Anxiety Disorders in Children: From Screening to Management
Zahra Naqvi, MD
Assistant Professor of Psychiatry
Weill Cornell Medicine-Qatar
Anxiety and worries are a normal part of human emotion; however, when they become overwhelming or impair our ability to function, we can consider the possibility and need for medical attention. This is important to identify in children and young adults, as often they are unable to advocate or identify issues themselves, and anxiety disorders may come to the attention of various people that interact on a frequent or daily basis with them, such as parents, teachers, pediatricians and other caregivers.
The United States Preventive Services Task Force (USPSTF) recommends screening all children and adolescents (age 8 to 18 years) for the presence of an anxiety disorder and this is well supported by data: early identification, and thus early intervention, leads to appropriate management and prevention of anxiety related comorbidities [1]. A widely used screening tool is the Screen for Child Anxiety-Related Emotional Disorders (SCARED) which is available below:
https://www.pediatricbipolar.pitt.edu/sites/default/files/assets/ScaredChild-Boris.pdf
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) includes diagnostic criteria that help identify anxiety disorders in childhood and adolescence, use of a structured diagnostic interview, and differential diagnosis [2]. Although the specific contents are beyond the scope of this article, in brief, they include the number and type of symptoms that are required to be exhibited (for example restlessness, irritability, difficulty concentrating, among others), the time period for presentation of the symptoms, and the level of distress or impairment in various domains of functioning of the patient.
Once a child is diagnosed, it is imperative to begin treatment, as untreated pediatric anxiety can persist into adulthood leading to comorbid disorders like depression and substance misuse [3]. When deciding how to treat the patient, there are two modalities that can be offered: therapy or pharmacological intervention. While data comparing the two modalities show mixed results, there is good evidence that offering both together is beneficial [4]. Logistically, this may not always be possible, and thus we stratify treatment based on severity of presentation and availability of treatments. This means identifying whether medications like serotonin reuptake inhibitors and/or a therapist trained in administering psychotherapy specific for anxiety disorders in children, such as cognitive behavioral therapy, are available, and assessing whether they can be tolerated by the patient for the course of treatment.
References:
- Viswanathan M, Wallace IF, Cook Middleton J, et al. Screening for Anxiety in Children and Adolescents: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 328:1445.
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. APA, 2013.
- Brady EU, Kendall PC. Comorbidity of anxiety and depression in children and adolescents. Psychol Bull 1992; 111:244.
- Ginsburg GS, Kendall PC, Sakolsky D, et al. Remission after acute treatment in children and adolescents with anxiety disorders: findings from the CAMS. J Consult Clin Psychol 2011; 79:806.
- Primary Healthcare Corporation (PHCC). Mental health Data among children. PHCC, Qatar. 2020.
- Hamad Medical Corporation. Child and adolescent mental health services, Hamad Medical Corporation, Qatar. 2020.
- Sidra Medicine. Mental health Data among children & Adolescents. Sidra Medicine, Qatar. 2020.