COMMENTARY

Treating Pediatric Anxiety: What Works?

Michael T. Compton, MD, MPH

Disclosures

June 10, 2011

In This Article

The State of Knowledge and New Developments

"So, what is the current state of knowledge?" Dr. Walkup asked. There are many anxiety disorders that manifest in childhood, some of which (like separation anxiety disorder, generalized anxiety disorder, and social phobia) can be very difficult to tease apart. Others include specific phobia, OCD, acute stress disorder, posttraumatic stress disorder, and panic disorder. In the context of specific phobia (eg, to animals or insects), 70% have another anxiety disorder. In terms of OCD, one of the most important recent advances has been a "dismantling of the spectrum." Dr. Walkup indicated that obsessive-compulsive-spectrum disorders may vary in their treatment responsiveness. For example, pure obsessions, such as contamination obsessions, may respond to SSRIs and behavioral therapy, though others, such as hoarding compulsions, are more difficult to treat. Also part of the OCD spectrum, tic-related OCD typically has minimal distress and doesn't respond well to therapy.

Dr. Walkup discussed recent developments in terms of various anxiety disorders in childhood and adolescence. Acute stress disorder is a common condition; however, the field has had difficulty pinpointing the phenotype (eg, traumas can range from parental divorce to ongoing, chronic, and severe stress). Social phobia is very impairing at the crucial psychosocial developmental period of adolescence. Selective mutism, as strictly defined, may be relatively uncommon, but many children and adolescents show related impairments such as relying on one-word responses or speaking very softly/whispering at school, though they do not meet full criteria for selective mutism. In such cases, a comorbid anxiety disorder is common. In general, anxiety disorders in childhood and adolescence are highly prevalent, with up to 8%-10% of youth being affected.

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