SEATTLE – The presence of a comorbid anxiety disorder in children with phobias does not interfere with the child's ability to respond to cognitive-behavioral treatment.
The children who responded to cognitive-behavioral treatment (CBT) were also able to reduce the symptoms of their comorbid disorder, according to data presented by Thomas H. Ollendick, Ph.D., at the annual meeting of the Anxiety Disorders Association of America.
“The presence of a comorbid anxiety disorder made no difference and did not interfere with the ability to treat,” reported Dr. Ollendick, in a poster presentation. “There was no difference as to the type of comorbidity, although we did exclude comorbid disorders such as autism and schizophrenia, which generally cause more severe impairment.”
The rates of comorbidity in children with anxiety are significant. But the impact of comorbidity on treatment efficacy is relatively unknown, and this area has not been well studied, said Dr. Ollendick, professor of psychology and director of the Child Study Center at Virginia Polytechnic Institute and State University in Blacksburg. In fact, no studies have been undertaken looking at the influence of specific treatments on nontargeted comorbid conditions.
The investigators evaluated treatment efficacy in 105 children aged 7–16 years, who met the DSM-IV criteria for a specific phobia based on a pretreatment structured interview.
Within the group, 22.8% had a specific phobia (SP) only, 42.8% had an SP as their primary diagnosis and another untreated SP as a secondary diagnosis, 29.5% had a generalized anxiety disorder as a secondary diagnosis, 17.1% were diagnosed with comorbid separation anxiety disorder, 17.1% had comorbid social anxiety disorder, and 12.4% had comorbid attention-deficit hyperactivity disorder, Dr. Ollendick reported.
The primary diagnosis was determined as the one causing the greatest interference and distress for the child, based on the Anxiety Disorders Interview Schedule for Children and Parent (ADIS-C/P).
Treatment was an intensive CBT for specific phobias called “One Session Treatment,” which was implemented in a single session and involved several CBT techniques, including in vivo exposure, participant modeling, social reinforcement, and cognitive restructuring.
Another therapy, known as Educational Supportive Treatment (EST), served as a control and did not provide exposure to fear-producing stimuli or modeling of contact with the phobic object.
The study is still in progress, Dr. Ollendick said, but based on the data found so far, the numbers are robust.
Children with a specific phobia had a 62.5% response rate to CBT, compared with 53.8% of those with an accompanying comorbid anxiety disorder.
Response rates to EST were much lower, compared with intensive CBT. But no significant difference was found between subjects with and without a comorbid condition.
Another finding was that treating for a specific phobia also had an impact on the comorbid disorder. Before receiving therapy, 77% of the children had at least one additional diagnosis, but at posttreatment, that percentage had declined to 48.6%.
“It is very important to know that treatment can work with children who are more complex, and we found that it worked very well,” Dr. Ollendick said.