Practitioner Review: Anxiety disorders in children and young people – assessment and treatment

Abstract

Despite significant advancements in our knowledge of anxiety disorders in children and adolescents, they continue to be underrecognised and undertreated. It is critical that these disorders are taken seriously in children and young people as they are highly prevalent, have a negative impact on educational, social and health functioning, create a risk of ongoing anxiety and other mental health disorders across the life span and are associated with substantial economic burden. Yet very few children with anxiety disorders access evidence-based treatments, and there is an urgent need for widespread implementation of effective interventions. This review aimed to provide an overview of recent research developments that will be relevant to clinicians and policymakers, particularly focusing on the development and maintenance of child anxiety disorders and considerations for assessment and treatment. Given the critical need to increase access to effective support, we hope this review will contribute to driving forward a step change in treatment delivery for children and young people with anxiety disorders and their families. Key practitioner messages:Assessment of anxiety disorders should routinely involve valid and reliable interview and questionnaire measures of anxiety disorders and other common comorbid problems.Cognitive behaviour therapy is effective for treating anxiety disorders in children and young people. There is currently insufficient evidence for the effectiveness of any other psychological treatment. There is evidence that SSRIs are effective in the short-medium term, but there is a lack of longer-term evaluation.Few children who could benefit receive treatment for anxiety disorders. Brief guided interventions that can be delivered by nonspecialists are effective for some preadolescent children and provide a means to increase access to psychological interventions, potentially within a stepped care model, but less is known about their effectiveness for adolescents. Anxiety disorders in children and young people 637 Areas for future research:Experimental studies to elucidate (cognitive, behavioural, environmental) maintenance mechanisms of anxiety disorders and how they vary across childhood and adolescence and in particular contexts.Sufficiently large treatment studies to examine predictors, mediators and moderators of treatment to help optimise treatment outcomes and support improvements in personalised care.Use of technology to promote engagement, access, integrity, efficiency and effectiveness of treatments. Comparisons of different treatment approaches that are fully powered to detect meaningful clinical differences, with appropriate control conditions (e.g. including placebo where appropriate).Health economic evaluations to enable health services to increase access by offering the most efficient treatment approaches. Implementation research to maximise application and integrity of evidence-based treatments in routine clinical practice.

Practitioner review: health anxiety in children and young people in the context of the COVID-19 pandemic

“…There is evidence to support the use of CBT for childhood anxiety, ranging from low-intensity interventions (bibliotherapy and E-therapy) to high-intensity interventions (nine to 20 face-toface sessions: Creswell et al, 2014;Creswell et al, 2020;James et al, 2015). The response to CBT is dependent on the type of anxiety presentation; children and adolescents with social anxiety may experience a slower rate of change post-treatment than those suffering from generalised anxiety (Hudson et al, 2015).…”

“…This will be most effective if adapted to be developmentally appropriate. Creswell et al (2020) suggest that disorder-specific treatments may improve outcomes for young people with anxiety, but that evidence-based models need to be developed and tested in large clinical trials. In this paper we therefore provide an adaptation of the adult disorder-specific model, with developmental considerations.…”

Acceptability and Feasibility of Early Identification of Mental Health Difficulties in Primary Schools: A Qualitative Exploration of UK School Staff and Parents’ Perceptions

“…The issue of parental consent requires careful consideration. The implementation of screening for mental health issues, such as anxiety, has been reported in some studies to be acceptable to parents (Beaston, 2014;Cresswell, Waite, & Hudson, 2020;Fox et al, 2013). In general, parents rarely withdraw consent for participation in school activities such as when presented with a community based anxiety prevention programme (Beatson, 2014;Fox et al, 2013).…”

Research Review: Pediatric anxiety disorders – what have we learnt in the last 10 years?

“…Herein, we review (a) epidemiology and course, (b) risk factors, (c) neurobiology, and (d) psychopharmacologic and psychotherapeutic treatment of pediatric anxiety disorders. Assessment of anxiety disorders has recently been the subject of a Practitioner Review in this journal (see Creswell, Waite, & Hudson, 2020) and is not covered in this review.…”