In this chapter, we consider the anxiety disorders as defined by the DSM-IV criteria including panic, phobias, and general anxiety. The major subtypes of anxiety include panic disorder (with or without agoraphobia), specific phobia, social phobia, and generalized anxiety disorder (GAD). Although obsessive -compulsive disorder and post-traumatic stress disorder are also included as anxiety disorders in the DSM-IV, they will not be included here due to differences in their prevalence rates and correlates. There are two additional subtypes of anxiety that are specific to youth: separation anxiety disorder and overanxious disorder. The DSM-IV did not include the category of overanxious disorder because of the purportedly substantial degree of overlap with GAD. However, as described below, there is emerging evidence that overanxious disorder does indeed provide coverage of anxiety disorder in youth who do not meet criteria for GAD.
Despite the biologic underpinnings of anxiety, there are no pathognomonic markers with which a presumptive diagnosis of an anxiety disorder may be made. Therefore, information for assessing the diagnostic criteria for anxiety disorders are strictly based on either a direct clinical interview or observation of objective manifestations of anxiety. Because of the broad meaning of the term "anxiety," numerous measures of anxiety have been employed. The most commonly used assessments include self-report checklists of both state and trait anxiety (e.g., State-Trait Anxiety Inventory, Spielberger et al., 1983); fears (Revised Fear Survey Schedule for Children, Ollendick et al., 1985); anxiety factors (Multidimensional Anxiety Scale for Children, March et al., 1997), as well as clinician-administered symptom checklists (e.g. Anxiety Rating for Children—Revised, Bernstein et al., 1996). In addition, the major structured and semistructured diagnostic interviews assess the diagnostic criteria for anxiety disorders. These include the lay interviewer administered Diagnostic Interview Schedule for Children (DISC) (Shaffer et al., 1996) and the clinician administered semistructured Schedule for Affective Disorders and Schizophrenia for School-Age Children Kiddie-(SADS) (Chambers et al., 1985); and the Diagnostic Interview for Children and Adolescents—Revised (DICA-R) (Welner and Rice, 1988, Welner et al., 1987). The Anxiety Disorders Interview Schedule for Children (Silverman et al., 1988) is the most comprehensive diagnostic interview of anxiety disorders for youth.
Several psychophysiologic indicators of anxiety have also been used in both adults and children. Experimental models which induce stress and measure auto-nomic output to test the human ''fight or flight'' response to threat have been used to study the range of triggers, correlates, and responses to fear-provoking situations. Behavioral tasks such as giving a speech or response to novelty, have been used to experimentally induce anxiety states in normals as well as those with anxiety disorders. Measures of changes in pulse, galvanic skin response, heart rate, and temperature regulation, as well as self-reported changes and observations of facial expressions, blushing, and other overt signs of anxiety are presumed to provide a more accurate depiction of anxiety than self-reports or interviews about typical response patterns to stress.
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