Preschool predictors of childhood anxiety disorders: a prospective community study

​Background
Anxiety disorders are often present at preschool age. Research on older children and studies contrasting preschoolers with high versus low behavioral inhibition (BI) highlight several risk factors, but these have not been investigated in community samples of young children. Child, parent, and peer factors at age 4 were therefore examined as potential predictors of anxiety disorders at age 6.

Methods
Two birth cohorts of 4-year olds living in the city of Trondheim, Norway, were screened for emotional and behavioral problems. A subsample oversampled for emotional and behavioral problems were drawn to take part in the study; 82.1% consented. Parents of 1000 children were interviewed with the Preschool Age Psychiatric Assessment and provided ratings of children's BI, victimization by peers and their own anxiety symptoms. Assessments of attachment and parent–child interaction were based on observation. Preschool teachers rated children's social competence. Children were reassessed after 2 years (N = 797).

Results
High scores on BI, attention-deficient/hyperactivity disorder, parental anxiety, and peer victimization, along with low scores on social skills at age 4 collectively predicted anxiety disorders at age 6 after controlling for initial anxiety and other disorders. The effect of parental anxiety did only apply to children with high levels of BI. No effects of age-4 anxiety, gender, parenting, parental SES, divorce, peer acceptance, or attachment emerged.

Conclusions
Behavioral inhibition, parental anxiety, and peer victimization function as risk factors whereas high social competence may protect against anxiety disorders in young children.