Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Overview of Mental Disorders in Children
Anxiety Disorders
Treatment of Anxiety
Although anxiety disorders are the most common disorder of youth, there is
relatively little research on the efficacy of psychotherapy (Kendall et al.,
1997). For childhood phobias, contingency management10 was the only intervention
deemed to be well-established, according to an evaluation by Ollendick and King
(1998), which applied the American Psychological Association Task Force criteria
(noted earlier). Several psychotherapies are probably efficacious for treating
phobias: systematic desensitization11 ; modeling, based on research by Bandura
and colleagues, which capitalizes on an observational learning technique (Bandura,
1971; see also Chapter 2); and several cognitive-behavioral therapy (CBT)
approaches
(Ollendick & King, 1998).
CBT, as pioneered by Kendall and colleagues (Kendall et al., 1992; Kendall,
1994), is deemed by the American Psychological Association Task Force as
probably efficacious. It has four major components: recognizing anxious
feelings, clarifying cognitions in anxiety-provoking situations,12 developing a
plan for coping, and evaluating the success of coping strategies. A more recent
study in Australia added a parent component to CBT, which enhanced reduction in
post-treatment anxiety disorder significantly compared with CBT alone (Barrett
et al., 1996). However, none of the interventions identified above as
well-established or probably efficacious has, for the most part, been tested in
real-world settings.
In addition, psychodynamic treatment to address underlying fears and worries can
be helpful, and behavior therapy may reduce the child’s fear of separation or of
going to school; however, the experimental support for these approaches is
limited.
Preliminary research suggests that selective serotonin reuptake inhibitors may
provide effective treatment of separation anxiety disorder and other anxiety
disorders of childhood and adolescence. Two large-scale randomized controlled
trials are currently being undertaken (Greenhill, 1998a, 1998b). Neither
tricyclic antidepressants nor benzodiazepines have been shown to be more
effective than placebo in children (Klein et al., 1992; Bernstein et al., 1998).
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