The treatment of anxiety disorders in children and adolescents

Anxiety disorders are the most common psychiatric conditions in the pediatr ic population, with prevalence estimates ranging from 5-18%. Children and a dolescents with excessive anxiety often meet diagnostic criteria far a numb er of disorders within the DSM-TV. Unfortunately, the current diagnostic sy stem is controversial because of high rates of symptom overlap, comorbidity with other psychiatric disorders, and lack of biological markers that woul d support a more empirical anxiety nosology. Treatment strategies for pediatric anxiety disorders have important histori cal roots. Several controlled studies of cognitive-behavioral therapy (CBT) demonstrate efficacy for pediatric anxiety disorders. In contrast, no cont rolled psychopharmacology studies have demonstrated efficacy in children an d adolescents with anxiety disorders, except obsessive-compulsive disorder; however, several large, methodologically sound psychopharmacotherapy trial s are underway for pediatric anxiety disorders. This update will review the current status of psychosocial and psychopharma cologic treatment of pediatric anxiety disorders. In addition, a brief disc ussion. of nosology, epidemiology, and developmental course of anxiety is i ncluded. Preliminary psychopharmacology treatment and CBT treatment algorit hms are presented for pediatric anxiety disorders, based on the best availa ble data. Recommendations for future research directions are also discussed . (C) 1999 Society of Biological Psychiatry.