Early Recognition Aids Anxious Youths’ Transition to Adulthood

Separation anxiety, generalized anxiety disorder (GAD), and social anxiety are common and impairing for children and adolescents, but early recognition and treatment can help prevent accumulation of functional disability and adult psychiatric illness.1

“Anxiety disorders are the most common of all childhood and adolescent mental health disorders. They occur in 12% to 20% of youths. Separation anxiety, GAD, and social phobia make up the anxiety triad for youth,” Anne Marie Albano, PhD, director of the Columbia University Clinic for Anxiety and Related Disorders, in New York City, told Psychiatry Advisor.

Specific phobias that occur at about age 5 years are also common and can be an indicator of anxiety disorders to follow, she added. Examples of specific phobias include excessive fear of bugs, school, doctors, or the dark.

“We know that specific phobias often lead to separation anxiety at about age 5 or 6 years. GAD may start in middle childhood. Social phobias start in late childhood and adolescence. It is very rare to have just one type of anxiety,” Albano explained.

As a child moves into adult years, these disorders often transition into depression and substance abuse. “Absent or poor treatment results in a poor prognosis. These children may become young adults who are unable to live independent of family or state assistance,” Albano said.  

Treatment for anxiety disorders in children and adolescents consists of a combination of cognitive behavioral therapy (CBT), family therapy, education, support and medication.2,3

Response to Treatment

The Child/Adolescent Anxiety Multimodal Study (CAMS) examined predictors and moderators of anxiety disorder treatment outcomes in 488 youths aged 7 to 17 years.2

In the study, Albano and colleagues assessed 12 weeks of acute treatment and six months of maintenance treatment with CBT or SSRI monotherapy, combination treatment with CBT and SSRIs, or placebo.

“Combination treatment was the best bang for the buck with about an 80% response rate for acute and maintenance. CBT alone and SSRI alone were both effective, and better than placebo,” Albano noted.

Although participants generally responded well to treatment, severe anxiety, caregiver stress, and social phobia were associated with less favorable outcomes.3

Improving Outcomes

Primary care doctors and schools may be the key to improving outcomes. Specific phobias need to be recognized as red flags for anxiety disorder.2,3

Intense anxiety in everyday situations that interferes with daily function cannot be ignored. Caregivers should be alert for physical symptoms of anxiety, including rapid breathing, shortness of breath, and excessive sweating.3

“When anxiety disorders are diagnosed at an early age, we can often work with the parents on interventions that may delay or avoid the use of medication,” Albano said.

However, some big questions still remain. More research is needed to determine the best treatment to start with, when and how long to use medication, and what to do after taking a child off of medication.


Untreated or poorly treated anxiety disorder in youth may lead to depression, dependence, and substance abuse in adulthood. A combination of SSRI and CBT is the most effective treatment.

Early recognition by caregivers of anxiety disorder, sometimes heralded by specific phobias, should improve future outcomes. More research is needed to answer questions about optimum treatment protocols.

Chris Iliades, MD, is a full-time freelance writer based in Cape Cod, Massachusetts.

This article was medically reviewed by Pat F. Bass III, MD, MS, MPH.


  1.  Mohatt J, Bennett S, Walkup J et al. Treatment of Separation, Generalized, and Social Anxiety Disorders in Youths. American Journal of Psychiatry. 2014; doi: 10.1176/appi.ajp.2014.13101337.
  2. Compton S, Peris T, Almirall D et al. Predictors and moderators of treatment response in childhood anxiety disorders: results from the CAMS trial. Journal of Consulting and Clinical Psychology. 2014 Apr;82(2):212-24.
  3. National Alliance on Mental Illness, Anxiety Disorders in Children and Adolescents, Available at: http://www.nami.org/Content/ContentGroups/Helpline1/Anxiety_Disorders_in_Children_and_Adolescents.htm. Accessed: June 13, 2014.