Anxiety Disorders in Children and Adolescents

Anxiety Disorders in Children and Adolescents

• Fear and worry are common in children and are part of normal development, but anxiety disorders can begin in childhood and adolescence.
• The overall prevalence of anxiety disorders in this age group is between 8% and 30%, depending on the impairment cut-offs used.
• Anxiety disorders may be even more common in children with neurodevelopmental disorders.

Clinical Presentation and Assessment

• In children, anxiety disorders may be masked by prominent behavioral symptoms, such as irritability and angry outbursts.
• Clinicians need to discriminate between normal worries and anxiety disorders that significantly impair a child's functioning.
• Developmental variations in symptom presentation must be considered.

Treatment and Prognosis

• Anxiety symptoms in children and adolescents often improve with age, possibly due to the development of the prefrontal cortex and executive function.
• Anxiety disorders are distressing and impairing conditions that need prompt treatment.
• Chronic stress mediators may impact brain development and functional impairment.
• Early and effective treatment may prevent continuity of psychopathology into adulthood.

Guidelines for Treatment

• NICE guidelines focus on the treatment of social anxiety disorder in children and adolescents, recommending cognitive behavioral therapy (CBT) and cautioning against routine pharmacological treatment.
• AACAP guidelines cover the treatment of all non-OCD, non-PTSD anxiety disorders, suggesting multimodal treatment including psychoeducation, psychotherapy, and pharmacotherapy.

Prescribing for Anxiety Disorders

• Before prescribing, exclude other diagnoses, including depression, bipolar disorder, oppositional-defiant disorder, psychotic disorders, ADHD, Asperger syndrome, and learning disabilities.
• Anxiety symptoms can be mimicked by various medical conditions, such as endocrine, neurological, cardiovascular, and respiratory disorders.
• Be aware of contraindications to SSRIs and potential interactions.
• Measure baseline severity using structured interviews, questionnaires, and measures of functional impairment.
• Obtain consent and discuss treatment with the young person and their family.

Medications

• Selective serotonin reuptake inhibitors (SSRIs) are the medications of choice for the treatment of anxiety disorders in children and adolescents.