Paeds Vivas · mental-behavioural-and-psychosomatic
Anxiety disorders in children and adolescents — branching viva
Branching viva on distinguishing disorder from normal fear, multi-informant assessment, stepped care, CAMS and Cochrane evidence, SSRI dosing and suicidality monitoring.
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Examiner: What distinguishes an anxiety disorder from normal developmental fear in a child? [2]
Candidate: Normal developmental fear — stranger anxiety at 7 to 9 months, separation distress peaking at 12 to 18 months, fear of the dark and of animals in the preschool years — is age-appropriate, transient and resolves with reassurance. An anxiety disorder is excessive, out of proportion to the actual threat, persists beyond the developmental window (with DSM-5 duration thresholds), and causes functional impairment. The two things that flip it into a disorder are persistence and impairment. [2]
References5ShowHide
- [1]Walkup JT, Albano AM, Piacentini J, Birmaher B, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med, 2008.PMID 18974308
- [2]Walter HJ, Bukstein OG, Abright AR, Keable H, Ramtekkar U, et al. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders. J Am Acad Child Adolesc Psychiatry, 2020.PMID 32439401
- [3]James AC, Reardon T, Soler A, James G, Creswell C. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev, 2020.PMID 33196111
- [4]Bridge JA, Iyengar S, Salary CB, Barbe RP, et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA, 2007.PMID 17440145
- [5]Birmaher B, Khetarpal S, Brent D, Cully M, et al. The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry, 1997.PMID 9100430