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Practice Guidelines and Clinical Assessment Tools

Practice Guidelines for Pediatric Anxiety

Summary of the Practice Parameters for the Assessment and Treatment of Children and Adolescents with Anxiety Disorders
American Academy of Child and Adolescent Psychiatry

Summary of the Practice Parameters for the Assessment and Treatment of Children and Adolescents with Obsessive-compulsive Disorder
American Academy of Child and Adolescent Psychiatry

Summary of the Practice Parameters for the Assessment and Treatment of Children and Adolescents with Posttraumatic Stress Disorder
American Academy of Child and Adolescent Psychiatry

Assessment Tools for Pediatric Anxiety

Self-Report Measures

There are a number of commonly used self-report measures for assessing anxiety symptoms in children and teens. Self-report measures can be useful for making a diagnosis, and determining the severity of anxiety symptoms.

A rating scale, such as the Child Behavior Checklist, has an anxiety subscale that can be completed by parents and teachers, and may provide useful in making a diagnosis.

Clinician-Administered Assessments

Structured clinical interviews require more time on the part of the assessor and informants, but can be useful for informing diagnosis, including ruling in or out other pediatric disorders.

Clinician Administered Treatment Resources

Psychotherapy

In general, cognitive behavioral treatments (CBT) are frequently used to treat Anxiety Disorders in children and adolescents.1 CBT is designed to help anxious youth change thinking patterns that contribute to anxiety. Cognitive strategies are also used to help the child or adolescent recognize anxious thoughts, manage anxiety, and cope with anxiety-producing situations. According to Division 53 of the American Psychological Association several specific forms of short-term psychotherapy have been shown to be beneficial in the treatment certain Anxiety Disorders in children and teens:

SpecificPhobia

The following are well established treatments for specific phobias in young people:

  • Participant Modeling involves a therapist, friend, or peer demonstrating fearlessness and coping responses when confronting a feared situation or object. The "model" assists the child in practicing approaching and confronting the feared situation or object.
  • Reinforced Practice involves exposure, or practicing approaching and confronting a feared situation or object, and rewards the child when he/she does so.
  • The following therapies have proven effective in treating simple phobias in young people.
  • Cognitive behavior therapy focuses on changing unhealthy thinking that contributes to anxiety. Cognitive strategies are also used to help a child or adolescent recognize anxious thoughts, manage anxiety, and cope with anxiety-producing situations.
  • Systematic desensitization involves encouraging a child or adolescent to imagine his/her feared object or situation while he/she is engaged in a response that is incompatible with anxiety (e.g. relaxation or play), instead of physically exposing them to the feared object or situation.

Generalized Anxiety Disorder

The following therapies have been shown to be likely help in the treatment for Generalized Anxiety Disorder in young people.

  • Cognitive behavior therapy is designed to help anxious youth change unhealthy thinking that contributes to anxiety. Cognitive strategies are also used to help the child or adolescent recognize anxious thoughts, manage anxiety, and cope with anxiety-producing situations.
  • Exposure involves practicing approaching and confronting a feared situation or object. Regular exposure makes confronting a feared situation easier.
  • Family Anxiety Management (FAM) teaches parents to reward a child for confronting his/her feared situation or object, and ignore excessive complaining when confronted with his/her feared situation or object.
  • Participant Modeling involves a therapist, friend, or peer demonstrating fearlessness and coping responses when confronting a feared situation or object. The "model" assists the child in practicing confronting the feared situation or object.
  • Reinforced Practice involves exposure, or practicing approaching and confronting a feared situation or object, and rewards the child when he/she does so.
  • Relaxation training teaches young people ways to let go of physical and psychological tension.

Separation Anxiety Disorder

The following therapies are helpful in treating Separation Anxiety Disorder in young people.

  • Family Anxiety Management (FAM) teaches parents to reward a child for confronting his/her feared situation or object, and ignore excessive complaining when confronted with his/her feared situation or object. This treatment is useful in treating Separation Anxiety Disorder for children 7 to 10 years of age, however it appears less useful for children and adolescents 11 to 14 years of age.
  • Cognitive behavior therapy is designed to help anxious youth change unhealthy thinking that contributes to anxiety. Cognitive strategies are also used to help the child or adolescent recognize anxious thoughts, manage anxiety, and cope with anxiety-producing situations.
  • Exposure, which involves practicing approaching and confronting a feared situation or object.
  • Reinforced Practice involves exposure, or practicing approaching and confronting a feared situation or object, and rewards the child when he/she does so.
  • Systematic desensitization involves having the child or adolescent imagine his/her feared object or situation while he/she is engaged in a response that is incompatible with anxiety (e.g. relaxation or play), instead of physically exposing them to the feared object or situation.
  • Relaxation training teaches young people ways to let go of physical and psychological tension.

Therapy Advisor
This site offers information about empirically supported treatments for pediatric Anxiety Disorders. Providers are required to register to view online resources.

Phobic and Anxiety Disorders in Children and Adolescents : A Clinician's Guide to Effective Psychosocial and Pharmacological Interventions
T. H. Ollendick & J. S. March

Practitioner's Guide to Treating Fear and Anxiety in Children and Adolescents : A Cognitive-Behavioral Approach (Child Therapy Series)
A. R. Eisen & C. A. Kearney

Pharmacotherapy

Although medications are sometimes used to treat Anxiety Disorders in children and adolescents, data supporting their efficacy and safety with young people is limited.2 According to the Academy of Child and Adolescent Psychiatry, medication should not be used as the sole intervention, but as an adjunct to psychotherapeutic interventions. Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are most commonly used to treat pediatric Anxiety Disorder. Benzodiazepines, a class of anti-anxiety medication, may be used on a short-term basis for anxiety symptoms. Less commonly used anxiolytics include buspirone and beta-blockers.3 It is important to consider potential side-effects compared to the benefits of medications.

TRICARE Pharmacy Information

1Laurent, J., & Potter, K. I. (1998).Anxiety-related difficulties.In. T. S. Watson & F. M. Gresham (Eds.). Handbook of child behavior therapy (pp. 239-260. New York: Plenum Press.

2Christopherson, E. R., & Mortweet, S. L. (2005).Treatments that work with children. Washington, DC: American Psychological Association.

3American Academy of Child and Adolescent Psychiatry (1997). Practice parameters for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 36 (10suppl).