EBD Blog

Children who show behavioral inhibition in video-taped sessions at a child development laboratory are substantially more likely to manifest social anxiety five years later than their peers who do not exhibit behavioral inhibition, according to a recent study appearing in . In the study by Hirshfeld-Becker and colleagues of the Harvard Infant Study Laboratory, the researchers found that the children who do and do not have behavioral inhibition are about equally likely to exhibit other developmental disorders (e.g., ADHD). The children showing behavioral inhibition did not differ significantly in gender, family intactness, or race, from those who did not show behavioral inhibition.

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.

Method: 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.

Conclusion: 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.

Students with social anxiety and other acting in disorders (e.g., shy or withdrawn) are too easy to overlook. Educators need all the help they can get in catching these problems early and addressing them with effective interventions.

Hirshfeld-Becker, D. R., Biederman, J., Henin, A., Faraone, S. V. Davis, S., Harrington, K., & Rosenbaum, J. F. (2007). Behavioral inhibition in preschool children at risk is a specific predictor of middle childhood social anxiety: A five-year follow-up. Journal of Developmental & Behavioral Pediatrics, 28, 225-233. Link.