Author: Sujata Gupta / Source: Science News
When Molly was 10 months old, her parents took her to a Halloween party with other young families.
While the other babies explored their surroundings, Molly sat and watched. She’s always been cautious, says Molly’s mom, Rachel. Early on, though, the little girl’s shyness didn’t raise red flags.By the time Molly turned 4, however, life was getting harder — for everyone. Even though she loved to dance, Molly refused to engage in class without her parents nearby. She clung to her mom in public and became whiny and upset. The family began avoiding outings. Dance classes ceased, as did gymnastics. Playdates were rare and had to be held in Molly’s home. “Our world was getting smaller,” says Rachel, who asked to use only first names to protect her daughter’s privacy.
In kindergarten, Molly’s anxiety escalated. Parents were supposed to drop their children off in front of the school so a teacher could walk them inside, but Molly struggled. “She would … chase us into the road,” Rachel says. Concerned for Molly’s safety, school administrators eventually gave the family permission to escort her inside. Once at school, Molly latched onto another girl, trying hard to dress exactly like her. It seemed to Rachel that Molly “wanted to be invisible.”
Fears about going to school consumed Molly, who felt sick every night before school. “She had stomachaches,” Rachel says. “She was constipated.”
Molly’s issues may appear extreme, but anxiety is surprisingly common among young children. Estimates vary widely, but most studies indicate that 10 to 20 percent of U.S. preschoolers suffer from one of several anxiety disorders. When anxiety hits young, it often holds on into adolescence and adulthood. Children diagnosed with clinical anxiety early have double the risk of anxiety and substance abuse in their teen years, compared with children who don’t have an anxiety disorder. That later anxiety has been linked to missed school, drug abuse, depression and even suicide.
So for decades, researchers have been trying to decipher the biological roots of the young, anxious mind in hopes of sorting out how to intervene before worries become debilitating. It now seems that all forms of anxiety are linked to abnormalities in how the brain processes fear. So sometimes, when symptoms are particularly severe and very young children struggle to do typical things like start school or go to the playground, psychiatrists turn to antidepressants.
But studies of antidepressants in children tend to be small and shorter than a year in duration, with sparse studies looking at medicating children under age 5. Anecdotally, researchers know that antidepressants can cause hyperactivity in young children, in the form of uncontrolled outbursts, restlessness and disrupted sleep.
Estimated share of U.S. preschoolers who suffer from one of several anxiety disorder
Not surprisingly, Prozac for the preschool set remains controversial. Some psychiatrists say that a short-term dose can help an anxious child find the courage to talk to a therapist. Therapy can be a form of training that helps the brain develop along a less anxious path. To that end, researchers are trying to modify therapies that work for adults or develop new approaches to meet the needs of young children.
One of the most promising strands of research involves individuals like Molly, as researchers have identified a clear link between shyness in infancy and later anxiety, namely social anxiety.
Born cautious
To experience fears about the future or social belonging is human, says Jerome Kagan, a retired Harvard University psychologist and a leading researcher in the field. It’s normal for children to fear big, barking dogs, or to worry about losing a parent or how to respond when a classmate is being bullied. Only when such anxieties become all encompassing, when they interfere with overall happiness or the ability to interact in society, does the condition become pathological, meriting the name “anxiety disorder.”
But what enables some individuals to confront their fears while others are left reeling? That question has consumed Kagan ever since he began interviewing participants in a longitudinal study that began back in 1929. By the time Kagan joined the project in the late 1950s, the first participants were adults. Kagan soon noticed that those who had been wary babies — marked by caution, inhibition around strangers and a tendency to stick close to a trusted adult — remained shy and withdrawn as adults. What’s more, being wary in new situations was the only temperament Kagan observed that stayed constant throughout life.
In 1989, Kagan began recruiting mothers and infants to build his own longitudinal study. Soon, he had 500 mothers, all of whom came to his laboratory when their babies were 4 months old. The babies were exposed to various stimuli, such as swaying mobiles or tape recordings intoning statements like, “Hello baby. How are you today?”
Most babies responded to the objects and recordings with stares, babbles and grunts. But about one-fifth of the babies cried or thrashed their legs, signs of distress that marked them as highly reactive, or inhibited. (Researchers used the term “behavioral inhibition” to describe this tendency.)
Kagan continued to observe the boys and girls throughout childhood. By age 7, about half of those who were babies in the reactive group remained cautious as children. “They needed a night-light at home, they wouldn’t sleep over at a friend’s house, they were afraid of dogs,” Kagan recalls. “And they were quiet and shy in the classroom.”
Separation anxiety — excessive fear surrounding separation from caregivers. Tots sobbing at day care drop-off is a common example. The behavior is normal in the first year or two of life.
Social anxiety — excessive fear of negative social evaluation, essentially a fear of judgment from others.
Generalized anxiety — excessive anxious anticipation of future events. Children worrying about the house burning down, for example, or about mom dying while the child’s at school.
Specific phobias — excessive fear of specific things, for example, dogs, spiders or heights.
By age 18, about 40 percent of those formerly reactive babies met the criteria for an anxiety disorder — double the risk of those who were not reactive as babies and of the general population. Kagan was floored. These are kids “that come from middle-class homes. They have a protective environment,” Kagan says. “They’re not in a war zone.”
Equally intriguing to Kagan and, later, his protégé, Nathan Fox, were the 60 percent of reactive babies who did not go on to develop an anxiety disorder. Fox, a developmental neuroscientist at the University of Maryland in College Park, has followed two similar study groups of his own for decades. The wary, reactive babies who manage to avoid becoming anxious adults don’t undergo a 180-degree temperament change, Fox says. “There is a core temperament in there. Our kids may not have a social anxiety disorder, but they’re not the captains of football teams, and they’re not the exuberant, outgoing [ones].”
That realization led researchers to focus on a key question: Is there a way to help shy, anxious kids become shy, well-adjusted adults?
Feeling the fear
Two months into Molly’s kindergarten year, her parents were growing desperate. They put their daughter in therapy, which was its own ordeal. “At the first therapy appointment, I couldn’t leave the room,” Rachel says. “She was hysterical.”
Molly slowly adjusted to visits to the therapist, who had her draw a “worry bully.” (Molly named him Otis.) If Molly was worried that people would laugh at her, Rachel says, the therapist would say things like, “Oh, you think Otis is going to laugh at you? But Otis doesn’t know that.” Transferring her fears to Otis let Molly label the source of her angst….
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