Brief Psychotherapeutic Interventions for Pediatric Anxiety 8/13/2020

Pediatric Anxiety is one of the most common mental health challenges a child and their family can face. One study estimated a 7% prevalence of diagnosed anxiety disorder in children from 3-17 and a lifetime prevalence of 31.9% (Ghandour et al, 2019). Presumably, the earlier significant anxiety challenges can be addressed, the fewer immediate consequences that would be expected and, potentially, the lower the likelihood of illness progression with further downstream symptomatology. When not identified and not treated, youth with anxiety disorders are at risk for decreased performance in academic, social, and general emotional functionality—not good news! The good news is that brief psychotherapeutic interventions can help– whether delivered at school, within a pediatrics clinic, or in traditional mental health settings, therapy for anxiety can reduce symptoms and give children and families skills to help control anxiety in the future.

In as few as 5 sessions (Haugland et al, 2020), Cognitive Behavioral Therapy (CBT) interventions delivered on-site at school has been found effective. In pediatrics settings, CBT and other behavioral interventions (Brief Behavioral Therapy or BBT), have also been effective in treating anxiety symptoms (Asarnow et al, 2015; Weersing et al 2017). Most importantly, the ability for families to access these services in a timely way, within familiar settings such as school or the pediatrician’s office decreases stigma, increases access to evidence based care. This may be particularly true for youth and families with lower socioeconomic status and those with barriers related to ethnic and cultural minority status.

Clearly early identification is most important and the consensus guidance is for providers in primary care settings to advocate for and implement screening for anxiety symptoms (GAD-7, ages 13 and older; SCARED, age 8 – 17) as a frontline intervention to case find and to engage with youth and parents in seeing office visits as opportunities to address behavioral health issues. Even when formal screening is not available, simple inquiry as to whether the youth “feels nervous or worried a lot” can be effective in identifying vulnerable and at-risk individuals. If an anxiety problem is identified, providers should make appropriate referrals to therapy and encourage families to reach out the school for help. (Similarly, screening for depression using the PHQ-2 or PHQ-9 has been demonstrated to be effective in case identification for that disorder and expanding the inquiry to include “feeling sad or depressed a lot” can be an effective clinical tool.)

Implementing a behavioral health treatment capability within a primary care clinic (or within a school based setting), of course, does require significant planning and commitment above and beyond the scope and authority of the individual provider, but advocacy for this type of collaborative clinical capacity is increasingly being supported by both ongoing research and by advocates of the system of care model for community based service delivery.

Within the San Diego community, the SmartCare program is the dedicated publically-funded, no-cost resource that is charged with assisting primary care providers—particularly those who are without ‘in-clinic’ resources — in assisting parents and families in finding suitable linkages and referrals to needed and appropriate behavioral health treatment and related support services and support resources. The contact phone number for families is (858) 956-5900. Providers seeking consultation with a child/adolescent psychiatrist can call (858) 880-6405 to discuss assessment, diagnosis, psychotherapy and psychopharmacologic concerns.

Asarnow, J. R., Rozenman, M., Wiblin, J., & Zeltzer, L. (2015). Integrated medical-behavioral care compared with usual primary care for child and adolescent behavioral health: A metaanalysis. JAMA Pediatrics, 169(10), 929–937.
Ghandour, R. M., Sherman, L. J., Vladutiu, C. J., Ali, M. M., Lynch, S. E., Bitsko, R. H., & Blumberg, S. J. (2019). Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children. Journal of Pediatrics, 206, 256-267.e3.
Haugland, B. S. M., Haaland, Å. T., Baste, V., Bjaastad, J. F., Hoffart, A., Rapee, R. M., … Wergeland, G. J. (2020). Effectiveness of Brief and Standard School-Based Cognitive-Behavioral Interventions for Adolescents With Anxiety: A Randomized Noninferiority Study. Journal of the American Academy of Child and Adolescent Psychiatry, 59(4), 552-564.e2.
Weersing, V. R., Brent, D. A., Rozenman, M. S., Gonzalez, A., Jeffreys, M., Dickerson, J. F., … Iyengar, S. (2017). Brief behavioral therapy for pediatric anxiety and depression in primary care: A randomized clinical trial. JAMA Psychiatry, 74(6), 571–578.

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