Anxiety Disorders 99anxiety is increased or maintained by the parents’ own need to stay
close to their child, by the parents’ own anxieties, or by the parents’
underestimation of their child’s capacity for independence, then these
issues can be the focus for work with the parents or with the family
as a whole. Parents can be encouraged to take practical steps to make
their child feel more secure, for example, providing adequate warning and
explanation before going out and leaving a baby-sitter in charge. There is
no convincing evidence that tricyclic antidepressants or benzodiazepines
are helpful. There is limited evidence that selective serotonin reuptake
inhibitors (SSRIs) provide symptomatic relief, but no evidence that this
benefit persists when medication is discontinued.
Course
Some affected individuals experience a chronic low level of separation
anxiety that is punctuated by episodes of exacerbated anxiety, for example,
precipitated by a change of school or by illness in a parent. Over the
years, anxieties about separations may be replaced by a wider range of
anxieties more typical of generalised anxiety disorder. Follow up into adult
life suggests a particular vulnerability to panic disorder and depression.
Generalised anxiety disorder
The adult criteria for generalised anxiety disorder in DSM-IV are slightly
modified for use with children, requiring fewer somatic symptoms. Simi-
larly, although ICD-10’s criteria for generalised anxiety disorder require a
relatively large number of somatic symptoms, there is an alternative set of
criteria provided for use with children and adolescents, and these criteria
require fewer somatic symptoms.
Characteristic features
Children and adolescents with generalised anxiety disorder are marked
and persistent worriers whose anxieties are not consistently focused on
any one object or situation. Typical worries focus on the future, on
past behaviour, and on personal competence and appearance. To meet
diagnostic criteria, worries must be present on more days than not, be hard
for the individual to control, and have caused clinically significant distress
or social impairment. The worries are commonly accompanied by rest-
lessness, fatigue, irritability, poor concentration, tension, inability to relax
and sleep problems. Other common symptoms are self-consciousness,
need for frequent reassurance, and somatic complaints, such as headaches
and stomach-aches.
Epidemiology
Roughly 1–2% of young people are affected, with substantially higher
rates in adolescents than prepubertal children, and slightly higher rates
in females than males. Many children with generalised anxiety disorder
also fulfil the criteria for other DSM-IV and ICD-10 diagnoses, particularly
relating to separation anxiety, depression and specific phobias.