- A new study has shown that certain patterns of behavior that begin in childhood might be able to predict anxiety later in life.
- Children and teens who have high levels of wariness, fear, and avoidance might be at an increased risk for developing an anxiety-related disorder when faced with a stressful life event during young adulthood.
- Parents of kids and teens who display social wariness and worry dysregulation should talk to a pediatrician or mental health professional about the best way to help their child.
A recent study supported by the National Institutes of Health (NIH) reviewed 16 years of data to predict which individuals were most likely to report elevated levels of anxiety when faced with a stressful life event during young adulthood—in this case, the COVID-19 pandemic.
Researchers identified early risk factors that predicted heightened anxiety in young adults during the COVID-19 pandemic. The researchers found that participants who continued to show a childhood temperament called behavioral inhibition (BI) were more likely to experience worry dysregulation at age 15, which then predicted elevated anxiety during the early months of the COVID-19 pandemic when the participants were around 18-years-old.
Behavioral inhibition is a childhood temperament that typically involves high levels of cautious, fearful, and avoidant responses to unfamiliar people, objects, and situations.
The study, which was part of an ongoing longitudinal study of temperament and socioemotional development, was published in the Journal of the American Academy of Child and Adolescent Psychiatry in mid-February.
What This Means For You
Children who show certain behavioral patterns might be more likely to develop anxiety later on when confronted with stressful life events. If your child is anxious or worries a lot, talking with your pediatrician and a mental health professional can get you started on an individualized approach to helping them, which might mitigate their risk of anxiety as they grow up.
Studying Children Over Time
“Not everyone expresses the same level of concerns or anxiety in the pandemic,” Santiago Morales, PhD, a postdoctoral researcher at the University of Maryland, College Park, and study author, tells Get Meds Info. “So, we were trying to understand if we could draw this deep, developmental pathway and make use of all this rich information to understand the individuals who are experiencing the most anxiety during the pandemic.”
To find out which children were at the most risk for developing high levels of anxiety related to stressful events later in life (in this case, the COVID-19 pandemic), the researchers looked at behavioral or reported markers in each child at specific ages from toddlerhood to young adulthood.
The researchers had already been collecting data on the 291 participants from a large metropolitan Atlantic region in the United States for almost two decades as part of a larger study. When the COVID-19 pandemic started, they decided to analyze the data to identify which individuals were most at risk for elevated anxiety during the stressful time.
The years of data the researchers already had on the participants gave them an opportunity. “It allowed us to characterize a group of children prior to anybody ever having heard of something like COVID-19,” study author Nathan Fox, PhD, a professor and director of the Child Development Lab at the University of Maryland, College Park, tells Get Meds Info. “We had information on their temperament and anxiety problems, so we were in a unique situation in which we had pre-COVID-19 data on these kids so that we could see what it is that a stressful set of life events leads to, and how these children reacted to those events.”
Taking a Closer Look at Behaviors
To identify the children most at risk for increased anxiety in young adulthood in the context of COVID-19, the researchers drew upon the data that had been collected at specific milestones in the participants’ development.
Specifically, the researchers analyzed three components believed to manifest anxiety levels:
- Behavioral inhibition at ages 2 to 3
- Social wariness (SW) at age 7
- Worry dysregulation at age 15
Ages 2 to 3: Behavioral Inhibition
Fox says that when observing behavioral inhibition, the researchers were interested in the toddlers’ “responses to novelty, unfamiliarity, and uncertainty.”
To examine BI, the researchers constructed a set of tasks or events for when the mothers brought their children to the lab. The researchers videotaped and coded behaviors based on how each child responded to stimuli such as an unfamiliar adult and/or a novel and unpredictable toy.
Fox says that the researchers were watching closely to see what the child would do in these situations. “Will a child do something somewhat risky, like crawl through a tunnel to fetch a ball?” Fox says. “Those are the kinds of things that we observe.”
According to Morales, the kids that scored the highest in BI can be thought of “as very shy or fearful children.”
The researchers also looked at each child’s expressions of stress and joy, as well as their latency to respond or talk when confronted with novelty or uncertainty.
“The normal response in a novel situation for any child will be to be a little hesitant to approach,” Morales says. “But after a little bit, they let go of mom’s leg, they approach and play with the new toys. But these children, [who score a higher BI], are more on the extreme.”
Age 7: Social Wariness
After BI, the researchers looked at social wariness which was collected in the lab at around age 7.
For these observations, the children were given an unstructured, free play task with an unfamiliar, but same-age, same-sex peer. The researchers evaluated SW in each child by rating behaviors like hesitance to play and fearfulness toward the peer.
Age 15: Worry Dysregulation
At the 15-year mark, worry dysregulation was rated with the dysregulation subscale of the Children’s Worry Management Scale, which “captures maladaptive worry expression,” the authors write. The scale consists of questions such as “I can’t stop myself from acting really worried.” Higher scores on the scale reflect greater worry dysregulation.
Lastly, the researchers turned to the Generalized Anxiety Disorder (GAD) 7-Item Scale. The participants were evaluated with the scale twice—once in April, and again in May 2020, the first two full months of the pandemic in the U.S.
High scores of the GAD-7 indicate greater anxiety levels, with scores higher than or equal to ten considered clinical anxiety.
What Do the Results Mean?
The researchers found that the people who exhibited high BI, SW, and worry dysregulation early in life were the most at risk for heightened anxiety when confronted with stressors as young adults.
The authors considered that stressful life events in young adulthood are linked to increased mental health symptoms; therefore, they used the years of data they had to see which individuals were most vulnerable to developing an anxiety disorder in the context of COVID-19.
Even though the study focused on specific elements—BI, SW, worry dysregulation, and the GAD scales—all are thought to be different manifestations of the same risk factor.
“As children get older, they’re not showing the exact same type of response,” Morales says. In other words, a person’s core temperament or traits are there, but people adapt and express behaviors differently as they age.
The researchers believe that’s what makes following the trajectory so important: the children whose behavioral inhibition leads to social wariness and continues on that trajectory are the most at risk for developing an anxiety disorder later in life. Those who do not follow that trajectory may not be at as high of a risk.
“There’s a lot of change that’s going on during early childhood,” Selin Zeytinoglu, PhD, a postdoctoral researcher at the University of Maryland, College Park, and a study author, tells Get Meds Info. “A lot of children just don’t show that pattern anymore.” For example, some of the children with high BI at age 2 or 3 did not go on to show SW at age 7.
Zeytinoglu suggests that a question for further research could be, “What might be some factors that make children maintain their fearfulness over time?”
What Did the Follow-Up Show?
Even though 20% of the sample reported clinical levels of anxiety during the first GAD assessment, those who followed the trajectory sustained heightened levels of anxiety even though the sample average went down.
“At the beginning of the pandemic, when everything was closing down and there were a lot of uncertainties, and we didn’t know what this ‘new normal’ was going to be, that’s when our participants reported the highest levels of anxiety,” Morales says.
It was expected that a larger chunk of the sample would report elevated anxiety related to the pandemic. However, as the situation evolved and participants adapted, overall anxiety levels decreased—except for those that had shown BI, SW, and worry dysregulation throughout the study milestones.
“That is another important piece that we focused on: those who are experiencing relatively high levels across both time points,” Morales says.
What Parents Can Do
The researchers suggest that addressing and helping kids with these behaviors could reduce their risk of developing anxiety-related disorders in the future.
Zeytinoglu says that researchers are still trying to figure out why certain children develop and maintain high levels of BI, SW, and worry dysregulation. “What might be some factors that protect those children from developing anxiety long-term?” is a question Zeytinoglu says additional research could investigate.
Ask for Help From a Professional
For a child or teenager who is presenting with high anxiety, Daniel Pine, MD, a study author and chief of the National Institute of Mental Health (NIMH) Section on Development and Affective Neuroscience, recommends that parents encourage conversation and seek out an individualized treatment approach.
“If you have some worries about your child, paying a little more attention and talking about the issue with healthcare professionals who know the child, is usually the best first thing to do,” Pine tells Get Meds Info, adding that many pediatricians are increasingly recognizing their role in attending to mental health—especially during the pandemic.
Talk With Your Child About Their Fears
In addition to speaking with a pediatrician, parents shouldn’t be afraid to talk about scary things with their kids. “Parents are sometimes afraid of bringing things up,” Pine says. “Because they’re worried that they might put an idea in a child’s head, or that they might create anxiety that isn’t already there, and we know pretty clearly that as long as a parent is sensitive and understanding, it is more helpful than not to talk about things that a child is afraid of.”
Parents naturally want to protect their children, but they also don’t want to inadvertently make them more fearful. “We know that parents who have children that are not encouraged to do things that make them a little afraid are at higher risk for having more anxiety over time compared to children who are encouraged to face their fears,” Pine says.
Pine says that it’s hard being a parent, especially in the context of the pandemic, but the best thing they can do is try to strike a balance—namely, one between encouraging their child to face fears they can handle and protecting them from those they can’t.
The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.