Anxiety disorders are among the most common pediatric mental health diagnoses. The prevalence of childhood anxiety has spurred a wealth of clinical research on the etiology, epidemiology and treatments for childhood anxiety. For any busy healthcare professional, it can be difficult to keep up with the evolving scientific landscape of pediatric anxiety. To help pediatricians stay up to date with the latest research in this area, I performed a literature review examining studies on childhood anxiety published from 2010 to 2020. I have identified four main points that may be particularly relevant to pediatricians.
A Highly Comorbid Problem
While pediatric anxiety is highly comorbid with other psychiatric conditions, the exact rates of comorbidities remain elusive and vary widely across studies. A 2013 study in The Journal of Anxiety Disorders estimated that as many as two-thirds of children with an anxiety disorder are assigned an additional mental health diagnosis. Not surprisingly, childhood anxiety has a high comorbidity rate with depression. However, although these diagnoses can occur simultaneously, it is often the case that anxiety and depression are sequentially comorbid with anxiety acting as a developmental precursor for depression later in adolescence. Anxiety is also highly comorbid with pediatric ADHD, with co-occurrence rates estimated as high as 40 percent. Finally, for males in particular, anxiety is often comorbid with disruptive behavioral disorders (e.g., oppositional defiant disorder).
The Key to Long-Term Change: Exposure, Exposure, Exposure
While pharmacotherapy is an effective adjunctive treatment for childhood anxiety, recent research continues to support cognitive behavioral therapy (CBT) as the most efficacious treatment. Over the past 10 years, however, anxiety researchers have attempted to “dismantle” CBT to identify the “active ingredients” in this therapy that have the strongest influence on sustained clinical improvement. Researchers have pinpointed exposure as the core element of CBT. Exposure aims to lower anxiety by systematically having the child come into contact with feared stimuli so the child can learn through experience that the feared stimuli are safe and that the feeling of anxiety is uncomfortable but tolerable. While there are many psychosocial interventions for childhood anxiety, pediatricians should consider recommending interventions that use exposure-based procedures.
Brief Interventions in Primary Care Settings
Last year, collaborating researchers from Arizona State University and Stony Brook University published a study summarizing the literature on brief, non-pharmacological, psychosocial interventions for pediatric anxiety. Examining the data, the researchers found that many cases of mild to moderate pediatric anxiety can be treated in a primary care setting employing brief psychosocial interventions such as CBT. While more severe and complex cases may require longer-term treatment, brief interventions can yield statistically significant and clinically meaningful reductions in anxiety symptoms among youth. Indeed, recent research suggests that pediatric primary care providers with training in CBT are in a position to offer brief yet effective psychosocial interventions.
The Importance of Parental Intervention
In 2013, researchers from Macquarie University in Australia found that certain parental factors (e.g., parental anxiety) significantly predicted treatment non-responsiveness in anxious youth. Helping parents of anxious children learn how to respond to their child’s anxiety is a critical yet overlooked part of any intervention. Many parents often go to extreme lengths to protect their children from anxiety. This well-meaning level of protection unfortunately has the unintended effect of perpetuating the child’s anxiety in the long run. Pediatricians are well-advised to spend time educating parents on how to remain empathetic to their child’s anxiety while simultaneously promoting their child’s ability to independently handle anxiety evoking situations.
About the Author
Sam Marzouk, Ph.D., L.P. is a pediatric psychologist and owner of Promethean Psychology in Edina, Minnesota. In addition to his routine clinical work, Dr. Marzouk also enjoys providing trainings on pediatric mental health to pediatricians and other pediatric medical providers.