Harvard Mental Health Letter

Commentary: Treatment that works for anxious children


Treatment that works for anxious children

Parents who are trying to choose the right treatment for a child diagnosed with an anxiety disorder are apprehensive (with justification) about the effects of psychotropic medication on the developing brain. Yet when they seek psychotherapy for their children, they often learn that a good therapist is hard to find and that the costs in time and money can be difficult for families to bear.

An article published in the Oct. 30, 2008, issue of The New England Journal of Medicine should help clarify the relative value of various treatment options for anxiety disorders in children, especially separation anxiety, generalized anxiety disorder, and social phobia. The authors reported on a 12-week, randomized, controlled trial comparing cognitive behavioral therapy (CBT), the antidepressant sertraline (Zoloft), the combination of the two, and a placebo drug. Almost 500 children with these disorders, ranging in age from 7 to 17, participated in the research. More than 80% of children receiving combined therapy experienced significant improvement, compared with 60% of children receiving only CBT and 55% of those receiving only sertraline. The difference between CBT and sertraline response was not statistically significant, but both solo treatments were more than twice as effective as the placebo.

This study, funded by the National Institute of Mental Health and conducted at several sites around the United States, was well crafted. Subjects were ethnically and racially diverse. Psychotherapy was administered by experienced therapists employing a standardized treatment under careful supervision. The children receiving sertraline were evaluated in eight sessions of 30 to 60 minutes each. This design enabled investigators to compare the efficacy of one treatment against the other and against placebo. Researchers also could measure how well sertraline was tolerated compared to placebo, and assess what risks the sertraline group bore compared with groups not receiving medication.

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