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Childhood anxiety is a common psychiatric disorder. It is estimated that more than 7% of adolescents 13 to 17 years of age have been diagnosed with anxiety, and more than 36% of children with behavioral problems have been diagnosed with anxiety disorders. 1 A systematic review of studies conducted in 27 countries estimates that the worldwide prevalence of anxiety disorders in children is 6.5%. 2 In the United States, nearly 1 in 12 children three to 17 years of age have anxiety. 1 The National Institute of Mental Health estimates that the prevalence of anxiety disorders in adolescents 13 to 18 years of age is 1 in 4, and the prevalence of severe anxiety is about 1 in 17. 3 Prevalence rates are approximately 20% for specific phobias, 9% for social anxiety disorder, 8% for separation anxiety disorder, and 2% each for agoraphobia, panic disorder, and generalized anxiety disorder. 3
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| CBT should be offered to patients six to 18 years of age with social anxiety disorder, generalized anxiety disorder, separation anxiety disorder, specific phobia, or panic disorder. 8,10,11,13 | A | Consistent evidence from randomized controlled trials showing improvement in symptoms, remission, and function |
| SSRIs should be offered to patients six to 18 years of age with social anxiety disorder, generalized anxiety disorder, separation anxiety disorder, specific phobia, or panic disorder. 8,10,13 | A | Consistent evidence from randomized controlled trials showing improvement in symptoms, remission, and function, with mostly minor adverse events |
| Combination treatment (i.e., CBT and an SSRI) could be offered preferentially over CBT or an SSRI alone to patients six to 18 years of age diagnosed with social anxiety disorder, generalized anxiety disorder, separation anxiety disorder, specific phobia, or panic disorder. 8,11,13 | B | Few clinical trials showing significant improvement in symptoms and function over either treatment alone |
CBT = cognitive behavior therapy; SSRI = selective serotonin reuptake inhibitor.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
Etiology and Risk Factors
Risk factors for anxiety disorders in children and adolescents include low socioeconomic status, exposure to violence, trauma, and...