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evidence is consistent with this theory (Edwards et al, 2010). There is also some evidence that an interaction between the serotonin transporter gene and parenting predicts later anxiety in young children (Fox et al, 2005). It has often been assumed that anxious parents increase risk for anxiety in their children by modelling their own fears and coping strategies. This theory, however, has received very little examination. The main research has come from laboratory studies with very young children. Research has shown that children aged around 6-18 months can learn to fear and avoid a novel stimulus by observing their mothers acting in a fearful manner. More importantly, socially anxious mothers have been shown to transmit a fear of strangers to their infants in this way, and the extent of fear that the infant develops depends partly on the pre-existing level of inhibited temperament that the infant displays (de Rosnay et al, 2006). Thus, it seems that fear of strangers can be increased through an interaction between the infant’s temperament and the mother’s overt indications of fear. Among older children it has been shown that verbally transmitted information about danger can increase fear of particular cues. For example, when children are presented with information about a novel cue that suggests the cue might be dangerous, they show increases in fear, physiological arousal, threat beliefs, and avoidance of the cue that can last for several months (Field, 2006). Finally, a key question is whether disturbed family environments play a role in the development of child anxiety. There has been a wealth of longitudinal research examining the long-term impact of family distress and violence, parent divorce or separation, and sexual and physical abuse, although little of this work has focussed clearly on anxiety disorders. Overall, it appears that sexual abuse – and to a lesser extent physical abuse and family violence – can increase anxiousness in children. However, this increase is likely to be temporary and it is not clear whether these factors contribute significantly to the development of longer-term anxiety disorders. More importantly, it is clear that these factors are relatively nonspecific and increase risk for a wide variety of child psychopathology, probably least of all for anxiety disorders (Rapee, 2012). Life events Although there has been a large body of research examining the role of negative life events in the onset of adult anxiety disorders (mostly agoraphobia), there has been very little work looking at life events in childhood anxiety. This may be because child anxiety often develops in a background of inhibited temperament It seems that fear of strangers can be increased through an interaction between the infant's temperament and the mother's overt indicators of fear. Anxiety disorders F.1 11 IACAPAP Textbook of Child and Adolescent Mental Health and a clear and sudden onset of the disorder is relatively rare. What research has been conducted suggests that anxious children do report a greater number and impact of negative life events than do children without anxiety disorders. While it is possible that this difference reflects cognitive and reporting biases, at least some work has demonstrated this difference using interviews with parents and identifying corroborating evidence (Allen et al, 2008). Nevertheless, demonstrating that anxious children have more negative life events than non-anxious children does not mean that these events necessarily cause or trigger their anxiety. Indeed, the data suggest that the greatest difference is found on so-called “dependent” life events. Dependent events are ones that might be the result of the child’s behaviour (e.g., doing badly in a test might be a result of the child not studying). Thus, it is very possible that child anxiety leads to more negative life events, perhaps due to the worry and avoidance associated with the anxiety. Of course, it is also possible that this increased stress, in turn, helps to maintain and even increase the anxiety. One specific form of life event that has received particular attention is bullying and teasing. There is considerable evidence that anxious children are more likely to be teased and bullied than non-anxious children and that they are often neglected or even rejected by their peers (Juvonen & Graham, 2014). Once again, the direction of causation is unknown but it is very likely that anxious children elicit teasing from others due to their behaviours; in turn, it is likely that teasing will further enhance their anxiety. Cognitive biases Anxious children report heightened beliefs and expectations of threat. To some extent this is a reflection of the diagnosis, but it is also argued to represent a core maintaining feature. Although there is considerable overlap, to some extent the threat expectancies are specific. That is, socially phobic children are more likely to have increased expectancies for social threat (e.g., “other kids won’t like me”), children with separation anxiety will have increased expectancies for physical threat (e.g., “my parents will get hurt”), and so on. Evidence suggests that these threat beliefs are greater among anxious children than among children with other psychopathology and that they decrease with successful treatment (Schniering & Lyneham, 2007). Whether they are causally related to the onset of anxiety or simply reflect the anxiousness is not
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