Six decades of preventing and treating childhood anxiety disorders: a systematic review and meta-analysis to inform policy and practice

Abstract

QuestionAnxiety 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?MethodsWe 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.FindingsFor 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).ConclusionsCBT 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.

Prevalence of childhood mental disorders in high-income countries: a systematic review and meta-analysis to inform policymaking

“…[11][12][13] These shortfalls also persist despite longstanding recognition that all children have the right to adequate health, social and educational servicesincluding mental health services 14 -and despite considerable research evidence describing effective interventions for preventing and treating childhood mental disorders. [15][16][17] To address children's mental health needs, policymakers require pooled prevalence data from multiple high-quality epidemiological studies using current or recent diagnostic standards. 18 19 Studies using rigorous diagnostic measures in large representative/probabilistic samples and examining a range of mental disorders across multiple age groups provide accurate and comprehensive population estimates-and therefore the most accurate estimates of community burden.…”

Increased Incidence of Stress-related Tic Habit Cough in Children During the Recent Greek Financial Crisis

“…The prompt and favorable response to cognitive behavioral therapy in children further supports the diagnosis of THC (8,10). Another proposed effective therapeutic intervention in children is the Suggestion Therapy (24,50). On rare occasions, when family history is positive for serious psychiatric disorders, appropriate medication may be used.…”

“…in vivo 35: 1811-1820 (2021) The mechanisms behind stress-induced THC are incompletely understood. Children, under stressful conditions, tend to reproduce a physical symptom they are familiar with, cough being the commonest during the various respiratory infections of early life (7,24). Both the neuroendocrine and the immune systems are activated during stress as part of the adaptive response that maintains homeostasis (38)(39)(40).…”

“…Psychotherapy. Cognitive behavioural therapy (CBT) was used as therapeutic intervention (23,24). It combines cognitive therapy by investigating a child's thoughts, with behavioural therapy by reviewing the child's actions and feelings.…”

Educational fMRI: From the Lab to the Classroom

“…Neurofeedback protocols have been used for diverse conditions, including ADHD (Zilverstand et al, 2017; Rubia et al, 2019), motor disorders (Liew et al, 2016), and cognitive rehabilitation in stroke populations (Kober et al, 2015; Renton et al, 2017). Another interesting application of fMRI-based neurofeedback is in emotion regulation (Linhartová et al, 2019), where self-regulation of amygdala activity helped participants to improve emotion control and reduce anxiety (Herwig et al, 2019), which is highly beneficial in the educational context given the high burden of many anxiety disorders on children functioning (Schwartz et al, 2019). Before looking at the translational potential of such intervention protocols to education, their effectiveness should be assessed with randomized controlled trials and randomized controlled cross-over trials, as has been conducted for tDCS in stroke survivors (Elsner et al, 2015), tDCS for enhancing working memory capacity in healthy individuals (Ikeda et al, 2019), and neurofeedback in adults with ADHD (Schönenberg et al, 2017).…”