Current Psychiatry Reports

, Volume 13, Issue 2, pp 99–110

Assessment and Treatment of Anxiety Disorders in Children and Adolescents

  • Sucheta D. Connolly
  • Liza Suarez
  • Carrie Sylvester


This article reviews the current screening and assessment tools for anxiety disorders in children and adolescents, as well as evidence-based treatment interventions for these disorders. The following anxiety disorders are discussed: separation anxiety disorder, generalized anxiety disorder, specific phobia, panic disorder, social anxiety disorder (social phobia), and selective mutism. There are several well-studied screening and assessment tools to identify childhood anxiety disorders early and differentiate the various anxiety disorders. Evaluations of baseline somatic symptoms, severity, and impairment ratings of the anxiety disorders, and collecting ratings from several sources is clinically helpful in assessment and treatment follow-up. Cognitive-behavioral therapy (CBT) has been extensively studied and has shown good efficacy in treatment of childhood anxiety disorders. A combination of CBT and medication may be required for moderate to severely impairing anxiety disorders and may improve functioning better than either intervention alone. Selective serotonin reuptake inhibitors are currently the only medications that have consistently shown efficacy in treatment of anxiety disorders in children and adolescents. Despite proven efficacy, the availability of CBT in the community is limited. Current research is focusing on early identification of anxiety disorders in community settings, increasing the availability of evidence-based interventions, and modification of interventions for specific populations.


Childhood anxiety disorders Screening Assessment CBT Psychopharmacology 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Costello EJ, Egger HL, Angold A: Developmental epidemiology of anxiety disorders, in Phobic and Anxiety Disorders in Children and Adolescents, Edited by Ollendick TH, March JS. New York, Oxford University Press, 2004, pp 334-380.Google Scholar
  2. 2.
    Egger HL, Angold A: Common emotional and behavioral disorders in preschool children: Presentation, nosology, and epidemiology. J Child Psychol Psychiatry, 47, 313–337, 2006.PubMedCrossRefGoogle Scholar
  3. 3.
    Bittner A, Egger HL, Erkanli A, et al.: What do childhood anxiety disorders predict? J Child Psychol Psychiatry 48:1174–1183, 2007.PubMedCrossRefGoogle Scholar
  4. 4.
    Ialongo N, Edelsohn G, Werthamer-Larsson L, et al: 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 36:427–437, 1995.PubMedCrossRefGoogle Scholar
  5. 5.
    Woodward LJ, Fergusson DM: Life course outcomes of young people with anxiety disorders in adolescence. J Am Acad Child Adolesc Psychiatry 40:1086–1093, 2001.PubMedCrossRefGoogle Scholar
  6. 6.
    Marquenie LA, Schade A, van Balkom A JLM, et al: Origin of the comorbidity of anxiety disorders and alcohol dependence: Findings from a general population study. Eur Addict Res 13:39–49, 2007.PubMedCrossRefGoogle Scholar
  7. 7.
    Weissman MM, Wokk S, Wickramaratne P, et al: Children with prepubertal-onset major depressive disorder and anxiety group up. Arch Gen Psychiatry 56:794–801, 1999.PubMedCrossRefGoogle Scholar
  8. 8.
    Verduin TL, Kendall PC: Differential occurrence of comorbidity within childhood anxiety disorders. J Clin Child and Adoles Psychology 32:290–295, 2003.CrossRefGoogle Scholar
  9. 9.
    Lewinsohn PM, Zinbarg R, Seeley JR, et al: Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents. J Anxiety Disord 11:377–394, 1997.PubMedCrossRefGoogle Scholar
  10. 10.
    Kendall PC, Brady EU, Verduin TL. Comorbidity in childhood anxiety disorders and treatment outcome. J Am Acad Child Adolesc Psychiatry 40:787–794, 2001.PubMedCrossRefGoogle Scholar
  11. 11.
    Schuckit MA, Hesselbrock V: Alcohol dependence and anxiety disorders: what is the relationship? Am J Psychiatry 151:1723–1734, 1994.PubMedGoogle Scholar
  12. 12.
    Chavira DA, Stein MB, Bailey K, Stein MT: Child anxiety in primary care: prevalent but untreated. Depress Anxiety 2004, 20:155–164.PubMedCrossRefGoogle Scholar
  13. 13.
    Connolly SD, Suarez LM. Generalized anxiety disorder, specific phobia, panic disorder, social phobia and selective mutism. In Dulcan MK, ed. Dulcan’s Textbook of Child and Adolescent Psychiatry. American Psychiatric Publishing, Inc; 2009.Google Scholar
  14. 14.
    Murray L, Creswell C, Cooper PJ: The development of anxiety disorders in childhood: an integrative review. Psychological Medicine 2009, 39:1413–1423.PubMedCrossRefGoogle Scholar
  15. 15.
    American Academy of Child and Adolescent Psychiatry: Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry 46:267–283, 2007.Google Scholar
  16. 16.
    Choudhury MS, Pimentel SS, Kendall PC: Childhood anxiety disorders: parent-child (dis) agreement using a structured interview for the DSM-IV. J Am Acad Child Adolesc Psychiatry 42:957–964, 2003.PubMedCrossRefGoogle Scholar
  17. 17.
    March JS, Parker JD, Sullivan K, et al.: The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry 1997, 36: 554–565.PubMedCrossRefGoogle Scholar
  18. 18.
    Birmaher B, Brent DA, Chiapetta L, et al.: Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders Scale (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry 1999, 38: 1230–1236.PubMedCrossRefGoogle Scholar
  19. 19.
    Velting ON, Setzer NJ, Albano AM: Update and advances in assessment and cognitive-behavioral treatment of anxiety disorders in children and adolescents. Professional Psychology: Research and Practice 35:42–54, 2004.CrossRefGoogle Scholar
  20. 20.
    Research Units on Pediatric Psychopharmacology Anxiety Study Group. The Pediatric Anxiety Rating Scale (PARS): development and psychometric properties. J Am Acad Child Adolesc Psychiatry 2002, 41(9): 1061–9.CrossRefGoogle Scholar
  21. 21.
    Ollendick TH: Reliability and validity of the Revised Fear Survey Schedule for children (FSSC-R). Behav Res Ther 1983, 21: 395–399.CrossRefGoogle Scholar
  22. 22.
    La Greca AM: Manual and instructions for the SASC, SASC-R, SAS-A, and parent versions of the scales, 1999. Miami FL.Google Scholar
  23. 23.
    Beidel DC, Turner SM, Morris TL, et al.: A new inventory to assess childhood social anxiety and phobia: the Social Phobia and Anxiety Inventory for Children. Psychol Assess 1995, 7:73–79.CrossRefGoogle Scholar
  24. 24.
    Bergman RL, Keller ML, Piacentini J, et al: The development and psychometric properties of the Selective Mutism Questionnaire. J Clin Child Adolesc Psychology 37:456–464, 2008.CrossRefGoogle Scholar
  25. 25.
    Bailey KA, Chavira DA, Stein MT, Stein MB: Brief measures to screen for social phobia in primary care pediatrics. J Pediatric Psychology 2006, 31(5): 512–521.CrossRefGoogle Scholar
  26. 26.
    Silverman WK, Ollendick TH: Evidence-based assessment of anxiety and its disorders in children and adolescents. J Clin Child Adolesc Psychology 34:380–411, 2005.CrossRefGoogle Scholar
  27. 27.
    Silverman WK, Albano AM: Anxiety Disorders Interview Schedule for DSM-IV: Child Version, child and parent interview schedules. San Antonio, TX, Psychological Corporation, 1996.Google Scholar
  28. 28.
    Dadds MR, Spence SH, Holland D, et al: Early intervention and prevention of anxiety disorders: a controlled trial. J Consult Clin Psychol 65:627–635, 1997.PubMedCrossRefGoogle Scholar
  29. 29.
    Ginsburg GS, Schlossberg MC: Family-based treatment of childhood anxiety disorders. Int Rev Psychiatry 14:143–154, 2002.CrossRefGoogle Scholar
  30. 30.
    March JS, Ollendick TH: Integrated psychosocial and pharmacological treatment, in Phobic and Anxiety Disorders in Children and Adolescents. Edited by Ollendick TH, March JS. New York, Oxford University Press, 2004, pp 141-172.Google Scholar
  31. 31.
    Birmaher B, Axelson DA, Monk K, et al: Fluoxetine for the treatment of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry 42:415–423, 2003.PubMedCrossRefGoogle Scholar
  32. 32.
    Black B, Uhde TW: Treatment of elective mutism with fluoxetine: a double-blind, placebo-controlled study. J Am Acad Child Adolesc Psychiatry 33:1000–1006, 1994.PubMedCrossRefGoogle Scholar
  33. 33.
    Beidel DC, Turner SM, Sallee FR, Ammerman RT, Crosby LA, Pathak S: SET-C versus fluoxetine in the treatment of childhood social phobia. J Am Acad Child Adolesc Psychiatry 2007, 46(12):1622–1632.PubMedCrossRefGoogle Scholar
  34. 34.
    •• Walkup JT, Albano AM, Piacentini J, et al.: Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med 2008, 359: 2753–2766. This empiric article provides the results of the 12-week treatment phase of the CAMS study, the largest multisite randomized controlled study evaluating the relative and combined efficacy of CBT and SSRIs in youth with anxiety disorders in a clinically diagnosed sample. PubMedCrossRefGoogle Scholar
  35. 35.
    Compton SN, March JS, Brent D, et al: Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: an evidence-based medicine review. J Am Acad Child Adolesc Psychiatry 43:930–959, 2004.PubMedCrossRefGoogle Scholar
  36. 36.
    In-Albon T, Schneider S: Psychotherapy of childhood anxiety disorders: a meta-analysis. Psychother Psychosom 76:15–24, 2007.PubMedCrossRefGoogle Scholar
  37. 37.
    Hudson JL, Rapee RM, Deveney C, Schniering CA, Lyneham HJ, Bovopoulos N: Cognitive-behavioral treatment versus an active control for children and adolescents with anxiety disorders: a randomized trial. J Am Acad Child Adolesc Psychiatry 2009, 48(5): 533–544.PubMedCrossRefGoogle Scholar
  38. 38.
    Ishikawa S, Okajima I, Matsuoka H, Sakano Y: Cognitive behavioural therapy for anxiety disorders in child and adolescents: a meta-analysis. Child Adolesc Mental Health 2007, 12(4): 164–172.CrossRefGoogle Scholar
  39. 39.
    Liber JM, Van Widenfelt BM, Utens EMWJ, Ferdinand RF, Van der Leeden AJM, Van Gastel W, Treffers PDA: No differences between group versus individual treatment of childhood anxiety disorders in a randomized clinical trial. J Child Psychology Psychiatry 2008, 49(8): 886–893.CrossRefGoogle Scholar
  40. 40.
    Albano AM, Kendall PC: Cognitive behavioural therapy for children and adolescents with anxiety disorders: clinical research advances. Int Rev Psychiatry 2002, 14:129–134.CrossRefGoogle Scholar
  41. 41.
    Gosch EA, Flannery-Schroeder E, Mauro CF, Compton SN: Principles of cognitive-behavioral therapy for anxiety disorders in children. J Cognitive Psychotherapy: An International Quarterly 2006, 20(3): 247–262.CrossRefGoogle Scholar
  42. 42.
    • Hirschfeld-Becker DR, Masek B, Henin A et al.: Cognitive behavioral therapy for 4- to 7-year-old children with anxiety disorders: a randomized clinical trial. J Consulting Clinical Psychology 2010, 78(4): 498–510. This study examined the efficacy of a parent–child CBT protocol adapted for young children with anxiety disorders in a randomized clinical trial. CrossRefGoogle Scholar
  43. 43.
    Silverman WK, Pina AA, Viswesvaran C: Evidence-base psychosocial treatments for phobic and anxiety disorders in children and adolescents. J Clinical Child Adolesc Psychology 2008, 37: 105–130.CrossRefGoogle Scholar
  44. 44.
    Grover RL, Hughes AA, Bergman RL, et al: Treatment modifications based on childhood anxiety diagnosis: demonstrating the flexibility in manualized treatment. J Cognitive Psychotherapy: An International Quarterly 20:275–286, 2006.CrossRefGoogle Scholar
  45. 45.
    Albano AM, Marten PA, Holt CS, et al: Cognitive-behavioral group treatment for social phobia in adolescents. J Nerv Ment Dis 183:649–656, 1995.PubMedCrossRefGoogle Scholar
  46. 46.
    Beidel DC, Turner SM, Young BJ: Social effectiveness therapy for children: five years later. Behav Ther 2006, 37: 416–425.PubMedCrossRefGoogle Scholar
  47. 47.
    King NJ, Muris P, Ollendick TH: Childhood fears and phobias: assessment and treatment. Child Adolesc Mental Health 10(2):50–56, 2005.CrossRefGoogle Scholar
  48. 48.
    Barlow DH, Craske MG: Mastery of your anxiety and panic: Therapist Guide. New York, NY, Oxford University Press, pp 209, 2007.Google Scholar
  49. 49.
    Cohan SL, Chavira DA, Stein MB: Practitioner review: Psychosocial interventions for children with selective mutism: a critical evaluation of the literature from 1990–2005. J Child Psychol Psychiatry 47:1085–1097, 2006.PubMedCrossRefGoogle Scholar
  50. 50.
    Cohan SL, Price JM, Stein MB: Suffering in silence: Why a developmental psychopathology perspective on selective mutism is needed. J Dev Behav Pediatr 27:341–355, 2006.PubMedCrossRefGoogle Scholar
  51. 51.
    Maid R, Smokowski P, Bacallao M: Family treatment of childhood anxiety. Child Family Social Work 2008, 13:433–442.CrossRefGoogle Scholar
  52. 52.
    Cobham VE, Dadds MR, Spence SH: The role of parental anxiety in the treatment of childhood anxiety. J Consult Clin Psychol 66:893–905, 1998.PubMedCrossRefGoogle Scholar
  53. 53.
    Khanna MS, Kendall PC: Exploring the role of parent training in the treatment of childhood anxiety. J Consult Clin Psychol 2009, 77(5): 981–986.PubMedCrossRefGoogle Scholar
  54. 54.
    Dadds MR, Roth JH. Family processes in the development of anxiety problems, in The Developmental Psychopathology of Anxiety, Edited by Vasey MW, Dadds MR, New York, Oxford University Press, 2001, pp 278–303.Google Scholar
  55. 55.
    Lis A, Zennaro A, Mazzeschi C: Child and adolescent empirical psychotherapy research: a review focused on cognitive-behavioral and psychodynamic-informed psychotherapy. Eur Psychol 2001, 6: 36–64.CrossRefGoogle Scholar
  56. 56.
    Muratori F, Picchi L, Bruni G, Patarnello, M, Romagnoli G: A two-year follow-up of psychodynamic psychotherapy for internalizing disorders in children. J Am Acad Child Adolesc Psychiatry 42: 331–339, 2003.PubMedCrossRefGoogle Scholar
  57. 57.
    Seidel L, Walkup JT: Selective serotonin reuptake inhibitor use in the treatment of pediatric non-obsessive-compulsive disorder anxiety disorders. J Child Adolesc Psychopharmacology 16:171–179, 2006.CrossRefGoogle Scholar
  58. 58.
    Research Units on Pediatric Psychopharmacology Anxiety Study Group (RUPP): Fluvoxamine for the treatment of anxiety disorders in children and adolescents. N Engl J Med 344:1279–1285, 2001.CrossRefGoogle Scholar
  59. 59.
    Rynn MA, Siqueland L, Rickels K: Placebo-controlled trial of sertraline in the treatment of children with generalized anxiety disorder. Am J Psychiatry 158:2008–2014, 2001.PubMedCrossRefGoogle Scholar
  60. 60.
    Wagner KD, Berard R, Stein MB, et al: A multicenter, randomized, double-blind, placebo-controlled trial of paroxetine in children and adolescents with social anxiety. Arch Gen Psychiatry 61:1153–1162, 2004.PubMedCrossRefGoogle Scholar
  61. 61.
    • Murphy TK, Segarra A, Storch EA, Goodman WK: SSRI adverse events: how to monitor and manage. International Review of Psychiatry 2008, 20(2): 203–208. This article reviews identification and management of side effects associated with SSRI treatment in children and adolescents. PubMedCrossRefGoogle Scholar
  62. 62.
    Reinblatt SP, Riddle MA: The pharmacological management of childhood anxiety disorders: a review. Psychopharmacology 191:67–86, 2007.PubMedCrossRefGoogle Scholar
  63. 63.
    Carlson JS, Kratochwill TR, Johnston HF: Sertraline treatment of 5 children diagnosed with selective mutism: a single-case research trial. J Child Adolesc Psychopharmacol 9:293–306, 1999.PubMedCrossRefGoogle Scholar
  64. 64.
    Renaud J, Birhamer B, Wassick SC, et al: Use of selective serotonin reuptake inhibitors for the treatment of childhood panic disorder: a pilot study. J Child Adolesc Psychopharmacol 9:73–83, 1999.PubMedCrossRefGoogle Scholar
  65. 65.
    Fairbanks JM, Pine DS, Tancer NK, et al.: Open fluoxetine treatment of mixed anxiety disorders in children and adolescents. J Child Adolesc Psychopharmacol 1997, 7: 17–29.PubMedCrossRefGoogle Scholar
  66. 66.
    Masi G, Toni C, Mucci M, et al.: Paroxetine in child and adolescent outpatients with panic disorder. J Child Adolesc Psychopharmacol 2001, 11: 151–157.PubMedCrossRefGoogle Scholar
  67. 67.
    Pine DS: Treating children and adolescents with selective serotonin reuptake inhibitors: how long is appropriate? J Child Adolesc Psychopharmacol 12:189–203, 2002.PubMedCrossRefGoogle Scholar
  68. 68.
    Safer DJ, Zito JM: Treatment-emergent adverse events from selective serotonin reuptake inhibitors by age group: children versus adolescents. J Child Adolesc Psychopharmacol 16:159–169, 2006.PubMedCrossRefGoogle Scholar
  69. 69.
    Labellarte M, Biederman J, Emslie G, et al: Multiple-dose pharmacokinetics of fluvoxamine in children and adolescents. J Am Acad Child Adolesc Psychiatry 43:1497–1505, 2004.PubMedCrossRefGoogle Scholar
  70. 70.
    Rynn MA, Riddle MA, Yeung PP, et al: Efficacy and safety of extended-release venlafaxine in the treatment of generalized anxiety disorder in children and adolescents: Two placebo-controlled trials. Am J Psychiatry 164:290–300, 2007.PubMedCrossRefGoogle Scholar
  71. 71.
    Tourian KA, March JS, Mangano RM: Venlafaxine ER in children and adolescents with social anxiety disorder. Poster: American Psychiatric Association Meeting, New York, 2004.Google Scholar
  72. 72.
    Gittelman-Klein R, Klein DF: Controlled imipramine treatment of school phobia. Arch Gen Psychiatry 25:204–207, 1971.Google Scholar
  73. 73.
    Berney T, Kolvin I, Bhate SR, et al: School phobia: a therapeutic trial with clomipramine and short-term outcome. Br J Psychiatry 138:110–118, 1981.PubMedCrossRefGoogle Scholar
  74. 74.
    Klein RG, Kopelwicz HS, Kanner A: Imipramine treatment in children with separation anxiety disorder. J Am Acad Child Adolesc Psychiatry 31:21–28, 1992.PubMedCrossRefGoogle Scholar
  75. 75.
    Bernstein GA, Borchardt CM, Perwein AR, Crosby RD, Kushner MG, Thuras PD, Last CG: Imipramine plus cognitive-behaviral therapy in the treatment of school refusal. J Am Acad Child Adolesc Psychiatry 2000, 39: 276–283.PubMedCrossRefGoogle Scholar
  76. 76.
    Simeon JV, Knott VJ, Dubois C, et al: Buspirone therapy of mixed anxiety disorders in childhood and adolescence: a pilot study. J Child Adolesc Psychopharmacol 1994, 4(3):159–170.CrossRefGoogle Scholar
  77. 77.
    Salazar DE, Frackiewicz EJ, Dockens R, et al: Pharmacokinetics and tolerability of buspirone during oral administration to children and adolescents with anxiety disorder and normal healthy adults. J Clin Pharmacol 2001, 41:1351–1358.PubMedCrossRefGoogle Scholar
  78. 78.
    Birmaher B, Yelovich AK, Renaud J: Pharmacologic treatment for children and adolescents with anxiety disorders. Pediatric Clinics of North America 1998, 45(5): 1187–1204.PubMedCrossRefGoogle Scholar
  79. 79.
    Ressler KJ, Rothbaum BO, Tannenbaum L, et al.: Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear. Arch Gen Psychiatry 2004, 61: 1136–1144.PubMedCrossRefGoogle Scholar
  80. 80.
    Gleason MM, Egger HL, Emslie GJ, et al.: Psychopharmacological treatment for very young children; contexts and guidelines. J Am Acad Child Adolesc Psychiatry 2007, 46(12); 1532–1572.PubMedCrossRefGoogle Scholar
  81. 81.
    Weisz, Jensen & Dos: Youth psychotherapy outcome research: A review and critique of the evidence base. Annual Rev Psychol 2005, 56:337–63.Google Scholar
  82. 82.
    Bernstein GA, Bernat DH, Victor AM, Layne AE: School-based interventions for anxious children: 3-, 6-, and 12-month follow-ups. J Am Acad Child Adolesc Psychiatry 2008, 47(9): 1039–1047.PubMedGoogle Scholar
  83. 83.
    Farrell LJ, Barrett PM: Prevention of childhood emotional disorders: reducing the burden of suffering associated with anxiety and depression. Child Adolesc Mental Health 2007, 12(2): 58–65.CrossRefGoogle Scholar
  84. 84.
    Ginsburg GS, Drake KL: Anxiety sensitivity and panic attack symptomatology among low-income African-American adolescents. Anxiety Disorders 16:83–96, 2002.CrossRefGoogle Scholar
  85. 85.
    Wood JJ, Chiu AW, Hwang W-C, Jacobs J, Ifekwunigwe M: Adapting cognitive-behavioral therapy for Mexican American students with anxiety disorders: recommendations for school psychologist. School Psychol Quarterly 2008, 23(4): 515–532.CrossRefGoogle Scholar
  86. 86.
    Lyneham HJ, Rapee RM: Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children. Behav Res Ther 2006, 44: 1287–1300.PubMedCrossRefGoogle Scholar
  87. 87.
    • Salloum A: Minimal therapist-assisted cognitive-behavioral therapy interventions in stepped care for childhood anxiety. Professional Psychol: Research Practice 2010, 41(1): 41–47. This article reviews the evidence on minimal therapist-assisted CBT and general guidelines for use with childhood anxiety in a stepped care model. CrossRefGoogle Scholar
  88. 88.
    Creswell C, Hentges F, Parkinson M, Sheffield P, Willetts L, Cooper P: Feasibility of guided Cognitive behaviour therapy (CBT) self-help for childhood anxiety disorders in primary care. Mental Health Family Medicine 2010, 7: 49–57.Google Scholar
  89. 89.
    Salloum A, Sulkowski ML, Sirrine E, Storch EA: Overcoming barriers to using empirically supported therapies to treat childhood anxiety disorders in social work practice. Child Adolesc Soc Work J 2009, 26: 259–273.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Sucheta D. Connolly
    • 1
  • Liza Suarez
    • 1
  • Carrie Sylvester
    • 2
  1. 1.Department of Psychiatry/Institute for Juvenile ResearchUniversity of Illinois Medical Center at ChicagoChicagoUSA
  2. 2.Sound Mental HealthSeattleUSA

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