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J Abnorm Child Psychol (2006) 34:799–812

DOI 10.1007/s10802-006-9079-y


The Interactive Role of Anxiety Sensitivity and Pubertal Status
in Predicting Anxious Responding to Bodily Sensations among
Ellen W. Leen-Feldner · Laura E. Reardon ·
Laura G. McKee · Matthew T. Feldner ·
Kimberly A. Babson · Michael J. J. Zvolensky

Published online: 18 November 2006 
C Springer Science+Business Media, LLC 2006

Abstract The present study examined the interaction be- Keywords adolescent . hyperventilation . pubertal status .
tween pubertal status and anxiety sensitivity (AS) in predict- anxiety sensitivity . panic vulnerability
ing anxious and fearful responding to a three-minute vol-
untary hyperventilation challenge among 124 (57 females) Puberty is a key developmental process characterized by pro-
adolescents between the ages of 12 and 17 years (Mage = found biopsychosocial changes that occur in a relatively short
15.04; SD = 1.49). As predicted, after controlling for base- period of time (Rogol, Roemmich, & Clark, 2002; Sheehy,
line anxiety, age, and gender, there was a significant inter- Gasser, Molinari, & Largo, 1999). These hormonally–driven
action between pubertal status and AS in predicting anx- changes typically co-occur with unexpected and/or undesir-
ious responding to bodily sensations to the hyperventilation able bodily events (e.g., Costos, Ackerman, & Paradis, 2002;
challenge. Specifically, adolescents reporting more advanced Omar, McElderry, & Zakharia, 2003), increased susceptibil-
pubertal status and higher levels of AS reported the great- ity to negative affect (Brooks-Gunn, Graber, & Paikoff, 1994;
est post-challenge self-reported anxiety focused on bodily Susman, Dorn, & Chrousos, 1991), and enhanced emotional
sensations, whereas pubertal status had relatively less of an lability (Buchanan, Eccles, & Becker, 1992; Spear, 2003).
effect on low AS adolescents. A test of specificity also was In addition, empirical evidence suggests an association be-
conducted; as expected, the interaction between AS and pu- tween pubertal stage and psychopathology, including eat-
bertal status was unrelated to generalized negative affectivity, ing disorders (Killen et al., 1992), substance use problems
suggesting the predictor variables interact to confer specific (Patton et al., 2004), and depression (Angold, Costello &
risk for anxious responding to bodily sensations. Finally, ex- Worthman, 1998; Patton et al., 1996). Overall, available data
ploratory analyses of psychophysiological reactivity to the indicate puberty may be important for better understanding
challenge indicated AS, but not pubertal status, moderated affective vulnerability and psychopathology. However, rela-
the relation between challenge-related change in heart-rate tively little is known about the association between puberty
and post-challenge anxiety such that high AS youth who and anxiety psychopathology.
had experienced a relatively greater heart-rate change re- Although in its relative infancy, evidence is emerging that
ported the most anxious reactivity to the challenge. Results links puberty to panic attacks. In a groundbreaking study,
are discussed in relation to theory regarding vulnerability to Hayward and colleagues (1992) administered structured clin-
anxious responding to bodily sensations among adolescents. ical interviews to determine panic attack history to an un-
screened sample (n = 754) of 6th and 7th grade females, who
self-reported pubertal status using the Tanner staging system.
E. W. Leen-Feldner () · L. E. Reardon · M. T. Feldner · K. A.
Babson Findings from this cross-sectional analysis indicated a two-
University of Arkansas, Department of Psychology, fold increase in the likelihood of having had a panic attack for
216 Memorial Hall, Fayetteville, AR, 72701 each one-point change in Tanner stage. In a follow-up study,
e-mail: Hayward and colleagues (1997) examined pubertal timing in
L. G. McKee · M. J. Zvolensky relation to panic attack status among 758 adolescent females
University of Vermont, Department of Psychology, across a six-year period. Compared to their on-time coun-
John Dewey Hall, Burlington, VT 05405 terparts, early maturing girls were significantly more likely


Zvolensky. First. sensations. & Curtin. wherein they are learning to fear bodily 1992). 2000) indicates AS oretically useful. Finally. Overall. work with youth (Ollendick. nerability factor that may interact with the biopsychoso- tant. with an increased likelihood of developing panic problems. 1995) and adolescents who have not yet developed psychopathology. & Blacker. 2002. Such data inform our understanding of of the sample distribution were associated with a two-fold vulnerability processes among youth who have not yet devel. In addition. Third.. the repeated pairing of bodily sensations and anx- hypothesis. & Taylor. 2002. Anxiety sensitivity (AS) is a well established panic-relevant tion was observed such that. Lau. ety and negative affectivity are accounted for (Leen-Feldner. as the potential confound associated with prospectively predicts the development of panic attacks and pre-existing psychopathology is delimited. 1990. (Barlow. among provoking and thereby be exposed to more frequent and in- psychologically vulnerable adolescents.. 2006). & Jackson. AS is associated with panic puberty-panic association. increase risk for occur during puberty as personally threatening and anxiety- psychopathology only under certain conditions (e. adults with no history of panic. Albano. That is. Second. 1997) compared to those without itation of previous studies. relative to the rest of the sam. puberty-panic linkage. youth with psychopathology have Feldner. McCormick. 2001). 1997. & McIntyre. To address this methodological lim. Schneider. 2004). individual difference variable reflecting a cognitive vulner- ple. 1996). In the context of puberty. may at least partially explain the & Waraczynski. Schmidt. accentuation Over time. Lerew. ory and research on affective vulnerability (e. adoles- likely that changes associated with puberty alone are cents with elevated AS may perceive the bodily events that pathogenic in their own right. 2005. & Zvolensky. adults (Telch et al. Maller & Reiss. Collectively. Keogh. evidence across methodological Haggerty. Schmidt. rather than with panic attacks (Ginsburg & Drake. conceptualization is drawn from contemporary theoretical In light of these limitations. This ogy among some adolescents. Embry. approaches indicates elevations in AS are reliably associated Second. and is elevated among adolescents abuse/dependence. (Hayward. ference factors may interact with pubertal status to increase Lowe. Bernstein. 2002).. Allan. McNally.800 J Abnorm Child Psychol (2006) 34:799–812 to have experienced a panic attack.e. The relative neglect of this empirical question is impor. AS scores in the upper half ological) processes. ical disorder (including panic disorder). & panic-relevant vulnerability. 1999) and adolescents this methodological approach is clinically-relevant and the. Stuart. it may be that psychopathology (e. Reiss & McNally. 1996) and panic disorder (Kearney. 1991. but rather.g. & Kupfer. we sought to examine the models of panic development. 2004) in this way. increase in the likelihood of developing panic attacks.. vulnerability currently is limited in at least two regards. even after controlling for symptoms of tween puberty and other mental health problems (e. 1992. pubertal status per se. & Florin. 2005. 2002.g. 1985). 2006). Zvolensky.g. For instance. early maturing females with a history of internalizing ability to experience fear in the context of bodily arousal symptoms had the highest overall risk of developing a clin. Eisen. not been excluded). Buchanan et al. in the development of anxious reactivity to such sensations Springer . particularly since puberty is a normative (Rosenfeld & cial changes that occur during puberty to potentiate panic- Nicodemus. substance rez. AS may represent a key vul- ity. symptomatology. Margraf. among non-clinical researchers to interpret findings in terms of risk-factor (eti. 1993). Bernstein. clinical levels of depression). These data suggest At least four lines of research support the conceptualiza- that puberty is related to panic attacks and that individual dif. 1993. Caspi & Moffit. Calamari. Rabian. Unnewehr. given the link be. & Telch. specific individual iety about such sensations may result in a learned association differences may be critical to understanding why puberty is between these two phenomena. & or under what conditions panic problems develop (Mrazek & Maner. Smits.g. little is known about the variables that may mod. Cho. Powers. it is not relevant learning. Zvolensky. in press. work completed factors related to psychopathology (Forsyth & Zvolensky. with adults (Li & Zinbarg. ultimately come to elicit fear-relevant affective states.. where bodily sensations be- moderating role of anxiety sensitivity on the puberty-panic come associated with fearful responding. even oped panic psychopathology and help to specify for whom after controlling for trait anxiety (Schmidt. an interac.. 1999. screened adolescents (i. 2003) developmental process. Kraemer. even when conceptually-relevant variables such as trait anxi- existing work has thus far focused on psychologically un. investigations need to focus on such histories. Gutier- et al. thereby setting the stage for panic development. This conceptualization is consistent with extant the. ultimately resulting association among psychologically healthy adolescents. compared to low AS youth. the extant work on puberty and panic sponding to biological challenge procedures among youth. As a result. tion of AS as a panic-relevant variable risk factor (Kraemer. erate the association between puberty and panic vulnerabil. Patton general anxiety and depression (Deacon. existing psychopathology played a role in the documented Jenkins.. indicates AS is sensitive to change following clinical inter- tributed to the predictor variables of interest rather than vention for panic-related problems. observed findings can be more confidently at. tense learning trials. AS predicts anxious and fearful re- Although promising. Killen. For example. Lejeuz. thereby allowing related anxiety disorders. First. such that bodily sensations characterized by heightened vulnerability for psychopathol. 1994). Valentiner. it is not clear whether pre.. & Barlow. Thus.

been safely used with youth in the past (Unnewehr et al. Schmidt. & Barlow. Thereafter. & Telch. Springer . it was explained support for our first hypothesis. Finally. 3) produces responses that remit imme. 2 social negative affectivity. Bouton. 21 between $101..g. anxiety sensitivity. 2000): 90. particularly 15.. 0. adolescents were apprised of exclusionary analysis aimed to provide an initial test of whether. adolescent-oriented commu- diately upon return to normal breathing. or challenge responding. nity centers) and advertisement booths also were set up in a ommended treatment strategy for children and adolescents local well-traveled marketplace on two separate occasions. 1997. and 4) is a rec. First. and compensation for partic- 1996). It was not expected that the AS x pubertal nine participants (5 females) were excluded on the basis of ADIS-C status interaction term would relate to self-reported levels of responses (primary diagnoses: 6 past or current depression. a main 5. Perna. participants had completed 9. empirical tests of this perspective analyses of physiological reactivity to the hyperventilation are scant. Of the 151 adolescents recruited.. 12 were divorced oretically. Therefore. & Franklin.g. Brooks-Gunn inclusionary criteria. A main effect of pubertal status for 113 participants.8% (n = 1) Asian. Method lenge among psychologically healthy adolescents. On average.. an interview. Specifically.. or whether pubertal youth high in AS are at an a bad cold right now”). “if a doctor ever diagnosed you with a mental health problem or gave you medication for it” or “if you have specifically.8% (n = 1) Amer- weigh the temporary discomfort that may result from study ican Indian.56). Mineka. Analyses indicated that there were no hypothesis. “real-time” assessment of multimodal (e. 1994). & Vermont Department of Health. approximately two months apart. Although new research in this domain. Politi.49) were recruited from the general commu- in regard to the reporting of emotional states/processes. 20 reported less than $50. Specifically. feel uncomfortable. In addition. Thirty-three adolescents (17 fe- particularly relevant in light of established relations between males) who contacted the laboratory reported that they did not meet the pubertal status and negative affectivity (e. in terms years of education (SD = 1.g. primary care offices.000/year. in Caucasian.g. arcades. 91 females) provided additional demographic data effect of AS was expected.000 and $100.e. The primary means of advertising was flyers that alerted subject to recall biases and other types of reporting er. given criteria upon contacting the laboratory. An additional et al. the changes associated with puberty would not or separated. A bio- logical challenge procedure was utilized because it allows Participants for a controlled.91 Three hypotheses guided the investigation. Coles. 1 specific phobia). This essary participant burden. Overall.g. ticipated in the present study.8% (n = 1) “other.2% (n = 4) did procedures. 2002. 0. prospective research indicates respiratory-based One hundred twenty four adolescents (57 females) par- challenges do not increase risk of panic-type problems (e. This approach elim. The objective of this investigation was to examine the interaction between pubertal status and AS in predicting anxious responding to a voluntary hyperventilation chal.J Abnorm Child Psychol (2006) 34:799–812 801 (Barlow. participants were reminded before completing the question- naire battery that they were free to skip any questions that made them among individuals low in AS. 124 completed Second.3% (n = 112) Bellodi. is nity.44 [SD: of predicting post-challenge self-reported anxiety. 2001).To delimit unnec- responding versus general levels of negative affectivity. with PD (Bouchard. we conducted a discriminative test of our primary the Tanner stage questionnaire. SD = 1. Parents (Mage = 46. adolescents to a study being conducted at a northeastern rors (McNally. whereas pubertal In light of the sensitive nature of questions on the Tanner stage ques- status would demonstrate less of a relation to such anxiety tionnaire. for the purposes of generating phobia. 2004). it was expected that pubertal status would predict post-challenge 1 anxiety among adolescents high in AS.. challenge (i.. ipation. but rather only among those already at tween $50. 0. Cocchi. & Barrios. 97 respondents were currently married on post-challenge anxiety was not predicted because the- or living with someone.2% (n = 4) African American. g. 1999). the interaction between AS that participants would be excluded for any of the six conditions de- and pubertal status is predictive of panic-type responding scribed in the narrative (e. the participant was asked whether increased risk for negative affect in general. Moreover. Mendlowitz. These fliers were placed in the community (e. In terms of total be expected to potentiate panic responding among healthy family income.. Forsyth. this procedure: 1) has university that involved a breathing exercise. This test seemed he/she was still interested in the study. the potential gains in knowledge far out- Native Hawaiian. not specify race. 0. we conducted some exploratory theoretically promising. completion of questionnaires. in ily by participants. 1996.8% (n = 1) press). and 3 were never married. Kelly..000 and risk by virtue of elevated levels of AS. 1 was widowed. gender.1 The racial distribution of the sample reflected that of the local population (State of Harrington. 3. changes in heart-rate).” and 3. specific reasons for ineligibility were not recorded and no additional information (e.99]. Adolescents between the ages of 12 and 17 years (M = inates exclusive reliance on self-report. 52 be- adolescents per se. we examined the specificity of the significant differences between adolescents who completed the Tan- AS x pubertal stage interaction for predicting panic-type ner stage questionnaire and those who did not with respect to age. physiological) responding. self-report. Prenoveau. age) was gathered.000/year.04. 2) is a non-invasive challenge controlled voluntar. which.

1994) .g. age) were not used because they do not Axis I psychopathology related to anxiety and mood states necessarily reflect pubertal status (e. Each participant questions) was provided throughout the study.000/year. that cation of the adult 16-item Anxiety Sensitivity Index (Reiss. 0. and validated anger). In terms of construct validity. Additional exclusionary cri. Woodward. are not necessarily valid tools in the assessment sions. varies across youth.. Hayward et al. of negative affectivity. none of the participants had current ratings were averaged to generate a single score ranging or past Axis I psychopathology. training involved intensive didactic ses.g. self-reported ological challenge work with adults (Feldner et al. participants were instructed Silverman. This standard. Broader develop- ized assessment strategy allows for the clinical evaluation of mental indices (e.g. 1986). Pre-challenge assessment Gullone. Measures The negative affectivity subscale of the Positive and Negative Affect Schedule for Children (PANAS-C. asthma). Based upon their re. descriptors on the PANAS-C. & Peterson. Tanner. Cronbach’s alpha for the late specifically to panic-type states and not to general levels total scale in present sample = 0.g. & Biro.000/year. 2 (some).e. (d) suicidality. a population of children and adolescents. was shown sex-appropriate drawings depicting specific sec- medical history was assessed with a brief semi-structured ondary sexual characteristics across the course of puberty screening interview (e. This instrument is commonly used in diopulmonary (chronic) illness (e. how you feel on average” on a 5-point Likert-type scale Peterson. berty assessment and is more reliable than other methods sion (ADIS-C. 2005). & Gross (1980) reported good use. and diagnostic of puberty (Dorn. puberty research (e. (e. Gursky.g. with kappa coefficients ranging from exclusionary criteria have been used successfully in past bi.g. Wilson et al.. (b) current acute respiratory illness 1991) and data support the validity of this assessment strat- (e. Duke.g.82) and satisfactory valid.. Such ings of pubertal stage. female breast development teria. breasts and pubic hair in girls. 2002). 1991). 1991). Tanner stage is positively correlated with physiological pro- and aside from avoiding medical complications and risks that cesses known to occur during puberty. chronic obstructive pul.. For instance. (1 = “very slightly” to 5 = “extremely”). anxiety. As such.. “Do you have asthma?”) that we (i. Rabian. it demonstrates good internal consistency The Tanner staging system was selected as the index of pu. Self- sponse to the ADIS-C.81 to 0.802 J Abnorm Child Psychol (2006) 34:799–812 $150. 2006). from Tanner stage I (immature) to Tanner stage V (mature) teria for the present study included: (a) current or past car... 2006)...88. 1992. it represents a particularly conservative test with. and (e) limited mental competency and convergent validity between this measure and physician rat- the inability to give informed. Silverman & Albano. for instance. genitalia and pubic hair developed and used successfully in previous work with ado. 1998) was used to assess a generalized propensity to experience negative affectivity. Male Drawings = . Springer . 1962) of the instrument. characteristics and. 1996). (c) current or past psychotropic medication egy. such as increases in might arise from the procedure. as such. or test in the current study because it is nonspecific. 10 more than $150. Although there is no “gold standard” in terms sample). Dahl. Research personnel were trained to mastery in the use typically begins anywhere from ages 8 to 13. written consent/assent. bach’s alphas for the current sample are: Female Drawings = . bronchitis).g. Wilson et al. a modifi. jects provided ratings of pubertal stage based on the Tan- In addition. was used to assess AS. ongoing supervision (e. in boys).. (e. & McNally. age at pubertal onset and ensures a conservative evaluation of the exclusionary cri. they serve to reduce potential sex steroid concentrations (reflected by increased levels of confounds introduced by individual difference factors known Insulin-Like Growth Factor I. sadness. for each participant.. and hence. to resolve diagnostic ner staging system (Morris & Udry. Participants were asked to “choose the drawing that lescents (Leen-Feldner et al.74. Litt. reflect the two major hormonal Participants were screened for psychopathology using the events associated with pubertal onset. The scale has of the study hypothesis that AS and pubertal status will re- good psychometric properties (e. it covers a 3 (a lot) in response to questions such as “it scares me when wide range of negative affective states (e. the PANAS-C is psycho- ity estimates (Silverman et al. 2003).. metrically sound. 1996).g..g. to indicate “to what extent you usually feel this way. & Moss. retrospective recall of menarche). 1980).. is. In addition. α = .. The PANAS-C Participants rated their perceptions of the aversive nature was selected as the outcome variable for the discriminant of anxiety symptoms by endorsing 1 (none). direct observation of administrations. most looks like you” from each set of five drawings. For each of 15 The 18-item Childhood Anxiety Sensitivity Index (CASI... monary disease. as well as adequate discriminant and convergent of measuring pubertal development (Hayward. Catanzaro. & Laurent.g. the validity (Joiner.71.” This scale was adapted for. Wilson. and 10 did not Tanner stages provide a reliable index of secondary sexual specify. adrenarche and go- Anxiety Disorders Interview Schedule for the Diagnostic and nadarche (Fechner. In addition. Sub- comparison until 100% diagnostic reliability was reached. Cron- to affect responding to the hyperventilation procedure.80 for the negative affectivity scale in the present bertal status. Fleisig. my heart beats fast. This approach is standard in pu- Statistical Manual – Fourth Edition (DSM-IV): Child Ver..

penalty (no participant withdrew from the study). trained in administration of reported anxiety in studies with adolescents (e. breathe out. In this exercise. Garssen. Respiration rate was examined trator has any reason to believe the participant is becoming to validate the efficacy of the breathing rate manipulation. Audiotaped directions levels (Fried & Grimaldi.. Clinic across the hall from the laboratory. Respiration going training in the safe use of the procedure. Stretching across the sensors causes a voltage told they may give a simple indicator (e. This is a well-established assessment of self. To ensure consistency of were then played for participants that described the hyper- breathing rates across the duration of the interval and across ventilation procedure as follows: subjects. Raw electrocardiogram data were collected with cedures were conducted in accordance with comprehensive disposable Ag/AgCl electrodes placed in a standard bilateral and strict laboratory policies. Leen-Feldner.. 1996). Unnewehr et al.. which ranged from sibility of having a panic attack.” tutional Review Board and ethical guidelines for research and exhale when asked to “breathe out” – making each with children and adolescents were adhered to throughout breath in as deep as possible and each breath out as all stages of the project. abrupt increases in bodily arousal) in a safe and offer consultation services if necessary. atric interviews. and continue the exercise from adolescents was obtained upon arrival at the labora. agement of adverse reactions. until you are asked to stop and rest.. this procedure has been shown an adverse reaction occurred or consultation was necessary. & van Spiegel. Thereafter. an 8ft × 12ft sound attenuated experimen- duces bodily arousal that mimics anxiety and panic attack tal room. you will be asked to breathe in General Laboratory Layout and Procedure and breathe out very deeply. so that he/she blood pH. “I don’t know”) second across all channels using J & J Engineering Physiolab coded as a positive endorsement. Biological challenge pro- Software. and increases in plasma epinephrine and lactate could adjust to the laboratory context. audiotaped instructions were used to standardize participant breathing tempo (see below for details). which include in-depth and on- configuration on the palmar side of each wrist. As part of the informed consent/assent process. with any ambiguous responses (e. to be reliable and safe when used with children and adoles. ject testing room. and that participants had 0 (“no anxiety”) to 100 (“extreme anxiety”). forceful as possible. informed written con. the procedure is screened for outliers prior to data analysis. for portant to note that we did not have a single instance where a discussion). However. licensed child clin- selected as the challenge induction because this laboratory. ical psychologists. doctoral level graduate student. Wolpe. the experimenter left the symptoms (Hornsveld. partic- ipants and parental guardians were fully informed about the Self-reported anxiety was indexed using a Subjective Units side effects of the challenge procedure.g. an elevation in with adolescents (e..g. “You will now be guided through a deep breathing ex- ercise. 1996). 2000. In this event.. thereby providing a gross measure of excursion of wish to stop the procedure.g. housed in the University Psychological based procedure allows for the modeling of panic-like expe. Electrodes were attached. 1993).g. It is important that you follow these sent (for child participation) from parents and written assent instructions as best as you can.J Abnorm Child Psychol (2006) 34:799–812 803 Challenge assessment tory. participants were seated in the sub- parametric properties are well studied. this rate has with prior studies utilizing the hyperventilation procedure been shown to produce a decrease in pCO2 .g.” Springer . Specifically. or if the adminis- the chest during respiration. stopped immediately. 2005. 1990). and was ad. rate (breaths-per-minute) was sampled using a Pnemograph challenge administrators were carefully trained in the man- sensor cable with two elastic PS-2 sensors filled with con. 2000). subject testing room. physiological data were dure via a closed-caption television system). Simply inhale when asked to “breathe in. Dop. a challenge. and the participant sat quietly for a The challenge involved a three-minute hyperventilation with five-minute adaptation/baseline period. Psychophysiological responding was indexed using a conducted the medical exclusionary screenings and psychi- J & J Engineering I-330-C2 system. wave) if they change. upset (each participant is monitored throughout the proce- As is standard in our laboratory. Specifically. Eligible participants first completed the pre-experimental cents (Leen-Feldner et al. it is im- well-controlled manner (see Zvolensky & Eifert. including the pos- of Distress Scale (SUDS. and it reliably pro.. In addition.. participants were ductive fluid.. Pine et al.g. Laboratory Challenge relaxation training) to help participants relax if they are upset and participants do not leave the laboratory until they have A well-established voluntary hyperventilation procedure was returned to a relaxed state. were on-hand to riences (e.. which is consistent a breathing rate of 30 respiratory cycles/min. Unnewehr et al. its assessments. which recorded phys. The instructions will tell you when you should breathe in and when you should The current study was approved by the University Insti. the right to discontinue participation at any time without ministered during a baseline period and immediately post. 1958). In addition. the ADIS-C and directly supervised by Dr. The administrator is trained in the use of cognitive-behavioral methods of anxiety reduction (e. Specifically. Next. Exclusionary criteria were rigorously as- iological data on-line at a sample rate of 1024 samples per sessed.

Supporting the efficacy of the procedure. t = 20. For instance. avoidance-type behavior.804 J Abnorm Child Psychol (2006) 34:799–812 Post-challenge SUDS (anxiety) ratings were collected individual differences in pre-challenge levels of anxiety as directly following the hyperventilation challenge and theoretically important2 . Springer . SD = 2. and therefore. AS related positively to Separate hierarchical multiple regression analyses were con- post-challenge anxiety ratings and Tanner stage was not sig- ducted to examine the study hypotheses. At the end of the study. Rabian et al. in the equation (Cohen.. M = $50 for their efforts. Nonetheless. AS and Tanner stage request). The current study is the first direct test of the relation between pu- ciations between the interaction term and criterion variables berty and panic-relevant responding among both male and female ado- lescents.. age.. Specifi. Although the specific events of puberty differ across gen- are above and beyond the variance accounted for by fac- ders (e. These general features are characteristic of puberty across (1983). and of anxiety were entered at level one. & of the model that merits empirical attention. physiological data were gathered continuously throughout the adaptation and challenge periods.6%). AS also was related to this variable that met criteria for entry into the model (p = . the triple interaction was non-significant). age.20. Tanner stage. CASI scores for the current participants.53.31. Finally. and Tanner stage related positively to female gender. for post-pubertal girls (Hayward & Sanborn. 1999).. we elected to treat we viewed the isolation of the effects of the predictor vari. post-hoc probing analyses were conducted on the role of puberty in panic attack development may be similar for males data to examine significant moderational effects.. Each negative affectivity (r = . is predicated on the notion that the co-occurrence of bodily perturba- tion and fearful reactivity to such sensations may potentiate panic-type cordance with the recommendations of Cohen and Cohen responding. and a newsletter describing specific also were comparable to those observed in studies of youth study findings and details about the scientific research pro- using similar methodologies (e. to- physiological responsivity to the challenge. No other significant associations emerged General Analytic Approach among predictor and demographic variables.49) were Mchallenge = 25. SD = 5. and issue of gender as paramount for future research in the area.07.15. Finally. and baseline levels were no significant relations among AS.. CASI scores and Tanner stage shared little enter) was retained. and pre-experimental anxiety fer as a function of gender. we contend that the (2002). Sechrest. all participants took part 28. Hayward et al. cess (mailed to participants at the conclusion of data collec- In terms of zero-order correlations among the predictor and tion. the newsletter is available from the first author upon demographic variables (see Table 1). defining anxiety sensitivity. scores ob- creased breaths per minute (Mbaseline = 18. Seeley. pubertal status correlated positively with and (3) the interaction term was entered at level three. Silverman et al. and females. 1988). SD = 3. In regard to challenge responding. 1991). 01) from lower compared to youth with panic disorder (M = 34. the partic- SD = 8.e. psychoeducation about panic Post-challenge anxiety ratings and mean challenge heart rate and bodily sensations.01. and various psychiatric diagnoses (e. served in the current study (M = 23. Unnewehr et al. ipant and his or her parental guardian were compensated SD = 9. differences in the amount and type of hormones released. results sample are consistent with previous findings (e. Overall.81). and similar to in our comprehensive debriefing procedure. In addition. the role of gender is an important element taken in previous reports (Graber.g. Main effect variables were mean-centered prior to computing product terms (Aiken & West. 1963).. Craske (2003) points out that the frequency of prodromal panic symptomatology such as panic attacks does not dif- In each model. Fechner. Notably. 1991).32). rather. Also. we were underpowered to test hypotheses in separate genders (a test of Lewinsohn.. in line with our conceptualization and the approach development. with expectations. other non-panic anxiety disorders (M = 28. 1996).. gender as a co-variate in this initial test of the model and highlight the ables relative to chronological age. Instead. In the present study. 1992. 3. supporting the con- were used as indices of effect size for those variables retained ceptualization that they are each tapping distinct processes. In the case of significant interactions.g. the current model the form of the interaction was graphically depicted in ac. Indeed. Silverman et al. The model was nificantly correlated with this outcome variable. in line tal CASI scores and Tanner stage) were entered at level two. The subject and exper- Results imenter rooms were equipped with a closed circuit television so the experimenter could monitor participant behavior and Means and standard deviations for predictor and criterion ensure that the depth of breathing was comparable for all variables are reported in Table 1. non-clinical samples (M = 26. 1992).. Kearney indicated that the hyperventilation challenge significantly in- et al.73).g.g.. there divided into three levels: (1) gender. SD = 7. 2002).58. p < .06). 1991). (2) main effects (e. participant gender. SD = 4.. which included unscreened. and the risk for internalizing-type problems is higher 1983.. based on recommendations of Holmbeck the sexes (Buchanan et al.31. as predicted. baseline to challenge.71.g. 2004.05 to variable. girls are more likely to engage in were selected as covariates on an a priori basis.98. 1997. Squared semi-partial correlations (sr2 ) variance with one another (i. related positively to age.32. increasing the likelihood of panic disorder cally. tors at levels one or two in the equation (Cohen & Cohen. this analytic approach provides a test 2 of incremental validity and ensures that any observed asso. Brooks-Gunn. 2002). gender.

among individuals of advanced pu- SD = 9.01) Next.05. when CASI scores were entered simultaneously main effects of AS and age. no main effect of Tanner stage. After controlling for ance (R2 = .12.04 (1.30∗∗ − . Holmbeck. SD = 20.03. the predictor set negative affectivity (β = .87 (20.22∗ . interoceptive states and/or 4 Post hoc exploration of the association between pubertal status and be more sensitive to the demand characteristics of the testing situation.98 (4.32∗∗ 4.36) 5. Finally.47) 4.05.41∗∗ − . older adolescents may evidence greater awareness of.12 . respectively) period [t (self-reported not appear as strongly related to anxiety ratings among in- anxiety) = 7.08 .01 (16. pre-experimental anxiety. p < . 1980.01. Springer . and the can be seen in Table 2. To assess the degree to which the hyperventilation chal.12 − .14 − . predictors at level such that higher levels of pre-experimental anxiety predicted one of the model accounted for a significant amount of vari- higher levels of post-challenge anxiety. AS regression line was not significantly different from zero Results of the regression analyses are presented in Table 2. predictor set at the first level in the model accounted for a 2002).07 . After controlling for gender.08 . CASI total score — . (t = . However. p < .53∗∗ .49) 6. the nature of the interaction was consistent with iety (M = 9.70 (9.19.56. there was a main effect of AS (β = .10 57 3.42) 8.27. Gender was dummy coded (0 = male.77. sr2 = . Figure 1. At this challenge anxiety ratings are higher among adolescents at level only pre-experimental anxiety was significantly associ.18.82. p < . the number listed for gender reflects number of girls in the sample. Specif- ically. β = − .15 − . There was fectivity.35∗∗ 15. bertal stage.02. PANAS-C: negative affect subscale score — 12. ∗∗ = p < . Baseline mean heart-rate — − .J Abnorm Child Psychol (2006) 34:799–812 805 Table 1 Descriptive Data for Predictor and Criterion Variables Variable 1 2 3 4 5 6 7 8 9 M (SD) Predictor Variables 1. β = .18 − .70. p < . As can be seen in Paired samples t-tests suggested baseline self-reported anx. p < . t (heart rate) = 16.01).47) and heart rate (M = 74.34. whereas pubertal status did 90. Gender — − .05). SUDS: Subjective Units of Distress Scale (Wolpe.10 . p < . Level variance (R2 = . the interaction did not predict negative 3 affectivity (see Table 2).02) 9.25∗∗ − . There was not a main effect of pubertal status4 .01.11 . p < . (Wilson et al. there was a two of the model also was significant (R2 = .19.14 . N = 124. CASI: Child Anxiety Sensitivity Index (Silverman et al.12. the gression line was significant (t = 2.36) significantly increased in response to the hy.05. suggesting post- significant amount of variance (R2 = . Tanner stage — .13. prediction. 1991).62. 1 = female). At level three.29∗∗ 22. and pre-experimental anxiety.19∗ 9.05) such that increased CASI scores predicted increased that increased CASI scores predicted increased negative af- anxiety following the hyperventilation procedure. 1998). we examined changes in SUDS ratings and heart rate. greater AS was associated with increased anx- perventilation challenge (M = 22. t = − .05). p = . Specifically. p < . p < .72) Criterion Variables 7. Post-challenge anxiety (SUDS) ratings — .40∗∗ 23. ns). compared to younger youth.10 90.87 (4. p < .01) such that increased at the second level in the model accounted for additional age predicted elevated levels of negative affectivity. p < main effect of AS on post-challenge anxiety (β = .04. more advanced pubertal stage when AS is also high. and ability to report. As predicted. Age (in years) — .03).. These analyses support hypotheses. SD = 14.21 (. Here.01).78.10 . Post hoc probing of this These data suggest the hyperventilation procedure effec. p < . Tanner stage: self-reported Tanner stages of pubertal development (Morris & Udry. 1958).56).40. 1962).06 74. gender.42. in regard to negative affectivity.87. moderational effect indicated the simple slope for the low tively elicited a panic-relevant response.15) Note. whereas the simple slope for the high AS re- With respect to post-challenge SUDS (anxiety) ratings.28∗∗ . pubertal status no longer predicted anxiety ratings (R2 = . only age related positively to age3 . as anxiety. ated with post-challenge anxiety ratings (β = . Tanner.09 − . negative affectivity.82 (14.03 − . M = ious responding to the challenge. Baseline anxiety (SUDS) ratings — .05 . it predicted negative affectivity above between anxiety sensitivity (AS) and age in predicting post-challenge and beyond variance accounted for by age and gender.56∗∗ − . the interaction was not predictive of SUDs with pubertal status at level two.17 − . ∗ = p < . as predicted.49) 2. negative affectivity indicated that when pubertal status was entered by To explore this alternative explanation. we examined the interaction itself at level two of the model. mean challenge responding scores were derived by averaging heart- rate across the three-minute challenge period.10 − .00.15 . dividuals low in AS (see Figure 1).19∗ . SD = 16. the interac- lenge elicited self-reported anxiety and physiological arousal tion term accounted for additional variance (R2 = . A reviewer made the interesting suggestion that observed findings may be due to the effects of age. t = 2.34.01) such .01 . PANAS-C: Positive and Negative Affect Scale for Children.01]. rather than pubertal status..01. Mean challenge heart-rate — − .01.02 .

SUDS: Dependent Variable: Post-Challenge Anxiety Ratings Subjective Units of Distress Step 1 ..02 ns CASI-total score x Tanner stage − 1. p < . Tanner.01). Theoretically-Derived Exploratory Analyses the puberty by heart-rate change interaction term was non- significant (see Table 2). CASI-total score x Heart Rate Change 2.05 Gender was dummy coded (0 = male.05 < .62 .01). the J & J Engineering software we use .19 .00 .16 .01 stages of pubertal development Tanner stage 1.13 < .81 . HF power and the LF/HF ratio (as an index of cardiac autonomic balance) were employed as the index tween challenge-related changes in HRV and anxious reactivity to the of HRV.05 CASI-total score x Tanner stage 2.85 .00 ns Baseline Anxiety (SUDS) 4.02 ns (Morris & Udry.17 .55 . voluntary hyperventilation. the predictor set at the second level in the model accounted for additional variance 5 We also examined the study hypotheses in terms of heart rate vari.08.16 .17.10 . we explored psychophysiological reactivity to the predictor set at the first level accounted for a significant challenge.09 .05). Heart Rate Change 2. Tanner Baseline Anxiety (SUDS) 4. Specifically.13 . However.53 . The model with ratings (β = .11 .01 ns Baseline Anxiety (SUDS) 4.01 ns Children. p < . 1980. and pre-experimental anxiety.02 ns Step 3 .14 < .05 Dependent Variable: PANAS-C negative affectivity subscale total score Step 1 .27 .11 < .87 .05 < .01 Step 3 .16 < . 1958).04 < ..92 − . in the AS model.01 Tanner stage 1. Springer .18 .g. provides power values for the high frequency (HF) and low frequency these were qualified by a significant interaction at level three (LF) components of the power spectra.08 − .24 . 1998).01 ns Gender − 1. gen- der.52 . PANAS-C: Positive and Step 3 .48 .01 Step 2 .08 < .01 Age (in years) 1.73 .03 < .05 standardized beta weight.38 .05) and heart-rate change (β = .01 CASI-total score 1.39. Specifically. we examined AS and pubertal status amount of variance (R2 = .07 .34 . pre-experimental anxiety predicted post-challenge anxiety rate change5 and post-challenge anxiety.19 .40 . CASI: Age (in years) 1. There was a main effect of AS (β = ability (HRV).00 ns Step 2 .03 < .10 . p < . (Wilson et al.01 ns Gender − 1.02 ns Dependent Variable: Post-Challenge Anxiety Ratings Step 1 .01 Gender .09 .806 J Abnorm Child Psychol (2006) 34:799–812 Table 2 Anxiety Sensitivity.18 < .00 ns Child Anxiety Sensitivity Index Gender − 1. and Heart-Rate R2 t (each predictor) β sr2 p (F) Change Predicting Dependent Variable: Post-Challenge Anxiety Ratings Post-Challenge Anxiety Ratings and Negative Affectivity Step 1 .01 CASI-total score 4.22 − . Friedman & Thayer. (R2 = .03 < .01 Scale (Wolpe.11 < . At this level only as independent moderators of the relation between heart. consistent with extant research (e.11 .89 .24 − .03 < .72 .19 < .12 < .05 Heart Rate Change 2.21 .12 .01 < .34 .05 CASI-total score 2.15 < .18. 1 = female). 1998).01 stage: self-reported Tanner Step 2 .02 < .33 ..95 .39 . Pubertal Status.01 Age (in years) 3.24 . the Finally. β = Step 3 . Neither AS nor pubertal status moderated the association be.28 1.07 < .01 Note: N = 124.31 . 1991).03 ns Negative Affect Scale for Tanner Stage x Heart Rate Change 1.00 ns (Silverman et al.05 Tanner stage 1. After controlling for age.01).01 Step 2 . p < .45 .01 Age (in years) 1.18 .03 < .18 < .24.05 1962). p < .

Graber. there was no main effect of pu. Although the size of the observed effect consistent with hypotheses. related positively to post-challenge anxiety ratings. 1997)... tus reported the greatest overall post-challenge anxiety. t = 2. 1997).01. relates positively to catastrophic misinterpretation of internal p < . timing. This supports our variance. it is important to consider the larger context when contention that puberty per se does not increase panic re. considering the potential significance of this finding. post-challenge tant literature linking AS to a number of anxiety-relevant anxiety results cannot be attributed to Axis I psychopathol- outcomes (Silverman & Weems. Findings from the current study coalesce well with these data. high AS).. whereas the simple slope (Bouton et al. may provide slope for the low AS regression line was not significantly dif. 1991) among participants one-half of a standard deviation (measured using the Tanner staging system.58 15 10 5 0 Low Tanner High Tanner Tanner Stage Fig. setting the stage for a panic attack. recent data suggest AS for the high AS regression line was significant (t = 3. 6.03. total CASI scores ogy or individual difference factors.28. somatic cues among youth in grades 3. 1980) and above and/or below the mean for each predictor. ultimately To date. In among youth who experienced a greater change in heart-rate contrast. As predicted. Rather. as a function of pubertal status man et al. 1999). and consistent with the ex. Interestingly.47. in the literature. Lewinsohn.g. 1. Morris & Udry. pubertal status had relatively less of an effect on in response to the challenge. Specif- activity.03). a relatively large amount of variance was explained Springer . whereas heart conceptualization that AS and pubertal status interact to in- rate change did not appear as strongly related to anxiety rat. Post-challenge anxiety ratings. Holmbeck. Post hoc Thus. Also age. anxiety sensitivity (indexed via the Anxiety Sensitivity Index. Future research may bertal status and AS in predicting panic vulnerability among benefit by examining other features of puberty that may po- adolescents. Silver- (R2 = . including state anxiety. and gender. pubertal stage interacted with AS such that ically.33. These findings support the increased anxious responding to the challenge. Importantly. the simple pre-existing panic vulnerability (i. The present study sought to address this gap tentiate panic development (e.05. a critical context in which panic-relevant learning occurs ferent from zero (t = − . and 9 (Mattis & Ollendick. crease vulnerability to anxious responding to bodily arousal. no study has examined the interactive role of pu. greater AS was associated with low AS adolescents (see Figure 1).J Abnorm Child Psychol (2006) 34:799–812 807 40 35.75 35 30 Post-Challenge SUDS Rating 26 25 20 Low AS High AS 17 16. ns). β = 1. sr2 = .19. p < .. 2001). A high AS adolescents endorsing more advanced pubertal sta- graphical depiction of the interaction is presented in Figure 2. ings among individuals low in AS (see Figure 2). & Brooks-Gunn. Seeley. bodily changes related to puberty among youth with probing of this effect supports this interpretation.e. the Discussion events of puberty may provide a fecund context for expe- riencing fear in the context of somatic arousal. 2002). among adolescents high in AS. was small in overall magnitude at 3% of uniquely explained bertal status on post-challenge anxiety.

baseline anxiety. the AS by heart-rate change inter- bine to increase a general propensity to experience negative action predicted post-challenge anxiety after accounting for affect. reactivity to the challenge. Utilization of prospec. and the respective main effects. In any case. age.. AS.75 10 9. gender. In terms of main effects. et al. developmentally-sensitive risk factor amining the main effect of AS on psychophysiological reac- models of panic psychopathology (Kraemer et al. In this sense. Post-challenge anxiety ratings. wherein null findings have been observed among both Of note. we examined the predictor initial results suggesting pubertal development and AS may variables in relation to self-reported negative affectivity. negative affectivity was indexed via self-report youth (Leen-Feldner et al. which would delimit the impact of constrained variance.. 24%). Such specificity tests are critical for This analytic approach uniquely extends available work ex- building sophisticated. In addition. suggesting these factors do not com. it is noteworthy was surprising in light of theory and research suggesting pu- that the interaction term enhanced the model’s predictive berty is marked by increased negative affect (Brooks-Gunn power (Abelson. lated positively with negative affectivity. Feldner. Eifert. expected. tivity. below the mean for each predictor. the AS by pubertal status interaction was unrelated In exploratory analyses focused on psychophysiological to negative affectivity. by predictor variables. although there was there was relatively less variance that could be accounted no main effect in regression analyses. 2. ing to bodily sensations. thus.e. & Brown. with pubertal status at level two of the model. 1994). multi-informant assessment ing that anxious responding was elevated among youth who Springer . 1997). 2001). The find- this construct via multi-modal..808 J Abnorm Child Psychol (2006) 34:799–812 60 55 50 Post-Challenge SUDS Ratings 40 Low AS 30 High AS 20 19. sitivity (indexed via the Anxiety Sensitivity Index. Prior to drawing con- roles of pubertal status. 1999) and and therefore future studies would benefit from measuring adults (Zvolensky. post-hoc analyses (see Footnote #4) untary hyperventilation challenge among psychologically suggested the absence of a main effect in regression analyses healthy adolescents.5 0 0 Low Heart Rate Change High Heart Rate Change Change in Heart Rate Fig. we employed a vol. including the covariates and the main strategies. pubertal status corre- effect of AS. was due to the fact that when AS was entered simultaneously ability in panic-relevant responding.. these two sets of findings provide promising Next. puberty-related biopsychosocial development. which likely truncated upper-end vari. at earlier levels in the model (i. but rather are specifically related to anxious respond. Silverman et al. This latter finding for by the interaction term. as a function of heart rate 1991) among participants one-half of a standard deviation above and/or change (baseline to mean within-challenge heart rate) and anxiety sen. as a test of specificity. Rabian et al. it accounted tive time-sampling methodologies to examine the interactive for much of the associated variance.. and panic-relevant responding in clusions. 2005. a sample of adolescents with less stringent selection crite- derstanding of how these factors relate across time during ria.. However. this pattern of findings should be replicated among “real-world” contexts would further develop empirical un. 1985). As interact to specifically influence panic onset among youth.

(1985). Teachman. Marc Hartigan. investigators could identify high AS adoles- the study was cross-sectional. a key research objective will be to empirically estab- ticular events that occur during puberty. 1991). future research that inte. Washington. and Lindsay Van Zanten for their assistance with this project. Third. this design does not permit causal inferences.g. (1991).. research with adults suggests time. Moreover.. which allows that impact panic problems among youth. In this sense. 1996).. Justin McCormick. physiological) observation of panic-relevant re. L. Here.. but does not reflect ac- tual PD development. While useful at this early stage cents in a primary care setting who are just entering puberty of research. CA: Sage. groups of youth ages 9. & related risk factor research has been articulated within a Brooks-Gunn. lems. play among risk factors as a critical step toward designing and not pubertal status.. the current study is note- change in heart-rate from baseline to challenge is consistent worthy for two primary reasons. Author. direct implications of the current findings for work with clin- ple and increase the generalizability of these findings. laboratory-based) anxiety- likely to be pathogenic in its own right (Graber.. stages. S. cortisol levels) dependently replicated and extended) evidence for the roles would further bolster these conclusions. Stephanie Sinisi. To rule (Feldner. Specifically. & Leen-Feldner. in press). olensky. Diagnostic and statisti- relevant cognitive variables such as anxiety-relevant memory cal manual of mental disorders (4th Edition). Reiss. Amanda O’Dell. Here. note #3) increased our confidence that findings from the current study were not due to the effects of age. of AS and pubertal development in the onset of panic psy- A number of issues warrant further consideration. specific pubertal processes were not directly such an approach may be effective (Schmidt et al. a lot.g. psychologically healthy. researchers are now situated to extend ple and utilizing alternative recruitment efforts. Comeau. and design a brief intervention aimed at reducing AS. this sample is limited as it panic development meaningfully increases (Bernstein. Stewart. and 11 at each of the five Tanner Aiken. 01) awarded to the sixth author. 2005).g.g. Zv- was a relatively homogenous (e. the interaction between pubertal status translational framework where risk factor research informs and heart-rate change did not predict post-challenge anxiety. 2006). investigated. The authors thank Kate Follansbee. Con. there are in- out the potential role of self-selection bias among this sam.g. Multiple regression: Testing and interpreting interactions. S. 97. Finally. Inc. much has yet to be learned regarding the par. an important area receiving individuals find bodily perturbation to be fear-relevant. 2002).. Extending these findings to iety. there are direct im- with AS theory (e. 10. Second. lems. 129–133. P. G. which may promote lish cut-offs that indicate at what level of AS the risk for panic-relevant learning. combined with heart-rate reactivity effective preventative interventions for youth at risk for anx- to predict challenge response.” This approach represents a useful research targeted at disentangling the specific mechanisms laboratory model of panic-relevant responses. the present study sets the stage for additional sponding in “real-time. Zvolensky. R. Acknowledgements This project was supported by a grant from grates both laboratory and naturalistic (prospective) methods Child & Adolescent Research and Training.g. the these findings to clinical samples of adolescents with panic present study used a controlled laboratory-based induction disorder to begin to understand if AS and pubertal status may of abrupt bodily sensations to allow for a multimodal (e.g. This type primarily Caucasian) group of adolescents who volunteered of criterion would enhance prevention-related efforts by de- to participate for monetary reward and whose parents were lineating specific subpopulations at risk for developing panic available/willing to transport them to the laboratory.. 2003) and to directly examine theoretically American Psychiatric Association (1994). prevention efforts and vice versa (Zvolensky et al. given compelling (e. in- other indices of physiological arousal (e. This stage model of progress highlights studies of the inter- only the theoretically-relevant individual difference (AS). First. burgeoning empirical attention (Craske & Zucker.. 2006).J Abnorm Child Psychol (2006) 34:799–812 809 were both high in AS and had experienced relatively greater From a clinical perspective. R03 DA16307-01. awarded to the first author and National Institute on Drug Abuse research grants will ultimately provide the most comprehensive account of (1 R01 DA018734-01A1. Al- nor does it speak to changes in vulnerability processes across though in its relative infancy. the two sets of findings are complementary.. Petersen. be involved in the maintenance or exacerbation of such prob- self-report. The value of well-controlled (e. DC: biases (e. A variance explanation paradox: When a little is that evidence variability in both age and Tanner stage (e. First. for insight into panic vulnerability. & Schmidt. future ical populations of adolescents suffering from panic prob- studies would benefit by examining a more diverse sam.g. chopathology. such as References cognitive development) is a critical issue for future investiga- tors to elucidate. it will be important to obtain samples Abelson. Psychological Bulletin. 2004). Overall.. Hayward. which suggests high AS plications for panic prevention. and 1 R21 DA016227- the role of AS and puberty in panic development. Newbury Park. As an illustrative example. although an inspection of the non-significant interaction be. & West. sistent with the interactionist perspective that puberty is un. Springer . tween AS and age predicting challenge response (see foot. Accordingly. Second. the specific role of puberty (versus other age-related variables.

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