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BI, FAMILY ENVIRONMENT AND ANXIETY 1
Temperament, family environment and anxiety in preschool children.
Running head: BI, family environment and anxiety
Jennifer L. Hudson, Helen F. Dodd, Nataly Bovopoulos
Centre for Emotional Health, Macquarie University.
Corresponding author.
Jennifer L Hudson, Ph.D.
Centre for Emotional Health
Macquarie University
NSW 2109 AUSTRALIA
jennie.hudson@mq.edu.au (email)
+61298508668 (ph)
+61298508062 (fax)
This project was supported by the Australian Research Council Discovery Grant (DP0342793).
Acknowledgements: Thank you to the following research assistants and students who assisted in
the data collection and coding for this project: Ruth Locker; Natalie Gar; Delyse Hutchinson;
Tania Trapolini; Elizabeth Seeley; Heidi Lyneham; Ivone Rebelo; Matthew Horne; Kirsteen Moss;
Katy Vidler, Rachel Smith and to the numerous undergraduate volunteers who assisted in the
data collection. Thank you also to Alan Taylor for his statistical advice.
BI, FAMILY ENVIRONMENT AND ANXIETY 2
Abstract
This research examines the relationship between behavioural inhibition (BI), family
environment (overinvolved and negative parenting, parental anxiety and parent-child
attachment) and anxiety in a sample of 202 preschool children. Participants were aged
between 3 years 2 months and 4 years 5 months, 101 were male. A thorough methodology
was used that incorporated data from multiple observations of behaviour, diagnostic
interviews and questionnaire measures. The results showed that children categorised as
behaviourally inhibited were significantly more likely to meet criteria for a range of anxiety
diagnoses. Furthermore, a wide range of family environment factors, including maternal
anxiety, parenting and attachment were significantly associated with BI, with inhibited
children more likely to experience adverse family environment factors. No interactions
between temperament and family environment were found for child anxiety. However, a
significant relationship between current maternal anxiety and child anxiety was found
consistently even after controlling for BI. Additionally, there was some evidence of a
relationship between maternal negativity and child anxiety, after controlling for BI. The
results may suggest that temperament and family environment operate as additive, rather
than interactive risk factors for child anxiety. This is discussed in the context of theoretical
models of child anxiety and directions for future research.
Keywords: Anxiety, Parenting, Parental Anxiety, Attachment, Behavioural Inhibition.
BI, FAMILY ENVIRONMENT AND ANXIETY 3
Anxiety disorders are amongst the most common form of psychopathology in
children and adolescents (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003). Despite
increased attention aimed at the treatment of childhood anxiety and the well-documented
efficacy of such treatments (Cartwright-Hatton, Roberts, Chitsabesan, Fothergill, &
Harrington, 2004), research into the causes and prevention of these disorders remains
relatively scarce. One factor that has been clearly identified as an early risk factor for the
development of anxiety disorders is temperament style Behavioural Inhibition (BI). Kagan
has defined BI in terms of reactions of withdrawal, wariness, avoidance and shyness in
novel, unfamiliar situations (Garcia-Coll, Kagan, & Reznick, 1984). It is estimated that
roughly 15% of infants in the general population are behaviourally inhibited (Fox,
Henderson, Marshall, Nichols, & Ghera, 2005) and that BI is moderately heritable with
around 50% - 80% of the variance accounted for by genes (Dilalla, Kagan, & Reznick, 1994).
Several studies report that early BI is associated with increased risk for anxiety
disorders, particularly social anxiety disorder, later in life (Chronis-Tuscano et al., 2009;
Schwartz, Snidman, & Kagan, 1999). Importantly, however, not all temperamentally
vulnerable children develop an anxiety disorder (Prior, Smart, Sanson, & Oberklaid, 2000).
Consequently, etiological models of childhood anxiety (Hudson & Rapee, 2004; Vasey &
Dadds, 2001) and recent reviews of the literature (Degnan, Almas, & Fox, 2010) have
stressed the importance of considering the interplay between child temperament and
environmental risk factors in order to better understand the development of anxiety in
children.
Given that the family context is an important environmental factor in young
children’s lives, a number of researchers have explored the role of family factors in the
development of child anxiety including: parental overcontrol/overinvolvement (Hudson &
BI, FAMILY ENVIRONMENT AND ANXIETY 4
Rapee, 2001), parental negativity (Barrett, Fox, & Farrell, 2005), parental anxiety
(Biederman et al., 2001) and parent-child attachment (Moss et al., 2006). In the present
research the relationship between each of these family environment factors, BI and anxiety
will be examined with a specific focus on whether these risk factors interact to affect anxiety
or operate as additive risk factors.
Parenting styles
Traditional conceptualisations of parenting focused on the dimensions of acceptance
versus rejection and control verses autonomy granting, with acceptance and autonomy
granting considered optimal parenting (Rapee, 1997). More recent research has examined
parenting styles within this framework. Across this literature, a plethora of terms and
corresponding definitions have been used. For example, in relation to the rejection
dimension, research has used terms such as negativity, lack of warmth, and hostility. In
relation to the control dimension, the terms overprotection, overinvolvement,
oversolicitousness and intrusiveness have been used. In the present paper, the terms
negativity and overinvolvement are used. Negativity is conceptualised as parenting that is
higher in criticism and lower in warmth. It is hypothesized that parents who are negative
during interactions with their child may criticise and minimise the child’s feelings,
undermining the child’s emotion regulation and increasing their sensitivity to anxiety
(Wood, McLeod, Sigman, Hwang, & Chu, 2003). Overinvolvement is conceptualised as
parenting behaviour that provides more assistance and help to the child than needed,
overprotecting the child from potential danger or distress. This behaviour is often intrusive
in nature and controlling. Overinvolved parenting is hypothesised to affect child anxiety by
increasing the child's perception of threat, reducing the child's perceived control over threat
and increasing the child's avoidance of threat (Rapee, 1997).
BI, FAMILY ENVIRONMENT AND ANXIETY 5
Overinvolvement.
There is consistent evidence from observation research that parents of anxious
children are more overinvolved during interactions with their children than parents of non-
anxious children (Hudson & Rapee, 2001; van der Bruggen, Stams, & Bogels, 2008).
Furthermore, longitudinal research suggests that overinvolvement may play a role in the
development of anxiety over time (Lieb et al., 2000). Similarly, two studies have shown that
overinvolved parenting is associated with subsequent anxiety in preschool children (Bayer,
Sanson, & Hemphill, 2006; Edwards, Rapee, & Kennedy, 2010). Importantly, there is also a
growing body of research showing that overinvolved parenting is associated with the
maintenance of BI and social reticence in childhood (Degnan et al., 2008; Rubin, Burgess &
Hastings, 2002).
Parental Negativity.
Although some detailed observation studies have shown that parents of anxious
children are more negative during interactions with their child than parents of control
children (Barrett et al., 2005), in general the evidence that negativity plays a role in the
development of child anxiety is less convincing than for overinvolvement (McLeod, Wood, &
Weisz, 2007). Limited longitudinal research has been conducted and to date findings are
inconclusive with some studies reporting significant associations between negativity and
anxiety over time (Lieb et al., 2000) and others finding no association (Bayer et al., 2006).
Parental Anxiety
It is well-established that anxiety runs in families; anxious parents are more likely to
have an anxious child (Biederman et al., 2001) and anxious children are more likely than
non-anxious children to have an anxious parent (Cooper, Fearn, Willetts, Seabrook, &
Parkinson, 2006). However, the transmission of anxiety from parent to child is likely to be
BI, FAMILY ENVIRONMENT AND ANXIETY 6
more than the transmission of genetic material. Anxious parents may model anxious
behaviour (Murray et al., 2008), may provide threat information to their child (Field,
Lawson, & Banerjee, 2008) or encourage avoidant responses to threat (Barrett, Rapee,
Dadds, & Ryan, 1996). Consequently, having an anxious parent can be considered an
environmental, as well as a genetic risk factor for child anxiety.
Attachment
Finally, parent-child attachment has also been identified as a risk factor for the
development of anxiety disorders. A recent review of the literature concluded that
attachment security in general and ambivalent attachment and disorganised attachment,
more specifically, may act as risk factors for anxiety (Brumariu & Kerns, 2010). For example,
Moss et al. (2006) found that children who were classified as having disorganised
attachment at age 5-7 years exhibited significantly more anxiety symptoms two years later.
Family Environment, BI and Anxiety
From this brief overview of the literature it can be seen that, along with BI, a number
of family environment factors are associated with the development of child anxiety.
Importantly, there is also some indication that children high in BI are more likely to
experience these adverse family environments. For example, children classified as high on BI
are more likely to have anxious an parent (Biederman et al., 1993; Hirshfeld-Becker et al.,
2004; Rosenbaum et al., 1992), more likely to have an insecure-ambivalent attachment style
(Shamir-Essakow, Ungerer, & Rapee, 2005), more likely to experience maternal negativity
(Hirshfeld-Becker, Biederman, Brody, & Faraone, 1997) and less likely to be encouraged to
be independent (Rubin, Nelson, Hastings, & Asendorpf, 1999). It is essential therefore that
research examining the developmental psychopathology of child anxiety consider the
interplay between temperament and family environment factors.
BI, FAMILY ENVIRONMENT AND ANXIETY 7
There are a number of ways in which BI and family environment might be associated
with anxiety risk. First, family environment factors may not be significantly associated with
child anxiety once temperament is controlled. Second, family environment factors might
represent an additive risk for anxiety, over and above child temperament. Third, family
environment factors might interact with temperament such that adverse family
environment may have a greater impact on an inhibited child than an uninhibited child. In
this way family environment would be conceptualised as a moderator of the child
temperament – anxiety relationship. Finally, it has also been proposed that family
environment might mediate the relationship between temperament and child anxiety
(Degnan et al., 2010). For example, temperament might lead to more overinvolved
parenting which might, in turn, lead to increased anxiety. Examination of mediation
necessitates longitudinal research, preferably with three time points (Maxwell & Cole,
2007).
To examine the interplay between temperament and environment, recent research
has begun to examine multiple family environment risk factors alongside BI. To date, there
is little evidence to suggest that BI and family environment interact to affect anxiety risk.
Instead, additive effects have been reported for attachment, maternal anxiety and BI
(Shamir-Essakow et al., 2005) and for attachment, maternal overinvolvement and BI (van
Brakel, Muris, Bogels & Thomassen, 2006) in cross-sectional research, and for BI and
maternal anxiety (Muris, van Brakel, Arntz & Schouten, 2010) and BI, child anxiety, maternal
negative affect and maternal overinvolvement (Edwards et al., 2010) in longitudinal
research. There is, however, some evidence to suggest that BI interacts with overinvolved
parenting to affect child temperament and shyness over time (Degnan et al., 2008; Muris et
al., 2010; Rubin et al., 2002).
BI, FAMILY ENVIRONMENT AND ANXIETY 8
Summary and Hypotheses
In summary, although research has established that BI and family environment are
associated with child anxiety, research including multiple risk factors remains scarce
(Degnan et al., 2010). Furthermore, with the notable exception of the cross-sectional study
by Shamir-Essakow et al. (2005), previous research examining multiple risk factors has relied
on questionnaire measures of temperament, family environment and anxiety. There are a
number of problems with relying on questionnaire measures. Most pertinent is that when
several measures are completed by the same individual, shared method variance can lead to
biased estimates of the relationship between the variables assessed. The purpose of the
current study was, therefore, to examine the interactive and additive effects of BI and family
environment (overinvolvement and negativity, parental anxiety and parent-child
attachment) in relation to concurrent anxiety disorders and symptoms in a sample of
preschool children using a thorough methodology. Both parent and child anxiety were
assessed using structured diagnostic interviews and questionnaire measures, BI is assessed
using both observation and parent-report questionnaires and multiple observations of
parent-child interactions were used to assess parenting factors and attachment. This is the
first study to examine this range of risk factors using observation and clinical assessments.
Based on previous research and theoretical models, it was hypothesised that: (1)
behaviourally inhibited children would have a higher rate of anxiety diagnoses overall and in
particular social anxiety disorder; (2) behaviourally inhibited children would be more likely
to have anxious parents, more likely to experience overinvolved and negative parenting and
more likely to have an insecure-ambivalent attachment style. The additive versus interactive
effects of BI and family environment in relation to anxiety diagnoses and symptoms were
BI, FAMILY ENVIRONMENT AND ANXIETY 9
examined. As limited previous research has explored this research question, no a priori
hypotheses were formed.
Method
Participants
Participants were 202 children and their parents, recruited as part of a longitudinal
study. Participants were recruited through local preschools and via an advertisement in a
free parenting magazine. Mothers were invited to complete the Short Temperament Scale
for Children (STSC; Sanson, Smart, Prior, Oberklaid, & Pedlow, 1994) which contains 30
items assessing four temperament dimensions: Approach (tendency to approach versus
withdraw from novel situations and people), Inflexibility, Persistence, and Rhythmicity. The
STSC has adequate validity, good internal consistency and reliability (e.g., Sanson et al.,
1994). In the current screening sample, the internal consistency for the approach scale was
Cronbach alpha = .92. A total of 2182 screening questionnaires were distributed and 567
(26%) were returned. Children scoring one standard deviation above or below the
normative mean on the Approach Scale were classified as behaviourally inhibited or
behaviourally uninhibited respectively (N=317). These participants were then invited to
participate in the full study and 202 (64%) agreed; 102 classified as high on BI (BI group) and
100 classified as low on BI (BUI group). Children with a developmental disorder or with
parents who were unable to read a standard English newspaper were excluded from the
study.
The final sample included children aged between 3 years 2 months and 4 Years 5
months (mean = 4 years, sd = 4 months) . There were an equal number of boys and girls in
both temperament groups, 60% of the children were first born and the majority had one or
more siblings (85%). Of the final sample, 89% came from two-parent homes, 56% were from
BI, FAMILY ENVIRONMENT AND ANXIETY 10
middle to high income families. Mothers were aged between 20 and 50 years (mean = 36.28
years, sd = 4.47 years). The majority of mothers (50%) stayed at home by choice, 42%
worked part-time; 92% of mothers had completed school up to the age of 18 (92%) and 85%
had obtained a post-school qualification. For ethnicity, 64% of participants were identified
as being Oceanic, 20% as European and 10% as Asian, with the remainder being American,
African or Middle Eastern. There were no significant differences between temperament
groups for child age, maternal age, education, marital status, family income, number of
siblings or birth order (p > .05). Significant differences were found for ethnicity, χ
2
(5) =
11.87, p = .04, with greater numbers of children of Asian ethnicity in the BI group. Thus, a
dummy variable for Asian ethnicity was added as a covariate in all analyses involving
comparisons of the temperament groups.
Fathers were also asked to complete a single questionnaire measure of anxiety
symptoms. Completed questionnaires were received from 186 fathers. Of the fathers that
did not return the questionnaire 69% were from single-parent or blended families where
contact with the father was minimal.
Measures
Observed behavioural inhibition. In addition to the STSC, BI was assessed using
observation of performance on a series of laboratory tasks (Kagan, Reznick, & Gibbons,
1989). In the first session participants were exposed to: a new room, a novel toy; a masked
experimenter dressed in a strange suit. In the second session, conducted on a different day,
participants were assessed during a 10 minute period of free play with a same-sex
unfamiliar peer. Behaviours used to determine inhibition status included i) time spent
proximal to the mother, ii) amount of time staring at the peer, iii) time spent talking, iv)
number of approaches to the stranger and v) number of approaches to the peer. A
BI, FAMILY ENVIRONMENT AND ANXIETY 11
participant was defined as behaviorally inhibited, based on observation, if they scored
above the cutoff on three or more of these five behaviours. The cutoffs were: total time
spent talking during stranger and peer components combined - less than 1 min; total time
within arm's length of mother during stranger and peer components combined - greater
than 1 min; total time spent staring at peer - greater than 2 min; frequency of approach to
stranger - one or less; frequency of approach to peer - one or less (Rapee, Kennedy, Ingram,
Edwards, & Sweeney, 2005). Coding was conducted by postgraduate students in psychology,
trained by the first author, who were blind to participants’ STSC scores and diagnoses. Inter-
rater reliability for observed BI was determined by having a second trained coder
independently score the videotapes for 25% of the sample. The inter-rater reliability for
number of cutoffs exceeded was ICC = .91 and for overall BI classification base on
observation was kappa = .79.
Child anxiety disorders. All mothers were interviewed using the Anxiety Disorders
Interview Schedule for DSM-IV, Parent Version (ADIS-P; Silverman & Albano, 1996). At
baseline, items referring to school were changed to ‘preschool.’ Previous research has
shown that the ADIS-P can be reliably used to diagnose anxiety disorders in preschool
children (Rapee et al., 2005). Diagnoses and Clinical Severity Ratings (CSRs on a scale of 0-8)
were assigned by graduate students in psychology or qualified clinical psychologists trained
by the first author, who were unaware of the child’s group membership. Diagnoses were
based on the criteria set out by the DSM-IV (American Psychiatric Association, 1994) and
were only considered ‘clinical’ if the CSR was four or greater. As a method of assessing
anxiety severity, number of anxiety diagnoses was used. A total of 44 cases (22%) were
coded by a second clinician from videotape. Interrater agreement was as follows: presence
of clinical anxiety diagnosis (kappa = .86), number of anxiety diagnoses (ICC = .90). Reliability
BI, FAMILY ENVIRONMENT AND ANXIETY 12
for individual diagnoses ranged from .77 to .81. There were no gender differences in child
anxiety status for the entire sample, χ
2
(1, N = 202) = 0.18, p = .67, or for the BI group
independently, χ
2
(1, N = 102) = 0.79, p = .38.
Child anxiety symptoms. Mothers completed the Preschool Anxiety Scale, adapted
from the Spence Children’s Anxiety Scale (PAS; Spence, Rapee, McDonald, & Ingram, 2001).
The PAS contains 28 items that provide an overall measure of child anxiety as well as five
specific aspects of child anxiety including generalised anxiety, separation anxiety, social
phobia, physical injury fears, and obsessive-compulsive (scores range from 0 to 128). The
measure has good construct validity, satisfactory internal consistency and good cross-
informant and test-retest reliability (Spence et al., 2001). Internal consistency in this sample
was as follows: Cronbach’s alpha = .93. There were no significant gender differences in total
anxiety scores on the PAS, t (196) = 1.54, p = .13.
Maternal anxiety disorders. At baseline, mothers were interviewed with the Anxiety
Disorders Interview Schedule for DSM-IV (DiNardo, Brown, & Barlow, 1994) to assess
current and lifetime Axis 1 diagnoses. Diagnoses and Clinical Severity Ratings were assigned
by graduate students in psychology or qualified clinical psychologists trained by the first
author, who were unaware of the child’s group membership and anxiety status. Diagnoses
were based on the criteria set out by the DSM-IV (APA, 1994) and were only considered
‘clinical’ if the CSR was four or greater. As a measure of anxiety severity number of clinical
anxiety diagnoses was used. A total of 20 cases (10%) were coded by a second clinician from
videotape. Interrater agreement was as follows: any current anxiety diagnosis (kappa = .76),
any lifetime (including current and past) anxiety diagnosis (kappa = .78), number of current
anxiety diagnosis (ICC = .85), number of lifetime anxiety diagnoses (ICC = .67). Inter-rater
agreement for a current diagnosis of the main anxiety disorders ranged from .77 – 1.
BI, FAMILY ENVIRONMENT AND ANXIETY 13
Maternal and paternal anxiety symptoms. Mother’s and fathers anxiety symptoms
were assessed using the Anxiety subscale of the Depression, Anxiety and Stress Scale (DASS-
21; Lovibond & Lovibond, 1995). The DASS is a self-report measure of anxiety and
depressive symptoms that asks participants to rate how they feel ‘generally’. Participants
rate 21 items, seven of which form the anxiety subscale, using a scale from zero (does not
apply to me at all) to three (applies to me very much). The DASS-21 has good factor
structure, concurrent validity and internal consistency (Antony, Bieling, Cox, Enns, &
Swinson, 1998). In the present sample the internal consistency of the DASS was as follows:
fathers (Cronbach’s alpha = .89); mothers (Cronbach’s alpha = .88).
Overinvolvement and Negativity.
Parent Protection Scale. The Parent Protection Scale was used to assess specific
parenting behaviors related to child autonomy and parental overprotection (Thomasgard,
Metz, Edelbrock, & Shonkoff, 1995). The PPS contains 25 items (on a scale from zero to
three) and four subscales: Supervision, Separation, Dependence and Control. The Control
scale was of greatest interest to the current study. The PPS has shown adequate internal
reliability, re-test reliability, criterion and content validity (Thomasgard & Metz, 1999;
Thomasgard et al., 1995). The internal consistency in this sample was Cronbach’s alpha =
.65.
Speech preparation task. Mothers were observed interacting with their child during
a three minute speech preparation task, adapted from Hudson and Rapee (2001). This task
has been shown to reliably induce mild stress in participants. Children were asked to
prepare a 1-minute speech and mothers were asked to provide support but only to provide
help if they felt their child really needed it. The experimenter then left the room for 3
BI, FAMILY ENVIRONMENT AND ANXIETY 14
minutes before returning and asking the child to stand and tell their story. The preparation
time was videotaped and parental behaviour was coded.
Coders watched the entire interaction and then rated the parent’s behaviour using
six scales, each consisting of a nine-point continuum. The involvement factor consisted of
the following global scales (i) general degree of mother’s involvement, (ii) degree of
unsolicited help, (iii) degree to which the mother directs the child’s speech. The involvement
factor (a mean of the three scales) represented the overall measure of the degree of help
the parent gave during the task. The developmental level of the child and the amount of
help that was therefore required was taken into account when judging evidence of
overinvolved behaviour in the mother. The negativity factor assessed the degree of parental
warmth during the interaction and comprised the following subscales (i) general mood –
atmosphere of the interaction, (ii) mother’s degree of positive affect, and (iii) mother’s
degree of verbal and non-verbal encouragement and criticism. The negativity rating was
based on a mean of the above three scales. The involvement and negativity factors
represent theoretically constructed and empirically tested factors (Hudson & Rapee, 2001).
All of the speech preparation tasks were coded by two postgraduate students in
psychology, trained by the first author in the coding system until 80% accuracy was reached.
Both coders were unaware of participants’ diagnostic status. The reliability for the average
of these ratings was ICC = .94 for the overinvolvement factor and ICC = .73 for the negativity
factor. The average ratings of these two coders were used in analyses, with the exception of
eight participants whose ratings were discrepant by more than two points. These
interactions were coded again by the first author who decided on a final value taking into
account the coders’ initial responses.
BI, FAMILY ENVIRONMENT AND ANXIETY 15
Five Minute Speech Sample. The Five Minute Speech Sample (FMSS) task was
conducted and coded according to the method described by Magana et al. (1986). Parents
were asked to describe their child and their relationship for five minutes without
interruption. The speech samples were videotaped and transcribed. Two measurements
were taken from the FMSS: Criticism and Over-involvement. A high criticism rating was
assigned on the basis of one or more criticisms, a negative relationship rating, or a negative
initial statement. A high over-involvement rating was assigned on the basis of reports of
self-sacrificing or overprotective behaviour. The first author was trained and certified as a
reliable rater by Sybil Zaden of U.C.L.A. and coded 48 transcripts. The first author trained the
primary coder until 80% agreement was reached. Inter-rater reliability was as follows:
Overinvolvement (kappa = .63), Criticism (kappa = .96).
Attachment. Child-mother attachment was assessed using the preschool version of
the Strange Situation procedure (Cassidy & Marvin, 1992). Similar to the infant version of
the Strange Situation (Ainsworth, Blehar, Waters, & Wall, 1978) it consists of eight episodes
of separation and reunion between mother and child, including an episode where the child
plays in the room by themselves for 3 minutes and two episodes where the stranger is also
present, one of these in the company of the mother.
Children were classified as either securely (B) or insecurely (insecure-avoidant (A),
insecure-ambivalent (C), disorganised-controlling (D) or insecure-other) attached following
observational coding of videotaped interactions by one of two certified coders trained in the
Cassidy-Marvin (Macarthur) Preschool Attachment Classification System (Cassidy & Marvin,
1992). For the purposes of data analysis, children classified as insecure-other were
combined with disorganised-controlling to form a single D group. Reliability was established
BI, FAMILY ENVIRONMENT AND ANXIETY 16
by having both coders independently code 42 cases. Agreement for classification into one of
the four groups was kappa = .74.
Procedure
Macquarie University Human Ethics Committee approved the methods of the study.
Following the initial screen using the parent-reported STSC, children meeting entry criteria
were invited to take part in the full study. After a description of the study, mothers provided
written informed consent for themselves and their children. The children provided assent to
the study procedures. Families were reimbursed $50 plus a small gift for their child. Parents
and children visited the university for two 2-hour sessions during which all baseline
assessments outlined above were completed. Additional questionnaires and observed tasks
were also completed during the baseline session that are not presented here.
Data Preparation and Analysis
Multiple methods were used to assess the broad constructs of overinvolvement and
negativity. Overinvolvement was measured using the Parent Protection Scale, the FMSS and
the speech preparation task. To construct a single overinvolvement variable, the
overinvolvement variable for each of these measures was converted to a z-score and the
mean of the three measures was computed. Similarly, to construct a single negativity
variable, the criticism variable from the FMSS and the negativity variable from the speech
preparation task were converted into z-scores and the mean of the mean of the two
measures was computed.
Due to technical problems with recording equipment, missed responses in
questionnaires or the unavailability of fathers, there was a small amount of missing data.
The analyses were conducted with the following family environment variables, the number
in brackets shows the number of cases with complete data for each variable:
BI, FAMILY ENVIRONMENT AND ANXIETY 17
overinvolvement (202), negativity (201), maternal current anxiety diagnosis (202), maternal
lifetime anxiety diagnosis (202), maternal number of current diagnoses (202), maternal
number of lifetime anxiety diagnoses (202), maternal anxiety symptoms as reported on the
DASS (201), paternal anxiety symptoms as reported on the DASS (186) and an attachment
variable representing the four attachment classifications described above (197). Child
anxiety is represented by three variables: presence of clinical anxiety diagnosis (202),
number of clinical anxiety diagnoses (202) and PAS score (198). Analyses are conducted with
all available data.
Based on behaviour during the laboratory assessment of BI, 92 participants were
classified as inhibited and 110 participants as uninhibited. Classifications were in agreement
with the original parent-report groups for 74% of participants. All analyses were therefore
conducted initially using the parent-report groups and then conducted again using only
those participants whose parent-report classification was consistent with their laboratory-
based classification. Where differences in significance were found, these are reported. For
all analyses including comparisons of temperament groups, the analyses were conducted
with ethnicity controlled for. No significant effect of ethnicity was found for any of the
analyses and no difference in the overall pattern of results was found when ethnicity was
included. For simplicity the results are therefore reported without ethnicity.
Scores on the baseline PAS, mother-report DASS Anxiety scale and father-report
DASS Anxiety scale were positively skewed and were successfully transformed using a
square root transformation.
Results
BI and Anxiety
BI, FAMILY ENVIRONMENT AND ANXIETY 18
Table 1 shows the prevalence rates for anxiety diagnoses in the BI group and BUI
group. Chi-squared analyses were used to compare prevalence rates between temperament
groups. Where number of anxiety diagnoses was the dependent variable, negative binomial
regression was used to be consistent with the distribution of the data. T-tests were
conducted to compare temperament groups on PAS score. A Bonferroni-adjusted p-value of
0.006 (0.05/8) was used to establish statistical significance. Effect size estimates are
included as appropriate.
[Insert Table 1 here]
In comparison to the BUI group, the BI group were significantly more likely to meet
criteria for an anxiety disorder and had a higher number of anxiety diagnoses. Significantly
higher prevalence rates of Social Anxiety Disorder, Specific Phobia and Separation Anxiety
Disorder were found in the BI group compared to the BUI group. The difference between
temperament groups on Generalised Anxiety Disorder did not reach significance at the
adjusted p-value. The total PAS score for the BI group (M = 35.99, SD = 16.02) was
significantly greater than the total score for the BUI group (M = 11.36, SD = 9.40), t (196) = -
13.51, p < 0.001, d = 1.92. When these analyses were conducted with the subsample of
participants whose parent report BI status and observed BI status were consistent, the same
patterns of significance were found.
BI and Family Risk Factors
Table 2 displays each family risk factor variable for the BI group and BUI group. To
examine group differences, chi-squared analyses, t-tests and negative binomial regressions
were conducted as appropriate. Bonferroni-adjusted p-values for statistical significance
were as follows: maternal anxiety p < .008 (.05/6); parenting p < .025 (.05/2); attachment p
< 0.05 (no adjustment necessary). A significant difference between the temperament groups
BI, FAMILY ENVIRONMENT AND ANXIETY 19
was found on: maternal current anxiety diagnoses, maternal lifetime anxiety diagnoses,
number of current maternal anxiety diagnoses, maternal anxiety symptoms,
overinvolvement, and negativity. In addition, significant differences were found between
temperament groups on ambivalent attachment, with inhibited children more likely to be
classified as having ambivalent attachment than uninhibited children. No significant
differences were found between temperament groups for paternal anxiety symptoms or
number of maternal lifetime anxiety diagnoses. These findings were consistent when the
sample was limited to only those participants whose BI classifications on parent report and
observation were in agreement. The only exception to this was differences between
temperament groups on negativity, which did not reach significance using the smaller
sample, t (148) = -1.94, p = .05, d = .32.
[Insert Table 2 here]
Family Risk Factors, BI and Anxiety
In the following analyses, the association between child anxiety and each of the
following was examined: (1) temperament; (2) each family risk factor (Overinvolved
Parenting, Negative parenting, Attachment, and Maternal Anxiety); (3) the interaction
between each family risk factor and temperament. The continuous independent variables
were centred prior to these analyses. The presence/absence of a clinical anxiety diagnosis
and the total PAS score were the dependent variables. The results for each are presented in
turn. For each set of analyses the Bonferroni-adjusted p-values for statistical significance
were as follows: maternal anxiety analyses p < .008 (.05/6); parenting analyses p < .025
(.05/2); attachment analysis p < 0.05 (no adjustment necessary).
Presence of clinical anxiety diagnosis.
BI, FAMILY ENVIRONMENT AND ANXIETY 20
To examine the additive and interactive effects of BI and family environment factors,
logistic regression was used. For each analysis, temperament group was entered initially
into the model. Subsequently, the variable representing the family factor of interest was
entered, and finally the interaction between temperament and the family environment
factor was entered. None of the interaction terms were statistically significant (p > .1). A
significant main effect of temperament group was found for all analyses (p < .0001). The
effect of each family environment factor, after controlling for the effect of temperament
group, is shown in Table 3. This shows that, after controlling for the significant main effect
of temperament group, there was a significant effect of maternal current anxiety diagnosis,
number of current maternal anxiety diagnoses and number of maternal lifetime diagnoses,
demonstrating additive effects. No significant effect of any of the other family environment
factors was found, after controlling for the effect of temperament.
[Insert Table 3 here]
The only significant predictors of child anxiety diagnosis were maternal anxiety and
temperament group. Together maternal current anxiety diagnosis (the maternal anxiety
variable with the largest effect size) and temperament group correctly predicted the
presence of an anxiety diagnosis in 81% of participants and correctly predicted the absence
of an anxiety diagnosis in 75% of participants.
When the analyses were conducted using only those participants whose parent
reported BI status and observation of BI were consistent, the pattern of results were
consistent with the exception that no significant effect of number of maternal lifetime
anxiety diagnoses, b = .20, SE = .15, Wald
= 1.87, df = 1, p = .17, OR = 1.22, was found.
PAS scores.
BI, FAMILY ENVIRONMENT AND ANXIETY 21
The general linear model procedure (GLM) was used to examine the relationship
between family factors, BI and the interaction between each family factor and BI with child
anxiety symptoms. For each analysis temperament group was initially entered into the
model. Subsequently, the variable representing the family factor of interest was entered
and finally the interaction between temperament and the family environment factor was
entered. Type I sums of squares was used. No significant interactions were found between
temperament group and any of the family factor variables (p > .1). For all analyses the main
effect of temperament group was significant (p < 0.0001; partial η
2
> .4). The effect of each
family environment factor after controlling for temperament group is shown in Table 4. In
addition to the significant main effect of temperament group, a significant relationship
between child anxiety symptoms and maternal current anxiety disorder, maternal lifetime
anxiety disorder, number of maternal current anxiety disorders, number of maternal
lifetime anxiety disorders, and maternal anxiety symptoms, was found. In addition, there
was a significant main effect of maternal negativity. No significant effect of
overinvolvement, attachment style, or paternal anxiety symptoms was found. The results
were consistent when the sample was limited to only those participants whose BI
classifications on parent report and observation were in agreement.
To examine the relative contribution of all the significant predictors found above
(temperament group, maternal anxiety, and maternal negativity) a GLM analysis was
conducted including all of these variables in a single model using type III marginal sums of
squares. As no significant interactions were found, no interactions were included. Maternal
current anxiety diagnosis was used to represent maternal anxiety as this variable received
the highest effect size of the diagnostic variables above. A significant main effect of
maternal negativity, F (1, 193) = 7.29, MSE = 12.04, p = .008 (partial η
2
= .036), maternal
BI, FAMILY ENVIRONMENT AND ANXIETY 22
current anxiety disorder, F (1, 193) = 33.78, MSE = 55.79, p < .0001 (partial η
2
= .149), and
temperament group, F (1, 193) = 158.13, MSE = 261.20, p < .0001 (partial η
2
= .45), were
found. Together, maternal current anxiety diagnoses, temperament group and maternal
negativity accounted for 58% of the variance in PAS score.
To examine whether family factors might influence the association between
temperament and anxiety differently according to child gender, we conducted the above
analyses including three way environment x temperament x gender interactions. None of
these interactions were significant (p > .1).
Discussion
The aim of this research was to examine the relationship between BI, family
environment and anxiety in a sample of preschool children, with a specific focus on the
interactive and additive effects of child temperament and family environment. A number of
hypotheses were made based on the findings of previous research and relevant etiological
models of child anxiety. First, it was hypothesised that BI would be significantly associated
with child anxiety and that this association would be particularly strong for social anxiety.
The results provided some support for this initial hypothesis; children in the BI group had
significantly higher prevalence rates of anxiety disorders and parent-reported symptoms,
but this was not specific to Social Anxiety Disorder; significantly higher rates were also
found for Specific Phobia and Separation Anxiety Disorder. 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
BI, FAMILY ENVIRONMENT AND ANXIETY 23
(Chronis-Tuscano et al., 2009; Muris et al., 2010). It will be important to explore this finding
further in future research using a longitudinal methodology.
The second hypothesis was that the BI group, relative to BUI group, would
experience more adverse family environments across the environmental factors assessed.
The results also supported this hypothesis; high BI was associated with elevated rates of
maternal anxiety disorders and symptoms, more overinvolved parenting, more negative
parenting and higher rates of ambivalent attachment. The only family environment risk
factor assessed that was not associated with BI was paternal anxiety symptoms. These
results are also in keeping with previous findings suggesting a relationship between BI and
overinvolvement (Rubin et al., 1999), negativity (Hirshfeld-Becker et al., 1997), maternal
anxiety (Biederman et al., 1993) and attachment (Shamir-Essakow et al., 2005).
As discussed previously, there are a number of ways in which temperament and
family environment may be associated with child anxiety. In the present research we were
interested in whether family environment factors accounted for additional variance in child
anxiety, after controlling for child temperament (additive effect of family environment) and
whether family environment factors interacted with temperament to account for variance in
child anxiety (interactive effects). The results provided no evidence for temperament by
family environment interactions. There was, however, consistent evidence that parent-
reported BI and maternal anxiety were both independently associated with child anxiety
diagnoses. Furthermore, the results suggest that maternal negativity may also be
significantly related to child anxiety, even after controlling for BI and maternal anxiety. In
contrast, overinvolvement, attachment and paternal anxiety symptoms were not
significantly associated with child anxiety when the relationship between BI and anxiety was
BI, FAMILY ENVIRONMENT AND ANXIETY 24
taken into account. These findings suggest that adverse family environment may add to
anxiety risk equally in both temperamentally at risk and not at risk children.
The lack of significant interactions between temperament and family environment
factors is not in keeping with recent theoretical models (Hudson & Rapee, 2005; Vasey &
Dadds, 2001) but is consistent with the small number of previous studies to have examined
BI and environmental risk factors. There are a number of possible explanations for the lack
of significant interactions. First, as discussed, children high on BI may not be any more
vulnerable to adverse environments than those low on BI and these risk factors might
instead have additive effects on child anxiety. Alternatively, the outcome of interactions
between temperament and environment may not be expressed until later in development,
perhaps when children encounter stressors such as starting school. If this is the case then
longitudinal follow-ups across childhood will be required for the effect of interactions to be
observed. Similarly, it is possible that temperament, as assessed at different developmental
stages, such as infancy, or stable temperament across early childhood, might interact with
family environment factors. Finally, it is also possible that the lack of significant interactions
is an artefact of the difficulty finding interactions in non-experimental research (See
McClelland & Judd, 1993 for a discussion).
Although no significant interaction with BI was found, the results provided consistent
evidence for a relationship between maternal anxiety and child anxiety, even after
controlling for child temperament. This relationship was particularly strong for current
maternal anxiety, as contrasted with lifetime maternal anxiety. This might suggest that
maternal anxiety not only infers genetic risk for anxiety but also acts as an environmental
risk factor for child anxiety, possibly via the modelling of anxious behaviour, verbal
communication of threat information and encouragement of avoidance (Barrett et al., 1996;
BI, FAMILY ENVIRONMENT AND ANXIETY 25
Field et al., 2008; Murray et al., 2008). However, it is also possible that mothers who had a
current anxiety diagnosis had more chronic or severe anxiety than those who had met
criteria for an anxiety disorder in the past but had recovered. Further research more closely
comparing these groups will be important to clarify the relationship between maternal
anxiety and child anxiety.
In contrast to the strong support for a relationship between maternal anxiety and
child anxiety, no significant relationship between paternal anxiety and child anxiety, or BI,
was found. This finding is somewhat surprising in light of recent etiological models
emphasising the role of fathers in the development of child anxiety (Bogels & Phares, 2008).
Previous research has been mixed with regards the relationship between paternal anxiety
and child anxiety with some research finding a relationship between anxiety in fathers and
anxiety in children (Muris et al., 2010), and other research finding no relationship (McClure,
Brennan, Hammen, & Le Brocque, 2001). It seems likely that the effect of paternal anxiety
on child anxiety might depend on the role the father plays in the child’s care. In the
circumstance where the child’s mother is their primary caregiver, the environmental effects
of maternal anxiety may be stronger than the effects of paternal anxiety. It is possible that a
relationship between paternal anxiety and child anxiety might have been found if full
diagnostic interviews had been conducted. It will be useful, therefore, for future research to
include diagnostic measures of paternal anxiety as well as maternal anxiety and also to
record the extent to which each parent is involved in the child’s care.
After controlling for maternal anxiety and BI, there was a significant relationship
between maternal negativity and child anxiety symptoms. It is possible therefore that
maternal negativity may affect child anxiety. Previous research has, however, yielded
inconsistent evidence for a causal relationship (McLeod et al., 2007; Wood et al., 2003).
BI, FAMILY ENVIRONMENT AND ANXIETY 26
Alternatively, it is possible that mothers tend to be more negative when talking about their
child, and interacting with their child, if their child is anxious. This may be exaggerated when
the parent-child interaction is assessed in an anxiety provoking situation. Future longitudinal
research will provide further insight into this relationship and the direction of this effect.
The results of this study provide important insights into the relationship between
risk factors typically studied in isolation and between these risk factors and child anxiety.
However, the limitations of the study should be considered. First, the cross-sectional design
means that it is not possible to disentangle patterns of cause and effect. For example, it
remains possible that parenting an anxious child could lead to an increase in maternal
anxiety. It will be important for future research to use a thorough methodology, as
exemplified here, to conduct longitudinal research into the causes of child anxiety.
Longitudinal research will also provide an opportunity for mediation pathways to be
examined. For example, BI could affect parenting, which might affect future anxiety risk.
Second, the main focus of the present research was on mother-child interactions and
mother-child relationships. However, as highlighted in a recent review (Bogels & Phares,
2008), fathers may also play a role in the development of child anxiety. This represents an
exciting area for future research. Third, the majority of the participants were from middle
class families. The extent to which the present findings generalise to other populations is
not currently clear. Finally, it was not possible to include all risk factors that have been
associated with BI and child anxiety. Other risk factors that may be of particular importance
for future research to consider are parental depression, effortful control and life events.
Although it is not possible to examine causal pathways in the present research, the
findings clearly demonstrate that inhibited preschool children are likely to be exposed to a
variety of environmental risk factors and that certain family environment factors may affect
BI, FAMILY ENVIRONMENT AND ANXIETY 27
anxiety over and above child temperament. On the basis of the present findings, it may be
particularly important to assess maternal anxiety, temperament and maternal negativity
when seeking to identify children at-risk for elevated anxiety. However, longitudinal data is
essential to clarify the factors that predict change in anxiety over time. The findings have
implications for early intervention programs aimed at reducing anxiety risk in this group.
Rather than specifically focusing on inhibition and reactivity to novelty, it may be necessary
to target a range of risk factors, in particular those that might play a role in the maintenance
of BI such as overinvolved parenting, in order to affect anxiety risk in this group.
BI, FAMILY ENVIRONMENT AND ANXIETY 28
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BI, FAMILY ENVIRONMENT AND ANXIETY 34
Table 1
Prevalence rates for anxiety diagnoses and mean number of anxiety diagnoses in the high BI
(BI) and low BI (BUI) groups.
BI BUI Between group comparisons
Any anxiety disorder * 73% 17% χ
2
(1, N = 202) = 62.94, p < .0001, φ = .56
Social Anxiety Disorder * 43% 0% χ
2
(1, N = 202) = 55.15, p < .0001, , φ = .52
Separation Anxiety Disorder * 30% 2% χ
2
(1, N = 202) = 29.782, p < .0001, , φ = .39,
Specific Phobia* 50% 12% χ
2
(1, N = 202) = 33.98, p < .0001, φ = .41
Generalised Anxiety Disorder * 12% 3% χ
2
(1, N = 202) = 5.64, p = .02, φ = .17.
Obsessive Compulsive Disorder 2% 2% -
Post Traumatic Stress Disorder 2% 0% -
Mean number of anxiety
diagnoses *
1.59
(sd =
1.38)
0.24
(sd =
0.55)
b = -1.896, SE = .26, Wald χ
2
(1, N = 202) =
53.167, p < .0001
* denotes significant group difference after controlling for ethnicity at p < 0.05.
BI, FAMILY ENVIRONMENT AND ANXIETY 35
Table 2
Comparisons between in the high BI (BI) and low BI (BUI) groups on family risk factors.
BI BUI
Parental Anxiety
Maternal current anxiety disorder * 50% 28% χ
2
(1, N = 202) = 10.26, p = .001, , φ = .23,
Maternal lifetime anxiety disorder * 73% 50% χ
2
(1, N = 202) = 10.83, p = .001, φ = .23
Mean number of maternal current anxiety disorders * 0.88
(1.15)
0.47
(0.89)
b = -.63, SE = .23, Wald χ
2
(1, N = 202) = 7.60, p = .006
Mean number of maternal lifetime anxiety disorders 1.60
(1.57)
1.06
(1.40)
b = -.411, SE = .188, Wald χ
2
(1, N = 202) = 4.764, p = .029
Mean maternal DASS Anxiety Scale * 2.95
(2.99)
1.92
(2.36)
t (199) = -3.12, p = .002, d = .38
Mean paternal DASS Anxiety Scale 1.71
(2.13)
1.94
(1.98)
t (184) = 1.20, p = .23, d = .11
BI, FAMILY ENVIRONMENT AND ANXIETY 36
Parenting Behaviour
Overinvolvement
a
* 0.14
(0.70)
-0.14
(0.59)
t (200) = -3.07, p = .002, d = .43
Mean negativity score
a
* 0.13
(0.70)
-0.16
(0.67)
t (199) = -3.03, p = 0.003, d = 0.42
Attachment χ
2
(3, N = 197) = 11.12, p = .01, φ = .24
Avoidant – A 32.3% 29.6% χ
2
(1, N = 197) = .17, p = .68, φ = .03
Secure – B 40% 60% χ
2
(1, N = 197) = 4.30, p = .04, φ = .15
Ambivalent – C * 12.1% 1% χ
2
(1, N = 197) = 9.85, p = .002, φ = .22
Disorganised - D 11.1% 11.2% χ
2
(1, N = 197) = .001, p = .98, φ = .002
Note. Standard deviations are shown in brackets.
a
Positive scores indicate greater overinvolvement/negativity.
* Significant between group differences, p < 0.05
BI, FAMILY ENVIRONMENT AND ANXIETY 37
Table 3
The relationship between family environment factors and the presence of a clinical anxiety diagnosis after controlling for the effect of
temperament group.
b SE Wald df p OR
Parental Anxiety
Maternal current anxiety disorder 1.15 0.36 10.23 1 .001* 3.16
Maternal lifetime anxiety disorder 0.78 .36 4.56 1 .033
#
2.17
Number of maternal current anxiety disorders 0.58 .18 9.79 1 .002* 1.78
Number of maternal lifetime anxiety disorders 0.33 .12 7.18 1 .007* 1.39
Maternal DASS Anxiety Scale 0.45 .19 5.41 1 .020
#
1.57
Paternal DASS Anxiety Scale 0.09 .21 .19 1 .67 1.10
Parenting Behaviour
Overinvolvement
0.29 .27 1.12 1 .29 1.34
Negativity 0.39 .252 2.44 1 .12 1.48
Attachment
Attachment style .46 .37 1.56 1 .21 .63
* Significant between group differences at Bonferroni-adjusted p-value. # p < 0.05 but not significant at Bonferroni-adjusted p-value.
BI, FAMILY ENVIRONMENT AND ANXIETY 38
Table 4
The relationship between family environment factors and child anxiety symptoms after controlling for the effect of temperament group.
df F MSE p partial η
2
Parental Anxiety
Maternal current anxiety disorder 1, 193 38.41 64.81 <.0001* .17
Maternal lifetime anxiety disorder 1, 193 26.46 46.84 <.0001* .12
Number of maternal current anxiety disorders 1, 193 36.64 62.02 <.0001* .16
Number of maternal lifetime anxiety disorders 1, 193 30.98 54.09 <.0001* .14
Maternal DASS Anxiety Scale 1, 192 41.64 69.59 <.0001* .18
Paternal DASS Anxiety Scale 1, 179 2.04 3.95 .16 .02
Parenting Behaviour
Overinvolvement
1, 193 .40 .81 .39 <.01
Negativity 1, 192 9.57 18.54 .002* .05
Attachment
Attachment style 3, 184 .82 1.67 .48 .01
* Significant between group differences at Bonferroni-adjusted p-value.
