Longitudinal patterns of anxiety from childhood to adulthood: the Great Smoky Mountains Study
Open accessAbstract
Objective The aims of this study were 2-fold: to provide a brief introduction to the prospective longitudinal Great Smoky Mountains Study and review recent findings; and to use this sample to conduct an epidemiologic analysis of common childhood anxiety disorders.Method The population-based Great Smoky Mountains Study assessed 1,420 participants from 11 counties in the southeastern United States up to 11 times between ages 9 and 26 years with the structured Child and Adolescent Psychiatric Assessment and its upward extension, the Young Adult Psychiatric Assessment.Results The U-shaped age prevalence curve for any anxiety disorder was the product of high levels of childhood separation anxiety and adult panic, agoraphobia, and generalized anxiety. More than 1 in 5 subjects met criteria for an anxiety disorder by early adulthood. In terms of cumulative comorbidity, there was evidence of overlap between anxiety disorders, but the level of overlap was generally consistent with what is seen among other common childhood disorders. All childhood anxiety disorders were associated with adverse functioning in at least 1 young adult functional domain, with the poorest outcomes for childhood generalized anxiety and DSM-III-R overanxious disorder.Conclusion Clinically significant anxiety is a common mental health problem to have had by adulthood. There was little evidence to support the consolidation of anxiety disorders, and some evidence to justify reintroduction of DSM-III-R overanxious disorder. The transition to young adulthood appears to be a key period for understanding the development of common adult anxiety disorders such as panic and agoraphobia.
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Anxiety disorders emerging during childhood and early adolescence will often persist into young adulthood.
“Anxiety disorders emerging during childhood and early adolescence will o en persist into young adulthood (Copeland 2014;Essau 2018).”
From Exercise for the treatment of anxiety in children and adolescents (2022) · cites this paper as Copeland 2014
The Results (Prevalence by Age; page unavailable) say separation anxiety, common in childhood, became vanishingly rare by early to midadolescence, while panic disorder and agoraphobia were rare before young adulthood. The Discussion likewise attributes childhood and young-adult anxiety peaks to different disorders. These patterns run contrary to the claim that childhood-onset anxiety disorders often persist into young adulthood; the reported lasting functional effects are not evidence that the disorders themselves persisted. (LLM, conf=0.82)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredExperiences of depressive and anxiety symptoms in childhood and adolescence are associated with an elevated risk of poor mental health in adulthood.
“Experiences of depressive and anxiety symptoms in childhood and adolescence are associated with an elevated risk of poor mental health in adulthood [8–12]”
From Psychological impacts of “screen time” and “green time” for children and adolescents: A systematic scoping review (2020) · cites this paper as [11]
The Discussion reports links between childhood anxiety status and adult psychiatric outcomes, while the Results link childhood anxiety disorders to adverse functioning in young adulthood. The paper does not establish the claimed association for childhood depressive symptoms; its analyses concern anxiety disorders rather than depressive and anxiety symptoms together. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAdolescent anxiety disorders are linked to significant short- and long-term impairments across a broad spectrum of life domains.
“Adolescent ADs have also been linked to significant short and long-term impairments across a broad spectrum of life domains [13–16].”
From Acceptance and commitment therapy as a transdiagnostic approach to adolescents with different anxiety disorders: study protocol. (2025) · cites this paper as [15]
The Results (Long-Term Outcomes; page not provided) link anxiety disorders assessed through age 16 to adverse health, financial, or interpersonal functioning in young adulthood. The paper does not report short-term impairments across those life domains, and each disorder was associated with at least one domain, not necessarily all of them. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAnxiety disorders can interfere with daily activities such as school work and relationships during the child/adolescent period, with negative impacts on social, educational/vocational and health functioning persisting into young adulthood.
“Anxiety disorders can interfere with daily activities such as school work and relationships during the child/adolescent period (Wang 2017), with negative impacts on social, educational/vocational and health functioning persisting into young adulthood (Copeland 2014).”
From Exercise for the treatment of anxiety in children and adolescents (2022) · cites this paper as Copeland 2014
Early intervention may reduce anxiety prevalence in adults, attenuate the frequent worsening of symptoms, and lessen the associated impairment over time.
“suggesting that early intervention may reduce anxiety prevalence in adults, attenuate the frequent worsening of symptoms and lessen the associated impairment over time [1, 5, 6].”
From A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders (2021) · cites this paper as [1]
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“The 12-month prevalence of GAD in children and adolescents aged 6–18 years (hereafter youth) in the community is 1–3%, with affected individuals experiencing high rates of comorbidity, functional impairments, and a chronic course (Copeland et al. 2014).”
BackgroundCognitive behavioral therapy for children and adolescents with anxiety disorders
Stiede, J. T., Trent, E. S., Viana, A. G., Guzick, A. G., Storch, E. A., & Hershfield, J. (2023) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2022.12.001 · Cited by 25 · see citing works
Lønfeldt, N. N., Silverman, W. K., & Esbjørn, B. H. (2017) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2017.10.2.115 · Cited by 19 · see citing works
Stiles-Shields, C., Ho, J., & Mohr, D. C. (2016) · DIGITAL HEALTH · doi:10.1177/2055207616675706 · Cited by 18 · see citing works
Jolstedt, M., Vigerland, S., Mataix-Cols, D., Ljótsson, B., Wahlund, T., Nord, M., Högström, J., Öst, L.-G., & Serlachius, E. (2021) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-020-01645-x · Cited by 17 · see citing works
Peterson, B. S., West, A. E., Weisz, J. R., Mack, W. J., Kipke, M. D., Findling, R. L., Mittman, B. S., Bansal, R., Piantadosi, S., Takata, G., et al. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03314-y · Cited by 13 · see citing works
Anxiety and depression correlates at age 10 in children born extremely preterm
Moore, P. S., Mokrova, I., Frazier, J. A., Joseph, R. M., Santos, H. P., Dvir, Y., Hooper, S. R., O’Shea, T. M., Douglass, L. M., & Kuban, K. C. K. (2021) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsaa118 · Cited by 9 · see citing works
Figueiredo, D. V., Salvador, M. D. C., Rijo, D., & Vagos, P. (2025) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02608-2 · Cited by 2 · see citing works
Exercise for the treatment of anxiety in children and adolescents
Bailey, A. P., Castellano, G., & Aleman, A. (2022) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014426 · Cited by 1 · see citing works
Isaksson, A., Åhlén, J., Hasson, H., & Eriksson, L. (2026) · BMC Primary Care · doi:10.1186/s12875-026-03191-y
“Beyond impairment in well-being and daily functioning, having an anxiety disorder in childhood is associated with an increased risk of developing other mental disorders and physical health issues later in life [3, 4].”
- Authors
- Copeland, W. E., Angold, A., Shanahan, L., & Costello, E. J.
- Affiliations
- Duke Medical Center (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Copeland, William E.
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 53
- Issue
- 1
- Pages
- 21-33
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC3939681
- OpenAlex
- W2059359883
- Cited by
- 604
- References
- 50
- Citations by year
- 2026: 31 · 2025: 38 · 2024: 54 · 2023: 65 · 2022: 96 · 2021: 62 · 2020: 64 · 2019: 42 · 2018: 44 · 2017: 41 · 2016: 26 · 2015: 29 · 2014: 12
- FWCI
- 3.27
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH-63671, R01MH063970, R01MH048085, MH-63970, R03MH094605, K23MH080230, R01MH063671)
- National Institute on Drug Abuse (DA/MH11301, R01DA011301)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD065563, R24HD065563)
- 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 › Social Psychology › Mental Health Treatment and Access
- Keywords
- childhood anxiety disorders, separation anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, overanxious disorder, comorbidities, transition to young adulthood, functional outcome, Great Smoky Mountains Study
- MeSH terms
- Adolescent, Adult, Anxiety Disorders, Child, Humans, Human Development, Young Adult
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