Pediatric Anxiety and Tic Disorders Program
Resources
Differentiating Normal Anxiety from Disorder:
Subclinical anxiety symptoms are very common in the general pediatric population, with about 70% of grade school children report they worry "every now and then". Common worries relate to school performance, illness of self or others, getting teased, making mistakes, or concern about physical appearance. In moderation, worry can be helpful to a child; for instance, motivating to prepare for a test or an athletic event. However, if worry is intense, distressing and/or difficult for a child to control, it may impair a child’s functioning and deserves evaluation by a trained clinician. Further information on when and how to seek help for anxious children can be found at the following sites:
Diagnosis and presentation of anxiety disorders in youth:
Anxiety is classified into disorders (OCD, GAD, social anxiety, separation anxiety, specific phobia, post-traumatic stress disorder, panic disorder) based on how it is experienced, the situations that trigger it, and the course that it tends to follow. Most anxiety disorders begin in childhood or adolescence, with symptoms waxing and waning over time. The following web-based resources provide detailed descriptions of how specific anxiety disorders are diagnosed and the treatments that are most likely to be effective.
The presentation and treatment of specific anxiety disorders in youth may be further explored in the following resources:
Obsessive Compulsive Disorder (OCD) – characterized by recurrent, intrusive thoughts (obessions) and repetitive, ritualistic behaviors (compulsions).
- Obsessive-Compulsive Foundation
- JAMA Patient Page: Obsessive-Compulsive Disorder
- OCF sponsored parent-guide: "How to help your child with OCD – a guide for parents"
- “When your child has OCD” by Kate D. Fitzgerald, M.D.
- ADAA and AACAP Fact Sheets - pdf
Seperation Anxiety Disorder – associated with severe distress upon separation from a place or person with whom a patient is emotionally attached.
- AACAP Fact Sheet – pdf
Generalized Anxiety Disorder –characterized by chronic, exaggerated worry, tension, and irritability that are more intense than the situation warrants.
- ADAA Fact Sheet – pdf
Social Phobia – characterized by a strong fear of being judged by others and of being embarrassed.
- ADAA Fact Sheet – pdf
Specific Phobia - excessive, irrational fear of a specific object or situation. Spefiic phobias can lead to avoidance behaviors
- ADAA Fact Sheet – (open directly to pdf)
Post-traumatic Stress Disorder – recurrent, intrusive thoughts of a traumatic event with associated numbing, hypervigilance, irritability, and difficulty sleeping.
- AACAP Fact Sheet – pdf
- ADAA Fact Sheet - pdf
Panic Disorder –sudden feeling of terror for no reason, often in combination with physical symptoms
- AACAP Fact Sheet – pdf
- ADAA Fact Sheet – pdf
Cognitive behavior therapy (CBT) is a first-line treatment for a range of pediatric anxiety disorders. Finding a CBT-trained therapist can be challenging and you may find the following search engines helpful. Disclaimer that we are not recommending these people
Research strides to advance the treatment of pediatric anxiety
CAMS: Child/Adolescent Anxiety Multimodal Treatment Study
This study tested treatments for various anxiety disorders. Patients with separation anxiety, social anxiety and/or generalized anxiety disorders were given sertraline (Zoloft), cognitive behavioral therapy, a combination of both, or placebo. Both sertraline and cognitive behavior therapy were effective alone, but were even more effective in combination. Both treatments were well-tolerated. http://clinicaltrials.gov/ct2/show/NCT00052078?intr=%22Sertraline%22&rank=35POTS: Pediatric OCD Treatment Study
Funded by the National Institute of Mental Health, this study compared the efficacy of various pediatric OCD treatments – including SSRI sertraline (Zoloft), cognitive behavioral therapy (CBT), and CBT plus sertraline compared to placebo (a sugar pill) over a period of 12 weeks. The study found strong evidence suggesting that while medication is effective, pediatric OCD can be treated effectively with specialized psychotherapy (exposure and response prevention) alone. For OCD that is causing severe distress or has not responded to CBT alone, combined SSRI/CBT treatment is advised. http://pn.psychiatryonline.org/cgi/content/full/39/23/32RUPP: Research Unit on Pediatric Psychopharmacology
A federally funded, multi-site study of SSRI fluvoxamine in 128 children with social phobia, separation anxiety disorder, or generalized anxiety disorder who had failed to respond to 3 weeks of “talk therapy” showing fluvoxamine to be a safe and effective treatment for childhood anxiety. Include any info here on potential side effects?Future Directions in Treatment Research: Prevention
Early identification and intervention is an important area of investigation. Research to better understand the cause and treatments for anxiety will help to generate better diagnostic, treatment, and preventative strategies for childhood anxiety in the years that lie ahead.
