Onset of anxiety disorders in children

There has been relatively little research interest focused on the age of onset and precipitating factors regarding anxiety disorders in children. Relatively more research has been done on these issues for adults, and thus both bodies of research are summarized in this chapter.

Age of onset in children

Table 13.1 summarizes studies in which information concerning age of onset for various childhood anxiety disorders has been found. Separation anxiety disorder, avoidant disorder and simple phobia seem to have the earliest age of onset.

Especially relevant are the recent studies by Biederman et al. (1997) and by Wittchen, Reed & Kessler (1998). Biederman et al. (1997) charted the mean ages of onset of anxiety disorders among children with panic disorder and agoraphobia. They examined 472 consecutively referred children and adolescents via a structured diagnostic interview. These children and adolescents were referred to a paediatric psychopharmacology clinic that did not specialize in the treatment of any particular disorder. Among children with agoraphobia the earliest anxiety disorder to emerge was specific phobia, followed by avoidance disorder and separation anxiety disorder; each of these disorders preceded the onset of agoraphobia. Overanxious disorder, social phobia and obsessive–compulsive disorder tended to follow the emergence of agoraphobia. Children with panic disorder showed a similar course, but they showed slightly later ages at onset for all the disorders. Agoraphobia had an earlier age at onset than panic disorder. This last finding was confirmed in the community study by Wittchen et al. (1998).