Childhood Anxiety Disorders Remain Poorly Understood
Feb. 22, 2000 (Washington) -- The quiet wheel -- not just the squeaky --
needs attention too, according to a report on anxiety disorders in youth
released Monday by the National Institute of Mental Health (NIMH) and the
Anxiety Disorders Association of America (ADAA).
According to the report, this range of so-called "internalized"
disorders is poorly understood, imperfectly diagnosed, undertreated, and
inadequately researched in trials.
"It's relatively unknown because these kids don't cause problems in
school," Deborah Beidel, PhD, psychology professor at the University of
Maryland in College Park, and chairwoman of the ADAA's task force on children.
"Kids with anxiety disorders are usually very inhibited. They sit in their
seat and they do their work. They're suffering inside, but they're not making
trouble for the teacher and therefore nobody's really paying attention to
"Of the money that we spend on children, only a small portion is in the
area of anxiety," says Steven Hyman, MD, director of the NIMH. He tells
WebMD, "The major investments have [primarily] been in attention deficit
disorder, conduct disorder, and ... adolescent depression. This is, to me, very
Childhood anxiety disorders include separation anxiety disorder, panic
disorder, posttraumatic stress disorder, obsessive-compulsive disorder, social
anxiety disorder, and specific phobias.
The lack of understanding on these conditions is not because the problem is
small. In fact, the U.S. Surgeon General's 1999 report on mental health
estimated that anxiety disorders are the most common mental disorders among
youth, affecting 13% of those aged 9-17. The conditions have long-term
consequences if untreated, with recent research suggesting links to alcoholism
and depression later in life.
But the new report noted that fewer than 20 well-controlled trials have
examined treatments for these disorders. "We're still really in the dark
about how these disorders manifest themselves and can best be treated in
youngsters," says Jerilyn Ross, MA, president of the ADAA.
Societal attitudes also conspire against a full understanding of these
conditions. Hyman tells WebMD that children with anxiety disorders have been
"at the crossroads of two stigmas." For one, he notes, children may
suffer quietly because they are ashamed that they have a mental condition. For
the other, "even if parents are aware, often they either hope that it is
just a passing phase or they're afraid if they bring a child to the
pediatrician that they may be blamed."
Moreover, Hyman says, these disorders have also had to escape from the
shadow of outmoded theory. "This was the last area of psychiatry to be
liberated from Freudian dogmas," he tells WebMD, recalling from psychiatric
residency in the early 1980s that "it was dogma that children could not be
depressed because depression required the full development of this theoretical
entity called the superego."