Dr. Chad Sylvester, a child and adolescent psychiatrist at Washington University, reviewed common types of childhood anxiety disorders, how anxiety and attention-deficit/hyperactivity disorder (ADHD) can overlap, and evidence-based treatment approaches during a public corporate mental health clinic event.

Sylvester said anxiety disorders "are the most common form of mental health problem at any age, adult or child," and stressed early identification because symptoms most often begin in childhood. He described separation anxiety, social anxiety (social phobia) and generalized anxiety disorder, and explained that specific phobias are the most common single form seen in community settings.

The talk focused on treatments backed by research. Sylvester summarized a multisite randomized study of nearly 500 children with separation, social or generalized anxiety that compared medication, cognitive-behavioral therapy (CBT), both treatments together and placebo. "Medicine and therapy are equally effective for kids with anxiety. The combination is better than either 1 alone," he said, citing study outcomes in which roughly one-quarter of placebo participants improved at 12 weeks, about 60 percent improved after either medication or therapy alone, and about 80 percent improved with the combined treatment.

On medication, Sylvester named selective serotonin reuptake inhibitors such as sertraline (Zoloft) and fluoxetine (Prozac) as commonly studied options for pediatric anxiety, noting they take weeks to months to reduce symptoms and are not the same as fast-acting benzodiazepines. For therapy he recommended CBT with exposure, describing the standard approach of teaching children to identify thoughts, feelings and body sensations and then using a graded hierarchy of exposures (a 1-to-10 fear scale) to practice approaching feared but safe situations.

On ADHD, Sylvester said stimulant medications (methylphenidate formulations such as Ritalin and mixed amphetamine salts such as Adderall) are markedly more effective for core ADHD symptoms than current behavioral therapies. He explained that behavioral and organizational strategies—breaking tasks into small chunks, routines, explicit instructions and frequent reinforcement—are useful workarounds but do not typically change core attention or hyperactivity symptoms in the way stimulants can.

Sylvester discussed comorbidity: having one condition raises the chance of the other and can complicate diagnosis because anxiety can produce concentration problems and ADHD can generate worry about performance. He said treatment sequencing is individualized; sometimes clinicians treat ADHD first because stimulant effects are rapid, while other times they address severe anxiety first.

The psychiatrist also described ongoing research in his lab on attention-related brain systems in children with anxiety, ADHD, or both, including MRI scanning of 8-to-12-year-olds and a pregnancy-to-infant cohort that follows infants at 4, 14 and 24 months. A lab clinician, identified in the session only as Molly, summarized study procedures and recruitment.

Throughout audience questions, Sylvester emphasized practical parent strategies used in CBT: be empathic but firm; avoid excessive reassurance that reinforces avoidance; practice coping skills gradually; and create planned "worry time" for children with generalized anxiety. He advised parents and caregivers to coordinate school, therapy and medical care and said there is stronger evidence for conventional CBT and medication than for many marketed alternatives such as unvalidated brain scans or unproven commercial programs.

He encouraged parents considering medication to weigh side effects against untreated disorder risks, noting stimulants can reduce risks associated with impulsive behavior and that SSRIs' side effects are generally mild and often transient. Sylvester recommended involving parents in treatment for younger children and ensuring therapists provide a clear plan and goals.

Sylvester closed by urging families and clinicians to rely on evidence-based approaches and to seek coordinated care when multiple providers are involved.