Efficacy, feasibility and acceptability of a dual treatment approach for anxious children who do not respond to first-line psychological treatment

INTERVENTION: A referral letter addressed to children's medical practitioner containing information about, and a recommendation for, the 2018 Royal Australian and New Zealand College of Psychiatrists (RANZCP) guidelines for selective serotonin reuptake inhibitor (SSRI) medication as the follow‐up treatment for children with anxiety disorders who do not respond to cognitive behavioural therapy (CBT). This letter will be given to children's parent/guardian after completion of the CBT course once the treating clinician has assessed the child and determined them to be a 'non‐responder' to CBT. Parents/guardians will be informed to make and attend an appointment with their child's current treatment medical practitioner within the following 3 weeks to give the medical practitioner the referral letter. Adherence to the intervention, as well as issues concerning feasibility or acceptability (e.g., if parents were unable to get an appointment with their medical practitioner within the 3 week time allocation; if they did not want their child to be prescribed medication), will be measured through questionnaires that will be given to parents at the end of the testing phase, which will be 12 weeks after the referral letter has been delivered to treating medical practitioners. CONDITION: Anxiety; ; Anxiety Mental Health ‐ Anxiety PRIMARY OUTCOME: Any change in anxiety symptoms, assessed by parent report using Spence Children’s Anxiety Scale[12 weeks after referral letter has been delivered to treating medical practitioners] Any change in life impairment from anxiety, assessed by parent report using Child Anxiety Life Interference Scale[12 weeks after referral letter has been delivered to treating medical practitioners] Remission from all anxiety disorders according to online diagnostic interview "Youth Online Diagnostic Assessment" (YODA)[12 weeks after referral letter has been delivered to treating medical practitioners] SECONDARY OUTCOME: Adherence to any treatment prescribed by treating medical practitioners, assessed through parent‐report using a study‐specific questionnaire[12 weeks after referral letter has been delivered to treating medical practitioners] Any change in anxiety symptoms, assessed by child report using Spence Children’s Anxiety Scale[12 weeks after referral letter has been delivered to treating medical practitioners] Any change in life impairment from anxiety, assessed by child report using Child Anxiety Life Interference Scale[12 weeks after referral letter has been delivered to treating medical practitioners] Family treatment acceptability, assessed using a study‐specific questionnaire[12 weeks after referral letter has been delivered to treating medical practitioners] Family treatment satisfaction, assessed using a study‐specific questionnaire[12 weeks after referral letter has been delivered to treating medical practitioners] Proportion of families who agree to participate in randomisation to medication, determined by an audit of study enrolment/withdrawal logs[An audit of study enrolment/withdrawal logs will be maintained throughout the duration of the project. However, final numbers will be determined 12 weeks after referral letter has been delivered to treating medical practitioners.] Proportion of randomised families who successfully access a medical practitioner, assessed using a study‐specific questionnaire[12 weeks after referral letter has been delivered to treating medical practitioner] Time taken to access a prescribing medical practitioner, assessed using a study‐specific questionnaire[12 weeks after referral letter has been delivered to treating medical practitioners] Type of treatment that children were prescribed by their treating medical practitioner, assessed through parent‐report using a study‐specific questionnaire[12 weeks after referral letter has been delivered to treating medical practitioners] INCLUSION CRITERIA: Children with at least one anxiety disorder who attend a psychological program for the treatment of their anxiety disorder/s at the Macquarie University Centre for Emotional Health Clinic or the Griffith University Childhood Anxiety Disorders Clinic and who, after completion of the program, are assessed by a psychology clinician to still meet clinical criteria for an anxiety disorder. Parents/guardians of these children will be asked to provide consent on behalf of their child and to provide information on primary and secondary outcomes. Any parents/guardians of children who meet inclusion criteria will be included.