Pediatric anxiety disorders: management in primary care

Abstract

Anxiety disorders are common in children and adolescents, with prevalence rates varying from 6 to 20%. These disorders can result in significant academic, social, and familial impairment. Early identification in pediatric primary care and effective management may help improve outcomes. Self-report measures of pediatric anxiety can supplement the clinical interview and assist in screening children and adolescents for separation anxiety disorder, generalized anxiety disorder, and social phobia. Substantial evidence supports the use of cognitive behavioral therapy and selective serotonin reuptake inhibitors in the treatment of pediatric anxiety disorders. Although treatment with serotonin reuptake inhibitors may lead to a small increase in the risk for suicidal ideation in children and adolescents, the risk benefit ratio for serotonin reuptake inhibitor use in pediatric anxiety disorders is favorable with appropriate monitoring. Although evidence-support treatments have emerged for pediatric anxiety disorders, their effectiveness in pediatric primary care has not been evaluated. Future research should assess the delivery of manual-based cognitive behavioral therapy for anxiety disorders by mental health professionals integrated into the primary care settings, the effectiveness of serotonin reuptake inhibitor prescription by pediatric primary care clinicians, and the use of collaborative models for providing anxiety treatments for children and adolescents in primary care settings.