Anxiety Disorders

Information for Professionals


Referral to a child and adolescent psychiatrist for assessment is indicated when the diagnosis is unclear, the initial treatment is not working or where a second or third line treatment is being considered.
Anxiety Disorders are some of the most common mental health disorders in children and adolescents and are readily treatable. For most anxiety disorders, the pattern of excessive fear and worry accompanied by avoidance and/or distress about a particular experience or situation (such as animals, separation from a carer or social situations) is the basis for diagnosis. In children and adolescents, the age relative to what are normal developmental fears is important, for example transient fear of separation from a carer is normal in a 14 month old but suggests difficulties in a 7 year old.

A less common but important anxiety disorder is Obsessive Compulsive Disorder (OCD) where the fears are typically of contamination or unrealistic harm to themselves or their family. For children and adolescents with OCD, patterns of behaviour to try to “ward off” the feared consequence develop, often with some degree of magical thinking (for example the idea that tapping the door seven times will prevent harm to a family member). In addition the child may check things many times or have to repeat actions until they “feel right”.

When education about the nature of anxiety and simple relaxation strategies are not sufficient, the first line treatment for anxiety disorders1 in older children and adolescents is with Cognitive Behavioural Therapy that includes parents. Addressing avoidance of feared activities that are actually safe (and parents inadvertently supporting avoidance) is crucial. One common reason for treatment to be ineffective is when a parent is very anxious and this is either not recognised or not addressed.

In younger children adaptations of this with more focus on parent involvement, addressing symptoms in parents and supporting the family to reduce avoidance are the main elements of treatment.

The home environment needs to be safe in order for treatment for an anxiety disorder to work effectively.

The best outcomes for children and adolescents can be expected with therapists with specific training and experience with the appropriate therapy (such as CBT including parents) with children and/or adolescents.

When these interventions are not sufficient then medication with some selective serotonin re-uptake inhibitors (SSRIs) is appropriate. Medications that reduce immediate anxiety (such as benzodiazepines) are to be avoided as they may reduce the benefit of psychological treatment and rapidly induce tolerance and worse symptoms on withdrawal.
1. Treatment will only be effective when the child or adolescent and their carer are safe. In the presence of ongoing abuse, neglect or domestic violence the other interventions will not be effective and so safety must be addressed first.

2. Effective treatments for anxiety involve safe exposure to the feared situation, where the child or adolescent learns from experience that they will eventually become less fearful despite the feared situation continuing (providing they are actually safe). In Flooding, the person is exposed to the feared situation (for example in a lift or a confined space) for as long as it takes for their anxiety to reduce to minimal levels, because this is a feared situation this process can be quite distressing and if the person removes themselves because of their distress they may actually have more difficulties afterwards so this is not recommended for children.