Dimensional Diagnosis of Anxiety in Youth

Abstract

The diagnosis of anxiety disorders in children and adolescents is associated with several problems including high comorbidity and low clinical utility of diagnostic categories. This chapter will begin by outlining the weaknesses of the current categorical diagnostic system and reviewing the history and evidence for taking a dimensional approach to the diagnosis of anxiety disorders in children and adolescents. The problem of the high comorbidity of anxiety and depression in youth will be discussed, followed by a review of several quantitative structural models which have been proposed to differentiate between the shared and specific components of anxiety and depression. Based on the research indicating that anxiety disorders are best classified as highly correlated symptom clusters comprising internalizing syndromes, approaches to assessment and diagnosis will be covered in the last section of this chapter. Tools that have been validated to measure anxiety and depression dimensionally in youth will be presented, as well as measurement of narrow traits that have been found to put children and adolescents at risk for the development of pathological anxiety. Finally, we will discuss the need to move toward a system of classification that corresponds more directly to effective interventions for anxiety disorders in youth.