Developmental Pathways from Early Behavioral Inhibition to Later Anxiety: An Integrative Review of Developmental Psychopathology Research and Translational Implications

Anxiety is among the most prevalent, early emerging, and detrimental mental conditions for children and adolescents. As with most psychiatric disorders, prevention and intervention efforts are most effective when the early etiology of the disorder is well understood from a developmental perspective. To illustrate this point, this article reviews the developmental psychopathology research in youth anxiety, with a focus on a prominent temperamental risk for anxiety, behavioral inhibition. This review underscores three systems that may act as mechanisms with behavioral inhibition in conferring risks for anxiety: neural, cognitive, and environmental. Based on findings from these systems, a developmental model is proposed to illustrate the multi-determined pathways from early behavioral inhibition to anxiety, which often is most acute in adolescence. This article further discusses several translational directions for developing targeted prevention/intervention tools. As emphasized in this review, understanding the early mechanisms of youth anxiety can help health practitioners target specific constructs that predispose individuals at risk, capturing developmental time windows that are more malleable for prevention/intervention, and identify bio-behavioral indicators that predict illness trajectories and treatment effects. This article provides an integrative summary of the literature and sheds light on future work of both mechanistic investigations and clinical practices for anxiety in youth and adolescents.