Study, Aug/19: Six decades of preventing and treating childhood anxiety disorder

The full title of this Canadian study is "Six decades of preventing and treating childhood anxiety disorders: a systematic review and meta-analysis to inform policy and practice".

https://www.ncbi.nlm.nih.gov/pubmed/31315926 

Abstract

QUESTION:

Anxiety disorders are the most prevalent childhood mental disorders. They also start early and persist, causing high individual and collective costs. To inform policy and practice, we therefore asked: What is the best available research evidence on preventing and treating these disorders?

METHODS:

We sought randomised controlled trials (RCTs) evaluating interventions addressing anxiety problems in young people. We identified RCTs by searching CINAHL, ERIC, MEDLINE, PsycINFO and Web of Science. Thirty-three RCTs met inclusion criteria-evaluating 8 prevention programmes, 12 psychosocial treatments and 7 pharmacological treatments. We then conducted meta-analyses by intervention type.

FINDINGS:

For prevention, the cognitive-behavioural therapy (CBT) programme Coping and Promoting Strength stood out for reducing anxiety diagnoses. For psychosocial treatment, 9 CBT interventions also reduced diagnoses: Cool Kids; Cool Little Kids Plus Social Skills; Coping Cat; Coping Koala; One-Session Treatment; Parent Education Program; Skills for Academic and Social Success; Strongest Families and Timid to Tiger. Successful CBT interventions were used with children ranging from pre-schoolers to teens in homes, communities/schools and clinics. For pharmacological treatment, selective-serotonergic-reuptake-inhibitors (SSRIs) significantly improved symptoms. Fluoxetine stood out for also reducing post-test diagnoses, but caused adverse events. Meta-analyses indicated strongest effects for CBT (Log OR=0.95; 95% CI, 0.69 to 1.21) and SSRI treatments (1.57; 1.09 to 2.06).

CONCLUSIONS:

CBT is effective for preventing and treating childhood anxiety-across a range of ages and formats. Fluoxetine is also an effective treatment but side effects must be managed. CBT prevention and treatment interventions should be made widely available, adding fluoxetine in severe cases.

I was glad to see that there's more focus on CBT than on pharmaceuticals for childhood anxiety. When there was a mention of SSRIs, there was also an acknowledgement of the side effects. 

YES!!! HURRAH!!!

I'm so thankful that children are (hopefully) spared from these pills. They need to TALK it out, not be dulled by a pill.

Thank you, Lapis!!

For pharmacological treatment, selective-serotonergic-reuptake-inhibitors (SSRIs) significantly improved symptoms. Fluoxetine stood out for also reducing post-test diagnoses, but caused adverse events.

 

CONCLUSIONS:

 

CBT is effective for preventing and treating childhood anxiety-across a range of ages and formats. Fluoxetine is also an effective treatment but side effects must be managed. CBT prevention and treatment interventions should be made widely available, adding fluoxetine in severe cases.[/i]

 

This still makes me angry and sad. First, just because a medication reduces symptoms, does not mean it should be used in children, nor that it's safe for long-term use. Children's brains are still developing....

If you've read Whitaker, Breggin and others, you'll see that these studies are almost never run for longer than about 3 to 6 months. Does anyone really think that 3 months are enough to see the physiological changes wrought by medication in a developing child, over a longer period of time?

At least they're recommending meds only in 'severe' cases - but who gets to define 'severe'? How do you 'manage' the side effects of fluoxetine? (Wait...of course - more drugs...ka-ching!) And why are we not getting to the root causes for this epidemic of 'childhood anxiety disorder' - which was unknown in earlier times?

There are many studies outside the mainstream that are looking at these questions regarding childhood mental issues, yet they are never widely published. Books, too. Look into the work of Drs Benjamin Feingold, Abram Hoffer, Doris Rapp (pediatric allergist - Is This Your Child's World?), K.P. O'Meara (Doping Kids) to read about the multiple possible causes of childhood anxiety. There are too many others studies & books to list here.

These factors can all cause anxiety in children (and adults): nutritional imbalances, infections, food allergies, chemical sensitivity, stressful environment, bad parenting, social media...and more. Also, childhood depression and anxiety - even the 'severe' forms - often respond excellently to targeted nutritional intervention and natural therapies.

CBT is a step forward (although it would not 'prevent' anxiety in children). But it's by no means the full answer. Time to look at the society we've created...time to love the children. And medication in these kids is almost always disastrous.

Great post, Wildflower!

In my opinion, the atmosphere that the child grows up in plays a huge role. I'm sure "bad parenting" can be defined in many different ways, depending on whom you to talk to, though. That's a difficult one. Children don't come with instruction manuals, and the huge range of opinion on what constitutes "good parenting" is probably very confusing for most people.

When I was growing up, Dr. Benjamin Spock was, apparently, the "expert". Now, there are probably thousands of self-described "experts".

Anyway, I agree that medication comes with way too many risks. Children's brains are still developing, and we just don't know what those meds can do over time. I was on fluoxetine (Prozac) as an adult, and I will forever regret it. The side effects and withdrawal effects were awful. I would never wish that on a child, especially because one of those side effects is, possibly, lowered bone density. Who would say that's okay for children?

Thanks, Lapis. I agree with what you write.

In terms of good parenting, there are the obvious basics (which, sadly, no longer seems 'obvious' to many nowadays): home-life stability; insistence on healthy, sit-down meals; very limited screen/on-line time, more family time and real communication; building solid self-esteem....

Regarding medication: there are now 2- and 3-year-olds being diagnosed with 'anxiety disorders' - and medicated accordingly. (CBT wouldn't work in this age group, either, of course.) And this is not a rare thing. I find this terrifying. Have you ever seen a 2-year-old being withdrawn from a benzo? I have. And I never want to see it again.... I don't use the word 'evil' lightly, but it applies.

And YES, to your experience with Prozac. Ditto.

Thanks for posting the study. It's so important that more people are aware of this issue. I appreciate it.