This is a commentary on Hinshaw, Nguyen, O’Grady & Rosenthal’s ‘ADHD in Girls and Women: Underrepresentation, Longitudinal Processes, and Key Directions’, which reviews the empirical literature on ...female‐specific impairments, mechanisms and developmental pathways. Having conducted one of the most prominent and informative longitudinal investigations of girls with and without ADHD, Hinshaw et al. (2021) provide a compelling synthesis of their findings, highlighting research and clinical priorities. In this commentary, I highlight the pernicious effects of unrecognized and untreated ADHD in girls and women, challenges of making an accurate differential diagnosis and the need to raise awareness among health professionals, educators and parents about the clinical presentation of girls with ADHD in order to achieve earlier identification and intervention that can interrupt the developmental trajectory to widespread impairment, comorbidity and, in some cases, devastating outcomes.
In this article, we provide definitional clarity for the construct of social withdrawal as it was originally construed, and review the original theoretical and conceptual bases that led to the first ...research program dedicated to the developmental study of social withdrawal (the Waterloo Longitudinal Project). We also describe correlates (e.g., social and social‐cognitive incompetence), precursors (e.g., dispositional characteristics, parenting, insecure attachment), and consequences (e.g., peer rejection and victimization, negative self‐regard, anxiety) of social withdrawal, and discuss how the study of this type of withdrawal led to a novel intervention that targets risk factors that predict social withdrawal and its negative consequences.
Behavioral inhibition (BI), a temperamental style identifiable in early childhood, is considered a risk factor for the development of anxiety disorders, particularly social anxiety disorder (SAD). ...However, few studies examining this question have evaluated the stability of BI across multiple developmental time points and followed participants into adolescence-the developmental period during which risk for SAD onset is at its peak. The current study used a prospective longitudinal design to determine whether stable early BI predicted the presence of psychiatric disorders and continuous levels of social anxiety in adolescents. It was hypothesized that stable BI would predict the presence of adolescent psychiatric diagnoses, specifically SAD.
Participants included 126 adolescents aged 14 to 16 years who were first recruited at 4 months of age from hospital birth records. Temperament was measured at multiple time points between the ages of 14 months and 7 years. In adolescence, diagnostic interviews were conducted with parents and adolescents, and continuous measures of adolescent- and parent-reported social anxiety were collected.
Stable maternal-reported early BI was associated with 3.79 times increased odds of a lifetime SAD diagnosis, but not other diagnoses, during adolescence (95% confidence interval 1.18-12.12). Stable maternal-reported early BI also predicted independent adolescent and parent ratings of ongoing social anxiety symptoms.
Findings suggesting that stable maternal-reported early BI predicts lifetime SAD have important implications for the early identification and prevention of SAD.
Background
Attention‐deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with origins early in life. There is growing evidence that individual differences in temperament reactivity ...are predictive of ADHD symptoms, yet little is known about the relations between temperament reactivity in early infancy and later ADHD symptoms or the combined effect of reactivity with early environmental factors on ADHD symptom development. Using a 9‐year prospective longitudinal design, this study tested the independent and interactive contributions of infant reactivity and maternal caregiving behaviors (MCB) on parent‐ and teacher‐reported childhood ADHD symptoms.
Methods
Participants included 291 children (135 male; 156 female) who participated in a larger study of temperament and social–emotional development. Reactivity was assessed by behavioral observation of negative affect, positive affect, and motor activity during novel stimuli presentations at 4 months of age. MCB were observed during a series of semistructured mother–infant tasks at 9 months of age. Finally, ADHD symptoms were assessed by parent‐ and teacher‐report questionnaires at 7 and 9 years, respectively.
Results
Reactivity was predictive of ADHD symptoms, but results were sex specific. For boys, infant motor activity was positively predictive of later ADHD symptoms, but only at lower quality MCB. For girls, infant positive affect was positively predictive of later ADHD symptoms at lower quality MCB, and—unexpectedly—infant positive affect and motor activity were negatively predictive of later ADHD symptoms at higher quality MCB.
Conclusions
These results point to early parenting as a moderating factor to mitigate temperament‐related risk for later ADHD, suggesting this as a potential intervention target to mitigate risk for ADHD among reactive infants.
Background
Attention‐deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset as early as preschool and impairment across the lifespan. Temperament factors, ...specifically those that theoretically map onto ADHD symptoms, may be early markers of risk for developing later childhood ADHD that could be identifiable in infancy or toddlerhood. This meta‐analysis examined the associations between these early temperamental factors and later symptoms and diagnosis of ADHD and mapped early temperament constructs onto the three ADHD symptom dimensions.
Methods
A systemic review of the literature was conducted to identify prospective longitudinal studies that included theoretically relevant temperament constructs (sustained attention, activity level, inhibition, and negative emotionality) examined from birth to 36 months old and ADHD (symptoms or diagnosis) in preschool or childhood. The association between each temperament construct and ADHD outcomes was examined using pooled standardized estimates in meta‐analyses.
Results
Forty‐eight articles (n = 112,716 infants/toddlers) prospectively examined temperament and the relation to childhood ADHD symptoms or diagnosis. Activity level (k = 18) in infancy and toddlerhood was moderately associated with childhood ADHD (r = .39, CI = 0.27, 0.51, p < .001). Moderate effect sizes were also observed for sustained attention (k = 9; r = −.28, CI = −0.42, −0.12, p < .001) and negative emotionality (k = 33; r = .25, CI = 0.16, 0.34, p < .001) with ADHD. The specificity of each temperament construct for later ADHD symptom dimensions was such that activity level and negative emotionality were predictive of all three symptom dimensions (i.e., inattention, hyperactivity/impulsivity, and combined), whereas sustained attention was only associated with combined symptoms.
Conclusions
Infant and toddler temperament is an early risk factor for the development of childhood ADHD that could be utilized for early intervention identification. Yet, this systematic review found that relatively few prospective longitudinal studies have examined sustained attention (k = 9) and inhibition (k = 15) in infancy and toddlerhood in relation to later ADHD highlighting the need for further research.
Background
Children classified as behaviorally inhibited (BI) are at risk for social anxiety. Risk for anxiety is moderated by both parental behavior and social–emotional competence. Grounded in ...developmental–transactional theory, the Turtle Program involves both parent and child treatment components delivered within the peer context. Our pilot work demonstrated beneficial effects of the Turtle Program (‘Turtle’) over a waitlist control group. Herein, we report results of a rigorous randomized controlled trial (RCT) comparing Turtle to the best available treatment for young children high in BI, Cool Little Kids (CLK).
Methods
One hundred and fifty‐one parents and their 3.5‐ to 5‐year‐old children selected on the basis of BI were randomly assigned to Turtle or CLK, delivered in group format over 8 weeks. Effects on child anxiety, life interference, BI, and observed parenting were examined at post‐treatment and 1‐year follow‐up. ClinicalTrials.gov registration: NCT02308826.
Results
No significant main effect differences were found between Turtle and CLK on child anxiety; children in both programs evidenced significant improvements in BI, anxiety severity, family accommodation, and child impairment. However, Turtle yielded increased observed warm/engaged parenting and decreased observed negative control, compared with CLK. Parental social anxiety moderated effects; parents with higher anxiety demonstrated diminished improvements in child impairment, and parent accommodation in CLK, but not in Turtle. Children of parents with higher anxiety demonstrated more improvements in child BI in Turtle, but not in CLK.
Conclusions
Turtle and CLK are both effective early interventions for young children with BI. Turtle is more effective in improving parenting behaviors associated with the development and maintenance of child anxiety. Turtle also proved to be more effective than CLK for parents with social anxiety. Results suggest that Turtle should be recommended when parents have social anxiety; however, in the absence of parent anxiety, CLK may offer a more efficient treatment model.
Background
Given the robust evidence base for the efficacy of evidence‐based treatments targeting youth anxiety, researchers have advanced beyond efficacy outcome analysis to identify mechanisms of ...change and treatment directionality. Grounded in developmental transactional models, interventions for young children at risk for anxiety by virtue of behaviorally inhibited temperament often target parenting and child factors implicated in the early emergence and maintenance of anxiety. In particular, overcontrolling parenting moderates risk for anxiety among highly inhibited children, just as child inhibition has been shown to elicit overcontrolling parenting. Although longitudinal research has elucidated the temporal unfolding of factors that interact to place inhibited children at risk for anxiety, reciprocal transactions between these child and parent factors in the context of early interventions remain unknown.
Method
This study addresses these gaps by examining mechanisms of change and treatment directionality (i.e., parent‐to‐child vs. child‐to‐parent influences) within a randomized controlled trial comparing two interventions for inhibited preschoolers (N = 151): the multicomponent Turtle Program (‘Turtle’) and the parent‐only Cool Little Kids program (‘CLK’). Reciprocal relations between parent‐reported child anxiety, observed parenting, and parent‐reported accommodation of child anxiety were examined across four timepoints: pre‐, mid‐, and post‐treatment, and one‐year follow‐up (NCT02308826).
Results
Hypotheses were tested via latent curve models with structured residuals (LCM‐SR) and latent change score (LCS) models. LCM‐SR results were consistent with the child‐to‐parent influences found in previous research on cognitive behavioral therapy (CBT) for older anxious youth, but only emerged in Turtle. LCS analyses revealed bidirectional effects of changes in parent accommodation and child anxiety during and after intervention, but only in Turtle.
Conclusion
Our findings coincide with developmental transactional models, suggesting that the development of child anxiety may result from child‐to‐parent influences rather than the reverse, and highlight the importance of targeting parent and child factors simultaneously in early interventions for young, inhibited children.
Background
Depression is a highly prevalent, debilitating disorder that runs in families. Yet, empirical support for bidirectional mechanisms linking mother–adolescent depression symptoms remains ...limited. This study examined longitudinal bidirectional relations among emotion regulation (ER) constructs and depressive symptoms among mother–adolescent dyads over time. Pathways for girls and boys were explored separately, given extant research on sex differences in the intergenerational transmission of depression.
Methods
Adolescent (n = 232; M = 15.02 years, SD = 0.95; 44% female)‐mother dyads, drawn from a longitudinal study on the development of risky behaviors, completed annual assessments of depressive symptoms and facets of ER over 4 years. Panel modeling examined lagged and cross‐lagged effects of mother–adolescent depressive symptoms and ER constructs over time, in a multigroup model of boys and girls.
Results
Among girls, higher baseline maternal depression scores predicted increased adolescent ER difficulties (std. est. = −.42, p < .001) in turn, predicting increased adolescent depressive symptoms (std. est. = −.33, p = .002) and subsequent maternal ER difficulties (std. est. = .39, p = .002). The indirect effect of maternal depressive symptoms→adolescent ER→adolescent depressive symptoms→maternal ER was significant (ind. eff. = .10, 95% confidence interval >.001, .19) for girls, but not boys.
Conclusion
Implications for interrupting intergenerational cycles of depressive symptoms and emotion dysregulation are discussed.
Background
Social anxiety is amongst the most prevalent adolescent mental health problems; however, it is often unrecognized due to its comorbidity with other anxiety problems such as generalized ...anxiety. Thus, understanding the unique developmental pathways to social anxiety is critical for improving its prevention. We examined the pathway from maternal shyness, when children were 4 years old, to adolescents’ social anxiety at age 15 through social wariness at age 7. We hypothesized that childhood social wariness would mediate the association between maternal shyness and social anxiety in adolescence.
Methods
Participants (N = 291; 54% female) were followed from early childhood to adolescence. Mothers reported on their own shyness when children were 4 years old. Social wariness toward unfamiliar peers was observed in the laboratory at ages 4 and 7. Adolescent social anxiety and generalized anxiety were assessed via self‐report, parent‐report, and clinical diagnoses at age 15.
Results
Maternal shyness was positively associated with adolescent social anxiety but not generalized anxiety at age 15. Higher levels of maternal shyness at age 4 predicted greater social wariness at age 7, which in turn predicted greater social anxiety but not generalized anxiety at age 15. Social wariness at age 7 partially mediated the association between maternal shyness and adolescent social anxiety.
Conclusions
This study identifies a unique developmental pathway from maternal shyness to adolescent social anxiety. Findings suggest that childhood social wariness connects maternal shyness to adolescent social anxiety.
Behavioral inhibition (BI) is a temperamental style characterized by cautious and fearful behaviors in novel situations. The present multi‐method, longitudinal study examined whether young children's ...observed and parent‐reported BI in social versus non‐social contexts predicts different long‐term psychosocial outcomes. Participants (N = 279) were drawn from a longitudinal study of socioemotional development. BI in social contexts (“social BI”) was measured via children's observed wariness toward unfamiliar adults and peers at 24 and 36 months and parents’ reports of children's social fear/shyness at 24, 36, and 48 months. BI in non‐social contexts (“non‐social BI”) was measured via children's observed fearful responses to masks and novel toys, and parents’ reports of children's distress to non‐social novelty at 9 months and non‐social fear at 48 months. At 15 years, anxiety was assessed via adolescent‐ and parent‐reports, and global internalizing and externalizing problems were assessed via parent‐reports. Confirmatory factor analysis showed that a two‐factor model fit the BI data significantly better than a single‐factor model, providing evidence for the dissociation of BI in social versus non‐social contexts. Social BI was uniquely associated with adolescent social anxiety, whereas non‐social BI was specifically associated with adolescent separation anxiety. Neither social BI nor non‐social BI predicted global internalizing and externalizing problems, providing evidence for the specific relations between BI and anxiety problems. Together, these results suggest that young children's inhibited responses in social versus non‐social situations predict different subtypes of anxiety problems in adolescence, highlighting the multifaceted nature of BI and the divergent trajectories of different anxiety problems.
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