Medicated Anxious Children: Characteristics and Cognitive-Behavioural Treatment Response

Abstract

A nxiety disorders in children and adolescents are highly prevalent psychopathologies affecting as many as 10% of youth (1-3). These disorders are frequently associated with psychosocial difficulties, school difficulties, and risk for more serious conditions including depression, suicide, and substance abuse. The goals of treatment are to target overwhelming, incapacitating anxiety that interferes with functioning in social or academic spheres and to prevent a chronic Can J Psychiatry, Vol 48, No 11, December 2003 W 741 Objective: To determine whether individual and family characteristics of children with anxiety disorders who take psychotropic medications differ from those that are unmedicated and whether there is a differential response to cognitive-behavioural therapy (CBT). Method:Children ages 8 to 12 years (n = 102: 18 medicated, 84 unmedicated) were recruited in a specialized outpatient clinic over a 3-year period. All had a primary diagnosis of an anxiety disorder. Comparisons were done using t-tests for continuous measures and chi-square tests for discrete measures. Treatment-related changes were assessed using repeated measures analyses of variance.Results: Medicated and unmedicated groups did not differ by age, sex, socioeconomic status, or diagnostic profile. Initial ratings of anxiety symptoms, depressive symptoms, and global functioning were comparable. Greater family dysfunction and family frustration were reported in medicated children. With treatment, both groups improved symptomatically and showed improved family functioning. Families of medicated children showed a greater reduction in frustration than families of unmedicated children, whereas unmedicated children showed greater gains in global functioning. Conclusions:Initial family functioning of medicated children seems to show more disturbances. Both medicated and unmedicated children can benefit from CBT. Further studies of differential treatment effects for medicated and unmedicated children are indicated. Information on funding and support and author affiliations appears at the end of the article. Clinical Implications· Families of children with anxiety disorders who require medications may show higher rates of family dysfunction and family frustration. · Family dysfunction appears to improve with cognitive-behavioural therapy (CBT). · Even anxious children who require medications can benefit from CBT, although gains in global functioning may be more limited. Limitations· This was an exploratory, uncontrolled study without randomization. · Results were not corrected for number of comparisons. · Results must be replicated with the inclusion of more medicated children.

Worried no more: The effects of medication status on treatment response to a CBT group for children with anxiety in a community setting

“…Thus, the present results suggest that medicated and non-medicated children both benefited similarly from GCBT, consistent with Liashko and Manassis' (2003) findings.…”

“…Although the current sample scored in the "normal" range at pre-treatment, they all met criteria for an anxiety disorder as determined by the clinician administered DICA-IV (Reich, 2000). Furthermore, the average pretreatment scores obtained were similar to those reported by Liashko and Manassis (2003; i.e., 53.73 and 51.52 for the non-medicated and medicated children, respectively, at pre-treatment). The obtained change in MASC scores over treatment, however, exceeded those reported by Liashko and Manassis (2003).…”

A Case Series of Cognitive-Behavioral Therapy Augmentation of Antidepressant Medication for Anxiety in Children With Autism Spectrum Disorders

“…There were no differences between youth who were taking an SRI (n = 13) versus those who were not on medication (n = 29) following 12 sessions of group CBT at post-treatment and 4-month follow-up with both groups experiencing significant clinical benefit. Similarly, Liashko and Manassis (2003) showed that CBT was effective when augmenting medication treatment; response did not differ between 18 youth taking a psychotropic medication (only 11 of whom were taking an antidepressant) relative to 84 un-medicated children with clinical benefit experienced regardless of medication status. The results of sequential CBT augmentation of SRI treatment of anxiety among typically developing youth are promising and may, therefore, possibly be extended to youth with ASD.…”

“…daily sessions for three weeks duration) was associated with significantly improved outcomes among youth who remained symptomatic following antidepressant treatment. Two post-hoc studies in non-OCD anxiety suggest that CBT provided sequentially after antidepressant treatment was beneficial for alleviating anxiety symptoms (Eichstedt, Tobon, Phoenix, & Wolfe, 2010;Liashko & Manassis, 2003). Eichstedt et al (2010) found CBT to be efficacious when delivered after receiving SRI treatment.…”

Paroxetine improves social anxiety disorder in children and adolescents

“…It is also not clear whether the combination of CBT and SSRI is better than either one alone, and whether this combination should be provided concurrently or sequentially. 4 The risks and benefits of long-term SSRI use also warrant further investigation.…”