Podcast
Questions and Answers
Fear and worry are unusual in children and are not part of normal development.
Fear and worry are unusual in children and are not part of normal development.
False
Anxiety disorders are rare in children and adolescents.
Anxiety disorders are rare in children and adolescents.
False
Anxiety disorders are less common in children with neurodevelopmental disorders.
Anxiety disorders are less common in children with neurodevelopmental disorders.
False
Assessing anxiety disorders in children is a straightforward process.
Assessing anxiety disorders in children is a straightforward process.
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Anxiety symptoms in children and adolescents tend to worsen with age.
Anxiety symptoms in children and adolescents tend to worsen with age.
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Chronic stress has no significant impact on brain development.
Chronic stress has no significant impact on brain development.
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Treating anxiety disorders in children is not urgent and can be delayed.
Treating anxiety disorders in children is not urgent and can be delayed.
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Untreated anxiety disorders in children do not have long-term consequences.
Untreated anxiety disorders in children do not have long-term consequences.
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There are no established guidelines for the treatment of anxiety disorders in children and adolescents.
There are no established guidelines for the treatment of anxiety disorders in children and adolescents.
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Anxiety disorders in children are not likely to affect their social, emotional, and cognitive development.
Anxiety disorders in children are not likely to affect their social, emotional, and cognitive development.
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NICE guidelines recommend the use of pharmacological treatment as the first line of treatment for social anxiety disorder in children and adolescents.
NICE guidelines recommend the use of pharmacological treatment as the first line of treatment for social anxiety disorder in children and adolescents.
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AACAP guidelines recommend the use of psychotherapy alone for the treatment of non-OCD, non-PTSD anxiety disorders in children and adolescents.
AACAP guidelines recommend the use of psychotherapy alone for the treatment of non-OCD, non-PTSD anxiety disorders in children and adolescents.
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Before prescribing medication for anxiety disorders in children and adolescents, clinicians should exclude other psychiatric diagnoses, but not endocrine or neurological conditions.
Before prescribing medication for anxiety disorders in children and adolescents, clinicians should exclude other psychiatric diagnoses, but not endocrine or neurological conditions.
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SSRIs are contraindicated in the treatment of anxiety disorders in children and adolescents.
SSRIs are contraindicated in the treatment of anxiety disorders in children and adolescents.
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A trial of medication for anxiety disorders in children and adolescents should be started at a period of high stress and demands.
A trial of medication for anxiety disorders in children and adolescents should be started at a period of high stress and demands.
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Discontinuation of medication for anxiety disorders in children and adolescents should be done abruptly.
Discontinuation of medication for anxiety disorders in children and adolescents should be done abruptly.
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The Maudsley Prescribing Guidelines in Psychiatry recommend the use of cognitive behavioural therapy (CBT) as the medication of choice for the treatment of anxiety disorders in children and adolescents.
The Maudsley Prescribing Guidelines in Psychiatry recommend the use of cognitive behavioural therapy (CBT) as the medication of choice for the treatment of anxiety disorders in children and adolescents.
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Psychotherapy is not a recommended treatment for anxiety disorders in pre-school children.
Psychotherapy is not a recommended treatment for anxiety disorders in pre-school children.
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The Kiddie-Schedule for Affective Disorders and Schizophrenia (Kiddie-SADS) is a questionnaire used to measure baseline severity of anxiety symptoms in children and adolescents.
The Kiddie-Schedule for Affective Disorders and Schizophrenia (Kiddie-SADS) is a questionnaire used to measure baseline severity of anxiety symptoms in children and adolescents.
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The Children’s Global Assessment Scale (CGAS) is a questionnaire used to measure anxiety symptoms in children and adolescents.
The Children’s Global Assessment Scale (CGAS) is a questionnaire used to measure anxiety symptoms in children and adolescents.
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The starting dose for Fluoxetine in children and adolescents is between 5-10 mg.
The starting dose for Fluoxetine in children and adolescents is between 5-10 mg.
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Duloxetine is started at a dose of 37.5 mg per day.
Duloxetine is started at a dose of 37.5 mg per day.
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The recommended dose range for Venlafaxine XR in the treatment of anxiety disorders in children and adolescents is 37.5-120 mg per day.
The recommended dose range for Venlafaxine XR in the treatment of anxiety disorders in children and adolescents is 37.5-120 mg per day.
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Guanfacine has a dose range of 1-6 mg per day for treating anxiety in children and adolescents.
Guanfacine has a dose range of 1-6 mg per day for treating anxiety in children and adolescents.
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Buspirone's starting dose needs to be administered three times daily.
Buspirone's starting dose needs to be administered three times daily.
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Clonazepam is not supported by RCT evidence for treating anxiety disorders in children and adolescents.
Clonazepam is not supported by RCT evidence for treating anxiety disorders in children and adolescents.
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Study Notes
Anxiety Disorders in Children and Adolescents
- Fear and worry are normal in children, but anxiety disorders can start in childhood and adolescence, affecting 8%-30% of children and adolescents.
- Anxiety disorders may be more common in children with neurodevelopmental disorders.
- Anxiety symptoms in children and adolescents often improve with age, possibly due to the development of the prefrontal cortex and executive function.
Clinical Guidance
- Anxiety disorders are distressing and impairing conditions that need prompt treatment to prevent long-term effects on brain development and social, emotional, and cognitive development.
- Early and effective treatment can prevent continuity of psychopathology into adulthood.
Treatment Guidelines
- NICE guidelines recommend cognitive behavioural therapy (CBT) for social anxiety disorder in children and adolescents, with caution against routine pharmacological treatment.
- AACAP guidelines suggest multimodal treatment, including psychoeducation, psychotherapy (e.g., exposure-based CBT), and pharmacotherapy for non-OCD, non-PTSD anxiety disorders.
Prescribing for Anxiety Disorders
- Exclude other diagnoses that can mimic anxiety symptoms, such as depression, bipolar disorder, oppositional-defiant disorder, psychotic disorders, ADHD, Asperger syndrome, learning disabilities, and medical conditions.
- Measure baseline severity using structured interviews and questionnaires (e.g., ADIS, Kiddie-SADS, RCADS, SCARED, MASC).
- Obtain consent and discuss treatment with the young person and family.
- Document consent in writing.
Medication
- Selective serotonin reuptake inhibitors (SSRIs) are the medications of choice for treating anxiety disorders in children and adolescents.
- Consider discontinuing treatment after a period of stable improvement due to lack of information on long-term safety and possible improvement with age and learning.
- Discontinuation should also be considered if the medication is no longer working or the side effects are too severe.
- Taper SSRIs slowly to minimize risk of discontinuation symptoms.
Specific Issues
- Treatment of anxiety disorders in pre-school children should focus on psychotherapy.
- In rare cases, clinicians may reconsider diagnosis and case formulation and reassess the adequacy of the psychotherapy trial.
- There are no RCTs of pharmacological interventions for anxiety in pre-school children, but case reports suggest potential benefit of fluoxetine and buspirone.
Medications for Anxiety in Children and Adolescents
- SSRIs (Selective Serotonin Reuptake Inhibitors) are used to treat anxiety disorders in children and adolescents.
SSRI Medications
- Sertraline: starting dose 12.5-25mg, dose range 25-200mg/day
- Fluoxetine: starting dose 5-10mg, dose range 10-60mg/day
- Fluvoxamine: starting dose 12.5-25mg, dose range 50-200mg/day (twice daily if >50mg)
- Paroxetine: starting dose 5-10mg, dose range 10-40mg/day
- Citalopram*: starting dose 5-10mg, dose range 10-40mg/day
SNRI Medications
- Venlafaxine XR: starting dose 37.5mg, dose range 37.5-225mg/day
- Duloxetine: starting dose 30mg, dose range 30-120mg/day
Alpha2 Agonist Medication
- Guanfacine: starting dose 1mg, dose range 1-6mg/day
5-HT1A Partial Agonist Medication
- Buspirone*: starting dose 5mg TDS, dose range 15-60mg/day
Benzodiazepine Medications (PRN)
- Clonazepam*: starting dose 0.25-0.5mg, no specified dose range
- Lorazepam*: starting dose 0.5-1mg, no specified dose range
- Note: These medications do not have sufficient RCT evidence to support their use. Always check dosages with the latest formal guidance, such as the British National Formulary for Children (in the UK).
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Description
Learn about anxiety disorders in children and adolescents, including their prevalence, risk factors, and how symptoms improve with age.
