Australian-first clinical guidelines for treating anxiety in children have been released. These guidelines include information specific to psychological treatment of children as well as medical management. One clear theme throughout the guideline is the strong recommendation for psychological treatment before medication is considered. There are also many recommendations to explore anxiety symptoms when there is a strong family history of anxiety and where there are behavioural indicators such as school refusal or aggression for example, or there is an existing diagnosis of illness or neurodivergence. Treatment recommendations pertinent to psychologists are the emphasis on family involvement in treatment, including parent only interventions and CBT and ACT based approaches.
Recommendations specific to psychological treatment are:
- Cognitive behavioural therapy (CBT) should be used to improve daily functioning of children and young people aged 8-18 who have mild or moderate symptoms. It should also be used to target the remission of an anxiety diagnosis.
- Parent-only CBT could be used to reduce anxiety symptoms and improve daily function of children and young people with anxiety.
- Group-CBT could be used for children and young people aged 8-18 years. Contraindications to Group-CBT might include social anxiety as primary presentation and other social/emotional factors that may inhibit treatment benefit and fit with the group dynamic.
- Play-based approaches should be used to assist the child or young person to explore cognitive and behavioural concepts where developmentally appropriate.
- Evidence-informed internet CBT (CBT using online/app based programs) could be used for children and young people with anxiety. Examples of online programs are below:
- The University of Queensland’s BRAVE Program
- Macquarie University’s Cool Kids Anxiety Program
- Internet CBT can be used as an alternative to face-to-face treatment where appropriate, or an adjunct to work in session (eg for homework).
- Clinicians delivering cognitive-behavioural interventions to children and young people should consider the age and developmental abilities of the child or young person, including their capacity to self-reflect, their learning abilities and preferences, their theory of mind and their attention and concentration abilities, and should adjust choice of therapy or delivery of cognitive behavioural components appropriately.
- In cases where a child or young person aged 8-18 years is already receiving medication for their anxiety (or related mental health condition), CBT should be used in conjunction with medication to reduce anxiety symptoms.
- Acceptance and Commitment Therapy (ACT) could be used for children and young people aged 12-18 and could be helpful for children and young people with co-occurring chronic health conditions.
- CBT should be a first intervention for children under 12 years, however where they have found it difficult to engage in cognitive behavioural therapy, play-based approaches using cognitive behavioural concepts could be considered.
- Play-based approaches using cognitive behavioural concepts could be considered for treatment of anxiety diagnosis in children and young people aged 8 and under.
- Families should be closely involved at all stages of treatment to ensure that they understand the treatment approach and can continue to support the child or young person outside of the therapy room. This may mean that caregivers are always present in session, or it may be a combination of caregiver-only sessions, caregiver-child sessions, and child-only sessions. In most instances, completely excluding caregivers from therapy is not developmentally appropriate, however considering the child/adolescent’s engagement and preferences is vital.