COMMENTARY

Treating Pediatric Anxiety: What Works?

Michael T. Compton, MD, MPH

Disclosures

June 10, 2011

In This Article

Treatment: What Works?

Treatment approaches were then presented. For OCD, cognitive behavioral therapy is the treatment of choice. Several SSRIs are approved for use in children and adolescents, though Dr. Walkup noted that "we're going to have to prescribe off-label to make full use of available, efficacious agents." For social phobia, Social Effectiveness Therapy for Children -- a complicated behavioral approach that may be difficult to disseminate in real-world settings -- has been shown to be efficacious. In most trials of anxiety disorders, monotherapies are effective but combination treatment (with a pharmacologic agent and a psychosocial intervention) is almost always superior. Placebo responses are generally low in trials of child/adolescent anxiety disorders, indicating that a lack of treatment is not effective; most children and adolescents do not spontaneously get better. Successfully treating affected prepubertal youth allows them to have less accumulated psychosocial dysfunction.

Outlook

"So, where are we going?" Dr. Walkup then asked. Ongoing questions for the field include: Who needs medication? What do we do in the context of a partial response to treatment? How long does one need to continue the medications? What is the impact of such agents on brain development, growth, and sexual maturation? Regarding the latter, he suggested that the field may need to rely mainly on animal data or very complex human study designs (many of which may not be feasible) to get this complicated information. Other medications need to be studied, and we need more information on optimal dosages, durations, and the exact timing of when to give them.

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