Early intervention crucial in anxiety disorders in children.

Anxiety disorders are amongst the most common mental disorders of childhood. Anxiety in childhood can be crippling to a child or young person, interfering with what should be a time of fun and innocence. The impact of anxiety can be wide reaching – with social relationships, education, family life and health all potentially disrupted. 75% of anxiety disorders often have their origins in childhood, with their presentation often being chronic in nature.1 The presence of an anxiety disorder in childhood means that the child is 3.5 times more likely to experience depression or anxiety in adulthood,2 highlighting the importance for early diagnosis and appropriate treatment. Primary care can play a key role in the recognition and early treatment of these disorders. In the UK, 3% of children and young people have a diagnosable anxiety disorder,1 however making a diagnosis can often prove difficult. Fear and anxiety have important developmental roles and are of major evolutionary significance; therefore it is important for a clinician to distinguish between normal anxiety and anxiety disorders.3 This distinction is usually when the symptoms are impairing function and/or causes marked avoidance and significant distress. Furthermore, many children’s presentation is complicated by the high co-morbidity with depression, or that symptoms can present as somatic in nature. For example, one third of children presenting with medically unexplained symptoms also experience anxiety or depression.4 There are a number of different anxiety disorders in children and young people and despite their high prevalence, there is a relative lack of guidance for GPs on their diagnosis and treatment. Although NICE provides guidance for Common Mental Health Problems, and some specific anxiety disorders, guidance for many of the anxiety disorders presenting in children and young people is lacking (See Figure 1 for available guidance).