Category: Child / Adolescent - Anxiety
With lifetime prevalence rates ranging from 6% to 15%, anxiety disorders are among the most common childhood mental health diagnoses. Anxiety disorders diagnosed in childhood generally show an unremitting course, lead to additional psychopathology and interfere with social, emotional, and academic development. Effective evidence-based treatments (EBT’s) include cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRI’s). However, if anxious children receive any treatment, it is usually through primary care, typically consists of medication, and very rarely includes evidence-based psychotherapy.
Despite the high prevalence of anxiety disorders, there have only been two independent research labs that have investigated long-term results for CBT treatment for all childhood anxiety disorders and two for specific anxiety disorders. Generally, the studies indicate that the majority of youth maintain gains up to 7.4 years after treatment. These studies have not been replicated. In addition, little is known about the additional mental health care received by these patients in the intervening years after anxiety treatment, which seems likely to influence maintenance of gains for anxiety symptoms as well as the development of additional psychopathology during the subsequent years.
The original sample consisted of 335 children ages 7 to 17 years (mean 13.09, 53% female) diagnosed with an anxiety disorder in 2010. Medical record review included provider billing records for mental health appointments during the five years after anxiety treatment. The subsample for this study was classified into three groups: 64 children who received CBT in an anxiety disorders clinic, 56 who received treatment from a psychiatrist, and 10 who were seen in a primary care setting. Results of a one-way ANOVA during preliminary analysis of the 2,546 appointments, suggested differences in the number of appointments received by each group in the initial treatment year (F(2,129) = 10.59, p < .001) and no significant differences in appointments during the 5 follow-up years. Fisher’s LSD post-hoc comparisons revealed that patients who received specialty anxiety clinic treatment receive a greater number of initial treatment appointments (M=5.66) than patients seen by psychiatry (2.86 ± 0.71 appts, p < .001) and primary care (1.30 ± 1.32 appts, p = .001).
The results of the current study have important implications for developing dissemination materials to help guide parents when they are selecting treatment for their children. Youth who receive CBT treatment appear to receive approximately 6 treatment appointments and require occasional booster sessions after treatment. Because booster sessions are fewer in number, this data suggests that children do not continue to require higher levels of care over time, which may indicate that booster sessions help to maintain gains from treatment. Follow-up questionnaire data that may further explain these results are currently being collected for the youth seen in the anxiety clinic and will be included in the presentation.