Behavioral inhibition in preschool children at risk is a specific predictor of middle childhood social anxiety: a five-year follow-up.
OBJECTIVE
Behavioral inhibition (BI) to the unfamiliar represents the temperamental tendency to exhibit fearfulness, reticence, or restraint when faced with unfamiliar people or situations. It has been hypothesized to be a risk factor for anxiety disorders. In this prospective longitudinal study, we compared the psychiatric outcomes in middle childhood of children evaluated at preschool age for BI.


METHODS
The baseline sample consisted of 284 children ages 21 months to 6 years, including offspring at risk for anxiety (children of parents with panic disorder and/or major depression) and comparison offspring of parents without mood or major anxiety disorders. They had been assessed for BI using age-specific laboratory protocols. We reassessed 215 of the children (76.5%) at 5-year follow-up at a mean age of 9.6 years using structured diagnostic interviews.


RESULTS
BI specifically predicted onset of social anxiety. The rate of lifetime social anxiety (DSM-IV social phobia or DSM-III-R avoidant disorder) was 28% versus 14% (odds ratio [OR] = 2.37; 95% confidence interval [CI]: 1.10-5.10) in inhibited versus noninhibited children. BI significantly predicted new onset of social phobia among children unaffected at baseline (22.2% vs 8.0% in inhibited versus noninhibited children (OR = 3.15, 95% CI: 1.16-8.57). No other anxiety disorders were associated with BI.


CONCLUSIONS
BI appears to be a temperamental antecedent to subsequent social anxiety in middle childhood. Children presenting with BI should be monitored for symptoms of social anxiety and may be good candidates for preventive cognitive behavioral strategies.
Hirshfeld-Becker
Dina R
DR
Harvard Medical School/Massachusetts General Hospital, Boston, MA 02138, USA. dhirshfeld@partners.org
Biederman
Joseph
J
Henin
Aude
A
Faraone
Stephen V
SV
Davis
Stephanie
S
Harrington
Kara
K
Rosenbaum
Jerrold F
JF
D000375:Aging / Q000523:psychology; D001007:Anxiety / Q000523:psychology*; D001008:Anxiety Disorders / Q000517:prevention & control*; D002648:Child; D016241:Child of Impaired Parents; D002675:Child, Preschool; D003865:Major Depressive Disorder; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007266:Inhibition, Psychological; D007398:Interpersonal Relations; D008297:Male; D016584:Panic Disorder; D011446:Prospective Studies; D012307:Risk Factors; D012917:Social Adjustment; D013694:Temperament