Anxiety in Youth: Assessment, Treatment, and School-Based Service Delivery

  • Kristy A. LudwigEmail author
  • Aaron R. Lyon
  • Julie L. Ryan


Anxiety is a natural, protective, and normal part of childhood. Temporary fears are developmentally typical; however, fears and worries that persist and impair functioning may be indicative of an anxiety disorder (Muris, Merckelbach, Mayer, & Prins, 2000). Anxiety disorders are the most common mental health problem in children and youth and are a significant source of distress for those afflicted (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003; Merikangas et al., 2011).


Autism Spectrum Disorder Autism Spectrum Disorder Anxiety Disorder Cognitive Behavioral Therapy Eating Disorder 
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  1. Aarons, G., Hurlburt, M., & Horwitz, S. (2011). Advancing a conceptual model of evidence-based practice implementation in child welfare. Administration and Policy in Mental Health, 38, 4–23.PubMedCentralPubMedCrossRefGoogle Scholar
  2. Adelman, H. S., & Taylor, L. (1999). Mental health in schools and system restructuring. Clinical Psychology Review, 19(2), 137–163.PubMedCrossRefGoogle Scholar
  3. Albano, A. M., & Detweiler, M. F. (2001). The developmental and clinical impact of social anxiety and social phobia in children and adolescents. In S. G. Hofmann & P. M. DiBartolo (Eds.), From social anxiety to social phobia: Multiple perspectives (pp. 162–178). Needham Heights, MA: Allyn and BaconGoogle Scholar
  4. Albano, A. M., & Kendall, P. C. (2002). Cognitive behavioural therapy for children and adolescents with anxiety disorders: Clinical research advances. International Review of Psychiatry, 14(2), 129–134.CrossRefGoogle Scholar
  5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Washington, DC: American Psychiatric Publishing.Google Scholar
  6. Anglin, T. M. (2003). Mental health in schools: Programs of the federal government. New York: Kluwer Academic/Plenum Publishers.Google Scholar
  7. Aydin, G., & Yerin, O. (1994). The effect of a story-based cognitive behavior modification procedure on reducing children’s test anxiety before and after cancellation of an important examination. International Journal for the Advancement of Counselling, 17(2), 149–161.CrossRefGoogle Scholar
  8. Becker, E. M., Becker, K. D., & Ginsburg, G. S. (2012). Modular cognitive behavioral therapy for youth with anxiety disorders: A closer look at the use of specific modules and their relation to treatment process and response. School Mental Health, 4(4), 243–253.CrossRefGoogle Scholar
  9. Beidas, R. S., & Kendall, P. C. (2010). Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology: Science & Practice, 17, 1–30.Google Scholar
  10. Beidas, R. S., Mychailyszyn, M. P., Edmunds, J. M., Khanna, M. S., Downey, M. M., & Kendall, P. C. (2012). Training school mental health providers to deliver cognitive-behavioral therapy. School Mental Health, 1–10.Google Scholar
  11. Beidel, D. C., Turner, S. M., & Morris, T. L. (1998). Social effectiveness therapy for children: A treatment manual. Charleston: Medical University of South Carolina.Google Scholar
  12. Benjamin, R. S., Costello, E. J., & Warren, M. (1990). Anxiety disorders in a pediatric sample. Journal of Anxiety Disorders, 4(4), 293–316.CrossRefGoogle Scholar
  13. Bittner, A., Egger, H. L., Erkanli, A., Jane Costello, E., Foley, D. L., & Angold, A. (2007). What do childhood anxiety disorders predict? Journal of Child Psychology and Psychiatry, and Allied Disciplines, 48(12), 1174–1183.PubMedCrossRefGoogle Scholar
  14. Brady, E. U., & Kendall, P. C. (1992). Comorbidity of anxiety and depression in children and adolescents. Psychological Bulletin, 111(2), 244–255.PubMedCrossRefGoogle Scholar
  15. Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. [Review]. Journal of Consulting and Clinical Psychology, 66(1), 7–18.PubMedCrossRefGoogle Scholar
  16. Chorpita, B. F. (2007). Modular cognitive behavioral therapy for childhood anxiety disorders. New York: Guilford Press.Google Scholar
  17. Chorpita, B. F., & Daleiden, E. L. (2007). Biennial report: Effective psychosocial interventions for youth with behavioral and emotional needs. Honolulu, HI: Child and Adolescent Mental Health Division, Hawaii Department of Health.Google Scholar
  18. Chorpita, B. F., Daleiden, E. L., & Weisz, J. R. (2005). Modularity in the design and application of therapeutic interventions. Applied and Preventive Psychology, 11(3), 141–156.CrossRefGoogle Scholar
  19. Chorpita, B. F., Yim, L. M., Donkervoet, J. C., Arensdorf, A., Amundsen, M. J., McGee, C., et al. (2002). Toward large-scale implementation of empirically supported treatments for children: A review and observations by the Hawaii Empirical Basis to Services Task Force. Clinical Psychology: Science and Practice, 9, 165–190.Google Scholar
  20. Collins, K. A., Westra, H. A., Dozois, D. J., & Burns, D. D. (2004). Gaps in accessing treatment for anxiety and depression: Challenges for the delivery of care. [Review]. Clinical Psychology Review, 24(5), 583–616.PubMedCrossRefGoogle Scholar
  21. Compton, S. N., March, J. S., Brent, D., Albano, A. M., Weersing, V. R., & Curry, J. (2004). Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: An evidence-based medicine review. Journal of the American Academy of Child & Adolescent Psychiatry, 43(8), 930–959.CrossRefGoogle Scholar
  22. Constantino, G., Malgady, R. G., & Rogler, L. H. (1994). Storytelling through pictures: Culturally sensitive psychotherapy for Hispanic children and adolescents. Journal of Clinical Child Psychology, 23(1), 13–20.Google Scholar
  23. Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60(8), 837–844.PubMedCrossRefGoogle Scholar
  24. Demertzis, K. H., & Craske, M. G. (2012). Cognitive-behavioral therapy for anxiety disorders in primary care. Primary Psychiatry. Retrieved from Scholar
  25. Eldevik, S., Hastings, R. P., Hughes, J. C., Jahr, E., Eikeseth, S., & Cross, C. (2009). Meta-analysis of early intensive behavioral intervention for children with autism. Journal of Clinical Child & Adolescent Psychology, 38(3), 439–450.CrossRefGoogle Scholar
  26. Evans, S. W., & Weist, M. D. (2004). Implementing empirically supported treatments in the schools: What are we asking? Clinical Child and Family Psychology Review, 7(4), 263–267.PubMedCrossRefGoogle Scholar
  27. Farahmand, F. K., Grant, K. E., Polo, A. J., & Duffy, S. N. (2011). School-based mental health and behavioral programs for low-income, urban youth: A systematic and meta-analytic review. Clinical Psychology: Science and Practice, 18(4), 372–390.Google Scholar
  28. Farmer, E. M., Burns, B. J., Phillips, S. D., Angold, A., & Costello, E. J. (2003). Pathways into and through mental health services for children and adolescents. Psychiatric Services, 54(1), 60–66.PubMedCrossRefGoogle Scholar
  29. Fergusson, D. M., & Woodward, L. J. (2002). Mental health, educational, and social role outcomes of adolescents with depression. Archives of General Psychiatry, 59(3), 225–231.PubMedCrossRefGoogle Scholar
  30. Fisher, P. H., Wasian Warner, C., & Klein, R. G. (2004). Skills for social and academic success: A school-based intervention for social anxiety disorder in adolescents. Clinical Child and Family Psychology Review, 7, 241–249.Google Scholar
  31. Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network.Google Scholar
  32. Forman, S. G., & Barakat, N. M. (2011). Cognitive-behavioral therapy in the schools: Bringing research to practice through effective implementation. Psychology in the Schools, 48(3), 283–296.CrossRefGoogle Scholar
  33. Foster, E. M., & Connor, T. (2005). The public costs of better mental health services for children and adolescent. Psychiatric Services, 56, 50–55.PubMedCrossRefGoogle Scholar
  34. Franklin, C., Kim, J. S., & Tripodi, S. J. (2009). A meta-analysis of published school social work practice studies: 1980-2007. Research on Social Work Practice, 19(6), 667–677.CrossRefGoogle Scholar
  35. Ginsburg, G. S., Becker, K. D., Kingery, J. N., & Nichols, T. (2008). Transporting CBT for childhood anxiety disorders into inner-city school-based mental health clinics. Cognitive and Behavioral Practice, 15(2), 148–158.CrossRefGoogle Scholar
  36. Ginsburg, G. S., & Drake, K. L. (2002). School-based treatment for anxious African-American adolescents: A controlled pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 768–775.PubMedCrossRefGoogle Scholar
  37. Gregory, A. M., Caspi, A., Moffitt, T. E., Koenen, K., Eley, T. C., & Poulton, R. (2007). Juvenile mental health histories of adults with anxiety disorders. American Journal of Psychiatry, 164(2), 301–308.PubMedCrossRefGoogle Scholar
  38. Gryczkowski, M. R., Tiede, M. S., Dammann, J. E., Brown Jacobsen, A., Hale, L. R., & Whiteside, S. P. (2013). The timing of exposure in clinic-based treatment for childhood anxiety disorders. Behavior Modification, 37(1), 113–127.PubMedCrossRefGoogle Scholar
  39. Hoagwood, K. E., Serene Olin, S., Kerker, B. D., Kratochwill, T. R., Crowe, M., & Saka, N. (2007). Empirically based school interventions targeted at academic and mental health functioning. Journal of Emotional and Behavioral Disorders, 15(2), 66–92.CrossRefGoogle Scholar
  40. Ialongo, N., Edelson, G., Werthamer-Larsson, L., Crockett, L., & Kellam, S. (1996). Social and cognitive impairment in first-grade children with anxious and depressive symptoms. Journal of Clinical Child Psychology, 25(1), 15.CrossRefGoogle Scholar
  41. Kashani, J. H., & Orvaschel, H. (1990). A community study of anxiety in children and adolescents. American Journal of Psychiatry, 147(3), 313–318.PubMedGoogle Scholar
  42. Kataoka, S., Jaycox, L. H., Wong, M., Nadeem, E., Langley, A., Tang, L., et al. (2011). Effects on school outcomes in low-income minority youth: Preliminary findings from a community-partnered study of a school-based trauma intervention. Ethnicity and Disease, 21(3 Suppl 1), 71–77.Google Scholar
  43. Kataoka, S. H., Stein, B. D., Jaycox, L. H., Wong, M., Escudero, P., Tu, W., et al. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(3), 311–318.PubMedCrossRefGoogle Scholar
  44. Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among US children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159, 1548–1555.PubMedCrossRefGoogle Scholar
  45. Keel, P. K., & Haedt, A. (2008). Evidence-based psychosocial treatments for eating problems and eating disorders. Journal of Clinical Child & Adolescent Psychology, 37(1), 39–61.CrossRefGoogle Scholar
  46. Kendall, P. C. (1994). Treating anxiety disorder in youth: Results of randomized clinical trial. Journal of Consulting and Clinical Psychology, 62(10).Google Scholar
  47. Kendall, P. C., Brady, E. U., & Verduin, T. L. (2001). Comorbidity in childhood anxiety disorders and treatment outcome. Journal of the American Academy of Child and Adolescent Psychiatry, 40(7), 787–794.PubMedCrossRefGoogle Scholar
  48. Kendall, P. C., Kortlander, E., Chansky, T. E., & Brady, E. U. (1992). Comorbidity of anxiety and depression in youth: Treatment implications. Journal of Consulting and Clinical Psychology, 60(6), 869–880.PubMedCrossRefGoogle Scholar
  49. Kendall, P. C., Safford, S., Flannery-Schroeder, E., & Webb, A. (2004). Child anxiety treatment: Outcomes in adolescence and impact on substance use and depression at 7.4-year follow-up. Journal of Consulting and Clinical Psychology, 72(2), 276–287.PubMedCrossRefGoogle Scholar
  50. Kendall, P. C., & Southam-Gerow, M. A. (1996). Long-term follow-up of a cognitive-behavioral therapy for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 64(4), 724–730.PubMedCrossRefGoogle Scholar
  51. Kessler, R. C. (2003). The impairments caused by social phobia in the general population: Implications for intervention. Acta Psychiatrica Scandinavica. Supplementum, 417, 19–27.PubMedCrossRefGoogle Scholar
  52. Langley, A. K., Nadeem, E., Kataoka, S. H., Stein, B. D., & Jaycox, L. H. (2010). Evidence-based mental health programs in schools: Barriers and facilitators of successful implementation. School Mental Health, 2(3), 105–113.PubMedCentralPubMedCrossRefGoogle Scholar
  53. Last, C. G., Strauss, C. C., & Francis, G. (1987). Comorbidity among childhood anxiety disorders. Journal of Nervous and Mental Disease, 175(12), 726–730.PubMedCrossRefGoogle Scholar
  54. Lowry-Webster, H. M., Barrett, P. M., & Lock, S. (2003). A universal prevention trial of anxiety symptomology during childhood: Results at 1-year follow-up. Behaviour Change, 20(01), 25–43.CrossRefGoogle Scholar
  55. Lyon, A. R., Charlseworth-Attie, S., Vander Stoep, A., & McCauley, E. (2011). Modular psychotherapy for youth with internalizing problems: Implementation with therapists in school-based health centers. School Psychology Review, 40(4), 569–581.Google Scholar
  56. Lyon, A. R., Ludwig, K., Vander Stoep, A., Gudmundsen, G., & McCauley, E. (2013). Patterns and predictors of mental healthcare utilization in schools and other service sectors among adolescents at risk for depression. School Mental Health, 5, 155–165.Google Scholar
  57. Lyon, A. R., McCauley, E., & Vander Stoep, A. (2011). Toward successful implementation of evidence-based practices: Characterizing the intervention context of counselors in school-based health centers. Report on Emotional and Behavioral Disorders in Youth, 11, 19–25.Google Scholar
  58. Manassis, K., Wilansky-Traynor, P., Farzan, N., Kleiman, V., Parker, K., & Sanford, M. (2010). The feelings club: Randomized controlled evaluation of school-based CBT for anxious or depressive symptoms. Depression and Anxiety, 27(10), 945–952.PubMedCrossRefGoogle Scholar
  59. Mash, E. J., & Hunsley, J. (2005). Evidence-based assessment of child and adolescent disorders: Issues and challenges. Journal of Clinical Child & Adolescent Psychology, 34(3), 362–379.CrossRefGoogle Scholar
  60. Masia Warner, C., Fisher, P. H., Shrout, P. E., Rathor, S., & Klein, R. G. (2007). Treating adolescents with social anxiety disorder in school: An attention control trial. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 48(7), 676–686.PubMedCrossRefGoogle Scholar
  61. Masia Warner, C., Klein, R. G., Dent. H. C., Fisher, P. H., Alvir, J., Albano, A. M., et al. (2005). School-based intervention for adolescents with social anxiety disorder: Results of a controlled study. Journal of Abnormal Child Psychology, 33, 707–722.Google Scholar
  62. Masia, C., Beidel, D. C., Albano, A. M., Rapee, R. M., Turner, S. M., Morris, T. L., et al. (1999). Skills for academic and social success. Available from Carrie Masia Warner, PhD, New York University School of Medicine, Child Study Center.Google Scholar
  63. McLoone, J., Hudson, J. L., & Rapee, R. M. (2006). Treating anxiety disorders in a school setting. Education and Treatment of Children, 29(2), 219–242.Google Scholar
  64. McLoone, J. K., & Rapee, R. M. (2012). Comparison of an anxiety management program for children implemented at home and school: Lessons learned. School Mental Health, 4(4), 231–242.CrossRefGoogle Scholar
  65. Merikangas, K. R., He, J. P., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., et al. (2011). Service utilization for lifetime mental disorders in U.S. adolescents: Results of the National Comorbidity Survey–Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 32–45.PubMedCrossRefGoogle Scholar
  66. Muris, P., Meesters, C., & van Melick, M. (2002). Treatment of childhood anxiety disorders: A preliminary comparison between cognitive-behavioral group therapy and a psychological placebo intervention. Journal of Behavior Therapy and Experimental Psychiatry, 33(3), 143–158.Google Scholar
  67. Muris, P., Merckelbach, H., Mayer, B., & Prins, E. (2000). How serious are common childhood fears? Behaviour Research and Therapy, 38(3), 217–228.PubMedCrossRefGoogle Scholar
  68. Mychailyszyn, M. P., Mendez, J. L., & Kendall, P. C. (2010). School functioning in youth with and without anxiety disorders: Comparisons by diagnosis and comorbidity. School Psychology Review, 39(1), 15.Google Scholar
  69. Olfson, M., Guardino, M., Struening, E., Schneier, F. R., Hellman, F., & Klein, D. F. (2000). Barriers to the treatment of social anxiety. American Journal of Psychiatry, 157(4), 521–527.PubMedCrossRefGoogle Scholar
  70. Pincus, D. (2012). Growing up brave: Expert strategies for helping your child overcome fear, stress, and anxiety: Little Brown and Company, New York.Google Scholar
  71. Pine, D. S., Cohen, P., Gurley, D., Brook, J., & Ma, Y. (1998). The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry, 55(1), 56–64.PubMedCrossRefGoogle Scholar
  72. PracticeWise. (2013). Evidence-based services database. Satellite Beach, FL: PracticeWise.Google Scholar
  73. Rapee, R. M., Schniering, C. A., & Hudson, J. L. (2009). Anxiety disorders during childhood and adolescence: Origins and treatment. Annual Review of Clinical Psychology, 5, 311–341.PubMedCrossRefGoogle Scholar
  74. Rogers, S. J., & Vismara, L. A. (2008). Evidence-based comprehensive treatments for early autism. Journal of Clinical Child & Adolescent Psychology, 37(1), 8–38.CrossRefGoogle Scholar
  75. Ryan, J. L., & Warner, C. M. (2012). Treating adolescents with social anxiety disorder in schools. Child and Adolescent Psychiatric Clinics of North America, 21(1), 105–118.PubMedCentralPubMedCrossRefGoogle Scholar
  76. Saavedra, L. M., Silverman, W. K., Morgan-Lopez, A. A., & Kurtines, W. M. (2010). Cognitive behavioral treatment for childhood anxiety disorders: Long-term effects on anxiety and secondary disorders in adulthood. Journal of Child Psychology and Psychiatry, 51(8), 924–934.PubMedCrossRefGoogle Scholar
  77. Schneier, F. R., Johnson, J., Hornig, C. D., Liebowitz, M. R., & Weissman, M. M. (1992). Social phobia. Comorbidity and morbidity in an epidemiologic sample. Archives of General Psychiatry, 49(4), 282–288.PubMedCrossRefGoogle Scholar
  78. Silverman, W. K., & Albano, A. M. (1996). The anxiety disorders interview schedule for children for DSM-IV (Child and parent versions). San Antonio, TX: Psychological Corporation.Google Scholar
  79. Silverman, W. K., Pina, A. A., & Viswesvaran, C. (2008). Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 37(1), 105–130.PubMedCrossRefGoogle Scholar
  80. Stein, M. B., & Stein, D. J. (2008). Social anxiety disorder. The Lancet, 371(9618), 1115–1125.CrossRefGoogle Scholar
  81. Stephan, S. H., Wissow, L., & Pichler, E. (2010). Utilizing common factors and practice elements to improve mental health care by school-based primary care providers. Report on Emotional and Behavioral Disorders in Youth, 10, 81–86.Google Scholar
  82. Turner, S. M., Beidel, D. C., Dancu, C. V., & Keys, D. J. (1986). Psychopathology of social phobia and comparison to avoidant personality disorder. Journal of Abnormal Psychology, 95(4), 389–394.PubMedCrossRefGoogle Scholar
  83. Weist, M. D. (1997). Expanded school mental health services: A national movement in progress. In T. H. Ollendick & R. J. Prinz (Eds.), Advances in clinical child psychology (Vol. 19, pp. 319–352). New York: Plenum.CrossRefGoogle Scholar
  84. Weist, M., Lever, N., Stephan, S., Youngstrom, E., Moore, E., Harrison, B., et al. (2009). Formative evaluation of a framework for high quality, evidence-based services in school mental health. School Mental Health, 1(4), 196–211.CrossRefGoogle Scholar
  85. Weisz, J. R., Chorpita, B. F., Palinkas, L. A., Schoenwald, S. K., Miranda, J., Bearman, S. K., et al. (2012). Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: A randomized effectiveness trial. Archives of General Psychiatry, 69(3), 274–282.PubMedCrossRefGoogle Scholar
  86. Wittchen, H.-U., Lieb, R., Wunderlich, U., & Schuster, P. (1999). Comorbidity in primary care: Presentation and consequences. Journal of Clinical Psychiatry, 60(suppl 7), 29–36.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Kristy A. Ludwig
    • 1
    Email author
  • Aaron R. Lyon
    • 1
  • Julie L. Ryan
    • 2
  1. 1.Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleUSA
  2. 2.School of Psychology, Fairleigh Dickinson UniversityTeaneckUSA

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