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Preschool Environment and Temperament as Predictors of Social and Nonsocial Anxiety Disorders in Middle Adolescence

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Objective

Of the few risk factors identified for the development of anxiety disorders, behavioral inhibition has received the strongest support. However, studies examining prediction of anxiety disorder from inhibition over time have not been extensive, and very few have assessed the impact of inhibition assessed early in life on anxiety in adolescence.

Method

The current study assessed 3 risk factors among 91 children when they were approximately 4 years of age, and determined anxiety diagnoses when the children were in midadolescence (mean age, 15 years). Children were included in the study at preschool age if they scored high (n = 57) or low (n = 34) on behavioral inhibition. Maternal anxiousness and maternal attitudes toward the child were assessed at the same time. Diagnoses at age 15 years were categorized as social anxiety disorder or other anxiety disorders.

Results

Social anxiety disorder at age 15 years was predicted by both inhibition and maternal anxiousness at age 4 years, whereas other anxiety disorders were predicted only by maternal anxiousness. Almost 37% of inhibited preschool-aged children demonstrated social anxiety disorder at age 15, compared with 15% of uninhibited children.

Conclusions

The results support a growing body of research pointing to the importance of behavioral inhibition as a risk for social anxiety well into adolescence, and also highlight maternal anxiousness as a more general risk across anxiety disorders.

Section snippets

Participants

Participants in the study included 91 young persons with a mean age of 15.4 years (standard deviation [SD] = 0.9 year; range = 12.4–17.2 years). Participants were initially recruited when they were at preschool age (mean = 3.8 years; SD = 0.4 year; range = 3.0–4.6 years) through 95 preschools in the Sydney area. Mothers of the children at that time returned a screening measure of inhibition (Short Temperament Scale for Children),38 and those scoring high or low (>30 or <15) on the approach

Categorical Associations Between Behavioral Inhibition and Diagnostic Status

The number of adolescents in each group who met DSM-IV diagnostic criteria for each of the major anxiety disorders was compared (Table 1). Participants in the BI group were significantly more likely to meet criteria for social anxiety disorder [χ2(1, N = 91) = 5.11, p = .02] and any anxiety disorder [χ2(1, N = 91) = 5.37, p = .02]. The groups did not differ significantly on the number with separation anxiety disorder [χ2(1, N = 91) = 1.22, p = .27], generalized anxiety disorder [χ2(1, N = 91) =

Discussion

The current results show a clear relationship between early behavioral inhibition and adolescent anxiety disorders. Consistent with most previous research, this relationship was significant only for social anxiety disorder.19, 20 Conceptually social anxiety disorder and behavioral inhibition have marked similarities, and, in many ways, it is difficult to distinguish high social anxiety from high behavioral inhibition.16 At the very least, the temporal relationship between these constructs

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    Dr. Rapee is with the Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia.

    This research was supported by grants from the National Health and Medical Research Council and Australian Rotary Health to the author.

    The author extends his deepest thanks to Dianne Swinsburg MClinPsy, of the Heart Centre for Children, Children's Hospital, Westmead, without whose tenacity and attention to detail, we would not have achieved these great recruitment rates. Thanks are also given to the original research team, Lynn Sweeney PhD, of the Australian Psychological Society, Susan Kennedy PhD, of the Roseville Anxiety Clinic, Michelle Ingram MClinPsy, of Kids and Co., and Susan Edwards PhD, of Northern Beaches Psychology Clinic.

    Disclosure: Dr. Rapee reports no biomedical financial interests or conflicts of interest.

    This article can be used to obtain continuing medical education (CME) at www.jaacap.org.

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