title: Early risk factors and developmental pathways to chronic high inhibition and social anxiety disorder in adolescence.
abstract: OBJECTIVE
  Evidence suggests that chronic high levels of behavioral inhibition are a precursor of social anxiety disorder. The authors sought to identify early risk factors for, and developmental pathways to, chronic high inhibition among school-age children and the association of chronic high inhibition with social anxiety disorder by adolescence.
  
  
  METHODS
  A community sample of 238 children was followed from birth to grade 9. Mothers, teachers, and children reported on the children's behavioral inhibition from grades 1 to 9. Lifetime history of psychiatric disorders was available for the subset of 60 (25%) children who participated in an intensive laboratory assessment at grade 9. Four early risk factors were assessed: female gender; exposure to maternal stress during infancy and the preschool period; and at age 4.5 years, early manifestation of behavioral inhibition and elevated afternoon salivary cortisol levels.
  
  
  RESULTS
  All four risk factors predicted greater and more chronic inhibition from grades 1 to 9, and together they defined two developmental pathways. The first pathway, in girls, was partially mediated by early evidence of behavioral inhibition and elevated cortisol levels at age 4.5 years. The second pathway began with exposure to early maternal stress and was also partially mediated by childhood cortisol levels. By grade 9, chronic high inhibition was associated with a lifetime history of social anxiety disorder.
  
  
  CONCLUSIONS
  Chronic high levels of behavioral inhibition are associated with social anxiety disorder by adolescence. The identification of two developmental pathways suggests the potential importance of considering both sets of risk factors in developing preventive interventions for social anxiety disorder.
authors.affiliation: Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, 6001 Research Park Blvd., Madison, WI 53719, USA. mjessex@wisc.edu
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Essex
authors.forename: Marjorie H
authors.initials: MH
authors.lastname: Klein
authors.forename: Marcia J
authors.initials: MJ
authors.lastname: Slattery
authors.forename: H Hill
authors.initials: HH
authors.lastname: Goldsmith
authors.forename: Ned H
authors.initials: NH
authors.lastname: Kalin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002652:Child Behavior / Q000523:psychology*; D016241:Child of Impaired Parents / Q000523:psychology; D002675:Child, Preschool; D002908:Chronic Disease; D002940:Circadian Rhythm / Q000502:physiology; D003866:Depressive Disorder / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D007266:Inhibition, Psychological; D008137:Longitudinal Studies; D008297:Male; D010698:Phobic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012463:Saliva / Q000737:chemistry; D012792:Shyness; D013694:Temperament
chemical_list: D006854:Hydrocortisone