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Should you medicate your child? This is one of the biggest questions you might face if you are a parent of an anxious child.
This page will help you understand at what point it might be necessary to decide to put your anxious child on medication.
The research is inconclusive about whether medicine or therapy is more effective for children with anxiety.
Some studies have shown that cognitive behavioral therapy (CBT) and medication combined are more effective than one modality alone for some kinds of anxiety disorders.
However, most professionals generally advise parents to try a good therapist who uses a combination of Cognitive Behavioral Therapy (CBT) strategies first. With medication always comes the risk of side effects, and most parents don't want to medicate their children if avoidable.
If a child's functioning is seriously impaired and must be quickly gotten under control.medication may be recommended first.
Watch a video summary of this page.
It's also important to be able to ascertain that you have received good therapy before you make that decision to try medicine. Here is a checklist of some of what should be happening in therapy with children who have anxiety. This list does not apply for teens and adolescents. Therapy with teens is often conducted with less parent involvement.
Has your child's therapist:
Generally this is what good therapy for anxiety should look like. Different diagnoses such as obsessive compulsive disorder, panic disorder, or selective mutism will require more specific approaches, but good treatment has all of these components in common.
If you ask your therapist why they haven't tried something above, they should have a good explanation that makes sense to you. You should not be minimally involved in your child's anxiety treatment. You are central to their healing.
If you feel that you have given good therapy a try, and your child's child’s symptoms have not improved significantly, it may be time to consider child anxiety medication.
If your child’s symptoms have improved but continue to interfere with success at home, school, or with friends, you may also want to consider medication. This is a deeply personal decision, and no one can make it but you.
Keep in mind that although we know CBT works it may be somewhat difficult to use with young children. A three year old will not be capable of participating in traditional cognitive behavioral therapy. In cases of young children, most of the work should occur with you. Research is showing us more and more that in these cases the work should be with the parent( Lebowitz 2019). It is also important to remember that other techniques may work also.
CBT is not the only therapy, it is just the best researched therapy. We know children who receive it generally make improvements. The important thing to remember is that you feel your child has received the benefit of good therapy prior to trying medication. A good child anxiety therapist will make use of a combination of techniques such as art and play therapy during the different phases of CBT, and may use these strategies to highlight the concepts and issues above for the child. For example, the therapist may have the child draw out what they are thinking and feeling rather than say it. Remember, they will always work with you the parent, to help you work with your child.
Even though I’m not a psychiatrist, I can read and understand the research, and so can you. It's crucial for parents to be educated and understand the medicine choices your child's doctor makes. The most up to date research on anxiety medicine for children at this time shows that SSRI's can be successful at helping anxious children.
SSRI’s have been shown to increase depressive symptoms, including suicidal ideation, in a SMALL percent of these children and adolescents. Also, there are no research studies on the long term effects of SSRI'S on anxious children (AACAP OFFICIAL ACTION Clinical Report, February 1, 2007). Seriously, what parent wants to put their kids on medication?
Here are some of the SSRI's
Only a doctor can prescribe and advise you on child anxiety medicine, but you can be informed enough to ask questions about SSRI’S or any other choices of medications.
A doctor may prescribe something other than an SSRI, or in combination with an SSRI as a child anxiety medication. If your child’s doctor makes a different choice, ask why.
There are two other classes of drugs utilized to treat child and adolescent anxiety. Tricyclic Antidepressants ( TCA’s) and benzodiazepines. TCA’s generally have more serious side effects and need to be monitored more closely . (AACAP OFFICIAL ACTION Clinical Report, February 1, 2007) .
If you and your doctor have decided to try a child anxiety medication, carefully monitor your child for any changes in their behavior. I also recommend children be told about the medication that is being prescribed, and that they know the names and doses of their medications. Parents need to check in regularly with their child when medication is prescribed to get the child’s opinion of how they feel and how it may be helping or hurting.
Here are some questions to ask your doctor about your child's medication.
I hope this page was helpful for you when thinking about whether or not to medicate your child for anxiety.
This page does not apply to Obsessive Compulsive Disorder (OCD) or Post Traumatic Stress Disorder ( PTSD).These diagnoses require different consideration when examining questions about medication (AACAP OFFICIAL ACTION Clinical Report, February 1, 2007)
OFFICIAL ACTION Clinical Report. (February 1, 2007). Practice Parameter for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child and Adolesecent Psychiatry , 267-283.(Rep.). (n.d.).
Lebowitz, E. R., Marin, C., Martino, A., Shimshoni, Y., & Silverman, W. K. (2019). Parent-Based Treatment as Efficacious as Cognitive Behavioral Therapy for Childhood Anxiety: A Randomized Noninferiority Study of Supportive Parenting for Anxious Childhood Emotions. Journal of the American Academy of Child & Adolescent Psychiatry. doi:10.1016/j.jaac.2019.02.014
M., Alvarez et. al. (n.d.). Psychotherapy for anxiety disorders in children and adolescents. Retrieved April 19, 2019, from https://www.uptodate.com/contents/psychotherapy-for-anxiety-disorders-in-children-and-adolescents#H10658364.
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