Psych · Child and adolescent psychiatry — anxiety disorders
Child and adolescent anxiety
Also known as Paediatric anxiety · Youth anxiety disorders · Separation anxiety disorder · Child GAD · Adolescent social anxiety · School refusal · Selective mutism · CAMS trial · Coping Cat
Exam-exhaustive fellowship reference on child and adolescent anxiety — separation anxiety, GAD, social anxiety, selective mutism, school refusal functional analysis, exposure-based CBT, SSRI evidence (CAMS, RUPP, fluoxetine, paroxetine, duloxetine), family accommodation, and stepped care. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Active suicidal ideation, intent or plan, or escalating self-harm in an anxious youth — same-day risk assessment and safety planning, not 'anxiety only' reassurance
- Severe school refusal with medical red flags (weight loss, dehydration, unexplained neurological signs) or prolonged complete non-attendance — urgent MDT and medical review
- Acute panic with chest pain, syncope, or first presentation needing organic exclusion before pure psychiatric labelling
- Marked behavioural activation, new or worsening suicidal thinking after starting an antidepressant — urgent review and dose/treatment reassessment
- Safeguarding concerns (abuse, neglect, bullying with safety risk, exploitation) disclosed in anxiety assessment — escalate per local child protection pathways
- Inability to leave home with extreme avoidance and carer collapse — escalate intensity of care and legal least-restrictive options if capacity and risk require it
Meet the patient
An 11-year-old has missed nineteen school days this term. Every one of them started the same way: awake at 6am, abdominal pain by 7, vomiting by 7:30, and completely well by 10am watching television. Three normal paediatric work-ups. Two open-ended medical certificates. Her mother now drives her to school, sits in the car park, and drives her home again.[17][18]
Nobody in this story is doing anything unreasonable. Everyone is making it worse. The examiner's question is "what is the non-attendance achieving, and who is paying for it?" — and the answer decides the treatment.[17][18]
References25ShowHide
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- [2]Research Unit on Pediatric Psychopharmacology Anxiety Study Group. Fluvoxamine for the treatment of anxiety disorders in children and adolescents N Engl J Med, 2001.PMID 11323729
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- [9]Ginsburg GS, Kendall PC, Sakolsky D, Compton SN, et al. Remission after acute treatment in children and adolescents with anxiety disorders: findings from the CAMS J Consult Clin Psychol, 2011.PMID 22122292
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- [17]Kearney CA, Albano AM. The functional profiles of school refusal behavior. Diagnostic aspects Behav Modif, 2004.PMID 14710711
- [18]Kearney CA. Forms and functions of school refusal behavior in youth: an empirical analysis of absenteeism severity J Child Psychol Psychiatry, 2007.PMID 17244270
- [19]King NJ, Tonge BJ, Heyne D, Pritchard M, et al. Cognitive-behavioral treatment of school-refusing children: a controlled evaluation J Am Acad Child Adolesc Psychiatry, 1998.PMID 9549960
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- [21]Zhou X, Zhang Y, Furukawa TA, Cuijpers P, et al. Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents: A Network Meta-analysis JAMA Psychiatry, 2019.PMID 30383099
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