Childhood Anxiety Disorders Remain Poorly Understood
WebMD News Archive
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
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.