High Behavioral Inhibition Research Articles

Combining child social skills training with a parent early intervention program for inhibited preschool children

BackgroundPrevious studies have demonstrated the efficacy of early intervention for anxiety in preschoolers through parent-education. The current study evaluated a six-session early intervention program for preschoolers at high risk of anxiety disorders in which a standard educational program for parents was supplemented by direct training of social skills to the children. MethodsSeventy-two children aged 3–5 years were selected based on high behavioural inhibition levels and concurrently having a parent with high emotional distress. Families were randomly assigned to either the intervention group, which consisted of six parent-education group sessions and six child social skills training sessions, or waitlist. After six months, families on waitlist were offered treatment consisting of parent-education only. ResultsRelative to waitlist, children in the combined condition showed significantly fewer clinician-rated anxiety disorders and diagnostic severity and maternal (but not paternal) reported anxiety symptoms and life interference at six months. Mothers also reported less overprotection. These gains were maintained at 12-month follow-up. Parent only education following waitlist produced similar improvements among children. Quasi-experimental comparison between combined and parent-only interventions indicated greater reductions from combined intervention according to clinician reports, but no significant differences on maternal reports. ConclusionsResults suggest that this brief early intervention program for preschoolers with both parent and child components significantly reduces risk and disorder in vulnerable children. The inclusion of a child component might have the potential to increase effects over parent-only intervention. However, future support for this conclusion through long-term, randomised controlled trials is needed.

Behaviorally Inhibited Individuals Exhibit Greater Minute Ventilation and Breathing Frequency Than Non‐Inhibited Individuals When Breathing 4.5% CO2

Behavioral inhibition (BI) is a temperament in which an individual tends to avoid unfamiliar situations or environments. Individuals with high BI are more vulnerable to developing an anxiety disorder, such as Post‐Traumatic Stress Disorder (PTSD), when placed under stressful conditions. Behaviorally inhibited individuals learn faster and are slower to stop the response to a stimulus (Sheynin, 2005; Servatius, 2008). Our lab over the past several years has been investigating the relationship between a respiratory stress response to 4.5% CO2 and BI. BI is characterized by avoidance behavior, which is an active response aimed to reduce fear of a certain stimulus. In this study, a computer game was used as an aversive stimulus to detect BI. 4.5% CO2 was applied as a mild respiratory stimulant to detect any differences in those with BI compared to those without. One indication of PTSD is avoidance behaviors. 4.5% CO2 decreases the pH of the blood, hence causing an increase in frequency of breathing (fbr), tidal volume (VT), and inspired minute ventilation (VI). We hypothesize that individuals with high BI will exhibit greater increases in all parameters of breathing compared to individuals with low BI. The 4.5% CO2 was obtained by mixing room air with pure CO2 in a Tissot Spirometer and was validated using an Oxygraph O2 and CO2 analyzer. The mixed gas was then delivered from a 100 liter gas bag attached to a breathing tube attached to a Hans Rudolph two‐way nonrebreathing valve. The subjects placed the two‐way valve attached to a mouthpiece into their mouths and then had a nose clip placed over their noses to created a tight seal between the breathing gas bags and the participants. BI and non‐BI individuals were separated based on Adult Measure of Behavioral Inhibition (AMBI) and Retrospective Measure of Behavioral Inhibition (RMBI). Heart rate and respiratory data were collected using a BioPac computer data collection system while breathing room air and 4.5% CO2. In BI individuals, we observed a 35.9% (+/−33.3) increase in minute ventilation and a 32.4% (+/−32.1) increase in breathing frequency (n=4). In non‐BI individuals, we observed a −6.4% (+/−18.3) decrease in minute ventilation and a −15.1% (+/−2.9) decrease in breathing frequency (n=2). We observed no difference in tidal volume or heart rate for either group. In conclusion, individuals who scored high on the BI test have a greater response to a respiratory stimuli. Our future studies will include cortisol measurements by analyzing saliva samples taken before and after the test.Support or Funding InformationCarthage College Research and Development Grants

Anxiety-Proneness, Anxiety Symptoms, and The Role of Parental Overprotection in Young South African Children

This study examined anxiety in preschool children within a South-African context. The parents and teachers of 101 South African children aged 2 to 6 years completed measures of children's anxiety-prone temperament (behavioral inhibition) and anxiety disorders symptoms. Parents and teachers of 59 children could be re-approached one year later, with the request to fill in both scales again, while parents at that time also completed a measure of parental overprotection. Results indicated that, compared with normative scores collected in Western countries, young South African children displayed relatively high levels of anxiety-proneness and anxiety disorders symptoms, although this cultural difference could only be demonstrated when using the parentreport data. Further, on both occasions there were substantial and positive correlations between children's behavioral inhibition and anxiety symptoms. Behavioral inhibition and anxiety symptoms, in particular when assessed by parent report, appeared to be fairly stable during the one-year period, and we found only tentative support for the idea that behavioral inhibition on time 1 increased the risk for anxiety symptoms on time 2. Finally, a cross-sectional analysis of the data collected on time 2 revealed a positive correlation between overprotection and children's anxiety symptoms as well as a marginally significant interaction of behavioral inhibition and overprotection on children's anxiety symptoms, indicating that in particular the combination of high behavioral inhibition and high overprotection tended to be associated with the highest anxiety levels.

The role of social anxiety, the behavioural inhibition system and depression in online gaming addiction in adults

Abstract This study explored whether adults, who have symptoms of social anxiety or depression, or a temperamental tendency towards having a high behavioural inhibition system (BIS), will be more prone to developing online gaming addiction. Data were collected over a two-month period with a total of 186 participants completing all the online questionnaires (147 university students and 39 Second Life (SL) users), of whom 66 were male (M=34.6, SD=14.15) and 120 were female (M=33.32, SD=12.8). Results of a hierarchical multiple linear regression analysis indicated that combined, social anxiety, a high BIS and depression explained a small amount of variability (9.9 per cent) in gaming addiction, with social anxiety explaining the most variance in the model. Any effect of the BIS was mainly through its impact on social anxiety. Young adult (26–40 years) and middle adult (41–60 years) females represented a higher proportion of problematic gamers in this sample than males. Further research is required into risk factors for addictive gaming, particularly in adult female players.

ALTERED TOPOGRAPHY OF INTRINSIC FUNCTIONAL CONNECTIVITY IN CHILDHOOD RISK FOR SOCIAL ANXIETY.

Extreme shyness in childhood arising from behavioral inhibition (BI) is among the strongest risk factors for developing social anxiety. Although no imaging studies of intrinsic brain networks in children with BI have been reported, adults with a history of BI exhibit altered functioning of frontolimbic circuits and enhanced processing of salient, personally relevant information. BI in childhood may be marked by increased coupling of salience (insula) and default (ventromedial prefrontal cortex [vmPFC]) network hubs. We tested this potential relation in 42 children ages 9-12, oversampled for high BI. Participants provided resting-state functional magnetic resonance imaging. A novel topographical pattern analysis of salience network intrinsic functional connectivity was conducted, and the impact of salience-default coupling on the relation between BI and social anxiety symptoms was assessed via moderation analysis. Children with high BI exhibit altered salience network topography, marked by reduced insula connectivity to dorsal anterior cingulate and increased insula connectivity to vmPFC. Whole-brain analyses revealed increased connectivity of salience, executive, and sensory networks with default network hubs in children higher in BI. Finally, the relation between insula-ventromedial prefrontal connectivity and social anxiety symptoms was strongest among the children highest in BI. BI is associated with an increase in connectivity to default network hubs that may bias processing toward personally relevant information during development. These altered patterns of connectivity point to potential biomarkers of the neural profile of risk for anxiety in childhood.

Neural correlates of attention biases, behavioral inhibition, and social anxiety in children: An ERP study

Behavioral inhibition (BI) is a biologically-based temperament characterized by vigilance toward threat. Over time, many children with BI increasingly fear social circumstances and display maladaptive social behavior. BI is also one of the strongest individual risk factors for developing social anxiety disorder. Although research has established a link between BI and anxiety, its causal mechanism remains unclear. Attention biases may underlie this relation. The current study examined neural markers of the BI-attention-anxiety link in children ages 9–12 years (N=99, Mean=9.97, SD=0.97). ERP measures were collected as children completed an attention-bias (dot-probe) task with neutral and angry faces. P2 and N2 amplitudes were associated with social anxiety and attention bias, respectively. Specifically, augmented P2 was related to decreased symptoms of social anxiety and moderated the relation between BI and social anxiety, suggesting that increasing attention mobilization may serve as a compensatory mechanism that attenuates social anxiety in individuals with high BI. The BI by N2 interaction found that larger N2 related to threat avoidance with increasing levels of BI, consistent with over-controlled socio-emotional functioning. Lastly, children without BI (BN) showed an augmented P1 to probes replacing angry faces, suggesting maintenance of attentional resources in threat-related contexts.

The better of two evils? Evidence that children exhibiting continuous conduct problems high or low on callous-unemotional traits score on opposite directions on physiological and behavioral measures of fear.

The present study examines whether heterogeneous groups of children identified based on their longitudinal scores on conduct problems (CP) and callous-unemotional (CU) traits differ on physiological and behavioral measures of fear. Specifically, it aims to test the hypothesis that children with high/stable CP differentiated on CU traits score on opposite directions on a fear-fearless continuum. Seventy-three participants (M age = 11.21; 45.2% female) were selected from a sample of 1,200 children. Children and their parents completed a battery of questionnaires assessing fearfulness, sensitivity to punishment, and behavioral inhibition. Children also participated in an experiment assessing their startle reactivity to fearful mental imagery, a well-established index of defensive motivation. The pattern of results verifies the hypothesis that fearlessness, assessed with physiological and behavioral measures, is a core characteristic of children high on both CP and CU traits (i.e., receiving the DSM-5 specifier of limited prosocial emotions). To the contrary, children with high/stable CP and low CU traits demonstrated high responsiveness to fear, high behavioral inhibition, and high sensitivity to punishment. The study is in accord with the principle of equifinality, in that different developmental mechanisms (i.e., extremes of high and low fear) may have the same behavioral outcome manifested as phenotypic antisocial behavior.

Fearful victims and fearless bullies? Subjective reactions to emotional imagery scenes of children involved in school aggression

Being aggressive has been related to fearlessness, low empathy and premeditated antisocial behaviors. The current study examined how school bullies and victims respond to affective situations presented through imagery. It was hypothesized that victims would perceive fear imagery as more fearful than bullies, demonstrating their proneness to fear and high behavioral inhibition. Bullies were expected to perceive fear imagery as less fearful and experience less negative affect, based on their callous-unemotional characteristics. Children participated in a tone-cued imagery experiment during which they imagined for 8s twelve pre-normed scripts describing fear, anger, joy and pleasant relaxation. Children rated their experienced emotions of fear, anger, joy and sadness for each scene. Bullies responded with low levels of fear to fear imagery and across emotion types and reported overall higher positive affect, even during provocative anger scenes. In contrast, victims responded with higher fear, anger and sadness. The varied emotional responses appeared to be partly explained by group differences in behavioral inhibition, which was high in victims. Results are discussed in light of aggression theories and potential interventions.

Multi-dimensional correlates of Internet addiction symptoms in adolescents with attention-deficit/hyperactivity disorder

This study examined the associations of the severity of Internet addiction symptoms with reinforcement sensitivity, family factors, Internet activities, and attention-deficit/hyperactivity disorder (ADHD) symptoms among adolescents in Taiwan diagnosed with ADHD. A total of 287 adolescents diagnosed with ADHD and aged between 11 and 18 years participated in this study. Their levels of Internet addiction symptoms, ADHD symptoms, reinforcement sensitivity, family factors, and various Internet activities in which the participants engaged were assessed. The correlates of the severities of Internet addiction symptoms were determined using multiple regression analyses. The results indicated that low satisfaction with family relationships was the strongest factor predicting severe Internet addiction symptoms, followed by using instant messaging, watching movies, high Behavioral Approach System (BAS) fun seeking, and high Behavioral Inhibition System scores. Meanwhile, low paternal occupational SES, low BAS drive, and online gaming were also significantly associated with severe Internet addiction symptoms. Multiple factors are significantly associated with the severity of Internet addiction symptoms among adolescents with ADHD. Clinicians, educational professionals, and parents of adolescents with ADHD should monitor the Internet use of adolescents who exhibit the factors identified in this study.

Behavioral inhibition and developmental risk: a dual-processing perspective.

Behavioral inhibition (BI) is an early-appearing temperament characterized by strong reactions to novelty. BI shows a good deal of stability over childhood and significantly increases the risk for later diagnosis of social anxiety disorder (SAD). Despite these general patterns, many children with high BI do not go on to develop clinical, or even subclinical, anxiety problems. Therefore, understanding the cognitive and neural bases of individual differences in developmental risk and resilience is of great importance. The present review is focused on the relation of BI to two types of information processing: automatic (novelty detection, attention biases to threat, and incentive processing) and controlled (attention shifting and inhibitory control). We propose three hypothetical models (Top-Down Model of Control; Risk Potentiation Model of Control; and Overgeneralized Control Model) linking these processes to variability in developmental outcomes for BI children. We argue that early BI is associated with an early bias to quickly and preferentially process information associated with motivationally salient cues. When this bias is strong and stable across development, the risk for SAD is increased. Later in development, children with a history of BI tend to display normative levels of performance on controlled attention tasks, but they demonstrate exaggerated neural responses in order to do so, which may further potentiate risk for anxiety-related problems. We conclude by discussing the reviewed studies with reference to the hypothetical models and make suggestions regarding future research and implications for treatment.

Early Behavioral Inhibition and Increased Error Monitoring Predict Later Social Phobia Symptoms in Childhood

Behavioral inhibition (BI) is an early childhood temperament characterized by fearful responses to novelty and avoidance of social interactions. During adolescence, a subset of children with stable childhood BI develop social anxiety disorder and concurrently exhibit increased error monitoring. The current study examines whether increased error monitoring in7-year-old, behaviorally inhibited children prospectively predicts risk for symptoms of social phobia at age 9 years. A total of 291 children were characterized on BI at 24and 36months of age. Children were seen again at 7 years of age, when they performed aFlanker task, and event-related potential (ERP) indices of response monitoring were generated. At age 9, self- and maternal-report of social phobia symptoms were obtained. Children high in BI, compared to those low in BI, displayed increased error monitoring at age 7, as indexed by larger (i.e., more negative) error-related negativity (ERN) amplitudes. In addition, early BI was related to later childhood social phobia symptoms at age 9 among children with a large difference in amplitude between ERN and correct-response negativity (CRN) at age7. Heightened error monitoring predicts risk for later social phobia symptoms in children with high BI. Research assessing response monitoring in children with BI may refine our understanding of the mechanisms underlying risk for later anxiety disorders and inform prevention efforts.

Preschool predictors of childhood anxiety disorders: a prospective community study

Anxiety disorders are often present at preschool age. Research on older children and studies contrasting preschoolers with high versus low behavioral inhibition (BI) highlight several risk factors, but these have not been investigated in community samples of young children. Child, parent, and peer factors at age 4 were therefore examined as potential predictors of anxiety disorders at age 6. Two birth cohorts of 4-year olds living in the city of Trondheim, Norway, were screened for emotional and behavioral problems. A subsample oversampled for emotional and behavioral problems were drawn to take part in the study; 82.1% consented. Parents of 1000 children were interviewed with the Preschool Age Psychiatric Assessment and provided ratings of children's BI, victimization by peers and their own anxiety symptoms. Assessments of attachment and parent-child interaction were based on observation. Preschool teachers rated children's social competence. Children were reassessed after 2years (N=797). High scores on BI, attention-deficient/hyperactivity disorder, parental anxiety, and peer victimization, along with low scores on social skills at age 4 collectively predicted anxiety disorders at age 6 after controlling for initial anxiety and other disorders. The effect of parental anxiety did only apply to children with high levels of BI. No effects of age-4 anxiety, gender, parenting, parental SES, divorce, peer acceptance, or attachment emerged. Behavioral inhibition, parental anxiety, and peer victimization function as risk factors whereas high social competence may protect against anxiety disorders in young children.

Perceptions of Verbal Aggression in Romantic Relationships: The Role of Family History and Motivational Systems

This study examined the perceived acceptability of verbally aggressive behavior in adult romantic relationships as a function of both exposure to familial verbal aggression in childhood and the strength of peoples' motivational systems. Previous research suggests that a history of familial verbal aggression in childhood desensitizes an individual's psychological, behavioral, and physiological responses in adulthood to be more tolerant of their own and other's verbally aggressive behavior. In addition, the degree to which childhood exposure to familial verbal aggression leads to desensitization in the form of adult acceptance of aggression in romantic relationships may be influenced by characteristics of people's motivational systems. To examine this, 87 college-aged students completed measures assessing their history of familial verbal aggression, strength of their behavioral inhibition and activation systems, and their reported inclination to enact verbal aggression in a romantic relationship. History of familial verbal aggression was positively associated with the perceived acceptability of verbal aggression against a romantic partner, and this association was stronger for individuals with higher behavioral inhibition system scores.

Behavioral inhibition and childhood stuttering

PurposeThe purpose of this study was to assess the relation of behavioral inhibition to stuttering and speech/language output in preschool-age children who do (CWS) and do not stutter (CWNS). MethodParticipants were preschool-age (ages 36–68 months), including 26 CWS (22 males) and 28 CWNS (13 males). Participants’ behavioral inhibition (BI) was assessed by measuring the latency to their sixth spontaneous comment during conversation with an unfamiliar experimenter, using methodology developed by Kagan, Reznick, and Gibbons (1989). In addition to these measures of BI, each participant's stuttered and non-stuttered disfluencies and mean length of utterance (in morphemes) were assessed. ResultsAmong the more salient findings, it was found that (1) there was no significant difference in BI between preschool-age CWS and CWNS as a group, (2) when extremely high versus low inhibited children were selected, there were more CWS with higher BI and fewer CWS with lower BI when compared to their CWNS peers, and (3) more behaviorally inhibited CWS, when compared to less behaviorally inhibited CWS, exhibited more stuttering. ConclusionsFindings are taken to suggest that one aspect of temperament (i.e., behavioral inhibition) is exhibited by some preschool-age CWS and that these children stutter more than CWS with lower behavioral inhibition. The present results seem to support continued study of the association between young children's temperamental characteristics and stuttering, the diagnostic entity (i.e., CWS versus CWNS), as well as stuttering, the behavior (e.g., frequency of stuttered disfluencies).Educational objectives: After reading this article, the reader will be able to: (a) summarize the salient empirical findings in the extant literature with regard to the association between temperament and childhood stuttering; (b) describe the concept of behavioral inhibition (BI) as well as the methods to measure BI; and (c) discuss the association between behavioral inhibition and childhood stuttering in preschool-age children.

Enhanced avoidance learning in behaviorally inhibited young men and women

Behavioral inhibition (BI) is a temperamental tendency to avoid or withdraw from novel social and nonsocial situations, and has been shown to predispose individuals to anxiety disorders. However, adequate means to assess individual differences in avoidance learning in humans are presently limited. Here, we tested whether individuals with high self-reported BI show faster associative learning on a purely cognitive task and whether such inhibited individuals are more prone to avoid aversive outcomes. In Experiment 1, we tested 74 healthy undergraduate students (mean age 19.5 years; 55.4% female) on a computer-based probabilistic classification task, where participants were asked to classify four distinct visual stimuli into two categories. Two stimuli were associated with reward (point gain) and two were associated with punishment (point loss). In Experiment 2, 79 participants from the same population (mean age 19.8 years; 62% female) were tested on a novel modification of the same task, where they also had the option to opt out of responding on each trial, thus avoiding any chance of being punished (or rewarded) on that trial. Results show that inhibited participants demonstrated better associative learning in Experiment 1, while exhibiting a greater tendency to opt out in Experiment 2 (repeated-measures analysis of variance, main effects of BI, both p < 0.05). These results indicate that the facilitated classically conditioned learning previously observed in inhibited individuals can be extended to a cognitive task, and also highlight a specific preference in inhibited individuals for withdrawal (“opting out”) as a response strategy, when multiple strategies are available to avoid punishment.

Coping mediates relationships between reinforcement sensitivity and symptoms of psychopathology

Limited research has evaluated whether coping strategies mediate the relationships between reinforcement sensitivity theory (RST) and symptoms of psychopathology. Undergraduates (n=293) completed questionnaires assessing RST, coping, and symptoms of psychopathology. Consistent with our hypotheses, bootstrapping analyses indicated that emotion- and avoidance-focused coping mediated the relationship between high Behavioral Inhibition System (BIS) and depression, anxiety, and worry. Less problem-focused coping mediated the relationship between low Behavioral Approach System (BAS) and depression. Avoidance-focused coping mediated the effects of high BIS on drug and alcohol use whereas high BAS directly predicted alcohol and drug use. Unexpectedly, emotion-focused coping mediated the relationship between BAS and anxiety and worry. These results provide support for the hypothesis that personality variables are associated with psychopathology partially through coping.

Maternal Over-Control Moderates the Association Between Early Childhood Behavioral Inhibition and Adolescent Social Anxiety Symptoms

Behavioral inhibition (BI) and maternal over-control are early risk factors for later childhood internalizing problems, particularly social anxiety disorder (SAD). Consistently high BI across childhood appears to confer risk for the onset of SAD by adolescence. However, no prior studies have prospectively examined observed maternal over-control as a risk factor for adolescent social anxiety (SA) among children initially selected for BI. The present prospective longitudinal study examines the direct and indirect relations between these early risk factors and adolescent SA symptoms and SAD, using a multi-method approach. The sample consisted of 176 participants initially recruited as infants and assessed for temperamental reactivity to novel stimuli at age 4 months. BI was measured via observations and parent-report across multiple assessments between the ages of 14 months and 7 years. Maternal over-control was assessed observationally during parent-child interaction tasks at 7 years. Adolescents (ages 14-17 years) and parents provided independent reports of adolescent SA symptoms. Results indicated that higher maternal over-control at 7 years predicted higher SA symptoms and lifetime rates of SAD during adolescence. Additionally, there was a significant interaction between consistently high BI and maternal over-control, such that patterns of consistently high BI predicted higher adolescent SA symptoms in the presence of high maternal over-control. High BI across childhood was not significantly associated with adolescent SA symptoms when children experienced low maternal over-control. These findings have the potential to inform prevention and early intervention programs by identifying particularly at-risk youth and specific targets of treatment.

Progression along the bipolar spectrum: A longitudinal study of predictors of conversion from bipolar spectrum conditions to bipolar I and II disorders.

Little longitudinal research has examined progression to more severe bipolar disorders in individuals with "soft" bipolar spectrum conditions. We examine rates and predictors of progression to bipolar I and II diagnoses in a nonpatient sample of college-age participants (n = 201) with high General Behavior Inventory scores and childhood or adolescent onset of "soft" bipolar spectrum disorders followed longitudinally for 4.5 years from the Longitudinal Investigation of Bipolar Spectrum (LIBS) project. Of 57 individuals with initial cyclothymia or bipolar disorder not otherwise specified (BiNOS) diagnoses, 42.1% progressed to a bipolar II diagnosis and 10.5% progressed to a bipolar I diagnosis. Of 144 individuals with initial bipolar II diagnoses, 17.4% progressed to a bipolar I diagnosis. Consistent with hypotheses derived from the clinical literature and the Behavioral Approach System (BAS) model of bipolar disorder, and controlling for relevant variables (length of follow-up, initial depressive and hypomanic symptoms, treatment-seeking, and family history), high BAS sensitivity (especially BAS Fun Seeking) predicted a greater likelihood of progression to bipolar II disorder, whereas early age of onset and high impulsivity predicted a greater likelihood of progression to bipolar I (high BAS sensitivity and Fun-Seeking also predicted progression to bipolar I when family history was not controlled). The interaction of high BAS and high Behavioral Inhibition System (BIS) sensitivities also predicted greater likelihood of progression to bipolar I. We discuss implications of the findings for the bipolar spectrum concept, the BAS model of bipolar disorder, and early intervention efforts.

Progression along the bipolar spectrum: a longitudinal study of predictors of conversion from bipolar spectrum conditions to bipolar I and II disorders

Little longitudinal research has examined progression to more severe bipolar disorders in individuals with soft bipolar spectrum conditions. We examine rates and predictors of progression to bipolar I and II diagnoses in a nonpatient sample of college-age participants (n = 201) with high General Behavior Inventory scores and childhood or adolescent onset of soft bipolar spectrum disorders followed longitudinally for 4.5 years from the Longitudinal Investigation of Bipolar Spectrum (LIBS) project. Of 57 individuals with initial cyclothymia or bipolar disorder not otherwise specified (BiNOS) diagnoses, 42.1% progressed to a bipolar II diagnosis and 10.5% progressed to a bipolar I diagnosis. Of 144 individuals with initial bipolar II diagnoses, 17.4% progressed to a bipolar I diagnosis. Consistent with hypotheses derived from the clinical literature and the Behavioral Approach System (BAS) model of bipolar disorder, and controlling for relevant variables (length of follow-up, initial depressive and hypomanic symptoms, treatment-seeking, and family history), high BAS sensitivity (especially BAS Fun Seeking) predicted a greater likelihood of progression to bipolar II disorder, whereas early age of onset and high impulsivity predicted a greater likelihood of progression to bipolar I (high BAS sensitivity and Fun-Seeking also predicted progression to bipolar I when family history was not controlled). The interaction of high BAS and high Behavioral Inhibition System (BIS) sensitivities also predicted greater likelihood of progression to bipolar I. We discuss implications of the findings for the bipolar spectrum concept, the BAS model of bipolar disorder, and early intervention efforts.

Maternal anxiety, behavioral inhibition, and attachment

In a community sample of mothers (N = 763), 46% rated their anxiety above a “normal” range compared with only 15% for depression. Mothers without a partner had significantly higher anxiety (but not depression) than those with a partner. In a subsample of intact families with 1–3 children and mothers selected for low, medium, or high anxiety levels (N = 98), their 4.5-year-olds were observed for behavioral inhibition (BI) and attachment. Although ratings of maternal anxiety (MA) and BI were each significantly negatively correlated with ratings of attachment security, regression analyses showed MA as the only significant predictor. With patterns of attachment, only the Ambivalent group had significantly high levels of both BI and MA. When regression slopes of BI against MA were compared for each attachment group, the Ambivalent group differed significantly from the rest. Further analyses suggest that a child with high BI may be particularly vulnerable to MA, resulting in an Ambivalent attachment.