns of fearful or anxious behavior when faced with unfamiliar situations, objects, or people. It has been suggested that children who are inhibited may experience early peer difficulties. However, researchers have yet to systematically compare BI versus typically developing children's observed asocial and social behavior in familiar, naturalistic settings.

Method

We compared the in-school behaviors of 130 (M = 54 months, 52% female) highly inhibited preschoolers (identified using the parent-reported Behavioral Inhibition Questionnaire) to 145 (M = 53 months, 52% female) typically developing preschoolers. Both samples were observed on at least two different days for approximately 60 min. Observers used the Play Observation Scale to code children's behavior in 10-s blocks during free play. Teachers completed two measures of children's behavior in the classroom.

Results

Regression models with robust standard errors controlling for child sex, age, and weekly hours in school revealed that preschoolers identified as BI engaged in significantly more observed reticent and solitary behavior, and less social play and teacher interaction than the typically developing sample. Children with BI also initiated social interaction with their peers and teachers less often than their counterparts who were not inhibited. Teachers reported that children identified as BI were more asocial and less prosocial than their non-BI counterparts.

Discussion

Significantly, the findings indicated that inhibited children displayed more solitude in the context of familiar peers. Previous observational studies have indicated behavioral differences between BI and unfamiliar typical age-mates in novel laboratory settings. Children identified as BI did not receive fewer bids for social interaction than their typically developing peers, thereby suggesting that children who are inhibited have difficulty capitalizing on opportunities to engage in social interaction with familiar peers. These findings highlight the need for early intervention for children with BI to promote social engagement, given that the frequent expression of solitude in preschool has predicted such negative outcomes as peer rejection, negative self-regard, and anxiety during the elementary and middle school years.

Developmental trajectories of behavioral inhibition from infancy to age seven: The role of genetic and environmental risk for psychopathology

The present study leveraged data from a longitudinal adoption study of 361 families recruited between 2003 and 2010 in the United States. We investigated how psychopathology symptoms in birth parents (BP; Mage  = 24.1 years; 50.5-62.9% completed high school) and adoptive parents (AP; Mage  = 37.8 years; 80.9% completed college; 94% mother-father couples) influenced children's behavioral inhibition (BI) trajectories. We used latent growth models of observed BI at 18 and 27 months, and 4.5 and 7 years in a sample of adopted children (Female = 42%, White = 57%, Black = 11%, Multi-racial = 21%, Latinx = 9%). BI generally decreased over time, yet there was substantial variability in these trajectories. Neither BP nor AP psychopathology symptoms independently predicted systematic differences in BI trajectories. Instead, we found that AP internalizing symptoms moderated the effects of BP psychopathology on trajectories of BI, indicating a gene by environment interaction.

Serotonin transporter (5-HTT) gene network moderates the impact of prenatal maternal adversity on orbitofrontal cortical thickness in middle childhood

In utero, the developing brain is highly susceptible to the environment. For example, adverse maternal experiences during the prenatal period are associated with outcomes such as altered neurodevelopment and emotion dysregulation. Yet, the underlying biological mechanisms remain unclear. Here, we investigate whether the function of a network of genes co-expressed with the serotonin transporter in the amygdala moderates the impact of prenatal maternal adversity on the structure of the orbitofrontal cortex (OFC) in middle childhood and/or the degree of temperamental inhibition exhibited in toddlerhood. T1-weighted structural MRI scans were acquired from children aged 6-12 years. A cumulative maternal adversity score was used to conceptualize prenatal adversity and a co-expression based polygenic risk score (ePRS) was generated. Behavioural inhibition at 18 months was assessed using the Early Childhood Behaviour Questionnaire (ECBQ). Our results indicate that in the presence of a low functioning serotonin transporter gene network in the amygdala, higher levels of prenatal adversity are associated with greater right OFC thickness at 6-12 years old. The interaction also predicts temperamental inhibition at 18 months. Ultimately, we identified important biological processes and structural modifications that may underlie the link between early adversity and future deviations in cognitive, behavioural, and emotional development.

DREADD-mediated amygdala activation is sufficient to induce anxiety-like responses in young nonhuman primates

Anxiety disorders are among the most prevalent psychiatric disorders, with symptoms often beginning early in life. To model the pathophysiology of human pathological anxiety, we utilized Designer Receptors Exclusively Activated by Designer Drugs (DREADDs) in a nonhuman primate model of anxious temperament to selectively increase neuronal activity of the amygdala. Subjects included 10 young rhesus macaques; 5 received bilateral infusions of AAV5-hSyn-HA-hM3Dq into the dorsal amygdala, and 5 served as controls. Subjects underwent behavioral testing in the human intruder paradigm following clozapine or vehicle administration, prior to and following surgery. Behavioral results indicated that clozapine treatment post-surgery increased freezing across different threat-related contexts in hM3Dq subjects. This effect was again observed approximately 1.9 years following surgery, indicating the long-term functional capacity of DREADD-induced neuronal activation. [11C]deschloroclozapine PET imaging demonstrated amygdala hM3Dq-HA specific binding, and immunohistochemistry revealed that hM3Dq-HA expression was most prominent in basolateral nuclei. Electron microscopy confirmed expression was predominantly on neuronal membranes. Together, these data demonstrate that activation of primate amygdala neurons is sufficient to induce increased anxiety-related behaviors, which could serve as a model to investigate pathological anxiety in humans.

Contemporary Hermits: A Developmental Psychopathology Account of Extreme Social Withdrawal (Hikikomori) in Young People

Although it is widely accepted that human beings have an ingrained 'need to belong,' there seem to be a substantial subset of young people who seclude themselves for most of the time at home and no longer engage in education or work, ultimately withdrawing from participation in society. In Japan, this phenomenon has been labeled as 'hikikomori,' but given its global presence it may be preferable to use the term 'extreme social withdrawal' (ESW). In this qualitative review, we provide a description and definition of ESW, provide figures on its prevalence, and discuss a number of associated concepts, including loneliness and "aloneliness," school absenteeism and dropout, the 'new' developmental stage of adultolescence, and the labor force categories of freeter ('freelance arbeiter') and NEET (a young person not in employment, education, or training). The core of the paper is focused on the origins of ESW in young people and provides a narrative overview of relevant etiological factors, such as aberrant brain processes, unfavorable temperament, psychiatric conditions, adverse family processes including detrimental parenting, negative peer experiences, societal pressures, and excessive internet and digital media use, which are all placed within a comprehensive developmental psychopathology framework. We will close with a discussion of possible interventions for young people with ESW and formulate a guideline that describes (the temporal order of) various components that need to be included in such a treatment.