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Therapy or pills to treat anxiety in kids?

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Mayo Clinic researchers Zhen Wang, Ph.D. and M. Hassan Murad, M.D. of the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery  recently published a paper examining the body of research on the use of cognitive behavioral therapy and/or medication for reducing childhood anxiety symptoms.

“Childhood anxiety is very common, occurring in as many as 20 percent of young people,” says Mayo Clinic psychologist Stephen Whiteside, Ph.D. “It is very persistent, and gets in the way of life; and so is very important to address.”

A young patient talks with Stephen Whiteside, Ph.D.

The team, with clinical guidance from Dr. Whiteside, report that from the research studies examined, both cognitive behavioral therapy and selective serotonin uptake inhibitors (SSRIs) appear to be safe and effective for treating anxiety in children and adolescents, ages 3-18. They found mixed results for use of serotonin-norepinephrine reuptake inhibitors (SNRIs), and no benefit from benzodiazepines and tricyclics.

They also saw indications of a slightly better result for children treated with cognitive behavioral therapy.

“What I hope is that parents will consider and ask for CBT as a first course of action,” Dr. Whiteside says. “But it should be true exposure-based CBT—incorporating exercises to help children build confidence through facing their fears. Cognitive behavioral therapy is at least as effective as medication, and probably more desirable, given the side effects associated with medication.

“We worked together with Mayo Clinic’s Evidence-Based Practice Center and the Knowledge Synthesis team to comb the literature to discover the most effective, efficient and safe ways to treat anxiety in children. They are not just ‘little adults,’ and so it’s important to find what works best for them,” says Dr. Whiteside.

The authors defined cognitive behavioral therapy as attempts to change thought patterns and behavior via some combination of cognitive restructuring, relaxation training, and exposure therapy. They included research on:

“This type of research, or meta-analysis, enables us to break down the huge amount of information that is out there into easily digestible facts,” says Dr. Whiteside.

This “digestible” information can help both mental health care providers and parents make the best possible decisions regarding treatment for childhood anxiety, he continues.

Dr. Whiteside and the team hope to see more head-to-head comparisons between various medications, among different approaches to CBT, and different combinations of treatment in future research. But for today, their research contains the best available information in the field.