Assessment and treatment of anxiety disorders in children and adolescents

Abstract

Recent advances in the developmental epidemiology, neurobiology, and treatment of pediatric anxiety disorders have increased our understanding of these conditions and herald improved outcomes for affected children and adolescents. This article reviews the current epidemiology, longitudinal trajectory, and neurobiology of anxiety disorders in youth. Additionally, we summarize the current evidence for both psychotherapeutic and psychopharmacologic treatments of fear-based anxiety disorders (e.g., generalized, social, and separation anxiety disorders) in children and adolescents. Current data suggest that these disorders begin in childhood and adolescence, exhibit homotypic continuity, and increase the risk of secondary anxiety and mood disorders. Psychopharmacologic trials involving selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SSNRIs) are effective in pediatric patients with anxiety disorders and have generally demonstrated moderate effect sizes. Additionally, current data support cognitive behavioral therapy (CBT) for the treatment of these conditions in youth and suggest that the combination of psychotherapy + an SSRI may be associated with greater improvement than would be expected with either treatment as monotherapy.

FIGURE 1. The age of onset distribution of (A) anxiety, depressive and substance use disorders and (B) specific anxiety disorders at age 33, and estimated cumulative incidence rates at age 33 (in parenthesis)

Data from the Early Developmental Stages of Psychopathology (EDSP) Study. Adapted from [8].

FIGURE 2. Structures and regions implicated in pediatric patients with fear-based anxiety disorders

The cuneus (yellow), precuneus (light green), dorsal anterior cingulate (red), pre/subgenual anterior cingulate (purple) and ventromedial prefrontal cortex (light blue) are show medially in A, while the ventrolateral prefrontal cortex (VLPFC, lime green) is shown in the left lateral view in B. Adapted from [28].