Homotypic Versus Heterotypic Continuity of Anxiety Symptoms in Young Adolescents: Evidence for Distinctions Between DSM-IV Subtypes
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OBJECTIVE: to investigate homotypic and heterotypic longitudinal patterns of symptoms of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), social phobia (SoPh), panic disorder (PD), and obsessive compulsive disorder (OCD) in young adolescents from the Dutch general population. METHOD: 2,067 individuals (51.4% girls) from a Dutch community sample, who were assessed for the first time when they were aged 10 to 12 years, were followed up across a period of two years. At both assessments, anxiety symptoms were assessed with the RCADS, a self-report questionnaire. RESULTS: Regression analyses indicated that homotypic continuity was relatively high for SAD, GAD, and SoPh symptoms, and for PD in girls. CONCLUSIONS: In many studies, anxiety disorders are treated as one group of disorders, and some widely used assessment instruments, such as the Child Behavior Checklist, do not even contain scales that tap different anxiety dimensions. In the present study, evidence for homotypic continuity was found, especially for symptoms of separation, social, and generalized anxiety, and for symptoms of panic disorder in girls, underscoring the usefulness of making distinctions between different anxiety constructs.
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Both Social Anxiety Disorder and Generalized Anxiety Disorder tend to reveal a chronic course that may fluctuate by evolving into other anxiety disorders or mood disorders in adulthood.
“Both these disorders tend to reveal a chronic course that may fluctuate by evolving into other ADs or mood disorders in adulthood [21, 68, 69].”
From Acceptance and commitment therapy as a transdiagnostic approach to adolescents with different anxiety disorders: study protocol. (2025) · cites this paper as [68]
The Discussion (page unavailable) reports both homotypic and heterotypic continuity for generalized anxiety and social phobia symptoms, supporting persistence and shifts among anxiety symptoms. The study followed young adolescents for only two years; it does not establish that either disorder evolves into mood disorders in adulthood. (LLM, conf=0.88)
Experimental — accuracy not yet measuredACT has been proven effective for Social Anxiety Disorder and Generalized Anxiety Disorder treatment in adults.
“ACT has been proven effective for SAD and GAD treatment in adults [68–73].”
From Acceptance and commitment therapy as a transdiagnostic approach to adolescents with different anxiety disorders: study protocol. (2025) · cites this paper as [68]
The Methods (Measures; page unavailable) uses SAD for separation anxiety disorder, not social anxiety disorder. The Discussion (Practical implications; page unavailable) mentions generally efficacious anxiety treatments but does not identify ACT or report its effectiveness for adults with social anxiety disorder or GAD. Searches for ACT and adult treatment effectiveness found no passage addressing that claim. (LLM, conf=0.76)
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“Similarly, scales from a self-report questionnaire measuring separation anxiety disorder, GAD, social phobia and panic disorder at ages 10–12 each predicted the corresponding scale 2 years later; however each scale was also predicted in roughly equal measure by the combination of all of the others (heterotypic scales)…”
BackgroundTowards a multifactorial approach for prediction of bipolar disorder in at risk populations
Brietzke, E. M., Mansur, R. B., Soczynska, J. K., Kapczinski, F. P., Bressan, R. A., & McIntyre, R. S. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.02.016 · Cited by 101 · see citing works
“In addition, prospective studies in BD indicated the possibility of heterotypic continuity (when a disorder is predicted by a different one) (Ferdinand et al., 2007).”
BackgroundLahey, B. B., Zald, D. H., Hakes, J. K., Krueger, R. F., & Rathouz, P. J. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.359 · Cited by 99 · see citing works
Children's problems predict adults' DSM-IV disorders across 24 years.
Reef, J., van Meurs, I., Verhulst, F., & van der Ende, J. (2010) · Journal of the American Academy of Child and Adolescent Psychiatry · doi:10.1016/j.jaac.2010.08.002 · Cited by 112 · see citing works
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Association of Autistic-Like and Internalizing Traits During Childhood: A Longitudinal Twin Study
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“Even though anxiety disorders share transdiagnostic processes, they can be separated by their primary focal point of anxiety (Ferdinand et al., 2007), therefore accurate and thorough assessment is imperative to access the right support.”
BackgroundLahey, B. B., & Waldman, I. D. (2011) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2011.02509.x · Cited by 85 · see citing works
Measurement and the Study of Change
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“Anxiety ( Ferdinand, Dieleman, Ormel, & Verhulst, 2007 ), temperament ( Durbin, Hayden, Klein, & Olino, 2007 ), reading ability ( Fergusson, Horwood, Caspi, Moffitt, & Silvia, 1996 ), various aspects of personality ( Caspi & Roberts, 2001 ; Kagan, 1980 ), and antisocial behaviors ( Moffitt, 1993 ; Pajer, 1998 ) have a…”
First Genome-Wide Association Study on Anxiety-Related Behaviours in Childhood
Trzaskowski, M., Eley, T., Davis, O., Doherty, S. J., Hanscombe, K. B., Meaburn, E., Haworth, C., Price, T. S., & Plomin, R. (2013) · PLoS ONE · doi:10.1371/journal.pone.0058676 · Cited by 98 · see citing works
“They often begin in childhood [2] and continue into adulthood [3], when they become co-morbid with other psychi-”
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“Given that anxiety disorders demonstrate a high degree of heterotypic continuity (Copeland et al. 2009; Ferdinand et al. 2007), Morin and colleagues’ results may be more specific to PD.”
BackgroundHomotypic and heterotypic psychopathological continuity: a child cohort study
Shevlin, M. E., McElroy, E., & Murphy, J. (2017) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-017-1396-7 · Cited by 69 · see citing works
Course of comorbid anxiety disorders among adults with bipolar disorder in the U.S. population
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Predictors of the Course of Anxiety Disorders in Adolescents and Young Adults
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“…show homotypic (within-disorder) and heterotypic (across-disorder) continuity over time (Merikangas, 1993; Pine et al. 2001; Costello et al. 2003; Goodwin et al. 2004; Rutter et al. 2006; Ferdinand et al. 2007; Gregory et al. 2007; Mof fi tt et al. 2007; Trzaskowski et al. 2011; Lahey et al. 2014).”
BackgroundGeneralized Anxiety Disorder: Revisited
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Stable Genetic Influence on Anxiety-Related Behaviours Across Middle Childhood
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“For example, a Dutch study of 10– 12 year old children demonstrated that symptoms of separation anxiety (SAD), social phobia (SoPh) and panic disorder (PD) were characterised by strong homotypic continuity (Ferdinand et al. 2007), indicating specificity of anxiety constructs.”
BackgroundMethodResultInfluentialDevelopmental risk factors in generalized anxiety disorder and panic disorder
Newman, M. G., Shin, K. E., & Zuellig, A. R. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.07.008 · Cited by 56 · see citing works
“In addition, Ferdinand et al. (2007) used a self-report diagnostic measure with only a one-year assessment interval.”
BackgroundMethodCLINICAL FEATURES OF BIPOLAR DISORDER COMORBID WITH ANXIETY DISORDERS DIFFER BETWEEN MEN AND WOMEN
Saunders, E. F. H., Fitzgerald, K. D., Zhang, P., & McInnis, M. G. (2012) · Depression and Anxiety · doi:10.1002/da.21932 · Cited by 55 · see citing works
“In addition, early onset anxiety symptoms may commingle across the anxiety disorders, such that children with separation anxiety disorder, GAD, PD, or OCD are likely to develop any of the others at a 2-year follow-up.[40] Given the age at interview of subjects included in our study, it is possible that early childhood…”
BackgroundBurstein, M., Georgiades, K., Lamers, F., Swanson, S. A., Cui, L., He, J.-P., Avenevoli, S., & Merikangas, K. R. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0026069 · Cited by 50 · see citing works
“, 2009) as well as longitudinal studies of anxiety (Ferdinand et al., 2007) that have offered support for differentiating among anxiety disorder subtypes.”
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Kerns, K. A., Siener, S., & Brumariu, L. E. (2011) · Development and Psychopathology · doi:10.1017/s0954579411000228 · Cited by 43 · see citing works
“All of these studies found evidence for continuity in anxiety symptoms (Bosquet & Egeland, 2006; Ferdinand et al., 2007; Gullone, King, & Ollendick, 2001; Ialonga et al, 1995; Verhulst & van der Ende, 1992; Westenberg et al., 2007).”
BackgroundResultPhenotypic and genetic differentiation of anxiety-related behaviors in middle childhood
Hallett, V., Ronald, A., Rijsdijk, F. V., & Eley, T. C. (2009) · Depression and Anxiety · doi:10.1002/da.20539 · Cited by 38 · see citing works
“This suggests that children may experience different ARBs at different times during development.[24,25] However, few multivariate studies have investigated the genetic and environmental relationship between different ARB groups within the general population.”
BackgroundLebowitz, E. R., Silverman, W. K., Martino, A., Zagoory‐Sharon, O., Feldman, R., & Leckman, J. F. (2017) · Depression and Anxiety · doi:10.1002/da.22585 · Cited by 35 · see citing works
“In particular, there is evidence for the continuity of separation anxiety, social anxiety, and generalized anxiety in childhood (Ferdinand et al., 2006; Ferdinand et al., 2007).”
BackgroundStudying a moving target in development: The challenge and opportunity of heterotypic continuity
Petersen, I. T., Choe, D. E., & LeBeau, B. C. (2020) · Developmental Review · doi:10.1016/j.dr.2020.100935 · Cited by 35 · see citing works
“Other research has examined the continuity of constructs at the higher-order construct level (Ferdinand et al., 2007; Lahey et al., 2014; Lavigne et al., 2014; Miller et al., 2009; Nagin & Tremblay, 2001; Putnam et al., 2008; Snyder et al., 2017).”
BackgroundProspective 2-Year Course and Predictors of Outcome in Avoidant/Restrictive Food Intake Disorder
Kambanis, P. E., Tabri, N., McPherson, I. K., Gydus, J. E., Kuhnle, M. C., Stern, C. M., Asanza, E., Becker, K. R., Breithaupt, L. E., Freizinger, M., et al. (2024) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2024.04.010 · Cited by 34 · see citing works
Separation anxiety disorder in OCD
Mroczkowski, M. M., Goes, F. S., Riddle, M. A., Grados, M. A., Bienvenu, O. J., Greenberg, B. D., Fyer, A. J., McCracken, J. T., Rauch, S. L., Murphy, D. L., et al. (2011) · Depression and Anxiety · doi:10.1002/da.20773 · Cited by 30 · see citing works
“Several studies have examined whether SAD is related to other disorders in the anxiety spectrum, such as generalized anxiety disorder, social phobia, and panic disorder, and therefore may share a common diathesis.([1,20,21]) Second, SAD may be a precursor or indicator of later psychopathology.”
BackgroundHeterotypic and homotypic continuity in psychopathology: a narrative review
Speranza, A. M., Liotti, M., Spoletini, I., & Fortunato, A. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1194249 · Cited by 32 · see citing works
“Homotypic and heterotypic continuity patterns of anxiety disorders were thoroughly investigated by the TRacking Adolescents’ Individual Lives Survey (TRAILS; Ferdinand et al., 2007) in early adolescents (10–12 years).”
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Xu, X., Huebner, E. S., & Tian, L. (2021) · Journal of Youth and Adolescence · doi:10.1007/s10964-021-01411-5 · Cited by 25 · see citing works
Developmental Epidemiology of Pediatric Anxiety Disorders
Warner, E. N., Ammerman, R. T., Glauser, T. A., Pestian, J. P., Agasthya, G. A., & Strawn, J. R. (2023) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2023.02.001 · Cited by 24 · see citing works
Courtroom modifications for child witnesses: Law and science in forensic evaluations.
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Predictors of Outcome in Cognitive‐Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder
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The clinical phenomenology and classification of child and adolescent anxiety
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“continuity of type over time) of anxiety disorders in children (Ferdinand et al., 2007).”
BackgroundInfluentialThe effects of measurement non-invariance on parameter estimation in latent growth models
Wirth, R. J. (2019) · Carolina Digital Repository (University of North Carolina at Chapel Hill) · doi:10.17615/tgzh-a739 · Cited by 13 · see citing works
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“…asserting heterotypic continuity fi nd a predictive asso-ciationof one behavioror syndromeat T1inpredictinganother behavior or syndrome at T2 (e.g., Ferdinand et al., 2007; Lahey et al., 2014; Lavigne et al., 2014; Miller et al., 2009; Nagin & Tremblay, 2001; Putnam et al., 2008; Richards et…”
BackgroundGenetic, Environmental, and Epigenetic Influences on Behavior
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“There is also evidence that early emotional symptoms are linked to continued emotional symptoms throughout adolescence (e.g., Ferdinand et al., 2007; Gregory et al., 2007).”
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- Authors
- Ferdinand, R. F., Dieleman, G., Ormel, J., & Verhulst, F. C.
- Affiliations
- Erasmus MC (NL)
- University of Groningen (NL)
- Corresponding author
- Ferdinand, Robert F.
- Venue
- Journal of Abnormal Child Psychology
- Published
- 2007-01-17
- Volume
- 35
- Issue
- 3
- Pages
- 325-333
- ISSN
- 0091-0627 (ISSN-L)
- 1573-2835
- PMC
- PMC1915634
- OpenAlex
- W2153178271
- Cited by
- 78
- References
- 52
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 6 · 2022: 4 · 2021: 3 · 2020: 4 · 2019: 1 · 2018: 1 · 2017: 6 · 2016: 6 · 2015: 4 · 2014: 3 · 2013: 4 · 2012: 7
- FWCI
- 5.44
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Research on Child and Adolescent Psychopathology (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- Rijksuniversiteit Groningen
- ZonMw (GB-MW 940-38-011, 10-000-1001, GB-MAG 480-01-006)
- Erasmus Medisch Centrum
- Trimbos-instituut
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- heterotypic continuity, anxiety disorders, separation anxiety disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, obsessive-compulsive disorder, early adolescents, sex differences
- MeSH terms
- Adolescent, Psychology, Adolescent, Age Factors, Anxiety Disorders, Anxiety, Separation, Child, Cross-Sectional Studies, Diagnosis, Differential, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Netherlands, Obsessive-Compulsive Disorder, Personality Inventory, Phobic Disorders, Psychiatric Status Rating Scales, Surveys and Questionnaires, Regression Analysis, Sex Factors, Panic Disorder, Diagnostic and Statistical Manual of Mental Disorders
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