Skip to main content

Advertisement

SpringerLink
Log in

Somatic Complaints in Anxious Youth

  • Original Article
  • Published:
Child Psychiatry & Human Development Aims and scope Submit manuscript

Abstract

This study examined (a) demographic and clinical characteristics associated with physical symptoms in anxiety-disordered youth and (b) the impact of cognitive-behavioral therapy (Coping Cat), medication (sertraline), their combination, and pill placebo on physical symptoms. Youth (N = 488, ages 7–17 years) with a principal diagnosis of generalized anxiety disorder, separation anxiety disorder, or social phobia participated as part of a multi-site, randomized controlled trial and received treatment delivered over 12 weeks. Diagnostic status, symptom severity, and impairment were assessed at baseline and week 12. The total number and severity of physical symptoms was associated with age, principal diagnosis, anxiety severity, impairment, and the presence of comorbid internalizing disorders. Common somatic complaints were headaches, stomachaches, head cold or sniffles, sleeplessness, and feeling drowsy or too sleepy. Physical symptoms decreased over the course of treatment, and were unrelated to treatment condition. Clinical implications and directions for future research are discussed (ClinicalTrials.gov number, NCT00052078).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. Youth with comorbid, secondary depression were initially included in CAMS. However a decision was made to exclude youth with major depressive disorder (MDD) early in the trial. Participants with comorbid, secondary dysthymia were included throughout the trial.

  2. Site differences in demographic variables have been discussed by Walkup et al. [20].

  3. Findings did not differ when analyses were conducted using the intent-to-treat sample with last observation carried forward versus participants with complete data at baseline and week 12.

References

  1. Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 60(8):837–844

    Article  PubMed  Google Scholar 

  2. Ezpeleta L, Keeler G, Erkanli A, Costello EJ, Angold A (2001) Epidemiology of psychiatric disability in childhood and adolescence. J Child Psychol Psychiatry 42(7):901–914

    Article  PubMed  Google Scholar 

  3. Van Ameringen M, Mancini C, Farvolden P (2003) The impact of anxiety disorders on educational achievement. J Anxiety Disord 17(5):561–571

    Article  PubMed  Google Scholar 

  4. Bittner A, Egger HL, Erkanli A, Jane costello E, Foley DL, Angold A (2007) What do childhood anxiety disorders predict? J Child Psychol Psychiatry 48(12):1174–1183

    Article  PubMed  Google Scholar 

  5. Costello EJ, Angold A (eds) (1995) Epidemiology. Guilford, New York

    Google Scholar 

  6. Ferdinand RF, Verhurlst FC (1995) Psychopathology from adolescence into young adulthood: an 8-year follow-up study. Am J Psychiatry 152:1586–1594

    PubMed  Google Scholar 

  7. Swendsen J, Conway KP, Degenhardt L, Glantz M, Jin R, Merikangas KR et al (2010) Mental disorders as risk factors for substance use, abuse and dependence: results from the 10-year follow-up of the National Comorbidity Survey. Addiction 105(6):1117–1128

    Article  PubMed Central  PubMed  Google Scholar 

  8. Woodward LJ, Fergusson DM (2001) Life course outcomes of young people with anxiety disorders in adolescence. J Am Acad Child Adolesc Psychiatry 40(9):1086–1093

    Article  PubMed  Google Scholar 

  9. Beidel DC, Christ MAG, Long PJ (1991) Somatic complaints in anxious children. J Abnorm Child Psychol 19:659–670

    Article  PubMed  Google Scholar 

  10. Ginsburg GS, Riddle MA, Davies M (2006) Somatic symptoms in children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry 45(10):1179–1187

    Article  PubMed  Google Scholar 

  11. Hofflich SA, Hughes AA, Kendall PC (2006) Somatic complaints and childhood anxiety disorders. Int J Clin Health Psychol 6:229–242

    Google Scholar 

  12. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed.). Author, Washington

    Google Scholar 

  13. Garber J, Walker LS, Zeman J (1991) Somatization symptoms in a community sample of children and adolescents: further validation of the Children’s Somatization Inventory. Psychol Assess 3(4):588–595

    Article  Google Scholar 

  14. Kingery JN, Ginsburg GS, Alfano CA (2007) Somatic symptoms and anxiety among African American adolescents. J Black Psychol 33(4):363–378

    Article  Google Scholar 

  15. Last CG (1991) Somatic complaints in anxiety disordered children. J Anxiety Disord 5(2):125–138

    Article  Google Scholar 

  16. Storch EA, Merlo LJ, Keeley ML, Grabill K, Milsom VA, Geffken GR et al (2008) Somatic symptoms in children and adolescents with obsessive-compulsive disorder: associations with clinical characteristics and cognitive-behavioral therapy response. Behav Cogn Psychother 36(03):283–297

    Article  Google Scholar 

  17. Hughes AA, Lourea-Waddell B, Kendall PC (2008) Somatic complaints in children with anxiety disorders and their unique prediction of poorer academic performance. Child Psychiatry Hum Dev 39(2):211–220

    Article  PubMed  Google Scholar 

  18. Bernstein GA, Massie ED, Thuras PD, Perwien AR, Borchardt CM, Crosby RD (1997) Somatic symptoms in anxious-depressed school refusers. J Am Acad Child Adolesc Psychiatry 36(5):661–668

    Article  PubMed  Google Scholar 

  19. Masia-Warner C, Colognori D, Kim RE, Reigada LC, Klein RG, Browner-Elhanan KJ et al (2011) Cognitive-behavioral treatment of persistent functional somatic complaints and pediatric anxiety: an initial controlled trial. Depress Anxiety 28(7):551–559

    Article  PubMed Central  Google Scholar 

  20. Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT et al (2008) Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med 359(26):2753–2766

    Article  PubMed Central  PubMed  Google Scholar 

  21. Silverman WK, Albano AM (1996) The anxiety disorders interview schedule for DSM-IV-child and parent versions. Graywind Publications, San Antonio

    Google Scholar 

  22. Compton SN, Walkup JT, Albano AM, et al. Child/adolescent anxiety multimodal study (CAMS): rationale, design, and methods. Child Adolesc Psychiatry Ment Health 4(1): 1–15

  23. Hollingshead AB (1975). Four factor index of social status. Unpublished manuscript. Department of Sociology, Yale University

  24. Kendall PC, Compton SN, Walkup JT, Birmaher B, Albano AM, Sherrill J et al (2010) Clinical characteristics of anxiety disordered youth. J Anxiety Disord 24(3):360–365

    Article  PubMed Central  PubMed  Google Scholar 

  25. Silverman WK, Nelles WB (1988) The anxiety disorders interview schedule for children. J Am Acad Child Adolesc Psychiatry 27(6):772–778

    Article  PubMed  Google Scholar 

  26. Silverman WK, Eisen AR (1992) Age differences in the reliability of parent and child reports of child anxious symptomatology using a structured interview. J Am Acad Child Adolesc Psychiatry 31(1):117–124

    Article  PubMed  Google Scholar 

  27. Emslie G, Kratochvil C, Vitiello B, Silva S, Mayes T, McNulty S et al (2006) Treatment for adolescents with depression study (TADS): safety results. J Am Acad Child Adolesc Psychiatry 45(12):1440–1455

    Article  PubMed Central  PubMed  Google Scholar 

  28. Research Units on Pediatric Psychopharmacology Anxiety Study (2002) The pediatric anxiety rating scale (PARS): development and psychometric properties. J Am Acad Child Adolesc Psychiatry 41:1061–1069

    Article  Google Scholar 

  29. Ginsburg GS, Keeton CP, Drazdowski TK, Riddle MA (2011) The utility of clinicians ratings of anxiety using the pediatric anxiety rating scale (PARS). Child Youth Care Forum 40(2):93–105

    Article  Google Scholar 

  30. Shaffer D (1983) A children’s global assessment scale (CGAS). Arch Gen Psychiatry 40(11):1228–1231

    Article  PubMed  Google Scholar 

  31. Bird HR (1987) Further measures of the psychometric properties of the children’s global assessment scale. Arch Gen Psychiatry 44(9):821–824

    Article  PubMed  Google Scholar 

  32. Guy W (1976) ECDEU assessment manual for psychopharmacology, revised. National Institute of Mental Health, Rockville

    Google Scholar 

  33. Kendall PC, Hedtke K (2006) Cognitive-behavioral therapy for anxious children: therapist manual (3rd ed). Workbook Publishing, Ardmore

    Google Scholar 

  34. Kendall PC, Hedtke K (2006) Coping cat workbook (2nd ed.). Workbook Publishing, Ardmore

    Google Scholar 

  35. Kendall PC, Choudhury M, Hudson J, Webb A (2002) The C.A.T project workbook for the cognitive-behavioral treatment of anxious adolescents. Workbook Publishing, Ardmore

    Google Scholar 

  36. Podell JL, Kendall PC, Gosch EA, Compton SN, March JS, Albano AM, Piacentini JC (2013) Therapist factors and outcomes in CBT for anxiety in youth. Prof Psychol Res Pract 44(2):89

    Article  Google Scholar 

  37. Safer DJ, Zito JM (2006) Treatment-emergent adverse effects from selective serotonin reuptake inhibitors by age group: children versus adolescents. J Child Adolesc Psychopharmacol 16:159–169

    Article  PubMed  Google Scholar 

  38. Ialongo N, Edelsohn G, Werthamer-Larsson L, Crockett L, Kellam S (1995) The significance of self-reported anxious symptoms in first grade children: prediction to anxious symptoms and adaptive functioning in fifth grade. J Child Psychol Psychiatry 36(3):427–437

    Article  PubMed  Google Scholar 

  39. Strauss CC, Frame CL, Forehand R (1987) Psychosocial impairment associated with anxiety in children. J Clin Child Psychol 16(3):235–239

    Article  Google Scholar 

Download references

Acknowledgments

This research was supported by grants (U01 MH064089, to Dr. Walkup; U01 MH64092, to Dr. Albano; U01 MH64003, to Dr. Birmaher; U01 MH63747, to Dr. Kendall, U01 MH64107, to Dr. March; U01 MH64088, to Dr. Piacentini; and U01 MH064003, to Dr. Compton) from the National Institute of Mental Health. Sertraline and matching placebo were supplied free of charge by Pfizer. Views expressed within this article represent those of the authors and are not intended to represent the position of NIMH, NIH, or DHHS.

Author information

Authors and Affiliations

  1. Department of Psychology, Temple University, Weiss Hall, 1701 North 13th Street, Philadelphia, PA, 19122, USA

    Sarah A. Crawley, Nicole E. Caporino & Philip C. Kendall

  2. Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Boris Birmaher & Dara Sakolsky

  3. Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Golda Ginsburg & Courtney Keeton

  4. Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA

    John Piacentini & James McCracken

  5. Department of Psychiatry, Columbia University Medical Center, New York, NY, USA

    Anne Marie Albano & Moira Rynn

  6. Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD, USA

    Joel Sherrill

  7. Department of Psychiatry and Behavioral Services, Duke University Medical Center, Durham, NC, USA

    Scott N. Compton & John March

  8. Department of Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA

    Elizabeth Gosch

  9. Division of Child and Adolescent Psychiatry, Weill Cornell Medical College, New York, NY, USA

    John T. Walkup

Authors
  1. Sarah A. Crawley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicole E. Caporino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Boris Birmaher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Golda Ginsburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John Piacentini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anne Marie Albano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joel Sherrill
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dara Sakolsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Scott N. Compton
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Moira Rynn
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. James McCracken
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Elizabeth Gosch
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Courtney Keeton
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. John March
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. John T. Walkup
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Philip C. Kendall
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philip C. Kendall.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Crawley, S.A., Caporino, N.E., Birmaher, B. et al. Somatic Complaints in Anxious Youth. Child Psychiatry Hum Dev 45, 398–407 (2014). https://doi.org/10.1007/s10578-013-0410-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-013-0410-x

Keywords

Search

Navigation