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New toolkit helpful for both pediatricians and parents

Innovations in Pediatrics - Spring 2016

Anxiety is fairly common in children and teens, with studies showing the incidence between 8 and 12 percent. Nevertheless, it can sometimes be challenging for pediatricians to diagnose.

“It’s easy to miss, especially in younger children,” says Nancy Roizen, MD, Chief of the Division of Developmental-Behavioral Pediatrics and Psychology at University Hospitals Rainbow Babies & Children’s Hospital. “When they’re anxious, these kids become irritable, lose it and have a temper tantrum, which can mask their underlying anxiety.” Dr. Roizen is also Professor of Pediatrics at Case Western Reserve University School of Medicine.

To address this issue, the UH Rainbow Care Network of primary care pediatricians has worked with Dr. Roizen and her division to develop an anxiety “toolkit,” with resources for both pediatricians and parents. For physicians and other clinicians, the toolkit includes evidence-based steps for anxiety management and the Screen for Child Anxiety-Related Disorders (SCARED) questionnaire for children, teens and their parents.Anxiety Disorders: Overview for Physicians

“The SCARED questionnaire is very helpful,” Dr. Roizen says. “It helps the caregiver and clinician understand what’s driving a child’s anxiety, such as whether it’s very school-focused or social-focused.”

For parents, the toolkit includes a fact sheet covering the causes and signs of anxiety disorders, the different types of anxiety disorders and examples of when anxiety is not normal. It also includes a comprehensive treatment overview, emphasizing the role of stress reduction at home and school, physical exercise and cognitive behavioral therapy (CBT). It also includes information for parents on anti-anxiety medications.

“First-line treatment for anxiety is always cognitive behavioral therapy,” Dr. Roizen says. “However, depending on the situation, therapy and medication are much more efficacious together than either alone. The evidence for medication is positive; the evidence for CBT is more positive, but both together have a synergistic effect. It’s the most positive. But first line should be therapy.”

Also featured in the toolkit is an up-to-date list of local agencies that provide anxiety counseling for children and teens, including the insurance plans they accept.

With all of these elements, Dr. Roizen says, the goal is to promote earlier diagnosis and more effective management of anxiety in children and teens.

“What we want to do is intervene and give children, families and the pediatricians they work with the tools they need,” she says. “In the end, we want to give kids tools they can snatch out of their pocket all their lives.”

The UH Rainbow Care Network at UH Rainbow Babies & Children’s Hospital has also produced toolkits for pediatricians and parents on mild traumatic brain injury, ADHD, headache and asthma. To request these toolkits, email or

The anxiety toolkit was developed by developmental-behavioral pediatricians and psychologists from UH Rainbow Babies & Children’s Hospital and the MetroHealth System, with funding from Ohio’s Medicaid Technical Assistance and Policy Program (MEDTAPP).