Anxiety Disorders Have Many Facets in Youths: Distinguish from Ordinary Anxiety

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MIAMI BEACH -- It is important for clinicians to be able to recognize the signs of anxiety disorders in children and adolescents and to distinguish them from the ordinary anxieties of growing up, Dr. Eugenio M. Rothe said at a meeting on mood and anxiety disorders sponsored by the University of Miami.

Anxiety can take many forms in children and teenagers. Separation anxiety disorder tends to occur in younger children, whereas generalized anxiety disorder is more common in older children and adolescents. Other anxiety syndromes common in these populations include panic disorder, phobias, obsessive-compulsive disorder, and posttraumatic stress disorder.

Anxiety disorders are among the most prevalent child and adolescent psychopathologies, said Dr. Rothe of the university. A study of 800 children aged 7-11 years showed that almost 9% met the definition for one or more anxiety disorders. Most of the children and adolescents studied were functioning normally with their anxiety (J. Am. Acad. Child Adolesc. Psychiatry 28[6]:851-55, 1989).

Other researchers looked at impairment from anxiety. For example, a study of 150 adolescents showed that 8.7% had at least one anxiety disorder that impaired them enough to require treatment (Am. J. Psychiatry 145[8]:960-64, 1988).

A comprehensive clinical interview is the most important diagnostic tool, Dr. Rothe said. History taking should include age of onset of symptoms, medical history, school history, family psychiatric history, and a mental status examination.

A structured questionnaire aimed at assessing anxiety is recommended, and many are available, he said at the meeting, also sponsored by the Florida Psychiatric Society.

Although the physical manifestations are the same, anxiety and fear are distinct. Anxiety is an unpleasant emotion that originates in anticipation of danger. Fear, on the other hand, is a more specific reaction to a specific danger.

Behavioral inhibition is one factor that may increase risk of anxiety. "Children with behavioral inhibition are more likely to develop anxiety disorders and phobias," Dr. Rothe said. "This is particularly true for stably inhibited children." These children may also be at higher risk for school maladjustment, distress, and social dysfunction. A predisposition toward behavioral inhibition may be genetic and cause children to respond intensely to anxiety-producing situations, according to researchers (J. …