Behavioral Inhibition and Attentional Control in Adolescents: Robust Relationships with Anxiety and Depression

Behavioral inhibition (BI) has been associated with the development of internalizing disorders in children and adolescents. It has further been shown that attentional control (AC) is negatively associated with internalizing problems. The combination of high BI and low AC may particularly lead to elevated symptomatology of internalizing behavior. This study broadens existing knowledge by investigating the additive and interacting effects of BI and AC on the various DSM-IV based internalizing dimensions. A sample of non-clinical adolescents (N = 1806, age M = 13.6 years), completed the Behavioral Inhibition System/Behavioral Activation System Scales (BIS/BAS), the attentional control subscale of the Adult Temperament Questionnaire (ATQ) and the Revised Child Anxiety and Depression Scale (RCADS). As expected, BI was positively, and AC was negatively related to internalizing dimensions, with stronger associations of BI than of AC with anxiety symptoms, and a stronger association of AC than of BI with depressive symptoms. AC moderated the association between BI and all measured internalizing dimensions (i.e., symptoms of generalized anxiety disorder, social phobia, separation anxiety disorder, panic disorder, obsessive–compulsive disorder, and major depressive disorder). Since high AC may reduce the impact of high BI on the generation of internalizing symptoms, an intervention focused on changing AC may have potential for prevention and treatment of internalizing disorders.     

Developmental trajectories of anxiety symptoms among boys across early and middle childhood

This study examined the developmental trajectory of anxiety symptoms among 290 boys and evaluated the association of trajectory groups with child and family risk factors and children's internalizing disorders. Anxiety symptoms were measured using maternal reports from the Child Behavior Checklist (T. M. Achenbach, 1991, 1992) for boys between the ages of 2 and 10. A group-based trajectory analysis revealed 4 distinct trajectories in the development of anxiety symptoms: low, low increasing, high declining, and high-increasing trajectories. Child shy temperament tended to differentiate between initial high and low groups, whereas maternal negative control and maternal depression were associated with increasing trajectories and elevated anxiety symptoms in middle childhood. Follow-up analyses to diagnoses of preadolescent depression and/or anxiety disorders revealed different patterns on the basis of trajectory group membership. The results are discussed in terms of the mechanisms of risk factors and implications for early identification and prevention.     

The Development of Adolescent Generalized Anxiety and Depressive Symptoms in the Context of Adolescent Mood Variability and Parent-Adolescent Negative Interactions

This study explored the influence of adolescent mood variability on the symptom development of generalized anxiety and depression in the context of parent-adolescent negative interactions. Participants were 456 adolescents (55.7 % male) from a community sample, who were followed from age 13 to 16 years. During 4 annual assessments, adolescents reported on their generalized anxiety and depressive symptoms, and both parents and adolescents on levels of negative interactions with each other. Within each study year, adolescents rated their daily mood states during 5 consecutive days for 3 times per year (total of 9 weeks). The absolute differences between mood states on consecutive days were summed to construct a mood variability score. Results showed that high levels of adolescent mood variability predicted increases in generalized anxiety and depressive symptoms across the studied period. No influence of negative interactions on anxiety and depression development was found, but positive predictive links from mood variability to negative interactions at age 14 and 15 appeared. The study underscores the role of adolescent mood variability in the development of symptoms of generalized anxiety and depression during adolescence, but found little evidence for an influence of parent-adolescent negative interactions on internalizing problem development.     

Higher-order structure in the trajectories of depression and anxiety following sudden involuntary unemployment

Recent work on comorbidity finds evidence for hierarchical structure of mood and anxiety disorders and symptoms. This study tests whether a higher-order internalizing factor accounts for variation in depression and anxiety symptom severity and change over time in a sample experiencing a period of major life stress. Data on symptoms of depression, chronic worry, and social anxiety were collected five times across seven months from 426 individuals who had recently lost jobs. Growth models for each type of symptom found significant variation in individual trajectories. Slopes were highly correlated across symptom type, as were intercepts. Multilevel confirmatory factor analyses found evidence for a higher-order internalizing factor for both slopes and intercepts, reflective of comorbidity of depression and anxiety, with the internalizing factor accounting for 54% to 91% of the variance in slopes and intercepts of specific symptom sets, providing evidence for both a general common factor and domain-specific factors characterizing level and change in symptoms. Loadings on the higher order factors differed modestly for men and women, and when comparing African American and White participants, but did not differ by age, education, or history of depression. More distal factors including gender and history of depression were strongly associated with internalizing in the early weeks after job loss, but rates of change in internalizing were associated most strongly with reemployment. Findings suggest that stressors may contribute in different ways to the common internalizing factor as compared to variance in anxiety and depression that is independent of that factor.     

Socialization of Emotion and Offspring Internalizing Symptoms in Mothers with Childhood-Onset Depression

This study examines how mothers with and without a history of childhood-onset depression respond to their 3-9 year-old children's emotions. Mother-child dyads included 55 offspring of mothers with a history of childhood-onset depressive disorders and 57 offspring of never-depressed mothers. Mothers with a history of childhood depression were less likely than control mothers to respond in supportive ways to their children's negative emotions and were more likely to magnify, punish, or neglect their children's negative emotions. Magnification, neglect, and punishment of children's negative emotions were concurrently associated with children's internalizing symptoms, and neglect and punishment were associated with internalizing over a one year follow-up. Maternal neglect of children's negative emotion was positively associated with later internalizing symptoms for children who already had higher internalizing symptoms at the initial assessment. Findings suggest that atypical socialization of emotion may be one mechanism in the development of internalizing disorders.     

Predictive validity of automatic self-associations for the onset of anxiety disorders

Negative self-cognitions are assumed to play an important role in the onset of anxiety disorders. Current dual-process models emphasize the relevance of differentiating between more automatic and more deliberate self-cognitions in this respect. Therefore, this study was designed to test the prognostic value of both deliberate and automatic self-anxious associations as a generic vulnerability factor for the onset of anxiety disorders between baseline and 2-year follow-up. To test the disorder specificity of negative self-associations, we also measured self-depressed associations. Self-report measures of depressive symptoms, anxiety symptoms, neuroticism, and fearful avoidance were included as covariates. Healthy controls (n=593), individuals who had depression (n=238), and individuals remitted from an anxiety disorder (n=448) were tested as part of the Netherlands Study of Depression and Anxiety. Deliberate self-anxious associations predicted the onset of anxiety disorders in all groups. Automatic self-anxious associations showed predictive validity only in individuals remitted from an anxiety disorder or in currently depressed individuals. Although deliberate self-depressed associations were related to the onset of anxiety disorders as well, automatic self-depressed associations were not. In the (remitted) patient groups, only deliberate self-anxious associations showed independent predictive value for the onset of anxiety disorders together with self-reported fearful avoidance behavior. In the healthy controls, only a composite index of negative emotionality (depressive or anxiety symptoms and neuroticism) showed independent predictive validity. This study provides the first evidence that automatic and deliberate self-anxious associations have predictive value for the future onset of anxiety disorders.     

Symptom and substance use reporting consistency over two years for offspring at high and low risk for depression

We examined 2-year recall of reports of lifetime symptomatology and substance use questions on the K-SADS-E in a sample of offspring at high and low risk for depression. Comparisons were made between those who forgot and those who remembered reports of screening symptoms made at the initial interview. In general, recall for symptoms of internalizing disorders (depression and anxiety disorder) was much worse than recall for symptoms of externalizing disorders (conduct disorder and substance use). Less than two-thirds of those initially meeting the lifetime depression screening criteria provided reports which met the lifetime screening criteria at followup. Significant correlates of screening criteria recall included the following variables (measured at the initial interview): history of treatment for any disorder, impairment on the GAS (a score less than 61), and the presence of hypersomnia and suicidal symptoms (thoughts or ideation). Logistic regression suggested that a prior report of suicidal symptoms (including thoughts, ideation, or behavior) was the most important correlate of screen recall.This research was supported in part by grants from the National Institute on Drug Abuse (grant R29DA07995), the National Institute of Mental Health (grant P50MH43878-03) and from the University of Illinois Campus Research Board. The authors would like to thank Dr. Myrna Weissman for making the data available and acknowledge the data analytic assistance provided by Yanchun Xu.     

Anxiety between personality and cognition: The gray zone

The aim of the study was to explore relations between Gray’s revised Reinforcement Sensitivity Theory (rRST) systems (Behavior Inhibition, Behavior Activation and Fight/Flight/Freeze System – BIS, BAS and FFFS) and two cognitive vulnerabilities to anxiety disorders (Intolerance of Uncertainty – IU and Anxiety Sensitivity – AS). The sample comprised 223 participants. The results suggested that BIS was a significant predictor of all components of the anxiety vulnerability measures. However, Freeze and Flight had also significant contributions, particularly in explaining vulnerabilities to physical and social threats as well as inhibitory behaviours while facing uncertainty. The findings provide insights into the nature of AS and IU which is in accordance with the rRST.     

Reducing the Risk of Internalizing Symptoms among High‐risk Hispanic Youth through a Family Intervention: A Randomized Controlled Trial

Familias Unidas is an intervention that has been found to be efficacious in preventing and reducing substance use, sexual risk, and problem behaviors among Hispanic youth. While it does not specifically target youth internalizing symptoms, the intervention works to strengthen parenting and family factors associated with reduced risk of internalizing symptoms (i.e., depression, anxiety symptoms). This study examines the effects of Familias Unidas on internalizing symptoms among high‐risk youth, as well as the role of family level factors in the intervention's effects. A total of 242 12–17‐year‐old Hispanic youth with a history of delinquency and their primary caregivers were recruited from the school and juvenile justice systems, and randomly assigned to the Familias Unidas intervention or community practice control. A linear latent growth model was used to examine intervention effects on the trajectory of adolescent internalizing symptoms from baseline to 6 and 12 months post‐baseline. Results show that the Familias Unidas intervention was more efficacious than control in reducing youth internalizing symptoms. Baseline youth externalizing and internalizing symptoms did not moderate the intervention's effects on the trajectory of youth internalizing symptoms. While parent – adolescent communication did not significantly moderate the intervention's effects, changes in parent – adolescent communication mediated the intervention's effects on internalizing symptoms, showing stronger intervention effects for youth starting with poorer communication. Findings indicate that the Familias Unidas intervention can reduce internalizing symptoms among high‐risk Hispanic youth, and that improving parent – youth communication, a protective family factor, may be one of the mechanisms by which the intervention influences youth internalizing symptoms.     

Developmental coordination disorder and internalizing problems in children: The environmental stress hypothesis elaborated

There is a growing literature connecting poor motor coordination to physical and mental health outcomes in children and adolescents. These studies suggest that children with disorders such as developmental coordination disorder (DCD) are at greater risk for depression and anxiety, as well as obesity, and poor physical fitness. With regard to internalizing problems (symptoms of depression and anxiety), there is also evidence to suggest that the environment may play an important role in the etiology of psychological distress in this population. Cairney, Veldhuizen, & Szatmari, 2010 used the phrase “environmental stress hypothesis” to highlight the role that negative exposure to personal and interpersonal stressors might play in accounting for higher rates of internalizing symptoms in children with DCD. In this paper, we elaborate further on this basic premise, offering a model linking DCD to internalizing problems based on Pearlin’s stress process framework. In addition to stressors (risk) and protective factors, we incorporate both physical activity and obesity into our stress model. Next, we review the existing literature to see if there is evidence supporting specific components (pathways) of the model. In doing so, areas in need of further research are identified. Implications for intervention are also provided.     

Exploring Behavioral Activation and Inhibition Sensitivities Among College Students at Risk for Bipolar Spectrum Symptomatology

We explored cross-sectionally the roles in bipolar spectrum symptomatology of two broad motivational systems that are thought to control levels of responsiveness to cues of threat and reward, the Behavioral Inhibition System (BIS) and the Behavioral Activation System (BAS). Undergraduate students (n = 357) completed questionnaires regarding (a) bipolar spectrum disorders [the General Behavior Inventory (GBI), a well-established clinical screening measure], (b) current depression and mania symptoms (the Internal State Scale; ISS), and (c) BIS/BAS sensitivities (the BIS/BAS scales). Validated cutoff scores on the GBI were used to identify individuals at risk for a mood disorder. It was hypothesized that, among at-risk respondents, high BAS and low BIS levels would be associated with high current mania ratings, whereas low BAS and high BIS would be associated with high current depression ratings. Multiple regression analyses indicated that, among at-risk individuals (n = 63), BAS accounted for 27% of current mania symptoms but BIS did not contribute. For these individuals, BAS and BIS were both significant and together accounted for 44% of current depressive symptoms.     

Psychosocial Functioning in Children and Adolescents with Gastrointestinal Complaints and Disorders

The current study examined the prevalence and presentation of psychosocial symptoms in pediatric patients and their parents presenting for first time appointments at a gastroenterology (GI) clinic compared to healthy controls (HC). One hundred GI patients, aged 8-17 years, and their mothers were compared to 100 age- and gender-matched HC on measures of child and parental behavioral/psychosocial functioning, depression, and anxiety. Results revealed significant correlations between mother- and child-reported internalizing behaviors and psychological symptoms. Significant group differences were observed in internalizing problems, adaptive and social skills, and leadership competency, as well as parental interpersonal sensitivity, depression, phobic anxiety, and number of psychological symptoms. GI patients are at increased risk for psychosocial and social dysfunction compared to healthy peers. Psychosocial factors should be considered when assessing patients in GI clinics. Patients might benefit from treatment plans that involve adjunctive behavioral intervention to assist patients in managing their conditions.     

Maternal Depression and Youth Internalizing and Externalizing Symptomatology: Severity and Chronicity of Past Maternal Depression and Current Maternal Depressive Symptoms

Maternal depression is a well-documented risk factor for youth depression, and taking into account its severity and chronicity may provide important insight into the degree of risk conferred. This study explored the degree to which the severity/chronicity of maternal depression history explained variance in youth internalizing and externalizing symptoms above and beyond current maternal depressive symptoms among 171 youth (58 % male) ages 8 to 12 over a span of 3 years. Severity and chronicity of past maternal depression and current maternal depressive symptoms were examined as predictors of parent-reported youth internalizing and externalizing symptomatology, as well as youth self-reported depressive symptoms. Severity and chronicity of past maternal depression did not account for additional variance in youth internalizing and externalizing symptoms at Time 1 beyond what was accounted for by maternal depressive symptoms at Time 1. Longitudinal growth curve modeling indicated that prior severity/chronicity of maternal depression predicted levels of youth internalizing and externalizing symptoms at each time point when controlling for current maternal depressive symptoms at each time point. Chronicity of maternal depression, apart from severity, also predicted rate of change in youth externalizing symptoms over time. These findings highlight the importance of screening and assessing for current maternal depressive symptoms, as well as the nature of past depressive episodes. Possible mechanisms underlying the association between severity/chronicity of maternal depression and youth outcomes, such as residual effects from depressive history on mother–child interactions, are discussed.     

Parent-Offspring Transmission of Internalizing and Sensory over-Responsivity Symptoms in Adolescence

Reactions to sensory experiences are an overlooked correlate of affective regulation, despite the importance of bodily states on psychological processes. Children who display sensory over-responsivity (i.e., adverse reactions to typical sensations) are at greater risk for developing affective disorders. We extended this literature to adolescents and their middle-aged parents. Participants in a birth record-based study of families of adolescent twins (N = 506 families; 1012 adolescents; 53% female) completed a subset of items from the Adult Sensory Profile. We derived adolescent self-reported internalizing disorder symptoms and parent affective diagnoses from structured diagnostic interviews. Structural equation models tested the relationship between parent sensory over-responsivity symptoms and affective diagnoses and their adolescent offspring’s sensory over-responsivity and internalizing symptoms. Adolescent sensory over-responsivity symptoms were correlated with internalizing disorder symptoms. Parents with a diagnosis of anxiety or depression (mothers only) reported more frequent SOR symptoms than parents without a diagnosis. Parent depression was significantly related to adolescent sensory over-responsivity symptoms, over and above parent sensory over-responsivity symptoms (β = 0.26, p < 0.001 for mothers; β = 0.13, p = 0.004 for fathers). Father alcohol abuse/dependency also predicted offspring sensory over-responsivity symptoms. Offspring of parents with affective disorders were at additional risk for sensory dysregulation via parents’ influence on offspring internalizing problems.     

Dimensions of Oppositional Defiant Disorder in Young Children: Heterotypic Continuity with Anxiety and Depression

There are distinct dimensions of Oppositional Defiant Disorder (ODD) that have been associated with symptoms of other disorders (heterotypic continuity). The present study compared the heterotypic continuity of a two-factor (Pitt-2) model and the three-factor model incorporated into DSM-5 with symptoms of anxiety and depression. Participants were a diverse community sample of 796 children (38.8 % minority, 49.1 % boys) assessed at ages 4, 5 and 6 years. Symptoms were assessed with the dimensional scales of the Diagnostic Interview Schedule for Children-Young Child version and the Child Symptom Inventory. Dimensions of both the two- and three-factor DSM-5 models were associated with later symptoms of anxiety and depression. The association, however, was weak when accounting for initial levels of internalizing symptoms: thus there was little evidence for the unique contributions of ODD dimensions to symptoms of subsequent internalizing disorders for either model.     

Acceptability and Preliminary Effects of a Mindfulness Mobile Application for Ruminative Adolescents

Rumination is a transdiagnostic risk factor that appears to be reduced through mindfulness interventions. However, mindfulness mobile apps have not been tested for their effects on rumination, especially among adolescents. Thus, we aimed to test the acceptability and effects of a mindfulness mobile intervention among ruminative adolescents using a within-subjects pretest/posttest design. Participants were 80 adolescents ages 12-15, selected for moderate-to-high rumination (M age = 14.01, SD = .99; 46.2% girls; 86.25% White; 3.75% Hispanic). We asked adolescents to use our mindfulness app 3 times per day for 3 weeks. Participants and parents completed questionnaires at baseline, post-intervention, and 6 and 12 weeks later. Acceptability was assessed by tracking app use and asking adolescents and parents to report on their experiences post-intervention. We assessed repetitive negative thinking (i.e., rumination and worry) and internalizing symptoms via self- and parent-report. The intervention demonstrated acceptability, and there were significant reductions in rumination, worry, anxiety and parent-reported internalizing symptoms post-intervention. Effects on rumination, anxiety and internalizing symptoms persisted throughout the 12-week follow-up with large effect sizes using an intention-to-treat approach. Thus, a brief mindfulness mobile app intervention appeared to be both engaging and helpful in reducing negative repetitive thinking and internalizing symptoms among ruminative adolescents. It will be important to test this intervention in a randomized controlled trial to control for effects of time and attention.     

Emotional Dynamics in the Development of Early Adolescent Psychopathology: A One-Year Longitudinal Study

This study examined the role of the level and variability of happiness, anger, anxiety, and sadness in the development of adolescent-reported anxiety disorder symptoms, depressive symptoms, and aggressive behavior in 452 adolescents (250 male) followed from age 13 to 14. Level and between-day variability of emotions were assessed through adolescent report at 3-month intervals across a 1 year period. Level and variability of the four emotions contributed to changes in anxiety disorder and depressive symptoms more consistently than to changes in aggressive behavior. All four emotions were predictive of changes in internalizing problems, while anger played the most prominent role in the development of aggressive behavior. Variability of emotions contributed to changes in anxiety disorder symptoms, while heightened levels of negative emotions and diminished happiness contributed to changes in depression. Results suggested somewhat stronger effects of negative affect on aggressive behavior for females than for males. Results underscore the role of emotion dysregulation in the development of psychopathology.     

Testing the Direction of Longitudinal Paths between Victimization,Peer Rejection,and Different Types of Internalizing Problems in Adolescence

The transition to secondary school is accompanied by the fragmentation of peer groups, while adolescents are also confronted with heightened incidents of bullying and increased levels of internalizing problems. Victimization, peer rejection, and internalizing problems are known to be interrelated, but how they influence each other over time remains unclear. We tested the direction of these associations by applying a cross-lagged path model among a large sample of Finnish adolescents (N = 5645; 49.1 % boys; M age at T1 = 14.0 years) after they transitioned to secondary school (grades 7–9). Self-reported depression, anxiety, and victimization and peer-reported rejection were measured 3 times over the course of 1 year. Results showed that depression was predictive of subsequent victimization for both boys and girls, in line with a symptoms-driven model; for girls, anxiety was reciprocally related to victimization, in line with a transactional model; for boys, victimization was related to subsequent anxiety, in line with an interpersonal risk model. Peer rejection was not directly related to depression or anxiety, but among girls peer rejection was bi-directionally related to victimization. Overall, our results suggest that associations between internalizing problems and peer relations differ between depression and anxiety and between genders. Implications for practice and directions for future research are discussed.     

Throwing light on the dark side of personality: Reinforcement sensitivity theory and primary/secondary psychopathy in a student population

In a student sample, we examined two major issues in relation to primary/secondary subtypes of psychopathy and the reinforcement sensitivity theory of personality: the roles played by (a) fear (related to the fight-flight-freeze system, FFFS) and anxiety (related to the behavioural inhibition system, BIS), and (b) different aspects of the behavioural approach system (BAS). Largely consistent with Corr’s (2010a) proposal concerning the neuropsychological deficits associated with the psychoticism-psychopathy continuum, results confirmed that low BIS activity was associated with both primary and secondary psychopathy; whereas low FFFS activity was associated with only primary psychopathy. In relation to the BAS, reward sensitivity and drive were positively related to primary psychopathy; whereas Fun Seeking was negatively related to primary psychopathy but positively related to secondary psychopathy. These results represent a more nuanced picture of FFFS/BIS/BAS and dispositional psychopathy in a student sample. Specifically, they challenge the view that low BIS is preferentially associated with primary psychopathy and a high BAS is preferentially associated with secondary psychopathy. Further work is needed to confirm that these findings extend to clinical and forensic psychopathy populations.     

Psychological Distress and Symptoms of Posttraumatic Stress Disorder in Jewish Adolescents Following a Brief Exposure to Concentration Camps

We investigated the psychological impact of an organized visit to Polish concentration camps on Jewish-American adolescents. Eighty-seven adolescents who participated in a B'nai B'rith memorial visit to concentration camps in Poland completed measures of general psychological adjustment and posttraumatic stress disorder (PTSD) at four time-points: pretest, posttest, 6-month follow-up and 12-month follow-up. Measures included the SCL-90-R, the Mississippi Scale for PTSD, and the Impact of Events Scale (IES) for PTSD. On the SCL-90-R, changes in somatization, interpersonal sensitivity, obsessive-compulsive tendencies, depression, anxiety, and phobic anxiety were observed over time, with peak symptom scores at posttest and 6-month follow-up. Scores on the Mississippi Scale for PTSD and the IES Intrusion subscale also increased at 6-months. Predictors of PTSD symptoms on the Mississippi Scale included previous psychiatric treatment and SCL-90-R symptoms of paranoia, depression, and psychosis. Elevated psychotic symptoms on the SCL-90-R predicted PTSD symptoms on the IES. Jewish adolescents with preexisting symptoms of generalized distress or psychoticism appeared at increased risk for PTSD symptoms following exposure to Holocaust stimuli. This study contributes a prospective, multi-measure assessment of trauma reactions in adolescents.