This book represents a second edition, with the original publication occurring over 10 years ago. In the past decade, significant advances in our knowledge base have occurred, particularly in our understanding of biological bases of anxiety, and this growth is reflected in this newly revised, comprehensive second edition. This book provides an extensive overview of anxiety disorders and intermediate phenotypes related to anxiety dysfunction in the span of 18 chapters, divided into four conceptual sections.
The book opens with a historical overview by Treffers and Silverman, which provides a context for the field of psychology and psychiatry in terms of where we have been and where we are currently in our thinking about the manifestations of anxiety in youth (Section 1). This section also covers substantive conceptual issues that face clinicians and clinical researchers investigating the nature of anxiety in youth including nosology, developmental epidemiology, fear and anxiety development, and the role of cognitive processes in the expression of anxiety. Of the four theoretical sections, the historical and conceptual issues section covers the most content with a total of seven chapters devoted to these topics. Although the biological section (Section 2) is the shortest of the four sections, it has undergone the most revision given the considerable advancements in neuroimaging and twin research in the past decade. In all, this section nicely reviews the relevant literature regarding the biology of anxiety including genetics, brain–behavior relations based on fMRI methods, and temperament. Unlike family-based studies, twin studies allow for the disaggregation of genetic and common environment and this statistical agility is reflected in Gregory and Eley's chapter where they adeptly describe basic quantitative genetic concepts such that readers with no background in psychiatric genetics will be able to understand the presented information. Moreover, this chapter moves beyond a simple review of the genetic and environmental contributions on an anxiety disorder by anxiety disorder basis and incorporates literature pertaining to complex processes such as epigenetics and G×E interactions. Pine, one of the leaders in child anxiety disorders and neuroimaging, skillfully conveys the current state of this literature, noting the primary structures involved in the neural circuitry of anxiety as well as processes (e.g. memory, threat appraisal) relevant to understanding brain–behavior relations. In Section 3, significant environmental influences on anxiety are reviewed. This includes the role of learning in the etiology of anxiety, traumatic events, parent–child attachment, parenting, and the impact of peer relations. Most contemporary books covering youth anxiety disorders do not address topics such as parent–child attachment, which is an innovative aspect of this book and certainly worthy of inclusion. The fourth and final section addresses the outcome literature associated with prevention and intervention efforts. The first of the three chapters captures the current state of affairs and the increased commitment to prevention of pediatric anxiety, but nonetheless notes the instability of long-term gains and the small effect sizes observed across most studies. The two treatment chapters reflect the increased sophistication of outcome trials and the movement beyond simple clinical trials (i.e. active treatment vs. placebo), although the reader realizes the need for continued research to determine mechanisms of change in psychosocial treatments and personalization of pharmacological treatments (e.g. medication augmentation) for optimal outcomes. Moreover, while evidence is still mixed regarding the efficacy of cognitive-behavioral therapy relative to credible control conditions, the pharmacological chapter's overarching recommendation is that serotonin reuptake medications are the treatment of choice for anxious youth.
This book provokes thought regarding the complex nature of fear and anxiety and touches on the richness of processes related to the integral nature of anxiety and pushes us to think beyond the diagnostic level to consider other important topics like information processing biases and brain–behavior as endophenotypes. Moreover, a nuanced feature of this edited book is a subtle level of continuity that is present in that authors of differing chapters reference content of related chapters within the book, cueing the reader to its integrated nature. In the ‘Adult Models of Anxiety’ chapter, Cartwright-Hatton, Reynolds, and Wilson note the lack of developmental perspective in studying anxiety across childhood and adolescence. In line with this sentiment, there may be utility in the future inclusion of a chapter that focuses on the statistical methods available, most notably methods used to examine developmental trajectories like growth curve models and those that combine the concepts of endophenotypes measured using latent methods and growth/change (e.g. latent class growth analysis). This is suggested, knowing that by the time of the next edition, there is likely to be a fairly well developed literature based on these types of methods.
In summary, this is an excellent and comprehensive book that assembles the latest scientific findings and puts them in context while acknowledging existing gaps in our understanding of anxiety disorders; even seasoned anxiety researchers will come away learning a significant amount. It expands coverage of topics beyond the original publication, most notably biological aspects of anxiety. Overall, the chapters provide a thorough, up-to-date, and balanced overview of a wide variety of topics important to the understanding of pediatric anxiety. Although clinical researchers will find the most value in this book, clinicians and service providers also will find this text to have significant utility as the books covers such a wide range of topics related to anxiety from relevant cognitive processes to clinical outcomes.
