eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Anxiety Disorder: Generalized Anxiety: Follow-up

Author: Dennis A Nutter, Jr, MD, Consulting Staff, Department of Psychiatry, Northeast Georgia Medical Center
Coauthor(s): Lene Holm Larsen, PhD, Instructor, Department of Child and Adolescent Psychiatry, Children's Memorial Hospital of Chicago; Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Contributor Information and Disclosures

Updated: Sep 18, 2006

Follow-up

Further Outpatient Care

  • Weekly outpatient therapy for 3-4 months with less frequent follow-up booster sessions may be sufficient.
  • A cognitive-behavioral approach is likely to be most beneficial. Treatment should consist of individual sessions with family involvement to support the treatment process. Cognitive therapy features may be incorporated into an eclectic approach by highly skilled and experienced therapists.
  • Psychodynamic therapies, including play therapy, are time-honored modalities, but most outcomes research has focused on the brief or intermediate therapies, which are more structured.

Inpatient & Outpatient Medications

  • For patients for whom medication is prescribed, regular appointments with a child and adolescent psychiatrist or developmental-behavioral pediatrician are necessary for the duration of treatment. Parents and patients must be warned of the possible risks of activation and disinhibition and what to do in such circumstances.

Deterrence/Prevention

  • Consistent, stable, supportive home environment
  • Parenting practices that promote self-confidence, self-esteem, and effective coping skills
  • Minimal number of psychosocial stressors or traumatic events
  • Adaptive problem solving and coping skills modeled by parents and other significant people in the child's life
  • Psychoeducation

Complications

  • Comorbid depression and other comorbid conditions
  • School truancy and withdrawal from other age-appropriate activities
  • Strained family relationships when the child's anxiety contributes to irritability, noncompliance, demanding behavior, and/or chronic reassurance seeking
  • "Self-medication" leading to substance abuse by adolescents
  • Parents' inability to help in the child's treatment or to model adaptive coping/anxiety management because of their own untreated anxiety (or other psychiatric condition)

Prognosis

  • Prognosis is thought to be relatively good when treatment is implemented early and effectively. However, the child remains at risk of developing GAD or other anxiety disorders. For example, Last and colleagues in 1996 reported an 80% recovery rate from overanxious disorder during a 3- to 4-year follow-up period. However, 35% of the children developed a new psychiatric disorder in the same interval.

Patient Education

  • Psychoeducation should be part of the treatment process. Patients and parents should have a good understanding of the contributing and maintaining factors of anxiety. Also, they should be clear regarding treatment goals, processes, and expectations.
  • For excellent patient education resources, visit eMedicine's Anxiety Center. Also, see eMedicine's patient education articles, Anxiety, Panic Attacks, and Hyperventilation.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose and, thus, failure to treat the disorder
 


More on Anxiety Disorder: Generalized Anxiety

Overview: Anxiety Disorder: Generalized Anxiety
Differential Diagnoses & Workup: Anxiety Disorder: Generalized Anxiety
Treatment & Medication: Anxiety Disorder: Generalized Anxiety
Follow-up: Anxiety Disorder: Generalized Anxiety
References
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References

  1. AACAP. Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry. Oct 1998;37(10 Suppl):63S-83S. [Medline].

  2. APA. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Elk Grove, Ill: APA; 1994.

  3. APA. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Elk Grove, Ill: APA; 1987.

  4. Barrett PM, Dadds MR, Rapee RM. Family treatment of childhood anxiety: a controlled trial. J Consult Clin Psychol. Apr 1996;64(2):333-42. [Medline].

  5. Barrios BA, Hartmann DB. Fears and anxieties. In: Marsh EJ, Terdal LG, eds. Behavioral Assessment of Childhood Disorders. 2nd ed. New York, NY: Guilford;1988:196-264.

  6. Beidel DC. Psychophysiological assessment of anxious emotional states in children. J Abnorm Psychol. Feb 1988;97(1):80-2. [Medline].

  7. Birmaher B, Brent DA, Chiappetta L, et al. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry. Oct 1999;38(10):1230-6. [Medline].

  8. Green WH. Child and Adolescent Clinical Psychopharmacology. 3rd ed. Lippincott Williams & Wilkins;2001.

  9. Kagan J. Temperamental contributions to social behavior. Am Psychol. 1989;44:668-74.

  10. Kendall PC. Childhood Disorders. London, England: Psychology Press;2000.

  11. Kendall PC, Chu BC, Pimental SS. Treating anxiety disorders in youth. In: Kendall PC, ed. Child & Adolescent Therapy: Cognitive-Behavioral Procedures. 2nd ed. New York, NY: Guilford;2000:235-287.

  12. Last CG, Hansen C, Franco N. Cognitive-behavioral treatment of school phobia. J Am Acad Child Adolesc Psychiatry. Apr 1998;37(4):404-11. [Medline].

  13. Last CG, Perrin S, Hersen M, Kazdin AE. A prospective study of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry. Nov 1996;35(11):1502-10. [Medline].

  14. Manassis K. Keys to Parenting Your Anxious Child. Hauppage, NY: Barron's Educational Series; 1996.

  15. March JS, Parker JD, Sullivan K, et al. The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry. Apr 1997;36(4):554-65. [Medline].

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  18. Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC- 2.3): description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. J Am Acad Child Adolesc Psychiatry. Jul 1996;35(7):865-77. [Medline].

  19. Silverman WK, Albano AM. The Anxiety Disorders Interview Schedule for Children (DSM-IV). San Antonio, Tex: The Psychological Corporation; 1997.

  20. Silverman WK, Kurtines WM, Ginsburg GS, et al. Treating anxiety disorders in children with group cognitive-behaviorial therapy: a randomized clinical trial. J Consult Clin Psychol. Dec 1999;67(6):995-1003. [Medline].

  21. Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. Jan 2006;163(1):41-7. [Medline]. [Full Text].

  22. Spence S. Helping Your Anxious Child: A Step-By-Step Guide for Parents. Oakland, Calif: New Harbinger Publications; 2000.

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Further Reading

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Keywords

anxiety disorder, generalized anxiety, overanxious disorder, overanxious reaction, generalized anxiety disorder of childhood, generalized anxiety disorder, GAD

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Contributor Information and Disclosures

Author

Dennis A Nutter, Jr, MD, Consulting Staff, Department of Psychiatry, Northeast Georgia Medical Center
Dennis A Nutter, Jr, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry and American Psychiatric Association
Disclosure: Nothing to disclose.

Coauthor(s)

Lene Holm Larsen, PhD, Instructor, Department of Child and Adolescent Psychiatry, Children's Memorial Hospital of Chicago
Disclosure: Nothing to disclose.

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Medical Editor

Chet Johnson, MD, Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center
Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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