Recent studies in adolescents show heightened sensitivity and neuroplasticity in brain development, where certain cognitive skills, thought patterns, and behaviours are particularly malleable (Fuhrmann et al. Thus, pathological worry is a debilitating mental health problem in children and adolescents with long-term negative consequences.Ĭhildhood and adolescence, collectively referred to as youth from here onwards, is a period that entails significant cognitive, social, and physiological changes that can have an impact on the development of worry (Copeland et al. Pathological worry is one of the core features of generalised anxiety disorder (GAD) (American Psychiatric Association 2013) and lifetime prevalence of GAD amongst youth ranges from 2 to 6%, with early onset occurring from middle childhood onwards (Merikangas et al. 2016).Įxcessive levels of worry, when left untreated, is a risk factor for the development of anxiety disorders, with many adults reporting that their excessive worries began to develop in childhood or adolescence (Costello et al. Pubertal development in females was associated with worry frequency, with those 13-year-olds with advanced pubertal timing experiencing greater worry frequency (Caes et al. In one study, for instance, a gender difference in worry frequency had emerged by age ten, but was not present at age seven, whilst gender differences in the interference caused by worry had emerged by age 13. Females tend to report higher levels and frequencies of worry compared with males (Barahmand 2008 Caes et al. The content of worries in children and adolescents is wide ranging and typically involves issues relating to school, relationships, health, as well as interpersonal and social problems (Muris et al. Pathological worry in children and adolescents is associated with poor academic functioning, school absenteeism, severe difficulty concentrating, withdrawal from social activities, and disrupted sleep patterns (Albano and Hack 2004). However, at the other end of the spectrum, pathological worry is of clinical concern and is characterised by excessive worries that persist over time and cause significant distress. In moderation, worry can serve as an adaptive process that enables problem-solving, prepares individuals for future threat, and increases motivation (Davey 1994). Research shows that worry is common in children and adolescents and varies continuously across the normal population (Goncalves and Byrne 2013). 1991) that involves repetitive thoughts and images that focus on the potentially negative outcomes of future events (Vasey and Daleiden, 1994). Worry is a cognitive component of anxiety (Borkovec et al. We conclude that cognitive models of worry should incorporate a developmental framework in order to provide greater insight into the mechanisms uniquely associated with worry in children and adolescents and help to identify the cognitive processes to target for early interventions and treatments. Building upon Hirsch and Matthews' cognitive model (Behav Res Therapy 50:636–646,, 2012), we propose a model of child and adolescent worry to provide a guiding framework for future research. However, evidence that children and adolescents experience verbal worry is inconclusive.
Evidence indicates that negative information-processing biases and reduced executive functions play an important role in worry and GAD in children and adolescents. Following a systematic search of the literature and screening for eligibility, 30 studies were identified. The current systematic review investigated whether this cognitive model of worry could be extended to understand child and adolescent worry. An influential cognitive model of adult pathological worry (Hirsch and Matthews in Behav Res Therapy 50:636–646,, 2012) proposes that negative information-processing biases, reduced executive functions, and verbal worry are critical in the aetiology of GAD in adults. Whilst the literature on worry and generalised anxiety disorder (GAD) in adults is well established, relatively less is known about the cognitive mechanisms underlying child and adolescent worry.
Worry is common in children and adolescents, yet some youth experience excessive worries that persist over time and cause significant distress.
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