Welcome to the training on Childhood Anxiety Disorders provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
Goal
The goal of this module is to equip Texas Health Steps providers and others to screen for and identify childhood anxiety in a primary care setting, make appropriate referrals when needed, and provide ongoing care and coordination.
Target Audience
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Summarize the signs and symptoms of anxiety disorders in children and adolescents.
- Apply current recommendations for screening children and adolescents for anxiety disorders as part of routine clinical practice.
- Examine the role of the medical home in the treatment and ongoing management of anxiety disorders in children and adolescents.
Please note this module expires on 7/17/2022.
This module was released on 7/17/2019.
Accreditation Statement
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hour(s) of Continuing Nursing Education.
Social Workers
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hour(s) of Continuing Social Work Education.
Certified Health Education Specialists
Sponsored by The Texas Department of State Health Services, Continuing Education Service, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to 1.25 total entry-level Category I contact education contact hours.
Licensed Marriage and Family Therapists
The Texas Department of State Health Services, Continuing Education Service is an approved provider (#1039) by the Texas State Board of Examiners of Marriage and Family Therapists to offer continuing education contact hours to Licensed Marriage and Family Therapists. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hour(s) for Licensed Marriage and Family Therapists.
Licensed Professional Counselors
The Texas Department of State Health Services, Continuing Education Service is an approved provider (#690) by the Texas State Board of Examiners of Professional Counselors to offer continuing education contact hours to Licensed Professional Counselors. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hour(s) for Licensed Professional Counselors.
Licensed Chemical Dependency Counselors
Provider (Texas Department of State Health Services, Continuing Education Service) approved by the TCBAP Standards Committee, Provider Number 2026-18, 1.25 hours general and 0 hours clinical supervision. Expires annually on August 31. Complaints about provider or workshop content may be directed to the TCBAP Standards Committee, 402 Ranch Road 620 S., Ste. 210, Austin, Texas 78734, Fax No. (888) 506-8123.
Licensed Psychologists
The Texas Department of State Health Services is authorized by the Texas State Board of Examiners of Psychologists as a (c)(2)(A) provider of professional development hours for licensed psychologists. Per the Texas State Board of Examiners of Psychologists Act and Rules, at least half (10) of the required 20 hours of professional development must be obtained by a provider listed in section (c)(2)(A). The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hour(s) for Licensed Psychologists.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.25 hour(s) for attendance.
Disclosures
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support. - Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose. - Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center. - Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
Browser Requirements
Texas Health Steps courses are best viewed using a current browser. If you are using an out-of-date browser or a version of Internet Explorer less than 11, lesson progress and interactive features may not function properly.
- American Academy of Family Physicians. Cultural competence self-test for physicians.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, DSM–5.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, DSM–5. Glossary of Cultural Concepts of Distress provided by the federal Substance Abuse and Mental Health Services Administration’s “Improving Cultural Concepts, Tip 59” (2014).
- Camp Cope A Lot, a 12-session interactive CD-ROM-assisted treatment for use with children who have anxiety.
- Screen for Child Anxiety-Related Emotional Disorders (SCARED). All versions.
- Screening Tools: Texas Health Steps links for developmental and mental health screenings:
- Pediatric Symptom Checklist (PSC-17)
- Pediatric Symptom Checklist (PSC-35)
- Pediatric Symptom Checklist for Youth (Y-PSC)
- CRAFFT (Car, Relax, Alone, Forget, Family/Friends, Trouble) Screening Questionnaire
- Patient Health Questionnaire (PHQ-9)
- Patient Health Questionnaire for Adolescents (PHQ-A) - Depression screen
- Patient Health Questionnaire for Adolescents (PHQ-A) - Anxiety, eating problem, mood problem, and substance use screen
- Spence Children’s Anxiety Scale (SCAS). All versions.
- STAR Kids
- Suicide Prevention Lifeline. Best Practices: Resources and Publications.
- Texas Health and Human Services Commission. Community Resource Coordination Groups (CRCGs).
- Texas Health and Human Services Commission. Children’s Health Insurance Program.
- Texas Health and Human Services Commission. List of Local Mental Health Authorities and Local Behavioral Health Authorities in Texas.
- Texas Health and Human Services Mobile Crisis Outreach Teams (MCOT).
- Texas Health and Human Services Commission. (2018). Texas Health Steps Periodicity Schedule for Infants, Children, and Adolescents.
- Texas Health and Human Services Suicide Prevention.
- Texas Medicaid & Healthcare Partnership (TMHP) Online Provider Lookup.
- Texas Suicide and Crisis Hotlines.
- Woebot.
- YouthSuicideWarningSigns.com. (n.d.). Healthcare Professionals: Youth Suicide Warning Signs.
- Zero Suicide in Texas (ZEST). Download a toolkit for providers in the public health system to implement best practices for a suicide safe care system.
- American Academy of Child and Adolescent Psychiatry. (2017). Facts for Families: Anxiety and Children.
- American Academy of Family Physicians. Cultural competence self-test for physicians.
- American Academy of Pediatrics. (2019). The Resilience Project: Anxiety Fact Sheet.
- American Academy of Pediatrics, Section on Integrative Medicine. (2016). Mind-Body Therapies in Children and Youth. Pediatrics, 138:3.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, DSM–5.
- Anxiety and Depression Association of America. (2015). Childhood Anxiety Disorders.
- Bitsko, R. H., Holbrook, J. R., Ghandour, R. M., Blumberg, S. J., Visser, S. N., Perou, R., & Walkup, J. T. (2018). Epidemiology and Impact of Health Care Provider–Diagnosed Anxiety and Depression Among U.S. Children. Journal of Developmental & Behavioral Pediatrics, 39(5), 395-403.
- Centers for Disease Control and Prevention. (2018). Children’s Mental Health: Anxiety and Depression in Children.
- Centers for Disease Control and Prevention, National Center for Health Statistics. (2018). Use of Yoga, Meditation, and Chiropractors Among U.S. Children Aged 4–17 Years, NCHS Data Brief 324.
- Child Mind Institute. (2018). Understanding Anxiety in Children and Teens: 2018 Children’s Mental Health Report.
- Child Mind Institute. (2015). Children’s Mental Health Report.
- Connolly, S. (n.d.). Anxiety Disorders in Children and Adolescents. Presentation by the director, University of Illinois at Chicago Pediatric Stress and Anxiety Disorders Clinic.
- Dabkowska, M., & Dabkowska-Mika, A. (2015). A Fresh Look at Anxiety Disorders. Chapter: Risk Factors of Anxiety Disorders in Children. IntechOpen.
- Garber, J. & Weersing, V. R. (2010). Comorbidity of Anxiety and Depression in Youth: Implications for Treatment and Prevention. Clinical Psychology, 17(4): 293–306.
- Georgetown University, Health Information Group and Bright Futures. (2019). Cultural Concepts of Distress, from Addressing Mental Health Concerns, Module 14. Mental Health: Culture, Race, and Ethnicity.
- Kabat-Zin, J. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology,10:144-156.
- Kodish, I., Rockhill, C., & Varley, C. (2011). Pharmacotherapy for anxiety disorders in children and adolescents. Dialogues in Clinical Neuroscience, 13(4): 439–452.
- Lawrence, P. J., Murayama, K., & Creswell, C. (2019). Systematic Review and Meta-Analysis: Anxiety and Depressive Disorders in Offspring of Parents With Anxiety Disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 58(1):46-60.
- Lebowitz, E. R., Omer, H., Hermes, H., & Scahill, L. (2014). Parent Training for Childhood Anxiety Disorders: The SPACE Program. Cognitive and Behavioral Practice, 21(4), 456–469.
- Leonte, K. G., Puliafico, A., Na, A., & Rynn, M. (2017). Pharmacotherapy for anxiety disorders in children and adolescents. Up-to-Date.
- Merck Manual: Professional Version. (2019). Overview of Anxiety Disorders in Children and Adolescents.
- Mitchell, K. J., Wells, M., Priebe, G., & Ybarra, M. L. (2014). Exposure to websites that encourage self-harm and suicide: Prevalence rates and association with actual thoughts of self-harm and thoughts of suicide in the United States. Journal of Adolescence, 37(8):1335-1344
- National Institute on Drug Abuse. (2018). Common Comorbidities with Substance Use Disorders.
- Norman, K. R., Silverman, W. K., & Lebowitz, E. R. (2015). Family Accommodation of Child and Adolescent Anxiety: Mechanisms, Assessment, and Treatment. Journal of Child and Adolescent Psychiatric Nursing, 28(3): 131-140.
- Pentz, J., & Simkin, D. R. (2016). The Use of Meditation in Children With Mental Health Issues. Psychiatric Times, 13/11.
- Runyon, K., Chesnut, S. R., & Burley, H. (2018). Screening for childhood anxiety: A meta-analysis of the screen for child anxiety related emotional disorders. Journal of Affective Disorders, 240:220-229.
- Smith, V. C., Wilson, C. R., & the American Academy of Pediatrics Committee on Substance Use and Prevention. (2016). Families Affected by Parental Substance Use. Pediatrics, 138(2):e20161575.
- Southammakosane, C., & Schmitz, K. (2015). Pediatric Psychopharmacology for Treatment of ADHD, Depression, and Anxiety. Pediatrics, 136:2.
- Wehry, A. M., Beesdo-Baum, K., Hennely, M. M., Connolly, S. D., & Strawn, J. R. (2015). Assessment and Treatment of Anxiety Disorders in Children and Adolescents. Current Psychiatry Reports, 17(7): 591.
- Weitzman, C. C., & Bridgemohan, C. (2019). Up to 30% of youths will develop anxiety disorders; how you can help. American Academy of Pediatrics News, Jan. 15.
- YouthSuicideWarningSigns.com. (n.d.). Healthcare Professionals: Youth Suicide Warning Signs.
The medical definitions provided in this module were adapted or obtained from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5), Healthline.com, Indiana University, Oxford University Press, PsychCentral, and the U.S. Department of Health and Human Services.