Elsevier

Biological Psychiatry

Volume 46, Issue 11, 1 December 1999, Pages 1536-1541
Biological Psychiatry

Early childhood predictors of adult anxiety disorders

https://doi.org/10.1016/S0006-3223(99)00137-7Get rights and content

Abstract

This paper considers the influence of temperamental factors on the development of anxious symptoms in children and adolescents.

About 20 percent of healthy children are born with a temperamental bias that predisposes them to be highly reactive to unfamiliar stimulation as infants and to be fearful of or avoidant to unfamiliar events and people as young children. Experiences act on this initial temperamental bias and, by adolescence, about one-third of this group is likely to show signs of serious social anxiety. These children are also likely to have one or more biological features, including a sympathetically more reactive cardiovascular system, asymmetry of cortical activation in EEG favoring a more active right frontal area, more power in the EEG in the higher frequency range, and a narrower facial skeleton. The data imply that this temperamental bias should be conceptualized as constraining the probability of developing a consistently fearless and spontaneous profile rather than as determining an anxious or introverted phenotype.

Introduction

One feature that distinguishes European-American conceptualizations of psychological variation during most of this century with the views of physicians and philosophers in ancient Athens, Rome, and Alexandria is the stigma the former group attributes to individuals who are excessively apprehensive over physical harm, task failure, or unfamiliar social settings. Citizens in ancient societies regarded anger, not anxiety, as the more harmful emotion that individuals should try to control. The contemporary judgment that chronic anxiety is a greater obstacle to adjustment than chronic anger, boredom, or sexual frustration is the product of historical factors. Conformity to authority and to the values of the local community were adaptive in early societies; worry over the evaluative judgments of others is easier if one is vulnerable to apprehension. These anxiety states are a burden in modern society because assuming risk, defending an unpopular opinion, engaging strangers, and meeting difficult obligations serve effective adaptation. Thus, the current concern with, and intensive study of, anxiety and its symptoms are understandable.

Current hypotheses regarding the causes of variation in susceptibility to this family of feelings have cycled back to the views of Hippocrates and Galen who claimed that some individuals inherited a constitutional vulnerability to anxious states, a quality called “temperament” by modern authors.

The suggestion by Thomas and Chess (1977) that temperamental factors render some children especially susceptible to fear and anxiety was followed by elegant discoveries in neuroscience laboratories that made it possible for scientists to speculate on the possible biological substrates for vulnerabilities to fear and anxiety. It took less than 50 years after the first Chess and Thomas publication to persuade the psychiatric and psychological community that some children inherited a biology that made it easier for them to feel uncertain, tense, or apprehensive to unfamiliarity and challenge and, as a result, to be more vulnerable to one or more of the anxiety disorders.

This paper summarizes what scholars have learned about these temperamental biases. My colleagues and I—especially Nancy Snidman, Doreen Arcus, J. Steven Reznick, and Mark McManis—have been studying this interesting problem for almost 20 years and much of the evidence to be summarized comes from my laboratory. Before presenting the data, however, it is necessary to make a methodological point.

The primary information in the work to be described came from direct observations rather than parental descriptions of children. Investigators who rely only on parental descriptions assume that these verbal reports correspond closely to what would be detected by direct behavioral observations. Unfortunately, the degree of correspondence between the two sources of information is modest at best; therefore, generalizations based only on parental descriptions have a special meaning and validity Spiker et al 1992, Seifer et al 1994, Rosicky 1993, March, Klein 1991, Perrin and Last 1992, Kagan 1998.

Section snippets

Reactivity in infancy

Research with animals reveals that the amygdala is responsive to unfamiliar events and, in addition, is a necessary structure for the acquisition of conditioned reactions that imply a fear state when aversive events, like shock, are the unconditioned stimuli Davis et al 1995, Blanchard and Blanchard 1988, LeDoux 1996. The amygdala contains receptors for a large number of neurotransmitters and neuromodulators that are relevant to the display of fearful behavior, including GABA, opioids,

The consequences of variation in infant reactivity

A sample of 462 healthy, Caucasian, middle-class, four-month-old infants were administered a battery of visual, auditory, and olfactory stimuli (Kagan 1994). About 20% of the sample showed a combination of frequent vigorous motor activity, including arching of the back, combined with fretting and crying. These infants were called high reactive. About 40% of the sample showed the opposite profile of low motor activity and minimal distress to the same battery and these children were classified as

Inhibition in children of panic disorder parents

An early study on a small sample suggested that children with a panic parent were more likely than controls to show inhibited behavior in a laboratory setting (Rosenbaum et al 1988). A subsequent collaboration involved an evaluation of two larger samples of Caucasian, middle-class children (65 4.5-year-olds and 83 6.5-year-olds), who had a parent with panic disorder or panic combined with depression. We compared the behavior and physiology of these children with that of 42 4.5-year-old and 36

Implications

The major implication of this work is that high reactive infants, many of whom show an inhibited profile to unfamiliar events and situations in the second year, are at slightly higher than normal risk for the later development of some form of anxious symptomatology. This suggestion is affirmed by longitudinal study of an independent sample of 79 13-year-olds, who had been classified as inhibited or uninhibited in the second year of life (Kagan et al 1988b). These adolescents were interviewed by

Summary

The evidence and ideas presented in this paper support the usefulness of combining biological and behavioral evidence. During the first half of this century, psychiatrists and psychologists ignored the modest but significant contribution of temperament to personality profiles. The child’s social history determines the meaning he or she will impose on an event; the combination of temperament and history determines the ease with which the event activates limbic structures and the subsequent

Acknowledgements

The preparation of this article was supported by grants from the W. T. Grant Foundation, Foundation Bial, and NIMH Grant 47077. We thank Mark McManis, Donna Steinberg, Jenny Mongkolcheep, Melissa Lewis, Eric Peterson, and Vali Kahn for their contribution to this research.

This work was presented at the scientific satellite conference, “The Role of Biological and Psychological Factors on Early Development and Their Impact on Adult Life,” that preceded the Anxiety Disorders Association of America

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