Treatment that combines a certain type of psychotherapy with an antidepressant medication is most likely to help children with anxiety disorders, but each treatment alone is also effective, according to a new study funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health.
The study is currently available online in the New England Journal of Medicine.
Anxiety disorders are among the most common mental disorders affecting children and adolescents. Untreated anxiety can undermine a child's success in school, jeopardize his or her relationships with family and inhibit social functioning.
"This study represents a significant advance in the treatment of children and adolescents with anxiety disorders," said study author Dr. John Piacentini, a professor of psychiatry and director of UCLA's Child OCD, Anxiety and Tic Disorders Program. UCLA was one of six study sites.
The Child/Adolescent Anxiety Multimodal Study randomly assigned 488 children between the ages of 7 and 17 to one of the following four treatment options for a 12-week period:
- Cognitive behavioral therapy a specific type of therapy that, for this study, taught children about anxiety and helped them face and master their fears by guiding them through structured tasks
- The antidepressant sertraline (Zoloft), a selective serotonin reuptake inhibitor
- Cognitive behavioral therapy combined with sertraline
- A placebo (sugar pill)
The children, recruited from six regionally dispersed sites throughout the United States, all had moderate to severe separation anxiety disorder, generalized anxiety disorder or social phobia. Many also had coexisting disorders, including other anxiety disorders, attention-deficit hyperactivity disorder and behavioral problems.
Piacentini and colleagues found that 81 percent of the children and adolescents who received the combination treatment improved, compared with 60 percent in the therapy-only group, 55 percent in the sertraline-only group and 24 percent in the placebo group.
Results also showed that the treatments were safe. Children taking sertraline alone showed no more side effects than the children taking the placebo, and few children discontinued the trial due to side effects. In addition, no child attempted suicide a rare side effect sometimes associated with antidepressant medications in children.
The study findings echo previous studies in which sertraline and other selective serotonin reuptake inhibitors were found to be effective in treating childhood anxiety disorders. The study's results also provide further evidence that high-quality cognitive behavioral therapy, with or without medication, can effectively treat anxiety disorders in children, according to the researchers.
In addition to UCLA, study sites included Duke University; Columbia University/New York University; Johns Hopkins University; Temple University/University of Pennsylvania; and the Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center.
Faculty within the UCLA Department of Psychiatry and Biobehavioral Sciences are experts in the origins of and treatments for disorders of complex human behavior. The department is an integral part of the Semel Institute for Neuroscience and Human Behavior at UCLA, an interdisciplinary research and education institute devoted to the understanding of complex human behavior and the causes and consequences of neuropsychiatric disorders.
