Abstract
This study assessed the prevalence of anxiety disorders in preschool children and their associations with behavioral inhibition as a temperamental precursor. A representative sample of 1,342 children aged 4–7 years (M = 6;1, SD = 4.80) was examined with a standardized parental questionnaire, including items referring to anxiety disorders at the current age and behavioral inhibition at the age of 2 years. The total prevalence of anxiety disorders was 22.2 %. Separation anxiety (SAD) affected 7 %, social phobia (SOC) 10.7 %, specific phobia (PHOB) 9.8 % and depression/generalized anxiety (MDD/GAD) 3.4 % of children. The prevalence of most types of anxiety was higher in girls except for separation anxiety, which affected more boys. Behavioral inhibition in the second year of life was associated with all types of anxiety. Anxiety disorders are common but frequently overlooked in preschool children. Different subtypes can be differentiated and are often preceded by behavioral inhibition. Assessment, prevention and treatment of anxiety disorders are recommended in preschool children.
Similar content being viewed by others
Abbreviations
- BI:
-
Behavioral inhibition
- CBCL/1½–5:
-
Child behavior checklist 1½–5
- CBCL/4–18:
-
Child behavior checklist 4–18
- DSM-5:
-
Diagnostic and statistical manual-5
- GAD:
-
General anxiety disorder
- IBQ-R:
-
Infant behavior questionnaire
- ICD-10:
-
International classification of diseases-10
- MDD/GAD:
-
Major depressive disorder/generalized anxiety disorder
- PAPA:
-
Preschool age psychiatric assessment
- PHOB:
-
Specific phobia
- RIBI:
-
Retrospective infant behavioral inhibition scale
- SAD:
-
Separation anxiety disorder
- SOC:
-
Social phobia
References
Egger HL, Angold A (2006) Common emotional and behavioural disorders in preschool children: presentation, nosology, and epidemiology. J Child Psychol Psychiat 46:313–337
Essau CA, Olaya B, Ollendick TH (2013) Classification of anxiety disorders in children and adolescents. In: Essau CA, Ollendick TH (eds) The Wiley-Blackwell handbook of the treatment of childhood and adolescent anxiety. Wiley-Blackwell, Chichester, pp 1–21
WHO (1996) Multiaxial classification of child and adolescent psychiatric disorders. Cambridge University Press, Cambridge
APA (2013) Diagnostic and statistical manual of mental disorders (5th ed.) (DSM-5) American Psychiatric Association, Washington DC
Cartwright-Hatton S, McNicol K, Doubleday E (2006) Anxiety in a neglected population: prevalence of anxiety disorders in pre-adolescent children. Clin Psychol Rev 26:817–833
Ford T, Goodman R, Meltzer H (2003) The British child and adolescent mental health survey 1999: the prevalence of DSM-IV disorders. J Am Acad Child Adolesc Psychiatry 42:1203–1211
Kroes M, Kalff AC, Kessels A, Steyaert J, Feron F, Van Someren A et al (2001) Child psychiatric diagnoses in a population of Dutch schoolchildren aged 6–8 years. J Am Acad Child Adolesc Psychiatry 40:1401–1409
Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 60:837–844
Canals J, Marti-Henneberg C, Fernandez-Ballart J, Clivillé R, Domènech E (1992) Scores on the state-trait anxiety inventory for children in a longitudinal study of pubertal Spanish youth. Psychol Rep 71:503–512
McLean CP, Anderson ER (2009) Brave men and timid women? A review of the gender differences in fear and anxiety. Clin Psychol Rev 29:496–505
Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 62:593–602
Bodden DHM, Dirksen CD, Bögels SM (2008) Societal burden of clinically anxious youth referred for treatment: a cost-of-illness study. J Abnorm Child Psychol 36:487–497
Egger HL, Angold A (2006) Anxiety Disorders. In: Luby JL (ed) Handbook of preschool mental health: development, disorders, and treatment. Guilford Press, New York, pp 137–164
Lavigne JV, LeBailly SA, Hopkins J, Gouze KR, Binns HJ (2009) The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds’. J Clin Child Adolesc Psychol 38:315–328
Gadow KD, Sprafkin J, Nolan EE (2001) DSM-IV symptoms in community and clinic preschool children. J Am Acad Child Adolesc Psychiatry 40:1383–1392
Poulton R, Milne BJ, Craske MG, Menzies RG (2001) A longitudinal study of the etiology of separation anxiety. Behav Res Ther 39:1395–1410
Sterba S, Egger HL, Adrian A (2007) Diagnostic specificity and nonspecificity in the dimensions of preschool psychopathology. J Child Psychol Psychiatry 48:1005–1013
Achenbach TM, Rescorla LA (2000) Manual for the ASEBA preschool forms and profiles. University of Vermont Department of Psychiatry, Burlington
Egger HL, Angold A (2004) The preschool age psychiatric assessment (PAPA): a structured parent interview for diagnosing psychiatric disorders in preschool children. In: DelCarmen-Wiggins R, Carter A (eds) Handbook of infant, toddler, and preschool mental health assessment. Oxford University Press, New York, pp 223–243
Kagan J, Reznick JS, Snidman N (1988) Biological bases of childhood shyness. Science 240:167–171
Asendorpf JB (1989) Shyness as a final pathway for two different kinds of inhibition. J Person Soc Psychol 57:481–492
Kagan J, Snidman N, Kahn V, Towsley S (2007) The preservation of two infant temperaments into adolescence. Monogr Soc Res Child Dev 72:1–75
Schwartz CE, Wright CI, Shin LM, Kagan J, Rauch SL (2003) Inhibited and uninhibited infants ‘grown up’: adult amygdalar response to novelty. Science 300:1952–1953
Pérez-Edgar K, Roberson-Nay R, Hardin MG, Poeth K, Guyer AE, Nelson EE et al (2007) Attention alters neural responses to evocative faces in behaviourally inhibited adolescents. Neuroimage 35:1538–1546
Smoller JW, Rosenbaum JF, Biederman J, Kennedy J, Dai D, Racette SR et al (2003) Association of a genetic marker at the corticotrophin-releasing hormone locus with behavioural inhibition. Biol Psychiatry 54:1376–1381
Smoller JW, Yamaki LH, Fagerness JA, Biederman J, Racette S, Laird NM et al (2005) The corticotrophin-releasing hormone gene and behavioural inhibition in children at risk for panic disorder. Biol Psychiatry 57:1485–1492
Fox NA, Calkins SD, Bell MA (1994) Neural plasticity and development in the first two years of life: evidence from cognitive and socioemotional domains of research. Dev Psychopathol 6:677–696
Fox NA, Henderson HA, Marshall PJ, Nichols KE, Ghera MM (2005) Behavioral inhibition: linking biology and behaviour within a developmental framework. Annu Rev Psychol 56:235–262
Kennedy SJ, Rapee RM, Edwards SL (2009) A selective intervention program for inhibited preschool-aged children of parents with an anxiety disorder: effects on current anxiety Disorders and temperament. Am Acad Child Adolesc Psychiatry 48:602–609
Kagan J (1994) Galen’s prophecy. Basic Books, New York
Park S, Belsky J, Putnam S, Crnic K (1997) Infant emotionality, parenting, and 3-year inhibition: exploring stability and lawful discontinuity in a male sample. Dev Psychol 3:218–272
Kagan J (2012) The biography of Behavioral Inhibition. In: Zentner M, Shiner RL (eds) Handbook of temperament. Guilford Press, New York, pp 69–82
Rothbart MK (1981) Measurement of temperament in infancy. Child Dev 52:569–578
Gensthaler A, Möhler E, Resch F, Paulus F, Schwenck C, Freitag CM, Goth K (2013) Retrospective assessment of behavioral inhibition in infants and toddlers: development of a parent report questionnaire. Child Psychiatry Hum Dev 44:152–165
Hirshfeld-Becker DR, Biederman J (2002) Rationale and principles for early intervention with young children at risk for anxiety disorders. Clin Child Fam Psychol Rev 5:161–172
Schwartz CE, Snidman N, Kagan J (1999) Adolescent social anxiety as an outcome of inhibited temperament in childhood. J Am Acad Child Adolesc Psychiatry 38:1008–1015
Hirshfeld-Becker DR (2010) Familial and temperamental risk factors for social anxiety disorder. In: Gazelle H, Rubin KH (eds) Social anxiety in childhood: Bridging developmental and clinical perspectives. New Dir Child Adolesc Dev 127:51–65. San Francisco: Jossey-Bass
Biederman J, Faraone SV, Hirshfeld-Becker DR, Friedman D, Robin JA, Rosenbaum JF (2001) Patterns of psychopathology and dysfunction in high-risk children of parents with panic disorder and major depression. Am J Psychiatry 158:49–57
Hayward C, Killen JD, Kraemer HC, Taylor CB (1998) Linking selfreported childhood behavioral inhibition to adolescent social phobia. J Am Acad Child Adolesc Psychiatry 37:1308–1318
Mick MA, Telch MJ (1998) Social anxiety and history of behavioral inhibition in young adults. J Anx Disor 12:1–20
Prior M, Smart D, Sanson A, Oberklaid F (2000) Does shy-inhibited temperament in childhood lead to anxiety problems in adolescence? J Am Acad Child Adolesc Psychiatry 39:461–468
Zeanah CH, Boris NW, Larrieu JA (1997) Infant development and developmental risk: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 36:165–178
Achenbach TM (1991) Manual for the Child Behavior Checklist/4-18 and 1991 profile. University of Vermont, Department of Psychiatry, Burlington
Arbeitsgruppe Deutsche Child Behavior Checklist (1998) Elternfragebogen über das Verhalten von Kindern und Jugendlichen (CBCL/4-18) [Parent questionnaire on the behavior of children and adolescents] 2nd ed. with german norms. Ed by Döpfner M, Plück J, Bölte S, Lenz K, Melchers P, Heim K. Arbeitsgruppe Kinder-, Jugend-, und Familiendiagnostik (KFDJ), Cologne
Döpfner M, Görtz-Dorten A, Lehmkuhl G, Breuer D, Goletz H (2008) DISYPS-II -Diagnostik-System für psychische Störungen nach ICD-10 und DSM-IV für Kinder und Jugendliche-II [Diagnostic System for Mental Disorders in Childhood and Adolescence], 1st edn. Huber, Bern
Goth A, Gensthaler A, Moehler E (2008) RIBI (Retro-Infant-BI). Unpublished Manual. Ruprecht Karls University Heidelberg
Kagan J (1988) Temperamental contributions to social behavior. Am Psychol 44:668–674
Essau CA, Gabbidon J (2013) Epidemiology, comorbidity and mental health services utilization. In: Essau CA, Ollendick TH (eds) The Wiley-Blackwell handbook of the treatment of childhood and adolescent anxiety. Wiley-Blackwell, Chichester, pp 24–42
Last CG, Perrin S, Hersen M, Kadzin AE (1992) DSM-III anxiety disorders in children: sociodemographic and clinical characteristics. J Am Acad Child Adolesc Psychiatry 31:1070–1076
Feigon SA, Waldman ID, Levy F, Hay DA (2001) Genetic and environmental influences on separation anxiety disorder symptoms and theid moderation by age and sex. Behav Genet 31:403–411
Leung PWL, Hung S, Ho TP, Lee CC, Liu WS et al (2008) Prevalence of DSM-IV disorders in Chinese adolescents and the effects of an impairment criterion: a pilot community study in Hong Kong. Eur Child Adolesc Psychiatry 17:452–461
Kagan J (1989) Unstable ideas. Temperament, cognition, and self. Harvard University Press, Cambridge
Laucht M, Esser G, Schmidt MH (2000) Externalisierende und Internalisierende Störungen in der Kindheit: untersuchungen zur Entwicklungspsychopathologie [Externalizing and internalizing disorders in childhood: studies on developmental psychopathology]. Z Klin Psychol Psychoth 29:284–292
Hirshfeld-Becker DR, Micco J, Henin A, Bloomeld A, Biederman J, Rosenbaum J (2008) Behavioral inhibition. Depr Anx 25:357–367
Caron C, Rutter M (1991) Comorbidity in child psychopathology: concepts, issues and research strategies. J Child Psychol Psychiatry 32:1063–1080
Angold A, Costello EJ, Erkanli A (1999) Comorbidity. J Child Psychol Psychiatry 40:57–87
Forbes EA, Bertocci MA, Gregory AM, Ryan ND, Axelson DA et al (2008) Objective sleep in pediatric anxiety disorders and major depressive disorder. J Am Acad Child Adolesc Psychiatry 47:148–155
Alfano CA, Ginsburg GS, Kingery JN (2007) Sleep-related problems among children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry 46:224–232
Fox NA, Henderson HA, Rubin KH, Calkins SD, Schmidt LA (2001) Continuity and discontinuity of behavioural inhibition and exuberance: psychophysiological and behavioural influences across the first four years of life. Child Dev 72:1–21
Rapee RM, Kennedy S, Ingram M, Edwards S, Sweeney L (2005) Prevention and early intervention of anxiety disorders in inhibited preschool children. J Consult Clin Psychol 73:488–497
Rapee RM, Kennedy SJ, Ingram M, Edwards SL, Sweeney L (2010) Altering the trajectory of anxiety in at-risk young children. Am J Psychiatry 167:1518–1525
Tacket JL (2006) Evaluating models of the personality-psychopathology relationship in children and adolescents. Clin Psychol Rev 26:584–599
Acknowledgments
The authors would like to thank Prof. E. Möhler for the provision of the RIBI items [46].
Conflict of interest
There is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Paulus, F.W., Backes, A., Sander, C.S. et al. Anxiety Disorders and Behavioral Inhibition in Preschool Children: A Population-Based Study. Child Psychiatry Hum Dev 46, 150–157 (2015). https://doi.org/10.1007/s10578-014-0460-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10578-014-0460-8