Treating broad-based anxiety problems

Transient anxiety and fears are common in children and are often considered part of normal development (Last et al., 1996). It is increasingly recognised, however, that some children experience levels of anxiety that significantly affect their day-to-day functioning. This anxiety might make it difficult for them to make friends, to join in with activities they might enjoy or adversely affect their school attendance. These children would be considered to have clinical levels of anxiety and may meet criteria for an anxiety disorder. Together, anxiety disorders represent the most common form of psychopathology affecting children and adolescents (Costello et al., 2003). Exact prevalence rates vary depending on the methods used but there is consensus that, at any given point in time, between 2.5% and 5% of children meet criteria for an anxiety disorder (Rapee et al., 2009). The presence of an anxiety disorder in childhood has been associated with poor peer relationships, increased victimisation, poor academic performance and disrupted family processes (Ezpeleta et al., 2001; La Greca & Lopez, 1998; Verduin & Kendall, 2008). In the longer term, anxious children are at increased risk for continued mental health problems in adulthood, including chronic anxiety, depression and substance abuse (Buckner et al., 2008; Pine et al., 1998). In this chapter we will focus on the presentation and treatment of three of the most prevalent anxiety disorders seen in children: separation anxiety disorder (SAD), social phobia and generalised anxiety disorder (GAD). Each of these disorders has unique features, but an underlying construct of anxiety is common across them all. As a consequence, there are high rates of comorbidity between these disorders and they are often treated using a single protocol (Rapee et al., 2006a).