Behavioral Inhibition in Preschool Children At Risk Is a Specific Predictor of Middle Childhood Social Anxiety: A Five-Year Follow-up

Harvard University, Cambridge, Massachusetts, United States
Journal of Developmental & Behavioral Pediatrics (Impact Factor: 2.13). 07/2007; 28(3):225-33. DOI: 10.1097/01.DBP.0000268559.34463.d0
Source: PubMed

ABSTRACT Behavioral inhibition (BI) to the unfamiliar represents the temperamental tendency to exhibit fearfulness, reticence, or restraint when faced with unfamiliar people or situations. It has been hypothesized to be a risk factor for anxiety disorders. In this prospective longitudinal study, we compared the psychiatric outcomes in middle childhood of children evaluated at preschool age for BI.
The baseline sample consisted of 284 children ages 21 months to 6 years, including offspring at risk for anxiety (children of parents with panic disorder and/or major depression) and comparison offspring of parents without mood or major anxiety disorders. They had been assessed for BI using age-specific laboratory protocols. We reassessed 215 of the children (76.5%) at 5-year follow-up at a mean age of 9.6 years using structured diagnostic interviews.
BI specifically predicted onset of social anxiety. The rate of lifetime social anxiety (DSM-IV social phobia or DSM-III-R avoidant disorder) was 28% versus 14% (odds ratio [OR] = 2.37; 95% confidence interval [CI]: 1.10-5.10) in inhibited versus noninhibited children. BI significantly predicted new onset of social phobia among children unaffected at baseline (22.2% vs 8.0% in inhibited versus noninhibited children (OR = 3.15, 95% CI: 1.16-8.57). No other anxiety disorders were associated with BI.
BI appears to be a temperamental antecedent to subsequent social anxiety in middle childhood. Children presenting with BI should be monitored for symptoms of social anxiety and may be good candidates for preventive cognitive behavioral strategies.

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Available from: Dina R Hirshfeld-Becker, Jul 30, 2014
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    • "Among a variety of neurobiological and neurobehavioral factors representing a source of risk for pathological avoidance, some have been amenable to study in animal models. For example, the personality trait of behavioral inhibition, characterized as extreme withdrawal in the face of social and non-social challenges (Kagan et al., 1987; Rosenbaum et al., 1991; Fox et al., 2005), is consistently linked to anxiety disorders (Kagan et al., 1987; Hirshfeld et al., 1992; Biederman et al., 1993; Rosenbaum et al., 1993; Fox et al., 2005; Hirshfeld-Becker et al., 2007). Behavioral inhibition can be studied via an animal model, the inbred Wistar Kyoto (WKY) rat strain, which displays behavioral withdrawal, propensity to avoid, hyper-responsiveness to stress, and hypervigilance, compared to outbred strains such as the Sprague-Dawley (SD) rat (Pare, 1992, 1993; Solberg et al., 2001; Drolet et al., 2002; McAuley et al., 2009; Lemos et al., 2011). "
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    ABSTRACT: Avoidance behaviors, in which a learned response causes omission of an upcoming punisher, are a core feature of many psychiatric disorders. While reinforcement learning (RL) models have been widely used to study the development of appetitive behaviors, less attention has been paid to avoidance. Here, we present a RL model of lever-press avoidance learning in Sprague-Dawley (SD) rats and in the inbred Wistar Kyoto (WKY) rat, which has been proposed as a model of anxiety vulnerability. We focus on "warm-up," transiently decreased avoidance responding at the start of a testing session, which is shown by SD but not WKY rats. We first show that a RL model can correctly simulate key aspects of acquisition, extinction, and warm-up in SD rats; we then show that WKY behavior can be simulated by altering three model parameters, which respectively govern the tendency to explore new behaviors vs. exploit previously reinforced ones, the tendency to repeat previous behaviors regardless of reinforcement, and the learning rate for predicting future outcomes. This suggests that several, dissociable mechanisms may contribute independently to strain differences in behavior. The model predicts that, if the "standard" inter-session interval is shortened from 48 to 24 h, SD rats (but not WKY) will continue to show warm-up; we confirm this prediction in an empirical study with SD and WKY rats. The model further predicts that SD rats will continue to show warm-up with inter-session intervals as short as a few minutes, while WKY rats will not show warm-up, even with inter-session intervals as long as a month. Together, the modeling and empirical data indicate that strain differences in warm-up are qualitative rather than just the result of differential sensitivity to task variables. Understanding the mechanisms that govern expression of warm-up behavior in avoidance may lead to better understanding of pathological avoidance, and potential pathways to modify these processes.
    Frontiers in Behavioral Neuroscience 08/2014; 8:283. DOI:10.3389/fnbeh.2014.00283 · 3.27 Impact Factor
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    • "Although Social Anxiety Disorder (SAD; also, Social Phobia) is most commonly diagnosed in adolescence, an increasing body of literature suggests that risk for SAD can be identified much earlier in development (Biederman et al. 2001; Hirshfeld-Becker et al. 2007). Dispositional risk for SAD may first be shown by infants and toddlers demonstrating high levels of inhibited temperament (also, fearful temperament or behavioral inhibition; Kagan et al. 1984), which is at least partly heritable and biologically based, and is manifested behaviorally as reacting to novelty with wariness, hesitance, and avoidance (Kagan et al. 1984). "
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    ABSTRACT: Prevention of later anxiety problems would best be accomplished by identifying at-risk children early in development. For example, children who develop Social Anxiety Disorder (SAD) may show social withdrawal in the form of social inhibition (i.e., shyness with unfamiliar adults and peers) at school entry. Although the use of children's perceptions of their own social inhibition would provide insight into early risk, the utility of young children's self-reports remains unclear. The current study examined whether children deemed more extreme on social inhibition or social anxiety by adult report provided self-report of social inhibition that related to observed social reticence in the laboratory. Participants included 85 kindergarten children (36 female, 49 male), their parents, and their teachers. Moderation analyses revealed that children's self-reported social inhibition related significantly to observed social reticence under the conditions of high parent-reported social inhibition, high teacher-reported social inhibition, and high SAD symptoms. These results suggest that the most inhibited children are aware of their behavior and can report it in a meaningfully way as young as kindergarten age.
    Journal of Abnormal Child Psychology 08/2014; 43(3). DOI:10.1007/s10802-014-9925-2 · 3.09 Impact Factor
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    • "Although BI is not a psychiatric illness, a subset of children with early-life BI develops SAD, whereby the association persists over decades. Both retrospective and longitudinal characterizations of behaviorally inhibited temperament in early childhood have been linked to SAD in middle childhood and adolescence (Biederman et al., 2001; Chronis-Tuscano et al., 2009; Hirshfeld-Becker et al., 2007; Schwartz et al., 1999). For example, longitudinal maternalreported and behavioral evidence suggests that early-life BI increases the odds of having SAD in adolescence by four-fold, and doubles the chance for any anxiety disorder (Chronis-Tuscano et al., 2009). "
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    ABSTRACT: Social anxiety disorder (SAD) markedly impairs daily functioning. For adolescents, SAD can constrain typical development precisely when social experiences broaden, peers' opinions are highly salient, and social approval is actively sought. Individuals with extreme, impairing social anxiety fear evaluation from others, avoid social interactions, and interpret ambiguous social cues as threatening. Yet some degree of social anxiety can be normative and non-impairing. Furthermore, a temperament of behavioral inhibition increases risk for SAD for some, but not all adolescents with this temperament. One fruitful approach taken to understand the mechanisms of social anxiety has been to use neuroimaging to link affect and cognition with neural networks implicated in the neurodevelopmental social reorientation of adolescence. Although initial neuroimaging studies of adolescent SAD and risk for SAD underscored the role of fear-processing circuits (e.g., the amygdala and ventral prefrontal cortex), recent work has expanded these circuits to include reward-processing structures in the basal ganglia. A growing focus on reward-related neural circuitry holds promise for innovative translational research needed to differentiate impairing from normative social anxiety and for novel ways to treat adolescent SAD that focus on both social avoidance and social approach.
    10/2013; 8. DOI:10.1016/j.dcn.2013.10.003
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