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Pediatric Generalized Anxiety Disorder Treatment & Management

  • Author: Dennis A Nutter, Jr, MD; Chief Editor: Caroly Pataki, MD  more...
 
Updated: Nov 14, 2014
 

Approach Considerations

For patients for whom medication is prescribed, regular appointments with a child and adolescent psychiatrist or developmental-behavioral pediatrician are necessary for the duration of treatment. Parents and patients must be warned of the possible risks of activation and disinhibition and what to do in such circumstances.

Go to Pediatric Obsessive-Compulsive Disorder, Pediatric Panic Disorder, and Anxiety Disorders for complete information on these topics.

Patient therapy

Weekly outpatient therapy for 3-4 months with less frequent follow-up booster sessions may be sufficient.

A cognitive-behavioral approach is likely to be most beneficial. Treatment should consist of individual sessions with family involvement to support the treatment process. Cognitive therapy features may be incorporated into an eclectic approach by highly skilled and experienced therapists.

Psychodynamic therapies, including play therapy, are time-honored modalities, but most outcomes research has focused on the brief or intermediate therapies, which are more structured.

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Behavioral and Cognitive-Behavioral Therapy

Behavioral and cognitive-behavioral therapies are among the most researched and promising treatments for childhood anxieties. Behavioral techniques (eg, relaxation training, modeling, imagining and visualizing, in vivo exposure) and cognitive techniques (eg, identifying and modifying self-talk, challenging irrational beliefs) often are used in combination with psychoeducation and contingency maintenance. Typically, children are taught to recognize early physiologic and cognitive signs of anxiety and to develop and implement coping techniques.[6, 7]

The importance of parental participation in the treatment process recently has received attention. Adding a family component focused on techniques such as contingency management, communication, and problem solving to individual child cognitive-behavioral therapy has produced favorable long-term treatment benefits in several clinical trials.[8, 9, 10]

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Exercise, Caffeine Avoidance, Preoperative Relaxation Therapy

Regular exercise promotes a sense of well-being that is particularly beneficial in individuals with anxiety and mood disorders.

Limiting caffeine intake is appropriate.

Prior to a surgical procedure, children with an anxiety disorder are particularly likely to benefit from age-appropriate preparation, including relaxation practice for elective procedures.

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Deterrence and Prevention

The following measures may aid in the prevention of generalized anxiety disorder (GAD) in children:

  • Consistent, stable, supportive home environment
  • Parenting practices that promote self-confidence, self-esteem, and effective coping skills
  • Minimal number of psychosocial stressors or traumatic events
  • Adaptive problem solving and coping skills modeled by parents and other significant people in the child's life
  • Psychoeducation
  • Family-based interventions

Ginsburg conducted a study to determine the effectiveness of preventive intervention in the prevention and/or amelioration of anxiety symptoms in children of parents with anxiety disorders and found evidence to support the concept that family-based intervention may yield benefits in children at risk for anxiety.[11] Forty children and their families were randomized to undergo an 8-week cognitive-behavioral intervention (the Coping and Promoting Strength [CAPS] program; 20 participants) or a wait list control condition (20 participants). After a 1-year follow-up, none of the children in the CAPS program developed an anxiety disorder, while 30% of the children in the wait list group did.

The authors of one study developed a novel prediagnosis intervention, Strongest Families, which includes trained nonprofessionals supervised by mental health professionals for children with disruptive behavior and/or anxiety disorders. The intervention provides care using a handbook, instructional videos, and weekly telephone contacts. The study results noted that these telephone-based treatments resulted in a significant decrease in the proportion of children diagnosed with disruptive behavior or anxiety disorders; this treatment may be an option for those patients who are unable to attend face-to-face sessions.[12]

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Referrals

Early referral to a psychologist, psychiatrist, or behavioral-developmental pediatrician for evaluation and treatment can alleviate symptoms and stress that may be the early manifestations of a more severe disorder.

Family therapy referral also may be indicated, but that may be best managed by the mental health professional or the developmental and behavioral pediatrician who performs the consultative evaluation.

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Contributor Information and Disclosures
Author

Dennis A Nutter, Jr, MD President and Director, North Georgia Neuropsychiatry, PC

Dennis A Nutter, Jr, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Psychiatric Association

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgements

Chet Johnson, MD Professor and Chair of Pediatrics, Associate Director, Developmental Pediatrician, Center for Child Health and Development, Shiefelbusch Institute for Life Span Studies, University of Kansas School of Medicine; LEND Director, University of Kansas Medical Center

Chet Johnson is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Lene Holm Larsen, PhD Instructor, Department of Child and Adolescent Psychiatry, Children's Memorial Hospital of Chicago

Disclosure: Nothing to disclose.

Carrie Sylvester, MD, MPH Senior Child and Adolescent Psychiatrist, Sound Mental Health

Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
  1. Barrios BA, Hartmann DB. Fears and anxieties. Marsh EJ, Terdal LG, eds. Behavioral Assessment of Childhood Disorders. 2nd ed. New York, NY: Guilford; 1988. 196-264.

  2. Kendall PC. Childhood Disorders. London, England: Psychology Press; 2000.

  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

  4. Last CG, Perrin S, Hersen M, Kazdin AE. A prospective study of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry. 1996 Nov. 35(11):1502-10. [Medline].

  5. March JS, Parker JD, Sullivan K, Stallings P, Conners CK. The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry. 1997 Apr. 36(4):554-65. [Medline].

  6. Kendall PC, Chu BC, Pimental SS. Treating anxiety disorders in youth. Kendall PC, ed. Child & Adolescent Therapy: Cognitive-Behavioral Procedures. 2nd ed. New York, NY: Guilford; 2000. 235-87.

  7. Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med. 2008 Dec 25. 359(26):2753-66. [Medline]. [Full Text].

  8. Barrett PM, Dadds MR, Rapee RM. Family treatment of childhood anxiety: a controlled trial. J Consult Clin Psychol. 1996 Apr. 64(2):333-42. [Medline].

  9. Last CG, Hansen C, Franco N. Cognitive-behavioral treatment of school phobia. J Am Acad Child Adolesc Psychiatry. 1998 Apr. 37(4):404-11. [Medline].

  10. Silverman WK, Kurtines WM, Ginsburg GS, Weems CF, Lumpkin PW, Carmichael DH. Treating anxiety disorders in children with group cognitive-behaviorial therapy: a randomized clinical trial. J Consult Clin Psychol. 1999 Dec. 67(6):995-1003. [Medline].

  11. Ginsburg GS. The Child Anxiety Prevention Study: intervention model and primary outcomes. J Consult Clin Psychol. 2009 Jun. 77(3):580-7. [Medline].

  12. McGrath PJ, Lingley-Pottie P, Thurston C, et al. Telephone-based mental health interventions for child disruptive behavior or anxiety disorders: randomized trials and overall analysis. J Am Acad Child Adolesc Psychiatry. 2011 Nov. 50(11):1162-72. [Medline].

  13. Cymbalta (duloxetine) [package insert]. Indianapolis, IN 46285: Lilly USA, LLC. October 29, 2014. Available at [Full Text].

  14. Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. 2006 Jan. 163(1):41-7. [Medline].

  15. Bridge JA, Iyengar S, Salary CB, et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA. 2007 Apr 18. 297(15):1683-96. [Medline].

  16. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Elk Grove, Ill: APA; 1987.

  17. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th Edition, Text Revision. 4th ed. Washington, DC: APA Press; 2000.

  18. Keeton CP, Kolos AC, Walkup JT. Pediatric generalized anxiety disorder: epidemiology, diagnosis, and management. Paediatr Drugs. 2009. 11(3):171-83. [Medline].

  19. Manassis K. Keys to Parenting Your Anxious Child. Hauppage, NY: Barron's Educational Series; 1996.

  20. Spence S. Helping Your Anxious Child: A Step-By-Step Guide for Parents. Oakland, Calif: New Harbinger Publications; 2000.

 
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