Understanding the Emergence of Social Anxiety in Children With Behavioral Inhibition

Abstract

Behavioral inhibition (BI) is a temperament characterized in early childhood by distress to novelty and avoidance of unfamiliar people, and it is one of the best-known risk factors for the development of social anxiety. However, nearly 60% of children with BI do not go on to meet criteria for social anxiety disorder. In this review we present an approach to understanding differential developmental trajectories among children with BI. We review research using laboratory-based tasks that isolate specific attention processes that enhance versus mitigate risk for social anxiety among behaviorally inhibited children and studies that suggest that BI is associated with heightened detection of novelty or threat. Moreover, stimulus-driven control processes, which we term "automatic control," increase the probability that behaviorally inhibited children display socially reticent behavior and develop social anxiety. In contrast, goal-driven control processes, which we term "planful control," decrease risk for anxiety. We suggest that these three categories of processes (detection, automatic control, and planful control) function together to determine whether behaviorally inhibited children are able to flexibly regulate their initial reactions to novelty, and in turn, decrease risk for social anxiety. Although laboratory-based tasks have identified these processes underlying risk and resilience, the challenge is linking them to the emotions, thoughts, and behaviors of behaviorally inhibited children in real-world contexts.

Keywords: Automatic control; Developmental trajectories; Planful control; Response to detection; Social anxiety; Temperament.

Figure 1.

The grouping of attentional and control processes in the current model. Bullets provide an example of a task used in the study of each process, with specific indices from each task presented in parentheses. Note that this list of example is non-comprehensive. Within the leftmost box labelled “Detection”, processes range continuously from “More Stimulus-Driven” at the bottom to “More Goal-Driven”. The inclusion of this continuum reflects the heterogeneity of these processes along this dimension, with their unification in a single box reflecting the equivalency in their relations to BI in the current model. ERN = Error Related Negativity. MID = Monetary Incentive Delay. ABT = Attention Bias to Threat. DCCS = Dimensional Change Card Sort. AX-CPT = AX-Continuous Performance Task.

Figure 2.

An illustration of the proposed developmental cascade from Behavioral Inhibition in toddlerhood to social behavior in later childhood. Children exhibiting BI in toddlerhood complete an assessment of cognitive control (e.g., AX-CPT) later in childhood. The AX-CPT enables measurement of both automatic and planful control processes through its use of contextual cues (e.g., the letters “A” or “B”) that help signal to the participant how they should respond to an upcoming probe (e.g., the letters “X” or “Y”). Because participants are instructed to only respond when they see an “A” that is followed by an “X,” participants must use a combination of planful control (i.e., upon seeing the cue, anticipating a possible response to the upcoming probe) and automatic control (i.e., upon seeing the probe, choosing the appropriate response given the cue that was seen earlier) in order to maximize task accuracy. Children ending toward planful control are predicted to exhibit lower levels of social anxiety, while those tending toward automatic control are predicted to exhibit higher levels of social anxiety.

Figure 3.

Hypothetical attentional behavior of a) children high in behavioral inhibition (BI) and b) non-BI children in response to a novel or salient stimulus in a goal-directed setting.

Figure 4.

Hypothetical attentional behavior of a) a child high in behavioral inhibition (BI) at low risk of developing anxiety, and b) a high-BI child at higher risk of developing anxiety.