Beyond behavioral inhibition: etiological factors in childhood anxiety

Theoretical models of childhood anxiety have emphasized temperamental vulnerability, principally behavioral inhibition, and its interaction with various environmental factors promoting anxiety (for example, overprotective parenting, insecure attachment, life stress). Although clearly establishing the importance of both nature and nurture in anxious psychopathology, these models have not adequately explained the diversity of anxiety disorders presenting in childhood, the fact that some children's diagnoses change over time, and the progression (in some children) from highly comorbid presentations in middle childhood to one predominant disorder in adolescence. This article presents additional factors that may be helpful to consider when trying to understand these findings and describes applications to promote healthy adjustment in anxious youngsters. Such factors include specific risks for certain disorders, developmental changes and cultural factors affecting the intensity and expression of anxiety, and the emergence of various more or less adaptive coping styles.