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Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances. • Anxiety disorders are the most common form of paediatric mental disorder. • Both distal and proximal risk factors predict the onset of paediatric anxiety disorders. • Extensive research demonstrates strong outcomes from CBT treatments. • A smaller evidence base also shows good efficacy from pharmacological treatments. • The potential for early intervention can reduce the lifelong impact of these disorders. [ABSTRACT FROM AUTHOR]

The aims of this study were to determine the impact of adolescent-relevant risk factors on changes in social anxiety symptoms from pre-to early-adolescence. From 2016 to 2018, 528 youth (51% boys) were tested in three annual waves across grades 6, 7, and 8 (M ages 11.2, 12.7, 13.7 years). Through online surveys youth reported on peer relationships that were combined into two latent factors: 1) appearance comparisons, comprising youth reports of appearance comparisons relative to others in general and while using social media, along with perceived attractiveness; and 2) positive peer connections, comprising youth reports of group affiliation, school belonging, and peer victimisation. Youth and their parents also reported on the youth's level of pubertal development as well as the youth's level of social anxiety using previously validated questionnaires. Social anxiety was also assessed with structured diagnostic interview. Separate cross-lagged panel models were used to model longitudinal associations between all risk factors and youth, parent, and interviewer-reported measures of social anxiety. Of the associations tested, only appearance comparisons directly predicted increases in social anxiety symptoms 12 months later across all models. More advanced pubertal development was associated with increased appearance comparisons the following year. On the other hand, higher levels of social anxiety predicted subsequent reductions in positive peer connections in parent and interviewer models. These results highlight the important and interconnected impact of pubertal development and appearance comparisons on both the development of social anxiety symptoms during early adolescence, as well as the social consequences of social anxiety. • Social anxiety disorder commonly begins during early adolescence. • Comparing one's appearance against others predicted social anxiety the following year. • More advanced pubertal development indirectly predicted social anxiety. • Poor peer connections did not predict future social anxiety. • However, higher levels of social anxiety predicted poorer peer connections. [ABSTRACT FROM AUTHOR]

Social anxiety disorder (SAD) is associated with marked physiological reactivity in social-evaluative situations. However, objective measurement of biomarkers is rarely evaluated in treatment trials, despite potential utility in clarifying disorder-specific physiological correlates. This randomized controlled trial sought to examine the differential impact of imagery-enhanced vs. verbal-based cognitive behavioral group therapy (IE-CBGT, n = 53; VB-CBGT, n = 54) on biomarkers of emotion regulation and arousal during social stress in people with SAD (pre- and post-treatment differences in heart rate variability (HRV) and skin conductance). We acquired psychophysiological data from randomized participants across four social stress test phases (baseline, speech preparation, speech, interaction) at pre-treatment, and 1- and 6-months post-treatment. Analyses revealed that IE-CBGT selectively attenuated heart rate as indexed by increases in median heart rate interval (median-RR) compared to VB-CBGT at post-treatment, whereas one HRV index showed a larger increase in the VB-CBGT condition before but not after controlling for median-RR. Other psychophysiological indices did not differ between conditions. Lower sympathetic arousal in the IE-CBGT condition may have obviated the need for parasympathetic downregulation, whereas the opposite was true for VB-CBGT. These findings provide preliminary insights into the impact of imagery-enhanced and verbally-based psychotherapy for SAD on emotion regulation biomarkers. • People with social anxiety report marked physiological arousal in social situations. • Physiological change is rarely reported in treatment studies. • RCT of imagery vs. verbal group CBT investigated physiological change. • Imagery-enhanced CBT led to lower sympathetic arousal under stress post-treatment. • Findings provide insight into biomarkers of emotion regulation in social anxiety. [ABSTRACT FROM AUTHOR]

A considerable body of research in adults has demonstrated that anxiety disorders are characterised by attentional biases to threat. Findings in children have been inconsistent. The present study examined anxiety-related attention biases using eye tracking methodology in 463 preadolescents between 10 and 12 years of age, of whom 92 met criteria for a DSM-5 anxiety disorder and 371 did not. Preadolescent's gaze was recorded while they viewed adolescent face pairs depicting angry-neutral and happy-neutral expressions with each face pair presented for 5000 ms. No group differences were observed across any eye tracking indices including probability of first fixation direction, latency to first fixation, first fixation duration and dwell time. The sample overall showed faster initial attention towards threat cues, followed by a later broadening of attention away from threat. There is a need to identify the types of threats and the developmental period during which visual attention patterns of anxious and non-anxious youth diverge to inform more developmentally sensitive treatments. • Assessed visual attention allocation to peers' emotional face in preadolescents. • No differences between anxious and non-anxious preadolescents were observed. • Regardless of anxiety, time to first fixation was shorter for threat than neutral faces. • Faster initial allocation of attention to threatening peers may be common to all preadolescents. [ABSTRACT FROM AUTHOR]