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Valdes V, Craighead LW, Nelson CA, Enlow MB. The Influence of Temperament, Theory of Mind, Inhibitory Control, and Prosocial Behavior on Child Anxiety Symptoms in the First Five Years of Life. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01250-5. [PMID: 39331278 DOI: 10.1007/s10802-024-01250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2024] [Indexed: 09/28/2024]
Abstract
Anxiety disorders are among the most prevalent of all mental health disorders, often originating in early childhood and extending into later childhood, adolescence, and adulthood. Determining salient risk factors that precede their development is important for prevention and intervention efforts. Towards this end, we examined the role of temperament, theory of mind, inhibitory control, and prosocial behavior on child anxiety symptoms in the first 5 years of life. A community sample of children and their parents (N = 399) enrolled in a longitudinal study of emotion processing were assessed when the children were infants and at ages 2 years, 3 years, and 5 years. Linear mixed models and linear regression models revealed that greater anxiety at 5 years was associated with greater negative affectivity and behavioral inhibition, lower effortful control, lower theory of mind scores on the "desires" domain, and higher scores on the "intentions" domain (assessed from infancy to 3 years of age). These characteristics may be useful to assess in clinical settings to evaluate a patient's risk for developing anxiety. They may also be useful in developing interventions targeting specific vulnerabilities.
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Affiliation(s)
- Viviane Valdes
- Division of Developmental Medicine, Boston Children's Hospital, Brookline, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | | | - Charles A Nelson
- Division of Developmental Medicine, Boston Children's Hospital, Brookline, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Harvard Graduate School of Education, Cambridge, MA, USA
| | - Michelle Bosquet Enlow
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, 300 Longwood Avenue, BCH 3199, Boston, MA, 02115, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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2
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Dumont É, Parent S, Castellanos-Ryan N, Jacques S, Freeston MH, Zelazo PD, Séguin JR. The Role of Executive Function at 6 Years in the Association between Behavioral Inhibition at 5 Years and Anxiety at 7 Years. Res Child Adolesc Psychopathol 2024; 52:919-931. [PMID: 38329683 DOI: 10.1007/s10802-024-01175-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
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.
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Affiliation(s)
- Émilie Dumont
- School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada
- CHU Ste-Justine Research Center, Bureau B17.107; 3175 chemin Côte Ste-Catherine, Montréal, Québec, H3T 1C5, Canada
| | - Sophie Parent
- School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada
- CHU Ste-Justine Research Center, Bureau B17.107; 3175 chemin Côte Ste-Catherine, Montréal, Québec, H3T 1C5, Canada
| | - Natalie Castellanos-Ryan
- School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada
- CHU Ste-Justine Research Center, Bureau B17.107; 3175 chemin Côte Ste-Catherine, Montréal, Québec, H3T 1C5, Canada
| | - Sophie Jacques
- Department of Psychology and Neuroscience, Dalhousie University, Nova Scotia, Canada
| | - Mark H Freeston
- School of Psychology and Affiliated to the Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Philip David Zelazo
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Jean R Séguin
- CHU Ste-Justine Research Center, Bureau B17.107; 3175 chemin Côte Ste-Catherine, Montréal, Québec, H3T 1C5, Canada.
- Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada.
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3
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Ramos ML, Zhou AM, Lytle MN, Myruski S, Pérez-Edgar K, Buss KA. Interactions among stress, behavioral inhibition, and delta-beta coupling predict adolescent anxiety during the COVID-19 pandemic. Dev Psychobiol 2024; 66:e22485. [PMID: 38483054 PMCID: PMC11000197 DOI: 10.1002/dev.22485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/27/2023] [Accepted: 02/26/2024] [Indexed: 04/10/2024]
Abstract
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.
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Affiliation(s)
- Michelle L Ramos
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Anna M Zhou
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Marisa N Lytle
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sarah Myruski
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Koraly Pérez-Edgar
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Kristin A Buss
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
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4
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Cardinale EM, Bezek J, Siegal O, Freitag GF, Subar A, Khosravi P, Mallidi A, Peterson O, Morales I, Haller SP, Filippi C, Lee K, Brotman MA, Leibenluft E, Pine DS, Linke JO, Kircanski K. Multivariate Assessment of Inhibitory Control in Youth: Links With Psychopathology and Brain Function. Psychol Sci 2024; 35:376-389. [PMID: 38446868 PMCID: PMC11145514 DOI: 10.1177/09567976241231574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 01/11/2024] [Indexed: 03/08/2024] Open
Abstract
Inhibitory control is central to many theories of cognitive and brain development, and impairments in inhibitory control are posited to underlie developmental psychopathology. In this study, we tested the possibility of shared versus unique associations between inhibitory control and three common symptom dimensions in youth psychopathology: attention-deficit/hyperactivity disorder (ADHD), anxiety, and irritability. We quantified inhibitory control using four different experimental tasks to estimate a latent variable in 246 youth (8-18 years old) with varying symptom types and levels. Participants were recruited from the Washington, D.C., metro region. Results of structural equation modeling integrating a bifactor model of psychopathology revealed that inhibitory control predicted a shared or general psychopathology dimension, but not ADHD-specific, anxiety-specific, or irritability-specific dimensions. Inhibitory control also showed a significant, selective association with global efficiency in a frontoparietal control network delineated during resting-state functional magnetic resonance imaging. These results support performance-based inhibitory control linked to resting-state brain function as an important predictor of comorbidity in youth psychopathology.
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Affiliation(s)
- Elise M. Cardinale
- Department of Psychology, The Catholic University of America
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD
| | | | - Olivia Siegal
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD
| | - Gabrielle F. Freitag
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD
| | - Anni Subar
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine
| | - Parmis Khosravi
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD
| | - Ajitha Mallidi
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD
| | - Olivia Peterson
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD
| | - Isaac Morales
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD
| | - Simone P. Haller
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD
| | | | - Kyunghun Lee
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD
| | | | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD
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5
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Conte S, Richards JE, Fox NA, Valadez EA, McSweeney M, Tan E, Pine DS, Winkler AM, Liuzzi L, Cardinale EM, White LK, Buzzell GA. Multimodal study of the neural sources of error monitoring in adolescents and adults. Psychophysiology 2023; 60:e14336. [PMID: 37212619 PMCID: PMC10524909 DOI: 10.1111/psyp.14336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/16/2023] [Accepted: 05/01/2023] [Indexed: 05/23/2023]
Abstract
The ability to monitor performance during a goal-directed behavior differs among children and adults in ways that can be measured with several tasks and techniques. As well, recent work has shown that individual differences in error monitoring moderate temperamental risk for anxiety and that this moderation changes with age. We investigated age differences in neural responses linked to performance monitoring using a multimodal approach. The approach combined functional MRI and source localization of event-related potentials (ERPs) in 12-year-old, 15-year-old, and adult participants. Neural generators of two components related to performance and error monitoring, the N2 and ERN, lay within specific areas of fMRI clusters. Whereas correlates of the N2 component appeared similar across age groups, age-related differences manifested in the location of the generators of the ERN component. The dorsal anterior cingulate cortex (dACC) was the predominant source location for the 12-year-old group; this area manifested posteriorly for the 15-year-old and adult groups. A fMRI-based ROI analysis confirmed this pattern of activity. These results suggest that changes in the underlying neural mechanisms are related to developmental changes in performance monitoring.
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Affiliation(s)
- Stefania Conte
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - John E Richards
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
| | - Emilio A Valadez
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
| | - Marco McSweeney
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
| | - Enda Tan
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
| | - Daniel S Pine
- National Institute of Mental Health, Emotion and Development Branch, Bethesda, Maryland, USA
| | - Anderson M Winkler
- National Institute of Mental Health, Emotion and Development Branch, Bethesda, Maryland, USA
| | - Lucrezia Liuzzi
- National Institute of Mental Health, Emotion and Development Branch, Bethesda, Maryland, USA
| | - Elise M Cardinale
- National Institute of Mental Health, Emotion and Development Branch, Bethesda, Maryland, USA
| | - Lauren K White
- Lifespan Brain Institute of the Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania, USA
| | - George A Buzzell
- Florida International University and the Center for Children and Families, Miami, Florida, USA
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6
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Tumanova V, Choi D, Wang Q. Effects of behavior inhibition on stuttering severity and adverse consequences of stuttering in 3-6-year-old children who stutter. JOURNAL OF COMMUNICATION DISORDERS 2023; 104:106332. [PMID: 37178639 PMCID: PMC10348486 DOI: 10.1016/j.jcomdis.2023.106332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 03/10/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE The purpose of this study was to investigate whether 3- to-6-year-old children who stutter and exhibit a higher degree of behavioral inhibition (BI), a correlate of shyness, stutter more frequently and experience greater negative consequences of stuttering (per parent-report) than their peers who stutter but have lower BI. METHOD Forty-six children who stutter (CWS; 35 boys & 11 girls; mean age 4 years, 2 months) participated. Their degree of BI was assessed by measuring the latency to their 6th spontaneous comment during a conversation with an unfamiliar examiner (following Kagan, Reznick, & Gibbons's (1989) methodology). The frequency of stuttering and the negative impact of stuttering that CWS may have experienced was assessed using parent reports (i.e., Test of Childhood Stuttering (TOCS) Observational Rating Scale; Gillam, Logan, & Pearson, 2009). RESULTS We found that children's degree of BI was not associated with their speech fluency per parent report. However, children's degree of BI was significantly associated with greater negative consequences of stuttering. Specifically, among the four categories of TOCS Disfluency-Related Consequences, children's BI significantly predicted the occurrence of physical behaviors that accompany moments of stuttering (such as increased tension or excessive eye blinks). Other Disfluency-Related Consequences, such as avoidance behaviors, negative feelings, and negative social consequences, were not associated with children's behavioral inhibition tendencies. Additionally, children's stuttering severity (per the Stuttering Severity Instrument-4 scores) was significantly associated with increased physical behaviors that accompany moments of stuttering and greater negative social consequences of stuttering. CONCLUSIONS This study provides empirical evidence that behavioral inhibition to the unfamiliar may have salience for childhood stuttering as it predicted the development of physical behaviors associated with stuttering (e.g., tension or struggle) in 3- to 6-year-old CWS. Clinical implications of high BI for the assessment and treatment of childhood stuttering are discussed.
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Affiliation(s)
- Victoria Tumanova
- Department of Communication Sciences and Disorders, Syracuse University, 621 Skytop Rd, Syracuse, NY, 13244, United States.
| | - Dahye Choi
- Department of Speech Pathology and Audiology, University of South Alabama, 5721 USA Drive North, Mobile, AL, 36688, United States
| | - Qiu Wang
- Department of Higher Education, Department of Mathematics, Syracuse University, 350 Huntington Hall, Syracuse, NY, 13244, United States
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7
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Cardinale EM, Bezek J, Morales S, Filippi C, Smith AR, Haller S, Valadez EA, Harrewijn A, Phillips D, Chronis-Tuscano A, Brotman MA, Fox NA, Pine DS, Leibenluft E, Kircanski K. Cross-sectional and Longitudinal Associations of Anxiety and Irritability With Adolescents' Neural Responses to Cognitive Conflict. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:436-444. [PMID: 35358745 PMCID: PMC9764223 DOI: 10.1016/j.bpsc.2022.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 04/12/2023]
Abstract
BACKGROUND Psychiatric symptoms are commonly comorbid in childhood. The ability to disentangle unique and shared correlates of comorbid symptoms facilitates personalized medicine. Cognitive control is implicated broadly in psychopathology, including in pediatric disorders characterized by anxiety and irritability. To disentangle cognitive control correlates of anxiety versus irritability, the current study leveraged both cross-sectional and longitudinal data from early childhood into adolescence. METHODS For this study, 89 participants were recruited from a large longitudinal research study on early-life temperament to investigate associations of developmental trajectories of anxiety and irritability symptoms (from ages 2 to 15) as well as associations of anxiety and irritability symptoms measured cross-sectionally at age 15 with neural substrates of conflict and error processing assessed at age 15 using the flanker task. RESULTS Results of whole-brain multivariate linear models revealed that anxiety at age 15 was uniquely associated with decreased neural response to conflict across multiple regions implicated in attentional control and conflict adaptation. Conversely, irritability at age 15 was uniquely associated with increased neural response to conflict in regions implicated in response inhibition. Developmental trajectories of anxiety and irritability interacted in relation to neural responses to both error and conflict. CONCLUSIONS Our findings suggest that neural correlates of conflict processing may relate uniquely to anxiety and irritability. Continued cross-symptom research on the neural correlates of cognitive control could stimulate advances in individualized treatment for anxiety and irritability during child and adolescent development.
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Affiliation(s)
| | - Jessica Bezek
- National Institute of Mental Health, Bethesda, Maryland
| | - Santiago Morales
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland; Department of Psychology, University of Southern California, Los Angeles, California
| | | | | | - Simone Haller
- National Institute of Mental Health, Bethesda, Maryland
| | - Emilio A Valadez
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | - Anita Harrewijn
- National Institute of Mental Health, Bethesda, Maryland; Department of Clinical Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Andrea Chronis-Tuscano
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | | | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | - Daniel S Pine
- National Institute of Mental Health, Bethesda, Maryland
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8
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Brief Report: Discrete Effortful Control Skills Moderate Relations Between Childhood Behavioural Inhibition and Mental Health Difficulties in Autistic Youth. J Autism Dev Disord 2023; 53:489-494. [PMID: 35133546 DOI: 10.1007/s10803-021-05360-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 02/03/2023]
Abstract
Studies of the general population suggest that the risk for mental health difficulties conferred by dispositional behavioural inhibition (BI) may be modified by self-regulation; however, this possibility has not been explored in the context of autism. This study investigated the moderating effects of attentional-, activation-, and inhibitory control on the relationship between childhood BI and anxiety and depression among 47 autistic youths (55% male, Mage = 19.09 years, SD = 2.23). Childhood BI was associated with anxiety at low but not high levels of attentional- and activation control, and depression at low but not high levels of attentional control. However, there were no moderating effects of inhibitory control. These preliminary findings are partially consistent with those from the general population and point to avenues for future work.
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9
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Valadez EA, Morales S, Buzzell GA, Troller-Renfree SV, Henderson HA, Chronis-Tuscano A, Pine DS, Fox NA. Development of Proactive Control and Anxiety Among Behaviorally Inhibited Adolescents. J Am Acad Child Adolesc Psychiatry 2022; 61:1466-1475. [PMID: 35490841 PMCID: PMC9613813 DOI: 10.1016/j.jaac.2022.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/26/2022] [Accepted: 04/21/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Behavioral inhibition (BI) is an infant temperament characterized by heightened reactivity and negative affect in response to novel people and situations. BI is among the earliest and strongest predictors of future anxiety problems. However, not all children with a history of BI will manifest anxiety problems. A growing body of evidence suggests that proactive control skills may help buffer youth with BI from future anxiety difficulties; yet, it remains unclear how temperament may interact with the development of cognitive control to influence anxiety risk. The present study tested whether enhancements in proactive control occurring during adolescence may reduce risk for anxiety among youth with a history of BI. METHOD Participants included 185 adolescents (56% female) whose temperament was assessed during toddlerhood. In adolescence, participants completed anxiety assessments and an AX Continuous Performance Test (AX-CPT) to assess cognitive control strategy. Both assessments were administered at age 13 years and again at 15 years. RESULTS Latent change score modeling revealed that, on average, participants increasingly used proactive control strategies and experienced worsening anxiety from age 13-15 years. Early BI was associated with a smaller anxiety increase from 13-15 years, but only among participants whose proactive control skills improved at mean or greater rates. CONCLUSION The present findings suggest that greater proactive control development during adolescence protects youth with high BI from age-related increases in anxiety. Results support a framework that highlights cognitive control as a key moderator of anxiety risk among children with a history of high BI.
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Affiliation(s)
| | | | | | | | | | | | - Daniel S Pine
- National Institute of Mental Health, Bethesda, Maryland
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10
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Gilbert K, Sudit E, Fox NA, Barch DM, Luby JL. Childhood behavioral inhibition and overcontrol: Relationships with cognitive functioning, error monitoring, anxiety and obsessive-compulsive symptoms. Res Child Adolesc Psychopathol 2022; 50:1629-1642. [PMID: 35852701 PMCID: PMC9906714 DOI: 10.1007/s10802-022-00953-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
Anxiety and obsessive-compulsive disorders are common childhood psychiatric disorders. Behavioral inhibition (BI) is a widely studied risk factor for anxiety. Less is known about overcontrol, a related behavioral phenotype characterized by concern for errors, perfectionism, and inflexibility and also associated with anxiety and obsessive-compulsive disorder. Both BI and overcontrol show associations with aberrant cognitive control and neural error responding (via the error-related negativity; ERN) yet it is unknown whether each imparts differential risk. Understanding whether overcontrol demonstrates independent associations from BI with cognitive functioning, neural error monitoring, and childhood anxiety and obsessive-compulsive presentations could aid in identifying a novel mechanistic treatment target. We assessed BI, overcontrol, cognitive functioning and psychopathology in a cross-sectional sample of 5-6 year old children (N = 126). Children completed an electroencephalogram (EEG) to assess the ERN. Overcontrol was associated with worse cognitive shifting, worse inhibitory control and higher anxiety and obsessive-compulsive symptoms, beyond BI. BI was associated with worse cognitive shifting, better inhibitory control and higher anxiety symptoms, beyond overcontrol. When assessed simultaneously, only overcontrol demonstrated a significant relationship with a blunted ERN. Moreover, overcontrol mediated (cross-sectionally) the well-established relationship between ERN and anxiety and obsessive-compulsive symptoms. BI and overcontrol impart differential risk for child cognitive functioning and anxiety while overcontrol demonstrates additional risk for aberrant neural error monitoring, anxiety and obsessive-compulsive presentations. Overcontrol may also be a mechanistic pathway between the ERN and transdiagnostic anxiety and obsessive-compulsive symptoms. Overcontrol may be a target warranted for early-childhood intervention in anxiety and OCD.
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Affiliation(s)
- Kirsten Gilbert
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Ella Sudit
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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11
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Zainal NH, Newman MG. Executive Functioning Constructs in Anxiety, Obsessive-Compulsive, Post-Traumatic Stress, and Related Disorders. Curr Psychiatry Rep 2022; 24:871-880. [PMID: 36401677 PMCID: PMC9676877 DOI: 10.1007/s11920-022-01390-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE OF REVIEW We synthesize theories proposing complex relations between cognitive functioning and anxiety-related concepts. We evaluate vulnerability theories suggesting that deficits in various cognitive functioning domains predict future anxiety-associated concepts. We examine scar theories asserting the opposite direction of effects (i.e., anxiety predicting cognitive dysfunction). Furthermore, we examine more novel frameworks on this topic. RECENT FINDINGS Reliable evidence exists for the scar and vulnerability theories. This includes mounting data on diverse anxiety symptoms predicting cognitive dysfunction (and conversely) unfolding at between- and within-person levels (dynamic mutualism theory). It also includes data on the stronger effects or central influence of anxiety (versus non-anxiety) symptoms on executive functioning (EF; i.e., higher-order cognitive control governing myriad thinking and action repertoires) versus non-EF domains and vice versa (network theory). In addition, it reviews emerging evidence that enhanced cognitive control can correlate with higher anxiety among children (overgeneralized control theory). The generally inverse relations between anxiety symptoms and cognitive dysfunction are bidirectional and complex within and between persons. Plausible mediators and moderators merit more attention, including immune, metabolism, and neural markers and the social determinants of health.
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Affiliation(s)
| | - Michelle G Newman
- The Pennsylvania State University, 371 Moore Building, University Park, PA, 16802, USA.
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12
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Valadez EA, Pine DS, Fox NA, Bar-Haim Y. Attentional biases in human anxiety. Neurosci Biobehav Rev 2022; 142:104917. [PMID: 36252826 PMCID: PMC9756271 DOI: 10.1016/j.neubiorev.2022.104917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/20/2022]
Abstract
Across clinical and subclinical samples, anxiety has been associated with increased attentional capture by cues signaling danger. Various cognitive models attribute the onset and maintenance of anxiety symptoms to maladaptive selective information processing. In this brief review, we 1) describe the evidence for the relations between anxiety and attention bias toward threat, 2) discuss the neurobiology of anxiety-related differences in threat bias, 3) summarize work investigating the developmental origins of attention bias toward threat, and 4) examine efforts to translate threat bias research into clinical intervention. Future directions in each area are discussed, including the use of novel analytic approaches improving characterization of threat-processing-related brain networks, clarifying the role of cognitive control in the development of attention bias toward threat, and the need for larger, well-controlled randomized clinical trials examining moderators and mediators of treatment response. Ultimately, this work has important implications for understanding the etiology of and for intervening on anxiety difficulties among children and adults.
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Affiliation(s)
- Emilio A Valadez
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA.
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Yair Bar-Haim
- School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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13
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Schroder HS, Ip KI, Hruschak JL, Horbatch F, Hall M, Liu Y, Mannella K, Muzik M, Rosenblum KL, Moser JS, Fitzgerald KD. Targeting cognitive control to reduce anxiety in very young children: A proof of concept study. Depress Anxiety 2022; 39:646-656. [PMID: 35708131 DOI: 10.1002/da.23270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 04/15/2022] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Underdeveloped cognitive control (CC)-the capacity to flexibly adjust to changing environments-may predispose some children to early onset anxiety disorders and represents a promising intervention target. The current study established and pilot-tested "Camp Kidpower"-a novel group-based, interactive CC training intervention-and assessed its impacts on behavioral and neurophysiological indices of CC among preschool children with elevated anxiety symptoms. METHODS Forty-four anxious children (4-6 years) were enrolled in Camp Kidpower, delivered in four sessions over 10 days. Before and after camp, children's capacity for CC was measured using well-validated, non-trained behavioral tasks and error-related negativity (ERN). Child anxiety symptoms were measured by parent report on the Spence Preschool Anxiety Scale. RESULTS Thirty-two children completed the study, as defined by completion of pre- and follow-up assessments and at least three camp sessions. From baseline to after camp, performance on behavioral tests of CC improved, ERN amplitude increased, and anxiety symptoms decreased. CONCLUSION Results provide initial evidence that play-based cognitive training targeted to behavioral and brain markers of CC reduces anxiety in preschoolers.
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Affiliation(s)
- Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ka I Ip
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Jessica L Hruschak
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Faith Horbatch
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Melissa Hall
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA
| | - Yanni Liu
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kristin Mannella
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Maria Muzik
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kate L Rosenblum
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jason S Moser
- Department of Psychology, Michigan State University, E. Lansing, Michigan, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, New York, USA
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14
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Filippi CA, Valadez EA, Fox NA, Pine DS. Temperamental risk for anxiety: emerging work on the infant brain and later neurocognitive development. Curr Opin Behav Sci 2022; 44:101105. [PMID: 35342779 PMCID: PMC8955382 DOI: 10.1016/j.cobeha.2022.101105] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Behavioral inhibition (BI), an infant temperament characterized by distress to novelty, is amongst the strongest early risk markers for future anxiety. In this review, we highlight three ways that recent research elucidates key details about the pathophysiology of anxiety in individuals with BI. First, atypical amygdala connectivity during infancy may be related to BI. Second, developmental shifts in cognitive control may portend risk for anxiety for children with BI. Lastly, distinct cognitive control processes moderate the BI-anxiety relation in different ways. Studying the intersection of these three streams of work may inform prevention or intervention work.
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Affiliation(s)
- Courtney A Filippi
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, 20892, United States
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, 20742, United States
- Indicates shared first authorship
- Present address: Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, Maryland, 20892
| | - Emilio A Valadez
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, 20742, United States
- Indicates shared first authorship
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, 20742, United States
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, 20892, United States
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15
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Morales S, Zeytinoglu S, Buzzell GA, Valadez EA, Troller-Renfree SV, Bowers ME, Chronis-Tuscano A, Degnan KA, Almas AN, Pine DS, Fox NA. Neurocognitive Profiles in Adolescence Predict Subsequent Anxiety Trajectories During the COVID-19 Pandemic. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:192-200. [PMID: 34144216 PMCID: PMC8674375 DOI: 10.1016/j.bpsc.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The COVID-19 pandemic has created increased stress and anxiety for many; however, some individuals are particularly prone to heightened anxiety. It is unclear if and how prestress neurocognitive factors moderate risk for anxiety during high-stress situations. Enhanced error monitoring and a cognitive control strategy of more instantaneous (reactive) control have both been independently related to anxiety. We examined if a specific neurocognitive profile characterized by heightened error monitoring and a more reactive cognitive control strategy in adolescence predicts young adults' anxiety trajectories across 3 early months of the COVID-19 pandemic. METHODS As part of a longitudinal study (N = 291), data were acquired in adolescence (13 years) on error monitoring (n = 124) and cognitive control strategy (n = 119). In young adulthood (18 years), anxiety was assessed three times during the COVID-19 pandemic (n = 162). RESULTS On average, participants experienced greater anxiety in the first COVID-19 pandemic assessment, then anxiety decreased in the following months. Error monitoring and cognitive control strategy interacted to predict anxiety trajectories, such that among adolescents with an increased reliance on reactive control, error monitoring predicted greater anxiety in the first assessment but greater decreases the following months as stay-at-home orders were lifted and families adapted to the restrictions. CONCLUSIONS Results suggest that neurocognitive profiles in adolescence predict young adults' anxiety responses during a highly stressful period, such as the initial months of the COVID-19 pandemic. Our findings have implications for the early identification of individuals at greater risk for anxiety.
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Affiliation(s)
- Santiago Morales
- Department of Human Development and Quantitative Methodology, University of Maryland College Park, College Park, Maryland; Neuroscience and Cognitive Science Program, University of Maryland College Park, College Park, Maryland.
| | - Selin Zeytinoglu
- Department of Human Development and Quantitative Methodology, University of Maryland College Park, College Park, Maryland
| | - George A Buzzell
- Department of Human Development and Quantitative Methodology, University of Maryland College Park, College Park, Maryland; Neuroscience and Cognitive Science Program, University of Maryland College Park, College Park, Maryland; Department of Psychology, Florida International University, Miami, Florida
| | - Emilio A Valadez
- Department of Human Development and Quantitative Methodology, University of Maryland College Park, College Park, Maryland
| | - Sonya V Troller-Renfree
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York
| | - Maureen E Bowers
- Department of Human Development and Quantitative Methodology, University of Maryland College Park, College Park, Maryland; Neuroscience and Cognitive Science Program, University of Maryland College Park, College Park, Maryland
| | | | - Kathryn A Degnan
- Department of Psychology, Catholic University of America, Washington, D.C
| | - Alisa N Almas
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland College Park, College Park, Maryland; Neuroscience and Cognitive Science Program, University of Maryland College Park, College Park, Maryland
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16
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Filippi CA, Subar A, Ravi S, Haas S, Troller-Renfree SV, Fox NA, Leibenluft E, Pine DS. Developmental Changes in the Association Between Cognitive Control and Anxiety. Child Psychiatry Hum Dev 2022; 53:599-609. [PMID: 33738691 PMCID: PMC9107422 DOI: 10.1007/s10578-021-01150-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
Anxiety has been associated with reliance on reactive (stimulus-driven/reflexive) control strategies in response to conflict. However, this conclusion rests primarily on indirect evidence. Few studies utilize tasks that dissociate the use of reactive ('just in time') vs. proactive (anticipatory/preparatory) cognitive control strategies in response to conflict, and none examine children diagnosed with anxiety. The current study utilizes the AX-CPT, which dissociates these two types of cognitive control, to examine cognitive control in youth (ages 8-18) with and without an anxiety diagnosis (n = 56). Results illustrate that planful behavior, consistent with using a proactive strategy, varies by both age and anxiety symptoms. Young children (ages 8-12 years) with high anxiety exhibit significantly less planful behavior than similarly-aged children with low anxiety. These findings highlight the importance of considering how maturation influences relations between anxiety and performance on cognitive-control tasks and have implications for understanding the pathophysiology of anxiety in children.
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Affiliation(s)
- Courtney A Filippi
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, 20892, USA.
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, 20742, USA.
| | - Anni Subar
- Department of Psychology, University of Denver, Denver, CO, 80208, USA
| | - Sanjana Ravi
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, 20742, USA
| | - Sara Haas
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Sonya V Troller-Renfree
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, 10027, USA
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, 20742, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, 20892, USA
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, 20892, USA
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17
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Suarez GL, Morales S, Miller NV, Penela EC, Chronis-Tuscano A, Henderson HA, Fox NA. Examining a developmental pathway from early behavioral inhibition to emotion regulation and social anxiety: The moderating role of parenting. Dev Psychol 2021; 57:1261-1273. [PMID: 34591570 PMCID: PMC8496912 DOI: 10.1037/dev0001225] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We examined the longitudinal relation between behavioral inhibition (BI) and social anxiety symptoms and behavior and the mediating role of emotion regulation (ER). Moreover, we investigated the influence of parenting behavior on the development of ER strategies. Participants were 291 children (135 male) followed longitudinally from 2 to 13 years. Mothers were predominantly well educated and non-Hispanic Caucasian. Children were screened for BI using maternal report and observational measures (ages 2 and 3), parenting behavior was observed while children and their mothers participated in a fear-eliciting task (age 3), ER strategies were observed while children completed a disappointment task (age 5), and socially anxious behavior was measured via multimethod assessment at 10 and 13 years. Children who exhibited high BI in early childhood exhibited more socially anxious behavior across ages 10 and 13, and there was a significant indirect effect of BI on socially anxious behavior through ER strategies. Children who were high in BI demonstrated less engaged ER strategies during the disappointment task, which in turn predicted more socially anxious behavior. Furthermore, parenting behavior moderated the pathway linking early BI and ER strategies to social anxiety outcomes such that children who exhibited high BI and who received more affectionate/oversolicitous behavior from their mother displayed less engaged ER strategies and more socially anxious behavior than children low in BI or low in oversolicitous parenting behaviors. These findings expand on our understanding of the role that ER strategies and parenting play in the developmental pathway linking early BI to future social anxiety outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Gabriela L. Suarez
- Department of Psychology, The University of Michigan, Ann Arbor, MI, USA
| | - Santiago Morales
- Department of Human Development and Quantitative Methodology, The University of Maryland, College Park, MD, USA
| | - Natalie V. Miller
- Department of Human Development and Quantitative Methodology, The University of Maryland, College Park, MD, USA
| | | | | | | | - Nathan A. Fox
- Department of Human Development and Quantitative Methodology, The University of Maryland, College Park, MD, USA
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18
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Fox NA, Buzzell GA, Morales S, Valadez EA, Wilson M, Henderson HA. Understanding the Emergence of Social Anxiety in Children With Behavioral Inhibition. Biol Psychiatry 2021; 89:681-689. [PMID: 33353668 PMCID: PMC7954867 DOI: 10.1016/j.biopsych.2020.10.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/23/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022]
Abstract
Behavioral inhibition (BI) is a temperament characterized in early childhood by distress to novelty and avoidance of unfamiliar people, and it is one of the best-known risk factors for the development of social anxiety. However, nearly 60% of children with BI do not go on to meet criteria for social anxiety disorder. In this review we present an approach to understanding differential developmental trajectories among children with BI. We review research using laboratory-based tasks that isolate specific attention processes that enhance versus mitigate risk for social anxiety among behaviorally inhibited children and studies that suggest that BI is associated with heightened detection of novelty or threat. Moreover, stimulus-driven control processes, which we term "automatic control," increase the probability that behaviorally inhibited children display socially reticent behavior and develop social anxiety. In contrast, goal-driven control processes, which we term "planful control," decrease risk for anxiety. We suggest that these three categories of processes (detection, automatic control, and planful control) function together to determine whether behaviorally inhibited children are able to flexibly regulate their initial reactions to novelty, and in turn, decrease risk for social anxiety. Although laboratory-based tasks have identified these processes underlying risk and resilience, the challenge is linking them to the emotions, thoughts, and behaviors of behaviorally inhibited children in real-world contexts.
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Affiliation(s)
- Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland.
| | - George A Buzzell
- Department of Psychology, Florida International University, Miami, Florida
| | - Santiago Morales
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | - Emilio A Valadez
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | - McLennon Wilson
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
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