ABSTRACT
One of the most prevalent and debilitating set of mental disorders among children and adolescents is anxiety disorders. Common anxiety and anxiety-related disorders among youths include separation anxiety disorder, generalized anxiety disorder, social anxiety disorder, specific phobia, school refusal behavior, selective mutism, and mixed anxiety-depressive symptoms. Less common anxiety disorders among youths include panic, obsessive-compulsive, and posttraumatic stress disorders. The symptoms and prevalence of these disorders have been described in great detail elsewhere and are not a critical part of this chapter (see Morris & March, 2004; Ollendick & March, 2004). However, assessment measures that are pertinent to specific disorders are covered here. In addition, some general characteristics regarding anxiety that affect assessment are described next.Anxiety is a normal emotional state that generally comprises physiological, cognitive, and behavioral components (Vasa & Pine, 2004). A child who refuses to attend school because of high social anxiety, for example, may initially experience intense physiological symptoms such as heart palpitations, sweating, trouble breathing, and trembling. These physiological symptoms may then lead to cognitive worries about peer rejection and ridicule, mistakes at school, and awkward performance before others. If these cognitive symptoms are sufficiently intense, then certain anxiety-based behaviors may become evident, such as avoidance, escape, withdrawal from others, crying, clinginess, temper tantrums, and excessive reassurance-seeking. A good sample of anxiety-based physiological, cognitive, and behavioral components is presented by Barrios and Hartmann (1997). Each of these components should be assessed for any particular case.Anxiety in children necessarily means that significant others are impinging upon, and reacting to, a child’s behaviors. Significant others typically include parents, siblings, extended relatives, peers, dating partners, and teachers, although this is not an exclusive list. Because children interact daily with these people, and because these people are often
integral to the treatment process, the assessment of childhood anxiety must include information from multiple sources (Silverman & Kearney, 1991). In addition, because of the internalizing nature of anxiety, a child’s subjective report of his or her emotional state must be given considerable credence during assessment.Human anxiety is a complicated state that likely results from many factors. Common factors implicated in the etiology of anxiety disorders include behavioral inhibition, genetic predisposition, physiological hyperarousal, attachment difficulties, cognitive vulnérabilités, lack of control, problematic parenting styles and family environment, maladaptive learning experiences, and poor development of social, coping, and anxiety management skills (Vasey & Dadds, 2001). A common developmental pathway for childhood anxiety begins with initial biological predispositional factors, such as withdrawal from novel situations, genetic contributions, attachment difficulties, and key brain changes that may produce overarousal to various situations. As a child ages and encounters more challenging situations, he or she may develop psychological vulnerabilities such as alienation from peers and poor social and coping skills. Should family dysfunction and other difficulties such as lack of social support occur as well, a child could be at serious risk for developing an anxiety disorder (Kearney, 2005). Therefore, assessment for a particular child must focus on multiple areas of functioning and development.In related fashion, children differ greatly with respect to age and cognitive development, gender, race, social status, temperament, and other key variables that can influence treatment. Therefore, a clinician’s assessment of a particular child must consider these individual differences. This is most pertinent to cognitive development, where the treatment of an anxious 7-year-old will necessarily differ from the treatment of an anxious 17-year-old. Using instruments that are developmentally sensitive and that assess for cognitive/verbal ability is thus imperative. In addition, use of instruments that are culturally sensitive must be closely considered (Cooley & Boyce, 2004).Literature regarding the assessment of youth with anxiety disorders has burgeoned in recent years, so we encourage clinicians to avail themselves of techniques with established reliability and validity, such as the ones discussed in this chapter. In addition, we encourage clinicians to choose assessment devices that allow them to chart treatment progress and that are sensitive enough to detect even minor differences in anxiety, avoidance, cognitions, and other sometimes subtle constructs. We begin our discussion of various assessment instruments by covering the technique most common to this population: the interview.
