Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands.
J Child Psychol Psychiatry. 2020 Dec;61(12):1339-1348. doi: 10.1111/jcpp.13221. Epub 2020 Feb 20.
Self-conscious emotional reactivity and its physiological marker - blushing has been proposed to be an etiological mechanism of social anxiety disorder (SAD), but so far, untested in longitudinal designs. This study tested, for the first time, whether self-conscious emotional reactivity (indexed as physiological blushing) contributes to the development of SAD symptoms over and above social behavioral inhibition (BI), which has been identified as the strongest predictor of SAD development in early childhood.
One hundred fifteen children (45% boys) and their mothers and fathers participated at ages 2.5, 4.5, and 7.5 years. Social BI was observed at all time points in a stranger approach task, and physiological blushing (blood volume, blood pulse amplitude, and temperature increases) was measured during a public performance (singing) and watching back the performance at ages 4.5 and 7.5. Child early social anxiety was reported by both parents at 4.5 years, and SAD symptoms were diagnosed by clinicians and reported by both parents at 7.5 years.
Higher social BI at 2.5 and 4.5 years predicted greater social anxiety at 4.5 years, which, in turn, predicted SAD symptoms at 7.5 years. Blushing (temperature increase) at 4.5 years predicted SAD symptoms at 7.5 years over and above the influence of social BI and early social anxiety.
That blushing uniquely contributes to the development of SAD symptoms over and above social BI suggests two pathways to childhood SAD: one that entails early high social BI and an early onset of social anxiety symptoms, and the other that consists of heightened self-conscious emotional reactivity (i.e. blushing) in early childhood.
自我意识情绪反应及其生理标志物——脸红，被认为是社交焦虑障碍（SAD）的发病机制，但迄今为止，这一机制还没有在纵向设计中得到验证。本研究首次测试了自我意识情绪反应（以生理脸红为指标）是否会导致 SAD 症状的发展，而社交行为抑制（BI）已被确定为儿童早期 SAD 发展的最强预测因素。
115 名儿童（45%为男孩）及其父母在 2.5、4.5 和 7.5 岁时参与了研究。在陌生人接近任务中观察到所有时间点的社交 BI，在 4.5 和 7.5 岁时进行公开表演（唱歌）和观看表演时测量生理脸红（血流量、脉搏幅度和温度升高）。父母在 4.5 岁时报告了儿童早期社交焦虑，临床医生在 7.5 岁时报告并由父母报告了 SAD 症状。
2.5 岁和 4.5 岁时的社交 BI 越高，4.5 岁时的社交焦虑程度越高，而 4.5 岁时的社交焦虑程度又预测了 7.5 岁时的 SAD 症状。4.5 岁时的脸红（温度升高）在考虑到社交 BI 和早期社交焦虑的影响之外，还预测了 7.5 岁时的 SAD 症状。
脸红在社交 BI 之外，独特地预测了 SAD 症状的发展，这表明了儿童 SAD 的两种发展途径：一种是早期高社交 BI 和早期出现社交焦虑症状，另一种是儿童早期的自我意识情绪反应（即脸红）增强。
