Symptoms and Development of Anxiety in Children With or Without Intellectual Disability

Abstract

Objective To examine group differences in presentation and trajectory of anxiety symptoms and disorders in children with moderate to borderline Intellectual Disability (ID) and children with typical cognitive development (TD). Method Examined anxiety disorders and symptoms in children with ID (n=74) or TD (n=116) annually from ages 5 through 9 using a parent structured interview and questionnaire. Logistic regression was used to examine odds of meeting anxiety criteria and hierarchical linear modeling was used to examine anxiety trajectory. Results Children with ID had significantly higher rates of clinical levels of anxiety on the CBCL at ages 8 and 9 and higher rates of separation anxiety disorder (SAD) at age 5 compared to those with TD. Children with ID were also more likely to have externalizing problems co-occurring with anxiety. The rate of increase of anxiety symptoms over time was positive and similar in the two groups, and neither group showed sex differences in anxiety rates. Conclusions Results suggest that children with ID have both higher rates of anxiety across time and are delayed in showing typical decreases in separation anxiety in early childhood. Implications for intervention are discussed in terms of the importance of screening for and treating anxiety in children with ID.

Psychopathology: ADHD, Autism Spectrum Disorders, and Other Conditions Present in Early Childhood

“…Dekker and Koot (2003) found that twice as many children with ID and an anxiety disorder also met criteria for one or more co-occurring disruptive behavior disorders (42.5 %; i.e., ADHD, ODD, and conduct disorder), compared to typically developing children with anxiety disorders (20.6-20.9 %; e.g., Fleitlich-Bilyk and Goodman 2004). Green et al (2014) also found significantly higher odds of children with ID meeting clinical significance for both anxiety and inattentive/hyperactive symptoms, in particular, and externalizing problems, overall. These odds proved to be above chance levels (at least twice the frequency as expected by chance), given the higher rates of clinical levels of anxiety and other psychiatric symptoms in this population, and may result in higher levels of impairment among these children.…”

“…However, later in childhood, children with TD and ID exhibit more comparable rates of separation anxiety. When analyzing parent reports of children's anxiety symptoms through written questionnaires, elementary-aged (i.e., 5-9 years) children with ID are more likely to fall within clinical levels of symptoms on the anxiety problems subscale of the Child Behavior Checklist (13.7-28.1 %) compared to children with typical development (6.0-14.8 %), with significant differences between the groups emerging by ages 8 and 9 (Green et al 2014). Additionally, anxiety levels appear to be related to children's level of cognitive functioning.…”

“…In fact, in one of these studies, specific phobia was the most prevalent DSM-IV disorder among children with ID (17.5 %) as assessed via the Diagnostic Interview Schedule for Children (DISC), though fewer children experience significant impairment due to their phobia (6.8 %; Dekker and Koot 2003). Five-year-old children with ID exhibit significantly higher rates of separation anxiety (17.6 %) than typically developing 5-yearold children (5.2 %), as measured using this same parent-interview measure (Green et al 2014). However, later in childhood, children with TD and ID exhibit more comparable rates of separation anxiety.…”

Psychopathology in Down Syndrome

“…ADHD and anxiety comorbidities were found higher among individuals with DS-ID than in typically developed individuals [3,69].…”

“…Studies suggest that 10-22% of the individuals with ID have met diagnostic criteria for anxiety disorder; this rate is higher than the individuals with typical development (3-7%). Studies have found no diference in prevalence of anxiety among mentally disabled individuals between the genders [69]. As in the general population, anxiety symptoms such as fear, trembling, lushing, and irritability can be observed in DS [9].…”