Open Access
Feature Article

Anxiety disorders in children and adolescents

Open Access
Feature Article

Anxiety disorders in children and adolescents

GEMMA SICOURI, IAIN PERKES, JENNIFER L. HUDSON

Figures

© hidesy/istockphoto.com model used for illustrative purposes only
© hidesy/istockphoto.com model used for illustrative purposes only
Dr Sicouri is a Senior Research Associate and Clinical Psychologist at the Black Dog Institute, Faculty of Medicine and School of Psychology, UNSW, Sydney. Dr Perkes is a Senior Lecturer in the School of Psychiatry, School of Women’s and Children’s Health and School of Psychology, UNSW, Sydney; and a Child and Adolescent Psychiatrist in the Department of Psychological Medicine, Sydney Children’s Hospital Network, Sydney. Professor Hudson is Director of Research and Professor of Clinical Psychology at the Black Dog Institute, Faculty of Medicine and School of Psychology, UNSW, Sydney, NSW.

Abstract

Anxiety disorders are highly prevalent in children and adolescents and GPs play an important role in identifying and initiating management of such patients. Clinical presentations and the extent of anxiety can be successfully measured using reliable validated questionnaires, such as the Revised Child Anxiety and Depression Scale. Cognitive behavioural therapy is the first-line treatment, with the goal of remission and functional improvement.

Key Points

  • Anxiety disorders in children and adolescents are common and disabling, but often under-recognised and poorly treated.
  • Fears and worries are common and developmentally normal in children.
  • Duration, distress and impairment are the markers of clinical threshold.
  • Anxiety disorders often co-occur with other conditions, and these should be routinely screened for.
  • Self-reported or parent-reported measures of symptoms and function enable detection and monitoring.
  • Cognitive behavioural therapy (CBT) is the first-line treatment for anxiety disorders, with the goal of sustained remission or functional improvement.
  • Exposure is the active ingredient in CBT and referrals should be made to professionals who deliver exposure-based treatment.

Anxiety lies on a spectrum that runs from normal worry to transient anxiety, through to severe and disabling symptoms.1 Normal anxiety does not interfere in functioning and can be helpful, for example, by motivating a child to work towards a goal or avoiding a potential threat. The fears of children and adolescents with anxiety disorders differ from normative worries in that anxiety disorder symptoms are persistent and associated with marked distress in addition to avoidance of triggering situations. This all amounts to substantial disruption to everyday life. Fortunately, cognitive behavioural therapy (CBT) is effective in treating anxiety disorders. GPs are well placed to help with the early detection and management of anxiety disorders in children and adolescents. 

Anxiety disorders are estimated to occur in 7% of children and adolescents in Australia within a 12-month period.2 Separation anxiety, specific phobia, social phobia and generalised anxiety are the most prevalent anxiety disorders. Typically, anxiety disorders are found to be more common in girls than boys.3 The presence of one anxiety disorder predicts the co-occurrence of other anxiety disorders, major depressive disorder, attention-deficit hyperactivity disorder and oppositional defiance disorder.2,4,5 Anxiety disorders are associated with significant emotional and financial cost to individuals, their families and wider society.2,6,7 This includes an average of three weeks of missed school per year, a sixfold increase in the likelihood of a suicide attempt and later substance and alcohol abuse.8,9 Anxiety disorders in childhood can persist into adulthood if left untreated.10

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Assessment

Clinical presentation 

Children and adolescents experience seven types of anxiety disorders: separation anxiety, specific phobia, social anxiety generalised anxiety, selective mutism, agoraphobia and panic disorder. Clinical features common to all these conditions involve excessive fear and related behavioural disturbances, particularly avoidance or safety behaviours (i.e. behaviours to prevent the feared situation from coming true). However, these diagnoses are differentiated by the content of the fear and developmental characteristics (Table 1). Obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are no longer technically classified as anxiety disorders.11

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