Finding the right treatment for your child’s anxiety can feel overwhelming. Parents are often faced with the choice between two options: skills-based therapy or medication (pills). Of course, there’s no one-size-fits-all answer as each child’s needs are unique. The best plan will be one that combines parent and child input in conjunction with a trusted psychologist or psychiatrist. A good provider will explain the available options, help your family weigh them, and adjust the plan as your child’s needs change over time.
With so many possibilities, it can be hard to know where to begin. To make the process less daunting, we’ll discuss a few questions to consider as you make your decision. These include: What are my child’s needs? How ready is my child (and family) to engage in the treatment? What resources and commitments can we realistically make?
What Exactly Are Your Child’s Needs?
The first step is to consider what concerns are bringing you to seek treatment. Is your child facing a temporary challenge, such as a school transition, that may improve with short-term support? Or are they coping with a longer-term, ongoing pattern of anxiety that is disruptive to their daily life? When it comes to anxiety, professional guidelines from the American Academy of Child and Adolescent Psychiatry recommend starting with therapy if symptoms are mild to moderate. More severe anxiety, however, can make it hard for a child to practice and apply therapeutic skills, which may limit the effectiveness of therapy. In these cases, beginning with medication—or pairing it with therapy—may be the most effective path forward.
How Ready Are You and Your Child to Begin Anxiety Treatment?
Whether you are considering medication or behavioral therapy for the treatment of your child’s anxiety, your child’s willingness is an important factor. They don’t need to be enthusiastic, but some openness makes the process more effective. If your child is strongly opposed, therapy is less likely to help, and it may be better to wait until they’re more ready. While this would be understandably frustrating as a parent, you still have options. Consider meeting with a psychologist yourself to learn tips or strategies for supporting your child at home or scheduling a consultation with a psychiatrist to understand more about medications. It is also essential that adults in a child’s life are aligned about treatment. When parents or caregivers disagree about how to address anxiety, it can create additional stress for everyone involved and slow progress.
Readiness also shapes which treatment path may work best. Therapy requires active participation, including practicing skills between sessions. Without that effort, progress is slower, and treatment may take longer. Medication, on the other hand, doesn’t require the same level of “buy-in” as you simply take the pill. However, it can take time to find the right medication and adjust the dosage and side effects may occur. In both cases, commitment is key, though the kind of effort involved looks different depending on the path you take.
What Resources Do You Have Available?
Beyond the clinical questions of whether therapy, medication, or both are the right fit, families also need to weigh practical considerations. As parents, we often say that we will do anything for our children—and sometimes we can. But sometimes time, transportation, and finances place limits on what is possible. Recognizing these factors early on can help you set realistic expectations and avoid unnecessary stress.
Time and Effort – Getting started with any treatment requires some time and energy. It can take several hours to research providers, consider in-network and out-of-network options, and try to find someone who you feel comfortable working with. These logistics can feel daunting, but support from a pediatrician, school counselor, or trusted friend can help streamline the search. Once you get going, therapy and medication management also require availability for meetings at the recommended frequency.
Transportation – It can be hard to find a provider who “checks all the boxes,” and sometimes that means your best match isn’t around the corner. Some families work to accommodate the necessary travel. For families already stretched thin, long commutes may not be realistic. Finding virtual therapy or hybrid options can ease the burden, but these are not always appropriate for every child or every type of therapy. You can discuss the option with the providers you are considering seeing what they recommend.
Finances – Treatment is also a financial commitment. Weekly therapy sessions add up quickly depending on how your insurance covers or reimburses. Medication may seem less expensive at first, but prescriptions, follow-up visits, and monitoring can also carry expenses. High-quality care often comes with higher costs, so it’s important to understand your insurance coverage and budget before committing to a plan.
How Much of a Commitment Can You Make?
Therapy and medication are both effective treatments for anxiety, but each entail a different type of commitment. Therapy takes weeks of consistent sessions and skill building before children can apply techniques effectively in daily life. Even though this is a longer-term time investment, the goal is to provide your child with a toolbox of skills that can be applied long after treatment has concluded, perhaps with a few booster sessions as needed.
If you are pursuing medication, there is often a less substantial investment of time. Medication management for anxiety doesn’t typically involve weekly meetings the way therapy does. And for some children, relief comes within several weeks. For others, finding the right prescription and dosage may involve trial and error, and side effects, both physical and emotional, may also need to be managed. While the daily effort of taking a pill may be simple, the overall process still demands commitment, patience, and ongoing communication.
Is Anxiety Therapy or Medication the Best Treatment for My Child?
Every situation is different, and what works for one child may not work for another. The most effective approach is one that is developed in collaboration with a trusted provider who can guide your family through options and adjust the plan over time. It also has to fit the practical realities of your family’s life – your time, resources, and level of commitment.
As a parent, a large part of your role is to stay engaged in the process by asking questions and continue to support and encourage your child. Remember, therapy is not a sign of weakness, and medication is not simply “the easy way out.” Unfortunately, many children who need help for anxiety never receive treatment, and among those who do, the chosen approach is not always the best fit. By staying present in the process through reading articles – like this and others – you are already beginning to help your child to manage their anxiety and build the skills necessary to lead a brave and productive life.
Meir Flancbaum, PsyD, is a licensed psychologist, Founder, and Director of the Center for Cognitive Behavior Therapy in New Jersey. He works with children, teens, young adults, and families to help them manage anxiety, OCD, ADHD, Tourette syndrome, trichotillomania, skin picking, school refusal, and related challenges using practical, evidence-based strategies. Dr. Flancbaum provides therapy both in person and through telehealth, and he partners with schools to offer consultations and workshops that give parents and educators tools to better support kids in their daily lives. He can be reached at www.CenterForCBT.org and (732) 994-3456.
Erica Dashow, PhD, BCBA-D, is a licensed psychologist and Clinical Director at the Center for Cognitive Behavior Therapy. She specializes in CBT for feeding disorders, anxiety, and obsessive-compulsive disorder. Dr. Dashow also has expertise in behavioral parent training for caregivers of children with attention deficit hyperactivity disorder, oppositional defiant disorder, and autism spectrum disorder. Dr. Dashow sees clients in-person and through telehealth, and she takes pride in working collaboratively with her clients to improve treatment outcomes.
Note: This article is intended for informational purposes only. It should not be taken as medical advice. All medical and mental health decisions should be made in consultation with a qualified professional.
In the article, the discussion around balancing skills-based therapy and medication for childhood anxiety is intriguing. As a parent considering treatment options, I wonder how a medication like propranolol, which is often prescribed for conditions beyond just cardiac issues, might play a role in treatment for anxiety? I’ve read that it can help with performance anxiety and migraines in children, but I’m curious about its effectiveness and safety as highlighted in this recent guide on pediatric care: https://alynachien.org/navigating-pediatric-care-physicians-guide. What are the main points to consider when discussing this option with a healthcare provider?