Assessment and Treatment of Anxiety Disorders in Children and Adolescents

Wehry, Anna M.; Beesdo‐Baum, Katja; Hennelly, Meghann M.; Connolly, Sucheta D.; Strawn, Jeffrey R.

doi:10.1007/s11920-015-0591-z

Cited by 202 publications

(153 citation statements)

References 75 publications

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“…Therefore, whereas some children may exhibit symptoms that meet diagnostic threshold criteria for either a depressive or anxiety disorder, the symptoms in these areas that most children and adolescents exhibit are better explained as being on an affective/anxiety continuum. 17,18 …”

Section: A Dimensional Conceptualizationmentioning

confidence: 99%

Comorbid Anxiety and Depressive Symptoms in Children and Adolescents

Melton

Croarkin

Strawn

et al. 2016

Journal of Psychiatric Practice

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137

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Background. A large and extensive body of research has examined comorbid anxiety and depression in adults. Children and adolescents also frequently present with comorbid anxiety and depression; however, research and treatment require unique environmental and neurodevelopmental considerations in children. As a result, our understanding of comorbid anxiety and depression in children and adolescents is limited. Objective. The goal of this systematic review was to examine current literature focused on comorbid anxiety and depression in children and adolescents. The review included theoretical conceptualizations as well as diagnostic, neurobiologic, prevention, and treatment considerations. In addition, a proposed algorithm for the treatment of comorbid anxiety and depression in children/adolescents is provided. Methods. This systematic literature review included three discrete searches in Ovid SP Medline, PsychInfo, and Pubmed. Results. The review included and synthesized 115 articles published between 1987 and 2015. The available evidence suggests that anxiety and depression are common in clinical populations of children and adolescents, and that comorbidity is likely underestimated in children and adolescents. Children and adolescents with comorbid anxiety and depression have unique presentations, greater symptom severity, and treatment resistance compared with those who have either disease in isolation. A dimensional approach may be necessary for the future development of diagnostic strategies and treatments for this population. Nascent neuroimaging work suggests that anxiety and depression each represents a distinct neurobiological phenotype. Conclusion. The literature that is currently available suggests that comorbid anxiety and depression is a common presentation in children and adolescents. This diagnostic picture underscores the importance of comprehensive dimensional assessments and multimodal evidence-based approaches given high disease severity. Future research on the neurobiology and treatment of these common clinical conditions is warranted.

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Section: A Dimensional Conceptualizationmentioning

confidence: 99%

Comorbid Anxiety and Depressive Symptoms in Children and Adolescents

Melton

Croarkin

Strawn

et al. 2016

Journal of Psychiatric Practice

Self Cite

137

View full text Add to dashboard Cite

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“…CBT studies that include parent or family components have demonstrated effectiveness for young children (Cartwright-Hatton et al, 2011;Hirshfeld-Becker et al, 2010;Jongerden & Bogels, 2015;Lyneham & Rapee, 2006;Wehry, Beesdo-Baum, Hennelly, Connolly & Strawn, 2015). However, most CBT studies exploring services delivered directly to the child have been conducted with children older than school age children and have strong results.…”

Section: Mental Health Interventionmentioning

confidence: 99%

Child-centered play therapy with young children who are anxious: A controlled trial

Stulmaker

Ray

2015

Children and Youth Services Review

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“…A nxiety disorders, including generalized, social, and separation anxiety disorders, are among the most common psychiatric conditions in youth (Kessler et al 2005), frequently emerge during adolescence (Beesdo et al 2010;Wehry et al 2015), and are associated with significant morbidity and mortality (Sareen et al 2005;Husky et al 2012). However, these disorders are also amenable to both psychotherapeutic and psychopharmacologic interventions (Connolly and Bernstein 2007;Walkup et al 2008;Strawn et al 2015a;Strawn et al 2015b), and long-term data suggest that successful treatment may result in sustained reductions in anxiety .…”

Section: Introductionmentioning

confidence: 99%

Placebo Response in Pediatric Anxiety Disorders: Implications for Clinical Trial Design and Interpretation

Dobson

2016

Journal of Child and Adolescent Psychopharmacology

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Objectives: The characterization and prediction of placebo response in clinical trials of youth with anxiety disorders have received little attention, despite the critical effects of placebo response rate on the success or failure of clinical trials. With this in mind, we sought to examine the factors that predict or influence placebo response in randomized controlled trials of youth with anxiety disorders. Methods: Prospective, randomized, parallel-group controlled trials of psychopharmacologic interventions in pediatric patients with anxiety disorders were identified using a search of PubMed/Medline (1966. Weighted least squares regression models and z-tests were utilized to examine the impact of continuous and categorical variables, respectively, on placebo response. These variables included demographic (e.g., age, percent white, percent female), clinical (e.g., baseline symptom severity), and trial characteristics (sample size, duration, funding). Finally, the relationship between the class of comparator medication and placebo response rate was examined using a multiple comparison for proportions test.Results: The analyses of data from 14 trials involving 2230 patients and 9 medications reveal that higher placebo response rates were associated with a greater number of study sites ( p = 0.013) and fewer patients per site ( p < 0.008), while placebo dropout rates increased with more recent publication ( p = 0.01) and were positively associated with the number of study visits ( p < 0.02). Lower placebo response rates were associated with federally funded studies (z = -4.61, p < 0.001), studies conducted in the United States (z = 1.81, p < 0.035), and with an increased likelihood of detecting a significant effect on the primary outcome (z = 4.58, p < 0.0001). Additionally, studies, in which the majority of patients (>60%) had a diagnosis of social anxiety disorder, exhibited lower placebo response rates ( p < 0.001). Finally, for trials, effect size has decreased over time ( p = 0.004). Conclusions: Important trial-specific factors affect placebo response and placebo dropout in youth with anxiety disorders and have pragmatic implications for the conduct and design of clinical trials and raise the possibility that limiting the number of sites while maximizing the number of patients per site could enhance the ability to detect medication-placebo differences.

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Assessment and Treatment of Anxiety Disorders in Children and Adolescents

Cited by 202 publications

References 75 publications

Comorbid Anxiety and Depressive Symptoms in Children and Adolescents

Comorbid Anxiety and Depressive Symptoms in Children and Adolescents

Child-centered play therapy with young children who are anxious: A controlled trial

Placebo Response in Pediatric Anxiety Disorders: Implications for Clinical Trial Design and Interpretation

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