Anxiety Disorders in Children

Features, Prevalence, and Prognosis

In general, anxiety disorders share similar features, including (a) maladaptive thoughts or cognitions of harm or injury to self or loved ones; (b) physiological arousal or reaction (e.g., palpitations, sweating, irritability); (c) avoidance or attempts at avoidance of particular objects or situations, and when avoidance is not possible, the child endures with severe distress (e.g., crying, freezing up, panic attacks); (d) presence of anxiety, fear, and/or worry that is developmentally inappropriate and causes clinically significant distress or impairment in important functioning (e.g., social, academic); and (e) prolonged period of anxiety, fear, and/or worry (e.g., 4 weeks for posttraumatic stress disorder and 6 months for social phobia).

Anxiety disorders are one of the most prevalent disorders of childhood and adolescence, with an estimated prevalence of 12% to 20% (Costello & Angold, 1995). Among the most prevalent anxiety disorders are social phobia, specific phobia, separation anxiety disorder, and generalized anxiety disorder. Longitudinal investigations have shown that anxiety disorders in childhood do not usually spontaneously remit. Rutter, Graham, Chadwick, and Yule (1976) found that approximately one half of children at age 10 with emotional problems, including anxiety disorders, continued to have emotional problems at age 14. Cantwell and Baker (1989) similarly found that 66% of children with [Page 86]emotional disorders either had the same disorder or another emotional disorder 4 years later.

Assessment

When assessing anxiety disorders, it is important to assess for the presence of comorbid psychiatric disorders, including other anxiety, mood, and externalizing disorders (e.g., attention deficit/hyperactivity disorder, oppositional defiant disorder). A multisource, multimethod assessment procedure is preferable and may include (a) diagnostic interviews, (b) rating scales, and (c) behavioral observations. A variety of structured (e.g., Diagnostic Interview Schedule for Children) and semistructured interviews (e.g., Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions) are available for assessment and diagnosis.

There are several types of rating scales that may be used, including (a) general behavior problem scales, (b) global anxiety scales, (c) specific anxiety scales, and (d) DSM-based scales. The Child Behavior Checklist, Teacher Reporting Form, and the Conner's Rating Scales (parent and teacher versions) are examples of general problem scales that use parent or teacher report and yield total problem scores as well as anxiety/internalizing problems subscale scores. The Revised Child Manifest Anxiety Scale and the State-Trait Anxiety Inventory for Children are examples of global self-rating scales to assess symptoms of anxiety. Several scales are available to assess specific anxiety problems, such as social anxiety (e.g., Social Anxiety Scale for Children–Revised, Social Phobia and Anxiety Inventory for Children) and specific fears (e.g., Revised Fear Survey Schedule for Children). The Multidimensional Anxiety Scale for Children, Screen for Child Anxiety-Related Emotional Disorders, and Spence Children's Anxiety Scale are examples of DSM-based rating scales that use both parent and child report.

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