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Child Psychiatry & Human Development

, Volume 45, Issue 4, pp 398–407 | Cite as

Somatic Complaints in Anxious Youth

  • Sarah A. Crawley
  • Nicole E. Caporino
  • Boris Birmaher
  • Golda Ginsburg
  • John Piacentini
  • Anne Marie Albano
  • Joel Sherrill
  • Dara Sakolsky
  • Scott N. Compton
  • Moira Rynn
  • James McCracken
  • Elizabeth Gosch
  • Courtney Keeton
  • John March
  • John T. Walkup
  • Philip C. KendallEmail author
Original Article

Abstract

This study examined (a) demographic and clinical characteristics associated with physical symptoms in anxiety-disordered youth and (b) the impact of cognitive-behavioral therapy (Coping Cat), medication (sertraline), their combination, and pill placebo on physical symptoms. Youth (N = 488, ages 7–17 years) with a principal diagnosis of generalized anxiety disorder, separation anxiety disorder, or social phobia participated as part of a multi-site, randomized controlled trial and received treatment delivered over 12 weeks. Diagnostic status, symptom severity, and impairment were assessed at baseline and week 12. The total number and severity of physical symptoms was associated with age, principal diagnosis, anxiety severity, impairment, and the presence of comorbid internalizing disorders. Common somatic complaints were headaches, stomachaches, head cold or sniffles, sleeplessness, and feeling drowsy or too sleepy. Physical symptoms decreased over the course of treatment, and were unrelated to treatment condition. Clinical implications and directions for future research are discussed (ClinicalTrials.gov number, NCT00052078).

Keywords

Children Adolescents Anxiety Treatment 

Notes

Acknowledgments

This research was supported by grants (U01 MH064089, to Dr. Walkup; U01 MH64092, to Dr. Albano; U01 MH64003, to Dr. Birmaher; U01 MH63747, to Dr. Kendall, U01 MH64107, to Dr. March; U01 MH64088, to Dr. Piacentini; and U01 MH064003, to Dr. Compton) from the National Institute of Mental Health. Sertraline and matching placebo were supplied free of charge by Pfizer. Views expressed within this article represent those of the authors and are not intended to represent the position of NIMH, NIH, or DHHS.

References

  1. 1.
    Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 60(8):837–844PubMedCrossRefGoogle Scholar
  2. 2.
    Ezpeleta L, Keeler G, Erkanli A, Costello EJ, Angold A (2001) Epidemiology of psychiatric disability in childhood and adolescence. J Child Psychol Psychiatry 42(7):901–914PubMedCrossRefGoogle Scholar
  3. 3.
    Van Ameringen M, Mancini C, Farvolden P (2003) The impact of anxiety disorders on educational achievement. J Anxiety Disord 17(5):561–571PubMedCrossRefGoogle Scholar
  4. 4.
    Bittner A, Egger HL, Erkanli A, Jane costello E, Foley DL, Angold A (2007) What do childhood anxiety disorders predict? J Child Psychol Psychiatry 48(12):1174–1183PubMedCrossRefGoogle Scholar
  5. 5.
    Costello EJ, Angold A (eds) (1995) Epidemiology. Guilford, New YorkGoogle Scholar
  6. 6.
    Ferdinand RF, Verhurlst FC (1995) Psychopathology from adolescence into young adulthood: an 8-year follow-up study. Am J Psychiatry 152:1586–1594PubMedGoogle Scholar
  7. 7.
    Swendsen J, Conway KP, Degenhardt L, Glantz M, Jin R, Merikangas KR et al (2010) Mental disorders as risk factors for substance use, abuse and dependence: results from the 10-year follow-up of the National Comorbidity Survey. Addiction 105(6):1117–1128PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Woodward LJ, Fergusson DM (2001) Life course outcomes of young people with anxiety disorders in adolescence. J Am Acad Child Adolesc Psychiatry 40(9):1086–1093PubMedCrossRefGoogle Scholar
  9. 9.
    Beidel DC, Christ MAG, Long PJ (1991) Somatic complaints in anxious children. J Abnorm Child Psychol 19:659–670PubMedCrossRefGoogle Scholar
  10. 10.
    Ginsburg GS, Riddle MA, Davies M (2006) Somatic symptoms in children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry 45(10):1179–1187PubMedCrossRefGoogle Scholar
  11. 11.
    Hofflich SA, Hughes AA, Kendall PC (2006) Somatic complaints and childhood anxiety disorders. Int J Clin Health Psychol 6:229–242Google Scholar
  12. 12.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed.). Author, WashingtonGoogle Scholar
  13. 13.
    Garber J, Walker LS, Zeman J (1991) Somatization symptoms in a community sample of children and adolescents: further validation of the Children’s Somatization Inventory. Psychol Assess 3(4):588–595CrossRefGoogle Scholar
  14. 14.
    Kingery JN, Ginsburg GS, Alfano CA (2007) Somatic symptoms and anxiety among African American adolescents. J Black Psychol 33(4):363–378CrossRefGoogle Scholar
  15. 15.
    Last CG (1991) Somatic complaints in anxiety disordered children. J Anxiety Disord 5(2):125–138CrossRefGoogle Scholar
  16. 16.
    Storch EA, Merlo LJ, Keeley ML, Grabill K, Milsom VA, Geffken GR et al (2008) Somatic symptoms in children and adolescents with obsessive-compulsive disorder: associations with clinical characteristics and cognitive-behavioral therapy response. Behav Cogn Psychother 36(03):283–297CrossRefGoogle Scholar
  17. 17.
    Hughes AA, Lourea-Waddell B, Kendall PC (2008) Somatic complaints in children with anxiety disorders and their unique prediction of poorer academic performance. Child Psychiatry Hum Dev 39(2):211–220PubMedCrossRefGoogle Scholar
  18. 18.
    Bernstein GA, Massie ED, Thuras PD, Perwien AR, Borchardt CM, Crosby RD (1997) Somatic symptoms in anxious-depressed school refusers. J Am Acad Child Adolesc Psychiatry 36(5):661–668PubMedCrossRefGoogle Scholar
  19. 19.
    Masia-Warner C, Colognori D, Kim RE, Reigada LC, Klein RG, Browner-Elhanan KJ et al (2011) Cognitive-behavioral treatment of persistent functional somatic complaints and pediatric anxiety: an initial controlled trial. Depress Anxiety 28(7):551–559PubMedCentralCrossRefGoogle Scholar
  20. 20.
    Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT et al (2008) Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med 359(26):2753–2766PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Silverman WK, Albano AM (1996) The anxiety disorders interview schedule for DSM-IV-child and parent versions. Graywind Publications, San AntonioGoogle Scholar
  22. 22.
    Compton SN, Walkup JT, Albano AM, et al. Child/adolescent anxiety multimodal study (CAMS): rationale, design, and methods. Child Adolesc Psychiatry Ment Health 4(1): 1–15Google Scholar
  23. 23.
    Hollingshead AB (1975). Four factor index of social status. Unpublished manuscript. Department of Sociology, Yale UniversityGoogle Scholar
  24. 24.
    Kendall PC, Compton SN, Walkup JT, Birmaher B, Albano AM, Sherrill J et al (2010) Clinical characteristics of anxiety disordered youth. J Anxiety Disord 24(3):360–365PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Silverman WK, Nelles WB (1988) The anxiety disorders interview schedule for children. J Am Acad Child Adolesc Psychiatry 27(6):772–778PubMedCrossRefGoogle Scholar
  26. 26.
    Silverman WK, Eisen AR (1992) Age differences in the reliability of parent and child reports of child anxious symptomatology using a structured interview. J Am Acad Child Adolesc Psychiatry 31(1):117–124PubMedCrossRefGoogle Scholar
  27. 27.
    Emslie G, Kratochvil C, Vitiello B, Silva S, Mayes T, McNulty S et al (2006) Treatment for adolescents with depression study (TADS): safety results. J Am Acad Child Adolesc Psychiatry 45(12):1440–1455PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Research Units on Pediatric Psychopharmacology Anxiety Study (2002) The pediatric anxiety rating scale (PARS): development and psychometric properties. J Am Acad Child Adolesc Psychiatry 41:1061–1069CrossRefGoogle Scholar
  29. 29.
    Ginsburg GS, Keeton CP, Drazdowski TK, Riddle MA (2011) The utility of clinicians ratings of anxiety using the pediatric anxiety rating scale (PARS). Child Youth Care Forum 40(2):93–105CrossRefGoogle Scholar
  30. 30.
    Shaffer D (1983) A children’s global assessment scale (CGAS). Arch Gen Psychiatry 40(11):1228–1231PubMedCrossRefGoogle Scholar
  31. 31.
    Bird HR (1987) Further measures of the psychometric properties of the children’s global assessment scale. Arch Gen Psychiatry 44(9):821–824PubMedCrossRefGoogle Scholar
  32. 32.
    Guy W (1976) ECDEU assessment manual for psychopharmacology, revised. National Institute of Mental Health, RockvilleGoogle Scholar
  33. 33.
    Kendall PC, Hedtke K (2006) Cognitive-behavioral therapy for anxious children: therapist manual (3rd ed). Workbook Publishing, ArdmoreGoogle Scholar
  34. 34.
    Kendall PC, Hedtke K (2006) Coping cat workbook (2nd ed.). Workbook Publishing, ArdmoreGoogle Scholar
  35. 35.
    Kendall PC, Choudhury M, Hudson J, Webb A (2002) The C.A.T project workbook for the cognitive-behavioral treatment of anxious adolescents. Workbook Publishing, ArdmoreGoogle Scholar
  36. 36.
    Podell JL, Kendall PC, Gosch EA, Compton SN, March JS, Albano AM, Piacentini JC (2013) Therapist factors and outcomes in CBT for anxiety in youth. Prof Psychol Res Pract 44(2):89CrossRefGoogle Scholar
  37. 37.
    Safer DJ, Zito JM (2006) Treatment-emergent adverse effects from selective serotonin reuptake inhibitors by age group: children versus adolescents. J Child Adolesc Psychopharmacol 16:159–169PubMedCrossRefGoogle Scholar
  38. 38.
    Ialongo N, Edelsohn G, Werthamer-Larsson L, Crockett L, Kellam S (1995) The significance of self-reported anxious symptoms in first grade children: prediction to anxious symptoms and adaptive functioning in fifth grade. J Child Psychol Psychiatry 36(3):427–437PubMedCrossRefGoogle Scholar
  39. 39.
    Strauss CC, Frame CL, Forehand R (1987) Psychosocial impairment associated with anxiety in children. J Clin Child Psychol 16(3):235–239CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Sarah A. Crawley
    • 1
  • Nicole E. Caporino
    • 1
  • Boris Birmaher
    • 2
  • Golda Ginsburg
    • 3
  • John Piacentini
    • 4
  • Anne Marie Albano
    • 5
  • Joel Sherrill
    • 6
  • Dara Sakolsky
    • 2
  • Scott N. Compton
    • 7
  • Moira Rynn
    • 5
  • James McCracken
    • 4
  • Elizabeth Gosch
    • 8
  • Courtney Keeton
    • 3
  • John March
    • 7
  • John T. Walkup
    • 9
  • Philip C. Kendall
    • 1
    Email author
  1. 1.Department of PsychologyTemple UniversityPhiladelphiaUSA
  2. 2.Western Psychiatric Institute and ClinicUniversity of Pittsburgh Medical CenterPittsburghUSA
  3. 3.Division of Child and Adolescent PsychiatryThe Johns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Semel Institute for Neuroscience and Human BehaviorUniversity of California Los AngelesLos AngelesUSA
  5. 5.Department of PsychiatryColumbia University Medical CenterNew YorkUSA
  6. 6.Division of Services and Intervention ResearchNational Institute of Mental HealthBethesdaUSA
  7. 7.Department of Psychiatry and Behavioral ServicesDuke University Medical CenterDurhamUSA
  8. 8.Department of PsychologyPhiladelphia College of Osteopathic MedicinePhiladelphiaUSA
  9. 9.Division of Child and Adolescent PsychiatryWeill Cornell Medical CollegeNew YorkUSA

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