Preschool anxiety disorders in pediatric primary care: prevalence and comorbidity

J Am Acad Child Adolesc Psychiatry. 2013 Dec;52(12):1294-1303.e1. doi: 10.1016/j.jaac.2013.09.008. Epub 2013 Sep 27.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anxiety Disorders / epidemiology*
  • Anxiety, Separation / epidemiology*
  • Child Health Services / statistics & numerical data
  • Child, Preschool
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Phobic Disorders / epidemiology*
  • Prevalence
  • Primary Health Care / statistics & numerical data*