Comorbidity in childhood anxiety disorders

When an anxiety disorder presents in a child, it rarely occurs in isolation. The most likely comorbid diagnosis is an additional anxiety disorder, but other disorders such as depression often present, particularly in adolescence. Another group of disorders often comorbid with anxiety in children and adolescents, perhaps less frequently than other internalizing disorders, are externalizing disorders such as Attention Deficit Hyperactivity Disorders, Oppositional Defiant Disorder, and Substance Use Disorders. Children with Autism Spectrum Disorders also have a significantly elevated rate of comorbid anxiety disorders. Given comorbid diagnoses can impact on treatment decisions and treatment efficacy, this chapter presents an overview of typical comorbid presentations with reference to prevalence, impact, and course, as well as guidance for clinicians on assessment and treatment when comorbidity is present.