title: Treating child and adolescent anxiety effectively: Overview of systematic reviews.
abstract: We conducted an overview of systematic reviews about child and adolescent anxiety treatment options (psychosocial; medication; combination; web/computer-based treatment) to support evidence informed decision-making. Three questions were addressed: (i) Is the treatment more effective than passive controls? (ii) Is there evidence that the treatment is superior to or non-inferior to (i.e., as good as) active controls? (iii) What is the quality of evidence for the treatment? Pre-specified inclusion criteria identified high quality systematic reviews (2000-2015) reporting treatment effects on anxiety diagnosis and symptom severity. Evidence quality (EQ) was rated using Oxford evidence levels [EQ1 (highest); EQ5 (lowest)]. Twenty-two of 39 eligible reviews were high quality (AMSTAR score≥3/5). CBT (individual or group, with or without parents) was more effective than passive controls (EQ1). CBT effects compared to active controls were mixed (EQ1). SSRI/SNRI were more effective than placebo (EQ1) but comparative effectiveness remains uncertain. EQ for combination therapy could not be determined. RCTs of web/computer-based interventions showed mixed results (EQ1). CBM/ABM was not more efficacious than active controls (EQ1). No other interventions could be rated. High quality RCTs support treatment with CBT and medication. Findings for combination and web/computer-based treatment are encouraging but further RCTs are required. Head-to-head comparisons of active treatment options are needed.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. Electronic address: kbennett@mcmaster.ca.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Katharina
authors.initials: K
authors.lastname: Manassis
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Duda
authors.affiliation: Department of Psychiatry, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada.
authors.forename: Alexa
authors.initials: A
authors.lastname: Bagnell
authors.affiliation: Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States.
authors.forename: Gail A
authors.initials: GA
authors.lastname: Bernstein
authors.affiliation: Department of Psychiatry, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: E Jane
authors.initials: EJ
authors.lastname: Garland
authors.affiliation: Department of Educational and Counselling Psychology and Special Education, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Lynn D
authors.initials: LD
authors.lastname: Miller
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Newton
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Pamela
authors.initials: P
authors.lastname: Wilansky
mesh_terms: D000293:Adolescent; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D001008:Anxiety Disorders / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D006801:Humans; D016896:Treatment Outcome
chemical_list: D014151:Anti-Anxiety Agents
keywords: Adolescent; Anxiety; Child; Clinical decision making; Review; Therapeutics