Developmental trajectories of anxiety symptoms among boys across early and middle childhood

Bringing a developmental perspective to anxiety genetics

Despite substantial recent advancements in psychiatric genetic research, progress in identifying the genetic basis of anxiety disorders has been limited. We review the candidate gene and genome-wide literatures in anxiety, which have made limited progress to date. We discuss several reasons for this hindered progress, including small samples sizes, heterogeneity, complicated comorbidity profiles, and blurred lines between normative and pathological anxiety. To address many of these challenges, we suggest a developmental, multivariate framework that can inform and enhance anxiety phenotypes for genetic research. We review the psychiatric and genetic epidemiological evidence that supports such a framework, including the early onset and chronic course of anxiety disorders, shared genetic risk factors among disorders both within and across time, and developmentally dynamic genetic influences. We propose three strategies for developmentally sensitive phenotyping: examination of early temperamental risk factors, use of latent factors to model underlying anxiety liability, and use of developmental trajectories as phenotypes. Expanding the range of phenotypic approaches will be important for advancing studies of the genetic architecture of anxiety disorders.

Symptoms of anxiety and associated risk and protective factors in young Asian American children

Anxiety is one of the most prevalent mental health problems in young children but there has been a dearth of studies focusing on Asian American children. This study examines the patterns and the predictors of childhood anxiety and related symptoms in young children in a diverse Asian American (ASA) sample (n = 101). Findings indicate that ASA children are at higher risk for anxiety, somatization, and depressive problems than their peers. Parents' level of acculturation (i.e., American identity, English competence), parental negative emotion socialization, conflicted parent-child relationship, child emotional knowledge and adaptive skills, as well as teachers' ethnic background and school class types were all associated with ASA children's anxiety. A combination of cultural, family, and school factors explained from 17 to 39 % of the variance in anxiety symptoms. Findings inform prevention services for young ASA children.

Preventive intervention for anxious preschoolers and their parents: strengthening early emotional development

The high prevalence and early onset of anxiety disorders have inspired innovative prevention efforts targeting young at-risk children. With parent-child prevention models showing success for older children and adolescents, the goal of this study was to evaluate a parent-child indicated preventive intervention for preschoolers with mild to moderate anxiety symptoms. Sixteen children (ages 3-5) and at least one of their parents participated in Strengthening Early Emotional Development (SEED), a new 10-week intervention with concurrent groups for parents and children. Outcome measures included clinician-rated and parent-rated assessments of anxiety symptoms, as well as measures of emotion knowledge, parent anxiety, and parental attitudes about children's anxiety. Participation in SEED was associated with reduced child anxiety symptoms and improved emotion understanding skills. Parents reported decreases in their own anxiety, along with attitudes reflecting enhanced confidence in their children's ability to cope with anxiety. Reductions in child and parent anxiety were maintained at 3-month follow-up. Findings suggest that a parent-child cognitive-behavioral preventive intervention may hold promise for young children with mild to moderate anxiety. Improvements in parent anxiety and parental attitudes may support the utility of intervening with parents. Fostering increased willingness to encourage their children to engage in new and anxiety-provoking situations may help promote continued mastery of new skills and successful coping with anxiety.

Differential susceptibility effects: the interaction of negative emotionality and sibling relationship quality on childhood internalizing problems and social skills

Whereas socialization influences in early childhood have been linked to children's emerging internalizing problems and prosocial behavior, relatively few studies have examined how NE might moderate such associations in both advantageous and maladaptive ways. Furthermore, more research is needed to evaluate the impact of sibling relationships as an influential socialization influence on these child outcomes. In the current study we examined how NE might differentially moderate the associations between quality of relationships with siblings and both internalizing problems and social skills at school entry. NE moderated the effects of positive and destructive sibling relationship quality on child internalizing problems. Specifically, for boys high on NE, more positive sibling relationship quality predicted fewer internalizing problems, but more destructive sibling conflict predicted more internalizing problems. NE also moderated the effects of destructive sibling conflict on child social skills. For boys high on NE, destructive sibling conflict predicted fewer social skills. Boys high on NE appear to show greater susceptibility to the effects of sibling socialization on child outcomes, relative to boys low on NE. The implications of these interactions are discussed with respect to differential susceptibility theory.

Lost toy? Monsters under the bed? Contributions of temperament and family factors to early internalizing problems in boys and girls

This study was designed to examine the contribution of multiple risk factors to early internalizing problems and to investigate whether family and ecological context moderated the association between child temperament and internalizing outcomes. A sample of 1,202 mothers of 2- and 3-year-old children completed a survey of child social-emotional functioning, family environment, and violence exposure. Child temperament, maternal affective symptoms, and family expressiveness were associated with child anxiety and depression problems. Violence exposure was related only to child anxiety. When maternal affective symptoms were elevated, inhibited girls but not boys were rated as more anxious and youngsters with heightened negative emotionality were rated as more depressed. Family expressiveness moderated the association between inhibited temperament and anxiety symptoms.

Childhood anxiety, worry, and fear: individualizing hypnosis goals and suggestions for self-regulation

Determining hypnosis goals and specific suggestions for childhood anxiety, worry, and fear can be enhanced by a developmental psychopathology perspective. This article examines underlying causal risk factors that guide a focused assessment and individualized interventions, targeting self-regulation of emotional, cognitive, behavioral, and psychophysiological arousal and reactivity. The author summarizes current knowledge about childhood anxiety disorders and outlines a hypnotic approach when encountering anxious children and youth, including strategies to use spontaneous trance states and enhance underdeveloped resources (e.g. locus of control, discrimination of realistic risk appraisal, coping capacities).

Socialization of Emotion and Offspring Internalizing Symptoms in Mothers with Childhood-Onset Depression

This study examines how mothers with and without a history of childhood-onset depression respond to their 3-9 year-old children's emotions. Mother-child dyads included 55 offspring of mothers with a history of childhood-onset depressive disorders and 57 offspring of never-depressed mothers. Mothers with a history of childhood depression were less likely than were control mothers to respond in supportive ways to their children's negative emotions and were more likely to magnify, punish, or neglect their children's negative emotions. Magnification, neglect, and punishment of children's negative emotions were concurrently associated with children's internalizing symptoms, and neglect and punishment were associated with internalizing over a one year follow-up. Maternal neglect of children's negative emotion was positively associated with later internalizing symptoms for children who already had higher internalizing symptoms at the initial assessment. Findings suggest that atypical socialization of emotion may be one mechanism in the development of internalizing disorders.

Mother–child relationships, family context, and child characteristics as predictors of anxiety symptoms in middle childhood

The goal of the study was to examine several factors that may explain the development of anxiety symptoms in middle childhood. Using data from the NICHD Study of Early Child Care (n = 1,364 families), we examined mother–child relationships, other aspects of family context, and child characteristics as predictors of anxiety in preadolescence. Latent growth curve analyses revealed that children who were more anxious at the beginning of middle childhood had been more behaviorally inhibited as preschoolers, and in middle childhood lived in families who experienced more negative life events and had mothers who were more anxious. Children who became more anxious across middle childhood were less behaviorally inhibited as preschoolers and in middle childhood perceived less security in their attachments to their mothers, experienced more negative life events, and had mothers who were more anxious. The findings illustrate the need to include a broad set of risk factors in etiological models of anxiety. In addition, the evidence for cumulative effects suggests several possible points of intervention with anxious children and their parents.

Parental negative control moderates the shyness-emotion regulation pathway to school-age internalizing symptoms

Models of developmental psychopathology emphasize both mediation and moderation processes among child and caregiving attributes; however, little research has examined both these processes simultaneously on the development of internalizing problems. This study tested a moderated mediation model that related early childhood shyness, emotion regulation and maternal negative control to school-age internalizing problems among 257 boys from low-income families. Shyness and maternal negative control was assessed at ages 1.5-2, emotion regulation was observed at age 3.5, and internalizing symptoms were assessed by mothers and teachers at age 6 or 7. Results indicated that 1) the active distraction regulation strategy mediated the relations between early shyness and maternal report of internalizing symptoms; 2) the passive/dependent regulation strategy mediated the relations between shyness and teacher report of internalizing symptoms; and 3) both mediation processes were moderated by maternal negative control. The results are discussed in relation to implications for early prevention and intervention.

Temperament and emotion regulation: the role of autonomic nervous system reactivity

The aim of the present study was to examine the moderating role of parasympathetic and sympathetic nervous system functioning on the relationship between child temperament and emotion regulation. Sixty-two 4.5-year olds (31 females) were rated by their parents on temperamental surgency. Respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP) were measured at baseline and in reaction to an interaction with an unfamiliar person and a cognitive test. The preschoolers' ability to self-regulate emotion was assessed in response to a disappointment. Results revealed little or no PEP reactivity to the unfamiliar person to be related to poorer emotion regulation for children high in surgency, indicating that the lack of sympathetic activation may be a risk factor for behavioral maladjustment. Reciprocal sympathetic activation, or increases in sympathetic activity accompanied by decreases in parasympathetic activity, was associated with better regulation of emotion for all levels of temperamental surgency supporting previous work that reciprocal activation is an adaptive form of autonomic control.

Influence of parental depressive symptoms on adopted toddler behaviors: an emerging developmental cascade of genetic and environmental effects

This study examined the developmental cascade of both genetic and environmental influences on toddlers' behavior problems through the longitudinal and multigenerational assessment of psychosocial risk. We used data from the Early Growth and Development Study, a prospective adoption study, to test the intergenerational transmission of risk through the assessment of adoptive mother, adoptive father, and biological parent depressive symptoms on toddler behavior problems. Given that depression is often chronic, we control for across-time continuity and find that in addition to associations between adoptive mother depressive symptoms and toddler externalizing problems, adoptive father depressive symptoms when the child is 9 months of age were associated with toddler problems and associated with maternal depressive symptoms. Findings also indicated that a genetic effect may indirectly influence toddler problems through prenatal pregnancy risk. These findings help to describe how multiple generations are linked through genetic (biological parent), timing (developmental age of the child), and contextual (marital partner) pathways.

Trajectories of anxiety in a population sample of children: clarifying the role of children's behavioral characteristics and maternal parenting

This study pursued three goals. The first goal was to explore children's trajectories of anxiety from age 6 to 12 using a representative community sample. The second goal was to assess the link between certain behavioral characteristics assessed in kindergarten (i.e., inattention, hyperactivity, aggressiveness, and low prosociality) and these trajectories. The third goal was to determine whether certain aspects of maternal parenting (i.e., warmth and discipline) could moderate the association between these characteristics and the trajectories of anxiety. A population sample of 2,000 children (1,001 boys, 999 girls) participated in this longitudinal study. Developmental trajectory analyses allowed us to identify four trajectory groups: low, low-increasing, high-declining, and high anxiety groups. Moreover, multinomial logistic regressions revealed a profile of children at risk of developing high anxiety symptoms (i.e., high group), characterized by sociofamily adversity, inattention, and low prosociality in the classroom. Hyperactivity was also found in this profile, but only for children exposed to a mother who showed little affective warmth. Finally, mothers' high level of discipline increased the odds of belonging to the high anxiety group. The results are discussed in relation to studies examining the association among anxiety, behavioral characteristics, and parenting during childhood.

Stability in infant frontal asymmetry as a predictor of toddlerhood internalizing and externalizing behaviors

Stability in frontal brain electrical activity (i.e., electroencephalographic or EEG) asymmetry at 10 and 24 months was examined with respect to maternal ratings of internalizing and externalizing behaviors at 30 months in a sample of 48 children. Children with stable left frontal EEG asymmetry during infancy were rated higher in externalizing behaviors by their mothers, whereas children with stable right frontal EEG asymmetry were rated higher in internalizing behaviors. These findings highlight the need to focus on the early stability in physiological measures that may be implicated later in developing behavioral problems.

Temperament and the environment in the etiology of childhood anxiety

Anxiety disorders are prevalent throughout childhood and adolescence. As such, identifying the factors and mechanisms that precede, maintain, or exacerbate anxiety disorders is essential for the development of empirically based prevention and intervention programs. The current review focuses on child temperament (i.e., behavioral inhibition) and the child's environment, including parenting, childcare, and peer relationships, as these factors have been linked to internalizing problems and anxiety diagnoses. Research programs are needed that examine the associations between the environment and anxiety in temperamentally at-risk populations. In order to be successful, early intervention and prevention programs require a more detailed analysis of the interplay between various environmental contexts, both distal and proximal to the child, and the child's temperamental reactivity to novelty and threat. Furthermore, conducting these investigations across multiple levels of analysis in large-scale, longitudinal samples would be an important addition to the literature on the developmental psychopathology of anxiety.

Influences of a Covariate on Growth Mixture Modeling

This study investigated the influence of including a covariate and/or a distal outcome on growth mixture modeling (GMM). GMM was used to examine patterns of days of heroin use over 16 years among 471 heroin users and the relationship of those patterns to mortality (distal outcome). Comparisons were made among four types of models: without a covariate and a distal outcome (two-stage approach), with a distal outcome, with a covariate, and with a covariate and a distal outcome in conjunction with three different covariates. The two-stage approach and models with the inclusion of a distal outcome resulted in different conclusions when testing the impact of latent trajectory membership on the distal outcome. Differences in membership classifications between unconditional and conditional models were mainly determined by two factors: (1) the associations of the trajectories with the covariate and the distal outcome, and (2) the distribution of the covariate in the study sample.

Structured parenting of toddlers at high versus low genetic risk: two pathways to child problems

OBJECTIVE

Little is known about how parenting might offset genetic risk to prevent the onset of child problems during toddlerhood. We used a prospective adoption design to separate genetic and environmental influences and test whether associations between structured parenting and toddler behavior problems were conditioned by genetic risk for psychopathology.

METHOD

The sample included 290 linked sets of adoptive families and birth mothers and 95 linked birth fathers. Genetic risk was assessed via birth mother and birth father psychopathology (anxiety, depression, antisociality, and drug use). Structured parenting was assessed via microsocial coding of adoptive mothers' behavior during a cleanup task. Toddler behavior problems were assessed with the Child Behavior Checklist.

RESULTS

Controlling for temperamental risk at 9 months, there was an interaction between birth mother psychopathology and adoptive mothers' parenting on toddler behavior problems at 18 months. The interaction indicated two pathways to child problems: structured parenting was beneficial for toddlers at high genetic risk but was related to behavior problems for toddlers at low genetic risk. This crossover interaction pattern was replicated with birth father psychopathology as the index of genetic risk.

CONCLUSIONS

The effects of structured parenting on toddler behavior problems varied as a function of genetic risk. Children at genetic risk might benefit from parenting interventions during toddlerhood that enhance structured parenting.

The correlates and consequences of early appearing social anxiety in young children

Social anxiety is the fear of social situations and being negatively evaluated by others. Most previous studies of childhood social anxiety have employed clinical samples of children aged 10 years and older. The current study explored the correlates of social anxiety in an unselected sample of young children. Participants were n=178 elementary school children in grade 2 (aged 7-8 years). Children were individually administered the Social Anxiety Scale for Children-Revised (SASC-R), as well as measures of socio-emotional adjustment. Teachers completed measures of children's socio-emotional problems and school adjustment. Results indicated that social anxiety was positively associated with self-reported loneliness, school avoidance, and internalizing coping, and negatively related to school liking. However, social anxiety was mostly unrelated to teacher-rated outcomes. Findings are discussed in terms of use of the SASC-R for this type of population and reasons for the disparity between child and teacher reports of adjustment outcomes.

Temperament and parental child-rearing style: unique contributions to clinical anxiety disorders in childhood

Both temperament and parental child-rearing style are found to be associated with childhood anxiety disorders in population studies. This study investigates the contribution of not only temperament but also parental child-rearing to clinical childhood anxiety disorders. It also investigates whether the contribution of temperament is moderated by child-rearing style, as is suggested by some studies in the general population. Fifty children were included (25 with anxiety disorders and 25 non-clinical controls). Child-rearing and the child's temperament were assessed by means of parental questionnaire (Child Rearing Practices Report (CRPR) (Block in The Child-Rearing Practices Report. Institute of Human Development. University of California, Berkely, 1965; The Child-Rearing Practices Report (CRPR): a set of Q items for the description of parental socialisation attitudes and values. Unpublished manuscript. Institute of Human Development. University of California, Berkely, 1981), EAS Temperament Survey for Children (Boer and Westenberg in J Pers Assess 62:537-551, 1994; Buss and Plomin in Temperament: early developing personality traits. Lawrence Erlbaum Associates, Inc, Hillsdale, 1984s). Analysis of variance showed that anxiety-disordered children scored significantly higher on the temperamental characteristics emotionality and shyness than non-clinical control children. Hierarchical logistic regression analyses showed that temperament (emotionality and shyness) and child-rearing style (more parental negative affect, and less encouraging independence of the child) both accounted for a unique proportion of the variance of anxiety disorders. Preliminary results suggest that child-rearing style did not moderate the association between children's temperament and childhood anxiety disorders. The limited sample size might have been underpowered to assess this interaction.

Epidemiologic heterogeneity of common mood and anxiety disorders over the lifecourse in the general population: a systematic review

BACKGROUND

Clinical evidence has long suggested there may be heterogeneity in the patterns and predictors of common mood and anxiety disorders; however, epidemiologic studies have generally treated these outcomes as homogenous entities. The objective of this study was to systematically review the epidemiologic evidence for potential patterns of heterogeneity of common mood and anxiety disorders over the lifecourse in the general population.

METHODS

We reviewed epidemiologic studies examining heterogeneity in either the nature of symptoms experienced ("symptom syndromes") or in patterns of symptoms over time ("symptom trajectories"). To be included, studies of syndromes were required to identify distinct symptom subtypes, and studies of trajectories were required to identify distinct longitudinal patterns of symptoms in at least three waves of follow-up. Studies based on clinical or patient populations were excluded.

RESULTS

While research in this field is in its infancy, we found growing evidence that, not only can mood and anxiety disorders be differentiated by symptom syndromes and trajectories, but that the factors associated with these disorders may vary between these subtypes. Whether this reflects a causal pathway, where genetic or environmental factors influence the nature of the symptom or trajectory subtype experienced by an individual, or whether individuals with different subtypes differed in their susceptibility to different environmental factors, could not be determined. Few studies addressed issues of comorbidity or transitions in symptoms between common disorders.

CONCLUSION

Understanding the diversity of these conditions may help us identify preventable factors that are only associated with some subtypes of these common disorders.

Parent Depression and Child Anxiety: An Overview of the Literature with Clinical Implications

The association of parental depression with child anxiety has received relatively little attention in the literature. In this paper we initially present several reasons for examining this relationship. We then summarize the empirical support for a link between these two variables. Finally, we discuss directions for future research and clinical implications of an association of parental depression with child anxiety.

The relations among cumulative risk, parenting, and behavior problems during early childhood

BACKGROUND

This study examined relations among cumulative risk, nurturant and involved parenting, and behavior problems across early childhood.

METHODS

Cumulative risk, parenting, and behavior problems were measured in a sample of low-income toddlers participating in a family-centered program to prevent conduct problems.

RESULTS

Path analysis was utilized to examine longitudinal relations among these constructs, with results supporting an indirect effect of cumulative risk on externalizing and internalizing problems through nurturant and involved parenting.

CONCLUSION

Results highlight the importance of cumulative risk during early childhood, and particularly the effect that the level of contextual risk can have on the parenting context during this developmental period.