Anxiety in Early Childhood: What Do We Know?

By Altman, Cindy; Sommer, Julie L. et al. | Journal of Early Childhood and Infant Psychology, Annual 2009 | Go to article overview

Anxiety in Early Childhood: What Do We Know?


Altman, Cindy, Sommer, Julie L., McGoey, Kara E., Journal of Early Childhood and Infant Psychology


Anxiety is frequently cited as one of the most common mental health problems experienced by children and adolescents (e.g., Morris & March, 2004), yet it becomes apparent in perusing recently published literature that a dearth of studies related to anxiety in toddlers and preschool-aged children have been conducted to date. As a consequence of the lack of research attention afforded to this population, relatively little is known about the experience of anxiety among young children as compared to their adolescent and adult counterparts. The potential knowledge to be gained from studies of anxiety in early childhood is vital for improving early identification of anxiety and informing future approaches to prevention and intervention of anxiety during this phase of development.

In an effort to clarify the present state of knowledge pertaining to anxiety among young children, this paper briefly summarizes the symptoms most commonly associated with anxiety in this age group and discusses multiple factors that have previously been implicated in the development of anxiety in young children. Numerous approaches to assessment and treatment of anxiety in early childhood are also presented before discussing implications for clinical practice, addressing several limitations in the reviewed literature, and suggesting potential areas for future research. The intent of this work is to provide a succinct overview of the above issues in an attempt to stimulate further discussion and research in these topical areas.

Symptoms of Anxiety

As Lyons-Ruth, Zeanah, and Benoit (2003) note, the way a child functions during the early years of life is quite different from functioning at later developmental stages. This applies equally well to the experience of anxiety across the lifespan as it does to other aspects of development. A limited amount of study has focused on anxiety among young children to date. Nonetheless, researchers tend to agree that symptoms of separation anxiety, as described in the fourth edition, text revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) published by the American Psychiatric Association (APA, 2000), are the predominant manifestation of anxiety in the early years of childhood (e.g., Weems & Costa, 2005). Due to the prevalence of separation anxiety disorder in early childhood and available research devoted to this topic, the next section focuses wholly on it, while the remainder of text pertains to anxiety in more general terms.

Separation Anxiety Disorder

Separation anxiety is characterized by the experience of marked distress when separation from the home or an attachment figure occurs, or perhaps is merely anticipated by a child (APA, 2000). More specifically, children with separation anxiety may be clingy (APA), be tearful or cry inconsolably at times of separation (Schniering, Hudson, & Rapee, 2000), evidence nightmares or other sleep difficulties (Velting, Setzer, & Albano, 2002), and/or present with temper tantrums that become especially intense when separation is required (Choate, Pincus, Eyberg, & Barlow, 2005). Children with separation-related concerns also often present with somatic complaints, most commonly headaches, stomachaches, and nausea (Velting et al.). This may lead to frequent visits to the pediatrician and/ or school nurse and in some cases, claims of feeling so poorly that the child cannot attend school altogether (Choate et al.; Christophersen & Mortweet, 2001).

Although anxiety surrounding separation is generally considered a normal facet of child development in the early years of life, there may be reason for concern when: (a) a child's anxiety related to separation from home or those to whom the child is attached is deemed excessive, (b) such anxiety is beyond what is expected given the child's age and developmental level, and/or (c) the anxiety is believed to adversely impact the child's everyday functioning. …

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