For most children, anxiety is a common, functional, and transitory experience.1 Unfortunately, for a considerable number of children and adolescents, anxiety may increase in intensity and cause significant disruptions in normative social and academic development.2 Indeed, current epidemiological data suggest that anxiety disorders are the most prevalent type of childhood psychological disorder.3
The long-term consequences of childhood anxiety disorders take on particular importance given their high prevalence. Anxiety disorders have an early onset and run a chronic or fluctuating course into adulthood.4–6 Childhood anxiety disorders predict risk for mood and anxiety disorders at later ages7–8 and are associated with suicide attempts and psychiatric hospitalization.5–6
Although widely prevalent, childhood anxiety often goes undetected and is treated inadequately, despite the availability of excellent psychosocial and pharmacologic interventions. On one hand, treatment may be incomplete because of the secrecy inherent to some disorders (eg, obsessive-compulsive disorder), or because childhood anxiety typically is not as overtly disruptive as a behavior disorder such as oppositional defiant disorder. On the other hand, incomplete treatment may be attributed to limited dissemination of efficacious treatments to front-line clinicians or to practitioners' lack of knowledge about appropriate assessment and available interventions.9 For example, despite strong evidence supporting cognitive-behavior psychotherapy as the treatment of choice for pediatric obsessive-compulsive disorder (either alone or in conjunction with a selective serotonin reuptake inhibitor),10 only a minority of children and adolescents are treated accordingly.11
During the past few decades, recognition of these issues has contributed to great expansion in the study and understanding of childhood anxiety. The articles contained in this issue continue this advancement by providing comprehensive, current reviews about the phenomenology, assessment, and treatment of each condition, in a manner that captures the complexities of childhood anxiety as well as uncovers areas in need of future study.
In This Issue
Dr. Hudson and colleagues open the issue with a discussion of current thinking about the nature, assessment, and treatment of generalized anxiety disorder. The authors provide an excellent description of the current state of the knowledge on effective treatment, emphasizing the utility of cognitive-behavior approaches. As with other childhood conditions, more data is needed to examine the merits of dual psychosocial and pharmacological treatment over one form alone.
Although normal separation distress is a natural developmental occurrence, a small number of children continue to present “clingy” behavior and separation anxiety as they age. Known as separation anxiety disorder, this condition is linked to considerable family and academic impairment, as well as childhood distress. Ms. Jurbergs and Dr. Ledley discuss the nature and treatment of separation anxiety disorder, providing an excellent description of psychosocial treatment for this condition.
Drs. Ginsburg and Grover discuss childhood social phobia. Social phobia previously was considered rare and something that children “grow out of.” However, the authors review data indicating that social phobia is one of the most common childhood psychiatric illnesses and, left untreated, results in considerable impairment. Fortunately, available information provides solid support for the use of cognitive-behavior and pharmacologic approaches. The article concludes by providing examples of helpful texts for practitioners and parents of anxious children.
Dr. Lewin and colleagues describe the nature, epidemiology, assessment, and treatment of pediatric obsessive-compulsive disorder. Like social phobia, obsessive-compulsive disorder once was considered extremely rare but now is thought to affect 2% to 4% of children. In their article, the authors highlight the importance of complete treatment of this condition, which includes cognitive-behavior and pharmacologic therapies. The article also presents a number of areas in need of further study, including improving the dissemination of cognitive-behavior treatment and examining variations of treatment format.
In her article, Dr. Brown describes posttraumatic stress disorder among children. Rates of exposure to traumatic events during childhood have escalated during the past few decades due, in part, to high rates of inner-city violence, terrorism, and increased access to violent weaponry. Not surprisingly, a sizable proportion of children exposed to trauma go on to experience signs and symptoms of posttraumatic stress disorder, a condition characterized by intrusive reliving of the trauma, avoidance of trauma related stimuli, and physiological arousal. Dr. Brown provides thoughtful comment on some of the issues applying to psychosocial and pharmacologic treatment.
Finally, Dr. Lehninger discusses effective treatment for childhood anxiety from a resident's perspective. He provides thoughtful comment on issues of training and dissemination of treatment.
Each of the articles contains a wealth of knowledge. Perhaps the greatest contribution of this series, however, is the synergy with which it addresses the complexity of childhood anxiety and emphasizes the various interventions with empirical support. It is my hope that the reader is left to consider issues inherent to effective treatment. Currently, a major issue within mental health treatment is disseminating evidence-based treatment to front-line practitioners to ensure that quality care is uniformly provided. It is crucial for psychiatrists and psychologists (and other child health professionals) to collaborate not only in patient care but also in educating the other about their field. With this in mind, my wish is that this issue will serve as a bridge between disciplines and stimulate additional discussion and scholarship on effective interventions for childhood anxiety.
- Last CG, Perrin S, Hersen M, Kazdin AE. A prospective study of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry. 1996;35(11):1502–1510. doi:10.1097/00004583-199611000-00019 [CrossRef]8936917
- Messer SC, Beidel DC. Psychosocial correlates of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry. 1994;33(7):975–983. doi:10.1097/00004583-199409000-00007 [CrossRef]7961353
- Albano AM, Chorpita BF, Barlow DH. Childhood anxiety disorders. In: Mash EJ, Barkley RA, eds. Child Psychopathology. New York, NY: The Guilford Press; 1996:196–241.
- Costello EJ, Angold A. Epidemiology. In: March JS, ed. Anxiety Disorders in Children and Adolescents. Guilford Press, New York, NY: The Guilford Press; 1995:314.
- Ferdinand RF, Verhulst FC. Psychopathology from adolescence into young adulthood: an 8-year follow-up study. Am J Psychiatry. 1995;152(11):1586–1594. doi:10.1176/ajp.152.11.1586 [CrossRef]7485620
- Pine DS, Cohen P, Gurley D, Brook J, Ma Y. The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry. 1998;55(1):56–64. doi:10.1001/archpsyc.55.1.56 [CrossRef]9435761
- Cole DA, Peeke LG, Martin JM, Truglio R, Seroczynski AD. A longitudinal look at the relation between depression and anxiety in children and adolescents. J Consult Clin Psychol. 1998;66(3):451–460. doi:10.1037/0022-006X.66.3.451 [CrossRef]9642883
- Klein RG. Is panic disorder associated with childhood separation anxiety disorder?Clin Neuropharmacol. 1995;18(1): S7–S14. doi:10.1097/00002826-199518002-00003 [CrossRef]
- Storch EA, Dent HC. Bringing clinic-based treatment to the schools. Clin Child Fam Psychol Rev. 2004;7(4):191–193. doi:10.1007/s10567-004-6084-y [CrossRef]
- Pediatric OCD Treatment Study (POTS) Team. Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: the Pediatric OCD Treatment Study (POTS) randomized controlled trial. JAMA. 2004;292(16):1969–1976. doi:10.1001/jama.292.16.1969 [CrossRef]15507582
- Heyman I, Fombonne E, Simmons H, et al. Prevalence of obsessive-compulsive disorder in the British nationwide survey of child mental health. Br J Psychiatry. 2001;179:324–329. doi:10.1192/bjp.179.4.324 [CrossRef]11581112