Anxiety-Related Difficulties

Abstract

Our understanding of childhood anxiety has evolved significantly over the last 10 to 15 years. A defining event in this evolution was the advent of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980). Until the release of the DSM-III,much of our knowledge about childhood anxiety dealt with fears and phobias. The DSM-III, and its successors, the DSM-III-R (American Psychiatric Association, 1987) and the DSM-IV (American Psychiatric Association, 1994), have facilitated research in childhood anxiety by providing a common classification system. Changes have occurred between DSM-III-R and DSM-IV that suggest that the symptoms associated with anxiety are consistent across children, adolescents, and adults, although the specific manifestations of these symptoms may reflect developmental differences. These changes include removing Avoidant Disorder from the section of the DSM dealing with disorders first evidenced in infancy, childhood, and adolescence, and considering Avoidant Disorder as a form of Social Phobia; it is no longer an available diagnosis. The other change was allowing Overanxious Disorder, another category previously presented with disorders first evidenced in infancy, childhood, and adolescence, to be subsumed under Generalized Anxiety Disorder. The symptoms of DSM-IV anxiety disorders that have been examined with children (i.e., Generalized Anxiety Disorder/Overanxious Disorder, Separation Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, Phobias) are presented in Table 1. It is important to note that to receive a DSM-IV diagnosis of an anxiety disorder, symptoms must be present for a specified period of time (e.g., 4 weeks, 6 months), and to such a significant extent that the anxiety interferes with the child’s functioning. Children who demonstrate symptoms of anxiety, but not to the extent that would warrant a DSM-IV diagnosis, may still experience distress.