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Pediatric Anxiety Disorders

Michael A. Scharf, M.D. University of Rochester

Why should you care about Anxiety?

Prevalence of common pediatric disorders ADHD 3-5% Anxiety Disorders (any) 8% Major Depression Children 2% Adolescents 5% Diabetes Mellitus, Type I 0.2% Cerebral Palsy 0.2% Epilepsy 0.3%

Is Anxiety Normal?
As a phenomenon, yes.
Preschool: fears (monsters), nightmares School age: school and the unknown Adolescence: identity, self image.

A disorder indicates a severity and

chronicity outside of normal developmental expectations.

Symptoms
Worries/fears about routine parts of life Fear of social situations Fear of separation from a loved one Fear of leaving home School refusal Physical complaints Trouble sleeping Trouble concentrating

Assessment*
Assessment of Children and Adolescents
Should Routinely Include Screening Questions About Anxiety Symptoms.
Clinical interview Screen for Child Anxiety Related Disorders

(SCARED)
* Recommendations adapted from AACAP Practice Parameter for
the Assessment and Treatment of Children and Adolescents with Anxiety Disorders. Journal of the American Academy of Child and
Adolescent Psychiatry 2007.

Assessment
Assessment Should Consider Differential
Diagnosis of Other Physical Conditions and Psychiatric Disorders.

Differential Considerations
Physical conditions that can mimic anxiety
disorders:
Migraine Asthma (disease and treatment- albuterol) Caffeine and other drugs Hyperthyroidism Lead Pregnancy Arrhythmias, delirium, CNS tumor, hypoglycemia, pheochromocytoma- all rare

Differential Considerations
Psychiatric conditions that can mimic
anxiety disorders:
ADHD PDDs/Autistic Spectrum Disorders Learning Disorders Mood Disorders (particularly Depression) Adjustment Disorder Abuse, bullying, unsafe environment Psychosis- rare

Assessment
If the Screening Indicates Significant Anxiety,
Then the Clinician Should Conduct a Formal Evaluation to Determine Which Anxiety Disorder May Be Present, the Severity of Anxiety Symptoms, and Functional Impairment.

What Anxiety Disorders are Seen in Children and Adolescence?

Separation Anxiety Disorder Specific Phobias Generalized Anxiety Disorder Social Anxiety Disorder Panic Disorder Obsessive compulsive disorder Post-Traumatic stress Disorder Anxiety Disorder not Otherwise Specified

Separation Anxiety
Feelings of discomfort on or anticipating
separation from primary caregiver. Physical symptoms and associated thoughts and behaviors.

Separation Anxiety
4% prevalence w/ onset peaks age 7-9yo. Insidious OR precipitous onset Rate decreases in adolescence Chronic or remitting course Increased risk for:
Panic Disorder Major Depressive Disorder

Specific Phobia
Belief of imminent danger from specific
stimulus with resulting avoidance of that stimulus. May have associated physiologic response. Incidence: approx. 4%.

Closing Thoughts
Anxiety Disorders are common Anxiety Disorders are highly treatable Primary Care has a critical role in the
assessment and management of Anxiety Disorders But you dont have to do it alone!