Anxiety disorders are one of the most common disorders in youth. Depending on the report, in the United States between 5%-10% of youth have an anxiety disorder with some studies reporting as high as 20% (ref Silverman). The same article cites, a study based on surveys in New Zealand and Australia reporting between 3% and 44% of youth have an anxiety disorder! In these studies, the anxiety disorders include separation anxiety/school refusal (sometimes called school phobia), social anxiety, specific phobias (e.g., needles, animals, heights, etc.), and overanxious/generalized anxiety. Three anxiety disorders together — social anxiety, separation anxiety, and generalized anxiety — make up what clinicians call the ‘anxiety triad’ and are highly prevalent among youth. Most youth who have symptoms of one of these disorders often have symptoms of the other two. Similar prevalence rates in the 3% to 10% range occur for OCD (ref March and Storch, Drew article).

In 1998, Ollendick’s and King’s meta-analysis showed that behavioral procedures like imaginal (using guided instruction to imagine a real-life event) and in vivo (real life)desensitization (exposure therapy that uses small steps to help the brain turn off alarms related to a specific trigger) were “probably efficacious “ (such a cautious statement!) for childhood phobias and that these same procedures were similarly effective with and without family anxiety management training. In 1998, the authors concluded (as researchers are wont to do) – that more research with better methodology was needed. Thankfully, better studies with better methodologies occurred, producing the updated meta-analysis by Silverman and colleagues and numerous publications about separate, effective OCD treatment for youth by March, Storch, and many others.

Studies included in the meta-analysis by Silverman and her colleagues were categorized from the most rigorous – randomized prospective clinical trials (random assignment, blinded assessments, inclusion/exclusion, adequate sample, state-of-the-science diagnostics, well-established and sound measures with clearly defined interventions and adherence in implementing the intervention). These very ‘tight’ studies are Type 1 studies. Other studies included ranged from 2, to 6. As the number descended, criticism of methods increased. For example, studies designated Type 6 were case studies or opinion papers. The carefully designed studies, which contributed greatly to the conclusions reached, had qualities like strict inclusion/exclusion criteria (for example, youth with low IQ, psychotic disorder, unstable family life, co-occurring mental disorders, and similar characteristics that could affect the viability of a treatment were excluded).

Compared to the tentative conclusions of the 1998 analysis by Ollendick and King, Silverman and her colleagues concluded: “The considerable progress made shows that cognitive behavioral treatments, in individual or group formats, with and without parent involvement lead to positive treatment outcomes in children and adolescents with phobic and anxiety disorders.” Similar conclusions by March and Storch for OCD, support CBT’s effectiveness for all anxiety disorders in youth.

These strong improvements in methodology and treatment study outcomes that support CBT open the way for more-detailed questions about what works in CBT. Scientists want to further refine information about treatment (e.g., how much of a treatment is needed specifically, what is it about the treatment that works, what other factors affect whether the treatment works, whether medicine should be included in treatment, which aspects of treatment over what period of time make the most difference, and other similar questions). From studies of specific aspects of CBT, we know, for example, that it is important to reduce anxious self talk. Also, a parent’s anxiety or depression can negatively affect treatment. Refining treatment questions (what works/what doesn’t) is a good thing because it helps provide better answers for families and more specific direction for treatment providers. How much treatment, the role played by medications, how to measure precisely, and other methodological issues will occupy researchers for awhile, but it’s great as a clinician to be able to offer effective, evidence-based CBT interventions for anxiety disorders in youth.

At NeuroScience, Inc., we contribute to research while we practice as clinicians. One of our current studies explores the effects of a novel medication on the disorders of the ‘anxiety triad’ mentioned above. To learn more about this study or consult with one or our experts about treating youth anxiety disorders, please contact us at 703-787-9090.

References:
Silverman, Wendy K.; Pina Amrado A,; Chocklingam Viswevaran., Evidence-based psychosocial treatment for phobic and anxiety disorders in children and adolescents.
Journal of Clinical Child & Adolescent Psychology, Volume
37, Issue 1 January 2008 , pages 105 – 130

John S. March and Karen Muelle, New York, Guilford Press, 1998, 298 pages, ISBN 1-57230-242-9, OCD in Children and Adolescents: A Cognitive-Behavioral Treatment Manual

Lindsay Brauer, MA,1 Adam B. Lewin, PhD, and Eric A. Storch, PhD Evidence-Based Treatment for Pediatric Obsessive-Compulsive Disorder Isr J Psychiatry Relat Sci – Vol. 48 – No 4 (2011)

Most of us spend so much time moving, doing, engaged in media (phone, computer, television, portable gaming, texting, etc) or rushing toward the next event of the day that we lose awareness of the experience of ‘now’ — the moment we’re in. The rush to do, achieve, and squeeze in just one more thing leaves us stressed, anxious, inattentive, and feeling disappointed. Day after day this experience accumulates and contributes to anxiety, sleep, mood, and attention disorders in addition to stress-related illness, impatience, and anger.

Fortunately, neuroimaging and meditation studies offer specific treatment suggestions to reduce or ameliorate these harmful outcomes. Spending about 30 minutes per day, it is possible to change your brain in just 8 weeks. Compared to pretest brain images, posttest images in the study referenced above found increased density in the gray matter of the hippocampus (important for learning and memory) and in frontal lobe areas important for self-awareness, attention, introspection, and empathy. Equally exciting was the decreased gray-matter density seen in the amygdala, which is key to generating anxiety and stress responses.

Neuroplasticity is the term used to refer to the ever-changing nature of the brain as part of the normal developmental process from birth to death. This study is particularly exciting because it shows specific, important changes to key brain areas in a short period. Although past studies have shown that the brains of experienced meditators were indeed different than non-meditators, it wasn’t clear if the differences were due to meditation or some other factor. Additionally, it wasn’t evident whether people who don’t meditate could produce beneficial changes quickly. This study showed assertively that benefits occur in a brief period of time. People like you and me can start to benefit today.

I hope you will join me in ‘committing to sitting’ every day (or as often as you can).

To learn more about NeuroScience or our Cognitive Behavioral Therapy (CBT) program please contact us.

Dr. Keith Saylor, President of NeuroScience, Inc. (NSI), is pleased to welcome Sajjad Khan, PhD, MSW, LCSW, to the private practice. Dr.Khan, who has 17 years of clinical experience, provides treatment services to adults, adolescents, and children with the following conditions:

• Neurobehavioral disorders, such as ADHD
• Autism spectrum disorders, including Asperger’s and PDD diagnoses
• Mood disorders, such as depression, bipolar disorder, and anxiety disorders, including obsessive-compulsive disorder (OCD)

Dr. Khan’s services for individuals and families include assessments, treatment plans, parent training, coordination of behavioral interventions with parents and teachers, social skills training, and adaptive function coaching. Please visit our website at www.neuroscienceinc.com or call 703-787-9090 to learn more about Dr. Khan.

Caitlin Counihan graduated from George Mason University in 2011 with a BA in Psychology. During her time at GMU, she worked in a clinical psychology research laboratory and as an ABA therapist for children with autism spectrum disorders. Caitlin eventually hopes to pursue a graduate degree in psychology. At NSI, Caitlin manages the private practice scheduling and billing for Dr. Saylor, Dr. Khan, and Dr. Burns. She also works as a Research Assistant for NSI’s clinical trials, working on recruitment activities and providing regulatory and data support.

Groups at NSI

• Obsessive-Compulsive Disorder Group with Dr. Saylor October 15, 2011 through March 10, 2012
• Mood/Anxiety Disorders Group with Dr. Khan Begins October 12
• ADHD Social Skills Group with Dr. Khan Now Forming
• Panic Disorder Group with Dr. Saylor Now Forming

Dr. Saylor and Dr. Khan Present

Dr. Saylor will present at CHADD in November 2011:

• CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder) Meeting, Orlando, Florida, November 10th. Parent Global Assessments Following Adjunctive ADHD Medication Administration

Dr. Khan will make the following presentations in 2012:

• NASW Annual Conference in Richmond, VA. March 9th. Clinical Assessment of Adaptive Functioning for ADHD and Asperger’s Children and Adolescents.
• Auburn School, Herndon, VA. April 18, 7:30-9:00 p.m. Updates on Adaptive Functioning in Children with Autism Spectrum Disorder
• The Lab School, Washington, DC. May 3rd. Assessing Outcomes in ADHD, Asperger’s, and Autistic Children: The Right Brain/Left Brain Perspective