A Computational Network Perspective on Pediatric Anxiety Symptoms

Abstract

Background: Psychiatric taxonomy segregates pediatric anxiety symptoms into distinct diagnostic subtypes. However, typical mixed symptom presentations pose significant challenges for diagnosis, treatment, and research. Pediatric anxiety alternatively may manifest along multiple, inter-connected domains in ways poorly captured by current classification systems. To evaluate this possibility, we utilize network analytic approaches to characterize pediatric anxiety as a network of symptom domains. Quantifying this network structure could inform our clinical conceptualization of pediatric anxiety, and, accordingly, clinical practice and research. Methods: Participants were 4,964 youths (ages 5-17 years) from seven international sites. Participants completed the Screen for Child Anxiety Related Emotional Disorders which assesses symptom severity along domains that follow pediatric anxiety DSM diagnostic categories (generalized anxiety, social anxiety, separation anxiety, and panic disorders; additionally, school avoidance). We used network analytic methods to quantify patterns of associations among these symptom domains and to relate network variation to important moderators of anxiety symptom expression (age, sex). Findings: The anxiety symptoms network was estimated with high accuracy and featured a highly inter-connected structure. Anxiety patients and healthy youth demonstrated comparable network structures. Sex differences were noted in network structure. Longitudinal data over a three-year period demonstrated specific network structure changes during childhood but not adolescence. Generalized anxiety and panic symptoms consistently emerged as central domains in the symptom network. Interpretation: Pediatric anxiety manifests along inter-connected symptom domains. The revealed pattern of domain associations, alongside moderation effects by age and sex, could inform conceptualization, treatment, and study of pediatric anxiety. Funding Statement: This research was supported (in part) by the NIMH Intramural Research Program (ZIAMH002781-15, NCT00018057), and grants R01 MH094633, R34 MH097931, UH2 MH101470; the Netherlands Organisation for Health Research and Development, ZonMW (grant number 200210010). Declaration of Interests: All authors declare no conflict of interests with regard to this manuscript. Ethics Approval Statement: At each site, the study was performed in compliance with the Code of Ethics of the World Medical Association (Declaration of Helsinki), approved by the local Institutional Review Board. Prior to participation, informed consent and assent were obtained from parents and youth, respectively.