School Functioning in Youth with and without Anxiety Disorders: Comparisons by Diagnosis and Comorbidity.

Abstract This article reports on school functioning for 227 youth ages 7-14 (M = 10.3) with principal diagnoses of separation anxiety disorder (n = 40), social phobia (n = 58), generalized anxiety disorder (n = 76), or no diagnoses (n = 53). School functioning data were gathered via parent and teacher report. Youth with no diagnoses demonstrated significantly higher levels of school functioning than those with separation anxiety disorder, social phobia, or generalized anxiety disorder. The specific anxiety-disordered groups were differentiated to some degree on parent and teacher report of school functioning. Analyses revealed that differences were often attributable to increasingly complex comorbidity. These results underscore the need for services for youth with anxiety given the range of challenges they face in the school environment. ********** Reviews of epidemiologic studies conclude that anxiety disorders are common and possibly the most prevalent category of disorder in youth (Albano, Chorpita, & Barlow, 2003; Bernstein & Borchardt, 1991; Chavira, Stein, Bailey, & Stein, 2004). Using diagnostic criteria (e.g., Diagnostic Statistical Manual of Mental Disorders [4th ed., text rev.; DSM-IV-TR]; American Psychiatric Association, 2000), prevalence rates of anxiety disorders in children and adolescents range from 2% to 27%, depending on age, measure/assessment used, and assessment interval (Costello, Egger, & Angold, 2004). Yet, despite initial efforts (e.g., Phillips, 1978) and the high prevalence of anxiety disorders in youth, the relationship between anxiety and school functioning remains understudied. Surprisingly, a search of four major school psychology journals (e.g., School Psychology Review, Journal of School Psychology, School Psychology Quarterly, and Psychology in the Schools) has revealed a dearth of published studies involving a specific focus on the overlap between DSM-classified anxiety disorders typically found among school-age children and the associated influence on school functioning. Only a very small number (e.g., Callahan, Panichelli-Mindel, & Kendall, 1996; Wood, Chiu, Hwang, Jacobs, & Ifekwunigwe, 2008) have addressed this topic area. The literature highlights a number of deleterious outcomes linked to anxiety as rated by various informants. Children with anxiety tend to be rated by peers as being shyer and more socially withdrawn (Coplan, Girardi, Findlay, & Frohlick, 2007), and are rated as less popular and less likeable, relative to children who are not anxious (Nelson, Rubin, & Fox, 2005). Other studies (e.g., Kashani et al., 1990) have compared parent report of anxious youth to those who are not anxious, finding more difficulties experienced among the former group across ages. Strauss, Frame, and Forehand (1987) found that children classified as highly anxious by their teachers exhibited greater psychosocial difficulties and problems with adjustment than did children rated as nonanxious. Moreover, the effects of anxiety are not confined to childhood and adolescence, but can lead to problems in later functioning. Negative sequelae of childhood anxiety include adult anxiety disorders, mood disorders, and substance use problems (Kendall, Safford, Flannery-Schroeder, & Webb, 2004; Woodward & Fergusson, 2001). In considering contexts likely to produce anxiety for youth, the school environment emerges as especially salient, offering no lack of stress-producing stimuli for youth. Indeed, Langley, Bergman, McCracken, and Piacentini (2004) found that school-related stressors were among the most frequently endorsed as causing significant interference by their sample of youth with an anxiety disorder. Furthermore, numerous school-related "hassles" (e.g., peers, schoolwork, teachers, homework, and parent-school relations) affecting elementary and middle school children have been found to be significantly correlated with internalizing disorders such as anxiety (Barrett & Heubeck, 2000; Heubeck & O'Sullivan, 1998). …