Temperament Distinguishes Persistent/Recurrent from Remitting Anxiety Disorders Across Early Childhood

Abstract

Up to 20% of preschool-age children meet criteria for anxiety disorders and, for a large subset, anxiety appears to persist throughout early childhood. However, little is known about which factors predict persistence/recurrence of anxiety in young children. Temperament, including behavioral inhibition (BI), negative emotionality (NE), and positive emotionality (PE), predict the onset of anxiety disorders, but to our knowledge no study has examined whether temperament predicts the course of anxiety in young children. From a community sample of 3-year-olds, we identified 89 children (79.8% White, non-Hispanic; 41.6% female) who met criteria for an anxiety disorder and examined whether observed and parent-reported BI, NE, and PE at age 3 distinguished children who continued to meet criteria for an anxiety disorder from those who remitted by age 6. Higher levels of BI and lower levels of PE assessed in the laboratory and higher parent-reported BI and shyness and lower surgency at age 3 significantly predicted persistence/recurrence of anxiety disorders from age 3 to 6. These data are the first to demonstrate the influence of temperament on the course of anxiety disorders in young children. These findings can enhance assessment and treatment of anxiety by focusing intervention efforts on children who are at risk for persistent or recurring anxiety rather than children who are displaying transient, and possibly developmentally normative, anxiety.

ACKNOWLEDGMENTS

Portions of this work were presented in April 2013 at the meeting of the Society for Research in Child Development, Seattle, WA. Dr. Carlson reports grants from National Institute of Mental Health, grants from Pfizer, grants from Weyerhaeuser Foundation, and grants from Schering-Plough/Merck outside the submitted work.

FUNDING

This research was supported by a National Institute of Mental Health grants R01 MH069942 (Klein) and F31 MH084444 (Ruth L. Kirschstein National Research Service Award; Bufferd). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

Notes

¹ We did not include the CBQ’s third broadband factor, Effortful Control, because its associations with anxiety have been inconsistent (Thorell, Bohlin, & Rydell, 2004; White, McDermott, Degnan, Henderson, & Fox, 2011).

² We also examined temperamental predictors of dimensional anxiety scores in the 89 children who met criteria for an anxiety diagnosis at age 3. We ran multiple regression models with the temperament variable as an independent variable, the age 3 anxiety symptom scale as the covariate, and the age 6 anxiety symptom scale as the dependent variable. The findings were consistent with the results of the analyses using diagnoses as the dependent variables as reported in the article, with the exception that Lab-TAB PE was not associated with the course of symptoms: Lab-TAB BI (B = 1.95, SE = .90, t = 2.17, p = .03); Maternal CBQ Surgency (B = –2.50, SE = .92, t = –2.72, p = .008); BIQ/CSPS scale (B = 1.57, SE = .57, t = 2.75, p = .007).

Additional information

Funding

This research was supported by a National Institute of Mental Health grants R01 MH069942 (Klein) and F31 MH084444 (Ruth L. Kirschstein National Research Service Award; Bufferd). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.