Abstract
BackgroundSocial anxiety is highly prevalent in neurotypical children and children with fragile X syndrome (FXS). FXS is a genetic syndrome that is characterized by intellectual disability and an increased risk for autism spectrum disorder. If social anxiety is left untreated, negative outcomes are highly prevalent later in life. However, early detection of social anxiety is challenging as symptoms are often subtle or absent very early in life. Given the prevalence and impairment associated with childhood social anxiety, efforts have accelerated to identify risk markers of anxiety. A cluster of early features of anxiety have been identified including elevated behavioral inhibition, attentional biases, and physiological dysregulation that index early emerging markers of social anxiety. Infants with FXS provide a unique opportunity to study the earlier predictors of social anxiety. The current study utilized a multi-method approach to investigate early markers of social anxiety in 12-month-old infants with FXS.MethodParticipants included 32 infants with FXS and 41 low-risk controls, all approximately 12 months old. Parent-reported social behavioral inhibition was recorded from the Infant Behavior Questionnaire (IBQ-R). Direct observations of behavioral inhibition and attention were measured during a stranger approach task with respiratory sinus arrhythmia collected simultaneously.ResultsParent-reported social behavioral inhibition was not significantly different between groups. In contrast, direct observations suggested that infants with FXS displayed elevated behavioral inhibition, increased attention towards the stranger, and a blunted respiratory sinus arrhythmia response.ConclusionsFindings suggest that infants with FXS show both behavioral and physiological markers of social anxiety at 12 months old using a biobehavioral approach with multiple sources of input. Results highlight the importance of a multi-method approach to understanding the complex early emergent characteristics of anxiety in infants with FXS.
Highlights
Social anxiety is highly prevalent in neurotypical children and children with fragile X syndrome (FXS)
Findings suggest that infants with FXS show both behavioral and physiological markers of social anxiety at 12 months old using a biobehavioral approach with multiple sources of input
Results highlight the importance of a multi-method approach to understanding the complex early emergent characteristics of anxiety in infants with FXS
Summary
Social anxiety is highly prevalent in neurotypical children and children with fragile X syndrome (FXS). If social anxiety is left untreated, negative outcomes are highly prevalent later in life. Understanding the early predictors of social anxiety in infants and very young children can improve early identification, facilitate early intervention, and optimize long-term outcomes. Behavioral inhibition, a temperament characteristic that includes features of fear, shyness, and withdrawal in response to novelty early in life, is one of the most robust predictors of later social anxiety symptoms and diagnoses [7,8,9]. High behavioral inhibition across infancy, starting as young as 6 months of age, is a risk marker for social anxiety later in life [10]. Preschool-aged children who demonstrate elevated and stable behavioral inhibition are up to four times more likely to be later diagnosed with social anxiety than children without elevated behavioral inhibition [7]
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