Pediatric Anxiety Disorders: Insights From Basic Neuroscience, Development, and Clinical Research

Abstract

Challenges confronting research on mental illness might be met by integrating data across basic neuroscience, development, and clinical research. Pediatric anxiety disorders represent one of the few areas where sufficient progress exists to provide a foundation for such integration. This special issue of Biological Psychiatry describes neuroscientific, developmental, and clinical discoveries illuminating a path that could initiate a paradigm shift. These discoveries involve research on defensive behaviors; these are behaviors that are deployed when organisms confront perceived dangers. These discoveries also involve research on regulatory behaviors; these are behaviors deployed to modulate the initial defensive response based on previous experiences, current goals, and context. Defensive and regulatory behaviors are considered throughout the special issue as they relate to brain function across species and clinical expression in people at distinct ages. The special issue reflects research domain criteria principles carving mental illness components into continuously distributed domains spanning normative and pathological areas (1). Research domain criteria encourage multilevel work on these domains, incorporating brain and behavior assessments applicable to developmental samples and targetable with novel therapies attuned to each domain (2). A dimensional, multilevel approach to this special issue unfolds in four sections, each related to defensive and regulatory behaviors. The first section reviews basic science research, followed by a second section on early human brain development and premorbid risk as these processes relate to defensive behavior. The third section describes specific domains of disrupted functioning in children with clinical features of anxiety. The fourth section describes new treatments that target domain-specific disruptions and causally link defensive and regulatory behaviors to clinical end points. Together, the articles in this special issue leverage basic research in the service of clinical innovation. The fundamental observation arising from this issue is a view of defensive and regulatory behaviors at distinct life stages as reflecting developmentally layered amalgamations. This framework encourages age-specific approaches to classification, risk prediction, and treatment. While the current issue focuses on anxiety, this framework is likely to have broad relevance for other disorders with developmental unfolding, including adult mental illnesses associated with pediatric anxiety. As such, progress in pediatric anxiety might encourage efforts to create broad perspectives that integrate neuroscience, clinical research, and developmental approaches.