Effectiveness of Treatments for Childhood Anxiety Disorders
Overview of Childhood Anxiety Disorders
Childhood anxiety disorders are prevalent mental health issues, affecting approximately 15% to 20% of children. These disorders can lead to significant impairment, particularly in individuals aged 13 to 18 years. Alongside psychological symptoms, children often experience physical manifestations such as headaches, stomachaches, muscle tension, and fatigue. These symptoms can interfere with daily activities, leading to school absences and social withdrawal. Generalized anxiety may cause children to feel overwhelmed, emotionally numb, or irritable, prompting them to avoid certain places, people, or activities.
The prevalence of specific anxiety disorders varies; separation anxiety disorder affects about 2.8% to 8% of children, while specific phobias and social phobias have prevalence rates of approximately 10% and 7%, respectively.
Research Methodology
A systematic meta-analysis was conducted to assess previous studies comparing cognitive behavioral therapy (CBT) with pharmacological treatments for childhood anxiety disorders. Researchers utilized several databases, including EMBASE, SciVerse Scopus, MEDLINE, PsycINFO, the Cochrane Database of Systematic Reviews, and the Central Register of Controlled Trials. The analysis focused on studies involving children diagnosed with panic disorder, social anxiety, specific phobias, generalized anxiety disorder, and separation anxiety disorder who had undergone CBT or pharmacotherapy. The sample included 7,719 patients, with 4,290 females (55.6%) and a mean age of 9 years, ranging from 5 to 16 years.
Findings on Treatment Effectiveness
The findings, published in JAMA Pediatrics, indicated that selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and CBT were all effective in alleviating anxiety symptoms. The review showed that SSRIs, when compared to placebo, initially reduced primary anxiety symptoms, which were associated with higher remission rates. SNRIs also demonstrated a significant reduction in anxiety symptoms. However, tricyclics and benzodiazepines were not effective in treating anxiety.
CBT proved to be beneficial, leading to reductions in primary symptoms and improved remission rates. One study found CBT to be more effective than fluoxetine and more effective at achieving remission compared to sertraline. Notably, combining sertraline with CBT showed the greatest efficacy in reducing primary symptoms, as assessed by clinicians. Some studies indicated that medication alone could have adverse effects, whereas the combination with CBT did not present the same issues.
Considerations on Treatment Options
Researchers noted that many studies included were relatively small or lacked sufficient duration to draw conclusions about suicidal tendencies associated with SSRIs and SNRIs. One clinical trial raised concerns about suicidal ideation linked to Venlafaxine, although the findings were not statistically significant. Overall, CBT was associated with lower dropout rates compared to medications and placebo treatments.
The authors of the meta-analysis concluded that treatment decisions should consider individual values, preferences, service availability, and the profile of adverse effects. A variety of treatment options are available for childhood anxiety disorders, including psychotherapy, pharmacotherapy, and combined approaches. Current treatment guidelines recommend CBT and SSRIs or SNRIs as the most effective interventions. Further research is necessary to establish the comparative effectiveness of these treatments.
References
Wang Z, Whiteside SPH, Sim L, Farah W, Morrow AS, Alsawas M, Barrionuevo P, Tello M, Asi N, Beuschel B, Daraz L, Almasri J, Zaiem F, Larrea-Mantilla L, Ponce OJ, LeBlanc A, Prokop LJ, Murad MH. (2017). Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders: A Systematic Review and Meta-analysis. JAMA Pediatr. doi:10.1001/jamapediatrics.2017.3036.
Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current Diagnosis and Treatment of Anxiety Disorders. Pharmacy and Therapeutics, 38 (1), 30–57.
Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in Clinical Neuroscience, 17 (3), 337–346.