Anxiety disorders are the most prevalent psychiatric condition in children and adolescents, affecting between 15% to 20% of youth.1 Some data estimate an even higher prevalence, up to 31% in young persons aged 13 to 18 years.2
Recently reported data also highlight the steady rise in anxiety disorders in adolescents, showing an increased prevalence of 20% between 2007 and 2012.3 A further recent report highlighted that up to 30% will develop an anxiety disorder in their lifetime.4
The impact of these types of disorders in the young cannot be understated. Children and adolescents who struggle with an anxiety disorder face difficulties with academic, social, and family functioning, and are at increased risk for other mental health issues such as depression, substance abuse, and suicide.1,2
Despite the high prevalence and associated negative impacts, pediatric anxiety disorders can go unrecognized as it can be difficult for parents and clinicians to differentiate an anxiety disorder from anxiety a child experiences as part of growing, developing, and adapting to new situations and experiences. Whereas this latter type of anxiety is characterized by transient fears as part of normal development, anxiety disorders are characterized by their persistence and the extensive distress and functional impairment they cause. In addition, a child with an anxiety disorder will typically respond with a disproportionate amount of fear to a threat that reason cannot allay.2
Early diagnosis and treatment of pediatric anxiety disorders are critical to both minimize the negative impacts on the child’s life as well as to lessen the negative impacts that can impair a child long into adulthood if left untreated. Data suggest that although the onset of anxiety disorders usually begins in childhood, these disorders typically are chronic and persistent and can evolve into a pattern of multiple anxiety disorders (ie, depressive or substance use disorders) into early adulthood.1 Primary care clinicians play a key role in identifying and treating anxiety disorders in children and helping them to learn effective coping skills. This article summarizes some of the current data on screening, diagnosis, and treatment of pediatric anxiety disorders.
Clinical presentation and diagnosis
Differentiating an anxiety disorder from developmentally appropriate anxiety or other conditions that may mimic an anxiety disorder is challenging. To help make the differential diagnosis, recognizing the risk factors is important as well as knowing a number of hallmark features that present in adolescents with anxiety disorders (Tables 1 and 2). In addition, clinicians should be aware that children and parents/caregivers may describe anxiety-related symptoms in terms that misinterpret anxiety for something else (eg, parents may describe their child as sensitive, picky, or shy, or attribute symptoms of irritability, crying, or tantrums as signs of disobedience or oppositional behavior, while children may use words such as angry, upset, tense, or uncomfortable to describe their anxiety).2
1. Wehry AM, Beesdo-Baum K, Hennelly MM, Connolly SD, Strawn JR. Assessment and treatment of anxiety disorders in children and adolescents. Curr Psychiatry Rep. 2015;17(7):591.
2. Chiu A, Falk A, Walkup JT. Anxiety disorders among children and adolescents. Focus. 2016;14:26-33.
3. McCarthy C. Anxiety in teens is rising: What’s going on? Healthychildren.org. Available at: https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Anxiety-Disorders.aspx. Published April 30, 2019. Accessed September 4, 2019.
4. Weitzman CC, Bridgemohan C. Up to 30% of youths will develop anxiety disorders; how you can help. AAP News. Available at: https://www.aappublications.org/news/2019/01/15/anxiety011519. Published January 15, 2019. Accessed September 4, 2019.
5. Weitzman C, Wegner L; Section on Developmental and Behavioral Pediatrics, Committee on Psychosocial Aspects of Child and Family Health; Council on Early Childhood; Society for Developmental and Behavioral Pediatrics; American Academy of Pediatrics. Promoting optimal development: screening for behavioral and emotional problems. Pediatrics. 2015;135(2):384-395.
6. Panganiban M, Yeow M, Zugibe K, Geisler SL. Recognizing, diagnosing, and treating pediatric generalized anxiety disorder. JAAPA. 2019;32(2):17-21.
7. Fernandez S. Anxiety disorders in childhood and adolescence: a primary care approach. Pediatr Ann, 2017;46(6):e213-e216.
8. Neal P. Pediatric anxiety disorder: When to worry about the “worrier.” Presented at: 40th National Conference on Pediatric Health Care; March 7-10. 2019; New Orleans, LA. Available at: https://www.napnap.org/sites/default/files/userfiles/Conferences/2019Speakerhandouts/104-Neal.pdf. Accessed September 4, 2019.