Running head: CHILD ANXIETY LITERATURE REVIEW 1

Child Anxiety Literature Review

Eliah Evangelio

Bakersfield College
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Anxiety is commonly known as an abnormal amount of nervousness or fear. Research

points to definite characteristics of anxiety in children as well as the brain region responsive to

anxiety. These characteristics help to identify and measure anxiety in a child. There is much

known about how anxiety manifests itself physically and mentally, yet other research and

treatments are limited. Some treatment measures have been found to be effective, but this lack

may point to a further need in child anxiety research publication.

A child’s anxiety is identified, defined, and measured through questionnaires based on

the DSM-V, or the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. In one

study, researchers wanted to test the internal consistency of SCARED, the Screen for Child

Anxiety Related Emotional Disorders. It tests for social phobia, school phobia, separation

anxiety disorder, panic disorder, and general anxiety disorder. There were 341 children and

adolescents and 300 parents. First, researchers gave an 85 item questionnaire from SCARED to

all participants. They then took a subsample of the participants, about 5 weeks later, and retested

them with a smaller 38 item questionnaire. They found the difference between the two results to

not be significant. These results indicated good test-retest reliability as well as internal

consistency. The items that were presented in SCARED included: “I worry about things working

out for me,” “I worry about the future, I worry about things in the past,” and “I am nervous.”

(Birmaher et al., 1997) From these items, it is clear to see that anxiety can be defined as a

considerable amount of fear, worry, and nervousness in a child. Since SCARED measured

several types of anxiety along with similar disorders, it can be seen that anxiety can manifest

itself in different manners in response to various environments and situations and it is related to

some phobias. In another study, researchers wanted to see if they could test anxiety by levels of

intensity using a scale in the DSM-5. Previously, the DSM only had two levels, which were
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whether you had the disorder or not. Participants were from eight primary schools, from which

38 children, ages 8-13, and their parents, 285 mothers and 255 fathers participated. Children

were given the scaled questionnaire in class and parents completed it at home and sent it back to

the university. They found that the parent and the child agreement on the dimensional scales

were not significantly different, suggesting that the scales were reliable and internally consistent.

(Möller et al., 2014) From this study, anxiety can be defined as dimensional, having various

levels of intensity and severity.

One of the previous articles, in which the SCARED was tested for internal consistency,

can be utilized to view how anxiety manifests itself. Besides items about excessive worrying,

other items concerning anxiety in the SCARED included, “I follow my parents wherever they

go,” “I have nightmares about my parents,” and “nightmares about bad things happening to me.”

Items concerning disorders and phobias similar to anxiety include, “when frightened, it is hard to

breathe,” “when frightened, feel like I am choking,” and “get headaches when I am at school.”

(Birmaher et al., 1997) This shows that along with worrying about different situations, anxiety

can have an effect on a child’s sleep as well as how a child behaves. If a child follows their

parents, wherever they go, they will not be able to develop a sense of independence and they will

not be able to develop as well as other children who are partaking in normal activities. In this

way, anxiety can hinder development. Similar disorders and phobias to anxiety, have an affect on

children’s bodies. If a child is overtaken by physical attacks, such as headaches or choking, they

will also experience developmental hinderance, because they will be less successful in the

normal activities most children partake in. One research study examined the amygdala of

children with and without an anxiety disorder. Participants, aged 8-16, included 12 children with

generalized anxiety or panic disorder and a control group of 12 children who were healthy.
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Researchers utilized MRI while presenting images of fearful and neutral facial expressions to the

participants. Using Post Hoc t-tests, they found that anxious children had greater responses in the

right amygdala when shown fearful faces than the children who were healthy. The magnitude

also positively correlated with the child’s self report of their SCARED anxiety symptoms.

(Thomas et al., 2001) This study shows that fear is associated with the amygdala, and is

therefore, involved with anxiety. It also evidences that when a child has greater or more anxiety

symptoms, their fear response in their amygdala is greater, also suggesting the large role of the

amygdala in anxiety.

A study examined 25 years of research on the most popular database of psychology

literature, PsychNet, for publication trends of literature on child anxiety disorders. They found

that anxiety disorder literature made up a small amount of publications, about 10.2%. Much of

the research was on posttraumatic disorders and obsessive compulsive disorders, though anxiety

disorders are very prevalent. However, there has been a significant increase over the years in

child anxiety disorder literature, as scientists realize that most adult anxiety disorder cases are

based in their childhood. They also found that most of the research on child anxiety examines

phenomenology, rather than its etiology, assessment or intervention. (Muris et al., 2008) The

amount and nature of the research published currently illustrates what we know about anxiety,

how seriously we are taking it, and where we likely advance in the future. The fact that there has

been more publications on child anxiety over the years demonstrates that it has been taken more

seriously, that more treatment is being administered or will be discovered, and more knowledge

is being discovered about it so that it can be identified and treated more effectively. Since much

of adult anxiety comes from childhood, anxiety can be treated before it matures or evolves,

causing less and less adult cases. Because most of child anxiety research is about the
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manifestation or phenomena of anxiety and less on the causes, evaluation, and intervention, one

might conclude that there is still much to learn about child anxiety. It suggests that there is not

much treatment for children who do have anxiety and that many children who have anxiety may

not be identified. The results of this study will likely direct scientists in future areas of interest so

that the future of child anxiety will hold much more information on causes, assessment, and there

will be much more treatment available. Though lack of publication suggests a lack of treatment,

child anxiety is currently being treated successfully with measures such as cognitive behavioral

therapy (CBT). One study examined CBT meta analysis publications on databases PubMed,

PsychInfo, and Cochrane library. They found that CBT was significantly effective in anxiety

disorders, which is evidenced in a study where secondary symptoms of anxiety were

significantly affected positively and in other studies where self-help or internet guided measures

showed a positive effect on symptoms with immediate relief. The publications showed that CBT

was consistently effective. (Hofmann, 2012)

The abnormal fear, nervousness, and worry found in child anxiety disorders is identified

and measured through questionnaires like SCARED and scales and diagnosis in the DSM-V.

Anxiety has several levels and can manifest itself in different situations and manners, such as

nightmares or following parents too closely. Of course, the amygdala is greatly involved in

anxiety and shows a greater response depending on symptoms. Overall, treatment and knowledge

on child anxiety is limited, especially compared to PTSD and OCD. Scientists should use this

knowledge to further research on lacking areas, like the causes, intervention, and assessment of

anxiety disorders, in order to better treat patients and to identify and intervene on anxiety cases

before they mature in adulthood. Nevertheless, CBT methods have been found to be effective in

anxiety disorder cases.

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References

Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., & Neer, S. M. (1997).

The Screen for Child Anxiety Related Emotional Disorders (SCARED): Scale

Construction and Psychometric Characteristics. Journal of the American Academy of

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Child & Adolescent Psychiatry, 36(4), 545–553. doi: 10.1097/00004583-199704000-

00018

Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of

Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and

Research, 36(5), 427–440. doi: 10.1007/s10608-012-9476-1

Möller, E. L., Majdandžić, M., Craske, M. G., & Bögels, S. M. (2014). Dimensional assessment

of anxiety disorders in parents and children for DSM-5. International Journal of Methods

in Psychiatric Research, 23(3), 331–344. doi: 10.1002/mpr.1450

Muris, P., & Broeren, S. (2008). Twenty-five Years of Research on Childhood Anxiety

Disorders: Publication Trends Between 1982 and 2006 and a Selective Review of the

Literature. Journal of Child and Family Studies, 18(4), 388–395. doi: 10.1007/s10826-

008-9242-x

Thomas, K. M. (2001). Amygdala Response to Fearful Faces in Anxious and Depressed

Children. Archives of General Psychiatry, 58(11), 1057–1063. doi:

10.1001/archpsyc.58.11.1057