Cited by 203Child and Adolescent Psychosocial and Emotional DevelopmentAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMaternal Mental Health During Pregnancy and Postpartum

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Early Risk Factors and Developmental Pathways to Chronic High Inhibition and Social Anxiety Disorder in Adolescence

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Essex, Marilyn J., Klein, Marjorie H., Slattery, Marcia J., Goldsmith, H. Hill, Kalin, Ned H.·2010·American Journal of Psychiatry

DOI 10.1176/appi.ajp.2009.07010051PMC PMC2806488

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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. METHOD: 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.

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Authors: Essex, M. J., Klein, M. H., Slattery, M. J., Goldsmith, H. H., & Kalin, N. H.
Affiliations: University of Wisconsin–Madison (US)
ORCID: Essex, Marilyn J.
Goldsmith, H. Hill
Kalin, Ned H.
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 2010-01-01
Volume: 167
Issue: 1
Pages: 40-46
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/appi.ajp.2009.07010051
PMC: PMC2806488
OpenAlex: W2116296032
Cited by: 202
References: 41
Citations by year: 2026: 7 · 2025: 2 · 2024: 2 · 2023: 8 · 2022: 9 · 2021: 5 · 2020: 12 · 2019: 22 · 2018: 8 · 2017: 6 · 2016: 14 · 2015: 17 · 2014: 31 · 2013: 14 · 2012: 15
FWCI: 15.95
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: John D. and Catherine T. MacArthur Foundation
National Institute of Mental Health (R01MH44340, P50-MH 52354, P50MH052354, P50MH069315, R01MH044340, P50MH084051, P50-MH69315, R01MH059785)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (P30HD003352)
Topics: Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Keywords: behavioral inhibition, social anxiety disorder, developmental pathways, early risk factors, maternal stress, salivary cortisol, sex differences, childhood anxiety, adolescence, preventive interventions
MeSH terms: Adolescent, Adult, Age Factors, Child, Child Behavior, Child, Preschool, Chronic Disease, Circadian Rhythm, Depressive Disorder, Female, Humans, Hydrocortisone, Inhibition, Psychological, Longitudinal Studies, Male, Phobic Disorders, Psychiatric Status Rating Scales, Risk Factors, Saliva, Shyness, Temperament, Child of Impaired Parents, Diagnostic and Statistical Manual of Mental Disorders

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Early Risk Factors and Developmental Pathways to Chronic High Inhibition and Social Anxiety Disorder in Adolescence

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