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Keywords:

  • Distress to novelty;
  • behavioural inhibition;
  • child temperament

Abstract

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. Introduction
  5. Method
  6. Potential covariates
  7. Results
  8. Discussion
  9. Limitations
  10. Clinical implications
  11. Acknowledgments
  12. References

Background:  Focusing on early identification of developmental risk factors, this study examined the question whether maternal report of child behaviour during early infancy is related to a laboratory measure of behavioural inhibition at 14 months of age.

Method:  A sample of 101 mother-infant pairs was recruited from local obstetric units. The Infant Behaviour Questionnaire (IBQ) was presented at 4 months postnatal age. Child behavioural inhibition was assessed at 14 months in a laboratory procedure.

Results:  Infant distress to novelty as measured by the IBQ at 4 months postnatal age was found to be associated with toddler’s fear score/behavioural inhibition at 14 months (p = .003). Distress-to-limitations subscore, smile/laughter subscore, activity subscore, and soothability subscore of the IBQ showed no correlation with behavioural inhibition.

Conclusions:  Behavioural inhibition, as a potential risk factor for childhood shyness and anxiety, can be predicted by maternal judgment of infant distress to novelty at age 4 months. The Infant Behaviour Questionnaire therefore might be used to identify infants presumably at risk for childhood anxiety disorders.


Key Practitioner Message:

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. Introduction
  5. Method
  6. Potential covariates
  7. Results
  8. Discussion
  9. Limitations
  10. Clinical implications
  11. Acknowledgments
  12. References
  • • 
    Childhood shyness can be predicted in early infancy
  • • 
    Predictive signs are crying to unfamiliar stimuli at four months of age (distress to novelty)
  • • 
    Distress to novelty can easily be assessed by questionnaire in maternal judgment

Introduction

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. Introduction
  5. Method
  6. Potential covariates
  7. Results
  8. Discussion
  9. Limitations
  10. Clinical implications
  11. Acknowledgments
  12. References

Behavioural inhibition has been defined as an inborn bias to respond to unfamiliar events with anxiety (Kagan, Reznick, & Gibbons, 1989). A body of evidence has emerged stating that extremely inhibited toddlers are likely to exhibit inhibition with peers in later childhood (e.g. Kagan, Reznick, & Snidman, 1987a, b; Kagan et al., 1989; Kochanska, 1997) and even adolescence (Schwartz et al., 1999). Also, inhibited children at 14 months have been shown to more often exhibit shy and withdrawn behaviour at age 3 and 4 and have a higher rate of social anxiety at age 7.5 and social phobia in adolescence (Biedermann et al., 1990, 1993; Hirshfeld et al., 1992; Kagan & Snidman, 1991; Rosenbaum et al., 1992). Fear or inhibition to unfamiliar events, people, and stimuli at 14 months can therefore be regarded as an important predictor for child and adolescent emotional development. Extreme inhibition at 14 months seems to put the child at risk for developing an internalising disorder in later childhood (Rubin et al., 1997).

To date, knowledge about the origins of these early and long-lasting behavioural differences is limited. A moderate association with specific sites on the glutamic acid decarboxylase gene has been shown to be linked to some degree with behavioural inhibition in mice (Smoller et al., 2001). Later, a modest relation between an allele of the CRH-linked (CRH means corticotropin-releasing hormone) locus and behavioural inhibition was observed by the same authors (Smoller et al., 2003).

Other findings support the view of behavioural inhibition as a dispositional trait: children with lower vagal tone tend to be more behaviourally inhibited (Kagan, 1982). Furthermore, infant cardiac sympathetic tone at 6 weeks of age was found to predict behavioural inhibition as early as 6 weeks. An association between foetal heart rate and behavioural inhibition has also been postulated (Kagan et al., 1994). In accordance with these findings, behaviourally inhibited children were found to display elevated levels of salivary cortisol. A right frontal EEG asymmetry has also been shown to be associated with inhibited behaviour (Kagan, Reznick, & Snidman, 1988). Furthermore, an association with hair (Moehler et al., 2006) and eye colour (Rosenberg & Kagan, 1989) has been reported, pointing to a biological component of behavioural inhibition, as assessed in a laboratory procedure. Thus laboratory assessment of behavioural inhibition has become an established tool to assess a dispositional vulnerability for shyness and anxiety in later life. However, with regard to prevention efforts, an easier tool to identify children at risk would be preferable. Therefore recent research has started to focus on parent report of behavioural inhibition. Bishop, Spence, & McDonald (2003) were able to show that parental report correlates with laboratory assessments of behavioural inhibition in a large Australian sample of 3- to 5-year-old children. However, to date no evidence has been presented about the ability of parent report measures to identify the predictors of behavioural inhibition in infancy, although the need for reliable and valid screening instruments for assessment of behavioural inhibition on a large-scale basis has repeatedly been stated (e.g. Bishop et al., 2003). Because easy identification of children at risk for anxiety disorders at an early stage would be crucial for prevention efforts, we examined the aptitude of a specific parent report measure of infant temperament to predict behavioural inhibition in the 2nd year of life. The Infant Behaviour Questionnaire (IBQ), as an established instrument assessing parent report of distress to novelty (Goldsmith & Rothbart, 1991), seemed suitable for this purpose.

The Infant Behaviour Questionnaire is a caregiver report measure designed to assess various aspects of infant temperament during the first year of life (Pauli-Pott, Mertesacker, & Beckmann, 1991). Aspects of temperament examined by the IBQ are distress to novelty, soothability, distress to limitations, motor activity, and smiling/laughter. Despite the good psychometric properties of the American and German versions of the instrument (see Goldsmith & Rothbart, 1991; Pauli-Pott et al., 1991) recent reports have given reason to doubt the validity of this parent report questionnaire, as it was demonstrated that maternal judgment of infant temperament was partly influenced by maternal psychopathology (Pauli-Pott, Mertesacker, & Beckmann, 2004). Nonetheless, in a sample of 37, longitudinal stability of parental judgment of infant temperament by IBQ from age 3 months to 6 years was demonstrated (Tomlinson, Harbaugh, & Anderson, 1996). Furthermore, convergence with IBQ subscales and independent concurrent observations of infant temperament has been reported previously (Pauli-Pott et al., 1999).

The question, whether distress to novelty as assessed by the IBQ in parental judgment is related to childhood behavioural inhibition remains unclear yet important, because screening tools that are applicable both very early and very easily are essential for efficient preventive strategies. Therefore, this study examined whether behavioural inhibition in the second year of life can be detected by the distress-to-novelty subscale of the IBQ as early as 4 months of age.

Method

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. Introduction
  5. Method
  6. Potential covariates
  7. Results
  8. Discussion
  9. Limitations
  10. Clinical implications
  11. Acknowledgments
  12. References

Participants

The study sample consisted of volunteers of healthy Caucasian mothers and their infants after singleton pregnancies, recruited in the four major local obstetric units, which attract a mixed urban and rural population. Eligibility criteria were full-term deliveries and infant weight above 2500 g; all Apgar Scores >7; and good health of the baby as documented by the first, second, and third postnatal examination. Exclusion criteria were inability to speak and read German language, acute maternal psychiatric disorder, as well as the use of drugs or medication posing a risk to the foetus and/or excessive smoking (>5 cigarettes/day) or alcohol consumption during pregnancy. Written informed consent was obtained from all participants. Only mothers of children fulfilling the inclusion criteria were approached.

Power calculation expecting medium sized effects had determined a sample size of 100 mother-infant pairs. Out of 342 mothers contacted, 114 finally decided to take part in the study, but 13 dropped out before study inclusion, so that 102 mother-infant pairs were included. One mother later decided not to continue with the study after the first assessment, so that 101 mother-infant pairs completed the study.

Study design

The subjects were seen in the laboratory when the infant was 2 weeks, 6 weeks, and 14 months of age. Socioeconomic status as well as pre- and perinatal data were documented at the first assessment, and infant health status was assessed at every visit. Medical pregnancy complications and maternal and paternal personality were assessed at 2 weeks postnatal age. The Infant Behaviour Questionnaire was filled in at 4 months. Behavioural inhibition was assessed in a laboratory procedure at 14 months. Mothers brought their infants to the laboratory during daytime, when the infants were alert, fed, and rested.

Measures

Infant Behaviour Questionnaire

We chose the IBQ to measure temperament because it emphasizes individual differences in discrete categories of temperament and shows good internal consistency and discriminate validity (Goldsmith, Rieser-Danner, & Briggs, 1991; Goldsmith & Rothbart, 1991). There is substantial evidence for external validity of the IBQ scales. They converged to a moderate degree with similar behaviours recorded during home observations (Rothbart, 1986). Moreover, conceptually related scales from other questionnaires converge with the IBQ. For example, maternal report on the IBQ distress-to-novelty scale correlated -.69 with the RITQ Approach Scale (Carey & McDevitt, 1978) and .61 with Bates’ Infant Characteristics Questionnaire Unadaptability Scale, two of the other widely used measures of infant fearfulness. Similar convergent validity correlations (-.73 and .76, respectively) emerged from corresponding teacher-report data (Goldsmith et al., 1991). Interrater reliability is good with coefficients between .91 and .96 (Lamb et al., 1983).

The IBQ assesses infant temperament in 78 items on five subscales. The questionnaire asks about frequency of certain behaviours in specific situations (diaper change, bath) during the preceding week in order to minimise the chance of distorted maternal perceptions to influence maternal judgment. The internal consistency and independence of the five scales in the German version of the questionnaire are satisfactory. The stability coefficients of the German version (between .89 and .92) correspond to a good degree with those of the American version of the IBQ scales (Pauli-Pott et al., 2004).

The subscale smiling/laughter consists of 13 items; the subscale distress to limitations has 15 items; the subscale distress to novelty consists of 13 items; and the subscale motor activity has 2 items. The soothability subscale consists of 9 items.

The full broad IBQ was used because of the assumption that inhibited children might show different aspects of atypical behaviour in infancy. Specificity of distress to novelty as a precursor for behavioural inhibition can only be shown if other subscales of the IBQ can be demonstrated not to predict behavioural inhibition at 14 months.

Behavioural inhibition at 14 months

Mothers and toddlers visited the laboratory during daytime, when the child was fed and rested. Behavioural inhibition was assessed according to the standardised procedures previously described (Kagan & Snidman, 1999). Each dyad entered an unfamiliar room containing a low table and one large and two small chairs. For each dyad the visit began with the measurement of the toddler’s ECG. Toddlers sat in a high chair and had three ECG electrodes placed on their chests.

For Trial 1 a large metal wheel was placed on a table directly in front of the child’s seat and rotated six times for 30 seconds, filled with an increasing number of rattling coloured objects (0, 1, 2, 3, 4, 0). For the next trial the child was asked to dip her/his finger in small cups containing water, red liquid, and black liquid. Trial 3 required the child to accept a drop of water, sweet liquid, and sour liquid on his or her tongue. After that two different rotating toys were placed in front of the child, with the examiner speaking in friendly and unfriendly syllables (ma pa ga in different voice modulations).

The next trial involved a second examiner entering the room, with a white coat and a face mask, placing herself at 30 cm in front of the child and speaking a short sentence to the child. Trial 5 consisted of a puppet theatre with a friendly and an unfriendly puppet mutually speaking to the child. Next, an unfamiliar woman entered the room. She sat quietly for 1 min, then (if the toddler had not yet approached) encouraged the child to join her in play. After a 3rd minute, she left, returning with a large toy robot that moved and made noise. The experimenter did not say anything for 30 seconds and then invited the child to play with the robot for 1 minute. For the last episode the experimenter returned with a dark cloth over head and shoulders, sitting quietly for 1 minute and then asking the child to join her. At the end a separation reunion procedure was conducted, with the mother leaving the room for 30 seconds and the examiner staying in the room, comforting the child if necessary. The whole procedure was videotaped.

Inhibition coding

The infant’s behaviour was rated by two coders independently observing the videotaped session. Both coders were trained according to the standardised coding procedures given by Kagan, 1994. Each child’s individual fear scores were composed of the sum of the frequency of following aspects of behaviour: failure to follow instruction for the finger-dunking and liquid-tasting episodes, failure to approach for the stranger episodes, and crying/fretting on each of the episodes. Fear scores ranged from 0 to 11, with a distribution skewed to the low normal spectrum and a mean of 3.1. Interrater reliability was good, with an intraclass-correlation of 0.92.

Potential covariates

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. Introduction
  5. Method
  6. Potential covariates
  7. Results
  8. Discussion
  9. Limitations
  10. Clinical implications
  11. Acknowledgments
  12. References

Maternal and paternal personality characteristics were assessed at 2 weeks by the NEO-FFI (Costa & McCrae, 1985; German version Borkenau & Ostendorf, 1989), a 60-item questionnaire assessing five dimensions of personality (extroversion, openness, conscientiousness, agreeableness, and neuroticism). Maternal psychopathology was measured via SCL 90-R (Derogatis, Lipman, & Covi, 1973; German version Franke, 1992), consisting of the scales somatisation, depression, compulsions, general anxiety, social anxiety, phobic anxiety, psychoticism, paranoia, hostility, and global severity index.

Symptoms of postnatal depression were assessed by the Edinburgh Postnatal Depression Scale. The Edinburgh-Postnatal-Depression-Scale (EPDS) (Bergant et al., 1998; Cox, Kolden, & Sagavosky, 1987) is a screening instrument for postnatal depression. It is an internationally accepted 10-item self-report measure of the specific symptomatology of postnatal depression. The analysis of the sensitivity and the specificity (Teissedre & Chabrol, 2004) of the Edinburgh Postnatal Depression Scale provides a cut-off score of 9 (Sensibility: 0.88, Specificity: 0.50) as predictive of postpartum depression. For this cut-off score, the type I error is low (5.8%) the type II error is higher (18.9%).

Results

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. Introduction
  5. Method
  6. Potential covariates
  7. Results
  8. Discussion
  9. Limitations
  10. Clinical implications
  11. Acknowledgments
  12. References

Sample

The women were between the ages of 19 and 45, (= 33.3 years). Mean infant weight was 3497 g, ranging from 2520 to 4500. Some 44.6% of the infants were girls; 51.5% were firstborn; 35.6% had 1 sibling; and 12.9% had 2 or more siblings. Some 55.5% of the mothers had at least a college degree; 19.8% a high school degree. All mothers were in a partnership with the infant’s father. This sample is representative of a small town with a large university and a high percentage of high income, high education families.

Covariates

Infant gender (= .28) or maternal education (= .9) had no relation to behavioural inhibition as assessed by ANOVA (see Table 1). The ‘Big Five’ Maternal (F (5,95 = .2, = .96) and paternal (F (5,93) = .8, = .2) personality characteristics also had no relation to child’s behavioural inhibition at 14 months as tested by Pearson Correlations.

Table 1.   Mean and SD of fear score for sociodemographic variables
 Fear scoren%p1
MeanSD
  1. 1p-value is the results of analysis of variance relating the fear score as dependent variable with sociodemographic categories

Gender
 Male2.952.195655.4.289
 Female3.422.274544.6
Maternal Education
 High school3.082.592524.6.910
 College3.352.342019.8
 University Degree3.122.045655.6
Number of siblings
 02.822.015251.5.300
 13.552.473635.6
 2 and more3.382.921312.9
Total sample3.162.23101100

Infant Behaviour Questionnaire

All 101 mothers completed all IBQ subscales. Concordant with the principal hypothesis of the study, the IBQ subscale, distress to novelty, at 4 months was significantly associated with toddler’s fear score at 14 months (F(3.90) = 2.87, = 0.29) (see Table 2). Because data have been presented relating maternal depression to maternal judgment of infant behaviour in the IBQ (Pauli-Pott et al., 2004), we analysed the relationship between maternal depression and the Infant Behaviour Questionnaire. Maternal depression as assessed by SCL90-R subscale depression (= 0.27, = 0.006) and EPDS (= 0.21, = .03) was found to be significantly associated with the IBQ distress-to-novelty subscale. The distress-to-limitations, smiling/laughter, motor activity and soothability–dimensions of the Infant Behaviour Questionnaire were not related to maternal psychopathology. This should have been the case if maternal depression led to a generally distorted perception of the child in a more negative way. Nevertheless, when regression analysis between fear score as the dependent variable and distress to novelty (IBQ), depression assessed by EPDS and depression assessed by SCL-90-R as the predictor variables was performed, relationship between fear score and depression was not influenced by maternal depression.

Table 2. Means and SD of IBQ scales and their correlation with children’s fear score
Infant Behaviour QuestionnaireMeanSDr1p2
  1. 1correlation coefficient

  2. 2p-values are the results of correlation analysis relating the fear score as dependent variable

Smiling/laughter4.020.96−0.002.980
Distress to limitations2.680.740.097.330
Distress to novelty2.240.620.299.003
Soothability4.670.88−0.121.228
Motor activity2.640.78−0.052.601

Discussion

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. Introduction
  5. Method
  6. Potential covariates
  7. Results
  8. Discussion
  9. Limitations
  10. Clinical implications
  11. Acknowledgments
  12. References

The data presented above indicate an association between maternal judgment of infant distress to novelty in the first year of life and behavioural inhibition assessed in a laboratory procedure in toddlerhood. The following conclusions might be drawn from this result:

  • 1
    Because this effect was not mediated by maternal personality or education or infant gender it might be postulated that maternal judgment of infant temperament with the Infant Behaviour Questionnaire seems to be an appropriate measure with regard to the detection of early signs of distress to novelty.
  • 2
    Because stability of the IBQ has previously been demonstrated (see above), this finding underlines the validity of the questionnaire within the broader context of childhood anxiety disposition.

Recent findings (Pauli-Pott, Mertesacker, & Beckmann, 2003) indicate that maternal judgment of infant temperament by the IBQ is influenced by maternal psychopathology, and therefore its accuracy in assessing true temperamental dimensions might be limited. Nonetheless, Pauli-Pott et al. (2003) provide evidence for accuracy of maternal judgement of infant distress to novelty in this longitudinal study. The association between maternal depression and IBQ distress-to-novelty scale was detected in our study, replicating the findings cited above (Pauli-Pott et al., 2003).

The findings of this study support the validity of the IBQ as a screening instrument for children at risk: maternal psychopathology and depression were associated only with the distress-to-novelty subscale, not with the other subscores of the IBQ. Distortion of maternal perception therefore is not likely to be the mechanism behind the association of maternal depression and maternal report of infant distress to novelty, as in the case of perceptive distortion the infant would probably appear more negative in other subscales of the IBQ. Furthermore, even when considering maternal depression as a covariate, the relationship between the distress-to-novelty subscale and the infant’s fear score remained unchanged. These data indicate that mothers of a community sample seem to be able to detect their infant’s distress to novelty at an early stage and that these judgments correspond to laboratory assessments of distress to novelty 10 months later.

Distress to novelty or behavioural inhibition is an established predictor for anxiety proneness during later childhood (Biedermann et al., 1990, 1993; Hirshfeld et al., 1992; Kagan & Snidman, 1999; Rosenbaum et al., 1992). Therefore these data provide evidence for the aptitude of the distress-to-novelty IBQ subscale as an early screening tool to identify infants at risk for developing anxiety disorders. This instrument is easily accepted by parents and caregivers and with only 13 items is conveniently short in application. Mifsud and Rapee (2005) demonstrate the effectiveness of early prevention and intervention programs in a sample of disadvantaged preschool children. However, Rapee et al. (2005) showed that underlying behavioural inhibition is unchanged by early prevention efforts; the factor that seems to be the most susceptible to early intervention is the manifestation of anxiety disorders. Thereby, while it might not be possible to modify behavioural inhibition as a temperamental trait, prevention efforts might still be able to lower the risk of an inhibited child to develop an anxiety disorder.

Moreover, prevention programmes in early infancy might differ from those applied in preschool age or later childhood, as infancy is a period of heightened cerebral plasticity (Schore, 2003). Therefore detection of inhibition in a time window as early as the fourth month of life might open up possibilities of even more effective prevention than preschool programmes, e.g. by modifying infants’ environments; day care or other stimulating surroundings provide possibilities of habituation to novelty, thereby reducing the disposition of distress to novelty.

Limitations

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. Introduction
  5. Method
  6. Potential covariates
  7. Results
  8. Discussion
  9. Limitations
  10. Clinical implications
  11. Acknowledgments
  12. References

The study sample was community based. Therefore this study does not permit conclusions about clinical populations, because judgement of infant temperament might be distorted by more severe parental psychopathology. This study also does not permit statements about a genetic or environmental influence on infant behaviour.

Clinical implications

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. Introduction
  5. Method
  6. Potential covariates
  7. Results
  8. Discussion
  9. Limitations
  10. Clinical implications
  11. Acknowledgments
  12. References

High scores on the distress-to-novelty scale imply a risk for later behavioural inhibition according to the data presented above. With behavioural inhibition being a relatively stable personality trait that puts children at risk for anxiety disorder, early tools for intervention are highly important in order to prevent childhood emotional disorders. These data might justify usage of the distress-to-novelty IBQ subscale, for the routine postnatal examinations at 3 to 4 months postnatal Cerebral plasticity in the first year of life is high (Hershkowitz, Kagan, & Zilles, 1997; Schore, 1994); therefore preventive interventions should be most effective when targeting infants. These data support the application of the Infant Behaviour Questionnaire as a screening tool of high efficiency in order to identify children at risk for psychopathology at a very early stage.

Acknowledgments

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. Introduction
  5. Method
  6. Potential covariates
  7. Results
  8. Discussion
  9. Limitations
  10. Clinical implications
  11. Acknowledgments
  12. References

We thank the participating obstetric hospitals and Professor Kagan for their support. We also thank Oliver Moehler for his help in establishing the experimental procedures. The research was funded by the German Research Foundation (DFG).

References

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. Introduction
  5. Method
  6. Potential covariates
  7. Results
  8. Discussion
  9. Limitations
  10. Clinical implications
  11. Acknowledgments
  12. References
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