Therapy for Childhood Anxiety
By Dr. Randi Fredricks, Ph.D.
Cognitive behavioral therapy (CBT) and Zoloft are effective treatments for childhood anxiety disorders, and the combination works best,
a government-funded study found.
Anxiety disorders and social phobias limit the lives of at least one in 10 children. Yet up to half of these kids aren't helped by
short-term treatment with psychotherapy alone or medications alone.
That's why Johns Hopkins researcher John T. Walkup and colleagues led a multi-institution, government-funded study to see
whether combination treatment would help.
The researchers enrolled 488 children and teens age 7 to 17 years. All suffered separation anxiety disorder, generalized anxiety
disorder, or social phobia.
There were four different treatment groups:
76 kids got inactive placebo pills.
133 kids got Zoloft alone -- beginning with 25 milligrams per day and adjusted up to 200 milligrams per day within eight
weeks, including eight 30- to 60-minute sessions to rate treatment response and adverse events.
139 kids got CBT alone -- 14 one-hour sessions based on the Coping Cat program.
140 kids got combination treatment with CBT and Zoloft.
After 12 weeks:
24% of the kids in the placebo group were "very much" or "much" improved.
55% of the kids in the Zoloft group were "very much" or "much" improved.
60% of the kids in the CBT group were "very much" or "much" improved.
81% of the kids in the CBT/Zoloft combination group were "very much" or "much" improved.
Walkup and colleagues conclude that all three of the active treatments -- CBT, Zoloft, or the combination -- are effective
short-term treatments for kids with anxiety disorders.
The researchers conlcuded that among these effective therapies, combination therapy provides the best chance for a positive outcome.
Sadly, most children with anxiety disorders don't get diagnosed or treated which is too bad, he says, because research now shows that
untreated childhood anxiety persists into adulthood.
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
American Psychiatric Association (2000), Diagnostic and statistical manual of mental
disorders. (4th Ed.). Washington, DC: American Psychiatric Association.
Sareen, J., Jacobi, F., Cox, B. J., Belik, S. L., Clara, I., & Stein, M. B. (2006). Disability and poor quality of life associated with comorbid anxiety disorders
and physical conditions. Arch Intern Med, 166, 2109-2116.
Sareen, J., Cox, B. J., Clara, I., & Asmundson, G. J. (2005). The relationship between anxiety disorders and physical disorders
in the U.S. National Comorbidity Survey. Depress Anxiety, 21(4): 193-202.
Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., Ginsburg, G. S., Rynn, M. A.,
McCracken, J., Waslick, B., Iyengar, S., March, J. S., & Kendall P. C. (2008).
Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety.
New England Journal of Medicine, 359(26), 2753-2766.
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