Pediatric anxiety disorders: Basic concepts for primary care

Anxiety disorders in children and adolescents commonly appear in primary care, and many clinicians will need to guide families on treatment. Our purpose in this article is to give a brief overview of assessment and treatment principles for clinicians who intend to work in primary care. Anxiety and its expression are heavily influenced by children's developmental progression and capabilities. Anxiety disorders have multiple underlying etiologies including temperament and environmental exposure to stressors and trauma. All anxiety disorders are strengthened by an operant process known as escape conditioning. The most effective treatments for child and adolescent anxiety begin with behavioral based interventions including exposure with response prevention (ERP) and cognitive behavioral therapy (CBT). Medication can be effective in combination with CBT and ERP, or as a standalone treatment when behavioral interventions are NOT available. Selective Serotonin Reuptake Inhibitors and Serotonin Norepinephrine Reuptake Inhibitors have been evaluated via randomized clinical trials for treatment of childhood anxiety, but most are not approved by the Food and Drug Administration. When anxiety is severe and functional impairment is high, referral for psychiatric consultation and multimodal treatment reduces the likelihood of poor outcomes.