Vulnerability Factors for Anxiety Disorders in Children and Adolescents

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Community studies of anxiety disorders

There are an increasing number of community studies of children and adolescents. It is difficult to draw conclusions across the aggregate data because of differences in diagnostic criteria and instruments, and variations in the source, and age and sex composition of the sample. Table 1 presents the methods of contemporary large-scale community studies of children and adolescents [4], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29]

Vulnerability factors

A summary of individual and contextual risk factors for the development of anxiety disorders is presented in Box 1. The following section summarizes the current knowledge base for each of these vulnerability factors. It is likely, however, that combinations of individual and environmental factors play a more important role in influencing children who develop anxiety disorders in adulthood.

Perinatal exposures

There is no evidence that either prenatal factors or delivery complications enhance the risk for the development of anxiety disorders. The results of three studies that retrospectively assessed perinatal events converged in linking such exposures to behavioral outcomes but not to subsequent anxiety. For example, Allen and colleagues [137] found that children who suffered from various exposures, which ranged from prenatal substance use to postnatal injuries, were more likely to develop

Summary

Anxiety disorders are the most common mental disorder in the general population of children and adolescents. In general, approximately 20% of youth suffer from one of the anxiety disorders, and half as many have impairment in functioning that results from anxiety or phobias. The most common anxiety disorder is specific phobia, followed by social phobia and overanxious disorder. Similar to the sex ratio for adults, girls tend to have more of all subtypes of anxiety disorders across all

Acknowledgments

The author appreciates the editorial assistance of Erin Knight, BA.

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References (188)

  • M. Feehan et al.

    Mental health disorders from age 15 to 18 years

    J Am Acad Child Adolesc Psychiatry

    (1993)
  • H.M. Douglass et al.

    Obsessive-compulsive disorder in a birth cohort of 18-year-olds: prevalence and predictors

    J Am Acad Child Adolesc Psychiatry

    (1995)
  • P.M. Lewinsohn et al.

    Major depressive disorder in older adolescents: prevalence, risk factors, and clinical implications

    Clin Psychol Rev

    (1998)
  • P.M. Lewinsohn et al.

    Natural course of adolescent major depressive disorder: I. Continuity into young adulthood

    J Am Acad Child Adolesc Psychiatry

    (1999)
  • K.R. Merikangas et al.

    Anxiety disorders in women

  • C.G. Last et al.

    DSM-III-R anxiety disorders in children: sociodemographic and clinical characteristics

    J Am Acad Child Adolesc Psychiatry

    (1992)
  • S.N. Compton et al.

    Social phobia and separation anxiety symptoms in community and clinical samples of children and adolescents

    J Am Acad Child Adolesc Psychiatry

    (2000)
  • C.G. Last et al.

    A prospective study of childhood anxiety disorders

    J Am Acad Child Adolesc Psychiatry

    (1996)
  • J. Biederman et al.

    A high risk study of young children of parents with panic disorders and agoraphobia with and without comorbid major depression

    Psychiatry Res

    (1991)
  • V. Warner et al.

    Offspring at high risk for depression and anxiety: mechanisms of psychiatric disorder

    J Am Acad Child Adolesc Psychiatry

    (1995)
  • D.C. Beidel et al.

    At risk for anxiety: I. Psychopathology in the offspring of anxious parents

    J Am Acad Child Adolesc Psychiatry

    (1997)
  • K.R. Merikangas et al.

    Comorbidity of substance use disorders with mood and anxiety disorders: results of the international consortium in psychiatric epidemiology

    Addict Behav

    (1998)
  • C.E. Sylvester et al.

    The diagnostic interview for children and personality inventory for children in studies of children at risk for anxiety disorders or depression

    J Am Acad Child Adolesc Psychiatry

    (1987)
  • R.C. Kessler et al.

    Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication

    Arch Gen Psychiatry

    (2005)
  • Diagnostic and statistical manual of mental disorders (DSM-III-R)

    (1987)
  • Diagnostic and statistical manual of mental disorders (DSM-IV)

    (1994)
  • A. Angold et al.

    A test-retest reliability study of child-reported psychiatric symptoms and diagnoses using the child and adolescent psychiatric assessment (CAPA-C)

    Psychol Med

    (1995)
  • P.A. Di Nardo et al.

    Anxiety Disorders Interview Schedule–Revised (ADIS-R)

    (1988)
  • J.C. Anderson et al.

    DSM-III disorders in preadolescent children: prevalence in a large sample from the general population

    Arch Gen Psychiatry

    (1987)
  • H.R. Bird et al.

    Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico: the use of combined measures

    Arch Gen Psychiatry

    (1988)
  • J. Canals et al.

    Prevalence of DSM-III-R and ICD-10 psychiatric disorders in a Spanish population of 18-year olds

    Acta Psychiatr Scand

    (1997)
  • J. Canals et al.

    A longitudinal study of depression in an urban Spanish pubertal population

    Eur Child Adolesc Psychiatry

    (1995)
  • P. Cohen et al.

    An epidemiological study of disorders in late childhood and adolescence. I. Age and gender-specific prevalence

    J Child Psychol Psychiatry

    (1993)
  • E.J. Costello et al.

    Psychopathology in pediatric primary care: the new hidden morbidity [abstract]

    Pediatrics

    (1988)
  • J. Costello et al.

    The Great Smoky Mountains study of youths: goals, design, methods, and the prevalence of DSM-III-R disorders

    Arch Gen Psychiatry

    (1996)
  • M. Feehan et al.

    DSM-III-R disorders in New Zealand 18-year-olds

    Aust N Z J Psychiatry

    (1994)
  • J. Kashani et al.

    Psychiatric disorders in a community sample of adolescents

    Am J Psychiatry

    (1987)
  • P.M. Lewinsohn et al.

    Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students

    J Abnorm Psychol

    (1993)
  • P.M. Lewinsohn et al.

    Adolescent psychopathology: II. Psychosocial risk factors for depression

    J Abnorm Psychol

    (1994)
  • D.L. Newman et al.

    Psychiatric disorder in a birth cohort of young adults: prevalence, comorbidity, clinical significance, and new case incidence from ages 11–21

    J Consult Clin Psychol

    (1996)
  • D.R. Offord et al.

    Ontario Child Health Study: summary of selected results

    Can J Psychiatry

    (1989)
  • D.S. Pine et al.

    The risk for early adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders

    Arch Gen Psychiatry

    (1998)
  • E. Simonoff et al.

    The Virginia twin study of adolescent behavioral development: influences of age, sex, and inpairment on rates of disorders

    Arch Gen Psychiatry

    (1997)
  • F.C. Verhulst et al.

    The prevalence of DSM-III-R diagnoses in a national sample of Dutch adolescents

    Arch Gen Psychiatry

    (1997)
  • A. Whitaker et al.

    Uncommon troubles in young people: prevalence estimates of selected psychiatric disorders in a nonreferred population

    Arch Gen Psychiatry

    (1990)
  • H.-U. Wittchen et al.

    Prevalence of mental disorders and psychosocial impairments in adolescents and young adults

    Psychol Med

    (1998)
  • R.A. Pollock et al.

    Anxiety sensitivity in adolescents at risk for psychopathology

    J Child Clinical Psychology

    (2002)
  • E.J. Costello et al.

    The prevalence of serious emotional disturbance: a re-analysis of community studies

    J Child Fam Stud

    (1998)
  • P.M. Lewinsohn et al.

    Gender differences in anxiety disorders and anxiety symptoms in adolescents

    J Abnorm Psychol

    (1998)
  • K.R. Merikangas et al.

    Comorbidity and social phobia: evidence from clinical, epidemiologic and genetic studies

    Eur Arch Psychiatry Clin Neurosci

    (1995)
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