Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice

Abstract

The objective of this narrative review of the literature is to describe the epidemiology, etiology, pathophysiology, diagnosis, and treatment of pediatric anxiety disorders. We aim to guide clinicians in understanding the biology of anxiety disorders and to provide general guidelines for the proper diagnoses and treatment of these conditions early in life. Anxiety disorders are prevalent, associated with a number of negative life outcomes, and currently under-recognized and under-treated. The etiology involves both genes and environmental influences modifying the neural substrate in a complex interplay. Research on pathophysiology is still in its infancy, but some brain regions, such as the amygdala and the prefrontal cortex, have been implicated in fear and anxiety. Current practice is to establish diagnosis based purely on clinical features, derived from clinical interviews with the child, parents, and teachers. Treatment is effective using medication, cognitive behavioral therapy, or a combination of both. An introduction to the neuroscience behind anxiety disorders combined with an evidence-based approach may help clinicians to understand these disorders and treat them properly in childhood.

Specific and social fears in children and adolescents: separating normative fears from problem indicators and phobias

“…31,32 The fear system matures in the beginning of infant development; as a consequence, normative fears are commonly present since very early in life. 5,33,34 Our data showed that common fears occur in Rev Bras Psiquiatr. 2017;39 (2) Specific and social fears in children most children and adolescents, and it is their intensity that differentiates normative from clinically salient manifestations.…”

“…3,4 In contrast, clinically significant specific phobias and social phobias are characterized by one or more persistent fears that cause distress and impairment to the child's life. 1,5 The prevalence of specific and social phobia in children and adolescents is 2.9 and 0.3% respectively. 6 In short, the presence of fears is typically normative, and only a minority of children is significantly impaired by fears requiring clinical attention.…”

Behavioural Neurology of Personality Disorders: A Bi-dimensional Model

“…This can become one of the most overwhelming challenges to the child's basic trust during their natural development. Such anxiety usually resolves spontaneously through carers' support and more and better social awareness [237][238][239]. Unresolved physiological separation anxiety can contribute to the development of complications including pathological separation anxiety, social anxiety, and school phobia [240].…”

What can HPA axis-linked genes tell us about anxiety disorders in adolescents?

“…1 Most adults with AD report that their anxious symptoms had onset early in life, especially during childhood and adolescence. 2,3 According to epidemiological data from multiple sources, the prevalence of AD ranges from 3.1 to 17.5% in children and adolescents, 4 while the current global prevalence is 7.3%.…”