Preschool anxiety disorders in pediatric primary care: prevalence and comorbidity

Abstract

Objective: We sought to establish prevalence rates and detail patterns of comorbidity for generalized anxiety disorder, separation anxiety disorder, and social phobia in preschool-aged children.

Method: The Duke Preschool Anxiety Study, a screen-stratified, cross-sectional study, drew from pediatric primary care and oversampled for children at risk for anxiety. A total of 917 parents of preschool children (aged 2-5 years) completed the Preschool Age Psychiatric Assessment.

Results: Generalized anxiety disorder, separation anxiety disorder, and social phobia are common in preschool-aged children attending pediatric primary care. Three-fourths of preschoolers with an anxiety disorder only had a single anxiety disorder. Generalized anxiety disorder displayed the greatest degree of comorbidity: with separation anxiety disorder (odds ratio [OR] = 4.1, 95% CI = 2.0-8.5), social phobia (OR = 6.4, 95% CI = 3.1-13.4), disruptive behavior disorders (OR = 5.1, 95% CI = 1.6-15.8), and depression (OR = 3.7, 95% CI = 1.1-12.4).

Conclusions: The weakness of association between generalized anxiety disorder and depression stands in contrast to substantial associations between these 2 disorders reported in older individuals. Attenuated associations in preschool-aged children could translate into clinical opportunities for targeted early interventions, aimed at modifying the developmental trajectory of anxiety disorders.

Keywords: comorbidity; pediatric primary care; preschool anxiety disorders; prevalence.

Figure 1

Comorbidity among generalized anxiety disorder (GAD), separation anxiety disorder (SAD), and social phobia (SOC). Note: Percentages add up to 100, n = 327. Figure 2 shows comorbidity across all disorders. n = unweighted number in group; % = weighted percentage.

Figure 2

Comorbidity across all disorders in preschoolers with anxiety disorders. Note: Percentages add up to 100. ADHD = attention-deficit/hyperactivity disorder; DBD = disruptive behavior disorders (oppositional defiant disorder or conduct disorder); n = unweighted number in group; non-anxious disorders = depression (major depressive disorder, depression–not otherwise specified [NOS], or dysthymia); % = weighted percentage.