Levels of early-childhood behavioral inhibition predict distinct neurodevelopmental pathways to pediatric anxiety

Rany Abend, Caroline Swetlitz, Lauren K. White, Tomer Shechner, Yair Bar-Haim, Courtney Filippi, Katharina Kircanski, Simone P. Haller, Brenda E. Benson, Gang Chen, Ellen Leibenluft, Nathan A. Fox, Daniel S. Pine

Research output: Contribution to journalArticlepeer-review


Background Anxiety symptoms gradually emerge during childhood and adolescence. Individual differences in behavioral inhibition (BI), an early-childhood temperament, may shape developmental paths through which these symptoms arise. Cross-sectional research suggests that level of early-childhood BI moderates associations between later anxiety symptoms and threat-related amygdala-prefrontal cortex (PFC) circuitry function. However, no study has characterized these associations longitudinally. Here, we tested whether level of early-childhood BI predicts distinct evolving associations between amygdala-PFC function and anxiety symptoms across development.Methods Eighty-seven children previously assessed for BI level in early childhood provided data at ages 10 and/or 13 years, consisting of assessments of anxiety and an fMRI-based dot-probe task (including threat, happy, and neutral stimuli). Using linear-mixed-effects models, we investigated longitudinal changes in associations between anxiety symptoms and threat-related amygdala-PFC connectivity, as a function of early-childhood BI.Results In children with a history of high early-childhood BI, anxiety symptoms became, with age, more negatively associated with right amygdala-left dorsolateral-PFC connectivity when attention was to be maintained on threat. In contrast, with age, low-BI children showed an increasingly positive anxiety-connectivity association during the same task condition. Behaviorally, at age 10, anxiety symptoms did not relate to fluctuations in attention bias (attention bias variability, ABV) in either group; by age 13, low-BI children showed a negative anxiety-ABV association, whereas high-BI children showed a positive anxiety-ABV association.Conclusions Early-childhood BI levels predict distinct neurodevelopmental pathways to pediatric anxiety symptoms. These pathways involve distinct relations among brain function, behavior, and anxiety symptoms, which may inform diagnosis and treatment.

Original languageEnglish
Pages (from-to)96-106
Number of pages11
JournalPsychological Medicine
Issue number1
StatePublished - 1 Jan 2020

Bibliographical note

Publisher Copyright:
Copyright © Cambridge University Press 2019.


  • Amygdala
  • anxiety
  • attention
  • behavioral inhibition
  • children
  • connectivity
  • developmental
  • fMRI
  • prefrontal cortex

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology


Dive into the research topics of 'Levels of early-childhood behavioral inhibition predict distinct neurodevelopmental pathways to pediatric anxiety'. Together they form a unique fingerprint.

Cite this