Journal of Abnormal Child Psychology

, Volume 46, Issue 6, pp 1309–1319 | Cite as

Trajectories of Social Anxiety in Children: Influence of Child Cortisol Reactivity and Parental Social Anxiety

  • Kristie L. PooleEmail author
  • Ryan J. Van Lieshout
  • Angela E. McHolm
  • Charles E. Cunningham
  • Louis A. Schmidt


Few studies have examined the interactive effect of intra- and extra-individual vulnerability factors on the trajectory of social anxiety in children. In this study, we examined the joint influence of familial vulnerability (i.e., parental social anxiety) and child biological stress vulnerability (i.e., cortisol reactivity) on trajectories of social anxiety. Children (N = 112 (57 males), M age = 8.14 years, S.D. = 2.25) were followed over three visits spanning approximately three years. Parental social anxiety was assessed using the Social Phobia and Anxiety Inventory, children’s behavior and salivary cortisol reactivity were measured in response to a speech task, and children’s social anxiety was assessed at all three visits using the Screen for Child Related Emotional Disorders (SCARED; Parent-report). A growth curve analysis was used to examine trajectories of child social anxiety as predicted by children’s cortisol reactivity and parental social anxiety, adjusting for covariates. We found a significant interaction between parental social anxiety and child cortisol reactivity in predicting child social anxiety across time. Having a socially anxious parent coupled with heightened cortisol reactivity predicted the highest levels of child social anxiety, with scores that remained above clinically significant levels for social anxiety across all visits. Children with familial risk for social anxiety and who also exhibit high stress-reactivity appear to be at risk for persistent, clinically significant social anxiety. This highlights the importance of considering the interaction between both biological and contextual factors when considering the development, maintenance, and treatment of social anxiety in children across time.


Developmental psychopathology Anxiety Longitudinal studies Shyness Phobias 



This research was supported by an Ontario Graduate Scholarship (OGS) and a Canadian Institutes of Health Research (CIHR) Doctoral Award awarded to KLP, and operating grants from the Ontario Mental Health Foundation (OMHF) Grant awarded to CEC and from the Natural Sciences and Engineering Research Council of Canada (NSERC) and the Social Sciences and Humanities Research Council of Canada (SSHRC) awarded to LAS. CEC’s participation was supported by the Jack Laidlaw Chair in Patient-Centred Health Care. We would like to thank the many children and their primary caregivers for their participation in the study. We would also like to thank Lindsay Bennett, Diana Carbone, Sue McKee, Renee Nossal, and Matilda Nowakowski for their help with data collection and coordinating the visits, and Alexander Greenberg, Annie Mills, Jhanahan Sriranjan, and Anna Swain for their assistance with video coding.

Compliance with Ethical Standards

Conflict of Interest

Dr. Charles Cunningham developed the Brief Child and Family Phone Interview (BCFPI) used in the present study.

Ethical Approval

All procedures were approved by the Hamilton Integrated Research Ethics Board.

Informed Consent

Parental consent and child assent were received from all participants.


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  2. Beesdo-Baum, K., Knappe, S., Fehm, L., Höfler, M., Lieb, R., Hofmann, S. G., & Wittchen, H. (2012). The natural course of social anxiety disorder among adolescents and young adults. Acta Psychiatrica Scandinavica, 126, 411–425.CrossRefPubMedGoogle Scholar
  3. Beidel, D. C., & Turner, S. M. (2007). Clinical presentation of social anxiety disorder in children and adolescents. In D. C. Beidel & S. M. Turner (Eds.), Shy children, phobic adults: Nature and treatment of social anxiety disorders (2nd ed., pp. 47–80). Washington, DC: American Psychological Association.Google Scholar
  4. Beidel, D. C., Borden, J. W., Turner, S. M., & Jacob, R. G. (1989). The social phobia and anxiety inventory: Concurrent validity with a clinical sample. Behaviour Research and Therapy, 27, 573–576.CrossRefPubMedGoogle Scholar
  5. Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., et al. (1997). The screen for child anxiety related emotional disorders (SCARED): Scale construction and psycho- metric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 545–553.CrossRefPubMedGoogle Scholar
  6. Broeren, S., Muris, P., Diamantopoulou, S., & Baker, J. R. (2013). The course of childhood anxiety symptoms: Developmental trajectories and child-related factors in normal children. Journal of Abnormal Child Psychology, 41, 81–95.CrossRefPubMedGoogle Scholar
  7. Buckner, J. D., & Turner, R. J. (2009). Social anxiety disorder as a risk factor for alcohol use disorders: a prospective examination of parental and peer influences. Drug and Alcohol Dependence, 100, 128–137.Google Scholar
  8. Buckner, J. D., Timpano, K. R., Zvolensky, M. J., Sachs‐Ericsson, N., & Schmidt, N. B. (2008). Implications of comorbid alcohol dependence among individuals with social anxiety disorder. Depression and Anxiety, 25, 1028–1037.Google Scholar
  9. Budinger, M. C., Drazdowski, T. K., & Ginsburg, G. S. (2013). Anxiety-promoting parenting behaviors: A comparison of anxious parents with and without social anxiety disorder. Child Psychiatry and Human Development, 44, 412–418.CrossRefPubMedCentralGoogle Scholar
  10. Bunnell, B. E., Joseph, D. L., & Beidel, D. C. (2013). Measurement invariance of the social phobia and anxiety inventory. Journal of Anxiety Disorders, 27, 84–91.CrossRefPubMedGoogle Scholar
  11. Chronis-Tuscano, A., Degnan, K. A., Pine, D. S., Perez-Edgar, K., Henderson, H. A., Diaz, Y., et al. (2009). Stable early maternal report of behavioral inhibition predicts lifetime social anxiety disorder in adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 48, 928–935.CrossRefGoogle Scholar
  12. Cicchetti, D. (1989). Developmental psychopathology: Past, present, and future. In D. Cicchetti (Ed.), The Emergence of a Discipline: The Rochester Symposium on Developmental Psychopathology (Vol. 1, pp. 1–12). Hillsdale: Lawrence Erlbaum Associates.Google Scholar
  13. Cicchetti, D. (1993). Fractures in the crystal: Developmental psychopathology and the emergence of the self. Developmental Review, 11, 271–287.CrossRefGoogle Scholar
  14. Clauss, J. A., & Blackford, J. U. (2012). Behavioral inhibition and risk for developing social anxiety disorder: A meta-analytic study. Journal of the American Academy of Child & Adolescent Psychiatry, 51, 1066–1075.CrossRefGoogle Scholar
  15. Cunningham, C. E., Boyle, M. H., Hong, S., Pettingill, P., & Bohaychuck, D. (2009). The brief child and family phone interview (BCFPI): 1. Rationale, development, and description of a computerized children’s mental health intake and outcome assessment tool. Journal of Child Psychology and Psychiatry, 50, 416–523.CrossRefPubMedGoogle Scholar
  16. Del Piero, L. B., Saxbe, D. E., & Margolin, G. (2016). Basic emotion processing and the adolescent brain: Task demands, analytic approaches, and trajectories of changes. Developmental Cognitive Neuroscience, 19, 174–189.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Delucia, C., & Pitts, S. C. (2006). Applications of individual growth curve modeling for pediatric psychology research. Journal of Pediatric Psychology, 31, 1002–1023.CrossRefPubMedGoogle Scholar
  18. Ferro, M. A. (2014). Missing data in longitudinal studies: Cross-sectional multiple imputation provides similar estimates to full-information maximum likelihood. Annals of Epidemiology, 24, 75–77.CrossRefPubMedGoogle Scholar
  19. Fox, N. A., Rubin, K. H., Calkins, S. D., Marshall, T. R., Coplan, R. J., Porges, S. W., & Long, J. (1995). Frontal activation asymmetry and social competence at four years of age: Left frontal hyper and hypo activation as correlates of social behavior in preschool children. Child Development, 66, 1770–1786.CrossRefPubMedGoogle Scholar
  20. Ginsburg, G. S., Drake, K. L., Tein, J. Y., Teetsel, R., & Riddle, M. A. (2015). Preventing onset of anxiety disorders in offspring of anxious parents: A randomized controlled trial of a family-based intervention. American Journal of Psychiatry, 172, 1207–1214.CrossRefPubMedGoogle Scholar
  21. Goldsmith, H.H., Reilly, J., Lemery, K.S., Longley, L., Prescott, A. (1993). The Laboratory Temperament Assessment Battery. (Technical Manual) University of Wisconsin: Madison.Google Scholar
  22. Graham, J. W. (2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology, 60, 549–576.CrossRefPubMedGoogle Scholar
  23. Granger, D. A., Weisz, J. R., & Kauneckis, D. (1994). Neuroendocrine reactivity, internalizing behavior problems, and control-related cognitions in clinic-referred children and adolescents. Journal of Abnormal Psychology, 103, 267–276.CrossRefPubMedGoogle Scholar
  24. Gunnar, M. R., & Talge, N. M. (2008). Neuroendocrine measures in developmental research. In L. A. Schmidt & S. J. Segalowitz (Eds.), Developmental psychophysiology: Theory, systems, & applications (pp. 343–364). New York: Cambridge University Press.Google Scholar
  25. Gunnar, M. R., Talge, N. M., & Herrera, A. (2009a). Stressor paradigms in developmental studies: What does and does not work to produce mean increases in salivary cortisol. Psychoneuroendocrinology, 34, 953–967.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Gunnar, M. R., Wewerka, S., Frenn, K., Long, J. D., & Griggs, C. (2009b). Developmental changes in hypothalamus-pituitary-adrenal activity over the transition to adolescence: Normative changes and association with puberty. Development and Psychopathology, 21, 69–85.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Hale, W. W., Raaijmakers, Q., Muris, P., & Meeus, W. I. M. (2005). Psychometric properties of the screen for child anxiety related emotional disorders (SCARED) in the general adolescent population. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 283–290.CrossRefGoogle Scholar
  28. Hale, W. W., Raaijmakers, Q., Muris, P., & Meeus, W. (2008). Developmental trajectories of adolescent anxiety disorder symptoms: A 5-year prospective community study. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 556–564.CrossRefGoogle Scholar
  29. Hale, W. W., Raaijmakers, Q. A., García-López, L. J., Espinosa-Fernández, L., Muela, J. A., & del Mar Díaz-Castela, M. (2013). Psychometric properties of the screen for child anxiety related emotional disorders for socially anxious and healthy Spanish adolescents. The Spanish Journal of Psychology, 16, 1–7.CrossRefGoogle Scholar
  30. Hallgren, K. A. (2012). Computing inter-rater reliability for observational data: An overview and tutorial. Tutorial in Quantitative Methods for Psychology, 8, 23–34.CrossRefGoogle Scholar
  31. Herbert, J. D., Bellack, A. S., & Hope, D. A. (1991). Concurrent validity of social phobia and anxiety inventory. Journal of Psychopathology and Behavioral Assessment, 13, 357–368.CrossRefGoogle Scholar
  32. Kagan, J., Reznick, J. S., & Snidman, N. (1987). The physiology and psychology of behavioral inhibition in children. Child Development, 58, 1459–1473.CrossRefPubMedGoogle Scholar
  33. Khoury, J. E., Gonzalez, A., Levitan, R. D., Pruessner, J. C., Chopra, K., Santo Basile, V., et al. (2015). Summary cortisol reactivity indicators: Interrelations and meaning. Neurobiology of Stress, 2, 34–43.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Kirschbaum, C., & Hellhammer, D. H. (1994). Salivary cortisol in psychoneuroendocrine research: Recent developments and applications. Psychoneuroendocrinology, 19, 313–333.CrossRefPubMedGoogle Scholar
  35. Lewis, M. (1990). Models of developmental psychopathology. In M. Lewis & S. M. Miller (Eds.), Handbook of developmental psychopathology (pp. 15–27). New York: Plenum Press.CrossRefGoogle Scholar
  36. Lieb, R., Wittchen, H. U., Höfler, M., Fuetsch, M., Stein, M. B., & Merikangas, K. R. (2000). Parental psychopathology, parenting styles, and the risk of social phobia in offspring: A prospective-longitudinal community study. Archives of General Psychiatry, 57, 859–866.CrossRefPubMedGoogle Scholar
  37. Mancini, C., Van Ameringen, M., Szatmari, P., Fugere, C., & Boyle, M. (1996). A high-risk pilot study of the children of adults with social phobia. Journal of the American Academy of Child & Adolescent Psychiatry, 35, 1511–1517.Google Scholar
  38. Marmorstein, N. R., White, H., Chung, T., Hipwell, A., Stouthamer-Loeber, M., & Loeber, R. (2010). Associations between first use of substances and change in internalizing symptoms among girls: Differences by symptom trajectory and substance use type. Journal of Clinical Child & Adolescent Psychology, 39, 545–558.CrossRefGoogle Scholar
  39. Merikangas, K. R., Lieb, R., Wittchen, H. U., & Avenevoli, S. (2003). Family and high-risk studies of social anxiety disorder. Acta Psychiatrica Scandinavica, 108, 28–37.CrossRefGoogle Scholar
  40. Miers, A. C., Blöte, A. W., De Rooij, M., Bokhorst, C. L., & Westenberg, P. M. (2013). Trajectories of social anxiety during adolescence and relations with cognition, social competence, and temperament. Journal of Abnormal Child Psychology, 41, 97–110.CrossRefPubMedGoogle Scholar
  41. Monga, S., Birmaher, B., Chiappetta, L., Brent, D., Kaufman, J., Bridge, J., & Cully, M. (2000). Screen for child anxiety-related emotional disorders (SCARED): Convergent and divergent validity. Depression and Anxiety, 12, 85–91.CrossRefPubMedGoogle Scholar
  42. Murray, L., De Rosnay, M., Pearson, J., Bergeron, C., Schofield, E., Royal‐Lawson, M., & Cooper, P. J. (2008). Intergenerational transmission of social anxiety: the role of social referencing processes in infancy. Child Development, 79, 1049–1064.Google Scholar
  43. Newman, D. A. (2003). Longitudinal modeling with randomly and systematically missing data: A simulation of ad hoc, maximum likelihood, and multiple imputation techniques. Organizational Research Methods, 6, 328–362.CrossRefGoogle Scholar
  44. Ollendick, T. H., & Benoit, K. E. (2012). A parent–child interactional model of social anxiety disorder in youth. Clinical Child and Family Psychology Review, 15, 81–91.CrossRefPubMedGoogle Scholar
  45. Ollendick, T. H., & Hirshfeld-Becker, D. R. (2002). The developmental psychopathology of social anxiety disorder. Biological Psychiatry, 51, 44–58.CrossRefPubMedGoogle Scholar
  46. Osman, A., Barrios, F. X., Haupt, D., King, K., Osman, J. R., & Slavens, S. (1996). The social phobia and anxiety inventory: Further validation in two nonclinical samples. Journal of Psychopathology and Behavioral Assessment, 18, 35–47.CrossRefGoogle Scholar
  47. Peters, L. (2000). Discriminant validity of the social phobia and anxiety inventory (SPAI), the social phobia scale (SPS) and the social interaction anxiety scale (SIAS). Behaviour Research and Therapy, 38, 943–950.CrossRefPubMedGoogle Scholar
  48. Pine, D. S., Cohen, P., Gurley, D., Brook, J., & Ma, Y. (1998). The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry, 55, 56–64.CrossRefPubMedGoogle Scholar
  49. Posener, J. A., Schildkraut, J. J., Samson, J. A., & Schatzberg, A. F. (1996). Diurnal variation of plasma cortisol and homovanillic acid in healthy subjects. Psychoneuroendocrinology, 21, 33–38.CrossRefPubMedGoogle Scholar
  50. Rao, P. A., Beidel, D. C., Turner, S. M., Ammerman, R. T., Crosby, L. E., & Sallee, F. R. (2007). Social anxiety disorder in childhood and adolescence: Descriptive psychopathology. Behaviour Research and Therapy, 45, 1181–1191.CrossRefPubMedGoogle Scholar
  51. Rodebaugh, T. L., Chambless, D. L., Terrill, D. R., Floyd, M., & Uhde, T. (2000). Convergent, discriminant, and criterion-related validity of the social phobia and anxiety inventory. Depression and Anxiety, 11, 10–14.CrossRefPubMedGoogle Scholar
  52. Schiefelbein, V. L., & Susman, E. J. (2006). Cortisol levels and longitudinal cortisol change as predictors of anxiety in adolescents. Journal of Early Adolescence, 26, 397–413.CrossRefGoogle Scholar
  53. Schmidt, L. A., & Miskovic, V. (2013). A new perspective on temperamental shyness: Differential susceptibility to endoevironmental influences. Social and Personality Psychology Compass, 7, 141–157.CrossRefGoogle Scholar
  54. Schmidt, L. A., Fox, N. A., Rubin, K. H., Sternberg, E. M., Gold, P. W., Smith, C. C., & Schulkin, J. (1997). Behavioral and neuroendocrine responses in shy children. Developmental Psychobiology, 30, 127–140.CrossRefPubMedGoogle Scholar
  55. Schulkin, J., Morgan, M. A., & Rosen, J. B. (2005). A neuroendocrine mechanism for sustaining fear. TRENDS Neuroscience, 28, 629–635.CrossRefGoogle Scholar
  56. Spence, S. H., & Rapee, R. M. (2016). The etiology of social anxiety disorder: An evidence-based model. Behaviour Research and Therapy, 86, 50–67.CrossRefPubMedGoogle Scholar
  57. Theall-Honey, L. A., & Schmidt, L. A. (2006). Do temperamentally shy children process emotion differently than nonshy children? Behavioral, psychophysiological, and gender differences in reticent preschoolers. Developmental Psychobiology, 48, 187–196.CrossRefPubMedGoogle Scholar
  58. Turner, S. M., Beidel, D. C., Dancu, C. V., & Stanley, M. A. (1989a). An empirically derived inventory to measure social fears and anxiety: The social phobia and anxiety inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychopathology, 1, 35–40.CrossRefGoogle Scholar
  59. Turner, S. M., Stanley, M. A., Beidel, D. C., & Bond, L. (1989b). The social phobia and anxiety inventory: Construct validity. Journal of Psychopathology and Behavioral Assessment, 11, 221–234.CrossRefGoogle Scholar
  60. Turner, S. M., Beidel, D. C., & Dancu, C. V. (1996). Social phobia and anxiety inventory manual. Toronto: Multi-Health Systems Inc.Google Scholar
  61. van den Bos, E., Rooij, M., Miers, A. C., Bokhorst, C. L., & Westenberg, P. M. (2014). Adolescents' increasing stress response to social evaluation: Pubertal effects on cortisol and alpha-amylase during public speaking. Child Development, 85, 220–236.CrossRefPubMedGoogle Scholar
  62. van den Bos, E., Tops, M., & Westenberg, P. M. (2017). Social anxiety and the cortisol response to social evaluation in children and adolescents. Psychoneuroendocrinology, 78, 159–167.CrossRefPubMedGoogle Scholar
  63. Van West, D., Claes, S., Sulon, J., & Deboutte, D. (2008). Hypothalamic-pituitary-adrenal reactivity in prepubertal children with social phobia. Journal of Affective Disorders, 111, 281–290.CrossRefPubMedGoogle Scholar
  64. Walker, R. F. (1984). Salivary cortisol determinations in the assessment of adrenal activity. In D. B. Ferguson (Ed.), Steroid hormones in saliva (pp. 33–50). Basel: Karger.Google Scholar
  65. Wittchen, H. U., & Fehm, L. (2003). Epidemiology and natural course of social fears and social phobia. Acta Psychiatrica Scandinavica, 417, 4–18.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of Psychology, Neuroscience & BehaviourMcMaster UniversityHamiltonCanada
  2. 2.Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonCanada

Personalised recommendations