Anxiety disorders often accompany ADD and/or ADHD and represent the most common form of psychopathology in children and adolescents. In community studies including adolescents, approximately 4–19% of young people were found to be suffering from anxiety disorders There is a slightly higher occurrence of anxiety disorders in adolescent girls than boys.
Anxiety disorders can significantly interfere with a young person’s ability to function in interpersonal relationships and at school yet they often go unrecognized by parents and teachers.
Anxiety disorders frequently co-occur with other mood disorders, depression, and disruptive behavior disorders. Anxiety disorders early in life place young people at heightened risk for subsequent anxiety disorders, major depressive disorder, schizophrenia, substance abuse, suicide, and psychiatric hospitalization in adolescence and young adulthood.
major presence in the treatment and prevention area, the cognitive-behavioral theoretical model and treatment approach is described in detail. The chapter concludes with a set of recommendations for best practices in the treatment and prevention of anxiety disorders in children and adolescents.
The Diagnostic and Statistical Manual of Mental Disorders IV-TR (DSM-IV-TR American Psychiatric Association, 2000) provides a comprehensive categorical system for classifying anxiety disorders. Each of these disorders has distinct features, yet they all share a common foundation of excessive, irrational fear and dread. A brief synopsis of each major anxiety disorder follows.
Children and adolescents with Separation Anxiety Disorder (SAD) experience developmentally excessive fear and distress concerning separation from home or significant attachment figures. Frequently these young people worry excessively about their parents’ health and safety, have difficulty sleeping without their parents, complain of stomachaches and headaches, and may manifest school refusal.
Generalized Anxiety Disorder (GAD) is characterized by chronic, excessive, and uncontrollable worry. Worries may relate to friends, family, health, safety, and/or the future. A diagnosis of GAD also requires that at least one somatic symptom be present, such as motor tension or sleep difficulty.
Adolescents with Social Phobia (SocP) experience excessive fear or discomfort in social or performance situations. These young people fear negative evaluations from others and worry about doing something embarrassing, stupid, or awkward in social settings such as classrooms and restaurants or during sports activities.
Specific Phobia (SP) represents an intense fear of a particular object or situation and frequently is accompanied by avoidance of the focal object or situation. To distinguish between a developmentally normal fear and a specific phobia, one must consider age, severity of symptomatology, and impairment. Compared to normal fears, phobias are excessive, persistent, or maladaptive.
Panic Disorder (PD) involves recurrent and spontaneous attacks or episodes of intense fear. These episodes are accompanied by at least four somatic symptoms such as pounding or racing heart, sweating, shaking, difficulty breathing, chest pain, or fear of dying or going crazy. For many individuals, the onset of PD occurs at some point during adolescence.
Adolescents with Agoraphobia (Ag) avoid or are extremely uncomfortable in places they fear they will be unable to get help or escape. Agoraphobia may present independently or accompany panic disorder. Common stressful situations for agoraphobics include crowds, standing in line, shopping malls, traveling (especially via public transportation), enclosed places such as elevators, open spaces such as large parks, and trips or camps away from home.
NEGATIVE LIFE EVENTS. Multiple studies have shown that children and adolescents with mental health needs experience more negative, stressful, or traumatic life events than their healthy counterparts (Boer, Markus, Maingay, Linkhout, Borst & Hoogendijk, 2002), and these events represent risk factors for anxiety disorders as well. Elevated rates of anxiety disorders have been found following natural disasters (Yule & Williams, 1990) and negative life events such as the death of a family member, divorce, or changes in school (Donovan & Spence, 2000). Several studies suggest that youth with anxiety disorders experience a higher incident of negative life events compared to non-anxious children (Benjamin, Costello, & Warren, 1990; Boer et al., 2002; Goodyer & Altham, 1991), even when compared with siblings in the same household (Boer et al., 2002).
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