Generalized Anxiety Disorder in Very Young Children: First Case Reports on Stability and Developmental Considerations

Generalized anxiety disorder (GAD) is purported to start in early childhood but concerns about attenuation of anxiety symptomsover time and the development of emerging cognitive and emotional processing capabilities pose multiple challenges for accuratedetection. This paper presents the first known case reports of very young children with GAD to examine these developmentalchallenges at the item level. Three children, five-to-six years of age, were assessed with the Diagnostic Infant and PreschoolAssessment twice in a test-retestreliability study. One case appeared to show attenuation of the worries during the test-retestperiodbased on caregiver report but not when followed over two years. The other two cases showed stability of the full complementof diagnostic criteria. The cases were useful for demonstratingthat the current diagnostic criteria appear adequate for thisdevelopmental period. The challenges of accurate assessment of young children that might cause missed diagnoses are discussed.Futureresearchon the underlying dysregulation of negative emotionality and long-term follow-ups are needed to betterunderstandthe etiology, treatment, and course of GAD in this age group