Child Psychopathology

By Eric J. Mash; Russell A. Barkley | Go to book overview

CHAPTER
SIX
Childhood Anxiety Disorders

Anne Marie Albano

Bruce F Chorpita

David H Barlow

Anxiety disorders are widely recognized as among the most common psychiatric disorders affecting children and adolescents (Anderson, Williams, McGee, & Silva, 1987; Bell-Dolan & Brazeal, 1993; Costello & Angold, 1995; Gurley, Cohen, Pine, & Brook, 1996; Kashani & Orvaschel, 1988; Orvaschel & Weissman, 1986), and yet these disorders are not well understood with regard to youths (Zahn-Waxler, KlimesDougan, & Slattery, 2000). Transient fears and anxieties are considered part of normal development; however, for some children, this developmental expectation may serve to mask the presence of an emerging or existing anxiety disorder (Muris, Merckelbach, Mayer, & Prins, 2001). High and stable levels of anxiety are associated with severe impairment in functioning, expressed in its most disabling form through a child's avoidance of such activities as school, peer involvement, and the attainment of stage-related developmental tasks (Albano & Detweiler, 2001; Bell-Dolan & Brazeal, 1993). Long-term outcomes of anxiety disorders in childhood and adolescence are still not well understood, and conflicting evidence exists suggesting a more optimistic prognosis in some studies (e.g., Last, Perrin, Hersen & Kazdin, 1996; Last, Hansen, & Franco, 1997), while others show an increased risk for additional anxiety disorders, depression, and other negative mental health outcomes over time (Berg et al., 1989; Feehan, McGee, & Williams, 1993; Ferdinand & Verhulst, 1995; Flament et al., 1990;

Keller et al., 1992; Pine, Cohen, Gurley, Brook, & Ma, 1998). The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) introduced a separate section delineating three anxiety disorders unique to childhood and adolescence: separation anxiety disorder (SAD), avoidant disorder of childhood or adolescence, and overanxious disorder (OAD). Consequently, a multitude of studies emerged documenting the incidence and prevalence of these three disorders along with the “adult” anxiety disorders in youths. Advances in child psychopathology research focused on the anxiety disorders resulted in further nosological changes to DSM's fourth edition (DSM-IV; American Psychiatric Association, 1994). Although SAD is the only remaining childhood anxiety disorder per se, several criteria for the “adult” anxiety disorders include descriptors for their application to children. However, developmental epidemiologists and clinical scientists caution that the DSM-IV categories, while guiding clinicians toward modifying certain criteria for youths, do not actually reflect a developmental psychopathology perspective (Angold & Costello, 1995; Cantwell & Baker, 1988). As noted by March and Albano (2002), a clinician is left to his or her own devices in translating these criteria for each child by taking into account demographic and developmental variables, such as age, gender, race, cultural background, socioeconomic status (SES), and cognitive level. This leaves much room

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