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Anxiety disorder undertreated in young adults.

TORONTO--Anxiety is too often being ignored during the transition period between childhood and adulthood, but a program at Columbia University is trying to change that by offering comprehensive treatment of anxiety in affected adults and, perhaps as importantly, their families.

"Anxiety starts by about the age of 4, picks up steam all the way through adolescence, and is our most common psychiatric condition among children and adolescents. And it predicts every adult psychiatric diagnosis," said Anne Marie Albano, Ph.D., the founder and director of the Columbia University clinic for anxiety and related disorders (CUCARD) in the division of child and adolescent psychiatry at Columbia University, New York.

"What happens is that, at the end of adolescence, we say, 'Good luck, goodbye, go to school, have a good time, enjoy the rest of your life,' when in fact, there is a lot more that needs to be done," she said during a session at the annual meeting of the American Psychiatric Association devoted to the latest research in major psychiatric disorders.

Mood disorders often get treated in college, but anxiety disorders, which very frequently are comorbid with substance abuse, often are not treated.

"When kids get anxious, and then they develop a mood disorder, and they start drinking, that's when you see suicide attempts and such," said Dr. Albano. "We have neglected the emerging adults. Eighteen to 28 [years] is a dynamic period of development. A lot is going on, and we know it is the period of emergence of serious mental illness."

Delayed development

Anxiety disorders are highly prevalent in childhood and adolescence, affecting between 10% and 20% of youth.

They are significantly impairing, and highly co-morbid with mood and substance abuse disorders.

There is evidence that nearly half of children and adolescents treated for anxiety, be it with cognitive-behavioral therapy (CBT), drugs, or a combination of both, ultimately relapse.

And part of the reason for this, said Dr. Albano, is that the focus of treatment is generally on symptomatic improvement, which is appropriate.

But what is lacking is a focus on functional outcomes, especially developmental trajectories, she said.

"We're diagnosing these kids at age 4, 5, and 6 years of age, so they are taken off track very quickly, compared to their same-age peers, in meeting developmental milestones," Dr. Albano reported.

"So by the time you get a 12- or 14-year-old with an anxiety disorder, it's not just that you're treating the obsessive-compulsive behavior, or the generalized worry, or social phobia, you have to think about the fact that they are not the same as the kids they have to go back into class with and socialize with; they are not on the same path."

Parents need help, too

Not only do standard treatments not address development, but they also tend to neglect the role of family involvement.

"We know very well from lots of data that family involvement in anxiety is high, whether it's chicken or egg," said Dr. Albano. "Parents get drawn into the cycle of anxiety --they overprotect and overcontrol," which again puts the child behind in development, because while parental behavior may minimize anxiety in the short term, it solidifies it in the long term.

Not only are parents often over-involved with their anxious children, but the advice they give often serves to further delay their child's development. Parents too often help their children avoid uncomfortable situations rather than learn to problem solve and handle them, thereby maintaining the anxiety rather than helping it, said Dr. Albano.

"They are focusing in on ambiguous clues and interpreting them in a negative, anxious way for their children," she said.

LEAP into adulthood

"At the age of 18 if you're sending your kid off to college, they better know how to soothe themselves, problem solve, know who they are affirmatively, complete tasks on their own, manage money to some degree, make and keep relationships, and, especially, take care of their personal selves--get enough sleep, eat right, exercise, and so forth," said Dr. Albano.

To this end, CUCARD has developed LEAP: the Launching Emerging Adults Program, a treatment program that expands on traditional cognitive-behavioral exposure therapy by integrating the skills needed to help the young people thrive in adulthood.

LEAP and Dr. Albano were featured recently in a Wall Street Journal article on good mental health in college students.

The program, which is run with New York-Presbyterian Hospital's Youth Anxiety Center (YAC), focuses on the unique needs of young adults with anxiety and related disorders and is designed for families struggling with the transition from high school to college, work and career problems, family conflict, limitations in friendships and romantic relationships, and limited independence.

The program also takes on directly the issue of parental over-protection and control, while also addressing inappropriate dependence on parents.Dr. Albano's team has developed a way of bringing parents into treatment collaboratively with the young adults and without threatening the therapeutic alliance.

Dr. Albano reported receiving honoraria from the American Psychological Association and royalties from Oxford University Press.



Anxious teens are sent to college with no medications, often to self-medicate.
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Title Annotation:MENTAL HEALTH
Author:Beck, Debra L.
Publication:Family Practice News
Date:Jun 1, 2015
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