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

Abstract

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), χ² (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.