Friday, October 31, 2008

Anxious Children: What Treatment is Best?

Anxious Children: What Treatment is Best?

The New England Journal of Medicine has recently published a large research study looking at what treatment works best for children with anxiety disorders, medication or cognitive behavioral treatment. This study has been described in detail by Lindsey Tanner of the Associated Press. Sertraline (Zoloft), a selective_serotonin_reuptake_inhibitor, and cognitive behavioral therapy were found to be equally effective on their own. However, when a combination of sertraline and therapy were used together, the reduction of symptoms of anxiety in the children was much greater. The implications of this study are that a combination of medical and psychological treatment is the most effective treatment for children who have struggled with significant anxiety that has affected their day-to-day functioning and relationships with other people.

This study is quite significant and will no doubt increase the use of SSRIs with children. Insurance companies and national associations will use these results to promote the use of medication as the crucial component of helping children cope with anxiety. Even though cognitive behavioral treatment is just as effective as medication on its own, taking a pill is much quicker and more cost-effective to administer. Many parents will chose to take the "quick fix" approach and ignore that these children actually need to learn life-skills as well.

I strongly encourage parents to deeply self-reflect before giving their anxious child a pill. Before you jump to medicating your child, be sure that the anxiety is not just a situational feeling. We all become anxious from time to time. Many times, this anxiety goes away when the situation changes. Also, be sure that you are teaching some of the basics of cognitive behavioral therapy (e.g., relaxation, reinterpreting events). We all have to learn to overcome our fears through lots of hard work. In order for children to become strong adults, it is a wonderful skill to how to manage fears through positive self-talk, brief relaxation (i.e., deep breathing, visualizing a safe place), and persistence. If we give too much power to medication, our children will be less inclined to learn the success principles that are so important in life.

Of course there are times when medication is indicated (e.g., persistent symptoms of anxiety over time that are greatly affecting performance and relationships) and the decision to medicate is a personal one made on case-by-case basis. However, even if medication is utilized, the children on medication still need to be taught how to effectively overcome the challenges that they will face throughout their lifetime. The medication may "cut the edge" off the symptoms of anxiety which could help the child be more able to learn. The medication will not teach such skills as assertion, prioritization of life's goals, and reinterpreting stressful events (e.g., calling someone up on the phone, entering a group of people) as "no big deal." The more that children are taught how to manage fears and stressors, the better off they will be.

To learn more about children and anxiety, go to my recommended resources page by clicking here.