Anxiety Disorders Specialty Clinic

The Yale Child Study Center Anxiety Disorders Specialty Clinic specializes in the evaluation, treatment, and follow-up of individuals with Anxiety Disorders and related difficulties. Services offered by our clinic include:

Evaluation and Consultation Service: Our comprehensive evaluation focuses on diagnosis, prognosis, and treatment recommendations. Prior to the clinic visit, a thorough review of the individual’s history and symptoms is conducted through the use of assessment questionnaires completed by the patient and/or family and review of clinical and school records. During the clinical interview, the clinic team will meet with the patient and family together and, if clinically indicated or requested, separately as well. Follow-up visits and consultation to the patient’s primary providers may be arranged depending upon the individual needs of the family. Please note that this evaluation does not include formal testing (i.e., cognitive, educational, etc.)

Cognitive-Behavioral Therapy Service: Over the past several years, a growing body of research has shown that cognitive-behavioral therapy (CBT) can be highly effective in the treatment of anxiety disorders. In offering these services to children and adolescents, an initial evaluation is conducted to gain an understanding of the child’s individual presentation and needs in order to determine if CBT is an appropriate treatment approach. If so, treatment is generally provided on a weekly basis over a period of three to six months. For OCD and anxiety, the treatment is centered on exposure and, for OCD, ritual prevention.

Childhood Anxiety

Anxiety is a natural and healthy part of life. The anxiety system plays a vital role in protecting us from danger by alerting us to potential risks and causing us to avoid unsafe situations. All children will feel afraid some of the time and many fears will pass or fade as the child matures. Examples of age appropriate fears include the fear of loud noises or of strangers in young babies, fear triggered by separation from parents in toddlers or the fear of kidnapping among school age children. The appearance of these and many other fears is often a passing phase and usually does not require psychological intervention.

For some children, however the fears will grow rather than pass, reaching the point of becoming an anxiety disorder. Anxiety disorders are characterized by extreme or recurring fears that lead to marked distress or that interfere with the child’s ability to function in an age appropriate way. For example, a child who fears the monster in the closet may be experiencing a normal developmental stage, but a child who is losing significant amounts of sleep because of the thought of monsters may be suffering from an anxiety disorder.

Anxiety Disorders

Anxiety disorders are the most frequent disorders of childhood affecting as many as fifteen percent of all children and adolescents. Studies have indicated that most adults suffering from anxiety disorders experienced an onset of their symptoms during childhood. Many children however remain undiagnosed for long periods of time, leading to considerable distress for the child, grave concern for the parents and to significant impairment in daily life.

Anxiety can take many forms and may manifest in a variety of ways. Often a child diagnosed with one anxiety disorder will also meet criteria for another disorder at the same time. The currently recognized anxiety disorders are:

Specific Phobias – characterized by strong irrational fear of a given stimulus or situation. Common phobias include dogs, dark, heights, loud sounds and needles or blood.

Separation Anxiety – characterized by distressed caused separation from parents or other attachment figures. Children suffering from separation anxiety may express concern over things that could happen to them in their parents’ absence such as kidnapping or a worry for the parent’s wellbeing and fear that they will come to harm.

Social Phobia – characterized by extreme discomfort in certain social situations. Children suffering from social phobia may avoid speaking to others or making eye contact, going to social events or even answering the telephone.

Generalized Anxiety – characterized by persistent and fatiguing worrying over various concerns that can include any aspect of life. Common worried include health issues, family’s financial status, wars and natural catastrophes or other negative events.

Obsessive Compulsive Disorder – characterized by intrusive thoughts and the need to perform rituals or adhere to strict and illogical rules.

Panic Disorder – characterized by repeated intense episodes of extreme anxiety, usually lasting approximately fifteen minutes. During these episodes children may feel they are near fainting or even death. Panic disorder can often trigger Agoraphobia.

Agoraphobia– a reluctance to go to certain places or a need to be accompanied to them because of the fear of experiencing a panic attack.

Course of Anxiety Disorders

Although anxiety is a healthy mechanism with an important role in preventing risk and identifying danger, anxiety disorders can cause significant distress and psychological damage and do not tend to disappear untreated. Because of the tendency to avoid anxiety provoking situations anxiety disorders tend to persist over time when untreated and may intensify or be generalized to more and more symptoms. With proper treatment the majority of childhood anxiety disorders can be cured or significantly alleviated.

The two therapeutic approaches that have the best evidence for their effectiveness are medication, often with SSRIs (Selective Serotonin Reuptake Inhibitors) and Cognitive Behavioral Therapy (CBT). CBT consists of providing the child with skills for better managing anxiety and of practicing gradual exposure to previously avoided stimuli. CBT usually lasts between 10 and 15 sessions.