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Child Psychiatry Hum Dev (2015) 46:158–166

DOI 10.1007/s10578-014-0461-7

ORIGINAL PAPER

Anxiety Disorder Symptoms in Chinese Preschool Children
Meifang Wang • Jinxia Zhao

Published online: 26 March 2014
Ó Springer Science+Business Media New York 2014

Abstract The present study investigated anxiety disorder
symptoms in Chinese preschool children. A total of 1,854
mothers of children aged 3–6 years completed the 28-item
Chinese version of Spence Preschool Anxiety Scale (PAS).
Results demonstrated that the structure of anxiety in Chinese preschool children included five factors, and this fivefactor structure applied to different age and gender groups.
Inconsistent with the study by Edwards et al. (J Clin Child
Adolesc Psychol 39:400–409, 2010) suggesting that
obsessive–compulsive disorder did not comprise an independent factor in Australian preschoolers, this symptom
can be viewed as an independent factor in Chinese preschoolers. Younger children displayed higher anxiety levels than older children. Anxiety symptoms of Chinese
preschoolers were found at a high level compared to other
studies. Substantial differences were found with regard to
the content of prevalent anxiety symptoms among Chinese
and Australian preschool children. The applicability of the
five-factor structure of PAS and research implications are
discussed.
Keywords Anxiety  Preschool children  Preschool
Anxiety Scale  China

M. Wang (&)  J. Zhao
Department of Psychology, Shandong Normal University,
No. 88 East Wenhua Road, Jinan 250014, People’s Republic of
China
e-mail: meifangw@hotmail.com; wangmf@sdnu.edu.cn
J. Zhao
Department of Education, Linyi University, Linyi, People’s
Republic of China

123

Introduction
In the past two decades, research efforts in childhood and
adolescence anxiety disorders have greatly increased our
understanding of anxiety in older children. However, we
know relatively little about the anxiety problems in very
young children [1, 2]. Research suggests that anxiety disorders have an early age of onset [3, 4], with prevalence
rates around 9 % in preschool populations [1]. This prevalence among young children is comparable to those
reported for older children [5]. Meanwhile, preschool
anxiety problems have demonstrated stability into midchildhood and adolescence [6, 7], and are associated with
future onset of other disorders like depression and conduct
disorders [8–10]. These early-onset disorders may result in
moderate to marked life impairment for young children if
left untreated [4, 11]. All these findings highlight the
importance of understanding and screening anxiety symptoms in early childhood.
Despite early onset and severity of anxiety disorders, it
is rare that young children with anxiety problems receive
appropriate care and treatment [1, 5]. One of the main
barriers is the lack of reliable and valid instruments for
assessing preschool anxiety. Thus, psychometrically sound
instruments for identifying anxiety symptoms in early
childhood are urgently needed. Currently, several measures
such as the Child Behavior Checklist [12], the Strengths
and Difficulties Questionnaire [13], and the Children’s
Moods, Fears and Worries Questionnaire [6] are often used
for assessing anxiety of preschool children. Although these
measures possess adequate psychometric properties and
provide valuable information on psychopathological
symptoms of preschool children, they do not identify the
specific anxiety symptoms. Instead, they tend to address
more global aspects of internalizing behaviors, such as

the primary purpose of this study was to examine anxiety disorder symptoms of Chinese preschool children in several ways: (1) to examine the factor structure of anxiety symptoms in Chinese preschool children.41. These findings seem to indicate that the symptom of obsessive–compulsive disorder is not included in the structure of anxiety among Australian preschoolers. The aforementioned findings demonstrated that the structure of anxiety symptoms in very young children may differ across cultures. Cheng. Methods Participants Participants consisted of 1. The majority of mothers had a high school (20 %) or a college/university education (74 %). considering the differences in socialization practices between Chinese and Western cultures. To date. Meanwhile.51) and relatively infrequent endorsement in Australian samples. only 1. Previous studies suggest that the patterns of anxiety symptoms can already be sub-typed in the preschool period [1. and generalized anxiety disorder. in a study using CBCL to examine preschoolers’ behavioral problems. from which we can infer that obsessive–compulsive disorder may exist as a distinct factor in Chinese preschool children. this study also evaluates the factorial invariance of the structure of anxiety symptoms in different age (3. However. Construct validity of the PAS was also supported by significant correlations with internalizing factor of the CBCL to a greater extent than with externalizing factor of the CBCL. Broeren and Muris [15] investigated the applicability of the original PAS in Dutch children aged 2–6 years. SD = .and 4-year-olds and 5. Confirmatory factor analysis revealed five factors: separation anxiety disorder. and Leung [19] found that Chinese preschool children scored higher on internalizing problems than their American counterparts. this study will explore the structure of anxiety in Chinese preschoolers using the original PAS containing the symptom of obsessive–compulsive disorder. Specifically. Liu. this subscale was therefore removed from the PAS-R. (2) to investigate age and gender differences and the prevalence of anxiety symptoms in Chinese preschool children. The PAS is a 28-item parent-report measure that was designed to assess anxiety dimensions specified in the DSM-IV.46/. 14]. the items relating to obsessive– compulsive disorders in the original PAS were reported frequently by the mothers of Chinese preschoolers. 123 . The kindergartens were selected by a clustered random sampling method.95) and their mothers (M = 33. Eastern China. physical injury fears. To the best of our knowledge. located in Shandong Province. social phobia.62). In that study.05 years. obsessive–compulsive disorder. Exploratory factor analysis revealed five factors that are broadly consistent with the structure of the original PAS. several items relating to obsessive–compulsive disorder in the PAS were reported infrequently by Australian parents. [11] slightly modified this measure with another Australian sample. (3) to compare anxiety symptoms of Chinese preschool children to those of Australian/Dutch counterparts. SD = 2.854 Chinese young children aged 3–6 years (M = 4.and 6year-olds) and gender (males and females) groups. Specifically. Therefore. there seems to be a need for symptom-specific and ageappropriate instruments to assess anxiety problems in preschool children. Therefore. A Chinese translation of the PAS has already been used in at least one study [16]. The factor structure and construct validity of the PAS were examined in a large Australian community sample [14]. 18]. They were recruited from six public kindergartens in the metropolitan areas of Jinan and Linyi. Given the reported variation in the 159 structure of anxiety symptoms in different countries. and all the five factors had acceptable internal consistency and construct validity. depression.76 % of fathers rated these items as ‘‘quite often true’’ or ‘‘very often true’’. the other aim of this study is to compare anxiety symptoms of the current Chinese community sample with those found in previous studies of the PAS in other cultures. Notably. the Preschool Anxiety Scale (PAS) is the only measure that specifically assesses multiple anxiety symptoms in preschool-aged children [14]. Psychometric evaluation of the PAS-R indicated that. Edwards et al. 12-month reliability = . Therefore. in a subsequent study. In summary. there is evidence that obsessive–compulsive disorder represented an independent factor among Dutch preschoolers. the psychometric properties of the PAS have been examined predominately in Australian and Dutch community samples. the anxiety levels of Chinese children may be different from those of Western peers. the current study intends to examine the structure of anxiety symptoms in Chinese preschool children. For example. except for obsessive– compulsive disorder.57/. the total scale and the other subscales displayed satisfactory internal consistency. since a wide range of evidence seems to indicate that children’s anxiety symptoms vary significantly between these groups [17. Additionally. test–retest reliability (over a period of 12 months) and good discriminate validity.84 % of mothers and . Given the fact that obsessive–compulsive disorder subscale had quite poor psychometrics (mother/father report: a = . and withdrawal. A total of 988 boys and 866 girls from 63 classes and their mothers participated in the present study.Child Psychiatry Hum Dev (2015) 46:158–166 anxiety.93 years. resulting in a revised version of the PAS (PAS-R). Based on the above mentioned reasons.

a threshold of 5 % missing values was used to remove unsatisfactory items in this study. Mothers were asked to evaluate on a three-point scale (0 = not true. Those mothers who were absent from the meeting on the day of testing (e. obsessive–compulsive disorder (five items) and generalized anxiety disorder (five items). Following the criterion for evaluating factorial invariance across subgroups described by Cheung and Rensvold [23].90 indicate an acceptable fit [21]. social phobia (six items). CFA was performed using Robust Maximum Likelihood estimation in LISREL 8. Cronbach’s alpha coefficients were calculated to evaluate the internal consistency of the PAS total and subscales. a subgroup of mothers (n = 1. physical injury fears (seven items). To further examine the convergent and divergent validity of the measure. Cronbach’s alpha coefficients were . and then back-translated to the original language by a bilingual translator. comparative fit index (CFI). Measures Preschool Anxiety Scale (PAS) As mentioned previously.160 Procedure The design of this study was approved by the Institutional Review Board at Shandong Normal University. Data Analysis To examine the factor structure of anxiety symptoms in Chinese preschool children. Mothers were asked to rate the items of each subscale on a five-point scale ranging from 0 (not at all true) to 4 (very often true). the PAS is a 28-item parentreport measure of anxiety symptoms for preschool children [14]. in the present study. normed fit index (NFI). RMSEA value below .21 and 1. Age and gender differences in anxiety . The PAS consists of five subscales: separation anxiety disorder (five items). due to illness or working) received a packet containing questionnaires and instructions from their child’s teacher. Since in large sample sizes the v2 statistic is likely to be significant. During the meeting.g. Mothers were invited to participate in a meeting at the kindergarten. The scores of total scale and each subscale can be calculated by adding the responses of the relevant items.70.076) were also asked to complete the Children Behavior Checklist [12] at the first screening. Pearson product moment correlations were utilized to assess test–retest reliability and convergent and divergent validity. To examine the test–retest reliability of the original PAS in Chinese culture. The item ‘‘Is nervous of going swimming’’ was therefore excluded from the scale and replaced by the new added item ‘‘Is nervous of going across the road’’ in this study. the differences in goodness-of-fit indices (DGFIs) between constrained and unconstrained models less or equal to . non-normed fit index (NNFI).08 indicate a relatively good fit [22].7 % missing values. In each multigroup analysis. Frequency analyses revealed that. The English version of the PAS was translated into Chinese by the authors. Internalizing and Externalizing. The CBCL was validated in China and demonstrated adequate reliability and validity [20]. 2 = very true) regarding whether the behavior is occurring now or has occurred over the past 6 months. 1 = somewhat true. the item ‘‘Is nervous of going swimming’’ and the new added item ‘‘Is nervous of going across the road’’ had 10.06 and SRMR value below . Following the criterion employed by Broeren and Muris 123 Child Psychiatry Hum Dev (2015) 46:158–166 [15].87 for Externalizing factor. a model in which all factor loadings were constrained to be equal (constrained model) across age or gender groups was compared to a model in which these factor loadings were free to vary (unconstrained model) across groups. It was assured that the content of the translated Chinese version was similar to the original English version by the translators.. we conducted two multi-group confirmatory factor analyses. root mean square error of approximation (RMSEA) and standardized root mean square residual (SRMR) were calculated in the present study to evaluate the fit of the model. a subgroup of mothers (n = 217) were retested over a period of one month after the initial screening. Values of NFI. Approximately 90 % of mothers attended the meeting. a new item ‘‘Is nervous of going across the road’’ was added considering the growing traffic problems and parents’ emphases on children’s security in China. .01 are considered reasonably invariant. Permissions to administer questionnaires from the kindergarten principals and maternal consents were obtained prior to data collection. NNFI and CFI greater than .86 for Internalizing factor and . they completed the Chinese version of the PAS and a questionnaire on family demographics. To further examine whether the factor structure of anxiety symptoms is invariant across age and gender groups. Children Behavior Checklist (CBCL) The CBCL designed for 4–18 year old children [12] was selected as an indicator of convergent and divergent validity of the PAS. A study with Chinese preschool children suggested that the item ‘‘Is nervous of going swimming’’ was most frequently missing [16].92 for the total scale. Thus. respectively. It is a 118-item parent-report measure to assess two broad band factors. They were asked to fill it out at home and return the completed form to their child’s teacher. In the current sample. Additionally.

Results from model comparisons showed that the differences in GFIs were less than .56 9.g. getting lost or kidnapped). Washes his/her hands over and over many times each day .g.52 to . Internal Consistency and Test–Retest Reliability Cronbach’s alpha coefficients were calculated to evaluate the internal consistency of the PAS in Chinese preschool children. Results demonstrated that the Pearson correlation coefficients (r) were . Is scared of heights (high places) .68 for obsessive–compulsive disorder.g.56 24. turned off a tap) . so he/ she won’t be able to see you again . NNFI = . Coefficient a values were . which supported the factorial invariance of the model across gender groups. Is afraid of crowded or closedin places 13.year-olds) children.55 2. Is afraid of meeting or talking to unfamiliar people .72 for physical injury fears. Has nightmares about being apart from you . Is scared of thunder storms . Worries that something bad will happen to his/her parents . very similar to that of the model in which the factor loadings were free to vary across groups.057..53 20.31 12.. numbers or words) to stop bad things from happening . show and tell) .50 18.55 for separation anxiety disorder.94. Keeps checking that he/she has done things right (e.93. Worries that he/she will do something to look stupid in front of other people .59 19.46 10. .01. CFI = .87 for the total scale.60 5.. that he/ she closed a door.11 years. Is nervous of going across the road . indicating a satisfactory fit of the five-factor model to the present data. SRMR = .56 11. RMSEA = .52 3. Results Confirmatory Factor Analysis The correlated five-factor model reported by Spence et al.58 for separation anxiety disorder.42 25.73 for the total scale. Is afraid of insects and/or spiders . Table 2 shows that the model in which the factor loadings were constrained to be equal between younger and older children provided a good fit. we then tested the factorial invariance of the model between boys and girls.g.54 21. and .44 26. Worries that something bad might happen to him/her (e.62 23. We first tested whether the model is invariant between younger (3. The five factors were found to be strongly intercorrelated. .59 123 . a total of 217 participants (M = 5. Missing values were estimated in SPSS using the estimated means (EM) procedure. Is afraid of talking in front of the class (e.94. . The prevalence of anxiety symptoms was evaluated through frequency statistics. SD = 1. The differences in GFIs below . To examine test–retest reliability of the Chinese PAS..75 for social phobia. a preschool teacher) .48 SP OCD GAD .Child Psychiatry Hum Dev (2015) 46:158–166 scores were examined using multivariate analyses of variance (MANOVA) and effect size statistics. Multi-group confirmatory factor analyses were conducted to test the factorial invariance of this model across demographic groups. Is reluctant to go to sleep without you or to sleep away from home .58 17. Becomes distressed about your leaving him/her at preschool/ school or with a babysitter .56 16.58 15. Worries that he/she will do something embarrassing in front of other people .and 4-year-olds) and older (5.. 110 boys and 107 girls) were reassessed one month later.and 6.70 for generalized anxiety disorder. with rs ranging from . Is scared to ask an adult for help (e.g.71 for physical injury fears. .31 on their hypothesized factors (see Table 1) and that the values for fit indices fell within the acceptable to good ranges (NFI = .056).01 suggested factorial invariance across age groups. [14] in the original PAS was tested in current Chinese preschool populations. The results demonstrated that all 28 items had loadings in excess of . .64 for social 161 Table 1 Factor loadings of the five-factor model after confirmatory factor analysis Item SAD 6. .87. Is afraid to go up to group of children and join their activities .48 PIF 7.01 between unconstrained and constrained models (see table 2). Has to keep thinking special thoughts (e. Has to have things in exactly the right order or position to stop bad things from happening . Is afraid of the dark . After combining the data of younger and older children. Is frightened of dogs .56 27. Has bad or silly thoughts or images that keep coming back over and over . .58 22.

Prevalence of Anxiety Symptoms phobia.58 28.31 to .1846) = 7.057 . results of the MANOVA indicated that the combined dependent variables were significantly different between younger (3.920 . PIF physical injury fears. .058 .94 680 \.920 . but not for gender groups [F(5.and 4-year-olds) and older (5. Following previous studies [14.934 . Convergent and Divergent Validity To further explore the convergent and divergent validity of the Chinese PAS. g2 = .057 Constrained model 2. As shown in Table 4.1846) = . thunder storms.939 . SP social phobia. The results indicated that the correlations with the Internalizing score are significantly greater than the correlations with the Externalizing score for all scales of the PAS. and . younger children were found to score significantly higher on the total score and all the subscales of the PAS as compared to the older children (see table 3). the most prevalent symptoms of Chinese preschool children were examined by calculating the percentage of mothers who rated each item as either 3 (quite often true) or 4 (very often true) for their children.81.64 703 \.059 NFI normed fit index. g2 = . and ‘‘Keeps checking that he/she has done things right’’) relating to obsessive–compulsive disorder were also among the top 10 presenting problems. Asks for reassurance when it does not seem necessary .058 Constrained model 2. restless or irritable due to worrying .808.933 .1846) = 1.63 for obsessive–compulsive disorder.21 to .004] or gender by age interactions [F(5.53 4.758.058 .162 Child Psychiatry Hum Dev (2015) 46:158–166 Age and Gender Differences Table 1 continued Item SAD PIF SP OCD GAD 1.001.56 703 \. CFI non-normed fit index.057 .076 participants. OCD obsessive–compulsive disorder. Is tense.001 . Spends a large part of each day worrying about various things .000]. Following the recommendation of Meng et al. ps \ . p [ .40).56 14. p \ .791.939 . RMSEA root mean square error of approximation. GAD generalized anxiety disorder A MANOVA on the total score and subscales of the PAS was conducted to examine age and gender differences of anxiety symptoms in preschool children.922 . a series of Z tests were conducted to determine whether correlations between PAS scales and Internalizing score (convergent relationship) are significantly stronger than correlations between PAS scales and Externalizing score (divergent relationship).59) and with the CBCL Externalizing score (r = . this finding supported the convergent and divergent validity of the PAS.001 .934 .05.826.53 SAD separation anxiety disorder.001 . Has trouble sleeping due to worrying .15.932 . Based on the Wilks’ lambda criterion. g2 = . physical injury fears (dark. Comparisons to Previous Studies To investigate whether the means of anxiety symptoms experienced by the current Chinese community sample differed from those found in previous studies of the PAS Table 2 Tests of factorial invariance across age (younger and older) and gender (boys and girls) groups v2 df p NFI NNFI CFI RMSEA SRMR Unconstrained model 2.91.05. crowded or closedin places) and social phobia (‘‘Is afraid of talking in front of the class or preschool group’’).939 . Additionally. ‘‘Washes his/ her hands over and over many times each day’’. dogs. 25]. p [ .59 for generalized anxiety disorder.058 Model Invariance across age groups Invariance across gender groups Unconstrained model 2. [24] for significant correlations. insects and/or spiders. three items (‘‘Has things in exactly the right position’’. Overall.940 . The total score and subscales of the PAS correlated significantly with the CBCL Internalizing score (r = . SRMR standardized root mean square residual 123 . Has difficulty stopping him/ herself from worrying .48 to 10.52. Specifically. Z-scores ranged from 3. the most prevalent symptoms in Chinese preschool children were related to separation anxiety (‘‘Is reluctant to go to sleep without you or to sleep away from home’’).021].22 680 \.921 .66 8.001.001 . correlations between the PAS and CBCL subscales were calculated in a subgroup of 1.and 6-year-olds) groups [F(5. NNFI non-normed fit index.

73 ± 13. Specifically.44 ± 12.19 4. PIF physical injury fears.24 4. a series of t tests were conducted. OCD obsessive–compulsive disorder. 15] 6.89 11.34 ± 2.21 .43 ± 2.51 ± 4. three items referring to obsessive–compulsive disorder mentioned above.91 3. and generalized anxiety disorder) in the original PAS fit the current data well.95 ± 2.19 -.26* 18.01 .48 OCD GAD Total 4.75 27.00 6.90 2.91 5.72 ± 4.28 4.031 5. p [ .86*** 5.114 .19 ± 4. To compare the most prevalent anxiety symptoms of Chinese preschoolers with those found in prior research of the PAS.115 .65 .81 ± 3. As presented in Table 3.69 ± 4.84 ± 11.45 ± 3. 14].43 ± 4. were evidently reported frequently in Chinese preschool children. except 123 . ps \ . Specifically. SP social phobia.58 .24 ± 2.16 ± 3. The contents of the most prevalent anxiety symptoms in Chinese preschool children and Australian samples showed substantial differences.001] and Dutch samples [ts(1. ** p \ .57 2.23 ± 2.001] in previous studies.25 4.07 8.47 ± 3.83 3. which is inconsistent with the study by Edwards and colleagues [11] suggesting that obsessive–compulsive disorder did not comprise an independent factor in Australian young children.21.83 5.22 163 Dutch sample Child Psychiatry Hum Dev (2015) 46:158–166 Although a large body of research has consistently shown that anxiety disorders have an early onset in childhood [1.42 ± 3.70.65 ± 3.109 .37 4. The present study contributes to the existing literature by examining the nature of anxiety symptoms in Chinese preschool children.08 ± 13.28 ± 2.08 3.03* .85 Australian sample Current sample Total by gender Total by age Table 3 Means and standard deviations of the PAS (mean ± SD) for current and previous community samples [14.71 5.99 8.12 ± 4.02 .90 5.91 5.15 ± 2.19 ± 2.034 4. the items representing obsessive– compulsive disorder comprised an independent factor in Chinese preschool children. 5.66 ± 3.93 36. which were rare in Australian preschoolers. *** p \ .01. physical injury fears.201 3. social phobia. These findings demonstrated that the anxiety symptoms of Chinese preschoolers reflected a five-factor structure.16 ± 2.55*** . GAD generalized anxiety disorder 1.43.28 ± 11.001 SAD separation anxiety disorder.78 26.75 ± 4.85 27.07 SAD F Cohen’s d Girls Boys 5–6 years Cohen’s d F 3–4 years 5. with exception of the social phobia subscale on which no significant difference was found between Chinese preschool children and their Dutch peers (t = .62 ± 13.04 ± 3.91 18.039 -.75 9.91 ± 4.83 1. and both boys and girls presented the same pattern of anxiety symptoms. Chinese preschool children in the current sample were found to score significantly higher on the total scale and subscales of the PAS than Australian [ts(1.87 ± 13.33 ± 2. Notably.11 with Australian [14] and Dutch community samples [15].21 ± 2. and that both younger and older children.21 6.54* .05).98 ± 3.04 PIF SP 8.46 4. Table 4 also presents the results reported by Spence et al.853) [ 19.152 5. [14] in Australian community samples. the current study found that.05. although they also displayed many similarities.84 ± 2.09** 6. 4.16 ± 3.00 ± 2.95 27. little research has focused on the anxiety problems of very young children.63 ± 4. Further multigroup analyses supported the factorial invariance of this model across age and gender groups in Chinese preschool populations. ps \ .45 .57 17.013 9.16 4.41 2.73 ± 2.92 . obsessive– compulsive disorder.74 .853) [ 8.19 2.10 ± 2.92 -.082 5.Discussion * p \ .93 ± 3.92 29. Confirmatory factor analysis indicated that the correlated five-factor model (including separation anxiety disorder. The reliability and validity of the Chinese PAS provided empirical support for the five-factor structure of anxiety (particularly for obsessive–compulsive disorder as an independent factor of anxiety) in Chinese preschool populations.

Worries that he/she will do something to look stupid in front of other people 23. test–retest reliability and convergent and divergent validity. show and tell 11. that he/she closed a door. Washes his/her hands over and over many times each day 14.g. The prevalence of anxiety symptoms provided further support for obsessive–compulsive disorder as an independent factor in the structure of anxiety for Chinese preschoolers. Parents’ over-controlling practices and teachers’ rigorous instructional styles in Chinese societies may be related to the high prevalence of these symptoms. this finding is consistent with the notion that cultural factors are involved in the manifestation of children’s anxiety symptoms [26]..9 24.8 1.0 8.9 4.0 4.6 9. which suggested that obsessive–compulsive disorder was an important section of the five-factor structure of anxiety in very young Chinese children.164 Child Psychiatry Hum Dev (2015) 46:158–166 Table 4 The percentage of children receiving mother ratings of 3 or 4 (quite often true or very often true) for current and previous Australian samples [14] Item Table 4 continued Item Current sample (%) Australian sample (%) 14. very specific instructions (e. Is nervous of going across the road 5. Has trouble sleeping due to worrying 1.6 123 for separation anxiety subscale having an a of .7 13. Is afraid to go up to group of children and join their activities 4.7 17.2 10.0 7.0 1. Is scared of heights (high places) 9.3 3.2 26.and .9 3. Worries that something bad will happen to his/her parents 4. ‘‘Washes his/her hands over and over many times each day’’. In specific. Keeps checking that he/she has done things right (e.g.8 9.8 5. turned off a tap) 9.5 1. were reported frequently by the mothers of Chinese preschoolers..9 1.8 10.6 . and ‘‘Keeps checking that he/she has done things right’’) representing obsessive–compulsive disorder.1 1. our data showed that younger children (3.3 1. Is afraid of insects and/or spiders 16. restless or irritable due to worrying 6. Is afraid of meeting or talking to unfamiliar people 8.g.g.1 2.1 1..3 – 22. As mentioned above.1 3. in China. Is afraid of talking in front of the class (preschool group) e.7 2.0 17.1 4.4 19. Has difficulty stopping him/herself from worrying 5.2 1. comparisons of the prevalent PAS items (rated as ‘‘quite often true’’ or ‘‘very often true’’) indicated that there were substantial differences regarding the contents of the prevalent anxiety symptoms among Chinese and Australian preschoolers. Asks for reassurance when it doesn’t seem necessary 6.6 1. three items (‘‘Has things in exactly the right position’’. Inconsistent with the study by Edwards and colleagues suggesting that the obsessive– compulsive disorder subscale had quite poor psychometrics [11]. a preschool or school teacher) 7. Is frightened of dogs 20.g. Worries that he/she will do something embarrassing in front of other people 5.1 2. Has to have things in exactly the right order or position to stop bad things from happening 14.4 Current sample (%) Australian sample (%) 6.8 15. Spends a large part of each day worrying about various things 1.9 12. Is afraid of the dark 26 17. Is reluctant to go to sleep without you or to sleep away from home 44 12. Is scared of thunder storms 12.. Has to keep thinking special thoughts (e. [14] demonstrating age differences in preschoolers’ anxiety symptoms. Is tense. ‘‘Has toys in exactly the right order or position’’) are commonly given at home and in the kindergartens.2 28.4 2.55. Consistent with the study by Spence et al.6 5. the PAS total scale and subscales displayed satisfactory levels of internal consistency reliability. Becomes distressed about your leaving him/her at preschool/school or with a babysitter 5. numbers) to stop bad things from happening 2.3 7. Is afraid of crowded or closed-in places 12..8 25. which were rare in Australian preschool children [14]. getting lost or kidnapped).2 20.4 4. Has bad or silly thoughts or images that keep coming back over and over 1.4 13. Worries that something bad might happen to him/her (e. Even though it remains unclear why these symptoms are relatively prevalent among Chinese preschool children.8 16.6 18.0 11. this subscale had acceptable internal consistency and test–retest reliability in the present study.7 1.4 4..7 21. Is scared to ask an adult for help (e. Has nightmares about being apart from you . For instance.g. This interpretation requires further exploration.7 27. so he/she won’t be able to see you again 4.6 1. These results supported the applicability of the five-factor structure of PAS in Chinese preschool populations.

by contrast. Compared to other studies with Western samples. Guggenmos J (2006) Prevalence of behavioral and emotional problems among six-years-old preschool children. They may not only suffer from the fear of leaving their parents and home but also experience difficulties adjusting to kindergarten. Most Chinese children enter into kindergarten and start a new period in their life at age 3–4 years. Chinese preschool children displayed higher anxiety levels than their Australian and Dutch peers in previous studies [14. Comparisons to previous studies revealed that. Inconsistent with prior research [11]. O’Connor TG. nosology. Schniering CA. Hemphill SA (2006) Children’s moods. This study found that the structure of anxiety in Chinese preschool children included five factors. It has been speculated that Chinese socialization practices stress self-control. much of the research with school-age children found that girls report higher anxiety scores than boys [27. J Emot Behav Disord 14:41–49 123 . although it is consistent with the result (a = . References 1. 15]. the current study only recruited the samples from the Shandong region. the elevated levels of anxiety symptoms in younger children may be a response to this transition. Bolton D. These discrepancies may be accounted for by different socialization practices in Chinese and Western cultures. Arch Gen Psychiatry 62:593–602 4. Third. it seems that gender differences in anxiety symptoms do not emerge in preschool period. Egger HL. Hudson JL (2009) Anxiety disorders during childhood and adolescence: origins and treatment. Thus. Bayer JK. First. More studies are needed to explore cultural factors that account for obsessive–compulsive disorder as an independent factor and the higher rates of anxiety in Chinese young children. so it is not clear whether our findings can be generalized to clinical populations. These crossnational differences in anxiety levels for younger children are comparable to those reported for older children and adolescents. Therefore. Beyer T. Plomin R (2003) A twin study of anxiety-related behaviors in preschool children. For instances. J Child Psychol Psychiatry 47:313–337 2. encourage individualism and independence [33]. and obedience to authority [31. no significant gender differences in anxiety scores were found in the present study. 15]. the data of this study were based solely on mother-report. Further research needs to recruit some representative samples from different regions in China to replicate these results. and can be viewed as an independent anxiety factor in Chinese preschool children.59) in the previous study [15]. Chinese school children reported higher degree of anxiety than their American counterparts [29]. Although parents as informants of young 165 children’s anxiety are satisfactory [14. the manifestations of anxiety in Chinese children may be adaptive and may represent ‘‘normal’’ reactions to dominant cultural forces [19]. Finally. and worries: development of an Early Childhood Parent Questionnaire. It may be due to the low number of items for this subscale (n = 5) and the fact that this subscale includes individual items which intend to assess children’s separation anxiety but are only loosely related to each other.55) in the current sample must be acknowledged. and epidemiology. Furniss T. only community sample was included in this study. obsessive–compulsive disorder had satisfactory psychometrics and high endorsement. It is hypothesized that the high level of anxiety symptoms in younger children may be related to their life transition. 5. In this vein. It should be acknowledged that the present study suffers from several limitations. which may contribute to children’s internalizing issues such as anxiety. emotional restraint.Child Psychiatry Hum Dev (2015) 46:158–166 4-year-olds) were reported to have higher anxiety levels in comparison to older children (5. Berglund P. Demler O. Smith P. Kessler RC. Sanson AV. 14]. which in turn may contribute to the lowering of anxiety problems. anxiety symptoms of Chinese preschool children were found at a high level. fears. and may become more distinct with increasing age. Merikangas KR. Rapee RM. Soc Psychiatry Psychiatr Epidemiol 41:394–399 6. and this five-factor structure applied to different age and gender groups in Chinese preschool populations. Annu Rev Clin Psychol 5:311–341 5. Eley TC. Western socialization practices. with exception of social phobia. Angold A (2006) Common emotional and behavioral disorders in preschool children: presentation. Summary The current study makes significant inroads to understanding anxiety problems in Chinese preschool children. future studies still need to include direct behavioral observations or anxiety ratings by teachers to confirm this measure. In contrast. Second. Consistent with earlier studies relating to preschoolers [1. From a cultural context. It remains unknown whether our results can be applied to preschool children in other Chinese regions. Jin R. 32].and 6-year-olds). Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in National Comorbidity Survey Replication. This seems to indicate that the individual items of this subscale may have greater utility than the aggregate [34]. J Child Psychol Psychiatry 44:945–960 3. the relatively low alpha for separation anxiety disorder subscale (a = . Chinese adolescents reported higher anxiety levels than their Dutch and German peers [30]. 28]. a higher level of anxiety may not necessarily reflect the presence of anxiety pathology in Chinese preschool children. Perrin S.

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