Psychiatry and Psychology in Minnesota

Child and Adolescent Anxiety Disorder Program

Mayo Clinic's comprehensive child and adolescent anxiety treatment program provides state-of-the-art, evidenced-based medical and psychological treatment for anxiety disorders, including panic disorder, obsessive-compulsive disorder, social phobia, generalized anxiety disorder, posttraumatic stress disorder and separation anxiety. The expertise and facilities at Mayo Clinic promote deep integration of services, including inpatient, outpatient, and intensive outpatient programs. The close coordination of these services allows patients to smoothly transition from one level of care to another based on their needs. Mayo's services are designed to provide children and adolescents with 24-hour care for acute stabilization, short-term intensive treatment for families who travel from out of town, as well as standard care weekly.

Inpatient Services

Mayo Clinic's child and adolescent inpatient unit provides evidenced-based treatment to children who need acute stabilization for severe anxiety disorders such as panic disorder with agoraphobia, obsessive-compulsive disorder, social phobia and others. Our multidisciplinary staff, which consists of a child psychiatrists, child psychologists, psychiatric nurses, and other allied health professionals, provides integrated, individualized therapy for each patient. Psychotherapy treatment primarily involves exposure-based cognitive behavioral therapy. This treatment teaches children the skills to manage their anxiety and has them complete a series of exercises during which they face their fears and learn how to manage anxiety. Children also are assessed to determine if medication would be an appropriate component of treatment or if adjustments to current medications are needed. The goal of hospitalization is to begin relieving anxiety symptoms and return the child to daily activities in a timely manner. Children and families can then be monitored by the outpatient treatment team.

Outpatient Services

The Mayo Clinic Child and Adolescent Anxiety Disorders Program includes three primary services: the Child and Adolescent Anxiety Diagnostic Clinic; the Child Outpatient Anxiety Treatment Service; and the Intensive Child Anxiety Treatment Service.

Child and Adolescent Anxiety Diagnostic Clinic (CADC) — The CADC is a comprehensive one-day assessment clinic for children and adolescents with the anxiety, fears, nervousness, and worry that typically occur in anxiety disorders such as panic disorder, obsessive-compulsive disorder, social phobia, generalized anxiety disorder, posttraumatic stress disorder and separation anxiety disorder. The clinic thoroughly evaluates the child and provides diagnoses and treatment recommendations in a time-efficient manner. The clinic is staffed by a clinical child psychologist and child psychiatrist who specialize in anxiety disorders, which allows for an integrated medical and psychological understanding of the child's symptoms. In addition, the psychologist also conducts a brief psychoeducational assessment to incorporate cognitive and academic information into a broader understanding of the child. A structured diagnostic interview, objective questionnaires, clinical interviews and psychological testing are used in the evaluation process.

Child Outpatient Anxiety Treatment Service (COATS) — Cognitive behavioral therapy and medication management are available on an outpatient basis. Psychotherapy treatment consists primarily of exposure-based cognitive behavioral therapy. This treatment teaches children skills to manage their anxiety and teaches parents to effectively provide support. With these tools in place the child and therapist develop a list of situations that cause the child to feel anxious. With the help of the therapist, the child then gradually faces these fears and learns that his or her fears are excessive and can be managed. Treatment typically consists of 10 to 16 sessions completed on a weekly basis.

Intensive Child Anxiety Treatment Service (ICATS) — Treatment for child and adolescent anxiety disorders is also available in an intensive format for children and families. This service is offered to families for whom frequent trips or extended time at Mayo Clinic are impossible. For patients wishing to receive treatment in a single block, treatment can be provided in a 10-session format over five days. Therapy can also be offered in multiple blocks of four sessions over two days for patients who travel from lesser distances. The goals of these intensive treatments are:

1. Teach the child and parents to be experts on anxiety and how behavioral treatment works
2. Have the child experience some decrease of anxiety through successful completion of exposures, and
3. Teach the child and parents how to conduct exposure therapy on their own so they can continue working at home.

Follow-up care is then provided via phone or e-mail.

Clinical Trials

Children and families receiving treatment through the Child and Adolescent Anxiety Disorders Program can participate in clinical trials. These trials include the development of observational and written diagnostic tools, development and improvement and treatment approaches, understanding the individual and environmental factors that contribute to anxiety disorders, and using neuroimaging to investigate the neurobiology of anxiety disorders.