Evaluation and Management of Anxiety Disorders in Children and Adolescents.

Anxiety disorders are one of the most commonly diagnosed psychiatric disorders in children and adolescents, with an estimated lifetime prevalence in the United States of 20-30%. These disorders can have significant adverse effects on child development, making their diagnosis and treatment critical. Screening resources are available to aid in identification and diagnosis. Treatments include both pharmacologic and non-pharmacologic interventions. Depending on the severity of presentation, providers may consider cognitive behavioral therapy (CBT) first line. Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacologic treatment and have been shown to improve anxiety symptoms. Combination treatment with an SSRI and CBT may have improved outcomes compared to monotherapy. Serotonin and norepinephrine reuptake inhibitors (SNRIs) may also be considered for the treatment of anxiety disorders. While benzodiazepines have been used to treat anxiety disorders historically, there is insufficient evidence of efficacy to be currently recommended, especially when combined with potential adverse effects. Treating anxiety disorders can be more difficult in patients with comorbid psychiatric conditions such as attention-deficit/hyperactivity disorder (ADHD). Although the management of anxiety disorders in children and adolescents can be challenging, screening tools, pharmacologic and non-pharmacologic interventions, and emerging support resources exist to aid the provider.