Evidenced Based Services and
from SPIN Hawaii Online
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services or interventions (EBS) are those that have been
scientifically proven to have a positive effect in the treatment
of a particular disorder. In our last issue we began sharing
information from an important Hawaii report* about EBS for
children and teens with mental health disorders that was
released in December, 2002.
We continue in this issue to share the report's findings on what
works in treating anxiety disorders in children and teens, so
that families can make informed choices about intervention
options. As you read these findings on effective practices keep
in mind the following:
* no intervention or medication is 100% effective with all kids,
* only those studies that met scientific research standards (for
example, randomized control and experimental groups) were
* a number of promising practices in the field of children's
mental health have not been studied thoroughly enough to receive
an EBS rating, and
* if your child is receiving an intervention that is not listed
in the report, but that seems to be giving real benefit, then it
may be the best option available for him or her.
The important thing with any intervention is to have some way to
measure its effectiveness.
What are Anxiety Disorders?
Anxiety is a natural part of every child's life. It normal for
infants and toddlers to be distressed when they have to leave
their parents, or for young children to be afraid of the dark.
Teens worry about how they appear to others and about speaking
up in class. Anxiety only becomes a mental health problem when
it is persistent and severe enough to interfere with the child's
More children and teens suffer from anxiety disorders than any
other mental health disorder. Of children age 9-17, roughly 13%
will experience some form of anxiety disorder within the year.
Here are some of the more common disorders:
Separation Anxiety Disorder involves fear of being away from
parents or other caretakers. Often the child will be afraid of
something bad happening to a parent and be reluctant to go to
school, stay at friend's houses or sleep alone. Stomachaches and
headaches are common.
Generalized Anxiety Disorder causes children to worry
excessively about all sorts of things--upcoming events, grades,
friends, family, being on time, even natural disasters. Other
symptoms can include trembling, dizziness, stomach upsets,
trouble sleeping and irritability.
Phobias are extreme fears of things or situations (such as
spiders, heights, getting a shot, dogs, and flying). The level
of fear is usually inappropriate to the situation and can lead
the child to avoid common, everyday situations.
Social Phobia is the most common anxiety disorder in teens. It
involves an ongoing fear of being embarrassed in social
situations or in class. This anxiety can cause the teen to have
trouble talking in class, taking tests or meeting new people.
Obsessive Compulsive Disorder causes frequent and uncontrollable
thoughts or impulses (obsessions) about bad things happening.
These thoughts lead the child to perform a ritual or routine
(compulsion) like hand-washing or checking locks to relieve the
anxiety caused by the obsession.
Post-Traumatic Stress Disorder can occur when children
experience a physical or emotional trauma such as witnessing a
disaster (like 9/11), being sexually or physically abused or
being in a car accident. The child "re-lives" the trauma through
nightmares or flashbacks, may be irritable, and have trouble
eating, concentrating and sleeping.
What works in anxiety disorders?
THERAPY. In reviewing the most current studies, the Evidence
Based Services Committee found the BEST SUPPORT for treating
anxiety through Cognitive Behavior Therapy (CBT), exposure and
modeling. Studies using CBT with parents included and
Educational Support met the criteria for GOOD SUPPORT.
Cognitive Behavioral Therapy teaches the anxious child or teen
skills to help them manage their fearful thoughts, so they can
see that they do not always need to be afraid. Then, the child
or teen participates in guided practice to get comfortable being
around the things they are afraid of.
"In vivo" exposure, or real-life exposure, involves practicing
approaching and confronting a feared situation or object.
Modeling involves demonstrating non-fearful behavior in a feared
situation and showing the child or teen a more appropriate
response for dealing with a feared object or event.
MEDICATION. The majority of the medication studies reviewed by
the EBS Committee for use in treating anxiety disorders of
childhood and adolescence did not have randomized controls, and
so earned the rating of "C" which indicates minimal or no
support. However, Selective serotonin reuptake inhibitors (SSRIs)
were found to be effective and safe in the short term in
treating Obsessive Compulsive Disorder (OCD). Common brand names
include Zoloft, Paxil and Prozac.
Services that work:
For anxiety, phobias and avoidance behavior:
Cognitive Behavior Therapy (with or without parents), Exposure,
Modeling and Educational Supports
Medications that work:
For obsessive compulsive disorder:
Selective serotonin reuptake inhibitors
Where do I go for help?
If you are concerned that your child may have an anxiety
disorder you should check with your family physician or ask the
school for help in evaluating whether school based behavioral
health services are needed. Early intervention can prevent
future difficulties, such as a loss of friendships, failure to
reach social and academic promise and feelings of low
Thanks to Dr. Bruce Chorpita for his help with definitions for