Anxiety disorders of childhood and adolescence: a critical review.

The 1980s were a decade of advancement in the knowledge of anxiety disorders in children and adolescents; this sets the stage for research achievements in the 1990s. This review examines the anxiety disorders of childhood and adolescence (separation anxiety disorder, overanxious disorder, and avoidant disorder), including prevalence rates, demographic profiles, comparisons of clinical presentations in different developmental age groups, and comorbidity patterns. Fears and simple phobias, obsessive-compulsive disorder, post-traumatic stress disorder, and panic disorder in children and adolescents are also evaluated. The controversy of whether panic attacks occur in prepubertal children is addressed. A brief review of behavioral and pharmacological treatment studies is included. Future directions for research are suggested.

[1]  D. Pelcovitz,et al.  Obsessive-compulsive symptomatology in children with Tourette's syndrome. , 1987, Journal of the American Academy of Child and Adolescent Psychiatry.

[2]  T. Insel.  Serotonin in Obsessive Compulsive Disorder , 1990 .

[3]  T. Cooper,et al.  Double-blind placebo-controlled study of nortriptyline in depressed adolescents using a "fixed plasma level" design. , 1990, Psychopharmacology bulletin.

[4]  J. McClellan,et al.  Attention deficit disorder in children at risk for anxiety and depression. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.

[5]  B. Cox,et al.  Factors associated with panic attacks in nonclinical subjects , 1986 .

[6]  C. Gatsonis,et al.  Depressive disorders in childhood. IV. A longitudinal study of comorbidity with and risk for anxiety disorders. , 1989, Archives of general psychiatry.

[7]  S. Torgersen.  Genetic factors in anxiety disorders. , 1983, Archives of general psychiatry.

[8]  C. Strauss.  Panic disorder in children and adolescents , 1989 .

[9]  Phil A. Silva,et al.  DSM-III disorders in preadolescent children. Prevalence in a large sample from the general population. , 1987, Archives of general psychiatry.

[10]  J. Rapoport,et al.  Treatment of childhood obsessive compulsive disorder with clomipramine and desmethylimipramine: a double-blind crossover comparison. , 1988, Psychopharmacology bulletin.

[11]  G. Bernstein.  Comorbidity and severity of anxiety and depressive disorders in a clinic sample. , 1991, Journal of the American Academy of Child and Adolescent Psychiatry.

[12]  C. Nakamura,et al.  A fear survey schedule for children (FSS-FC): a factor analytic comparison with manifest anxiety (CMAS). , 1968, Behaviour research and therapy.

[13]  B. Vitiello,et al.  Diagnosis of panic disorder in prepubertal children. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.

[14]  J. Rapoport,et al.  Biochemical changes during clomipramine treatment of childhood obsessive-compulsive disorder. , 1987, Archives of general psychiatry.

[15]  M. Hersen,et al.  Progress in Behavior Modification , 1983 .

[16]  D. C. Ross,et al.  Early Separation Anxiety and Adult Agoraphobia , 1988, The Journal of nervous and mental disease.

[17]  L. Terr.  Psychic trauma in children: observations following the Chowchilla school-bus kidnapping. , 1981, The American journal of psychiatry.

[18]  J. Biederman.  Clonazepam in the treatment of prepubertal children with panic-like symptoms. , 1987, The Journal of clinical psychiatry.

[19]  C. G. Last,et al.  Overanxious disorder: An examination of developmental differences , 1988, Journal of abnormal child psychology.

[20]  N. Ryan.  Pharmacotherapy of adolescent major depression: beyond TCAs. , 1990, Psychopharmacology bulletin.

[21]  Judith L. Rapoport,et al.  Obsessive-compulsive disorder in children and adolescents , 1989 .

[22]  E. McCauley,et al.  Phenomenology of depression in children and adolescents. , 1988, Journal of the American Academy of Child and Adolescent Psychiatry.

[23]  I. Marks,et al.  School phobia and agoraphobia , 1974, Psychological Medicine.

[24]  D. Klein,et al.  SCHOOL PHOBIA: DIAGNOSTIC CONSIDERATIONS IN THE LIGHT OF IMIPRAMINE EFFECTS , 1973, The Journal of nervous and mental disease.

[25]  T. Ayllon,et al.  Positive practice routines in overcoming resistance to the treatment of school phobia: a case study with follow-up. , 1987, Journal of behavior therapy and experimental psychiatry.

[26]  J. L. Ayuso,et al.  Childhood separation anxiety and panic disorder: A comparative study , 1989, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[27]  J. Kagan,et al.  Behavioral inhibition to the unfamiliar. , 1984 .

[28]  C. Adams-Tucker.  Proximate effects of sexual abuse in childhood: a report on 28 children. , 1982, The American journal of psychiatry.

[29]  T. Ayllon,et al.  Behavioral management of school phobia , 1970 .

[30]  D. Cohen,et al.  Obsessive compulsive disorder in children and adolescents: phenomenology and family history. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.

[31]  N. Alessi,et al.  Panic disorder in psychiatrically hospitalized children. , 1988, The American journal of psychiatry.

[32]  E. Foa,et al.  Post-traumatic stress disorder in sexually abused children. , 1988, Journal of the American Academy of Child and Adolescent Psychiatry.

[33]  C. Strauss.  Obsessive—compulsive disorder in childhood☆ , 1989 .

[34]  J. Kagan,et al.  Further evidence of an association between behavioral inhibition and anxiety disorders: Results from a family study of children from a non-clinical sample , 1991 .

[35]  D. Trueman.  The behavioral treatment of school phobia: A critical review , 1984 .

[36]  S Eth,et al.  Life threat and posttraumatic stress in school-age children. , 1987, Archives of general psychiatry.

[37]  G. Bernstein,et al.  Comparative studies of pharmacotherapy for school refusal. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.

[38]  C. Strauss.  Behavioral Assessment and Treatment of Overanxious Disorder in Children and Adolescents , 1988, Behavior modification.

[39]  W. Silverman,et al.  A Preliminary Analysis of a Functional Model of Assessment and Treatment for School Refusal Behavior , 1990, Behavior modification.

[40]  E. Garland,et al.  Panic disorder on a child psychiatric consultation service. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.

[41]  G. Canino,et al.  Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. The use of combined measures. , 1988, Archives of general psychiatry.

[42]  W. Eaton,et al.  The epidemiology of panic attacks and panic disorder. Results of three community surveys. , 1985, American journal of epidemiology.

[43]  J. Leckman,et al.  The inheritance of Gilles de la Tourette's syndrome and associated behaviors. Evidence for autosomal dominant transmission. , 1986, The New England journal of medicine.

[44]  D. Sheehan,et al.  Age of onset of phobic disorders: a reevaluation. , 1981, Comprehensive psychiatry.

[45]  J. H. Duffy,et al.  A clinical study of chloridazepoxide used in psychiatric disorders of children. , 1965, International journal of neuropsychiatry.

[46]  D. Beidel,et al.  Psychopathology in the offspring of anxiety disorders patients. , 1987, Journal of consulting and clinical psychology.

[47]  Phil A. Silva,et al.  DSM-III disorders in a large sample of adolescents. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.

[48]  D. Klein,et al.  Controlled Imipramine Treatment of School Phobia , 1971 .

[49]  N. Ryan,et al.  The clinical picture of major depression in children and adolescents. , 1987, Archives of general psychiatry.

[50]  O. Cameron,et al.  Ages of onset of DSM-III anxiety disorders. , 1985, Comprehensive psychiatry.

[51]  M. Gelder,et al.  Different ages of onset in varieties of phobia. , 1966, The American journal of psychiatry.

[52]  W. Agras,et al.  The natural history of phobia. Course and prognosis. , 1972, Archives of general psychiatry.

[53]  D. Price,et al.  Preliminary data on DSM-III associated features of major depressive disorder in children and adolescents. , 1985, The American journal of psychiatry.

[54]  J. Rapoport.  ANNOTATION CHILDHOOD OBSESSIVE COMPULSIVE DISORDER , 1986 .

[55]  C. Vélez,et al.  A longitudinal analysis of selected risk factors for childhood psychopathology. , 1989, Journal of the American Academy of Child and Adolescent Psychiatry.

[56]  J. Wolpe,et al.  Psychotherapy by reciprocal inhibition , 1958, Conditional reflex.

[57]  G. Bernstein,et al.  Pedigrees, functioning, and psychopathology in families of school phobic children. , 1988, The American journal of psychiatry.

[58]  K. Merikangas,et al.  Depression and anxiety disorders in parents and children. Results from the Yale family study. , 1984, Archives of general psychiatry.

[59]  R. Feiguine,et al.  Clinical effects of amitriptyline in adolescent depression. A pilot study. , 1981, Journal of the American Academy of Child Psychiatry.

[60]  M. Davies,et al.  The assessment of affective disorders in children and adolescents by semistructured interview. Test-retest reliability of the schedule for affective disorders and schizophrenia for school-age children, present episode version. , 1985, Archives of general psychiatry.

[61]  E. Brown,et al.  Post-traumatic stress disorder in young children: a reaction to purported sexual abuse. , 1988, Journal of the American Academy of Child and Adolescent Psychiatry.

[62]  M Davies,et al.  Uncommon troubles in young people: prevalence estimates of selected psychiatric disorders in a nonreferred adolescent population. , 1990, Archives of general psychiatry.

[63]  H. B. Ferguson,et al.  Alprazolam Effects in Children with Anxiety Disorders* , 1987, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[64]  H. J. Grubb,et al.  Psychiatric illness in the mothers of anxious children. , 1987, The American journal of psychiatry.

[65]  J. Oliver.  Successive Generations of Child Maltreatment: Social and Medical Disorders in the Parents , 1985, British Journal of Psychiatry.

[66]  N. Enzer,et al.  Hyperventilation syndrome in childhood. A review of 44 cases. , 1967, The Journal of pediatrics.

[67]  L. Frankel,et al.  Alprazolam in the treatment of anticipatory and acute situational anxiety in children with cancer. , 1987, Journal of the American Academy of Child and Adolescent Psychiatry.

[68]  L. Terr.  Chowchilla revisited: the effects of psychic trauma four years after a school-bus kidnapping. , 1983, The American journal of psychiatry.

[69]  R. Goetz,et al.  Imipramine in prepubertal major depressive disorders. , 1987, Archives of general psychiatry.

[70]  W. Yule,et al.  The behavioural treatment of school refusal--a comparative study. , 1984, Behaviour research and therapy.

[71]  K. Merikangas,et al.  Children of depressed parents. Increased psychopathology and early onset of major depression. , 1987, Archives of general psychiatry.

[72]  C. Barrett,et al.  Comparison of reciprocal inhibition, psychotherapy, and waiting list control for phobic children. , 1972, Journal of abnormal psychology.

[73]  T. Ollendick.  Reliability and validity of the Revised Fear Surgery Schedule for Children (FSSC-R). , 1983, Behaviour research and therapy.

[74]  Thomas P. Kobylski,et al.  Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised , 1988 .

[75]  C. G. Last,et al.  Comorbidity among Childhood Anxiety Disorders , 1987, The Journal of nervous and mental disease.

[76]  D. Barlow,et al.  Do children panic , 1988 .

[77]  David A. Sylvester,et al.  The epidemiology of common fears and phobia. , 1969, Comprehensive psychiatry.

[78]  B. Black,et al.  Panic disorder in children and adolescents. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.

[79]  Z. Solomon,et al.  Combat-related posttraumatic stress disorder among second-generation Holocaust survivors: preliminary findings. , 1988, The American journal of psychiatry.

[80]  T H Ollendick,et al.  Fears in children and adolescents: reliability and generalizability across gender, age and nationality. , 1989, Behaviour research and therapy.

[81]  F. Verhulst,et al.  Replication of empirically derived syndromes as a basis for taxonomy of child/adolescent psychopathology , 1989, Journal of abnormal child psychology.

[82]  R. Kleinknecht,et al.  Panic and panic attacks in adolescents , 1989 .

[83]  W. Silverman,et al.  The influence of gender on children's ratings of fear in self and same-aged peers. , 1988, The Journal of genetic psychology.

[84]  T. Berney,et al.  School Phobia: A Therapeutic Trial with Clomipramine and Short-Term Outcome , 1981, British Journal of Psychiatry.

[85]  J. Rapoport,et al.  Obsessive compulsive disorder in adolescence: an epidemiological study. , 1988, Journal of the American Academy of Child and Adolescent Psychiatry.

[86]  R. Gittelman.  Anxiety Disorders of Childhood , 1986 .

[87]  E. Frommer.  Treatment of childhood depression with antidepressant drugs. , 1967, British medical journal.

[88]  P. Kendall,et al.  The Anxious Child , 1988, Behavior modification.

[89]  C. Spielberger,et al.  Stress and Anxiety , 1981 .

[90]  C. Strauss,et al.  Assessing Fears in Anxiety-Disordered Children With the Revised Fear Survey Schedule for Children (FSSC-R) , 1989 .

[91]  J. Beitchman,et al.  Diagnostic continuity from preschool to middle childhood. , 1987, Journal of the American Academy of Child and Adolescent Psychiatry.

[92]  J. Ballenger,et al.  Three cases of panic disorder with agoraphobia in children. , 1989, The American journal of psychiatry.

[93]  J. C. Coolidge,et al.  The development, meaning and management of school phobia; workshop, 1956. , 1957, The American journal of orthopsychiatry.

[94]  L. Stanley.  Treatment of ritualistic behaviour in an eight-year-old girl by response prevention: a case reort. , 1980, Journal of child psychology and psychiatry, and allied disciplines.

[95]  M. Hersen,et al.  Comparison of DSM-III separation anxiety and overanxious disorders: demographic characteristics and patterns of comorbidity. , 1987, Journal of the American Academy of Child and Adolescent Psychiatry.

[96]  T. Insel,et al.  Obsessive-compulsive disorder. A double-blind trial of clomipramine and clorgyline. , 1983, Archives of general psychiatry.

[97]  M. Hersen.  Handbook of Child and Adult Psychopathology: A Longitudinal Perspective. , 1992 .

[98]  W. Garvey,et al.  Desensitization techniques in the treatment of school phobia. , 1966, The American journal of orthopsychiatry.

[99]  C. Stavrakaki,et al.  The Relationship of Anxiety and Depression: A Review of the Literature , 1986, British Journal of Psychiatry.

[100]  Leonard Krasner,et al.  Case studies in behavior modification , 1965 .

[101]  J. L. Taylor,et al.  A study of somatic complaints and psychiatric diagnosis in children. , 1988, Journal of the American Academy of Child and Adolescent Psychiatry.

[102]  N. Breslau,et al.  Traumatic events and posttraumatic stress disorder in an urban population of young adults. , 1991, Archives of general psychiatry.

[103]  The cycle of violence. , 1989, Science.

[104]  M. Hersen.  Behavior modification approach to a school-phobia case. , 1970, Journal of clinical psychology.

[105]  R. Pynoos,et al.  Post-traumatic stress disorder in children , 1985 .

[106]  I. J. Mansdorf,et al.  Cognitive-behavioral psychotherapy for separation anxious children exhibiting school phobia. , 1987, Journal of the American Academy of Child and Adolescent Psychiatry.

[107]  J. Kagan,et al.  Further evidence of an association between behavioral inhibition and anxiety disorders: results from a family study of children from a non-clinical sample. , 1991, Journal of psychiatric research.

[108]  J. Rapoport,et al.  Childhood obsessive compulsive disorder: a two-year prospective follow-up of a community sample. , 1989, Journal of the American Academy of Child and Adolescent Psychiatry.

[109]  T. Kratochwill,et al.  Treating children's fears and phobias : a behavioral approach , 1983 .

[110]  W. R. Brain.  Diseases of the Nervous System , 1892, Buffalo Medical and Surgical Journal.

[111]  D. Cantwell,et al.  Stability and natural history of DSM-III childhood diagnoses. , 1989, Journal of the American Academy of Child and Adolescent Psychiatry.

[112]  J. Kagan,et al.  Behavioral inhibition in children of parents with panic disorder and agoraphobia. A controlled study. , 1988, Archives of general psychiatry.

[113]  Ronald E. Brown.  School Phobia: Effects of Behavior Modification Treatment Applied By An Elementary School Principal. , 1974 .

[114]  C. Reynolds,et al.  What i think and feel: A revised measure of children's manifest anxiety , 1978, Journal of abnormal child psychology.

[115]  C. G. Last,et al.  Symptoms of anxiety disorders in normal children. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.

[116]  P. M. Miller.  The use of visual imagery and muscle relaxation in the counterconditioning of a phobic child: a case study. , 1972, The Journal of nervous and mental disease.

[117]  L. Eisenberg.  School phobia: a study in the communication of anxiety. , 1958, The American journal of psychiatry.

[118]  M Linnoila,et al.  Clomipramine treatment of childhood obsessive-compulsive disorder. A double-blind controlled study. , 1985, Archives of general psychiatry.

[119]  P. Zikis.  Treatment of an 11-year-old Obsessive-compulsive Ritualizer and Tiqueur Girl with in vivo Exposure and Response Prevention , 1983, Behavioural Psychotherapy.

[120]  G. Bernstein,et al.  School phobia: the overlap of affective and anxiety disorders. , 1986, Journal of the American Academy of Child Psychiatry.

[121]  T. Ollendick.  Fear Reduction Techniques with Children , 1979 .

[122]  D. Offord,et al.  The prevalence of overanxious disorder and separation anxiety disorder: results from the Ontario Child Health Study. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.

[123]  E. Costello.  Child psychiatric disorders and their correlates: a primary care pediatric sample. , 1989, Journal of the American Academy of Child and Adolescent Psychiatry.

[124]  D. Klein,et al.  Relationship between separation anxiety and panic and agoraphobic disorders. , 1984, Psychopathology.

[125]  H. M. Hoberman,et al.  Self-reported anxiety in adolescents. , 1989, The American journal of psychiatry.

[126]  L. Croghan.  Conceptualizing the critical elements in a rapid desensitization to school anxiety: a case study. , 1981, Journal of pediatric psychology.

[127]  G. D'amato.  Chlordiazepoxide in management of school phobia. , 1962, Diseases of the nervous system.

[128]  J. Rapoport,et al.  Obsessive-compulsive disorder in children and adolescents. Clinical phenomenology of 70 consecutive cases. , 1989, Archives of general psychiatry.

[129]  M. Hersen,et al.  Association between anxiety and depression in children and adolescents with anxiety disorders , 1988, Journal of abnormal child psychology.

[130]  C. Andrade,et al.  Unilateral brief-pulse ECT and bilateral sinusoidal ECT. , 1987, The Journal of clinical psychiatry.

[131]  J. Kashani,et al.  A community study of anxiety in children and adolescents. , 1990, The American journal of psychiatry.

[132]  D. Bolton,et al.  The Treatment of Obsessive-Compulsive Disorder in Adolescence , 1983, British Journal of Psychiatry.

[133]  J. Rapoport,et al.  A controlled trial of clomipramine in childhood obsessive compulsive disorder. , 1985, Psychopharmacology bulletin.

[134]  M. Weissman,et al.  Panic disorder in children at high risk for depression. , 1989, The American journal of psychiatry.

[135]  C. G. Last,et al.  Expression of separation anxiety disorder: The roles of age and gender , 1987, Child psychiatry and human development.

[136]  D. Doleys,et al.  The use of natural consequences and a make-up period to eliminate school phobic behavior: A case study ☆ , 1977 .

[137]  D. Cohen,et al.  Gilles de la Tourette's syndrome and obsessive-compulsive disorder. Evidence supporting a genetic relationship. , 1986, Archives of general psychiatry.

[138]  N. Alessi,et al.  Panic and depressive disorders among psychiatrically hospitalized adolescents , 1987, Psychiatry Research.

[139]  J L Rapoport,et al.  Computerized tomography and neuropsychological test measures in adolescents with obsessive-compulsive disorder. , 1984, The American journal of psychiatry.

[140]  E. McNamara.  The Self-Management of School Phobia: A Case Study , 1988, Behavioural and Cognitive Psychotherapy.

[141]  H. E. Rie.  DEPRESSION IN CHILDHOOD , 1966 .

[142]  T. Ollendick,et al.  Fears in children and adolescents: normative data. , 1985, Behaviour research and therapy.

[143]  J. Oliver.  Successive Generations of Child Maltreatment , 1988, British Journal of Psychiatry.

[144]  W. Silverman,et al.  Treatment of an adolescent with obsessive-compulsive disorder by alternating response prevention and cognitive therapy: an empirical analysis. , 1990, Journal of behavior therapy and experimental psychiatry.

[145]  J. Kashani,et al.  Anxiety disorders in mid-adolescence: a community sample. , 1988, The American journal of psychiatry.

[146]  D. Pauls,et al.  A family study of panic disorder. , 1983, Archives of general psychiatry.

[147]  P. Kendall,et al.  Anxiety disorders in children: A multiple-baseline evaluation of a cognitive-behavioral treatment , 1989 .

[148]  L. Grossman,et al.  Long-term outcome of obsessive-compulsive disorder in childhood. , 1980, Journal of the American Academy of Child Psychiatry.

[149]  J. Phillips,et al.  Childhood anxiety disorders in mothers and their children , 1987, Child psychiatry and human development.