Childhood Anxiety Disorders Remain Poorly Understood
Moreover, Hyman says, these disorders have also had to escape from the shadow of outmoded theory. "This was the last area of psychiatry to be liberated from Freudian dogmas," he tells WebMD, recalling from psychiatric residency in the early 1980s that "it was dogma that children could not be depressed because depression required the full development of this theoretical entity called the superego."
"We really need some research that clarifies the nature of these disorders in children -- when [children] get them, how they develop, how they might change as children age," Beidel tells WebMD. "We also need to know what factors might contribute to either the onset or particularly the maintenance of these disorders. Once we understand the disorder itself, then we can develop more effective interventions."
But there is a lack of qualified researchers. "I have been [more] prepared to allocate more money to the area of treatment trials in children than I've had highly rated applications to spend it on," Hyman tells WebMD. "There is a really dangerous shortage of investigators who could do the research."
Even with trained investigators, major ethical issues over risk and informed consent plague clinical trials involving children. "We wouldn't have a control with no treatment. The alternative would have to have some sort of appropriate psychosocial treatment," Hyman tells WebMD.
Now for the good news. As limited as the evidence still is, the report reflects consensus in the field that behavioral therapy is generally effective for treating the disorders, and that selective serotonin re-uptake inhibitors (SSRIs) are effective for treating obsessive-compulsive disorder and possibly other anxiety disorders. More news may emerge in the relatively near future on the latter front, as SmithKline Beecham is now conducting a trial of Paxil (paroxetine) for treating social phobia in youth.
Beidel tells WebMD that parents should think about seeking medical intervention if their child appears to be exceptionally fearful or shy for at least six months. "Kids should be joining sports teams, going to birthday parties, going to school and talking, having friends, sleeping over at other kids' houses." She recommends that parents seek care from a pediatrician, clinical psychologist, or psychiatrist.