Early Indicators of Anxiety Risk: Identifying Dysregulated Fear in Infancy

Temperament represents early-appearing, biologically-based, individual differences in emotion behaviors (Goldsmith et al., 1987). Temperament provides a framework for understanding child behavior and predicting developmental outcomes, including anxiety symptoms. Temperament includes emotion reactivity (arousal in certain nervous systems in the body) and self-regulation, the processes that modulate reactivity (Goldsmith et al., 1987). Psychopathology can be conceptualized as reactivity that is so strong or difficult that it exceeds regulatory systems. Anxiety is associated with high physiological arousal and a misinterpretation of non-threatening stimuli as threatening. Kagan and colleagues (1984) identified the temperament type of behavioral inhibition, characterizing children who exhibit greater levels of fear and physiological arousal during unfamiliar events (Kagan et al., 1984). Temperament (i.e., behavioral inhibition) affects regulatory behaviors in the context of high-threat situations that typically elicit fear (Buss & Goldsmith, 1998; Kagan et al., 1984). Dysregulated fear is a modified assessment of behavioral inhibition and fearful temperament, defined as showing high fear in low-threat contexts. Dysregulated fear better distinguishes vulnerability to the development of anxiety disorders (Buss, 2011) relative to inhibition alone, but dysregulation has primarily been assessed in toddlerhood. If it can be identified in infancy, prevention of anxiety could occur earlier in development. The current study will examine one hundred and sixty-nine infants and their mothers who participated in an ongoing longitudinal study. Infants participated in a puppet show task from which multiple fear and distress behaviors were coded. Mothers reported on infants’ anxiety risk with the Infant Toddler Social-Emotional Assessment (Carter & Briggs-Gowan, 2001) and the Toddler Behavior Assessment Questionnaire (Goldsmith, 1996) at age two. Bivariate correlations showed significant correlations among behavior codes, specifically vocal distress, gaze aversion, and escape behavior, and were used to create a dysregulated fear composite. Multiple regression analyses showed that this dysregulated fear composite did not signfiicantly predict anxiety scores at age two, controlling for age one anxiety and covariates (mom age and child sex). Although dysregulated fear did not significantly predict anxiety, more studies in the future should aim to analyze multiple contexts and larger array of fearful behaviors in order to examine anxiety risk in infancy through the construct of dysregulated fear. 

169 mothers and infants (43.7% female) participated in a longitudinal study at age 1, and 119 participated at age 2. Infants ranged from 10 to 17 (M = 13.09, SD = 1.81) months at age 1 and 22 to 30 (M = 24.75, SD = 1,60) months at age 2. Mothers ranged from 20.67 to 44.67 (M = 32.49, SD = 4.79) years at age 1 assessment.

Dysregulated Fear utilitized a Puppet Show task. The composite was coded for through vocal distress (0-5, whimpering, crying out, crying and screaming), gaze aversion (0-3, length of time looking away from stimuli), and escape behavior (0-3, turning away, sinking low, climbing, pushing, or leaning away).

Internalizing Problems utilized the Infant-Toddler Social Emotional Assessment. This measures normative and problematic behaviors in early life. We specifically used the Internalizing Subdimension items (age 1 [α=.84] and age 2 [α=.82]).

Fearful Reactivity utilized the Toddler Behavior Assessment Questionnaire. This measures temperament-related behavior in early life. We used the specific constructs of object fear, expressed distress and withdrawal during exposure to objects and non social situations (age 1 [α=.74] and age 2 [α=.79]),  and social fear: expressed distress and withdrawal during exposure to social situations, including shyness and fear to novelty (age 1 [α=.88] and age 2 [α=.83]).

Emotion Regulation also utilized the Toddler Behavior Assessment Questionnaire.

We used the construct of soothability: the ability to recover from distress (age 1 [α=.72] and age 2 [α=.73]).

Contrary to expectations, we did not find a positive relation between dysregulated fear and internalizing outcomes in this sample of infants. These findings were surprising given the previous developmental theories heavily support dysregulated fear as a risk for anxious behaviors. Dysregulated fear was developed to identify children prone to anxiety, as traditional measures may overestimate risk. It is possible that there are moderators for these associations, and that only particular infants who exhibit dysregulated fear may show risk; only 40% of behaviorally inhibited children go on to develop anxiety disorders (Kagan et al., 1984). Certain characteristics – individual, family, environmental – may help to strengthen identification in infancy. 

Limitations: Infants may be too young for dysregulated fear to indicate anxiety risk. Dysregulated fear is a construct measured across multiple contexts, and this study only utilized one low-threat context to measure behaviors. Other behaviors were not used in creating the dysregulated fear composite that were utilized in Buss’ (2011) study that may more strongly predict dysregulated fear (e.g., bodily fear, facial fear, freezing). Although the sample represented some diversity, it was still mostly European Americans and non-Hispanic or Latinx participants, which limits generalizability to other populations.

Future Directions: A longer longitudinal study may help understand temperamental profiles and their continuity/ discontinuity to most efficiently predict anxiety risk. Infants may be also examined in a high-threat situation to help characterize kids in a more holistic assessment. It is important to take in a large array of behaviors to create a holistic profile of dysregulated fear.

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