REGULAR ARTICLE The development and maintenance of anxiety …€¦ · REGULAR ARTICLE The...

REGULAR ARTICLE

The development and maintenance ofanxiety symptoms from infancy throughadolescence in a longitudinal sample

MICHELLE BOSQUETa and BYRON EGELANDb

aBoston Medical Center, Boston University School of Medicine; andbUniversity of Minnesota

AbstractThis study examined the etiology and course of anxiety symptoms from infancy through adolescence in alongitudinal high-risk community sample. One hundred fifty-five subjects were assessed using a variety ofobservational, projective, and objective measures. Results of path analyses revealed the following: ~a! anxietysymptoms showed moderate stability during childhood and adolescence; ~b! heightened neonatal biobehavioralreactivity and poor regulation predicted emotion regulation difficulties in preschool, which predicted anxietysymptoms in childhood; ~c! developmental incompetence in childhood predicted anxiety symptoms inpreadolescence, and anxiety symptoms in preadolescence predicted incompetence in adolescence; ~d! insecureattachment relationships in infancy predicted negative peer relationship representations in preadolescence, and theserepresentations predicted anxiety symptoms in adolescence; ~e! compared to males, females showed similar rates ofanxiety symptoms in childhood but greater and more stable rates in adolescence; however, males and femalesshowed similar patterns of association between risk factors and anxiety symptoms across childhood andadolescence; and ~f ! the model tested was specific in predicting anxiety symptoms and not psychopathology ingeneral. The results support a developmental model of the etiology and maintenance of anxiety symptoms inchildhood and highlight factors to consider in efforts to prevent and treat childhood anxiety.

Epidemiological studies suggest that anxietydisorders are the most common childhood andadolescent psychiatric disorders ~Beidel, 1991;Fergusson, Horwood, & Lynskey, 1993; Ver-

hulst, van der Ende, Ferdinand, & Kasius,1997!. Evidence also indicates that anxietysymptoms show moderate stability in child-hood and adolescence ~Gullone, King, & Ol-lendick, 2001; Keller et al., 1992; Verhulst &van der Ende, 1992!. However, despite theconsiderable data amassed on the prevalenceand correlates of anxiety symptoms and disor-ders, relatively little is known about the devel-opmental origins of anxious symptomatologyor the factors responsible for the maintenance,exacerbation, or reduction of symptoms. Fur-thermore, although a number of sophisticatedmodels of childhood anxiety have been pos-ited ~e.g., Barlow, 2002; Chorpita & Barlow,1998; Ollendick, 1998; Ollendick & Hirshfeld-Becker, 2002; Rapee, 2002!, few studies haveattempted to integrate the various identifiedrisk factors into a longitudinal, multivariatemodel ~Vasey & Dadds, 2001!. The goal of

This article is based on a doctoral dissertation completedby the first author. The research was supported by a Phil-anthropic Educational Organization Scholarship to thefirst author and by funds provided by grants to the secondauthor from the Maternal and Child Health Service ~MC-R-270416!; the William T. Grant Foundation, New York;and the National Institute of Mental Health ~MH-40864!.This study is currently supported by the National Instituteof Mental Health ~MH-40864-18!. The authors thank Man-fred van Dulmen for the invaluable statistical guidance heprovided in the preparation of this manuscript and thefamilies and teachers whose generation donation of timemade this project possible.

Address correspondence and reprint requests to: By-ron Egeland, Institute of Child Development, Universityof Minnesota, 51 East River Road, Minneapolis, MN55455; E-mail: [email protected].

Development and Psychopathology 18 ~2006!, 517–550Copyright © 2006 Cambridge University PressPrinted in the United States of AmericaDOI: 10.10170S0954579406060275

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this paper was to design a developmental modelincluding the roles of various risk factors inthe etiology and maintenance of anxiety symp-toms from infancy through adolescence, andthen test it.

Risk Factors for Anxiety

Data from various studies suggest several pos-sible factors that may influence individuals’risk for developing anxiety symptoms in child-hood and adolescence.

Emotion regulation

Eisenberg and Spinrad ~2004! defined emotionregulation as “the process of initiating, avoid-ing, inhibiting, maintaining, or modulating theoccurrence, form, intensity, or duration of in-ternal feeling states, emotion-related physio-logical, attentional processes, motivationalstates, and0or the behavioral concomitants ofemotion in the services of accomplishing affect-related biological or social adaptation or achiev-ing individual goals” ~p. 338!. Anxiety states,as described by Ekman ~1984!, are character-ized by “flooded” emotions that, by definition,the individual cannot easily regulate. There-fore, the failure to develop competent emotionregulation skills may be an important precur-sor to the development of anxiety difficultiesin childhood. Both psychophysiology and at-tachment history have been associated with thedevelopment of regulatory abilities. Further-more, these factors have been linked to risk foranxiety in childhood.

Physiological reactivity, emotion regulation,and anxiety. According to several develop-mental models ~e.g., Barlow, 2002; Ollendick,1998; Rapee, 2002!, a biological vulnerabilitymay underlie the development of anxiety dis-orders. In children, much of the evidence ofan association among anxiety and physiolog-ical and emotional reactivity and regulationhas emerged from the temperament literature.According to several temperament research-ers, biologically based emotional reactivity andregulation are at the core of temperament ~Fox

& Calkins, 1993; Rothbart & Derryberry,1981!. Two temperamental profiles, “diffi-cult” temperament and behavioral inhibition,have been identified as involving both ~a!heightened physiological and emotional reac-tivity and poor regulation and ~b! increasedrisk for the development of anxiety symptomsand disorders in later childhood ~Biedermanet al., 1990, 1993; Calkins, Fox, & Marshall,1996; Feldman, Greenbaum, Mayes, & Er-lich, 1997; Garcia-Coll, Kagan, & Reznick,1984; Hirshfeld et al., 1992; Kagan, Reznick,& Gibbons, 1989; Kagan, Reznick, & Snid-man, 1987; Kagan & Snidman, 1991a; Reznick,Hegeman, Kaufman, Woods, & Jacobs, 1992;Reznick et al., 1986; Rosenbaum et al., 1988;Sameroff, Seifer, & Elias, 1982; Shaw, Keenan,Vondra, Delliquadri, & Giovannelli, 1997!.These findings suggest that infants who dem-onstrate heightened physiological reactivity andpoor regulation may be at increased risk foremotion regulation difficulties and the devel-opment of anxiety problems.

Attachment, emotion regulation, and anxiety.According to attachment theorists, the care-giver–child relationship provides the contextin which the young child develops emotionregulation abilities ~Sroufe, 1995; Thompson,2001!. Infants who have a history of respon-sive, sensitive caregiving tend to develop se-cure attachment relationships that allow themto regulate their arousal, seeking comfort whendistressed and recovering easily from anaroused, disorganized state to a calm orga-nized state when comforted ~Sroufe, 1995!.Infants with an insecure attachment relation-ship, however, tend to have a history of incon-sistent, rejecting and hostile, or incoherent orthreatening care that interferes with their abil-ity to seek comfort from their caregiver and tomodulate their arousal appropriately when dis-tressed ~Sroufe, 1995!. Numerous studies havedocumented links between insecure attach-ment in infancy and later difficulties with emo-tion regulation ~Erickson, Sroufe, & Egeland,1985; Kochanska, 2001; Sroufe, 1995; Sroufe,Schork, Motti, Lawroski, & LaFrenier, 1984!.

Attachment theory posits that the attach-ment relationship has a most critical role inhelping the child to regulate fear and anxiety

518 M. Bosquet and B. Egeland

~Bowlby, 1973, 1979; Cassidy, 1995; Thomp-son, 2001!. Bowlby ~1973! hypothesized thatthe degree to which an individual is suscepti-ble to fear and anxiety is largely dependentupon the degree to which one’s attachmentfigures are physically and emotionally avail-able and responsive. Common to the differenttypes of insecure attachment relationships isthe caregiver’s inability or unwillingness tooffer comfort and proximity in response to theinfants’ signals of fear and attachment behav-iors. Experiences that cause a child to ques-tion the availability of his or her attachmentfigure often lead to chronic anxiety and exag-gerated responses to frightening situations be-cause, regardless of the sources of threat, thechild does not believe that the attachment fig-ure will be available to protect him or her~Bowlby, 1973; Cassidy, 1995!. Emerging datasupport a link between insecure attachmentrelationships in infancy and anxiety difficul-ties in later childhood and adolescence ~Bohlin,Hagekull, & Rydell, 2000; Kochanska, 2001;Manassis, Bradley, Goldberg, Hood, & Swin-son, 1994, 1995; Warren, Huston, Egeland, &Sroufe, 1997!. Further, anxiety disorders inadults have been found to be associated with“loss of secure base events” in childhood, par-ticularly during early childhood, including pa-rental separation, divorce, illness, and death~Kendler, Neale, Kessler, Heath, & Eaves,1992; Laraia, Stuart, Frye, Lydiard, & Bal-lenger, 1994; Torgersen, 1986; Tweed, Schoen-bach, George, & Blazer, 1989; Zahner &Murphy, 1989!.

Developmental incompetence

According to developmental psychopathol-ogy theory, development consists of a numberof stage-salient tasks that must be negotiatedfor competent development ~e.g., affect regu-lation and attachment in infancy; manage-ment of impulses in preschool; adjustment tothe school environment and the developmentof friendships in middle childhood; transitionto secondary schooling and the developmentand maintenance of same-gender and hetero-sexual friendships during adolescence; Cic-chetti & Lynch, 1995; Hartup, 1983; Masten& Braswell, 1991; Parker, Rubin, Price, &

DeRosier, 1995; Waters & Sroufe, 1983!. Fail-ure to achieve competence at one or moredevelopmental tasks may contribute to psy-chopathology, and psychopathology may in-terfere with the attainment of competence insubsequent developmental tasks ~Ialongo,Edelsohn, Werthamer-Larsson, Crockett, &Kellam, 1995; Kellam, 1990; Masten & Coats-worth, 1995!.

Evidence has begun to accumulate in sup-port of associations between developmentalincompetence and anxiety. As noted above,poor affect regulation and a history of inse-cure attachment have both been related to anx-iety symptoms in childhood. Anxiety has alsobeen associated with concurrent measures ofscholastic and social incompetence ~Benjamin,Costello, & Warren, 1990; Bowen, Vitaro, Kerr,& Pelletier, 1995; Chansky & Kendall, 1997;Hymel, Rubin, Rowden, & LeMare, 1990;Ialongo et al., 1995; Ialongo, Edelsohn,Werthamer-Larsson, Crockett, & Kellam, 1996;Kellam, 1990; Morison & Masten, 1991;Olson & Rosenblum, 1998; Rubin, Hymel, &Mills, 1989; Rubin & Lollis, 1988; Strauss,Frame, & Forehand, 1987!, and a few longi-tudinal studies have shown that social incom-petence predicts later anxiety difficulties~Bowen et al., 1995; Rubin et al., 1989!.Both social incompetence and school failuremay lead to anxiety through negative self-perceptions ~Ialongo et al. 1995; Ialongo, Edel-sohn, Werthamer-Larsson, Crockett, & Kellam,1994; Rubin & Lollis, 1988!. In addition, thequality of peer relationships may contribute tothe maintenance of anxiety symptoms in anx-ious children. For example, Rapee ~2001! sug-gested that protective and unchallenging peerrelationships, such as relationships with otheranxious peers who encourage avoidance andsocial withdrawal, may maintain or increaseanxiety in later childhood and adolescence.Finally, limited evidence suggests that anxietydifficulties may lead to incompetence ~Hymelet al., 1990!. For example, Vasey and Dadds~2001! noted that anxious children may copewith their anxiety by avoiding anxiety-provoking situations, thereby decreasing theiropportunities to master the skills necessaryfor competent development, further exacerbat-ing their own incompetence and increasing

The development and maintenance of anxiety 519

the likelihood that they will remain on a devi-ant developmental pathway.

Cognitive–affective representations

Various theories have posited a role forcognitive–affective representations in the eti-ology and0or maintenance of anxiety. Beck~1976! proposed a cognitive content-specificityhypothesis, which purports that different typesof emotional problems are associated withunique cognitive profiles, and several modelsof anxiety include a role for cognitive dis-tortions and information processing biases~e.g., Chorpita & Barlow, 1998; Ollendick &Hirshfeld-Becker, 2002; Rapee & Heimberg,1997!. Emerging research with children andadolescents has begun to document evidenceof particular cognitions associated with anxi-ety, including thoughts of lack of control,threat, and negative evaluation and views ofthe self as helpless and incompetent ~Chorpita& Barlow, 1998; Muris, Rapee, Meesters,Schouten, & Geers, 2003; Rapee & Heim-berg, 1997; Schniering & Rapee, 2004; Thomp-son, 2001; Weems, Berman, Silverman, &Saavedra, 2001; Weems, Silverman, Rapee, &Pina, 2003!. These associations are differentfrom those found with other disorders, includ-ing depression ~thoughts of loss or personalfailure!, and disruptive behavior disorders~thoughts of hostility or revenge! ~Schniering& Rapee, 2004!. However, the large majorityof research emerging out of this area has fo-cused on cross-sectional studies with subjectswith diagnosable disorders, and therefore can-not elucidate whether certain cognitive ten-dencies are a risk factor for developing ormaintaining anxiety or simply a symptom ofthe disorder ~Lonigan & Phillips, 2001!. Fur-thermore, the data do not indicate how thesecognitive profiles may originate.

Attachment theory provides testable hypoth-eses as to the origins of cognitive–affectiverepresentations. According to attachmenttheory, “cognitive–affective schemas” or“representational structures” are establishedthrough interpersonal interactions throughoutlife, beginning within the context of the pri-mary attachment relationship ~Blatt, 1995!.Early attachment experiences become a cen-

tral cognitive–affective structure by formingthe foundation of the child’s representationsor inner working models of relationships, theself, and the world, that is, whether one willexpect others to be available and responsive,whether one will feel confident or vulnerableand helpless, and whether one will see theworld as a trustworthy or dangerous place~Bowlby, 1973; Bretherton, 1995!. Accordingto Carlson, Sroufe, and Egeland ~2004!, rep-resentational processes and their associated af-fect and biological substrates serve a regulatoryfunction by guiding individuals in the selec-tion and interpretation of experiences and theirbehavioral responses in ways that are consis-tent with their earlier experiences, therebyproviding continuity across experiences andrelationships.

Several attachment theorists ~e.g., Bowlby,1973; Cassidy, 1995; De Ruiter & van IJzen-doorn, 1992; Shear, 1996! have suggested thatinsecure inner working models play a criticalrole in the etiology of several anxiety disor-ders, including childhood phobias, SeparationAnxiety Disorder, Agoraphobia, Panic Disor-der, and Generalized Anxiety Disorder. In ad-dition, numerous theories of childhood anxietyinclude a central role of early negative attach-ment experiences ~e.g., Chorpita & Barlow,1998; Ollendick, 1998; Rapee, 2002!. For ex-ample, Schniering and Rapee ~2004! noted thatthe cognitive biases and information process-ing styles found in studies with anxious chil-dren are similar to those found among anxiousadults. They concluded that such cognitive–affective patterns may be established at anearly age and influence functioning across de-velopment by contributing to both the devel-opment and maintenance of emotional distress.Chorpita and Barlow hypothesized that earlyinsecure attachment experiences contribute tothe development of cognitive styles character-ized by increased probability of interpretingevents as out of one’s control, and that suchcognitive styles are a psychological vulnera-bility for anxiety. Further support for thesetheories comes from data showing that chil-dren with insecure attachment relationshipshave representations of the self as incompe-tent and vulnerable and the world as threaten-ing and hostile ~Cassidy, 1988, 1995; Solomon,


George, & De Jong, 1995!, similar to repre-sentations of anxious children and adults ~Beck,Brown, Steer, Eidelson, & Riskind, 1987;Cassidy, 1995; Chorpita, Albano, & Barlow,1996; Di Nardo & Barlow, 1990; Warren,Emde, & Sroufe, 2000!.

Although cognitive–affective schemas arehypothesized to first emerge in the context ofthe primary attachment relationship, data in-dicate that they may be modified and elabo-rated over time in a dynamic process ofsuccessive transactions between the individ-ual and the environment to accommodate newexperiences ~Blatt, 1995; Carlson et al., 2004!.Evidence suggests that the quality of peer re-lationships may have important transactionalassociations with cognitive–affective represen-tations, particularly as the child spends increas-ing amounts of time away from the family andwith peers during middle childhood and ado-lescence ~Parker et al., 1995!. Data indicatethat the quality of early attachment relation-ships directly influences later peer-related rep-resentations, and that the quality of peerrelationships and relationships with other adultsmay modify individuals’ representational mod-els ~Carlson et al., 2004; Cassidy, Kirsh, Scol-ton, & Parke, 1996; Greenberg, 1999; Larose& Boivin, 1997; Main, Kaplan, & Cassidy,1985; Suess, Grossman, & Sroufe, 1992!.

Indirect evidence for associations amongattachment experiences, cognitive–affectiverepresentations, peer relationships, and anxi-ety has emerged from Rubin and colleagues’longitudinal research on associations betweensocial withdrawal and internalizing difficul-ties ~Rubin, 1993; Rubin et al., 1989; Rubin &Lollis, 1988!. Based on the results of theirstudies, they proposed that children who haveinsecure attachment histories with their pri-mary caregivers are at significant risk for ex-treme social withdrawal due to a heightenedsense of “felt insecurity.” As such childrenbegin to recognize their social failures in re-lation to peers, they may develop negativeself-perceptions about their own socialcompetencies and consequently be at riskfor anxiety. Social anxiety and negativeself-perceptions may lead to further socialwithdrawal and peer rejection. Concurrent ex-periences of social anxiety, negative self-

perceptions, and peer rejection may interact toexacerbate all three problems; interactions be-tween each of these problems may increasethe risk for subsequent major anxiety disor-ders as well as depression.

Gender and anxiety in childhoodand adolescence

Few studies have examined gender differ-ences in the etiology, course, and con-sequences of anxiety in childhood andadolescence. The data are mixed as to whetherthere are gender differences in the number,content, and stability of anxiety symptoms orin the patterns of association among risk fac-tors, anxiety symptoms, and developmentaloutcome ~Bell-Dolan, Last, & Strauss, 1990;Bowen et al., 1995; Fischer, Rolf, Hasazi, &Cummings, 1984; Hymel et al., 1990; Ialongoet al., 1996; Keller et al., 1992; Masi, Mucci,Favilla, Romano, & Poli, 1999; Olson &Rosenblum, 1998; Verhulst & van der Ende,1992!. However, the data are more consistentin demonstrating that, in adolescence, femalesshow greater rates of anxiety disorders thanmales following a pattern of similar rates be-tween the genders in childhood ~Cohen et al.,1993; Schniering, Hudson, & Rapee, 2000!.These findings suggest that there may begender-related factors involved in the etiol-ogy and0or maintenance of anxiety and thatmales and females may demonstrate differentpatterns of associations between risk factorsand outcome, particularly in adolescence.

Present Study

The major goal of this paper was to test amodel of the development and maintenance ofanxiety symptoms from infancy through ado-lescence. Based on the literature describedabove, the following hypotheses were pro-posed and tested:

1. Neonatal biobehavioral dysregulation andan insecure attachment history will be as-sociated with emotion regulation difficul-ties in the preschool period.

2. Emotion regulation difficulties and devel-opmental incompetence in preschool will


be associated with anxiety symptoms inchildhood.

3. Anxiety symptoms will show moderate sta-bility across development.

4. Anxiety symptoms and incompetence willshow bidirectional associations across de-velopment such that incompetence in onedevelopmental stage will predict anxietysymptoms in the following stage, and anx-iety symptoms in one stage will predictdevelopmental incompetence in the follow-ing stage.

5. A history of insecure attachment during in-fancy will predict negative peer relation-ship representations in preadolescence, andthese representations will be associated withanxiety symptoms in adolescence.

6. The model will specifically predict anxietysymptoms and not other psychopathologi-cal outcomes ~externalizing or depressivesymptoms! in adolescence.

7. Males and females will show similar pat-terns of risk for anxiety in childhood butdivergent patterns in adolescence.

Methodological issues

To accomplish these goals, a number of meth-odological issues needed to be addressed. Thefirst issue is the decision to employ a dimen-sional or categorical approach when opera-tionalizing anxiety ~Dobson & Cheung, 1990!.Compared to categorical approaches, dimen-sional approaches better capture symptom se-verity ~Bell-Dolan et al., 1990; Schnieringet al., 2000; Wadsworth, Hudziak, Heath, &Achenbach, 2001! and subclinical anxietyconditions, the latter of which have been as-sociated with impaired functioning and thedevelopment of anxiety disorders ~Beidel, Fink,& Turner, 1996; Gurley, Cohen, Pine, & Brook,1996; Masi et al., 1999!. However, individu-als who meet diagnostic criteria for a particu-lar disorder may be categorically different fromindividuals with subclinical symptoms in theirsymptom presentation, associated risk factors,and course of symptoms ~Rapee, 2001!. There-fore, both dimensional and categorical ap-proaches were used in this study.

A second issue concerned whether the dif-ferent anxiety disorders should be studied sep-

arately. Numerous researchers have concludedthat there is evidence for an overall constructof anxiety disorder in children, but only weakevidence for the delineation of separate child-hood anxiety disorders ~Angold, Costello,& Erkanli, 1999; Cantwell & Baker, 1989;Schniering et al., 2000!. Therefore, for thispaper, anxiety scales were created that in-cluded items that characterize the different anx-iety disorders, including generalized anxietydisorder0overanxious disorder, separation anx-iety disorder, panic disorder, agoraphobia,obsessive–compulsive disorder, social pho-bia, and specific phobias.

A third, related issue is that of the ability ofthe proposed model to differentially predictthe development of anxiety symptoms com-pared to other types of symptoms. Given thehigh correlations typically found across syn-dromes, Hinshaw ~1987! noted the difficultyin finding independent criterion measures inchild psychopathology, a situation that he stated“clearly hinders progress in the field” ~p. 444!.To demonstrate that the proposed model dif-ferentially predicts the development of anxi-ety symptoms compared to symptoms withinthe other broad category of externalizing symp-toms and within the same narrow category ofinternalizing symptoms, analyses were runcomparing the ability of the model to predictanxiety symptoms versus disruptive behaviordisorder symptoms and depressive symptomsin late adolescence.

The fourth and final issue is that research-ers must consider how to weigh informationfrom multiple reporters, as there is no agreedupon approach. Numerous studies have notedlow interreporter agreement among parent,teacher, and child reporters for child anxiety~Benjamin et al., 1990; Klein, 1991; Manas-sis, Mendlowitz, & Menna, 1997; Mesman &Koot, 2000a, 2000b; Schniering et al., 2000!.However, several researchers have notedthat parents, teachers, and children may eachprovide valid information from unique view-points important to our understanding ofchildren’s internalizing symptoms ~Achen-bach & Edelbrock, 1989; Kolko & Kazdin,1993!. Therefore, for this study, all availablereporters’ scores of the participants’ anxietysymptoms were used at each time period.


Method

Participants

Participants ~N � 155! were drawn from theongoing Minnesota Longitudinal Study of Par-ents and Children, a prospective longitudinalstudy of adaptation in families and childrenconsidered at high risk. Primiparous pregnantwomen were recruited from the MinneapolisPublic Health Clinic from 1975 through 1977during the third trimester of pregnancy andwere considered to be at high risk due to pov-erty and associated risk factors, such as loweducational level ~41% had not completed highschool at the time of the infant’s birth!, youngage ~mean age at delivery � 20.52, SD � 3.63,range � 12–34 years!, lack of support ~65%were single at delivery!, chaotic living condi-tions, and significant life stress. The originalsample consisted of 267 mothers. The major-ity of participant attrition occurred during thefirst 2 years of the study ~to N � 190!. Onehundred seventy-five participants completedthe 17.5-year assessment, the final assessmentof the current study. Twenty participants couldnot be included in the analyses due to criticalmissing data at earlier time points, leaving afinal sample of 155 participants. Examinationof basic demographic data showed no differ-ences between the 175 participants who com-pleted the 17.5-year assessment and those whodropped out of the study before 17.5 years. Inaddition, the 20 excluded participants did notdiffer from the 155 included participants onany of the variables used in this study. Theracial0ethnic background of the current sam-ple is 70% Caucasian, 9% African American,2% Native American or Hispanic, and 16%multiracial; in 4% of the cases, the father’sethnicity was not reported. Fifty-four percentof the participants are male.

Procedures and measures

Assessments included objective and projec-tive psychological tests, interviews, question-naires, and observations of child behavior andmother–child interactions. For this study, as-sessments that occurred during the followingperiods were used: neonatal period, 12 months,

18 months, 42 months, kindergarten, firstgrade, sixth grade, 16 years, and 17.5 years.

Neonatal biobehavioral reactivity and regula-tion. The Neonatal Behavioral AssessmentScale ~NBAS; Brazelton, 1973! was adminis-tered to the infants in their homes at approxi-mately 7 and 10 days by trained examiners~average reliability r � .93!. The NBAS con-sists of 27 behavioral items ~e.g., habituationto sensory stimulation; irritability, activity, andconsolability; physiological response to stress;state control! rated on 9-point scales and 17reflex items ~e.g., Babinski, moro, rooting!rated on 3-point scales. Studies have demon-strated moderate associations between scoreson the NBAS and temperament assessed upto 12 months later ~Green, Bax, & Tsitsikas,1989!. For this study, a NBAS summary scorewas calculated by first defining a range ofoptimal scores for each NBAS item, then re-coding the raw score on each item ~1–9! to anoptimal0nonoptimal dichotomy ~001!, and, fi-nally, calculating the total number of itemsscored nonoptimal for each participant ~Waters,Vaughn, & Egeland, 1980!. The criteria usedfor determining optimal performance wereadapted from Als ~1978!. The scores from thetwo assessment sessions were averaged to cre-ate one NBAS summary score. Results from aprevious study using the current sample sug-gest that the NBAS summary score reflectsproblems with physiological and state regula-tion and predicts later maladaptation ~Waterset al., 1980!.

Insecure attachment history. Quality of attach-ment was assessed using the Strange Situationprocedure when the infants were 12 and 18months of age ~Ainsworth, Blehar, Waters, &Wall, 1978!. The Strange Situation assess-ments were videotaped and coded by indepen-dent experienced coders. Two additional coderswere used to establish coding agreement.Agreement on attachment type ~A0B0C! withindependent rescoring of the entire 12-monthsample was 89%. Agreement with indepen-dent rescoring of 25 randomly selected 18-month assessments was 92%. Disagreementswere resolved by the more experienced coderreviewing the videotape. Available tapes were


later scored for disorganization by a codertrained by Mary Main; a second coder rated35 cases, with 85% agreement ~k � .72!. Anattachment insecurity score was computed bysumming the number of times that the infantwas insecurely attached ~0–2!. Infants whoreceived a classification of D were coded asinsecure for that assessment. Thirty-nine per-cent of dyads were coded as secure at bothassessments; 32% were coded as insecure atone assessment; and 29% were scored inse-cure at both assessments.

Preschool emotion regulation. When the chil-dren were 42 months old, they participated inthe Barrier Box task ~Harrington, Block, &Block, 1978!, a videotaped procedure duringwhich the child is observed in a potentiallyfrustrating situation without the mother present.Two observers scored the sessions on a vari-ety of 5- and 7-point scales. The preschoolemotion regulation score was the sum of thestandardized scores of the negative affectivity~reverse scored!, self-esteem, and ego controlscales ~average reliability r � .88!. The nega-tive affectivity scale assessed the child’s dis-tress, crying, anger, frustration, and generalnegativity expressed during the session. Theself-esteem scale assessed the degree to whichthe child was able to stay organized and con-structive and involved in the face of frus-tration. The ego control scale assessed thechild’s ability to exercise an optimal level ofcontrol over his or her impulses and emotionsduring the task, that is, not undercontrolled orovercontrolled.

Competence measures.

Preschool period. At 42 months, the chil-dren and their mothers were videotaped en-gaged in four tasks that were difficult enoughto require the mothers to use some teachingstrategies to enable the child to complete thetasks. Two observers coded maternal and childbehaviors on a variety of 7-point scales. Thepreschool competence scale was the sum ofthe standardized scores of the persistence, en-thusiasm, and reliance on mother ~reversescored! scales ~average reliability, intraclasscorrelation r � .85!. The persistence scale as-

sessed the extent to which the child was prob-lem oriented in the session. The enthusiasmscale assessed the child’s vigor, confidence,and eagerness in approaching the tasks. Thereliance on mother scale assessed the extent towhich the child expected the mother to pro-vide direction and help, displaying low per-sonal initiative.

Childhood period. A composite compe-tence score was created from several mea-sures administered to the participants’ teachersin kindergarten and first grade. At both assess-ment points, teachers were asked to rank orderthe children in the participant’s classroom onsocial competence and on emotional health0self-esteem. Social competence referred to thechild’s effectiveness in the peer group, includ-ing sociability, wide acceptance among otherchildren, friendship, social skills, and leader-ship qualities. Emotional health0self-esteemreferred to the child’s ability to take advan-tage of what the classroom offered, to enjoysocial and academic activities, and to engagein new experiences and challenges. Teacherswere unaware of which of the students wasthe study subject when they completed therankings. Reliability statistics could not becomputed, as a single teacher completed eachrank order; however, in a separate study withthis sample, children participating in a sum-mer camp were rank ordered on emotionalhealth by multiple camp counselors, and theinterrater reliability coefficients among the ob-servers ranged from .63 to .81.

Teachers were also administered an inter-view about the participant that covered numer-ous topics. They were asked to rate the childon several 5- and 6-point scales. A childhoodwork-habits scale was created by adding thestandardized scores of the following scalesobtained from the interview: enjoyment oflearning, persistence, ability to work indepen-dently, ability to express self, needs teacher’sapproval ~reverse scored!, needs encourage-ment and reassurance ~reverse scored!, andbecomes easily frustrated ~reverse scored!.

The standardized scores of the social com-petence, emotional health0self-esteem, andwork habits scales in kindergarten and firstgrade were highly correlated ~kindergarten:


social competence–emotional health r � .80,p, .001; social competence–work-habits com-petence r � .65, p , .001; emotional health–work-habits competence r � .65, p , .001;first grade: social competence–emotionalhealth r � .64, p , .001; social competence–work-habits competence r � .67, p , .001;emotional health–work-habits competence r �.73, p , .001!. The scores were summed tocreate a childhood competence measure.

Preadolescent period. The same proceduredescribed above in the childhood period wasused to create a total competence score inthe preadolescent period based on sixthgrade teacher ratings. The three competencemeasures were highly correlated: socialcompetence–emotional health r � .77, p ,.001; social competence–work-habits compe-tence r � .60, p, .001; and emotional health–work-habits competence r � .80, p , .001.

Adolescent period. The competence scorein adolescence was created from measures ad-ministered to participants’ English teachers aswell as participants at 16 years. As in the ear-lier assessment periods, teachers ranked theparticipants’ social competence and emo-tional health0self-esteem relative to their peers.Comparable self-report scores ~a social com-petence score and a scholastic competencescore! were taken from the Harter Self-Perception Profile for Adolescents ~Harter,1988!. The Harter is a 45-item paper and pen-cil measure that assesses the participant’s senseof adequacy and competence in several spe-cific domains as well as their global percep-tion of self-worth. The teacher- and self-ratedsocial and scholastic competence scores weremoderately to highly correlated; teacher so-cial competence–teacher emotional health r �.73, p, .001; teacher social competence–self-social acceptance r � .19, p , .05; teachersocial competence–self-scholastic compe-tence r � .37, p , .001; teacher emotionalhealth–self-scholastic competence r � .33, p,.001; teacher emotional health–self-socialacceptance r � .12, p � .15; self-socialacceptance–self-scholastic competence r� .15,p � .08. The teacher and self-rated scores were

standardized and summed to create an adoles-cent competence score.

Peer relationship representations. Peer rela-tionship representations were assessed using abattery of narrative projective tasks adminis-tered to participants when they were in thesixth grade ~Carlson et al., 2004!. The tasksincluded a storytelling task, a sentence com-pletion task, and a friendship interview. Thestorytelling task consisted of four picturesshowing ambiguous social situations; two werefrom the Tasks of Emotional Development~TED1 and 3; Cohen & Weil, 1971! and twowere from the Thematic Apperception Test~TAT 3BM and 16; Murray, 193801943!. Foreach picture, participants were asked to tell astory with a beginning, middle, and end anddescribe how the characters were thinking andfeeling. The sentence-completion task con-sisted of 28 ambiguous sentence stems in-tended to assess perceptions and attitudesaround various developmental issues, in-cluding peer relationships. The friendship in-terview was a semistructured, open-endedinterview developed for the project to assessparticipants’ expectations, perceptions, feel-ings, and attitudes regarding friendships andclose relationships. A previous study with thecurrent sample that used a composite scorefrom the projective tasks as a measure of re-lationship representations found that the mea-sure was significantly associated with measuresof representation in earlier developmental pe-riods ~e.g., Preschool Interpersonal Problem-Solving Assessment; family drawings at age 8!and later developmental periods ~e.g., friend-ship interview at age 16; Adult AttachmentInterview at age 19!, as well as with measuresof concurrent social behavior and social be-havior in earlier and later developmentalperiods, lending validity to the use of the de-scribed tasks as an assessment of relationshiprepresentations ~Carlson et al., 2004!.

In Carlson et al.’s ~2004! previous study,they found more robust associations for rep-resentational scores comprised of multiple lev-els of assessment ~e.g., including sentencecompletion, storytelling, and interview assess-ments for preadolescent representational mea-sure! than measures including only one level


of assessment. For the current study, a com-posite peer relationship representation scorewas created from various scales coded fromthe three tasks by two trained coders ~averagereliability r � .76!. Scales were chosen thatwere hypothesized to reflect the child’s senseof “felt security” within peer relationships.The scales included measures of the degree towhich the child invested in peer relationships~r � .79!; the extent to which the child ex-pected to feel accepted and valued or rejectedin peer relationships ~r � .84!; the degree towhich the child approached interpersonal sit-uations with ambivalence ~r � .76!; the extentto which the child expected and0or engagedin negative aspects of relationships, such asabuse, neglect, aggression, and isolation ~r �.72!; the expectation that the child’s closestfriend would be trustworthy, reliable, and sup-portive in times of distress ~r � .78!; and thedegree of reciprocity and symmetry within thechild’s closest friendship ~r � .70!. Codingdisagreements were conferenced. The stan-dardized scores of each of the scales weresummed to create a peer relationship represen-tation score, with higher scores reflecting morepositive peer representations. Cronbach’s al-pha for the representation scale was .63.

Anxiety measures.

Childhood period. The Child BehaviorChecklist ~CBCL; Achenbach & Edelbrock,1983!was administered to parents at 64 monthsand again when the children were in first grade.In addition, the participants’ kindergarten andfirst-grade teachers completed the CBCL:Teacher’s Report Form ~Achenbach & Edel-brock, 1986! in April or May of kindergartenand first grade. The different report forms showhigh test–retest reliabilities for the variousproblem scales ~Achenbach & Edelbrock,1983, 1986!. The Anxious0Depressed Scalehas been found to distinguish child patientswith and without simple phobias, separationanxiety disorder, overanxious disorder, gener-alized anxiety disorder, major depressive dis-order, and dysthymia ~Kasius, Ferdinand, vanden Berg, & Verhulst, 1997!.

Because the stated goal of this paper was toexamine the development of anxiety symp-

toms, not internalizing symptoms ~i.e., anxi-ety � depressive symptoms!, an anxiety scalewas created from items on the CBCL. Wads-worth et al. ~2001! distinguished between theanxious and depressed items on the Anxious0Depressed Scale. They described the follow-ing as anxious items: fears he or she mightthink or do something bad; feels he or she hasto be perfect; feels others are out to get him orher; nervous, highstrung, or tense; too fearfulor anxious; self-conscious or easily embar-rassed; suspicious; and worries. In addition tothese items, the following items from otherscales on the CBCL were included: fears go-ing to school; fears certain animals, situa-tions, or places other than school; cannot getmind off certain thoughts0obsessions; repeatscertain acts over and over0compulsions. Cron-bach’s alphas for the different reporters at thedifferent time periods ranged from .69 to .79.The standardized scores of the maternal andteacher reports in kindergarten and first gradewere averaged to create a childhood anxietymeasure ~mother kindergarten–mother firstgrade r � .59, p, .001; teacher kindergarten–teacher first grade r � .27, p � .001; motherkindergarten–teacher kindergarten r � .08, p �.36; mother first grade–teacher first grade r �.12, p � .15; mother kindergarten–teacher firstgrade r � .20, p , 05; mother first grade–teacher kindergarten r � .16, p � .05!. For15% of the subjects, one of the four data pointswas missing; for these cases, the anxiety scorewas based on the three available scores.

Preadolescent period. The CBCL was ad-ministered to participants’ sixth grade teach-ers. The same anxiety items used in childhood,described above, were used to create an anxi-ety score in sixth grade. Cronbach’s alphawas .69.

Adolescent period. Anxiety symptoms wereassessed at 16 years using the CBCL ~Achen-bach, 1991; Achenbach & Edelbrock, 1983,1986! and at 17.5 years using the Kiddie Sched-ule for Affective Disorders and Schizophrenia~K-SADS; Puig-Antich & Chambers, 1978!.

The relevant CBCL forms were adminis-tered to the participants and to their parents


and teachers at 16 years. The same anxietyitems described above were used to createanxiety scales from mother, teacher, and self-reports. Cronbach’s alphas were .78 for ma-ternal and self-report and .67 for teacherreport. The standardized scores of the mater-nal, teacher, and self-reports were averagedto create an adolescent anxiety scale ~mother–self r � .25, p , .01; teacher–self r � .02,p � .82; mother–teacher r � .06, p � .52!.

The K-SADS ~Puig-Antich & Chambers,1978! was administered to the participantsat age 17.5 years by advanced graduate stu-dents under clinical supervision ~k � .93,n � 30!. The K-SADS is an interview de-signed to obtain information on DSM-III-Rpast and present symptoms and disorders. A17.5-year anxiety score was created by sum-ming the total number of current symptomspresent, weighted for severity, for the follow-ing diagnoses: overanxious disorder, separa-tion anxiety disorder, specific phobias,obsessive–compulsive disorder, and panic dis-order. Cronbach’s alpha was .81. The K-SADSdata were also used to create a lifetime anx-iety diagnosis score, with participants whomet criteria for a past and0or present diagno-sis of overanxious disorder, separation anxi-ety disorder, panic disorder, social phobia,and0or obsessive–compulsive disorder receiv-ing a rating of “1” and those who did not arating of “0.”

Depressive symptoms in adolescence. A de-pressive symptoms score at 17.5 years wascreated from the K-SADS. The following itemswere included: depressed mood, anhedonia0boredom, fatigue, psychomotor agitation, psy-chomotor retardation, insomnia, hypersomnia,anorexia, weight loss, increased appetite,weight gain, and suicidal ideation ~Chamberset al., 1985!. Chambers et al. reported boththe test–retest reliability and Cronbach’s a �.72 for this scale. Cronbach’s alpha in thissample was .76. Because the depressive symp-toms scores were positively skewed, the datawere subjected to logarithmic transformationbefore being included in analyses; the skew-ness and kurtosis were reduced from 2.60 and8.58 to .21 and �.36, respectively ~Curran,West, & Finch, 1996!.

Disruptive behavior disorder symptoms inadolescence. A disruptive behavior disordersymptoms score at 17.5 years was createdfrom the K-SADS. Symptoms for opposi-tional defiant disorder and conduct disorderwere included. The score was the total num-ber of symptoms present, weighted for sever-ity. Cronbach’s alpha was .93.

Data analysis plan

A path analysis model was developed to re-flect the hypothesized relations among thestated variables. Path analysis was chosenbecause it allows for the simultaneous consid-eration of the effects of various predictor vari-ables and the ways in which the variablesinterrelate, and it provides a way to examinerelations of variables across time ~Maruyama,1997!.

The proposed model ~see Figure 1! showsthe expected associations of the variables overdevelopment. Neonatal biobehavioral reactiv-ity and regulation difficulties and an insecureattachment history were hypothesized to pre-dict emotion regulation difficulties in the pre-school period. An insecure attachment historywas further hypothesized to be negatively as-sociated with competence in preschool. Emo-tion regulation difficulties in preschool werehypothesized to predict anxiety symptoms inchildhood. Anxiety symptoms in childhoodwere hypothesized to predict anxiety symp-toms in preadolescence, and anxiety symp-toms in preadolescence to predict anxietysymptoms in adolescence. Competence at eachage was also hypothesized to contribute to theprediction of anxiety symptoms at the follow-ing age period. Finally, insecure attachmenthistory was hypothesized to be associated withnegative peer relationship representations inpreadolescence, which were hypothesized tobe related to anxiety symptoms in adolescence.

Because research and theory suggest thatnot only might incompetence predict anxietysymptoms, but that anxiety difficulties mightlead to further incompetence ~Vasey & Dadds,2001! a second path model ~see Figure 2! wastested that included an examination of the di-rect effects of preschool emotion dysregula-tion on childhood competence, childhood


Figure 1. The Model 1 path analysis examining the prediction of anxiety symptoms across childhood, preadolescence, and adolescence.

528

Figure 2. The Model 2 path analysis examining the prediction of anxiety symptoms across childhood, preadolescence, and adolescence.

529

anxiety on preadolescent competence, and pre-adolescent anxiety on adolescent competence.

As noted above, one of the stated hypoth-eses of this paper was that the model wouldspecifically predict anxiety symptoms and notpsychopathology in general. Therefore, themodel that emerged as the better fit for thedata ~see Figures 1 and 2! was used to predictdisruptive behavior disorder symptoms and de-pressive symptoms at 17.5 years. It was pre-dicted that the model would not account fordisruptive behavior disorder or depressivesymptoms as well as it accounted for anxietysymptoms at 17.5 years.

In addition, a modified version of the bet-ter fitting model that included only variablesfrom middle childhood through adolescencewas run separately for males and females toexamine possible gender differences. Four vari-ables were removed from the original modelto accommodate the reduction in sample sizefrom splitting the sample by gender. The ear-liest variables were excluded because previ-ous research suggests that gender differencesin anxiety are most likely to emerge duringadolescence ~Cohen et al., 1993; Schnieringet al., 2000!.

With the exception of the gender analyses,all path analyses involved 155 cases. Missingdata points ~5.38%! for the cases were esti-

mated by using estimation maximization inPRELIS ~Schafer, 1997!. For the gender analy-ses, path analyses involved 84 cases for themales and 71 cases for the females ~6.70 and6.34% missing data points, respectively!. Thepath analyses were tested using LISREL 8.5.

Following testing of the path analysis mod-els, which relied on continuous measures ofanxiety, analyses were conducted to examinethe extent to which the proposed risk vari-ables were associated with lifetime clinicaldiagnostic status.

Results

Descriptive data are presented in Table 1.

Correlations

To examine the relations among the variablesin the path analyses, Pearson product-momentcorrelations were calculated, presented inTable 2. As predicted, neonatal biobehavioralreactivity0regulation and insecure attachmenthistory were negatively correlated with pre-school emotion regulation, and preschool emo-tion regulation was negatively correlated withchildhood anxiety. Anxiety symptoms weremoderately correlated across development.Measures of competence showed robust asso-

Table 1. Descriptive statistics (N � 155)

Variable M SD Min. Max.

Neonatal biobehavioral reactivity0regulation 4.34 2.71 0 15Insecure attachment history 0.90 0.82 0 2Preschool emotion regulation �0.07 2.47 �4.66 5.28Preschool competence 0.00 2.56 �6.60 5.00Childhood competence 0.04 0.96 �1.83 2.06Preadolescent competence �0.06 2.68 �5.66 5.14Adolescent competence �0.05 1.37 �4.53 2.82Peer relationship representations �0.22 4.08 �10.68 9.12Childhood anxiety �0.02 0.66 �0.92 1.86Preadolescent anxiety �0.10 2.62 �2.71 10.29Adolescent ~16-year! anxiety �0.04 0.60 �1.01 2.8617.5-year anxiety symptoms 7.23 7.05 0 3817.5-year disruptive behavior disorder symptoms 9.79 11.40 0 5417.5-year depressive symptomsa 4.11 4.96 0 30

Note: Descriptive data are based on the sample of 155 participants after estimating for missingdata points using estimation maximization in PRELIS.aNontransformed data.


ciations across development. Furthermore, ateach age, competence and anxiety were nega-tively correlated, and poor competence inpreschool and in childhood were associatedwith anxiety symptoms in the following ageperiod. Conversely, emotion regulation0anxietysymptoms in preschool, childhood, and pre-adolescence were significantly correlated withcompetence in the following age period. Aspredicted, insecure attachment history was neg-atively correlated with peer relationship rep-resentations. Also as predicted, the peerrelationship representation measure showed amoderate negative correlation with anxietysymptoms at 16 and 17.5 years but was notrelated to depressive or disruptive behaviordisorder symptoms at 17.5 years. Disruptivebehavior disorder symptoms were associatedwith competence at every age period, and de-pressive symptoms were associated with poorcompetence in the preschool period. Anxiety,depressive, and disruptive behavior disordersymptoms at 17.5 years were all significantlycorrelated with each other and with anxietysymptoms at 16 years. Anxiety and depressivesymptoms at 17.5 years were also signifi-cantly correlated with anxiety symptoms inchildhood.

Path analyses

The results of the path analyses for the entiresample are shown in Figures 3, 4, and 5. Fig-ure 3 shows the results for predicting anxietysymptoms at 17.5 years. Figures 4 and 5 de-pict the results for predicting 17.5-year dis-ruptive behavior disorder symptoms anddepressive symptoms, respectively. The un-standardized, standardized, and statistical sig-nificance levels for the path model estimatesare included in Table 3. The model as a wholeaccounted for 20% of the variance in anxietysymptoms, 7% of the variance in disruptivebehavior disorder symptoms, and 7% of thevariance in depressive symptoms at 17.5 years.

The results from the model supported themajority of the study hypotheses. As pre-dicted by Hypotheses 1 and 2, both neonatalbiobehavioral reactivity0regulation and inse-cure attachment history were significantly as-sociated with emotion regulation in preschoolT

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Figure 3. The results of the path analysis examining the prediction of anxiety symptoms across childhood, preadolescence, and adolescence. The heavy line paths aresignificant at p , .05.

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Figure 4. The results of the path analysis examining the prediction of disruptive behavior disorder symptoms at 17.5 years. The heavy line paths are significant at p , .05.

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Figure 5. The results of the path analysis examining the prediction of depressive symptoms at 17.5 years. The heavy line paths are significant at p , .05.

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~b � �.16, t � �2.02; and b � �.21, t ��2.61, respectively!, and emotion regulationin preschool was negatively associated withanxiety symptoms in childhood ~b � �.25,t��3.03!. However, in the correlational analy-ses, only the NBAS score, and not attachment,was associated with childhood anxiety symp-toms. As predicted by Hypothesis 3, anxietyshowed moderate stability across childhood:anxiety symptoms in preadolescence were as-sociated with anxiety symptoms at 16 years~b� .32, t � 3.94!, and anxiety symptoms at

16 years were associated with anxiety symp-toms at 17.5 years ~b� .38, t � 4.81!. Anxi-ety symptoms in childhood and preadolescencewere not significantly associated in the pathanalysis ~b � .11, t � 1.46!, although theywere significantly correlated in the correla-tional analyses ~r � .27, p � .001!. There waslimited support for Hypothesis 4, in that com-petence at one age was associated with anxi-ety symptoms at the subsequent age period inonly one instance: competence in childhoodwas negatively associated with anxiety symp-

Table 3. Unstandardized and standardized path coefficients and significance levelsfor models in Figures 3, 4, and 5 (standard errors)

Path Model Estimates Unstandardized Standardized t

Neonatal biobehavioral reactivity0regulationr preschool emotion regulation �.16 ~.08! �.16 �2.02

Insecure attachment historyr preschoolemotion regulation �.21 ~.08! �.21 �2.61

Insecure attachment historyr preschoolcompetence �.18 ~.08! �.18 �2.24

Insecure attachment historyr peerrelationship representations �.25 ~.08! �.25 �3.12

Preschool emotion regulationr childhood anxiety �.25 ~.08! �.25 �3.03Preschool competencer childhood anxiety �.11 ~.08! �.11 �1.38Preschool competencer childhood competence .37 ~.08! .36 4.59Childhood anxietyr preadolescent anxiety .11 ~.08! .11 1.46Childhood competencer preadolescent anxiety �.39 ~.08! �.39 �5.10Childhood competencer preadolescent competence .52 ~.07! .53 7.42Preadolescent anxietyr adolescent~16-year! anxiety .32 ~.08! .32 3.94

Preadolescent competencer adolescent~16-year! anxiety .00 ~.08! .00 �0.04

Peer relationship representationsr adolescent~16-year! anxiety �.23 ~.08! �.23 �2.83

Preadolescent competencer adolescent competence .44 ~.08! .45 5.84Adolescent ~16-year! anxietyr 17.5-year anxiety .38 ~.08! .38 4.81Adolescent competencer 17.5-year anxiety .05 ~.08! .05 0.71Peer relationship representationsr 17.5-year anxiety �.17 ~.08! �.17 �2.16

Adolescent ~16-year! anxietyr 17.5-yeardisruptive behavior disorder symptoms .13 ~.08! .13 1.51

Adolescent competencer 17.5-yeardisruptive behavior disorder symptoms �.22 ~.08! �.22 �2.76

Peer relationship representationsr 17.5-yeardisruptive behavior disorder symptoms �.03 ~.08! �.03 �0.41

Adolescent ~16-year! anxietyr 17.5-yeardepressive symptoms .26 ~.08! .26 3.07

Adolescent competencer 17.5-yeardepressive symptoms �.03 ~.08! �.03 �0.38

Peer relationship representationsr 17.5-yeardepressive symptoms �.04 ~.08! �.04 �0.46

Note: N � 155.


toms in preadolescence ~b��.39, t ��5.10!.As predicted by Hypothesis 5, insecure attach-ment history was negatively associated withpeer relationship representations ~b � �.25,t � �3.12!, which were negatively associatedwith anxiety symptoms at 16 and 17.5 years~b � �.23, t � �2.83, and b � �.17, t ��2.16, respectively!.

The results of the path analysis depicted inFigure 2 revealed that including the associa-tions between anxiety at one developmentalstage and competence at the next developmen-tal stage did not add significantly to the over-all fit of the model, x2 ~3, N � 155! � 6.74,p . .05. Specifically, only the association be-tween preadolescent anxiety and adolescentcompetence was significant ~b � �.16, t ��2.03!, providing limited support for Hypoth-esis 4. Therefore, the simpler model depictedin Figure 1 was chosen for presentation ~seeFigure 3! and use in further analyses.

Figures 4 and 5 show that, as predicted byHypothesis 6, the model did not work as wellin accounting for disruptive behavior disordersymptoms or depressive symptoms as it didanxiety symptoms at 17.5 years. Compared tothe 20% of variance in anxiety symptoms ex-plained by the model, the model accounted foronly 7% of the variance in disruptive behaviordisorder symptoms and 7% of the variance indepressive symptoms. Neither anxiety symp-toms at 16 years nor peer relationship repre-sentations were significantly associated withdisruptive behavior disorder symptoms at 17.5years ~b � .13, t � 1.51, and b � �.03, t ��.41, respectively!. Competence at 16 years,however, was negatively associated with dis-ruptive behavior disorder symptoms at 17.5years ~b � �.22, t � �2.76!. Neither peerrelationship representations nor adolescentcompetence was significantly associated withdepressive symptoms at 17.5 years ~b� �.04,t � �.46, and b � �.03, t � �.38, respec-tively!. Anxiety symptoms at 16 years wereassociated with depressive symptoms at 17.5years ~b� .26, t � 3.07!.

The follow-up analyses results supportedthe specificity of associations between the pre-dictor variables and 17.5-year outcomes.First, regression analyses in which comorbidsymptoms at 17.5 years were statistically

controlled were run. After controlling for de-pressive and disruptive behavior disordersymptoms at 17.5 years, 16-year anxiety symp-toms ~b � .31, p , .001! and peer relation-ship representations ~b � �.15, p , .05!continued to be significant predictors of anx-iety symptoms at 17.5 years. Competence at16 years continued to predict 17.5-year disrup-tive behavior disorder symptoms ~b � �.25,p , .01! after controlling for anxiety anddepressive symptoms at 17.5 years. How-ever, 16-year anxiety symptoms no longerpredicted 17.5-year depressive symptoms~b� .11, p . .10! after controlling for 17.5-year anxiety and disruptive behavior disordersymptoms.

Comparison of beta weights from the pathanalyses, following transformation to z scores,also demonstrated some specificity. The betascore for 16-year anxietyr 17.5-year anxietywas significantly greater than the beta scorefor 16-year anxiety r 17.5-year disruptivebehavior disorder symptoms ~z � 3.13, p �.002!. However, the beta score for 16-yearanxietyr 17.5-year depressive symptoms wasnot significantly different from the beta scorefor 16-year anxietyr 17.5-year anxiety ~z �1.50, p � .13!. The differences between thebeta score for peer relationship representa-tionsr 17.5-year anxiety and the beta scoresfor peer relationship representations r 17.5-year disruptive behavior disorder symptomsand depressive symptoms both approached sig-nificance ~z �1.75, p � .08, and z �1.63, p �.10, respectively!. The difference between thebeta score for adolescent competencer 17.5-year anxiety and for adolescent competencer17.5-year disruptive behavior disorder symp-toms was significant ~z � 3.38, p � .0008!.The difference between the beta score for ad-olescent competencer 17.5-year anxiety andfor adolescent competence r 17.5-year de-pressive symptoms was not significant ~z �1.00, p � .32!.

Gender analyses

The t-test analyses showed that, consistent withHypothesis 7, males and females did not dif-fer on scores for preschool emotion regula-tion, t ~143! � .10, p � .92, or anxiety in


childhood, t ~124!� �.30, p � .76, or preado-lescence, t ~136!� 1.43, p � .16, but femaleshad higher anxiety scores than males at both16 years, t ~131! � 2.36, p , .05, and 17.5years, t ~114.09! � 4.29, p , .001. Femalesalso had higher competence scores than malesin preadolescence, t ~147! � 4.15, p , .001,and tended to have higher scores in preschool,t ~149! � 1.79, p , .10, and childhood,t ~134!�1.80, p, .10. Males and females didnot differ on any of the other variables in thisstudy.

In general, there were no significant differ-ences between males and females in the pathanalyses, with two exceptions: the associationbetween childhood anxiety and preadolescentanxiety was stronger for males than females,x2 ~1, N � 155! � 6.43, p , .05, and theassociation between 16-year anxiety and 17.5-year anxiety was stronger for females thanmales, x2 ~1, N �155!� 5.03, p, .05. Therewere no gender differences in the magnitudeof association between any of the predictorvariables and disruptive behavior disorder ordepressive symptoms at 17.5 years.

Diagnostic analyses

At the 17.5-year assessment, 14 participantsmet criteria for a current diagnosis of one ormore anxiety disorders, 14 met criteria forone or more past anxiety disorders, and 24met criteria for a lifetime diagnosis of one ormore anxiety disorders. Past and present diag-noses had similar average ages of onset: past �9.32 years, present � 9.08 years.

Participants with and without a lifetime di-agnosis of one or more anxiety disorders werecompared on the risk variables presented inthe path model. The t tests and Mann–WhitneyU tests ~for nonnormally distributed data! re-vealed that, compared to participants who didnot meet criteria for an anxiety disorder, par-ticipants who met criteria demonstratedhigher scores on preadolescent anxiety, Mann–Whitney z statistic � �2.68, p � .007; 16-year anxiety, Mann–Whitney z statistic ��2.51, p � .01; and 17.5-year anxiety, Mann–Whitney z statistic � �4.40, p � .000; andlower scores on childhood competence,t ~134!� 2.36, p � .02; and adolescent com-

petence, t ~138!� 2.97, p � 004. Participantswith a lifetime history of an anxiety disorderalso tended to have a history of insecure at-tachment, t ~153! � �1.72, p � .087, andlower scores on peer relationship representa-tions, t ~144! � 1.92, p � .057. Participantswith and without lifetime anxiety diagnosesdid not differ on the remaining variables: neo-natal biobehavioral reactivity0regulation,Mann–Whitney z statistic � �.20, p � .84;preschool emotion regulation, t ~143!� �.61,p � .55; preschool competence, t ~149!�1.13,p � .26; childhood anxiety, t ~124! � �1.05,p � .30; and preadolescent competence,t ~147! � .64, p � .53. Table 4 presents riskvariable z score means by lifetime anxiety di-agnostic status.

Discussion

The purpose of this study was to examine thedevelopment and maintenance of anxietysymptoms from infancy through adolescencein a high-risk longitudinal sample, with spe-cific attention to the roles of neonatal biobe-havioral reactivity and regulation, emotiondysregulation, insecure attachment, negativepeer relationship representations, and devel-opmental incompetence. The findings of thisstudy support and extend the literature on anx-iety in youth.

In general, the results were consistent withthe proposed model of childhood and adoles-cent anxiety and supported the majority ofstudy hypotheses. As predicted, there was mod-erate stability in emotion dysregulation andanxiety symptoms from infancy through ado-lescence. These results are consistent with aprevious study that found moderate stabilityin anxiety symptoms in children and adoles-cents over the course of 3 years ~Gullone et al.,2001!, and this is the first study to show cor-relates in anxiety from early childhood throughadolescence.

The pattern of results suggests differentpathways for anxiety that have implicationsfor understanding risk during different devel-opmental periods. First, heightened biobehav-ioral reactivity and poor regulation in theneonatal period, as assessed by the NBAS~Brazelton, 1973!, was associated with anxi-


ety symptoms in childhood. The data suggestthat neonatal biobehavioral reactivity and reg-ulation may influence risk for anxiety throughtheir impact on the development of emotionregulation abilities. Associations between theNBAS score and anxiety ratings diminishedby preadolescence. These findings are consis-tent with research showing that temperamentis a better predictor of anxiety when the twoconstructs are assessed close in time and thattemperament at a young age loses its ability topredict anxiety as the child develops ~Rapee,2002!. This pattern is expectable given thesignificant role that the environment is hypoth-esized to play in modifying the expression oftemperament and consequent risk for emotionregulation difficulties and the expression ofanxiety across development ~Kagan & Snid-man, 1991b; Lonigan & Phillips, 2001!. It ispossible that later measures of temperament0physiology would have predicted anxietysymptoms in preadolescence and adolescence;however, such measures were not availablefor the current study. Nevertheless, the factthat a measure assessed during the first 2 weeksof life was predictive of anxiety symptoms 6years later is noteworthy and consonant with

other studies that have used the NBAS to pre-dict later emotional and behavioral outcomes~Ohgi, Takahashi, Nugent, Arisawa, & Ak-iyama, 2003!. Our results suggest that it maybe possible to identify reactivity and regula-tion difficulties in the newborn period thatmay be indicative of an underlying physiolog-ical vulnerability to later emotion regulationdifficulties and anxiety symptoms in childhood.

Our results also showed that an insecureparent–child attachment relationship in in-fancy was associated with anxiety symptomsin adolescence but not necessarily in earlierperiods of development. The data further in-dicated that an insecure attachment history mayhave increased risk for anxiety difficulties inadolescence through its impact on the child’srepresentations of relationships: An insecureattachment history was predictive of preado-lescent negative peer relationship representa-tions, which were predictive of adolescentanxiety symptoms. As noted in the introduc-tory section, evidence from multiple sourcessuggests that anxiety disorders are associatedwith negative internal representations and cog-nitive biases and distortions in children andadults ~Beck et al., 1987; Cassidy, 1995; Chor-

Table 4. Mean z scores on anxiety risk variables by lifetime anxietydiagnostic status at 17.5 years

Lifetime AnxietyDiagnostic Status

Risk Variable Negative Positive

Neonatal biobehavioral reactivity0regulation �0.02 ~0.93! 0.08 ~1.36!Insecure attachment history 0.86 ~0.81! 1.17 ~0.82!†Preschool emotion regulation �0.02 ~0.97! 0.12 ~0.16!Preschool competence 0.04 ~1.02! �0.22 ~0.85!Childhood anxiety �0.04 ~0.97! 0.22 ~1.14!Childhood competence 0.09 ~0.99! �0.47 ~0.93!*Preadolescent anxiety �0.10 ~0.92! 0.56 ~1.24!*Preadolescent competence 0.02 ~0.98! �0.12 ~1.11!Peer relationship representations 0.06 ~0.98! �0.38 ~1.04!†Adolescent ~16-year! anxiety �0.12 ~0.81! 0.79 ~1.59!*Adolescent competence 0.10 ~0.96! �0.60 ~1.02!**17.5-Year anxiety �0.18 ~0.80! 1.00 ~1.38!***

Note: All means are group mean z scores, with the exception of the insecure attachmenthistory score, which is the nontransformed average number of insecure attachment ratings at12 and 18 months.†p , .10. *p , .05. **p , .01. ***p , .001.


pita et al., 1996; Di Nardo & Barlow, 1990;Schniering & Rapee, 2004; Warren et al., 2000;Weems et al., 2001, 2003!. However, this workhas been largely cross-sectional and correla-tional in nature, so it has not been possible todetermine if these negative internal represen-tations and biases are a premorbid risk factorfor anxiety or a symptom of the disorder. Sev-eral researchers have theorized that the qual-ity of early relationship experiences in general,and early attachment relationships in particu-lar, may play a critical role in the develop-ment of cognitive–affective representations andexpectations ~Blatt, 1995; Bowlby, 1973;Cassidy, 1995; Chorpita & Barlow, 1998;Greenberg, 1999!. As demonstrated in the cor-relational and path analyses, attachment his-tory was significantly associated with therepresentational score. Post hoc hierarchicalregression analyses showed that, even afterincluding all of the current and prior anxietyand competence scores ~preschool emotionregulation, childhood anxiety, preadolescentanxiety, preschool competence, childhoodcompetence, preadolescent competence!, in-clusion of attachment history resulted in a sig-nificant increase in F in the prediction of thepeer relationship representation score, DF ~1,147!� 7.13, p � .008. These regression analy-ses suggest that the association between earlyattachment experiences and later peer relation-ship representations was not mediated solelyby the impact of attachment on developmentalcompetence ~i.e., children with secure histo-ries are more likely to be competent in peerrelationships, and therefore more likely to havepositive peer relationship representations! oron anxiety ~i.e., children with insecure histo-ries are more likely to become anxious, andanxious children are more likely to have neg-ative peer relationships and representations!.Rather, the regression and path analysis re-sults suggest that ~a! the quality of earlyattachment relationships may have direct in-fluences on the development of relationshiprepresentations that generalize to other rela-tionships, including peer relationships, and that~b! these relationship representations con-tribute to risk for the development of anxietydifficulties, even after accounting for prior de-velopmental competence and anxiety. In addi-

tion, the fact that an insecure attachment historywas not predictive of anxiety symptoms untiladolescence is consistent with findings thatcognitive styles that arise from early experi-ences do not appear to have stable effects onemotion until after middle childhood whenthe cognitive style becomes more stable ~Chor-pita & Barlow, 1998!.

The data also suggest associations betweendevelopmental incompetence and anxiety thatare moderated by developmental stage. Al-though correlational analyses indicated thatanxiety symptoms and developmental compe-tence were significantly negatively correlatedat each time point, the path analyses revealedthat only incompetence in childhood pre-dicted later ~preadolescent! anxiety symp-toms. These findings are consistent with thoseof Rubin and colleagues ~Rubin, 1993; Rubinet al., 1989!, who found that shyness and pas-sive withdrawal in kindergarten and in secondgrade predicted perceptions of low self-worthand teacher-rated anxiety at age 11. Links be-tween childhood incompetence and preadoles-cent anxiety symptoms may be attributable tonormative cognitive changes occurring overdevelopment. By preadolescence, children areable to evaluate themselves relative to othersin more global terms ~Higgins, Loeb, & Mor-etti, 1995!. Therefore, preadolescents are ableto recognize their own social and academicdifficulties relative to their peers, and thoseindividuals who tend to focus on negative self-attributes may generalize such an evaluation~e.g., having poor social skills! to a globalnegative self-view ~Higgins et al., 1995!. Con-sequently, preadolescence may be the first de-velopmental stage when children can recognizetheir developmental difficulties relative to theirpeers, and this recognition may lead to anxi-ety symptoms, possibly through global nega-tive self-evaluations. Adolescents, however,are able to recognize different self-systemsand therefore may be able to distinguish theirview of themselves in relation to peers versusin relation to other people in their lives, suchas parents ~Higgins et al., 1995!. Therefore,adolescents may be able to recognize difficul-ties in one area of life without allowing thisrecognition to distort their view of their entireself and cause psychological symptoms.


Previous studies have found evidence for anegative impact of childhood anxiety on laterdevelopmental competence. Ialongo et al.~1994! and Rubin and Lollis ~1988! have sug-gested that anxiety may lead to social incom-petence when anxious children withdraw fromsocial interactions. Although we found thatanxiety was correlated with later competenceat each developmental stage in our study, therewas limited support in the path analyses for anassociation between anxiety and later devel-opmental incompetence. These results are con-sistent with those of Ialongo et al. ~1995!,who did not find that early anxiety ~in the firstgrade! predicted later social competence ~inthe fifth grade!. Nevertheless, there may besome evidence for a negative impact of anxi-ety on competence in the current findings. Inthe path analyses, the association between anx-iety and later developmental incompetence wassignificant when predicting from preadoles-cent anxiety to adolescent incompetence. Theimpact of anxiety on developmental adapta-tion may be strongest between preado-lescence and adolescence, when youth arebecoming increasingly more independent andable to make more decisions involving theiracademic and social activities. Anxious chil-dren may be more likely to withdraw fromsocial and academic challenges, increasing thelikelihood of developmental incompetence anddecreasing chances for corrective experiences~Vasey & Dadds, 2001!. In addition, the diag-nostic analyses showed that a positive life-time diagnosis of an anxiety disorder wasassociated with lower competence ratings inadolescence but not preadolescence. As themean age of onset of an anxiety disorder amongthose affected was approximately 9 years ofage, it is likely that the anxiety disorder pre-ceded the adolescent developmental difficul-ties for many of the participants. Possibly,anxiety does not have a negative impact ondevelopmental competence unless it reachesclinically significant levels where, by defini-tion, functional impairment occurs in socialand0or occupational functioning.

Overall, the diagnostic analyses revealedcomplementary findings to the path analyses.Specifically, incompetence in childhood andanxiety in preadolescence and adolescence

were significantly associated with one or morelifetime anxiety disorders by 17.5 years. Inaddition, the associations between lifetime di-agnostic status and both insecure attachmenthistory and peer relationship representationsapproached significance. However, the NBASand preschool emotion regulation measureswere not associated with the lifetime anxietydiagnostic variable. Perhaps these variableswould have emerged as significant predictorsof anxiety disorders if the analyses had fo-cused on anxiety disorders with a young ageof onset, as the path analyses demonstratedthat these predictors were associated with anx-iety in childhood but not later development.However, sample size restrictions did not al-low for such subgroup analyses.

It is interesting to note that the diagnosticstatus findings are more similar to the patternof correlations between the study variablesand the 16-year anxiety measure than the studyvariables and the 17.5-year anxiety measure.In addition, the 16-year anxiety measure wasmore often related to the predictor variablesthan the 17.5-year anxiety measure. These find-ings suggest that the 16-year continuous mea-sure of anxiety created from CBCL items maybe a more valid measure of clinical anxietyproblems than the 17.5-year scale created fromK-SADS items. Considering how commonlythe CBCL is used in clinical and research set-tings, validating an anxiety scale from theCBCL ~as opposed to an anxiety0depressionscale! may be worth pursuing in future stud-ies. In addition, the 16-year anxiety measuremay have performed better than the 17.5-yearanxiety measure because the former was basedon data from multiple informants ~self, mother,teacher!, whereas the latter was based on datafrom one informant ~self !. Although internal-izing symptoms are frequently conceptualizedas most accurately reported by the individualbeing assessed, outside reporters such as par-ents and teachers may be able to provide valu-able information regarding children’s andadolescents’ anxious behaviors ~Achenbach &Edelbrock, 1989; Kolko & Kazdin, 1993!.

Being able to differentially predict the de-velopment of anxiety symptoms compared toexternalizing disorder symptoms as well asdepressive symptoms was an important goal


of the current study. Uncovering different riskfactors for different disorders is important forclinicians and researchers interested in treat-ing and preventing psychological disorders andcritical to designing effective, targeted inter-ventions. The pattern of results suggests somesuccess in identifying risk factors specificallyassociated with risk for anxiety. The modelaccounted for 20% of the variance in anxietysymptoms at 17.5 years compared to only 7%in disruptive behavior disorder symptoms and7% in depressive symptoms. There were alsosome specific associations between the inde-pendent variables and anxious, depressive, anddisruptive behavior disorder symptoms.

The results of the path analyses and follow-upanalyses suggest that adolescent anxiety symp-toms were predictive of anxiety and depressivebut not disruptive behavior disorder symptomsat 17.5 years. These results are not surprisinggiven the frequent findings in the literature ofhigh comorbidity between anxiety and depres-sion and a temporal relationship between anx-iety and depression, with anxiety often precedingdepression ~Angold et al., 1999; Dobson, 1985;Strauss, Last, Hersen, & Kazdin, 1988; Watson& Kendall, 1989!.

The data suggest that developmentalstage may moderate associations between de-velopmental incompetence and emotional0behavioral symptoms. Incompetence at alldevelopmental stages assessed ~preschool,childhood, preadolescence, adolescence! wasassociated with disruptive behavior disordersymptoms at 17.5 years. These findings areconsistent with the literature in this area. Forexample, as noted by Masten and Coatsworth~1995!, the definition of conduct disorder im-plies competence problems in rule-governedbehavior and compliance, and the conceptual-ization of the disorder overlaps with devel-opmental psychopathologists’ definition ofincompetence. There is evidence from multi-ple studies that developmental incompetenceboth precedes and follows the development ofconduct disorder ~Masten & Coatsworth,1995!. Harsh, inconsistent parenting and pa-rental rejection combined with childhood hy-peractivity and impulsivity are hypothesizedto contribute to social incompetence that isoften met by peer rejection, which leads to

more serious antisocial behaviors ~Masten &Coatsworth, 1995; Sroufe, Egeland, Carlson,& Collins, 2005!.

Associations between developmental in-competence and anxiety are less firmly estab-lished in the literature. In the current study,the path analyses showed that only incompe-tence in childhood was predictive of later ~pre-adolescent! anxiety symptoms. As discussedabove, this specific pattern of associations maybe attributable to important developments incognition that occur during this developmen-tal period that allow the child to make self-evaluations relative to peers and, therefore,developmental incompetence may hold partic-ular relevance in the etiology of anxiety dur-ing middle childhood0preadolescence.

Correlational analyses showed few associ-ations between incompetence and adolescentdepressive symptoms. These findings are notconsistent with developmental models ofchildhood depression that hypothesize that de-velopmental incompetence contributes to de-pression ~Cicchetti & Schneider-Rosen, 1986!.It is possible that if depression had been as-sessed at multiple points, associations be-tween symptoms and competence would haveemerged. For example, as with anxiety, pre-adolescent depression may have been associ-ated with earlier incompetence. In addition,there is some evidence that incompetence inpeer relations may be particularly salient inthe etiology of depression ~Patterson &Stoolmiller, 1991!, and therefore incompe-tence measures that were focused solely onfunctioning with peers may have been moresuccessful in predicting depression.

Finally, the preadolescent peer relationshiprepresentation score appeared to be a some-what stronger predictor of anxiety than eitherdepressive or disruptive behavior disordersymptoms at 17.5 years. The representationmeasure used in the current study was de-signed to assess the participants’ feelings of“felt security” within the context of their peerrelationships. Such representations are hypoth-esized to be involved in the etiology of anxi-ety ~Rubin & Lollis, 1988! and to originatefrom the quality of early attachment relation-ships ~Blatt, 1995; Bowlby, 1973; Bretherton,1995!. The results provide support for the role


of “felt security” in the etiology of anxietyand for some specificity in peer relationshiprepresentations, consistent with studies thathave documented differences in the cognitivebiases and informational processing stylesof children with anxiety compared to thosewith depression and externalizing disorders~Schniering & Rapee, 2004; Sroufe et al., 2005;Weems et al., 2001!.

It deserves mention that, in the current analy-ses, the attachment rating was collapsed acrossinsecure attachment categories. Attachment his-tory was hypothesized to impact risk for anx-iety via its impact on three mediating variables:emotion regulation abilities, developmentalcompetence, and relationship representations.Based on the literature reviewed above, it washypothesized that all forms of insecure attach-ment would be associated with these mediat-ing variables and therefore with risk for anxiety.That the strongest evidence was found for apathway from insecure attachment to anxietyvia negative peer relationship representationsdeserves highlighting. These findings are con-sistent with Bowlby’s and other attachmenttheorists’ contentions that ~a! all types ofinsecure attachment share in common inter-nal representations of others as unreliable0unavailable, particularly during times of need;~b! expectations that others will be unavail-able are “intimately linked” to susceptibilityto respond with fear to potentially alarmingsituations in normal life and to experience “in-tense or chronic fear” ~Bowlby, 1973, p. 202–203!; and ~c! attachment relationships play aparticularly critical role in regulating fear andanxiety, such that insecure attachment histo-ries are involved in the etiology of anxietydisorders ~Bowlby, 1973, 1979; Cassidy, 1995;Chorpita & Barlow, 1998; De Ruiter & vanIJzendoorn, 1992; Shear, 1996; Thompson,2001!.

It is possible that if specific insecure cat-egories were examined, pathways from attach-ment to anxiety via emotion dysregulationand0or developmental incompetence wouldhave emerged more clearly. For example, al-though insecure attachment was associated withpreschool emotion dysregulation, and pre-school emotion dysregulation was associatedwith childhood anxiety, insecure attachment

was not associated with childhood anxiety.However, research suggests that early attach-ment experiences help to program children’sdeveloping physiological systems for regulat-ing stress and anxiety ~Chorpita & Barlow,1998; Nachmias, Gunnar, Mangelsdorf, Par-ritz, & Buss, 1996!. Insecure–resistant attach-ment ~C! in particular is associated with a lowthreshold for arousal, extreme displays of emo-tionality, and difficulty regulating distress~Schore, 1996!. Therefore, C attachment mayincrease risk for anxiety through its impact onemotion regulation abilities, and these associ-ations may have been obscured in the currentanalyses. In fact, a previous study using thecurrent sample found a significant relation be-tween C attachment history and anxiety dis-orders at 17.5 years ~Warren et al., 1997!,although mediating variables ~e.g., emotionregulation! were not included in those analy-ses. Also of note, in the current analysesinsecure attachment was associated with de-velopmental incompetence in preschool andchildhood, and childhood incompetence wasassociated with preadolescent anxiety; how-ever, insecure attachment was not correlatedwith preadolescent anxiety. Again, subgroupanalyses may have revealed pathways fromspecific insecure attachment classifications toanxiety via developmental incompetence ~e.g.,avoidant attachment to anxiety through socialisolation; Sroufe et al., 2005!. In the currentstudy, sample size precluded pathway analy-ses for specific insecure attachment catego-ries, but this is an important area for futureresearch.

An examination of specific insecure catego-ries of attachment also may have revealed ex-pected associations between attachment anddepression and disruptive behavior disorders.Numerous studies using the current sample aswell as other samples have demonstratedassociations between specific insecure attach-ment categories and these forms of psycho-pathology ~Cicchetti & Toth, 1995; Dozier,Stovall, & Albus, 1999; Sroufe et al., 2005!.For example, a previous study using the cur-rent sample suggests that insecure–avoidant~A! and C attachment histories may increaserisk for depression, although via differentroutes: A through its association with feelings


of alienation, and C through its impact onfeelings of helplessness and anxiety ~Duggal,Carlson, Sroufe, & Egeland, 2001!. External-izing problems have been associated with Aand disorganized0disoriented ~D! attachmenthistories, and both of these attachment catego-ries have been associated with developmentalincompetence, particularly poor peer relation-ships ~Sroufe et al., 2005!. As noted above,incompetence across development was consis-tently associated with adolescent disruptivebehavior disorder symptoms in the currentstudy. The combination of these findingssuggests that A and D attachment historiesmay increase risk for externalizing symp-toms through their impact on developmentalcompetencies.

The current study revealed gender findingsworth noting. Consistent with previous work~Cohen et al., 1993; Schniering et al., 2000!,males and females showed similar rates ofanxiety symptoms until adolescence, when fe-males showed greater rates. However, pathanalyses revealed few gender differences inthe associations between risk factors and out-come across development. Specifically, theonly significant gender differences were thatanxiety symptoms appeared more stable be-tween childhood and preadolescence amongmales and between mid- and late adolescenceamong females. These results suggest that al-though males and females may be equallylikely to develop anxiety symptoms in child-hood, females may be more vulnerable to de-veloping and maintaining anxiety symptomsin adolescence. Therefore, although the ratesof anxiety symptoms differed by gender inadolescence, the mechanisms by which malesand females developed symptoms appearedsimilar in this study. However, these findingsdo not preclude the possibility that there wererisk factors not assessed in this study that dif-ferentially affect males’ and females’ risk foranxiety symptoms. In fact, the differing ratesin adolescence suggest the existence of suchrisk factors, such as hormonal changes thataccompany puberty and0or exposure to differ-ing societal expectations for expression of emo-tional distress ~Vasey & Dadds, 2001!. It isalso important to note that the reduced sam-ple sizes for the gender analyses may have

decreased the power to detect differences.Further study of the role of gender in thedevelopmental psychopathology of anxiety isneeded.

Strengths, Limitations, and Directionsfor Future Research

This study offers several significant method-ological improvements to the study of anxietyin children and adolescents. First, few studieshave the data available to examine risk factorsand stability of symptoms beginning in in-fancy and continuing with regularly sched-uled assessments through adolescence. Second,many studies examining the etiology of child-hood anxiety focus on one or two risk factors;in this study, the roles of multiple risk factorswere examined. Third, the majority of studiesexamining associations between anxiety andcompetence measure both constructs concur-rently, disallowing examination of directionof effects. In this study, independent variableswere assessed at earlier assessment periodsthan dependent variables. Fourth, many of thestudies that assess competence and anxiety inchildhood and adolescence use the same rat-ers to rate both constructs; therefore, untan-gling the effects of reporter bias from the trueassociations between competence and anxietyis impossible. However, in this study, differ-ent raters rated most of the predictor and de-pendent variables. Fifth, this study tested theability of the proposed model to differentiallypredict anxiety symptoms compared to otherforms of psychopathology. Sixth, this studyexamined both dimensional ~normative to clin-ically significant! and categorical ~clinicallysignificant! measures of anxiety.

A number of methodological issues affect-ing the analyses in this paper deserve men-tion. The unconventional use of the CBCLshould be noted. This paper attempted to lookspecifically at the pathway of anxiety symp-toms in childhood by creating an anxiety scalefrom items from the CBCL, largely from theAnxious0Depressed Scale. However, some re-searchers have questioned if anxious and de-pressive symptomatology and disorders cantruly be separated, especially in childhood~Finch, Lipovsky, & Casat, 1989; Gurley et al.,


1996; Wadsworth et al., 2001!. Therefore, itcould be argued that our results show pre-dictions to internalizing symptoms, but notanxiety symptoms specifically. Although weacknowledge the high comorbidity betweenanxiety and depression, several findings in theliterature suggest that the two disorders maybe separable, even in childhood. For example,studies on cognitive content specificity amongdifferent disorders have found evidence forspecificity between the types of cognitionscharacteristic of anxiety versus depression,among adults as well as children ~Schniering& Rapee, 2004; Weems et al., 2001!. That ourpeer relationship representation measure wasa somewhat stronger predictor of anxiety thandepression is consistent with these findings.In addition, previous data indicate that anxi-ety may precede depression in the course ofinternalizing disorders such that, although de-pression without symptoms of anxiety is rela-tively uncommon, anxiety without depressionis relatively common ~Di Nardo & Barlow,1990; Dobson, 1985!. Our results showedcorrelations between early anxiety and laterdepressive symptoms, supporting this devel-opmental relation between anxiety and depres-sion. Although modest and in need of furtherreplication, our findings suggest possible dif-ferentiability between anxiety and depressivesymptoms in youth.

The results of this study may have beenimpacted by the difficulties inherent in assess-ing anxiety in children, and therefore be anunderestimation of the strength of associa-tions between anxiety symptoms across devel-opment and between risk factors and anxietysymptoms. The manifestation of anxiety symp-toms changes during development and is in-fluenced by context ~e.g., home vs. school!. Inaddition, anxiety symptoms are not as readilyobservable or recognizable as externalizingsymptoms and, as noted above, different ob-servers ~e.g., parent, teacher, self !may be moresensitive to reporting different types of anxi-ety symptoms at different ages ~Achenbach,Conners, Quay, Verhulst, & Howell, 1989; Hin-shaw & Park, 1999; Mesman & Koot, 2000a!.Furthermore, evidence indicates that the cor-relates of childhood disorders vary, dependingon who is rating the child’s symptomatology

and the predictor variables ~Hinshaw 1992;Hinshaw & Park, 1999!. An informant effectmay explain why, for example, in the pathanalyses childhood incompetence but notanxiety was associated with preadolescent anx-iety, for which only teacher ratings were avail-able. Previously, Benjamin et al. ~1990! foundthat teachers, but not parents, of 7- to 11-year-old children with an anxiety disorder rated thechildren as more impaired on measures of so-cial functioning than parents of children withno diagnosis. Therefore, social incompetencemay be a more salient indicator of psycholog-ical problems to teachers and0or teachers maybe better able to observe social anxiety, be-cause it may be easily elicited in the class-room setting. In addition, teachers may bebiased in their perceptions of children who arefunctioning poorly in the school setting, inflat-ing their reporting of psychological problems.~However, it should be noted that lower com-petence scores in early childhood was associ-ated with self-report of lifetime anxietydisorders, suggesting that the association be-tween early childhood competence and teacherreport of preadolescent anxiety was not solelydue to biased teacher reporting.! Future stud-ies may explore whether the pattern of associ-ations reported here are dependent upon theinformants used to assess child anxiety.

It is important to note that this study uti-lized a predominantly Caucasian, nonclinicalsample, although 15% of the current samplemet lifetime diagnostic criteria for one or moreanxiety disorders. More research is needed todetermine if the proposed model is valid inpopulations that differ in ethnicity and clini-cal severity. In addition, as noted elsewhere,sample size restricted the ability to conductcertain analyses and reduced the power to de-tect effects in other analyses; therefore, theresults of the current study should be con-firmed with larger samples.

Several potentially important risk factorsin the etiology of childhood anxiety were notincluded in the present study due to lack ofavailable data and0or sample size restrictions.For example, a number of models of child-hood anxiety posit an important etiologicalrole for an underlying physiological vulnera-bility ~Barlow, 2002; Ollendick, 1998; Rapee,


2002!, a direct measure of which was notavailable for this study. Also not included inthis study was the role of parenting style. Datafrom several studies suggest a link betweenparental overprotection0overcontrol and child-hood anxiety ~Chorpita & Barlow, 1998;Ollendick & Hirshfeld-Becker, 2002; Rapee,2002!. There is also evidence that parentsmay influence the development of anxiety intheir children by modeling social avoidanceand avoidant coping strategies in ambiguoussocial situations ~Barrett, Rapee, Dadds, &Ryan, 1996; Chorpita et al., 1996; Dadds, Bar-rett, Rapee, & Ryan, 1996!. Such modelingmay impact developmental competence andrelationship representations, which may in turnimpact risk for anxiety ~Ollendick & Hirshfeld-Becker, 2002!. The roles of vicarious or in-structional learning ~Rapee, 2002! and specificenvironmental0conditional experiences ~Bit-ran & Barlow, 2004; Ollendick & Hirshfeld-Becker, 2002! and the ways in which suchexperiences may interact with physiological~e.g., temperament! and psychological ~e.g.,cognitive–affective representations! vulnera-bilities were also not included in the currentstudy. Finally, there may be protective fac-tors ~e.g., supportive parenting style that dis-courages avoidant coping behaviors! thatmoderate associations between risk factors andoutcome that should be incorporated into fu-ture studies. Such protective factors may ex-plain why some participants with the notedrisk factors in this study did not develop anx-iety or developed transient symptoms. Inclu-sion in the current study of the variablesdescribed above may have resulted in greaterprediction of variance in anxiety symptomsacross development. Future studies would ben-efit from including measures of the con-structs included in the present study in additionto the constructs noted above.

Conclusions and Implications

In conclusion, this study makes several im-portant contributions to the study of anxietyin childhood and adolescence. The data indi-cate moderate stability in anxiety symptomsthroughout childhood and adolescence andsuggest that the impact of specific risk fac-

tors may differ at different developmentalstages. Risk for anxiety in early childhoodwas associated with earlier physiological0tem-peramental reactivity0regulation variables. Inpreadolescence, anxiety was associated witha history of developmental incompetence dur-ing the transition into the school and peerenvironment. Anxiety in adolescence was as-sociated with an insecure attachment historyin infancy that appeared to exert its influencevia negative relationship representations.Finally, anxiety in preadolescence was asso-ciated with developmental incompetence inadolescence.

These results have significant implicationsfor research and clinical work. The moderatestability in anxiety symptoms suggests that, forsome children, anxiety symptoms may not re-solve without intervention. Furthermore, anx-iety may negatively impact the negotiation ofstage-salient tasks of development, particu-larly during adolescence. That the relativecontribution of various risk factors to the de-velopment of anxiety appeared to be moder-ated by developmental stage indicates that, whendesigning clinical interventions, researchers andclinicians need to consider carefully the devel-opmental stage of the intended group and tailorthe interventions appropriately. For example,the results of this study suggest that promotingacademic and social competence during the tran-sition to school in childhood may prevent thedevelopment of anxiety disorders in at-risk chil-dren, and treating anxiety in preadolescence mayreduce the risk for later developmental malad-aptation. Although the model presented here issurely a simplification of the complex pro-cesses that underlie the development and main-tenance of anxiety symptoms in childhood, it isan attempt to test a broader model of childhoodanxiety than has previously been examined. Theresults provide support for several theoreticaldevelopmental models of anxiety, includingthose of Barlow ~Chorpita & Barlow, 1998!,Ollendick ~1998!, and Rapee ~2001, 2002!. Fi-nally, the data indicate that clinicians involvedin designing interventions for the preventionand treatment of childhood and adolescentanxiety should consider including the identifi-cation of reactive and poorly regulated physi-ological profiles early in development and the


promotion of sensitive early parental care, emo-tion regulation abilities, positive cognitive–

affective representations, and developmentalcompetencies.

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