Current and Future Approaches to Pediatric Anxiety Disorder Treatment

Abstract

This overview critically appraises the literature on the treatment of pediatric anxiety disorders. The two established treatments for these conditions comprise cognitive-behavioral therapy (CBT) and antidepressant medications. Many youths receiving these treatments fail to achieve remission, which creates a need for new treatments. After summarizing the literature on CBT and currently available medications, the authors describe research that lays a foundation for improvements in the treatment of pediatric anxiety disorders. This foundation leverages neuroscientific investigations, also described in the overview, which provide insights on mechanisms of successful treatment.

Keywords: Antidepressants; Anxiety Disorders; Child/Adolescent Psychiatry; Psychotherapy; SSRIs.

Figure 1:

Current treatment for individuals diagnosed with an anxiety disorder (red) consists of either medication, CBT, or a combination of both. Near term improvements in outcomes might follow by increasing availability of these treatments and by offering psychological treatment to people at-risk (‘purple’) for anxiety disorders. Current research seeks novel treatments based on their capacity to influence mammalian neural circuitry that is engaged by threats. The figure illustrates two behaviors and associated circuitry. One behavior concerns the capture of attention by a threat, such as the snake in the picture. This behavior engages the lateral prefrontal cortex, as also shown in the figure in green, and may be targeted by cognitive training as also illustrated in the figure. The other behavior appears in the bottom of the figure, where a mouse first learns that a sound predicts a shock before the mouse next extinguishes this learning. Retention of this subsequent extinction learning is represented by the associated sound that appears without the shock. Such learning requires the medial prefrontal cortex, shown in blue. This circuit could be targeted by brain stimulation, as also shown in the figure.