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Current Treatment Options in Pediatrics

, Volume 4, Issue 1, pp 70–93 | Cite as

Anxiety: a Primer for the Pediatrician

  • Stephanie Lichtor
  • Khalid Afzal
  • Jenna Shapiro
  • Tina Drossos
  • Karam Radwan
  • Seeba Anam
  • Sucheta Connolly
Mental Health (WF Njoroge and TD Benton, Section Editors)
  • 44 Downloads
Part of the following topical collections:
  1. Topical Collection on Mental Health

Abstract

Purpose of review

This paper focuses on the assessment and treatment of pediatric anxiety disorders targeted at pediatricians. It reviews the prevalence, role of the pediatrician in differentiating anxiety disorders from age-appropriate fears or normative responses to stressors, use of assessment tools, evidence-based treatment, and provides psychoeducation resources for children, parents, and clinicians. It reviews considerations for treatment modality and evidence for use of cognitive-behavioral therapy and psychopharmacology.

Recent findings

First-line treatment of mild severity anxiety disorders is guided by well-established evidence and supported by randomized controlled trials that includes psychoeducation and psychotherapy, particularly cognitive-behavioral therapy (CBT). When anxiety is moderate to severe in intensity or impairment, initiation of psychopharmacology is considered in combination with CBT. Selective serotonin reuptake inhibitors (SSRIs) have the most evidence in randomized double-blind placebo-controlled trials and are recommended as first line for anxiety disorders, starting with low doses. It is important to discuss and monitor for potential adverse effects. Complementary and alternative medical (CAM) therapies are often used by youth, though there is limited evidence for benefit in children and adolescents with anxiety disorders, and potential risks need to be considered.

Summary

Pediatric anxiety disorders are among the most common psychiatric disorders in children and adolescents and can result in significant impairment and morbidity. Pediatricians have an important role in identifying and facilitating treatment for youth with anxiety disorders, and CBT and psychopharmacology, particularly SSRIs, have the most evidence. However, accessing CBT for many families remains challenging. Pediatricians can provide psychoeducation and resources as a first step and initiate medications if indicated. Further research into integration of mental healthcare in pediatric settings could increase access to CBT and decrease morbidity. In addition, more randomized controlled trials and comparison studies for medications, CAM therapies, and combination treatments for pediatric anxiety disorders are needed.

Keywords

Pediatric anxiety Anxiety disorders Children Adolescents Cognitive-behavioral therapy SSRIs Pediatrician 

Notes

Compliance with Ethical Standards

Conflict of Interest

Stephanie Lichtor, Khalid Afzal, Jenna Shapiro, Tina Drossos, Karam Radwan, Seeba Anam, and Sucheta Connolly declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49(10):980–9.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kelsay K, Burstein A, Talmi A. Child & Adolescent Psychiatric Disorders & Psychosocial Aspects of Pediatrics. In: Hay WW, Levin MJ, Deterding RR, Abzug MJ, editors. CURRENT Diagnosis & Treatment Pediatrics. New York, NY: McGraw-Hill Education; 2016. p. 23e.Google Scholar
  3. 3.
    Global Burden of Disease Pediatrics C, Kyu HH, Pinho C, Wagner JA, Brown JC, Bertozzi-Villa A, et al. Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013: Findings From the Global Burden of Disease 2013 Study. JAMA Pediatr. 2016;170(3):267–87.CrossRefGoogle Scholar
  4. 4.
    Asselmann E, Beesdo-Baum K. Predictors of the course of anxiety disorders in adolescents and young adults. Curr Psychiatry Rep. 2015;17(2):7.CrossRefPubMedGoogle Scholar
  5. 5.
    Merikangas KR, He JP, Burstein M, Swendsen J, Avenevoli S, Case B, et al. Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2011;50(1):32–45.CrossRefPubMedGoogle Scholar
  6. 6.
    Owens PL, Hoagwood K, Horwitz SM, Leaf PJ, Poduska JM, Kellam SG, et al. Barriers to children’s mental health services. J Am Acad Child Adolesc Psychiatry. 2002;41(6):731–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Salloum A, Johnco C, Lewin AB, McBride NM, Storch EA. Barriers to access and participation in community mental health treatment for anxious children. J Affect Disord. 2016;196:54–61.CrossRefPubMedGoogle Scholar
  8. 8.
    Stein RE, Horwitz SM, Storfer-Isser A, Heneghan A, Olson L, Hoagwood KE. Do pediatricians think they are responsible for identification and management of child mental health problems? Results of the AAP periodic survey. Ambul Pediatr. 2008;8(1):11–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Tulisiak AK, Klein JA, Harris E, Luft MJ, Schroeder HK, Mossman SA, et al. Antidepressant Prescribing by Pediatricians: A Mixed-Methods Analysis. Curr Probl Pediatr Adolesc Health Care. 2017;47(1):15–24.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Association AP. Diagnostic And Statistical Manual of Mental Disorders. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington DC: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  11. 11.
    Stewart SM, Simmons A, Habibpour E. Treatment of culturally diverse children and adolescents with depression. J Child Adolesc Psychopharmacol. 2012;22(1):72–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Hwang WC, Ting JY. Disaggregating the effects of acculturation and acculturative stress on the mental health of Asian Americans. Cultur Divers Ethnic Minor Psychol. 2008;14(2):147–54.CrossRefPubMedGoogle Scholar
  13. 13.
    Fernandez RL, Morcillo C, Wang S, Duarte CS, Aggarwal NK, Sanchez-Lacay JA, et al. Acculturation dimensions and 12-month mood and anxiety disorders across US Latino subgroups in the National Epidemiologic Survey of Alcohol and Related Conditions. Psychol Med. 2016;46(9):1987–2001.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    McClain Z, Peebles R. Body Image and Eating Disorders Among Lesbian, Gay, Bisexual, and Transgender Youth. Pediatr Clin North Am. 2016;63(6):1079–90.CrossRefPubMedGoogle Scholar
  15. 15.
    Earnshaw VA, Bogart LM, Poteat VP, Reisner SL, Schuster MA. Bullying Among Lesbian, Gay, Bisexual, and Transgender Youth. Pediatr Clin North Am. 2016;63(6):999–1010.CrossRefPubMedGoogle Scholar
  16. 16.
    Hafeez H, Zeshan M, Tahir MA, Jahan N, Naveed S. Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review. Cureus. 2017;9(4):e1184.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Connolly SD, Suarez LM, Victor AM, Zagaloff AD, Bernstein GA. Anxiety Disorders. In: Dulcan MK, editor. Dulcan’s Textbook of Child and Adolescent Psychiatry. 2nd ed. Arlington, VA: American Psychiatric Association; 2016. p. 305–43.Google Scholar
  18. 18.
    Hua A, Major N. Selective mutism. Curr Opin Pediatr. 2016;28(1):114–20.CrossRefPubMedGoogle Scholar
  19. 19.
    Choudhury MS, Pimentel SS, Kendall PC. Childhood anxiety disorders: parent-child (dis)agreement using a structured interview for the DSM-IV. J Am Acad Child Adolesc Psychiatry. 2003;42(8):957–64.CrossRefPubMedGoogle Scholar
  20. 20.
    Connolly SD, Bernstein GA, Work Group on Quality I. Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2007;46(2):267–83.CrossRefPubMedGoogle Scholar
  21. 21.
    Jellinek MS, Murphy JM, Burns BJ. Brief psychosocial screening in outpatient pediatric practice. J Pediatr. 1986;109(2):371–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry. 1999;38(10):1230–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Spence SHA. measure of anxiety symptoms among children. Behav Res Ther. 1998;36(5):545–66.CrossRefPubMedGoogle Scholar
  24. 24.
    Edwards SL, Rapee RM, Kennedy SJ, Spence SH. The assessment of anxiety symptoms in preschool-aged children: the revised Preschool Anxiety Scale. J Clin Child Adolesc Psychol. 2010;39(3):400–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Gleason MM, Egger HL, Emslie GJ, Greenhill LL, Kowatch RA, Lieberman AF, et al. Psychopharmacological treatment for very young children: contexts and guidelines. J Am Acad Child Adolesc Psychiatry. 2007;46(12):1532–72.CrossRefPubMedGoogle Scholar
  26. 26.
    Jensen PS, Hinshaw SP, Kraemer HC, Lenora N, Newcorn JH, Abikoff HB, et al. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry. 2001;40(2):147–58.CrossRefPubMedGoogle Scholar
  27. 27.
    Manassis K, Monga SA. therapeutic approach to children and adolescents with anxiety disorders and associated comorbid conditions. J Am Acad Child Adolesc Psychiatry. 2001;40(1):115–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med. 2008;359(26):2753–66.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Piacentini J, Bennett S, Compton SN, Kendall PC, Birmaher B, Albano AM, et al. 24- and 36-week outcomes for the Child/Adolescent Anxiety Multimodal Study (CAMS). J Am Acad Child Adolesc Psychiatry. 2014;53(3):297–310.CrossRefPubMedGoogle Scholar
  30. 30.
    •• Ginsburg GS, Becker EM, Keeton CP, Sakolsky D, Piacentini J, Albano AM, et al. Naturalistic follow-up of youths treated for pediatric anxiety disorders. JAMA Psychiatry. 2014;71(3):310–8. This is a follow-up study evaluating participants of the Child/Adolescent anxiety multimodal study (CAMS), a randomized placebo-controlled trial comparing cognitive behavioral therapy (CBT), SSRI (sertraline), and combination of CBT and SSRI for treatment of child/adolescent anxiety, 6 years after randomization. It demonstrates the role of acute treatment, particularly the combination of CBT and SSRI, with long-term benefit, though potential for relapse indicates role for more intensive or continued treatment for youth with anxiety.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Sakolsky D, Compton SN, Pine DS. Results From the Child/Adolescent Anxiety Multimodal Extended Long-Term Study (CAMELS). J Am Acad Child Adolesc Psychiatry. 2017;56(10, Supplement):S17–S318.Google Scholar
  32. 32.
    Taylor JH, Lebowitz ER, Jakubovski E, Coughlin CG, Silverman WK, Bloch MH. Monotherapy Insufficient in Severe Anxiety? Predictors and Moderators in the Child/Adolescent Anxiety Multimodal Study. J Clin Child Adolesc Psychol. 2017:1–16.Google Scholar
  33. 33.
    •• Higa-McMillan CK, Francis SE, Rith-Najarian L, Chorpita BF. Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety. J Clin Child Adolesc Psychol. 2016;45(2):91–113. This comprehensive review examines the effectiveness of different types of psychotherapeutic interventions for child and adolescent anxiety.CrossRefPubMedGoogle Scholar
  34. 34.
    Wang Z, SPH W, Sim L, Farah W, Morrow AS, Alsawas M, et al. Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders: A Systematic Review and Meta-analysis. JAMA Pediatr. 2017;171(11):1049–56.CrossRefPubMedGoogle Scholar
  35. 35.
    Warwick H, Reardon T, Cooper P, Murayama K, Reynolds S, Wilson C, et al. Complete recovery from anxiety disorders following Cognitive Behavior Therapy in children and adolescents: A meta-analysis. Clin Psychol Rev. 2017;52:77–91.CrossRefPubMedGoogle Scholar
  36. 36.
    Evidence-Based Psychotherapies for Children and Adolescents. 2nd ed. New York: Guilford Press; 2010.Google Scholar
  37. 37.
    Kendall PC, Choudhury MS, Hudson J, Webb A. “The C.A.T. Project” Manual for the Cognitve-Behavioral Treatment of Anxious Adolescents. Ardmore, PA: Workbook Publishing; 2002.Google Scholar
  38. 38.
    • Kaczkurkin AN, Foa EB. Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogs Clin Neurosci. 2015;17(3):337–46. This review paper provides descriptions of the main components of CBT for different anxiety disorders.Google Scholar
  39. 39.
    Pincus DB, Ehrenreich JT, Mattis SG. Mastery of Anxiety and Panic for Adolescents Riding the Wave, Therapist Guide (Treatments That Work). New York: Oxford University Press; 2008.CrossRefGoogle Scholar
  40. 40.
    Albano AM, Marten PA, Holt CS, Heimberg RG, Barlow DH. Cognitive-behavioral group treatment for social phobia in adolescents. A preliminary study. J Nerv Ment Dis. 1995;183(10):649–56.CrossRefPubMedGoogle Scholar
  41. 41.
    Beidel DC, Turner SM, Young B, Paulson A. Social effectiveness therapy for children: three-year follow-up. J Consult Clin Psychol. 2005;73(4):721–5.CrossRefPubMedGoogle Scholar
  42. 42.
    Beidel DC, Turner SM, Sallee FR, Ammerman RT, Crosby LA, Pathak S. SET-C versus fluoxetine in the treatment of childhood social phobia. J Am Acad Child Adolesc Psychiatry. 2007;46(12):1622–32.CrossRefPubMedGoogle Scholar
  43. 43.
    Simona Scaini, Raffaella Belotti, Anna Ogliari, Marco Battaglia. A comprehensive meta-analysis of cognitive-behavioral interventions for social anxiety disorder in children and adolescents. Journal of Anxiety Disorders. 2016;42:105–112CrossRefPubMedGoogle Scholar
  44. 44.
    Weisz JR, Chorpita BF, Palinkas LA, Schoenwald SK, Miranda J, Bearman SK, et al. Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial. Arch Gen Psychiatry. 2012;69(3):274–82.CrossRefPubMedGoogle Scholar
  45. 45.
    Blossom JB, Roberts MC. Assessment and intervention for anxiety in pediatric primary care: a systematic review. Evidence-based Practice in. Child and Adolescent Mental Health. 2017;2(2):69–81.Google Scholar
  46. 46.
    Khanna MS. A primer on internet interventions for child anxiety. Behav Ther. 2014;37(5):122–5.Google Scholar
  47. 47.
    Rapee RM, Wignall A, Spence S, Lyneham H, Cobham V. Helping Your Anxious Child: a step-by-step guide for parents. 2nd ed. Oakland, CA: New Harbinger Publications; 2008.Google Scholar
  48. 48.
    Manassis K. Keys To Parenting Your Anxious Child. 2nd ed. Barron’s Educational Series: Hauppauge, NY; 2008.Google Scholar
  49. 49.
    Pincus D. Growing Up Brave: Expert Strategies for Helping Your Child Overcome Fear, Stress, and Anxiety. Little Brown and Company: New York, NY; 2012.Google Scholar
  50. 50.
    McHolm AE, Cunningham CE, Vanier MK. Helping Your Child With Selective Mutism. Oakland, CA: New Harbinger Publications; 2005.Google Scholar
  51. 51.
    Kearney CA. Helping Children With Selective Mutism and Their Parents: A Guide for School-Based Professionals. New York, NY: Oxford University Press; 2010.CrossRefGoogle Scholar
  52. 52.
    Kearney CA, Albano AM. When Children Refuse School: A Cognitive-Behavioral Therapy Appraoch: Parent Guide. New York, NY: Oxford University Press; 2007.CrossRefGoogle Scholar
  53. 53.
    Huebner D. What To Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety. Washington DC: Magination Press; 2006.Google Scholar
  54. 54.
    Crist JJ. What to Do When You’re Scared & Worried: A Guide for Kids. Minneapolis, MN: Free Spirit Publishing; 2004.Google Scholar
  55. 55.
    Helsley D. The Worry Glasses: Overcoming Anxiety. Milwaukee, WI: Mirror Publishing; 2012.Google Scholar
  56. 56.
    Buron KD. When my worries get too big! A Relaxation Book for Children Who Live with Anxiety. Shawnee Mission, KS: Autism and Asperger Publishing Company; 2006.Google Scholar
  57. 57.
    Lite L. A Boy and a Bear: The Children’s Relaxation Book. Plantation, FL: Specialty Press; 1996.Google Scholar
  58. 58.
    Lite L. The Goodnight Caterpillar: A Children’s Relaxation Story. [United States]: LiteBooks.net; 2001.
  59. 59.
    Lite L. Sea Otter Cove: A Relaxation Story. Marietta, GA: Litebooks.Net LLC; 2008.Google Scholar
  60. 60.
    Tompkins MA, Martinez KA. My Anxious Mind: A Teen’s Guide to Managing Anxiety and Panic Washington DC: Magination Press; 2010.Google Scholar
  61. 61.
    Pincus DB, Ehrenreich JT, Spiegel DA. Riding the Wave Workbook. New York, NY: Oxford University Press; 2008.CrossRefGoogle Scholar
  62. 62.
    Connolly SD, Petty CL, Simpson DA. Anxiety disorders. Collins CE, editor. Chelsea House: New York, NY; 2006.Google Scholar
  63. 63.
    Rapee RM, Wignall A, Hudson JL, Schniering CA. Treating Anxious Children and Adolescents. Oakland, CA: New Harbinger Publications; 2000.Google Scholar
  64. 64.
    Manassis K. Cognitive Behavioral Therapy with Children: A Guide for the Community Practitioner. New York, NY: Routledge; 2009.Google Scholar
  65. 65.
    Lowenstein L, Creative CBT. Interventions for Children with Anxiety. Toronto, Canada: Champion Press; 2016.Google Scholar
  66. 66.
    Kearney CA, Albano AM. When Children Refuse School: A Cognitive-Behavioral Therapy Approach: Therapist Guide. 2nd ed. New York, NY: Oxford University Press; 2007.CrossRefGoogle Scholar
  67. 67.
    • Hussain FS, Dobson ET, Strawn JR. Pharmacologic Treatment of Pediatric Anxiety Disorders. Curr Treat Options Psychiatry. 2016;3(2):151–60. This paper outline an update on medication management of pediatric anxiety disorders with indications and adverse effects.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Landry MJ, Smith DE, Mc Duff D, Baughman OL 3rd. Anxiety and substance use disorders: a primer for primary care physicians. J Am Board Fam Pract. 1991;4(1):47–53.PubMedGoogle Scholar
  69. 69.
    Birmaher B, Yelovich AK, Renaud J. Pharmacologic treatment for children and adolescents with anxiety disorders. Pediatr Clin North Am. 1998;45(5):1187–204.CrossRefPubMedGoogle Scholar
  70. 70.
    Velosa JF, Riddle MA. Pharmacologic treatment of anxiety disorders in children and adolescents. Child Adolesc Psychiatr Clin N Am. 2000;9(1):119–33.PubMedGoogle Scholar
  71. 71.
    Williams TP, Miller BD. Pharmacologic management of anxiety disorders in children and adolescents. Curr Opin Pediatr. 2003;15(5):483–90.CrossRefPubMedGoogle Scholar
  72. 72.
    Reinblatt SP, Walkup JT. Psychopharmacologic treatment of pediatric anxiety disorders. Child Adolesc Psychiatr Clin N Am. 2005;14(4):877–908.Google Scholar
  73. 73.
    Rifkin A, Braga RJ. Behavioral therapy, sertraline, or both in childhood anxiety. N Engl J Med. 2009;360(23):2475–6.Google Scholar
  74. 74.
    Sciberras E, Lycett K, Efron D, Mensah F, Gerner B, Hiscock H. Anxiety in children with attention-deficit/hyperactivity disorder. Pediatrics. 2014;133(5):801–8.CrossRefPubMedGoogle Scholar
  75. 75.
    • Strawn JR, Dobson ET, Giles LL. Primary Pediatric Care Psychopharmacology: Focus on Medications for ADHD, Depression, and Anxiety. Curr Probl Pediatr Adolesc Health Care. 2017;47(1):3–14. This is a good review of complex medication management of comorbid psychiatric disorders in the pediatric population.CrossRefPubMedGoogle Scholar
  76. 76.
    Rynn MA, Siqueland L, Rickels K. Placebo-controlled trial of sertraline in the treatment of children with generalized anxiety disorder. Am J Psychiatry. 2001;158(12):2008–14.CrossRefPubMedGoogle Scholar
  77. 77.
    Carlson JS, Kratochwill TR, Johnston HF. Sertraline treatment of 5 children diagnosed with selective mutism: a single-case research trial. J Child Adolesc Psychopharmacol. 1999;9(4):293–306.CrossRefPubMedGoogle Scholar
  78. 78.
    Black B, Uhde TW. Treatment of elective mutism with fluoxetine: a double-blind, placebo-controlled study. J Am Acad Child Adolesc Psychiatry. 1994;33(7):1000–6.CrossRefPubMedGoogle Scholar
  79. 79.
    Wagner KD, Berard R, Stein MB, Wetherhold E, Carpenter DJ, Perera P, et al. A multicenter, randomized, double-blind, placebo-controlled trial of paroxetine in children and adolescents with social anxiety disorder. Arch Gen Psychiatry. 2004;61(11):1153–62.CrossRefPubMedGoogle Scholar
  80. 80.
    Pine DS. Affective neuroscience and the development of social anxiety disorder. Psychiatr Clin North Am. 2001;24(4):689–705.CrossRefPubMedGoogle Scholar
  81. 81.
    Schirman S, Kronenberg S, Apter A, Brent D, Melhem N, Pick N, et al. Effectiveness and tolerability of citalopram for the treatment of depression and anxiety disorders in children and adolescents: an open-label study. J Neural Transm (Vienna). 2010;117(1):139–45.CrossRefGoogle Scholar
  82. 82.
    Kodish I, Rockhill C, Varley C. Pharmacotherapy for anxiety disorders in children and adolescents. Dialogs Clin Neurosci. 2011;13(4):439–52.Google Scholar
  83. 83.
    Strawn JR, Prakash A, Zhang Q, Pangallo BA, Stroud CE, Cai N, et al. A randomized, placebo-controlled study of duloxetine for the treatment of children and adolescents with generalized anxiety disorder. J Am Acad Child Adolesc Psychiatry. 2015;54(4):283–93.CrossRefPubMedGoogle Scholar
  84. 84.
    Strawn JR, Whitsel R, Nandagopal JJ, Delbello MP. Atypical Stevens-Johnson syndrome in an adolescent treated with duloxetine. J Child Adolesc Psychopharmacol. 2011;21(1):91–2.CrossRefPubMedGoogle Scholar
  85. 85.
    March JS, Entusah AR, Rynn M, Albano AM, Tourian KA. A Randomized controlled trial of venlafaxine ER versus placebo in pediatric social anxiety disorder. Biol Psychiatry. 2007;62(10):1149–54.CrossRefPubMedGoogle Scholar
  86. 86.
    Rynn MA, Riddle MA, Yeung PP, Kunz NR. Efficacy and safety of extended-release venlafaxine in the treatment of generalized anxiety disorder in children and adolescents: two placebo-controlled trials. Am J Psychiatry. 2007;164(2):290–300.CrossRefPubMedGoogle Scholar
  87. 87.
    Strawn JR, Compton SN, Robertson B, Albano AM, Hamdani M. Rynn MA. Extended Release Guanfacine in Pediatric Anxiety Disorders: A Pilot, Randomized, Placebo-Controlled Trial. J Child Adolesc Psychopharmacol. 2017;27(1):29–37.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Mrakotsky C, Masek B, Biederman J, Raches D, Hsin O, Forbes P, et al. Prospective open-label pilot trial of mirtazapine in children and adolescents with social phobia. J Anxiety Disord. 2008;22(1):88–97.CrossRefPubMedGoogle Scholar
  89. 89.
    Geller D, Donnelly C, Lopez F, Rubin R, Newcorn J, Sutton V, et al. Atomoxetine treatment for pediatric patients with attention-deficit/hyperactivity disorder with comorbid anxiety disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(9):1119–27.CrossRefPubMedGoogle Scholar
  90. 90.
    Kratochvil CJ, Newcorn JH, Arnold LE, Duesenberg D, Emslie GJ, Quintana H, et al. Atomoxetine alone or combined with fluoxetine for treating ADHD with comorbid depressive or anxiety symptoms. J Am Acad Child Adolesc Psychiatry. 2005;44(9):915–24.CrossRefPubMedGoogle Scholar
  91. 91.
    Bruni O, Angriman M, Calisti F, Comandini A, Esposito G, Cortese S, et al. Practitioner Review: Treatment of chronic insomnia in children and adolescents with neurodevelopmental disabilities. J Child Psychol Psychiatry. 2017.Google Scholar
  92. 92.
    Owens JA, Rosen CL, Mindell JA, Kirchner HL. Use of pharmacotherapy for insomnia in child psychiatry practice: A national survey. Sleep Med. 2010;11(7):692–700.CrossRefPubMedGoogle Scholar
  93. 93.
    Gale CK, Millichamp J. Generalized anxiety disorder in children and adolescents. BMJ Clin Evid. 2016;2016.Google Scholar
  94. 94.
    Graae F, Milner J, Rizzotto L, Klein RG. Clonazepam in childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry. 1994;33(3):372–6.CrossRefPubMedGoogle Scholar
  95. 95.
    Simeon JG, Ferguson HB, Knott V, Roberts N, Gauthier B, Dubois C, et al. Clinical, cognitive, and neurophysiological effects of alprazolam in children and adolescents with overanxious and avoidant disorders. J Am Acad Child Adolesc Psychiatry. 1992;31(1):29–33.CrossRefPubMedGoogle Scholar
  96. 96.
    •• Friedman RA. Antidepressants’ black-box warning--10 years later. N Engl J Med. 2014;371(18):1666–8. To clarify the controversy surrounding the use of SSRIs and increased suicidal ideation in youth, this paper presents the most recent data to address this issue.CrossRefPubMedGoogle Scholar
  97. 97.
    Mula M, Hesdorffer DC. Suicidal behavior and antiepileptic drugs in epilepsy: analysis of the emerging evidence. Drug Healthc Patient Saf. 2011;3:15–20.CrossRefPubMedPubMedCentralGoogle Scholar
  98. 98.
    Desjardins I, Cats-Baril W, Maruti S, Freeman K, Althoff R. Suicide Risk Assessment in Hospitals: An Expert System-Based Triage Tool. J Clin Psychiatry. 2016;77(7):e874–82.CrossRefPubMedGoogle Scholar
  99. 99.
    Singh T, Prakash A, Rais T, Kumari N. Decreased Use of Antidepressants in Youth After US Food and Drug Administration Black Box Warning. Psychiatry (Edgmont). 2009;6(10):30–4.PubMedPubMedCentralGoogle Scholar
  100. 100.
    Hammad TA, Laughren T, Racoosin J. Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry. 2006;63(3):332–9.CrossRefPubMedGoogle Scholar
  101. 101.
    Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002–2012. Natl Health Stat Rep. 2015;79:1–16.Google Scholar
  102. 102.
    Edwards E, Mischoulon D, Rapaport M, Stussman B, Weber W. Building an evidence base in complementary and integrative healthcare for child and adolescent psychiatry. Child Adolesc Psychiatr Clin N Am. 2013;22(3):509–29.Google Scholar
  103. 103.
    Simkin DR, Popper CW. Overview of integrative medicine in child and adolescent psychiatry. Child Adolesc Psychiatr Clin N Am. 2013;22(3):375–80.Google Scholar
  104. 104.
    Potter M, Moses A, Wozniak J. Alternative treatments in pediatric bipolar disorder. Child Adolesc Psychiatr Clin N Am. 2009;18(2):483–514.Google Scholar
  105. 105.
    Lakhan SE, Vieira KF. Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutr J. 2010;9:42.CrossRefPubMedPubMedCentralGoogle Scholar
  106. 106.
    Boyle NB, Lawton C, Dye L. The Effects of Magnesium Supplementation on Subjective Anxiety and Stress-A Systematic Review. Nutrients. 2017;9(5).Google Scholar
  107. 107.
    Wehry AM, Beesdo-Baum K, Hennelly MM, Connolly SD, Strawn JR. Assessment and treatment of anxiety disorders in children and adolescents. Curr Psychiatry Rep. 2015;17(7):52.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Stephanie Lichtor
    • 1
  • Khalid Afzal
    • 1
  • Jenna Shapiro
    • 1
  • Tina Drossos
    • 1
  • Karam Radwan
    • 1
  • Seeba Anam
    • 1
  • Sucheta Connolly
    • 1
  1. 1.Department of Psychiatry and Behavioral NeuroscienceUniversity of ChicagoChicagoUSA

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