A computational network perspective on pediatric anxiety symptoms

Rany Abend*, Mira A. Bajaj, Daniel D.L. Coppersmith, Katharina Kircanski, Simone P. Haller, Elise M. Cardinale, Giovanni A. Salum, Reinout W. Wiers, Elske Salemink, Jeremy W. Pettit, Koraly Pérez-Edgar, Eli R. Lebowitz, Wendy K. Silverman, Yair Bar-Haim, Melissa A. Brotman, Ellen Leibenluft, Eiko I. Fried, Daniel S. Pine

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background While taxonomy segregates anxiety symptoms into diagnoses, patients typically present with multiple diagnoses; this poses major challenges, particularly for youth, where mixed presentation is particularly common. Anxiety comorbidity could reflect multivariate, cross-domain interactions insufficiently emphasized in current taxonomy. We utilize network analytic approaches that model these interactions by characterizing pediatric anxiety as involving distinct, inter-connected, symptom domains. Quantifying this network structure could inform views of pediatric anxiety that shape clinical practice and research. Methods Participants were 4964 youths (ages 5-17 years) from seven international sites. Participants completed standard symptom inventory assessing severity along distinct domains that follow pediatric anxiety diagnostic categories. We first applied network analytic tools to quantify the anxiety domain network structure. We then examined whether variation in the network structure related to age (3-year longitudinal assessments) and sex, key moderators of pediatric anxiety expression. Results The anxiety network featured a highly inter-connected structure; all domains correlated positively but to varying degrees. Anxiety patients and healthy youth differed in severity but demonstrated a comparable network structure. We noted specific sex differences in the network structure; longitudinal data indicated additional structural changes during childhood. Generalized-anxiety and panic symptoms consistently emerged as central domains. Conclusions Pediatric anxiety manifests along multiple, inter-connected symptom domains. By quantifying cross-domain associations and related moderation effects, the current study might shape views on the diagnosis, treatment, and study of pediatric anxiety.

Original languageEnglish
Pages (from-to)1752-1762
Number of pages11
JournalPsychological Medicine
Issue number10
StatePublished - Jul 2021


FundersFunder number
National Institutes of HealthR34 MH097931, R01 MH094633, UH2 MH101470
National Institute of Mental HealthZIAMH002781-15, NCT00018057, ZIAMH002969


    • Adolescent
    • anxiety
    • child
    • comorbidity
    • development
    • network
    • pediatric
    • symptoms


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