Evaluation and Treatment of Anxiety Disorders in the General Pediatric Population: A Clinician's Guide

Autistic adolescents who experience anxiety face unique challenges. Cognitive-behavioural therapy is an evidence-based treatment for anxiety in Autistic children, yet there is less evidence for adaptations of these CBT group interventions for adolescent populations.

This study evaluated the efficacy of the Cool Kids Autism Spectrum Disorder Anxiety program in reducing anxiety in Autistic adolescents. Forty-nine Autistic adolescents with clinically significant anxiety (ages 12–18; IQ > 70) were randomly assigned to the intervention condition or waitlist.

There were reductions in anxiety severity for the intervention group compared to waitlist, in diagnostic status, clinical severity, and parent ratings. Post-treatment, 72% of participants in the intervention group showed remission of their primary anxiety disorder diagnosis compared to 31.6% of the waitlist.

The Cool Kids ASD Anxiety Program may be effective for reducing clinical anxiety in Autistic adolescents, and future studies should replicate these findings with additional consideration of the role of parents in treatment outcomes.

All trials conducted to date on BRAVE-ONLINE for youth anxiety disorders have excluded children with High Functioning Autism Spectrum Disorder (HFASD) and therefore it is unknown whether these programs might be beneficial to HFASD children. The aim of this study was to evaluate the efficacy of BRAVE-ONLINE in HFASD children with an anxiety disorder.

Forty-two HFASD children, aged 8–12 years, with an anxiety disorder, and their parents, were randomly assigned to either the BRAVE-ONLINE condition (NET) or a waitlist control (WLC). Diagnostic interviews and parent/child questionnaires were completed at pre-treatment, post-treatment and 3-month follow-up.

At post- assessment, compared to children in the WLC condition, children in the NET condition demonstrated a significantly greater reduction in number of anxiety diagnoses, clinical severity of diagnosis, and self and parent reported anxiety symptoms, as well as significantly greater increases in overall functioning. However, loss of primary diagnosis in this sample was lower than in previous studies.

The small sample size, coupled with attrition rates, makes it difficult to generalise the findings of the study to HFASD population and to conduct analyses regarding mediators, moderators and predictors of outcomes.

The BRAVE-ONLINE program may be useful in reducing anxiety symptoms in HFASD children, although the effects are less strong than those found in neurotypical children for a variety of reasons.

Comorbidity between balance and anxiety disorders in adult population is a well-studied clinical entity. Children might be particularly prone to develop balance-anxiety comorbidity, but surprisingly they are practically neglected in this field of research. The consequence is that children are treated for what seems to be the primary disorder without noticing possible effects on the other disorder. In Study 1, children with balance dysfunction were compared to normally balanced controls on anxiety and self-esteem. In study 2, children with balance dysfunction were assigned to either balance training or a waiting-list control. Training consisted of 12 weekly sessions of balance treatment. Anxiety and self-esteem were tested before and after treatment/waiting. Study 1 confirmed significantly higher anxiety and lower self-esteem in the balance dysfunction group compared to the control group. Study 2 showed that treatment improved balance performance, reduced anxiety, and increased self-esteem relative to the control waiting list group. Taken together, the present findings are in accord with the observations of comorbidity between balance and anxiety disorders in adults and confirm their validity in children younger than 7 years of age. This profile of comorbidity between balance dysfunction and anxiety also include lower self-esteem.

A significant component of palliative care is the prompt diagnosis and management of distress, anxiety, and depression. This article reviews the symptoms and treatment of anxiety and depressive disorders in children at the end of life. Distinguishing between symptoms and disorders, the importance of open communication, consideration of the child's understanding of death, diagnostic challenges in chronically ill children, and suicidality are discussed. Because treatment options are available, it is imperative that symptoms are recognized and addressed. Understanding the issues involved in screening and diagnosis and the risks and benefits of available treatments can lead to an informed approach to the management of these disorders in the palliative care setting.