The interplay between parental over-involvement and children's theory of mind in social anxiety

The Interplay Between Parental Over-involvement and Children’s Theory of Mind in Social Anxiety

Masterscriptie Orthopedagogiek Pedagogische en Onderwijskundige Wetenschappen

Universiteit van Amsterdam M. L. Jofre Begeleiding: dr. M. Nikolić Tweede beoordelaar: dr. C. Colonnesi

Abstract

Social anxiety can have severe consequences for children and adolescents. Parental over-involvement and Theory of Mind (ToM) have been associated with social anxiety. In this longitudinal study on the moderating role of child’s ToM in the relation between parental over-involvement and child social anxiety, 118 children and their parents participated. It was hypothesized that a high level of ToM would work as a protective factor in the relation between parental over-involvement at 4.5 years old and social anxiety at 7.5 years old. At the age of 4.5 years, paternal- and maternal over-involvement were measured with a parenting questionnaire and ToM was measured with a validated battery. At the age of 7.5 years, social anxiety was assessed using children’s reports and both parent’s reports on reliable

questionnaires. To test the hypotheses four moderator analyses were conducted with maternal over-involvement and paternal over-involvement separately as the predictors, ToM as the moderator, and social anxiety as the outcome. ToM did not work as a moderator in the relation between parental over-involvement and child social anxiety. Over-involvement and ToM did not predict social anxiety independently. Further research is necessary to detect possible moderators in the prospective relation between parental over-involvement and child social anxiety.

Keywords: parental over-involvement, over-control, overprotection, parenting, theory of mind, social anxiety, moderator

Abstract

Sociale angst kan grote consequenties hebben voor kinderen en adolescenten. Eerder

onderzoek laat zien dat ouderlijke overbetrokkenheid en Theory of Mind (ToM) gerelateerd zijn aan sociale angst. In deze longitudinale studie is onderzocht of een hoog niveau van ToM als een protectieve factor werkt in de relatie tussen ouderlijke overbetrokkenheid op 4.5-jarige leeftijd en sociale angst van het kind op 7.5-4.5-jarige leeftijd. In totaal participeerden 118 kinderen en hun ouders. Toen de kinderen 4.5 jaar oud waren, werd de vaderlijke en

moederlijke overbetrokkenheid gemeten met een opvoedvragenlijst en werd ToM gemeten met een gevalideerde testbatterij. Toen de kinderen 7.5 jaar oud waren, werd sociale angst gemeten met zowel een vragenlijst voor het kind en oudervragenlijsten ingevuld door beide ouders. Om de hypotheses te toetsen werden vier moderatoranalyses opgesteld met vaderlijke overbetrokkenheid en moederlijke overbetrokkenheid apart als voorspeller, ToM als

moderator, en sociale angst als uitkomst. Er werd geen indicatie gevonden voor de

modererende rol van ToM in de relatie tussen ouderlijke overbetrokkenheid en sociale angst van het kind. ToM en ouderlijke overbetrokkenheid voorspelden ook niet apart van elkaar de sociale angst. Verder onderzoek is nodig om mogelijke moderatoren in de relatie tussen overbetrokkenheid en sociale angst aan te tonen.

Keywords: ouderlijke overbetrokkenheid, ouderlijke overcontrole, ouderlijke overbescherming, theory of mind, sociale angst, moderator

The Interplay Between Parental Over-involvement and Children’s Theory of Mind in Social Anxiety

Social anxiety disorder (SAD) is one of the most prevalent disorders in children and adolescents (Cartwright-Hatton, McNicol, & Doubleday, 2006; Rigter, 2013). The prevalence of SAD among children and adolescents varies from 5% to 10% (Burstein et al., 2011;

Kessler et al., 2012; Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993; Wittchen, Stein, & Kessler, 1999). Great impairments in academic performance, social skills, peer

relationships, and family life are often seen in children and adolescents with SAD (Khalid-Khan, Santibanez, McMicken, & Rynn, 2007). Furthermore, there is a lot of co-morbidity with other disorders, such as a major depressive disorder, attention deficit hyperactivity disorder, specific phobia, and selective mutism. Social anxiety is the fear or anxiety to be negatively evaluated by others in social interactions or social situations (DSM-5; American Psychiatric Association, 2013). Social anxiety may become a disorder if the anxiety is

persistent and excessive and causes distress or impairment in functioning (DSM-5; American Psychiatric Association, 2013; Peijnenburg, Jongerden, & Bögels, 2014). The disorder is usually diagnosed during adolescence or later, however the first signs may already be noticeable during childhood (Beidel, 1998). Anxiety symptoms in childhood may lead to anxiety disorders later in childhood and adulthood (Cartwright-Hatton et al., 2006). Because of the severe consequences that SAD might have for children’s lives, it is important to identify the early protective and risk factors in its development (Peijnenburg et al., 2014). Parental over-involvement and social anxiety

Parental over-involvement may play a role in the development of social anxiety in children. In literature, overprotection and control are both used as aspects of over-involvement. Parental overprotection is defined as highly supervising, controlling and vigilant, having difficulties with separation from the child and discouraging independent behavior (Thomasgard & Metz, 1993). This may support avoidance, give the child the idea that the world is dangerous, and limit the development of skills and confidence for coping with challenges (Chorpita & Barlow, 1998; Murray, Creswell, & Cooper, 2009; Rapee, 1997). In fact, parental overprotection is consistently found to be associated with child anxiety symptoms and disorders (e.g. McLeod, Wood, & Weisz, 2007; Van der Bruggen, Stams, & Bögels, 2008; Wood, McLeod, Sigman, Hwang, & Chu, 2003). Parental over-control is normally defined as a pattern of behavior consisting of excessive regulation of children’s activities and/or routines, high levels of parental intrusion, and discouragement of independent problem-solving (Bögels & Brechman-Toussaint, 2006). It is assumed that

parental over-control limits the development of children’s autonomy, generates perceptions of the environment as uncontrollable and a less developed sense of personal competence (Bögels & Brechman-Toussaint, 2006). These beliefs are theorized to contribute to the development of childhood anxiety (Chorpita, Albano, & Barlow, 1996; Chorpita, Brown, & Barlow, 1998; Rapee, 2001). Links have been found between parental over-involvement and childhood anxiety in general (Hudson & Rapee, 2001; McLeod et al., 2007; Siqueland, Kendall, & Steinberg, 1996; Whaley, Pinto, & Sigman, 1999). Links between parental over-involvement and specific social anxiety have also been found. Several studies looked at parental overprotection in relation to child social anxiety. In a sample of first year college students, maternal overprotection significantly predicted an increase in social anxiety (Sporas & Heimberg, 2008). This was assessed using self-reported recollections of maternal

overprotection and a self-report questionnaire for social anxiety. Paternal overprotection was not found to be a significant predictor of increased social anxiety. Furthermore, using direct observation of parenting style, it was found that both paternal- and maternal overprotection were related to child social anxiety (Rork & Morris, 2009). Anxiety was measured with both self-reports and parent-reports. Additionally, several studies looked at parental over-control in relation to child social anxiety. One study looked specifically at maternal over-control. Affrunti and Ginsburg (2011) measured maternal over-control with child reports and anxiety with a child questionnaire. It was found that children with mothers who showed higher levels of over-controlling behavior, showed higher levels of social anxiety as well (Affrunti & Ginsburg, 2011). This is consistent with the findings of a study on predictors of child social anxiety. Parental over-control was one of the strongest predictors for child rated social anxiety symptoms (Festa & Ginsburg, 2011). Parental over-control was measured with children’s perceptions and observed in a parent-child interaction. In another study child’s perceived parental over-control was also found to be associated with higher levels of self-reported social anxiety (Bögels, Van Oosten, Muris, & Smulders, 2001). This association was shown within a clinical sample of children with various disorders and a healthy control group. In sum, parental over-involvement seems to be associated with child social anxiety, both perceived and objectively measured. By limiting a child’s autonomy, discouraging a child’s independent behavior and not allowing a child to solve a problem by itself, parents might not give the child the chance to involve in social experiences and develop social skills (Vinden, 2001). Furthermore, it is possible that the parental over-involvement not only has an assumed etiological relation to the child’s social anxiety but also has a maintaining role in this relation (Hudson & Rapee, 2001). For example, the parental over-involvement may

prevent the child to approach situations and therefore prevent the child from attaining evidence contrary to their anxiety beliefs.

Earlier research suggests that fathers and mothers parent differently (Möller,

Majdandžić, & Bögels, 2014; Paquette, 2004). Several differences are seen between fathers’ and mothers’ parenting. Mothers tend to spend more time with their children than fathers, except for physical play (Geary, 2010). It is assumed that mothers and fathers show different roles in parenting behavior (Bögels & Perotti, 2011). Fathers show more ‘external protection’ and mothers show more ‘internal protection’ (Bögels & Perotti, 2011). For example, fathers play more physical and mothers show more pretend play (Möller et al., 2014). In contrast, mothers are more responsive, sensitive, warm, supportive, and talk more about emotions than fathers. In most past research on parental over-involvement only maternal over-involvement was investigated. However, parenting behavior of fathers may also play a role in child social anxiety. The meta-analysis of Möller, Majdandžić, De Vente, and Bögels (2013) showed that both maternal and paternal parenting behavior seem to have an influence in the development of child social anxiety. Although past studies found significant effects of parental over-involvement on child social anxiety, these effects were low to medium. Thus, it is interesting to investigate under which circumstances parental over-involvement influences child social anxiety.

Theory of Mind and social anxiety

The development of theory of mind (ToM), a socio-cognitive skill, may also play an important role in the development of child social anxiety (Colonnesi, Nikolić, De Vente, & Bögels, 2016). ToM is the capability to detect and understand mental states by observing others and to predict others’ behavior by understanding these mental states (Sabbagh, 2004). It is described as a ‘commonsense’-psychology by Wellman (1990). From 3 to 4 years of age, children share ‘commonsense mentalistic psychology’ with adults. This vision is based on a triad of concepts consisting ‘beliefs’, ‘desires’ and ‘intention’. At the age of 4 children

develop an explicit ToM and they are able to predict and understand others’ behavior in terms of inner states by using and understanding language (Wellman & Liu, 2004). At this age, children are able to pretend, to understand basic emotions, and to understand the difference between reality and non-reality. The more advanced ToM abilities, such as the understanding of others’ beliefs and false belief, are still developing when children are 4 years old. The ToM abilities are very important for the socio-emotional development of children and adolescents (Carpendale & Lewis, 2004). Studies have shown that a well-developed ToM is related to prosocial behavior in childhood (Imuta, Henry, Slaughter, Selcuk, & Ruffman,

2016), social competence (Hughes, Fujisawa, Ensor, Lecce, & Marfleet, 2006), and school success (Lecce, Caputi, & Hughes, 2011). On the other hand, deficits in ToM are related to externalizing disorders (Olson, Lopez-Duran, Lunkenheimer, Chang, & Sameroff, 2011), autism spectrum disorder (Yirmiya, Erel, Shaked, & Solomonica-Levi, 1998), and

schizophrenia (Bora, Yucel, & Pantelis, 2009).

Studies on the relation between ToM and social anxiety show mixed results. A few studies found associations between ToM and child social anxiety. An important facet of ToM is emotion understanding. In a meta-analysis on several studies on emotion understanding and both clinical and non-clinical social anxiety it was concluded that social anxiety is

negatively related to emotion understanding (O’Toole, Hougaard, & Mennin, 2013). Banerjee and Henderson (2001) investigated whether socially anxious children were more likely to show a deficit in social cognition, in particular in the understanding of others’ mental states in interpersonal situations, also an important facet of ToM. The children were between 6 and 11 years old. Social anxiety was measured with a self-report questionnaire and by ratings from teachers. The more socially anxious children were more likely, than the non-socially anxious children, to have difficulties with understanding links between emotions, intentions and beliefs. Furthermore, the more socially anxious children were rated by their teachers as poorer on social skills for which they need to understand others’ mental states. Another study on ToM in children between 4 and 9 years old showed that a low level of ToM is related to more inhibited behaviors in performance situations and interactions with peers and adults (Muris & Broeren, 2009). This was reported by parents. Finally, Colonnesi et al. (2016) examined whether social anxiety is related to lower levels of ToM in children of 4.5 years old. This study showed that a low level of ToM is associated with early social anxiety symptoms. On the other hand, some studies found no associations between ToM and child social anxiety. In the same study of Colonnesi et al. (2016) no relation was found between a lower level of understanding of beliefs, a facet of ToM, and social anxiety. Alike, no relation was found between false belief understanding, a facet of ToM, and the level of social anxiety of children between 4 and 9 years old (Colonnesi, Engelhard, & Bögels, 2010). Finally, in a longitudinal study, no relation was found between ToM and social anxiety trajectory or individual social anxiety symptoms of children between 4 and 11 years old (Broeren, Muris, Diamantopoulou, & Baker, 2013). Social anxiety was measured with a parent report

questionnaire and ToM was measured with the Theory of Mind test. So far mixed results were found on the relation between ToM and social anxiety. Relations between a low level of ToM and a high level of social anxiety were found and no relations between ToM and social

anxiety were found. There has been a variability across studies in the measurement of ToM. Different facets of ToM have been measured, such as emotion understanding and false belief. The age range of the children is wide, from 4 to 11 years old. Furthermore, only one study used a longitudinal design, which is a good design to show development over time and prospective relations.

The interplay between parental over-involvement and ToM in child social anxiety So far, most studies showed that ToM may have a protective role in the development of social anxiety. Possibly, a high level of ToM works as a protective factor for the development of social anxiety in children with overinvolved parents. Children with a high level of ToM may understand why their parents act overinvolved and therefore will feel less socially anxious. On the other hand, children with a low level of ToM may not understand why their parents act overinvolved and therefore will feel more socially anxious. Over-involvement behavior makes it seem that there is a threat, however when the child understands that there is no threat and this behavior comes forth out of the parents own ideas and anxiety, it is possible that this protects the child against the development of social anxiety.

Present study

In this study we will investigate if ToM in children of 4.5 years old influences the relationship between parental over-involvement, both maternal and paternal, and social anxiety of the child at 7.5 years old. It is expected that the level of the child’s ToM would moderate the relation between parental over-involvement and social anxiety (see Figure 1), such that a high level of ToM would work as a protective factor for the development of social anxiety for children with overinvolved parents. In other words, it is hypothesized that there is a relation between parental over-involvement and child social anxiety for children with a low level of ToM, but this relation does not exist for children with a high level of ToM. Because mothers and fathers parent differently, both maternal- and paternal over-involvement will be investigated.

Figure 1. Theoretical model of the moderating influence of the child’s ToM on the relation between parental over-involvement and child’s social anxiety

Method Participants

The participants of this study are part of an ongoing longitudinal study on the risk factors and protective factors in the development of social anxiety in young children at the University of Amsterdam. The original sample consisted of 151 firstborn babies and their parents. The families were recruited during the pregnancy of their first child through midwives, advertisements and leaflets. The children visited the lab several times separately with their mother and father. In this study parenting and ToM were measured when the children were 4.5 years old (M = 53.87 months, SD = .74) and social anxiety was measured when the children were 7.5 years old (M = 90.01 months, SD = 1.03). The sample consisted of 118 children (54 boys). Parents were mostly Caucasian (93%) with a middle-high socio-economic status. Their educational level was relatively high M = 6.84, SD = 1.16 on a scale of 1 (primary school) to 8 (university). The children were all healthy with no pre- or post-natal medical histories. Written consent by both parents was necessary to participate in this study. The study was approved by the Ethics Review Board of the University of Amsterdam. Materials

ToM. ToM was measured with the ToM-test-r interview (Muris et al., 1999;

Steerneman, Meesters, & Muris, 2009) when the children were 4.5 years old. This interview is for children from 3 to 12 years old and consists of 14 short stories accompanied with drawings, about which 36 questions have to be answered. The test consists of three subscales: ToM1, ToM2, and ToM3. ToM1 measures a basic level of ToM with: pretense (e.g. “Do as if

Parental over-involvement

Child’s social anxiety Child’s ToM

you brush your teeth”), the difference between reality and non-reality (e.g. “Can people see a bicycle you are dreaming about?”), and recognition of basic emotions (e.g. “Who in this picture is happy?”). ToM2 measures the understanding of beliefs: the first order belief (e.g. “What children think about real events, “Peter thinks that Sue is sad”), and the first order false-belief (e.g. the “Smarties test”). ToM3 measures more advanced aspects of ToM, like second order belief and the understanding of humor. ToM3 was not measured because the children were not expected to have developed a more advanced level of ToM yet. The ToM-test is found reliable and valid with a sufficient to good internal consistency, ToM-test-reToM-test stability, and interrater reliability (Muris et al., 1999). The interviews with the children were digitally video-recorded and coded by three trained master student observers. Internal consistency was close to acceptable, α = 0.67 for both ToM1 and ToM2 probably because of the multidimensionality of the instrument and the low number of subscales (3 for ToM1 and 2 for ToM2). The average inter-rater reliability, assessed using 22 double-coded observations (20 %) (κ) was: ToM1, к = 0.99, ToM2, к = 0.92.

Social anxiety. Social anxiety of the children was measured with the Dutch version of the Screen for Child Anxiety Related Emotional Disorders-revised for parents (SCARED-R; Muris, Merckebach, Schmidt, & Mayer, 1998) and the Picture Anxiety Test (PAT; Dubi & Schneider, 2009) for children when the children were 7.5 years old.

The SCARED-R (Muris et al., 1998) consists of 66 items which measure symptoms of separation anxiety disorder, generalized anxiety disorder, panic disorder, traumatic stress disorder, social phobia, specific phobia, and school phobia. In this study only the modified social anxiety subscale was used (Bodden, Bögels, & Muris, 2009; Bögels & Van Melick, 2004). To improve the psychometric properties of the original social anxiety subscale five items were added (Bodden et al., 2009). The modified social anxiety subscale consists of 10 items. The internal consistency is excellent for mother report (α = .91) and good for father report (α = .89). Parents had to indicate how frequently their child experiences the symptoms on a three-point scale rated 0 (almost never), 1 (sometimes), and 2 (often). The internal consistency for the present population was good (mother α = .85, father α = .83)

The PAT (Dubi & Schneider, 2009) measures anxiety and avoidance through an interview about 17 situations. Each item includes two pictures of different responses in a potentially fearful situation. The pictures are presented at the same time: one with the critical symptom (e.g., the child shows fear), and one where the symptom is not shown (neutral). The child has to answer to which child he or she resembles and has to give an indication of the degree of the feeling. The child’s degree of fear of avoidance is assessed on a four-point scale

rated from 0 (not at all) to 3 (very much). Only the social anxiety subscale was used in this study, which consists of three items. The internal consistency of the anxiety subscale of the PAT is acceptable for the general population (α = .78) (Dubi, Lavallee, & Schneider, 2012). The internal consistency of the social anxiety subscale for the present population was close to acceptable (α = .69).

Parenting. The parenting style was measured with the Comprehensive Parenting Behavior Questionnaire (CPBQ; Majdandžić, De Vente, & Bögels, 2008) for 4-year-old children. Only the dimension ‘over-involvement’ was used for this study. This subdimension consists of two subdimensions: over-control and overprotection. In total the dimension consists of 36 items, 25 for over-control and 11 for overprotection, (e.g. “I always stand next to my child when he/she is climbing”) rated from 1 (not at all true) to 5 (very true). The internal consistency of the dimension ‘over-involvement’ for the general population is acceptable (mother α = .79, father α = .78) (Majdandžić, De Vente, & Bögels, 2016). For the present population the internal consistency of the dimension was close to acceptable for mother report (α = .68) and acceptable for father report (α = .73).

Procedure

The study took place in the Familylab of the University of Amsterdam. At the age of 4.5 the children visited the lab with their mother. At this visit the children’s level of ToM was assessed with the ToM-test-r interview. Shortly after the first visit the parents filled in the CPBQ. At the age of 7.5 a home visit was planned where the PAT was conducted with the children. After this visit both their parents filled in the SCARED-R. Children received a small present in return for their participation, and parents received a 20-euro gift voucher, and a DVD of the laboratory session.

Data analysis

First, data were checked for skewness and kurtosis. Next, data were assessed for homoscedasticity. Furthermore, data were checked for outliers. Pearson’s correlations analyses were conducted to examine the relations between parental over-involvement, ToM and child social anxiety. The main hypotheses were tested with four moderator analyses with parental over-involvement as the independent variable, social anxiety as the dependent variable and ToM as the moderator. To perform the four analyses SPSS statistic software and the macro PROCESS (Hayes, 2013) were used. Moderation model = 1 was used (5000 bootstrap samples), and the scores of all the variables were standardized before the analyses. Parental over-involvement was the predictor, ToM was the moderator and social anxiety was the outcome. Because the PAT and the SCARED-R were not correlated strongly, the two

tests were separately analyzed. Furthermore, to look at the influence of maternal over-involvement and paternal over-over-involvement on child social anxiety separately, these were also separately analyzed.

Results Preliminary results

Maternal- and paternal over-involvement, ToM, and social anxiety tested with the PAT were normally distributed, except for social anxiety tested with the SCARED-R, which was positively skewed (.994, SE = .235). A log transformation was performed, which

improved the distribution (.554, SE = .235). The assumption of homoscedasticity was met for all the variables. One outlier was found in the PAT data. This outlier was winsorized. Only the results with the winsorized outlier are shown. Descriptive statistics and Pearson’s correlations between ToM, maternal over-involvement, paternal over-involvement, social anxiety tested with the PAT, and social anxiety tested with the SCARED-R are shown in Table 1. A significant positive relation was found between the social anxiety scores of the PAT and the SCARED-R.

Table 1

Descriptive statistics and correlations (p values) of ToM, maternal over-involvement, paternal over-involvement, social anxiety (PAT), and social anxiety (SCARED-R)

M (SD) Range 2. 3. 4. 5. 1. ToM (n = 107) 12.79 (3.55) 5.00–20.00 .16 -.06 .12 -.14 2. Maternal over-involvement (n = 91) 2.68 (.25) 2.08–3.28 - .11 .12 .17 3. Paternal over-involvement (n = 90) 2.65 (.26) 1.97–3.22 - -.16 -.17 4. Social anxiety (PAT) (n = 84) .74 (.67) .00–3.00 - .34** 5. Social anxiety (SCARED-R) (n = 99) 1.42 (.36) 1.00–2.61 -

** p < .01 (two-tailed).

Moderator analyses

To examine the possible relation between parental over-involvement and child’s social anxiety with ToM as a moderator, four moderator analyses were conducted. The results of the moderator analyses are shown in Table 2 to Table 5.

Table 2

Moderator analysis with paternal over-involvement as the independent variable, social anxiety (SCARED-R) as the dependent variable and ToM as the moderator (N = 84)

b (SE) t p F p

Model 1.16 .331

Constant .03 (.11) .25 .805

ToM -.12 (.11) -1.09 .281

Paternal over-involvement -.18 (.11) -1.58 .119 Paternal over-involvement x ToM -.01 (.11) -.10 .923

No significant result was found for the moderation model with paternal over-involvement as the independent variable and the social anxiety tested with the SCARED-R as the dependent variable. For the relation between the paternal over-involvement and the parent’s perception on the child’s social anxiety, no moderation effect of the child’s ToM was found. Also, paternal over-involvement and child’s ToM did not predict social anxiety independently.

Table 3

Moderator analysis with paternal over-involvement as the independent variable, social anxiety (PAT) as the dependent variable and ToM as the moderator (N = 73)

b (SE) t p F p

Model 1.73 .168

Constant -.00 (.11) -.01 .994

ToM .18 (.11) 1.64 .105

Paternal over-involvement -.13 (.12) -1.10 .276 Paternal over-involvement x ToM .08 (.11) .78 .439

Furthermore, the model with paternal over-involvement as the independent variable and the child’s social anxiety tested with the PAT as the dependent variable, was not found to be significant. For the relation between paternal over-involvement and the child’s anxiety tested with the PAT, no moderation effect of the child’s ToM was found. Again, paternal over-involvement and child’s ToM did not predict social anxiety independently.

Table 4

Moderator analysis with maternal over-involvement as the independent variable, social anxiety (SCARED-R) as the dependent variable and ToM as the moderator (N = 86)

b (SE) t p F p

Model 1.79 .155

Constant .00 (.11) .02 .986

ToM -.13 (.18) -1.27 .231

Maternal over-involvement .20 (.11) 1.81 .074 Maternal over-involvement x ToM .13 (.11) 1.20 .235

For the model with maternal over-involvement as the independent variable and the social anxiety tested with the SCARED-R as the dependent variable, no significant result was found. For the relation between the maternal over-involvement and the parent’s perception on the child’s social anxiety, no moderation effect of the child’s ToM was found. Maternal over-involvement and ToM did not predict social anxiety independently. Although, for the relation between maternal over-involvement and social anxiety a trend towards a significance is shown.

Table 5

Moderator analysis with maternal over-involvement as the independent variable, social anxiety (PAT) as the dependent variable and ToM as the moderator (N = 75)

b (SE) t p F p

Model 1.70 .176

Constant -.06 (.11) -.54 .589

ToM .19 (.11) 1.76 .083

Maternal over-involvement .09 (.11) .81 .419 Maternal over-involvement x ToM .12 (.10) 1.14 .256

Finally, the model with maternal over-involvement as the independent variable and the child’s anxiety tested with the PAT as the dependent variable was not found to be significant. For the relation between maternal over-involvement and the child’s anxiety tested with the PAT, no moderation effect of the child’s ToM was found. For this model, maternal

over-involvement and ToM did not predict child social anxiety independently either. Although, a trend towards a significant relation is shown between ToM and the child’s social anxiety.

Discussion

In this study we examined the moderating role of the child’s ToM on the predicting relationship between parental over-involvement at the age of 4.5 years and child’s social anxiety at the age of 7.5 years. It was hypothesized that the level of ToM would moderate the relation between parental over-involvement and child social anxiety, such that a high level of ToM would work as a protective factor in the development of social anxiety and that a low level of ToM would work as a risk factor in the development of social anxiety. This

hypothesis was tested four times, with maternal and paternal over-involvement and with both the social anxiety score of the PAT and the SCARED-R. The study’s hypothesis did not receive support. Based on the results the child’s ToM does not influence the relationship between parental over-involvement and the child’s social anxiety. In other words, a high level ToM does not work as a protective factor in this relationship and a low level of ToM does not work as a risk factor in this relationship.

Some results of the present study are in line with previous research on ToM and child social anxiety. In the present study no significant relation was found between a child’s ToM and social anxiety. Colonnesi et al. (2010) also did not find a relation between false belief understanding, a facet of ToM, and social anxiety of children from 4 to 9 years old. However, most past studies found a relation between ToM, or a facet of ToM, and child social anxiety (Banerjee & Henderson, 2001; Colonnesi et al., 2010; Colonnesi et al., 2016; O’Toole et al., 2013; Muris & Broeren, 2009). This difference in findings between the present study and past studies may be because of the prospective relation that was investigated in the present study. Furthermore, the only child factor that was used in this study as a risk-factor for the

development of social anxiety was ToM. Past research has shown that different child factors play a role in child social anxiety. For example, it was found that 50% of children with a chronic high behavioral inhibition developed SAD in comparison with children with a chronic low behavioral inhibition (Essex, Klein, Slattery, Goldsmith, & Kalin, 2010). Furthermore, social and communication difficulties have been shown to be associated with social anxiety (Pickard, Rijsdijk, Happé, & Mandy, 2017).

In relation to parental over-involvement and child social anxiety, some results of the present study are not in line with previous research. For example, we did not find a

significant relation between parental over-involvement and social anxiety. This is in contrast with the findings of several studies, where a significant relation was found between parental

over-involvement and social anxiety of children (Bögels et al., 2001; Rork & Morris, 2009). Furthermore, in the present study no significant relation was found between maternal over-involvement and social anxiety, contrary to earlier research where this relation was found significantly (Affrunti & Ginsburg, 2011; Rork & Morris, 2009; Sporas & Heimberg, 2008). Although we did find a trend to significance between maternal over-involvement and social anxiety of the child tested with the SCARED-R. For maternal over-involvement and social anxiety of the child tested with the PAT we did not find a trend to significance. Which indicates that this result could possibly be due to the subjective measurement that was used, namely the mother reports on the SCARED-R. Furthermore, only the dimension parental over-involvement was used as a predictor for social anxiety of children. It is possible that other dimensions of parenting behavior have an influence on the development of child social anxiety. For example, it was shown that paternal challenging behavior predicted less social anxiety in children of 4 years old (Majdandžić, Möller, De Vente, Bögels, & Van den Boom, 2013). In contrast, maternal challenging behavior predicted more social anxiety in children of 4 years old. Furthermore, in a comparison study on Italian and British mothers it was found that, although Italian mothers showed more overprotection than British mothers, the influence of overprotection on social anxiety was moderated by the higher levels of warmth of Italian mothers (Raudino et al., 2013). This indicates that parental warmth works as a moderator on the relation between parental overprotection and child’s social anxiety. It is possible that the parents in the present study showed a lot of warmth, and therefore the children showed less social anxiety.

The present study is one of the first studies to investigate a prospective relation between parental over-involvement and ToM in children from 4.5 years old and social

anxiety in children from 7.5 years old. Broeren et al. (2013) also used a longitudinal design in their study on ToM and anxiety in children from 4 to 11 years old. They did not find a

relation between ToM and social anxiety trajectory or individual social anxiety symptoms in children from 4 to 11 years old, which is in line with our findings. It is possible that ToM does not play a moderating role in the relation between parental over-involvement in children from 4.5 years old and child’s social anxiety in children from 7.5 years old. Furthermore, maybe ToM does play a moderating role in the relation between parental over-involvement and child social anxiety only not in a prospective way.

Several limitations of the present study warrant mentioning. First, the parents had a relatively high educational level, which possibly limits the generalizability of our findings. Second, the internal consistencies for both the ToM-test-r interview and the PAT were close

to acceptable, which is why the results should be interpreted carefully. For the ToM-test-r interview the internal consistency was probably close to acceptable because of the

multidimensionality of the instrument and the low number of subscales. Third, the parental over-involvement was tested with a self-report parenting questionnaire. This type of questionnaires is prone to social desirability bias. It is advisable to use a combination of a questionnaire and an observation to test parenting more objectively.

Despite the several limitations, the study contributes to the field. A longitudinal design was used, giving a developmental view on the relation between parental

over-involvement, ToM and social anxiety. Social anxiety was tested with two different tests, one filled in by the parents giving a parent’s perspective of the social anxiety of the child, and one test conducted with the children. Child reported measures are important to use in combination with parent reports because it provides information from different points of view (Cartwright-Hatton et al., 2006). Furthermore, both maternal involvement and paternal

over-involvement investigated separately, giving a broader view on parental over-over-involvement and ToM in relation to social anxiety.

The present study also offers new input for further research on parenting behavior and social anxiety. Although no significant results were found regarding to a moderating role of ToM on the relation between parental over-involvement and child’s social anxiety, further research should be conducted to look at other possible parenting and child individual factors that may influence child’s social anxiety. For instance, more parental behavior, such as negativity, warmth and challenging behavior, should be taken into consideration. Furthermore, child individual factors should also be taken into consideration, such as behavioral inhibition and social and communication difficulties.

In summary, the findings of the present study suggest that ToM does not play a moderating role in the prospective relation between parental over-involvement and child’s social anxiety. Furthermore, only small effects were found for parental over-involvement. Social anxiety in children is an important area for research because of the severe

consequences. Further research is necessary to detect possible moderators in the relation between parental over-involvement and child social anxiety. There is still a lot to learn about this complex relation.

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