Comparative effectiveness of cognitive behavioral treatment, serotonin, and serotonin noradrenaline reuptake inhibitors for anxiety in children and adolescents: a network meta-analysis.

AIM: Cognitive behavioral treatment (CBT) and selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatments for childhood anxiety disorders (ADs). The objective of this current analysis was to conduct a network meta-analysis to evaluate the comparative effectiveness of CBT, pharmacotherapy, and the combination of the two in treating pediatric ADs. METHODS: The studies included consisted of randomized controlled trials evaluating non-selective serotonin reuptake inhibitors (e.g. clomipramine), SSRIs, selective noradrenaline reuptake inhibitors, CBT, or a combination of CBT and pharmacotherapy. Studies were eligible for inclusion if participants were 18 years or younger. RESULTS: A total of 86 studies were included, with a total of 7594 participants, of which 41.51% were females. For remission, all three treatments were significantly more effective than both placebo (ORs ranging from 0.07 and 0.18) and wait-list (ORs ranging from 0.06 and 0.16). In terms of the severity of anxiety symptoms, all treatment forms were significantly more effective for reducing anxiety than wait-list (standardized mean differences (SMDs) ranging from 0.98 and 2.91). Only pharmacotherapy was significantly more effective in reducing anxiety symptoms than placebo (SMD = 2.01, 95% confidence interval, 1.02 to 3.01). Overall, the results demonstrate that CBT, pharmacotherapy, and their combination are effective treatments for childhood ADs. There was no significant difference between the three treatment forms. However, CBT was associated with lower attrition rates. CONCLUSION: CBT, pharmacotherapy, and the combination of the two should all be considered to treat youths with ADs. However, potential risks and benefits should be considered before devising a treatment plan.

Faces and words are both associated and dissociated as evidenced by visual problems in dyslexia.

Faces and words are traditionally assumed to be independently processed. Dyslexia is also traditionally thought to be a non-visual deficit. Counter to both ideas, face perception deficits in dyslexia have been reported. Others report no such deficits. We sought to resolve this discrepancy. 60 adults participated in the study (24 dyslexic, 36 typical readers). Feature-based processing and configural or global form processing of faces was measured with a face matching task. Opposite laterality effects in these tasks, dependent on left-right orientation of faces, supported that they tapped into separable visual mechanisms. Dyslexic readers tended to be poorer than typical readers at feature-based face matching while no differences were found for global form face matching. We conclude that word and face perception are associated when the latter requires the processing of visual features of a face, while processing the global form of faces apparently shares minimal-if any-resources with visual word processing. The current results indicate that visual word and face processing are both associated and dissociated-but this depends on what visual mechanisms are task-relevant. We suggest that reading deficits could stem from multiple factors, and that one such factor is a problem with feature-based processing of visual objects.