Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What is the effectiveness of interventions intended to treat anxiety disorders in children (<18 years of age) over the long term (6-12 months)?

What is the effectiveness of interventions intended to prevent the development of anxiety disorders in children at risk for the diagnosis?

What is the effectiveness of combination interventions (pharmacologic and behavioral) for anxiety disorders in children?

What characteristics of the child (severity/type of anxiety disorder, sex, age, family history, parenting style, etc.) modify treatment effectiveness?

What are the effects of treatment on common mental health comorbidities (ADHD, depression, etc.)?

What is the effectiveness of interventions directed at the child compared with interventions directed at parents/family or involving the parent/family?

What is the evidence for choosing one intervention over another to treat persistent or recurrent anxiety after an initial intervention fails to achieve target outcome(s)?

What are the harms of treatments for anxiety disorders in children?

What evidence supports specific components of interventions as driving outcomes?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Pharmacologic, psychosocial/behavioral, allied health, complementary and other approaches to treating anxiety disorder

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Children (<18 yrs of age) with anxiety disorder or at risk for diagnosis

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Children with anxiety disorders and comorbidities including ADHD, depression, somatic medical conditions; age ranges (e.g., younger children, adolescents; SES and patient history (e.g., history of trauma, family history of anxiety disorder, parenting behavior/familial context)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

-Improvement in patient symptoms and family functioning, including potential improvements in somatic symptoms

-Increase understanding of presentation of anxiety disorder in children as symptoms may mimic typical childhood behavior and anxiety is natural part of development

-Increase understanding of potential modifiers of treatment

-Increase understanding of optimal treatment pathway if first line approaches are not effective

Describe any health-related risks, side effects, or harms that you are concerned about.

-Medication side effects -Unintended consequences/harms potentially associated with psychosocial, behavioral, or other therapies

-Family and child distress associated with diagnosis/labeling

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Depression and other mental health disorders

AHRQ Priority Populations

• Children

Federal Health Care Program

• Medicaid
• State Children's Health Insurance Program (SCHIP)

Importance

Describe why this topic is important.

Anxiety disorders typically arise in early childhood and include separation anxiety, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, PTSD, and panic disorder. They are among the most common childhood mental health disorders with prevalence estimates ranging from 12-20% across disorders. NIMH reports a lifetime prevalence of any anxiety disorder of 25.1% among 13 to 18 year olds and a lifetime prevalence of 5.9% for "severe" disorder. Disorders are typically chronic or recurring and often include symptoms of fear and anxiety as well as somatic symptoms such as stomach pain or headache. If untreated, anxiety disorders can cause significant impairment in children's and families' daily functioning, school performance, and quality of life as well as elevate risks for adult depression, suicide, and substance abuse. Early diagnosis and appropriate treatment can minimize morbidity and mortality. Cognitive behavioral therapy is generally accepted as a first line intervention, and several RCTs have addressed pharmacotherapy, particularly SSRIs for separation anxiety, generalized anxiety, and social phobia, but longer terms effects of treatment are not well-understood. Updated syntheses of studies addressing other classes of medications (antidepressants, benzodiazepines, etc.)are needed for clinical decision-making. Understanding of modifiers of treatment, particularly related to familial context, is similarly lacking, and synthesis of the primary literature could help inform clinicians and families. Pediatric health care providers may lack training in recognizing or differentiating anxiety disorder from normal childhood development and other psychiatric disorders.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Clinical practice dilemma

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Need for evidence-based approaches to treatment and treatment choices; effects of treatment on comorbidities and harms of treatment ; training for pediatric care providers and educating families about the disorder.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Understanding treatment effects and harms and instituting appropriate treatment can reduce morbidity and mortality in this chronic and potentially debilitating condition.

Describe the timeframe in which an answer to your question is needed.

Pediatricians and other care providers continue to see children with anxiety disorders

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Synthesis of the literature can help to educate pediatric providers in recognizing and differentiating symptoms related to anxiety disorders in children in order to inform treatment choices. Understanding modifiers of treatment and treatment pathways can help to optimize choices.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Understanding treatment effects and harms and instituting appropriate treatment can reduce morbidity and mortality in this chronic and potentially debilitating condition.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program