Introduction to Special Issue: Developments in the Etiology and Psychosocial Treatments of Anxiety Disorders in Children and Adolescents

Anxiety is a normal emotional response to a perceived threat to one’s physical or emotional well-being. Feeling fearful and fleeing from a genuinely dangerous situation is adaptive. However, if the anxiety response is elicited by a situation or object that is not truly dangerous, then the anxiety and the avoidance associated with it are no longer adaptive. A diagnosis of an anxiety disorder is warranted if the anxiety response is excessive in frequency, intensity and/or duration, and if it results in significant impairment in functioning. Excessive anxiety is distressing to children and adolescents, and the associated avoidance frequently interferes with their ability to engage in developmentally appropriate tasks and activities. Alarmingly, anxiety disorders are one of the most common psychological difficulties experienced by children and adolescents, and these disorders tend to persist into late adolescence and adulthood unless effective treatment is received (Essau et al. 2000; Ollendick and March 2004; Ollendick and Seligman 2006) Consistent with Lang’s (1979) tripartite model, anxiety is best viewed as a multidimensional construct involving physiological features such as increased heart rate and respiration, cognitive ideation including catastrophic and unhelpful thoughts (e.g., ‘‘I can’t do it,’’ ‘‘What if something terrible happens?’’), and behavioral responses such as avoidance of the anxiety provoking object or situation. Furthermore, there are developmental differences in the expression of anxiety. For example, young children may avoid objects or situations that scare them and might have trouble relating or connecting their physiological symptoms to their anxiety. They might also have difficulty in identifying the distorted or catastrophic cognitions associated with their fears and anxieties. For example, a child with separation anxiety might insist that the reason she has a headache when she has to go to school is because of the flu, not because she is fearful about being separated from her caregivers. She might also not be able to identify her maladaptive cognitions and simply assert that she ‘‘just does not want to go to school and that she does not know why.’’ As noted, for many children and adolescents, fears and worries are a normal part of development. Accordingly, clinicians assessing anxiety in children need to be aware of what constitutes ‘‘normal’’ fear and anxiety at each level of development. For example, young infants and toddlers tend to fear aspects of their immediate environment such as loud noises, unfamiliar people, separation from their caregivers, or heights. Fears of animals, being alone, and of the dark begin to emerge emerging during pre-school years. As cognitive abilities continue to develop during the early school years, children’s fears begin to include abstract, imaginary, or anticipatory fears such as fear of failure or evaluation, death, bodily injury, and supernatural phenomena. Finally, concerns about death, danger, social comparison, personal conduct, and physical appearance extend from adolescence into adulthood (King et al. 2004). Developmentally normal fears are, by definition, age appropriate, and usually transitory in nature. In contrast, a diagnosis of an anxiety disorder is warranted when a child experiences anxiety that is not typical of a child his or her age, and when a child experiences anxiety that is severe and causes considerable distress, and/or which impairs a A. Grills-Taquechel University of Houston, Houston, TX, USA e-mail: agrills@vt.edu