Stable Early Maternal Report of Behavioral Inhibition Predicts Lifetime Social Anxiety Disorder in Adolescence

Abstract

Objective-Behavioral inhibition (BI), a temperamental style identifiable in early childhood, is considered a risk factor for the development of anxiety disorders, particularly social anxiety disorder (SAD). However, few studies examining this question have evaluated the stability of BI across multiple developmental time points and followed participants into adolescence-the developmental period during which risk for SAD onset is at its peak. The current study used a prospective longitudinal design to determine whether stable early BI predicted the presence of psychiatric disorders and continuous levels of social anxiety in adolescents. It was hypothesized that stable BI would predict the presence of adolescent psychiatric diagnoses, specifically SAD.Method-Participants included 126 adolescents aged 14 to 16 years who were first recruited at 4 months of age from hospital birth records. Temperament was measured at multiple time points between the ages of 14 months and 7 years. In adolescence, diagnostic interviews were conducted with parents and adolescents, and continuous measures of adolescent-and parent-reported social anxiety were collected.Results-Stable maternal-reported early BI was associated with 3.79 times increased odds of a lifetime SAD diagnosis, but not other diagnoses, during adolescence (95% confidence interval 1.18-12.12). Stable maternal-reported early BI also predicted independent adolescent and parent ratings of ongoing social anxiety symptoms.Conclusions-Findings suggesting that stable maternal-reported early BI predicts lifetime SAD have important implications for the early identification and prevention of SAD. Keywords temperament; behavioral inhibition; social anxiety disorderApproximately 15% to 20% of children can be classified as behaviorally inhibited during early childhood. This temperamental style involves the tendency to show signs of fear, reticence, or wariness in response to unfamiliar situations and to withdraw from unfamiliar peers. 1,2 Approximately half of all children categorized as extremely behaviorally inhibited continue to

Temperament, Family Environment and Anxiety in Preschool Children

“…These results are consistent with previous research demonstrating that BI is associated with increased anxiety in children (Chronis-Tuscano et al, 2009;Schwartz et al, 1999). Importantly, however, these results provide the first evidence that BI may be a related to a range of childhood anxiety disorders rather than just Social Anxiety Disorder, as has been suggested in previous research (Chronis-Tuscano et al, 2009;Muris et al, 2010).…”

Temperament and Family Environment in the Development of Anxiety Disorder: Two-Year Follow-up

“…This was high in comparison to previous research with older samples. 5,12 These rates are, however, consistent with other research with preschool-aged inhibited children. 34 This may be due to the fact that anxiety was assessed at the same time as the participants were selected as being BI.…”

“…3 Several studies have shown that BI is associated with increased risk for anxiety, concurrently and over time. 4,5 The association between BI and anxiety is so strong that there has been some debate regarding the independence of these constructs. 6 As not all BI children develop clinical anxiety, 7 the present research takes a "vulnerability" perspective, which assumes that BI increases risk for anxiety.…”

“…5,12 For example, Chronis-Tuscano and colleagues compared participants classified as high BI and low BI on the basis of parent-report across childhood, and found a significant difference between groups on social phobia during adolescence. 5 The results suggested that stable BI across childhood may be a better predictor of anxiety than BI assessed at a single time point.…”

“…There is increasing recognition of the importance of fathers in child development and future research should seek to include these additional environmental factors. 5,12,33 A further point for consideration is the prevalence of anxiety diagnoses in the BI group. This was high in comparison to previous research with older samples.…”