A developmental approach to fear, worry and rituals among typically developing children

Abstract

The aim of the studies reported in this thesis was to take a developmental psycho-pathological approach to fear, worry and ritualistic behaviour in typical childhood. The first study examined developmental trends in, and interrelations between, fear, worry and ritualistic behaviour in childhood and adolescence. Content and intensity of fear, worry and ritualistic behaviour were assessed through a semi-structured interview administered to 142 typically developing children aged 7 to 16 years. In line with predictions, fear, worry and ritualistic behaviour decreased in intensity with age, although this decline was only significant between 7 and 10 years. Worry was found to be a particularly strong predictor of ritualistic behaviour across this age range. The second study followed up a sub-sample of these participants (N=80) in examining children's cognitive appraisals of anxiety-related thoughts, and showed predictable age-related decreases in strength of appraisals forethought-Action Fusion and Intolerance of Uncertainty, but not Responsibility. In support of the cognitive model of OCD, the previously observed relation between worry and ritualistic behaviour was mediated by biased cognitive appraisals, particularly Intolerance of Uncertainty. In the third study, a separate sample of 83 typically developing children aged 11 to 16 years reported on fear, worry and ritualistic behaviour, and also completed tasks designed to assess executive functioning in the orbitofrontal ('hot') and dorsolateral ('cool') neural systems. Predicted patterns of impaired 'hot' task performance combined with intact 'cool' task performance in high-anxiety participants were not observed, suggesting that characterisations of OCD in these terms may not apply to anxiety in typical childhood. Against prediction, performance was not impaired when personally salient versions of the orbitofrontal tasks were presented. However, there was a trend towards high levels of ritualistic behaviour being associated with impaired orbitofrontal task performance in the salience manipulation condition in boys only. Taken together, these studies demonstrate the value of taking a developmental psychopathological approach to anxiety processes in typical childhood. Theoretical considerations and implications for future research are discussed.