【研究背景與研究目的】
焦慮疾患在兒童與青少年中為最普遍的問題，許多孩童經驗焦慮/憂鬱會持續至青少年與成人時期。在社區樣本中發現，符合一種以上之焦慮疾患的孩童，其中有幾近五成在兩年後仍患有焦慮疾患。由於焦慮的高盛行率及對於兒童日常生活功能造成的影響，故研究者正努力探究發展焦慮疾患的危險因子，期待能進一步發展出預防及介入的方向。
探討影響兒童焦慮的相關因素中，氣質建構－行為抑制對於焦慮的影響為近二十年來提出的研究議題，研究發現兒童的行為抑制與焦慮有關，但並非所有行為抑制的孩童均發展出焦慮疾患。研究者指出行為抑制與依附的交互作用可能增加焦慮疾患發生的可能，實證研究發現行為抑制與依附型態對兒童焦慮均佔有解釋量，但兩者的交互作用並未得到多數研究的證實。有學者指出在探討行為抑制與依附型態對於焦慮症狀的影響應考慮是否因性別而有所不同。然而，過去研究結果發現行為抑制與依附型態有關，是否不安全依附在行為抑制與兒童焦慮的關係中扮演中介的角色，仍需進一步驗證。
回顧過去研究，較少以縱貫研究來探討行為抑制與矛盾型依附或逃避型依附對於兒童焦慮的影響，故本研究以橫斷及縱貫研究來探討行為抑制與矛盾型依附或逃避型依附對於兒童焦慮症狀的影響是否因男女生而有所不同，或不安全依附是否中介行為抑制與焦慮症狀的關係。

【研究方法】
受試者為台南市兩所國小三、四年級學童為樣本，兩年後進行第二次追蹤，共143位學童納入本橫斷與縱貫性研究分析。研究工具：以兒童依附因應量表、兒童行為抑制量表與兒童行為情緒量表來評估兒童依附、行為抑制及焦慮症狀。研究程序為在2004年及2006年，先取得家長及學童的同意，再請學童進行問卷填答。統計分析以t檢定 (t-test) 及卡方檢定 (χ2 test) 檢驗基本人口學變項；以皮爾森相關 (Pearson correlation) 檢驗各變項間的相關；最後以多元階層迴歸 (hierarchical regression) 檢驗本研究假設模式。

【研究結果】
以多元階層迴歸分析，在橫斷分析中，結果顯示時間1矛盾型依附與兒童焦慮呈正相關，而在時間2行為抑制與矛盾型依附均與兒童焦慮呈正相關，且矛盾型依附中介行為抑制與兒童焦慮的關係。但在縱貫分析中，發現控制了時間1焦慮症狀後，時間1的行為抑制與時間1的矛盾型依附可以顯著預測時間2的焦慮症狀；而時間1矛盾型依附並未中介時間1行為抑制對時間2焦慮症狀的預測。

【結論與討論】
長期追蹤研究發現，行為抑制或矛盾型依附較高的孩童可能會發現出較多的焦慮症狀。基於本研究的限制，建議未來研究變項加入父母或老師對於孩童的評估；另外，本研究的結果，未來可在臨床的樣本上做進一步驗證。研究應用方面，建議教育母親對於行為抑制孩童，能鼓勵他們面對挑戰或新的刺激；另外，當孩童需要支持或溫暖時，也能針對孩童的需求給予一致性的回應。上述之建議仍需進一步研究驗證。

【Background and Purpose】
Anxiety disorders are one of the most common psychiatric problems among children and adolescents. Many children who experienced anxiety/depression continue to have mood disorders during adolescence and adulthood. Moreover, previous research demonstrated that approximately 50% of children in a community sample who had met diagnostic criteria for an anxiety disorder continued to exhibit an anxiety disorder two years later. Due to the high prevalence and the psychosocial impairment that anxiety has on the youths’ daily functioning, researchers have increasingly examined risk factors that are involved in the child development of elevated anxiety levels in attempt to develop early preventive intervention trials.
Over the past twenty years, researches that have focused on the early precursors to anxiety disorder have mostly highlighted on the temperamental construct of “behavioral inhibition to the unfamiliar” (BI). Previous research presented that behavioral inhibition may interact with attachment to increase the likelihood for an individual to develop an anxiety disorder. We concluded that both behavioral inhibition and attachment accounted for a unique proportion of the variance of anxiety, but the interaction between behavioral inhibition and attachment in predicting children anxiety was needed to examine. Additionally, researchers proposed that gender differences also exist in the association between behavior inhibition and attachment should not be overlooked. However, previous studies found that behavior inhibition was associated wtih attachment. The issue on the mediation effect of behavioral inhibition on children anxiety through insecure attachment are worthy of further illumination.
Reviewing previous studies, only one longitudinal study was conducted to investigate the relationships among behavioral inhibition, insecure attachment, and anxiety disorders previously. These associations need to be replicated by using a longitudinal design.
Therefore, the current study was designed to examine how behavioral inhibition and insecure attachment on symptoms of anxiety through a cross-sectional and longitudinal analyses.
We hypothesized that the interaction between gender, behavioral inhibition and ambivalent or avoidant attachment may play an important role in the development of anxiety symptoms. Moreover, insecure attachment would mediate the relationship between behavior inhibition and children’s anxiety symptoms.

【Method】
Participants were recruited from two elementary schools in Southern Taiwan. At Time1 226 3rd- and 4th-grade students completed all measures. A two year follow-up was conducted on a total of 143 students. Children completed self-reported measures of the Children’s Attachment Questionnaire, the Chinese Version of Behavioral Inhibition Scale, and the Child Behavioral and Emotional Checklist. After informing the purpose of the study and obtaining consent forms from parents and children under the instructions to the questionnaires, students completed inventories. Two years later, the exact procedures were followed. t-test, χ2 test, and Pearson correlation were used to examine the demographic data and the relationships among all variables. Furthermore, in order to examine our hypothetical model in predicting anxiety symptoms, we analyzed the variables by multiple hierarchical regression analyses.

【Results】
In the cross-sectional regression analyses, results indicated that at Time 1, only preoccupied attachment was positively associated with anxiety symptoms. At Time 2, both behavior inhibition and preoccupied attachment were associated with Time 2 anxiety symptoms. Moreover, preoccupied attachment played a mediating role between BI and anxiety symptoms. Results following the longitudinal study showed that either Time 1 BI or Time 1 preoccupied attachment independently made an impact on the increase in anxiety symptoms for Time 2 after controlling for Time 1 anxiety symptoms. However, Time 1 preoccupied attachment would not serve as a mediator between Time 1 behavior inhibition and Time 2 anxiety symptoms.

【Discussion】
Our findings showed that following a longitudinal design, we found that children with high BI and/or preoccupied attachment at T1 displayed high levels of anxiety symptoms across the 2-year period. There are several limitations in this study. First, in the future, study should rely on multiple informants such as the inclusion of parents and teachers in the assessment. Second, for future investigations, our findings should be replicated in extension to the clinical population. Moreover, our findings provide implications for clinicians to develop preventive program for children anxiety. We suggest that caregivers should be educated to encourage his/her behavior inhibited children to be willing to face challenging situations and help them to learn self-soothing strategies in the time of arousal; and should be more responsive and consistent when the child needs their warmth or support. Further studies are needed to examine the suggestions.

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