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Marlene Busko
Information from Industry
March 14, 2008 (Savannah, Georgia) — From a public health point of view, it is hard to find another intervention for mental health disorders that has the potential of having as great an impact as treating anxiety disorders in children, argued Ronald Kessler, PhD, from Harvard Medical School, in Boston, Massachusetts, in a keynote address at the Anxiety Disorders Association of America 28th Annual Meeting.
Anxiety disorders are very powerful predictors of the subsequent onset of other disorders, he told Medscape Psychiatry in a phone interview about his presentation. For example, compared with a child who was not afraid of dogs at age 4 years, a child who was afraid of dogs at that age is 2, 3, or 4 times more likely to have depression, an alcohol problem, or oppositional-defiance disorder at age 25 years, he said.
These individuals do not get treatment for their anxiety at all, unless it is very severe or goes on for many years, so when they are in their 20s or 30s, they finally end up in treatment, he added.

For most people with mental health disorders, the anxiety disorders are the first type they have, he said. For example, separation-anxiety disorder or fear of dogs may occur very early in life.

Compared with people without anxiety disorders, those with these disorders have higher rates of mental health comorbidities such as depression and alcoholism. In most cases, among people who have both an anxiety disorder and another mental health disorder such as depression, the anxiety began first.
Very few people, other than children who have really severe dog phobia, school phobia, or separation-anxiety disorders, for example, will get into treatment for those disorders as youngsters, because they tend to be good, well-behaved kids. "They're not trouble for parents or teachers, they don't squawk a lot, and they're shy. . . . They don't tell anybody about their problem," he noted.

"But it's exactly those people who have this very high risk and make up a substantial percentage of the people with serious mental illnesses later in life," he stressed.

"What Would Happen if We Treated Kids?"

"We have very little understanding of the implications of treating kids with anxiety disorders as kids, rather than waiting, as typically happens," he added. "What would happen if at the age of 8 or 12, we found these children with anxiety disorders and got them into treatment for the anxiety disorder?" he asked. "Would we discover that that 3- or 4-fold risk of depression at the age of 25 would disappear, if we were successful in treating the anxiety? The answer is we don't know. We don't have a clue, because there have never been studies of this sort done," he said.

"But from a public health point of view, it's hard to find in the panoply of all the possibilities for doing interventions for mental disorders something that has the potential of having as great an impact as exactly that kind of intervention," he argued.

"Kids with anxiety disorders really want to be helped, we have treatments, they are effective, and we know where to find them — they're all sitting in the classroom from 9 to 3, 5 days a week, nine and a half months a year. From a public health point of view, it makes a lot of sense to do that," he summarized.

The data that he presented about patterns of comorbidity of anxiety disorders with other physical and mental disorders came from the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey that assessed the prevalence of a wide range of mental and physical disorders.
He plans to publish some of these analyses in future.


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