Anxiety disorders are common even in very young children. Preschool-aged children often have symptoms of social or separation anxiety. The prevalence of these disorders is 7.5 and 10.5 respectively. A substantial number of preschoolers with anxiety disorders have more than one psychiatric diagnosis, which may be another anxiety disorder or a non-anxious disorder such as depression. Symptoms of separation anxiety include extreme distress when separated from a caregiver, nightmares, fear of negative events occurring when separated from the caregiver, and crying spells or tantrums. Children with social anxiety typically avoid unfamiliar social situations and suffer severe symptoms when forced to endure them. These disorders are caused by genetic, temperament, and environmental factors. Studies have shown it is possible to reduce risk of future anxiety development if very young children receive brief interventions. Typical treatment includes cognitive behavioral therapy, with parent-child play-oriented sessions to teach coping strategies, and medications such as anti-depressants or anxiolytics.

In addition to developmental disorders, professionals in psychiatry and psychology have noted that many adult mental disorders can be see in children and adolescents. For example, a variety of anxiety disorders have been identified even in very young children. Among the most common are separation anxiety, in which children become distressed when caregivers leave, and social anxiety, when children experience anxiety symptoms around new people or situations. The number of young children taking anxiety-reducing medications has increased dramatically in the 21st century. According to a study published in 2013 (Franz et al.) which measure prevalence and comorbidity in a large sample (n=917) of preschoolers aged 2-5, prevalence of separation anxiety disorder was 10.5, social anxiety 7.5, and any anxiety disorder 19.4. For children with separation anxiety, 21% also had another anxiety disorder while 41% had at least one non-anxiety disorder. More children with social anxiety had no other mental disorder, 25% had another anxiety disorder, while 34% had at least one other non-anxiety disorder. Non-anxiety disorders included depression, disruptive behavior disorders, and attention deficit disorders. The measures used in this study included the Child Behavior Checklist for Ages 1 ½ to 5 and the Preschool Age Psychiatric Assessment for 2-5-year-olds (Franz et al., 2013).

Children experiencing separation anxiety show extreme distress when away from caregivers (parents or others). Preschoolers often have intense crying spells, tantrums, defiance, headaches, stomachaches, and dizziness, and may express fear that something will happen to them or their caregivers when they are separated. Another symptom of separation anxiety is nightmares about being lost or hurt. Symptoms of social anxiety include excessive self-consciousness and fear of humiliation, shyness, crying or throwing tantrums when faced with a social situation, and physical symptoms such as shortness of breath, pounding heartbeat, sweating, and shaking (similar to physical symptoms of panic) (Mian et al., 2012).

Diagnosis of separation anxiety or social anxiety requires that the symptoms are severe enough to interfere with normal functioning. Children with these disorders make extreme efforts to avoid situations that make them anxious, and if the situations are forced on them, they experience high levels of distress, often including panic symptoms. Symptoms of social anxiety disorder must occur in a variety of settings and last for six or more months; separation anxiety symptoms must occur for at least four weeks (Bufferd et al., 2012).

Both genetic and environmental risk factors have been identified for childhood anxiety disorders. Twin studies, while they have not found specific genes, suggest that the genetic aspects of emotional reactivity and neurobiological arousal form important processes around which anxiety can develop (Rapee et al., 2010). It is believed that these processes support the development of certain personality traits and temperaments that are associated with future anxiety symptoms. For example, high levels of the traits variously named behavioral inhibition, social withdrawal, inhibition, and shyness, place young children at greater risk for internalized stress and subsequent anxiety disorders. Environmental factors are also important, especially when considered as temperament-environment interactions. For instance, inhibited behavior by the child can produce overprotective and controlling behavior related to parental anxiety, which further induces the child’s inhibition (Clauss & Blackford, 2012). Based on these observations, Rapee and colleagues (2010) developed a six-session group intervention for parents of children with inhibited preschool-age children. The sessions included parenting instruction, cognitive intervention, and exposure therapy. They found that, although the brief intervention did not alter children’s temperaments – they still display inhibited behavior – it did result in a lower incidence of anxiety disorders and less anxiety symptoms (Rapee et al., 2010).

Cognitive behavioral therapy (CBT) is the most frequent treatment prescribed for anxiety disorders, even for young children, in which case it should be adjusted to developmentally appropriate cognitive processing. Treatment for preschoolers should be given to parent and child together whenever possible, in addition to separate parent-only session similar to the Rapee and colleagues (2010) protocol discussed above. CBT teaches adults and children to recognize thoughts that have negative effects and teaches them to substitute thoughts that are more helpful. Children are taught coping strategies that are specific to their individual needs. Additional methods that may be helpful when incorporated in the CBT framework include verbal self-instructions, graded exposure and desensitization, roleplaying, modeling, and reinforced practice. With young children, therapy is often given in a play setting with games, puppet play, and similar methods (Hirshfeld-Becker et al., 2010). For children with mild to moderate anxiety, therapy is usually sufficient. However, children with severe symptoms may require medication to help them make progress in therapy. The most commonly used classes of drugs are anti-depressants and anxiolytics.

Separation anxiety and social anxiety disorders are relatively common among preschool-aged children, with prevalence of 10.5 and 7.5 respectively. Children may have one or more anxiety disorders in addition to other psychiatric disorders such as attention deficit disorders or conduct disorders. Young children with anxiety disorders have a greatly increased risk of being diagnosed with anxiety and depression as they grow older, and these diagnoses can have serious impacts on their academic, social, and personal growth. Causes of anxiety disorders include genetics, temperament, and environment. In very young children, brief interventions with parents have shown some success in preventing further development of anxiety disorders and decreasing anxiety symptoms up to three years later. Cognitive-behavioral therapy can be used to treat social and separation anxiety, sometimes in conjunction with medication.