CHOP Psychologists Build Resilience Across Generations

Dr. Lauren White is studying how parents unintentionally transmit risk factors for anxiety to their children, and what can clinicians do to support them.

Editor's Note: Where Discovery Leads is a multimedia storytelling project that delves into key research themes at Children's Hospital of Philadelphia Research Institute. This is part five of a five-part series that focuses on the scientific studies aimed at addressing behavioral and mental health.

Complementing this series is a brief video featuring Tami Benton, MD, Psychiatrist-in-Chief, as she highlights CHOP's behavioral health lifespan research, which is moving treatment closer to personalized medicine.

Two children enter a classroom to see a new student at a desk. For one child, the new classmate's presence suggests a potential friend, so they take the seat next to them. The other suspects the possibility of a bully and sits further away.

It's a small and mostly subconscious decision, the kind we make daily as adults, but for Psychologist Lauren White, PhD, these individual interpretations of an ambiguous event have wide-ranging impact. Dr. White says that how a person processes potential threats can not only predict their risk of developing mental health conditions like anxiety — it may predict their children's risk, too.

This "intergenerational picture" of risk and resilience is at the heart of Dr. White's current research at Children's Hospital of Philadelphia's Department of Child and Adolescent Psychiatry and Behavioral Sciences. Supported by a new grant from the National Institutes of Mental Health (NIMH), her team is working with more than 300 mothers from the Philadelphia Neurodevelopmental Cohort (PNC) and their children. The PNC was a collaborative research effort between the Brain Behavior Laboratory at the University of Pennsylvania and the Center for Applied Genomics at CHOP, led by Raquel Gur, MD, PhD, and Hakon Hakonarson, MD, PhD.

The initial PNC focused on the intersection of brain, behavior, and genetics. Now, roughly a decade later, many of the PNC participants are parents and Dr. White wants to follow-up with them and their children. This effort provides a unique longitudinal lens on how children inherit threat sensitivity and anxiety from caregivers and combines a wealth of multi-modal data, some of which dates back to the mothers' childhoods.

Go to Philadelphia Neurodevelopmental Cohort to learn more.

"There's a saying, 'healthy children depend on a healthy mom,'" Dr. White said. "So, we have to devote resources, not just to the child's development, but to the family, to the mom, to the dad, to the caregivers, to support the family and everyone's mental health."

With anxiety in children slowly on the rise, Dr. White said that findings from the five-year NIMH grant will enrich our understanding of anxiety development and inform stronger interventions for both parents and children.

How Do You Transmit a Sense of Threat?

To understand the importance of studying threat sensitivity in anxiety, it helps to first define it. Dr. White describes threat sensitivity as, "the recognition, interpretation, and response to threat cues in the environment — even when those 'threats' are actually ambiguous or benign."

For example, if researchers ask a child to finish a story about a dog approaching them at the park, children with a heightened threat sensitivity might end the story with the dog biting their hand rather than settling down for a cuddle. They viewed the dog, and perhaps dogs in general, as a threat.

"We all have individual patterns in how we interpret and remember negative information in our environment," Dr. White said. "And it's the same for children; some children experience their world through a negative lens, even when presented with neutral situations."

Dr. White's previous research shows that heightened threat sensitivity is a strong predictor of anxiety across the lifespan. A question that arises, then, is how children acquire these patterns of threat processing, and what role parents play in their development. The answer may have more to do with family dynamics than DNA.

"What's particularly interesting with anxiety is that, like many mental health disorders, it tends to run in families-and part of that is due to genetic heritability," Dr. White said. "But twin and adoption studies suggest the genetic heritability of anxiety is lower than it is for other disorders like depression, bipolar disorder, or schizophrenia. This tells us that environmental factors — such as exposure to an anxious parent — likely play a key role in how anxiety is passed on from one generation to the next."

In a 2025 study published in the Journal of Child Psychology and Psychiatry, Dr. White's and colleagues examined over 200 mothers and how they communicated about a given series of ambiguous situations to their children, paying special attention to the words used. In one situation, for example, the researchers had mom talk to their child about a party invite from a hypothetical classmate.

"We would leave the room, and moms would talk to their kids about this for two minutes," Dr. White said. "And I thought that moms would give their children only neutral or positive information about that hypothetical party, but I was wrong. We actually saw parents provide a huge range of positive and negative information."

Some parents emphasized how much fun the children would have at the party while others asked their child to be wary since they didn't know the new classmate's parents or suggested the child would be nervous and not enjoy the party. These various ways of communicating about the same situation resulted in different perceptions of threat for the children.

For example, if moms provided more positive information [about the situations], children's fears went down. But if moms provided negative information, it increased their children's fear.

"While this finding is not totally surprising, it showed that in ambiguous situations, moms who are providing more negative information can actually increase their kids' fear about the situation," Dr. White said. "That told us that kids are likely learning their threat processing biases or their threat sensitivity, in part, from the verbal information their parents provide."

The current NIMH grant takes Dr. White's work on the development of threat sensitivity one step further, going beyond just verbal cues from a caregiver.

Building a Bigger Picture of Anxiety

With existing data from the PNC cohort when mothers were adolescents, coupled with in-depth visits from more than 300 mother-and-child pairs over the next five years, Dr. White will examine how other environmental factors in a family's life influence the transmission of anxiety risk factors to children. She will build a new intergenerational cohort with the PNC participants who are now parents.

When the researchers are looking at these dynamics and how parents are talking to children, it will be important for them to know what environment the parent are coming from and the struggles that they are experiencing.

"When we're studying what makes us who we are, you think about it in layers," Dr. White said. "It's you, then your family and close loved ones, then your community and neighborhood, then where you are in the country, etc."

The work will go beyond just interpersonal dynamics: A growing body of research from CHOP Lifespan Brain Institute has illustrated how neighborhoods play a significant role in brain development. Factors like access to green space, lead exposure, and violence can be stressful factors that influence how a child recognizes threat and how a mother views certain experiences from a wary lens.

Dr. White also plans to study different socioeconomic stressors that families might face.

"If you're studying anxiety in an upper middle-class person, different factors might play a role compared to anxiety in a poor family who's struggling to pay the bills," Dr. White said. "They may be worried about food or housing insecurity or transportation needs — very real threats. It will be important for us to consider these contexts when examining the transmission of threat and anxiety across generations."

The data Dr. White gathers will add to a rich tapestry of lifespan information about the PNC families; since more than 50% of the mothers gave birth at Penn Medicine, electronic medical records will help her team paint a larger picture that includes possible birth complications, postpartum depression screenings, and more.

"The interesting thing about this [research] is that we get to look at how mental health symptoms or traumatic life experiences in a mom's youth relate to her current cognitive processing, parenting style and emotional well-being," Dr. White said. "Then, with this intergenerational cohort, we can examine how those early life experiences affect their own children's threat sensitivity and anxiety risk. It will provide a much needed intergenerational picture."

Behavioral Health Lifespan Research: Moving Closer to Personalized Medicine. Access the video transcript.

Research in Action: From Cohort to Clinic

Dr. White aims to continue studying the PNC beyond the five-year grant to create a truly longitudinal picture of intergenerational mental health. In the meantime, however, she envisions findings from the current grant can inform more holistic prevention and intervention approaches to anxiety that consider the family as a whole.

"In practice, that might look like providing specific examples to caregivers of how they may be unintentionally transmitting their anxiety both verbally and nonverbally with body language or facial expressions," Dr. White said. "As a parent, learning how to catch yourself in a moment of stress or anxiety, take a deep breath or do some mindfulness, before interacting or communicating with your child may be a useful tool to decrease the transmission of anxiety."

While her work emphasizes the role parents might play in their child's development, Dr. White emphasizes that the research does not suggest that parents are the cause of their children's anxieties. Instead, the intergenerational nature of anxiety risk factors calls for a more mindful and universal view of mental health.

"When we're thinking about where to intervene and how to better help these families, we have to remember this intergenerational cycle, this transmission can keep happening," Dr. White said. "What we need to do as mental health professionals is figure out how to best help families, how to meet them where they are, and give them the support they need early on and figure out what is the best way to do that — not just for a few weeks, but long-term."