Materiały źródłowe

• #1 Anxiety Disorders in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1200/anxiety-disorders-children-adolescents.html

  Anxiety disorders are the most common psychiatric conditions in children and adolescents, affecting nearly 1 in 12 children and 1 in 4 adolescents. […] Risk factors for anxiety disorders in children and adolescents include low socioeconomic status, exposure to violence, trauma, and biologic factors such as heritability and temperament. Parental anxiety predisposes children to a higher risk of functional impairment and anxiety disorders. […] The impact of the COVID-19 pandemic on child and adolescent mental health has become a growing concern. […] Symptoms include excessive anxiety, fear, or worry that is out of proportion to the situation, event, person, object, or threat. […] Physical symptoms of anxiety disorders in children and adolescents manifest as autonomic nervous system activation, including diaphoresis, palpitations, chest tightness, nausea, faintness, chills, and muscle tightness.

• #2 SciELO Brazil – Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice

  https://www.scielo.br/j/rbp/a/Szkh9fMKDKnts5dczMXGm9k/

  Anxiety disorders are prevalent, associated with a number of negative life outcomes, and currently under-recognized and under-treated. […] The etiology involves both genes and environmental influences modifying the neural substrate in a complex interplay. […] Research on pathophysiology is still in its infancy, but some brain regions, such as the amygdala and the prefrontal cortex, have been implicated in fear and anxiety. […] Mental disorders reflect individual differences in brain function. […] Those differences are a result of a complex combination of factors that ultimately represent the distal effects of risk genes and/or environmental components (etiological factors). […] These etiological risk factors act on neural circuits (neural substrates) during brain development and cause quantitative and/or qualitative abnormalities in brain functions (pathophysiological processes).

• #3 Anxiety Disorders: Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/286227-overview

  Anxiety disorders appear to be caused by an interaction of biopsychosocial factors, including genetic vulnerability, which interact with situations, stress, or trauma to produce clinically significant syndromes. (See Pathophysiology and Etiology.) […] In the central nervous system (CNS), the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involved in the hypothalamic-pituitary-adrenal (HPA) axis. […] Genetic factors significantly influence risk for many anxiety disorders. Environmental factors such as trauma, neglect, chaos, or Adverse Childhood Experiences (ACEs) can also contribute to risk for later anxiety disorders. The debate whether gene or environment is primary in anxiety disorders has evolved to a better understanding of the important role of the interaction between genes and environment.

• #4 Neurobiology of Pediatric Anxiety Disorders

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4347469/

  While the fear-based anxiety disorders (i.e., generalized anxiety disorder, social phobia and separation anxiety disorder) are among the most common psychiatric conditions in children and adolescents, only recently has an integrated understanding of the neurobiology of these disorders developed. […] In this regard, both structural and functional neuroimaging studies have demonstrated neuroanatomic and functional abnormalities within the amygdala and prefrontal cortex in youth with fear-based anxiety disorders, and have also suggested altered functional connectivity among components of the anterior limbic network (ALN), as well as alterations in neurochemistry within the anterior cingulate cortex. […] Additionally, several prefrontal structures and regions (e.g., medial prefrontal cortex) appear to be dysregulated in youth who are at risk of developing anxiety disorders (e.g., youth with inhibited temperament, behavioral inhibition, etc.).

• #5 Neurobiology of Pediatric Anxiety Disorders

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4347469/

  Finally, emerging data raise the possibility that functional activity within these amygdala-prefrontal networks may be affected by successful psychopharmacologic and psychotherapeutic treatment and may predict outcome. […] Over the last decade, accumulating evidence suggests that there are specific alterations within central fear networks in anxiety disorders in youth. […] This includes the anterior limbic network (ALN), which involves connections between the amygdala, medial prefrontal cortex (Brodmann area [BA] 10/11), rostral insula, subgenual/rostral anterior cingulate cortex (ACC, BA 25, BA 24/32), […] and dorsolateral prefrontal cortex. […] The most notable and frequently implicated structure in pediatric anxiety disorders, including GAD, is the amygdala. […] Moreover, the amygdala is comprised of multiple nuclei that are reciprocally connected to the hypothalamus, hippocampus, and neocortex structures which, as discussed below, have been implicated in the pathophysiology of anxiety disorders.

• #6 Neurobiology of Pediatric Anxiety Disorders

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4347469/

  To date, nearly all (n = 9) studies of pediatric patients with GAD have demonstrated increased activation of the amygdala, although it is important to note that these have primarily involved the presentation of fearful faces in the context of facial affect probes. […] In addition to increased amygdala activation, adolescents with GAD exhibit dysfunction within amygdala-based intrinsic functional connectivity networks, which includes connectivity between the amygdala and regions in medial prefrontal cortex, insula, and cerebellum. […] Additionally, in adolescents with GAD the activation of amygdala, ventral prefrontal cortex, and ACC are highly correlated during the viewing fearful faces as compared to healthy subjects. […] The cingulate, in particular the anterior cingulate, cortex has regularly been implicated in several of the fear-based anxiety disorders in youth, in particular, GAD.

• #7 Neurobiology of Pediatric Anxiety Disorders

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4347469/

  Additionally, a recent proton (1H) spectroscopy study of adolescents with GAD demonstrated that the severity of anxiety symptoms correlated with increased glutamatergic tone in the pregenual anterior cingulate. […] Overall, the literature suggests that abnormalities in neural structures that subserve threat appraisal, modulation of fear responses, attachment, and mentalization are present early in the course of the disorder. […] Amygdala volumes are increased in adolescents with GAD when examined with manual tracing methods, although voxel-based morphometry-based studies have observed decreased left amygdala volumes in adolescents with mixed anxiety disorders, of whom nearly 80 % met criteria for GAD. […] Moreover, we have demonstrated decreased gray matter volumes in the right precuneus and right precentral gyrus as well as decreased gray matter volumes in the left orbital gyrus and posterior cingulate in un-medicated adolescents with GAD.

• #8 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Neural-Mechanism-of-Generalized-Anxiety-Disorder.aspx

  Generalized anxiety disorder (GAD) is a psychological disorder that is described by extreme anxiety in response to normal challenges, a response that has been characterized as a result of functional deterioration in the limbic system of the brain. […] The limbic system controls and drives the basic emotions of an individual through neural networks among the amygdala, ventromedial anterior cortex, dorsolateral prefrontal cingulate cortex (DLPFC), and the hippocampus regions of the brain. These regions are associated with anxiety acquisition, expression, and its consecutive inactivity. […] Amygdala (gray matter of brain) volume was found to be higher in pediatric patients with GAD. […] The gray matter: white matter ratio in the upper temporal lobe of children with GAD is raised significantly during the negative emotional process. This factor is a major one that complements the other symptoms of GAD.

• #9 Neurobiology of Pediatric Anxiety Disorders

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4347469/

  While the fear-based anxiety disorders (i.e., generalized anxiety disorder, social phobia and separation anxiety disorder) are among the most common psychiatric conditions in children and adolescents, only recently has an integrated understanding of the neurobiology of these disorders developed. […] In this regard, both structural and functional neuroimaging studies have demonstrated neuroanatomic and functional abnormalities within the amygdala and prefrontal cortex in youth with fear-based anxiety disorders, and have also suggested altered functional connectivity among components of the anterior limbic network (ALN), as well as alterations in neurochemistry within the anterior cingulate cortex. […] Additionally, several prefrontal structures and regions (e.g., medial prefrontal cortex) appear to be dysregulated in youth who are at risk of developing anxiety disorders (e.g., youth with inhibited temperament, behavioral inhibition, etc.).

• #10 SciELO Brazil – Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice

  https://www.scielo.br/j/rbp/a/Szkh9fMKDKnts5dczMXGm9k/

  Despite a considerable advance over the last years, little is known about the neural underpinnings of anxiety disorders in children and adolescents. […] Most of the work in this area focuses on information processing functions involved in emotional processing (in particular threat processing) and cognitive control. […] This set of findings suggests that anxiety disorders involve dysfunctional processes in various emotional and cognitive processes, each of which is in turn regulated by several brain regions that may support anxiety disorder pathophysiology. […] Some of the regions include: the amygdala, several portions of the prefrontal cortex – particularly the ventrolateral and dorsomedial divisions – and dysfunctions in the basal ganglia, particularly in patients with OCD.

• #11 Neurobiology of Pediatric Anxiety Disorders

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4347469/

  Additionally, a recent proton (1H) spectroscopy study of adolescents with GAD demonstrated that the severity of anxiety symptoms correlated with increased glutamatergic tone in the pregenual anterior cingulate. […] Overall, the literature suggests that abnormalities in neural structures that subserve threat appraisal, modulation of fear responses, attachment, and mentalization are present early in the course of the disorder. […] Amygdala volumes are increased in adolescents with GAD when examined with manual tracing methods, although voxel-based morphometry-based studies have observed decreased left amygdala volumes in adolescents with mixed anxiety disorders, of whom nearly 80 % met criteria for GAD. […] Moreover, we have demonstrated decreased gray matter volumes in the right precuneus and right precentral gyrus as well as decreased gray matter volumes in the left orbital gyrus and posterior cingulate in un-medicated adolescents with GAD.

• #12 Overview of Anxiety Disorders in Children and Adolescents – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/psychiatric-disorders-in-children-and-adolescents/overview-of-anxiety-disorders-in-children-and-adolescents

  Evidence suggests that anxiety disorders involve dysfunction in the parts of the limbic system and hippocampus that regulate emotions and response to fear. In mice, loss of expression of the serotonin 1A-receptor (5-HT1AR) in the forebrain during early development results in dysregulation of the hippocampus and leads to anxiety behaviors. Heritability studies indicate a role for genetic and environmental factors. No specific genes have been identified; many genetic variants are probably involved. […] Anxiety symptoms among youth doubled during the COVID-19 pandemic, especially in girls, and mental health visits for anxiety increased 43%. These study results were controlled for gender, age, and presence of pre-COVID anxiety symptoms and showed that poor connectedness to caregiver, poor sleep hygiene, and high amounts of screen time were reported to be significant predictors of the child’s COVID-19 anxiety symptoms.

• #13 Neurobiology of Pediatric Anxiety Disorders

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4347469/

  Finally, diffusor tensor imaging and voxel-wise Tract-Based Spatial Statistics (TBSS) analysis of white matter architecture in adolescents with GAD reveals decreased fractional anisotropy (FA), a measure of white matter integrity, in the bilateral uncinate fasciculus, inferior fronto-occipital fasciculus, as well as the inferior longitudinal fasciculus, and corona radiata. […] In general, these studies have focused on anterior limbic circuitry described previously in patients with GAD and social phobia. […] These studies have shown abnormalities in the same regions seen in studies of youth with the triad of anxiety disorder discussed above. […] Overall, there is increased activation of the amygdala, abnormalities in cortical regions of the ALN, and as with SoP, some indication of striatal involvement.

• #14 Anxiety Disorders: Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/286227-overview

  Anxiety disorders appear to be caused by an interaction of biopsychosocial factors, including genetic vulnerability, which interact with situations, stress, or trauma to produce clinically significant syndromes. (See Pathophysiology and Etiology.) […] In the central nervous system (CNS), the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involved in the hypothalamic-pituitary-adrenal (HPA) axis. […] Genetic factors significantly influence risk for many anxiety disorders. Environmental factors such as trauma, neglect, chaos, or Adverse Childhood Experiences (ACEs) can also contribute to risk for later anxiety disorders. The debate whether gene or environment is primary in anxiety disorders has evolved to a better understanding of the important role of the interaction between genes and environment.

• #15 Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners – Patel – Translational Pediatrics

  https://tp.amegroups.org/article/view/16525/html

  Anxiety disorders are common in children and adolescents with reported prevalence rates between 10% and 30%. […] A combination of genetic factors, temperamental characteristics of the child, and environmental risk factors play a role in the development of anxiety disorders. […] While long term outcomes of childhood anxiety disorders have not been clearly elucidated, it is generally recognized that most tend to persist into adulthood. […] The long term impact of anxiety disorders on the psychosocial development of the child or adolescent is significant. […] SSRIs are the recommended drugs of choice for pediatric anxiety disorders and found to be effective alone or in combination with cognitive behavior therapy. […] SSRIs act by blocking the reuptake of serotonin into pre-synaptic neurons and enhance serotonergic neurotransmission.

• #16 Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners – Patel – Translational Pediatrics

  https://tp.amegroups.org/article/view/16525/html

  Selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in children and adolescents; whereas, the safety and efficacy of other drugs in the treatment of anxiety disorders in children and adolescents is not fully established. […] SSRIs are the drugs of choice for the treatment for treatment of anxiety disorders in children and adolescents. […] Data are insufficient to recommend any other class of anti-anxiety drugs in children for long term treatment. […] Most children and adolescents respond well to treatment with long lasting resolution of symptoms. Recurrence of the same, or development of a different type of anxiety disorder, is not uncommon and in most individuals, anxiety disorders tend to persist into adulthood requiring long-term treatment planning.

• #17 Pediatric Generalized Anxiety Disorder – Conditions and Treatments | Children’s National Hospital

  https://www.childrensnational.org/get-care/health-library/generalized-anxiety-disorder

  Generalized anxiety disorder is caused by both biological and environmental factors. […] Experts believe generalized anxiety disorder is caused by both biological and environmental factors. A child may inherit a tendency to be anxious. An imbalance of two chemicals in the brain (norepinephrine and serotonin) most likely plays a part. […] A child can also learn anxiety and fear from family members and others. For example, a child with a parent who is afraid of thunderstorms may learn to fear thunderstorms. A traumatic event may also cause general anxiety. This can include things such as the death of a parent, a divorce, or a serious family accident or illness.

• #18 Separation Anxiety Disorder in Children

  https://www.nationwidechildrens.org/conditions/health-library/separation-anxiety-disorder-in-children

  Separation anxiety disorder (SAD) is a type of mental health problem. Experts believe SAD is caused by both biological and environmental factors. A child may inherit a tendency to be anxious. An imbalance of 2 chemicals in the brain (norepinephrine and serotonin) most likely plays a part. […] A child can also learn anxiety and fear from family members and others. A traumatic event may also cause SAD. […] The cause of SAD is both biological and environmental. […] A mental health evaluation is needed to diagnose SAD. […] Treatment includes therapy and medicines.

• #19 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Neural-Mechanism-of-Generalized-Anxiety-Disorder.aspx

  In several studies, the dysregulation of GABA (gamma amino butyric acid), a inhibitory neurotransmitter, especially the GABAA variant, has long been found to elevate the amygdala activity in the brain, thereby causing GAD. […] Studies have hypothesized that the nervous dysregulation affecting the synergy of the VLPFC-amygdala connections might cause anxiety. […] An increased level of amygdala activation indirectly causes the secretion of stress hormones which directly interacts with the hippocampus. […] Researchers have discovered that continuous exposure of an individual to stress hormones adversely affects the development of nerve cells in the hippocampus region of the brain. This aspect may be responsible for the memory dysfunction in GAD patients. […] The major autonomic dysfunction in GAD patients is the inability to alter the heart rate as a result of reduction in heart rate variance (HRV). […] A very few studies also depict that increased secretion of CRF or glucocorticoids results in GAD symptoms when they come in contact with the HPA axis.

• #20 Separation Anxiety in Children and Adolescents | IntechOpen

  https://www.intechopen.com/chapters/19373

  Evidence suggests a genetic link between separation anxiety disorders in children and a history of panic disorder, anxiety, or depression in their parents. Infants with anxious temperaments may have a predisposition toward later development of anxiety disorders. […] The liability threshold for SAD is higher for males and increases with age (Tari et al., 1997). Genetic factors seem to play an important role in shaping the co-occurrence of different anxiety dimensions in childhood (Ogliari et al., 2010). […] Parenting stress, parental psychopathology, and family functioning are associated with child anxiety (Victor et al., 2007). Separation anxiety would appear to be a core form of anxiety that is associated with anxious attachment. […] Anxiety states are considered to be a result of insufficient inhibitory control. In these disorders, a major role is played by the gamma-amino-butyric acid (GABA) system. […] Etiopathogenesis of anxiety disorders is multifactorial with a significant role played by neurotransmitters pathways.

• #21 Anxiety Disorders: Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/286227-overview

  Panic disorder appears to be a genetically inherited (heritability of 40%) neurochemical dysfunction that may involve autonomic imbalance; decreased GABA-ergic tone; allelic polymorphism of the catechol-O-methyltransferase (COMT) gene; increased adenosine receptor function; increased cortisol; diminished benzodiazepine receptor function; and disturbances in serotonin, norepinephrine, dopamine, cholecystokinin, and interleukin-1-beta. […] Social anxiety disorder can be initiated by traumatic social experience (eg, embarrassment) or by social skills deficits that produce recurring negative experiences. A hypersensitivity to rejection, perhaps related to serotonergic or dopaminergic dysfunction, is present. Current thought is that social anxiety disorder appears to be an interaction between biological and genetic factors and environmental events. […] Agoraphobia may be the result of repeated, unexpected panic attacks, which, in turn, may be linked to cognitive distortions, conditioned responses, and/or abnormalities in noradrenergic, serotonergic, or GABA-related neurotransmission.

• #22 Risk Factors of Anxiety Disorders in Children | IntechOpen

  https://www.intechopen.com/chapters/48919

  Anxiety disorders are common; lifetime prevalence for the group of disorders is estimated to be as high as 25%. […] The anxiety disorders are not, from a genetic perspective, etiologically homogeneous. […] Familial aggregation that largely results from genetic risk factors has been documented for all of the major anxiety disorders. […] Trauma in childhood disposes to further anxiety disorders through the hyperactivity of the HPA axis and the hypersecretion of CRF. […] Traumatic experience in developmental age leads to neurobiochemical changes in brain, typical for panic disorder or PTSD. […] Behavioral inhibition in early childhood is a predictor of further anxiety disorders. […] Some types of parental behaviors and family environment can lead to them, as well as improper interactions between parents and child.

• #23 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Neural-Mechanism-of-Generalized-Anxiety-Disorder.aspx

  In several studies, the dysregulation of GABA (gamma amino butyric acid), a inhibitory neurotransmitter, especially the GABAA variant, has long been found to elevate the amygdala activity in the brain, thereby causing GAD. […] Studies have hypothesized that the nervous dysregulation affecting the synergy of the VLPFC-amygdala connections might cause anxiety. […] An increased level of amygdala activation indirectly causes the secretion of stress hormones which directly interacts with the hippocampus. […] Researchers have discovered that continuous exposure of an individual to stress hormones adversely affects the development of nerve cells in the hippocampus region of the brain. This aspect may be responsible for the memory dysfunction in GAD patients. […] The major autonomic dysfunction in GAD patients is the inability to alter the heart rate as a result of reduction in heart rate variance (HRV). […] A very few studies also depict that increased secretion of CRF or glucocorticoids results in GAD symptoms when they come in contact with the HPA axis.

• #24 Anxiety Disorders: Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/286227-overview

  Anxiety disorders appear to be caused by an interaction of biopsychosocial factors, including genetic vulnerability, which interact with situations, stress, or trauma to produce clinically significant syndromes. (See Pathophysiology and Etiology.) […] In the central nervous system (CNS), the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involved in the hypothalamic-pituitary-adrenal (HPA) axis. […] Genetic factors significantly influence risk for many anxiety disorders. Environmental factors such as trauma, neglect, chaos, or Adverse Childhood Experiences (ACEs) can also contribute to risk for later anxiety disorders. The debate whether gene or environment is primary in anxiety disorders has evolved to a better understanding of the important role of the interaction between genes and environment.

• #25 Anxiety disorders in children – NHS

  https://www.nhs.uk/mental-health/children-and-young-adults/advice-for-parents/anxiety-disorders-in-children/

  Having a close family member with anxiety may increase your child’s chance of having it too. […] Children can also pick up anxious behaviour from being around anxious people. […] Some children develop anxiety after stressful events, such as: frequently moving house or school, parents fighting or arguing, the death of a close relative or friend, becoming seriously ill or getting injured in an accident, school-related issues like exams or bullying, being abused or neglected. […] Children with attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorders are more likely to have problems with anxiety.

• #26 Anxiety disorders in children and adolescents: aetiology, diagnosis and treatment | BJPsych Advances | Cambridge Core

  https://www.cambridge.org/core/journals/bjpsych-advances/article/anxiety-disorders-in-children-and-adolescents-aetiology-diagnosis-and-treatment/4B01CB20878DE968860331F7D31B83AE

  The presentation of anxiety disorders in children and adolescents shares similarities and differences with that in adults, and may vary significantly, depending on the age of the individual. […] Aetiology of anxiety disorders in this group encompasses complex genetic and environmental influences. […] Comprehend the complex aetiological influences (e.g. genetics, family environment, brain development) on the pathogenesis of these disorders. […] Despite their symptomatic variation, anxiety disorders may share some common aetiological or pathophysiological characteristics. […] Research suggests a relationship between preexisting personality traits and later anxiety disorders. […] Family studies indicate an association between parental anxiety and depression and anxiety disorders in offspring.

• #27 Anxiety disorders in children and adolescents: aetiology, diagnosis and treatment | BJPsych Advances | Cambridge Core

  https://www.cambridge.org/core/journals/bjpsych-advances/article/anxiety-disorders-in-children-and-adolescents-aetiology-diagnosis-and-treatment/4B01CB20878DE968860331F7D31B83AE

  Twin studies therefore indicate that genetic factors endow a broad susceptibility to anxiety in general as opposed to a specific disorder. […] Parentchild interactions and the family environment have been linked to heightened behavioural inhibition and/or anxiety in children. […] Prenatal stress may also lead to neuroanatomical changes in offspring, such as reduced hippocampal and grey matter volume. […] Traumatic events predispose not only to PTSD, but also to various anxiety disorders, particularly specific phobia and social phobia. […] Recurrent dyspnoea, particularly in asthma, is a risk factor for paediatric anxiety disorders such as panic and separation anxiety.

• #28 Risk Factors of Anxiety Disorders in Children | IntechOpen

  https://www.intechopen.com/chapters/48919

  There is an etiological relation between stressful life events (unique to the individual or common to other members of the family) and anxiety disorders. […] Childhood sexual abuse is a strong risk factor of anxiety disorders. […] Bullying behavior is a frequent risk factor of anxiety disorder among adolescents. […] Most children with anxiety disorders are from middle- to upper-middle class families; however, 50-75% of those with separation anxiety disorder come from low socioeconomic status homes. […] Genetic factors play a significant role in etiology of anxiety disorders; for example, inherited risk factor for social phobia is estimated as 47%. […] Increased risk for anxiety disorder in children occurs if at least one parent has anxiety disorder. […] Anxiety disorders (in total) are two times more frequent in MZ than in DZ co-twins. […] A significant familial aggregation according to panic disorder, GAD, and phobias was shown in meta-analysis based on family and twin studies. […] It is shown that polymorphism in the serotonin transporter gene regulatory region is associated with anxiety-related traits.

• #29 Anxiety Disorders: Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/286227-overview

  Panic disorder appears to be a genetically inherited (heritability of 40%) neurochemical dysfunction that may involve autonomic imbalance; decreased GABA-ergic tone; allelic polymorphism of the catechol-O-methyltransferase (COMT) gene; increased adenosine receptor function; increased cortisol; diminished benzodiazepine receptor function; and disturbances in serotonin, norepinephrine, dopamine, cholecystokinin, and interleukin-1-beta. […] Social anxiety disorder can be initiated by traumatic social experience (eg, embarrassment) or by social skills deficits that produce recurring negative experiences. A hypersensitivity to rejection, perhaps related to serotonergic or dopaminergic dysfunction, is present. Current thought is that social anxiety disorder appears to be an interaction between biological and genetic factors and environmental events. […] Agoraphobia may be the result of repeated, unexpected panic attacks, which, in turn, may be linked to cognitive distortions, conditioned responses, and/or abnormalities in noradrenergic, serotonergic, or GABA-related neurotransmission.

• #30 Risk Factors of Anxiety Disorders in Children | IntechOpen

  https://www.intechopen.com/chapters/48919

  There is an etiological relation between stressful life events (unique to the individual or common to other members of the family) and anxiety disorders. […] Childhood sexual abuse is a strong risk factor of anxiety disorders. […] Bullying behavior is a frequent risk factor of anxiety disorder among adolescents. […] Most children with anxiety disorders are from middle- to upper-middle class families; however, 50-75% of those with separation anxiety disorder come from low socioeconomic status homes. […] Genetic factors play a significant role in etiology of anxiety disorders; for example, inherited risk factor for social phobia is estimated as 47%. […] Increased risk for anxiety disorder in children occurs if at least one parent has anxiety disorder. […] Anxiety disorders (in total) are two times more frequent in MZ than in DZ co-twins. […] A significant familial aggregation according to panic disorder, GAD, and phobias was shown in meta-analysis based on family and twin studies. […] It is shown that polymorphism in the serotonin transporter gene regulatory region is associated with anxiety-related traits.

• #31 Overview of Anxiety Disorders in Children and Adolescents – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/psychiatric-disorders-in-children-and-adolescents/overview-of-anxiety-disorders-in-children-and-adolescents

  Evidence suggests that anxiety disorders involve dysfunction in the parts of the limbic system and hippocampus that regulate emotions and response to fear. In mice, loss of expression of the serotonin 1A-receptor (5-HT1AR) in the forebrain during early development results in dysregulation of the hippocampus and leads to anxiety behaviors. Heritability studies indicate a role for genetic and environmental factors. No specific genes have been identified; many genetic variants are probably involved. […] Anxiety symptoms among youth doubled during the COVID-19 pandemic, especially in girls, and mental health visits for anxiety increased 43%. These study results were controlled for gender, age, and presence of pre-COVID anxiety symptoms and showed that poor connectedness to caregiver, poor sleep hygiene, and high amounts of screen time were reported to be significant predictors of the child’s COVID-19 anxiety symptoms.

• #32 What are anxiety disorders in kids? – Children’s Health

  https://www.childrens.com/specialties-services/conditions/anxiety

  Its normal for children and teenagers to worry about things like getting hurt, thunderstorms or getting good grades. Anxiety is different. Kids with anxiety have excessive, unmanageable worry that makes it hard to concentrate on necessary tasks or fun activities. […] Children and teens with anxiety can feel overwhelmed and helpless. If a child doesnt get treatment, anxiety can impact schoolwork and friendships, affect sleep and even lead to substance abuse. […] Genetics – If one or both parents suffer from anxiety, its more likely their child will have it too. […] Environment – Children who are exposed to stressful events are more likely to experience anxiety. These events can include things like being exposed to bullying, trauma or abuse, or witnessing a traumatic event. Also, having a parent who is unusually anxious about things like going to school or getting hurt can increase the risk of anxiety. […] Temperament – Children who tend to be sensitive or quiet may be more likely to experience anxiety.

• #33

  https://www.aacap.org/aacap/medical_students_and_residents/mentorship_matters/developmentor/Advances_in_Child_and_Adolescent_Anxiety_Disorder_Research.aspx

  Advances in Child and Adolescent Anxiety Disorder Research. The last few years have brought exciting breakthroughs in the area of anxiety disorders in youth. Anxiety disorders in children and adolescents has been recognized as one of the most common areas of pediatric psychopathology. These advances are of great importance because anxiety disorders in children are associated with negative outcomes including peer relationship difficulties, academic failure, and later onset of comorbid disorders including major depression and alcohol abuse. […] A number of factors have been identified as contributing to the etiology of anxiety disorders in children. These factors include genetics/temperament, mother-child attachment pattern, presence of parental psychopathology, and parenting style. Behavioral inhibition in young children, characterized as persistent, fearful, avoidant behavior in response to new situations and novel stimuli, increases the likelihood of later developing anxiety disorders, especially social phobia in adolescence. Insecure mother-child attachment pattern has been linked to subsequent onset of anxiety. In addition, offspring of parents with anxiety disorders and of parents who exhibit a controlling, overprotective parenting style are more likely to manifest anxiety disorders themselves. Future research that investigates the interplay of these etiological factors will serve to identify which children are at risk for anxiety.

• #34 Risk Factors of Anxiety Disorders in Children | IntechOpen

  https://www.intechopen.com/chapters/48919

  Anxiety disorders are common; lifetime prevalence for the group of disorders is estimated to be as high as 25%. […] The anxiety disorders are not, from a genetic perspective, etiologically homogeneous. […] Familial aggregation that largely results from genetic risk factors has been documented for all of the major anxiety disorders. […] Trauma in childhood disposes to further anxiety disorders through the hyperactivity of the HPA axis and the hypersecretion of CRF. […] Traumatic experience in developmental age leads to neurobiochemical changes in brain, typical for panic disorder or PTSD. […] Behavioral inhibition in early childhood is a predictor of further anxiety disorders. […] Some types of parental behaviors and family environment can lead to them, as well as improper interactions between parents and child.

• #35 Generalized Anxiety Disorder (GAD) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/generalized-anxiety-disorder-gad

  Temperament factors: A child whose temperament is timid or shy or who avoids anything dangerous may be more prone to generalized anxiety disorder than others are. […] Environmental factors: A traumatic experience (such as a divorce, illness, or death in the family, or major events outside of the family) may also trigger the onset of an anxiety disorder. […] Children with generalized anxiety disorder experience excessive and uncontrollable worry about a number of events or activities. […] Symptoms of generalized anxiety disorder can vary. […] Evidence-based treatments for GAD in children and adolescents includes cognitive behavioral therapy, medication, or a combination of medication and therapy. […] If left untreated, studies show that GAD is often a chronic illness with symptoms that tend to wax and wane across the lifespan.

• #36 What are anxiety disorders in kids? – Children’s Health

  https://www.childrens.com/specialties-services/conditions/anxiety

  Its normal for children and teenagers to worry about things like getting hurt, thunderstorms or getting good grades. Anxiety is different. Kids with anxiety have excessive, unmanageable worry that makes it hard to concentrate on necessary tasks or fun activities. […] Children and teens with anxiety can feel overwhelmed and helpless. If a child doesnt get treatment, anxiety can impact schoolwork and friendships, affect sleep and even lead to substance abuse. […] Genetics – If one or both parents suffer from anxiety, its more likely their child will have it too. […] Environment – Children who are exposed to stressful events are more likely to experience anxiety. These events can include things like being exposed to bullying, trauma or abuse, or witnessing a traumatic event. Also, having a parent who is unusually anxious about things like going to school or getting hurt can increase the risk of anxiety. […] Temperament – Children who tend to be sensitive or quiet may be more likely to experience anxiety.

• #37 Anxiety Disorders: Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/286227-overview

  Panic disorder appears to be a genetically inherited (heritability of 40%) neurochemical dysfunction that may involve autonomic imbalance; decreased GABA-ergic tone; allelic polymorphism of the catechol-O-methyltransferase (COMT) gene; increased adenosine receptor function; increased cortisol; diminished benzodiazepine receptor function; and disturbances in serotonin, norepinephrine, dopamine, cholecystokinin, and interleukin-1-beta. […] Social anxiety disorder can be initiated by traumatic social experience (eg, embarrassment) or by social skills deficits that produce recurring negative experiences. A hypersensitivity to rejection, perhaps related to serotonergic or dopaminergic dysfunction, is present. Current thought is that social anxiety disorder appears to be an interaction between biological and genetic factors and environmental events. […] Agoraphobia may be the result of repeated, unexpected panic attacks, which, in turn, may be linked to cognitive distortions, conditioned responses, and/or abnormalities in noradrenergic, serotonergic, or GABA-related neurotransmission.

• #38 Anxiety Disorders (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/anxiety-disorders.html

  Anxiety disorders cause extreme fear and worry, and changes in a child’s behavior, sleep, eating, or mood. […] Several things play a role in causing the overactive „fight or flight” that happens with anxiety disorders. They include: Genetics. A child who has a family member with an anxiety disorder is more likely to have one too. Kids may inherit genes that make them prone to anxiety. […] Brain chemistry. Genes help direct the way brain chemicals (called neurotransmitters) work. If specific brain chemicals are in short supply, or not working well, it can cause anxiety. […] Life situations. Things that happen in a child’s life can be stressful and difficult to cope with. Loss, serious illness, death of a loved one, violence, or abuse can lead some kids to become anxious. […] Learned behaviors. Growing up in a family where others are fearful or anxious also can „teach” a child to be afraid too.

• #39 Risk Factors of Anxiety Disorders in Children | IntechOpen

  https://www.intechopen.com/chapters/48919

  Infants who were anxiously attached in infancy develop more anxiety disorders during childhood and adolescence than infants who were securely attached. […] Anxiety disorders are common among offspring of anxious and depressed parents. […] Environmental mechanisms (e.g., maternal anxious attachment perceptions, maladaptive parenting practices, parental modeling of anxiety, and avoidance) may account for the observed association between parent and child anxiety. […] The experience of a traumatic event may influence the development of anxiety disorders. […] Trauma in childhood disposes to further anxiety disorders through the hyperactivity of the HPA axis and the hypersecretion of CRF. […] Neurobiological evidence supports the hypothesis of dysfunction in hippocampus, amygdala, medial prefrontal cortex, and other limbic structures believed to mediate anxiety and mood dysregulation following early abuse.

• #40

  https://www.aacap.org/aacap/medical_students_and_residents/mentorship_matters/developmentor/Advances_in_Child_and_Adolescent_Anxiety_Disorder_Research.aspx

  Advances in Child and Adolescent Anxiety Disorder Research. The last few years have brought exciting breakthroughs in the area of anxiety disorders in youth. Anxiety disorders in children and adolescents has been recognized as one of the most common areas of pediatric psychopathology. These advances are of great importance because anxiety disorders in children are associated with negative outcomes including peer relationship difficulties, academic failure, and later onset of comorbid disorders including major depression and alcohol abuse. […] A number of factors have been identified as contributing to the etiology of anxiety disorders in children. These factors include genetics/temperament, mother-child attachment pattern, presence of parental psychopathology, and parenting style. Behavioral inhibition in young children, characterized as persistent, fearful, avoidant behavior in response to new situations and novel stimuli, increases the likelihood of later developing anxiety disorders, especially social phobia in adolescence. Insecure mother-child attachment pattern has been linked to subsequent onset of anxiety. In addition, offspring of parents with anxiety disorders and of parents who exhibit a controlling, overprotective parenting style are more likely to manifest anxiety disorders themselves. Future research that investigates the interplay of these etiological factors will serve to identify which children are at risk for anxiety.

• #41 Risk Factors of Anxiety Disorders in Children | IntechOpen

  https://www.intechopen.com/chapters/48919

  Infants who were anxiously attached in infancy develop more anxiety disorders during childhood and adolescence than infants who were securely attached. […] Anxiety disorders are common among offspring of anxious and depressed parents. […] Environmental mechanisms (e.g., maternal anxious attachment perceptions, maladaptive parenting practices, parental modeling of anxiety, and avoidance) may account for the observed association between parent and child anxiety. […] The experience of a traumatic event may influence the development of anxiety disorders. […] Trauma in childhood disposes to further anxiety disorders through the hyperactivity of the HPA axis and the hypersecretion of CRF. […] Neurobiological evidence supports the hypothesis of dysfunction in hippocampus, amygdala, medial prefrontal cortex, and other limbic structures believed to mediate anxiety and mood dysregulation following early abuse.

• #42 Anxiety in children and youth: Part 1 – Diagnosis | Canadian Paediatric Society

  https://cps.ca/en/documents/position/anxiety-in-children-and-youth-diagnosis

  Anxiety disorders are the most common mental health concerns affecting Canadian children and adolescents. […] The etiology of anxiety disorders is multifactorial and includes biological factors (e.g., temperament, genetics, and epigenetics), combined often with psychological and social exposures (e.g., adverse childhood experiences (ACEs)). […] Parental anxiety disorder is a specific risk factor for child anxiety. […] Anxiety disorders are often comorbid with OCD (in 26% to 75% of cases) or tic disorders (in 30% of cases). […] A key diagnostic criterion for anxiety disorders is that the symptoms experienced fall well beyond normal fears and inhibitions expected for a child or youths developmental age and stage, causing clinically significant distress or impairment in social or school life, and possibly in other important areas of functioning.

• #43 Risk Factors of Anxiety Disorders in Children | IntechOpen

  https://www.intechopen.com/chapters/48919

  Infants who were anxiously attached in infancy develop more anxiety disorders during childhood and adolescence than infants who were securely attached. […] Anxiety disorders are common among offspring of anxious and depressed parents. […] Environmental mechanisms (e.g., maternal anxious attachment perceptions, maladaptive parenting practices, parental modeling of anxiety, and avoidance) may account for the observed association between parent and child anxiety. […] The experience of a traumatic event may influence the development of anxiety disorders. […] Trauma in childhood disposes to further anxiety disorders through the hyperactivity of the HPA axis and the hypersecretion of CRF. […] Neurobiological evidence supports the hypothesis of dysfunction in hippocampus, amygdala, medial prefrontal cortex, and other limbic structures believed to mediate anxiety and mood dysregulation following early abuse.

• #44

  https://www.aacap.org/aacap/medical_students_and_residents/mentorship_matters/developmentor/Advances_in_Child_and_Adolescent_Anxiety_Disorder_Research.aspx

  Advances in Child and Adolescent Anxiety Disorder Research. The last few years have brought exciting breakthroughs in the area of anxiety disorders in youth. Anxiety disorders in children and adolescents has been recognized as one of the most common areas of pediatric psychopathology. These advances are of great importance because anxiety disorders in children are associated with negative outcomes including peer relationship difficulties, academic failure, and later onset of comorbid disorders including major depression and alcohol abuse. […] A number of factors have been identified as contributing to the etiology of anxiety disorders in children. These factors include genetics/temperament, mother-child attachment pattern, presence of parental psychopathology, and parenting style. Behavioral inhibition in young children, characterized as persistent, fearful, avoidant behavior in response to new situations and novel stimuli, increases the likelihood of later developing anxiety disorders, especially social phobia in adolescence. Insecure mother-child attachment pattern has been linked to subsequent onset of anxiety. In addition, offspring of parents with anxiety disorders and of parents who exhibit a controlling, overprotective parenting style are more likely to manifest anxiety disorders themselves. Future research that investigates the interplay of these etiological factors will serve to identify which children are at risk for anxiety.

• #45 Anxiety disorders in children – NHS

  https://www.nhs.uk/mental-health/children-and-young-adults/advice-for-parents/anxiety-disorders-in-children/

  Having a close family member with anxiety may increase your child’s chance of having it too. […] Children can also pick up anxious behaviour from being around anxious people. […] Some children develop anxiety after stressful events, such as: frequently moving house or school, parents fighting or arguing, the death of a close relative or friend, becoming seriously ill or getting injured in an accident, school-related issues like exams or bullying, being abused or neglected. […] Children with attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorders are more likely to have problems with anxiety.

• #46 Generalized Anxiety Disorder (GAD) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/generalized-anxiety-disorder-gad

  Temperament factors: A child whose temperament is timid or shy or who avoids anything dangerous may be more prone to generalized anxiety disorder than others are. […] Environmental factors: A traumatic experience (such as a divorce, illness, or death in the family, or major events outside of the family) may also trigger the onset of an anxiety disorder. […] Children with generalized anxiety disorder experience excessive and uncontrollable worry about a number of events or activities. […] Symptoms of generalized anxiety disorder can vary. […] Evidence-based treatments for GAD in children and adolescents includes cognitive behavioral therapy, medication, or a combination of medication and therapy. […] If left untreated, studies show that GAD is often a chronic illness with symptoms that tend to wax and wane across the lifespan.

• #47

  https://link.springer.com/article/10.1007/s00787-017-1038-3

  Exposure to stressors is associated with an increased risk for child anxiety. […] The aim of this study was to compare the frequency of parent-dependent negative life events and chronic adversities experienced by children with an anxiety disorder in the 12 months prior to the onset of the child’s most recent episode, compared to healthy controls. […] Findings suggest that parents contribute to an increased frequency of chronic adversities but not negative life events prior to their child’s most recent onset of anxiety. […] Furthermore, increased child exposure to parent-dependent chronic adversities was related to parental history of mental disorder. […] Stressful life events have been identified as an important risk factor for childhood anxiety disorders. […] However, contemporary theory also predicts that exposure to any form of stressors may contribute to the development and maintenance of anxiety due to increased child perceptions of threat and uncontrollability over adverse circumstances.

• #48

  https://link.springer.com/article/10.1007/s00787-017-1038-3

  Theories of parenting stress highlight the reciprocal nature of this relationship: parenting stress is associated with parental psychopathology and parents with mental health issues tend to experience more intense reactions to stressful events. […] The present study aims to examine the number of parent-dependent life events and chronic adversities experienced by anxious children prior to the onset of their most recent clinical episode in comparison to matched controls over an equivalent time period. […] It was predicted that compared to matched controls, anxious children would experience significantly more parent-dependent chronic adversities. […] The findings suggest that parental history of mental disorder dramatically increases children’s risk of exposure to parent-dependent chronic adversities.

• #49 Overview of Anxiety Disorders in Children and Adolescents – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/psychiatric-disorders-in-children-and-adolescents/overview-of-anxiety-disorders-in-children-and-adolescents

  Evidence suggests that anxiety disorders involve dysfunction in the parts of the limbic system and hippocampus that regulate emotions and response to fear. In mice, loss of expression of the serotonin 1A-receptor (5-HT1AR) in the forebrain during early development results in dysregulation of the hippocampus and leads to anxiety behaviors. Heritability studies indicate a role for genetic and environmental factors. No specific genes have been identified; many genetic variants are probably involved. […] Anxiety symptoms among youth doubled during the COVID-19 pandemic, especially in girls, and mental health visits for anxiety increased 43%. These study results were controlled for gender, age, and presence of pre-COVID anxiety symptoms and showed that poor connectedness to caregiver, poor sleep hygiene, and high amounts of screen time were reported to be significant predictors of the child’s COVID-19 anxiety symptoms.

• #50 From Childhood to Adulthood: The Impacts of Trauma on Anxiety Disorders | OxJournal

  https://www.oxjournal.org/from-childhood-to-adulthood-the-impacts-of-trauma-on-anxiety-disorders/

  Childhood traumas appear to be a risk factor in the development of anxiety disorders, both in childhood and adulthood. Exposure to trauma as a child can have an influence on brain development, and traumas in childhood can lead to attachment difficulties that are expressed as anxiety disorders. […] The longitudinal effects of childhood traumas include increased risk of developing anxiety disorders, physical changes in brain functions, and many other medical conditions. […] Evidence suggests that consistent exposure to stress and intense emotions during childhood substantially impacts a range of physiological systems. […] When persistently under stress, the central nervous system, which regulates emotions, can be subject to neurological deficits, which result in increased vulnerability and possibly the development of anxiety and depression, as well as other mood disorders later in life.

• #51 Anxiety disorders in children and adolescents: aetiology, diagnosis and treatment | BJPsych Advances | Cambridge Core

  https://www.cambridge.org/core/journals/bjpsych-advances/article/anxiety-disorders-in-children-and-adolescents-aetiology-diagnosis-and-treatment/4B01CB20878DE968860331F7D31B83AE

  Twin studies therefore indicate that genetic factors endow a broad susceptibility to anxiety in general as opposed to a specific disorder. […] Parentchild interactions and the family environment have been linked to heightened behavioural inhibition and/or anxiety in children. […] Prenatal stress may also lead to neuroanatomical changes in offspring, such as reduced hippocampal and grey matter volume. […] Traumatic events predispose not only to PTSD, but also to various anxiety disorders, particularly specific phobia and social phobia. […] Recurrent dyspnoea, particularly in asthma, is a risk factor for paediatric anxiety disorders such as panic and separation anxiety.

• #52 From Childhood to Adulthood: The Impacts of Trauma on Anxiety Disorders | OxJournal

  https://www.oxjournal.org/from-childhood-to-adulthood-the-impacts-of-trauma-on-anxiety-disorders/

  Childhood traumas appear to be a risk factor in the development of anxiety disorders, both in childhood and adulthood. Exposure to trauma as a child can have an influence on brain development, and traumas in childhood can lead to attachment difficulties that are expressed as anxiety disorders. […] The longitudinal effects of childhood traumas include increased risk of developing anxiety disorders, physical changes in brain functions, and many other medical conditions. […] Evidence suggests that consistent exposure to stress and intense emotions during childhood substantially impacts a range of physiological systems. […] When persistently under stress, the central nervous system, which regulates emotions, can be subject to neurological deficits, which result in increased vulnerability and possibly the development of anxiety and depression, as well as other mood disorders later in life.

• #53 From Childhood to Adulthood: The Impacts of Trauma on Anxiety Disorders | OxJournal

  https://www.oxjournal.org/from-childhood-to-adulthood-the-impacts-of-trauma-on-anxiety-disorders/

  Childhood trauma can cause changes in brain function and structure, leading to anxiety disorders and panic attacks in adulthood. […] These changes in brain structure alter brain activity in modified areas. […] Childhood trauma can impact the mind, brain, and body, which leads to higher vulnerability to disorders later in life; the trauma physically damages the brain by provoking toxic stress and pressure on the brain. […] The development of anxiety disorders is believed to be the product of a complex interplay between various factors involving genetics and the environment, with early attachment experiences serving as the primary mediator. […] Anxious attachment and using hyperactivating strategies lead to various anxiety disorders. […] Separation anxiety disorder (SAD), one of the most common childhood anxiety disorders, is defined as a negative emotion, worry, or a feeling like loneliness that a child experiences when separated from their caregiver or attached figure.

• #54 When Childhood Trauma Leads to Anxiety | Psych Central

  https://psychcentral.com/anxiety/the-connection-between-childhood-trauma-and-generalized-anxiety-disorder

  Childhood trauma can create an environment that is chaotic, unstable, or unpredictable. The impact of this instability can be profound and lifelong. […] Research from 2010 found that children who grew up in environments with a lot of conflict and adversity showed higher stress reactivity in early adulthood, which may put them at greater risk for developing mood and anxiety disorders. […] Certain types of childhood trauma may even change the structure and function of the brain. […] A 2019 study found that young adults who experienced childhood abuse and neglect showed greater activation in the amygdala the brain’s emotional center to threat. One year later, this greater activation partly explained the presence of anxiety and depression symptoms. […] If you think your anxiety may be rooted in childhood trauma, you can try treatments that specifically help you address the traumatic events. […] Both anxiety and trauma are treatable.

• #55 ERIC – EJ813530 – The Pathogenesis of Childhood Anxiety Disorders: Considerations from a Developmental Psychopathology Perspective, International Journal of Behavioral Development, 2006

  https://eric.ed.gov/?id=EJ813530

  The Pathogenesis of Childhood Anxiety Disorders: Considerations from a Developmental Psychopathology Perspective Muris, Peter International Journal of Behavioral Development, v30 n1 p5-11 2006 Anxiety disorders are among the most prevalent psychiatric problems in children and adolescents. The present article summarizes the main evidence that has accumulated on the pathogenesis of childhood anxiety disorders during the past two decades. Various risk and vulnerability factors (e.g., genetics, behavioral inhibition, disgust sensitivity, negative life events, family influences), protective factors (e.g., effortful control, perceived control), and maintaining factors (e.g., avoidance, cognitive biases) will be discussed. The information will be described in terms of a developmental psychopathology perspective, which assumes that (a) most forms of psychopathology are the result of multiple causal influences; (b) both successful and unsuccessful adaptation are important for understanding the origins of psychopathology; and (c) psychopathology occurs in a developing organism. […] Descriptors: Emotional Disturbances, Inhibition, Psychopathology, Pathology, Children, Genetics, Anxiety, Behavior Disorders, Risk, Child Development, Developmental Stages, Attribution Theory

• #56 Psychophysiological mechanisms underlying the failure to speak: a comparison between children with selective mutism and social anxiety disorder on autonomic arousal | Child and Adolescent Psychiatry and Mental Health | Full Text

  https://capmh.biomedcentral.com/articles/10.1186/s13034-021-00430-1

  Selective mutism (SM) has been conceptualized as an extreme variant of social anxiety disorder (SAD), in which the failure to speak functions as an avoidance mechanism leading to a reduction of intense fear arousal. […] However, psychophysiological studies in children with SM are scarce and physiological mechanisms underlying the failure to speak are largely unknown. […] The increased tonic arousal generalized to non-social situations in SM could indicate a long-term alteration of the autonomic nervous system. […] Furthermore, the differential physiological stress response may indicate that silence acts as a maladaptive compensatory mechanism reducing stress in verbal social situations, which does not function in nonverbal situations. […] Our findings support the idea that the failure to speak might function as an avoidance mechanism, which is already active in anticipation of a verbal situation.

• #57 Novel mechanism-based treatments for pediatric anxiety and depressive disorders | Neuropsychopharmacology

  https://www.nature.com/articles/s41386-023-01709-x

  Pediatric anxiety and depressive disorders are common, can be highly impairing, and can persist despite the best available treatments. […] The current review focuses on new treatments that target underlying cognitive, emotional, interpersonal, and neural circuit mechanisms disrupted in pediatric psychiatric disorders. […] Thus, new mechanism-based treatments are clearly needed. […] The current review highlights three novel treatments lying along this continuum: cognitive training, which involves low risk but has a modest effect size, such that stand-alone treatment may be most applicable for problems with no more than moderate impact; psychotherapy, which includes a higher level of clinical involvement and has a medium-to-large effect size, justifiable for problems with at least moderate impact; and brain stimulation, which may have the highest potential risks and unclear efficacy, thus only appropriate for problems with high impact.

• #58 Novel mechanism-based treatments for pediatric anxiety and depressive disorders | Neuropsychopharmacology

  https://www.nature.com/articles/s41386-023-01709-x

  Cognitive training aims to reduce symptoms by targeting cognitive and neural mechanisms underlying mental illnesses. […] In the domain of cognitive training, attention bias modification for the treatment of anxiety disorders represents one of the best studied therapies among children. […] This work provided support for the hypothesis that attention bias to threat contributes to the onset or maintenance of anxiety disorders. […] Attention to threat increases activity in many brain regions among children with anxiety disorders. […] Explicating the neural circuitry associated with altered attention in pediatric anxiety disorders is an important goal. […] The study of novel treatments might be justified for adolescents who fail to respond to the two available first-line treatments. […] Given these longitudinal data, treatments for adolescents can be discovered by adapting treatments efficacious in adults.

• #59 Psychophysiological mechanisms underlying the failure to speak: a comparison between children with selective mutism and social anxiety disorder on autonomic arousal | Child and Adolescent Psychiatry and Mental Health | Full Text

  https://capmh.biomedcentral.com/articles/10.1186/s13034-021-00430-1

  Given that inflexibility of the fear response, rather than high reactivity, is indicative of pathological anxiety, and that children with SM experience an extreme fear in verbal social situations compared with SAD, SM might be associated with an even stronger inflexibility of the fear response. […] The assumption that failure to speak occurs due to more intense fear and associated overarousal in children with SM compared to children with SAD implies that children with SM have higher autonomic reactivity during an expectation to speak. […] However, the few existing studies on autonomic activity in SM do not support the notion of a higher reactivity in SM compared to SAD as a mechanisms of failure to speak. […] The combination of high tonic arousal and blunted response is also known as restrictive autonomic flexibility, which can transdiagnostically be found in anxious individuals and has been interpreted as chronic dysregulation of the autonomic nervous system.

• #60 Generalized Anxiety Disorder (GAD) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/generalized-anxiety-disorder-gad

  Generalized anxiety disorder (GAD) is characterized by excessive and uncontrollable worry about a variety of events. […] The difference between normal feelings of anxiety and the presence of generalized anxiety disorder is that children with GAD worry more often and more intensely than other children in the same circumstances. […] GAD may result in significant academic, social, and familial impairment. If left untreated, the disorder may be chronic and predicative of adulthood anxiety and depression. […] As with many other mental health conditions, the exact cause of generalized anxiety disorder is unknown but may be linked to: […] Genetic factors: GAD may run in families. […] Biological factors: The brain has special chemicals, called neurotransmitters, that send messages back and forth to control the way a person feels.

• #61 Neurobiology of Pediatric Anxiety Disorders

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4347469/

  To date, nearly all (n = 9) studies of pediatric patients with GAD have demonstrated increased activation of the amygdala, although it is important to note that these have primarily involved the presentation of fearful faces in the context of facial affect probes. […] In addition to increased amygdala activation, adolescents with GAD exhibit dysfunction within amygdala-based intrinsic functional connectivity networks, which includes connectivity between the amygdala and regions in medial prefrontal cortex, insula, and cerebellum. […] Additionally, in adolescents with GAD the activation of amygdala, ventral prefrontal cortex, and ACC are highly correlated during the viewing fearful faces as compared to healthy subjects. […] The cingulate, in particular the anterior cingulate, cortex has regularly been implicated in several of the fear-based anxiety disorders in youth, in particular, GAD.

• #62 Generalized Anxiety Disorder (GAD) in Children and Teens | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/g/generalized-anxiety-disorder-gad-in-children.html

  Generalized anxiety disorder (GAD) is a mental health problem. A child with GAD has a lot of worry and fear that seems to have no real cause. […] Experts believe GAD is caused by both biological and environmental factors. A child may inherit a tendency to be anxious. An imbalance of two chemicals in the brain (norepinephrine and serotonin) most likely plays a part. […] A child can also learn anxiety and fear from family members and others. For example, a child with a parent who is afraid of thunderstorms may learn to fear thunderstorms. A traumatic event may also cause GAD. This can include things such as the death of a parent, a divorce, or a serious family accident or illness. […] GAD is caused by both biological and environmental factors. […] Untreated, chronic anxiety can lead to other serious problems such as depression, substance abuse, and self-harm.

• #63 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Neural-Mechanism-of-Generalized-Anxiety-Disorder.aspx

  Generalized anxiety disorder (GAD) is a psychological disorder that is described by extreme anxiety in response to normal challenges, a response that has been characterized as a result of functional deterioration in the limbic system of the brain. […] The limbic system controls and drives the basic emotions of an individual through neural networks among the amygdala, ventromedial anterior cortex, dorsolateral prefrontal cingulate cortex (DLPFC), and the hippocampus regions of the brain. These regions are associated with anxiety acquisition, expression, and its consecutive inactivity. […] Amygdala (gray matter of brain) volume was found to be higher in pediatric patients with GAD. […] The gray matter: white matter ratio in the upper temporal lobe of children with GAD is raised significantly during the negative emotional process. This factor is a major one that complements the other symptoms of GAD.

• #64 Separation Anxiety in Children and Adolescents | IntechOpen

  https://www.intechopen.com/chapters/19373

  Anxiety disorders are among the most common psychological disorders in younger patients, affecting 6% to 20% of developed countries children and adolescents (Walkup et al. 2008). Separation anxiety is the only anxiety disorder restricted to infancy, childhood, or adolescence (APA, 2000). Separation anxiety disorder (SAD) is defined by developmentally inappropriate, excessive, persistent, and unrealistic worry about separation from attachment figures, most commonly parents or other family members. […] In the aetiology of SAD play a part a complex interplay of biological and genetic vulnerabilities, temperamental qualities, negative environmental influences and negative attachment experiences, parental psychopathology and disadvantageous socio-cultural factors (Pine Grun, 1999). Biological risk factors include genetics and child temperament.

• #65 Separation Anxiety Disorder in Children

  https://www.nationwidechildrens.org/conditions/health-library/separation-anxiety-disorder-in-children

  Separation anxiety disorder (SAD) is a type of mental health problem. Experts believe SAD is caused by both biological and environmental factors. A child may inherit a tendency to be anxious. An imbalance of 2 chemicals in the brain (norepinephrine and serotonin) most likely plays a part. […] A child can also learn anxiety and fear from family members and others. A traumatic event may also cause SAD. […] The cause of SAD is both biological and environmental. […] A mental health evaluation is needed to diagnose SAD. […] Treatment includes therapy and medicines.

• #66 Separation Anxiety Disorder in Children – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=separation-anxiety-disorder-in-children-90-P02582

  Separation anxiety disorder (SAD) is a type of mental health problem. A child with SAD worries a lot about being apart from family members or other close people. […] Experts believe SAD is caused by both biological and environmental factors. A child may inherit a tendency to be anxious. An imbalance of 2 chemicals in the brain (norepinephrine and serotonin) most likely plays a part. […] The cause of SAD is both biological and environmental. […] Symptoms of SAD are more severe than the normal separation anxiety that nearly every child has to some degree between the ages of 18 months and 3 years of age. […] A mental health evaluation is needed to diagnose SAD. […] Treatment includes therapy and medicines.

• #67 From Childhood to Adulthood: The Impacts of Trauma on Anxiety Disorders | OxJournal

  https://www.oxjournal.org/from-childhood-to-adulthood-the-impacts-of-trauma-on-anxiety-disorders/

  Childhood trauma can cause changes in brain function and structure, leading to anxiety disorders and panic attacks in adulthood. […] These changes in brain structure alter brain activity in modified areas. […] Childhood trauma can impact the mind, brain, and body, which leads to higher vulnerability to disorders later in life; the trauma physically damages the brain by provoking toxic stress and pressure on the brain. […] The development of anxiety disorders is believed to be the product of a complex interplay between various factors involving genetics and the environment, with early attachment experiences serving as the primary mediator. […] Anxious attachment and using hyperactivating strategies lead to various anxiety disorders. […] Separation anxiety disorder (SAD), one of the most common childhood anxiety disorders, is defined as a negative emotion, worry, or a feeling like loneliness that a child experiences when separated from their caregiver or attached figure.

• #68 Separation Anxiety in Children and Adolescents | IntechOpen

  https://www.intechopen.com/chapters/19373

  Evidence suggests a genetic link between separation anxiety disorders in children and a history of panic disorder, anxiety, or depression in their parents. Infants with anxious temperaments may have a predisposition toward later development of anxiety disorders. […] The liability threshold for SAD is higher for males and increases with age (Tari et al., 1997). Genetic factors seem to play an important role in shaping the co-occurrence of different anxiety dimensions in childhood (Ogliari et al., 2010). […] Parenting stress, parental psychopathology, and family functioning are associated with child anxiety (Victor et al., 2007). Separation anxiety would appear to be a core form of anxiety that is associated with anxious attachment. […] Anxiety states are considered to be a result of insufficient inhibitory control. In these disorders, a major role is played by the gamma-amino-butyric acid (GABA) system. […] Etiopathogenesis of anxiety disorders is multifactorial with a significant role played by neurotransmitters pathways.

• #69 Anxiety Disorders: Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/286227-overview

  Panic disorder appears to be a genetically inherited (heritability of 40%) neurochemical dysfunction that may involve autonomic imbalance; decreased GABA-ergic tone; allelic polymorphism of the catechol-O-methyltransferase (COMT) gene; increased adenosine receptor function; increased cortisol; diminished benzodiazepine receptor function; and disturbances in serotonin, norepinephrine, dopamine, cholecystokinin, and interleukin-1-beta. […] Social anxiety disorder can be initiated by traumatic social experience (eg, embarrassment) or by social skills deficits that produce recurring negative experiences. A hypersensitivity to rejection, perhaps related to serotonergic or dopaminergic dysfunction, is present. Current thought is that social anxiety disorder appears to be an interaction between biological and genetic factors and environmental events. […] Agoraphobia may be the result of repeated, unexpected panic attacks, which, in turn, may be linked to cognitive distortions, conditioned responses, and/or abnormalities in noradrenergic, serotonergic, or GABA-related neurotransmission.

• #70 Psychophysiological mechanisms underlying the failure to speak: a comparison between children with selective mutism and social anxiety disorder on autonomic arousal | Child and Adolescent Psychiatry and Mental Health | Full Text

  https://capmh.biomedcentral.com/articles/10.1186/s13034-021-00430-1

  Selective mutism (SM) has been conceptualized as an extreme variant of social anxiety disorder (SAD), in which the failure to speak functions as an avoidance mechanism leading to a reduction of intense fear arousal. […] However, psychophysiological studies in children with SM are scarce and physiological mechanisms underlying the failure to speak are largely unknown. […] The increased tonic arousal generalized to non-social situations in SM could indicate a long-term alteration of the autonomic nervous system. […] Furthermore, the differential physiological stress response may indicate that silence acts as a maladaptive compensatory mechanism reducing stress in verbal social situations, which does not function in nonverbal situations. […] Our findings support the idea that the failure to speak might function as an avoidance mechanism, which is already active in anticipation of a verbal situation.

• #71 Psychophysiological mechanisms underlying the failure to speak: a comparison between children with selective mutism and social anxiety disorder on autonomic arousal | Child and Adolescent Psychiatry and Mental Health | Full Text

  https://capmh.biomedcentral.com/articles/10.1186/s13034-021-00430-1

  The finding that children with SM may show increased tonic arousal even in familiar surroundings in the absence of social threat might highlight the importance of defocused communication and anxiety reduction during therapy even in supposedly non-anxious situations. […] The indication that children with SM show restricted autonomic flexibility, especially in non-verbal social situations, could be an indicator for a generalized pathological fear response beyond verbal situations.

• #72 Psychophysiological mechanisms underlying the failure to speak: a comparison between children with selective mutism and social anxiety disorder on autonomic arousal | Child and Adolescent Psychiatry and Mental Health | Full Text

  https://capmh.biomedcentral.com/articles/10.1186/s13034-021-00430-1

  Selective mutism (SM) has been conceptualized as an extreme variant of social anxiety disorder (SAD), in which the failure to speak functions as an avoidance mechanism leading to a reduction of intense fear arousal. […] However, psychophysiological studies in children with SM are scarce and physiological mechanisms underlying the failure to speak are largely unknown. […] The increased tonic arousal generalized to non-social situations in SM could indicate a long-term alteration of the autonomic nervous system. […] Furthermore, the differential physiological stress response may indicate that silence acts as a maladaptive compensatory mechanism reducing stress in verbal social situations, which does not function in nonverbal situations. […] Our findings support the idea that the failure to speak might function as an avoidance mechanism, which is already active in anticipation of a verbal situation.

• #73 Neurobiology of Pediatric Anxiety Disorders

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4347469/

  Finally, emerging data raise the possibility that functional activity within these amygdala-prefrontal networks may be affected by successful psychopharmacologic and psychotherapeutic treatment and may predict outcome. […] Over the last decade, accumulating evidence suggests that there are specific alterations within central fear networks in anxiety disorders in youth. […] This includes the anterior limbic network (ALN), which involves connections between the amygdala, medial prefrontal cortex (Brodmann area [BA] 10/11), rostral insula, subgenual/rostral anterior cingulate cortex (ACC, BA 25, BA 24/32), […] and dorsolateral prefrontal cortex. […] The most notable and frequently implicated structure in pediatric anxiety disorders, including GAD, is the amygdala. […] Moreover, the amygdala is comprised of multiple nuclei that are reciprocally connected to the hypothalamus, hippocampus, and neocortex structures which, as discussed below, have been implicated in the pathophysiology of anxiety disorders.

• #74 Anxiety Disorders in Childhood and Adolescence

  https://www.tavahealth.com/blogs/anxiety-disorders-childhood-adolescence

  The third system that anxiety can manifest in is the behavioral system. This symptom manifestation presents as physical behaviors such as lip biting, nail or cuticle biting, tense body language, or other behaviors out of the ordinary for your child. […] Generalized Anxiety Disorder, GAD, is the occurrence of excessive worry about many things during many/most days. Children and adolescents with GAD tend to be overly sensitive and perceptive, noticing frightening or worrisome things around them that others may brush off. […] Cognitive Behavioral Therapy (CBT) is one treatment option for children and adolescents. CBT helps clients manage persistent and problematic anxiety by identifying the components that keep the anxiety going. Managing anxiety involves re-evaluating the threat, approaching, and testing feared and avoided situations, and using mindfulness skills to calm our mind and body. These strategies are often tailored according to the anxiety someone is experiencing. […] Being able to identify the behavior chain of anxiety I can work with the client to interrupt the behavior chain that has maintained the overwhelming feelings of anxiety and help the client to become more effective in their lives.

• #75 Anxiety in children and youth: Part 2 – The management of anxiety disorders | Canadian Paediatric Society

  https://cps.ca/en/documents/position/anxiety-in-children-and-youth-management

  Cognitive behaviour therapy (CBT) is the most common evidence-based treatment modality for anxiety disorders. […] Studies have evaluated the use of CBT for a variety of childhood anxiety diagnoses, including generalized anxiety disorder, social anxiety disorder, specific phobias, panic disorder, separation anxiety disorder, and selective mutism. […] While psychotherapy is first-line treatment for anxiety disorders in children and adolescents with mild to moderate anxiety symptoms, medication can be also considered for children with acute or moderate symptoms and partial response to psychotherapy. […] A number of medications are used to treat anxiety, with the most effective being selective serotonin reuptake inhibitors (SSRIs). […] Evidence-based guidelines endorsed by the American Academy of Child and Adolescent Psychiatry recommend SSRIs as the medication of choice for treating anxiety disorders in children and adolescents aged 6 to 18 years old. […] Combination therapy using SSRIs in conjunction with CBT should be considered at treatment onset for children and adolescents with moderate to severe anxiety disorders because this two-pronged approach has been shown to improve global functioning, response to treatment, and achievement of remission.

• #76 Anxiety in children and youth: Part 2 – The management of anxiety disorders | Canadian Paediatric Society

  https://cps.ca/en/documents/position/anxiety-in-children-and-youth-management

  Cognitive behaviour therapy (CBT) is the most common evidence-based treatment modality for anxiety disorders. […] Studies have evaluated the use of CBT for a variety of childhood anxiety diagnoses, including generalized anxiety disorder, social anxiety disorder, specific phobias, panic disorder, separation anxiety disorder, and selective mutism. […] While psychotherapy is first-line treatment for anxiety disorders in children and adolescents with mild to moderate anxiety symptoms, medication can be also considered for children with acute or moderate symptoms and partial response to psychotherapy. […] A number of medications are used to treat anxiety, with the most effective being selective serotonin reuptake inhibitors (SSRIs). […] Evidence-based guidelines endorsed by the American Academy of Child and Adolescent Psychiatry recommend SSRIs as the medication of choice for treating anxiety disorders in children and adolescents aged 6 to 18 years old. […] Combination therapy using SSRIs in conjunction with CBT should be considered at treatment onset for children and adolescents with moderate to severe anxiety disorders because this two-pronged approach has been shown to improve global functioning, response to treatment, and achievement of remission.

• #77 Neurobiology of Pediatric Anxiety Disorders

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4347469/

  Finally, emerging data raise the possibility that functional activity within these amygdala-prefrontal networks may be affected by successful psychopharmacologic and psychotherapeutic treatment and may predict outcome. […] Over the last decade, accumulating evidence suggests that there are specific alterations within central fear networks in anxiety disorders in youth. […] This includes the anterior limbic network (ALN), which involves connections between the amygdala, medial prefrontal cortex (Brodmann area [BA] 10/11), rostral insula, subgenual/rostral anterior cingulate cortex (ACC, BA 25, BA 24/32), […] and dorsolateral prefrontal cortex. […] The most notable and frequently implicated structure in pediatric anxiety disorders, including GAD, is the amygdala. […] Moreover, the amygdala is comprised of multiple nuclei that are reciprocally connected to the hypothalamus, hippocampus, and neocortex structures which, as discussed below, have been implicated in the pathophysiology of anxiety disorders.

• #78 Novel mechanism-based treatments for pediatric anxiety and depressive disorders | Neuropsychopharmacology

  https://www.nature.com/articles/s41386-023-01709-x

  Cognitive training aims to reduce symptoms by targeting cognitive and neural mechanisms underlying mental illnesses. […] In the domain of cognitive training, attention bias modification for the treatment of anxiety disorders represents one of the best studied therapies among children. […] This work provided support for the hypothesis that attention bias to threat contributes to the onset or maintenance of anxiety disorders. […] Attention to threat increases activity in many brain regions among children with anxiety disorders. […] Explicating the neural circuitry associated with altered attention in pediatric anxiety disorders is an important goal. […] The study of novel treatments might be justified for adolescents who fail to respond to the two available first-line treatments. […] Given these longitudinal data, treatments for adolescents can be discovered by adapting treatments efficacious in adults.

• #79 Anxiety in children and youth: Part 2 – The management of anxiety disorders | Canadian Paediatric Society

  https://cps.ca/en/documents/position/anxiety-in-children-and-youth-management

  Cognitive behaviour therapy (CBT) is the most common evidence-based treatment modality for anxiety disorders. […] Studies have evaluated the use of CBT for a variety of childhood anxiety diagnoses, including generalized anxiety disorder, social anxiety disorder, specific phobias, panic disorder, separation anxiety disorder, and selective mutism. […] While psychotherapy is first-line treatment for anxiety disorders in children and adolescents with mild to moderate anxiety symptoms, medication can be also considered for children with acute or moderate symptoms and partial response to psychotherapy. […] A number of medications are used to treat anxiety, with the most effective being selective serotonin reuptake inhibitors (SSRIs). […] Evidence-based guidelines endorsed by the American Academy of Child and Adolescent Psychiatry recommend SSRIs as the medication of choice for treating anxiety disorders in children and adolescents aged 6 to 18 years old. […] Combination therapy using SSRIs in conjunction with CBT should be considered at treatment onset for children and adolescents with moderate to severe anxiety disorders because this two-pronged approach has been shown to improve global functioning, response to treatment, and achievement of remission.

• #80 Anxiety disorders in children – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/anxiety-disorders-in-children

  Anxiety disorders can have significant effects on social functioning and educational attainment, with the potential for lifelong consequences. Having an anxiety disorder as a child increases the risk of having anxiety or depression as an adult. Additionally, experiencing anxiety in childhood also increases the risk of later suicide attempts, psychiatric admissions and abuse of alcohol or substances. […] The assessment and management of anxiety disorders in children is carried out by specialists within child and adolescent mental health services. An important consideration during the assessment process is determining whether symptoms deviate from developmentally normal fears and worries. The triggers for anxiety are generally normal experiences, such as putting a hand up in class, eating out, going to a party or sleepover, or being asked a question by a teacher. If reactions to such events are severe, disproportionate and persistent, or lead to a change in behaviour, such as school refusal, being unable to sleep alone or social withdrawal, then assessment is warranted.

• #81 Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners – Patel – Translational Pediatrics

  https://tp.amegroups.org/article/view/16525/html

  Anxiety disorders are common in children and adolescents with reported prevalence rates between 10% and 30%. […] A combination of genetic factors, temperamental characteristics of the child, and environmental risk factors play a role in the development of anxiety disorders. […] While long term outcomes of childhood anxiety disorders have not been clearly elucidated, it is generally recognized that most tend to persist into adulthood. […] The long term impact of anxiety disorders on the psychosocial development of the child or adolescent is significant. […] SSRIs are the recommended drugs of choice for pediatric anxiety disorders and found to be effective alone or in combination with cognitive behavior therapy. […] SSRIs act by blocking the reuptake of serotonin into pre-synaptic neurons and enhance serotonergic neurotransmission.

• #82 Generalized Anxiety Disorder (GAD) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/generalized-anxiety-disorder-gad

  Temperament factors: A child whose temperament is timid or shy or who avoids anything dangerous may be more prone to generalized anxiety disorder than others are. […] Environmental factors: A traumatic experience (such as a divorce, illness, or death in the family, or major events outside of the family) may also trigger the onset of an anxiety disorder. […] Children with generalized anxiety disorder experience excessive and uncontrollable worry about a number of events or activities. […] Symptoms of generalized anxiety disorder can vary. […] Evidence-based treatments for GAD in children and adolescents includes cognitive behavioral therapy, medication, or a combination of medication and therapy. […] If left untreated, studies show that GAD is often a chronic illness with symptoms that tend to wax and wane across the lifespan.

• #83 Generalized Anxiety Disorder (GAD) in Children and Teens | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/g/generalized-anxiety-disorder-gad-in-children.html

  Generalized anxiety disorder (GAD) is a mental health problem. A child with GAD has a lot of worry and fear that seems to have no real cause. […] Experts believe GAD is caused by both biological and environmental factors. A child may inherit a tendency to be anxious. An imbalance of two chemicals in the brain (norepinephrine and serotonin) most likely plays a part. […] A child can also learn anxiety and fear from family members and others. For example, a child with a parent who is afraid of thunderstorms may learn to fear thunderstorms. A traumatic event may also cause GAD. This can include things such as the death of a parent, a divorce, or a serious family accident or illness. […] GAD is caused by both biological and environmental factors. […] Untreated, chronic anxiety can lead to other serious problems such as depression, substance abuse, and self-harm.

• #84 Anxiety disorders in children – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/anxiety-disorders-in-children

  Anxiety disorders can have significant effects on social functioning and educational attainment, with the potential for lifelong consequences. Having an anxiety disorder as a child increases the risk of having anxiety or depression as an adult. Additionally, experiencing anxiety in childhood also increases the risk of later suicide attempts, psychiatric admissions and abuse of alcohol or substances. […] The assessment and management of anxiety disorders in children is carried out by specialists within child and adolescent mental health services. An important consideration during the assessment process is determining whether symptoms deviate from developmentally normal fears and worries. The triggers for anxiety are generally normal experiences, such as putting a hand up in class, eating out, going to a party or sleepover, or being asked a question by a teacher. If reactions to such events are severe, disproportionate and persistent, or lead to a change in behaviour, such as school refusal, being unable to sleep alone or social withdrawal, then assessment is warranted.

• #85 Anxiety disorders in children – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/anxiety-disorders-in-children

  Anxiety disorders can have significant effects on social functioning and educational attainment, with the potential for lifelong consequences. Having an anxiety disorder as a child increases the risk of having anxiety or depression as an adult. Additionally, experiencing anxiety in childhood also increases the risk of later suicide attempts, psychiatric admissions and abuse of alcohol or substances. […] The assessment and management of anxiety disorders in children is carried out by specialists within child and adolescent mental health services. An important consideration during the assessment process is determining whether symptoms deviate from developmentally normal fears and worries. The triggers for anxiety are generally normal experiences, such as putting a hand up in class, eating out, going to a party or sleepover, or being asked a question by a teacher. If reactions to such events are severe, disproportionate and persistent, or lead to a change in behaviour, such as school refusal, being unable to sleep alone or social withdrawal, then assessment is warranted.

• #86 Anxiety disorders in children – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/anxiety-disorders-in-children

  Anxiety disorders can have significant effects on social functioning and educational attainment, with the potential for lifelong consequences. Having an anxiety disorder as a child increases the risk of having anxiety or depression as an adult. Additionally, experiencing anxiety in childhood also increases the risk of later suicide attempts, psychiatric admissions and abuse of alcohol or substances. […] The assessment and management of anxiety disorders in children is carried out by specialists within child and adolescent mental health services. An important consideration during the assessment process is determining whether symptoms deviate from developmentally normal fears and worries. The triggers for anxiety are generally normal experiences, such as putting a hand up in class, eating out, going to a party or sleepover, or being asked a question by a teacher. If reactions to such events are severe, disproportionate and persistent, or lead to a change in behaviour, such as school refusal, being unable to sleep alone or social withdrawal, then assessment is warranted.

• #87 Anxiety | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/anxiety-in-children

  Also, experiencing a traumatic event can result in persistent anxiety or post-traumatic stress disorder. […] An accurate diagnosis and early treatment are important in overcoming an anxiety disorder. […] Early treatment is key to overcoming an anxiety disorder and minimizing the chance of recurrence. […] Most children who receive early and effective evidence-based treatment for an anxiety disorder will recover. However, in some children, the anxiety disorder recurs or a different anxiety disorder develops. […] Early treatment is key to minimizing your child’s vulnerability to later episodes of anxiety and depression. […] Early, effective treatment is crucial to helping a child overcome an anxiety disorder and to prevent a later vulnerability to anxiety and depression.

• #88 Anxiety in children and youth: Part 1 – Diagnosis | Canadian Paediatric Society

  https://cps.ca/en/documents/position/anxiety-in-children-and-youth-diagnosis

  Anxiety disorders are the most common mental health concerns affecting Canadian children and adolescents. […] The etiology of anxiety disorders is multifactorial and includes biological factors (e.g., temperament, genetics, and epigenetics), combined often with psychological and social exposures (e.g., adverse childhood experiences (ACEs)). […] Parental anxiety disorder is a specific risk factor for child anxiety. […] Anxiety disorders are often comorbid with OCD (in 26% to 75% of cases) or tic disorders (in 30% of cases). […] A key diagnostic criterion for anxiety disorders is that the symptoms experienced fall well beyond normal fears and inhibitions expected for a child or youths developmental age and stage, causing clinically significant distress or impairment in social or school life, and possibly in other important areas of functioning.

• #89 ERIC – EJ813530 – The Pathogenesis of Childhood Anxiety Disorders: Considerations from a Developmental Psychopathology Perspective, International Journal of Behavioral Development, 2006

  https://eric.ed.gov/?id=EJ813530

  The Pathogenesis of Childhood Anxiety Disorders: Considerations from a Developmental Psychopathology Perspective Muris, Peter International Journal of Behavioral Development, v30 n1 p5-11 2006 Anxiety disorders are among the most prevalent psychiatric problems in children and adolescents. The present article summarizes the main evidence that has accumulated on the pathogenesis of childhood anxiety disorders during the past two decades. Various risk and vulnerability factors (e.g., genetics, behavioral inhibition, disgust sensitivity, negative life events, family influences), protective factors (e.g., effortful control, perceived control), and maintaining factors (e.g., avoidance, cognitive biases) will be discussed. The information will be described in terms of a developmental psychopathology perspective, which assumes that (a) most forms of psychopathology are the result of multiple causal influences; (b) both successful and unsuccessful adaptation are important for understanding the origins of psychopathology; and (c) psychopathology occurs in a developing organism. […] Descriptors: Emotional Disturbances, Inhibition, Psychopathology, Pathology, Children, Genetics, Anxiety, Behavior Disorders, Risk, Child Development, Developmental Stages, Attribution Theory

• #90

  https://www.aacap.org/aacap/medical_students_and_residents/mentorship_matters/developmentor/Advances_in_Child_and_Adolescent_Anxiety_Disorder_Research.aspx

  The future directions in anxiety research are numerous. This burgeoning field needs new researchers. Since academic child and adolescent anxiety psychiatry offers a lifestyle with variety, flexibility, challenge, and innovation, I strongly recommend an academic career that includes research. Linking neuroscience, genetics, behavioral science, and epidemiology will advance our knowledge of etiology, risk, and protective processes in early-onset mental illnesses and will guide our treatment approaches. Translational research that incorporates basic science findings in designing real-life interventions is a crucial area of investigation. It is important that basic science findings, developmental theory, and conceptual models guide child and adolescent psychiatry research.

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