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Assessing the Impact of Childhood Interventions
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skip navigation About the Conference
Agenda
Commissioned Papers
Barbara J. Burns, Ph.D.
Scott N. Compton, Ph.D.
Helen L. Egger, M.D.
Elizabeth M.Z. Farmer, Ph.D.
E. Jane Costello
Tonya D. Armstrong
Alaattin Erkanli
Paul E. Greenbaum
Chi-Ming Kam
Linda M. Collins
Selected Bibliography
Program Contacts
An Annotated Review of the Evidence Base for Psychosocial and Psychopharmacological Interventions for Children with Attention-Deficit/Hyperactivity Disorder, Major Depressive Disorder, Disruptive Behavior Disorders, Anxiety Disorders, and Posttraumatic Stress Disorder

Burns, Compton, Egger & Farmer

Part 5: Studies of Childhood Anxiety Disorder

Links to other parts of this paper:


Studies of Childhood Anxiety and Anxiety Disorders

Studies of outpatient interventions for anxiety symptoms and anxiety disorders in school-aged children are presented in table 4. Studies were included in this review if they covered children in the 6–12 years age range, although studies that also included younger children or adolescents were not excluded. Several approaches were combined to identify relevant published studies. The following key words and synonyms were searched in PsycINFO and Medline: anxiety, worries, fears, anxiety disorder, separation anxiety disorder, generalized anxiety disorder, overanxious disorder, avoidant disorder, panic disorder, agoraphobia, phobia, simple phobia, social phobia, and obsessive compulsive disorder.

The results of these searches were then crossed with the appropriate age group (6–12 years old), with treatment modalities (treatment, psychopharmacology, psychotherapy, cognitive behavior therapy, intervention, behavior modification), then with study type (randomized clinical trial, clinical trial), and time frame (1985 to 1999). Studies investigating school refusal/school phobia were also included because the behavior is so often associated with anxiety and anxiety disorders. Reference lists obtained from review articles and book chapters were searched to ensure that all of the relevant studies had been identified. The initial pool of 75 articles was then reduced using the general inclusion criteria for this project. Thirty-eight papers were excluded for the following reasons: open-label drug study, single case report, all subjects older than 12 years old, retrospective chart review, or no comparison group. The final anxiety matrix (table 4) includes 37 papers that met the inclusion criteria. The matrix divides the treatments into three categories: psychosocial, psychopharmacological, and adjunctive. This summary describes studies with treatments that have been found to be effective for children with symptoms of anxiety, studies with a mix of DSM-defined anxiety disorders overall, and finally, specific DSM anxiety disorders.

Most of the anxiety treatment literature has focused on childhood fears, phobias, or anxiety symptoms, rather than clearly defined anxiety disorders. Psychosocial interventions reviewed began with Blagg’s 1984 study, which demonstrated that "behavioral therapy" was more effective than hospitalization or home-tutoring and psychotherapy at returning school-refusing children back to school. Systematic desensitization, modeling (either live or symbolic), modeling in conjunction with assisted participation and/or desensitization, and reinforced practice (in vivo exposure and rewards) have also been shown to be more effective than no treatment in reducing phobic symptoms. Cognitive behavior therapy (CBT) has also been found to reduce anxiety symptoms and fears. Interestingly, in several of the CBT studies, nonspecific therapeutic interventions were also effective in reducing anxiety symptoms. There are no studies on the effectiveness of medication without concurrent psychotherapy for reducing anxiety symptoms. Three adjunctive studies on the treatment of anxiety symptoms were identified; however, the effectiveness of medication to treat anxiety symptoms in children has not been definitively demonstrated to date.

Seven studies (five on cognitive behavior therapy and two on medication) have assessed treatments for a mix of DSM-defined anxiety disorders. Various types of cognitive behavior therapy have been shown to be effective in reducing anxiety symptoms in these children. Neither of the drugs investigated (alprazolam and clonazepam) were found to be more effective than placebo in reducing symptoms in children with DSM-defined anxiety disorders.

In this matrix, nine studies meeting the criteria focused on the treatment of specific DSM childhood anxiety disorders: six were interventions for obsessive compulsive disorder (OCD), one was for separation anxiety disorder, and two for simple phobia. No studies on the treatment of generalized anxiety disorder, social phobia, or panic disorder met the criteria necessary to be included in this review. Psychosocial treatments for DSM-defined social phobia included emotive imagery (a version of systematic desensitization), which was found to be an effective treatment for darkness phobia with gain maintained at 3 months; in the second study, exposure-based contingency management treatment and exposure-based cognitive self-control treatment resulted in substantial improvements on all outcome measures at 3, 6, and 12 months. Children in an educational support treatment, an approach chosen to control for "nonspecific" therapeutic effects, also experienced significant symptom reduction that was maintained during followup. Only one DSM-defined disorder, OCD, has had effectiveness demonstrated for a pharmacological intervention. Four studies have evaluated use of clomipramine for OCD with contradictory results. Fluoxetine and sertraline have been reported to be more effective than placebo in reducing obsessive compulsive symptoms in children with an OCD diagnosis, but sample size for the fluoxetine study (n = 14) is too small to produce reliable results.

In conclusion, the effectiveness of behavior therapy and cognitive therapy for treatment of childhood anxiety disorders has been shown in a number of studies. Clearly, however, the current research on the treatment of childhood anxiety disorders contains many significant gaps that must be addressed in order to provide effective interventions for children and their families.

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Table 4.1 Psychosocial Studies of Childhood Anxiety Disorders
Study Citation(s) Study Design/
Description
Target Population Demographic Characteristics Outcomes Notes
Barabasz, 1973 RCT; Imaginal systematic desensitization (n = 42) vs. no treatment control (n = 41) Highly test anxious 5th and 6th graders Age: DK

Gender: DK

Race/Ethnicity: DK

Children in treatment group obtained lower autonomic indices of test anxiety and significant improvement on measures of test performance Polygraph used to measure autonomic indices
Barrett, Dadds, & Rapee, 1996 RCT; 12-session cognitive-behavior therapy (n = 28) vs. cognitive-behavior therapy plus family management (n = 25 ) vs. wait-list control (n = 26) Children with DSM-III-R overanxious disorder (n = 30), separation anxiety disorder (n = 30), or social phobia (n = 19) Age: 7 – 14

Gender:
57% boys
43% girls

Race/Ethnicity: DK

Cognitive-behavior therapy more effective than control; 69.8% in either cognitive-behavior therapy group no longer met criteria for an anxiety disorder vs. 26% in the control; cognitive-behavior therapy plus family management more effective than cognitive-behavior therapy alone; at 12-month followup 70.3% in the cognitive-behavior therapy alone and 95.6% in the cognitive-behavior therapy plus family management no longer met criteria for an anxiety disorder Younger children (7–10) and girls responded better to the cognitive-behavior therapy plus family management intervention; used manualized protocol; small overall dropouts
Blagg & Yule, 1984 Quasi-experimental design; behavior therapy (n = 30) vs. hospitalization (n = 16) vs. psychotherapy and home tutoring (n = 20) School refusing youth Age: 11 – 16

Gender:
46% boys
54% girls

Race/Ethnicity: DK

Success (defined as return to school measured at 1 year) was greatest for behavior therapy group (93.3%) vs. hospitalization (37.5%) vs. psychotherapy and home tutoring (10%) Groups not matched; subjects not randomized; behavior therapy group significantly younger than other two groups; therapies not manualized; psychiatric diagnoses not assessed; no control group
Cornwall, Spence, & Schotle, 1992 RCT; 6-week emotive imagery therapy vs. wait-list control group
(n = 24)
Darkness phobia; children met DSM-III-R criteria for simple phobia; children excluded for comorbid anxiety disorder, other anxiety disorders, and taking medication Age: 7 – 10

Gender: DK

Race/Ethnicity: DK

Significant reduction in darkness fear, anxiety, and impairment in treatment group; improvement maintained at 3-month followup Emotive imagery is a variant of systematic desensitization; no significant reduction in fears and anxiety in control group
Graziano & Mooney, 1980; Graziano & Mooney, 1982 RCT; 3 weeks of verbal self-instruction (n = 17) vs. wait-list control group (n = 16) Children with severe nighttime fears present for more than 2 years Age: 6 – 13

Gender:
54% boys
46% girls

Race/Ethnicity: DK

Treatment group had significantly fewer fears than control group Treatment gains were maintained or improved at both 6-month, 12-month, and 2- to 3-year followup
Kanfer, Karoly, & Newman, 1975 RCT; positive self-talk group (n = 15) vs. positive talk about the environment group (n = 15) vs. reciting nursery rhymes (n = 15) Children with fear of the dark Age: 5 – 6

Gender: DK

Race/Ethnicity: DK

Greater reduction in fear for positive self-talk group relative to other two groups Mean change in tolerance to remain in dark room only 2 minutes; no psychiatric diagnosis
Kendall, 1994; Kendall & Southam-Gerow, 1996 RCT; 16-session individual cognitive-behavior therapy n = 27) vs. wait-list (n = 20) Children with DSM-III-R diagnosis of overanxious disorder, separation anxiety disorder, or avoidant disorder; children excluded for primary diagnosis of specific phobia or current antianxiety medication Age: 9 – 13

Gender:
60% boys
40% girls

Race/Ethnicity:
75% White
1% African American
24% Other

Cognitive-behavior therapy was more effective than control; 64% of the treated subjects no longer met criteria for an anxiety disorder vs. 5% in the control Treatment gains maintained at 1 year and 3- to 5-year followup; data support long-term beneficial effects of cognitive-behavior therapy; 22% noncompletion rate; comorbidity included 32% depression, 15% ADHD, 2% conduct disorder, 60% simple phobias; manualized treatment
Kendall, Flannery-Schroeder, Panichelli-Mindel, Southam-Gerow, Henin, & Warman, 1997 RCT; 16-week individual cognitive-behavior therapy (= 60) vs. wait-list control (n = 34) Children with primary anxiety disorder; overanxious disorder (n = 55), separation anxiety disorder (n = 22), avoidant disorder (n = 17) Age: 9 – 13

Gender:
62% boys
38% girls

Race/Ethnicity:
85% Caucasian
5% African American
2% Hispanic or Asian
5% Other

Cognitive-behavior therapy was more effective than waitlist control; 53.2% no longer met diagnostic criteria for an anxiety disorder in treatment group vs. 5.9% in the wait-list group; improvement in coping skills/functioning; Treatment gains and functional improvement maintained at 1-year followup; treatment effect the same for all three anxiety diagnoses
King, Tonge, Heyne, Pritchard, Rollings, Young, Myerson, & Ollendick, 1998 RCT; 4-week cognitive-behavior therapy and parent/teacher behavior management (n = 16) vs. wait-list (n = 16) School refusing children; 85.3% with a psychiatric diagnosis; subjects excluded if currently on antianxiety or antidepression medication Age: 5 – 15

Gender:
53% boys
47% girls

Race/Ethnicity: DK

Intensive, brief cognitive-behavior therapy was superior to control; 88.2% of cognitive-behavior group showed clinical improvement in school attendance vs. 29.4% of wait-list control Treatment gains were maintained at 3-month followup; no attrition; parental training might have enhanced the effectiveness of the treatment
Kondas, 1967 RCT; relaxation training (n = 6) vs. group imaginal systematic desensitization
(n = 6) vs. fear hierarchy without relaxation (n = 5) vs. no relaxation control (n = 6)
Children with "stage fright" Age: 11 – 15

Gender: DK

Race/Ethnicity: DK

Fear reduction greatest for systematic desensitization; relaxation training led to temporary fear reduction but treatment gains were maintained at followup Treatment gains maintained at 5-month followup for systematic desensitization
Last, Hansen, & Franco, 1998 RCT; 12-week cognitive-behavior therapy (n = 20) vs. educational support therapy (n = 21) Children with school refusal and DSM-III-R anxiety disorder of phobic disorder (58%), separation anxiety disorder (32%), avoidant disorder (4%), or panic disorder (2%); subjects excluded due to current diagnosis of depression or psychiatric medication Age: M = 12

Gender:
33% boys
67% girls

Race/Ethnicity:
90% Caucasian
4% African American
6% Hispanic

No significant between-group differences in school refusal behavior, symptoms of anxiety, or depression; no between-group differences at 4-week followup; 30% of both groups reported "moderate" difficulty returning to school the following year Cognitive-behavior therapy group had highest attrition rate; both treatments were more effective in younger children
Lewis, 1974 RCT; modeling of water play on film vs. assisted participation in the feared activity vs. combined modeling and participation vs. controls (total n = 40) Children with fear of water Age: 5 – 12

Gender:
100% boys

Race/Ethnicity:
100% African American

Greatest reduction in avoidance behavior with assisted participation plus modeling; assisted participation alone was more effective than modeling alone; each treatment was more effective than no treatment   
Mann & Rosenthal, 1969 RCT; individual desensitization (n = 10) vs. vicarious individual desensitization (n = 10) vs. group desensitization (n = 10) vs. vicarious group observing group desensitization (n = 10) vs. vicarious group observing individual desensitization (n = 10) vs. no treatment controls (n = 21) Test anxiety Age: 12 – 14

Gender:
45% boys
55% girls

Race/Ethnicity: DK

All active treatments superior to control; no significant between-group differences Small sample size
Menzies & Clarke, 1993 RCT; three-session reinforced practice vs. live modeling vs. in vivo exposure plus reinforced practice modeling vs. assessment only control (n = 48) Children with water phobia Age: M = 5.5

Gender:
65% boys
35% girls

Race/Ethnicity: DK

Reinforced practice produced clinically significant reduction in anxiety and avoidance of water activities; gains maintained at 3 months; gains generalized to other water situations Modeling was not more effective than control condition
Miller, Barrett, Hampe, & Noble, 1972 RCT; 24-session systematic desensitization vs. verbal or play psychotherapy vs. wait-list control (total n = 67) Children with a variety of "phobic" symptoms; 69% with a fear of school Age: 6 – 15

Gender:
55% boys
45% girls

Race/Ethnicity:
96% White
4% African American

Both treatments equally efficacious in reducing phobic behavior; both treatments more effective than wait-list control Findings of efficacy only true for children ages 6–10; both treatments included parent training
Murphy & Bootzin, 1973 RCT; up to four sessions of active contact desensitization vs. passive contact desensitization vs. no treatment control (total n = 67) Children with snake-phobia Age: 6 – 9

Gender:
49% boys
51% girls

Race/Ethnicity: DK

Both treatments effective; no significant between-group differences for active treatments; 86.7% of treated children overcame snake phobia vs. 22.7% controls In vivo desensitization is a very efficient treatment; mean treatment length was 15 minutes; maximum treatment length was 32 minutes (four 8-minute sessions)
Obler & Terwilliger, 1970 RCT; 5-session exposure and reinforced practice (n = 15) vs. no treatment control
(n = 15)
Neurologically impaired children with phobic disorders (either fear of dogs or of riding on a bus) Age: 7 – 12

Gender: DK

Race/Ethnicity: DK

Treatment superior to control; all children in treatment condition able to overcome phobia vs. three children in control condition IQ did not affect outcome
Ritter, 1968 RCT; live modeling/vicarious desensitization vs. participant modeling/contact desensitization vs. no treatment control (total
n
= 67)
Children with snake-avoidant behavior Age: 5 – 11

Gender:
36% boys
64% girls

Race/Ethnicity: DK

Contact desensitization (80% success) more effective than vicarious desensitization (53.3% success); both treatments more effective than control (0% success) Group treatment; reduction in fear reported by treatment groups not significantly different from controls
Silverman, Kurtines, Ginsburg, Weems, Lumpkin, & Carmichael, 1999 RCT; 8- to 10-week group cognitive-behavior therapy
(n = 37) vs. wait-list control (n = 19)
Youth with a primary DSM-III-R anxiety disorder Age: M = 10

Gender:
61% boys
39% girls

Race/Ethnicity:
45% White
49% Hispanic
5% Other

Group cognitive-behavior therapy more effective than control; 64% children in active treatment no longer met criteria for an anxiety disorder vs. 13% in control Treatment gains maintained at
3-, 6-, and 12-month followup; 27% dropout rate
Silverman, Kurines, Ginsburg, Weems, Rabian, & Serafini, 1999 RCT; 10-week exposure-based contingency management (n = 41) vs. exposure based cognitive self-control (n = 40) vs. nonspecific education support control (n = 23) Children with DSM-III-R phobias (83.6% primarily simple phobias)

Age: M = 9.8

Gender:
53% boys
47% girls

Race/Ethnicity:
62% White
37% Hispanic
2% Other

Improvement posttreatment and at followup for all three groups; 88% contingency management children, 55% self-control children, and 56% education support children no longer meet diagnostic criteria Treatment gains maintained at followup; 62% of sample between ages 6 and 11; 72% with comorbid disorder; manualized treatment; 22% noncompletion rate

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Table 4.2 Psychopharmacological Studies of Childhood Anxiety Disorders
Study Citation(s) Study Design/
Description
Target Population Demographic Characteristics Outcomes Notes
Berney, Klovin, Bhate, Garside, Jeans, Kay, & Scarth, 1981 Double-blind, placebo-controlled RCT; 12-week clomipramine (n = 27) vs. placebo
(n = 19); concurrent treatment with individual therapy
Children with school phobia; 87% with separation anxiety Age: 9 – 15

Gender:
41% boys
59% girls

Race/Ethnicity: DK

Clomipramine not superior to placebo in reducing separation anxiety, school refusal, or neuroticism Variable dosing by age; trial predates DSM-III
Bernstein, Garfinkel, & Borchardt, 1990 Double-blind, placebo-controlled RCT; 8-week alprazolam (n = 9) vs. imipramine
(n = 6) vs. placebo (n = 9); concurrent psychotherapy
Children with school refusal Age: 7 – 18

Gender:
54% boys
46% girls

Race/Ethnicity: DK

Mixed results; both active treatments resulted in symptom reduction on measures of anxiety and depression; alprazolam with largest effect; no significant differences relative to control on other measures Variable dosing; none to mild side effects; 84% of subjects with depression; 20% dropout rate
DeVeaugh-Geiss, Moroz, Biderman, Cantwell, Fontaine, Greist, Reichler, Katz, & Landau, 1992 Double-blind, placebo-controlled RCT; 8-week clomipramine
(n = 31) vs. placebo (n = 29)
Children with DSM-III diagnosis of obsessive-
compulsive disorder
Age: 10 – 17

Gender:
65% boys
35% girls

Race/Ethnicity:
97% White
3% African American

Clomipramine more effective than placebo in reducing obsessive-
compulsive symptoms and improving functioning; two children terminated treatment due to adverse side effects
Unclear whether an age effect; only 53% continued the drug for 1 year despite its efficacy; four children terminated treatment during open label due to adverse side effects
Flament, Koby, Rapoport, Berg, Zahn, Cox, Denckla, & Lenane, 1990 2-7 years' (M = 4.4 years) followup of 27 subjects admitted to NIMH between 1977 and 1983 (19/27 were in Flament et al., 1985 study); n = 93% of original sample and 29 matched controls Children with severe primary DSM-III OCD Age at followup: 13 – 24

Gender:
68% boys
32% girls

Race/Ethnicity: DK

68% of treatment sample still had OCD; 52% had a comorbid Axis I disorder; only 28% had no current psychiatric diagnosis compared with 35% of controls; most common psychiatric diagnosis for controls: alcohol and drug abuse Subjects had received intermittent, often irregular treatment during followup period; initial good response to clomipramine had no prognostic benefit for outcome
Flament, Rapoport, Berg, Sceery, Kilts, Mellstrom, & Linoila, 1985 Double-blind, placebo-controlled, within-subject crossover experimental design; 11-week clomipramine vs. placebo; concurrent individual supportive psychotherapy (total n = 27) Children with DSM-III diagnosis of obsessive-
compulsive disorder
Age: 6 – 18

Gender:
67% boys
23% girls

Race/Ethnicity: DK

75% of subjects on clomipramine showed "marked to moderate" improvement in obsessive-
compulsive symptoms; significant anticholinergic side effects noted
Improvement in obsessive-
compulsive symptoms independent of baseline depression; 30% noncompletion rate; variable dosing; most subjects hospitalized during trial; no significant change in symptoms of anxiety and depression; most subjects had prior unsuccessful medication trials
Gittelman-Klein & Klein, 1973 Double-blind, placebo-controlled RCT; 6-week imipramine and behavior therapy (= 16 ) vs. placebo and behavior therapy (n = 19) Children with school phobia and separation anxiety Age: 6 – 14

Gender:
54% boys
46% girls

Race/Ethnicity:
97% White
3% Other

Positive treatment effect was obtained on parent and clinician ratings of improvement for imipramine and behavior group; return to school was 81% for imipramine and behavior vs. 47% for placebo and behavior Variable dosing; predates DSM-III; 35% of subjects depressed; side effects reported were primarily anticholinergic; dropout rate not reported
Graae, Milner, Rizzotto, & Klein, 1994 Double-blind, placebo-controlled, within-subject crossover experimental design; 4-week clonazepam vs. placebo (n = 12); placebo group all also received supportive psychotherapy Children with DSM-III-R anxiety disorders Age: 7 – 13

Gender:
53% boys
47% girls

Race/Ethnicity:
100% Caucasian

No significant between-group differences; side effects included drowsiness, irritability, and oppositionality Questionable power due to small sample size; variable dosing; 20% of subjects dropped out due to adverse side effects, including disinhibition, aggressivity, and self-harming behavior
Klein, Koplewicz, & Kanner, 1992 Double-blind, placebo-controlled RCT; 6-week imipramine and behavior therapy (= 11) vs. placebo and behavior therapy (n = 10); study included a 4-week behavior therapy run-in with nonresponders eligible for study Children with DSM-III separation anxiety disorder who did not respond to 4-week behavior therapy run-in Age: 6 – 16

Gender:
66.7% boys
33.3% girls

Race/Ethnicity:
95% Caucasian
5% Hispanic

No significant between-group differences across multiple measures; more side effects reported for imipramine group; nonsignificant trend toward increase EKG PR and QRS intervals in children receiving imipramine Of the original sample (n = 45), 24 subjects responded to brief 4-week behavior therapy run-in; variable dosing
Leonard, Swedo, Lenane, Rettew, Cheslow, Hamburger, & Rapoport, 1991; Leonard, Swedo, Lenane, Rettew, Hamburger, Bartko, & Rapoport, 1993 Double-blind, within-subject alternating treatments experimental design; 3-month clomipramine with half of the subjects randomized to 2-month continued clomipramine (n = 11) or desipramine (n = 9) followed by 3-month clomipramine for all subjects Children with DSM-III diagnosis of obsessive-
compulsive disorder
Age: 8 – 19

Gender:
58% boys
42% girls

Race/Ethnicity: DK

89% of the group substituted with desipramine relapsed during 2-month comparison period vs. 18% of the nonsubstituted group; all eight who relapsed with desipramine regained clinical response within 1 month of clomipramine reinstatement Maintenance clomipramine treatment for obsessive-
compulsive disorder seems indicated; even with long-term clomipramine treatment, obsessive-
compulsive symptoms continued with varying intensity; 23% of subjects dropped out before the end of the trial; at 2- to 7-year followup, 43% met criteria for obsessive-
compulsive disorder; 70% still taking medication, none receiving behavior therapy; 81% improved from baseline
Leonard, Swedo, Rapoport, Koby, Lenane, Cheslow, & Hamburger, 1989 Double-blind, placebo-controlled, within-subject crossover experimental design; 10-week clomipramine vs. 10-week desipramine (n = 49) Children with DSM-III diagnosis of obsessive-
compulsive disorder
Age: 6 – 18

Gender:
63% boys
37% girls

Race/Ethnicity:
DK

Clomipramine more effective than desipramine in reducing obsessive-
compulsive symptoms and depressive symptoms
2-week washout period prior to study; ongoing psychotherapy with private psychotherapist not discontinued during trial; variable dosing; 8% did not complete trial; side effect profiles for medications were similar
March, Biederman, Wolkow, Safferman, Mardekian, Cook, Cutler, Dominguez, Ferguson, Muller, Riesenberg, Rosenthal, Sallee, & Wagner, 1998 RCT; 12-week sertraline (n = 92) vs. placebo (n = 95) Children with DSM-III diagnosis of obsessive-
compulsive disorder
Age: 6 – 17

Gender: DK

Race/Ethnicity: DK

Sertraline resulted in significantly more improvement of obsessive-
compulsive symptoms relative to placebo; mild to moderate side effects and negligible cardiovascular effects noted
Titrated dosing; significantly more discontinuation due to sertraline (13%) than placebo (3.2%); 16.6% noncompletion rate
Riddle, Scahill, King, Hardin, Anderston, Ort, Smith, Leckman, and Cohen, 1992 Double-blind, placebo-controlled, within-subject crossover experimental design; fluoxetine
(n = 7) vs. placebo
(n = 7)
Children with DSM-III-R diagnosis of obsessive-
compulsive disorder
Age: M = 11.8

Gender:
43% boys
57% girls

Race/Ethnicity:
99% White
1% Other

Obsessive-
compulsive symptoms decreased by 30% to 45% on fluoxetine and 12% to 27% on placebo; 50% of subjects who crossed over to placebo terminated due to symptom resurgence
Mild to moderate side effects; one child became suicidal on fluoxetine (this resolved when the drug was discontinued); fixed dosing (20 mg); 14 out of 30 subjects meeting inclusion criteria agreed to participate; 50% of subjects in supportive or psychodynamic psychotherapy during trial; only 43% completed entire 20-week trial so crossover analysis side effects not feasible
Simeon, Ferguson, Knott, Roberts, Gauthier, Dubois & Wiggens, 1992 Double-blind, placebo-controlled RCT; 4-week alprazolam (n = 17) vs. placebo (n = 13); 1-month followup Children with primary diagnosis of overanxious disorder or avoidant disorder Age: M = 12.6

Gender:
77% boys
23% girls

Race/Ethnicity: DK

No significant between-group differences in global ratings of clinical improvement; no significant differences at 1-month followup Variable dosing; no discussion of specific age effects; trend toward improvement in the avoidant group


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Table 4.3 Adjunctive Studies of Childhood Anxiety Disorders
Study Citation(s) Study Design/
Description
Target Population Demographic Characteristics Outcomes Notes
De Haan, Hoogduin, Buitelaar, & Keijsers, 1998 RCT; 12-week behavior therapy (n = 12) vs. clomipramine (n = 10) Children with DSM-III-R diagnosis of obsessive-
compulsive disorder
Age: 8 – 18

Gender:
50% boys
50% girls

Race/Ethnicity: DK

Significant improvement with both treatments (clomipramine 33.4%; behavior therapy 59.9%); in nonresponder extension, approximately 35% reported improvement in symptoms No untreated control group; variable dosing; small sample size

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References
Studies of Childhood Anxiety and Anxiety Disorders

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DeVeaugh-Geiss, J., Moroz, G., Biederman, J., Cantwell, D., Fontaine, R., Greist, J. H., Reichler, R., Katz, R., & Landau, P. (1992). Clomipramine hydrochloride in childhood and adolescent obsessive-compulsive disorder: A multicenter trial. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 45-49.

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