**Conflict of interest**

*Psychopathology - An International and Interdisciplinary Perspective*

occurs during adolescence [24, 46].

Different anxiety disorders have different age and gender distributions during childhood and adolescence. Separation anxiety disorder (SAD) and specific phobias (SPEC) are more common in children, while panic disorder and social phobia are more common in adolescents. Recent studies showed that, in the general population, anxiety symptoms first decrease during early adolescence and subsequently increase from middle to late adolescence [22]. SAD and SPEC tend to emerge and predominate during childhood, whereas the initial onset of generalized anxiety disorder (GAD), panic disorder (PD), and social anxiety disorder (SAD) most often

According to the findings of our study, gender and age contributed to the presence of comorbidity. Adolescents were more likely than children to meet criteria for other anxiety disorder or MDD. The age and gender trends for these comorbidities were different. While for the comorbidity with other anxiety disorder, the prevalence in adolescent boys is decreasing; in adolescent girls, it rises, being accountable for the significant difference between children and adolescents. For the comorbidity with MDD, the prevalence trends regarding age and sex are different. The comorbidity with MDD is rising with age, disregarding the gender, mentioning that the prevalence of MDD is higher in boys and the increase with age is milder than in girls. The girls were more likely to receive an additional diagnosis of other anxiety disorder and MDD, while the boys were more likely to receive an additional diagnosis of ADHD, ASD, or MR. This pattern is consistent with other studies which have found either no difference between the sexes or greater rates of comorbidity in males [48]. When examined separately, no difference was found in the presence of comorbidity by sex, for the principal diagnoses, but there were significant differences by age. The fact that adolescents experience higher levels of comorbid depres-

sive disorders is consistent with findings from a clinical population [49].

Regarding the treatment patterns, in our study, the most frequently recommended pharmacological treatment was SSRIs, 36% of the patients receiving fluoxetine or sertraline. Other recommended treatments were benzodiazepines recommended to 15.6% of the patients, antipsychotics recommended to 19.3%, and mood stabilizers recommended to 7.4% of them. About 49.6% of the patients in our sample did not receive pharmacological treatment, 30.7% patients received only one medication, and 19.7% received more than one pharmacological treatment. There were no statistically significant relationships between the recommended treatment and gender, but there were significant differences regarding the age group (children vs. adolescents), the adolescents being more likely to receive more medication. These results should be interpreted keeping in mind that the sample had a high rate of comorbidities (79.5%) and that the pharmacological treatment may target those disorders. There is some evidence that medication can be effective in treating anxiety in children and adolescents, at least on the short term. A recent meta-analysis showed anxiolytic medication to be associated with a significantly greater clinical response than placebo (58.1 vs. 31.5%). Selective serotonin reuptake inhibitors (SSRIs) are regarded as the pharmacological treatment of choice for anxiety disorders in children and adolescents because of their effectiveness and safety profile. It is important to note that benzodiazepines have not been systematically assessed in children and adolescents, and, in view of concerns about dependency and side effects, their use is not recommended. It is unclear if there is an age below which medication would be contraindicated and what the duration of treatment should be [36]. Understanding the common patterns of anxiety disorders comorbidities and its treatments has important implications for child anxiety disorders treatment planning. Whether comorbid conditions might increase the need for treatment or cause patients to respond more poorly to psychological or psychiatric interventions is an important research area. Future treatments might need to be

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The authors declare that they have no conflict of interest.
