Screening for Fearful and Shy Temperament in Toddlers Predicts Elevated Anxiety Symptoms: A Prospective Study

Behavioral inhibition and fearfulness in toddlers predict future anxiety disorders. Family-based interventions can prevent and treat anxiety in young children. However, anxiety disorders or their precursors are often untreated until later childhood. This study evaluates a brief caregiver-report meas...

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Bibliographic Details
Published in:Journal of child and family studies 2024-07, Vol.33 (7), p.2110-2120
Main Authors: Ver Pault, Mikayla, Dai, Yael G., Abel, Madelaine R., Carter, Alice S., Henin, Aude, Kagan, Elana, Holmén, Jordan, Hirshfeld-Becker, Dina R.
Format: Article
Language:English
Subjects:
Anxiety
Anxiety disorders
Behavior problems
Behavioral Science and Psychology
Caregivers
Child and School Psychology
Childhood
Children
Clinical assessment
Disorders
Early childhood education
Early intervention
Families & family life
Fear & phobias
Measures
Medical referrals
Medical screening
Mental health services
Original Paper
Outpatient clinics
Precursors
Psychology
Questionnaires
Referrals
Shyness
Social anxiety
Social Sciences
Sociology
Symptoms
Temperament
Toddlers
Young Children
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Summary:Behavioral inhibition and fearfulness in toddlers predict future anxiety disorders. Family-based interventions can prevent and treat anxiety in young children. However, anxiety disorders or their precursors are often untreated until later childhood. This study evaluates a brief caregiver-report measure that may prospectively identify toddlers at risk of subsequent clinically elevated anxiety. Caregivers of 152 children (21–35 months; M  = 27, SD  = 4) completed the Early Childhood Behavior Questionnaire (ECBQ) Fear and Shyness scales to assess children’s baseline temperament. Children were re-screened at one-year follow-up ( M age = 40, SD  = 4 mo.) with the Spence Preschool Anxiety Scale (PAS), to capture anxiety symptoms. Mean time between the two assessments was 12.82 months ( SD  = 1.97). Children high on baseline Fear, Shyness, or both Fear and Shyness were five times more likely to have elevated symptoms of clinical anxiety at follow-up (OR (95% CI) = 4.88 (1.51, 15.74), χ 2 (1, N = 152) = 8.32 p  = 0.004). When fear and shyness were used together as predictors, high shyness predicted social anxiety, while high fear predicted generalized, separation, and total anxiety. The ECBQ achieved 62% sensitivity and 67% specificity in the current sample, with a PPV of 55% and a NPV of 73%. Results suggested that a five-minute caregiver-report questionnaire can identify toddlers at risk for future anxiety disorders. This questionnaire can be administered during well-child visits, or in outpatient mental health clinics, early intervention, or early education centers, to identify toddlers who could benefit from referral for early or preventive intervention. Highlights Intervention in early childhood can prevent and treat anxiety disorders, but anxiety is often undetected until later childhood. In this prospective study, a five-minute caregiver-completed questionnaire assessing shy and fearful temperament in two-year-olds significantly predicted clinically elevated anxiety at age three. This study suggests that a brief questionnaire could identify toddlers who may benefit from a referral to early intervention to prevent or treat anxiety disorders.
ISSN:1062-1024
1573-2843
DOI:10.1007/s10826-024-02878-z