Studies of Childhood
Anxiety and Anxiety Disorders
Studies of outpatient interventions for anxiety symptoms
and anxiety disorders in school-aged children are presented in table
4. Studies were included in this review if they covered children in
the 6–12 years age range, although studies that also included younger
children or adolescents were not excluded. Several approaches were combined
to identify relevant published studies. The following key words and
synonyms were searched in PsycINFO and Medline: anxiety, worries, fears,
anxiety disorder, separation anxiety disorder, generalized anxiety disorder,
overanxious disorder, avoidant disorder, panic disorder, agoraphobia,
phobia, simple phobia, social phobia, and obsessive compulsive disorder.
The results of these searches were then crossed with the
appropriate age group (6–12 years old), with treatment modalities
(treatment, psychopharmacology, psychotherapy, cognitive behavior therapy,
intervention, behavior modification), then with study type (randomized
clinical trial, clinical trial), and time frame (1985 to 1999). Studies
investigating school refusal/school phobia were also included because
the behavior is so often associated with anxiety and anxiety disorders.
Reference lists obtained from review articles and book chapters were
searched to ensure that all of the relevant studies had been identified.
The initial pool of 75 articles was then reduced using the general inclusion
criteria for this project. Thirty-eight papers were excluded for the
following reasons: open-label drug study, single case report, all subjects
older than 12 years old, retrospective chart review, or no comparison
group. The final anxiety matrix (table 4) includes 37 papers that met
the inclusion criteria. The matrix divides the treatments into three
categories: psychosocial, psychopharmacological, and adjunctive. This
summary describes studies with treatments that have been found to be
effective for children with symptoms of anxiety, studies with a mix
of DSM-defined anxiety disorders overall, and finally, specific DSM
anxiety disorders.
Most of the anxiety treatment literature has focused on
childhood fears, phobias, or anxiety symptoms, rather than clearly defined
anxiety disorders. Psychosocial interventions reviewed began with Blagg’s
1984 study, which demonstrated that "behavioral therapy" was
more effective than hospitalization or home-tutoring and psychotherapy
at returning school-refusing children back to school. Systematic desensitization,
modeling (either live or symbolic), modeling in conjunction with assisted
participation and/or desensitization, and reinforced practice (in vivo
exposure and rewards) have also been shown to be more effective than
no treatment in reducing phobic symptoms. Cognitive behavior therapy
(CBT) has also been found to reduce anxiety symptoms and fears. Interestingly,
in several of the CBT studies, nonspecific therapeutic interventions
were also effective in reducing anxiety symptoms. There are no studies
on the effectiveness of medication without concurrent psychotherapy
for reducing anxiety symptoms. Three adjunctive studies on the treatment
of anxiety symptoms were identified; however, the effectiveness of medication
to treat anxiety symptoms in children has not been definitively demonstrated
to date.
Seven studies (five on cognitive behavior therapy and
two on medication) have assessed treatments for a mix of DSM-defined
anxiety disorders. Various types of cognitive behavior therapy have
been shown to be effective in reducing anxiety symptoms in these children.
Neither of the drugs investigated (alprazolam and clonazepam) were found
to be more effective than placebo in reducing symptoms in children with
DSM-defined anxiety disorders.
In this matrix, nine studies meeting the criteria focused
on the treatment of specific DSM childhood anxiety disorders: six were
interventions for obsessive compulsive disorder (OCD), one was for separation
anxiety disorder, and two for simple phobia. No studies on the treatment
of generalized anxiety disorder, social phobia, or panic disorder met
the criteria necessary to be included in this review. Psychosocial treatments
for DSM-defined social phobia included emotive imagery (a version of
systematic desensitization), which was found to be an effective treatment
for darkness phobia with gain maintained at 3 months; in the second
study, exposure-based contingency management treatment and exposure-based
cognitive self-control treatment resulted in substantial improvements
on all outcome measures at 3, 6, and 12 months. Children in an educational
support treatment, an approach chosen to control for "nonspecific"
therapeutic effects, also experienced significant symptom reduction
that was maintained during followup. Only one DSM-defined disorder,
OCD, has had effectiveness demonstrated for a pharmacological intervention.
Four studies have evaluated use of clomipramine for OCD with contradictory
results. Fluoxetine and sertraline have been reported to be more effective
than placebo in reducing obsessive compulsive symptoms in children with
an OCD diagnosis, but sample size for the fluoxetine study (n
= 14) is too small to produce reliable results.
In conclusion, the effectiveness of behavior therapy and
cognitive therapy for treatment of childhood anxiety disorders has been
shown in a number of studies. Clearly, however, the current research
on the treatment of childhood anxiety disorders contains many significant
gaps that must be addressed in order to provide effective interventions
for children and their families.
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| Table 4.1 Psychosocial Studies of Childhood
Anxiety Disorders |
| Study
Citation(s) |
Study
Design/
Description |
Target
Population |
Demographic
Characteristics |
Outcomes |
Notes |
| Barabasz,
1973 |
RCT; Imaginal
systematic desensitization (n = 42) vs. no treatment
control (n = 41) |
Highly test
anxious 5th and 6th graders |
Age:
DK
Gender: DK
Race/Ethnicity: DK
|
Children in
treatment group obtained lower autonomic indices of test anxiety
and significant improvement on measures of test performance |
Polygraph
used to measure autonomic indices |
| Barrett, Dadds,
& Rapee, 1996 |
RCT; 12-session
cognitive-behavior therapy (n = 28) vs. cognitive-behavior
therapy plus family management (n = 25 ) vs. wait-list
control (n = 26) |
Children with
DSM-III-R overanxious disorder (n = 30), separation anxiety
disorder (n = 30), or social phobia (n = 19) |
Age:
7 – 14
Gender:
57% boys
43% girls
Race/Ethnicity: DK
|
Cognitive-behavior
therapy more effective than control; 69.8% in either cognitive-behavior
therapy group no longer met criteria for an anxiety disorder
vs. 26% in the control; cognitive-behavior therapy plus family
management more effective than cognitive-behavior therapy alone;
at 12-month followup 70.3% in the cognitive-behavior therapy alone
and 95.6% in the cognitive-behavior therapy plus family management
no longer met criteria for an anxiety disorder |
Younger children
(7–10) and girls responded better to the cognitive-behavior
therapy plus family management intervention; used manualized protocol;
small overall dropouts |
| Blagg &
Yule, 1984 |
Quasi-experimental
design; behavior therapy (n = 30) vs. hospitalization
(n = 16) vs. psychotherapy and home tutoring (n
= 20) |
School refusing
youth |
Age:
11 – 16
Gender:
46% boys
54% girls
Race/Ethnicity: DK
|
Success (defined
as return to school measured at 1 year) was greatest for behavior
therapy group (93.3%) vs. hospitalization (37.5%) vs.
psychotherapy and home tutoring (10%) |
Groups not
matched; subjects not randomized; behavior therapy group significantly
younger than other two groups; therapies not manualized; psychiatric
diagnoses not assessed; no control group |
| Cornwall,
Spence, & Schotle, 1992 |
RCT; 6-week
emotive imagery therapy vs. wait-list control group
(n = 24) |
Darkness phobia;
children met DSM-III-R criteria for simple phobia; children excluded
for comorbid anxiety disorder, other anxiety disorders, and taking
medication |
Age:
7 – 10
Gender: DK
Race/Ethnicity: DK
|
Significant
reduction in darkness fear, anxiety, and impairment in treatment
group; improvement maintained at 3-month followup |
Emotive imagery
is a variant of systematic desensitization; no significant reduction
in fears and anxiety in control group |
| Graziano &
Mooney, 1980; Graziano & Mooney, 1982 |
RCT; 3 weeks
of verbal self-instruction (n = 17) vs. wait-list
control group (n = 16) |
Children with
severe nighttime fears present for more than 2 years |
Age:
6 – 13
Gender:
54% boys
46% girls
Race/Ethnicity: DK
|
Treatment
group had significantly fewer fears than control group |
Treatment
gains were maintained or improved at both 6-month, 12-month, and
2- to 3-year followup |
| Kanfer, Karoly,
& Newman, 1975 |
RCT; positive
self-talk group (n = 15) vs. positive talk about
the environment group (n = 15) vs. reciting nursery
rhymes (n = 15) |
Children with
fear of the dark |
Age:
5 – 6
Gender: DK
Race/Ethnicity: DK
|
Greater reduction
in fear for positive self-talk group relative to other two groups |
Mean change
in tolerance to remain in dark room only 2 minutes; no psychiatric
diagnosis |
| Kendall, 1994;
Kendall & Southam-Gerow, 1996 |
RCT; 16-session
individual cognitive-behavior therapy n = 27) vs.
wait-list (n = 20) |
Children with
DSM-III-R diagnosis of overanxious disorder, separation anxiety
disorder, or avoidant disorder; children excluded for primary
diagnosis of specific phobia or current antianxiety medication |
Age:
9 – 13
Gender:
60% boys
40% girls
Race/Ethnicity:
75% White
1% African American
24% Other
|
Cognitive-behavior
therapy was more effective than control; 64% of the treated subjects
no longer met criteria for an anxiety disorder vs. 5% in
the control |
Treatment
gains maintained at 1 year and 3- to 5-year followup; data support
long-term beneficial effects of cognitive-behavior therapy; 22%
noncompletion rate; comorbidity included 32% depression, 15% ADHD,
2% conduct disorder, 60% simple phobias; manualized treatment |
| Kendall, Flannery-Schroeder,
Panichelli-Mindel, Southam-Gerow, Henin, & Warman, 1997 |
RCT; 16-week
individual cognitive-behavior therapy (n = 60) vs.
wait-list control (n = 34) |
Children with
primary anxiety disorder; overanxious disorder (n = 55),
separation anxiety disorder (n = 22), avoidant disorder
(n = 17) |
Age:
9 – 13
Gender:
62% boys
38% girls
Race/Ethnicity:
85% Caucasian
5% African American
2% Hispanic or Asian
5% Other
|
Cognitive-behavior
therapy was more effective than waitlist control; 53.2% no longer
met diagnostic criteria for an anxiety disorder in treatment group
vs. 5.9% in the wait-list group; improvement in coping
skills/functioning; |
Treatment
gains and functional improvement maintained at 1-year followup;
treatment effect the same for all three anxiety diagnoses |
| King, Tonge,
Heyne, Pritchard, Rollings, Young, Myerson, & Ollendick, 1998 |
RCT; 4-week
cognitive-behavior therapy and parent/teacher behavior management
(n = 16) vs. wait-list (n = 16) |
School refusing
children; 85.3% with a psychiatric diagnosis; subjects excluded
if currently on antianxiety or antidepression medication |
Age:
5 – 15
Gender:
53% boys
47% girls
Race/Ethnicity: DK
|
Intensive,
brief cognitive-behavior therapy was superior to control; 88.2%
of cognitive-behavior group showed clinical improvement in school
attendance vs. 29.4% of wait-list control |
Treatment
gains were maintained at 3-month followup; no attrition; parental
training might have enhanced the effectiveness of the treatment |
| Kondas, 1967 |
RCT; relaxation
training (n = 6) vs. group imaginal systematic desensitization
(n = 6) vs. fear hierarchy without relaxation (n
= 5) vs. no relaxation control (n = 6) |
Children with
"stage fright" |
Age:
11 – 15
Gender: DK
Race/Ethnicity: DK
|
Fear reduction
greatest for systematic desensitization; relaxation training led
to temporary fear reduction but treatment gains were maintained
at followup |
Treatment
gains maintained at 5-month followup for systematic desensitization |
| Last, Hansen,
& Franco, 1998 |
RCT; 12-week
cognitive-behavior therapy (n = 20) vs. educational
support therapy (n = 21) |
Children with
school refusal and DSM-III-R anxiety disorder of phobic disorder
(58%), separation anxiety disorder (32%), avoidant disorder (4%),
or panic disorder (2%); subjects excluded due to current diagnosis
of depression or psychiatric medication |
Age:
M = 12
Gender:
33% boys
67% girls
Race/Ethnicity:
90% Caucasian
4% African American
6% Hispanic
|
No significant
between-group differences in school refusal behavior, symptoms
of anxiety, or depression; no between-group differences at 4-week
followup; 30% of both groups reported "moderate" difficulty
returning to school the following year |
Cognitive-behavior
therapy group had highest attrition rate; both treatments were
more effective in younger children |
| Lewis, 1974 |
RCT; modeling
of water play on film vs. assisted participation in the
feared activity vs. combined modeling and participation
vs. controls (total n = 40) |
Children with
fear of water |
Age:
5 – 12
Gender:
100% boys
Race/Ethnicity:
100% African American
|
Greatest reduction
in avoidance behavior with assisted participation plus modeling;
assisted participation alone was more effective than modeling
alone; each treatment was more effective than no treatment |
|
| Mann &
Rosenthal, 1969 |
RCT; individual
desensitization (n = 10) vs. vicarious individual
desensitization (n = 10) vs. group desensitization
(n = 10) vs. vicarious group observing group desensitization
(n = 10) vs. vicarious group observing individual
desensitization (n = 10) vs. no treatment controls
(n = 21) |
Test anxiety |
Age:
12 – 14
Gender:
45% boys
55% girls
Race/Ethnicity: DK
|
All active
treatments superior to control; no significant between-group differences |
Small sample
size |
| Menzies &
Clarke, 1993 |
RCT; three-session
reinforced practice vs. live modeling vs. in vivo
exposure plus reinforced practice modeling vs. assessment
only control (n = 48) |
Children with
water phobia |
Age:
M = 5.5
Gender:
65% boys
35% girls
Race/Ethnicity: DK
|
Reinforced
practice produced clinically significant reduction in anxiety
and avoidance of water activities; gains maintained at 3 months;
gains generalized to other water situations |
Modeling was
not more effective than control condition |
| Miller, Barrett,
Hampe, & Noble, 1972 |
RCT; 24-session
systematic desensitization vs. verbal or play psychotherapy
vs. wait-list control (total n = 67) |
Children with
a variety of "phobic" symptoms; 69% with a fear of school |
Age:
6 – 15
Gender:
55% boys
45% girls
Race/Ethnicity:
96% White
4% African American
|
Both treatments
equally efficacious in reducing phobic behavior; both treatments
more effective than wait-list control |
Findings of
efficacy only true for children ages 6–10; both treatments
included parent training |
| Murphy &
Bootzin, 1973 |
RCT; up to
four sessions of active contact desensitization vs. passive
contact desensitization vs. no treatment control (total
n = 67) |
Children with
snake-phobia |
Age:
6 – 9
Gender:
49% boys
51% girls
Race/Ethnicity: DK
|
Both treatments
effective; no significant between-group differences for active
treatments; 86.7% of treated children overcame snake phobia vs.
22.7% controls |
In vivo desensitization
is a very efficient treatment; mean treatment length was 15 minutes;
maximum treatment length was 32 minutes (four 8-minute sessions) |
| Obler &
Terwilliger, 1970 |
RCT; 5-session
exposure and reinforced practice (n = 15) vs. no
treatment control
(n = 15) |
Neurologically
impaired children with phobic disorders (either fear of dogs or
of riding on a bus) |
Age:
7 – 12
Gender: DK
Race/Ethnicity: DK
|
Treatment
superior to control; all children in treatment condition able
to overcome phobia vs. three children in control condition |
IQ did not
affect outcome |
| Ritter, 1968 |
RCT; live
modeling/vicarious desensitization vs. participant modeling/contact
desensitization vs. no treatment control (total
n = 67) |
Children with
snake-avoidant behavior |
Age:
5 – 11
Gender:
36% boys
64% girls
Race/Ethnicity: DK
|
Contact desensitization
(80% success) more effective than vicarious desensitization (53.3%
success); both treatments more effective than control (0% success) |
Group treatment;
reduction in fear reported by treatment groups not significantly
different from controls |
| Silverman,
Kurtines, Ginsburg, Weems, Lumpkin, & Carmichael, 1999 |
RCT; 8- to
10-week group cognitive-behavior therapy
(n = 37) vs. wait-list control (n = 19) |
Youth with
a primary DSM-III-R anxiety disorder |
Age:
M = 10
Gender:
61% boys
39% girls
Race/Ethnicity:
45% White
49% Hispanic
5% Other
|
Group cognitive-behavior
therapy more effective than control; 64% children in active treatment
no longer met criteria for an anxiety disorder vs. 13%
in control |
Treatment
gains maintained at
3-, 6-, and 12-month followup; 27% dropout rate |
| Silverman,
Kurines, Ginsburg, Weems, Rabian, & Serafini, 1999 |
RCT; 10-week
exposure-based contingency management (n = 41) vs.
exposure based cognitive self-control (n = 40) vs.
nonspecific education support control (n = 23) |
Children with
DSM-III-R phobias (83.6% primarily simple phobias) |
Age: M = 9.8
Gender:
53% boys
47% girls
Race/Ethnicity:
62% White
37% Hispanic
2% Other
|
Improvement
posttreatment and at followup for all three groups; 88% contingency
management children, 55% self-control children, and 56% education
support children no longer meet diagnostic criteria |
Treatment
gains maintained at followup; 62% of sample between ages 6 and
11; 72% with comorbid disorder; manualized treatment; 22% noncompletion
rate |
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| Table 4.2 Psychopharmacological Studies
of Childhood Anxiety Disorders |
| Study
Citation(s) |
Study
Design/
Description |
Target
Population |
Demographic
Characteristics |
Outcomes |
Notes |
| Berney, Klovin,
Bhate, Garside, Jeans, Kay, & Scarth, 1981 |
Double-blind,
placebo-controlled RCT; 12-week clomipramine (n = 27)
vs. placebo
(n = 19); concurrent treatment with individual therapy |
Children with
school phobia; 87% with separation anxiety |
Age:
9 – 15
Gender:
41% boys
59% girls
Race/Ethnicity: DK
|
Clomipramine
not superior to placebo in reducing separation anxiety, school
refusal, or neuroticism |
Variable dosing
by age; trial predates DSM-III |
| Bernstein,
Garfinkel, & Borchardt, 1990 |
Double-blind,
placebo-controlled RCT; 8-week alprazolam (n = 9) vs.
imipramine
(n = 6) vs. placebo (n = 9); concurrent psychotherapy |
Children with
school refusal |
Age:
7 – 18
Gender:
54% boys
46% girls
Race/Ethnicity: DK
|
Mixed results;
both active treatments resulted in symptom reduction on measures
of anxiety and depression; alprazolam with largest effect; no
significant differences relative to control on other measures |
Variable dosing;
none to mild side effects; 84% of subjects with depression; 20%
dropout rate |
| DeVeaugh-Geiss,
Moroz, Biderman, Cantwell, Fontaine, Greist, Reichler, Katz, &
Landau, 1992 |
Double-blind,
placebo-controlled RCT; 8-week clomipramine
(n = 31) vs. placebo (n = 29) |
Children with
DSM-III diagnosis of obsessive-
compulsive disorder |
Age:
10 – 17
Gender:
65% boys
35% girls
Race/Ethnicity:
97% White
3% African American
|
Clomipramine
more effective than placebo in reducing obsessive-
compulsive symptoms and improving functioning; two children
terminated treatment due to adverse side effects |
Unclear whether
an age effect; only 53% continued the drug for 1 year despite
its efficacy; four children terminated treatment during open label
due to adverse side effects |
| Flament, Koby,
Rapoport, Berg, Zahn, Cox, Denckla, & Lenane, 1990 |
2-7 years'
(M = 4.4 years) followup of 27 subjects admitted to NIMH
between 1977 and 1983 (19/27 were in Flament et al., 1985 study);
n = 93% of original sample and 29 matched controls |
Children with
severe primary DSM-III OCD |
Age
at followup: 13 – 24
Gender:
68% boys
32% girls
Race/Ethnicity: DK
|
68% of treatment
sample still had OCD; 52% had a comorbid Axis I disorder; only
28% had no current psychiatric diagnosis compared with 35% of
controls; most common psychiatric diagnosis for controls: alcohol
and drug abuse |
Subjects had
received intermittent, often irregular treatment during followup
period; initial good response to clomipramine had no prognostic
benefit for outcome |
| Flament, Rapoport,
Berg, Sceery, Kilts, Mellstrom, & Linoila, 1985 |
Double-blind,
placebo-controlled, within-subject crossover experimental design;
11-week clomipramine vs. placebo; concurrent individual
supportive psychotherapy (total n = 27) |
Children with
DSM-III diagnosis of obsessive-
compulsive disorder |
Age:
6 – 18
Gender:
67% boys
23% girls
Race/Ethnicity: DK
|
75% of subjects
on clomipramine showed "marked to moderate" improvement
in obsessive-
compulsive symptoms; significant anticholinergic
side effects noted |
Improvement
in obsessive-
compulsive symptoms independent of baseline depression;
30% noncompletion rate; variable dosing; most subjects hospitalized
during trial; no significant change in symptoms of anxiety and
depression; most subjects had prior unsuccessful medication trials |
| Gittelman-Klein
& Klein, 1973 |
Double-blind,
placebo-controlled RCT; 6-week imipramine and behavior therapy
(n = 16 ) vs. placebo and behavior therapy
(n = 19) |
Children with
school phobia and separation anxiety |
Age:
6 – 14
Gender:
54% boys
46% girls
Race/Ethnicity:
97% White
3% Other
|
Positive treatment
effect was obtained on parent and clinician ratings of improvement
for imipramine and behavior group; return to school was 81% for
imipramine and behavior vs. 47% for placebo and behavior |
Variable dosing;
predates DSM-III; 35% of subjects depressed; side effects reported
were primarily anticholinergic; dropout rate not reported |
| Graae, Milner,
Rizzotto, & Klein, 1994 |
Double-blind,
placebo-controlled, within-subject crossover experimental design;
4-week clonazepam vs. placebo (n = 12); placebo
group all also received supportive psychotherapy |
Children with
DSM-III-R anxiety disorders |
Age:
7 – 13
Gender:
53% boys
47% girls
Race/Ethnicity:
100% Caucasian
|
No significant
between-group differences; side effects included drowsiness, irritability,
and oppositionality |
Questionable
power due to small sample size; variable dosing; 20% of subjects
dropped out due to adverse side effects, including disinhibition,
aggressivity, and self-harming behavior |
| Klein, Koplewicz,
& Kanner, 1992 |
Double-blind,
placebo-controlled RCT; 6-week imipramine and behavior therapy
(n = 11) vs. placebo and behavior therapy (n
= 10); study included a 4-week behavior therapy run-in with nonresponders
eligible for study |
Children with
DSM-III separation anxiety disorder who did not respond to 4-week
behavior therapy run-in |
Age:
6 – 16
Gender:
66.7% boys
33.3% girls
Race/Ethnicity:
95% Caucasian
5% Hispanic
|
No significant
between-group differences across multiple measures; more side
effects reported for imipramine group; nonsignificant trend toward
increase EKG PR and QRS intervals in children receiving imipramine |
Of the original
sample (n = 45), 24 subjects responded to brief 4-week
behavior therapy run-in; variable dosing |
| Leonard, Swedo,
Lenane, Rettew, Cheslow, Hamburger, & Rapoport, 1991; Leonard,
Swedo, Lenane, Rettew, Hamburger, Bartko, & Rapoport, 1993 |
Double-blind,
within-subject alternating treatments experimental design; 3-month
clomipramine with half of the subjects randomized to 2-month continued
clomipramine (n = 11) or desipramine (n = 9) followed
by 3-month clomipramine for all subjects |
Children with
DSM-III diagnosis of obsessive-
compulsive disorder |
Age:
8 – 19
Gender:
58% boys
42% girls
Race/Ethnicity: DK
|
89% of the
group substituted with desipramine relapsed during 2-month comparison
period vs. 18% of the nonsubstituted group; all eight who relapsed
with desipramine regained clinical response within 1 month of
clomipramine reinstatement |
Maintenance
clomipramine treatment for obsessive-
compulsive disorder seems
indicated; even with long-term clomipramine treatment, obsessive-
compulsive
symptoms continued with varying intensity; 23% of subjects dropped
out before the end of the trial; at 2- to 7-year followup, 43%
met criteria for obsessive-
compulsive disorder; 70% still taking
medication, none receiving behavior therapy; 81% improved from
baseline |
| Leonard, Swedo,
Rapoport, Koby, Lenane, Cheslow, & Hamburger, 1989 |
Double-blind,
placebo-controlled, within-subject crossover experimental design;
10-week clomipramine vs. 10-week desipramine (n
= 49) |
Children with
DSM-III diagnosis of obsessive-
compulsive disorder |
Age:
6 – 18
Gender:
63% boys
37% girls
Race/Ethnicity:
DK
|
Clomipramine
more effective than desipramine in reducing obsessive-
compulsive
symptoms and depressive symptoms |
2-week washout
period prior to study; ongoing psychotherapy with private psychotherapist
not discontinued during trial; variable dosing; 8% did not complete
trial; side effect profiles for medications were similar |
| March, Biederman,
Wolkow, Safferman, Mardekian, Cook, Cutler, Dominguez, Ferguson,
Muller, Riesenberg, Rosenthal, Sallee, & Wagner, 1998 |
RCT; 12-week
sertraline (n = 92) vs. placebo (n = 95) |
Children with
DSM-III diagnosis of obsessive-
compulsive disorder |
Age:
6 – 17
Gender: DK
Race/Ethnicity: DK
|
Sertraline
resulted in significantly more improvement of obsessive-
compulsive
symptoms relative to placebo; mild to moderate side effects and
negligible cardiovascular effects noted |
Titrated dosing;
significantly more discontinuation due to sertraline (13%) than
placebo (3.2%); 16.6% noncompletion rate |
| Riddle, Scahill,
King, Hardin, Anderston, Ort, Smith, Leckman, and Cohen, 1992 |
Double-blind,
placebo-controlled, within-subject crossover experimental design;
fluoxetine
(n = 7) vs. placebo
(n = 7) |
Children with
DSM-III-R diagnosis of obsessive-
compulsive disorder |
Age:
M = 11.8
Gender:
43% boys
57% girls
Race/Ethnicity:
99% White
1% Other
|
Obsessive-
compulsive
symptoms decreased by 30% to 45% on fluoxetine and 12% to 27%
on placebo; 50% of subjects who crossed over to placebo terminated
due to symptom resurgence |
Mild to moderate
side effects; one child became suicidal on fluoxetine (this resolved
when the drug was discontinued); fixed dosing (20 mg); 14 out
of 30 subjects meeting inclusion criteria agreed to participate;
50% of subjects in supportive or psychodynamic psychotherapy during
trial; only 43% completed entire 20-week trial so crossover analysis
side effects not feasible |
| Simeon, Ferguson,
Knott, Roberts, Gauthier, Dubois & Wiggens, 1992 |
Double-blind,
placebo-controlled RCT; 4-week alprazolam (n = 17)
vs. placebo (n = 13); 1-month followup |
Children with
primary diagnosis of overanxious disorder or avoidant disorder |
Age:
M = 12.6
Gender:
77% boys
23% girls
Race/Ethnicity: DK
|
No significant
between-group differences in global ratings of clinical improvement;
no significant differences at 1-month followup |
Variable dosing;
no discussion of specific age effects; trend toward improvement
in the avoidant group |
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| Table 4.3 Adjunctive Studies of Childhood Anxiety Disorders |
| Study
Citation(s) |
Study
Design/
Description |
Target
Population |
Demographic
Characteristics |
Outcomes |
Notes |
| De Haan, Hoogduin,
Buitelaar, & Keijsers, 1998 |
RCT; 12-week
behavior therapy (n = 12) vs. clomipramine
(n = 10) |
Children with
DSM-III-R diagnosis of obsessive-
compulsive disorder |
Age:
8 – 18
Gender:
50% boys
50% girls
Race/Ethnicity: DK
|
Significant
improvement with both treatments (clomipramine 33.4%; behavior
therapy 59.9%); in nonresponder extension, approximately 35% reported
improvement in symptoms |
No untreated
control group; variable dosing; small sample size |
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