Anxiety Disorders in Children and Adolescents
Anxiety disorders in childhood and adolescence are extremely common and are often associated with lifelong psychiatric disturbance. Consistent with DSM-5 and the extant literature, this review concerns the assessment and treatment of specific phobias, separation anxiety disorder, generalised anxiety disorder, social anxiety disorder, panic disorder and agoraphobia. Evidence-based psychological treatments (cognitive behaviour therapy; CBT) for these disorders have been developed and investigated, and in recent years promising low-intensity versions of CBT interventions have been proposed that offer a means to increase access to evidence-based treatments. There is some evidence of effectiveness of pharmacological treatments for anxiety disorders in children and young people, however, routine prescription is not recommended due to concerns about potential harm.
Anxiety disorders are among the most common psychiatric conditions in young people, with community studies indicating a period prevalence between 9% and 32% during childhood and adolescence. They typically have an adverse impact on educational achievement, family life and leisure activities; and they often co-occur with other anxiety disorders, depression and behavioural disorders. Anxiety disorders in young people are associated with increased rates of anxiety and depression in early adulthood, as well as with a number of other adverse mental health and life course outcomes. Indeed, for the majority of adults with anxiety disorders and depression the onset of psychological difficulties was in childhood or adolescence, with anxiety disorders being the most common prior diagnosis. Despite the significant public health burden associated with anxiety disorders in children and young people, they commonly remain untreated. Collectively these considerations highlight the importance of early access to effective identification and treatment.
There have been some recent changes to the classification of anxiety disorders. Consistent with the previous version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), DSM-5 includes the following anxiety disorders: specific phobia, generalised anxiety disorder, social anxiety disorder (formerly social phobia), panic disorder and agoraphobia. Key changes in DSM-5 include: (i) agoraphobia has been classified as a stand-alone diagnosis (ie, no longer linked to the presence or absence of panic disorder), (ii) separation anxiety disorder and selective mutism have been re-classified as anxiety disorders (rather than in a section for 'disorders usually first diagnosed in infancy, childhood or adolescence') and (iii) obsessive-compulsive disorder, post-traumatic stress disorder and acute stress disorder are, respectively, grouped under obsessive-compulsive and related disorders, and trauma-related and stressor-related disorders (ie, no longer included within the anxiety disorders category). While core features of each anxiety disorder are broadly consistent with DSM-IV, in order to minimise the over-diagnosis of transient fears for agoraphobia, specific phobia and social anxiety disorder, those under the age of 18 are now required to have had symptoms for at least 6 months.
Abstract and Introduction
Abstract
Anxiety disorders in childhood and adolescence are extremely common and are often associated with lifelong psychiatric disturbance. Consistent with DSM-5 and the extant literature, this review concerns the assessment and treatment of specific phobias, separation anxiety disorder, generalised anxiety disorder, social anxiety disorder, panic disorder and agoraphobia. Evidence-based psychological treatments (cognitive behaviour therapy; CBT) for these disorders have been developed and investigated, and in recent years promising low-intensity versions of CBT interventions have been proposed that offer a means to increase access to evidence-based treatments. There is some evidence of effectiveness of pharmacological treatments for anxiety disorders in children and young people, however, routine prescription is not recommended due to concerns about potential harm.
Introduction
Anxiety disorders are among the most common psychiatric conditions in young people, with community studies indicating a period prevalence between 9% and 32% during childhood and adolescence. They typically have an adverse impact on educational achievement, family life and leisure activities; and they often co-occur with other anxiety disorders, depression and behavioural disorders. Anxiety disorders in young people are associated with increased rates of anxiety and depression in early adulthood, as well as with a number of other adverse mental health and life course outcomes. Indeed, for the majority of adults with anxiety disorders and depression the onset of psychological difficulties was in childhood or adolescence, with anxiety disorders being the most common prior diagnosis. Despite the significant public health burden associated with anxiety disorders in children and young people, they commonly remain untreated. Collectively these considerations highlight the importance of early access to effective identification and treatment.
Classification of Anxiety Disorders Among Children and Adolescents
There have been some recent changes to the classification of anxiety disorders. Consistent with the previous version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), DSM-5 includes the following anxiety disorders: specific phobia, generalised anxiety disorder, social anxiety disorder (formerly social phobia), panic disorder and agoraphobia. Key changes in DSM-5 include: (i) agoraphobia has been classified as a stand-alone diagnosis (ie, no longer linked to the presence or absence of panic disorder), (ii) separation anxiety disorder and selective mutism have been re-classified as anxiety disorders (rather than in a section for 'disorders usually first diagnosed in infancy, childhood or adolescence') and (iii) obsessive-compulsive disorder, post-traumatic stress disorder and acute stress disorder are, respectively, grouped under obsessive-compulsive and related disorders, and trauma-related and stressor-related disorders (ie, no longer included within the anxiety disorders category). While core features of each anxiety disorder are broadly consistent with DSM-IV, in order to minimise the over-diagnosis of transient fears for agoraphobia, specific phobia and social anxiety disorder, those under the age of 18 are now required to have had symptoms for at least 6 months.
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