Introduction
Inhibited Temperament and Child Anxiety
Parenting and Child Anxiety
Parenting as a Moderator
Objectives of the Review
Method
Literature Review
Inclusion and Exclusion Criteria
Study Selection
Study | N, race/ethnicity, socioeconomic status, sample | Child sex or gender | Child inhibited temperament | Parenting | Child anxiety | Results of moderation analyses | Risk of bias score |
---|---|---|---|---|---|---|---|
Hudson & Dodd, 2012 | N = 202 Race/ethnicity: 64% Oceanic, 20% European, 10% Asian, 6% American, African or Middle Eastern SES: 56% middle to high income; 42% of mothers worked part-time; 92% of mothers completed high school; 85% of mothers had a post-school qualification Sample: Australia, infants from community identified as behaviorally inhibited or behaviorally uninhibited | Gender: 50% boys at baseline | Measure: Short Temperament Scale for Children, approach scale; Observed BI during novel tasks similar to Garcia Coll et al., 1984 Child Age: 4 years | Measure: Observed overinvolvement and negativity during speech preparation task and the Five-Minute Speech Sample; Parent Protection Scale, Control scale Child Age: 4 years | Measure: Presence of anxiety disorder diagnosis and number of anxiety diagnoses from the ADIS-IV Child Age: 4 and 9 years | 4 non-significant moderation analyses | 5 |
Hudson et al., 2011 | N = 202 Race/ethnicity: Behaviorally inhibited children: 61% Australian, 17% Asian, 17% European, 7% other Behaviorally uninhibited children: 69% Australian, 3% Asian, 21% European, 7% other SES: Behaviorally inhibited children: 58% middle to high income; Maternal highest education: 14% school, 29% post-school, 57% degree Behaviorally uninhibited children: 59% middle to high income; Maternal highest education: 17% school, 40% post-school, 43% degree Sample: Australia, infants from community identified as behaviorally inhibited or behaviorally uninhibited | Sex: 50% male | Measure: Short Temperament Scale for Children, approach scale; Observed BI during novel tasks similar to Garcia Coll et al., 1984 Child Age: 4 years | Measure: Observed overinvolvement and negativity during speech preparation task and the Five-Minute Speech Sample; Parent Protection Scale, Control scale Child Age: 4 years | Measures: Presence of anxiety disorder diagnosis and number of anxiety diagnoses from the ADIS-IV; PAS Child Age: 4 and 6 years | 4 non-significant moderation analyses | 3 |
Hudson et al., 2019 | N = 202 Race/ethnicity: Behaviorally inhibited (BI) children: 57% Australian/Caucasian, 21% Asian, 12% European, 3% American, 3% African, 3% Middle Eastern Behaviorally uninhibited (BUI) children: 79% Australian/Caucasian, 5% Asian, 12% European, 1% American, 1% African, 2% Middle Eastern SES: Behaviorally inhibited family income: 76% > $80 k, 19% $40 k-80 k, 6% < 40 k Behaviorally uninhibited family income: BUI: 71% > $80 k, 17% $40-80 k, 11% < 40 k Sample: Australia, infants from community identified as behaviorally inhibited or behaviorally uninhibited | Gender: BI children: 51% girls; BUI children: 49% girls | Measure: Short Temperament Scale for Children, approach scale; Observed behavioral inhibition during novel tasks similar to Garcia Coll et al., 1984 Child Age: 4 years | Measure: Observed overinvolvement and negativity during speech preparation task and the Five-Minute Speech Sample; Parent Protection Scale, Control scale Child Age: 4 years | Measures and Child Age: Presence of anxiety disorder diagnosis from the ADIS-IV at child ages 4, 6, 9, and 12 years; PAS at child ages 4 and 6 years; Spence Children’s Anxiety Scale at child ages 9 and 12 years | 1 significant and 5 non-significant moderation analyses | 4 |
Kiel et al., 2016 | N = 117 Race/ethnicity: Mothers and toddlers, respectively: 97 (88.2%) and 92 (83.6%) European American, 2 (1.8%) and 6 (5.5%) African American, 7 (6.4%) and 9 (8.2%) Asian American, 1 (0.9%) and 1 (0.9%) American Indian, and 3 (2.8%) and 2 (1.8%) “other ethnic/racial identity.” In addition, one (0.9%) mother and six (5.5%) toddlers were identified as Hispanic/Latino SES: According to the Hollingshead four-factor index, participants were on average middle-class Sample: United States, community | Gender: 44% girls | Measure: observed IT during novelty tasks Child Age: 2 years | Measure: Maternal encouragement to approach novelty during novelty tasks Child Age: 2 years | Measure: Infant Toddler Social-Emotional Assessment-Revised separation distress subscale Child Age: 2 and 3 years | 1 significant moderation analysis | 3 |
Lawrence et al.,
2020 | N = 217 Race/ethnicity: Mostly Caucasian SES: Control group: 82.5% middle/upper class Social anxiety disorder (SAD) group: 73.3% middle/upper class Generalized anxiety disorder (GAD) group: 81.6% middle/upper class Sample: United Kingdom, mothers from community pre-screened for inclusion based on if they met criteria for social anxiety disorder, generalized anxiety disorder, or neither disorder | Sex: Control group: 51% female; SAD group: 64% female; GAD group: 57% female | Measures and Child Age: Observation of negative reactivity during Kagan et al., 1987 novelty tasks at child age 4 months; observation of BI during novelty tasks at child age 14 months | Measure: Observation of maternal encouragement, expressed anxiety, and intrusiveness during novelty tasks Child Age: 10 and 58 months | Measures: Presence of social anxiety disorder diagnosis from the ADIS-IV; CBCL anxiety problems scale Child Age: 58 months | 1 significant and 5 non-significant moderation analyses | 6 |
Lewis-Morrarty et al., 2012 | N = 176 Race/Ethnicity: 100% European American SES: Middle-to-upper class; 28% of mothers graduated high school, 49% graduated college, 11% completed graduate school Sample: United States, community | Gender: 51% girls | Child Ages 1 and 2 years: Observed BI during Calkins et al., 1996, Fox et al., 2001, and Kagan et al., 1987 tasks; Toddler Behavior Assessment Questionnaire, Social Fearfulness scale Child Ages 4 and 7 Years: Play Observation Schedule while playing with peers and Colorado Children's Temperament Inventory, Shyness/Sociability scale | Measure: Observation of maternal overcontrol during Hane et al., 2008 tasks Child Age: 7 years | Measure: Presence of lifetime diagnosis of social anxiety disorder from K-SADS and additional probe questions from the ADIS; SCARED social anxiety subscale Child Age: 14–17 years | 1 significant and 1 marginally significant moderation analysis | 3 |
Lorenzo et al., 2022 | N = 291 Race/ethnicity: 69.1% White, 16.5% Black, 7.2% Hispanic, 3.1% Asian, 3.4% other, and < 1% missing SES: 77.6% of parents had 2- or 4-year college degree Sample: United States, infants from community screened for higher levels of negative and positive reactivity to novelty at 4 months | Sex: 55% female | Measure: Observed temperament during Fox et al., 2001 novelty tasks Child Age: 36 months | Measure: Observation of dismissive, task- directive, and supportive parenting during LabTAB episodes Child Age: 36 months | Measures and Child Age: SCARED social anxiety subscale at child ages 9, 12, and 15 years controlling for CBCL anxiety problems domain at child age 4 years | 3 significant and 3 non-significant moderation analyses | 7 |
Majdandžić et al., 2018 | N = 132 Race/ethnicity: 89% of mothers and 95% of fathers had Dutch origin Education: Scale from 1 = primary education to 8 = university education Maternal Education: M = 7.05, range = 1–8 Paternal Education: M = 6.57, range = 2–8 Professional Level: Scale from 1 = manual labor to 11 = labor for which a university degree is required Maternal Professional Level: M = 8.70, range = 2–11 Paternal Professional Level: M = 8.22, range = 3–11 Sample: Netherlands, first-time community parents | 55% girlsa | Measure: Observed challenging and overprotective parenting behavior during structured tasks and unstructured free play Child Age: 1 and 2.5 years | Measure: PAS-R Child Age: 2.5 and 4.5 years | 1 marginally significant and 3 non-significant moderation analyses | 6 | |
Murray et al., 2014 | N = 136 Race/ethnicity: Control group: 98% White; Social anxiety group: 100% White SES: Control group: 73% upper class; Social anxiety group: 68.5% upper class Sample: United Kingdom, mothers from community pre-screened for inclusion based on if they met criteria for social anxiety disorder or neither social nor generalized anxiety disorder (control) | Sex: Control group: 47.6% boys; Social anxiety group: 39.7% boys | Measure: Observed BI during Kagan et al., 1987 novelty tasks Child Age: 14 months | Measure: Maternal encouragement and attribution of threat to the environment while reading a book about going to school to their child Child Age:
4–5 years | Measure: Presence of social anxiety disorder diagnosis from the
ADIS-IV Child Age: 4–5 years | 2 non-significant moderation analyses | 8 |
Vreeke et al., 2013 | N = 168 Race/ethnicity: 53% Native Dutch children who were all White/Caucasian and had parents and grandparents who were born in the Netherlands. 47% Non-Native Dutch children who were offspring of immigrant families originating from a variety of countries (11.9% from Surinam and the Netherlands Antilles, 2.4% from Morocco, 4.2% from Turkey, and 27% from other countries) SES: Not reported Sample: Netherlands, community | Sex: 54% boys | Measure: Short version of the Behavioral Inhibition Questionnaire Child Age: 3–6 years | Measure: The Parental Overprotection Measure Child Age: 3–6 and 4–7 years | Measure: PAS-R social anxiety subscale and composite of other anxiety subscales Child Age: 3–6 and 4–7 years | 1 significant and 3 non-significant moderation analysis | 11 |
Sample Characteristics
Method Characteristics
Measures of Inhibited Temperament
Measures of Parenting
Study | Construct | Measures and methods | Operational definition | Categorization in current review |
---|---|---|---|---|
Hudson & Dodd, 2012; Hudson et al., 2011; Hudson et al., 2019 | Overinvolvement | Observed behaviors (i.e., general involvement, unsolicited help, directing child speech) during speech preparation task; Parental report of self-sacrificing and overprotective behavior during the Five-Minute Speech Sample | Parenting behavior that helps the child more than is needed and overly protects them from potential danger and distress | Control-related: promotion of child avoidance |
Negativity | Observed behaviors (i.e., general mood and atmosphere, positive affect, verbal and nonverbal encouragement, and criticism) during speech preparation task; Negative first statement, parental criticism, and report of a negative relationship during Five-Minute Speech Sample | Parenting that is characterized by more criticism and less warmth | Affect-related | |
Kiel et al., 2016 | Encouragement to approach novelty | Observed behaviors (e.g., low scores = holding child back, verbally promoting avoidance, excessive comforting; middle score = positive verbal encouragement to approach, reinforcing play, modeling approach; high scores = physically pushing to approach, verbal demands to approach) during novelty tasks | Continuum of encouragement from no encouragement to approach (i.e., protective behavior) to behaviors that increase child independence through supporting child choice and acknowledging child perspectives (i.e., autonomy granting) to excessive encouragement (i.e., intrusive behavior) | Control-related: encouragement |
Lawrence et al., 2020 | Encouragement | Observed behaviors (e.g., positive comments, encouraging facial expressions and gestures, motivation to engage, enthusiasm for child effort) during novelty tasks | Not provided | Control-related: encouragement |
Expressed anxiety | Observed behaviors (e.g., biting lip, tense posture, worried expression, hand-wringing, fearful facial expression, nervous or rapid speech) during novelty tasks | Not provided | Affect-related | |
Intrusiveness | Observed behaviors (e.g., speaking for child, touching infant during infant’s interaction with stranger, physical and verbal interference in child’s behavior, imposing agenda) during novelty tasks | Not provided | Control-related: excessive promotion of child approach | |
Lewis-Morrarty et al., 2012 | Overcontrol | Observed behaviors (e.g., verbally dominating tasks and conversations, excluding child, frequent instructions, interrupting child, physically moving child away from interests, grabbing toy from child) during Hane et al., 2008 tasks | Controlling behaviors that are inappropriate and excessive relative to the child’s behavior and interests | Control-related: promotion of child avoidance |
Lorenzo et al., 2022 | Dismissive | Observed behaviors (e.g., asking child questions, describing what child is doing, ignoring child, being critical of child) during LabTAB episodes | Not provided | Affect-related |
Task-Directive | Observed behaviors (e.g., physically directing child, telling child what to do) during LabTAB episodes | Not provided | Control-related: excessive promotion of child approach | |
Supportive | Observed behaviors (e.g., praising, suggesting strategy to reduce negative emotion, asking about child’s feelings) during LabTAB episodes | Overly solicitous, overly supportive | Control-related: promotion of child avoidance | |
Majdandžić et al., 2018 | Challenging | Observed behaviors (e.g., chasing child, throwing baby in the air, tickling, rough-and-tumble play, challenging child to push their limits) during structured tasks and unstructured free play | Behaviors that playfully encourage child to go out of their comfort zone | Control-related:
encouragement |
Overprotective | Observed behaviors (e.g., comforting child when child was not in distress, making comments about safety, handling child very carefully) during structured tasks and unstructured free play | Behaviors that communicate excessive worry and concern for child’s wellbeing and safety | Control-related: promotion of child avoidance | |
Murray et al., 2014 | Encouragement | Recorded language (e.g., “You remember how happy your sister was when she started school,” “You are going to really enjoy school”) while reading a book about going to school to child | Communication that encourages child to engage in challenging situations | Control-related: encouragement |
Attribution of threat to the environment | Recorded language (e.g., “Those children look scary,” “There are lots of strange children in the classroom”) while reading a book about going to school to child | Communication that indicates that the environment is threatening | Affect-related | |
Vreeke et al., 2013 | Overprotection | The Parental Overprotection Measure, a self-report rating scale with items reflecting behaviors in specific, potentially threatening situations for preschoolers (e.g., “I protect my child from criticism,” “I am reluctant for my child to play some sports for fear he/she might get hurt”) | Behaviors that shield child from potential danger by unnecessarily helping child and limiting child’s exposure to a variety of situations | Control-related: promotion of child avoidance |
Measures of Child Anxiety
Results
Quality Assessment
Code | Values |
---|---|
Reporter of variablea | 0 = observation 1 = parent or other-report |
Internal consistency/interrater reliability of variablea,b | 0 = α ≥ .7, κ ≥ .8, ICC ≥ .75, r ≥ .80 1 = α < .7, κ < .8, ICC < .75, r < .80 |
Type of variablea | 0 = continuous 1 = dichotomous |
Adequate proportion of data availablea | 0 = ≥ 75% of data available 1 = < 75% of data available |
Methodology used and settinga | 0 = consistent across sample 1 = inconsistent across sample |
Description of statistical analyses | 0 = sufficient description of analyses 1 = insufficient description of analyses |
Management of missing data | 0 = full information maximum likelihood, multiple imputation, or expectation-maximization algorithm 1 = listwise or pairwise deletion or mean substitution |
Statistical analyses | 0 = adequate given study design 1 = inadequate given study design |
Confounding variables | 0 = potential confounds are measured and accounted for in analyses 1 = potential confounds are not measured or are not accounted for in analyses |
Description of population, sample, recruitment, and inclusion and exclusion criteria | 0 = sufficient descriptions 1 = insufficient descriptions |
Sample maintained to follow-up | 0 = ≥ 75% of sample maintained to follow-up 1 = < 75% of sample maintained to follow-up |
Differences between participants who completed study versus those who were lost to follow-up | 0 = no important differences 1 = important differences |
Type of anxiety | Type of parenting | Significant moderation results | Non-significant moderation results |
---|---|---|---|
Social anxiety symptoms | Control-related: excessive promotion of child approach | None | Lorenzo et al., 2022 (2) |
Control-related: promotion of child avoidance | Lewis-Morrarty et al., 2012 Lorenzo et al., 2022 (2) Vreeke et al., 2013 | Vreeke et al., 2013 | |
Affect-related | Lorenzo et al., 2022 | Lorenzo et al., 2022 | |
Other anxiety symptoms | Control-related: excessive promotion of child approach | None | Lawrence et al., 2020 |
Control-related: promotion of child avoidance | Hudson et al., 2019 | Hudson et al., 2011 Hudson et al., 2019 Majdandžić et al., 2018 (2) Vreeke et al., 2013 (2) | |
Control-related: encouragement | Kiel et al., 2016 Lawrence et al., 2020 | Majdandžić et al., 2018 Majdandžić et al., 2018a | |
Affect-related | None | Hudson et al., 2011 Hudson et al., 2019 (2) Lawrence et al., 2020 | |
Anxiety disorders | Control- and affect-related | None | Hudson & Dodd, 2012 (4) Hudson et al., 2011 (2) Hudson et al., 2019 (2) Lawrence et al., 2020 (3) Lewis-Morrarty et al., 2012a Murray et al., 2014 (2) |