Pediatric generalized anxiety disorder

Epidemiology, diagnosis, and management

Courtney Pierce Keeton, Amie C. Kolos, John T. Walkup

Research output: Contribution to journalReview article

45 Citations (Scopus)

Abstract

Pediatric generalized anxiety disorder (GAD) is characterized by excessive and uncontrollable worry about a variety of events and is accompanied by physical symptoms such as headaches, tension, restlessness, gastrointestinal distress, and heart palpitations. Symptoms impose marked distress and interfere with social, emotional, and educational functioning. GAD occurs in over 10 of children and adolescents, has an average age of onset of 8.5 years, and is more often reported in girls. Common co-occurring conditions include separation anxiety disorder and social phobia.Assessment involves a multi-informant, multi-method approach involving the child, parents, and school teachers. A clinical interview should be conducted to assess for the three primary ways anxiety presents: behaviors, thoughts, and somatic symptoms. Several semi-structured diagnostic interviews are available, and the Anxiety Disorders Interview Schedule is increasingly used. Rating scales completed by the patient, caregivers, and teachers provide useful information for diagnosis and symptom monitoring. Several scales are available to assess patients for the Diagnostic and Statistical Manual of Mental Disorders (4th Edition) GAD diagnosis; however, instruments generally cannot distinguish children with GAD from children with similar anxiety disorders.Both cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) have demonstrated efficacy for the treatment of pediatric anxiety disorders including GAD. Evidence suggests that the combination of CBT plus sertraline offers additional benefit compared with either treatment alone. With pharmacotherapy, systematic tracking of treatment-emergent adverse events such as headaches, stomach aches, behavioral activation, worsening symptoms, and emerging suicidal thoughts is important. Recommended starting doses are fluvoxamine 25mgday, fluoxetine 10mgday, and sertraline 25mgday, though lower starting doses are possible. Dosing can be adjusted as often as weekly with the goal of achieving a high-quality response, while minimizing side effects. Long-term treatment with medication has not been well studied; however, to achieve optimal long-term outcome extended use of medication may be required. It is recommended to continue medication for approximately 1 year following remission in symptoms, and when discontinuing medication to choose a stress-free time of the year. If symptoms return, medication re-initiation should be considered seriously.

Original languageEnglish (US)
Pages (from-to)171-183
Number of pages13
JournalPediatric Drugs
Volume11
Issue number3
DOIs
StatePublished - Jun 2 2009

Fingerprint

Anxiety Disorders
Epidemiology
Pediatrics
Sertraline
Cognitive Therapy
Interviews
Separation Anxiety
Fluvoxamine
Tension-Type Headache
Psychomotor Agitation
Fluoxetine
Serotonin Uptake Inhibitors
Age of Onset
Diagnostic and Statistical Manual of Mental Disorders
Caregivers
Headache
Stomach
Appointments and Schedules
Therapeutics
Anxiety

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pharmacology (medical)

Cite this

Keeton, Courtney Pierce ; Kolos, Amie C. ; Walkup, John T. / Pediatric generalized anxiety disorder : Epidemiology, diagnosis, and management. In: Pediatric Drugs. 2009 ; Vol. 11, No. 3. pp. 171-183.
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Pediatric generalized anxiety disorder : Epidemiology, diagnosis, and management. / Keeton, Courtney Pierce; Kolos, Amie C.; Walkup, John T.

In: Pediatric Drugs, Vol. 11, No. 3, 02.06.2009, p. 171-183.

Research output: Contribution to journalReview article

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