Introduction and Overview

The following resources are widely used in clinical settings to screen and assess, design treatment protocol, prescribe medication and provide referrals for children and adolescents with symptoms of anxiety.


Screening & Assessment

Anxiety Flowchart

A guide to design treatment protocol for a patient with anxiety symptoms.

 

General Anxiety Disorder GAD-7

A popular anxiety screening tool appropriate for adolescents, young adults, and adults.

 


Treatment

Evidence-Based Treatments for Anxiety Disorders

PTSD

Treating a Unique Anxiety Disorder

 

Relaxation Therapy

Breathing Control and Progressive Muscle Relaxation

 

UW Medicine’s Harborview Medical Center offers CBT for Anxiety handouts, worksheets, and resources. Cognitive Behavioral Therapy (CBT) is a leading treatment for anxiety.

Therapist Aid offers various anxiety tools to use with children.


Referral and Co-Management

NA for this topic


Medication

  • Comes in: 10,20,40 mg (capsule; only 10 is tablet); liquid 20mg/5ml
  • Start at: 5 or 10 mg
  • Titration schedule to effect: 5, 10, 20, 30, 40; one step every 1-2 weeks until 20 mg; then increase at 1 month intervals because of time to efficacy.
  • Most common dose range: 20-40 mg; max is 60 mg (if titrate to 60 with no effect – time to switch or refer to psychiatry)
  • FDA approved for MDD (age 8); for OCD, age 7)

Children <7 years: Limited data available: Oral: Initial: 5 mg once daily (Gleason 2007).

Children ≥7 years and Adolescents: Oral:

Lower weight Children: Initial: 10 mg once daily; if needed, may increase dose after several weeks; usual daily dose: 20 to 30 mg/day; minimal experience with doses >20 mg/day; no experience with doses >60 mg/day.

Higher weight Children and Adolescents: Initial: 10 mg once daily; increase dose to 20 mg once daily after 2 weeks; may increase dose after several more weeks, if needed; usual daily dose: 20 to 60 mg/day

  • Comes in: 25, 50, 100 mg tabs; liquid 20 mg/1ml
  • Start at: 25 mg
  • Titration schedule to effect: 25, 50,
  • Most common dose range: 100-200 mg/day; max – 200 mg
  • FDA approved for OCD (age 6) OCD

  • Comes in: 25, 50, 100 mg
  • Start at: 25 mg
  • Titration schedule to effect: .
  • Most common dose range:  mg. Maximum dose 300 mg
  • FDA approved for OCD (age 8)

  • Comes in: 10, 20, 40 mg; 10mg/5ml
  • Start at: 5-10 mg/day
  • Titration schedule to effect: .
  • Most common dose range:  mg. Maximum dose 40 mg
  • Not FDA approved

  • Comes in: 5, 10, 20 mg; liquid 5mg/5ml
  • Start at: 2.5 to 5 mg
  • Titration schedule to effect:
  • Most common dose range:  mg. Maximum dose 20 mg
  • Not FDA approved

Social anxiety disorder-- Limited data available.

  • Oral: Children and Adolescents 10-17 years
  • Start at: 5 mg once daily for 7 days
  • then 10 mg/day for 7 days; may then increase at weekly intervals by 5 mg/day if needed, based on clinical response and tolerability
  • maximum dose: 20 mg/day

  • Comes in: 20, 30, 40, 60mg, delayed-release particles and sprinkle capsules (eg, Cymbalta, Drizalma Sprinkle)
  • Start at: 30 mg
  • Titration schedule to effect: after 2 weeks, may increase based on response and tolerability to 60 mg once daily
  • Recommended daily dose range: 30 to 60 mg once daily; if further dose increases are necessary
  • Maximum daily dose: 120 mg/day
  • FDA approved for generalized anxiety (age 7)

Billing/Coding

  • Can code two per visit
  • Code pays $7.91 (at well visit and at E+M visit)
    • Examples: Bright Futures Adolescent Supplemental Questionnaire, GAPS, HEADSSS

  • Can code two per visit
  • Code pays $4.10 (at well visit and at E+M visit)
    • Examples: PSC, SCARED, CDI, CES-DEC, PHQ-9 Modified for Adolescents, Vanderbilt, Conners

  • May be reported in addition to E/M or Health Check
  • Code pays $30.73 (only code if screen is positive & counseling is documented from 3-15 minutes)
    • Examples: CRAFFT for Substance Use/Abuse

Additional Resources for Families

  • School Refusal: Dr. Katharina Manassis explains why children sometimes refuse to go to school when school refusal becomes a serious problem and helpful therapies.
  • Understanding Anxiety in Children: Dr. Jenny Yip addresses the challenges in diagnosing anxiety disorders in children, identifying the underlying cause of anxiety, and providing appropriate and effective treatment.

For children/adolescents:

  • What to Do When Your Brain Gets Stuck: A Kid’s Guide to Overcoming OCD (2007), by Dawn Huebner, PhD
  • What to Do When You Worry Too Much (2005), by Dawn Huebner, PhD
  • What to Do When You Are Scared and Worried (2004), by James Crist, PhD
  • We Are Teachers: Recommended reading for young children with anxiety.
  • Barnes and Noble: Young Adults book recommendations for teen anxiety.

For caregivers:

  • Freeing your Child from Anxiety (2004), by Tamar Chansky, PhD
  • Helping Your Anxious Child (2008), by Rapee, PhD, Wignall, DPsych, Spence, PhD, Cobham, PhD, and Lyneham, PhD
  • Worried No More: Help and Hope for Anxious Children (2005), by Aureen Pinto Wagner, PhD
  • Talking Back to OCD (2006), by John March, MD
  • Freeing Your Child from Obsessive-Compulsive Disorder (2001), by Tamar Chansky, PhD