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    2. 2. Overview of Research Questions <ul><li>Substantial numbers of children and adolescents develop internalizing behaviors that are associated with anxiety disorders </li></ul><ul><li>Focus on the developmental process from early childhood emotionality to internalizing symptoms is an overarching goal. </li></ul><ul><ul><li>Etiological research has focused, in part, on fearful temperament as one precursor or risk factor </li></ul></ul><ul><li>However, the exact mechanisms are still largely unknown. </li></ul><ul><ul><li>involving the complex interaction of behavioral and biological systems, both in terms of reactive and regulatory systems </li></ul></ul>
    3. 3. Is Fearful Temperament a Risk Factor? <ul><li>Behavioral inhibition/fearful temperament shows moderate stability, higher stability at extremes </li></ul><ul><ul><li>Although there is also considerable change with children becoming less fearful with development </li></ul></ul><ul><li>Risk for Social Anxiety </li></ul><ul><ul><li>17-30% of inhibited children develop clinically significant symptoms of social anxiety (Biederman et al., 2001; Schwartz et al., 1994) </li></ul></ul><ul><li>It remains unclear, however, who is at particular risk. Who are the children who continue to be fearful and are “disabled” by this fear. </li></ul><ul><ul><li>Biological diathesis </li></ul></ul><ul><ul><li>Intensity vs. regulation </li></ul></ul><ul><ul><li>Context effects </li></ul></ul>
    4. 4. New model Context Approach <ul><li>Examination of the role of the eliciting context on fear behavior may help in prediction of risk. </li></ul><ul><ul><li>How children regulate/modulate behavior in different context may be key component of risk. </li></ul></ul><ul><ul><li>Moreover, dysregulation (emotional distress outside the eliciting context) is a key defining feature of anxiety disorders in the DSM </li></ul></ul><ul><ul><li>Recent work in human infants has suggested that examining changes or consistencies in behavior across multiple contexts may yield important information about dysregulated behavior (Buss et al., 2004) </li></ul></ul><ul><ul><ul><li>It was children who displayed longer durations of freezing behavior in the lower threat context who showed the greatest physiological reactivity </li></ul></ul></ul>
    5. 5. Study Goals <ul><li>Replicate the dysregulated fear findings from previous work to identify risk by focusing on the fit, or lack of fit, between behavior and eliciting context. </li></ul><ul><li>Expand previous study to look at multiple contexts designed to vary in level and type of threat or novelty. </li></ul><ul><li>Look at behaviors and symptoms consistent with anxiety in a multi-method, longitudinal design. </li></ul>
    6. 6. Method Overview <ul><li>Participants </li></ul><ul><ul><li>111 toddlers and parents </li></ul></ul><ul><li>Phase 1 (24- month) Procedure </li></ul><ul><ul><li>Observed during 7 situations designed to elicit varying amounts of withdrawal behaviors (also had 5 non-threat episodes) </li></ul></ul><ul><ul><li>Maternal-reported temperament and behavior problems </li></ul></ul><ul><ul><li>Maternal negative affect/behavioral inhibition </li></ul></ul><ul><li>Phase 2 (Ages 3 & 4 follow-up) </li></ul><ul><ul><li>Questionnaire packets including temperament and behavior problem symptom measures </li></ul></ul><ul><li>Phase 3 (Kindergarten, ages 5-6) </li></ul><ul><ul><li>Two lab visits (temperament assessment and unfamiliar peer group) </li></ul></ul><ul><ul><li>Maternal-reported temperament & behavior problems in fall and spring </li></ul></ul>
    7. 7. 24-month Episodes and Scoring <ul><li>Episodes included: </li></ul><ul><ul><li>Clown, Puppet Show </li></ul></ul><ul><ul><li>2 Stranger Situations </li></ul></ul><ul><ul><li>Spider, Robot </li></ul></ul><ul><li>Episodes were scored for the latency presence and intensity of the several behaviors (second-by-second) </li></ul><ul><ul><li>Facial fear, sadness, pleasure </li></ul></ul><ul><ul><li>Crying, approach, withdrawal, freezing/inactivity </li></ul></ul><ul><ul><li>Comfort-seeking, proximity to mother </li></ul></ul><ul><ul><li>Distracting, playing, talking </li></ul></ul><ul><li>Three identical composites were formed across all the tasks </li></ul><ul><ul><li>Fear </li></ul></ul><ul><ul><li>Sadness </li></ul></ul><ul><ul><li>Engagement </li></ul></ul><ul><li>These composites were relatively independent. </li></ul><ul><li>Predictable pattern across episodes emerged. </li></ul><ul><li>Able to characterize high, moderate, and low threat episodes. </li></ul>
    8. 8. Context Effects: Fear & Engage Across Episodes
    9. 9. High Threat Low Threat
    10. 11. Why Dysregulated? <ul><li>Experience of threat/stress can be modulated by incentive properties of the situation: </li></ul><ul><ul><li>novelty, predictability, controllability and availability of coping resources. </li></ul></ul><ul><li>Ability to recognize these properties results in regulation of fear across contexts – flexibility of fear responses </li></ul><ul><li>Dysregulation = Rigidity of response in different situations, dynamic inflexibility </li></ul><ul><ul><li>Mismatch between incentive properties of, or coping resources available in, the situation AND the child’s behavioral response. </li></ul></ul>
    11. 12. Research Questions <ul><li>Children who experience high levels of fear and/or low levels of engagement in LOW THREAT tasks are dysregulated. </li></ul><ul><li>This dysregulated behavior at age 2 predicts risk for anxiety </li></ul><ul><ul><li>Is dysregulated fear behavior associated with anxious symptoms concurrently </li></ul></ul><ul><ul><li>Is dysregulated fear behavior associated with anxious symptoms and behavior and longitudinally (ages 3, 4, and 5)? </li></ul></ul><ul><li>Examining the trajectories of fearful temperament from 3-5. </li></ul><ul><ul><li>Does dysregulated fear behavior at age 2 moderate growth curves? </li></ul></ul><ul><ul><li>Do maternal characteristics moderate growth curves? </li></ul></ul>
    12. 13. Q1. Fear Groups and Concurrent Anxious Symptoms F (1, 40) = 7.86, p < .01 F (1, 33) = 1.41, n.s. High fear in the high threat, Spider, episode is not associated with anxiety, BUT high fear in the low threat, Clown, episode is associated with anxiety.
    13. 14. Q2. Fear Groups and 3 & 4 year Anxious Symptoms <ul><li>After controlling for 24-month anxiety, dysregulated fear was associated with maternal report of anxiety symptoms at both 3 and 4 years of age. </li></ul>F (1, 29) = 5.66, p < .01 F (1, 27) = 4.16, p < .05
    14. 15. Q2. Predicting Anxious Behavior in Kindergarten for Dysregulated Fear Toddlers (n = 50) Proportion of fear behavior in Clown predicted Social Withdrawal. r = .27, p < .05
    15. 16. Q2. Preliminary Kindergarten Outcomes (n = 50) Average fear behavior was moderately stable from the 24-month visit to the first kindergarten visit r = .36, p < .05 No evidence for greater stability at the extremes.
    16. 17. Q2. Are dysregulated fear children reticient with peers? <ul><li>Yes. </li></ul><ul><ul><li>We found peer behavior differences for the low vs. high dysregulated fear groups consistent with social reticence/anxious solitude but not with solitary-constructive behavior or group play (Rubin et al., 2002; Coplan et al., 1994) </li></ul></ul>
    17. 18. Q3. Growth curves for maternal-reported temperament Negative Affect decreases from age 3 to age 6 while Surgency increases. There were no moderating influences of gender.
    18. 19. Q3. Dysregulated Fear Moderates the Surgency Trajectory Surgency does not increase for toddlers showing high fear in the Clown episode.
    19. 20. Q4. Mother Approach Personality Moderates the Negative Affect Trajectory Negative Affect does not decrease for children whose mothers are low in Positive Affect and Approach personality.
    20. 21. Summary of Results <ul><li>High Fear in Low Threat situations characterized a dysregulated fear group. </li></ul><ul><li>These children had higher maternal-reported anxiety symptoms concurrently, and 1, 2, and 3 years later (at the transition to kindergarten). </li></ul><ul><li>Preliminary results for kindergarten adjustment support the stability of this behavioral profile to laboratory challenge tasks and social reticent behavior in an unfamiliar peer group setting. </li></ul><ul><li>Children characterized by dysregulated fear at age 2 did not show the expected increase in surgency from 3 to 5. Mothers high in approach personality had children with greater decreases in negative affect from 3-5. </li></ul>
    21. 22. Conclusions <ul><li>Assessing behavior across multiple contexts, including low threat contexts, provided a different perspective on risk. </li></ul><ul><ul><li>For instance, high fear in high threat episodes was not associated with anxiety symptoms </li></ul></ul><ul><li>Dysregulation of fear behavior across contexts may be important factor in determining which fearful children may be at higher risk for developing anxiety symptoms. </li></ul><ul><ul><li>Even if temperamental tendency is to be fearful, the ability to regulate fear when cues signal low threat and/or promote approach is important for adjustment </li></ul></ul><ul><li>We speculate that dysregulation of physiological systems will also be critical additional risk factor and moderator </li></ul><ul><ul><li>stronger physiological basis for dysregulated toddlers (e.g., higher cortisol levels) </li></ul></ul>
    22. 23. Acknowledgements <ul><li>People </li></ul><ul><ul><li>Elizabeth Kiel, MA University of Missouri </li></ul></ul><ul><ul><li>Natalie Williams, PhD University of Missouri </li></ul></ul><ul><ul><li>Rebecca Brooker Penn State University </li></ul></ul><ul><ul><li>Martha Early University of Missouri </li></ul></ul><ul><ul><li>Amy Dribin Penn State University </li></ul></ul><ul><ul><li>Ben Deweese Penn State University </li></ul></ul><ul><ul><li>Emily Robinson University of Missouri </li></ul></ul><ul><ul><li>Karyn Hartz Penn State University </li></ul></ul><ul><ul><li>Jennifer Krull, PhD University of Missouri </li></ul></ul><ul><ul><li>Kristin Hawley, PhD University of Missouri </li></ul></ul><ul><ul><li>Dozens of current and former undergraduate students </li></ul></ul><ul><li>Grants </li></ul><ul><ul><li>NIH R03 MH067797 </li></ul></ul><ul><ul><li>NIH R01 MH075750 </li></ul></ul>Thank you!