The Day-to-Day Associations Between Anxiety and Impairment in Preschool-Aged Children

Anxiety often emerges in early childhood and is associated with impairment in functioning and relationships. Additionally, early emerging anxiety often persists overtime and may be associated with long term impairment. However, behaviors related to anxiety are developmentally normative during early childhood. Therefore, it can be difficult to distinguish typical anxiety behaviors from clinically concerning anxiety. One factor that may influence whether anxiety is problematic is the extent to which the behaviors cause the child distress and/or interfere with the child’s functioning and relationships. Further, sleep quality has been associated with clinically anxious behavior in childhood and can be related to the level of impairment/distress that is experienced. The goal of the current study is to examine the day-to-day associations between children’s social and separation anxiety, related distress and impairment, and sleep quality to better understand whether behaviors typically considered normative in early childhood may be clinically concerning. Parents of preschool-aged children (3-5-years-old) completed an online daily diary to report the frequency of children’s anxious behavior each day for 14 consecutive days. To assess daily distress and impairment, parents rate the extent to which social and separation anxiety behaviors interfered with their children’s ability to follow daily routines or get along with others. Additionally, parents reported daily levels of distress for themselves and their child, their parent-child relationship quality, as well as their child’s sleep quality on the previous night. Separation and social anxiety were related to impairment and distress within the same day. Increased separation and social anxiety on a particular day were not related to increased levels of impairment and distress the following day, however increased social anxiety on particular day predicted decreased social anxiety the following day. Additionally, decreased sleep quality predicted next day separation anxiety and associated impairment as well as parent-child distress. Based on the present findings, child practitioners should consider children at risk for clinically concerning anxiety if they are experiencing both child and parent impairment or distress associated with such behaviors, particularly if children are experiencing decreased sleep quality in conjunction with higher than typical separation anxiety behaviors.