Which of the following is not considered first-line treatment for pediatric anxiety disorders?

• A. Cognitive-behavioral therapy
• B. Play therapy
• C. Medication therapy
• D. Family therapy

Answer: (C)

The main approach for pediatric anxiety disorders is psychotherapy, especially cognitive-behavioral therapy, which teaches kids to recognize anxious thoughts, confront feared situations through structured exposure, and use coping skills. This type of therapy directly reduces the core features of anxiety and has strong evidence in children and adolescents. Involving the family can boost results, particularly when there are family dynamics that influence anxiety.

Play therapy is helpful for engaging younger children and can support treatment, but on its own it isn’t established as a first-line treatment for anxiety disorders. Family therapy can be an important part of treatment, especially when family factors contribute to the anxiety, and it often complements CBT.

Medication therapy, while effective for many youths, is not considered first-line. Medications such as SSRIs are typically added when anxiety is moderate to severe or persistent despite psychotherapy, or when there are comorbid conditions, and they require careful supervision due to possible side effects and the need for monitoring, including attention to suicidality risk.