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Anxiety disorders are common in children and adolescents and can be debilitating if not recognized and treated. This issue covers the landscape of anxiety disorders in youth, from development and neurobiology; to treatments, advances, and novel approaches; to informing other systems of care: primary physicians, schools, and parents. Specific anxiety disorders discussed include: Obsessive-compulsive and tic-related disorders, PTSD, and school refusal and panic disorder. Pharmacotherapy, CBT, and Parent-Child ...
Anxiety disorders are common in children and adolescents and can be debilitating if not recognized and treated. This issue covers the landscape of anxiety disorders in youth, from development and neurobiology; to treatments, advances, and novel approaches; to informing other systems of care: primary physicians, schools, and parents. Specific anxiety disorders discussed include: Obsessive-compulsive and tic-related disorders, PTSD, and school refusal and panic disorder. Pharmacotherapy, CBT, and Parent-Child interaction therapies are reviewed.
Preface: Childhood Anxiety: Lessons Learned Moira A. Rynn Hilary B. Vidair Jennifer Urbano Blackford xiii
Section 1 Development and Neurobiology
Developmental Epidemiology of Anxiety Disorders Katja Beesdo-Baum Susanne Knappe 457
This review focuses on developmental aspects in the epidemiology of anxiety disorders including prevalence, onset, natural course, longitudinal outcome, and correlates and risk factors, with focus on childhood through young adulthood. Anxiety disorders are frequent and early-emerging conditions. They may remit spontaneously; however, the same or other mental disorders often recur. Although risk factors have been identified, more work is needed to identify the most powerful predictors for onset and the progression to more complex forms of psychopathology and to understand the underlying mechanisms and interactions. This identification is crucial to facilitate research prevention, early interventions, and treatment programs.
Genetics of Pediatric Anxiety Disorders Dara J. Sakolsky James T. McCracken Erika L. Nurmi 479
This article reviews the familiality, linkage, candidate gene, and genomewide association studies of obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, and other anxiety disorders (ie, generalized anxiety disorder, separation anxiety disorder, social phobia, and specific phobia). Studies involving children and adolescents are highlighted. Clinical and research implications are discussed.
Neural Substrates of Childhood Anxiety Disorders: A Review of Neuroimaging Findings Jennifer Urbano Blackford Daniel S. Pine 501
The development of fear is a normative process, and significant progress has been made in identifying fear neurocircuitry. The normal development of fear goes awry in children who develop anxiety disorders, and dysfunction in fear circuitry is likely. In this article, the authors present current knowledge about the neural basis of normal fear development and reviews findings from structural and functional neuroimaging studies of childhood anxiety disorders.
Section 2 Treatment Advances
Psychopharmacologic Treatment of Children and Adolescents with Anxiety Disorders Jeffrey R. Strawn Dara J. Sakolsky Moira A. Rynn 527
Over the last decade, psychopharmacologic treatments for pediatric anxiety disorders have been developed and increasingly subjected to randomized, controlled trials. The authors summarize the data concerning the use of tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), atypical anxiolytics, and benzodiazepines. The extant data suggest that SSRIs-both as monotherapy and when combined with psychotherapy-are effective in the treatment of pediatric anxiety disorders. In addition, some TCAs and SNRIs are effective. However, randomized controlled trials do not suggest efficacy for benzodiazepines or the atypical anxiolytic, buspirone, for children and adolescents with anxiety disorders.
Cognitive Behavior Therapy for the Anxiety Triad Olga Jablonka Alix Sarubbi Amy M. Rapp Anne Marie Albano 541
This article presents an overview of the existing, as well as newly developed, cognitive behavior therapy methods for treating the child anxiety triad (separation anxiety disorder, generalized anxiety disorder, and social phobia). For each disorder of the triad, the authors review diagnostic criteria, clinical presentation, disorder-specific treatment methods and innovations, and future directions for research.
Obsessive-Compulsive and Tic-Related Disorders Martin E. Franklin Julie P. Harrison Kristin L. Benavides 555
Youth affected by obsessive-compulsive disorder (OCD) and chronic tic disorders (CTDs) often experience significant distress, functional impairment, and psychiatric comorbidity. The authors review the extant literature on phenomenology and treatment and summarize the state of the treatment literature, focusing on the application of psychosocial interventions that have yielded substantial symptom improvements. Comorbidity of OCD and CTDs is common, and the authors provide clinical recommendations for managing patients when both disorders are present. They conclude with a brief discussion of clinical controversies, particularly the central role ascribed to habituation as the mechanism by which these treatments' effects are realized.
Posttraumatic Stress Disorder: Shifting Toward a Developmental Framework Victor G. Carrion Hilit Kletter 573
This article reviews the current classification of posttraumatic stress disorder and its limitations when applied to youth. Distinctions are made between single-event and multiple-event traumas. Diagnosis, neurobiology, treatment development, and treatment outcomes are presented. A summary of current empirical interventions is provided. The authors present implications for future research and for clinical practice.
Panic Disorder and School Refusal Bryce Hella Gail A. Bernstein 593
This article provides clinical and research information about panic disorder, agoraphobia, and school refusal. Proposed changes to the definition of panic disorder and agoraphobia for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition are outlined. Treatment of panic disorder, and school refusal in children and adolescents is also discussed.
Adapting Parent-Child Interaction Therapy to Treat Anxiety Disorders in Young Children Anthony C. Puliafico Jonathan S. Comer Donna B. Pincus 607
Anxiety disorders are prevalent in children 7 years and younger; however, these children generally do not possess developmental skills required in cognitive behavior treatment. Recent efforts have adapted parent-child interaction therapy (PCIT), originally developed for disruptive and noncom-pliant behavior, for young children with anxiety. This article reviews the principles underlying PCIT and the rationale for adapting it to target anxiety symptoms. The authors describe two related treatment approaches that have modified PCIT to treat anxiety: (1) Pincus and colleagues' treatment for separation anxiety, and (2) Puliafico, Comer, and Albano's CALM Program for the range of early child anxiety disorders.
Social Phobia and Selective Mutism Courtney P. Keeton Meghan Crosby Budinger 621
Social phobia (SOP) and selective mutism (SM) are related anxiety disorders characterized by distress and dysfunction in social situations. SOP typically onsets in adolescence and affects about 8% of the general population, whereas SM onsets before age 5 and is prevalent in up to 2% of youth. Prognosis includes a chronic course that confers risk for other disorders or ongoing social disability, but more favorable outcomes may be associated with young age and low symptom severity. SOP treatments are relatively more established, whereas dissemination of promising and innovative SM-treatment strategies is needed.
Section 3 Treatment in Other Settings and Parental Impact
Anxiety in the Pediatric Medical Setting Bela Gandhi Shannon Cheek John V. Campo 643
The relationship between pediatric anxiety disorders and physical health is not well-understood, but appreciation of the importance of this relationship is growing. Significant functional impairment may accompany a chronic physical health condition such as asthma, diabetes, or epilepsy, and anxiety may complicate the course. In addition, physical disease can present with symptoms of anxiety, and anxiety disorders may present or be associated with physical symptoms such as functional abdominal pain, headache, and fatigue. This article describes anxiety and its association with physical disease, outlines assessment, and presents a treatment overview including psychotherapy and pharmacotherapy.
School-Based Anxiety Treatments for Children and Adolescents Kathleen Herzig-Anderson Daniela Colognori Jeremy K. Fox Catherine E. Stewart Carrie Masia Warner 655
Anxiety disorders are the most common class of psychopathology among youth, yet many of these youngsters do not receive treatment. This is particularly concerning given the chronic course of anxiety disorders, which often lead to mood disorders, substance abuse, and serious impairment. Schools are an optimal venue for identifying anxious students and delivering mental health treatment given access to youth and ability to overcome various barriers to treatment. This article reviews four school-based treatments for anxiety disorders that have been evaluated in controlled trials. Discussion centers on feasibility, challenges to school-based implementation, and future research directions for this critical area.
Targeting Parental Psychopathology in Child Anxiety Hilary B. Vidair Cassie N. Fichter Kristin L. Kunkle Angelo S. Boccia 669
The increased risk of anxiety in children of parents with psychopathology is a significant public health problem, as early-onset is associated with a variety of difficulties later in life. The aim of this article is to determine if treating parents is associated with improvements in child anxiety through the review of both top-down (parent identified for treatment) and family-focused child anxiety treatment studies. The authors present conclusions based on the state of the current literature, discuss implications for research and clinical practice, and propose utilizing a family-based model for treating parental psychopathology, parental behavior, and child anxiety.