Section 1: Development and neurobiology
Developmental Epidemiology of Anxiety Disorders

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Variance in Anxiety Estimates

Anxiety disorders are the most frequent class of mental disorders in childhood and adolescence. Prevalence estimates for anxiety disorders in community samples vary in part because of differences in the:

  • Studied age groups

  • Assessment instruments (eg, Composite International Diagnostic Interview, Kiddie-Schedule for Affective Disorders and Schizophrenia for school-aged children

  • Information source (eg, self-report, parent/teacher report)

  • Method of data aggregation (from multiple information sources

Onset of Anxiety Disorders

The onset for the first or any anxiety disorder is clearly in childhood.22, 37, 41, 42 There is, however, some noteworthy heterogeneity between the onset patterns of specific anxiety disorders. The bars in Fig. 2 show the cumulative age of onset distribution for specific anxiety disorders in males and females assessed in the EDSP study. Separation anxiety disorder and specific phobia reveal the earliest onsets with 50% of cases emerging before the ages of 5 and 8, respectively, and almost all

Natural Course and Outcome of Anxiety Disorders

Findings from clinical adult populations45, 46 or cross-sectional studies that rely on retrospective information23, 47 suggest that anxiety disorders take a highly persistent course. The biases inherent in such studies, however, may lead to overestimations of the degree to which anxiety disorders typically appear chronic.48 The natural course and outcome of anxiety disorders are therefore ideally assessed in prospective-longitudinal population–based studies conducted during the high-risk

Correlates and Risk Factors for Anxiety Disorders

A range of variables assessed in epidemiologic studies have been found to be associated with anxiety disorders. Cross-sectional studies merely allow us to identify correlates and to generate initial hypotheses about potential risk factors. Prospective-longitudinal studies are necessary to show that a factor precedes the outcome and can therefore be considered a risk factor.72 Despite considerable overlap among the correlates and risk factors for specific anxiety disorders and for anxiety and

Implications for Research and Clinical Practice in Anxiety Disorders

As reviewed here, anxiety disorders are frequent and early-emerging conditions associated with considerable developmental, psychosocial, and psychopathologic complications. Early anxiety syndromes may remit spontaneously, but the vast majority of children and adolescents with an anxiety disorder will be suffering from either the same condition or other mental disorders (other anxiety disorders, depressive, and/or substance use disorders) throughout their life, causing tremendous burdens and

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