Section 1: Development and neurobiology
Neural Substrates of Childhood Anxiety Disorders: A Review of Neuroimaging Findings

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Introduction

Anxiety disorders are the most common group of childhood psychiatric disorders, with almost one in three children having suffered from an anxiety disorder at some point during childhood or adolescence.1 Most anxiety disorders begin early in development, with a median age at onset of 12 years.1 Although significant advances have been made in identifying the best treatments for anxious children,2 little is known about the neural underpinnings of anxiety disorders. Identifying the neural basis of childhood anxiety disorders can guide development of prevention programs, a critical step in reducing these early-onset and highly prevalent disorders. This article reviews the available literature to provide a current understanding of the neural basis of childhood anxiety disorders. It reviews the development of normative fear and the development of the brain regions that subserve fear and anxiety. It further provides a comprehensive summary of relevant functional and structural neuroimaging studies, including studies examining children with anxiety disorders and children at-risk for developing anxiety disorders.

Section snippets

Development of Fear

Fear is a normal and adaptive response to potential threat. Key components of the fear system mature early in development,3 and multiple periods of child development are marked by normative fears4 (see Ref.3 for a review). For example, most infants experience a period of stranger anxiety around 8 to 12 months of age, marked by wariness or distress around new people.5, 6, 7, 8 Stranger anxiety is often followed by separation anxiety, typically evident around 10 to 18 months, and characterized by

Neuroimaging Studies of Fear-Based Anxiety Disorders: Generalized Anxiety Disorder, Social Phobia, Separation Anxiety Disorder

Although we assume that differences in brain function underlie childhood anxiety, little research has focused on identifying the underlying neural causes. Studies of adult anxiety have provided critical information about possible brain dysfunction in childhood anxiety disorders; however, we do not know whether the differences found in adults reflect the underlying causes of anxiety or are the consequence of anxiety. Thus, studies in children with anxiety or at high-risk for developing anxiety

Neuroimaging Studies of Obsessive–Compulsive Disorder

Childhood-onset obsessive–compulsive disorder (OCD) can be considered to be distinct from the other childhood anxiety disorders.146 Instead of having fear at its core, childhood OCD is defined by recurrent obsessions and compulsions that are time consuming or cause marked distress or significant impairments in daily function.118 Childhood-onset OCD, relative to adult-onset OCD, is characterized more by motor and vocal tics and the presence of comorbid diagnoses such as Tourette syndrome and

Implications for Research and Clinical Practice

Using functional and structural neuroimaging methods to isolate the neural underpinnings of childhood anxiety disorders is still in its infancy, with the first childhood anxiety fMRI study conducted a little over a decade ago. Given this relatively short period of time, significant progress has been made in identifying possible sources of brain dysfunction contributing to childhood anxiety. In the fear-based anxiety disorders (GAD, SP, SAD), neuroimaging studies have reported brain dysfunction

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      Citation Excerpt :

      However, there is a paucity of research systematically and rigorously comparing differences in activation between the two internalising disorders in CYP (Melton et al., 2016). Furthermore, the reviews that have examined neural dysfunction in either anxiety or depression are somewhat dated (e.g., Blackford and Pine, 2012; Hulvershorn et al., 2011; Kerestes et al., 2014), which is pertinent given the recent increase in internalising disorders amongst CYP (NHS Digital, 2018). In addition, while Kerestes et al's. (2014) review systematically examined functional differences in youth with MDD, this only included participants aged 13–25, and so information regarding younger CYP was missed.

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    The preparation of this manuscript was partially supported by Award No. K01-MH083052 to Jennifer Urbano Blackford from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Mental Health or the National Institutes of Health.

    The authors have nothing else to disclose.

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