A systematic review of the role of parents in the development of anxious cognitions in children

Highlights

• Evidence for effect of parental modelling of fear on anxious cognitions in children.

• Inconsistent findings according to measurement.

• Future research should include fathers and ecologically valid designs.

Abstract

Anxious cognitions and parental behavior are important in the development of child anxiety. The current review aims to appraise the literature on the relationship between parental factors and chid anxious cognitions. Online database searches of PsycInfo, Scopus, ProQuest Dissertations and Web of Science were systematically searched using key terms related to ‘parent’, ‘child’, ‘anxiety’ and ‘cognitions’. Included studies (N = 13) were quality assessed and study findings were appraised in line with cognitive behavioral frameworks of the parental pathways to the development of anxious cognitions in children. Reviewed studies confirmed that parental factors have a role in the development of their children’s anxious cognitions by modelling fearful responses, reducing their child’s autonomy, and indirectly via their own expectations about their child. Limitations of the literature are considered, including issues of measurement. Future research should consider multi-modal assessment of parental factors and examine parental behavior and child anxious cognitions in the context of real-life threatening events.

Introduction

Anxiety affects as many as 10% of children and adolescents at any one time (Copeland, Angold, Shanahan, & Costello, 2014) and can lead to significant problems in child and family functioning (Remmerswaal, Muris, & Huijding, 2015). Anxiety disorders run in families; children of parents with anxiety disorders are almost four times more likely to develop an anxiety disorder than children who do not have a parent who experiences anxiety (Micco & Ehrenreich, 2008). Waters, Zimmer-Gembeck, and Farrell, (2012) suggest that parental anxiety is a significant risk factor for child anxiety and research has shown high incident rates of anxiety in the parents of anxious children. Cooper, Fearn, Willetts, Seabrook, and Parkinson, (2006) compared the rate of psychiatric disorders in parents of children with an anxiety disorder and parents of control children. A significantly greater proportion of mothers of anxious children met criteria for a current anxiety disorder themselves, compared to controls. A greater proportion of mothers and fathers of anxious children met criteria for lifetime diagnoses of an anxiety disorder, compared to controls. Eley and Gregory (2004) have estimated that genetic heritability accounts for up to 50% of the variance in childhood anxiety; therefore, the environment is considered to be of equal importance in the development of childhood anxiety, within which parents are considered to play a significant part (Podina, Mogoase, & Dobrean, 2013).

Previous psychological theory and studies have described two main behavioral pathways through which parents influence the development of anxiety in their child: by modelling a fear response, and through overprotective rearing behavior. Firstly, the application of Social Learning Theory (Bandura, 1971) suggests that children imitate fearful behavior modelled by their parents. de Rosnay, Cooper, Tsigaras, and Murray, (2006) demonstrated that children displayed higher levels of fear when faced with a stranger if their mother had modelled fearful behavior beforehand, in comparison to children of mothers who did not model fearful behavior. Secondly, parental rearing behavior may influence the development of childhood anxiety. High levels of parental over-control, characterized by excessive monitoring, discouragement of autonomy and high levels of intrusion (Bӧgels & Brechman-Toussant, 2006), is the most consistent parental rearing predictor of childhood anxiety (Ballash, Leyfer, Buckley, & Woodruff-Borden, 2006; McLeod, Wood, & Weisz, 2007; Murray, Cresswell, & Cooper, 2009; Wood, McLeod, Sigman, Hwang, & Chu, 2003). In their meta-analysis, Van der Bruggen, Stams, and Bögels, (2008) reported a medium overall effect size for the relationship between parental control and childhood anxiety. In a review of the literature, Chorpita and Barlow (1998) concluded that children who have over-controlling parents, and lack the granting of autonomy, are more likely to develop a cognitive style of interpreting their environment as threatening, and out of their control.

Cognitive-behavioral theories of childhood anxiety suggest that these parental behavior pathways contribute to the transmission of anxious cognitions to the child, such as biases toward threat interpretations (Bögels & Zigterman, 2000; Muris, Rapee, Meesters, Schouten, & Greers, 2003) and underestimation of coping ability (Bögels, van Dongen, & Muris, 2003; Micco & Ehrenreich, 2008) which in turn contribute to the development of anxiety. Creswell, Cooper, and Murray, (2010) presented a cognitive-behavioral framework that specifically describes the role of parental factors in the intergenerational transmission of anxious cognitions. Within this framework, parents’ own anxious cognitions directly influence their behavior through modelling of a fearful response (e.g. screaming when they see a spider), or by directly communicating fearful information (e.g. telling their child that spiders are dangerous). Parents’ anxious cognitions also influence their expectations of their child’s ability to cope, which leads to over-protective and over-controlling rearing behavior, including encouragement to avoid feared situations and the direct verbalisation of potential threats (Hudson & Rapee, 2004). In this way, an anxious cognitive style may be learned by the child, contributing to the development and maintenance of anxiety. Ultimately, parents’ expectations are reinforced by their experience of parenting an anxious child, resulting in a feedback cycle. In support of the pathways proposed within this cognitive-behavioral framework, Creswell and O’Connor (2006) reported that mothers who perceived the world as threatening and felt unable to cope were more likely to expect their children to respond in the same way. Creswell, O’Connor, and Brewin, (2008) demonstrated that these negative expectations influence parenting behavior: Parents who were given negative expectations about how their child would perform in completing a set of puzzles, were less likely to allow their child to complete the task independently (displaying more involvement) compared to parents who were given positive expectations of their child’s performance.

In order to assess whether the cognitive-behavioral framework proposed by Creswell et al. (2010) is useful for understanding how parents influence the development of anxious cognitions in children, it is critical that the current evidence is reviewed. This systematic review aims to synthesise research evidence examining the role of parent expectations and behavior in the development of child anxious cognitions. Furthermore, this review aims to summarise gaps and limitations of the body of work to date, in order to provide clear recommendations for advancing quality research in this field. Eligible studies will examine parental behavior and measure child anxious cognitions, including internal thinking styles that are biased to interpreting threat, interpreting situations negatively and underestimating ability to cope (Bögels et al., 2003). We will present a narrative review of the literature findings according to the three main pathways proposed by cognitive-behavioral theories of childhood anxiety (Creswell et al., 2010; Hudson & Rapee, 2004): the influence of parent modelling of a fear response (verbal and non-verbal), the influence of parent expectations of the child and rearing behavior (lack of autonomy granting). The limitations of the current evidence and future directions for research to inform theory development will be considered.