Anxiety disorders are common throughout childhood and adolescence, and the anxiety disorders observed throughout the life span often emerge during childhood. Prevalence rates for pediatric anxiety disorders are as high as 15% to 20%. Although some fears and anxieties are developmentally normative and even adaptive, they must be differentiated from anxiety disorders, which entail considerable impairment in academic, social, and family functioning. Unfortunately, anxiety disorders may go unnoticed, particularly when compared to the disruptive behavior disorders (eg, attention-deficit/hyperactivity disorder [ADHD] and oppositional defiant disorder) that are more frequently referred for treatment. Early identification and assessment of pediatric anxiety disorders require an evaluation that includes clinical interview, multi-informant report (parent, child, and teacher), careful attention to developmental level and ability, an evaluation of the family environment and the response of the caregivers to the child’s anxiety, and an assessment of functional impairment in daily life. Pediatric anxiety disorders are highly comorbid with one another, and affected youth are likely to meet criteria for multiple anxiety disorders. Moreover, anxiety disorders may serve as a gateway to developing major depressive disorder, suicidal ideation and behavior, and substance abuse in adolescence. Fortunately, anxiety disorders are highly treatable conditions, particularly when identified early. In this chapter, we review the various types of anxiety disorders, approaches to screening and evaluation of anxiety, and evidence-based treatment approaches.
Listed below are descriptions of anxiety disorders observed in children and adolescents, including diagnostic criteria and prevalence rates. For all of these disorders, significant distress and/or impairment is required for a diagnosis.
Separation Anxiety Disorder
Separation anxiety disorder is characterized by excessive anxiety or distress when anticipating or experiencing separation from caregivers or from home. Children suffering from separation anxiety disorder typically worry about harm befalling them or their caregivers when they are separated. They avoid attending social events or activities without their caregivers being present, and in severe cases, may try to avoid attending school to prevent separation. Children may also insist on sleeping near a caregiver and refuse to sleep away from home. Prevalence rates for separation anxiety disorder are estimated at 4%. Whereas some degree of separation anxiety is normative during the early toddler years, symptoms of separation anxiety disorder, interfering with the normal process of separation and individuation, may present as early as age 3. Initial onset is less common in adolescence.
Social anxiety disorder involves excessive fear of being embarrassed and of being negatively evaluated or rejected by others. To meet criteria for a diagnosis of social anxiety disorder, children and adolescents must fear negative evaluation or rejection by their peers (not only adults). Youth with social anxiety disorder typically avoid feared social situations, including participating in class, speaking informally with peers, performing or speaking in front of others, or initiating social plans. Prevalence rates for social anxiety disorder in youth are ...